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PubMed2003

Video-assisted thoracoscopic talc pleurodesis is effective for maintenance of peritoneal dialysis in acute hydrothorax complicating peritoneal dialysis.

BACKGROUND: Acute, massive, unilateral hydrothorax is an uncommon but well-recognized complication of peritoneal dialysis. Its clinical course and treatment outcome after a recently advocated technique of video-assisted thoracoscopic (VATS) talc pleurodesis remains unclear. METHODS AND RESULTS: Between July 1998 and March 2002, among 475 CAPD patients in two regional hospitals in Hong Kong, nine patients (three men, six women, mean age 53+/-12 years) developed acute hydrothorax due to pleuroperitoneal communication (R=8, L=1) within 5.8+/-4.2 months (median, 5.2 m; range, 2 days to 11.6 months) of commencing peritoneal dialysis. Analysis of simultaneously obtained peritoneal and pleural fluid in all subjects only showed concordance in protein content (consistently<4 g/l), while fluid glucose and lactate dehydrogenase levels were not comparable. The methylene blue test was negative (n=4). Radionuclide scan (n=6) and contrast CT peritoneography (CTP, n=3) detected pleuroperitoneal communication in half and one-third of the patients, respectively. All patients underwent pleurodesis achieved by talc insufflation into the pleural cavity under VATS guidance. All patients were successfully returned to peritoneal dialysis. After a mean follow-up of 18.8+/-12.5 months, hydrothorax recurred in one patient (at 7 months after pleurodesis), who was successfully treated by repeating the procedure. CONCLUSIONS: Hydrothorax complicating CAPD is more commonly right-sided, and tends to occur within the first year of starting peritoneal dialysis. Isotope scan and CTP are insensitive in diagnosing pleuroperitoneal communication. A low pleural fluid protein content is the most consistent biochemical finding. VATS talc pleurodesis is a safe and reliable treatment of choice that allows sustained continuation of CAPD with low recurrence rate.

Acute Disease↗
PubMed1986

Talc poudrage in the treatment of spontaneous pneumothoraces in patients with cystic fibrosis.

As patients with cystic fibrosis live longer, spontaneous pneumothoraces are seen with increasing frequency. Severe underlying pulmonary disease in these patients makes them particularly susceptible to life-threatening respiratory distress. Several modalities, including chemical sclerosis and open thoracotomy with pleurectomy, have been used to treat pneumothoraces in these patients. In the past 4 years, pneumothoraces in five patients (ages 9-22 years) with cystic fibrosis have been treated with thoracoscopy and talc poudrage. All procedures were performed under either regional or general anesthesia, depending on the age of the patient. Thoracoscopy was performed with a rod lens system and a 5.5-mm trocar, using biopsy forceps to lyse pleural adhesions, all of which ensures access to the entire pleural surface. United States Pharmacopeia-certified talc was insufflated to cover the entire pleural surface. There were no complications, and the patients had minimal pleural pain. Follow-up ranged from 6 months to 4 years. No patient has had a recurrent pneumothorax on the treated side. Thoracoscopy with talc poudrage is a preferable alternative to chemical sclerosis or thoracotomy for treating pneumothoraces in patients with cystic fibrosis. The procedure may be performed under regional anesthesia and allows rapid and complete sclerosis of the pleural cavity.

Adolescent↗
PubMed2003

Thoracoscopic talc pleurodesis for recurrent, symptomatic pleural effusion following cardiac operations.

Seventeen patients who underwent a cardiac operation developed a recurrent, symptomatic pleural effusion ultimately requiring video-assisted thoracic surgery (VATS) and talc pleurodesis. These patients represented 0.4% of all patients undergoing a cardiac operation over the same time period. Compared with an age- and sex-matched control group of cardiac surgery patients, patients requiring VATS for recurrent pleural effusion were more obese with higher body mass index (31.9 +/- 1.2 versus 28.3 +/- 1.4 kg/M2, P = 0.03), were more likely to have undergone a complex cardiac operation (8/17 versus 1/17, P =.01) and were more frequently on anticoagulation and antiplatelet agents besides aspirin (8/17 versus 2/17, P =.02). Patients underwent 1.86 +/- 0.34 thoracenteses with drainage of 846 +/- 166 mL/thoracentesis prior to referral for VATS. On average, patients underwent VATS 4.83 +/- 1.49 months after their cardiac operation. There were 3 VATS-related complications (17.6%) and no deaths. VATS talc pleurodesis led to symptomatic and radiologic improvement in all patients with a mean follow-up of 8.2 +/- 1.5 months. VATS talc pleurodesis effectively and safely treats the unusual postcardiac surgery patient with refractory pleural effusion.

