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• W2615829057 abstract "We thank Dr Aelony for his interest in our recent article in CHEST (June 2010)1Gonzalez AV Bezwada V Beamis Jr, JF Villanueva AG Lung injury following thoracoscopic talc insufflation: experience of a single North American center.Chest. 2010; 137: 1375-1381Abstract Full Text Full Text PDF PubMed Scopus (44) Google Scholar on the occurrence of lung injury following thoracoscopic talc insufflation (TTI). We did not report on pleurodesis success rate because our goal was to determine the incidence of respiratory complications. We acknowledge the design limitations of our retrospective study. We carefully assessed all cases of postprocedure respiratory insufficiency. Up to eight subjects may have had talc-related lung injury, but due to atypical features or because an alternate diagnosis was possible, we excluded four cases from the incidence calculation of 2.8%. Dr Aelony correctly notes that radiographic findings may be seen after pleural drainage or simple thoracoscopy. The occurrence of respiratory insufficiency was defined based on symptoms and increased oxygen requirements in addition to radiographic changes. Dr Aelony states that we are inappropriately referencing two articles as showing complications of talc pleurodesis. Rehse et al2Rehse DH Aye RW Florence MG Respiratory failure following talc pleurodesis.Am J Surg. 1999; 177: 437-440Abstract Full Text Full Text PDF PubMed Scopus (209) Google Scholar reported the occurrence of ARDS in 9% of patients undergoing talc pleurodesis. He is correct in pointing out that three patients had undergone mechanical pleurodesis followed by poudrage; the other patients received talc slurry. Thus, ARDS was reported following simple talc exposure, albeit after administration as slurry. Dresler et al3Dresler CM Olak J Herndon II, JE Cooperative Groups Cancer and Leukemia Group B Eastern Cooperative Oncology Group North Central Cooperative Oncology Group Radiation Therapy Oncology Group et al.Phase III intergroup study of talc poudrage vs talc slurry sclerosis for malignant pleural effusion.Chest. 2005; 127: 909-915Abstract Full Text Full Text PDF PubMed Scopus (433) Google Scholar reported the results of a randomized trial comparing TTI with talc slurry for malignant pleural effusions. The complications reported included bronchopleural fistula (2% with talc slurry and 2.7% after TTI). Separately, the authors reported that respiratory failure was observed in 4% of patients after talc slurry and 8% following TTI. It is stated that the etiology of the respiratory complications was unclear but consistent with prior reports of respiratory failure following talc administration. It is interesting that conversations with Bryan Corporation representatives would suggest that the current talc preparation is different from the original one. The four cases of talc-related lung injury we reported occurred in 2001, 2004, and 2007 (two cases). Dr Rodriguez-Panadero (personal communication, October 2009) recently compared Sclerosol (Bryan Corporation; Woburn, Massachusetts) with French-graded talc using laser diffraction and demonstrated that Sclerosol contains a larger proportion of small particles. There are ample data from both animal studies and clinical trials to suggest that talc preparations that include small particles are associated with a higher risk of respiratory complications.4Maskell NA Lee YC Gleeson FV Hedley EL Pengelly G Davies RJ Randomized trials describing lung inflammation after pleurodesis with talc of varying particle size.Am J Respir Crit Care Med. 2004; 170: 377-382Crossref PubMed Scopus (197) Google Scholar We are delighted that Dr Aelony seconds our call for the US Food and Drug Administration to approve European-graded, large-particle talc for pleurodesis, given its established safety record.5Janssen JP Collier G Astoul P et al.Safety of pleurodesis with talc poudrage in malignant pleural effusion: a prospective cohort study.Lancet. 2007; 369: 1535-1539Abstract Full Text Full Text PDF PubMed Scopus (249) Google Scholar Complications of Talc Poudrage in the United StatesCHESTVol. 139Issue 2PreviewA recent article in CHEST (June 2010) by Gonzalez et al1 on the complications of talc pleurodesis is important because it may be the largest report on the use of Sclerosol talc (Bryan Corporation; Woburn, Massachusetts), the only proprietary talc sanctioned by the US Food and Drug Administration (FDA). The article would have been enhanced if the authors had shared their 1- to 6-month success rates for pleurodesis, because Sclerosol may be more or less effective than other talcs. Conversations with Bryan Corporation representatives suggest that the current talc is different from the original one. Full-Text PDF" @default.
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• W2615829057 date "2011-02-01" @default.
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• W2615829057 title "Complications of Talc Poudrage in the United States: Response" @default.
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• W2615829057 doi "https://doi.org/10.1378/chest.10-2737" @default.
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