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PubMed1984

Pulmonary granulomatous reaction: talc pneumoconiosis or chronic sarcoidosis?

A chronic pulmonary granulomatous reaction was associated with an almost identical clinical picture in two patients exposed to talc. In both patients lung biopsy showed the deposition of talc particles and a heavy granulomatous reaction. At the time of diagnosis the Kveim test result was negative in both patients, urinary calcium excretion was normal, and there were no extrapulmonary manifestations and no response to steroid treatment. These findings point against sarcoidosis. The serum angiotensin-converting enzyme level, however, was raised in both patients. It was concluded that the patient who was exposed to talc in the rubber industry had a true talc pneumoconiosis. The other patient, who was exposed to cosmetic talcum powder, suffered from chronic sarcoidosis with talc deposition in the lungs, since an enlarged axillar lymph node containing granulomatous inflammation was discovered after two years' follow up. These cases show that it may be extremely difficult to differentiate between chronic sarcoidosis and talc pneumoconiosis even after careful clinical and histological analysis.

Chronic Disease↗
PubMed2002

A cohort mortality and nested case-control study of French and Austrian talc workers.

OBJECTIVES: To study whether the mortality from non-malignant and malignant respiratory diseases of workers employed in French and Austrian talc mines and mills is related to their long term occupational exposure. METHODS: Two historical cohorts were set up comprising all male subjects who had been working continuously for at least 1 year in a series of talc producing companies in France and Austria. The French cohort consisted of those employed at a site in the French Pyrenees and working between 1 January 1945 and 31 December 1994. The Austrian cohort consisted of the workers employed between 1 January 1972 and 31 December 1995 in one of four industrial sites in the Austrian Alps. The mortality within the cohorts was compared with local death rates. Two nested case-control studies focusing on non-malignant and malignant respiratory diseases were set up to estimate possible dose-response relations with cumulative exposure to talc dust based on an industry specific job exposure matrix. RESULTS: Mortality from lung cancer was in small excess in both cohorts (France, standardised mortality ratio (SMR) 1.23, 21 cases observed, 95% confidence interval (95% CI) 0.76 to 1.89; Austria, SMR 1.06, seven observed, 95% CI 0.43 to 2.19). A non-significant excess mortality was found for all non-malignant respiratory diseases in the French cohort due to a significant excess for pneumoconiosis (SMR 5.56, three observed, 95% CI 1.12 to 16.2). The case-control study of non-malignant respiratory disease showed an increased mortality in the highest exposure groups (odds ratio (OR) 2.5 for a cumulative exposure > or = 800 y.mg/m(3)) with a significant trend (OR/100 y.mg/m(3) 1.08) with cumulative exposure to talc. On the contrary, no increasing trend could be found in the case-control study of lung cancer. This result must be interpreted considering the small cohort size. Adjustment on smoking and exposure to quartz did not influence these results to any extent. CONCLUSIONS: The mortality from non-malignant respiratory disease was found to be related to high cumulative exposure to talc dust. The small excess in lung cancer does not seem to be attributable to talc.

Austria↗
PubMed1979

An epidemiologic study of a group of talc workers.

Chest roentgenograms, pulmonary function assessment by spirometry, respiratory symptoms, smoking history, and occupational history by questionnaire were obtained from 121 male talc miners and millers exposed to talc containing tremolite and anthophyllite asbestiform fibers. Ninety-three of the employees had worked in talc only at the plant under study. Symptoms were only slightly more prevalent in talc workers when compared to potash miners. Mean pulmonary function (forced expiratory volume in one sec, forced vital capacity, and maximal expiratory flow at 50 and 75 per cent of vital capacity) of talc workers was significantly decreased in comparison to that of potash miners. The prevalence of pleural calcification and pneumoconiosis in talc workers with 15 or more years of employment was higher than in potash miners. The prevalence of pleural thickening was 31 per cent in those who worked more than 15 years and was significantly increased as compared to that in potash miners. Workers with pleural thickening had decreased pulmonary function in comparison to those who did not. Decreased one-sec forced expiratory volume and forced vital capacity were associated with exposure to respirable particulate and asbestiform fibers.