Aged↗
PubMed2006

A case of acute pneumonitis following talc pleurodesis: high-resolution CT findings.

Talc is one of the most effective agents for pleurodesis but it may induce serious pulmonary complication caused by pulmonary talc deposition. We describe a case of acute pneumonitis following talc pleurodesis in a 30-year-old woman who had malignant pleural effusion. Air-space consolidation and ground-glass attenuation developed in both lungs, predominantly in the ipsilateral lung, shortly after pleurodesis and were not satisfactorily explained by reexpansion pulmonary edema or pneumonia. She was started on treatment with corticosteroid. Her dyspnea rapidly improved and air-space consolidation resolved over a few months on follow-up radiographs.

Acute Disease↗
PubMed2005

Prolonged survival after talc poudrage for malignant pleural mesothelioma: case series.

OBJECTIVE: Malignant pleural mesothelioma is a fatal disease with a mean life expectancy of 6-12 months. Since 1982, we have performed thoracoscopic talc poudrage (TTP) as a primary therapy in mesothelioma patients presenting with pleural effusion. As the survival data for our patients surpassed that of many published series, the patient data was analyzed to determine whether talc poudrage can be considered as a contemporary palliative option. METHODOLOGY: We reviewed all 26 patients with a final diagnosis of malignant pleural mesothelioma from our prospective database of 228 consecutive patients who received thoracoscopy from the same physician for recurrent symptomatic pleural effusion. Patients were followed up until their death. RESULTS: Mean survival after TTP was 23.8 +/- 16.3 months (median 19.4, range 2.9-68). Pleurodesis palliated dyspnoea in all patients. No perioperative deaths and one postoperative complication (pneumonia) occurred. Mean hospital stay was 3.9 +/- 2.7 days. CONCLUSION: TTP remains a safe, low-morbidity, inexpensive primary palliative treatment option for malignant pleural mesothelioma and a valid control arm option for therapeutic trials. TTP is ideal for patients who wish to avoid thoracotomy, long hospital stays and morbidity from multimodality therapy. Prospective randomized studies are needed to compare quality of life and survival after talc poudrage and other therapies.

Aged↗
PubMedDate not supplied

The efficacy of mechanical abrasion and talc slurry as methods of pleurodesis in normal dogs.

OBJECTIVE: To determine the efficacy of mechanical abrasion and talc slurry as methods for pleurodesis in normal dogs. STUDY DESIGN: Experimental study. ANIMALS OR SAMPLE POPULATION: Ten normal beagle dogs. METHODS: Group I dogs had mechanical abrasion (MA) of the pulmonary and costal pleurae performed in one hemithorax with a dry gauze sponge with a median sternotomy approach. Group II dogs had 100 mL of a 1 g talc slurry (TS) administered into one hemithorax through a tube thoracostomy. Administration of the TS was visualized by using video thoracoscopy. All dogs were evaluated at 2, 10, 20, and 30 days postoperatively by means of thoracic radiography and ultrasonographic thoracic wall measurement. The dogs were euthanatized 30 days postoperatively and a gross necropsy was performed. Hemithoraces were assigned a pleurodesis score (0-4) and an obliteration grade (0-6). Tissues were collected for histopathologic examination of pulmonary pleura, costal pleura, and pleural adhesions. Pulmonary and costal pleurae were graded for the degree of fibrosis (0-4). RESULTS: Obliteration grade and costal pleural fibrosis score were significantly higher for the treated sides in the MA dogs compared with the TS dogs. MA Dogs: Mechanical abrasion dogs had pleurodesis, obliteration, and pleural fibrosis scores that were greater on the treated side than the untreated side, however, the differences were not statistically significant. Only two MA dogs had firm adhesion of the pulmonary pleura to the costal pleura in portions of the cranial and middle lung lobes in the treated hemithorax. Thoracic wall surface area covered with adhesions was 15% and 21% in each of these two dogs. The median pulmonary pleural fibrosis score of all MA dogs for the treated hemithorax was 3 compared to 0 on the untreated side. TS Dogs: There was no statistical difference for pleurodesis scores and obliteration grades between the treated and untreated sides. No dogs showed evidence of pulmonary to costal pleural adhesions. Histopathology showed talc crossover into the untreated side in all five dogs. Median pulmonary fibrosis score of the treated hemithorax was 1 compared with 0 on the untreated side. CONCLUSIONS: Neither method of pleurodesis produced sufficient pleural adhesions to obliterate the pleural space. It is possible that the degree of pulmonary pleural fibrosis present in MA dogs may be sufficient to limit air leakage from pulmonary blebs and bullae resulting in successful treatment of spontaneous pneumothorax.

