Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2015, 159(2):234-241 | DOI: 10.5507/bp.2014.038
Predictive value of systemic and local inflammation parameters in talc pleurodesis assessment
- a Department of Cardiac Surgery, Faculty of Medicine in Hradec Kralove, Charles University in Prague and University Hospital in Hradec Kralove, Czech Republic
- b Department of Clinical Immunology and Allergy, Faculty of Medicine in Hradec Kralove, Charles University in Prague and University Hospital in Hradec Kralove
Background: One option for the palliative treatment of recurrent malignant pleural effusion is powdered talc using thoracoscopy. This paper presents the results of selected systemic and local manifestations of the talc-induced inflammatory reaction using a videothoracoscope.
Method: A total of 114 patients with repeated malignant pleural effusion were treated at the Cardiac Surgery Clinic in Hradec Kralove from January 2010 to December 2012. Those with a life expectancy more than ≥ 3 months were eligible for talcage surgery. The group was retrospectively divided according to treatment results into Group A (N1 = 98 - successful) and Group B (N2 = 16 - relapsing). The pleural effusion was quantified using ultrasound over 1 year at 3-month intervals. Systemic changes due to the inflammatory reaction (body temperature, serum leukocyte and CRP levels) were evaluated. Local indicators of inflammation included changes in the leukocyte cell population in the effusion and changes in the pleural CRP levels. The dynamics of local expression of membrane receptors TLR-2 and CD-64 on granulocyte and monocyte cell populations in the pleural effusion were also evaluated.
Results: The reaction after talcage, included a significant increase in axillary temperature and leukocyte count, 12 h after the procedure. The dynamics were different in the two groups. The dynamics of local inflammatory changes were an early increase in the pleural CRP levels in both groups. The time interval of local inflammatory development and duration was related to the treatment efficacy and showed a significant rise 2 h after talcage in Group A. In Group B the local inflammatory reaction was slower and the rise was only observed 24 h after talc application. A decrease in lymphocyte count and an increase in granulocyte count 2 h after talcage were found. After an initial drop in monocyte level, a rise occurred within 24 h after talcage. Changes in the expression of TLR-2 and CD-64 receptors in relation to their cell carriers were observed depending on time after talcage.
Conclusion: The differences in the serum and pleural effusion CRP levels suggest that the surgical stress manifests itself locally in the pleural space with a lower intensity and time delay. The TLR-2 and CD-64 receptors exhibit different behaviour depending on the type of cell membrane where they are found. The inverse relation between the granulocyte increase and TLR-2 receptor decrease in the membrane immediately after talcage is a new finding. The dynamics of TLR-2 expression on the monocytes demonstrates a direct proportion between the increasing expression of the TLR-2 receptor and increasing percent fraction of the cell carrier.
Keywords: malignant pleural effusion, thoracoscopy, talc, CRP, TLR-2, CD-64
Received: October 14, 2013; Accepted: June 12, 2014; Prepublished online: July 18, 2014; Published: June 28, 2015 Show citation
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References
- Marel M, Zrustova M, Stastny B. The incidence of pleural effusion in a well-defined region. Epidemiologic study in central Bohemia. Chest 1993;104:1486-9.
Go to original source...
Go to PubMed...
- Bennett R, Maskell N. Management of malignant pleural effusions. Curr Opin Pulm Med 2005;11:296-300.
Go to original source...
- Neville E, Antunes G, Duffy J. On behalf of the BTS Pleural Disease Group a subgroup of the BTS Standards of Care Committee. BTS guidelines for the management of malignit pleural effusions. Thorax 2003;58(2):1129-38.
Go to original source...
- Scott EM, Marshall TJ, Flower CD. Diffuse pleural thickening: percutaneous CT-guided cutting needle biopsy. Radiology 1995;194:867-70.
Go to original source...
Go to PubMed...
- Screaton NJ, Flower Ch. Percutaneous needle biopsy of the pleura interventional. Chest Radiology 2000;38:293-301.
Go to original source...
- Bouros D, Froudarakis M, Siafakas NM. Pleurodesis: everything flows. Chest 2000;118: 577-9.
Go to original source...
Go to PubMed...
