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Intrapleural streptokinase in experimental empyema
C Strange1, M L Allen, R Harley
1Department of Medicine, Medical University of South Carolina, Charleston.
The American Review of Respiratory Disease
|April 1, 1993
Summary
Intrapleural streptokinase reduced adhesions in rabbit empyema models but did not decrease pleural plaque. Increased pleural fluid was observed, suggesting non-fibrinolytic mechanisms may be involved in its efficacy.
Area of Science:
- Thoracic Surgery
- Pulmonary Medicine
- Experimental Pathology
Background:
- Multiloculated empyemas often require enhanced pleural space drainage.
- Intrapleural streptokinase is hypothesized to aid drainage by lysing septae through fibrinolysis.
Purpose of the Study:
- To evaluate the efficacy and safety of intrapleural streptokinase in resolving experimental empyema in rabbits.
- To assess streptokinase's impact on pleural fluid volume, adhesions, and pleural plaque formation.
Main Methods:
- Experimental empyema was induced in rabbits using turpentine and bacterial inoculation (E. coli, P. anaerobius, B. fragilis).
- Animals received daily intrapleural streptokinase (10,000 U) or saline for 3 days post-inoculation.
- Data analysis included rabbits meeting specific pleural fluid criteria (pH < 7.30, glucose < 50 mg/dl, or LDH > 500 IU/L).
Main Results:
- Streptokinase-treated rabbits showed significantly increased pleural fluid volume (18.8 ml vs. 4.8 ml) compared to saline controls (p = 0.015).
- Fewer interpleural adhesions were observed in the streptokinase group (8.2 vs. 25.1, p = 0.002).
- No significant difference in visceral and parietal pleural plaque was found between groups (p = NS).
- No systemic fibrinolysis was detected post-treatment.
Conclusions:
- Intrapleural streptokinase effectively reduces interpleural adhesions in experimental empyema.
- Streptokinase did not reduce pleural plaque formation in this rabbit model.
- Increased pleural fluid volume post-streptokinase may result from mechanisms beyond fibrinolysis.