Animals↗
PubMed1971

Talc-treated rice and Japanese stomach cancer.

The Japanese prefer talc-dusted rice in their diet. The incidence of stomach cancer in Japan is unusually high. Most talc has some asbestos contaminants. Epidemiologic evidence is presented that the asbestos-contaminated talc on rice in the diet is the carcinogen or cocarcinogen responsible for the high incidence of Japanese stomach cancer.

Asbestos↗
PubMed1980

Concentration of seeded simian rotavirus SA-11 from potable waters by using talc-celite layers and hydroextraction.

There is mounting evidence for the waterborne transmission of diarrhea caused by rotaviruses. As a result, proper techniques are required for their recovery from samples of incriminated water. The combined efficiency of the talc-Celite technique and polyethylene glycol 6000 hydroextraction was, therefore, tested for this purpose, using Simian rotavirus SA-11 and MA-104 cells. Conditioning of the dechlorinated tap water samples was carried out by pH adjustment to 6.0 and the addition of Earle balanced salt solution to a final concentration of 1:100. Passage of a 1-liter volume of such a conditioned sample through a layer containing a mixture of talc (300 mg) and Celite 503 (100 mg) led to the adsorption of nearly 93% of the added SA-11 plaque-forming units. For the recovery of the layer-adsorbed virus, 3% beef extract and 1x tryptose phosphate broth were found to be superior to a variety of other eluents tested. When we tested 100-liter sample volumes, layers containing 1.2 g of talc and 0.4 g of Celite were employed. Virus elution was carried out with 100 ml of tryptose phosphate broth. The eluate was concentrated 10-fold by overnight (4 degrees C) hydroextraction with polyethylene glycol. With a total input virus of 7.0 x 10(5) and 1.4 x 10(2) plaque-forming units, the recoveries were about 71 and 59%, respectively.

Animals↗
PubMed1972

Starch and talc emboli in drug addicts' lungs.

The lungs of eight drug addicts dying as a consequence of their habit have been examined. All showed the presence of small amounts of talc emboli and five the presence of starch emboli. Talc was invariably associated with a marked foreign body reaction which was insignificant in association with starch. Animal experiments showed very rapid (90% in 24 hours) removal of maize starch emboli; such rapid removal in man would explain the lack of a foreign body response. Quantitation of the amount of starch present in lungs from two of the cases gave values of 1.5 and 5.2 g. The higher amount could have been a contributory factor in the sudden death of the addict. The amounts of talc seen were not sufficient to be of clinical significance.

Acetaminophen↗
PubMed1988

Bronchoalveolar lavage in talc induced lung disease.

A 65 year old woman with a history of occupational talc inhalation presented with hypoxaemia, cough, and dyspnoea with a normal chest radiograph. Bronchoalveolar lavage showed considerable lymphocytosis, with a predominance of T8+ T lymphocytes, and open lung biopsy showed peribronchiolar granulomas containing talc crystals. Corticosteroid treatment resulted in dramatic improvement. Bronchoalveolar lavage may aid in the diagnosis of talc related lung injury.

Aged↗
PubMed1982

Talc granulomatosis: laboratory findings similar to sarcoidosis.

We studied 6 men who had some combination of dyspnea, abnormal chest radiographs, resting increased alveolar-arterial oxygen gradients, noncaseating granuloma by lung biopsies, increased serum angiotensin-converting enzyme concentrations, positive gallium lung scans, and increased lymphocyte counts by bronchoalveolar lavage. Our patients were suffering from talc granulomatosis secondary to the intravenous injection of suspended, crushed pentazocine tablets. In addition to the above findings, bronchoalveolar lavage revealed birefringent intracellular and extracellular particles consistent with talc. We conclude that talc granulomatosis can mimic the laboratory findings of pulmonary sarcoidosis, but the findings of birefringent particles in the bronchoalveolar lavage fluid by polarized microscopy is a simple laboratory method for confirming a clinical diagnosis.

