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PubMed1994

Pleurodesis using talc slurry.

OBJECTIVE: To determine the efficacy and safety of talc slurry for pleurodesis. DESIGN: Retrospective. PARTICIPANTS: All patients who received talc slurry via tube thoracostomy at Memorial Sloan-Kettering Cancer Center from March 1991 to April 1992. RESULTS: Fifty-eight patients received talc slurry in 75 procedures; five patients had 2 unilateral procedures and 12 had bilateral procedures. Fifty-two patients had malignant pleural effusions with the most common cell types being breast (23 of 52, 44 percent), lung (4 of 52, 8 percent), ovarian (4 of 52, 8 percent), and endometrial (3 of 52, 6 percent). Four patients had benign conditions. The mean duration of follow-up was 171 days (range, 2 to 450 days). Success, defined as the absence of pleural fluid reaccumulation, was evaluable in 47 of 73 (64 percent) procedures. Pleurodesis was successful in 38 of 47 (81 percent). Adverse effects associated with pleurodesis included fever (46 of 73, 63 percent), empyema (4 of 73, 5 percent), atrial arrhythmia (3 of 73, 4 percent), hypotension (3 of 73, 4 percent), and hypoxemic respiratory failure (3 of 73, 4 percent). There were no deaths attributable to the procedure. CONCLUSIONS: Talc slurry instilled through a chest tube is an effective bedside method of pleurodesis. Fever occurs frequently. Respiratory failure is a rare but potentially serious complication that deserves further investigation.

Adult↗
PubMed1994

Intrapleural talc for the prevention of recurrence in benign or undiagnosed pleural effusions.

Chemical pleurodesis has become the preferred treatment for definitive management of malignant pleural effusions. The treatment of patients with recurrent benign or undiagnosed pleural effusions, however, remains a difficult clinical problem. Tetracycline has been widely used as a sclerosing agent, but parenteral tetracycline is no longer available. Therefore, alternative sclerosing agents are needed. Talc was used for the first time in 1935, and subsequently there have been several reports documenting its effectiveness in the treatment of malignant pleural effusion and pneumothorax. The objective of this study is to present our experience with a low dose of aerosolized talc for controlling nonmalignant pleural effusions. Between May 1985 and October 1992, twenty-two patients underwent talc pleurodesis at the time of thoracoscopy for control of a nonmalignant effusion. The cause of the effusion was cirrhosis in six patients, systemic lupus erythematosus in two, chylothorax in five, and no diagnosis in nine patients. Follow-up has ranged from 18 days to 5 years. Only two patients (9 percent), one with cirrhosis and another with an undiagnosed pleural effusion, had a recurrence of the effusions. We conclude that the intrapleural administration of 2 g of aerosolized talc is an effective treatment for recurrent benign (including chylothorax) or undiagnosed pleural effusions.

Adolescent↗
PubMed1995

Sterilization of talc for pleurodesis. Available techniques, efficacy, and cost analysis.

Although talc has been used as a pleurodesis agent since 1935, a sterilization protocol has not been established. We obtained USP asbestos-free talc from six different suppliers and sterilized each using dry heat, gamma irradiation, and ethylene oxide gas. Aerobic, anaerobic, and fungal cultures were obtained prior to sterilization, and 1, 30, and 90 days after sterilization. Bacillus species were cultured from all six unsterilized specimens and coagulase-negative Staphylococcus grew from two unsterilized specimens. No growth of organisms was found following any method of sterilization. The cost of sterilization per 5-g packet of talc was $4.74, $7.85, and $16.25 for heat, ethylene oxide, and gamma irradiation, respectively. In conclusion, untreated talc is not sterile. Sterilization by prolonged dry heat exposure, ethylene oxide gas, and gamma irradiation are all effective, with dry heat being the least expensive.

Ethylene Oxide↗
PubMed1998

Medical thoracoscopic talc pleurodesis for chylothorax due to lymphoma: a case series.

