Foreign Body Granulomatous Response Research Articles

Bacterial Cellulose Membrane Experimentally Implanted in the Peritoneum of Wistar Rats—Inflammatory Immunoreactivity and Oxidative Stress

Bacterial cellulose (BC) has been used for various applications; however, studies investigating the immunohistochemical characteristics of the inflammatory and scarring component in BC implanted in the peritoneum in vivo have not yet been fully described. This study aimed to evaluate the systemic and organic safety of BC through oxidative stress, blood, and serum biochemical markers, as well as the late inflammatory response in rats, using histopathology and immunohistochemistry. Forty-three rats (26 males; 17 females) received BC in the peritoneal cavity (implanted group—IG), while twenty-seven rats (12 males; 15 females) served as the control (sham group—SG). Sixty days after surgery, oxidative stress in tissues, blood biochemical markers, and histopathological and immunohistochemical analyses for lymphocytes, macrophages, collagen, and vascular response around the BC were assessed. Only one oxidative stress marker, glutathione peroxidase, was elevated in the liver of IG rats. Creatine kinase MB and lactate dehydrogenase levels were significantly lower in IG animals. Histopathological analysis showed granulomatous inflammation in 93% of IG rats, with 74% of mild intensity. Immunohistochemistry revealed a significant macrophage presence (F4/80), with CD3, CD20, and F4/80 markers indicating differences favoring macrophages. In conclusion, BC implantation in the peritoneum induces a foreign body granulomatous response with prominent macrophage presence (F4/80). Type I and III collagen were observed around the membrane, and vascularization was intense 60 days post-implantation. From a biochemical and oxidative stress perspective, BC seems to be a safe material to be used in the peritoneal cavity.

Delayed adverse reaction to a natural dermal filler mimicking salivary gland neoplasia

BackgroundCosmetic dermal fillers are a sought-after procedure globally. However, despite the safety claims of filler materials by the manufacturers, adverse reactions still occur.Case presentationThis case report is of a 66-year-old female who presented with a late-onset complication of a hyaluronic acid dermal filler that clinically mimicked a salivary gland neoplasm. The patient presented with firm peri-oral swellings of short duration that clinically mimicked a pleomorphic adenoma and mucoepidermoid carcinoma. The diagnosis was that of a foreign-body granulomatous response to dermal fillers. Although other mimics of a similar nature are reported a knowledgeable clinician, careful choice of filler material, knowledge of the product, thorough pre-procedural history taking and post-procedural patient follow-up can drastically minimize a possible misdiagnosis. The reaction was treated with a combination of hyaluronidase, betamethasone and 5-flurouracil intra-lesional injections monthly for 11 consecutive months, with total clinical resolution.ConclusionsPatient education of the procedure, product name and the possibility of an adverse reaction occurring, even years later or at a site distant to the initial site of placement, is vital. Further, we review the recent reported adverse association of the new mRNA COVID-19 vaccines and dermal filler placement.

SAT0530 Development of A Patient Reported Outcome Measure of Tophus Burden: the Tophus Impact Questionnaire (TIQ-20)

BackgroundThe tophus represents a chronic foreign body granulomatous response to monosodium urate crystals. Tophi have been associated with activity limitation, joint damage and mortality in people with gout. Currently, tophus...

Complications of Endovascular Polymers Associated With Vascular Introducer Sheaths and Metallic Coils in 3 Patients, With Literature Review

Hydrophilic coatings on arterial introducer sheaths reduce the frequency of spasm during cardiac catheterization. Moreover, during treatment of cerebral artery aneurysms, hydrophilic coatings on microcatheters ease their maneuverability, and polymers within embolization coils enhance neointimal fibrosis at the aneurysm neck. Foreign-body giant cell reactions can result when a polymer is stripped from its source. CASES 1 AND 2: A 51-year-old man and a 66-year-old woman underwent coronary angiography via the radial artery, using hydrophilic-coated sheaths. They both developed tender lesions at the access site 2 weeks later. Microscopy of resected lesions showed pieces of hydrophilic coating and granulomatous inflammation, as has been reported by others. CASE 3: A 58-year-old woman underwent embolization of a ruptured distal right internal carotid artery aneurysm using polymer-containing coils. Nine months later, she began developing multiple right-sided cerebral ring-enhancing lesions. Biopsy revealed granulomas and microabscesses, in which polymer filaments were later identified. To our knowledge, this complication has not been described previously. Hydrophilic coating may dislodge and induce a prominent foreign-body granulomatous response or microabscesses. Although the culprit radial artery sheath is now rarely used, embolization coils containing polymers are commonly deployed in clinical practice and may be a source of recurrent inflammatory lesions.

