Tuberc Respir Dis.  2006 Jan;60(1):72-75.

Efficacious Pleurodesis with OK-432 Plus Autoblood or OK-432 Against the Pneumothorax with Persistent Air Leak

• Kim HS
• Choi GM

Abstract

BACKGROUND: This report reviews our experience with persistent air leaks in the peumothorax that were not considered candidates for surgical treatment in order to evaluate the efficacy and risks of the OK-432 plus autoblood or OK-432 pleurodesis. MATERIAL AND METHODS: From March 2004 to July 2005, 8 consecutive patients who had an air leak in the pneumothorax over 5 days and had been treated with OK-432 plus autoblood or OK-432 pleurodesis. The patients were not considered candidates for surgical treatments because the chest CT findings revealed severe chronic lung disease with multiple bullae and/or bullous changes. A prolonged air leak with/without dead space was treated with either OK-432 plus autoblood or OK-432 pleurodesis. The efficacy and side effects of OK-432 pleurodesis were assessed by determining the duration of the air leak, the number of pleurodesis, the patients' symptoms, measurements of the white blood cell count and the c-reactive protein level.
RESULTS
All of eight patients were male and the mean age was 72.4 +/- 8.5. The mean number of pleurodesis was 1.9 +/- 1.1 and the mean duration of the air leak was 4.6 +/- 4.6 days after pleurodesis. Side effects after pleurodesis were encountered in 7 patients, which included a chilling sensation in 7 cases, chest pain in 5 cases, headache in 3 cases, local heat sensation in 2 cases, and fever in 1 case. Leukocytosis was observed in 6 patients, and the mean of WBC count and CRP were 14500 +/- 2100 and 21.9 +/- 11.4mg/dL, respectively.
CONCLUSION
Either OK-432 plus autoblood or OK-432 pleurodesis has acceptable side effects, and can be considered a treatment option for persistent air leaks in the pneumothorax that are not candidates for surgical treatment.

Keyword

Pneumothorax; Pleurodesis; OK-432

MeSH Terms

C-Reactive Protein
Chest Pain
Fever
Headache
Hot Temperature
Humans
Leukocyte Count
Leukocytosis
Lung Diseases
Male
Picibanil*
Pleurodesis*
Pneumothorax*
Sensation
Tomography, X-Ray Computed
C-Reactive Protein
Picibanil

Reference

1. Weissberg D, Ben-Zeev I. Talc pleurodesis: experience with 360 patients. J Thorac Cardiovasc Surg. 1993. 106:689–695.

2. Yoon SM, Shin SJ, Kim YC, Shon JW, Yang SC, Yoon HJ, et al. The effects of autologous blood pleurodesis in the pneumothorax with persistent air leak. Tuberc Respir Dis. 2000. 49:724–732.

3. Lang-Lazdunski L, Coonar AS. A prospective study of autologous 'blood patch' pleurodesis for persistent air leak after pulmonary resection. Eur J Cardiothorac Surg. 2004. 26:897–900.

4. Kishi K, Homma S, Sakamoto S, Kawabata M, Tsuboi E, Nakata K, et al. Efficious pleurodesis with OK-432 and doxorubicin against malignat pleural effusion. Eur Respir J. 2004. 24:263–266.

5. Kim MH, Lee SH, Lee HJ, Kim KT, Lee IS, Kim HM. A case of idiopathic bilateral chylothorax treated by chemical pleurodesis with OK 432. Korean J Thorac Cardiovasc Surg. 1995. 28:951–953.

6. Chung JH, Park MS, Cheong JH, Kim YS, Chang J, Kim JH, et al. Comparison of OK-432 and doxycycline pleurodesis for malignant pleural effusions caused by lung cancer. Tuberc Respir Dis. 2002. 52:590–596.

7. Kimura I, Ohnishi T, Yasuhara S, Sugiyama M, Urabe Y. Immunochemotherapy in human lung cancer using the streptococcal agent OK-432. Cancer. 1976. 37:2201–2203.

8. Yokomise H, Satoh K, Ohno N, Tamura K. Autoblood plus OK 432 pleurodesis with open drainage for persistent air leak after lobectomy. Ann Thorac Surg. 1998. 65:563–565.

9. Song JP, Lee JH, Kim BY, Kang KM. Pleurodesis with autologous blood plus sclerosing agents. Korean J Thorac Cardiovasc Surg. 1999. 32:92–95.

10. Kim KU, Cha KY, Han SH, Yun YI, Park SW, Kim DJ, et al. A case of acute respiratory distress syndrome after talc pleurodesis. Tuberc Respir Dis. 2001. 51:265–269.