STUDY OBJECTIVES: Recurrent chylothorax as a complication of lymphoma has had unsatisfactory outcomes. Serial thoracentesis, tube thoracostomy, and pleurodesis via chest tube have been ineffective and compromise the nutritional and immune status of the patient. Medical thoracoscopic talc pleurodesis has been safe and effective in the treatment of some other varieties of recurrent pleural effusions. Our objective was to investigate the safety and efficacy of medical thoracoscopic talc pleurodesis in the palliation of chylothorax related to lymphoma. DESIGN: This is a report of 24 hemithoraces treated in 19 consecutive patients with lymphoma-related chylothorax, failing chemotherapy or radiation therapy. The average patient age was 55 years. INTERVENTIONS: Medical thoracoscopy was performed under local anesthesia and conscious sedation in a bronchoscopy suite. Sedation included midazolam (mean dose, 6 mg; range, 2-14 mg) with either meperidine (mean dose, 94 mg; range 25-140 mg), or morphine (mean dose, 18 mg; range 4-40 mg). Pleurodesis was performed with insufflation of sterile asbestos-free talc, (4-8 g). After pleurodesis, chest tubes were placed, with the mean duration of chest tube placement being 4 days, range 3 to 10 days. RESULTS: One patient died a few days after the procedure due to causes related to the primary disease process. Follow-up was for at least 90 days following the procedure. Patients were assessed at 30, 60, and 90 days following the procedure. At each of these endpoints, all patients remaining alive were without recurrence of pleural effusions, which was confirmed by chest radiography. Eight patients in the series died of the effects of their malignancy during the 90-day evaluation interval. Complications included medication reactions in two patients (8.3%) and ARDS in one patient (4.1%). CONCLUSION: Many patients with lymphoma-related chylothorax are refractory to chemotherapy and/or radiation therapy. In this group, medical thoracoscopic talc pleurodesis has an acceptable complication rate and a 100% success rate in the prevention of recurrence of pleural effusions at 30, 60, and 90 days following the procedure.

Chylothorax↗
PubMed2000

Hypercalcemia due to talc granulomatosis.

Pulmonary disease due to talc, a group of hydrous magnesium silicates, is almost exclusively encountered after occupational exposure. One form of this rare disorder is talc granulomatosis. In varying degrees, hypercalcemia is typical of granulomatous disease but has not yet been reported in talcosis. We report the case of a former mold maker who presented with hypercalcemia. Laboratory findings indicated extra-renal 1-alpha-hydroxylation of 25-hydroxyvitamin D. Pulmonary infiltrates prompted a lung biopsy that disclosed talc granulomatosis. We suggest that talc granulomatosis should be added to the list of granulomatous disorders capable of causing hypercalcemia due to increased extra-renal 1-alpha-hydroxylation of 25-hydroxyvitamin D.

Aged↗
PubMed2000

Successful talc slurry pleurodesis in patients with nonmalignant pleural effusion.

BACKGROUND: Chemical pleurodesis is an effective treatment for malignant pleural effusion and pneumothorax. This mode of therapy is, however, less widely accepted in the treatment of patients with refractory benign or undiagnosed pleural effusion. STUDY OBJECTIVES: To analyze the outcome of talc slurry pleurodesis in patients with nonmalignant pleural effusions. DESIGN: Retrospective and partly prospective analysis of clinical outcome. SETTING: Hadassah University Hospital, Jerusalem, Israel. PATIENTS AND PARTICIPANTS: Between 1992 and 1997, we treated 16 patients with nonmalignant pleural effusion using talc slurry pleurodesis. The cause of effusion was congestive heart failure in 6 patients, liver cirrhosis in 4 patients, yellow nail syndrome in 1 patient, systemic lupus erythematosus in 1 patient, chylothorax in 1 patient, and undiagnosed in 3 patients. INTERVENTIONS: Nine patients were hospitalized, and seven patients received treatment in a day-care setting. Follow-up ranged from 2 months to 3 years. RESULTS: Complete success was observed in 12 cases (75%), partial success in 3 cases (19%), and pleurodesis was ineffectual in 1 case (6%). There were no significant complications after the procedure in any of our patients. A review of the English-language medical literature revealed an additional 110 reported cases of nonmalignant pleural effusion that were treated with chemical pleurodesis. Of these cases, talc was used in 65% with a success rate of nearly 100%. CONCLUSIONS: Chemical pleurodesis, and specifically talc slurry, is an effective treatment for recurrent benign or undiagnosed pleural effusion. This procedure is safe and easily performed and, in selected cases, can be performed in an outpatient day-care setting.

