Granuloma formation induced by spines of the cactus, Opuntia acanthocarpa

Embedded cactus spines may cause immediate pain due to mechanical damage, be a source of infection, or result in foreign body granulomas. The cholla cacti are particularly tenacious in the manner in which the spines stay embedded in the skin. Pulling away from the cactus may result in a portion breaking away from the main plant and embedding other spines. Granuloma formation has been seen with plant material embedded in the dermis. Onset is generally within a few days, and duration may be as long as 9 mo. Treatment is generally best accomplished with a topical corticosteroid. We present a case of granuloma caused by the cactus Opuntia acanthocarpa which persisted for 8 w despite topical treatment with 0.05% fluocinonide.

[The clinical picture, classification and surgical treatment of paraffinomas of the external genitalia]

Basing on operative data on 42 patients and literature data, the authors hold that clinical presentation of external genitalia paraffinomas varies depending on the quantity of the introduced emulsion, its chemical structure, site and depth of the injection, duration of the suspension stay in the tissues. Paraffinoma dissection within intact tissue is thought the only and radical treatment. The technique should be based on adequate classification of the disease taking into consideration clinical varieties, localization and extent of the process, involvement of the adjacent tissues, complications. Four forms of the disease are recognized: foreskin, stem, penile-scrotal, penile-pubic-scrotal. Etiological factors, spread of the disease, kind of complication are considered also. The classification permits unification of surgery, reliable comparison of the results from various institutions. In preputial complicated disease a simple policy is employed--circular dissection of the foreskin. Radical dissection of the affected skin with subcutaneous fat and plastic repair of the defect with a scrotal skin double-end graft according to Reich's technique in modification of the authors or replacement of the wound-adjacent triangle grafts according to A. A. Limberg. Utilization of this approach led to substantial improvement of end results in the treatment of 39 patients.

Conjunctival mass formation with unexpected foreign body

Two 4-year-old females with inferior fornix conjunctival lesions are described. Both cases proved to be cotton-material-induced granulomas. These cases are reported to emphasize that recognition of foreign body conjunctival granuloma remains as a challenge to ophthalmologists.

[Angiothrombotic pulmonary granulomatosis in intravenous drug addicts]

Two cases of angio-thrombotic lung granulomatosis in intravenous drug addicts are described. This entity has been previously described in drug addicts who inject oral drugs intravenously. Talc, which is used in the preparation of several drugs, cotton and other substances provoke at lung vessels level, thrombotic phenomena with strange body granuloma formations. Depending on the predominating localization of these lesions, interstitial pneumonia or pulmonary hypertension can later occur, such is the case in one of our patients who had a fatal evolution in a short period of time.

["Food" granuloma of the jaws. Presentation of a new case and review of the literature]

The clinical observation of an oral pulse granuloma allows to detail the clinical and pathological characteristics of this lesion. The etiology of this particular granuloma is explained by the introduction of alimentary particles into maxillary bone. A review of the literature about this subject is also made.

Delayed complication of a foreign body causing retropharyngeal granuloma--a case report

A 37 year old female who presented with a history of foreign body ingestion ten months previously was found on examination to have a retropharyngeal swelling. An initial differential of foreign body granuloma or retropharyngeal tuberculous abscess was considered. The usefulness of the lateral neck radiograph in demonstrating retropharyngeal pathology and the supplementary role of the computed tomography scan in confirming and elucidating the identity of the radio-opacity is highlighted. This presentation is a timely reminder of the need for a simple inexpensive lateral neck radiograph in situations of doubt as to persisting foreign body impaction.

Long-standing reaction to a hemi-silastic implant

The complications associated with the hemi-silicone implants of the foot have been well documented. Reasons for their failure are many. In the past, there has been an overuse of these devices without strict adherence to their proper indications. Today, these implant failures are being manifested by extremely unusual pathology. Although silicone has not been shown to be carcinogenic, the florid reaction seen in this case demonstrated a degree of "malignancy" that may have incapacitated the patient.