Endoprótese revestida de jugular preservada de bovino: estudo comparativo da resposta tecidual em aorta torácica descendente e veia cava inferior de suínos

OBJETIVO: Avaliar e comparar a resposta tecidual de uma endoprótese biosintetica implantada na aorta torácica descendente e veia cava inferior de suínos. MÉTODO: Foi implantada uma endoprótese auto-expansível composta de aço inoxidável, revestida por veia jugular de bovino, processada pelo método L-hydro, com auxilio de uma bainha de liberação Taheri-Leonhardt (Flórida, EUA) na aorta torácica descendente, e a veia cava infra-renal de 10 suínos. Sessenta dias após, as endopróteses foram retiradas e analisadas sob o ponto de vista macro e microscópicos. Foram observados: perviedade, grau de incorporação a parede do vaso, tipo de reação inflamatória, e local de maior resposta, tanto em relação a camada do vaso quanto ao local de contato com o anel de aço RESULTADOS: Todas as endopróteses encontravam-se pérvias, e incorporadas à parede. No setor venoso, seis apresentaram traves fibrosas em sua luz, e quatro apresentaram fibrose perivascular. No setor arterial somente uma prótese apresentou discreta estenose, sem fibrose perivascular. A reação inflamatória crônica tipo corpo estranho ocorreu em 100% das peças, a camada média foi a mais acometida no setor venoso, enquanto a íntima foi mais constante na artéria, o grau de incorporação foi mais firme na veia em comparação a artéria. A reação tecidual mostrou maior tendência nas áreas em intimo contato com o anel de aço (intra-anelar), mais intensa na artéria do que na veia. CONCLUSÃO: A prótese apresentou baixa trombogenicidade em ambos os sistemas, houve maior reação tecidual e baixa biocompatibilidade no setor venoso.

Estudo da resposta tissular à endoprótese recoberta de jugular bovina em veia cava inferior de suínos

OBJETIVO: Avaliar a resposta tissular a uma endoprótese, com cobertura biológica heteróloga, implantada em veia cava inferior de suínos. MÉTODO: Desenvolvemos uma endoprótese auto-expansível, revestida com um segmento de jugular bovina, conservada por processo L-hydro e suturada em um stent de aço inoxidável 316L. O dispositivo introdutor utilizado foi a bainha de liberação da endoprótese aórtica Taheri-Leonhardt (Flórida, EUA). Foram implantadas endopróteses em 10 suínos, todas na veia cava infra-renal. Os animais foram submetidos à flebografia peroperatória. À necropsia, após 2 meses, cada endoprótese foi retirada em bloco e analisada macroscopicamente, visando a avaliação da perviedade, aderência aos tecidos vizinhos e incorporação à parede venosa; e, histopatologicamente, visando a resposta histológica ao enxerto. RESULTADOS: Na análise macroscópica, todas as endopróteses encontravam-se pérvias e totalmente incorporadas à parede venosa, porém seis apresentavam trabeculações grosseiras no seu interior e quatro algum grau de fibrose perivascular. Três animais desenvolveram linfocele, uma retroperitoneal e as outras na parede abdominal. No estudo histopatológico, observamos reação inflamatória granulomatosa tipo corpo estranho em todos os casos, sendo predominante na camada média (80%). CONCLUSÃO: O modelo estudado apresentou baixa trombogenicidade, corroborando com a eficácia do meio de conservação e material escolhidos; porém, baixa biocompatibilidade, provavelmente pelo obstáculo imunológico dos xenoenxertos e resposta tissular exagerada do território venoso.

Clinicopathologic analysis of 15 explanted hydroxyapatite implants.

