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PubMed1988

Talc granulomatosis in the rat: the relationship between osteoblast insufficiency and adjacent bone marrow hyperplasia.

Bone loss in talc granulomatosis is paralleled by hyperplasia of bone marrow in the rat. To test the hypothetical relation between those two phenomena, bone matrix osteoinduction was employed as a model in which bone formation and bone marrow appearance are separated in time. Implantation of demineralized bone matrix to normal rats was followed by three talc injections (one weekly), starting 1 week after matrix implantation. Implants of demineralized bone and [3H]thymidine-labeled tibial metaphyses from talc-injected and normal rats were analyzed histologically and evaluated for alkaline and tartrate-resistant acid phosphatase activity on days 7, 14, 21, and 30 after matrix implantation. Analysis of tibial autoradiographs showed a marked growth arrest and bone marrow hyperplasia in talc-injected rats 7 days after first talc injection. Alkaline phosphatase activity in homogenates of bone implants was low in talc-injected rats on day 14 after implantation. Moreover, histology of the bone implants showed numerical and functional inhibition of osteoblasts on the same day, causing marked growth delay. Bone marrow appeared as late as day 21 after bone matrix implantation. We conclude that hyperplasia of the adjacent bone marrow is not the cause of bone loss in talc granulomatosis, but rather its compensatory consequence.

Animals↗
PubMed1981

[Intrapleural talc in malignant pleural effusions (author's transl)].

Intrapleural talc poudrage was carried out at the end of thoracoscopy in 77 patients after complete aspiration of fluid with uniform insufflation over the whole surface area of the pleura of 4 to 5 ml of pure talc, asbestos free. A continuous suction drain was left in place for 3 to 6 days. Amongst these patients, there were 57 cases of pleural effusion due to metastases and 20 mesotheliomas. A satisfactory result was obtained in 70 patients (91%). There were 7 failures. Fourteen mesotheliomas in which talc was used were compared with 14 further cases operated upon by pleurectomy. Both series were compared retrospectively in terms of age, sex, exposure to asbestos, histological type and the interval between the first symptom and treatment. In the talc series, there were 11 excellent results, 2 moderate and 1 nil. In the operated series there were 10 excellent results, 1 nil and 3 postoperative deaths. Survival of the patients was 395 +/- 55 days after the application of talc and 315 +/- 65 days after pleurectomy. There was thus a slight benefit in favour of the talc technique but this was not statistically significant. A figure of approximately 90% of satisfactory results is found in other series of the use of intrapleural talc published. This technique is thus effective and free of danger, and may be used in malignant effusions when techniques of local instillation of various substances and systemic chemotherapy have failed.

Aged↗
PubMed1994

Talc deposition in skin and tissues surrounding silicone gel-containing prosthetic devices.

BACKGROUND AND DESIGN: Periprosthetic capsule formation is the most common cause of morbidity associated with silicone gel-filled breast implants. All implant recipients develop capsules. However, the extent of capsule formation varies greatly among patients, ranging from a thin flexible membrane to a constrictive inelastic band of sclerotic collagen. Although silicone gel bleed has been proposed as the most likely cause of excessive capsular sclerosis, liquid silicone did not induce fibrosis in early clinical trials. Because many implant modifications have been introduced since the original studies were performed, a more plausible explanation for excess capsular sclerosis is the inadvertent introduction of a fibrogenic contaminant. The skin and periprosthetic tissues removed from 41 women during implant revision surgery were examined for the presence of foreign substances that might contribute to capsular sclerosis. Tissue was examined histologically with and without polarizing filters and with scanning electron microscopy equipped for energy-dispersive x-ray analysis. RESULTS: A high incidence of talc was found within the skin and tissues adjacent to silicone-containing breast prostheses. Birefringent talc crystals, identified in 71% of the patients, were observed within nodular granulomas and perivascular histiocytes. Two specimens containing talc crystals were analyzed by energy-dispersive roentgenographic analysis, which confirmed the identity of the crystalline material as talc. Among 10 capsules examined by direct immunofluorescence, there was no evidence of immune complex deposition. CONCLUSIONS: The high incidence of talc deposition in the skin and tissues surrounding silicone implants suggests that talc either is introduced at the time of implant surgery (possibly in association with the silicone elastomer bag, tissue sizers, or surgical gloves) or is released into the tissues as a silicone gel contaminant during gel bleed. Talc, a known sclerosing agent, may contribute to periprosthetic fibrosclerosis.