Adult↗
PubMed2001

Thoracoscopy talc poudrage : a 15-year experience.

OBJECTIVES: To review our experience with thoracoscopy and talc poudrage during the previous 15 years with regards to efficacy, side effects, morbidity, and mortality. METHODS: Six hundred fourteen consecutive patients (58.6% female; mean age, 54.5 years) underwent thoracoscopy with talc poudrage from August 1983 to May 1999. Of these, 457 patients had malignant pleural effusions, 108 patients had benign pleural effusions, and 49 patients had spontaneous pneumothorax. RESULTS: Sixty-four patients were excluded from evaluation for efficacy: 30 patients (4.9%) because the lung did not expand at the time of the procedure and 34 patients (5.5%) because they died within 30 days of the thoracoscopy. All exclusions were in the malignant group. The overall success rate of the 393 patients with malignant pleural effusions was 93.4%, while the overall success for the 108 patients with benign effusions was 97%, although 7 patients (7%) with benign effusions required a second thoracoscopy. The success rate with pneumothorax was 100%. Major morbidity included empyema in 4%, reexpansion pulmonary edema in 2.2%, and respiratory failure 1.3%. CONCLUSION: Thoracoscopy with talc poudrage is effective in producing a pleurodesis in malignant and benign pleural effusion and in spontaneous pneumothorax. However, it should be noted that the insufflation of talc has a systemic distribution associated with a low rate of morbidity and perhaps does induce ARDS, which is sometimes fatal in a small percentage of patients. Because of these side effects, the search for a better agent should be continued.

Female↗
PubMed2005

Clinical efficacy and safety of thoracoscopic talc pleurodesis in malignant pleural effusions.

STUDY OBJECTIVES: In patients with disseminated neoplastic disease, recurrent pleural effusion is frequently observed. The purpose of this study was to determine the long-term efficacy and safety of pleurodesis by thoracoscopic talc poudrage (TTP) in malignant pleural effusions (MPEs). METHODS: We report a consecutive series of 102 patients (45 women, 57 men; 20 to 83 years of age) who underwent medical thoracoscopy and TTP for recurrent MPE between 1999 and 2001. Thoracoscopy was performed utilizing local anesthesia and IV sedation (medical thoracoscopy). For pleurodesis, an average of 8 g of sterile talc powder was used. One hundred eighty-day follow-up was completed for all patients, and outcome measures included time to recurrence of the effusion and survival. Efficacy was judged by clinical examination, chest radiograph, and/or thoracic ultrasound examination. Procedure-related complications were documented. RESULTS: The most common primary neoplasms were lung cancer (n = 48), breast cancer (n = 16), and malignant pleural mesothelioma (n = 10). Twenty-eight patients had other types of tumors, including renal cell carcinoma, ovarian carcinoma, GI tumors, prostate, malignant lymphoma, and unknown primary cancer. At the end of the primary observation period of 180 days, 38 of 46 surviving patients (82.6%) had a successful pleurodesis. Type of primary neoplasm had no significant influence on success rate. The 30-day mortality rate was 16.7% (n = 17). Survival curves after 180 days showed significant differences, with best survival in mesothelioma and shortest life expectancy in lung cancer (p = 0.005). Adverse effects included empyema in one case and malignant invasion of the scar. No episode of talc-induced ARDS was observed. CONCLUSION: Thoracoscopic talc pleurodesis is a safe and effective method to stop recurrent MPEs. Lasting pleural symphysis is obtained.

Adult↗
PubMed1992

[Biological evaluation of Indian and Chinese talc aggressiveness].

