Cases reported "Hypersensitivity"

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1/19. cobalt-specific T lymphocytes in synovial tissue after an allergic reaction to a cobalt alloy joint prosthesis.

    metals such as cobalt and nickel are common contact allergens. We studied the mechanisms underlying an allergic reaction with marked synovial inflammation in a patient with a cobalt alloy arthroplasty. After removing the joint prosthesis the adjacent synovial tissue was examined for cobalt-specific T lymphocytes. synovial membrane mononuclear cells were expanded in interleukin 2 and cloned using a representative cloning protocol. T cell clones were tested for their proliferative response to cobalt and further characterized with regard to cytokine secretion, phenotype, and HLA restriction. Additionally, synovial fibroblasts were tested for their function as antigen presenting cells (APC). Almost 30% of the T cell clones reacted to cobalt, but not to the control nickel. All these T cell clones were CD4 positive. The cobalt induced proliferative response could be blocked by anticlass II antibodies. Also, synovial fibroblasts expressing class II molecules induced by interferon-gamma were able to serve as APC. However, when testing a panel of APC of HLA class II mismatched donors, no requirement for a certain HLA class II molecule could be defined. Further studies are necessary to determine mechanisms of presentation and recognition of cobalt by T lymphocytes, a prerequisite for improved prevention and treatment of metal induced allergic reactions.
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keywords = metal
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2/19. An unusual reaction in muscle in association with vitallium plate: a report of possible metal hypersensitivity.

    A case is reported in which fractures of the radius and ulna were fixed with vitallium plates and screws. Seven years later a painful swelling appeared over the extensor aspect of the forearm. After eight years sarcoma was suspected and a pale tumour infiltrating muscle was found at operation. However, the histology excluded neoplasia and showed massive fibrosis and patchy necrosis of muscle, with chronic inflammatory changes peripherally. After the removal of the metal the swelling disappeared. A sinus down to the ulna followed operation and was not cured two years later. At this stage standard patch testing showed skin sensitivity to cobalt. Metal sensitivity is proposed as the cause of this extraordinary reaction in muscle.
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keywords = metal
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3/19. platinum concentrations in sera of catalyst production workers are not predictive of platinum salt allergy.

    platinum (Pt) salts are potent occupational allergens in precious metal refineries and catalyst productions. The threshold limit value of 2000 ng soluble Pt/m3 enforced in many countries has been questioned because there is still a high incidence of Pt salt allergy. The objective of the present case series is to define the predictive value of biological monitoring by relating Pt in the serum of catalyst production workers and control subjects to sensitization to Pt salts as assessed by skin prick testing. A total of 38 Pt measurements were taken from sera of six workers investigated several times during a 5-year cohort study. Three subjects showed a conversion of skin prick test (SPT) with Pt salts from negative to positive during the cohort study (all considered highly exposed to Pt), and three did not show SPT conversion. Previous therapy with Pt-containing anti-cancer drugs and metallic dental alloys were considered as confounders. Only one of the three workers sensitized to Pt salt had clearly elevated serum Pt concentrations, but this elevation was not observed in each examination. Elevated Pt concentrations were also found in two subjects with low or no exposure to Pt. Both had metallic dental alloys. One control subject without metallic dental alloys showed low Pt concentrations in the serum in four examinations, but a single unexplained high concentration in his initial examination. In this small case series, serum Pt concentrations were neither sensitive nor specific for the prediction of Pt salt sensitization. Low specificity may be explained by Pt-containing metallic dental alloys, but additional unknown confounders may be of importance.
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keywords = metal
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4/19. Metal allergy to stainless steel wire after coronary artery bypass grafting.

    To our knowledge, this is the first reported case of a manganese metal allergy to stainless steel wire. A 51-year-old man suffered from a refractory pruritic erythematous wheal after the insertion of a stainless steel wire. The patch test showed strong reactions to manganese, one of the constituents of stainless steel wire. After the removal of all stainless steel wires, the symptoms were much improved, except for mild pruritus on his face.
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keywords = metal
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5/19. Metal fragment in the temporomandibular joint: a case report.

