RESUMO
BACKGROUND: Adverse reactions, caused during the inflammation and healing process, or even later, can be induced by the injection of dermal filler and can present a variety of clinical and histological characteristics. In this study we aimed to review the adverse reactions associated with the injection of aesthetic filling materials in the face and neck. MATERIAL AND METHODS: The review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Studies published that mentioned adverse reactions in patients with aesthetic filling materials in the face or neck were included. Risk of bias was assessed using the Joanna Briggs Institute appraisal tool. After a 2-step selection process, 74 studies were included: 51 case reports, 18 serial cases, and five cohorts. RESULTS: A total of 303 patients from 20 countries were assessed. Lesions were more prevalent in the lip (18%), nasolabial folds (13%), cheeks (13%), chin (10%), submental (8%), glabella (7%), and forehead (6%). Histopathological analysis revealed a foreign body granuloma in 87.1% of the patients, 3% inflammatory granuloma, 3% lipogranuloma, 2.3% xanthelasma-like reaction, 1% fibrotic reaction, 0.7% amorphous tissues, 0.7% xanthelasma, 0.3% sclerosing lipogranuloma, 0.3% siliconoma, and 0.3% foreign body granuloma with scleromyxedema. In addition, two patients displayed keratoacanthoma and two others displayed sarcoidosis after cutaneous filling. The most commonly used materials were silicone fillers (19.7%), hyaluronic acid (15.5%), and hydroxyethyl methacrylate/ethyl methacrylate suspended in hyaluronic acid acrylic hydrogel (5.6%). All patients were treated, and only 12 had prolonged complications. CONCLUSIONS: There is evidence that adverse reaction can be caused by different fillers in specific sites on the face. Although foreign body granuloma was the most common, other adverse lesions were diagnosed, exacerbating systemic diseases. In this way, we reinforce the importance of previous systemic evaluations and histopathological analyses for the correct diagnosis of lesions.
Assuntos
Técnicas Cosméticas , Granuloma de Corpo Estranho , Humanos , Granuloma de Corpo Estranho/induzido quimicamente , Granuloma de Corpo Estranho/patologia , Técnicas Cosméticas/efeitos adversos , Ácido Hialurônico/efeitos adversos , Estética Dentária , Polimetil MetacrilatoRESUMO
The use of cosmetic fillers agents in orofacial region has become more often used for esthetic concern. Although adverse effects are rare, some patients may develop foreign body reaction to such fillers. Hyaluronic acid (HA) is a biomaterial in the spotlight, because it is normally present in several tissues of human body. The aim of this study was to report a case of a 54-year-old white woman with granulomatous reaction to the HA located in the lips. In addition, a review of the English-language literature of all previously described cases of this condition in oral and perioral region was performed. The location, clinical features, symptoms, time between injection and reaction, type of treatment and treatment outcome of 17 cases were summarized. The clinical and histopathological examination along with a detailed history about this condition is very important to management of patients with nodular lesions in maxillofacial region.
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Preenchedores Dérmicos/efeitos adversos , Granuloma de Corpo Estranho/induzido quimicamente , Granuloma de Corpo Estranho/diagnóstico , Ácido Hialurônico/efeitos adversos , Lábio , Técnicas Cosméticas/efeitos adversos , Feminino , Granuloma de Corpo Estranho/patologia , Humanos , Pessoa de Meia-IdadeRESUMO
Resumen Introducción A pesar de la evidencia sobre los malos resultados y riesgos del uso de inyecciones subcutáneas de silicona para mejorar el contorno corporal, esta técnica sigue siendo utilizada por personas no calificadas. Caso clínico Paciente de 56 años quien consultó por cuadro de celulitis en pierna izquierda. Se obtuvo el antecedente de intervención con silicona en cara, dorso de las manos, glúteos y piernas el año 2000. El cuadro progresó con múltiples abscesos en la totalidad de la pierna y sepsis. Se realizaron aseos quirúrgicos exponiendo planos fascial y muscular, se utilizó terapia local con sistemas de presión negativa y posterior injerto dermo-epidérmico (IDE). El manejo multidisciplinario se realizó en unidades críticas. Los resultados del manejo fueron satisfactorios, salvando la extremidad con cobertura total, logrando el alta luego de 4 meses. Conclusión A pesar de conocerse los peligros de la inyección de silicona, este sigue siendo un procedimiento frecuente. En nuestra paciente se manifestó como fascitis de la pierna, requiriendo tratamiento quirúrgico agresivo. Conocer esta entidad, su diagnóstico y tratamiento es fundamental para tratar pacientes con complicaciones graves.
