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PubMed1994

Biological effects of cosmetic talc.

A review of the literature reveals two primary issues: (1) a weak, but not causal, association of hygienic use of cosmetic talc and ovarian cancer; (2) lung changes in animals exposed to talc aerosol concentrations that resulted in lung overload. The evidentiary weight of the most significant of the epidemiological and laboratory studies and their biological significance for human risk assessment are briefly discussed. Publications describing granulomatous lesions attributed to talc on surgical gloves, and consequences of accidental inhalation of baby powder by infants are also reviewed. The literature reviewed does not provide any convincing evidence that pure cosmetic talc, when used as intended, presents a health risk to the human consumer.

Animals↗
PubMed2006

Videothoracoscopic talc poudrage in primary spontaneous pneumothorax: a single-institution experience in 861 cases.

OBJECTIVE: We sought to evaluate the outcome of 861 patients treated with videothoracoscopic talc poudrage for primary spontaneous pneumothorax. METHODS: From September 1995 through January 2004, a total of 861 patients (578 male, 283 female, mean age 28.6 years) underwent videothoracoscopy for recurrent and complicated primary spontaneous pneumothorax. Patients were treated with videothoracoscopic talc poudrage only (group A: Vanderschueren's stage I, 196 patients; stage II, 112 patients) or videothoracoscopic talc poudrage plus stapling of the blebs/bullae (group B: stage III, 391 patients; stage IV 162 patients). Follow-up included clinical interview and chest radiography (805 patients). In 26 patients (follow-up longer than 5 years), respiratory function was investigated to determine residual volume and diffusing lung capacity. RESULTS: No operative deaths occurred. No patient had adult respiratory distress syndrome. Postoperative complications occurred in 29 patients (3.36%). The conversion rate to an open procedure was 0.46% (4/861). After a mean follow-up of 52.5 months, 14 patients had recurrences (1.73%). The recurrence rate was 2.41% (7/290) in group A and 1.359% (7/515) in group B (chi2 value: 1.207389; P:.27; odds ratio: 0.56; 95% confidence interval: 0.20-1.62). Results of respiratory function tests were within normal ranges (80% or more of predictive value) in all 26 patients. CONCLUSIONS: Videothoracoscopic talc poudrage achieves a high success rate in the treatment of primary spontaneous pneumothorax with a very low morbidity rate. Recurrences show a statistically significant relationship (P:.037) with smoking habits.

Adolescent↗
PubMed1995

Talc poudrage for treatment of pleural effusion in selected patients.

Recurring pleural effusions are a significant cause of patient morbidity. Treatment goals are to relieve distressing symptoms (eg, dyspnea, pain) caused by the effusion, to prevent further extracellular fluid accumulation in the pleural space, and to restore the patient to a functional pulmonary status. Talc poudrage is a therapy that instills iodized talc through a tube thoracostomy to cover opposing pleural surfaces with an irritating powder. Talc stimulates adhesion formation that obliterates the pleural space. Recent study results indicate that intrapleural instillation of iodized talc is an adequate and effective treatment for control of neoplastic or benign pleural effusion.

Contraindications↗
PubMed1999

Pleurodesis by autologous blood, doxycycline, and talc in a rabbit model.

BACKGROUND: Management of recurrent spontaneous pneumothorax or symptomatic pleural effusion often uses thoracoscopic pleurodesis, about which many questions remain. Both effectiveness and toxicity of agents currently used for pleurodesis were evaluated in a rabbit model. METHODS: Agents administered were autologous blood 1 mL/kg, talc slurry (70 mg x mL(-1) x kg(-1)), and doxycycline 10 mg/mL, given through a chest tube to 30 rabbits. Controls had only chest tubes inserted. At 30 days surfaces were graded by gross observation and histologic examination. Blood and lung tissue from all animals were analyzed for enzymes and blood chemistries. RESULTS: Gross observations showed mediastinal thickening and adhesions with doxycycline, and threadlike adhesions with talc. Autologous blood was only slightly more effective than a chest tube alone. Talc significantly increased angiotensin converting enzyme activity in serum, whereas doxycycline changed liver function enzymes and produced tissue toxicity. CONCLUSIONS: Doxycycline produced effective pleurodesis but yielded remarkably severe local effects. The distant sequelae of talc and doxycycline pleurodesis-histologic changes in the contralateral lung and serum enzyme elevations-suggests undesirable systemic effects for the commonly used agents, and autologous blood exhibited no significant pleurodesis, short-term. The search for the ideal agent for chemical pleurodesis continues.

