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PubMed2002

Primary treatment of malignant pleural effusions: video-assisted thoracoscopic surgery poudrage versus tube thoracostomy.

The objective of this study is to show that primary treatment of malignant pleural effusions secondary to ovarian carcinoma with video-assisted thoracoscopic surgery (VATS)-assisted talc poudrage (VATS-ATP) results in shorter hospital stays and reduced time with a chest tube than primary treatment with a chest tube and chemical pleurodesis. We conducted a retrospective chart review of all patients with a symptomatic pleural effusion secondary to primary ovarian carcinoma receiving intervention from January 1996 to December 2000. Patients either received tube thoracostomy with pleurodesis (n = 22) or VATS-ATP (n = 12). Of the patients treated with tube thoracostomy 18 per cent (4/21) died in the hospital before pleurodesis, 77 per cent (14/19) had successful pleurodesis, and 22 per cent (4/18) failed pleurodesis requiring VATS-ATP. In the group treated primarily with tube thoracostomy the chest tube was in place 8.36 +/- 2.61 days with a hospital stay of 12.64 +/- 5.80 days after the procedure. In the group treated with VATS-ATP there was 100 per cent successful pleurodesis. There were no mortalities. There was one prolonged intubation of 3 days and one incomplete lung reexpansion. The chest tube was in place for 4.58 +/- 1.78 days and a hospital stay of 7.50 +/- 4.12 days postprocedure. Groups treated by tube thoracostomy and VATS were statistically different; P < 0.001 for days with a chest tube and P = 0.011 for hospital days. We conclude that both tube thoracostomy with chemical pleurodesis and VATS-ATP provide adequate treatment of ovarian carcinoma-associated malignant pleural effusions. VATS-ATP provides a shorter duration of chest tube placement and postprocedure hospital stay.

Aged↗
PubMedDate not supplied

[The treatment of malignant pleural effusions: the experience of a multidisciplinary thoracic endoscopy group].

More than half of neoplastic patients show in their clinical history the onset of pleural effusion. Malignant pleural effusion produces dyspnea, decreases respiratory function and quality of life in patients with advanced cancers. Optimal treatment is actually controversial. The aim of this study is to analyze the experience of malignant pleural effusion treatment of the Multidisciplinary Group of Thoracic Endoscopy. Patients are been subdivided in two group, depending on respiratory performance status and they are been submit to a Video-Assisted Thoracic Surgery (VATS) with talc pleurodesis and to positioning of a chronic indwelling pleural catheter. The treatment of malignant pleural effusion with the methods reported above allows, not only to achieve palliation of symptomatology, but also to achieve pleurodesis in patients with limited life-expectancy with good cost-beneficial ratio.

Aged↗
PubMedDate not supplied

Pneumoconiosis in a female worker exposed to a primer used in the production of non-stick pans: clinical case.

UNLABELLED: The primary prevention programmes carried out in the 1950's and 1960's in industrialized countries brought about a significant reduction in the incidence of pneumoconiosis. Nevertheless, it is still possible to diagnose new cases, perhaps in relatively unusual working activities. OBJECTIVE: To describe a case of q 2/2 pneumoconiosis associated with mixed powder containing less than 1% quartz that occurred in a 37 year-old female worker, who had been previously employed (1987-1994) in manually spraying a primer solution on the bottom of non-stick aluminium pans. METHODS: The manufacturing firm supplied details of the composition of the primer. The physiological, pathological and occupational history was obtained for the worker, who also underwent: respiratory functional exploration, chest radiographs and HRCT of the thorax, fibrobronchoscopy, with transbronchial biopsy and BAL collection. The lung tissue sample was examined via light microscopy and scanning electron microscope analysis. RESULTS: The primer contained 6.8% talc, free from asbestos or silica, 3.8% iron oxides and 0.6% bentonite which, in turn, contained less than 1% crystalline silica. The job was performed in a semi-confined environment, with an inefficient aspiration system. The worker had never complained of respiratory symptoms. Radiographs and HRCT showed widespread micronodulation. Light microscopy of pulmonary tissue showed multinucleate giant cell granulomas with intracytoplasmatic inclusions. Scanning electron microscope analysis revealed that these consisted of agglomerated particles, microanalysis of which showed the presence of a silicate. CONCLUSIONS: Particular jobs performed up to few years ago in Italy in a semi-confined environment can still involve exposure to doses of mineral dusts such as to cause pneumoconiosis. This is the first case of mixed powder pneumoconiosis described in a worker employed in the production of non-stick aluminium pans.

Adult↗
PubMed2004

[The diagnostic and curative strategy for spontaneous pneumothorax].

