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At least 199 records · Page 11Linked to original sources
PubMed1997

Palliative iodized talc pleurodesis with instillation via tube thoracostomy.

Pleural effusions are a severe complication of advanced malignant disease. Palliative treatment strategies should be simple and effective. We investigated iodized talc pleurodesis through tube thoracostomy for this purpose. A total of 43 patients received a suspension of 5 g talc with 3 g thymol iodine via chest tube. The procedure was well tolerated without major complications in all cases. Unfortunately, 4 patients died of disease within the 1st month after treatment, so that only 39 patients were evaluable for treatment outcome. Follow-up ranged from 1 to 14 months. The success rate after 3 months was 92.5%. In conclusion, iodized talc pleurodesis is an excellent tool in the palliative management of malignant pleural effusions. Administration via chest tube is sufficient for treatment success.

Adult↗
PubMedDate not supplied

Talc pleurodesis through small-bore percutaneous tubes.

Pleurodesis using talc as the sclerosing agent is an effective procedure for preventing reaccumulation of malignant pleural effusions. Because of its thickness, the talc slurry is usually instilled through large bore (20-28 Fr), surgically placed thorocostomy tubes. However, these tubes often cause considerable patient discomfort. Herein we report a series of eight patients in whom the talc slurry was inserted through 10 and 12 Fr percutaneous chest tubes. Six of the eight patients (75%) had a successful pleurodesis without a reaccumulation of fluid. We conclude that this is an acceptable method for treating patients with malignant pleural effusions.

Adult↗
PubMedDate not supplied

Ultrastructural acute features of active remodeling after chemical pleurodesis induced by silver nitrate or talc.

This study evaluated submicroscopic features of active pleural remodeling associated with chemical pleurodesis. Twenty seven rabbits received intrapleural injection of 0.5% silver nitrate (SN; N = 9) or 400 mg/kg talc slurry (N = 9) in 2 ml of saline solution; control rabbits (N = 9) received 2 ml of saline alone. The rabbits were sacrificed 15 minutes, 24 hours, or 7 days postinjection, and specimens of visceral pleura were obtained, fixed, and photographed for submicroscopic analysis. After 15 minutes of talc or SN exposure, prominent injury to the mesothelial cells and mesothelial cell-mesothelial basement membrane (MC-MBM) union was visible. There was focal remesothelialization of the denuded area through mesothelial cell migration, proliferation, and differentiation. After 24 hours, early wound healing, characterized by a superficial exudate, was evident where myofibroblasts had proliferated through a gap in the MC-MBM. After 7 days, proliferation of highly active myofibroblasts was observed; these cells produced abundant extracellular matrix components in a more organized distribution paralleling the surface. This third stage of remodeling was more evident with SN than talc-induced chemical pleurodesis. Our results suggest that ideal chemical pleurodesis results from injury to the MC-MBM union and abnormal wound healing, involving three essential steps: remesothelialization, fibroblastic proliferation, and extracellular matrix accumulation and remodeling.

Animals↗
PubMed1998

Talc pleurodesis in recurrent pleural effusions.

BACKGROUND AND AIMS: The treatment of recurrent malignant pleural effusions is known to be difficult and varies from observation in asymptomatic patients to pleurectomy with varying results. This prospective study presents the efficacy and the limits of iodized talc pleurodesis in patients with malignant and non-malignant recurrent pleural effusions. METHODS: In a prospective trial talc pleurodesis was performed in 50 patients with recurrent pleural effusions (malignant effusions: n=36, non-malignant effusions: n=14). After insertion of a chest tube and complete re-expansion of the lung, 5 mg of talc and 3 mg of thymol iodine were installed with 0.5 ml of 1% xylocaine/kg body weight and 30 ml 0.9% saline solution. The chest tube was removed after an average time of 4 days and chest radiographs were performed 1 month after instillation to evaluate the efficacy of pleurodesis. RESULTS: Successful therapy was achieved in 31 of 33 patients (94%) with malignant effusions within a follow-up period of 7 months. Three patients died within 1 month after therapy due to progressive malignant disease. The treatment was successful in all cases of non-malignant effusions and complications did not occur in either group. CONCLUSIONS: These results indicate that pleurodesis with iodized talcum slurry is a simple and inexpensive method with high efficacy in controlling malignant and non-malignant pleural effusions.

