[Ophthalmia nodosa caused by the hairs of the bird spider (family Theraphosidae) or hairy megalomorph (known in the US as tarantula)--case report and review of the literature]

BACKGROUND

Bird spiders, known in the US as tarantulas, are large hairy spiders that have become increasingly popular as pets in the Western world. We present a patient with a red irritated eye from exposure to the hairs of a spider of the Theraphosidae family, and review the literature.

PATIENT AND METHODS

We report on a 28-year old patient who was referred to our clinic with a red irritated eye following playing with a Chilean rose-haired bird spider (known in the US as tarantula). In addition, we reviewed the literature concerning similar cases using the Medline database and cited literature in the retrieved articles.

RESULTS

Our patient displayed theraphosidae (tarantula) hairs in the cornea of the right eye and developed a uveitis and a retinochoroiditis with associated vitritis. Treatment with topical corticosteroids resulted in an improvement of signs and symptoms, although the improvement was slow and incomplete. The disease process consists of a granulomatous reaction to the spider hairs. Hairs of Theraphosidae spiders (tarantulas) may cause inflammation at all levels of the eye, from the conjunctiva to retina. We were able to identify 14 cases of Ophthalmia nodosa secondary to the exposure to the tarantula hairs in the literature. Therapy includes removal of the offending hairs when possible and topical treatment with steroids.

CONCLUSION

Although the large hairy bird spiders (tarantulas) are considered harmless pets, ophthalmia nodosa is a potential danger when handling them. Ophthalmia nodosa has an unknown prognosis and may be difficult to manage.

Intracalvarial cholesterol granulomas--clinicopathologic correlates of three cases

Cholesterol granulomas (CGs) are tumor-like lesions seldom encountered by neuropathologists. CGs develop in reaction to localized hemorrhage, often occurring in bony sites with possible impaired drainage of blood and blood products. The most common bony location is the petrous apex, although orbital, frontal sinus, and maxillary sinus sites have been reported. We compare and contrast three recent cases seen at our institution that illustrate the spectrum of clinical, radiographic, and pathologic features that can be seen with these mass lesions. One case demonstrated the unique pathological features of Gamma-Gandy body formation, epithelioid histiocytes heavily encrusted with iron pigments, and extensive tophi. The latter most likely represented aggregates of calcium pyrophosphate crystals associated with extensive iron deposition.

Simultaneous presentation of silicone and silica granuloma: a case report

We report a case of a 45-year-old woman who presented a simultaneous foreign-body granuloma reaction to silicone in her face and to silica in the elbow and knee. The patient had received silicone injections in her face 7 years earlier and had suffered a motorcycle accident when she was young. Changes suggestive of silicone were observed in the biopsy obtained from the face, and silica was detected in the biopsy taken from the elbow, confirmed by polarized light and X-ray microanalysis. The presence of polarizable foreign matter in cutaneous epithelioid granulomas should alert to the diagnosis of sarcoidosis.

Talc retinopathy

A 45 year old man presented with talc retinopathy that had been present for decades. The static nature of this condition indicates that, in the absence of ongoing intravenous drug use, ophthalmological follow up is not necessary

Granulomatosis associated to porcelain wear debris

PURPOSE

To determine the origin of a cryptogenic granulomatosis using an innovative diagnosis technique.

MATERIALS AND METHODS

A patient affected by fever of unknown origin for 9 years was diagnosed with colestasis and acute renal failure with pathological evidence, in parenchimal samples, of granulomatosis of unknown origin. New scanning electron microscopic observations on the biopsy samples from the liver and the kidney and x-ray elemental microanalyses showed the presence of debris made of silicone, aluminum, sodium and potassium, and aluminum-silicate similar to dental porcelain. The same SEM and x-ray analyses were carried out on the patient's worn porcelain dental bridges.

RESULTS

A correlation was demonstrated between wear debris of porcelain and the cryptogenic granulomatosis, which lead to a different therapeutic approach and the removal of the origin of the debris; this stabilized the situation and caused an improvement of the disease. The results indicated that a material can be biocompatible when used in a solid bulk, but this property can be lost when it is degraded into small particles.

Consequences of PTFE membrane used for prevention of re-entry injuries in rheumatic valve disease

BACKGROUND

The value of polytetrafluoroethylene (PTFE) surgical membrane as a pericardium substitute in patients who undergo reoperation for rheumatic valve disease is reported in this observational study.

METHODS

PTFE was used for pericardial closure in 56 rheumatic valve patients. During reoperation of seven cases, adhesions were classified as none, minimal, moderate to severe and scored in the sections of heart. Data found at reoperations were collected prospectively in all patients.

RESULTS

Seven of 56 patients reoperated mean period of 67.1+/-23.4 (SD) months later. No infection, complication and operative or late death attributable to the membrane were observed. There were two right ventricular, three minimal right atrial and one innominate vein lacerations during resternotomy and all of them were controlled. During histological examination, a microscopically significant foreign body reaction was found.

