Chest ACCP Career Connection
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

Guest Access | Sign In via User Name/Password
This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF) Free
Right arrow Submit a response
Right arrow View responses
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Article Archive
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via ISI Web of Science (49)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Werebe, E. C.
Right arrow Articles by Vargas, F. S.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Werebe, E. C.
Right arrow Articles by Vargas, F. S.
(Chest. 1999;115:190-193.)
© 1999 American College of Chest Physicians

Systemic Distribution of Talc After Intrapleural Administration in Rats*

Eduardo Campos Werebe, MD; Rogério Pazetti; José Ribas Milanez de Campos, MD, PhD; Paulo Pêgo Fernandez, MD, PhD; Vera Luiza Capelozzi, PhD; Fábio Biscegli Jatene, MD, PhD and Francisco S. Vargas, MD, FCCP

* From the Department of Cardiology and Pulmonary Medicine Faculty of Medicine, University of São Paulo (FMUSP), São Paulo, Brazil.


   Abstract
TOP
 Abstract
Introduction
 Materials and Methods
 Results
 Discussion
 References
 
Study objectives: Many reports have shown the efficacy of talc to induce an effective pleurodesis. However, there is little information about the side effects related to this sclerosing agent. The objective of this experimental study is to recognize the systemic distribution of talc after its instillation into the pleural space of rats.

Design: Forty animals were assigned to receive talc through a catheter placed in a left minimal thoracotomy. They were randomly divided in two groups: group 1 received 20 mg of talc and group 2 received 10 mg in the same total volume of 1 mL of saline solution. Half of the animals in each group were killed 24 h and the other half 48 h after the procedure. BAL was collected and histologic sections of both lungs, chest wall, liver, kidneys, spleen, heart, and brain were examined. Crystals were tracked using polarized light and we have used a "birefringent particles index of deposition" in an attempt to quantify the amount or talc encountered in different organs.

Results: Talc crystals were found in every organ of all animals studied (100%). There was no statistical difference either on the dose of talc used or in the time of death. The amount of talc was statistically different in the organs, which made us divagate about a route of absorption.

Conclusions: We conclude that there is a progressive deposition of talc particles in the organs examined after its administration into the pleural space of normal rats. This report suggests that there is a rapid absorption of talc through the pleural surface and that the systemic distribution thereafter is not dose related. Further studies are necessary to assess the amount of crystals and the clinical correlation to these findings.

Key Words: malignant pleural effusion • sclerosing agent • talc pleurodesis


   Introduction
TOP
 Abstract
 Introduction
Materials and Methods
 Results
 Discussion
 References
 
Talc was used for the first time by Bethune1 in 1935 as a pleural sclerosing agent to avoid pulmonary collapse prior to surgery for tuberculosis.

Gaensler2 in 1956, as well as Gobbel et al3 in 1963, reported severe complications after intrapleural injection of talc. Despite that, Weissberg4 in 1981 said that "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."

However, recently Lineau et al5 in 1993, and Kennedy at al6 in 1994, reported pulmonary infiltrate and respiratory distress syndrome in patients undergoing talc pleurodesis.

We have previously reported our experience with 102 patients undergoing talc pleurodesis due to malignant effusion secondary to breast cancer,7 recurrent pneumothoraces,8 and other benign or undiagnosed pleural effusions.9 The overall morbidity in this set of patients was 18.97%.

Presently, many reports have been published comparing talc with other sclerosing agents, and it appears to be the most effective so far available.10 ,11 ,12 ,13 ,14 ,15 ,16 ,17 ,18 ,19 ,20

Nevertheless, we have been concerned with some cases well documented but not published yet, in which serious complications have been detected following pleurodesis. Furthermore, in these cases, talc was identified outside pleural space such as in BAL, brain, pulmonary artery, and liver. In one case, the embolization to pulmonary artery was the major cause of death at necropsy. Influenced by these experiences, and with the main objective of clarifying the side effects of intrapleural use of talc, an experimental model was designed to verify the distribution of talc after its administration into the pleural space of normal rats.


