Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: KEGG:D01084 (Talc)
 215 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The use of pleuroscopy or thoracoscopy in preoperative staging and resectability assessment of lung cancer is uncommon. Diagnostic and exploratory thoracoscopy could be helpful in three circumstances: when malignant pleural effusion is suspected with a lung cancer, while all the initial investigations remain negative: (cytology, needle-biopsy); in cases with radiological images (using CTs-can or MRI) of small metastatic pleural masses without effusion: thoracoscopy is performed after creating a pneumothorax; when mediastinal or hilar extension of the tumor and lymph-nodes (especially in the left superior mediastinum) cannot be reached for biopsy by mediastinoscopy or parasternal mediastinotomy. The investigation is performed under general anesthesia using double-lumen selective intubation and lung exclusion. This procedure provides a better view of the pleural space and mediastinal and hilar areas; macroscopic involvement of vital structures, organs or vessels can be easily seen and large biopsy specimens safely taken, without any postoperative morbidity. Talc insufflation for pleurodesis is added in patients with massive pleural effusion. Failures of the method or false-negative biopsies are related to previous pleurodesis, pleural partition, or adhesions. The contribution of CT scan and MRI imaging is mandatory to determine indications and to select the best endoscopic approach.
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PMID:[Pleuroscopy in the preoperative staging of bronchial cancer]. 234 76

The use of talc for pleurodesis is a controversial issue. I have used talc in patients with malignant pleural effusion, recurrent pneumothorax, chylothorax and in selected cases of empyema. During pleuroscopy talc is insufflated through the lumen of the mediastinoscope. Up to 2 gr of purified talc is sprinkled under vision over the entire pleural surface. Of our total experience with 83 patients, 77 were available for follow up. Among 52 patients with pleural effusion, complete pleurodesis was achieved in 43 and partial pleurodesis in 5, with 4 failures. Of 21 patients with recurrent pneumothorax, complete pleural symphysis was achieved in 17 and partial in 3, with 1 failure. In all patients with empyema and with chylothorax, pleurodesis was complete. In total, obliteration of the pleural space was complete (excellent result) in 64 patients (83%) and partial (fair result) in 8 patients (10.5%). Talc failed to induced pleural symphysis only in 5 patients (6.5%). There were no complications and no deaths related to the procedure. This is attributed to the fact that only purified (British Pharmacopoeia) talc was used and its amount never exceeded 2 gr. The use of talc in pleura is safe and useful. It provides excellent palliation in patients with malignant pleural effusion and cure in the other groups. Excessive concern about complications of using talc is unjustified.
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PMID:Talc pleurodesis : a controversial issue. 731 61

We performed diagnostic pleuroscopy in 66 patients with pleural effusion and in 14 with pleural masses. The findings were diagnostic in 76 patients (95%). Pleural metastases were found in 63 patients, primary pleural or lung tumor in 5, and less common findings in the remainder. Only 1 minor complication occurred, and there were no deaths. Malignant pleural effusion causing dyspnea was managed successfully by talc insufflation under direct vision in 31 of 35 patients. Talc also was used with equal success and without complications in management of recurrent pneumothorax. We conclude that pleuroscopy is a useful diagnostic and therapeutic procedure. It is simple and well tolerated, has a diagnostic yield of 95%, and is virtually free from complications. It provides the best way of insufflating talc for pleurodesis.
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PMID:Pleuroscopy in patients with pleural effusion and pleural masses. 736 9

Experience with 127 pleuroscopies using the mediastinoscope is reviewed. The most frequent indications were pleural effusion (73 patients), pleural involvement by tumor (14), empyema (14), and recurrent pneumothorax (14). Findings were diagnostic in 119 of 127 patients (93.7 percent). Pleural metastases were found in 63 patients, primary pleural or lung tumor in six, nonspecific or tuberculous empyema in 17, emphysematous blebs in 12 and less common findings in the remainder. Pleuroscopy was usefully employed to determine chest wall penetration by a malignant lung tumor in five patients with severely restricted pulmonary reserve. Positive findings helped to avoid unnecessary thoracotomy. There were two minor complications and no deaths. Malignant pleural effusion causing dyspnea was managed successfully by talc insufflation under direct vision in 35 of 39 patients. Talc was also used, with equal success and without complications, in eight patients with recurrent pneumothorax and in two with empyema after evacuation of pus. We conclude that pleuroscopy is a useful diagnostic and therapeutic procedure, simple and well tolerated, with the diagnostic yield of over 90 percent and virtually free of complications. It provides the best way of insufflating talc for pleurodesis.
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PMID:Diagnostic and therapeutic pleuroscopy. Experience with 127 patients. 742 55

Malignant pleural effusion (MPE) causes significant morbidity in cancer patients. Management is often challenging because of the recurrent nature of MPE and the inconsistent response rates of various treatments. In patients whose underlying malignancy is unresponsive to systemic chemotherapy or radiation, MPE is usually managed by tube thoracostomy with subsequent sclerotherapy. Selection of a sclerosing agent should be based on several factors, including efficacy, toxicity, cost, and convenience. Of the numerous agents available for managing MPE, doxycycline, bleomycin, and talc have emerged as the most promising. Even these agents have disadvantages, such as the high cost of bleomycin and the possible need for multiple dosing of doxycycline. Talc is clearly the most controversial of the three. Although its efficacy is well documented, its role remains unclear because of its unattractive side effect profile and inconvenient preparation and administration. Results of controlled comparative trials are needed to identify the optimal sclerosing agent.
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PMID:Sclerotherapy for malignant pleural effusions: alternatives to tetracycline. 774 98

