Document Z8JbwVdgYM6EeNOmz1mpxvzjJ

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? R e o s J V X H, X b , 3 PATHOLOGY ONCOLOGY RESEARCH________________________________Vol 11, No 3, 2005 Article is available online at http://www webio hu/por/2005/11/3/0184 COMMENT A Case of Fulminant "Talc Pneumoconiosis": Where is the Smoking Gun? Luigi TERRACCIANO, Gabriel R BOUYGUE, Rosario STARTARI, Francesca GUERRIERO, Colette MR BOUYGUh University of Milan Medical School at Melloni Pacdiatiia, Milan, Italy We refei to the case presented by Yoram Dekel and col leagues m the Vol, 10, No. 4 issue of the Journal,' which sets out pnma facie evidence of talc inhalation fiom "excessive cosmetic use of talc" as prime suspect in a 42yeai old woman's demise We would plead that the pioximal cause ot death is lai lrom established The tapid progression of pancardiac failure in a patient with a recent onset ot pulmonary hypertension and cor pulmonale is unconvincing. Documented pulmonary hypertension is attributed to interstitial fibrosis, but this is not backed up by X-ray findings. Neither letl heart function before the final crisis nor systemic blood piessure are reported and, despite a noimal left ventricular scan, left heart hypertrophy was found at autopsy. Caidiac en7ymology is omitted. This leaves the mteiprctation of acute cardiomyopathy either of dilatory or viral etiology undecided. The crystals found at microscopy aie actually compatible with othei sheet silicates apart fiom talc2 "Talc particles wete exceedingly laige and not of the usual granular configuiation" but cosmetic-grade talc is highly purified. It is sig nificant that aluminium was found as this element distin guishes talc fiom the aluminium silicate pyrophillitc [Al2 (Si4Ol0) (OH2)J, which is similar to most tales [Mg,(Si20 ,)2 (OH)j], is used m the construction and automobile mdustnes and causes pyrophilhtosis 1 Both mineials have the same hardness and specific mass volume (2.6-2 9 g/cnV) 1 The "elemental analysis" (Figure 5) does not clearly indicate if peaks relei to quantities or eneigy states, and which method of spectrometry was used4to identify talc from related phyllosihcate 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 icpoitcd), most of the evidence against cosmetic talc, with out "scene of crime" sampling, remains circumstantial C on expandcute Luigi TERRACCIANO, M D, C hief Registrar in Pulmonology M elloni Paeduilria, 52 Via M elloni, 20129 Milan, Italy Talc pneumoconiosis is an uncommon form of lung dust disease. In the mining or milling mdustnes. it occuis aftei inhalation of high concentrations of the dust.6' At very low concentrations, talc is unavoidable m eveiycay life Accoiding to the US Geological Suivey,8apart fiom appli cations m body powders or cosmetics, talc is extensively used in asphalt, auto body putty belts catalytic converters ceramics, flooring, loam packaging, gaskets, fio^es. joint compounds, paint, paper, plastics, roofing, rubber, sealants wire and cable insulation. It is also found m sweets, chew ing gum, pharmaceuticals, agricultural chemicals insecti cide cameis and animal feed. In these applications, talc is certainly in a less purified state than in the cosmet c indus hy. It can carry mineials of the asbestos group as impuri ties that have fibiogcmc propci tics. Thus, more methodological and clinical evidem e ought to be brought forward befote talc can be cleaily pointed out as the smoking gun m the case While cautionaiy iuIcs apply 'hen using rmneial substances (including watei), the same caution should be exeicised m generalizing hazards Thus, the blanket warning that "geneially talc inhalation results in lung disease" may be unduly alarmist References 1 Dekel Y, Rath-Wolfwn L, Rudrnki Cm lot, Koien R Talc inh. lation is a life-thieatemng condition Path Oncol Res 10 231-233, 2M4 2 Deei \\'A, Howie RA, Zussman / Rock-Foiming Mineials, vo III Sheet Silicates London, 1963, Longmans 3 Awai K, YamaneK, Nishioka Y et a! Analysis of pyiophillitos s b> highresolution computed tomogiaphy Nippon Igakit Hosahscn Gakkai Zasshi 51 656-662, 1991 4 Kurahashi M, Mizuiam J, fiioki A Determination ol tiacc c erncnls m sediment reference materials by monochromatic X-iay cxuia ion X-ias iluoiescence spectrometry Anal S u 21 X27-832 200^ 5 Rank AB Immune tesponse to exposuie to occupation tl and envium mental agents ICMR Bulletin 31 73-79 2001 6 Miller A, leu \'tem AS, Bader ME, et al Talc pneumoconiosis Signifi cance of sublight microscopic mineral pat tides A.mJ Med 50 395-402, 1971 7 Fine LJ, Petei s JM Bw gcssWA, Di Beuiidiuts LJ Studies oi lespnatoi) moibidity in lubbei woikeis Pau IV Respiraloiy moibicuty in taL workers Arch Lnvuon Health *1 195-200 1976 8 A( ceasedfrom http //minerals usgs gov/imnuals/pubs/commodii}/ taL 2005 Arnyi Lajos Foundation