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PubMed1980

Surface powders on surgical gloves.

Four different instrumental techniques were used to analyze the microscopic particles on the patient-contact surfaces of a variety of surgical gloves. The presence of talc was confirmed on most, but not all, gloves tested. The presence of talc, when it occurred, seemed to be due to design by the manufacturer rather than by accident, and it was predominantly on the patient-contact surfaces. The intentional inclusion of talc on modern surgical gloves has been unexpected up to now. A washing and wiping procedure showed that talc was more difficult to remove than starch-based powder. A powder-stripping procedure showed that powder that resisted removal by washing could be mechanically dislodged. Thus, a shedding hazard might exist during a surgical procedure even if the glove surfaces have been washed and wiped.

Gloves, Surgical↗
PubMed1984

An experimental histopathologic study of surgical glove powders.

Tissue reactions to surgical glove powders, ie, talc (magnesium silicate) and Keoflo (low cross-linked cornstarch) were studied histologically from day 1 to 16 weeks. These materials were tested as a contaminant on the surface of surgical suture or in a pellet form implanted in abdominal muscle of rat. Use of Keoflo resulted in an intense acute inflammatory response, with a progressive decrease in the amount of starch with time after implant. By the fourth week, most of the starch had disappeared with minimal tissue damage and scar formation. Rats implanted with talc showed an initial mild to moderate acute inflammation followed by chronic inflammatory response and granuloma formation by the third day. From the fourth week on, granulomas showed talc crystals within the giant cells surrounded by histiocytes, lymphocytes, some collagen, and fibroblasts. This study indicates that talc molecules are not absorbed, whereas low cross-linked cornstarch is an absorbable substance; therefore the latter is a safe material for use as surgical glove powder.

Drug Implants↗
PubMed1993

Optimal pleurodesis: a comparison study.

With the resurgence of thoracoscopy, there is renewed interest in less invasive methods of pleurodesis. We wished to compare in an animal model a variety of methods suggested in reports. The purpose of the study was to rank the effectiveness of each procedure against the standard mechanical pleurodesis. Twenty-five mongrel dogs (weight, 25 to 35 kg) underwent bilateral thoracotomy. Each animal was randomly assigned to receive two of the following methods of pleurodesis: tetracycline, talc, mechanical abrasion, neodymium: yttrium-aluminum garnet (Nd:YAG) laser (Hereus Inc, E. Rutherford, NJ) photocoagulation, and argon beam coagulator (ABC) (Beacon Lab, Bloomfield, CO) electrocoagulation of the parietal pleura. At evaluation at 30 +/- 2 days, the efficacy of pleurodesis was graded on a scale of 0 to 4, with 0 representing a complete absence of pleural symphysis and 4 the adhesion of more than one lobe to both the chest wall and mediastinum. Mean grade and standard deviation of each method were: talc, 3.0 +/- 0.67; mechanical, 3.0 +/- 0.82; tetracycline, 2.3 +/- 1.4; ABC, 1.5 +/- 0.97; and Nd:YAG laser, 0.7 +/- 0.95. Both the talc and mechanical methods were superior to either the Nd:YAG laser or the ABC (p < 0.01). In this study, neither the Nd:YAG laser nor the ABC proved efficacious in producing pleurodesis. Talc poudrage is the only method of pleural symphysis comparable with mechanical abrasion.

Animals↗
PubMed1991

Mineral-associated hepatic injury: a report of seven cases with X-ray microanalysis.

The patterns of hepatic injury associated with various minerals were studied in seven patients. The subjects included one patient who was a sandblaster (silica by inhalation), one patient who was a dental laboratory technician (silica and chromium-cobalt alloy by inhalation), one patient with inhalational talcum powder abuse, and four chronic intravenous (IV) drug abusers (talc by IV injection). In all cases, the liver was examined by light and polarizing microscopy, and by scanning electron microscopy with energy-dispersive x-ray microanalysis. In the two patients with silica exposure, silica-containing sclerohyaline nodules were diffusely present in portal tracts and lobules. Both chromium-cobalt alloy and silica were present in the dental technician. In contrast, in all cases of talc exposure, aggregates of talc-laden macrophages were present in portal and centrilobular areas. Three IV drug abusers and the talcum powder abuser had histologic evidence of chronic hepatitis, most probably of viral etiology. We conclude that mineral type plays an important role in the pathogenesis and fibrogenesis of hepatic lesions. Compared with silica, talc primarily elicits a macrophage response without granuloma formation or fibrosis. Hepatic silicosis is a rare complication in dental laboratory technicians, and chromium-cobalt alloy may contribute to hepatic injury and fibrosis in this setting.