Chest Tubes↗
PubMed1996

Thoracoscopic pleurodesis with minocycline vs talc in the porcine model.

BACKGROUND: Eighteen adult pigs (Sus scrofa) underwent thoracoscopy and were placed into one of three groups: no sclerosant, talc pleurodesis, or minocycline pleurodesis. METHODS: Animals were then sacrificed at matched time intervals. Gross inspection of the pleural cavity estimated percentage of pleural symphysis (>25% was considered substantial) and allowed assignment of a pleurodesis score based on a scale described by Bresticker. Microscopic examination evaluated degree of fibrosis as mild, moderate, or severe. RESULTS: The talc group had significantly better pleurodesis than the minocycline group as determined by (1) the proportion of animals with substantial surface pleural symphysis (5/6 vs 1/6, p < 0.01), (2) a higher pleurodesis score (3 vs 1.3, p < 0.05), and (3) the proportion of animals with moderate fibrosis (5/6 vs 0/6, p < 0. 01). CONCLUSIONS: The authors conclude that instillation of aerosolized talc produces significantly better fibrosis and pleural symphysis than atomized minocycline in this animal model.

Animals↗
PubMed1984

Evaluation by electron microscopy techniques of asbestos contamination in industrial, cosmetic, and pharmaceutical talcs.

Talc powders from national and international markets were analyzed in order to assess their fiber contents and the proportion of asbestos in the fibrous material. Samples of talc powders used as excipients in pharmaceutical and cosmetic preparations demonstrated fiber contents up to 30% of total particles. About a half of the talc powders revealed the presence of asbestos: in five samples chrysotile (a serpentine asbestos) was present, in the other ones tremolite and anthophyllite (an amphibole asbestos). The amounts of asbestos vary up to 90% in the different samples of the fibrous fraction. About 75% of observed asbestos fibers were thinner than 0.4 micron, i.e., below the resolving power of light microscopy which until now was the most utilized technique for evaluating the environmental pollution due to asbestos.

Asbestos↗
PubMed1986

A comparison of intracavitary talc and tetracycline for the control of pleural effusions secondary to breast cancer.

Forty-one patients with malignant pleural effusions secondary to breast cancer were randomly allocated to treatment with either intracavitary talc or intracavitary tetracycline. Of 33 evaluable patients, radiological control was achieved in 11/12 (92%) of the talc group compared with 10/21 (48%) of the tetracycline group (P = 0.022). Intracavitary talc provides effective palliation of metastatic pleural effusions secondary to breast cancer.

Breast Neoplasms↗
PubMed1977

Effect of talc injected intravenously in guinea pigs.

The pulmonary angiothrombotic lesions in narcotic addicts attributed to the talc present in drug tablets were studied experimentally in guinea pigs following repeated intravenous administration of a suspension of talc dust (75 mg per animal). In early periods there was a moderate localization of talc particles in the alveolar capillaries of lung, liver and abdominal lymph nodes. The vascular injury in the pulmonary tissue was in the form of mild proliferation of the endothelial cells. In addition, many nodular collections comprising macrophages and lymphocytes developed around such vascular structures. At later periods (150 days) the only significant reaction obtained was moderate thickening of interalveolar septa and the lesions were in no way comparable to the human reports. The significance of these findings has been discussed.

Animals↗
PubMed1999

Macular fibrosis associated with talc retinopathy.

PURPOSE: To investigate a patient with talc retinopathy who developed macular fibrosis with resultant visual loss. METHODS: A 64-year-old intravenous drug abuser was evaluated for bilateral peripheral retinal neovascularization. He admitted to abusing oral methylphenidate intravenously. Funduscopy showed numerous intravascular talc particles in the macular area of both eyes. Over a period of next 4 years, visually significant macular fibrosis gradually developed in both eyes, the left eye more than the right eye. RESULTS: Fluorescein angiography confirmed the presence of bilateral peripheral retinal neovascularization with adjacent areas of ischemic retina. The patient was treated with peripheral laser treatment to the ischemic retina with resultant regression of peripheral retinal neovascularization. Bilateral macular fibrosis accounted for the reduced vision in our patient. CONCLUSION: Talc retinopathy can be associated with macular fibrosis with resultant visual loss.