Adult↗
PubMed1981

Talc retinopathy in primates. A model of ischemic retinopathy: I. Clinical studies.

Four rhesus monkeys received intravenous injections of talc twice weekly for 3 1/2 to ten months. Within one month, talc particles were visible in fine perifoveal retinal vessels in the posterior pole. Continued deposition of talc could then be seen after subsequent injections. Hemorrhages in the nerve fiber layer, cotton-wool patches, and whitish plaques in the choroid were visible ophthalmoscopically. Fluorescein angiography revealed precapillary arteriolar occlusions, capillary nonperfusion, an abnormal foveal avascular zone, and retinal vascular leakage. Vitreous fluorophotometric findings were abnormal in all five eyes tested, while electroretinograms were normal in two eyes with advanced talc retinopathy. Talc retinopathy in the primate is similar to ischemic retinopathies in humans, including human talc retinopathy, sickle cell retinopathy, and hypertensive retinopathy. Subsequent reports will describe the light microscopic and ultrastructural changes in these eyes using tracer studies with in these eyes using tracer studies with horseradish peroxidase.

Animals↗
PubMed1982

Ovarian cancer and talc: a case-control study.

Opportunities for genital exposure to talc were assessed in 215 white females with epithelial ovarian cancers and in 215 control women from the general population matched by age, race, and residence. Ninety-two (42.8%) cases regularly used talc either as a dusting powder on the perineum or on sanitary napkins compared with 61 (28.4%) controls. Adjusted for parity and menopausal status, this difference yielded a relative risk of 1.92 (P less than 0.003) for ovarian cancer associated with these practices. Women who had regularly engaged in both practices had an adjusted relative risk of 3.28 (P less than 0.001) compared to women with neither exposure. This provides some support for an association between talc and ovarian cancer hypothesized because of the similarity of ovarian cancer to mesotheliomas and the chemical relation of talc to asbestos, a known cause of mesotheliomas. The authors also investigated opportunities for potential talc exposure from rubber products such as condoms or diaphragms or from pelvic surgery. No significant differences were noted between cases and controls in these exposures, although the intensity of talc exposure from these sources was likely affected by variables not assessed in this study.

Adolescent↗
PubMed1995

Intrapleural talc for the treatment of malignant pleural effusions secondary to breast cancer.

BACKGROUND: The management of malignant pleural effusions secondary to breast cancer is a difficult problem. In the 1980s tetracycline was probably the most commonly used sclerosing agent, but parenteral tetracycline is no longer available. Therefore, it is important to evaluate alternative sclerosing agents. This prospective study was designed to determine the efficacy of insufflated talc in producing pleurodesis in patients with pleural effusions secondary to breast cancer. METHODS: Fifty-two patients admitted between May 1985 and November 1992 to the Department of Thoracic Surgery underwent thoracoscopy and had 2 gm sterile asbestos free talc insufflated throughout the pleural space at the time of the procedure. One or two chest tubes were inserted and left in place until fluid drainage was less than 100 ml per day. RESULTS: Of the 52 patients, 5 were not evaluable. Two patients died within 30 days of the procedure. In three additional patients the lung did not expand after thoracoscopy. The intrapleural insufflation of talc was effective in preventing recurrence of pleural effusion. At 30 days there was no recurrence of the pleural fluid in 45 of the 47 (95.7%) patients. One of these patients had a recurrence of the effusion 2 months after the procedure but the remaining 44 (93.6%) had no recurrence for the duration of the study. Aerosolized talc was associated with a moderate morbidity. Six (11.5%) patients had re-expansion edema, but all recovered. Empyema developed in one patient after the procedure. No episodes of respiratory distress syndrome were observed after talc pleurodesis. CONCLUSION: The insufflation of 2 gm talc into the pleural space is an effective method to control pleural effusions secondary to breast cancer.