Adult↗
PubMed1974

Identification and quantitation of asbestos in talc.

The currently used analytical methods for identification, characterization and quantitation of asbestos fiber in consumer talcum products include polarized light microscopy, x-ray diffraction analysis, transmission electron microscopy with selected area electron diffraction and electron microprobe techniques. Light microscope methods have severe limitations imposed by the ultimate size resolution of the light-optical system. Small particles go unresolved; those marginally resolved may possess optical properties different from those properties cited in the literature; most optical properties, e.g., indices of refraction, are difficult to measure on small particles. In addition to these difficulties, talc fibers often possess optical properties different from those of talc plates, which further confound analysis. Light microscopy is recommended for use only as a preliminary tool on limited, large-sized, samples. Transmission electron microscopy is a good standard technique for visualization of contaminant asbestos fibers. Together with selected area electron diffraction, talc fibers may be easily differentiated from amphibole asbestos fibers on the basis of both morphological and structural characterization. Chrysotile fibers are easily distinguished on this basis as well. The amphibole asbestos minerals require chemical characterization to differentiate among the different fiber types. Probe analysis is mandatory for such fibers. The major drawbacks to electron beam instrumentation for the mineralogical characterization of talcum products are the time and effort required for data acquisition. These techniques do not lend themselves to routine study.X-ray diffraction analysis, utilizing the step-scan method, offers a relatively rapid, quantitative technique for gross fiber analysis. Based on comparison with standard specimens the fiber content of talcs may be quantitatively determined. It is essential to employ a specimen preparation technique which yields homogeneously dispersed particles. Tremolite may be determined at levels as low as 0.10% by weight, chrysotile 0.25%, and anthophyllite at 2.0% by weight occurrence in talc. The variance of these values depends upon many factors, including the mass absorption coefficient of the fiber types as compared to talc and selected diagnostic reflections and their relative intensities. Each of the above techniques is described in detail. A method for routine analysis of consumer talcum products is suggested.

Asbestos↗
PubMed1994

Sequential morphological changes of the constrictive basilar artery in a canine model of experimental cerebral vasospasm by talc injection.

To demonstrate the possible role of foreign-body reaction to extravasated blood in provoking chronic cerebral vasospasm, talc (crystallized hydrous magnesium silicate) was injected as a non-biologic foreign material into the canine-cisterna cerebellomedullaris, and pathologic changes were followed. Angiographically, this cisternal talc injection induced delayed and prolonged constriction of the basilar artery, without any evidence of so-called early phase cerebral vasospasm that should occur shortly after an insult. Pathologically, around the spastic artery in the subarachnoid space with talc injection, the appearance of a moderate cellular migration coincided with cerebral vasoconstriction, which took place 2 days after the talc injection. In the spastic basilar arterial wall, marked constrictive and degenerative changes including myonecrosis and subintimal proliferation were induced by cisternal talc injection as early as on day 2, and the changes were progressive with time. These pathologic changes were extremely analogous to those of the human autopsy cases with chronic cerebral vasospasm (chronic VS) but more prominent than those observed in the experimental autologous blood-induced model. The present study demonstrated that a foreign-body reaction to talc alone could induce chronic VS in the absence of extravasated blood. Thus, it is possible to consider that inflammatory reactions to extravasated autologous blood in subarachnoid hemorrhage may give rise to chronic VS.

Animals↗
PubMed2005

Influence of antiinflammatory drugs (methylprednisolone and diclofenac sodium) on experimental pleurodesis induced by silver nitrate or talc.