To report the clinical findings, treatment, outcomes, and histopathologic findings in patients with suspected orbital implant infection requiring implant removal. Retrospective, observational case series of 14 patients (15 hydroxyapatite orbital implants) undergoing implant removal from September 1994 through December 2002. Patient age, type of surgery, implant type, symptoms, treatment, histopathology of implant, and follow-up course were analyzed. Of the 14 patients, 7 were female and 7 were male. The mean age at explantation was 42 years. The most common symptoms were discharge and socket tenderness. The most common signs were conjunctival inflammation (edema, hyperemia), discharge, and recurrent pyogenic granuloma. Clinical evidence of infection was documented in 13 patients. Histopathologic assessment of the 15 explanted implants showed acute inflammation and necrosis (abscess) with identification of microorganisms (5 patients), acute inflammation and necrosis without identification of microorganisms (4 patients), chronic inflammation with identification of microorganisms (1 patient), chronic inflammation without identification of microorganisms (3 patients), and a predominant foreign body granulomatous response without identification of microorganisms (2 patients). Osseous metaplasia was seen in 10 implants. Prompt resolution of symptoms and signs occurred in all but one case. The clinical course of porous orbital implant infection may be prolonged, and the early symptom of recurrent discharge, a common problem for implant recipients, may delay diagnosis. Implant infection should be suspected when there is persistent conjunctival inflammation and discharge after implant placement despite antibiotic therapy, discomfort on implant palpation, and recurrent pyogenic granuloma (indicative of implant exposure). Implant removal is usually required in these cases. If orbital pain (not necessarily related to implant palpation) is the main complaint, without signs of conjunctival inflammation and with or without discharge, one should consider other reasons for the symptoms.

Focal osteolysis at the junctions of a modular stainless-steel femoral intramedullary nail.

During routine follow-up of patients treated with a three-piece stainless-steel modular femoral nail, osteolysis and periosteal reaction around the modular junctions of some of the nails were noted on radiographs. The purpose of this study was to evaluate the prevalence, etiology, and clinical relevance of these radiographic findings. Forty-four femoral fractures or nonunions in forty-two patients were treated with a modular stainless-steel femoral intramedullary nail. Seventeen nails were excluded, leaving twenty-seven intramedullary nails in twenty-seven patients for this study. All patients had had a femoral diaphyseal fracture; nineteen had had an acute fracture and eight, a nonunion. These twenty-seven patients returned for radiographs, a physical examination, assessment of functional outcomes, assessment of thigh pain with a visual analog scale, determination of serum chromium levels, and nail removal if desired. A control group of sixteen patients treated with a one-piece stainless-steel femoral intramedullary nail was evaluated with use of the same outcome measures and was compared with the group treated with the modular femoral nail with regard to prevalence of thigh pain and serum chromium levels. Twelve modular femoral nails were removed according to the study protocol. The modular nail junctions were analyzed for corrosion products, and histopathologic analysis of tissue specimens from the femoral canal was performed. The twenty-seven patients were seen at a mean of twenty-one months after fracture fixation; twenty-six of the twenty-seven fractures healed. Twenty-three femora had at least one of three types of abnormalities-osteolysis, periosteal reaction, or cortical thickening--localized to one or both modular junctions. Eighteen patients had severe reactions, defined as osteolysis of > or =2 mm, cortical thickening of > or =5 mm, and/or a periosteal reaction (group 1). Nine patients had mild or no reactions (group 2). Serum chromium levels in group 1 (mean, 1.27 ng/ mL; range, 0.34 to 3.12 ng/mL) were twice as high as those in group 2 (mean, 0.53 ng/mL; range, 0.12 to 1.26 ng/mL). However, this difference did not reach significance with the numbers available. The differences in serum chromium levels between group 1 and the control group with a one-piece nail (mean, 0.26 ng/mL; range, 0.015 to 1.25 ng/mL) (p<0.01) and a control group without an implant (mean, 0.05 ng/mL; range, 0.015 to 0.25 ng/ mL) (p<0.01) were significant. The level of thigh pain recorded on the visual analog scale was also significantly different between group 1 and the control group with a one-piece implant (p = 0.03). Retrieved modular nails had signs of fretting corrosion as well as stainless-steel corrosion products adherent to the junction where the osteolysis occurred. Histologic and spectrographic analysis revealed two types of corrosion products that were consistent with stainless-steel within the peri-implant tissue and were associated with a foreign-body granulomatous response. The presence of corrosion products at the taper junctions suggests that particulate debris was a major factor in the etiology of the radiographic findings of osteolysis, periosteal reaction, and cortical thickening. Serum chromium levels were substantially elevated in the patients with a modular femoral nail, and such levels may serve as a marker of fretting corrosion of these devices.