- Markman M, Clary S, King ME. Cisplatin and cytarabine administered as treatment of malignant pleural effusions. Med Pediatr Oncol1985;13:191-3.
Go to original source...
Go to PubMed...
- Walker-Renard PB, Vaugham LM, Sahn SA. Chemical pleurodesis for malignant pleural effusions. Ann Intern Med 1994;120:56-64.
Go to original source...
Go to PubMed...
- Rosso R, Rimoidi R, Salvami F. Intrapleural natural beta interferon in the treatment of malignant pleural effusions. Oncology1988;45:253-6.
Go to original source...
Go to PubMed...
- Randal E, Mitchem L, Herndon M, Fiorell a. Pleurodesis by autologous blood, doxycycline and talc in a rabbit model. Ann Thorac Surg1999;67:917-21.
Go to original source...
Go to PubMed...
- Webb HE, Osten SW. Treatment of malignant ascites and pleural effusions with Corynebacterium parvum. Br Med J1978;1:338-40.
Go to original source...
Go to PubMed...
- de Campos J, Vargas FS, Werebe E. Thoracoscopic talc poudrage: a 15-year experience. Chest 2001;119:801-6.
Go to original source...
Go to PubMed...
- Colt HG, Russack A, Chiu Y. A comparison of thoracoscopic talc insufflation, slurry, and mechanical abrasion pleurodesis. Chest 1997;111(2):442-8.
Go to original source...
Go to PubMed...
- Stefani A, Natali P, Casal C. Morandi U. Talc poudrage versus talc slurry in thetreatment of malignant pleural effusion. A prospective comparative study. Eur J Cardiothorac Surg 2006;30(6):827-32.
Go to original source...
Go to PubMed...
- Jacobeus HC. The practical importance of thoracoscopy in Surgery of the chest. Surg Gynecol Obstet 1922;34:289-96.
- Stammberger U, Steinacher C, Hillinger S. Early and long term complains following videoassisted thoracoscopic surgery. Cardiothorac Surg 2000;18:7-11.
Go to original source...
Go to PubMed...
- Van den Heuvel MM, Smith JM, Barbierato SB et al. Talc-induced infammation in the pleural cavity. Eur Respir J 1998;12:1449-23.
Go to original source...
- Antony VB, Godbey SW, Kunkel Sl et al. Recriument of inflammatory cells to the pleura space. Chemotactic cytokines, IL-8 and monocyte chemotactic peptide-1 in human pleural fluids. J Immunol 1993;151:7216-23.
Go to original source...
- Antony VB, Kamal MA, Godbey SW. Talc induced pleurodesis: role of a fibroblast growth factor (bFGF). Eur Respir J 1997;10:2411-8.
Go to PubMed...
- Yim AP, Chung SS, Lee TW. Thoracoscopic management of malignit pleural effusions. Chest1996;109:1234-8.
Go to original source...
Go to PubMed...
- Kirby RR, Civetta JM, Tailor RW. Problems in anaesthesia Hypothermia/Hyperthermia. Critical Care Medicine 1994;8:1-10.
- Hornick P, Georgie A. Blood contact activation: pathophysiological effects and terapeutic approches. Perfusion1996;11:3-19.
Go to original source...
Go to PubMed...
- Sofaer B. Bolest - příručka pro zdravotní sestry. 1. vyd. Praha: Grada 1997; 107 s. ISBN80-7013-386-394.
- Christensen R, Bradley PP, Rothstein G. The leukocyte left shift in clinical and experimental neonatal sepsis. J Pediatr 1981;98:101s.
Go to original source...
Go to PubMed...
- Volanakis JE. Human C-reactive protein:expression, structure and function. Mol Immunol 2001;38:189-97.
Go to original source...
Go to PubMed...
- Tillet WS, Francis T. Serological reactions in pneumonia with non protein somatic fraction of pneumococcus. J Exp Med 1930;2:561s.
Go to original source...
Go to PubMed...
- Bharadwaj D, Stein MP, Volze M. The major receptor for C-reactive protein on leukocyte Fc receptor II. J Exp Med 1999;190:585-90.
Go to original source...
Go to PubMed...
- Castell JV, Gomez-Lechon MJ, David M. Interleukin-6 is the major regulator of acute phase protein synthesis in adult human hepatocytes. FEBS Lett1989;242:237-9.