Adult↗
PubMed2006

Preparation and in vitro/in vivo evaluation of sustained-release metformin hydrochloride pellets.

In this study, metformin hydrochloride (MH) sustained-release pellets were successfully prepared by centrifugal granulation. Seed cores preparation, drug layering, talc modification and coating of polymeric suspensions were carried out in a centrifugal granulator. Talc modification was performed before coating in order to overcome the high water solubility of metformin. The influence of surface modification by talc, the effects of Eudragit types and ratios, as well as the correlation between in vitro release and in vivo absorption were investigated in detail. Experimental results indicated that talc modification made a decisive contribution to controlling the drug release by avoiding drug dumping. Three dissolution media: 0.1 M HCl, distilled water and pH 6.8 phosphate buffer were employed to determine the in vitro release behaviors of the above metformin hydrochloride pellets. The relative bioavailability of the sustained-release pellets was studied in 12 healthy volunteers after oral administration in a fast state using a commercially available immediate release tablet (Glucophage) as a reference. Following coating with a blend of Eudragit L30D-55 and Eudragit NE30D (1:20), at 7% or 10% coating level, respectively (referred to as F-2, F-3), the pellets acquired perfect sustained-release properties and good relative bioavailability. The Cmax, Tmax and relative bioavailability for F-2 and F-3 coated pellets were 1.21 microg/ml, 6 h, 97.6% and 1.65 microg/ml, 8 h, 165%, respectively. Combined use of two Eudragit polymers with different features as coating materials produced the desired results. Restricted delivery of metformin hydrochloride to the small intestine from differently coated pellets resulted in increased relative bioavailability and a sustained release effect. The adoption of several different pH dissolution media established a better relationship between the in vitro release and in vivo absorption of the sustained-release pellets.

Administration, Oral↗
PubMed2003

Mediastinal talcoma masquerading as thymoma.

We report a young woman with a large, calcified anterior mediastinal mass discovered 18 months following a left talc pleurodesis. The lesion was evaluated and treated as the thymoma or teratoma that it appeared to be, with excision by a transcervical approach. Pathologic examination revealed a giant talc granuloma. Awareness of such a possibility following talc pleurodesis may allow surgeons to avoid unnecessary mediastinal exploration, and its occurrence suggests that talc administration simultaneous with mechanical pleurodesis should be avoided.

Adult↗
PubMed1998

A prospective algorithm for the management of air leaks after pulmonary resection.

BACKGROUND: Air leaks (ALs) are a common complication after pulmonary resection, yet there is no consensus on their management. METHODS: An algorithm for the management of chest tubes (CT) and ALs was applied prospectively to 101 consecutive patients who underwent elective pulmonary resection. Air leaks were graded daily as forced expiratory only, expiratory only, inspiratory only, or continuous. All CTs were kept on 20 cm of suction until postoperative day 2 and were then converted to water seal. On postoperative day 3, if both a pneumothorax and AL were present, the CT was placed to 10 cm H2O of suction. If a pneumothorax was present without an AL, the CT was returned to 20 cm H2O of suction. Air leaks that persisted after postoperative day 7 were treated with talc slurry. RESULTS: There were 101 patients (67 men); on postoperative day 1, 26 had ALs and all were expiratory only. Univariable analysis showed a low ratio of forced expiratory volume in 1 second to forced vital capacity (FEV1/FVC) (p = 0.005), increased age (p = 0.007), increased ratio of residual volume to total lung capacity (RV/TLC) (p = 0.04), increased RV (p = 0.02), and an increased functional residual capacity (FRC) (p = 0.02) to predict the presence of an AL on postoperative day 1. By postoperative day 2, 22 patients had expiratory ALs. After 12 hours of water seal, 13 of the 22 patients' ALs had stopped, and 3 more sealed by the morning of postoperative day 3. However, 2 of the 6 patients whose ALs continued experienced a pneumothorax. Five of the 6 patients with ALs on postoperative day 4 still had ALs on postoperative day 7, and all were treated by talc slurry through the CT. All ALs resolved within 24 hours after talc slurry. CONCLUSIONS: Most ALs after pulmonary resection are expiratory only. A low FEV1/FVC ratio, increased age, increased RV/TLC ratio, increased RV, and an increased FRC were predictors of having an ALs on postoperative day 1. Conversion from suction to water seal is an effective way of sealing expiratory AL, and pneumothorax is rare. If an expiratory AL does not stop by postoperative day 4 it will probably persist until postoperative day 7, and talc slurry may be an effective treatment.

