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PubMed2000

Malignant pleural diseases.

The incidence of malignant pleural effusions has been increasing over the last few decades (mainly due to the absolute increase in several types of cancers, especially those of lung and breast origin) and they account for up to 50% of the exudates in many clinical series. Although pleural malignancies are thought to present most frequently with a pleural effusion, several autopsy series, including the current one, found a pleural effusion present in little more than half of the cases of malignant pleural involvement (55% in this series). Thus, many pleural malignancies without effusion might pass unnoticed in clinical practice, especially in metastatic disease. Primary malignancies of the pleura (mesotheliomas) are associated with asbestos exposure in about two-thirds of cases, and they frequently present with chest pain, sometimes associated with a pleural effusion. Benign pleural plaques can coexist with malignant mesothelioma, and this association should be suspected when long-standing plaques change in shape or size over the years, and especially if chest pain develops in a previously asymptomatic patient. Metastatic pleural involvement is much more frequent than mesotheliomas, and its most frequent mechanism is the vascular spreading of tumour cells from distant organs to the lungs, and on to the visceral and parietal pleura. The visceral pleura was involved in up to 87% of the current metastatic cases, whereas the parietal zone in only 47% of the autopsy series. The diagnostic work-up lies in cytology, whose average yield is approximately 50%, and a biopsy technique (either by blind needle biopsy or thoracoscopy) is recommended when the effusion persists, for > 2 weeks, and the first cytology has been negative. Thoracoscopy has the additional advantage of allowing pleurodesis with talc poudrage if clear tumour lesions are found in the pleura. In cases of malignant effusion which are not sensitive to chemotherapy, pleurodesis is the treatment of choice for palliation of symptoms, and talc is the most effective agent. It can be used either in suspension ("slurry") or in dry aerosolized form ("talc poudrage"), but it seems that this last technique achieves the best effects. However, it requires thoracoscopy for a proper application, and this is its main drawback when that technique is not readily available.

Humans↗

PubMed2002

[Secondary tumoral pleurisy].

WHEN THE PRIMARY CANCER IS KNOWN: Secondary tumoral pleurisy can develop at any stage in the evolution of a neoplastic disease and its diagnosis is easy when the primitive cancer is known. Cytological analysis of the pleural liquid and/or biopsy often provides material and the slides can then be compared with those of the primitive cancer and a relationship established. However, a probabilistic diagnosis should not be in haste, without anatomopathological confirmation, since the causes of pleurisy in a cancer patient are varied. WHEN THE PRIMARY CANCER IS NOT KNOWN: The most difficult situation is that when the pleurisy is revelatory of a neoplastic disease. In this case, explorations should be limited to a few essential examinations guided by the clinical profile, without being tempted to carrying out exhaustive explorations of the primitive cancer, which would not change the prognosis. Before such explorations, it is essential to obtain a precise pleural diagnosis, and for this, the indication for a pleuroscopy must be easily and rapidly accessible. FROM A THERAPEUTIC POINT OF VIEW: Once the diagnosis of pleurisy has be established, treatment is in two parts, associated or not: local treatment consisting in pleural sympysis and general treatment (chemotherapy or even hormone therapy, adapted to the primitive neoplasia). Pleural sympysis is often performed using talc, either during the pleuroscopy (talc insufflated under visual control), or during thoracic draining (talc slurry).

Biopsy↗

PubMed1977

In vitro adsorption of some corticosteroids on antacids.

The adsorption of prednisone, prednisolone, fluprednisolone, betamethasone, triamcinolone, beta-methylprednisone acetate and hydrocortisone acetate on various antacids or adsorbents was studied at 37 degrees C. The antacids or adsorbents used were magnesium trisilicate, aluminum hydroxide, bismuth oxycarbonate, magnesium oxide, magnesium carbonate, calcium carbonate, talc, kaolin and charcoal. Magnesium trisilicate and charcoal had the highest adsorption capacity for the corticosteroids tested. Bismuth oxycarbonate and talc had intermediate adsorption properties while kaolin and aluminium hydroxide had lower effects. Other antacids were without any adsorption character. Results of the elution study confirmed the higher affinity of magnesium trisilicate over that of bismuth oxycarbonate and talc for the steroids tested. Further in vivo testings are still needed to assess the effect of antacids on the bioavailability of coadministered corticosteroids.

