Endoscopic Treatment of Vesicoureteral Reflux with Polydimethylsiloxane in Adult Women

OBJECTIVES

Subureteral injection of bulking agents to a refluxing ureteral orifice is an attractive alternative to open repair. We record our experience of the endoscopic subureteral injection of polydimethylsiloxane in women for vesicoureteral reflux (VUR).

METHODS

From January 1997 to December 2001, 30 women (mean age 34.9 years) with 43 refluxing ureters underwent endoscopic treatment. The grade of VUR was I, II, III, and IV in 10, 16, 13, and 4 ureters, respectively. The indication for the procedure was VUR with a history of pyelonephritis in women of childbearing age or in whom antibiotic prophylaxis had been unsuccessful. All women underwent voiding cystourethrogram at 3 months and then yearly after the procedures. Follow-up ranged from 12 to 60 months (mean 26.5 months).

RESULTS

Reflux was corrected in 34 ureters after a single injection; only 3 ureters needed a 2nd injection. The overall success rate was 86.0%: for grades I, II, III, and IV was 90.0%, 87.5%, 76.9%, and 100% respectively. The mean hospital stay was 1.31 days (range 1-8 days), and no remarkable surgical complications occurred. Most of the patients in whom VUR was cured or improved showed a reduction in laboratory-proven urinary infection rates.

CONCLUSIONS

The endoscopic subureteral injection of polydimethylsiloxane in women with vesicoureteral reflux is an effective therapy with no associated morbidity.

Cystoscopic correction of reflux

Vesicoureteral reflux is a well-recognized cause of childhood illness and renal damage. In the past, surgical reimplantation had been the only procedure available to gain the immediate cessation of reflux. The development of an endoscopic injection technique as a less morbid alternative to traditional surgery began in the 1980s. Teflon was the first injectable agent to be investigated. The record of Teflon is one of efficacy and apparent patient tolerance. However, concerns regarding possible migration and other side effects led to a search for other injectable agents. The most recently investigated agents are polydimethylsiloxane and dextranomer polymer. These agents do not have the long-term follow-up of Teflon, but appear to be effective and safe. Time will tell which agent will become the implant of choice, but it seems clear that endoscopic management will play an increasingly larger role in the care of vesicoureteral reflux.

Mycobacterium abscessus cellulitis and multifocal abscesses of the breasts in a transsexual from illicit intramammary injections of silicone

We report the case of a 29-year-old transsexual who developed Mycobacterium abscessus infection after receiving intramammary liquid silicone injections in the nonphysician office setting. Our patient represents 1 of 14 confirmed and 11 suspected cases in New York City of M abscessus infection after illicit cosmetic procedures. As injectable cosmetic procedures are becoming increasingly popular, dermatologists should be aware of both the common and unusual complications. Furthermore, all physicians should be alerted to the current cluster of M abscessus infections after injections for cosmetic purposes by nonmedical practitioners in New York City.

Efficacy of Polydimethylsiloxane Injection to the Bladder Neck and Leaking Diverting Stoma for Urinary Continence

PURPOSE

Achieving urinary continence is a major goal in the treatment of patients with bladder exstrophy/epispadias, spinal dysraphism and other urological disorders. Endoscopic injection of bulking materials is an evolving, minimally invasive procedure that provides an attractive alternative to open bladder surgery to increase outlet resistance. We evaluated the efficacy of bladder outlet (bladder neck and diverting stoma) polydimethylsiloxane injection (BOMI) to achieve continence in children.

MATERIALS AND METHODS

We retrospectively reviewed the continence status of 33 patients prior to and following BOMI for urinary incontinence. The variables evaluated as predictors of success were underlying disease, ambulatory status, voiding status, bladder capacity, type and time from previous bladder neck reconstruction, anticholinergic treatment, injection site, amount of polydimethylsiloxane used, detrusor leak point pressure and immediate or delayed clean intermittent catheterization. Improvement was considered a 2-fold increase in the dry interval or 4 hours between bladder emptying in patients on clean intermittent catheterization and a 2-fold decrease in the number of absorbent pads needed.