Adult↗
PubMed2004

Minimally invasive thoracic surgery for diagnostic assessment and palliative treatment in recurrent neoplastic pleural effusion.

BACKGROUND: We evaluated the effectiveness of VATS in the diagnosis and palliative treatment of recurrent neoplastic pleural effusions. METHODS: From 1987 to 2001, we performed 325 VATS chemical pleurodesis for malignant pleural effusions. We used talc in 253 subjects (78 %) and alcohol in 72 (22 %) as the sclerosant agent. In 226 patients (68 %) we performed biopsies because the histology was unknown. RESULTS: Mean operating time was 33.38 +/- 9.77 minutes (median: 32; range: 19 - 58), and the mean duration of chest intubation was 3.78 +/- 1.33 days (median: 4; range 2 - 8). Complications occurred in 2 % of patients. Thirty-day mortality was 2 %. Mean postoperative in hospital stay was 5.53 +/- 1.90 days (median 6; range: 2 - 11). We obtained 264 (81 %) therapeutic successes (no effusion recurrence within 4 months), and 55 relapses of which 32 had talc insufflation (13 % of talc group) and 23 alcohol instillation (32 % of alcohol group). CONCLUSIONS: VATS chemical pleurodesis is a safe, useful, versatile procedure for oncological pleural effusion management. The use of talc rather than alcohol significantly increased the therapeutic success rate. VATS should be considered the treatment of choice in patients with advanced neoplasm to obtain good palliation and a better quality of life.

Adult↗
PubMed1987

Unusual intestinal talcosis.

A case of intestinal talcosis in a 46-year-old man is reported. At the age of 27, the patient was treated for pulmonary tuberculosis with tablets containing talc (183 g talc per 2,670 g total drug intake) over a period of 28 months. Eighteen years later, the patient was hospitalized for abdominal pain that remained refractory to antacids; he subsequently underwent a right hemicolectomy. Light-microscopic examination revealed a prominent fibrosis of the intestinal wall in which birefringent particles were demonstrated by polarized light. Using energy-dispersive spectroscopy, an analysis of these particles showed that they were predominantly composed of silicon and magnesium as well as small amounts of phosphorus, sulphur, calcium, and iron--the spectrum typically associated with talc. We believe that the source of this talc is the tablets ingested by the patient during prior antituberculosis therapy.

Cecum↗
PubMed2005

Alternative widely available, inexpensive agents for pleurodesis.

PURPOSE OF REVIEW: Pleurodesis is the one of the best options for the management of symptomatic patients with malignant pleural effusion, recurrent benign pleural effusion, and recurrent pneumothorax. Although talc, parenteral tetracycline derivatives, and bleomycin are the most commonly used agents for pleurodesis, parenteral tetracycline derivatives are not available worldwide, bleomycin is expensive, and concerns about the side effects of talc are growing. The purpose of this review is to provide information about other widely available agents for pleurodesis. RECENT FINDINGS: It has recently been shown that oral tetracycline/doxycycline is as effective and safe as parenteral doxycycline in producing pleurodesis in rabbits. SUMMARY: Oral forms of tetracycline derivatives, quinacrine, silver nitrate, iodopovidone, and other talc preparations such as facial talc can be used to create pleurodesis when commonly used agents are not available.

Animals↗
PubMed2004

The pathology associated with therapeutic procedures in malignant mesothelioma.