In order to evaluate biologically the action of two different kinds of talc pulmonary and hemolytic tests were applied and pathomorphological examination carried out on animals. The study was performed on 120 rats within the 6th and 9th months periods. The talcs used in the experiment did not indicate any fibrogenic properties. Morphologic examination did not show any differences in the pathogenetic activity between the Indian and Chinese talcs Inflammatory changes within the lungs and bronchi, pulmonary emphysema and increased levels of fibrosis indices in biochemical examinations have drawn our attention to problems connected with longterm exposure to talc dust.

Animals↗
PubMed2004

Severe hemorrhagic complication of talc pleurodesis for idiopathic pleural effusion.

Talc is a commonly used sclerosing agent for pleurodesis. However, there have been recent reports of a number of complications associated with the use of talc. Although there is significant data regarding the respiratory complications associated with talc, reports of bleeding complications are extremely rare. We present the case of a 78 year-old man who was treated with talc pleurodesis for recurrent pleural effusion and subsequently developed a massive hemothorax, a rare complication.

Aged↗
PubMed1989

[Value of talc administration using thoracoscopy in the symptomatic treatment of recurrent pleurisy. Apropos of 302 cases].

From the data of a retrospective study the authors assess the value of pleural symphysis by talc in the symptomatic treatment of recurrent pleural effusion. 300 patients, 254 of whom were suffering from pleural effusion secondary to cancer and 48 of whom had non-cancerous pleural effusion, were subjected to a thoracoscopy under local anaesthetic allowing the instillation of 5-10 mls of talc powder followed by aspiration drainage for 4-8 days. Out of 270 evaluable cases, an immediate positive result (defined as the absence of any recurrence of the pleural effusion at the drainage site) was obtained in 251 cases or 93% +/- 3% (being 92.1% +/- 3.5% of the cases of pleural cancer and 97.7 +/- 4.5% in cases of non-cancerous pleural effusion). At the end of 6 months there was no recurrence of the effusion in 80.6% of cases. There were 19 early failures (7% +/- 3%) and 25 late failures of whom 9 benefitted from a further attempt at a pleural symphysis (either a pleurectomy, or injection of talc in suspension, or new talc therapy by thoracoscopy). On the whole the complications were minor: pain, fever and rarely more serious: empyema in 6 cases and cancerous nodules down the drainage line in 10 cases. There had been 15 deaths (5.3% +/- 2.6%) during the period of drainage in some very weak and fragile patients. Pleural talcage leads to an improvement in dyspnoea in 82% +/- 7.4% of cases and the general condition was improved in 54% +/- 9.8%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

Treatment of malignant pleural effusion with drainage, with and without instillation of talc.

In order to determine whether pleural drainage with talc instillation was better than pleural drainage alone, in the treatment of malignant effusion, the present trial was initiated. Thirty-one patients with malignant pleural effusion and progressive disease, resistant to conventional therapy, were included. All patients had pleural drainage applied. After re-expansion of the lung, half of the patients had talc instilled through the chest tube. Twenty-one of the 31 treated patients were evaluable. After pleural drainage with talc instillation, all of 9 treated patients obtained complete resolution of the effusion and subjective improvement. After pleural drainage alone, 7 of 12 patients obtained complete resolution of the malignant effusion. If it is possible to re-expand the lung during pleural drainage in patients with a malignant pleural effusion, pleurodesis can be obtained in 60% of the treated patients with pleural drainage alone. This study showed a statistically significant improvement in the treatment associated with instillation of talc into the pleural cavity and this was achieved without causing increased discomfort to the patient.

Adult↗
PubMed1993

Talc pleurodesis. Experience with 360 patients.

Talc was used intrapleurally for the creation of pleural adhesions in 360 patients. The indications for use were malignant pleural effusion in 169 patients, benign effusions in 41, recurrent pneumothorax in 122, empyema in 19, and chylothorax in 9. Of 336 patients available for follow-up, excellent results (complete pleurodesis) were achieved in 284 patients (84.5%), fair results in 28 (8.3%), and poor results (no adhesions) in 24 (7.2%). The results were best in empyema (100%) and better in pneumothorax than in pleural effusions. With repeat talc insufflation, the results were improved to excellent in more than 90% of the patients. Talc is the most effective and least expensive agent for creation of pleural adhesions. Its use is simple and easily tolerated by the patients. Because of the carcinogenic effect of asbestos, purified talc that is free of asbestos fibers must be used.