RESULTS

Between 1998 and 2002, 25 male and 8 female patients 4 to 19 years old (mean age 12.4 +/- 3.9) underwent 42 BOMIs for incontinence. Mean followup was 13 +/- 9 months (range 3 to 42). Incontinence was via the urethra in 28 cases and via a diverting stoma in the remaining 5. Of the 28 patients with leakage via the urethra none were cured, 12 (42%) were improved and 16 (58%) had no change in continence status. However, 3 of the 5 inpatients (60%) with leakage via a diverting stoma were cured. No perioperative complications were recorded. Injecting to a diverting stoma was the only factor found to be predictive of success. Extrusion of polydimethylsiloxane during the procedure was the only factor predictive of failure (3 of 3 cases or 100%). New onset dilatation of the collecting system was noted in 2 patients and all had improved continence following injection.

CONCLUSIONS

Injection to the bladder neck did not result in any cure and had a low improvement rate of 42%. BOMI is a good therapeutic option for patients with leakage from a diverting stoma. Although no perioperative complications were recorded, 2 patients had new dilatation of the upper tract on ultrasound. Hence, long-term followup is warranted.

[Injectable therapy for urinary incontinence: a review]

Trans- or periurethral bladder neck injections are minimal invasive therapies for stress urinary incontinence which can be performed under local anaesthetic as an outpatient procedure. So far the best documented substance is collagen of bovine origin but other substances as silicone, autologous fat, chondrocytes and ethylenevinylalcohol are available. Success rates are between 60 and 80% with deteriorating long term results of approximately 30% requiring reinjection usually after 18 to 24 months.

Correlation of vesicoureteral reflux with degree of hydronephrosis and the impact of antireflux surgery

PURPOSE

We correlated the degree of hydronephrosis (HN) to the grade of vesicoureteral reflux (VUR) and assessed the impact of antireflux surgery on the resolution/persistence of HN.

MATERIALS AND METHODS

Between 1997 and 2000, 308 patients (476 units) underwent antireflux surgery for primary or secondary VUR. Surgical procedures included extravesical reimplantation (291 ureters), intravesical reimplantation (48) and endoscopic polydimethylsiloxane injection (137). The degree of HN was categorized as mild (grade 1 to 2) or moderate/severe (grade 3 to 4). VUR was grade I in 44 cases, II in 145, III in 203 and IV to V in 84. Followup renal ultrasound was performed at 3 and 12 months postoperatively. Statistical analysis consisted of a contingency table and chi-square test for independence.

RESULTS

Preoperative HN existed in 123 refluxing units, and was mild in 4 (9%), 11 (7.5%), 39 (19%) and 28 (33%), and moderate/severe in 0, 2 (1.4%), 14 (7%) and 25 (30%) of grade I, II, III and IV to V VUR cases, respectively. The degree of preoperative HN correlated with VUR grade (p <0.0001). At 3 months postoperatively HN resolved in 50.4%, improved in 16.3%, persisted in 30% and worsened in 3.3% of units. At 15 months postoperatively HN resolved in 80 units (65%) and persisted in 43 (35%). Patients with preoperative moderate/severe HN constituted 56% of those with persistent HN.

CONCLUSIONS

Our data indicate that the presence and degree of preoperative hydronephrosis are closely related to VUR grade. Furthermore, antireflux surgery resulted in a high resolution rate of hydronephrosis. Persistent postoperative hydronephrosis did not require any intervention.

Polydimethylsiloxane Injection Versus Open Surgery for the Treatment of Vesicoureteral Reflux in Complete Duplex Systems

PURPOSE

We compared the efficacy of subureteral polydimethylsiloxane injection (Macroplastique, Uroplasty, Inc., Minneapolis, Minnesota) versus open surgery for correction of varying degrees of reflux in complete duplex systems.