STUDY OBJECTIVE: To determine whether the administration of antiinflammatory drugs interferes with experimental pleurodesis induced by silver nitrate or talc. STUDY DESIGN: Two groups of 30 white New Zealand rabbits were scheduled to receive an intrapleural injection of 0.5% silver nitrate or 400 mg/kg of talc. Each group was further classified into three subgroups (10 animals each), which received the following: (subgroup 1) the sclerosing agent only, (subgroup 2) the sclerosing agent plus 1 mg/kg of methylprednisolone, and (subgroup 3) the sclerosing agent plus 1.1 mg/kg of diclofenac sodium. The antiinflammatory agents were administered IM 24 h before the sclerosing agent and daily during the first week, followed by once-weekly injections until death at 28 days. At this time, the pleural cavity was macroscopically evaluated, and samples of pleura and lungs were collected for further microscopic examination. MEASUREMENTS AND RESULTS: The degree of pleural adhesions was higher after silver nitrate administration (p = 0.019). No reduction in the adhesions was observed after administering antiinflammatory drugs to this group (p > 0.05). Conversely, the adhesion score was significantly reduced after administration of both prednisolone (p = 0.028) and diclofenac (p = 0.032) to the animals that received talc. Administration of the antiinflammatory agents did not influence microscopic pleural or lung changes induced by silver nitrate or talc. CONCLUSION: These results show that the sustained systemic administration of antiinflammatory agents (steroidal or nonsteroidal) reduces the degree of pleural adhesions in animals with talc-induced pleurodesis but does not affect silver nitrate-induced pleurodesis. Extrapolation of these results to humans suggests that the use of antiinflammatory drugs should be avoided in patients with talc-induced pleurodesis and that appropriate clinical studies with silver nitrate should be conducted in patients chronically treated with these antiinflammatory agents.

Animals↗
PubMedDate not supplied

Long-term effect and tolerance of talc slurry for control of malignant pleural effusions.

Drainage of malignant pleural effusions (MPE) by thoracocenthesis and subsequent pleurodesis is an established means of symptomatic relief in terminally-ill patients, but the optimal therapy remains unclear. Among many sclerosing agent, talc is the most widely used, but its intrapleural administration and dosage have not been clearly determined. To assess the efficacy of using talc slurry with high dose (8 g) as a sclerosing agent instilled into the pleural space at the patient bedside, we carried out a study in 31 patients suffering from symptomatic MPE, followed until death or up to 1 year with radiographs. Patients were evaluated for immediate tolerance (31 patients), and for efficacy and long-term tolerance (27 patients) of the talc therapy. We have shown, that pleurodesis was satisfactory in 22/27 patients (81.4%). This result appeared comparable with other series. Moreover, we observed a long-lasting efficacy: within 6 months and within 12 months after talc instillations, 20/20 patients and 9/9 patients respectively were symphysed with efficacy. Complications related to talc (8 g) were rare and moderate (pain, fever). Taking into account some technical aspects of talc instillation for good performance of the therapy, we recommend this method as the optimal route of administration.

Adult↗
PubMedDate not supplied

[Treatment of malignant pleural effusion by pleurodesis with talc].

In some types of cancer (breast, lung) a malignant pleural effusion may be present during the evolution of the neoplastic disease in more than 50% of cases. The main therapeutic option for palliative purposes in these cases is chemical pleurodesis with talc. The aims of this study were to report on our experience with the use of pleurodesis with talc in the treatment of patients affected by malignant pleural effusions and to analyse the results in the short and mean term. Over the period from January 1998 to December 1999, 16 patients were included in the study. The causes of the pleural effusion were a pleural mesothelioma in 1 patient and pleural metastases in 15 patients (from lung and breast cancers in 62%). We treated 14 of these patients with talc poudrage and 2 patients with talc slurry. The talc was applied under video-assisted thorascopic management in 15 patients, while in 1 patient the talc was injected via the thoracic drainage tube. Two patients died within the first month as a result of progression of the neoplastic disease and one patient was withdrawn from the study owing to failure to collaborate. Of the other 13 patients, 11 (84%) had a total or partial response to the pleurodesis; in 9 of these patients (69.2%) the response remained stable until death, while in 2 patients the pleural effusion reappeared after 3 and 5 months, respectively. Failure of the pleurodesis occurred in 2/13 patients owing to reappearance of the pleural effusion within the first month.