Fibrosis↗
PubMed2001

Effective treatment of malignant pleural effusion by minimal invasive thoracic surgery: thoracoscopic talc pleurodesis and pleuroperitoneal shunts in 101 patients.

BACKGROUND: For effective palliation of patients with malignant pleural effusion due to advanced neoplastic disease, any proposed treatment should have low procedure-related mortality and morbidity. METHODS: The clinical outcome of 119 thoracoscopies in 101 patients (56 women, 45 men), from 42 to 91 years of age (mean, 68 +/- 9 years) with malignant pleural effusions was evaluated in a retrospective study. Video-assisted thoracoscopy (VATS) talc pleurodesis was done in 105 instances, and a pleuroperitoneal shunt was performed 14 times as an alternative when complete expansion of the lung could not be achieved due to tumor implants on the visceral pleura. RESULTS: The VATS talc pleurodesis resulted in clinically significant improvement of dyspnea in 92.2% of the patients. Thirty-day mortality was 2.8% and morbidity was 2.8%. The mean duration of postoperative survival was 6.7 months. Recurrent pleural effusion occurred in 5.7% of patients after a mean interval of 6 months. Clinical relief of dyspnea was obtained in 73% of the patients treated with pleuroperitoneal shunts. Thirty-day mortality in this group was 21% and morbidity was 14.3%. The mean duration of survival was 4.2 months. CONCLUSIONS: The VATS talc pleurodesis is appropriate for palliation of patients with malignant pleural effusions and should be performed once the diagnosis has been confirmed. Patients with lungs trapped by visceral carcinomatosis may benefit from placement of a pleuroperitoneal shunt as an alternative.

Adult↗
PubMed1986

The use of talc for pleurodesis in the treatment of resistant empyema.

The use of talc in the infected pleural space has not been reported previously. Five patients who had empyema of the pleura in the fibrinopurulent stage and did not respond to treatment with tube drainage and antibiotics were treated by talc insufflation to stimulate pleural adhesions. Pleurodesis was achieved in all 5 patients, with complete recovery from empyema. No untoward effects were observed. These results suggest that talc pleurodesis may be an acceptable solution to the problem of empyema resistant to other methods of treatment.

Adult↗
PubMed1976

Treatment of malignant pleural effusion: a method using tube thoracostomy and talc.

Our experience with a simple bedside method for controlling recurrent symptomatic malignant pleural effusion is presented. The method consists of intercostal tube thoracostomy, instillation of a suspension of talc, and waterseal suction drainage. Based on our experience, we believe certain criteria should be met before undertaking talc pleurodesis. In properly selected patients the results with tube thoracostomy and talc pleurodesis have been uniformly good in preventing fluid recurrence and return of disabling symptoms. The technique and results are discussed.

Adolescent↗
PubMed1978

Pulmonary response to kaolin, mica and talc in mice.

Following intratracheal inoculation the pulmonary fibrogenic response of kaolin, mica and talc was investigated in mice over a period of 210 days. All the three dusts incited acute inflammatory reaction at early periods but with mica dust the acute reaction persisted longer. Subsequently there was gradual increase in the fibroblastic activity in the focal areas and mica produced, in addition, many cholesterol cleft-like structures together with marked fibroblastic activity and lymphocytic infiltration. Towards the termination of experiment at 210 days the fibrosis, in general, remained restricted to grade II with kaolin and mica while talc produced thickened interalveolar septa. The transport of dust from lungs to lymph nodes occurred earlier with mica than with kaolin or talc dust accompanied with little fibrotic reaction. The significance of the findings has been discussed.

Animals↗
PubMed1996

Video-assisted talc pleurodesis in the management of pleural effusion secondary to continuous ambulatory peritoneal dialysis: a report of three cases.

