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Evaldo Marchi, MD, PhD
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FINANCIAL/NONFINANCIAL DISCLOSURES: See earlier cited article for author conflicts of interest.

Thoracic Surgery Division, Medical College of Jundiai, Sao Paolo, Brazil

CORRESPONDENCE TO: Evaldo Marchi, MD, PhD, Thoracic Surgery Division, Medical College of Jundiai, Rua Francisco Telles, 250, Jundiai, 13.202-550, Sao Paolo, Brazil


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(6):1424-1425. doi:10.1016/j.chest.2016.10.012
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We thank Dr Acton for his comments regarding our paper in CHEST (September 2016). The author questioned us about finding that there was no pleurodesis but concluding that abrasion with fibrin sealant was as effective as pleurectomy in producing pleurodesis in rabbits. We believe that the confusion arises from the definition of pleurodesis. Pleurodesis is defined as “fusion of the visceral and parietal pleura to prevent collapse of the lung with pneumothorax or accumulation of pleural fluid with pleural effusions.” As stated in our paper, only in animal models it is possible to document the quality and extent of macroscopic pleural adhesions, microscopic pleural inflammation, and collagen deposition after the various forms of pleural interventions used to induce pleurodesis. We would agree that our rabbits did not have complete obliteration of the pleural space after the interventions were performed in a 3-cm area of the apex of the right pleural cavity, mimicking the apical pleurectomy or pleurodesis by abrasion commonly used in clinical practice to control recurrent pneumothorax. However, the rabbits did have significant local adhesions, microscopic pleural thickening, and collagen deposition when abrasion plus sealant application or pleurectomy was performed. We consider this partial pleurodesis and believe that the local adhesions and the collagen deposition make recurrence of the pneumothorax less likely. We will therefore stand by our conclusions.

References

Marchi E. .de Carvalho M. .Ventureli T. .et al Abrasion plus local fibrin sealant produces pleurodesis similar to pleurectomy in rabbits. Chest. 2016;150:661-672 [PubMed]journal. [CrossRef] [PubMed]
 
Light R.W. . Animal models in pleural investigation: pleurodesis.Light R.W.. Pleural Diseases.  :36- [PubMed]journal
 

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References

Marchi E. .de Carvalho M. .Ventureli T. .et al Abrasion plus local fibrin sealant produces pleurodesis similar to pleurectomy in rabbits. Chest. 2016;150:661-672 [PubMed]journal. [CrossRef] [PubMed]
 
Light R.W. . Animal models in pleural investigation: pleurodesis.Light R.W.. Pleural Diseases.  :36- [PubMed]journal
 
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