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(Chest. 2005;128:1798-1804.)
© 2005 American College of Chest Physicians

Intrapleural Low-Dose Silver Nitrate Elicits More Pleural Inflammation and Less Systemic Inflammation Than Low-Dose Talc*

Evaldo Marchi, MD; Francisco S. Vargas, MD; Lisete R. Teixeira, MD; Milena M. P. Acencio, BS; Leila Antonangelo, MD and Richard W. Light, MD

* From the Pleura Laboratory, Pulmonary Division, Heart Institute (InCor), University of São Paulo Medical School, Brazil; and Saint Thomas Hospital and Vanderbilt University, Nashville, TN.

Correspondence to: Evaldo Marchi, MD, Pulmonary Division, Heart Institute (InCor), University of São Paulo Medical School, Brazil, Rua Lucia B. Passarin, 590, Ap.42, Jundiai, São Paulo, Brazil; e-mail: evmarchi{at}uol.com.br

Study objectives: Several systemic effects have been described after talc pleurodesis. The aim of this study was to assess the systemic response induced by low, nonpleurodesis-inducing doses of talc and silver nitrate in an experimental model in rabbits.

Design: Groups of six rabbits were injected intrapleurally with talc, 100 mg/kg or 400 mg/kg, and silver nitrate, 0.1% or 0.5%. After 6, 24, or 48 h, samples of blood and pleural fluid were collected and assayed for leukocytes, percentage of neutrophils, lactate dehydrogenase, interleukin-8, and vascular endothelial growth factor (VEGF) levels. Preinjection blood samples were used as normal blood controls.

Measurements and results: Silver nitrate 0.1% induced a more intense pleural inflammation than that produced by talc 100 mg/kg. In contrast, talc 100 mg/kg induced a more pronounced acute systemic response with higher values of WBCs and neutrophils, whereas silver nitrate 0.1% produced no significant increases in leukocytes or neutrophils. The serum interleukin-8 and VEGF levels increased in all groups, and decreased with time only in the silver nitrate 0.1% group. The highest serum VEGF levels were observed in the talc 100 mg/kg group.

Conclusions: In conclusion, 0.1% silver nitrate produced an intense pleural inflammatory response with a less evident systemic response in comparison to 0.5% silver nitrate and talc 100 mg/kg or 400 mg/kg.

Key Words: inflammation • pleura • pleural effusion • pleurodesis • silver nitrate • systemic inflammatory response • talc






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