Introduction Despite the evidence of poor performance and risks of using silicone subcutaneous injections to improve body contour, this technique is still used by untrained people, generating an iatrogenic entity with serious complications. Case report 56 year old female presented left lower extremity cellulitis. A history of previous intervention with silicone injections in face, back of hands, buttocks and legs in year 2000 was obtained. An inflammatory process progressed locally and systemically with multiple abscesses, subcutaneous thickness in the entire leg and sepsis, requiring multiple surgical procedures, reaching fascial and muscle planes exposition of the left leg. The patient underwent local therapy with negative pressure systems and subsequent dermoepidermal graft. Multidisciplinary management was performed on a critical unit. The results were satisfactory, preserving the limb with full coverage. She was discharged after four months of inpatient management. Conclusion Despite knowing the risks of silicone injection (industrial or medical) it remains a common procedure. In our patient she presented as leg fasciitis, requiring aggressive surgical treatment. Knowing this entity, its diagnosis and treatment is essential to treat patients with serious complications.
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Humanos , Feminino , Pessoa de Meia-Idade , Silicones/efeitos adversos , Granuloma de Corpo Estranho/cirurgia , Granuloma de Corpo Estranho/induzido quimicamente , Transplante de Pele/métodos , Silicones/administração & dosagem , Úlcera/induzido quimicamente , Celulite (Flegmão)/induzido quimicamente , Sepse , Extremidade Inferior , Eritema , Fasciite/induzido quimicamente , Injeções SubcutâneasRESUMO
Silicone oil injections are often used for soft tissue augmentation and local and general adverse effects occurring from a few months to 15 years after injection have been reported. Here, we present a case of delayed granuloma formation due to liquid injectable silicone with large extent of involvement, which precluded surgical removal. Our patient was successfully treated with minocycline, considering its anti-inflammatory, immunomodulating and antigranulomatous properties. This case presents minocycline monotherapy as a useful treatment option for the management of severe granuloma induced by silicone use when surgical excision is not possible.
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Antibacterianos/uso terapêutico , Granuloma de Corpo Estranho/tratamento farmacológico , Minociclina/uso terapêutico , Dermatopatias/tratamento farmacológico , Adulto , Feminino , Granuloma de Corpo Estranho/induzido quimicamente , Humanos , Óleos de Silicone/efeitos adversos , Dermatopatias/induzido quimicamenteRESUMO
This study evaluated different dosage forms of aluminum adjuvant in generating allergic rhinitis animal models. Forty female BALB/c mice were assigned to four groups, including three dosage forms of aluminum adjuvant [powder, gel, and hydrosolvent of aluminum hydroxide, Al(OH)3] mixed with ovalbumin to simulate the symptoms of allergic rhinitis and one control group. Although the aluminum adjuvants were in different dosage forms, the content was 5 mg after conversion in all groups. The fourth group was given normal saline instead as a control. Mice of the powder group displayed typical symptoms of allergic rhinitis. We also found discrete eosinophils in the nasal mucosa of mice from the hydrosolvent group; however, no eosinophils were found in the gel group. These two groups both displayed cytotoxic symptoms and foreign body granuloma. Aluminum adjuvant used in producing animal models can induce foreign body granuloma and other untoward reactions, which are associated with the dosage level and form.