Animals↗
PubMed1981

Pulmonary pathology in workers exposed to nonasbestiform talc.

We studied pulmonary tissue from seven men employed in the mining and milling of talc that contained minimal amounts of crystalline silica and asbestiform minerals. The lungs exhibited varying degrees of fibrosis, located either adjacent to the vessels and bronchi or diffusely. Semiquantitative estimations of talc in the lung tissue indicated that the extent of the pulmonary lesions corresponded to its concentration in the tissue. Histopathologic findings were evaluated with regard to duration of occupational exposure and radiographic changes in the chest. In three of the seven workers with exposures of 26, 27, and 27 years chest roentgenographic changes were consistent with pneumoconiosis. The lung tissues from four other patients with exposure histories of four, five, 13, and 19 years exhibited focal and diffuse fibrosis with accumulations of talc, but the chest x-ray films were negative. Crystallographic studies of digestates of lung tissue indicated that the talc contained few mineral impurities. An increase in dust load in the lungs was associated with duration of employment.

Adult↗
PubMed2002

Comparing transforming growth factor-beta2, talc and bleomycin as pleurodesing agents in sheep.

BACKGROUND: Transforming growth factor (TGF)-beta2 can produce effective pleurodesis in animals, but its efficacy has not been compared with commonly used pleurodesing agents in sheep, which have a thick pleura resembling that of humans. The acute physiological effects and the level of systemic TGF-beta absorption after its intrapleural administration have not been studied. The aims of the present study were to compare: (i) the effectiveness of TGF-beta2, talc and bleomycin in producing pleurodesis in sheep; (ii) the acute side-effects and systemic TGF-beta levels following the intrapleural administration of these agents; and (iii) histological changes after intrapleural injections of these agents. METHODOLOGY: Twelve sheep were divided into three groups and were given a single intrapleural dose of TGF-beta2 (0.25 microg/kg), talc slurry (5 g) or bleomycin (60 IU) via a chest tube. Saline or buffer was injected into the contralateral side, which served as the control. Arterial blood gases and respiratory and heart rates were monitored for the first 24 h. Plasma levels of TGF-beta1 and TGF-beta2 were measured. Pleurodesis was graded macroscopically from 1 (none) to 8 (symphysis > 50% of hemithorax) at day 14. RESULTS: At day 14, the pleurodesis score of the TGF-beta2 group (7.7+/-0.6) was similar to that of the talc (7.0+/-1.7) group and significantly higher than that of the bleomycin group (3.3+/-2.3; P < 0.05). No significant differences were seen in arterial blood gas analysis, vital signs and plasma TGF-beta1 and TGF-beta2 concentrations among the three groups. CONCLUSIONS: Transforming growth factor-beta2 was as effective as talc and more so than bleomycin in inducing pleurodesis in sheep. Intrapleural administration of TGF-beta2 appeared safe. No acute changes in gaseous exchange or macroscopic abnormalities were seen following intrapleural TGF-beta2. Importantly, there was no evidence of an increase in systemic TGF-beta levels following its intrapleural administration.

Analysis of Variance↗
PubMed1978

Talc-coated rice as a risk factor for stomach cancer.

Analysis of data from Japan and Hawaii offers no support for the hypothesis that the use of talc-coated rice increases the risk of developing stomach cancer. This conclusion is based on the observation that Japanese in Japan have very high rates of stomach cancer but consume no talc-coated rice, that Japanese in Hawaii have intermediate rates of stomach cancer but consume considerable amounts of talc-coated rice, and that Filipinos in Hawaii have very low rates of gastric cancer but consume the highest amounts of talc-coated rice of these three groups. Furthermore, secular trends in gastric cancer incidence show a much greater decrease in the incidence of this tumor among the exposed Japanese in Hawaii than among the unexposed Japanese in Japan.

Asbestos↗
PubMed1987

Talc liver.

