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PubMed1977

Accidental percutaneous hexachlorophane intoxication in children.

Eighteen children with normal skin were accidentally intoxicated by a talc powder containing 6% hexachlorophane. Four died and two remained paraplegic. The clinical picture was intracranial hypertension, eight patients developing signs of spinal cord damage. The condition seemed to result from massive intramyelinic oedema. In the spinal cord vascular disturbances may occur as mechanical complications of oedema, giving rise to permanent sequelae.

Child, Preschool↗
PubMed1990

Management of recurrent malignant pleural effusion in the United Kingdom: survey of clinical practice.

Malignant pleural effusions are often symptomatic and tend to recur after simple aspiration. Pleurodesis may prevent recurrence of the effusion; many agents and techniques have been described. A questionnaire was sent to 448 clinicians in the United Kingdom to determine how pleurodesis is performed in practice. There was a 56% overall response, with replies from 101 respiratory physicians, 88 general physicians, 29 thoracic surgeons, and 35 general surgeons. General surgeons saw few cases of malignant pleural effusion and rarely performed pleurodesis. A patient with recurrent malignant pleural effusion would usually be managed with pleurodesis by 76 (76%) respiratory physicians, 26 (30%) general physicians, and 23 (81%) thoracic surgeons; a further 29 (33%) general physicians would refer such patients to another specialist. Most medical pleurodesis were performed by junior staff, whereas consultant thoracic surgeons were more likely to be concerned with the procedure. All the thoracic surgeons used an intercostal tube drain, usually with suction. An intercostal tube drain was used routinely by only 54 (54%) of the respiratory physicians and 28 (32%) general physicians. Thoracic surgeons preferred talc for pleurodesis whereas physicians most commonly used tetracycline. The variety of methods in use supports the need for randomised, controlled studies to determine the most effective technique of pleurodesis.

Bleomycin↗
PubMed1994

Strategy of treatment of pruritus during pregnancy. The Drugs and Pregnancy Study Group.

OBJECTIVE: To present a procedure for establishing treatment guidelines during pregnancy and, as an application of the method, the recommendations for treatment of pruritus. DESIGN: A preliminary survey was carried out among participants of the study group to determine drug choices for treatment of pruritus during pregnancy. Literature data on the selected drugs were analyzed. Recommendations for treatment were proposed, taking into account for most efficient agents and the least toxic for the fetus. This draft was submitted to all participants of the study group; criticism and suggestions were gathered. A new draft was evolved and repeatedly submitted to participants until consensus was reached. SETTING: Study group set up in southwestern France, with the help of national experts. PARTICIPANTS: Forty-three general practitioners, six gynecologists and/or obstetricians, five pharmacologists, two dermatologists, and an embryologist. RESULTS: The main recommendations for treatment of pruritus during pregnancy are to begin with topical treatment; emollient bath additives, moisturizing cream, talc. If insufficient, a systemic treatment should be added. Antihistamines are prescribed first: hydroxyzine or dexchlorpheniramine is used during the first 2 months. From the third month, the same agents can be used, as can mequitazine. The duration of treatment can be up to 10 days. The group's second choice was benzodiazepine (oxazepam) as second-line treatment. CONCLUSIONS: Strategies for treatment of diseases during pregnancy are not always well defined. For many common diseases, very few data are available concerning drug use in pregnant women. The study group, based on consensus among participants, proposed treatment guidelines.

Administration, Topical↗
PubMed1997

Pleurodesis: state of the art.