To evaluate the efficiency of pleurodesis (PD) in the management of symptomatic malignant pleural effusion (PE) in breast cancer, we reviewed 46 patients undergoing 49 PDs. When radiotherapy was part of the initial treatment, 41% of PEs were ipsilateral to the primary, if not, 85% of PEs were ipsilateral (P < 0.0075). Six percent of patients presented dyspneic with exertion, 32% during daily routine; 61% at rest. All except 1 were improved after PD; 74% had no dyspnea, 23% had exertional dyspnea. PD relieved chest pain in 4 and cough in 5 patients. With 31 Talc/Iodine PDs, 2 mortalities and 2 minor complications occurred. Of 17 tetracycline PDs, 1 was complicated by bronchopleural fistula and 1 failed. 1 Mustine PD was uncomplicated. Survival at 6, 12, and 24 months was 58%, 40%, and 13%, respectively. Primary local radiotherapy may prevent ipsilateral PE. Talc/Iodine and tetracycline PD reliably provide relief from the distressing symptoms of malignant PE.
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PMID:Breast cancer complicated by pleural effusion: patient characteristics and results of surgical management. 789 13

Chemical pleurodesis has become the preferred treatment for definitive management of malignant pleural effusions. The treatment of patients with recurrent benign or undiagnosed pleural effusions, however, remains a difficult clinical problem. Tetracycline has been widely used as a sclerosing agent, but parenteral tetracycline is no longer available. Therefore, alternative sclerosing agents are needed. Talc was used for the first time in 1935, and subsequently there have been several reports documenting its effectiveness in the treatment of malignant pleural effusion and pneumothorax. The objective of this study is to present our experience with a low dose of aerosolized talc for controlling nonmalignant pleural effusions. Between May 1985 and October 1992, twenty-two patients underwent talc pleurodesis at the time of thoracoscopy for control of a nonmalignant effusion. The cause of the effusion was cirrhosis in six patients, systemic lupus erythematosus in two, chylothorax in five, and no diagnosis in nine patients. Follow-up has ranged from 18 days to 5 years. Only two patients (9 percent), one with cirrhosis and another with an undiagnosed pleural effusion, had a recurrence of the effusions. We conclude that the intrapleural administration of 2 g of aerosolized talc is an effective treatment for recurrent benign (including chylothorax) or undiagnosed pleural effusions.
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PMID:Intrapleural talc for the prevention of recurrence in benign or undiagnosed pleural effusions. 798 98

Talc was used intrapleurally for the creation of pleural adhesions in 360 patients. The indications for use were malignant pleural effusion in 169 patients, benign effusions in 41, recurrent pneumothorax in 122, empyema in 19, and chylothorax in 9. Of 336 patients available for follow-up, excellent results (complete pleurodesis) were achieved in 284 patients (84.5%), fair results in 28 (8.3%), and poor results (no adhesions) in 24 (7.2%). The results were best in empyema (100%) and better in pneumothorax than in pleural effusions. With repeat talc insufflation, the results were improved to excellent in more than 90% of the patients. Talc is the most effective and least expensive agent for creation of pleural adhesions. Its use is simple and easily tolerated by the patients. Because of the carcinogenic effect of asbestos, purified talc that is free of asbestos fibers must be used.
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PMID:Talc pleurodesis. Experience with 360 patients. 841 64

Talc pleurodesis was performed in a prospective trial in 38 patients with recurrent malignant pleural effusion. After insertion of a chest tube a slurry containing 8g of iodined talcum, 0.5 ml of 1% xylocain/kg/body weight, and 80 ml of 0.9% NaCl was administered and suction drainage was performed. The chest tube could be removed after 4 +/- 1.7 days. A successful therapy could be achieved in 33/38 patients (86.8%). 2 patients (5.3%) suffered from recurrent pleural effusion which only in 1 case had to be drained. 3 patients died within the first month after talc pleurodesis due to an advanced cancer stage. Complications did not come to evidence in any case.
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PMID:[Talc pleurodesis in recurrent malignant pleural effusion--a prospective follow-up study]. 886 48

Pleurodesis is intended to prevent the accumulation of fluid or air in the pleural space by creating symphysis between the visceral and parietal pleura. The main indications for this procedure are malignant effusions and pneumothorax. A reexpandable lung and reasonably long expected survival are criteria that must be met before pleurodesis is attempted in a patient with malignant pleural effusion. A low pleural fluid pH (less than 7.20) is a good predictor for both the presence of a trapped lung and short expected survival. Talc appears to be the sclerosing agent of choice in cases of cancer, whereas video-assisted thoracic surgery techniques are preferable for the treatment of pneumothorax, especially in young patients. To improve results and prevent complications, application of the right technique is crucial, especially with regard to size of drainage and rate of suction. In addition, recent research suggests that prevention of a systemic activation of coagulation with prophylactic heparin should be taken into account in patients who are undergoing pleurodesis for palliative treatment of malignant effusion.
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PMID:Current trends in pleurodesis. 926 21


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