Talc in the liver is highly suggestive of intravenous drug abuse. We report three patients in whom finding talc or talc granuloma on liver biopsy led to the diagnosis of unsuspected i.v. drug abuse. There follows a discussion of the pathogenesis, laboratory and clinical features, and liver pathology of talc liver.

Adult↗
PubMed2001

Unilateral pulmonary edema after talc pleurodesis.

Talc is commonly given after drainage of the pleural space to create pleural symphysis. Recognized complications of pleural drainage followed by talc pleurodesis include reexpansion pulmonary edema, pneumonia, and adult respiratory distress syndrome. This report describes a complication of talc pleurodesis that appears not to have been appreciated previously. Chest radiographs obtained before and after talc pleurodesis were evaluated in a total of 108 patients in three groups; 89 of these patients were receiving palliative therapy for malignant pleural effusion. Approximately 16% of the 108 patients developed a transient interstitial process in the lung ipsilateral to the treated pleural space. The recognized complications are inadequate to account for these radiographic findings. Other interstitial diseases such as hydrostatic pulmonary edema and lymphangitic carcinomatosis also are not adequate explanations. The observed complication is most likely the result of endothelial damage leading to a capillary leak type of pulmonary edema.

Female↗
PubMed1996

Respiratory disease as a result of talc inhalation.

Three cases of respiratory disease in workers with occupational exposure to talc containing asbestos fibers are reported. Standard chest roentgenographs, high-resolution computed tomography, respiratory function tests, morphologic study of bronchoalveolar lavage fluid (BAL), light microscopic examination, and mineralogical analysis by transmission electron microscopy (TEM) of BAL was performed. All subjects showed bilateral pleural plaques, and in two subjects the study of BAL revealed lymphocytic alveolitis with an increased T4/T8 ratio. Mineralogical analysis of BAL detected asbestos-fiber concentrations of 510, 2039, and 3392 fibers/mL and many asbestos bodies. In one patient, mineralogical analysis of lung tissue was also performed; a concentration of 3,659,000 fibers/g dry tissue was found. Simultaneously, we performed a mineralogical study of 12 commercial talc samples, including those used by the patients during the last phase of their working lives. TEM revealed asbestos fibers in five samples. Two subjects used two of these talc powders. The study presented here confirms the need to perform all relevant clinical tests together with the study of BAL and mineralogical analysis of the materials to which the patients are or were exposed to determine occupational exposure to fibers, including those associated with talc, which are often misidentified.

Air Pollutants, Occupational↗
PubMed2003

Talc pleurodesis mimics pleural metastases: differentiation with positron emission tomography/computed tomography.

Talc pleurodesis is a technique used in the treatment of patients with persistent pleural effusions or pneumothorax not amenable to other treatment. These are commonly seen in patients with malignant thoracic neoplasms. Radiographic abnormalities resulting from prior talc pleurodesis could be confused with progression of the underlying neoplastic process. Positron emission tomography with F-18 fluorodeoxyglucose (FDG-PET) might be unable to distinguish between malignant and benign inflammatory processes. This report demonstrates the use of combined positron emission tomography/computed tomography (PET/CT) in a patient with a history of both malignant neoplasm and a prior talc pleurodesis. Fusion of PET and CT studies could add information that CT and PET alone cannot. This could alter the diagnostic and therapeutic course for patients with a history of both thoracic neoplasm and talc pleurodesis.

Chylothorax↗
PubMed1995

Survey of the respiratory health of the workers of a talc producing factory.

OBJECTIVES: To assess the effect of an occupational exposure to talc dust on respiratory health. METHODS: 166 talc millers from a French factory underwent spirometry and filled in a standardised respiratory questionnaire during their annual medical visit in 1989. A full sized chest radiograph taken in 1987 for the subjects hired before 1982 was also available, for the others a radiograph taken when hired was used. Radiography was repeated in 1992 for all subjects still active at this date (n = 139). The occupational exposure to talc dust was characterised for each workplace with 1440 personal samples collected since 1986 and by semiquantitative estimates of the historical exposure. RESULTS: The geometric mean (range) of estimated exposure was 1.87 (0.5 to 50) mg/m3 and the estimated cumulative exposure at the date of spirometry was > 150 y mg/m3 for 41 subjects. After adjustment for smoking in a linear model the standardised residual values of both forced vital capacity and forced expiratory volume in one second decreased significantly with increasing exposure. The prevalence of dyspnoea also increased after adjustment for smoking categories and age in a logistic regression. The prevalence of small radiological opacities was significantly related to age and to the exposure after adjustment for age and smoking categories. The incidence of new opacities between the two radiographs (11 new opacities with a profusion higher than 0/1) was significantly related to smoking (10 out of 11 are smokers) but not to the exposure. CONCLUSION: This study shows an effect of high levels of talc dust both on functional variables and on the prevalence of small radiological images, but provides no clear evidence about the possible effect of present levels of exposure.

