Pleurodesis treatments and the benefits of Steritalc

Jan. 11, 2013 - PRLog -- Normal lung function relies on there being adhesion between the lung and the chest wall. BUT, the lungs aren’t attached to the chest wall.

The adhesion is provided by ‘sticky’ membranes (pleura) that line both the lungs and the chest wall.
Parietal pleura – lines the chest wall
Visceral pleura – lines the lungs

The contact between these pleura is critical to providing efficient respiratory function.Think of the two pleura as being two thin sheets of glass With a thin layer of fluid between them one will pick the other up, and they act as if joined. With air or excess fluid between them they are separate.

PNEUMOTHORAX:

Air in the pleural cavity, caused by perforation of the chest wall, or of the lung pleura.

PLEURAL EFFUSION:

Pleural effusion is an abnormal accumulation of fluid in the pleural space

Mesothelioma:

A rapidly-growing tumour of the Pleura. Closely associated to exposure to asbestos, and extremely rare in it’s absence. The condition can remain latent for up to 40 years after exposure

SOME COMMON CAUSES OF PLEURAL EFFUSION…
- CARDIAC: congestive heart failure
- LIVER: liver failure
- KIDNEY: nephrotic syndrome, peritoneal dialysis, uremia
- LUNG: infections, pulmonary embolism, pulmonary infarction,cancer (primary lung and metastatic), asbestosis
- VASCULAR: collagen vascular disease (systemic lupus erythematosis, rheumatoid arthritis)
- TRAUMA: hemothorax, chylothorax, rupture of the oesophagus
- MISC: pancreatitis, post - abdominal or coronary artery bypass graft surgery, and drug reactions

HOW DOES FLUID ACCUMULATE IN THE PLEURAL SPACE?

A significant increase in the pressure of the arteries in the lung can drive fluid out of the vessels. This process occurs during congestive heart failure, which is the most common cause of a pleural effusion.

- An increase in vessel leakage, which often occurs at the site of infection (pneumonia) or inflammation, can enhance the loss of fluid from the vessels.

- Low protein levels in the blood, which is usually associated with liver or kidney disease, can allow fluid to escape from the vessels.

- A blockage in the lymphatic system, which normally drains the pleural fluid, can cause fluid to accumulate. This is usually the result of tumour obstruction.

- Adhesion of internal tissues is often perceived as being problematic (eg: scarring prompted by trauma, surgery or disease)

BUT, certain tissues are intended to exhibit adherence.

When natural adherence breaks down, deliberate introduction of an agent that is known to irritate tissues can prove beneficial. THIS IS PLEURODESIS

Pleurodesis
Pleurodesis is a treatment to stop fluid from building up and help relieve the symptoms.
By introducing sterile talc into the space between the pleura - which then irritates the pleura, promoting them to stick together.

Pleurodesis causes the two layers of pleura to become inflamed, so that when the lung re-expands they stick together and the lung is anchored to the chest wall.
The procedure is more effective if the pleural space is completely dry, which is why suction is applied to the drain overnight before the procedure takes place.

Talc Pleurodesis can be achieved either…
- As a dry powder
- As a solution

Pleurodesis techniques

Powder form…
- Known as “talc poudrage”
- Usually provides better results than slurry
- Introduction either via a thorascope, or by an aerosol

Liquid suspension form…
- Known as “slurry”
- Talc is manually dispersed in saline (10%)

Dr Maskell’s study concluded that:

‘Mixed talc’ (ie: including small particles) produces more lung and systemic inflammation, and more hypoxemia (insufficient oxygen content in the blood) than graded talc or tetracycline.“The magnitude of this effect is substantial.”

Thornton & Ross, Huddersfield, UK (pharmaceutical manufacturer)
Mixed Talc, typical of those used usually in UK/USA A range of particle sizes, 50% being < 10μm in size

Novatech, Steritalc
Graded Talc
Less than 50% of particles being < 20μm in size Average particle size of 14μm Less than 6μm particles move into lymphatic vessels, join general circulation and other organs.

STERITALC
- Stable, graded material
- Less than 50% of particles being < 20μm in size Average particle size of 14μm
- Physically, chemically and biologically inert
- Mined in Luzenac, in the Pyrenees
- A medicine from 01 Jan 2008 (MHRA)