The article presents the authors' experiences with treatment of 292 patients with spontaneous pneumothorax. Results of the suction drainage (188 patients), thoracoscopy and talc pleurodesis (43 patients), videothoracoscopic surgical treatment and pleurodesis (61 patients) are compared. The proposed algorithm allowed to make recurrences 2.8% rarer, the indications for tracheotomy appeared in 1.7% of the patients.

Adolescent↗
PubMed1992

[A new therapeutic approach in hepatic hydrothorax].

Hepatic hydrothorax is a complication of hepatic cirrhosis which frequently conditions respiratory insufficiency. Traditional therapy is almost always inefficacious. The paper reports four cases which were successfully treated using pleurodesis with sterile talc. Treatment was simple with no major complications. At the 6-month check-up no cases of recurrent pleural effusion were observed.

Adult↗
PubMed1995

The pneumoconioses.

Most recent studies have indicated that the incidence and prevalence of the mineral pneumoconioses have been declining as dust control has improved, This finding is particularly true for coal workers' pneumoconiosis, asbestosis, and silicosis. Although the present preoccupation with molecular biology and immunology has led to a spate of studies of the mechanisms involved in the development of these conditions, and although many advances have been made, no convincing complete elucidation of these mechanisms has evolved. Meanwhile, the "paratoxicologic fringe," supported by the National Institute of Occupational Safety and Health and the Environmental Protection Agency, has been presenting the notion that almost every naturally occurring or synthesized mineral ranging from aluminum to silica is a carcinogen. Much of the evidence produced by this consortium has been found wanting, especially in regard to the alleged hazards of talc, beryllium, and silica.

Animals↗
PubMed2005

[Effect of surface modification on surface energy of lactose and performance of dry powder inhalations].

AIM: To investigate the effects of surface modification of lactose carrier on performance of dry powder inhalations (DPIs). METHODS: Modified lactose surface was prepared using a "particle smoothing" process to obtain smooth carrier surface and low surface energy with the presence of magnesium stearate, colloidal silica dioxide and talc. Inverse gas chromatography (IGC) was used to assess the surface energy of treated lactose, and the in vitro deposition of carrier-based IFNa-2b DPIs was evaluated with twin stage impinger. RESULTS: The flowing property of lactose was greatly improved and the surface energy decreased by the "particle smoothing" process. Decreasing surface energy resulted in greater aspiration fraction of IFNa-2b. CONCLUSION: IGC is a potentially useful tool for rapid formulation design and screening.

Administration, Inhalation↗
PubMed2005

Autopsy confirmation of severe pulmonary interstitial fibrosis secondary to Munchausen syndrome presenting as cystic fibrosis.

Chronic factitious disorder with physical symptoms, or Munchausen syndrome, is a well-recognized but uncommonly diagnosed psychiatric condition characterized by the deliberate production of signs and symptoms of disease in order to receive medical attention. Clinical suspicion of this disease is rarely confirmed by autopsy, as the patients usually do not die as a consequence of feigning illness. Here we report the autopsy confirmation of a case of a suspected Munchausen syndrome patient who presented with a history of cystic fibrosis. Examination of the lungs demonstrated extensive severe interstitial fibrosis, and polariscopic examination revealed a large quantity of crystalline material throughout the tissue; X-ray diffraction identified the material as talc. Synopses of published cases of Munchausen syndrome presenting as cystic fibrosis, and cases of Munchausen syndrome with pulmonary talcosis are presented as part of the discussion.

Administration, Inhalation↗
PubMed2005

The treatment by V.A.T.S. and M.A.C. of secondary neoplastic pleural effusion in the old patient (> 70 years).

A secondary malignant pleural effusion is a common event in the evolution of some tumours. It is frequent in advanced phase, above all the breast cancer in the woman and the cancer of the lung in the man, but such pathology can interest also extra-thoracic cancers (ovary, colon, prostate, etc.) and the malignant lymphoma. In the majority of cases in order to obtain a good control of the effusion entity with reduction of the respiratory symptoms and improvement of the quality of life, palliative local therapy is indispensable. Numerous methods and substances have been proposed in the time for the treatment of the N.P.E. The talc pleurodesis executed in the old patients (> 70 years) by means of the V.A.T.S. "one trough" and "Monitored Anaesthesia Care" (MAC) has shown valid procedure for the control of the secondary neoplastic pleural effusion, with little uneasiness for the patients, reduced complications and a sure effectiveness.

Aged↗
PubMed1975

Investigation of some materials as dry binders for direct compression in tablet manufacture. Part 5: Effects of lubricants and flow conditions.

