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PubMed1980

Pleuroscopy in patients with pleural effusion and pleural masses.

We performed diagnostic pleuroscopy in 66 patients with pleural effusion and in 14 with pleural masses. The findings were diagnostic in 76 patients (95%). Pleural metastases were found in 63 patients, primary pleural or lung tumor in 5, and less common findings in the remainder. Only 1 minor complication occurred, and there were no deaths. Malignant pleural effusion causing dyspnea was managed successfully by talc insufflation under direct vision in 31 of 35 patients. Talc also was used with equal success and without complications in management of recurrent pneumothorax. We conclude that pleuroscopy is a useful diagnostic and therapeutic procedure. It is simple and well tolerated, has a diagnostic yield of 95%, and is virtually free from complications. It provides the best way of insufflating talc for pleurodesis.

Adult↗
PubMed1986

Factors influencing murine embryo bioassay: effects of proteins, aging of medium, and surgical glove coatings.

The 2-cell murine embryo bioassay as quality control for human in vitro fertilization (IVF) was used to evaluate the effects of protein supplements, medium aging, and surgical glove coatings. Ham's F-10 medium (GIBCO, Grand Island, NY) without protein supplementation supported growth of the 2-cell embryos to blastocysts. Addition of bovine serum albumin (BSA), fetal cord serum (FCS), or maternal serum (MS) did not enhance or reduce the blastulation rates (medium alone, 89.4%; BSA, 86.4%; FCS, 90%; MS, 74.7%). Unsupplemented Ham's F-10 medium was found to contain three major peaks of approximately 50,000 daltons and several minor peaks, analyzed on high-performance liquid chromatography (HPLC) and sodium sulfate-polyacrylamide gel electrophoresis (SDS-PAGE), suggesting the presence of protein(s) in the medium itself. The storing of medium up to 425 days at 4 degrees C affected neither the HPLC profile nor its ability to support embryo growth (blastulation rates: fresh, 84%; stored 150 to 425 days, 77.7%). The coating of surgical gloves affected embryo growth. Both talc-coated (TC) and "talc-free," starch-coated (SC) surgical gloves were found to be progressively embryotoxic when they touched the medium for increasing lengths of time, compared with uncoated latex (UL) gloves and untouched control medium. Quality control of medium preparation and handling in murine embryo bioassay is reemphasized, with requirements for protein supplementation, use of fresh medium, and possible contamination with even talc-free, SC surgical gloves reevaluated.

Animals↗
PubMed2004

Reconstruction of a century of airborne asbestos concentrations.

Airborne asbestos concentrations have been reconstructed for the entire 20th century for the first time through a combination of paleolimnological methods, particle-separation techniques, and analytical transmission electron microscopy. Pb concentrations and respirable aerosol mass concentrations in air and sediments yielded collection efficiencies of approximately 3000 m3 of air per gram of lake sediment. Airborne concentrations of chrysotile, the most common type of asbestos, reconstructed from control lake sediments echoed chrysotile's usage during the 20th century, with the highest concentrations mid-century (approximately 0.1 fibers/cm3) and then decreasing in the last quarter century. Reconstructed airborne concentrations of anthophyllite asbestos, a byproduct of local talc mining and milling, increased from <0.004 to 0.022 fibers/cm3 from 1846 to 1967. These anthophyllite concentrations during the approximately 100-year period of talc mining correlated well (r2 = 0.80, p < 0.01) with annual production of local talc and were much higher (p = 0.004) than concurrent concentrations in a control lake located upwind of the mines and mills. All of the chrysotile and more than 70% of the anthophyllite asbestos fibers were too narrow to be detected by phase-contrast light microscopy, the method used to measure airborne fiber concentrations before approximately 1980.

Air Pollutants↗
PubMed1999

Prevention of small black spots on sugar-coated tablets containing aluminum acetylsalicylic acid.

