Talco-silicosis in a rubber worker

Our plain-English summary of Talco-silicosis in a rubber worker, by W.G. Graham, E.A. Gaensler (Medicina Thoracalis, 1965).

The study

• Authors: W.G. Graham, E.A. Gaensler
• Journal: Medicina Thoracalis
• Published: 1965;22(6):590-604
• Type of article: Case report
• Cited by: 13 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 001526).

Abstract

This is a report of a rubber grinder with talco-silicosis who presented with unusual clinical features. The diagnosis was supported by chemical and physical analysis of dust at his place of work. The importance of an adequate occupational history and the difficulties of making a diagnosis of talcosis are emphasized. The literature concerning clinical and experimental talcosis is briefly reviewed. This is believed to be the first patient with talcosis who presented with a superior mediastinal mass, the first in whom the diagnosis was made by lung biopsy, and the first who had extensive lung function studies and follow-up observation.

PubMed has no abstract for this study. This is the authors' abstract, copied from the article.

In plain English

This was a case report of one man, a 42-year-old rubber grinder admitted to a university hospital in Boston in November 1961 with chest pain, fever, breathlessness and cough. X-rays showed fine nodules in both lungs, a mass in the right lung and marked widening of the mediastinum (the central chest). Doctors suspected tuberculosis, sarcoidosis, then cancer, and removed tissue at surgery. The lung showed fibrosis, granulomas and many needle-shaped crystals with the characteristics of talc. A small pleural nodule contained golden-brown asbestos bodies, and the lymph nodes held crystals presumed to be silica. The authors judged the lesions typical of a reaction to impure talc, with features of both silicosis and asbestosis. He had worked 22 years in a rubber factory. From 1947 he shredded and ground rubber scraps without a mask, and no vinyl-asbestos tile was ever shredded. Workroom air held 115 million particles per cubic foot, about 4 times the allowable level, roughly 10 per cent of it talc. Three years later he had few symptoms. The authors stressed the importance of a full occupational history.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient), with a brief review of earlier literature in the discussion
• Who was studied: One 42-year-old man working as a rubber grinder, admitted to the University Hospital (Boston University Thoracic Services) on 29 November 1961 and re-examined in March 1965
• Exposure: 22 years in a rubber factory. For the first 8 years he mixed materials for hard rubber casings, which contained a white dust and asphalt. From 1947 he operated a machine shredding and grinding rubber tire and rubber tile scraps, which were mixed with whiting. No vinyl-asbestos tile was ever shredded, and he never used a respirator or mask. Analysis of the workplace powder identified butadiene-styrene synthetic rubber, limestone, Georgia clay, talc and pigment accelerators.
• Main results:
  • A ten-minute sample of the general atmosphere in the grinding room contained 115 million particles per cubic foot, about 4 times the maximal allowable concentration
  • Talc made up approximately 10 per cent of the atmospheric sample
  • Lung tissue contained innumerable needle-shaped and plate-like crystals, 3 to 17 microns in size, with the characteristics of talc. The lung also showed interstitial fibrosis, granulomas and 'pseudo asbestos bodies'.
  • Golden-brown asbestos bodies were found at the base of a small pleural nodule
  • The mediastinal lymph nodes were largely replaced by fibrous nodules. They held few talc crystals but many irregular crystals presumed to be silica.
  • The lesions had features of both silicosis and asbestosis and were considered typical of a reaction to impure talc
  • Before the operation the vital capacity was restricted to about half of normal (2.05 L against a predicted 3.82 L in the table), with no evidence of obstructive airway disease
  • Three years later the vital capacity (2.83 L in the table) was somewhat larger but still markedly reduced. He had few symptoms and had lost no time from work.
• The authors' conclusion: The authors concluded that the case showed the importance of an adequate occupational history and the difficulties of diagnosing talcosis. They believed this was the first talcosis patient reported with a superior mediastinal mass, the first diagnosed by lung biopsy, and the first with extensive lung function studies and follow-up.
• Limitations the authors state:
  • The exact composition of the materials he handled during his first 8 years at the factory was not known
  • The initial lung function findings fit silicosis but could equally have been caused by a number of other miliary lung diseases

Topics

The National Library of Medicine indexes this study under subjects our site covers: Talc and vermiculite.

Medical terms in this study, explained in our Lexicon: Silicosis, Occupational History, Biopsy.

Related studies

• Exposure to nitrosamines, carbon black, asbestos, and talc and mortality from stomach, lung, and laryngeal cancer in a cohort of rubber workers — K. Straif, U. Keil, et al. (2000)
• Mixed pneumoconiosis: silicosis, asbestosis, talcosis, and berylliosis — G.J. Mark, C.B. Monroe, et al. (1979)
• Effect of tale dust inhalation on lung function — M. Kleinfeld, J. Messite, et al. (1965)
• Pulmonary ventilatory function in talcosis of lung — M. Kleinfeld, J. Messite, et al. (1964)
• An epidemiologic study of a group of talc workers — J.F. Gamble, W. Fellner, et al. (1979)
• Respiratory effects from industrial talc exposure among former mining workers — R.C. Loyola, A.P. Carneiro, et al. (2010)

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