Female↗
PubMed2003

Talc powder vs doxycycline in the control of malignant pleural effusion: a prospective, randomized trial.

BACKGROUND: Malignant pleural effusion is a common problem in advanced cancers, contributing to the poor quality of life in this group of patients. The aim of the study was to assess the efficiency of talc powder and doxycycline in pleurodesis in patients with malignant pleural effusion in comparable conditions. MATERIAL/METHODS: Of 52 patients screened, 33 entered the trial. They were randomized to the talc group (n=18) and the doxycycline group (n=15). Both groups were comparable with regard to age, sex and the most important variables influencing effectiveness of the procedure, i.e. primary malignancy and stage of metastatic involvement of the pleura. Efficiency of pleurodesis was prospectively assessed. RESULTS: The analysis of short-term effectiveness of pleurodesis in the first 33 patients has shown a highly significant difference in favor of talc powder (p=0.009); this difference was the reason for terminating the randomization. Further observation has revealed in the doxycycline group an increasing number of patients with fluid reaccumulation, as time went by; this was not observed in the talc group. A statistical analysis of the long-term effectiveness of both agents studied has shown a more significant difference in favor of the talc powder (p=0.00003). CONCLUSIONS: Talc powder is superior to doxycycline in achieving pleurodesis in patients with malignant pleural effusion, in both short- and long-term observations.

Adult↗
PubMed1989

[Study of talc for pharmaceutical use. Trials of pharmacopoeias].

A study has been carried out on the possible pharmaceutical use of spanish talcs following the normalized assays of the main european pharmacopoeia and other quantitative methods. Only the talc nr3, not processed, meets all the assays of pharmacopoeia. The samples 2 and 4 (crushed) exceed the highest tolerated content in chlorides. The talc 1 (also crushed) only meets the loss on drying. The measures of some of these assays by using quantitative methods lead to more correct results and even sometimes in opposition with those obtained by pharmacopoeia methods. The particle size estimated by shifting and sedimentation shows that the crushed talcs are silty, whereas the only talc not processed is sandy. Considering the medium sizes estimated by scanning microscopy, it can be said that the pulverization of the talcs 1, 2 and 4 is characteristic of a micronization.

Particle Size↗
PubMed1988

Immunosuppression induced by talc granulomatosis in the rat.

Granulomatosis caused by four subcutaneous talc powder-suspension injections induced strong immunosuppression in rats. The disturbance included reduction of mononuclear white blood cell count in the peripheral blood, atrophy of the thymic cortex, spleen enlargement with predominance of red over the white pulp, increase in the number of lymph node germinal centres and a significant delay of the first-set and second-set allograft rejection. Neither phagocytic function of reticuloendothelial system nor erythrocyte count and humoral immune response were found to be altered. Indomethacin suppression of prostaglandin production did not normalize the allograft rejection dynamics. In contrast, splenectomy completely abolished the immunosuppressive effects of granulomatosis. In splenectomized, talc-treated animals WBC counts were not altered and the rejection of allografts was not delayed. Suppression of immune response to alloantigens was transferred to normal and splenectomized recipients by both serum and spleen cells of talc-injected animals. Also, in a cell mixture-transfer experiment, spleen cells from talc-granulomatosis-bearing donors suppressed the immune response induced by lymph node cells from immune donors in T cell-deficient rats. The inability of serum from splenectomized talc-injected rats to transfer the suppression suggested the crucial role of the spleen in the mechanisms leading to suppression in rats bearing talc-granulomatosis.

Animals↗
PubMedDate not supplied

Update on talc, bleomycin, and the tetracyclines in the treatment of malignant pleural effusions.

Talc has been used to treat malignant pleural effusions (MPE) for over 30 years and is usually considered to be the most effective chemical agent for pleurodesis. Clinicians, aware of limited reports of serious adverse effects attributed to talc, have generally reserved it for selected patients who are refractory to first-line chemical sclerosants. Tetracycline and bleomycin have therefore been cited as the preferred agents for the treatment of MPE. Clinical studies reported over the last 5 years reflect a continuing interest in talc as a chemical sclerosant and provide evidence of its effectiveness with minimal side effects. Comparisons with other agents are necessary to evaluate further the application of talc insufflation in the thoracoscopy suite and talc slurry at the patient's bedside. As clinicians continue to debate the relative merits of various pleurodesis agents, talc appears to be a reasonable choice for the treatment of MPE.