Sugar-coated tablets containing aluminum acetylsalicylate gradually developed black spots on their surface. A factorial experiment was performed based on an L32 orthogonal array table in an attempt to halt this phenomenon. The factor responsible proved to be talc used to formulate the smooth coating layer over the subcoating layer containing aluminum acetylsalicylate. When HCl-treated talc was used as a filler for the smoothing layer, the black spots were markedly decreased. The spotting mechanism was considered to be due to hydrolysis of aluminum acetylsalicylate in the subcoating layer to salicylic acid and acetic acid, which sublimated into the pores of the smoothing layer. Then, ferrous ion substituted from magnesium ion in the talc molecule center was extracted by salicylic acid, acetic acid, and moisture. Finally, the ferrous ion was oxidized to ferric ion, and this produced an Fe3+ chelate compound together with salicylic acid.

Acetic Acid↗
PubMed1988

Personal and environmental characteristics related to epithelial ovarian cancer. II. Exposures to talcum powder, tobacco, alcohol, and coffee.

Vaginal exposures to talc and other particulates may play an etiologic role in epithelial ovarian cancer. Surgical sterilization may protect against ovarian cancer by blocking entry of such particulates into the peritoneal cavity. The authors assessed histories of talcum powder use, tubal sterilization, and hysterectomy with ovarian conservation in 188 women in the San Francisco Bay Area with epithelial ovarian cancers diagnosed in 1983-1985 and in 539 control women. To investigate the roles of blood-borne environmental exposures on ovarian cancer risk, they assessed lifetime consumption of coffee, tobacco, and alcohol in these women. Of the 539 controls, 280 were hospitalized women without overt cancer, and 259 were chosen from the general population by random digit telephone dialing. Ninety-seven (52%) of the cancer patients habitually used talcum powder on the perineum, compared with 247 (46%) of the controls. Adjusted for parity, the relative risk (RR) = 1.40, p = 0.06. There were no statistically significant trends with increasing frequency or duration of talc use, and patients did not differ from controls in use of talc on sanitary pads and/or contraceptive diaphragms. Fewer ovarian cancer patients (7%) than controls (13%) reported prior fallopian tube ligation (RR, adjusted for parity, = 0.56, p = 0.06), and fewer patients (20%) than controls (28%) reported prior hysterectomy (RR = 0.66, p = 0.05). The protective effect of hysterectomy was confined to those who underwent this surgery 10 or more years prior to interview and to those who had not undergone prior tubal sterilization. Consumption of cigarettes and alcohol did not differ between cases and controls. By contrast, 11 (6%) cases never regularly consumed coffee, compared with 31 (11%) hospital controls and 26 (10%) population controls (RR, adjusted for smoking, = 2.2, p = 0.03, for the comparison using all controls). Overall, ovarian cancer risk among women who had drunk coffee for more than 40 years was 3.4 times that of women who had never regularly consumed coffee (p less than 0.01). However, the data exhibited no clear trends in risk with increasing consumption. Although risk ratios relating duration of coffee drinking to ovarian cancer were unaffected by adjustment for several characteristics, further study is needed to exclude potential confounding by other unmeasured characteristics.

Adult↗
PubMed2000

Factors related to inflammation of the ovarian epithelium and risk of ovarian cancer.

Previous epidemiologic observations consistently suggest that suppression of ovulation, tubal ligation, and hysterectomy reduce the risk of ovarian cancer and that perineal talc use increases the risk. We examined these and other risk factors in the context of a new hypothesis: that inflammation may play a role in ovarian cancer risk. Ovulation entails ovarian epithelial inflammation; talc, endometriosis, cysts, and hyperthyroidism may be associated with inflammatory responses of the ovarian epithelium; gynecologic surgery may preclude irritants from reaching the ovaries via ascension from the lower genital tract. We evaluated these risk factors in a population-based case-control study. Cases 20-69 years of age with a recent diagnosis of epithelial ovarian cancer (767) were compared with community controls (1,367). We found that a number of reproductive and contraceptive factors that suppress ovulation, including gravidity, breast feeding, and oral contraception, reduced the risk of ovarian cancer. Environmental factors and medical conditions that increased risk included talc use, endometriosis, ovarian cysts, and hyperthyroidism. Gynecologic surgery including hysterectomy and tubal ligation were protective. Tubal ligation afforded a risk reduction even 20 or more years after the surgery. The spectrum of associations provides support for the hypothesis that inflammation may mediate ovarian cancer risk.

Adult↗
PubMed1989

Misconceptions regarding the pathogenicity of silicas and silicates.

