Eyelid lipoid granuloma following topical ointment application

Subcutaneous lipogranulomas have been known to occur after injection of lipids for cosmetic or therapeutic reasons. Fibrosis may occur around the granulomas, giving them a lobulated appearance that can clinically mimic a malignancy. Of the few reports of lipogranulomas after the use of topical ointment, none have occurred in the eyelid. We report a case of subconjunctival lipogranulomas after the use of topical ointment whose clinical appearance was suggestive of sebaceous gland carcinoma.

Encapsulated paravesical foreign body

A large, round, paravesical mass was surgically removed from a 65-year-old man. The mass was an encapsulated aseptic granuloma surrounding a gauze that was left in situ 10 years previously at hernioplasty.

Thorotrast granuloma--a renascence

A case of cervical thorotrast granuloma and its surgical complications is presented. The properties and usage of thorotrast and its later complications are described, and the management of the complications is discussed. It is emphasized that there is usually a long latent period between thorotrast exposure and the advent of complications and perhaps more cases of similar difficulty may be anticipated in the future.

Severe granulomatous arthritis due to spinous injury by a "sea mouse" annelid worm

A case of destructive arthritis and soft tissue granulomatous inflammation occurred in a 25 year old man who had injured his right index finger while snorkelling in the Mediterranean. It was initially thought that he had fallen on a sea-urchin. He removed some spines at the time of injury but the finger became stiff, swollen, and painful, and after eight months with no symptomatic improvement amputation through the proximal phalanx was performed. Examination showed an exuberant granulomatous and foreign body type inflammation in the dermis and subcutaneous tissues and affecting the bone, with erosion of the cartilaginous surfaces of the proximal interphalangeal joint. Spines present in soft tissue sections contained no calcium but did contain chitin as shown by a von Wisseling reaction for chitosan. It is concluded that the chitinous spines almost certainly came from a sea-mouse (Phylum Annelida, family Aphroditidae). Sea mice are inconspicuous creatures which live on the sea floor and which may cause some injuries thought to be attributable to sea-urchins.

[The effect of spirobromin and prospidin on acute and chronic inflammation in rats]

The effects of new antitumor drugs spirobromin and prospidin on acute (carraghenin-induced rat paw edema) and chronic ("pellet granuloma") inflammation in rats were studied. The drugs were found to exert the anti-inflammatory effect on the model of chronic proliferative inflammation but to produce no significant changes in the degree of the acute inflammatory reaction. Spirobromin is superior to prospidin by the power of the anti-inflammatory effect. The electron microscopic studies showed that spirobromin and prospidin decrease the activity of fibroblasts in the focus of chronic inflammation.

Aggressive granulomatous lesions associated with hip arthroplasty. Immunopathological studies

The local immunopathological response was analyzed in six patients who had a revision of a total hip prosthesis because of an aggressive granulomatous lesion and in six patients who had a revision because of common loosening of the prosthetic stem. All twelve patients had had a total replacement arthroplasty for primary osteoarthrosis. All of the prostheses had been cemented. The aggressive granulomas consisted of well organized connective tissue containing histiocytic-monocytic and fibroblastic reactive zones. The granulomas were highly vascularized, and villous structures were observed at many sites. In contrast, the areas around the loose cemented stems were characterized by dense connective tissue. Immunohistological evaluation revealed that most of the cells in the aggressive granulomatous tissue were multinucleated giant cells and C3bi-receptor and nonspecific esterase-positive monocyte-macrophages. This cytological finding suggests a foreign-body-type reaction, compatible with the rapidly progressive lytic nature of the lesion that was shown radiographically. There was a clear-cut difference between aggressive granulomatosis and the more common lesion accompanying prosthetic loosening--namely, the relative lack of activated fibroblasts in granulomatosis. We suggest that granulomatosis involves an uncoupling of the normal sequence of monocyte-macrophage-mediated clearance of foreign material and tissue debris that is normally followed by fibroblast-mediated synthesis and remodeling of the extracellular matrix. We also suggest that aggressive granulomatosis in association with a cemented hip prosthesis is a distinct entity, not only clinically and radiographically, but also histopathologically.

Foreign-body granuloma as a complication of wrapping and coating an intracranial aneurysm. Case report

A rare case is presented in which a foreign-body granuloma developed at the site of muslin wrapping and Aron Alpha A coating of an internal carotid artery aneurysm. The importance of avoiding the use of muslin, especially close to the optic nerve and chiasm, is emphasized.

Vesicoureteral reflux in children: endoscopic treatment

Endoscopic correction of vesicoureteral reflux in children has been increasingly used in the last years with encouraging results. During a 4-year period 152 children were treated by endoscopic injection of Teflon. A follow-up, ranging from 3 months to 5 years, was available for 173 refluxing ureters. For primary reflux, correction was observed after a single injection in 87% of the cases and in 93% after a second injection in some failures. In duplication, the technique is somewhat more difficult but the results quite satisfactory with 58% success after one injection, increasing to 74% after a second injection. The limitations of these techniques are underlined, the major concern being the safety of the injectable Teflon particles, eliciting a foreign-body granulomatous reaction with the potential hazard of distant migration. So far no long-term morbidity and complications have been observed with the use of Teflon to correct reflux. Extensive pathological study in 7 children submitted to ureteral reimplantation for failure of endoscopic correction showed a typical encapsulated granulomatous reaction below the intramural ureter, but particles of Teflon were noted in only one hypogastric ganglion when the Teflon was injected outside of the bladder. There is a need for finding an ideal substance for endoscopic injection, preferably prepared from the patient's own tissue allowing simple and safe correction of vesicoureteral reflux in children.

Reoperation after pericardial closure with bovine pericardium

To reduce the risk of damage to the anterior surface of the right ventricle after resternotomy, it has been recommended that the pericardium be closed with a patch after open heart operations. We have examined 4 patients undergoing resternotomy for the third time 3 to 8 years after bovine pericardium valve replacement. On each occasion the pericardium was closed with a patch of bovine pericardium. In all cases, the patch was frozen to the inner aspect of the sternum, increasing the difficulty of resternotomy. Histological examinations of the patches confirmed dense fibrous connective tissue, patchy calcification, and foreign body giant cell reaction. Bovine pericardium appears to increase the difficulty of repeat cardiac operations. We recommend its use be discontinued.

[Optic, scanning and transmission electron microscopic observations of synthetic fibers implanted in rabbit skin]

Artificial hair made of synthetic leacryl fibre was inserted into the skin of a rabbit in order to evaluate the biocompatibility of the insertion of heterologous material. On the 7th and 30th day following insertion, samples were taken from the areas involved and were observed by MO, TEM and SEM studies. Granuloma in both the early stage (7th day) and later at 30 days was evidenced and found to develop to cicatricial sclerosis.

Barium granuloma involving urinary bladder

The first case of barium granuloma involving urinary bladder is reported. Surgical removal was the treatment of choice. Histological diagnosis was foreign body granuloma with xanthomatous inflammation. The foreign body was identified as barium by analytical electron microscopy.