MATERIALS AND METHODS

Between 1997 and 2000 polydimethylsiloxane injection was performed in 15 females (22 refluxing moieties). Mean patient age at presentation and at surgery was 54 and 94 months, respectively. Extravesical common sheath reimplantation (ECSR) was performed in 34 children (bilateral 10) with a mean age at presentation and at surgery of 31 and 57 months, respectively. Voiding cystourethrography and ultrasound were performed at 3 months. In cases of persistent reflux repeat voiding cystourethrography was performed at followup. We then analyzed the surgical outcome for both groups.

RESULTS

Mean followup for the injection and ECSR groups was 12 and 15 months, respectively. The success rate per moiety after injection was 68% at 3 months, which increased to 81.8% at 12 months. One patient had contralateral vesicoureteral reflux and none had de novo hydronephrosis, urinary tract infection or complications postoperatively. The success rate of ECSR was 95.5% at 3 months, which improved to 97.7% at an average of 15 months (p <0.04). After ECSR transient contralateral vesicoureteral reflux was seen in 4 renal units, de novo hydronephrosis was seen in 2 units and 4 patients had urinary tract infections.

CONCLUSIONS

Although endoscopic subureteral polydimethylsiloxane injection was simple and successful in more than 80% of patients with low grade vesicoureteral reflux in duplex systems, it is less effective than surgery with regard to elimination of reflux.

Blood distribution to the anterior spinal artery from each segment of intercostal and lumbar arteries

AIM

Prevention of paraplegia, a serious complication of surgery for thoracoabdominal aortic aneurysm, has been well documented. However no assured prophylaxis against this complication has yet been found. Spinal ischemia is believed to be the major cause of paraplegia. We conducted an experimental study to define the development of paraplegia with regard to the blood supply to the spinal cord.

METHODS

A porcine model was used to evaluate blood distribution to the anterior spinal artery. Colored silastic agent was selectively injected into the intercostal and lumbar arteries, and distribution to the anterior spinal artery was evaluated on 50 animals. The intercostal and lumbar arteries were ligated in the segments where the blood supply to the anterior spinal artery would be interrupted. Whether or not paraplegia developed was checked 2 days later.

RESULTS

Colored silastic agent arrived at the anterior spinal artery from all segments of the 8th intercostal to 4th lumbar arteries. Two of 9 pigs (22.2%) that underwent ligation of the segments from the 9th intercostal to 2(nd) lumbar artery suffered paraplegia. In 3 non-paraplegic pigs, colored silastic agent injected into the preserved arteries was found to have covered a wider range.

CONCLUSION

All the intercostal and lumbar arteries supplied blood to the anterior spinal artery. When large segments of intercostal and lumbar arteries were ligated, the blood flow from the preserved segments acquired increased dominance. The possibility exists that any intercostal and lumbar artery can supply blood to the spinal cord and become collateral circulation to the anterior spinal artery.

Advancements in minimally invasive treatments for female stress urinary incontinence: Radiofrequency and bulking agents

Continuous advancements in materials technology have provided the possibility that multiple new urethral bulking agents will be available soon. Experience continues to accrue in clinical trials for urethral bulking with these agents. Parallel use for the indication of pediatric vesicourethral reflux also has provided evidence of biologic activity related to these compounds. All of the agents closest to complete analysis are synthetic and represent a variety of material types and characteristics. As these materials evolve, understanding of the preferential injection technique is being gained. Delivery methods and sites may prove to alter the biologic activity of these compounds substantially. Emphasis on other minimally invasive options for the surgical treatment of stress incontinence also has resulted in the development of radiofrequency vesicourethral suspension. Improved understanding of thermal application to tissue, acute and chronic tissue response to this application, and accumulating human experience with this method of therapy has provided an acceptable tolerability profile for this therapy. This profile may provide application of this method of therapy to an in-office treatment setting, precluding hospitalization and substantially decreasing convalescence times.

