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PubMed1993

Pneumothorax. Results of thoracoscopy and pleurodesis with talc poudrage and thoracotomy.

A retrospective study was performed of the evaluable data in 710 patients with a spontaneous pneumothorax. The male:female ratio was 3.4:1. A thoracoscopy was performed in 622 patients. The two main therapeutic strategies were pleurodesis with talc poudrage (n = 356) and thoracotomy (n = 248). The success rate of talc poudrage was 88 percent, and in the group failures who have undergone surgery afterwards, we found unexpected bullous structures in 20 of 37 patients. The success rate of operation (bullectomy, pleurectomy, or resection) was 97 percent. Our conclusion is that aggressive therapy in spontaneous pneumothorax is acceptable, with a high success rate with very few complications. The diagnostic thoracoscopic evaluation needs to be in experienced hands, especially to inspect the apical lobes with the Valsalva maneuver.

Adult↗

PubMed1994

Successful management of recurrent pneumothorax in cystic fibrosis by localized apical thoracoscopic talc poudrage.

Thoracoscopic talc poudrage of the entire pleural surface constitutes successful treatment of recurrent pneumothorax in cystic fibrosis (CF); however, subsequent lung transplantation is seriously jeopardized due to the development of extensive pleural adhesions. We describe a 27-year-old patient with CF with recurrent right-sided pneumothorax, refractory to chest tube drainage and to chemical (tetracycline) pleurodesis, who was successfully treated with a localized, apical thoracoscopic talc poudrage, thereby preserving the possibility of subsequent lung transplantation.

Adult↗

PubMed2000

Talc granulomatosis. A differential diagnosis of interstitial lung disease in HIV patients.

Consumers of adulterated drugs may present with talc-induced interstitial lung disease. A transbronchial biopsy specimen showing granulomas with intracellular talc crystals is necessary to confirm this diagnosis. In patients infected with HIV, such a condition can be indistinguishable at first glance from opportunistic infections or other pulmonary diseases. A case is presented of a seropositive patient whose chest radiographs showed a diffuse interstitial pattern.

Adult↗

PubMed2004

An Audit of medical thoracoscopy and talc poudrage for pneumothorax prevention in advanced COPD.

OBJECTIVES: To prospectively study all patients with COPD and spontaneous pneumothorax (SP) who underwent thoracoscopic talc poudrage (TP) under local anesthesia to determine its efficacy and safety in recurrence prevention. METHODS: Data on clinical measurements, complications, duration of chest tube drainage, length of hospital stay, and outcome were collected. RESULTS: Forty-one patients (38 men and 3 women) with a mean (+/- SD) age of 70.7 +/- 7.2 years were treated. All patients had COPD, with a mean FEV(1) of 41 +/- 14% predicted. The majority of SPs measured 20 to 50% in size, and 34% were recurrent. Three grams of talc were insufflated into the pleural cavity without complications. Thirteen patients (32%) complained of pain, 5 (12%) developed fever, 27 (66%) had subcutaneous emphysema, and 7 (17%) had prolonged air leaks. Postoperative chest tube drainage and hospital stay were 4 and 5 days, respectively. Success was 95% after a median follow-up of 35 months. Four patients with FEV(1) of < 40% predicted died within 30 days of the procedure, yielding a mortality rate of 10%. FEV(1) (in liters), FEV(1) (in % predicted), and ischemic heart disease were risk factors that influenced early mortality. CONCLUSION: Thoracoscopic TP is effective for pneumothorax prevention and can be performed with acceptable mortality in patients with advanced COPD.

Aged↗

PubMed2006

Evidence of innervation in talc-induced pleural adhesions.

STUDY OBJECTIVES: To conduct a detailed morphologic and ultrastructural study of pleural adhesions following talc pleurodesis. METHODS: Talc with a main particle size of 8.36 +/- 0.2 mum (mean +/- SEM) and at a dose of 200 mg/kg in a 2-mL slurry was instilled via a small catheter into the pleural cavity of 10 male rabbits. Five rabbits were killed at 1 week, and five rabbits were killed at 1 month after instillation. At autopsy, after macroscopically observing the pleural cavity, adhesions were excised from opposing pleural surfaces and processed for histopathologic, immunocytochemical, and ultrastructural study. RESULTS: At 1 week, all adhesions examined were mesothelium-covered fibrovascular bands containing well-developed blood and lymphatic vessels establishing a structural continuity between both pleural layers. Nerves were present in adhesions from 20% of the rabbits. They consisted of a single fascicle containing 5 to 20 thin myelinated axons of various diameters (1 to 6 microm) uniformly distributed throughout the nerve section. The anatomic location of the adhesion did not appear to influence its overall morphology. CONCLUSIONS: As early as at 1 week, adhesions are well-formed structures more resembling newly formed pleural tissue than a simple scar. Nerve fibers in pleural adhesions are reported for the first time, which suggests that these adhesions are potentially capable of conducting pain stimuli. Further studies are required in order to confirm our results in human pleural adhesions.