Bleomycin↗
PubMed1997

Perineal talc exposure and risk of ovarian carcinoma.

BACKGROUND: Clinical and epidemiologic studies have indicated the possible existence of an association between ovarian carcinoma and talcum powder use. Talc particles have been detected in histologic sections of ovarian carcinomas. It has also been demonstrated that inert particles travel from the perineum to the ovaries. Results from epidemiologic investigations have varied, from risks increased by twofold to no significant risk detected. METHODS: A total of 450 patients with borderline and invasive ovarian carcinoma and 564 population controls in metropolitan Toronto and nearby areas of southern Ontario, Canada, were identified. These subjects were interviewed about their reproductive and menstrual histories as well as their exposure to dusting powders. Continuous unconditional logistic regression methods were used for analysis. RESULTS: Exposure to talc, via sanitary napkins, direct application to the perineum, or both, was significantly associated with risk of ovarian carcinoma (odds ratio [OR] 1.42, 95% confidence interval [CI] 1.08-1.86). A borderline-significant association was detected between duration of talc exposure and risk (OR 1.09, 95% CI 0.98-1.21, per 10 years of exposure). No significant association was found between frequency of exposure and risk. In comparing invasive and borderline carcinomas, risk remained elevated for both carcinoma types. Only risk for invasive carcinoma was statistically significant. CONCLUSIONS: This investigation supports previous contentions that exposure to talc may increase risk of ovarian carcinoma. Questionable trends in duration and frequency of exposure suggest that further studies may be needed to clarify the role of talc in the etiology of this disease.

Adult↗
PubMed1999

Genital talc exposure and risk of ovarian cancer.

Epidemiologic studies have suggested an increased risk for ovarian cancer associated with the use of talcum powder in genital hygiene, but the biologic credibility of the association has been questioned. We conducted a population-based case-control study in eastern Massachusetts and New Hampshire involving 563 women with newly diagnosed epithelial ovarian cancer and 523 control women selected either by random digit dialing or through lists of residents. Use of body powders was assessed through personal interview and the exposure odds ratio (OR) for the use of talc in genital hygiene was calculated. Cases were more likely than controls (45% vs. 36%) to have used talc as a body powder in some manner, and the excess was confined to patients who used talc on the perineum directly or as a dusting powder to underwear or sanitary napkins. Relative to women who never used body powder or used it only in non-genital areas, the OR (and 95% confidence interval) associated with genital exposure to talc was 1.60 (1.18 and 2. 15) after adjustment for age, study location, parity, oral contraceptive use, body mass index and family history of breast or ovarian cancer. Exposure prior to rather than after a first livebirth appeared to be more harmful, and the association was most apparent for women with invasive serous cancers and least apparent for those with mucinous tumors. We conclude that there is a significant association between the use of talc in genital hygiene and risk of epithelial ovarian cancer that, when viewed in perspective of published data on this association, warrants more formal public health warnings.

Adult↗
PubMed2003

An update of a mortality study of talc miners and millers in Italy.

BACKGROUND: While talc containing asbestiform fibers is considered a human carcinogen, only limited animal and human data are available on non-asbestiform talc. To provide further evaluation on the issue, we updated the analysis of an Italian cohort of talc miners and millers in Val Chisone; talc found here is free from asbestiform fibers. METHODS: The cohort was comprised of 1,795 men who had worked for at least 1 year in the mine and/or in the factory between 1946 and 1995. Vital status and death certificates were obtained from registration offices in the municipality of death or of birth. Employment, termination of employment, and detailed job history were obtained from personnel records at the plant. RESULTS: No excess was found for total cancer mortality, nor mortality for lung cancer. No case of mesothelioma was reported. There was a significant excess mortality from non-neoplastic respiratory diseases (SMR 228.2, 95% CI 190.2-271.5). Mortality excess for non-neoplastic respiratory diseases was mainly due to silicosis. CONCLUSIONS: This study provides additional support for an association between talc in mining and milling and non-neoplastic respiratory diseases, while showing no significant excess risk for lung cancer and mesothelioma. The results also provide additional information of interest to evaluate the potential association between silica and lung cancer.