Go to original source...
Go to PubMed...
- Basso F, Lowe DO, Rumley A. Interleukin-6 174G polymorphism and risk of coronary heart disease in West of Scotland Coronary Prevention Study (WOSCOPS). Arterioscler Tromb BASF Biol 2002;22:599-604.
Go to original source...
Go to PubMed...
- Cau P, Astoul P. Distribution of calibrated talc after intrapleural administration: an experimental study in rats. Chest 2002;122:1737-41.
Go to original source...
Go to PubMed...
- Widimsky J, Maly J. Doporučení diagnostiky a léčby plicní embolie. Cor&Vasa1998; 40:139-54.
- Shimaoka M, Hosothubo K, Sugimoto M. The influence of surgical stress on t cells? Enhancement of early phase lymfocyte activation. Anesth Analg 1998;87:1431-5.
Go to original source...
Go to PubMed...
- De Longu G, Moretti S, Antonucci A. Apoptosis and surgical trauma. Arch Surg 2000; 135:1141-7.
Go to original source...
Go to PubMed...
- Krejsek J. Ateroskleróza - důsledek dlouhodobé poškozující zánětové reakce. Sanquis 2007;49:20-2.
- Ernst E, Hammerschmidt DE, Bagge U. Leukocytes and the risk of ischemic diseases. J Am Med Asso 1987;257:2318-24.
Go to original source...
Go to PubMed...
- Naldini A, Borelli E, Cesari S, Giomarelli P, Toscano M. In vitro cytosine production and t-cell proliferation in patiens under going cardiopulmonary bypass. Cytokine 1995; 7(2):165-70.
Go to original source...
Go to PubMed...
- Lokaj J, John C. Ilja Iljič Mečnikov a Paul Ehrlich: laureáti Nobelovy ceny v r.1908 za práce o imunitě. Epidemiol Mikrobiol Imunol 2008;57(4):119-24.
- Koenig W, Sund M, Frohlich M. C-reactive protein, sensitive marker of inflammation, predicts future risk of coronary heart disease in intially healthy modele-agedmen-results from the MONICA (Monitoring Trends and Determinants in Cardiovascular Disease) Augsburk kohort study 1984 to 1992. Circulation1999; l(99):237-42.
Go to original source...
- Habal P, Manďák J, Štětina M. Monitorace efektivity chirurgické léčby maligních pleurálních výpotků. Klin Onkol 2010;23(2):99-103.
Go to PubMed...
- Cassatella MA. The production of cytokines by polymorphonuclear neutrophils. Immunol Today 1995;16:21-6.
Go to original source...
Go to PubMed...
- Habal P,Jankovicova K, Omran N, Krejsek J, Mandak J. The dynamics of selected local inflammatory markers to talc in the treatment of malignant pleural effusions. BiomedPap Med Fac Univ Palacky Olomouc Czech Repub 2013;157(4):311-5.
Go to original source...
Go to PubMed...
- Jankovicova K, Kondelkova K, Habal P, Krejsek J, Mandak J. TLR2 in Pleural Fluid Is Modulated by Talc Particles during Pleurodesis. Clinical and Developmental Immunology 01/2012; 2012:158287. DOI:10.1155/2012/158287.
Go to original source...
Go to PubMed...
- Wittebole X, Coyle SM, Kumer A. Expression of tomour necrosis factor receptor and Toll-like receptor 2 and 4 on peripherial blood leucocytes of human volunteers after endotoxin challenge: a comparison of flow cytometric light scatter and imunofluorescence gating. Clin Exp Immunol 2005;141:325-32.
Go to original source...
Go to PubMed...
- Neustein SM. Reexpansion pulmonary edema. J Cardiotoracvasc Anesth 2007;1:887-91.
Go to original source...
Go to PubMed...
- Kopman D, Berkowitz D, Boiselle P. Large-volume thoracocentesis and the risk of reexpansion pulmonary edema. An Torac Surg 2007;84:1656-61.
Go to original source...
Go to PubMed...
- Her C, Mandy S. Acute respiratory distress syndrome of the contralateral lung after reexpansion pulmonary edema of a collapsed lung. J ClinAnesth 2004;16:244-50.
Go to original source...
Go to PubMed...