   Materials and Methods
TOP
 Abstract
 Introduction
 Materials and Methods
Results
 Discussion
 References
 
Experimental Design
Forty Wistar rats of similar weight (298 ± 11 g), provided by the Animal Quarters of the Faculty of Medicine—University of São Paulo, were assigned to one of the following groups: in group 1, animals received 20 mg of talc (extrapolated from the usual dose of 5 g in a 70-kg adult man); in group 2, half of this dose was employed, in the same total volume of 1 mL of saline solution. Both groups were divided in two subgroups based on the time of death; in subgroups 1a and 2a, it was performed after 24 h, and in subgroups 1b and 2b, it was performed after 48 h following the intrapleural administration of talc (Table 1 ), or hydrated magnesium silicate (Mg3 Si4 O10 [OH]2).


View this table:
[in this window]
[in a new window]

  		Table 1. Groups of Rats, Compared with Talc Dose and Time of Autopsy

 
The animals were anesthetized in an ether chamber, intubated with a polyethylene tube to provide general anesthesia by inhalation of enflurane (Ethrane) via a nebulizer (Model 1223; Takaoka; Brazil) and a small animal ventilator (Harvard Apparatus; South Natick, MA). Thereafter, a very small left thoracotomy was performed to place a catheter in the fifth intercostal space in order to administer talc as a slurry into the pleural cavity. Drainage of pleural space was accomplished using a polyethylene tube immersed in 0.5 cm H2O seal. When the animal was wide awake, the tracheal and pleural tubes were removed. The animals were maintained in adequate cages and fed according to the protocol of the animal quarters. After 24 h (groups 1a and 2a) or 48 h (groups 1b and 2b), the animals received intra-abdominal sodium pentobarbital and were killed by exsanguination.

Morphologic Analysis
The obtained lungs, chest wall, liver, kidneys, spleen, heart, and brain were fixed in 10% neutral buffered formalin. After that, they were cut into about 1-cm parasagittal slices and carefully examined for gross abnormalities. Slides 5 µm thick were taken and stained with hematoxylin-eosin. All slides were coded, randomized, and then evaluated by a single observer, who did not have access to the code. In a first approach, we studied all the organs at light microscopy considering the general histoarchitecture and the eventually pathologic process involved. After that, all the specimens were submitted to polarized light with the purpose to look for birefringent particles.

Birefringence Particle Index of Deposition
The analysis was designed to verify the amount of talc crystals deposition along the regions of venous and lymphatic drainage: from thoracotomy site, lungs, heart, and arterial system to possible systemic targets (subpleural connective tissue, axial connective tissue around bronchi and blood vessels and microcirculation). The number of crystal depositions was counted in five randomly selected bronchovascular bundles and in five fields of 100x along parietal and visceral pleura and microcirculation of heart, spleen, kidneys, and brain. The results of talc crystal were averaged for each case. Figure 1 shows the pattern of talc crystals usually employed for pleurodesis.



View larger version (75K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 1. The pattern of talc crystals usually employed for pleurodesis (original magnification x100).

 
Data Analysis
The mean and median scores for talc crystals were compared tabulary for the animals and the different organs by means of a nonparametric test (Kruskal-Wallis). The p values <{alpha} = 0.05 were considered significant.


   Results
TOP
 Abstract
 Introduction
 Materials and Methods
 Results
Discussion
 References
 
All animals did not have any side effects and tolerated both the anesthesia and surgery well. The technique was safe, and no animal suffered any complications from the surgery.

Morphologic Analysis
There were no abnormalities on gross examination of the cut surface of the main organs selected for this study. Microscopically, the most common lesions were observed on chest wall and were represented by an early pneumoconiosis characterized by a stellate interstitial collections of dust-laden macrophages containing pale yellow particles associated with inflammatory infiltrate of lymphocytes with mild fibroblastic proliferation (Fig 2 ). Polarized light revealed large numbers of irregular, strongly birefringence platy, acicular, and "Maltese Cross" crystals varying in length from 5.7 to 70 µm. In the remaining organs, no pneumoconiosis reactions were observed, although the talc crystals were present mainly inside of the microvessels. Figures 3 and 4, shows the platy birefringent crystalline particulate in the lung tissue and brain.



View larger version (127K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 2. Strongly birefringent platy crystalline particulates, talc in chest wall, representing a early pneumoconiosis (original magnification x160).