Continuous ambulatory peritoneal dialysis (CAPD) is an effective treatment for end-stage renal disease. Hydrothorax secondary to pleuroperitoneal communication is an unusual complication of CAPD, with persistence or recurrence requiring alternate forms of dialysis. We have recently managed three patients with CAPD-induced right hydrothorax secondary to such communications. Earlier treatment methods have included thoracentesis or tube thoracostomy with chemical pleurodesis and even thoracotomy with attempts to locate and close the communication. We used a new approach consisting of video-assisted thoracic surgery and direct talc poudrage. All patients were successfully returned to CAPD; one patient required a repeat procedure after an initial recurrence. Video-assisted thoracic surgery with talc poudrage is an effective and safe procedure with minimal morbidity for management of hydrothorax secondary to CAPD. This procedure allows identification of diaphragmatic defects amenable to repair and talc placement under direct visualization, allowing even distribution over the inferior surface of the lung.

Aged↗
PubMed2003

Matrix metalloproteinases production in malignant pleural effusions after talc pleurodesis.

In this study we have evaluated the modifications of matrix metalloproteinases (MMPs) in malignant pleural fluids taken from patients suffering from lung cancer and treated with intrapleural talc instillation to induce pleurodesis. Furthermore, we have analysed the variations of some inflammatory mediators (C-reactive protein, alpha-1 antitrypsin) and of a protein (plasminogen) involved in MMP activation. In all patients the clinical improvement after talc pleurodesis was followed by a reduction in MMP-1, TIMP-1, C-reactive protein, alpha-1 antitrypsin and plasminogen activity. Furthermore, MMP-9 levels were variable; in fact, in some patients they were high at the beginning of treatment, in others they increased a few days after pleurodesis induction. These inhibitory effects of talc on MMP-1 and inflammatory mediators associated with the reduction of pleural effusion could constitute an effective means to evaluate the evolution of the treatment.

Aged↗
PubMed1997

Influence of talc on the properties of polycarboxylate cement.

Zinc oxide, the inorganic component of polycarboxylate cement, was mixed with talc in various proportions from 10% to 50%. These powder mixtures were spatulated with poly(acrylic acid) in three powder to liquid (P/L) ratios of 1:1, 1.5:1 and 2:1 (w/w). Properties such as setting time and compressive and diametral tensile strengths of the resultant cements were determined. It was observed that the setting time of the resultant cements increased with increasing talc content. The compressive and diametral tensile strengths also increased by approximately 54% with a 10% concentration of talc.

Acrylic Resins↗
PubMed2000

Perineal application of talc and cornstarch powders: evaluation of ovarian cancer risk.

Some epidemiologic studies have reported associations between perineal talc exposure and epithelial ovarian cancer, which raises parallel questions about the consequences of perineal exposure to cornstarch. Cornstarch powder is an alternative to talc powder that by its nature is a completely different substance. In this review of the literature the epidemiologic data on ovarian cancer risk and perineal application of both powders are reviewed, and the chemical natures of the two powders are compared. All available data indicate that whereas associations between talc exposure and ovarian cancer have suggested but not proved a casual relationship, the application of perineal powder containing cornstarch exclusively is not predicted to be a risk factor for ovarian cancer.

Emollients↗
PubMed1983

Progressive massive fibrosis of the lung secondary to intravenous injection of talc. A pathologic and mineralogic analysis.

We present a patient with a history of heroin addiction and 19 years of methadone maintenance who died of respiratory failure following nine years of slowly progressive dyspnea. During this nine-year period, chest x-rays consistently had revealed large, bilateral densities having the appearance of progressive massive fibrosis (PMF). At autopsy the lungs exhibited corresponding areas of dense, gritty consolidation, which microscopically showed an active granulomatous reaction with associated vascular obliteration. Throughout the lesions were refractile and birefringent plates of particulate material. Interstitial, perivascular, and vascular granulomas also were noted in the periphery of the lung. X-ray energy spectroscopy and diffraction studies of the particulates confirmed the presence of talc at levels of 540 X 10(6) particles/g of dried tissue in the mass lesion and 96 X 10(6)/g in the peripheral lung. Smaller numbers of silica particles also were identified. Approximately 30% of the talc particles were greater than 5 mu in maximum dimension, a finding consistent with intravenous delivery. Particles larger than 15 mu were only found in the mass lesion. We conclude that massive granulomatous lesions with the radiographic appearance of PMF can occur in association with intravenous injection of talc. We suggest that particle size and cumulative particle load are important in the pathogenesis of these lesions.

Electron Probe Microanalysis↗