Adrenal Cortex Hormones↗

PubMed1981

Pleuroscopy in empyema: is it ever necessary?

The use of pleuroscopy in empyema has not been reported before. I performed this procedure in 19 empyema patients. In 7, empyema was found incidentally, while pleuroscopy was done for a variety of other indications. Twelve others had known empyema that did not respond to treatment with drainage and antibiotics. In these patients pleuroscopy was carried out in order to determine lung expansibility, to search for factors possibly responsible for therapy failure, and to aid treatment. Useful information was obtained in every patient. Some findings were totally unexpected and revealing, e.g. a surgical sponge forgotten at an earlier heart operation, undigested food particles traced to an unrecognised perforation of an esophageal tumor, or an unsuspected broncho-pleural fistula. Treatment was modified accordingly. In addition to its diagnostic value, pleuroscopy is an important aid in treatment of empyema. All pus and debris can be aspirated under vision and tube drains can be placed in the most dependent position. In selected patients talc can be insufflated in order to cause pleurodesis. Although the use of talc in empyema has not been described before, our early experience is encouraging. I used it on three occasions, achieving each time complete pleurodesis and prompt cure of empyema. It is concluded that pleuroscopy is a useful diagnostic and therapeutic procedure, applicable in patients with empyema in whom conventional therapy failed. It provides the best way for talc insufflation when pleurodesis is difficult to achieve. Pleuroscopy should have an established place in the management of empyema.

Adolescent↗

PubMed1975

Application of powder failure testing equipment in assessing effect on glidants on flowability of cohesive pharmaceutical powders.

Powder failure testing equipment was used successfully to study the effect of glidants on the flowability of two cohesive pharmaceutical powders, lactose and calcium hydrogen phosphate, using the flow factor as the flowability parameter. Fine silica, magnesium stearate, and purified talc were investigated as glidants; for each host powder-glidant mixture, an optimum concentration of glidant was observed beyond which no further increase in flowability occurred. The order of efficiency of glidants for both host powders was fine silica greater than magnesium stearate greater than purified talc. The mode of action of the three glidants is discussed.

Calcium Phosphates↗

PubMed1984

An epidemic of a "new" haemorrhagic disease in infants attributable to talcum powder contaminated with warfarin in Ho-Chi-Minh Ville (Vietnam).

In August 1981, pediatric hospitals in Ho-Chi-Minh Ville (Saigon) began to report numerous cases of a haemorrhagic syndrome in infants. A collaborative study with a French epidemilogist began on September 24, 1981, with the aim of finding the cause of this "new" haemorrhagic disease. After having excluded the hypothesis of a viral or bacterial infection, a retrospective study, using questionnaires with 83 items, concerning products of hygiene and nutrition and living conditions, was undertaken. This epidemiological investigation showed this phenomenon was caused by an anticoagulant contained in talcum powder. Analysis of the talcum powders found warfarin; the concentrations ranged between 1.7% and 6.5%. This dramatic episode (741 cases with 177 deaths) ended when the contaminated talc was withdrawn from circulation. The hypothesis of accidental contamination or use of warfarin in lieu of a perfuming agent must be rejected. Accidental addition of a rat-killer seems highly improbable and the possibility of intentional and malevolent adulteration is now under study. An experimental study of hemostasis in two baboons was carried out, using dermal application of the contaminated talc powder. The intoxicated animal died on the 5th day with severe vitamin K deficiency. This accident together with the animal study, shows the transcutaneous uptake of the anticoagulant, which could be of considerable importance in toxicology and in pharmacokinetics.

Blood Coagulation Disorders↗

PubMed2003

Lucigenin chemiluminescence assay as an adjunctive tool for assessment of various stages of inflammation: a study of quiescent inflammatory cells.

