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The biology of talc.

Data are presented on the effects on health of talc dusts from exposure in industry and use of talc-containing health products. The mineralogy of talc and the composition of cosmetic and industrial grade talc dusts are described. Studies in animals are reviewed, and epidemiological data are considered in relation to exposures that occur during industrial and consumer uses of talc dusts. Hamsters exposed to 8 mg/m3 of respirable cosmetic grade talc dust for up to 150 minutes a day for 300 consecutive days showed no difference in incidence or nature of pathological lesions from those observed in a group of untreated animals. A retrospective study of the causes of death of 227 talc mine millers exposed to cosmetic grade talc at the threshold limit value for talc (20 million parts per cubic foot) for an average of 15-8 years showed that the causes of death were no different from those in a control cohort not exposed to talc dust. The available data indicate that talc dust exposure in the modern mining of cosmetic grade talc does not appear to be injurious to health. The significantly lower dust exposure in the normal use of cosmetic grade talc dusts in talc-containing health and cosmetic products confirms that their use is not a hazard to health.

Animals

Studies of respiratory morbidity in rubber workers. Part IV. Respiratory morbidity in talc workers.

Pulmonary function tests, chest x-rays, and respiratory questionnaires were administered to eighty talc workers and 189 non-exposed rubber workers from three rubber tire manufacturing plants. The talc workers, who were exposed to talc at levels below the current threshold limit value (TLV) of 20 mppcf for nonfibrous talc, had a statistically significantly greater prevalence of productive cough and of positive criteria for chronic obstructive lung disease (COLD) than did the control workers. The talc workers with more than 10 years of exposure had significantly decreased residual FEV 1.0. Multiple regression analysis of FEV 1.0 in the talc workers estimated that each year of exposure to talc dust reduced the FEV 1.0 by 26 ml. Talc workers had a clear increase in respiratory morbidity, despite the absence of chest roentgenographic changes. Based on this study, a safe exposure level for talc appears to be 25 mg/m3 as a time-weighted average.

Bronchitis

Intravenous injection of talc-containing drugs intended for oral use. A cause of pulmonary granulomatosis and pulmonary hypertension.

Clinical and morphologic features are described in two patients known to have repeatedly injected intravenously talc-containing drugs intended for oral use. In one patient severe pulmonary hypertension developed; the talc granulomas in him were located predominantly within the pulmonary arteries. The second patient had normal pulmonary arterial pressures, and the talc granulomas in him were located predominantly in the pulmonary interstitium. Of 19 previously described patients with pulmonary talc granulomas, 12 had morphologic evidence of pulmonary hypertension (in three of severe degree); in each, talc granulomas were located predominantly within the pulmonary arteries. In those without signs of pulmonary hypertension, granulomas were located predominantly in the pulmonary interstitium. Why there are differences in the distribution of the talc granulomas is unclear. It is clear, however, as demonstrated by one of our patients, that severe pulmonary hypertension may be a consequence of intravenous injection of drugs intended for oral use.

Adolescent

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

Animal experiments with talc.

Italian talc has been tested on rats using three routes, intra-pleural inoculation, inhalation and ingestion. Groups exposed to superfine chrysotile asbestos and untreated controls were included for comparison. In all the experiments animals were allowed to live out their lives. The intra-pleural inoculation of talc produced no mesotheliomas in contrast to eighteen produced by the chrysotile asbestos. After ingestion, one leiomyosarcoma occurred with Italian talc and one with chrysotile asbestos. Whether these tumours are a consequence of the feeding is uncertain. The inhalation studies demonstrated that with equal dosage, talc can produce a similar amount of fibrosis as asbestos. However, the chrysotile exposed rats developed lung adenomas, adenomatosis and an adenocarcinoma, whereas the only lung tumour seen in animals exposed to talc was a small adenoma, which may have been an incidental finding.

Animals

[Biological evaluation of experiments in rats of Australian and Italian talc aggressiveness].

In order to evaluate biological effects of Austrian and Italian talc, pulmonary and hemolytic tests as well as pathomorphological examinations were performed. 120 Wistar rats divided into 5 groups were given intratracheally 50 mg of the examined talc dust suspended in 0.5 ml of 0.9 NaCl. The control group received one 0.5 ml dose of NaCl. The observation periods were 6 and 9 months. Then the biochemical tests for hydroxyproline content in the lung were carried out along with patho-morphologic tests to evaluate the fibrogenic activity of the talcs examined. In animals the intratracheal insufflation of talc dust causes inflammatory changes within the bronchi and lungs. On the basis of biochemical examination of lung homogenates, the differences in the hydroxyproline content were determined. After 6 months the symptoms of chronic inflammation and cellular modules developed. Within another 3 months the symptoms of chronic atrophic inflammation in the bronchi were observed and cellular modules containing dust particles were detected in the lung. Hemolytic test revealed a slightly higher degree of aggressiveness of the Austrian talc.

Animals

Role of talc and benzo(a)pyrene in respiratory tumor formation. An experimental study.

Biologic and morphologic alterations caused by repeated intratracheal instillations of talc, alone or in combination with benzo(a)pyrene (B(a)P), were studied in Syrian golden hamsters to determine the possible carcinogenic and cocarcinogenic effects of talc. Talc alone failed to induce respiratory tumors, granulomas or mesothelial proliferation, but when a mixture of equal quantities of talc with B(a)P was administered, papillomas, squamous cells carcinomas and undifferentiated tumors of the larynx, trachea and lungs resulted. It therefore appears that in the hamster, talc is devoid of carcinogenic activity in itself, but does affect the activity of polycyclic hydrocarbons.

Adenocarcinoma

Persistent chylothorax. Treatment by talc pleurodesis.

