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The authors review the literature concerned with the carcinogenic hazards of a long term exposure to talc. The epidemiological and experimental data are controversial, but, however, seem to be sufficient to draw attention to, and to introduce special precautions for occupationally exposed individuals. Large experimental and epidemiological studies should be undertaken.
Video-assisted thoracoscopic surgery (VATS) has been widely used in the treatment of spontaneous pneumothorax. The unexpectedly high increase of the recurrence rate is the most important problem. We examined the interaction between recurrence, clinical features and patient's backgrounds. The main causes of recurrence were oversight of bullae and the emphysematous changes at the periphery of the site where an autosuture device was used. 90% of the recurrence occurred in the patients with type III small diffuse bullae. Introduction of the regional talc pleurodesis and covering stapled line with absorbable mesh were extremely useful to lower the recurrence rate after VATS for spontaneous pneumothorax.
In applying amorphous silica and talc in the site of solid Sarcoma 180 implants, the authors found a suppression and delay of tumor growth which was proveked by peritumoral foreign-body granulomas. Correlating these findings which those experiments which resulted in granulomas of hypersensitivity type, it may be suggested that any kind of peritumoral chronic inflammation enables an anti-tumor effect.
The authors report their experience of pleural talcage under thoracoscopy in 21 cases of lymphomatous pleurisy. This represents 9.6% of the total number of cancerous pleurisies treated with talc over four years. A successful result with talcage was achieved in 84% of cases. The success of failure of talcalge seems to depend on the macroscopic appearance (the existence of masses or nodules) as well as an abundance of pleural liquid, all constitute unfavourable factors. On the other hand the lymphoma (Hodgkins or non Hodgkins) does not seem to have any unfavourable effect.
After talc pleurodesis performed between 1954 and 1964 because of spontaneous pneumothorax during thoracoscopy, 99 patients were followed up. Only 2 patients experienced a pneumothorax relapse. Mesothelioma was not observed in any case, X-ray changes in the Pleura were moderate, and lung function did not show any significant restriction. It is concluded therefrom that the method is effective and does also not produce any noticeable side effects on long-term observation.
The authors report the results of their experience using tale pleurodesis under thoracoscopic control in the treatment of 218 cases of malignant pleural involvement. Although this technique is well tolerated it is necessary to note certain factors which prevent a successful pleurodesis (12% of cases). Thus, huge effusions greater than 12 litres, pleural involvement with large tumour masses, a very long history and patients aged more than 70 years were all factors contributing to a poor outcome. The success of pleural talc also depends on the nature of the primary cancer, for example in our series broncho-pulmonary cancers yielded better results than those effusions which were secondary to ovarian cancers.
Polarizing microscopy, X-ray powder diffraction and differential thermal analysis can be used to detect small amounts of minerals which may occur in talcs as impurities. The characteristic features of chlorite, asbestos, magnesite, quartz and other minerals recognizable through these methods are described.
A total of 20 patients aged 50.5 +/- 4.5 years with 24 chronic pleural effusions associated with lymphomas underwent 24 thoracoscopic talc poudrages. Effusions were serofibrinous (32%), hemorrhagic (41%), or chylous (27%). The mean volume of pleural liquid evacuated by repeated thoracenteses before thoracoscopy was 5.2 +/- 0.6 l. Thoracoscopic biopsies confirmed a lymphomatous infiltration of the pleura in 95.5% of cases. A definitive pleural symphysis was obtained in all cases but 2 (92% positive results): in 1 case, a further single thoracentesis of 400 ml was necessary, and in the 2nd case the patient died within 6 days from an acute evolution of her Hodgkin's disease. The mean drainage time was 4.8 +/- 0.2 days. Overall results are thus identical to those obtained in solid tumor-related pleural effusions (91% positive results).
An analysis is presented of 44 patients with malignant pleural effusion treated by intercostal talc pleurodesis, all except eight of them between 1966 and 1971.
Of 210 patients who underwent pleurodesis with iodized talc or kaolin 14 to 40 years previously, all but 11 were traced. There was no increased incidence of lung cancer and no case of mesothelioma.
A fine needle aspiration specimen from the right lung of a 44-year-old former drug addict was submitted for cytologic evaluation. The specimen consisted of numerous mononucleate and multinucleate macrophages containing aggregates of silicate crystals, as seen by light microscopic examination using a polarizing filter. The background of the slides included fibroblasts, lymphocytes and other inflammatory cells. The finding within foreign-body giant cells of large groups of strongly birefringent, platelike crystals varying widely in size led to the conclusive cytologic diagnosis of intravenous talc granulomatosis.
Deaths for a 31-year period (1948-1978) were analyzed in a historical prospective cohort study of 655 white male talc workers. Death rates from all causes, from cancer of the respiratory system, and from nonmalignant respiratory disease were not significantly different from those of the U.S. white male population. However, significant differences for these causes of death were found among workers who had previous occupational histories. An analysis of the latency periods of the observed lung cancer suggests that exposure to an etiologic agent during previous work experience may play a role in the development of lung cancer.