Adult↗
PubMed1989

Spontaneous pneumothorax: comparison of simple drainage, talc pleurodesis, and tetracycline pleurodesis.

From 1978 to 1985 96 patients with their first spontaneous pneumothorax were randomised into three groups, receiving either treatment with simple drainage (34 patients), drainage with tetracycline pleurodesis (33 patients), or drainage with talc pleurodesis (29 patients). There were 58 men and 38 women, aged 18-88 years. There was no significant difference between the three groups in the mean time in hospital or the period for which the drains were retained. The incidence of infection, persistent pneumothorax, and relapse while in hospital was also similar for the three groups. At follow-up in 1987-89 patients could be accounted for, with an average follow-up period of 4.6 years. The incidence of recurrence was 36% in the simple drainage group, 13% in the tetracycline pleurodesis group, and 8% in the talc pleurodesis group. The difference between the talc and simple drainage groups was significant. None of the methods caused severe short or long term side effects or changes in the follow-up chest radiograph. Thoracoscopy, performed on admission in 85 patients, showed normal appearances in 73 patients and small cysts in 12. The thoracoscopic findings were of no value in predicting recurrence. Talc pleurodesis resulted in a significantly lower recurrence rate than simple drainage, tetracycline pleurodesis having intermediate efficacy.

Adolescent↗
PubMed1976

Comparison of talc-Celite and polyelectrolyte 60 in virus recovery from sewage: development of technique and experiments with poliovirus (type 1, Sabin)-contaminated multilitre samples.

For virus recovery from sewage, a mixture of talc and Celite was tested as a possible inexpensive substitute for polyelectrolyte 60 (PE 60). After adjustment of pH to 6 and the addition of 45-60 plaque forming units (PFU)/ml of poliovirus type I (Sabin) to the sewage sample under test, 100 ml of it was passed through either a PE 60 (400 mg) or a talc (300 mg)-Celite (100 mg) layer; the layer-adsorbed virus was eluted with 10 ml of 10% fetal calf serum (FCS) in saline (pH 7.2). In these experiments, PE 60 layers recovered 73-80% (mean 76%) of the input virus. In comparison, virus recoveries with the talc-Celite layers were 65-70% (mean 68%). Passage of 5 litres of raw sewage (containing 50 to 1.26 X 10(5) PFU/100 ml of the poliovirus) through the talc (15 g)-Celite (5 g) layers and virus elution with 50 ml of 10% FCS in saline gave virus recoveries of 33-63% (mean 49%). Except for pH adjustment and prefiltration through two layers of gauze to remove large solids, no other sample pretreatment was found to be necessary. Application of this technique to recovery of indigenous viruses from field samples of raw sewage and effluents has been highly satisfactory.

Adsorption↗
PubMed2006

The neutrophilic and fibrinolytic response to talc can predict the outcome of pleurodesis.

It was hypothesised that monitoring neutrophil and D-dimer (DD) levels into the pleural fluid, after talc instillation, could predict the outcome of pleurodesis. The current authors investigated a total of 168 patients with malignant pleural effusion, who were treated with talc poudrage. According to the outcome the patients were categorised into one of two groups, either successful or failed pleurodesis. In all cases, pleural fluid neutrophils and DDs were determined on serial measurements at 0, 3, 24 and 48 h after the procedure. The time course of these parameters was assessed in both groups and the time point at which they could better predict the outcome was further explored. Neutrophils rose rapidly after talc poudrage in both groups, reaching a plateau at 24 h, although in successful pleurodesis this response was significantly higher. DD dropped markedly at 24 h in the group with the successful outcome, but it did not show significant changes in the other group. A cut-off value of 61% for neutrophils and 61 mg.L-1 for the DD at 24 h yielded the best prognosis for successful pleurodesis. The current authors conclude that serial measurements of neutrophil and d-dimer values into the pleural fluid after talc poudrage could be used as predictors of the outcome of pleurodesis.