AIMS: To describe iatrogenic pathological lesions in malignant pleural mesothelioma. METHODS AND RESULTS: All cases of malignant pleural mesothelioma confirmed by antemortem pleural biopsy and undergoing post mortem examination over a 7-year period (1995-2001) formed the study group. This comprised 48 malignant pleural mesotheliomas [epithelioid (n = 21), biphasic (n = 14) and sarcomatoid (n = 13)]. Twenty-eight of 48 (58%) had received chemical (talc) pleurodesis, 30/48 (63%) palliative localized radiotherapy, 6/48 (13%) chemotherapy, and 14/48 (30%) surgery [12/48 (26%) pleural decortication and 2/48 (4%) pleuropneumonectomy]. CONCLUSIONS: Talc pleurodesis induces a marked pseudosarcomatous fibroblastic proliferation which may impart a biphasic pattern to the neoplasm. In more chronic cases, paucicellular fibrosis with a foreign body giant cell reaction is noted. The talc is polarizable and deposited in linear fashion within the tumour. In 2/28 (7%) pleurodesis cases platyform ferruginous bodies were seen in the peripheral alveolated lung parenchyma and these mimicked asbestos bodies. An awareness of this is important to prevent false attribution to asbestos. Talc could be identified by transmission electron microscopic mineral analysis in 5/15 (33%) cases examined. Tumour nodules developing subjacent to iatrogenic wound sites were noted in 8/48 (17%) cases. In 6/8 (75%) of these cases, comparative assessment of the locally irradiated subcutaneous chest wall tumour, with background pleural mesothelioma, showed no morphological difference in architectural tumour growth pattern, extent of necrosis, cytological or nuclear pleomorphism, mitotic activity or tumour immunophenotype. In 2/8 (25%) cases the locally irradiated tumour showed prominent bizarre multinucleated tumour giant cells and intense mixed inflammation, a feature not seen in the background (non-irradiated) tumour. All six malignant pleural mesotheliomas receiving chemotherapy appeared refractory to treatment in that chemotherapy did not appear to have any significant effect on the tumour morphology, cytonuclear pleomorphism, mitotic activity, extent of necrosis or immunophenotype. In the 12 decortication specimens and two pleuropneumonectomy resections, post mortem examination identified evidence of residual malignant mesothelioma of similar morphological subtype and immunophenotype to the resected tumour.

Antineoplastic Combined Chemotherapy Protocols↗
PubMedDate not supplied

Experimental aural cholesteatoma causing bone resorption.

A series of experiments were carried out on 55 guinea pigs in four groups to study the conditions fostering bone resorbin epidermal cysts. The first group had free grafts of canal wall skin applied to the cochlea with and without talc application. The second group had canal skin flaps applied to the cochlea with and without subsequent talc application. The third group had talc applied either to the tympanic membrane or on the cochlea. The fourth group had a canal skin flap inserted into a mucosal pocket in the bulla. The animals were killed three to four months after surgery and the temporal bones were prepared for histology. Epidermal cysts were found at the cochlea in 8 of 55 animals. Cochlear fistulas were found in 6 of 55 animals. The fistulas were associated with epidermal cysts in three cases, otitis media in two cases, and talc granuloma in one case. These experiments show that migrating skin attached to a source of epithelium is capable of inducing bone resorption. Chronic foreign body granulomas and chronic sepsis are also capable of resorbing bone. These three conditions all produce a layer of undifferentiated connective tissue containing chronic inflammatory cells lying against the resorbing bone.

Animals↗
PubMedDate not supplied

Pleural effusions: pathophysiology and management.

