Chest
Laboratory and Animal InvestigationsTalc Preparations Used for Pleurodesis Vary Markedly From One Preparation to Another
Section snippets
Materials and Methods
Talc was obtained from four different suppliers in the United States: talc A (Sigma Chemicals; Saint Louis, MO), talc B (Malinckrodt; Chesterfield, MO), talc C (J.T. Baker; Phillipsburg, PA), and talc D (Integra Chemical; Renton, WA); and from one supplier each in Spain (Luzenac talc; Distalc; Barcelona, Spain), France (Luzenac Europe; Toulouse, France), Taiwan (Merck Taiwan LTD; Taipei, Taiwan), and Brazil (Xilolite; Sao Paulo, Brazil). The particle size distribution was determined for each
Results
There was marked variation in the distribution of the particle sizes from one talc preparation to another (Table 1) . The mean particle sized ranged from 10.8 μm for one of the talcs from the United States to > 30 μm for the talcs from France and Taiwan. Similarly, the medium particle size ranged from 7.8 μm for the one talc from the United States to 31.3 μm for the talc from France. Similar wide variations were demonstrated in the 10th and 90th percentiles for the different talcs. The
Discussion
The present study demonstrates that there is marked variation in the mean particle size from one talc preparation to another. In addition, there are also marked differences in the impurities in the various talc preparations. The differences in the incidences of respiratory distress following the intrapleural administration of talc may be due to differences in the physical characteristics of the preparations.
Talc is a pulverized, natural, sheet-like, hydrated magnesium silicate with the
ACKNOWLEDGMENT
The authors thank Dr. Ming Jeng Peng for supplying the talc from Taiwan and Dr. Francisco Vargas for supplying the talc from Brazil. The authors also thank Dr. Gary Lee, Dr. Karl Kuhn, Ms. Ada Chako-Moore, and Dr. Hassaan Mohamed for editorial assistance.
References (18)
- et al.
Adult respiratory distress syndrome following intrapleural instillation of talc
Thorac Cardiovasc Surg
(1983) - et al.
Acute pneumonitis with bilateral effusion after talc pleurodesis
Chest
(1984) - et al.
Pleurodesis using talc slurry
Chest
(1994) - et al.
Respiratory failure following talc pleurodesis
Am J Surg
(1999) - et al.
Talc pleurodesis: experience with 360 patients
Thorac Cardiovasc Surg
(1993) - et al.
Talc slurry pleurodesis: pleural fluid and histologic analysis
Chest
(1995) - et al.
Systemic distribution of talc after intrapleural administration in rats
Chest
(1999) - et al.
Talc: occurrence, characterization, and consumer applications
Regul Toxicol Pharmacol
(1995) - et al.
Respiratory failure due to insufflated talc
Lancet
(1997)
Cited by (110)
Surgical Management of Pleural Diseases – Primer for Radiologists
2023, Seminars in RoentgenologyTalc Pleurodesis: A Medical, Medicolegal, and Socioeconomic Review
2020, Annals of Thoracic SurgeryDiagnosis and management of pleural metastases and malignant effusion in breast cancer
2018, The Breast: Comprehensive Management of Benign and Malignant DiseasesThoracoscopy
2015, Murray and Nadel's Textbook of Respiratory Medicine: Volume 1,2, Sixth EditionManagement of symptomatic and metastatic pleural effusions - Interactive clinical case
2014, Revue des Maladies Respiratoires ActualitesMalignant Pleural Effusions. A Review.
2013, Clinics in Chest MedicineCitation Excerpt :ARDS occurs in up to 9% of cases of talc pleurodesis41; however, this complication was associated with nongraded talc. It is believed that talc less than 10 μm in diameter may be harmful, because the pleural stomata are 8 to 10 μm in diameter and talc particles smaller than this may lead to systemic absorption of the talc and an exaggerated cytokine response.42 There may be a decreased risk of these complications when small-particle talc (<5 μm) is removed from the preparation,43 and in a European cohort study of 558 patients treated with 4 g of graded talc,41 no episodes of ARDS occurred.
Supported in part by the Saint Thomas Foundation, Nashville, TN.
Dr. Ferrer and Dr. Villarino contributed equally to the design of thestudy and writing the article.