Pleurodesis aims to achieve a symphysis between parietal and visceral pleural surfaces, in order to prevent accumulation of fluid or air in the pleural space. Its major indications are malignant effusions and pneumothorax, and a re-expandable lung is essential for the success of the technique. Moreover, expectation of a reasonably long survival is important before attempting pleurodesis. A successful lung re-expansion is unlikely if the pleural pressure falls more than 20 cmH2O x L(-1) of fluid removed, because there is a central bronchial obstruction or the lung is trapped by tumour and/or fibrin. Pleural fluid pH (<7.20) is a good indicator of the presence of trapped lung; moreover, a successful pleurodesis is less likely when pH is low, and this parameter is also a good predictor for survival of the patients. Among the many sclerosing agents that have been used for pleurodesis, talc has achieved the best results, with an average success rate of approximately 90%. The cellular and biochemical mechanisms involved in pleurodesis may be specific to the agent used, however, they may all follow a common final pathway leading to activation of the pleural coagulation cascade, the appearance of fibrin networks, and the proliferation of fibroblasts. The details of these mechanisms are still unclear and need to be further elaborated.

Humans↗
PubMed1999

An investigation into the erosion behaviour of a high drug-load (85%) particulate system designed for an extended-release matrix tablet. Analysis of erosion kinetics in conjunction with variations in lubrication, porosity and compaction rate.

The effects of the amounts of lubricants (magnesium stearate 0-5% and talc 0-3%) and changes in compaction rate and tablet porosity on the mechanism of drug release from high drug-load controlled-release theophylline tablets have been examined. Drug release was satisfactorily described by a surface-erosion model that takes into account the geometry of the tablet, differential radial and axial erosion rates, and the initial burst effect (r2 > 0.99 for all formulations). The axial and radial erosion rate constants were inversely proportional to the amount of magnesium stearate in the formulation (P < 0.0001). The most dramatic reductions in erosion rate occurred between 0 and 1% magnesium stearate content. For magnesium stearate concentrations > or =2.5% the ratio of radial to axial erosion rate constants was essentially constant at 3 (approx.); however, for formulations with magnesium stearate < or =1% the ratio tended toward unity. Reducing matrix porosity over the range 26 to 14% resulted in reduced erosion rates. However, a threshold of 17% (approx.) porosity was identified below which further reductions in porosity resulted in only incremental changes in release rates. The rate of erosion and drug release was insensitive to changes in machine speed over the range 20 to 100 rev min(-1). For highly loaded matrix tablets containing sparingly soluble drugs, such as theophylline, magnesium stearate at appropriate levels can modulate the erosion rate constants and act as an effective release-controlling excipient. Drug-release profiles are predictable and relatively robust in terms of changes in compaction rate and applied force routinely encountered in large-scale tablet manufacturing.

Chemistry, Pharmaceutical↗
PubMed2003

Accurate wavelength measurements of a putative standard for near-infrared diffuse reflection spectrometry.

The diffuse reflection (DR) spectrum of a sample consisting of a mixture of rare earth oxides and talc was measured at 2 cm-1 resolution, using five different accessories installed on five different Fourier transform near-infrared (FT-NIR) spectrometers from four manufacturers. Peak positions for 37 peaks were determined using two peak-picking algorithms: center-of-mass and polynomial fitting. The wavenumber of the band center reported by either of these techniques was sensitive to the slope of the baseline, and so the baseline of the spectra was corrected using either a polynomial fit or conversion to the second derivative. Significantly different results were obtained with one combination of spectrometer and accessory than the others. Apparently, the beam path through the interferometer and DR accessory was different for this accessory than for any of the other measurements, causing a severe degradation of the resolution. Spectra measured on this instrument were removed as outliers. For measurements made on FT-NIR spectrometers, it is shown that it is important to check the resolution at which the spectrum has been measured using lines in the vibration-rotation spectrum of atmospheric water vapor and to specify the peak-picking and baseline-correction algorithms that are used to process the measured spectra. The variance between the results given by the four different methods of peak-picking and baseline correction was substantially larger than the variance between the remaining five measurements. Certain bands were found to be more suitable than others for use as wavelength standards. A band at 5943.13 cm-1 (1682.62 nm) was found to be the most stable band between the four methods and the six measurements. A band at 5177.04 cm-1 (1931.61 nm) has the highest precision between different measurements when polynomial baseline correction and polynomial peak-picking algorithms are used.