The effect of talc, magnesium stearate, stearic acid, and Acrawax C, which are commonly used as lubricants, on the dry-binding efficiency of tragacanth, polyethylene glycol 4000, polyvinylpyrrolidone, and mannitol were investigated. The effect of Aerosil which is sometimes utilized as a flow conditioner for directly compressible powder blends was also studied. The type and concentration of lubricant or flow conditioner appeared to influence the binding efficiency of the binders investigated to various degrees. The results showed that the bonding characteristics of all the binders tested except mannitol were reduced by the addition of the lubricants and the flow conditioner.

Chemistry, Pharmaceutical↗
PubMed1979

Non-fibrous mineral dusts and malignant tumors: an epidemiological study of mortality.

The connection between enhanced oncological risk and the exposure to non-fibrous mineral dusts receives a contradictory but mostly negative estimation in the literature. The present authors estimated the death rate by relating the number of deaths from cancer, registered at different companies during a 21 to 27-year span, to the number of man-years of work for all employees during the same period. The death rates, calculated as above, were compared with the age standardized analogous death rates of the control population. The ratio of these indices, which statistically significantly exceeded 1.0, was taken as evidence of risk connected with exposure to the industrial environment. Frequency of registration of deaths from malignant tumors among other causes of death of silicotic patients was also studied. The results are in favor of accepting talc dust (even that not containing fibrous minerals) as a carcinogen, and silica containing dust only as a cocarcinogenic agent. The percent silica content in dust either plays no role at all, or plays a much lesser role than the total dust load. Tbc as the competing cause of death in silicotic patients, in grave forms of the disease, eliminates the susceptibility of patients to death from cancer.

Dust↗
PubMed1989

Non-fibrous inorganic particles in human bronchoalveolar lavage fluids.

Bronchoalveolar lavage (BAL) is a simple and non-invasive sampling technique of the deep lung. Analytical electron microscopy was used for the identification and quantification of non-fibrous inorganic particles recovered in BAL fluid samples from 51 subjects with various occupational exposures (silica, silicates, metals and alloys, metallic oxides, precious and hard metals, abrasives). Around 4750 particles were analysed. More than sixty different compounds were identified, among which silica, kaolinite, illite, mica, Fe oxides and hydroxides, appeared to be ubiquitous. Feldspar, talc, chlorite, Al oxide, Ti oxide, tungsten carbide, stainless steel, carbonaceous compounds and flyash were also frequently encountered. From 1 to 21 compounds were identified in each sample. Repeated BAL samples obtained for 2 subjects did not show significant differences. Particles characteristic of the occupational exposure were found in BAL up to 21 years after cessation. BAL content can also reflect mixed occupational exposures. Absolute particle concentrations measured in twelve samples ranged between 0.1 and 9.9 x 10(6) particles/ml BAL fluid and mean particle diameter ranged between 0.5 and 1.2 microns. Mineralogical analysis of non-fibrous particles in BAL can be a useful tool to investigate occupational exposures. It allows, in most cases, a better characterization of the exposure than medical questioning. It may be helpful in identifying pathogenic particles, however it must be kept in mind that a positive result is only a proof of exposure and never a proof of disease. The main limitations of this technique are difficulties in sampling severely diseased subjects and inaccuracy in detecting easily soluble compounds and particles with a high rate of alveolar clearance.

Adult↗
PubMed1986

[Testicular biopsy findings following orchiopexy].

320 testicular biopsies were evaluated from the years 1974 to 1984 and in (5.9%) cases an orchiopexy in the history of patients were found. The orchiopexy was made in 14 cases on both and in 5 cases on one site. Average age was 8.1 years during the operations and it seems to be very high. The spermiograms of these cases showed severe oligozoospermia and azoospermia. Histological investigation of biopsies demonstrated mild to severe hypospermatogenesis with and without maturation arrest and Sertoli cell and Klinefelter's syndrome. In the testicular biopsy from one patient were found granulomas with foreign material as talc which induced regional fibrosis.

Adolescent↗
PubMed1989

Enhanced activity of peritoneal cells after aclacinomycin injection: effect of pretreatment with superoxide dismutase on aclacinomycin-induced cytological alterations and antitumoral activity.