 


View larger version (120K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 3. Talc crystals in the lung (original magnification x100).

 
Birefringence Particle Index of Deposition
Table 2 shows the mean scores for talc crystals deposition and a comparison for the several organs examined between the two groups (different doses). For chest wall, the mean scores for talc crystals deposition are consistently higher than for other organs.


View this table:
[in this window]
[in a new window]

  		Table 2. Deposition Index of Talc Crystals in Various Organs, and Statistical Comparison Between Groups

 
There is a significant difference in the amount of talc deposition between the two groups for specific organs, like chest wall and lungs, despite the half dose employed in the second group.

Another difference was observed in the density of particles detected among the different organs. Clearly, there is a progressive decrease in the number of particles found in chest wall compared with the kidneys. This observation is a clue for the probable absorption route of the particles.


   Discussion
TOP
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
References
 
Several reports have been published regarding the potential risk of the indiscriminate use of talc pleurodesis. In 1956, Gaensler,2 for the first time (to our knowledge), observed severe effects resulting from pleural poudrage, such as severe pain (worse than the pain observed after thoracotomy) fever, shock, prolonged hospitalization, embolization with hemiplegia, significant changes of the pleura (thickening, granulomas, fibrothorax), and loss of respiratory function. More serious outcome was published by Youmans et al21 in 1970, reporting a fatal cardiac arrest of undetermined etiology in a 23-year-old youth immediately after a pleural poudrage.

Weissberg and Zeev,22 in 1993, gathering >10 years of experience with talc, concluded that "purified talc free of asbestos is safe for clinical use. It is the cheapest and most reliable substance in creating pleural adhesions, with effectiveness over 90%. Its use in doses not exceeding 2 g eliminates complications almost completely."

However, some authors such as Schafers and Dresler,10 in 1995, believe that there are still few reports relating talc itself to the side effects reported in the literature.

Recently, several authors have called attention to ARDS and pulmonary reexpansion edema after talc pleurodesis.5 ,6 ,7 Most of them agree with the fact that even when the indication is well established, the dose to be utilized should be limited to 5 g (in adults), until more data regarding its safety are available.

Our clinical experience has been to use 2 g of insufflated talc through thoracoscopy in 83 patients with benign and 255 patients with malignant diseases of the pleura. Our success rate has been between 88% and 94%. We have observed four patients (1.2%) who developed bilateral pulmonary infiltrates, hypoxemia, hypercapnia, mental confusion, and hypotension within 24 and 48 h after the procedure. All the patients required intubation and mechanical ventilation. Three of the patients died with the diagnosis of ARDS and one recovered after 36 h of mechanical ventilation. All the patients had talc crystals in their BAL performed 10 to 12 h after the thoracoscopy. Necropsy was done on one patient. Talc crystals were found in almost every organ examined.23

Worried with those facts, we designed this experimental model administrating talc into the pleural space of normal rats, and we could verify that a high incidence of crystals was present in several organs examined. Besides, it was amazing to find talc inside coronary artery, meninges, urinary tract, pulmonary artery, myocardium, and so forth. Secondly, these findings were not dependent on the dose of talc used or on the time of death.

This study suggests that talc is absorbed very rapidly through the pleura, reaching systemic circulation and being deposited on target organs as soon as 24 h after its administration into the pleural cavity. We were not able to demonstrate whether the absorption rate can be influenced by different pleural conditions, since our protocol uses only normal rats. However, these data suggest that morbidity and mortality associated with talc pleurodesis could come from the presence of talc particles.

For this reason, although we can find differences in pleural anatomy, porosity, venous and lymphatic drainage between interspecies, and in permeability of normal vs diseased pleura, until more consistent and definitive data are available, we suggest that talc should be avoided to promote pleurodesis in young patients with benign diseases and even in malignant diseases with a very good prognosis. Maybe we should use another sclerosing agent.

In conclusion, this experimental model with normal rats shows a rapid absorption of talc particles through the pleura. The crystals can be found outside the pleural cavity shortly after the procedure (BAL) and in target organs after 24 h. This is not dose related when an equivalent of 0.036 g/kg is used (2.5 g for a 70-kg man). We still cannot reach any further conclusion regarding clinical manifestations related to this phenomenon.