CONCLUSION

PTFE membrane produced an undesirable fibrous membrane that obscured the epicardial anatomy and hardened the dissection in patients with rheumatic heart disease.

Oxidized cellulose (Surgicel) granuloma mimicking a primary ovarian tumor

A 37-year-old woman presented with left lower quadrant pain and vaginal spotting 1 month after hysterectomy and right salpingo-oophorectomy, which were performed for hemoperitoneum related to a ruptured corpus luteum. An 8-cm left ovarian mass was removed that had a microcystic, mucoid sectioned surface. Histological examination revealed that the mass consisted of a massive foreign-body granulomatous reaction to oxidized cellulose (Surgicel). To our knowledge, this is only the second report of an ovarian Surgicel granuloma.

Dissecting popliteal cyst resulting from a fragmented, dislodged metal part of the patellar component after total knee arthroplasty

Dissecting popliteal cyst is an uncommon complication after total knee arthroplasty, occurring mainly as a result of either rheumatoid arthritis or a malfunctioning knee prosthesis. Its association with a failed metal-backed patellar component has not been reported since the introduction of the resurfacing of the patella with this kind of design in 1980. We present a case of a late fracture-dislocation of the metal part of the patellar component that migrated to the posterior popliteal fossa, resulting in a cystic mass formation caused by a foreign body granuloma. The patient was treated successfully with a 2-stage operation: first, revision of the total knee arthroplasty and, second, excision of the cyst. The patient had a pain-free functional knee 7 years after surgery, with no recurrence of the symptoms or the popliteal cyst.

Rupture of a silicone gel mammary prosthesis and amyloidosis: a case report

There has been a great deal of controversy regarding the safety of silicone breast implants. Silicone gel prostheses older than 10 years have the risk of either leakage or outright rupture. The role of silicone gel in relation to connective tissue disease or amyloidosis has not been proved by current serologic, immunologic, or epidemiologic tests. In this paper, we present a case with renal amyloidosis and a history of untreated silicone implant rupture for five years.

Reducing the hazards of exposure to cornstarch glove powder

Latex allergy has received considerable attention during the past decade. The occurrence of latex allergy in health care workers is higher than in the general population. Latex gloves are the most frequent form of exposure that health care workers have to natural rubber latex; therefore, the relationship between gloves and latex allergies, has been well studied. Scientific evidence supports the link between glove powder and the occurrence of latex allergies, as well as the development of postoperative complications in surgical patients. This article describes how a multihospital system, which is the seventh largest not-for-profit health care corporation in the nation and includes 35 ORs, successfully eliminated powdered gloves from the environment.

Inflammatory polyps in common bile duct caused by T-tube

We describe two patients who formed inflammatory polyps at the side holes of T-tubes. It seems advisable to remove T-tubes as soon as it is appropriate. New designs and materials may also help avert these lesions.

[Siliconomas. A case report]

In the early 1950s, the liquid silicone breast injection technique was developed in Japan. This breast augmentation method had local and systemic complications. Nevertheless, this technique is still used in some countries like Chile. We report a 41 years old woman, consulting due to breast pain and a nodule in her left breast. The clinical work up confirmed the presence of siliconomas, caused by silicone breast injections one year before. The physical and radiological findings (mammograms, ultrasound and breast MRI) of this woman are reported.

Complications after meniscal repair with bioabsorbable arrows: two cases and analysis of literature

Biodegradable implants were introduced in the middle 1990s as a new technique for the arthroscopic treatment of reparable meniscal tears. We have used these implants since 1999 and present two cases of failure of biodegradable meniscal repair implants. One foreign-body reaction with granuloma and one fresh meniscus tear after renewed trauma in the case of receding meniscus arrows with a chondral lesion. We also performed a review of the literature with the Medline database. Meniscus refixation with bioabsorbable arrows is considered reliable but shows various other complications that must be borne in mind.

Silicone migration from silicone-injected breasts: magnetic resonance images

Injection of liquid silicone into the breast was performed illicitly in the 1950s to 1960s and was subsequently prohibited. Many complications arise from silicone injection, and liquid silicone migration is a complication that has not been widely reported. The authors present magnetic resonance images of a patient with liquid silicone migration from the breast to the upper chest and lower neck. Breast ultrasonographic and mammographic findings are also presented for correlation.