Adult↗
PubMed1990

Talc granulomatosis in the rat. Involvement of bone in the acute-phase response.

We investigated the dynamics of the acute-phase response (APR) and osteoblast trabecular surface in rats with subcutaneous inflammation provoked by magnesium silicate (talc). The first visible indicator of the APR was a rapid and profound hypozincemia, paralleled by a decrease in metaphyseal trabecular surfaces covered with osteoblasts in long bones. Both the intensity of serum APR and the decrease in osteoblast trabecular surface were directly proportional to the number of granulomas. Alterations in bone metabolism were specific for the inflammation, whereas mild hypozincemia and decrease in mononuclear and increase in polymorphonuclear peripheral white blood cell fractions developed in animals pair-fed with rats bearing two or four granulomas. Rats with talc granulomatosis had high serum ACTH and corticosterone levels, but neither adrenalectomy nor high doses of hydrocortisone could revert bone alterations in talc-injected animals. Glucocorticoids were necessary for the development of hypozincemia and hypercupremia seen in talc granulomatosis, as well as for normal bone metabolism. Inhibition of prostaglandin synthesis had no effect on bone alterations and serum APR in rats bearing talc-induced granulomas. We conclude that the decrease in bone formation constitutes an important aspect of the host acute-phase response in a rat model of talc granulomatosis.

Acute-Phase Reaction↗
PubMed1998

Serial observations after high dose talc slurry in the rabbit model for pleurodesis.

The mechanisms leading to a pleurodesis after the intrapleural injection of a sclerosing agent are not completely understood. The purpose of the present study was to make serial observations over 28 days on the pleural fluid findings and the gross and microscopic changes in the pleura after talc slurry administered intrapleurally at a high dose. Sixty-six rabbits received 400 mg/kg talc slurry. Ten to 12 rabbits were sacrificed 1, 2, 4, 7, 14, and 28 days after the intrapleural injection. At sacrifice the pleural fluid was measured and analyzed, and the pleural surfaces were studied grossly and microscopically. The intrapleural injection of 400 mg/kg talc slurry resulted in an acute exudative pleural effusion that persisted for 4 days. There was a progressive increase in the gross and microscopic fibrosis over the 28 days. Talc was present at the time of sacrifice in all animals. At 28 days there was a clinically significant pleurodesis in all rabbits; pleurodesis was not observed before this time. From this study we conclude that the intrapleural injection of 400 mg/kg talc slurry leads to an acute exudative pleural effusion and clinically significant pleurodesis that is present on day 28 but not day 14. It appears that the production of a pleurodesis requires higher doses of talc in rabbits without a chest tube than in humans with a chest tube.

Acute Disease↗
PubMed1976

Intravenous injection of talc-containing drugs intended for oral use. A cause of pulmonary granulomatosis and pulmonary hypertension.

Clinical and morphologic features are described in two patients known to have repeatedly injected intravenously talc-containing drugs intended for oral use. In one patient severe pulmonary hypertension developed; the talc granulomas in him were located predominantly within the pulmonary arteries. The second patient had normal pulmonary arterial pressures, and the talc granulomas in him were located predominantly in the pulmonary interstitium. Of 19 previously described patients with pulmonary talc granulomas, 12 had morphologic evidence of pulmonary hypertension (in three of severe degree); in each, talc granulomas were located predominantly within the pulmonary arteries. In those without signs of pulmonary hypertension, granulomas were located predominantly in the pulmonary interstitium. Why there are differences in the distribution of the talc granulomas is unclear. It is clear, however, as demonstrated by one of our patients, that severe pulmonary hypertension may be a consequence of intravenous injection of drugs intended for oral use.

Adolescent↗
PubMed1996

Cisternal talc injection in dog can induce delayed and prolonged arterial constriction resembling cerebral vasospasm morphologically and pharmacologically.