Animals↗

PubMed1975

Pulmonary talc embolization.

A young woman with a history of drug abuse rapidly developed cor pulmonale, restrictive pulmonary defect, low diffusion capacity, and a suggestion of left ventricular dysfunction. She died from complications after a lung biopsy. Microscopic examination showed talc granulomas and arteritis. Some form of closed biopsy is probably safer, and trial of corticosteroid therapy seems warranted for this diagnosis. Talc ia a dangerous ingredient for any oral preparation that is likely to be used parenterally.

Adult↗

PubMed1980

Recurrent spontaneous pneumothorax; an effective method of talc poudrage.

Between January 1977 and December 1978, 24 patients with recurrent or chronic spontaneous pneumothorax were treated in the Hong Kong University Cardiothoracic Centre at Grantham Hospital by talc pleurodesis. Talc poudrage had been carried out under local infiltration anesthesia by a technique that utilizes the Venturi principle and the help of an oxygen injector, used normally for ventilating a patient during bronchoscopy with a rigid bronchoscope. By using this method of poudrage, a uniform application of the powder over the whole pleural surface can be achieved and successful pleurodesis can be obtained in all patients under local anesthesia.

Adult↗

PubMed1990

Pulmonary talc granulomatosis in a cocaine sniffer.

The development of pulmonary granulomatosis following intravenous injection of medications intended for oral use has been well described previously. Talc is the most commonly implicated agent. We present a case of talc granulomatosis which developed in a patient following cocaine sniffing and suggest that this may be the cause of development of granulomata in drug addicts who deny any history of intravenous drug abuse.

Adult↗

PubMed2004

[Talc pneumoconiosis among soapstone handicraft workers in a rural area of Ouro Preto, Minas Gerais, Brazil].

Talc pneumoconiosis in Brazil has received little research attention to date. The disease was investigated in Mata dos Palmitos, a district of Ouro Preto, Minas Gerais State, among soapstone handicraft workers. The district has some 180 inhabitants, of whom 108 are engaged in handicrafts production, while 15 alternate handicrafts production with work in the soapstone quarries. A clinical and occupational investigation was conducted, along with a respiratory symptoms standardized questionnaire, chest x-ray (ILO standard), and spirometry. Clinical data showed a low prevalence of respiratory complaints. Dyspnea was the most frequent symptom. Chronic bronchitis was identified in 12 adult workers. Chest x-rays showed evidence of small lung opacities in 5 workers, and in 11 there was suspicion of the same opacities. One worker showed a plaque-shaped pleural thickening. Seven workers showed abnormal spirometry. The soapstone dust composition showed breathable asbestos fibers from the amphibole group (tremolite-actinolite). The results suggest talc asbestosis occurrence among soapstone handicraft workers.

Adolescent↗

PubMed2001

Talc serodesis--report of four cases.

Talc is a known stimulator of fibrosis in biological systems. We present four cases in which instillation of talc in to serous cavities have produced obliteration of these cavities. No side-effects were noted.

Administration, Topical↗

PubMed1991

Talc granulomatosis: two unusual presentations.

Two patients with history of intravenous drug use and pulmonary talc granulomatosis are presented. The first patient is a black female who was found to have increased activity of serum angiotensin converting enzyme, in addition to other clinical manifestations of sarcoidosis. The second patient is a Hispanic male smoker who presented with a solitary lung nodule and underwent transbronchial biopsies on two separate occasions with the diagnosis of talc granulomatosis. The lung nodule was found to be an adenocarcinoma on resection. Both patients had lung functions consistent with obstructive airways disease.

Adenocarcinoma↗

PubMed1991

[Talc therapy during thoracoscopy of pneumothorax due to rupture of the bullae in emphysema. A study of 71 cases].