Macrophage exposure to polymethyl methacrylate leads to mediator release and injury

To understand further the role of macrophages in the loosening of cemented arthroplasty, several in vitro effects of polymethyl methacrylate (PMMA) particle exposure in these cells were studied. The kinetics of arachidonic acid and derived inflammatory mediator release was characterized following macrophage exposure to either PMMA or control polystyrene particles. Temporal release of radiolabeled products by [14C]arachidonate-labeled cells was determined by sequential scintillation counting. Significant dose-dependent release of arachidonic acid mediators by macrophages was observed within half an hour of exposure to either PMMA or styrene particles. Unexposed control cells incubated in media alone did not release detectable amounts of radiolabeled products. The leakage of intracellular lactate dehydrogenase (LDH), a marker of cell injury, was detected spectrophotometrically 4 h following exposure to PMMA but not styrene. PMMA-induced LDH release was dose dependent. In contrast, polystyrene exposure failed to increase LDH release above unexposed control cells. These in vitro studies reveal that macrophages rapidly released arachidonic acid and derived inflammatory mediators in response to both PMMA and styrene particles. However, cells exposed to PMMA are lethally damaged, as reflected by the subsequent leakage of their intracellular LDH. We propose that a similar sequence of events may occur when macrophages encounter PMMA particles at the bone-cement interface. This is characteristic of a foreign body granulomatous response.

Effects of polymethylmethacrylate exposure upon macrophages.

The effects of polymethylmethacrylate (PMMA) exposure upon macrophage viability and function were studied in an attempt to determine what role these cells play in the loosening of cemented arthroplasties. P388D1 murine macrophage cell line was exposed to PMMA and polystyrene particles of similar size and concentration. DNA synthesis following exposure to PMMA or polystyrene was studied by [3H]thymidine incorporation. Macrophage function was studied by analyzing the ability of activated macrophages to kill mast cell targets following particle exposure. Our results demonstrate that exposure of macrophages to PMMA particles in vitro inhibits DNA synthesis and impairs their cytotoxic ability. Histologic examination revealed that macrophages phagocytose both PMMA and styrene particles, but the former eventually lyse these cells. Our studies suggest that the histologic appearance of macrophages and foreign body giant cells at the bone-cement interface may be secondary to a repetitive cycle of PMMA particle phagocytosis and cell death, similar to that found in a foreign body granulomatous response.

Butylcyanoacrylate adhesives in microvascular surgery: an experimental pilot study.

An investigation was undertaken to examine the effects of the butylcyanoacrylate adhesives (Histoacryl) on vascular tissue. Using a rat femoral artery model, 18 vessels were prepared. End-to-end anastomoses were completed using three stay sutures of 10-0 nylon inserted at 120 degrees intervals around the vessels, followed by direct application of Histoacryl glue. Results showed a patency rate of 73 percent, the vessels being inspected between two and 14 weeks after anastomosis. Histological examination of the vessels showed an early marked foreign body granulomatous response with giant cell formation, and later extreme thinning of the vessel wall, splitting of the elastic lamina, and calcification of the media. It was concluded that the histologic results of butylcyanoacrylate tissue adhesives on the vessel wall preclude their use on human subjects.

Filtering Valve Implant for Neovascular Glaucoma in Proliferative Diabetic Retinopathy

The prevention and treatment of neovascular glaucoma in diabetic patients presents a difficult clinical challenge. This report presents the pathologic findings in a juvenile onset diabetic patient who underwent panretinal photocoagulation. She subsequently developed neovascular glaucoma, was treated with the Krupin-Denver valve implant, and received cyclocryotherapy after the filtering surgery failed to maintain a normal intraocular pressure. The pathologic findings resulting from each treatment modality are presented with emphasis on the failed intraocular valve. A fibrous ingrowth surrounded the valve, and a foreign body granulomatous response was present.

Quantitation of glycosaminoglycans of rabbit lung during delayed-type hypersensitivity reactions and granuloma formation

The specificity and kinetics of hyaluronic acid (HA) accumulation in relation to other glycosaminoglycans (GASs) were determined in rabbit lungs during an allergic granulomatous response to BCG, an allergic nongranulomatous response to tuberculoprotein, and during a foreign-body granulomatous response to carrageenan. Hyaluronic acid was the only GAG detected in the lung lavage fluids. Hyaluronic acid occurred in the airways on day two of the allergic granulomatous response, but its presence in the airway did not correlate with ensuing granuloma formation in the parenchyma. Generalized increases in GAG of the parenchyma also peaked on day two of the DTH responses. Generalized increases in GAG peaked on day five during the foreign-body granulomatous response to carrageenan. A persistently elevated level of HA in the lung tissue correlated with granuloma formation but not with the intensity of the response.