Platelets are known to contribute to ischemia/reperfusion in several organs, but their role in inflammation and organ injury after hemorrhagic shock (HS) has not been examined. To address this issue, we rendered mice thrombocytopenic (20% of normal platelet count) by treatment with pOp3, a rat monoclonal antibody against platelet glycoprotein Ibalpha, 24 h before subjecting them to either a standard HS or sham protocol. Liver apoptosis increased 3- to 5-fold (P<0.05), and focal liver necrosis increased 11-fold (P<0.01) in placebo-treated shock mice compared with sham; these increased indices of liver injury were completely prevented by pOp3 pretreatment. Neutrophils infiltrating the liver increased nearly 3-fold in placebo-treated shock mice versus sham (P<0.05); this shock-induced increase in neutrophil infiltration was also eliminated by pretreatment with pOp3. Alveolar cross-sectional area, used to histologically assess interstitial lung edema and cellular infiltration, was reduced by 25% in pOp3-treated shock mice versus placebo-treated shock mice (P<0.05). Similar to the results in liver, pOp3 pretreatment decreased neutrophil infiltration in the lung after HS. Thus, platelets contribute to the inflammatory injuries of the liver and lung after HS, in part, perhaps by facilitating neutrophil infiltration into tissues.

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Talc insufflation is usually performed by thoracic surgeons in the operating room through video-assisted thoracoscopic surgery (VATS) or by pulmonologists in a specially equipped suite (medical thoracoscopy). These techniques can cause postoperative pain, require placement of port sites through small incisions, and increase waiting time and cost for patients who have no need for visual inspection of the pleura, biopsy, or apical bleb resection. Poudrage (French for powdering) with asbestos-free talcum powder (talc) is a proven technique with wide acceptance for treatment of pneumothorax. Use of a small, 4 g, canister of talc under pressure is a commonly used method to aerosolize and apply it using the supplied Teflon catheters. This report describes a patient who was too ill for almost any formal procedure in whom we performed talc poudrage by an even less invasive technique, using controlled permissive pneumothorax in the radiology suite by using a small needle, guide wire, and dilator with no thoracoscopy ports. Given the increased expense, frequent waiting time delay, and diminished access to care, we believe this technique deserves consideration in patients who are poor surgical candidates and perhaps in the young patient with no computed tomography evidence that might suggest the need for apical bleb resection, biopsy, or additional investigation.