Correspondence to: Carolyn M. Dresler, MD, FCCP, PO Box 177, Mount Tabor, NJ 07878; e-mail: firstname.lastname@example.org
To the Editor:
The recent article by Werebe and colleagues (January
1999)1 concerning the systemic distribution of talc was a
fascinating and timely study. This group has a very large experience
with talc pleurodesis, and they are to be commended in pursuing not
only the efficacy of the procedure, but also the safety. As they are
aware, a large (n = 500) multicenter trial is underway in the United
States exploring the efficacy of talc pleurodesis—administered either
through a chest tube as a slurry or via video-assisted thoracoscopy as
an insufflated mist—in patients with a malignant pleural effusion. As
co-principal investigator of this trial, I have been very sensitive to
the potential safety issues relative to talc insufflation. For this
reason, I believe we need further studies exploring the results of
Somewhat surprisingly, all talcs are not equal. The crystal structure
and size of the talc particle may vary depending on the location of the
talc mine! Perhaps, it is this variability in the size or the structure
of the talc that determines the permeability or distribution, and thus
potential toxicity of intrapleural talc.
Approximately 250,000 people each year in the United States have a
malignant pleural effusion. Talc is the most effective sclerosing agent
identified to date. Thus, it is important to confirm its safety. I was
very pleased to read this study by Werebe and colleagues and hope that
further discussion and research is engendered.
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