View larger version (116K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 4. Talc crystals in the brain (original magnification x100).

 

   Footnotes
 
Correspondence to: Eduardo Campos Werebe, MD, Rua Ceará No. 449 apto 42, São Paulo/SP—Brazil CEP: 01243010; e-mail: werebe@ibm.net

Received for publication March 27, 1997. Accepted for publication May 27, 1998.


   References
TOP
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 

  1. Bethune, N (1935) Pleural poudrage: new technique for deliberate production of pleural adhesions as preliminary to lobectomy. J Thorac Surg 4,251
  2. Gaensler, E (1956) Parietal pleurectomy for recurrent spontaneous pneumothorax. Surg Gynecol Obstet 102,293
  3. Gobbel, WG, Rhea, WG, Nelson, IA, et al (1963) Spontaneous pneumothorax. J Thorac Cardiovasc Surg 46,331
  4. Weissberg, D (1981) Talc peurodesis: a controversial issue. Pulmon Coeur 37,291-294
  5. Lineau, C, LeCoz, A, Quinquenel, ML, et al (1993) Acute respiratory insufficiency after pleural talcage of pneumothorax: apropos of a case. Rev Pneumol Clin 49,153[Medline]
  6. Kennedy, L, Rusch, VW, Strange, C, et al (1994) Pleurodesis using talc slurry. Chest 106,342-346[Abstract/Free Full Text]
  7. Milanez, JR, Vargas, FS, Filomeno, LB, et al (1995) Intrapleural talc for the treatment of malignant pleural effusions secondary to breast cancer. Cancer 75,2688-2692[CrossRef][ISI][Medline]
  8. Milanez, JR, Vargas, FS, Filomeno, LT, et al (1994) Intrapleural talc for the prevention of recurrent pneumothorax. Chest 106,1162-1165[Abstract/Free Full Text]
  9. Vargas, FS, Milanez, JR, Filomeno, LT, et al (1994) Intrapleural talc for the prevention of recurrence in benign or undiagnosed pleural effusions. Chest 106,1771-1775[Abstract/Free Full Text]
  10. Schafers, SJ, Dresler, CM (1995) Update on talc, bleomycin, and the tetracyclines in the treatment of malignant pleural effusions. Pharmacotherapy 15,228-235[ISI][Medline]
  11. Ladjimi, S, M'Raihi, ML, Djemel, A, et al (1991) Le talcage pleural sous thoracoscopie au cours des pleuresies lymphomateuses. Rev Mal Respir 8,75-77[ISI][Medline]
  12. Light, RW, Wang, NS, Sassoon, CS, et al (1995) Talc slurry is an effective pleural sclerosant in rabbits. Chest 107,1702-1706[Abstract/Free Full Text]
  13. Ohri, SK, Oswal, SK, Townsend, ER, et al (1992) Early and late outcome after diagnostic thoracoscopy and talc pleurodesis. Ann Thorac Surg 53,1038-1041[Abstract]
  14. Weissberg, D, Kaufman, M (1986) The use of talc for pleurodesis in the treatment of resistant empyema. Ann Thorac Surg 41,143-145[Abstract]
  15. Bresticker, MA, Oba, J, LoCicero, J, et al (1993) Optimal pleurodesis: a comparison study. Ann Thorac Surg 55,364-366[Abstract]
  16. Walker, RPB, Vaughan, LM, Sahn, SA (1994) Chemical pleurodesis for malignant pleural effusions. Ann Intern Med 120,56[Abstract/Free Full Text]
  17. Windsor, PG, Como, JA, Windsor, KS (1994) Sclerotherapy for malignant peural effusions: alternatives to tetracycline. South Med J 87,709[CrossRef][ISI][Medline]
  18. Frankel, A, Krasna, I, Baronofsky, ID (1961) An experimental study of pleural symphysis. J Thorac Cardiovasc Surg 42,43
  19. MathlouthIa Chabchoub, A, Labbene, A, et al (1992) An experimental anatomopathological study of pleural talcosis. Rev Mal Respir 9,617[ISI][Medline]
  20. Kennedy, L, Harley, RA, Sahn, SA, et al (1995) Talc slurry pleurodesis: pleural fluid and histologic analysis. Chest 107,1707[Abstract/Free Full Text]
  21. Youmans, CR, Williams, RD, McMinn, MR, et al (1970) Surgical management of spontaneous pneumothorax by bleb ligation and pleural dry sponge abrasion. Am J Surg 120,644[CrossRef][ISI][Medline]
  22. Weissberg, D, Zeev, I (1993) Talc pleurodesis. J Thorac Cardiovasc Surg 106,689-695[Abstract]
  23. Milanez, JRC, Werebe, EC, Vargas, FS, et al (1997) Respiratory failure due to insufflated talc. Lancet 349,251-252[CrossRef]