[Characterization of immunological responses to bone and cartilage xenografts]

The immunological responses to subcutaneous bone and cartilage grafts were investigated in rats using phenol oxidase, a leukocyte labelling enzyme. The resulting development of granulomas reflects a cell-mediated immunological process and is proof of the immunogenicity of bone and cartilage. This method is a new criterium for the assessment of the biocompatibility of graft and implant materials.

Formation of granulation tissue in intra-abdominal viscose cellulose sponges. An experimental study in rats

Formation of intra-abdominal granulation tissue was studied in 32 rats 2, 4, 7 or 21 days after implantation of viscose cellulose sponges. The concentrations of DNA, RNA-ribose, uronic acids, hexosamines, nitrogen and collagen were then measured in the sponges. The rats' body weight fell by 10-15% in the first week, but was regained within 3 weeks. The sponges induced dense intra-abdominal adhesions, reflected in highly active connective tissue formation. This process seemed analogous to that seen in granuloma formation in subcutaneous tissue or wound healing, but the synthesis of macromolecules was especially pronounced in the peritoneal cavity. The experimental model offers a new means for studying intra-abdominal adhesions and permits evaluation of factors claimed to have stimulating, inhibiting or no effect on intra-abdominal adhesion formation.

Granulomatous inflammation and monstrous giant cells in response to intraperitoneal hormone implants in channel catfish (Ictalurus punctatus)

Plastic implants (2.7 mm maximum dimension) of an ethyl vinyl acetate copolymer (EVAc) matrix, containing inulin, bovine serum albumin (BSA) and luteinizing hormone releasing hormone (LHRH), were covered with impervious EVAc and then surgically placed into the peritoneal cavity of 1-year-old channel catfish, Ictalurus punctatus. In fish kept in cold water (13 degrees C), 10 per cent of the implants per month were encapsulated by granulation tissue. In fish kept in warm water (27 degrees C), 20 per cent of the implants per month were encapsulated, with a total of 86 per cent encapsulated at 5 months. In addition to fibroblasts and capillaries, the granulation tissue included macrophages, neutrophils, lymphocytes, plasma cells, multinucleated giant cells and a matrix of collagen fibres. The density of the fibrous capsule increased with time. In a separate investigation, it was found that the thickness of the capsule was directly proportional to the degree of exposure of the EVAc matrix to the fish (exposure influenced by the rate of dissolution of the capsule content). Monstrous giant cells with up to 600 nuclei per 5 microns thick section were seen in capsules around implants. On intraperitoneally implanted cover glasses, whole giant cells contained up to 6000 nuclei and were interconnected by cytoplasmic bridges. Signs of neoplasia, implant expulsion or massive adhesions were not seen.

A comparison of foreign body and hypersensitivity granuloma formation in the mouse: kinetic development, anergy, angiotensin converting enzyme levels, and response to captopril therapy

Pulmonary granuloma size, anergy, serum and lung angiotensin converting enzyme (ACE) levels, and responsiveness to captopril therapy were measured in both pulmonary hypersensitivity granuloma (HSG) and foreign body granuloma (FBG) murine models. The kinetic development of the granuloma was similar in both models, peaking at 3 days and resolving by 14 days. The granuloma size of the FBG model was significantly larger than the HSG model at 1 and 3 days. The FBG model further differed from the HSG model in that anergy was observed at 3 days and lung ACE levels were increased at 1, 7, and 14 days. In the HSG model anergy was not observed and lung ACE levels were significantly elevated only at 1 and 7 days. Furthermore, the HSG model was shown to be responsive to captopril therapy whereas the FBG model was not. This study shows that two murine pulmonary granuloma models, although displaying similar growth and resolution kinetics, differ in terms of granuloma size, anergy, lung ACE activity, and responsiveness to captopril therapy, suggesting that the mechanism(s) involved in the inflammatory response of the two models may be different.