    A 56-year-old woman was referred for severe pain and restricted jaw movements with a duration of more than 10 years.In the early 1990s a discectomy on the left side had been performed where the disc was extirpated and replaced with a polymeric implant. Due to infection and pain the implant was removed about 2 months later. In the 10-year period thereafter she suffered pain from the joint, pain from the left ear, tinnitus and restricted mouth opening.A computer tomography scan revealed a foreign body, approximately 4mm in size, situated in the medial part of the glenoid fossa. The metallic foreign body was surgically removed. The pain from her left temporomandibular joint decreased and the mouth opening capacity increased. Patch-testing showed that the patient had a potential for contact allergy to nickel, chromium and cobalt. The foreign body was most probably a fractured tip of a surgical awl. Energy dispersive X-ray analysis revealed that the fragment consisted of iron and chromium. The instrument fragment could have caused the symptoms either by an allergic reaction or a direct mechanical effect.
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keywords = metal
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6/19. osteonecrosis secondary to internal fixation.

    Allergies to metals as a cause of failure of joint prostheses has historically been a controversial issue. Loosening of a prosthesis may be due to trauma, infection of the surrounding area, or a faulty implantation of the device. However, cases of loosening of the device do occur without any history of the above criteria. This leads one to consider other explanations for this phenomenon, such as sensitivity of the tissues to one of the metals in the implant. The following presentation demonstrates that metal allergies are a surgical concern when considering joint prostheses, or internal fixation.
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keywords = metal
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7/19. Painful metal-on-metal total hip arthroplasty.

    Two patients were evaluated for the possibility of hypersensitivity to a Metasul articulation (Centerpulse, Austin, Tex) coupled with total hip arthroplasty. serum was tested with a lymphocyte proliferation assay, and the capsular tissues from the hip were examined for perivascular lymphocytes. The diagnosis of hypersensitivity to Metasul could not be confirmed in these patients, and ultimately, the painful hip arthroplasties were felt to be caused by a combination of musculoskeletal problems.
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keywords = metal
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8/19. Allergic contact dermatitis to nickel in children with atopic dermatitis.

    We report two atopic boys with allergic contact dermatitis to nickel. Both children had early onset of atopic dermatitis and subsequently presented with infraumbilical dermatitis corresponding to the site of contact with metal snaps. A positive patch test response to 2.5% nickel sulfate in petrolatum was observed in both boys. Allergic contact dermatitis in patients with atopic dermatitis is not uncommon and probably occurs more often than recognized.
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keywords = metal
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9/19. Mucosal reactions to amalgam restorations.

    Amalgam restorations have been implicated both in contact sensitivity reactions and in lichenoid reactions. This appears to be related principally to the mercury content, although other metals cannot be discounted. The cases of two patients are reported who showed features of lichenoid reactions of the oral mucosa, in addition to features of a contact hypersensitivity to mercury. The mucosal lesions resolved following replacement of the amalgams with non-metallic restorations. Consideration is given to the selection of materials and procedures currently available for treatment of these patients. This paper supports the view that sensitivity to heavy metals must be considered as a possible cause of erythematous and lichenoid reactions of the oral mucosa.
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keywords = metal
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10/19. Metacarpal fracture fixation with interosseous nylon suture in a patient with metal allergies.

    The successful repair of two oblique metacarpal shaft fractures with interosseous nylon sutures is reported. The technique was devised for the treatment of a 54-year-old woman with severe asthma and metal allergies that precluded the use of more conventional methods. Allergic reactions to mental implants and alternative stabilization techniques are discussed. The method is suggested not as a routine procedure, but rather as an option to standard means of fracture fixation in similar unusual circumstances.
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keywords = metal
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