This article has been cited by other articles:


Home page
 ChestHome page
E. Marchi, F. S. Vargas, L. R. Teixeira, M. M. P. Acencio, L. Antonangelo, and R. W. Light
Intrapleural Low-Dose Silver Nitrate Elicits More Pleural Inflammation and Less Systemic Inflammation Than Low-Dose Talc
Chest, September 1, 2005; 128(3): 1798 - 1804.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
C. M. Dresler, J. Olak, J. E. Herndon II, W. G. Richards, E. Scalzetti, S. B. Fleishman, K. H. Kernstine, T. Demmy, D. M. Jablons, L. Kohman, et al.
Phase III Intergroup Study of Talc Poudrage vs Talc Slurry Sclerosis for Malignant Pleural Effusion
Chest, March 1, 2005; 127(3): 909 - 915.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
N. A. Maskell, Y. C. G. Lee, F. V. Gleeson, E. L. Hedley, G. Pengelly, and R. J. O. Davies
Randomized Trials Describing Lung Inflammation after Pleurodesis with Talc of Varying Particle Size
Am. J. Respir. Crit. Care Med., August 15, 2004; 170(4): 377 - 382.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
E. Marchi, F. S. Vargas, M. M. P. Acencio, L. Antonangelo, L. R. Teixeira, E. H. Genofre, and R. W. Light
Talc and Silver Nitrate Induce Systemic Inflammatory Effects During the Acute Phase of Experimental Pleurodesis in Rabbits
Chest, June 1, 2004; 125(6): 2268 - 2277.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Cell Mol. Bio.Home page
R. J. Langley, R. Kalra, N. C. Mishra, F. F. Hahn, S. Razani-Boroujerdi, S. P. Singh, J. M. Benson, J. C. Pena-Philippides, E. B. Barr, and M. L. Sopori
A Biphasic Response to Silica: I. Immunostimulation Is Restricted to the Early Stage of Silicosis in Lewis Rats
Am. J. Respir. Cell Mol. Biol., June 1, 2004; 30(6): 823 - 829.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
M. Czerny, A. Salat, T. Fleck, W. Hofmann, D. Zimpfer, F. Eckersberger, W. Klepetko, E. Wolner, and M.-R. Mueller
Lung wedge resection improves outcome in stage I primary spontaneous pneumothorax
Ann. Thorac. Surg., May 1, 2004; 77(5): 1802 - 1805.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Roentgenol.Home page
M. Nguyen, V. Varma, R. Perez, and D. M. Schuster
CT with Histopathologic Correlation of FDG Uptake in a Patient with Pulmonary Granuloma and Pleural Plaque Caused by Remote Talc Pleurodesis
Am. J. Roentgenol., January 1, 2004; 182(1): 92 - 94.
[Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
J. F. Montes, J. Ferrer, M. A. Villarino, B. Baeza, M. Crespo, and J. Garcia-Valero
Influence of Talc Dose on Extrapleural Talc Dissemination after Talc Pleurodesis
Am. J. Respir. Crit. Care Med., August 1, 2003; 168(3): 348 - 355.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
O. Artemiou, G.-M. Marta, W. Klepetko, E. Wolner, and M.-R. Muller
Pleurovenous shunting in the treatment of nonmalignant pleural effusion
Ann. Thorac. Surg., July 1, 2003; 76(1): 231 - 233.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
E. Marchi, L. R. Teixeira, F. Vargas, P. Astoul, A. Fraticelli, A. Robaglia-Schlupp, and P. Cau
Talc for Pleurodesis: Hero or Villain?
Chest, July 1, 2003; 124(1): 416 - 417.
[Full Text] [PDF]