A simple, fast, precise and biologically relevant toxicity assay for screening cytotoxicity of minerals would have distinct advantages due to its cost benefits and relative savings in time. Furthermore, a bioassay to differentiate acute and chronic in vivo pulmonary reactions could have potential value as predictors of fibrogenicity and pathogenicity. In this study we examined the potential use of lucigenin as a probe to evaluate the correlation between chemiluminescence (CL) generated by alveolar macrophages with the known cytotoxicity and patho genicity by conventional bioassays. In this study, we used small doses of dust (20 microg) to minimize cellular overload and to maintain homeostasis. Crystalline silica a highly fibrogenic dust was used as positive control and results are compared with those for bentonite, kaolin and talc. Among the three minerals compared with silica, bentonite was more reactive (27%) in CL assay and declined sharply compared to other minerals. This sudden decline in bentonite CL is caused by cytotoxicity leading to cell death. CL-induced by talc was comparable to silica and declines slowly. Kaolin on the other hand produced relatively a weaker (25%) CL compared to silica. Our data using relatively low doses of dust suggest that the CL assay may have a better predictive value in cytotoxicity evaluations compared to conventional toxicity assays.

Acridines↗

PubMed1999

Power Doppler evaluation of joint effusions: investigation in a rabbit model.

OBJECTIVE: To study the power Doppler findings of septic arthritis and noninfectious synovitis in an animal model. MATERIALS AND METHODS: The right knees of 10 rabbits were inoculated with an aqueous suspension of Staphylococcus aureus. The right knees of 5 rabbits were injected with talc suspension. The right knees of 5 rabbits were injected with saline. All 20 left knees were injected with saline. Serial power Doppler images were obtained using constant-imaging parameters. Images were reviewed by blinded observers who assessed for increased power Doppler signal. RESULTS: All 10 knees inoculated with S. aureus developed septic arthritis. Each infected rabbit knee demonstrated increased signal on power Doppler on at least one examination, ranging from 1-6 days after inoculation. Only 23 of 45 examinations of infected knees were unequivocally positive by power Doppler on examinations performed 1 to 6 days after inoculation. No knee with talc synovitis demonstrated increased power Doppler signal. No control knee demonstrated increased power Doppler signal. CONCLUSION: Increased power Doppler signal may be seen with septic arthritis; however, its intensity and timing may vary from subject to subject. A normal power Doppler examination does not exclude septic arthritis.

Animals↗

PubMed1994

Use of video-assisted thoracic surgery in the treatment of chylothorax.

Chylothorax, a potentially lethal disorder that may cause profound respiratory, nutritional, and immunologic complications, has become increasingly common in recent years. Medical therapy has been found to have a significant failure rate. Therefore, surgical treatment of complicated chylothorax has become a mainstay of care. Between 1987 and 1993, ten patients at the University of Virginia Hospital were treated with video-assisted thoracic surgery for complicated chylothorax. Twelve thoracoscopic procedures were performed. Patients ranged in age from 7 months to 82 years. Causes included iatrogenic (2), congenital (2), caval thrombosis (2), amyloid (2), blunt trauma (1), and metastatic carcinoid tumor (1). In 10 cases, video-assisted thoracic surgery was employed as the principal mode of therapy: 8 using talc pleurodesis alone, 1 using talc pleurodesis and clipping of the thoracic duct with application of fibrin glue, and 1 requiring clipping of a pleural defect with application of fibrin glue. In 2 cases, a video-assisted thoracic operation was used in conjunction with pleuroperitoneal shunting: a previously placed pleuroperitoneal shunt that was malfunctioning was repositioned thoracoscopically after a pleural adhesiolysis, and a pleural adhesiolysis was performed thoracoscopically before placement of a pleuroperitoneal shunt. In all cases the effusion resolved after the video-assisted thoracic operation without further intervention. Video-assisted thoracic surgery offers an effective means of treating chylothorax, regardless of cause, allowing the advantage of access to thoracic structures without the morbidity of more extensive procedures.

Adult↗

PubMed1983

Scanning electron microscopy and X-ray microanalysis of foreign bodies associated with Silastic implants in humans.