BACKGROUND: The possible role of inflammation in the pathogenesis of cerebral vasospasm has been noted in recent studies. In order to examine the role of inflammation, we examined the vasocontractile activity of talc, which is known to cause severe inflammation, using a canine cisternal talc injection model. METHODS: Under general anesthesia, a sterile talc powder suspended in saline was injected into the cisterna magna of the dog. Serial vertebral angiography and postmortem histologic changes of the harvested basilar artery were examined. The morphologic and pharmacologic features of talc-induced vessel spasm were compared with the usual autologous blood-induced artery spasm. RESULTS: Cisternal injection of sterile talc powder caused no early spasm, but induced definite basilar arterial constriction 2 days after injection. This vascular constriction was observed to continue up to 7 days after injection. Ultrastructural study of the constricted vessel revealed several morphologic changes, such as corrugation of the elastic lamina, subintimal proliferation, migration of smooth muscle cells, detachment of endothelial cells, etc.; findings that are compatible with the changes observed in vasospasm. Pharmacologic study showed a moderate decrease in the maximal contraction to KCl and UTP. Endothelium-dependent relaxation was markedly disturbed, while endothelium-independent relaxation was preserved. These pharmacologic properties were also similar to those reported in vasospasm. CONCLUSIONS: Our present study indicates that the several changes of vascular properties, which had been considered to be specific to cerebral vasospasm, can be regarded as a nonspecific biologic defense reaction against the foreign body. The analysis of the common pathway from talc and autologous blood to vasospasm may lead to the pathogenesis of cerebral vasospasm.

Animals↗
PubMed1986

On talc translocation from the vagina to the oviducts and beyond.

The objective of this study was to investigate whether multiple vaginal depositions of neutron-activated talc in the cynomolgus monkey result in the translocation of this material to the uterus and beyond. Within a 45-day period, six monkeys received 30 applications of 125 mg neutron-activated talc, suspended in 0.3 ml physiological saline solution containing 1% carboxymethyl cellulose as a suspending agent. The suspension was deposited in the posterior vaginal fornix of the sedated monkeys. Two days after the final talc application, the animals were anaesthetized. Abdominal lavage was performed and the lavage fluid collected for gamma-ray analysis. Also collected for gamma-ray analysis were the following tissues/organs: ovaries, oviducts, uterus, and vagina with cervix. Six untreated control monkeys underwent the same procedures. The radioisotopes 46Sc, 60Co, 59Fe and 51Cr in the activated talc served as tracers. Only the samples containing vagina and cervix from the dosed monkeys contained varying quantities of talc. This demonstrates that no measurable quantities of talc, deposited by multiple applications in the vaginal fornix of the cynomolgus monkey, translocated to the uterus or beyond.

Animals↗
PubMed2006

Efficacy of video-assisted thoracoscopic surgery with talc pleurodesis for porous diaphragm syndrome in patients with refractory hepatic hydrothorax.

BACKGROUND: Patients with recurrent, refractory hepatic hydrothorax from porous diaphragm syndrome represent a therapeutic challenge with few options. METHODS: A retrospective review of an electronic prospective database of patients with cirrhosis and refractory hepatic hydrothorax. Patients underwent video-assisted thoracoscopic surgery (VATS) with talc pleurodesis insufflating 2.5 g of talc. Successful therapy was defined as relief of dyspnea and control of symptomatic hydrothorax for a minimum of 6 months after the procedure. RESULTS: There were 41 patients (21 men, median age 55 years), 25 with Child-Pugh class C and 14 with class B, and 2 liver transplant patients. The etiology of the cirrhosis was hepatitis B in 4, hepatitis C in 20, alcohol in 4, cryptogenic cirrhosis in 11, and other in 2. Definitive openings in the diaphragm were seen in only 2 patients. Seven patients (17%) required bedside talc slurry through the chest tube after the intraoperative talc. Overall success was achieved in 80% (33 of 41). Four patients experienced symptomatic fluid reaccumulation at 45, 61, 62, and 102 days and were treated with a repeat VATS, with success in 2. There was 1 operative death (coagulopathy). CONCLUSIONS: Patients with recurrent effusions from porous diaphragm syndrome have few options. Video-assisted thoracoscopic surgery with talc is safe and successful in about three fourths of patients, but repeat talc slurry through the chest tube or repeat VATS is often needed. Video-assisted thoracoscopic surgery provides an effective alternative to transjugular intrahepatic portosystemic shunt and is a bridge toward liver transplantation in patients with few other options.