Peritoneal macrophages from mice injected with aclacinomycin (ACM) (4 mg/kg, i.p.) showed increased functional activity, as assessed by increased antitumoral activity in vitro and in vivo and zymosan-triggered chemoluminescence. They also showed ultrastructural signs of activation (increased number of cytoplasmic organelles), and atypical alterations (giant vacuoles and giant lysosomes containing heterogenous myelinoid bodies, lipofuscine-like substance, cytoplasmic debris, and a fine granular material). As these atypical alterations could be due to the generation of superoxide following ACM injection, superoxide dismutase (SOD) was injected 1 h prior to ACM administration. Neither the morphological characteristics of activation, nor the enhanced metabolic and antitumoral activities induced by ACM were affected by SOD pretreatment, but the atypical alterations were inhibited in a dose-dependent manner. Heat-inactivated SOD did not prevent their appearance. The atypical alterations were not found in peritoneal macrophages from talc or lipopolysaccharide-injected mice, but they were present in Adriamycin-treated mice and were also prevented by SOD pretreatment, indicating that the alterations are due to anthracycline treatment. Finally, [125I]SOD was phagocytized by peritoneal macrophages in vitro and in vivo and not by L1210 tumoral cells, explaining why the atypical alterations induced by ACM were no longer seen after SOD pretreatment. The unchanged direct oncostatic activity of ACM following SOD pretreatment suggests that this combination may have some wider perhaps clinical, potential.

Aclarubicin↗
PubMed1986

Inorganic particulates associated with pulmonary alveolar proteinosis: SEM and X-ray microanalysis results.

Twenty-four cases of pulmonary alveolar proteinosis (PAP) were studied by light microscopy (LM) and scanning electron microscopy (SEM) to test the hypothesis that PAP was related to silica exposure. Increased numbers of birefringent particles (vs. controls) were found in 78% of PAP cases. SEM was used to locate inorganic particulates in situ, which were individually analyzed using energy dispersive X-ray analysis. When analyzed as an aggregate group of cases, no specific inorganic particulate was evidently associated with the PAP reaction. However, analysis of individual cases revealed more specific associations. The concentration of particles determined by SEM exceeded that found by LM by a factor ranging from 2.7 to 964. The concentration of inorganic particulates per cm3 in the areas of PAP ranged from 1.3 X 10(7) to 1.02 X 10(9). Controls all had less than 10(7) particles per cm3. Available environmental history correlated well with particulate analysis results, e.g., silica in a sandblaster, metal fumes in a welder, and cement particles in a cement finisher. Particulates with unique composition were also found in cases with unavailable histories, e.g. metal fumes suggestive of welding or soldering exposure, silicates suggestive of fine particle exposure (greater than 50% of particles less than 1 micron). Only 1 case (the sandblaster) showed greater than 50% of the particles to be silica. Of the 5 infants with PAP, 3 showed the major particulate to be talc, and 1 had evidence of toxic cadmium selenide fume exposure. These results are consistent with the hypothesis that PAP, at least in the majority of cases, is associated with exposure to small inorganic particulates of several types.

Electron Probe Microanalysis↗
PubMed1988

Granulomatous diseases of the lung that mimic respiratory infections.

Granulomatous diseases of the lung may have clinical, roentgenographic, and pathological features that closely mimic respiratory tract infections. The protean manifestations of sarcoidosis allow confusion with a wide variety of infectious diseases. Acute hypersensitivity pneumonitis closely mimics an infectious illness; even subacute or chronic presentations may be mistaken for infections. Less commonly, the manifestations of intravenous talc granulomatous disease may also mimic infection.

Alveolitis, Extrinsic Allergic↗
PubMed1988

Blepharopigmentation: histopathologic observations and X-ray microanalysis.

Blepharopigmentation or permanent eyeliner is a popular cosmetic procedure currently performed by a variety of methods. All methods attempt to implant ferrous oxide pigment into the dermis. We performed histopathologic studies on a series of three eyelid specimens, including two by a previously undescribed multi-needle pigment delivery system. Light microscopy revealed the epidermis to be pigment-free and the dermis to contain pigment in clumps. Transmission electron microscopy (EM) demonstrated that the pigment was largely in macrophages. Energy-dispersive x-ray micro-analysis showed that in addition to iron and talc, titanium particles were also present. These findings suggest that the pigment is tolerated by the eyelid despite the fact that current pigments are contaminated.

Adult↗
PubMed1977

The structure of mononuclear phagocytes differentiating in vivo. III. The effect of particulate foreign substances.

The response of mononuclear phagocytes to three inert particles--barium sulfate, talc, and thorium dioxide--was studied by correlated light and electron microscopy. All three particles induced maturation of the mononuclear phagocytes, which proceeded to the stage of the mature macrophage and required 7 to 9 days. Once established, maturation persisted as long as 45 days, as did the inert particles. The resultant lesions, dense aggregates of mature macrophages, were termed mature granulomas. The resultant maturation differed from that produced by digestible bacteria in tempo and extent but not in pattern.

Animals↗