Calibration↗
PubMed1993

Management of malignant pleural effusions.

Malignant pleural effusions (MPEs) are a common complication of advanced malignancies, particularly lung and breast cancer. They are caused by a variety of mechanisms including tumor obstruction of lymphatic flow, spread of malignant cells via the systemic circulation, and tumor invasion of the pulmonary arterioles. Therapy is determined by tumor histology, stage of malignancy, and a careful assessment of a patient's performance status and comorbid diseases. A number of approaches have been used to treat patients with MPE ranging from thoracentesis to pleurectomy. Tube thoracostomy drainage followed by application of a sclerosing agent is the most common strategy. Effective sclerosing agents include quinacrine, talc, bleomycin, tetracycline and Corynebacterium parvum. Results from a recent multicenter randomized trial suggest that bleomycin may be superior in terms of control of effusion at 30 days. Further randomized studies are ongoing to determine the optimal method of draining the pleural space and the most effective sclerosing agent. Thoracoscopy using video-assisted techniques is a promising new approach to MPEs both for diagnosis and treatment. The application of biological agents such as interleukin-2, the interferons, and novel chemotherapeutic agents are experimental approaches that are under investigation.

Bleomycin↗
PubMed2000

Predicting survival in patients with recurrent symptomatic malignant pleural effusions: an assessment of the prognostic values of physiologic, morphologic, and quality of life measures of extent of disease.

PURPOSE: To determine the prognostic value of pleural fluid pH, pleural fluid glucose, extent of pleural carcinomatosis (EPC) score, and Karnofsky Performance Scale (KPS) score in patients with recurrent symptomatic malignant pleural effusions. DESIGN: Prospective 53-month study. SETTING: Referral center for interventional pulmonology. PATIENTS: Eighty-five consecutive patients (42 men and 43 women) with recurrent symptomatic malignant pleural effusions who were referred to the interventional pulmonary service for thoracoscopic pleurodesis. MEASUREMENTS: Pleural fluid pH, pleural fluid glucose, EPC score, and KPS score. RESULTS: The KPS score was the only statistically significant predictor variable. Patients with a KPS score >/= 70 had a median survival of 395 days, as opposed to a median survival of only 34 days for patients with a KPS score </= 30. No prognostic advantage was evident when patients were categorized by pleural fluid pH, pleural fluid glucose, or EPC score. CONCLUSION: When assessing the prognosis of a patient with a recurrent symptomatic malignant pleural effusion, only the KPS score at the time of thoracoscopy is predictive of survival. Pleural fluid pH, pleural fluid glucose, and EPC scores are not as reliable as initially reported. For patients with a KPS score >/= 70, it may be very reasonable to proceed with thoracoscopic talc pleurodesis for management of their malignant pleural effusions.

Adult↗
PubMed2001

Use of small-bore vs large-bore chest tubes for treatment of malignant pleural effusions.

STUDY OBJECTIVE: To evaluate the efficacy of small-bore (12 French vanSonnenberg) catheters compared with standard large-bore chest tubes in the drainage and sclerotherapy of malignant pleural effusions. DESIGN: Retrospective review. SETTING: An academic tertiary care hospital. PATIENTS: Adult patients with documented neoplasms and malignant pleural effusions, treated between 1986 and 1995. INTERVENTION: All patients included in the study underwent drainage of malignant pleural effusions either by large-bore chest tube or by ultrasound-guided small-bore catheter. After drainage, pleurodesis was performed. RESULTS: Outcome as defined by recurrence of effusion was determined by blinded examination of all postpleurodesis chest radiographs. We identified 58 cases of malignant pleural effusion in which small-bore catheters were used and 44 in which large-bore chest tubes were used. The majority of patients had breast (n = 56, 55%) or lung cancer (n = 29, 28%). The median age was 65 years. Fifty-nine patients were actively being treated with chemotherapy at the time of pleurodesis. The following sclerosing agents were used: talc, 27 (26%); tetracycline, 72 (70%); bleomycin, 2 (2%); and interferon, 1 (1%). Actuarial probabilities of recurrence at 6 weeks and 4 months were 45% and 53% for the small tubes vs 45% and 51% for the large tubes. Univariate and multivariate analyses failed to demonstrate that tube size had any influence on the rate of recurrence. CONCLUSIONS: We were unable to detect any major differences in outcomes with the use of either size of chest tube. Our study suggests that small-bore catheters may be effective in the treatment of malignant pleural effusions and deserve further evaluation in prospectively designed trials.