Design of a silicone reservoir intravaginal ring for the delivery of oxybutynin

Oxybutynin, a drug of choice in the treatment of urinary incontinence, has low oral bioavailability due to extensive first-pass metabolism. A toxic metabolite, N-desethyloxybutynin, has been linked to adverse reactions to oral oxybutynin. This study, therefore, reports on the design of an oxybutynin intravaginal ring (IVR) of reservoir design, comprising an oxybutynin silicone elastomer core encased in a non-medicated silicone sheath, manufactured by reaction injection moulding at 50 degrees C. An unusually high initial burst release of oxybutynin (42.7 mg in 24 h) was observed in vitro with a full length core (100 mg drug loading), with subsequent non-zero order drug release. Use of fractional segment cores substantially reduced the burst effect, yielding linear cumulative drug release versus time plots from days 2 to 14. Thus, a 1/8 fractional segment core gave a 24 h burst of 11.28 mg oxybutynin and, thereafter, zero order release at the target dose of 5 mg/day over 14 days. Two oxybutynin cores, each 1/16 of full length, gave a greater release than a single 1/8 core, due to core segment end effects resulting in an increased surface area for release. The burst release was investigated by determining drug solubilities in the propan-1-ol product of elastomer condensation cure (390 mg/ml) and in the elastomer itself (13.9-20.21 mg/ml, by direct extraction and indirect thermal methods). These high oxybutynin solubilities were considered the major contributors to the burst effect. It was concluded that use of a fractional segment core would allow development of a suitable oxybutynin reservoir IVR.

In vitro release of nonoxynol-9 from silicone matrix intravaginal rings

The controlled-release characteristics of matrix silicone intravaginal rings loaded with between 100 and 971 mg of nonoxynol-9 have been investigated with a view to developing a ring that may offer a new female-controlled method for the prevention of transmission of sexually transmitted diseases, particularly HIV. Intravaginal rings containing 253, 487 and 971 mg of nonoxynol-9 provided a daily release of 2 mg or more over the 8-day release period, the minimal amount of nonoxynol-9 considered to provide an effective vaginal concentration for the prevention of HIV. Furthermore, the maximum daily release of N9 was about 6 mg, an amount significantly smaller than that observed for other nonoxynol-9 products whose large daily doses may in fact increase the occurrence of HIV by causing epithelial damage to the vaginal tissue. The release mechanism of the liquid nonoxynol-9 from the intravaginal rings has also been investigated and compared to models describing the release of solid drugs from the rings. It has been demonstrated through release studies and surface microscopy that a drug depletion zone is not established in such liquid-loaded intravaginal ring systems, with implications for the release kinetics.

Human histology and persistence of various injectable filler substances for soft tissue augmentation

An increasing number of soft tissue filler substances have been introduced to the beauty market outside the U.S. which lack experimental and clinical data in support of their claim. Ten commercially available filler substances were examined for biocompatibility and durability: 0.1 cc of each substance was injected deep intradermally into the volar forearm of one of the authors and observed for clinical reaction and permanence. At 1, 3, 6, and 9 months the test sites were excised, histologically examined, and graded according to foreign body reactions classification. Collagen (Zyplast) was phagocytosed at 6 months and hyaluronic acid (Restylane) at 9 months. PMMA microspheres (Artecoll) had encapsulated with connective tissue, macrophages, and sporadic giant cells. Silicone oil (PMS 350) was clinically inconspicuous but dissipated into the tissue, causing a chronic foreign body reaction. Polylactic acid microspheres (New-Fill) induced a mild inflammatory response and had disappeared clinically at 4 months. Dextran microspheres (Reviderm intra) induced a pronounced foreign body reaction and had disappeared at 6 months. Polymethylacrylate particles (Dermalive) induced the lowest cellular reaction but had disappeared clinically at 6 months. Polyacrylamide (Aquamid) was well tolerated and remained palpable to a lessening degree over the entire testing period. Histologically, it dissipated more slowly and was kept in place through fine fibrous capsules. Polyvinylhydroxide microspheres suspended in acrylamide (Evolution) were well tolerated, slowly diminishing over 9 months. Calcium hydroxylapatite microspheres (Radiance FN) induced almost no foreign body reaction but were absorbed by the skin at 12 months. Host defense mechanisms react differently to the various filler materials, but all substances-resorbable or nonresorbable-appeared to be clinically and histologically safe, although all exhibit undesirable side effects. Since the mechanism of late inflammation or granuloma formation is still unknown, early histological findings are not useful in predicting possible late reactions to filler substances.