Two patients with persistent chylothorax resistant to therapy by special diet, thoracenteses, and tube thoracostomy drainage were successfully treated by talc pleurodesis. In one patient with advanced lymphosarcoma involving pleura and mediastinal nodes, the chylothorax was managed by open thoracotomy and talc powder. The other patient developed chylothorax following resection of a thoracic aortic aneurysm. She was successfully treated by talc suspension introduced through a thoracostomy tube. Pleurodesis with talc should be considered only when the chylothorax persists after an adequate period of medical treatment and pleural decompression. Intrapleural instillation of talc through a thoracostomy tube should be successful if the chylothorax can be evacuated and the underlying lung fully expanded.

Chylothorax

Talc pneumoconiosis: a pathologic and mineralogic study.

Seventeen cases of "talc pneumoconiosis" were examined pathologically and mineralogically to ascertain whether a true talc pneumoconiosis existed and also to compare these results in primary, secondary, and tertiary exposures. Mineralogic analyses were performed on wet tissue or tissue blocks by a variety of techniques, including analytical transmission electron microscopy and x-ray diffraction. Overall, the pathologic appearance of the tissues was similar in primary, secondary, and tertiary exposures, although ferruginous bodies and foreign body giant cells were not always present in cases caused by secondary exposures. Mixed dust fibrotic lesions were found in two cases in which there were substantial quantities of quartz present. There was great variation in the minerals found within the lung tissues. Several cases showed significant quantities of mica and kaolin in addition to talc. One case consisted predominantly of mica and in fact could be regarded as "mica pneumoconiosis"; this diagnosis was correctly attributed because of the mineralogic findings. Tremolite fibers were found in only two cases. Substantial quantities of crocidolite and amosite fibers were found in one case. This study shows that "talcosis" frequently represents disease associated with a variety of minerals and that talc is a common denominator. It shows also the usefulness of lung dust mineral analysis, particularly in secondary industries, for evaluating the cause of a pathologic reaction when exposures are especially complex.

Aged

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

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

[Biological evaluation of Indian and Chinese talc aggressiveness].

In order to evaluate biologically the action of two different kinds of talc pulmonary and hemolytic tests were applied and pathomorphological examination carried out on animals. The study was performed on 120 rats within the 6th and 9th months periods. The talcs used in the experiment did not indicate any fibrogenic properties. Morphologic examination did not show any differences in the pathogenetic activity between the Indian and Chinese talcs Inflammatory changes within the lungs and bronchi, pulmonary emphysema and increased levels of fibrosis indices in biochemical examinations have drawn our attention to problems connected with longterm exposure to talc dust.

Animals

Effect of talc injected intravenously in guinea pigs.

The pulmonary angiothrombotic lesions in narcotic addicts attributed to the talc present in drug tablets were studied experimentally in guinea pigs following repeated intravenous administration of a suspension of talc dust (75 mg per animal). In early periods there was a moderate localization of talc particles in the alveolar capillaries of lung, liver and abdominal lymph nodes. The vascular injury in the pulmonary tissue was in the form of mild proliferation of the endothelial cells. In addition, many nodular collections comprising macrophages and lymphocytes developed around such vascular structures. At later periods (150 days) the only significant reaction obtained was moderate thickening of interalveolar septa and the lesions were in no way comparable to the human reports. The significance of these findings has been discussed.

Animals

Treatment of malignant pleural effusion: a method using tube thoracostomy and talc.

Our experience with a simple bedside method for controlling recurrent symptomatic malignant pleural effusion is presented. The method consists of intercostal tube thoracostomy, instillation of a suspension of talc, and waterseal suction drainage. Based on our experience, we believe certain criteria should be met before undertaking talc pleurodesis. In properly selected patients the results with tube thoracostomy and talc pleurodesis have been uniformly good in preventing fluid recurrence and return of disabling symptoms. The technique and results are discussed.

Adolescent

Pulmonary response to kaolin, mica and talc in mice.

Following intratracheal inoculation the pulmonary fibrogenic response of kaolin, mica and talc was investigated in mice over a period of 210 days. All the three dusts incited acute inflammatory reaction at early periods but with mica dust the acute reaction persisted longer. Subsequently there was gradual increase in the fibroblastic activity in the focal areas and mica produced, in addition, many cholesterol cleft-like structures together with marked fibroblastic activity and lymphocytic infiltration. Towards the termination of experiment at 210 days the fibrosis, in general, remained restricted to grade II with kaolin and mica while talc produced thickened interalveolar septa. The transport of dust from lungs to lymph nodes occurred earlier with mica than with kaolin or talc dust accompanied with little fibrotic reaction. The significance of the findings has been discussed.

Animals

Chemical and physical properties of British talc powders.

An examination of bulk talc samples imported into Great Britain has shown that they are extremely variable in their talc mineral content. Major contaminating minerals present with the talc are chlorite, carbonates and quartz. The chemistry of samples examined varied with their mineralogical content which also accounted for observed differences in particle morphology. Tremolite fibres were found in three samples, one of which contained the mineral as a major phase. No other varieties of asbestos were detected.

Asbestos

Talc emboli and macular ischemia in intravenous drug abuse.

A patient with decreased visual acuity had small, glistening white particles that were scattered over both posterior poles. Monochromatic fundus photography revealed ghost vessels and intraluminal particulate matter in small retinal vessels. Fluorescein angiography demonstrated nonperfusion of small arterioles and macular capillaries. The patient admitted to multiple intravenous injections of crushed methylphenidate (Ritalin) hydrochloride tablets, which contain talc 18 months prior to examination. To our knowledge, visual loss and irreversible macular ischemia from talc emboli have not been previously documented.

Adult