Polydimethylsiloxane (Silastic) capsules containing megestrol acetate have been implanted in subcutaneous tissue as a method of long-term contraception. Histological studies revealed a granulomatous foreign body reaction around these capsules with birefringent crystals in multinucleated giant cells. Although several authors had interpreted these crystals as steroids, this seemed unlikely since the tissue had been processed with organic solvents. Analysis of these crystals by polarization microscopy, scanning electron microscopy, and X-ray microanalysis demonstrated that the material was talc. The talc was probably introduced as a contaminant from gloves during the implantation. Further analysis showed that capsule fragmentation could not have produced the material since Silastic particles could not be detected.

Contraceptive Agents↗

PubMed1985

Do particles translocate from the vagina to the oviducts and beyond?

To investigate whether particles deposited in the vagina translocate to the oviducts, 0.3 ml of a 4% bone black suspension was deposited in the posterior vaginal fornix of each of five cynomolgus monkeys (Macaca fascicularis) during their mid-menstrual cycle. Simultaneously, each animal received 10 units of oxytocin by intramuscular injection. The oviducts of three animals were removed 1 hr after administration of the bone black, while those of the remaining two animals were removed 72 hr after dosing. The removed oviducts were flushed with Hank's solution and then with collagenase solution. The solutions were collected in clean vials and filtered. The filters were examined for bone black particles by light microscopy, as were filters through which solution blanks (negative controls) had been passed. Particles resembling bone black were found on all filters. There were no appreciable differences in the number or shape of these particles between the solution-blank filters and the oviduct-flush filters. The particles on both the solution-blank filters and on the oviduct-flush filters probably originated from environmental contamination by ubiquitous carbon particles. While these results suggested that no translocation took place, translocation could not be ruled out with certainty in the absence of quantitative analyses. A more definitive pilot study was then conducted with two dosed monkeys and one control, using talc labelled by neutron activation to circumvent the problem of environmental contamination. Gamma-Ray analysis of tissue and peritoneal lavage samples for the radionuclides 46Sc, 59Fe and 60Co indicated that no measurable quantities (i.e. greater than 0.5 micrograms) of talc translocated from the deposition site in the vagina to the uterine cavity and beyond.

Animals↗

PubMedDate not supplied

The nature and the occurrence of birefringent material in different organs in fatal drug addiction.

Insoluble birefringent tablet filler materials commonly found in tablets used in solution by drug addicts as intravenous injections were investigated microscopically. The following filler materials were investigated: talc, potato- and maize-starch, microcrystalline cellulose, magnesium stearate and siliciumoxid. The morphological characteristics of the different materials are described. Tissue sections (lung, liver, spleen, heart, bone-marrow, kidney, lymph-nodes and endocrine glands) from 33 consecutive fatality cases of intravenous drug addicts autopsied at the University Institute of Forensic Medicine in Copenhagen were studied with special reference to the occurrence and nature of birefringent material. Birefringent material was most often demonstrated in lung tissue (94%), followed by spleen (76%), liver (55%), lymph-nodes (portal: 39%) and bone-marrow (24%). The material was always localized intracellularly. Granulomatous reaction was only seen in the lungs. Except for one case, talc was the only foreign material seen in other organs than the lungs, undoubtedly due to its smaller size. The presence of insoluble foreign material in lung tissue of drug addicts indicates a habit of intravenous administration and the amount of the material indicates whether the addict usually injects tablets or only does so occasionally. The presence of birefringent material in the organs have only rarely any obvious clinical implications.

Cellulose↗

PubMed2006

Role of prostaglandin E2 in the invasiveness, growth and protection of cancer cells in malignant pleuritis.

The recurrence of pleural effusions is a common event in a variety of neoplastic diseases. The objective of this study was to identify the mechanisms promoting the homing and growth of cancer cells within the pleural space. A cancer cell line recovered from malignant pleural fluids (lung adenocarcinoma cell line) that constitutively expresses cyclooxygenase 2 (COX-2) and all types of prostaglandin receptors was studied. It was first demonstrated using a matrigel system, that malignant pleural fluids increase the invasiveness of adenocarcinoma cells more than congestive heart failure (CHF) pleural fluids. Moreover, exposure to exudative malignant, but not to CHF pleural fluids, increased the mRNA (measured by real-time polymerase chain reaction (PCR)) and protein expression of COX-2 (measured by Western blot), as well as the activation and nuclear translocation of nuclear factor kappaB (NFkappaB) in cancer cells. These events are all actively regulated by prostaglandin E2 (PGE2), since the addition of synthetic PGE2 to cancer cells and the depletion of PGE2 from malignant pleural fluids or the inhibition of COX-2 activity significantly increased and reduced these phenomena, respectively. Moreover, malignant pleural effusions and synthetic PGE2 increased the long-term proliferation of cancer cells and reverted the impairment in long-term proliferation due to talc exposure. This study demonstrates that PGE2 present in malignant effusions contributes to cancer expansion and may protect cancer cells by anti-proliferative effects induced by talc.