Technetium-99m-Sestamibi Scintimammography to Detect Breast Cancer in Patients with Paraffinomas or Siliconomas After Breast Augmentation

As the mechanism of (99)mTc-MIBI scintimammography is different from that of anatomic modalities, the detection of breast cancer should not be affected by prior breast augmentation. The aim of this study was to compare the diagnostic accuracy of (99)mTc-MIBI scintimammography for breast cancer in patients with or without paraffinomas or siliconomas. Twenty-eight women with a history of paraffin or silicone injection into the breasts and 17 without were included. All patients received intravenous injection of 1110 MBq (99)mTc-MIBI and were subsequently examined using high-resolution planar and SPECT imaging 5 minutes after the injection. In the 45 patients with 87 breasts, 21 abnormal breasts were found at scintigraphy. The sensitivity, specificity, and accuracy to detect cancer in these breasts with paraffinomas or siliconomas were 100% (5/5), 92% (46/50), and 93% (51/55), respectively. For the breasts without paraffinomas or siliconomas, the sensitivity, specificity, and accuracy were 92% (11/12), 95% (19/20), and 94% (30/32), respectively, not significantly different (p = 0.51, 0.66, and 0.86, respectively). (99)mTc-MIBI scintimammography is both sensitive and specific for the detection of breast cancer, whether or not paraffinomas or siliconomas are present. The accuracy of scintimammography did not seem to be affected by prior breast augmentation.

What's new in fillers?

This article is an in-depth review of various materials and products that have been used for the augmentation of soft tissue in the past, and covers several new products, methods, and techniques that may provide new options for dermatologists who use fillers in their practice. Pros and cons of each are discussed, along with mechanisms of action, dosages, approved and off-label uses, as well as a look ahead at some prospective technology.

Soft-tissue fillers for wrinkles, folds and volume augmentation

Hyaluronic acid gels, with or without dextran beads, and collagen with suspended PMMA microbeads are exciting new soft-tissue fillers that are becoming increasing popular for facial rejuvenation. Each material provides wrinkle reduction, contour improvement and volume augmentation when placed into lines and furrows or when used for lip augmentation. The duration of action varies from 6 months to permanent, depending on the product.

Treatment of diseases due to infections and old age using anti-foaming agents

The biochemical changes taking place in the organism in the course of ageing and infectious processes result in substantial catabolic processes during which a variety of gases are created (in addition to carbon dioxide and nitrogen, depending on the conditions, methane, ammonia, hydrogen sulphide, mercaptan, etc. are also created) in addition to peptides and low molecular organic compounds. These gases are dispersed in the extra-cellular space and in the capillary system of blood and lymph in the form of micro-foam. The accompanied disturbance in the ability to flow considerably impairs the immune defence system which is inseparably connected to the transport of catabolic products. Any resulting diseases can be alleviated or even removed by the application of a simple physical-chemical principle. Anti-foaming agents (solutions, all types of dispersions, micro-emulsions) based on polydimethylsiloxane but also based on fatty acid esters (preferably unsaturated fatty acids) are proposed for treatment purposes.