Adult↗
PubMed1998

Interstitial lung disease more than 40 years after a 5 year occupational exposure to talc.

A 62 yr old woman was initially diagnosed with sarcoidosis until a thoracoscopic biopsy revealed the presence of numerous birefringent particles in fibrotic areas of the centrilobular lung zones. These particles were examined by electron microscopy and X-ray spectrometry and characterized as impure talc. Further inquiry into her occupational history revealed that she had worked from the age of 14-18 yrs in a factory making rubber hoses, where she had had an intense exposure to talc. There was no evidence of silicosis or asbestosis, and other significant causes of interstitial lung disease were excluded. This case emphasizes the importance of a thorough occupational history, which may reveal a remote and forgotten exposure to a significant cause of interstitial lung disease. Although this presentation of talcosis is unusual, this case suggests that even a relatively short, but presumably intense exposure to talc more than 40 yrs previously may be a cause of progressive lung fibrosis.

Female↗
PubMed1998

Video-assisted talc pleurodesis for malignant pleural effusions utilizing local anesthesia and I.V. sedation.

METHODS: Twenty-four consecutive patients aged 36 to 84 years (mean, 63.3+/-12.9 years) underwent video-assisted talc pleurodesis (VATP) for malignant pleural effusion (MPE) utilizing local anesthesia with IV sedation at the Walter Reed Army Medical Center. The VATP procedure was performed in the operating room with the patient in the lateral decubitus position breathing spontaneously through a face mask with 4 L/min of oxygen. Anesthesia was achieved by intercostal nerve block using a 50/50 mixture of 1% lidocaine with epinephrine and 0.5% bupivacaine hydrochloride (Marcaine) supplemented with local infiltration of the access (Surgiport) sites as necessary. Sedation was achieved with propofol, and pleurodesis was performed with 3 to 8 g (average, 5 g) of sterile talc insufflated through a talc atomizer. RESULTS: The mean operating time was 44.3+/-14.9 min (range, 23 to 75 min). The average number of days of chest tube drainage was 2.9+/-1.2 days (range, 1 to 5 days). Patients stayed on the cardiothoracic ward for an average of 4.4+/-1.3 days before discharge home or transfer to a medical oncology ward. Seventeen of the 24 patients (71%) had excellent results, 4 patients (17%) had good results, and 3 patients (12%) had poor results. The three patients with poor results all had primary lung cancer as their underlying malignancy. The overall actuarial survival was 66% at 6 months, 48% at 12 months, and 32% at 24 months with a mean survival of 9 months. There was one operative death in an 84-year-old patient with primary lung cancer. Twelve of the 24 patients are alive 4 to 30 months after VATP. CONCLUSIONS: VATP, performed under local anesthesia, is a safe and highly effective method of managing MPE.

Adult↗
PubMed1984

Acute pneumonitis with bilateral pleural effusion after talc pleurodesis.

We describe a patient who developed acute pulmonary distress with bilateral interstitial infiltrates and pleural effusion following talc pleurodesis. Talc particles, obtained by bronchoalveolar lavage, were identified by transmission electron microscopy and chemical analysis. The patient improved with corticosteroid therapy. Acute respiratory failure can be a potential hazard of talc pleurodesis.

Adult↗
PubMed1997

CT appearance of the pleural space after talc pleurodesis.

OBJECTIVE: This study describes the CT appearance of the pleural space after talc pleurodesis. CONCLUSION: After talc pleurodesis, the pleural space reveals variable degrees of pleural thickening and nodularity, often with a residual loculated effusion. High-attenuation areas representing talc deposits are expected and should not be confused with other pleural abnormalities.

Adult↗
PubMed2002

Usefulness of imaging-guided catheter drainage and talc sclerotherapy in patients with metastatic gynecologic malignancies and symptomatic pleural effusions.