Several inhaled substances, from occupational or other environmental exposure, produce significant pulmonary disease and abnormalities demonstrated by pulmonary imaging. Areas of controversy and misconception relate principally to the extent and nature of both the clinical disease and the imaging abnormalities specific to each substance. The size and shape of the inhaled particles is an important determinant of the nature and severity of the disease produced, with fibrous shapes usually being the most pathogenetic. Fibrogenicity is another important pathogenetic characteristic of talc and kaolin, as well as asbestos. Talc produces four distinct forms of pulmonary disease, depending not only on the other substances with which it is inhaled, but also whether it is inhaled or injected intravenously. When inhaled alone, talc does not appear to produce significant pulmonary fibrosis or malignancy. Kaolin, mica, fuller's earth, zeolite, and fiberglass all vary in disease production according to their shape and fibrogenicity. Silica, diatomaceous earth, and other forms of silica are all highly fibrogenic and thus produce clinically obvious disease with sufficient inhalation. The largest particles usually produce nodular patterns in the upper pulmonary fields, as is typical of silicosis. The fibrous particles are more likely to manifest themselves as interstitial patterns in the lower pulmonary fields.

Aluminum Silicates↗
PubMed2004

Pleurodesis for malignant pleural effusions: current controversies and variations in practices.

PURPOSE OF REVIEW: Malignant pleural effusions are common, and pleurodesis remains the best method to control re-accumulation of the pleural fluid. There are few randomized controlled trials studying the optimal management of malignant pleural effusions. A recent international survey of pleurodesis practice has highlighted variations in how pleurodesis is performed worldwide. Future research should target these areas of variation to determine the best practice protocols. RECENT FINDINGS: The selection of pleurodesing agents remains controversial. Talc is more effective, but is associated with more adverse effects. Talc pleurodesis is followed by systemic and pulmonary inflammation. This is probably related to systemic embolization of talc following its intrapleural administration, though there are other potential causes that may also play a role. SUMMARY: The practice of pleurodesis varies considerably among individual pulmonologists and among different countries, in most technical aspects. This review serves to highlight some of these variations in practice, as well as reviewing the current literature on pleurodesis practice.

Drainage↗
PubMed2004

Radionuclide evaluation of pleural-peritoneal shunt before pleurodesis.

OBJECTIVES: Talc pleurodesis can be offered to patients with hepatic hydrothorax. The authors wanted to determine their patient's eligibility for talc pleurodesis by excluding a pleural-peritoneal shunt. MATERIALS AND METHODS: The authors measured the size of the talc particles and matched them with the radionuclide particle size. After injecting radiopharmaceutical into the pleura, the authors imaged the abdomen for possible migration. RESULTS: In their patient, there was no migration of radionuclide from the thorax into the abdomen. CONCLUSION: Injecting radionuclide into the thoracic cavity and then imaging for an extended period of time is one way to determine whether the patient has a pleural-peritoneal shunt.

Aged↗
PubMed2004

Management of malignant pleural effusions.

Malignant pleural effusion is a common clinical problem. Evacuation of the pleural fluid and prevention of its reaccumulation are the main aims of management. Pleurodesis should be attempted early, although considerable practice variations exist in the way it is performed. There is a lack of consensus among respiratory physicians worldwide on the optimal method and agent for pleurodesis. Talc remains the most commonly used pleurodesing compound in most countries. While talc produces a higher success rate than other compounds, it generates more side-effects. The association between talc and ARDS continues to be debated. Ambulatory small-bore pleural catheter drainage followed by intrapleural instillation of a pleurodesing agent is increasingly accepted as an alternative to conventional in-patient pleurodesis. Development of novel methods to control pleural fluid formation should be made a high priority in future pleural research.

Humans↗
PubMed1991

Panlobular emphysema in young intravenous Ritalin abusers.