Adolescent↗
PubMed1982

Talc retinopathy in primates: a model of ischemic retinopathy. II. A histopathologic study.

Experiment talc retinopathy was produced in four adult rhesus monkeys by biweekly intravenous injections of talc for 31/2 to ten months and was studied by retinal vascular flat preparations and by light microscopy. Talc particles were lodged in the walls of the precapillary arterioles and capillaries, producing focal occlusion of retinal and choroidal capillaries. The pericyte-endothelial cell ratio was 1:0.77 in the posterior pole and 1:0.53 in the retinal periphery. The horseradish peroxidase study showed leakage of tracer from the retinal vasculature into the extracellular interstitial space, but the barrier of the retinal pigment epithelium was intact. Microinfarcts produced small cystoid spaces in the outer plexiform layer, inner nuclear layer, and ganglion cell layer of the macula. Cytoid bodies and macrophages were scattered in the retina. No retinal or vitreal neovascularization was observed.

Animals↗
PubMed1990

Morbidity and mortality in talc-exposed workers.

Cancer incidence and cause-specific mortality were studied in a male cohort of 94 talc miners and 295 talc millers, exposed to non-asbestiform talc with low quartz content. No excess risk was found compared with national age-specific incidence. Six cases of lung cancer occurred versus 6.49 expected (miners: observed 2, expected 1.27; millers: observed 4, expected 5.22). There were 3 deaths due to non-malignant respiratory disease against 10.9 expected (miners: observed 1, expected 2.5; millers: observed 2, expected 8.4). Mesothelioma, tuberculosis, or pneumoconiosis were not recorded as causes of death. Pneumoconiosis was noted as a contributory cause in three cases (silicosis two, talcosis one). Further follow-up will reduce any potential impact of "healthy worker" selection.

Cause of Death↗
PubMed1989

Comparison of intracavitary bleomycin and talc for control of pleural effusions secondary to carcinoma of the breast.

In a prospective randomized study, patients with pleural effusions secondary to breast carcinoma were randomly allocated to be treated by pleurodesis using either intracavitary talc or bleomycin. For 25 assessable treatments in 22 patients, recurrence of effusion was observed in 5 of 15 (33 per cent) of the bleomycin group compared with none in the talc group. It is concluded that talc is superior to bleomycin in controlling pleural effusions secondary to breast carcinoma, but bleomycin may have a role in patients unfit for general anaesthesia or with extensive disease elsewhere.

Bleomycin↗
PubMed1995

A review of perineal talc exposure and risk of ovarian cancer.

The authors provide a detailed review of the events that led to the interest in talc as a possible ovarian carcinogen, the epidemiological studies published to date, and their perspective on the interpretation of the findings including potential limitations, biases, and issues surrounding the plausibility of a causal association. The authors conclude that the range of relative risk estimates from epidemiology, 1.0 to 1.8, is plausible, but that additional epidemiologic studies, especially prospective investigations are needed. In addition, clinicopathological studies are needed to confirm or deny the reports of talc embedded in human ovarian tissue and reports of talc migration through the human female reproductive tract.

Animals↗
PubMed1993

A nested case control study of lung cancer among New York talc workers.

This nested case control study assessed the relationship of lung cancer and time exposed to talc, while controlling for smoking, other talc exposures, and nontalc exposures. There were 22 lung cancer cases (91% smokers and 9% former smokers) and 66 controls (27% nonsmokers, 9% former smokers, and 64% smokers). Smokers were at sixfold increased risk compared to nonsmokers and ex-smokers. When stratified by smoking status, risk of lung cancer decreased with talc tenure and remained negative when excluding cases with < 20 years' latency and short-term workers. These data suggest that nontalc exposures are not confounding risk factors while smoking is, and that temporal and exposure-response relationships are consistent with a smoking etiology but not an occupational etiology for lung cancer.

Case-Control Studies↗