OBJECTIVE: To review the pathophysiology and management of pleural effusions, including available agents for pleural sclerosis. DATA SOURCES: A MEDLINE search (1966 to present) was performed that included clinical studies in the English language involving the pathophysiology and management of pleural effusions; references used in those articles were screened for additional published information. STUDY SELECTION: All clinical trials were considered for potential inclusion in the review. DATA SYNTHESIS: Pleural effusion is an accumulation of fluid in the pleural space that results when homeostatic forces that control the flow into and out of the area are disrupted. The management of transudative pleural effusions is primarily directed at treatment of the underlying disease. There are several treatment options for pleural effusions, including chemical pleurodesis. Many of the trials that examine the use of talc, bleomycin, and doxycycline have poorly described study designs and end points, with inconsistent evaluation of patients. Each agent is considered to be generally effective and safe, with fever and pain as the most frequently reported adverse effects. The use of talc requires sterilization, and many clinicians use general anesthesia with instillation, which increases the risk associated with the procedure. Bleomycin is generally safe; however, it should not be used in doses exceeding 40 mg/m2. Only uncontrolled trials support the use of doxycycline; however, it provides an effective, safe, and relatively inexpensive alternative. CONCLUSIONS: Pleural effusions are defined as an accumulation of fluid in the pleural space. Treatment is generally palliative. Intrapleural administration of talc, bleomycin, and doxycycline are effective sclerosing agents for treatment of recurrent, symptomatic pleural effusions. Although the most cost-effective agent has not been determined, doxycycline is an inexpensive alternative to bleomycin, and may have fewer adverse effects than talc.

Bleomycin↗
PubMed2003

Transforming growth factor-beta induces collagen synthesis without inducing IL-8 production in mesothelial cells.

Conventional pleurodesing agents often provoke acute pleural inflammation followed by fibrosis. The inflammation frequently causes pain and fever. Transforming growth factor (TGF)-beta is a pro-fibrotic but anti-inflammatory cytokine. Intrapleural TGF-beta2 administration produces effective pleurodesis in animals, but its effects on mesothelial cells are unknown. The authors hypothesised that, unlike conventional pleurodesing agents, TGF-beta2 can induce collagen synthesis without stimulating pleural inflammation. In the in vitro studies, TGF-beta2, talc and doxycycline were administered to rabbit mesothelial cells for 24 h. These agents were also injected intrapleurally in rabbits and the induced pleural fluids collected at 24 h. TGF-beta2 was as potent as talc and doxycycline in upregulating mesothelial cell collagen expression. Talc and doxycycline both induced significant increases in interleukin (IL)-8 production from mesothelial cells in vitro and in rabbit pleural fluids in vivo. TGF-beta2, however, did not stimulate mesothelial cell IL-8 release in vitro and induced a dose-dependent suppression of pleural fluid IL-8. Pleural fluid IL-8 levels correlated significantly with leukocyte and lactate dehydrogenase concentrations in the fluids. In summary, transforming growth factor-beta was a potent inducer of mesothelial cell collagen synthesis. Unlike talc and tetracycline, which provoked pleural inflammation, transforming growth factor-beta2 suppressed pleural inflammation in vivo. Transforming growth factor-beta2 can produce effective pleural fibrosis without necessitating acute pleural inflammation.

Animals↗
PubMed1994

Chemical pleurodesis for malignant pleural effusions.

PURPOSE: To provide information about available agents for chemical pleurodesis. DATA SOURCES: A MEDLINE search (1966 to October 1992) was conducted using the terms malignant pleural effusion and pleurodesis. STUDY SELECTION: All articles containing references to patients with recurrent, symptomatic, malignant pleural effusions treated with chemical pleurodesis were selected and reviewed for pleurodesis regimen, number of patients treated, success rate (complete response), and adverse effects. The agents studied included doxycycline, minocycline, tetracycline, bleomycin, cisplatin, doxorubicin, etoposide, fluorouracil, interferon-beta, mitomycin-c, Corynebacterium parvum, methylprednisolone, and talc. DATA EXTRACTION: Independent extraction by three observers. RESULTS: Studies including a total of 1168 patients with malignant pleural effusions were reviewed for efficacy of the pleurodesis agent and studies including 1140 patients were reviewed for toxicity. Chemical pleurodesis produced a complete response in 752 (64%) of 1168 patients. The success rate of the pleurodesis agents varied from 0% with etoposide to 93% with talc. Corynebacterium parvum, the tetracyclines, and bleomycin had success rates of 76%, 67%, and 54%, respectively. The most commonly reported adverse effects were pain (265 of 1140, 23%) and fever (220 of 1140, 19%). CONCLUSIONS: Doxycycline and minocycline, with success rates of 72% and 86%, respectively, appear to be effective tetracycline-replacement agents in the few patients studied. Talc appears to be the most effective and least expensive agent; however, insufflation has the disadvantages of the expense of thoracoscopy and the usual need for general anesthesia. Bleomycin appears to be less effective than talc and the tetracyclines and is substantially more expensive.

