SYSTEMIC CORTICOSTEROIDS DECREASE THE EFFECTIVENESS OF TALC PLEURODESIS

Corticosteroids can inhibit the inflammatory process and the formation of fibrosis. The purpose of this study was to determine whether the c oncurrent use of steroids at the time of talc-slurry pleurodesis would influence the development of the pleurodesis. One group of rabbits re ceived an intra-pleural injection of talc (400 mg/kg) and an intramusc ular injection of triamcinolone (0.8 mg/kg) 1 d before talc instillati on and weekly thereafter, whereas a control group received only talc. Ten rabbits in each group were killed at 6 h and at 1, 2, 4, 7, 14, an d 28 d after instillation. The mean volume of pleural fluid was signif icantly lower in the group receiving corticosteroids at 6 h through 4 d after talc slurry than in the other groups. The degree of pleural ad hesion was significantly smatter in the group receiving corticosteroid s from Day 2 through Day 28. At Day 28, all 10 rabbits that received t alc only had a pleurodesis score of 3 or 4, whereas only four of the 1 0 rabbits that also received steroids had a pleurodesis score of 3 or 4. This study shows that the use of corticosteroids at the time of tal c-slurry pleurodesis markedly decreases the inflammatory reaction to t he talc, and essentially prevents a pleurodesis from developing.