Assuntos
Adjuvantes Imunológicos/química , Hidróxido de Alumínio/química , Modelos Animais de Doenças , Rinite Alérgica/fisiopatologia , Adjuvantes Imunológicos/administração & dosagem , Adjuvantes Imunológicos/efeitos adversos , Hidróxido de Alumínio/administração & dosagem , Hidróxido de Alumínio/efeitos adversos , Animais , Eosinófilos/imunologia , Eosinófilos/patologia , Feminino , Géis , Granuloma de Corpo Estranho/induzido quimicamente , Granuloma de Corpo Estranho/fisiopatologia , Camundongos , Camundongos Endogâmicos BALB C , Mucosa Nasal/imunologia , Mucosa Nasal/fisiopatologia , Ovalbumina , Pós , Rinite Alérgica/induzido quimicamente , Rinite Alérgica/imunologiaRESUMO
Electrospun materials have been widely explored for biomedical applications because of their advantageous characteristics, i.e., tridimensional nanofibrous structure with high surface-to-volume ratio, high porosity, and pore interconnectivity. Furthermore, considering the similarities between the nanofiber networks and the extracellular matrix (ECM), as well as the accepted role of changes in ECM for hernia repair, electrospun polymer fiber assemblies have emerged as potential materials for incisional hernia repair. In this work, we describe the application of electrospun non-absorbable mats based on poly(ethylene terephthalate) (PET) in the repair of abdominal defects, comparing the performance of these meshes with that of a commercial polypropylene mesh and a multifilament PET mesh. PET and PET/chitosan electrospun meshes revealed good performance during incisional hernia surgery, post-operative period, and no evidence of intestinal adhesion was found. The electrospun meshes were flexible with high suture retention, showing tensile strengths of 3 MPa and breaking strains of 8-33%. Nevertheless, a significant foreign body reaction (FBR) was observed in animals treated with the nanofibrous materials. Animals implanted with PET and PET/chitosan electrospun meshes (fiber diameter of 0.71 ± 0.28 µm and 3.01 ± 0.72 µm, respectively) showed, respectively, foreign body granuloma formation, averaging 4.2-fold and 7.4-fold greater than the control commercial mesh group (Marlex). Many foreign body giant cells (FBGC) involving nanofiber pieces were also found in the PET and PET/chitosan groups (11.9 and 19.3 times more FBGC than control, respectively). In contrast, no important FBR was observed for PET microfibers (fiber diameter = 18.9 ± 0.21 µm). Therefore, we suggest that the reduced dimension and the high surface-to-volume ratio of the electrospun fibers caused the FBR reaction, pointing out the need for further studies to elucidate the mechanisms underlying interactions between cells/tissues and nanofibrous materials in order to gain a better understanding of the implantation risks associated with nanostructured biomaterials.
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Materiais Biocompatíveis/farmacologia , Quitosana/farmacologia , Reação a Corpo Estranho/induzido quimicamente , Granuloma de Corpo Estranho/induzido quimicamente , Nanofibras/química , Polietilenoglicóis/farmacologia , Telas Cirúrgicas/veterinária , Animais , Materiais Biocompatíveis/química , Quitosana/química , Modelos Animais de Doenças , Técnicas Eletroquímicas , Reação a Corpo Estranho/patologia , Granuloma de Corpo Estranho/patologia , Hérnia Abdominal/cirurgia , Herniorrafia/instrumentação , Masculino , Teste de Materiais , Polietilenoglicóis/química , Polietilenotereftalatos , Polipropilenos/farmacologia , Ratos , Ratos Wistar , Propriedades de Superfície , Suturas , Resistência à TraçãoRESUMO
BACKGROUND: Autologous bone grafts are usually well consolidated after 4 to 5 months but can be incompletely interlocked with the native bone. This study investigated the effect of acid demineralization of the graft-bed interface on graft consolidation. METHODS: Onlay bone grafts were performed on the calvaria of 36 guinea pigs. Half of the animals had the graft-bed contacting surfaces demineralized with 50% citric acid (pH 1.0) for 3 minutes (test group). The other half received no demineralization (control group). The bone grafts were immobilized by a resorbable membrane glued to the recipient bed with cyanoacrylate. After 7, 30, and 90 days, specimens (n = 6) were obtained for light microscopy. Data from qualitative analysis and computerized histomorphometry were statistically processed at a significance level of 5%. RESULTS: Osteogenesis was not seen at the interface after 7 days. After 30 days, the test group showed 34.39% ± 13.4% of the interface area filled with mineralized tissue, compared to 17.14% ± 8.6% in the control group (P = 0.026). After 90 days, the mean percentages of mineralized tissue at the interface in the test and control specimens were 54.00% ± 11.23% and 38.65% ± 7.76% (P = 0.041), respectively. Within groups, a higher percentage of the area filled with mineralized tissue was seen at 90 days compared to 30 days (P = 0.004 for control and 0.041 for test). CONCLUSIONS: Demineralization of the contacting surfaces between autologous bone graft and bone bed improved new bone formation and bone consolidation. These data need to be confirmed in humans.
