Document Yxw5b12vqpj2179dQdz5VVvk

FILE NAME Talc TALC DATE 2005 DOC TALC178 DOCUMENT DESCRIPTION Letter in Medical Journal - A Case of Fulminant Talc Pneumoconiosis Where is the Smoking Gun 39 2005 Vol 11 No. 3 PATHOLOGY ONCOLOGY RESEARCH Article is available online at www webio 2005 0184 Vol 11 No 3 2005 COMMENT | A Case of Fulminant Talc Pneumoconiosis Where is the Smoking Gun Luigi TERRACCIANO Gabriel R BOUYGUE Rosario STARTARI Francesca GUERRIERO Colette MR BOUYGUE University of Milan Medical School at Melloni Paediatria Milan Italy We refer to the case presented by Yoram Dekel and colleagues in the Vol 10 No. 4 issue of the Journal which sets out prima facie evidence of talc inhalation from excessive cosmetic use of talc as prime suspect in a 42year old woman's demise We would plead that the proxi- mal cause of death is far from established The rapid progression of pancardiac failure in a patient with a recent onset of pulmonary hypertension and cor pulmonale is unconvincing Documented pulmonary hypertension is attributed to interstitial fibrosis but this is not backed up by ray findings Neither left heart function before the final crisis nor systemic blood piessure are reported and despite a normal left ventricular scan left heart hypertrophy was found at autopsy Caidiac enzymology is omitted This leaves the interpretation of acute cardiomyopathy either of dilatory or viral etiology undecided The crystals found at microscopy are actually compatible with other sheet silicates apart from tale Talc particles were exceedingly large and not of the usual granular configuiation but cosmetic talc is highly purified It is sig- nificant that aluminium was found as this element distin- guishes talc from the aluminium silicate pyrophillite Al SO OH which is similar to most tales S OH is used in the construction and automobile industries ' and causes pyrophillitosis Both minerals have the same hardness and specific mass volume 2.6-29 2.6-29 cmThe elemental analysis Figure 5 does not clearly indicate if peaks refer to quantities or energy states and which method of spectrometry was used to identify talc from related phyllosilicate particulates Cement inhalation e.g would be hard to rule out outside occupational settings without the use of spectrometry As other environmental exposures cannot be totally excluded from the scant description of the case an estimate of the quantity of particulate matter found is not reported most of the evidence against cosmetic talc without scene of crime sampling remains circumstantial Correspondence Luigi TERRACCIANO MD Chief Registrar in Pulmonology Melloni Paediatria 52 Via Melloni 20129 Milan Italy Talc pneumoconiosis is an uncommon form of lung dust disease In the mining or milling industries It occurs after inhalation of high concentrations of the dust.67 At very low concentrations talc is unavoidable in everyday life According to the US Geological Survey apart from applications in body powders or cosmetics talc is extensively used in asphalt auto body putty belts catalytic converters ceramics flooring foam packaging gaskets hoses joint compounds paint paper plastics roofing rubber sealants wire and cable insulation It is also found in sweets chew- ing gum pharmaceuticals agricultural chemicals insecticide carriers and animal feed In these applications take is certainly in a less purified state than in the cosmet c indus ty It can carry minerals of the asbestos group as iipuri- tics that have fibrogenic properties Thus more methodological and clinical evidence ought to be brought forward before talc can be clearly pointed out as the smoking gun in the case While cautionary rules apply when using mineral substances including water the same caution should be exercised in generalizing hazards Thus the blanket warning that generally talc inhalation results in lung disease may be unduly alarmist RO eferences 1 Dekel Y Wolfson L Rudniki Carlos Koren R. Take inh lation a threatening condition Path Oncol Res 10 231-233 2004 2 Deer WA Howie RA Zussman / Forming Mincials vo III Sheet Silicates London 1963 Longmans 3 Awai K Yamane K Nishioka Y et al Analysis of pyrophillitos s by highresolution computed tomography Nippon Igaku Hosahsen Gakkai Zasshi 51 656-662 1991 4 Kurahashi M Mizutani J Hioki A Determination of trace e ements in sediment reference materials by monochromatic ray exulta ion ray fluorescence spectrometry Anal Sci 21 827-832 2005 5 Karik AB Immune response to exposure to occupational ocupational and envion mental agents ICMR Bulletin 31 73-79 2001 6 Miller A Ten stein AS Bader ME et al Tak pneumoconiosis Signifi- cance of sublight microscopic mineral particles AmJ Med 50 395-402 1971 7 Fine LJ Peters IM Burgess Burgess WA Di Berardinis LJ Studies of respirato- y morbidity in rubber workers Part IV Respiratory morbictity in tale workers Arch Environ Health 31 195-200 1976 8. Accessed from http minerals usgs commodity/ tale '2005 Ar^nyiLajos Foundation