Breast implant-related silicone granulomas: the literature and the litigation

Formation of a granuloma is a common tissue response to the presence of a variety of foreign materials. A silicone granuloma is, by definition, a type of tissue reaction elicited occasionally by silicone. Granulomas of this sort have not engendered a great deal of attention in the scientific literature since their first description in 1964, and they were considered by most surgeons through the 1980s to be an incidental finding of little or no consequence. Since it is tangible and readily visible to juries, the silicone granuloma became a frequent issue in breast implant litigation in the 1990s. Although most other complaints in this litigation have been subjective or causally unrelated to silicone, the presence of a granuloma has been used as a basis of local complication claims and, more creatively, as a mechanism for hypothetical systemic disease occurrence. This review examines the basic science and the clinical literature pertaining to breast implant-related silicone granulomas, viewing them in a context of current clinical thought and frequent issues of litigation. Clinically apparent silicone granulomas are a relatively rare complication of breast implant placement and surgical resection is indicated when they are symptomatic or of diagnostic concern. There is no evidence in the peer-reviewed scientific literature to support frequent plaintiff theories in litigation that silicone granulomas play some role in implant-related systemic disease. In fact, the very existence of such diseases, themselves, is equally unsubstantiated.

Functional capacity of the thyroid autograft: an experimental study

BACKGROUND

The aim of this study was to investigate the functional capacity of thyroid autografts after total thyroidectomy in a rabbit model.

MATERIAL AND METHODS

Thirty-eight rabbits underwent total thyroidetomy. One of the two thyroid lobes was cut into 1-mm pieces and was introduced intramuscularly into the right quadriceps muscle (group A, n = 10), the right rectus abdominalis muscle (group B, n = 10), and the right sacrodorsalis muscle (group C, n = 10). Another group of 8 rabbits underwent total thyroidectomy without autologous implantation and served as the control group (group D). The animals were observed for 8 weeks with weekly measurements of thyroid hormones. At the end of the 8th week, a scintigram was performed. The autografts were removed 2 days later.

RESULTS

The thyroid hormone levels showed a gradual decrease until the 2nd-5th week after implantation, followed by a gradual increase and establishment of euthyroid levels between the 5th and 8th weeks. Respectively, an increase of thyreotropin hormone was noted with maximal values in the 4th week, followed by a gradual decrease until the end of the 8th week. The scintigram at the end of the 8th week revealed the presence of functional thyroid tissue in all cases. Functional thyroid follicles were found in all animals who survived. In 35.7% of the autografts, we noted the development of fibrous tissue and gigantocytic granulomas in the periphery, which could be interpretated as a "foreign body" reaction.

CONCLUSION

Thyroid autografts can completely substitute thyroid function after total thyroidectomy.

Stone granuloma--not to be forgotten as a delayed complication of ureteroscopy

Endoscopic management of urolithiasis is one of the commonest urological procedures today. Its safety and efficacy in the management of ureteral calculi have been proven. A stone granuloma is a rare cause of recurrent ureteral obstruction subsequent to ureteroscopic stone removal. After its initial description by Dretler and Young [J Urol 1993;150:1800-1802] there have been sporadic reports of stone granuloma and paraureteral calculi secondary to iatrogenic perforations of the ureter and subsequent ureteric strictures as the cause of recurrent ureteral obstruction. We report two cases of delayed stone granuloma following pneumatic lithotripsy during ureteroscopy.

Magnetic resonance imaging characteristics of paraffinomas and siliconomas after mammoplasty

BACKGROUND AND PURPOSE

Breast paraffinomas and siliconomas are granulomas caused by tissue reaction to paraffin oil and silicone injection after mammoplasty. These granulomas usually present as multiple hard masses that mimic breast cancer. Mammography and sonography have only a limited role in differentiating these masses. Magnetic resonance (MR) imaging findings of these granulomas have rarely been reported. This study evaluated the MR imaging manifestations of these granulomas.

MATERIALS AND METHODS

MR imaging, mammography, and sonography were used to examine 58 breasts in 29 women with breast lumps who had undergone mammoplasty with injections of paraffin oil (n = 8) or liquid silicone (n = 50). The protocol included T1-weighted images (T1WI), fat-suppressed (FS) T2WI, post-contrast FS three-dimensional fast dynamic sequences, and FS T1WI.

RESULTS

Deep structures of the 58 breasts could not be clearly evaluated by sonography or mammography. Two types of MR imaging characteristics were identified: type I lesions were hypointense on T2WI and type II lesions had mixed hypointense and hyperintense components on T2WI. Both showed intermediate intensity on T1WI and revealed no enhancement on post-contrast dynamic sequences and FS T1WI. Type II lesions were seen only in siliconomas. Mastectomy was performed on seven breasts and paraffinomas or siliconomas were confirmed by pathology. When correlating MR images with pathology, hypointense lesions on T2WI in both type I and II lesions were foreign body granulomas with fibrosis and calcification. Hyperintense lesions on T2WI in type II were liquid silicone. A case of infiltrating ductal carcinoma was found in one breast in which MR imaging was successful in identifying the strongly enhanced solitary tumor from a background of type I lesions of paraffinomas preoperatively. Of the 51 breasts that did not receive surgery, no breast cancers were detected clinically or by follow-up imaging after a median of 27 months (19-54 mo).

CONCLUSIONS

Breast paraffinomas and siliconomas after mammoplasty have specific MR findings that are distinct from those of breast cancers. MR imaging is superior to sonography and mammography in the evaluation of breast paraffinomas and siliconomas.