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Autoenxertos/efeitos dos fármacos , Transplante Ósseo/métodos , Ácido Cítrico/uso terapêutico , Osteogênese/efeitos dos fármacos , Osso Parietal/efeitos dos fármacos , Implantes Absorvíveis , Animais , Autoenxertos/transplante , Técnica de Desmineralização Óssea , Matriz Óssea/efeitos dos fármacos , Matriz Óssea/patologia , Colágeno/química , Cianoacrilatos/efeitos adversos , Cianoacrilatos/uso terapêutico , Fibrina/análise , Tecido de Granulação/efeitos dos fármacos , Tecido de Granulação/patologia , Granuloma de Corpo Estranho/induzido quimicamente , Cobaias , Processamento de Imagem Assistida por Computador/métodos , Masculino , Membranas Artificiais , Osteócitos/efeitos dos fármacos , Osteócitos/patologia , Osso Parietal/transplante , Fatores de Tempo , Adesivos Teciduais/efeitos adversos , Adesivos Teciduais/uso terapêuticoRESUMO
CONTEXT: Byrsonima crassifolia is a tropical tree, commonly known as nance and distributed widely in Mexico and Central and South America. Since pre- Hispanic times, the seeds of the fruits have been used in folklore medicine as an anti-inflammatory; however, currently no researchers have examined its potential pharmacological properties in scientific studies. OBJECTIVE: This study investigated the anti-inflammatory activity of extracts obtained with the solvents n-hexane, chloroform, and methanol from seeds of B crassifolia. DESIGN: The research team induced edemas in Wistar rats with 12-O-tetradecanoylphorbol (TPA), formaldehyde, carrageenan, and histamine to study the anti-inflammatory activity of the three organic extracts of seeds from B crassifolia. The team also used the cotton-pellet granuloma method to induce edemas in Wistar rats and study the inhibitory effect of the three extracts from B crassifolia. Finally, the team examined the participation of the nitric oxide (NO) system in the anti-inflammatory activity of the hexane extract of nance seeds (NS), diclorofenac, and L-NAME as well as the effects of L-arginine and D-arginine on the antiinflammatory actions of the compounds. SETTING: This research was conducted in the Laboratory of Research of Natural Products, School of Chemical Engineering, National Polytechnic Institute (IPNESIQIE) and Department of Biotechnology and Bioengineering, Cinvestav-IPN, Av. IPN 2508, Col. San Pedro Zacatenco, Mexico D.F., CP 07360, Mexico. OUTCOME MEASURES: The research team measured the edema that the solvents caused, either in the ears of rats for tetradecanoylphorbol or in the paws for formaldehyde, carrageenan, and histamine. To study the antiproliferative effects of the extracts after implantation of the cotton-pellet granuloma, the team determined the wet and dry weights of the pellets, after drying at 70°C for 1 hour in the second case. To study the participation of the NO system in the anti-inflammatory activity of the hexane extract of NS, diclofenac, and L-NAME, the research team measured paw edema. RESULTS: Among the extracts tested, NS showed the most significant anti-inflammatory activity. That extract decreased the paw edema that carrageenan, formaldehyde, histamine, and cotton pellet-induced, either by oral or topical administration at doses of 200 mg/kg, with 31%, 66%, 83%, and 58.2% inhibition respectively. In addition, NS inhibited the ear edema that TPA induced by 62%. Methanol and chloroform extracts produced a small effect, so the team does not present the results in this article. L-arginine, a precursor of NO, significantly inhibited the anti-inflammatory effects of NS and L-NAME, an anti-inflammatory drug, on mouse paw edema, but D-arginine did not. In contrast, neither D-arginine nor L-arginine inhibited the anti-inflammatory effects that diclofenac produced. These results indicate that the anti-inflammatory effect of NS on mouse paw edema occurs via the inhibition of NO production, as does the anti-inflammatory effect of L-NAME but not the anti-inflammatory effect of diclofenac. The anti-inflammatory activity of NS was comparable to standard anti-inflammatory drugs such as indomethacin, dexamethasone, and sodium diclofenac. CONCLUSIONS: The hexane extract from seeds of B crassifolia exhibited significant anti-inflammatory activity in both acute and chronic inflammatory models with a partial contribution of inhibitory actions on some cellular inflammatory responses. The anti-inflammatory mechanism of NS may be related to the other isoform (iNOS).