Adult↗
PubMed2006

Predictors of acute lung injury and severe hypoxemia in patients undergoing operative talc pleurodesis.

BACKGROUND: Acute lung injury (ALI) is a life-threatening complication of talc pleurodesis. This study defines characteristics that predispose patients to ALI and severe hypoxemia in patients after video-assisted thoracoscopic surgery (VATS) talc pleurodesis. METHODS: Charts of patients who underwent talc pleurodesis at Northwestern Memorial Hospital between January 1, 1997 and December 31, 2003 were retrospectively reviewed. We sought variables associated with the development of postoperative ALI or severe hypoxemia, defined as an increase in fraction of the inspired oxygen by more than 0.15 within 24 hours after the surgery. The analysis included 84 patients (58 women, 26 men) who underwent VATS talc pleurodesis for malignant (n = 74) or benign (n = 10) indications. RESULTS: ALI developed in 5 patients (5.9%), severe hypoxemia developed in 25 (29.8%), and 54 (64.3%) did not have postoperative complications. In multivariate analysis, the presence of peripheral edema before pleurodesis (p = 0.005), any preoperative requirement for supplemental oxygen (p = 0.032), and chemotherapy within 14 days before pleurodesis (p = 0.04) were identified as predictors of ALI or severe postoperative hypoxemia. CONCLUSIONS: Oxygen supplementation, recent chemotherapy, and presence of peripheral edema were independent predictors of a combined outcome of ALI or severe hypoxemia after VATS talc pleurodesis. Patients with these characteristics might be at risk for adverse outcomes of talc pleurodesis and should be considered for alternative therapy for their effusions.

Aged↗
PubMed2004

Video-assisted thoracoscopic management of recurrent primary spontaneous pneumothorax after prior talc pleurodesis: a feasible, safe and efficient treatment option.

OBJECTIVE: To assess the role of video-assisted thoracoscopic surgery (VATS) in the management of a recurrent primary spontaneous pneumothorax after a prior talc pleurodesis. METHODS: From 1996 to 2002, we retrospectively reviewed all patients who were treated for a recurrent primary spontaneous pneumothorax after a previous talc pleurodesis. Data on the talc procedure and the recurrent pneumothorax, delay between both, and operative features were studied. Conversion rate to a thoracotomy and postoperative complications as well as long-term outcome were reported. RESULTS: We collected 39 patients (28 male) with a median age of 25 years (15-41 years). The initial procedure consisted of thoracoscopic talc poudrage in all cases. The median delay between the talc procedure and the recurrence was 23 months [10 days-13 years]. Size of recurrence involved 10-80% of the hemithorax. The VATS procedure was successfully achieved in 27 patients (69%) while 12 required conversion to a thoracotomy. The main cause for conversion was the presence of dense pleural adhesion at the mediastinal part of the pleural cavity. Postoperative morbidity was limited to pleural complications in the VATS group (n=6, 22%). Median follow-up was 26 months [10-38 months]. One patient treated by VATS developed a partial recurrent pneumothorax at 12 months with a favorable outcome without further surgery. CONCLUSIONS: Feasibility, safety and efficacy of VATS for management of recurrent primary spontaneous pneumothorax following thoracoscopic talc poudrage are strongly suggested.

Adolescent↗
PubMed2006

Intestinal ischemia/reperfusion injury aggravates talc-induced adhesions in rats.

BACKGROUND: Postoperative intraperitoneal adhesions are the leading cause of intestinal obstruction, but the underlying mechanisms remain incompletely understood. The aim of the current study was to investigate the involvement of intestinal ischemia/reperfusion (I/R) injury in adhesion formation in rats. MATERIALS AND METHODS: Rats were subjected to either a dusting of talc (15 mg/rat) over the entire small intestine or ischemia induced by clamping the superior mesenteric artery (SMA) for 30 min followed by reperfusion with or without talc dusting. On postoperative days 4, 7, and 14, the scores, lengths, and incidence of adhesions were evaluated. In addition, the contractile force of the jejunal muscle was measured at 0, 24, 48, and 96 h after the treatments using organ bath techniques under bethanechol-stimulated conditions. RESULTS: Talc induced mild adhesions in rats. Although I/R injury alone did not produce adhesions, it markedly aggravated the talc-induced adhesions, with higher scores and longer adhesions on postoperative days 4, 7, and 14. In addition, I/R injury caused 75-88% suppression of the circular muscle contractile force and 35-52% suppression of the longitudinal muscle contractile force at 24 h after SMA occlusion. However, talc did not affect the contractions. CONCLUSIONS: Intestinal I/R injury aggravated the talc-induced adhesions, and this consequence might be due to the functional suppression of jejunal muscle contractions. This finding suggests that intestinal ischemia is an important factor in the etiology of postoperative adhesions.