Adenocarcinoma↗

PubMed2004

Impact of pleural effusion pH on the efficacy of thoracoscopic mechanical pleurodesis in patients with breast carcinoma.

OBJECTIVE: A prospective randomised study was conducted to compare the efficacy of treating malignant pleural effusions (MPE) in patients with breast carcinoma by thoracoscopic mechanical pleurodesis (TMP) as a new palliative treatment and talc pleurodesis (TP) at various pleural fluid pH levels and to determine whether at low pH values, when the success of TP is reduced, TMP is more successful. METHODS: 87 female patients with breast carcinoma and a resulting MPE resistant to systemic therapy were divided into two groups: TMP and TP groups. In the TMP group 24 patients with pH levels above 7.3 and 21 patients with pH levels below 7.3 underwent thoracoscopic parietal and visceral pleural abrasion utilising general anaesthesia. In the TP group, 22 patients with pH levels above 7.3 and 20 patients with pH levels below 7.3 were administered 5 g of sterile talc, dissolved in 100 ml of physiological solution, via a chest tube, utilising local anaesthesia. Postoperative follow-up was performed to determine a possible recurrence of MPE with periodic radiographs, the duration of chest tube drainage and hospitalisation, occurrence of complications, and perioperative mortality. The following was used for statistical analysis: t-test for odd samples, chi2 test, logistic regression, and multiple linear regression. RESULTS: TMP and TP were equally successful (92 and 91%) in patients with pH levels above 7.3. Differences occurred in patients with pH below 7.3 (81 and 55%) (P = 0.07). The lowest pH value at which TMP proved successful was 7.06, while for TP this value was 7.25. In TMP group the average duration of chest tube drainage amounted to 3.8 days and hospitalisation to 5.5 days, while in TP group it was 5.6 and 7.5 days, respectively. Differences were statistically significant (P < 0.05). 16% of easily treatable complications and no case of perioperative mortality were identified in TMP group, while 26% of complications and four cases of perioperative mortality were noted in TP group. CONCLUSIONS: TMP is a safe palliative treatment for MPE in breast carcinoma, with a minimal number of complications and a short hospital stay; it is more successful than TP in patients with pH of MPE below 7.3.

Breast Neoplasms↗

PubMed2005

Video-thoracoscopic surgical pleurodesis in the management of malignant pleural effusion: the importance of an early intervention.

Thoracentesis plays an important role in cancer patients with symptomatic effusions, although its effect is short-lived and symptoms recur in almost all patients. Early video-thoracoscopic surgical pleurodesis may provide added benefit to a group of patients with advanced cancer presenting with symptomatic malignant pleural effusion. Seventy-six patients with advanced cancer and pleural effusion due to pulmonary-pleural metastases were recruited. In 51 cases (67.1%), at least one thoracentesis was performed before admission for surgery. Preoperative staging consisted of chest radiograph, CT scan, and blood gas analysis. The mean Karnofsky performance status was about 50. Pleurodesis with talc poudrage was completely successful in all patients, with a morbidity rate of 2.6%. There was no post-operative mortality. Three patients (3.9%) underwent further thoracenteses for recurrence of pleural effusion within two months after the procedure. Early use of talc insufflated by video-thoracoscopic surgery is an effective and relatively safe method for treating pleural effusion, and preventing recurrence, in advanced cancer patients.

Female↗

PubMed2002

Effects of dehydration on the apolar surface energetics of inorganic paper fillers.