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Anti-Inflamatórios/farmacologia , Modelos Animais de Doenças , Edema/prevenção & controle , Granuloma de Corpo Estranho/prevenção & controle , Malpighiaceae/química , Extratos Vegetais/farmacologia , Sementes , Animais , Anti-Inflamatórios/administração & dosagem , Comportamento Animal/efeitos dos fármacos , Relação Dose-Resposta a Droga , Edema/induzido quimicamente , Feminino , Granuloma de Corpo Estranho/induzido quimicamente , Hexanos , Masculino , Extratos Vegetais/administração & dosagem , Plantas Medicinais , Ratos , Ratos WistarRESUMO
INTRODUCTION: The purpose of this study was to evaluate the subcutaneous connective tissue reaction in rats to a mineral trioxide aggregate (MTA)-based endodontic sealer Fillapex (Angelus, Londrina, PR, Brazil) and compare it with Grossman sealer (Farmadental, Buenos Aires, Argentina). METHODS: Sterile medical-grade silicone tubes containing the test materials were implanted in 24 Wistar rats. After 10, 30, and 90 days, the animals (n = 8 per period) were euthanized, and the implants along with their surrounding tissues were dissected, fixed, and processed for histologic evaluation. A 4-category evaluation system was used to evaluate the microscopic observations. The tissue response on the lateral walls of the silicone tubes was used as the negative control. The data were analyzed for statistical significance using the Wilcoxon signed rank, Kruskal-Wallis, and Dunn tests. RESULTS: Fillapex showed a severe tissue reaction for all 3 observation periods. Grossman sealer showed similar features after 10 and 30 days, but the reaction decreased slightly after 90 days. In contrast, the negative controls did not show adverse reactions in any sample of the 3 time periods. After 10 and 30 days, no statistically significant differences were found between Fillapex and Grossman sealer (P > .05); however, the difference was significant after 90 days (P < .05). For all experimental periods, there were statistically significant differences between both Fillapex and Grossman sealer and the negative controls (P < .05). CONCLUSIONS: It was concluded that both MTA-Fillapex and Grossman sealer remained toxic to subcutaneous tissues in rats after 90 days.
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Compostos de Alumínio/toxicidade , Compostos de Cálcio/toxicidade , Óxidos/toxicidade , Materiais Restauradores do Canal Radicular/toxicidade , Silicatos/toxicidade , Tela Subcutânea/efeitos dos fármacos , Cimento de Óxido de Zinco e Eugenol/toxicidade , Animais , Materiais Biocompatíveis/toxicidade , Capilares/patologia , Combinação de Medicamentos , Fibroblastos/patologia , Reação a Corpo Estranho/induzido quimicamente , Células Gigantes de Corpo Estranho/patologia , Granuloma de Corpo Estranho/induzido quimicamente , Linfócitos/patologia , Macrófagos/patologia , Masculino , Teste de Materiais , Neutrófilos/patologia , Plasmócitos/patologia , Ratos , Ratos Wistar , Tela Subcutânea/patologia , Fatores de TempoRESUMO
The aim of this study was to evaluate the biocompatibility of sealers used in apical surgery in rat subcutaneous tissue. Sterile polyethylene tubes were filled with the following sealers: Sealapex, Sealapex with addition of zinc oxide, Sealer 26, Sealer 26 with thicker consistency (greater powder-to-resin ratio) and White MTA. The tubes were implanted in the dorsum of male rats and after 7, 21 and 42 days, the animals were killed, obtaining 5 specimens for each sealer in each evaluation period. The lateral surface of the tube was used as negative control. The inflammatory reaction to contact with the sealers was classified as absent, mild, moderate and severe. At 7 days, all sealers caused similar inflammatory reactions in the connective tissue of the animals, with most specimens presenting a moderate to intense chronic inflammatory reaction, with presence of multinucleated giant cells. At 21 days, Sealer 26 and Sealer 26 with thicker consistency presented more intense inflammatory reaction (p=0.004), whereas after 42 days, the inflammatory reaction ranged from absent to mild with statistically similar results for both materials (p=0.08). Except for MTA, all sealers presented foreign-body granulomatous reaction at 42 days. All sealers but Sealapex presented a statistically significant decrease of the inflammatory reaction over time. In conclusion, all sealers caused moderate to severe inflammation in the earlier evaluation period. However, Sealer 26 and Sealer 26 with thicker consistency caused more intense inflammatory reactions after 21 days of contact with the tissues and no granulomatous reaction was observed for MTA at the final period of analysis.