Animals↗
PubMed2006

Thoracoscopic talc poudrage decreases T-lymphocytes in the peripheral blood.

BACKGROUND: Thoracoscopic talc poudrage induces peripheral blood granulocytosis and lymphopenia. The aim of this study is to investigate the type of lymphopenia in patients undergoing thoracoscopic talc poudrage. METHODS: We have measured peripheral blood lymphocyte subsets in 11 patients undergoing thoracoscopic talc poudrage, before (baseline), at 24 and 48 h after the procedure. Lymphocyte numbers were analysed by flow cytometry for the evaluation of the CD3+, CD4+, CD8+ cells (total T-lymphocytes, helper T-lymphocytes, cytotoxic T-lymphocytes, respectively), the CD19+ cells (B-lymphocytes), and the CD16+, CD56+ and CD57+ cells (NK-cells). No anti-inflammatory medication was permitted before, during or after the procedure. RESULTS: Absolute peripheral blood lymphocyte count significantly decreased following thoracoscopic talc poudrage compared to baseline values (p=0.007). Similarly, peripheral blood CD3+, CD4+ and CD8+ lymphocyte counts significantly decreased compared to baseline (p=0.005, 0.02 and 0.03, respectively) with a more prominent reduction of CD3/CD45RO memory cells. No significant difference was found in the absolute number of CD19+, CD16+, CD56+, and CD57+ cells before and after thoracoscopic talc poudrage. CONCLUSION: Patients undergoing thoracoscopic talc poudrage display peripheral blood T-lymphopenia following the procedure.

Adult↗
PubMed1987

Mortality from lung cancer and respiratory disease among pottery workers exposed to silica and talc.

A cohort mortality study of white men employed for at least one year between 1939 and 1966 at three plants of a single United States company was conducted to evaluate the risk of lung cancer and nonmalignant respiratory disease among workers exposed to silica dust and nonfibrous (nonasbestiform) talc in the manufacture of ceramic plumbing fixtures. Follow-up of 2,055 men through January 1, 1981, indicated a substantial excess of nonmalignant respiratory disease among those with high levels of exposure to silica dust (standardized mortality ratio = 2.26). The risk of nonmalignant respiratory disease rose with the number of years exposed, was not further enhanced by talc exposure, and appeared to be appreciably lower among those exposed in more recent time periods. For lung cancer, men exposed to high levels of silica dust with no talc exposure had a nonsignificant standardized mortality ratio of 1.37. However, those exposed to nonfibrous talc in addition to high levels of silica had a significant 2.5-fold excess risk of lung cancer. Among this group, the lung cancer standardized mortality ratio rose with increasing years of talc exposure to 3.64 among those exposed for 15 or more years. Although the role of silica as a cofactor cannot be ruled out, these data suggest that nonfibrous talc exposure is associated with excess lung cancer risk.

Drug Synergism↗
PubMed2000

Diseases of the pleura: the use of talc for pleurodesis.

Talc either insufflated (poudrage) or in a suspension (slurry) is commonly used to create a pleurodesis in patients with recurrent pneumothorax or recurrent pleural effusions. There are now at least 32 cases in the literature in which patients developed the acute respiratory distress syndrome after receiving talc intrapleurally. The mechanism for the development of acute respiratory distress syndrome after the intrapleural administration of talc is not known, but it may be related to the systemic absorption of talc. Since there are effective alternatives to talc for producing pleurodesis (mechanical abrasion if thoracoscopy is performed; tetracycline derivatives or bleomycin if chest tubes are used), intrapleural talc should not be used to produce a pleurodesis.

Acute Disease↗