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Ann Thorac Surg 1996;62:1003-1004
© 1996 The Society of Thoracic Surgeons

Discussion

Discussion

The first 300 words of the full text of this article appear below.

See also page 1000.

DR JOSÉ RIBAS MILANEZ CAMPOS (São Paulo, Brazil): First of all, I congratulate Dr Cohen for the paper and his presentation.

At the University of São Paulo in Brazil, we have been using 2 g of talc as an agent to promote pleurodesis, delivering it through a thoracoscopic approach since 1983, with effective results of 94.6%. We have used this technique in more than 230 patients with malignant pleural effusion when it is established that the lung will fully expand.

A few months ago, we used this technique in a breast cancer patient. Two days later, talc crystals were noted in her bronchoalveolar lavage. Later on, this patient died, and her autopsy revealed talc emboli in pulmonary vessels and cerebral arteries.

Concerned about this finding, we went to the laboratory and, working with a rat model using 0.002 g, we were able to detect adhesions in the pleural space and talc emboli in the contralateral lung. We also found emboli of talc in the liver, spleen, kidney, and the brain in almost 100% of the animals that were killed 48 to 96 hours after the pleural application of talc.

In our opinion, these issues about talc—how to use it, the amount to be used, and the collateral effects it can cause—deserve much more research.

DR COHEN: Doctor Campos, thank you very much for your comments.

We did not specifically look for the presence of talc in other organs, and we only saw it occasionally in the lungs in the studies that we did. I agree that most people's experience would confirm that the side effects and toxicity from talc in the pleural space are probably dose related. We had 1 patient who had what appeared to be an anaphylactic reaction; we had used 10 g in . . . [Full Text of this Article]


Related Article

Talc Pleurodesis: Talc Slurry Versus Thoracoscopic Talc Insufflation in a Porcine Model
Robbin G. Cohen, William W. Shely, Suzanne E. Thompson, Jeffrey A. Hagen, Charles C. Marboe, Tom R. DeMeester, and Vaughn A. Starnes
Ann. Thorac. Surg. 1996 62: 1000-1002. [Abstract] [Full Text]





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Copyright © 1996 by The Society of Thoracic Surgeons.