Malignant pleural effusion is a frequent complication of metastatic breast cancer, leading to a significant degree of morbidity. Drainage of the effusion by thoracocentesis and subsequent pleurodesis is an established means of symptomatic relief in these patients. Several sclerosing agents have been reported in the literature, including doxycylin, minocyclin, tetracyclines, bleomycin, cisplatin, etoposide, fluorouracil, interferon-beta, Corynebacterium parvum, and talc which gives the best results. The condition of the lung's parenchyma must be evaluated prior to the procedure to rule out lymphangitis carcinomatosa or bronchial obstruction that would impair the expansion of the lung. In these situations, the implantation of a pleuroperitoneal shunt is an alternative to be considered.
Malignant pleural mesothelioma (MPM) remains a disease of very poor prognosis despite all new therapeutic approaches. We describe here 13 cases with MPM. The main symptoms at presentation were dyspnea (12/13) followed by weight loss (7/13), cough (3/13) and thoracic pain (2/13). On chest X-ray, all patients had pleural effusion associated with pleural thickening in 8/13 cases (62%). A definitive diagnosis was brought by thoracoscopy in 11/12 cases (diagnostic sensitivity 92%). In one patient, thoracoscopy was technically impracticable because of very important obesity. By thoracoscopic talc pleurodesis, we were able to control the pleural effusion in all patients with suppression of dyspnea (11). The mean survival after diagnosis was 6.8 +/- 5.0 months (range 1-16). At the present time, we believe that thoracoscopy is well indicated in any suspicion of MPM not only for diagnosis but also for palliative treatment of this pleural disease. However, there is a need for well controlled studies to improve the outcome of MPM.
Two new lamellar inorganic-organic magnesium silicates have been successfully synthesized by using sol-gel based processes under mild temperature conditions. The talc-organosilicates derived using two silylating agents as the silicon source, (i) 3-chloropropyltrimethoxysilane, and (ii) from the attachment of 5-amino-1,3,4-thiadiazole-2-thiol molecule to this precursor agent, yielded PhMg-Cl and PhMg-Tz phyllosilicates. These organoclays were characterized through elemental analyses, infrared spectroscopy, X-ray diffractometry, surface area, thermogravimetry, and carbon and silicon solid state nuclear magnetic resonance spectroscopy. The results confirmed the presence of organic moieties covalently bonded to the inorganic silicon sheet network of the 2:1 class of phyllosilicates, with a density of organic molecules of 6.6+/-0.1 and 2.7+/-0.2 mmol g(-1) anchored on the inorganic layer and with interlayer distances of 1158 and 1628 pm, respectively. The nuclear magnetic resonances results in the solid state are in agreement with the sequence of carbons distributed in the pendant chains of the original silylating agents and the silicon bonded to oxygen atoms or carbon atoms of the inorganic sheets, as expected for the organically functionalized phyllosilicates. The enhanced potential of the new compound PhMg-Tz as a multi property material was explored in adsorbing cations from aqueous solution. The basic sulfur and nitrogen centers attached to the pendant chains inside the lamellar cavity can coordinate mercury, by presenting an isotherm saturated at 0.19 mmol g(-1) of this heavy metal. The functionality of this organoclay-like material expresses its potential for heavy cation removal from an ecosystem.
Canine tracheal mucous transport rates of each of two organic (corn and ragweed pollen), and three inorganic (chrysotile asbestos fibers, silica, and talc), 99mTc labeled pollutants were simultaneously measured against those of 125I labeled Dowex anion exchange resin particles in healthy animals. The method of labeling of the pollutants with 99mTc is described. With the exception of ragweed pollen, which moved 15% faster than the reference marker (P <.02), we found no difference in the transport rates of these particulate pollutants and the reference marker. We conclude that the particulate pollutants studied are handled by the mucociliary system in a similar fashion, and that the transport rates of Dowex particles represent valid measurements of the transport rates of these pollutants.
Young children in the Seychelles were weighed and charted using both a beam balance with the standard growth chart and using the TALC direct recording scale with integral chart. The oscillating pointer and unwanted horizontal movement of the chart in the scale resulted in unacceptable misclassification of nutritional status equivalent to a weighing error in infants of +/- 2 kg. The electronic walk-on scale may provide the most important next step forward in low cost scale technology in primary health care.
Therapy for recurrent malignant pleural effusion (MPE) is palliative. Video-assisted thoracic surgery with talc pleurodesis (VATS/TP) is limited to inpatients with completely expandable lung parenchyma. We evaluated the outcomes, safety, and efficacy of an indwelling pleural drainage catheter (PDC) system compared with VATS/TP. Forty-one consecutive patients with symptomatic MPE seen between September 2000 and April 2002 were studied. Patients able to fully re-expand their lungs were treated with VATS/TP; those who could not had PDC placement. Twenty-four (59%) were women. The mean age was 64 +/- 13 years. VATS/TP was performed in only seven patients (17%), and 34 patients had PDC placement. The length of stay (LOS) was 2.8 +/- 5.1 days in the 18 PDC patients who were initially seen as outpatients and 9.4 +/- 9.0 days in the inpatient population (P = 0.013). Short (< 2 days) LOS occurred in 19 (56%) PDC patients but in no VATS/TP patients (P = 0.007). Twenty-eight patients (68%) died during follow-up: three VATS/TP patients (43%) and 25 (74%) PDC patients (P = 0.112). We conclude that the PDC system is an efficacious treatment of patients with MPEs and trapped lungs. The LOS is short in patients initially evaluated as outpatients which contributes to the perception of increased quality of life.