The treatment of pneumothorax for large emphysematous bullae is classically surgical. We report a study of 71 patients treated by pleural talc therapy using thoracoscopy with good or excellent long term results in 93% of cases at a cost of some minor side effects. These results were compared with other forms of medical treatment which were always less effective and with surgical techniques which had more severe side effects. These results enable us to stress the value of talc therapy using pleuroscopy in patients with respiratory failure.

Administration, Topical↗

PubMed1991

[Pulmonary hypertension secondary to talc microemboli in a HIV seropositive heroin-addict woman].

Severe pulmonary hypertension presenting as acute cor pulmonare was observed in a HIV positive heroin addict. The usual aetiological investigations were negative. The apparently primary pulmonary hypertension was resistant oxygen and vasodilator therapy and was fatal in 6 months. Anatomopathological examination revealed the presence of talc microemboli in the pulmonary arterioles, severe medial hypertrophy and fibrous subendothelial thickening. The presence of the talc suggests that the pulmonary hypertension in this case was due to obstruction of the pulmonary vascular bed by the obstructive arterial lesions, despite the context of HIV infection.

Adult↗

PubMedDate not supplied

Fine needle aspiration cytology of talc granulomatosis in a peripheral lymph node in a case of suspected intravenous drug abuse.

A fine needle aspiration (FNA) specimen of an epitrochlear lymph node from a 22-year-old suspected intravenous drug abuser was submitted for cytologic examination, which revealed numerous granulomatous tissue fragments, histiocytes, lymphocytes and giant cells. Polarizing microscopy revealed strongly birefringent material of varying shapes and sizes, including anisotropic crystals with the Maltese cross configuration characteristic of starch. A cytologic diagnosis of talc granulomatosis in the lymph node was made. This case emphasizes the value of FNA biopsy in the differentiation of inflammatory versus neoplastic processes; this appears to be the first case of peripheral talc granulomatosis diagnosed by FNA biopsy.

Adult↗

PubMed1987

[Chylothorax: treatment using talc pleurodesis].

Chylothorax is a rare complication of lymphoma with a poor prognosis. The treatment is not well established. We report a case of lymphoma complicated by bilateral chylothorax in which, despite optimal chemotherapy and radiotherapy, pleural effusion persisted. Pleuroscopy was performed under local anesthesia, followed by pleural instillation of pure talc. The immediate result was satisfactory and six months later there was no recurrence of chylothorax. Talc pleurodesis appears to be a simple and safe way of treating chylothorax resistant to conventional therapy.

Chylothorax↗

PubMed1978

Early appearance and mitotic activity of multinucleated giant cells in mice after combined injection of talc and prednisolone acetate. A model for studying rapid histiocytic polykarion formation in vivo.

Combined intraperitoneal injection of talc and particulate prednisolone acetate resulted in the formation of significant numbers of multinucleated giant cells within 48 hours. Neither one of these two agents had a comparable effect when injected alone. Evidence is presented showing that the multinucleated giant cells arose by cell fusion. Synchronous nuclear division could be observed in a considerable proportion of newly formed polykarions. Although the late prophases were usually normal, high proportions of abnormal mitotic figures were observed at later stages of mitosis, particularly in anaphase and telophase. The chromosome abnormalities were so severe that it is highly improbable that mitosis led to successful nuclear multiplication within a given syncytium. Similar to prednisolone acetate, prednisone elicited the formation of multinucleated giant cells when injected with talc. No polykarion formation was observed, however, when prednisolone acetate was substituted for other steroid preparations of similar particle size such as cortexon acetate, cortisone, or testosterone isobutyrate.

Animals↗

PubMed1983

[Production and characteristics of bacteria-labeled talc dust for experimental air hygiene studies].

Freeze-drying of suspensions of Micrococcus luteus together with talc yields bacteria-labelled dust. This material can be used in experimental air hygiene. Loss of viability due to drying in air during experiments can be expected to be negligible. A wide range of particle diameters (1 to greater than 23 micron) is available. Scanning electron microscopy shows the bacteria sticking on talc particles after freeze-drying (Fig. 3a + b). Viable counts of the material decreased very slowly on storage.

Air Microbiology↗

PubMed1983

[Pleural mesothelioma, asbestosis and silicosis following long-term exposure to talc dust].

A case report with pleural mesothelioma, asbestosis and silicosis after long time exposure to talc dust has been given. Pathological findings, professional exposure, diagnostic aspects, and medical assessment of disablement are described. The relationship between the diseases of lungs and the professional exposure to talc dust as well as the possibility of cause-distinction by co-working of pathologist and industrial hygienist are discussed.

Aged↗