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* From the Pulmonary Division—Heart Institute (InCor) (Drs. Vargas, Teixeira, Vaz, Carmo, Marchi, and Cury), University of São Paulo Medical School, Brazil, and Department of Medicine (Dr. Light), Saint Thomas Hospital and Vanderbilt University, Nashville, TN.
Correspondence to: Richard W. Light, MD, FCCP, Pulmonary Disease Program, Saint Thomas Hospital, 4220 Harding Rd, Nashville, TN 37205; e-mail: rlight98{at}yahoo.com
Study objective: The ideal agent for producing pleurodesis has not been identified. Although talc is the agent most commonly used at the present time, there are concerns about its safety. Silver nitrate is a possible alternative agent. The purpose of the present study was to compare the effectiveness of intrapleural silver nitrate and talc slurry in producing pleurodesis in rabbits. Additionally, the total amount of pleural collagen and the distribution of thick and thin collagen fibers were studied.
Design: Two groups of 10 rabbits received either 0.50% silver nitrate or 400 mg/kg talc in a total volume of 2 mL intrapleurally. The animals were killed 28 days after injection, and the pleural spaces were assessed grossly for evidence of pleurodesis and microscopically for evidence of inflammation and fibrosis. Collagen was assessed with the van Gieson’s and picrosirius stains.
Results: The macroscopic pleurodesis (scale, 0 to 4; mean ± SEM) resulting from the intrapleural injection of silver nitrate (3.4 ± 0.2) was significantly better (p < 0.001) than that resulting from talc (1.6 ± 0.1). The mean degree of microscopic pleural fibrosis induced by silver nitrate (3.3 ± 0.3) was significantly higher (p = 0.003) than that induced by talc (1.8 ± 0.1). The mean amount of microscopic pleural collagen (van Gieson’s) was significantly greater (p < 0.001) in the rabbits that received silver nitrate (3.0 ± 0.2) than in those that received talc (1.6 ± 0.2). The distribution of thick and thin collagen fibers did not differ between the groups.
Conclusions: We conclude that, in our rabbit model, intrapleural silver nitrate was more effective than talc in producing a pleurodesis.
Key Words: collagen • pleural effusion • pleurodesis • picrosirius • silver nitrate • talc
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