We studied a distinctive group of young intravenous Ritalin abusers with profound obstructive lung disease. Clinically, they seemed to have severe emphysema, but the pathologic basis of their symptoms had not been investigated previously. Seven patients have died and been autopsied: in four, the lungs were fixed, inflated, dried, and examined in detail radiologically, grossly, microscopically, and by electron probe X-ray microanalysis. All seven patients had severe panlobular (panacinar) emphysema that tended to be more severe in the lower lung zones and that was associated with microscopic talc granulomas. Vascular involvement by talc granulomas was variable, but significant interstitial fibrosis was not present. Five patients were tested for alpha-1-antitrypsin deficiency and found to be normal, as were six similar living patients. These findings indicate that some intravenous drug abusers develop emphysema that clinically, radiologically, and pathologically resembles that caused by alpha-1-antitrypsin deficiency but which must have a different pathogenesis. Talc from the Ritalin tablets may be important, but the mechanism remains to be elucidated.

Adult↗
PubMed1980

Diagnostic and therapeutic pleuroscopy. Experience with 127 patients.

Experience with 127 pleuroscopies using the mediastinoscope is reviewed. The most frequent indications were pleural effusion (73 patients), pleural involvement by tumor (14), empyema (14), and recurrent pneumothorax (14). Findings were diagnostic in 119 of 127 patients (93.7 percent). Pleural metastases were found in 63 patients, primary pleural or lung tumor in six, nonspecific or tuberculous empyema in 17, emphysematous blebs in 12 and less common findings in the remainder. Pleuroscopy was usefully employed to determine chest wall penetration by a malignant lung tumor in five patients with severely restricted pulmonary reserve. Positive findings helped to avoid unnecessary thoracotomy. There were two minor complications and no deaths. Malignant pleural effusion causing dyspnea was managed successfully by talc insufflation under direct vision in 35 of 39 patients. Talc was also used, with equal success and without complications, in eight patients with recurrent pneumothorax and in two with empyema after evacuation of pus. We conclude that pleuroscopy is a useful diagnostic and therapeutic procedure, simple and well tolerated, with the diagnostic yield of over 90 percent and virtually free of complications. It provides the best way of insufflating talc for pleurodesis.

Adolescent↗
PubMed1981

Transient pulmonary hypertension from the intravenous injection of crushed, suspended pentazocine tablets.

We describe a patient with biopsy-proven pulmonary talc granulomas (secondary to the long-term intravenous injection of crushed tablets of pentazocine) who had two episodes of transient pulmonary hypertension following the injection of this oral medication. We established a canine model and measured the right lymph duct flow, mean pulmonary arterial pressures, and pulmonary vascular resistance to determine the short-term effects on hemodynamics and the flow of lymph after intravenous administration of crushed pentazocine tablets (3 to 4 mg/kg of body weight) or pure talc (2.5 to 3 mg/kg). A typical response to both agents consisted of short-term elevations of mean pulmonary arterial pressure and pulmonary vascular resistance to approximately twice baseline values, with a slow decrement over 30 to 45 minutes. The average flow of lymph tripled, peaking at approximately two hours after injection. The lymph contained high levels of albumin. We concluded that the talc filler in oral tablets of pentazocine induces the pulmonary hypertension, probably by mechanical obstruction of the pulmonary vasculature. Association with this transient pulmonary hypertension is an increase in the permeability of the pulmonary microvasculature.

Adult↗
PubMed1999

Video-assisted thoracoscopic pleurodesis for malignant pleural effusions.

AIM: The objective was to analyse the efficiency, and safety of thoracoscopic pleurodesis (TP). A retrospective study was made of an initial series of 75 patients undergoing lifetime follow-up who received TP in our department for the treatment of malignant pleural effusions (MPE). MATERIAL AND METHODS: From May 1994 to December 1998, 34 men and 41 women with a median age of 63.4 +/- 12.5 years were treated by TP. We performed 36 partial diathermic abrasions on pleura combined with talc insufflation, and in 39 cases only talc poudrage. The mean duration of insention of the chest tube was 4.1 (range 2 to 17) days, with 8.4 (range 5 to 20) days of postoperative hospitalization. There were no severe intraoperative or postoperative complications. The 30-day mortality rate was 1.3% (1 case). The period of follow-up ranged from 2.5 to 40 months (average 6.8). No case of late recurrence has been observed to date. CONCLUSION: Videothoracoscopic pleurodesis (talc poudrage) as a simple and efficient procedure seems to be the best alternative treatment regimen for the management of MPE in a group of selected patients.