Giant chest wall tumor resulting from tissue reaction to foreign bodies

Three patients are reported in whom chest wall tumors developed 19 to 28 years after thoracoplasty and increased in size with time. The tumors could be removed operatively with good results. All tumors were composed of hematoma and necrotic material, and in all cases they revealed foreign bodies microscopically. Diagnosis and possible etiological factors are discussed.

Experimental study of starch-induced intraperitoneal adhesions

The effects of starch on the development of postoperative adhesions were examined in 144 Sprague Dawley rats. Groups of rats were injected intraperitoneally with suspensions of washings from starched gloves, starch-free gloves and starch-poor washed gloves, and after operative manipulation of the bowel. The incidence of adhesions was greatest (78 per cent) after laparotomy and injections of starch-rich washings and least when starch-poor (33 per cent) or starch-free glove suspensions (37 per cent) were used, confirming an advantage for washing gloves or switching to starch-free products.

Osteolysis in alloarthroplasty of the hip. The role of bone cement fragmentation

Movement at the interface between bone and cement and fractures of the cement can cause fragmentation of the polymethylmethacrylate (PMMA) bone cement implant. In order to obtain further information about the effect of PMMA fragments on the surrounding tissue and the role of such particles in the development of bone resorption, the authors investigated 17 patients with cemented total hip endoprostheses showing osteolysis and implant loosening in the femoral shaft with (Group B) and without (Group A) involvement of the acetabulum. The roentgenographic follow-up examinations revealed an initially slow and later more rapid extension of the endosteal bone erosions, with a predilection for the tip of the stem, the lesser trochanter, and laterally for the middle of the stem. At revision surgery, tissue samples were taken from the joint capsule and the bone-cement interface, in particular from the osteolysis in the femoral shaft and the acetabulum. The tissue samples were processed for histology, microscopically examined, and semiquantitatively evaluated. The retrieved devices were also carefully inspected. Large foreign-body granulomas were found at the bone-cement interface and in the joint capsule. Histiocytes and foreign-body giant cells stored particles of PMMA and polyethylene, of which fragmented bone cement predominated. Granulomatous tissue invaded bone canals and marrow spaces and induced resorption of the surrounding bone. In four cases in Group A, tissue from the osteolysis contained only fragmented bone cement, demonstrating that PMMA particles alone may be responsible for triggering focal bone resorption. Osteolysis seems to begin at the site where disintegration of bone cement begins. In cases in which polyethylene particles were found in the tissue in addition to fragmented bone cement, wear from the ultrahigh molecular weight polyethylene socket has been increased by entrapment of PMMA particles between the joint surfaces. Thus, fragmentation of bone cement and abrasion of polyethylene enhance each other. Bone cement particles promote polyethylene wear, which in turn promotes granuloma formation, bone resorption, and subsequent bone cement disintegration.

[Induction of granulomatous liver inflammation by noninfectious particles]

A single intravenous injection of 0.1 mg/g of zymosan led to the formation of granuloma-type clusters of mononuclears in the liver of CBA mice or (CBA X C57B1)F1 hybrid mice. The area occupied by the granulomas grows for 3 to 9 days and then gradually diminishes so that the granulomas disappear practically in one month. Hydrocortisone injected in a dose of 125 mg/kg 2 and 24 hours before or 2 and 24 hours after zymosan inhibited the initiation of granulomas but, at the same time, led to their slower involution. Mice with zymosan-induced granulomas became hypersensitive to the derivate of an endotoxin--prodigiosin, a polysaccharide obtained from S. marcescens. After intravenous infusion of a preparation of corpuscular alkaline phosphatase (CAP) granuloma-like structures also appear in the liver of rats. In distinction from zymosan-induced granulomas they persist for a much longer time (up to 27 weeks). The first signs of CAP-induced granulomas appear in 3 days. The liver per cent by volume occupied by the granulomas gradually doubles by the 15th week and then reduces. At the same time, the number of granulomas per 1 mm3 of hepatic tissue remains practically constant for 3 to 21 weeks from the moment of the induction by CAP. Their average size grows slowly and reaches maximum by the 15th week, with significant variations. Desmine and reticular fibres accumulate in the granulomas, which is evidence of active involvement of hepatic fat-accumulating cells in their formation. The results show that resident macrophages are the triggers of granulomatous inflammation of the liver.