Adult↗
PubMed1990

Successful closure of chronic BPF by thoracoscopy after failure of endoscopic fibrin glue application and thoracoplasty.

We report a case of chronic debilitating BPF following right upper lobe resection. Despite several endobronchial applications of fibrin glue, we could not close it. Since the patient was extremely debilitated by symptoms due to the BPF, a thoracoplasty was attempted but was not successful. Finally, the BPF was definitely closed by instillation of talc into the pleura through thoracoscopy. To our knowledge, this is the first reported case of chemical closure of a recalcitrant BPF by the route of thoracoscopy. It also shows the failure of endoscopic fibrin glue application in such a condition.

Bronchial Fistula↗
PubMed1980

Conglomerate pulmonary disease: a form of talcosis in intravenous methadone abusers.

A program of detoxification of heroin addicts by the use of oral methadone produced a series of patients who developed pulmonary granulomatous mass lesions as the result of the intravenous use of the oral form of the drug. Talc, used in the preparation of the tablet, seems to be the offending substance. Besides producing a diffuse interstitial granulomatous reaction, conglomerate masses in the upper lung zones were also noted. This radiographic pattern can occur rather rapidly from the background of fine diffuse interstitial micronodularity. The latter may be subtle, but can change to mass lesions associated with lung contraction, volume loss in the upper lung zones, and hyperinflation in the lower lungs. The mechanism of formation of mass lesions is unknown, but individual host reaction and immunologic mechanisms probably play a role. The development and progress of such a process is described in four heroin addicts.

Adult↗
PubMed1981

Micronodular pulmonary pattern: association with inhaled aerosol.

The micronodular pulmonary radiographic pattern consists of homogeneous rounded densities of 1 mm or less in diameter without a reticular element. The differential diagnosis is limited to alveolar microlithiasis and a few other conditions, such as intravenous talc injection. Two patients with this image had very heavy exposure to hairspray and a pulmonary noncaseating granulomatous tissue reaction. Reports of 31 patients with pulmonary reactions to hairspray aerosols have been reviewed together with original radiographs in five cases. The micronodular pattern occurred in the eight. Aerosol sprays of several sorts were examined by electron microscopy and x-ray energy dispersive spectrometry. Although the pathogenesis of the pulmonary reaction has not been established, steroids and abstinence from further exposure to aerosols encourage its disappearance.

Adult↗
PubMed1982

Potential complications in myelography: I. Technical considerations.

Scanning electron microscopy demonstrated starch powder contamination on the stylet tip from a spinal needle after it was lightly touched with nonwashed surgical gloves. A sterile solution of Pantopaque was injected through the spinal needle after the stylet was withdrawn and carried particulate contaminants to a 0.2 micrometer millipore filter. Using both scanning electron microscopy and energy dispersive x-ray analysis, particles of various sized (mostly 5-10 microns) and variable compositions, including starch, talc, and other elements, were identified. Also, glass particles from the Pantopaque vial and plastic particles from the plastic syringe and tubing used in drawing up the Pantopaque were seen. These observations indicate that strict attention to proper technique in myelography is essential in order to eliminate potential cerebrospinal fluid contamination.

