[Experimental study of the pleural effects of the pulverization, under thoracoscopic control, of a fibrin glue (Tissucol)].

The instillation of a fibrin sealant (Tissucol) has been proposed in the treatment of recurrent spontaneous pneumothorax. The present work is devoted to an experimental study in the dog of the effects of this substance on the pleural cavity one and two weeks after instillation under thoracoscopic control. Its action is compared to that of placebo (methylene blue). The instillation of a placebo (n = 5) did not alter the ventilatory mechanics or the structure of the pleura. On the other hand Tissucol (n = 6) led to a fall in the thoraco-pulmonary compliance (-14%), corresponding to that of the vital capacity (-10%). In these animals, no pleural symphysis was noted, but the histological analysis gave evidence of changes in the layers of the parietal and visceral pleura: an inflammatory mononuclear reaction (71% of cases) and/or polymorphonuclear (54%), recent fibrosis (67%) and more rarely a mesothelial hyperplasia (21%). The maintenance of the integrity of the mesothelial cellular layer would explain the absence of pleural symphysis after instillation of Tissucol. These results as well as those recently obtained in the human situation prompt us to advise other methods of pleural symphysis which have been tried and tested, such as talcage or surgery.