Cases reported "Foreign-Body Reaction"

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1/6. Polyester fibre prosthetic anterior cruciate ligament implant rupture: necrosis of ingrown connective tissue.

    AIMS: To describe the histopathological and microanalytical features in seven cases of ruptured Apex(R) polyester (Terylene(R)) fibre anterior cruciate ligament prosthesis. methods AND RESULTS: Transmitted and polarized light microscopy was performed in all cases; one case was investigated by immunohistochemistry, transmission electron microscopy and scanning electron microscopy, with backscatter and X-ray detectors for elemental microanalysis. For comparison we also studied synovial biopsy material and unused polyester fibres. In the excised ligaments there was much ingrowth of fibrous tissue accompanying a florid giant cell reaction to the individual intact polyester fibres throughout the ligaments. phagocytosis of particles of prosthesis-derived material was demonstrated and a striking finding was of necrosis of the ingrown connective tissue in the central portions of the ligaments. Hyalinized areas and 'neoligament growth' were less striking. A consistent finding in the polyester fibres was of small particles containing antimony, used as a catalyst in the manufacturing process. CONCLUSIONS: The pattern of reaction to the prosthetic material and the presence of necrosis differ from previous descriptions in animal and human explants of this and other prosthesis types. The mechanical effect of the necrosis is unlikely to be of significance with this ligament, which is load-bearing ab initio.
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2/6. Disseminated and recurrent sarcoid-like granulomatous panniculitis due to bovine collagen injection.

    Three to five percent of patients treated with injectable collagen implants have adverse local reactions. Systemic signs or symptoms are infrequent. We describe the case of a 53-year-old woman who developed local and general complaints 2 months after receiving two collagen injections in both nasolabial folds. She presented asthenia, malaise, polyarthralgia and inflammatory nodular panniculitis in the places of injection as well as on the forearms and lower extremities. skin testing was compatible with hypersensitivity to collagen. This case raises the question as to whether the injection of animal-derived collagen induces manifestations similar to those observed in connective autoimmune diseases or human adjuvant disease.
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3/6. Alveolitis due to hair-spray. Ultrastructural observations in two patients and the results of experimental investigations.

    observation of two patients with hair-spray induced lung disease have prompted us to study the ultrastructure of the lung lesion. We have compared the results with experimental lesions in animals injected with hair-spray extracts and with human monocyte cell cultures exposed to hair-spray. The lungs show a chronic alveolitis with a striking granulomatous reaction including macrophages and multinucleated giant cells of the foreign body type. The intraalveolar and interstitial macrophages and the giant cells all contain PAS-positive material. Ultrastructurally distinct lamellar inclusions are found in the secondary lysosomes of the macrophages and giant cells. Identical structures can be produced in animals injected with hair-spray extracts and with polyvinyl-pyrrolidone and -acetate (PVP/PVA), which are regular ingredients of hair-sprays. Large, presumeably polymeric particles (PVP/PVA) are ingested by giant cells. This "gigantophagocytosis" is associated with the fusion of mononuclear phagocytes and leads to the genesis of giant cells. In cell cultures of human blood monocytes hair-spray extracts and PVP/PVA induce maturation and aggregation of these cells, with PAS-positive cytoplasmatic inclusions. The development of multinuclear giant cells in these monocyte cell cultures is also seen. These observations suggest that hair-spray induced lung disease is caused by the prolonged and extensive body response of the local mononuclear phagocyte system (MPS). Overstimulation of the MPS leads to a quantitative and qualitative change which is followed by a partial blockade of this system. The alveolitis is a consequence of the foreign body response to inhaled hair-spray substances.
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4/6. Reaction to intraocular penetration of bentonite.

    A 20-year-old dental assistant had a severe case of anterior segment inflammation believed to be caused by bentonite, a component of Prophypaste. The patient's clinical course as well as animal studies, implicated bentonite as the offending agent.
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5/6. plasmacytoma arising in the vicinity of a foreign body in the nasal cavity.

    The development of a plasmacytoma in the vicinity of a long residing metallic foreign body in the nasal cavity is presented. In spite of the multitude of reports concerning neoplasma associated with trauma, most of which arise in chronic scars, this presentation is very rare. It is speculated that the plasma cell proliferation, occurring nearby the foreign body, roots from an immunologic and granulomatous reaction. This case is discussed in light of the vast data on foreign body tumorigenesis obtained from laboratory animals, and the implications of this data are outlined. Further attention should be drawn to the clinical associations of malignant processes co-existing with long-standing foreign bodies.
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6/6. Reactive synovitis from particulate silastic.

    A reactive synovitis secondary to intra-articular particles of silicone elastomer developed in three patients who had undergone Silastic hemiarthroplasty. In an attempt to duplicate this phenomenon, we used an animal model in which finely ground particulate silicone elastomer was introduced into the knee joints of adult new zealand White rabbits. In three of thirteen rabbits (p = 0.066) histological evidence of inflammatory changes developed in the synovial tissue, similar to those seen in our patients. Intraarticular particulate silicone elastomer created by abrasion of a Silastic hemiarthroplasty may be responsible for the development of an iatrogenic reactive synovitis.
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