Adolescent↗
PubMed1991

Amphibole content of cosmetic and pharmaceutical talcs.

Pharmaceutical and cosmetic-grade talcs were examined for asbestiform amphibole content using a new density-optical method. Talcs under the Food and Drug Administration are not regulated as to asbestos content; however, all talcs were well below the level mandated by the Occupational Safety and Health Administration for industrial talcs. Only one was found to contain an amphibole particle size distribution typical of asbestos.

Asbestos↗
PubMedDate not supplied

Pleurodesis with iodized talc for malignant effusions using pigtail catheters.

OBJECTIVE: To assess the efficacy of using an iodized talc slurry as a sclerosing agent instilled into the pleural space via a 12-French pigtail catheter for controlling malignant pleural effusions. DESIGN: A prospective study in which patients were followed until their death. SETTING: A university-affiliated tertiary-care teaching hospital. PATIENTS: Medical oncology patients admitted with symptomatic malignant pleural effusions were considered for iodized talc pleurodesis. MAIN OUTCOME MEASURES: The control of pleural effusion. Treatment failure was defined as any reaccumulation of fluid in the pleural space. RESULTS: Fifteen patients were treated for a total of 17 instillations. The median follow-up on all patients until death was 6 months (range 1-20). The most frequent adverse effect in the study group was pleuritic chest pain (60%). The probability of control of effusion, as determined by the method of Kaplan-Meier, was 81% (SEM 9.7%). The cost of preparing 5 g of iodized talc was $4.32 (US). CONCLUSIONS: Iodized talc slurry instilled through a small-bore pigtail catheter is a safe, economical, and effective treatment for malignant pleural effusion.

Adult↗
PubMed1993

Survival and talc pleurodesis in metastatic pleural carcinoma, revisited. Report of 125 cases.

STUDY OBJECTIVE: To find out whether patients with different types of metastatic pleural carcinomas have significant differences in survival, as related to pleural fluid glucose and pH. A second objective was to evaluate the outcome of talc poudrage for pleurodesis. DESIGN: Cohort analytic prospective study; follow-up of patients from thoracoscopic diagnosis and evaluation to death. SETTING: Pulmonary department at a referral medical center. PATIENTS: One hundred twenty-five patients with metastatic pleural carcinoma diagnosed by thoracoscopy were evaluated prospectively. One patient was lost to follow-up. INTERVENTIONS: Thoracoscopy was performed in every patient, with talc pleurodesis performed at the end of each procedure. MEASUREMENTS AND RESULTS: On the same day as thoracoscopy or the previous day, glucose levels and pH of both the blood and pleural fluid were determined. The outcome of talc poudrage was that pleural effusions were controlled in 104 out of 119 patients (87 percent). Pleurodesis failed in 43 percent (6/14) of the patients with a pleural fluid pH lower than 7.20, as opposed to 9 percent (8/92) of failures in patients with a pH above this limit (p < 0.01). Average survival was as follows: nonsmall cell lung cancer (n = 40), 4.3 months (range, 1 to 15 months); small cell lung cancer (n = 8), 3.7 months (1 to 12 months); breast carcinoma (n = 30), 7.4 months (1 to 29 months); and ovarian carcinoma (n = 8), 9.4 months (1 to 29 months). There was a significant difference in survival between patients with breast carcinoma and patients with cancer not sensitive to chemotherapy (7.4 vs 4.7 months; p < 0.02), although the pleural tumor lesion rating was even greater in the first group. We found no significant differences between lung carcinomas and those from other origins. Patients with a low pleural fluid glucose level and low pH had significantly shorter survival than the group with high glucose and high pH levels (1.9 vs 5.7 months, respectively; p < 0.005). CONCLUSIONS: We confirmed our previous data demonstrating poor survival in patients with pleural effusions with low glucose and pH levels. The outcome of talc pleurodesis correlated to these same parameters. These results apply to all kinds of metastatic pleural carcinomas.

Adult↗