Home page
 ChestHome page
P. A. Spiegler, A. N. Hurewitz, and M. L. Groth
Rapid Pleurodesis for Malignant Pleural Effusions
Chest, June 1, 2003; 123(6): 1895 - 1898.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
R. W. Light
Talc for Pleurodesis?
Chest, November 1, 2002; 122(5): 1506 - 1508.
[Full Text] [PDF]

Home page
 ChestHome page
A. Fraticelli, A. Robaglia-Schlupp, H. Riera, S. Monjanel-Mouterde, P. Cau, and P. Astoul
Distribution of Calibrated Talc After Intrapleural Administration: An Experimental Study in Rats
Chest, November 1, 2002; 122(5): 1737 - 1741.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
J. Ferrer, J. F. Montes, M. A. Villarino, R. W. Light, and J. Garcia-Valero
Influence of Particle Size on Extrapleural Talc Dissemination After Talc Slurry Pleurodesis*
Chest, September 1, 2002; 122(3): 1018 - 1027.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
C. A. Olivares-Torres, R. Laniado-Laborin, C. Chavez-Garcia, C. Leon-Gastelum, A. Reyes-Escamilla, and R. W. Light
Iodopovidone Pleurodesis for Recurrent Pleural Effusions*
Chest, August 1, 2002; 122(2): 581 - 583.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
J. Ferrer, M. A. Villarino, J. M. Tura, A. Traveria, and R. W. Light
Talc Preparations Used for Pleurodesis Vary Markedly From One Preparation to Another
Chest, June 1, 2001; 119(6): 1901 - 1905.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
J. R. M. de Campos, F. S. Vargas, E. d. C. Werebe, P. Cardoso, L. R. Teixeira, F. B. Jatene, and R. W. Light
Thoracoscopy Talc Poudrage : A 15-Year Experience
Chest, March 1, 2001; 119(3): 801 - 806.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
Y. C. GARY LEE, L. R. TEIXEIRA, C. J. DEVIN, M. A. C. VAZ, F. S. VARGAS, P. J. THOMPSON, K. B. LANE, and R. W. LIGHT
Transforming Growth Factor-{beta}2 Induces Pleurodesis Significantly Faster than Talc
Am. J. Respir. Crit. Care Med., March 1, 2001; 163(3): 640 - 644.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
R. W. Light
Talc Should Not Be Used for Pleurodesis
Am. J. Respir. Crit. Care Med., December 1, 2000; 162(6): 2024 - 2026.
[Full Text]

Home page
 ThoraxHome page
G ANTUNES and E NEVILLE
Management of malignant pleural effusions
Thorax, December 1, 2000; 55(12): 981 - 983.
[Full Text]

Home page
 ThoraxHome page
Y C G Lee, K B Lane, R E Parker, D S Ayo, J T Rogers, R W Diters, P J Thompson, and R W Light
Transforming growth factor beta 2 (TGFbeta 2) produces effective pleurodesis in sheep with no systemic complications
Thorax, December 1, 2000; 55(12): 1058 - 1062.
[Abstract] [Full Text]

Home page
 Am. J. Respir. Crit. Care Med.Home page
A. H. DIACON, C. WYSER, C. T. BOLLIGER, M. TAMM, M. PLESS, A. P. PERRUCHOUD, and M. SOLER
Prospective Randomized Comparison of Thoracoscopic Talc Poudrage under Local Anesthesia versus Bleomycin Instillation for Pleurodesis in Malignant Pleural Effusions
Am. J. Respir. Crit. Care Med., October 1, 2000; 162(4): 1445 - 1449.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
C. M. Dresler
Systemic Distribution of Talc
Chest, July 1, 1999; 116(1): 266 - 266.
[Full Text] [PDF]

eLetters:

Read all eLetters

Fatal outcome after talc poudrage
Michael-Rolf Mueller
Chest Online, 12 Aug 2001 [Full text]
This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF) Free
Right arrow Submit a response
Right arrow View responses
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Article Archive
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via ISI Web of Science (49)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Werebe, E. C.
Right arrow Articles by Vargas, F. S.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Werebe, E. C.
Right arrow Articles by Vargas, F. S.

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS