RESUMO
BACKGROUND: Polypropylene mesh is used widely for surgical treatment of pelvic organ prolapse and stress urinary incontinence. Although these surgeries demonstrate favorable functional and anatomic outcomes, their use has been limited by complications, the 2 most common being exposure and pain. Growing evidence suggests that T lymphocytes play a critical role in the regulation of the host response to biomaterials. OBJECTIVE: The purpose of this study was to define and characterize the T-cell response and to correlate the response to collagen deposition in fibrotic capsules in mesh tissue complexes that are removed for the complications of pain vs exposure. STUDY DESIGN: Patients who were scheduled to undergo a surgical excision of mesh for pain or exposure at Magee-Women's Hospital were offered enrollment. Forty-two mesh-vagina tissue complexes were removed for the primary complaint of exposure (n=24) vs pain (n=18). Twenty-one patients agreed to have an additional vaginal biopsy away from the site of mesh that served as control tissue. T cells were examined via immunofluorescent labeling for cell surface markers CD4+ (Th), CD8+ (cytotoxic) and foxp3 (T-regulatory cell). Frozen sections were stained with hematoxylin-eosin for gross morphologic condition and picrosirius red for collagen fiber analysis. Interrupted sodium-dodecyl sulfate gel electrophoresis was used to quantify the content of collagens type I and III, and the collagen III/I ratio. Transforming growth factor-ß and connective tissue growth factor, which are implicated in the development of fibrosis, were measured via enzyme-linked immunosorbent assays. Data were analyzed with the Student's t tests, mixed effects linear regression, and Spearman's correlation coefficients. RESULTS: Demographic data were not different between groups, except for body mass index, which was 31.7 kg/m2 for the exposure group and 28.2 kg/m2 for pain (P=.04). Tissue complexes demonstrated a marked, but highly localized, foreign body response. We consistently observed a teardrop-shaped fibroma that encapsulated mesh fibers in both pain and exposure groups, with the T cells localized within the tip of this configuration away from the mesh-tissue interface. All 3 T-cell populations were significantly increased relative to control: CD4+ T helper (P<.001), foxp3+ T regulatory (P<.001), and CD8+ cytotoxic T cell (P=.034) in the exposure group. In the pain group, only T-helper (P<.001) and T-regulatory cells (P<.001) were increased, with cytotoxic T cells (P=.520) not different from control. Picrosirius red staining showed a greater area of green (thin) fibers in the exposure group (P=.025) and red (thick) fibers in the pain group (P<.001). The ratio of area green/(yellow + orange + red) that represented thin vs thick fibers was significantly greater in the exposure group (P=.005). Analysis of collagen showed that collagen type I was increased by 35% in samples with mesh complications (exposure and pain) when compared with control samples (P=.043). Strong correlations between the profibrosis cytokine transforming growth factor-ß and collagen type I and III were found in patients with pain (r≥0.833; P=.01) but not exposure (P>.7). CONCLUSION: T cells appear to play a critical role in the long-term host response to mesh and may be a central pathway that leads to complications. The complexity of this response warrants further investigation and has the potential to broaden our understanding of mesh biology and clinical outcomes.
Assuntos
Colágeno/metabolismo , Reação a Corpo Estranho/imunologia , Polipropilenos/efeitos adversos , Telas Cirúrgicas/efeitos adversos , Linfócitos T/metabolismo , Adulto , Idoso , Biomarcadores/metabolismo , Remoção de Dispositivo , Feminino , Migração de Corpo Estranho/imunologia , Migração de Corpo Estranho/metabolismo , Migração de Corpo Estranho/patologia , Migração de Corpo Estranho/cirurgia , Reação a Corpo Estranho/diagnóstico , Reação a Corpo Estranho/metabolismo , Reação a Corpo Estranho/patologia , Humanos , Modelos Lineares , Pessoa de Meia-Idade , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/cirurgiaAssuntos
Estenose Coronária/terapia , Vasos Coronários/patologia , Embolia/patologia , Corpos Estranhos/patologia , Microvasos/patologia , Intervenção Coronária Percutânea/instrumentação , Idoso , Evolução Fatal , Corpos Estranhos/complicações , Migração de Corpo Estranho/patologia , Humanos , Interações Hidrofóbicas e Hidrofílicas , Rim/patologia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio com Supradesnível do Segmento ST , Choque Cardiogênico/etiologiaRESUMO
INTRODUCTION: Adverse effects on the oral mucosa after the use of dermal fillers have been reported due to their increased use for facial aesthetics. OBJECTIVE: This study aimed to evaluate, clinically and histologically, the local and systemic effects of two concentrations of polymethylmethacrylate (PMMA) dermal filler in rats. MATERIAL AND METHODS: Fifty-four female rats were allocated into three treatment groups (2% PMMA, 30% PMMA and 0.9% NaCl), according to the substance injected in the tongue, and three experimental periods: 7, 60 and 90 days. The rats were clinically evaluated and then euthanised, and their tongue and right kidney removed. The histological sections were stained with haematoxylin/eosin and picrosirius. RESULTS: Clinically, significant differences were found between test groups as to the occurrence of nodules (Kruskal-Wallis; p < 0.001). Histologically, there was greater inflammatory response in the PMMA compared with control (Kruskal-Wallis; p < 0.001). 30% PMMA had greater collagen formation (anova mixed models; p < 0.01). No migration of the material towards kidney was found. CONCLUSION: Polymethylmethacrylate induced intense reaction in the initial period of observation (7 days), followed by gradual decrease during the study, favouring the presence of fibroplasia adjacent to the material.
Assuntos
Polimetil Metacrilato/administração & dosagem , Polimetil Metacrilato/farmacologia , Língua/efeitos dos fármacos , Língua/patologia , Animais , Vasos Sanguíneos/efeitos dos fármacos , Vasos Sanguíneos/patologia , Colágeno/biossíntese , Preenchedores Dérmicos/administração & dosagem , Preenchedores Dérmicos/farmacologia , Eutanásia Animal , Feminino , Migração de Corpo Estranho/induzido quimicamente , Migração de Corpo Estranho/patologia , Reação a Corpo Estranho/induzido quimicamente , Reação a Corpo Estranho/patologia , Células Gigantes/efeitos dos fármacos , Células Gigantes/patologia , Inflamação/induzido quimicamente , Injeções Intradérmicas , Rim/efeitos dos fármacos , Rim/patologia , Mucosa Bucal/efeitos dos fármacos , Ratos , Ratos Wistar , Cloreto de Sódio/administração & dosagem , Cloreto de Sódio/farmacologia , Fatores de TempoRESUMO
BACKGROUND: Various alloplastic materials have been used for filling depressions and for body contouring. Among them, polymethylmethacrylate (PMMA) has provoked many clinical compilations in both the acute and chronic phases. This study shows the correlation between the clinical application of PMMA and the physiopathology of the acute and late complications. METHODS: Histological studies were performed on biopsy samples from patients who presented with side effects and acute and late complications after PMMA injections given at other health-care centers or aesthetic services. RESULTS: The histological findings of the samples that were harvested from patients who developed clinical complications or side effects caused by injection of PMMA disclosed not only normal tissues from the implanted areas but also development of capsules that involved individual microspheres of PMMA, and when the capsules were close together they formed concentric capsular groups involving various sets of microspheres and their capsules. CONCLUSIONS: The injection of PMMA within the tissues can cause severe complications and side effects in both acute and chronic phases. Initially, the complications are related to vascular compromise, but at the late phase they are a consequence of capsular contracture that involves particles of PMMA. The contracture causes local tissue hardening and clinical nodulation of the implanted areas, ending with extrusion of the filler material. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at www.springer.com/00266.
Assuntos
Materiais Biocompatíveis/efeitos adversos , Migração de Corpo Estranho/induzido quimicamente , Migração de Corpo Estranho/patologia , Reação a Corpo Estranho/induzido quimicamente , Reação a Corpo Estranho/patologia , Polimetil Metacrilato/efeitos adversos , Ritidoplastia/efeitos adversos , Adulto , Idoso , Materiais Biocompatíveis/administração & dosagem , Face/cirurgia , Feminino , Humanos , Injeções Subcutâneas/efeitos adversos , Masculino , Pessoa de Meia-Idade , Polimetil Metacrilato/administração & dosagem , Complicações Pós-Operatórias/induzido quimicamente , Complicações Pós-Operatórias/patologiaRESUMO
A variety of injectable permanent fillers have been used in orofacial tissues for cosmetic purposes. Most of these substances seem to be well tolerated but adverse reactions have been reported. Foreign body granulomas are a rare adverse reaction to injectable permanent fillers. The authors report the unusual case of a 56-year-old woman with a foreign body granuloma located exclusively in the oral cavity that was due to injection of a permanent filler.
Assuntos
Materiais Biocompatíveis/efeitos adversos , Técnicas Cosméticas/efeitos adversos , Migração de Corpo Estranho/complicações , Granuloma de Corpo Estranho/etiologia , Doenças da Boca/etiologia , Polimetil Metacrilato/efeitos adversos , Feminino , Migração de Corpo Estranho/patologia , Granuloma de Corpo Estranho/patologia , Granuloma de Corpo Estranho/cirurgia , Humanos , Hidrogéis/efeitos adversos , Injeções Subcutâneas/efeitos adversos , Pessoa de Meia-Idade , Doenças da Boca/patologia , Doenças da Boca/cirurgia , Rejuvenescimento , Resultado do TratamentoRESUMO
The authors describe a case of transmediastinal migration, and lodging into the right lung, of a Kirschner wire used to fix a fracture of the left clavicle. The medical literature reports cases of intrathoracic migration of Kirschner wire; however, a transmediastinal migration has not been previously described. A small right thoracotomy was performed and the wire was removed without complications. We discuss aspects of this uncommon finding and alert physicians for the potential risks of the migration of metallic pins used to fixate boney structures within the chest.
Assuntos
Fios Ortopédicos/efeitos adversos , Clavícula/cirurgia , Migração de Corpo Estranho/etiologia , Fixação Interna de Fraturas/efeitos adversos , Fraturas Ósseas/cirurgia , Pneumopatias/etiologia , Acidentes de Trânsito , Adulto , Clavícula/lesões , Migração de Corpo Estranho/patologia , Migração de Corpo Estranho/cirurgia , Fixação Interna de Fraturas/instrumentação , Humanos , Pneumopatias/patologia , Pneumopatias/cirurgia , Masculino , Mediastino , Radiografia Torácica , Toracoscopia , Toracotomia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Biodegradable injectable bulking agents of animal origin present a fast rate of bio-reabsorption and may cause an allergic reaction. Biodegradable elements of synthetic origin have a high rate of reabsorption after a year. Non-biodegradable agents of synthetic origin lead to the formation of a fibrotic capsule, giving stability and long-term permanence. VANTRIS is categorized into this last group; it belongs to the family of Acrylics, particles of polyacrylate polyalcohol copolymer immersed in a glycerol and physiological solution carrier. Molecular mass is very high. When injected in soft tissues, this material causes a bulkiness that remains stable through time. The carrier is a 40% glycerol solution with a pH of 6. Once injected, the carrier is eliminated by the reticular system through the kidneys, without metabolizing. Particles of this polyacrylate polyalcohol with glycerol are highly deformable by compression, and may be injected using a 23-gauge needle. The average of particles size is 320 mm. Once implanted, particles are covered by a fibrotic capsule of up to 70 microns. Particles of this new material are anionic with high superficial electronegativity, thus promoting a low cellular interaction and low fibrotic growth. The new polyacrylate polyalcohol copolymer with glycerol was tested for biocompatibility according to ISO 10993-1:2003 in vitro, showing that they are not mutagenic for the Salmonella T. strains analyzed. The extract turned out to be non-cytotoxic for cell lines in culture and non-genotoxic for mice. In in vivo studies, acrylate did not cause sensitization in mice. The macroscopic reaction of tissue irritation was not significant in subcutaneous implants and in urethras of rabbits. Seven female dogs were injected transurethrally with VANTRIS to evaluate short and long-term migration (13 weeks and 12 months respectively). No particles or signs of inflammation or necrosis are observed in any of the organs examined 13 weeks and 12 months after implantation. To conclude, this new material meets the conditions of ideal tissue bulking material.
Assuntos
Resinas Acrílicas/efeitos adversos , Materiais Biocompatíveis/efeitos adversos , Migração de Corpo Estranho/etiologia , Animais , Materiais Biocompatíveis/administração & dosagem , Cães , Feminino , Migração de Corpo Estranho/patologia , InjeçõesRESUMO
Central venous catheterization has become an important technique for the diagnosis and management of patients requiring intensive medical care. The use of devices to perform this procedure has been accompanied by a corresponding increase in complications. The embolization of foreign bodies to the venous system is not a rare event. This is a report on the transluminal effective and relatively easy removal of a sheath fragment from the right ventricle using standard angioplasty tools.
Assuntos
Angioplastia com Balão/instrumentação , Angioplastia com Balão/métodos , Cateteres de Demora/efeitos adversos , Remoção de Dispositivo/métodos , Embolia/terapia , Angioplastia/instrumentação , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/instrumentação , Cateterismo Venoso Central/métodos , Remoção de Dispositivo/instrumentação , Embolia/etiologia , Migração de Corpo Estranho/patologia , Migração de Corpo Estranho/terapia , Ventrículos do Coração/patologia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
A 24-year-old woman came to the emergency room with a history of diffuse abdominal pain in the form of colic, nausea, vomiting and intestinal constipation. Clinical and ultrasound findings suggested intestinal obstruction due to foreign body. She had been submitted to a cesarean section 4 months previously at another hospital. At laparotomy, a ileum loop was found to be distended by an inside large and hardened mass with another intestinal loops and omentum density adherent. An ileotomy was performed on the compromised segment with terminating anastomosis. When opened surgical specimen it was observed an intraluminal surgical sponge that had completely migrated into the interior of the ileum and stopped next to ileumcecal valve. No fistulas or open intestinal wall were observed.
Assuntos
Cesárea , Migração de Corpo Estranho , Íleo , Tampões de Gaze Cirúrgicos , Dor Abdominal , Adulto , Feminino , Migração de Corpo Estranho/complicações , Migração de Corpo Estranho/patologia , Migração de Corpo Estranho/cirurgia , Humanos , Íleo/cirurgia , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgiaRESUMO
A study of the local and migratory effects of free silicone gel taken from a mammary prosthesis is reported. Thirty eight Wistar rats were injected in their subcutaneous space with 1 cm3 of silicone gel. The animals were sacrificed on day: 3, 7, 15, 30, 60, 180, 240, 360, 420, 450. The visceral organs (heart, kidneys, lungs, stomach, gonads, liver, pancreas, spleen, intestine), as well as the tissue adjacent to the region of injection, were histologically analyzed. There was no detectable silicone and no damage to the visceral organs based on routine histopathological analysis. The greatest fibrosis was observed at the extremities of the disk formed by the silicone in the subcutaneous space.