OBJECTIVE: The purpose of our study was to assess the usefulness of imaging-guided catheter drainage and talc sclerotherapy in patients with metastatic gynecologic malignancies and symptomatic pleural effusions and to assess the affect of ascites on the success rate of this treatment. MATERIALS AND METHODS: Twenty-five patients (mean age, 63 years) with metastatic gynecologic malignancies who had 26 symptomatic effusions treated at our institution over a 4-year period with imaging-guided catheter drainage and talc sclerotherapy were included in this study. Response to treatment was assessed by comparing pre-, immediate post-, and 30-day postsclerotherapy chest radiographs. Response to the treatment was graded as complete (no reaccumulation), partial (accumulation above immediate post- but below presclerotherapy level), or no response (reaccumulation to or above the presclerotherapy level). The presence of ascites on CT (n = 23), sonography (n = 1), direct intraoperative visualization (n = 1), or at physical examination (n = 1) was also noted. RESULTS: Of the 25 patients, 13 patients with 14 treated malignant effusions survived at least 30 days after sclerotherapy and formed the final study group. The remaining patients either died (n = 11) or were lost to follow-up (n = 1). At 30 days, 12 of the 14 treated effusions showed complete responses and one showed a partial response. The overall response rate was 86%. Abdominal ascites was present at the time of treatment in 11 patients (79%) and did not affect the success rate (p > 0.999). CONCLUSION: Imaging-guided catheter drainage and talc sclerotherapy are an effective treatment for symptomatic pleural effusions in patients with metastatic gynecologic malignancies. Ascites does not adversely affect the response to pleurodesis.

Aged↗
PubMed2005

An autopsy case of primary pericardial mesothelioma in arc cutter exposed to asbestos through talc pencils.

An autopsy case of a primary pericardial mesothelioma in a 53-year-old arc cutter is reported. He had often had the chance to inhale dust generated by sharpening the slate pencils composed of talc. He was admitted for heart failure due to pericardial tumor, but later died. The tumor was mainly located on the pericardium with a thickness of about 2.5 cm. Small nodular disseminations were observed in the left parietal pleura. Microscopically, tumor cells were epithelial-like and rich in histochemical demonstrable hyaluronic acid. Findings of immunohistochemical markers revealed keratin (+), EMA (+), calretinin (+), and CEA (-), which were characteristics of mesothelioma of epithelial type. The number of asbestos bodies (AB) in the lung parenchyma was increased (2026 AB/gram dry lung tissue). Subsequent transmission electron microscopic examination equipped with an energy dispersive X-ray analyzer revealed that the fibers identified in the lungs were fibrous talc and actinolite. These findings suggested that this patient had been occupationally exposed to asbestos contaminated in the talc pencils, which induced the development of primary pericardial mesothelioma.

Asbestos, Amphibole↗
PubMed1991

Thoracoscopic talc poudrage pleurodesis for chronic recurrent pleural effusions.

OBJECTIVE: To assess the effectiveness of thoracoscopic talc poudrage for the treatment of chronic pleural effusions. DESIGN: Prospective evaluation. SETTING: Kaiser-Permanente Hospital. PATIENTS: Forty-seven consecutive patients with recalcitrant pleural effusions, referred for thoracoscopy. INTERVENTION: Patients received general or local anesthesia; 42 had a 7-mm rigid thoracoscopic examination followed by insufflation of 5 mL of talc. Patients then had chest-tube drainage. MEASUREMENTS: We recorded clinical characteristics, final diagnosis, procedure-related pain and morbidity, days of hospitalization, patient-reported degree of symptom relief, and chest roentgenographic results at 1, 3, and 12 months. All patients were followed for 16 months or until death. MAIN RESULTS: Of 39 evaluable patients, all reported prolonged relief of effusion-related dyspnea. Radiographic results confirmed the elimination of pleural effusions in 34 patients (87%), including all 11 with benign conditions and 23 of 28 (82%) with malignancies. Treatment failed in three patients because of entrapped lung and in two patients with mesotheliomas whose effusions recurred more than a year after treatment. No procedure-related mortality or morbidity was found. Ambulatory patients required hospitalization for a mean of 3.9 days (range, 2 to 11 days). Mild pain was reported by some patients. The mean duration of chest-tube drainage was 2.7 days (range, 1 to 9 days). Patients with malignant disease lived an average of 12.4 months (range, 1 to 61 months) after the procedure. CONCLUSIONS: Thoracoscopic talc poudrage is an effective pleural sclerosing technique and is relatively painless.

Adult↗