Adult↗
PubMedDate not supplied

[Thoracoscopic pleurodesis in malignant pleural effusions].

We performed retrospectively study on 136 thoracoscopies done in our clinic in the period January 2000 and December 2004. We reviewed 136 thoracoscopies, 71 patients were male and 65 were female (mean age 58.4 years). Straw colored effusions were present in 78 cases (57%) and hemorrhagic in 58 cases (43%). The surgical procedure consist in diagnostic of thoracoscopy with drainage of pleural effusion, multiply pleural biopsy, pleurodesis and continuous pleural drainage. In our study, the talc powder (5g) was successfully as sclerosing agent. The primary tumor was: lung-63 (46%), breast-26 (19%), mesothelioma-21 (15.5%), stomach-3, ovarian-3, prostate-3, colon-2, lymphoma-1, leukemia-2, plasmocytoma-1 and unknown primary tumor in 11 cases (8%). Adverse effects included-chest pain-35 cases (25%), fever-20 cases (15%), empyema-6 cases (4.5%), prolonged air leak-5 cases (4%), pulmonary infection-2 cases, acute respiratory failure-1 case, malignant invasion of scar-1 patient. For statistical analysis, the success of talc pleurodesis was defined as the absence of pleural fluid on the follow-up chest radiographs. Pleurodesis was successful in 125 cases (92%) of the patients after 1 month-follow-up. Thoracoscopic talc pleurodesis is a safe, economical and effective treatment for malignant pleural effusion.

Adult↗
PubMed1989

[Exposure to asbestos dust and asbestosis of employees in a Thüringen rubber industry].

131 exposed people by dust of talc in rubber industry in Thuringia were examined by contrast to a same no examined group of working people. The asbestos in talc did cause in 26 (19.8%) cases of exposed people a pneumoconiosis. The occupational disease was admitted. The time of development was between 20 and 40 years. We can found the chronic bronchitis and demages of ventilation much more in cases long time exposed people and by smokers. The following conclusions are: the renunciation of application of talc with asbestos, measures to fight against dust, the instruction of direction and of working people about the danger of asbestos and the dispensatory care for life.

Adult↗
PubMed1985

Carbon fiber debris within the synovial joint. A time-dependent mechanical and histologic study.

The consequences of release of carbon debris within the synovial joint are of interest to surgeons contemplating the intra-articular repair of cruciate-deficient knees with a carbon fiber-based material. Coverage of carbon fiber implants with absorbable polymer as well as autogeneic graft material has resulted in surgical procedures that minimize potential fiber release. However, finite risk of release of fiber debris certainly exists. With this in mind, a controlled animal experiment to model debris release in the synovial joint was performed. As a positive control, magnesium tetrasilicate (talc) in suspension was injected into the knees of rabbits. Talc produced a transient synovitis severe enough to alter the mechanical properties of the joint cartilage. Carbon fiber debris, when similarly injected, also produced a synovitis. However, the synovitis induced by carbon particulate was not of sufficient severity or duration to alter the mechanical properties of the cartilage. Neither talc nor carbon fiber debris appeared to physically abrade cartilage.

Animals↗
PubMed1981

[Scintigraphic diagnosis of experimentally induced pericarditis in dogs using 99mTc-labelled pyrophosphate (author's transl)].

In the present paper the possibilities of scintigraphic diagnosis of experimental pericarditis are discussed. Pericarditis was induced by either talc or formaldehyde intrapericardially. In all animals the administration of talc as well as formaldehyde produced inflammatory changes which were more serious after formaldehyde. The scan of the talc pericarditis was carried out on the 7th day after operation and of the formaldehyde pericarditis on the 3rd, 7th or 14th days. No positive scintigraphic finding was made in any of the experimental animals, apart from a massive incorporation in the operation scars. The counting of radioactive impulses after the exstirpation of the tissue samples confirmed the scintigraphic findings. Statistical evaluation did not reveal any essential difference between the accumulation of the radiopharmaceutical into the pericarditis as well as into the pericardial bag in comparison with the control animals. Although our model does not exactly reflect the situation of patients suffering from pericarditis it may be assumed that pyrophosphate scintigraphy is not suitable for the diagnosis of acute pericarditis in clinical practice.

Animals↗