Adjuvants, Immunologic↗
PubMed2004

Ovarian cancer and occupational exposure among pulp and paper employees in Norway.

OBJECTIVES: A cohort study of female pulp and paper workers in Norway has shown a significantly increased risk of ovarian cancer. Other than the involvement of hormonal and reproductive factors, little is known of the etiology of ovarian cancer. Asbestos and talc are two agents hypothesized to influence the development of the disease. The present study aimed to investigate the association between ovarian cancer and occupational exposure to asbestos, talc, and total dust among Norwegian pulp and paper workers. METHODS: Forty-six cases of ovarian cancer, with four controls each, were included in the study. Occupational exposure was assessed by combining work histories from personnel files, questionnaire information about production processes, and exposure assessments from the mills. To obtain information about possible confounders, cases and controls were invited to participate in a personal interview. RESULTS: The odds ratio for asbestos exposure was 2.02, 95% confidence interval 0.72-5.66. For talc exposure, the odds ratio was 1.10, and for ever exposure to total dust, it was below 1.00. The risk estimates did not essentially differ after adjustment for possible confounding variables. CONCLUSIONS: The results do not confirm an association between exposure to asbestos, talc, and total dust and ovarian cancer among Norwegian pulp and paper workers. However, the odds ratio for asbestos exposure was doubled, and control for established nonoccupational risk factors did not change the estimate. Therefore, the possibility that exposure to substances in the work environment contributes to the elevated risk cannot be rejected.

Asbestos↗
PubMed1988

[Talcosis-asbestosis: an unusual risk in a food industry].

In a 37 years-old female worker, who had undergone surgical excision of a segment of the right lower lobe for a chronic aspecific pleuropneumonitis, the histological examination of the excised lung tissue showed asbestos alveolitis with diffuse interstitial fibrosis, and multiple granulomata containing talc particles. An investigation at the work site showed that the worker had been engaged for 22 years in dusting salami with a mixture of rice flour and talc contaminated with chrysotile asbestos. Thirteen work-mates engaged in the same job were studied. In two of them, with chest X-rays negative for pneumoconiosis, a functional ventilatory impairment, restrictive in type, associated with a reduced pulmonary diffusion of gases, was demonstrated. In these two cases, bronchoalveolar lavage showed signs of severe exposure to asbestos (which at TEM evaluation resulted to be amphibolic) talc and other fibres, with presence of iron-laden macrophages, indicators of haemorrhagic alveolitis. Moreover, in one of them, a severe macrophagic-lymphocytic alveolitis, with inverted T helper/T suppressor ratio, was presented, possible expression of a hypersensitivity pulmonary reaction. Taking into consideration the length and modality of work, with exposure to talc powder contaminated with asbestos, for the three cases the diagnosis of "pre-radiologic talcosis-asbestosis" was made. Since the occupational risk was not known in this industry, no ambient and personal preventive and protective measures had been taken; anyway, such type of work has now been stopped. The exposed workers shall be kept under control in the future for surveillance directed towards early diagnosis of possible further asbestos effects.

Adult↗
PubMed1998

Medical thoracoscopy in the management of pneumothorax.

Medical thoracoscopy is an efficient technique to evaluate the gravity of a spontaneous pneumothorax in order to choose the most appropriate treatment. Classification of lesions into four types (from endoscopically normal lungs to large bullae) guides the choice from local talc pleurodesis to surgical bullectomy and pleurectomy. Most patients with the first three types can be treated with talc pleurodesis, with a good success rate (93%) and no functional sequelae (lung volumes within the normal range in primary pneumothorax and similar to previous values in secondary pneumothorax). Neuroleptanalgesia in association with patient-controlled analgesia appears to be superior to local anaesthesia in the prevention of immediate pain induced by talc poudrage. Talc pleurodesis is the treatment of choice for recurring spontaneous pneumothorax because of its high success rate and absence of complications.

Clinical Trials as Topic↗