Arachnoiditis↗
PubMed1994

Peritoneal mesotheliomas in Danish women: review of histopathologic slides and history of abdominal surgery.

An unexpectedly large number of peritoneal mesotheliomas among women was reported to the Danish Cancer Registry during the years 1960 through 1985. In a case-control study, we tested whether this was due to diagnostic misclassification or to direct exposure of the peritoneal membranes to talc during abdominal surgery. Tissue specimens were available from 96 reported peritoneal mesotheliomas; 35 cases (37%) were regarded as verified mesotheliomas, and 33 (34%) as possible mesotheliomas. Information on any intraabdominal surgery was obtained from the hospital records of these 68 cases and for 206 controls with a cancer of the uterine corpus or pancreas. No association was seen between peritoneal mesotheliomas and abdominal surgery performed more than 25 years prior to cancer diagnosis (odds ratio, 0.83; 95% confidence interval, 0.35-1.94). CONCLUSION. Misclassification of other cancers was the reason for the observed excess of peritoneal mesotheliomas.

Abdomen↗
PubMed1978

Pleural effusion from malignancy.

Pleural effusion from metastatic malignancy can cause major impairment of respiratory function and eventual death. Although cure is not possible, successful palliative treatment allows months to years of productive life, obviating the need for continuous hospitalization and repeated thoracenteses. Successful palliative treatment requires obliteration of the pleural space. Literature survey indicates that a wide variety of medical agents and surgical methods have been used with variable success. Medical methods include instillation of antineoplastic agents, antimicrobial agents, or colloidal radioisotopes into the pleural space; quinacrine and tetracycline are moderately to highly effective agents, but the toxicity of the former is substantial. Bedside talc poudrage with thoracostomy-tube drainage is a safe and highly effective alternative. Pleurectomy is the definitive method of preventing reaccumulation of pleural fluid that results from metastatic malignancy, even when other methods have failed, but thehigh morbidity and mortality of the procedures mandate careful patient selection.

Anti-Bacterial Agents↗
PubMed1997

[VATS in malignant pleural effusions].

Between November 1992 and October 1996, 20 patients with malignant pleural effusions were submitted to VATS under general anesthesia. The overall positive histological diagnoses were obtained through VATS (20/20). The malignant pleural mesothelioma in 8 cases and metastatic cancers in 12 cases were histopathologically confirmed. Talc pleurodesis was performed for all the cases, and 18 patients gained lasting pleurodesis and the other 2 patients did not. The failure of pleurodesis was due to that the lung could not reexpand to come into contact with the chest wall. Postoperative complications included transient fever and slight asthma in 2 cases, and the symptoms were relieved obviously after some simple therapy to symptom. In conclusion, VATS has provided a high positive diagnosis of patients with malignant pleural effusions not diagnosed by conventional methods and good results in pleurodesis, but some operating skills must be emphasized.

Adult↗
PubMed1975

Granulomatous pneumonitis. A result of intrapleural instillation of quinacrine and talcum powder.

A 73-year-old man with bilateral recurrent pleural effusions had relief of symptoms with intrapleural instillation of quinacrine hydrochloride and talcum powder. At postmortem, examination of the lungs showed granulomatous consolidation of a portion of the lower lobe of the left lung. The granulomatous reaction was in response to large numbers of talc and quinacrine crystals within the pulmonary parenchyma. A review of the literature disclosed no reports of pulmonary damage following the intrapleural administration of these two agents. This unusual complication of therapy may have resulted from the aspiration of crystals through a small, undetected bronchopleural fistula.

Aged↗
PubMedDate not supplied

[An unusual case of talco-asbestosis].

The authors present an unusual case of asbestosis. The latter had very diffuse macrophagic and giant cell granulomatous lesions. The morphological findings and the history enabled one to relate the appearance observed to the conjoined handling of asbestos and talc. A primary adenocarcinoma developed on these lesions.

Asbestosis↗