A histologic evaluation of the accuracy of TMJ diagnostic arthroscopy

Sixty-seven temporomandibular joints with internal derangement were examined with arthroscopy, and synovial biopsies were taken for histologic evaluation. Histologically, in 10 cases, the synovium appeared to be normal in appearance, 24 cases had moderate to severe synovitis, 11 cases showed hyperplastic synovitis, 13 cases showed synovial fibrosis, and foreign body granuloma was found in 9 cases. Correlation between arthroscopic observation and histologic findings disclosed an 89.1% specificity and 100% sensitivity.

Osteolysis in alloarthroplasty of the hip. The role of ultra-high molecular weight polyethylene wear particles

Massive localized osteolysis around artificial joints has been seen more frequently in the past few years. It is still not generally accepted that ultra-high molecular weight polyethylene (UHMWPE) wear particles can induce massive bone resorption, even distant from the joint. This article describes a series of eight soft-top prostheses with large UHMWPE ball heads that contributed to the erosion of surrounding bone. Roentgenographically, all of the cases showed a marked loss of proximal cortical bone, more or less combined with osteolysis, which was distal to the femoral shaft and deep into the acetabulum. In two cases, remodeling and resorption transformed the bone into a tumorlike appearance. Tissue samples from areas of osteolysis as well as from the joint capsule were taken at revision surgery, processed for histology, examined microscopically, and evaluated semiquantitatively. The retrieved devices were also carefully inspected. Large amounts of UHMWPE wear debris were found not only in the joint capsule but also in layers of granulomatous tissue from the acetabulum and femur, whereas metal particles and fragmented polymethylmethacrylate were either completely absent or occurred only in very small amounts. The results of this study demonstrate that UHMWPE wear products alone can cause massive osteolysis by triggering foreign-body granuloma formation at the bone-cement interface; the bone cement may remain fixed in areas beyond the osteolytic transformation.

[A case of foreign body granuloma after aortic valve replacement]

A patient who developed a foreign body granuloma three years after aortic valve replacement was surgically treated. Oxidized cellulose was suspected of its cause.

[Intravenous abuse of crushed tablets. A case with fatal outcome]

We present a case of fatal vascular destruction and granulomatosis of the lungs from intravenous injections of dissolved tablets containing microcrystalline cellulose as filler material. Numerous microcrystalline cellulose pulmonary emboli and foreign body granulomas were detected, and the pulmonary parenchyma showed signs of disturbed circulation with focal necrosis and oedema.

Foreign body gingivitis: an iatrogenic disease?

Gingival biopsy specimens from eight patients exhibiting a localized, erythematous, or mixed erythematous/leukoplakic gingivitis that was refractory to conventional periodontal therapy were examined histologically and by energy-dispersive X-ray microanalysis. Histologic examination revealed variable numbers of small, usually subtle, sometimes equivocal, and occasionally obvious foci of granulomatous inflammation. Special stains for fungi and acid-fast bacilli were consistently negative. In all cases, the granulomatous foci contained particles of foreign material that were often inconspicuous and easily overlooked during routine histologic examination. Energy-dispersive X-ray microanalysis of these foreign particles disclosed Ca, Al, Si, Ti, and P in most lesions. However, other elements such as Zr, V, Ag, and Ni were found only in specific biopsy specimens. By comparing the elemental analyses, clinical features, and history of the lesions, strong evidence for an iatrogenic source of the foreign material was found in one case, and good evidence in five cases. In the remaining two patients, the source of the foreign particles remains unresolved.