Asbestos↗
PubMed1995

Talc: occurrence, characterization, and consumer applications.

Talc is a mineral compound with unique attributes and significant commercial importance. As used in consumer products, talc has a long and proven history of safe use. Direct consumer applications include body powders, other cosmetic formulations, pharmaceutical tableting, and some confectionery food products. Production, characterization, and consumer applications of FDA-regulated talc products, particularly cosmetics, are described. The implementation of stringent safety and quality control measures designed to ensure the absence of asbestos fibers from consumer talc products is discussed. Consumer exposure to talc-containing products is at least 350 times lower than permissible industrial exposure.

Animals↗
PubMed1995

The NTP talc inhalation study: a critical appraisal focused on lung particle overload.

Recently published results in a NTP report of a 2-year inhalation study with talc in rats and mice seem to fit the category of being associated with particle overload quite well: Exposure concentrations of 6 and 18 mg/m3 induced pulmonary inflammation and fibrosis in male and female rats and induction of lung tumors (in female rats only) of the high exposure group; mice of either sex showed an inflammatory response but did not show pulmonary fibrosis or lung tumors. Analysis of the particle accumulation kinetics in lungs of both rats and mice indeed shows that lung overload had been reached at both exposure concentrations in both species resulting in increased talc accumulation of high lung burdens. This and the chronic inflammatory response indicate that the maximum tolerated dose (MTD) had been exceeded at both exposure levels. This result was predictable based on the outcome of a 4-week range-finding study prior to initiation of the chronic talc study; however, the short duration of the range-finding study may have been inadequate to give great confidence in the prediction and therefore may have accounted for the failure to include a concentration below the MTD in the chronic study. Further analysis of the results of the chronic talc study show that talc particles behave like other low-toxicity particles such as TiO2 and toner with respect to effects on lung clearance and chronic pulmonary inflammation.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Inhalation↗
PubMed1987

The pulmonary toxicity of talc and granite dust as estimated from an in vivo hamster bioassay.

A short-term animal bioassay was used to assess the toxicity of occupational dusts. We quantified pulmonary responses in hamsters exposed to granite (12% quartz) and talc (quartz and asbestos-free) dust collected from worksites. Personal samples collected on workers showed similar quartz content and particle-size distributions to the high-volume samples collected for bioassays, thus demonstrating that the particulates were representative of worker exposure. We measured biochemical and cellular indicators of injury in bronchoalveolar lavage fluid (BAL) of animals exposed to dust suspensions by intra-tracheal instillation. The assays measured release of cytoplasmic and lysosomal enzymes into the cell-free supernatant of BAL; levels of albumin and red blood cells; changes in macrophage and polymorphonuclear neutrophil cell numbers; and in situ macrophage phagocytosis. Dose-response (0.15, 0.75, and 3.75 mg/100 g body wt) and time-course (1-14 days postexposure) studies were performed. One day after exposure, both talc and granite dust resulted in elevated enzyme levels, pulmonary edema, and increased cell numbers in BAL. Macrophage phagocytosis was also inhibited. Based on earlier studies, response levels were either intermediate between nontoxic iron oxide and toxic alpha-quartz or comparable with alpha-quartz. The response to granite dust diminished fairly rapidly over time. By contrast, after talc exposure, there was a more persistent elevation in enzyme levels, and macrophage phagocytosis remained depressed. These results indicate that, when a similar mass was deposited in the lungs, talc caused more lung injury than did granite. Better estimates of exposure-dose relationships in talc and granite workers as well as longer-term animal studies are required to evaluate the harmfulness of these work environments at present-day exposure levels.

Animals↗