The surface energies of various inorganic fillers including kaolin clay, titanium dioxide, and talc were examined using inverse gas chromatography (IGC). In an earlier investigation that examined calcium carbonate fillers, dehydration by heating under a dry nitrogen purge had a substantial influence on the apolar (gammaS(LW)) and polar (gammaS(AB)) components of surface energy as measured using IGC. Using the same approach, the influence of such conditioning on several inorganic fillers used in papermaking were determined using preconditioning IGC from 100 to 300 degrees C, and sequential isothermal analysis at 100 degrees C. Results from IGC analysis of titanium dioxides (rutile and anatase) were similar to precipitated calcium carbonate (PCC) for temperatures up to 200 degrees C. PCC was significantly more energetic after preconditioning at 300 degrees C, which may indicate the onset of significant thermal decomposition that titanium dioxides will not exhibit. Kaolin clay samples had relatively high apolar surface energy similar to that of the chalk samples. Calcination gave lower gammaS(LW) values that could not be accounted for by changes in the microporous structure. More likely the differences resulted from contamination of highly energetic surface sites with adsorbates other than water. Talc samples exhibited relatively high apolar surface energies that increased with preconditioning temperature. The results provided insight into the significance of water on the final adhesion properties of fillers in the sheet structure or coating layer.

Chromatography, Gas↗

PubMed1985

Crystalline foreign particulate material in hernia sacs.

The subserosal stroma of hernia sacs consistently contains birefringent particulate material, in amounts greater than those observed in other intra-abdominal organs. The major component of this material was shown in the present study to be talc; thus, it cannot be of endogenous origin. Cellular response to this foreign material is remarkably slight. Possible sources of the material and mechanisms of access to the hernia sac were examined in a search of the available literature. It is proposed that the probable source is ingestion with food or, more likely, medications and that the particles reach the peritoneal cavity by migration through the intact intestinal wall. They probably reach the hernia by sedimentation in peritoneal fluid and subsequently migrate into the subserosa. The virtual absence of response to the particles is attributed to their composition (silicate) and their relatively small size (up to about 10 microns) compared with the particles in talc granulomas (up to at least 50 microns).

Aged↗

PubMed2001

Particulate composition and origin of suspended sediment in the R. Don, Aberdeenshire, UK.

Characterising the nature and origin of suspended particulate and colloidal matter in surface waters is a necessary first step in determining the role of these materials in the transport of pollutants. With this aim in mind, samples of suspended sediment were collected from the R. Don, Scotland, and analysed by a combination of X-ray diffraction (XRD) and vertically attenuated infrared spectroscopy (VATIR). Additionally, the carbon and nitrogen contents of the sediment were measured. Samples were collected at eight sites along the river from the headwaters to the mouth, twice during periods of base flow, and once during a storm. During the base flows, the amount of suspended solids was typically no more than 1-10 mg l(-1), whereas the high flow samples contained up to 150 mg l(-1). XRD showed that the crystalline component of the high flow samples consisted of the clay minerals illite, chlorite, kaolin, hydroxy-interlayered vermiculite, and a 10/14 A regularly interstratified mica/vermiculite. Non-clay components included quartz, feldspars, amphibole and goethite. Kaolin progressively increased in relative abundance downstream. The clay mineralogy of base flow samples was more or less identical to high flow samples but the non-clay components were reduced and, additionally, talc and calcite were present. The identification of many of the crystalline components was confirmed by VATIR, and amorphous silica was identified, particularly in base flow samples. Organic components were identified as wax, protein, and humate/fulvate. Proportionally more protein and wax components relative to silicates occurred in base flow samples, whereas the humate/fulvate component was most clearly identified in samples from the storm. Organic matter contents ranged from approximately 24% during base flow to 13% during the storm, whilst the C/N ratio showed a progressive decrease downstream, irrespective of flow conditions. Both the characteristics of the mineralogy and the organic matter suggested that topsoils were the primary source of the suspended sediment in the R. Don. However, the presence of talc and calcite were believed to fingerprint ground water sources, which together with the in-stream production of diatoms, may have accounted for a significant mass fraction of the suspended particulate matter during base flows.

Calcium Carbonate↗