[The injectables in urogynecology]

The purpose of this review is to summarize the results of reports of injectable agents for the treatment of female urinary stress incontinence. The real indication for injectables is intrinsic shincter deficiency (ISD) but urethral hypermobility is not a controindication. Six agents were reviewed: Teflon, autologous fat, collagen, silicone microparticles, silicone microballoons and pyrolytic carbon. Collagen was the most frequently reported agent and yielded 1 year cure/ improvement rate of 60-80%, but results de-creased significantly with longer term follow-up. Teflon has been used longer for the treatment of stress incontinence but both low long and short-term success rate and the reported complications such as particles migration have resulted in its lack of widespread acceptance. Autologous fat has been suggested as the natural injectable but yielded disappointing success rate. Injection of silicone microparticles was associated with a long-term success rate of about 70% in patients with ISD. Moreover, it is now injected without urethroscopy and this makes the procedure easier. Silicone microballoons and pyrolytic carbon have been recently introduced into clinical practice with a short-term success rate of about 70%. However, longer follow-up is needed. In conclusion, long-term durability, cost effectiveness and some safety issues still have to be addressed by further clinical trials.

Minoxidil-containing dosage forms: skin retention and after-rinsing hair-growth promotion

Three kinds of topical dosage forms of minoxidil (MXD), namely vesicles, double emulsions, and an inclusion complex with hydoxypropyl-beta-cyclodextrin (HP-beta-CD), were prepared. The skin retention of MXD in the preparations was evaluated in vitro using hairless mouse skins. After applying the preparations onto the skin and rinsing it, the amount of the drug left on the skin was determined using HPLC. Retention was the highest when the drug was encapsulated in cationic vesicles. Nonionic vehicle, the double emulsion, and HP-beta-CD left no significant amount of the drug after rinsing the skin. Thus, an ionic interaction between the cationic vehicle and negatively charged skin is likely responsible for the relatively high skin retention. In vivo hair growth-promotion effect of each dosage form was investigated, in which the sample application onto the clipped backs of female mice (C57BL6) and the subsequent rinsing of the backs were done once a day for 30 days. Only MXD in the cationic vesicles had hair growth promotion effect, possibly due to significant skin retention.

Lip silicone granulomatous foreign body reaction treated with aldara (imiquimod 5%)

We report a case of a lip granulomatous reaction after injection of silicone being treated successfully with topical Aldara (Imiquimod 5%). Silicone granulomas and the inflammatory foreign body reaction that can occur are some of the complications that arise from using silicone for cosmetic enhancement. The inflammatory reaction of this patient first appeared shortly after silicone injection of both the upper and lower lips. Histopathologic examination revealed a foreign body inflammatory reaction that is consistent with silicone granuloma. Although this reaction has been described extensively in the dermatologic literature as one of the disfiguring side effects of silicone injection, its treatment has plagued cosmetic dermatologists. We report the use of an immunomodulatory cream Aldara (Imiquimod 5%) to treat this type of reaction.

Injecting 1000 centistoke liquid silicone with ease and precision

BACKGROUND

Since the Food and Drug Administration approved the use of the 1000 centistoke liquid silicone, Silikon 1000, for intraocular injection, the off-label use of this injectable silicone oil as a permanent soft-tissue filler for facial rejuvenation has increased in the United States. Injecting liquid silicone by the microdroplet technique is the most important preventive measure that one can use to avoid the adverse sequelae of silicone migration and granuloma formation, especially when injecting silicone to improve small facial defects resulting from acne scars, surgical procedures, or photoaging.

OBJECTIVE

To introduce an easy method for injecting a viscous silicone oil by the microdroplet technique, using an inexpensive syringe and needle that currently is available from distributors of medical supplies in the United States.

METHOD

We suggest the use of a Becton Dickinson 3/10 cc insulin U-100 syringe to inject Silikon 1000. This syringe contains up to 0.3 mL of fluid, and its barrel is clearly marked with an easy-to-read scale of large cross-hatches. Each cross-hatch marking represents either a unit value of 0.01 mL or a half-unit value of 0.005 mL of fluid, which is the approximate volume preferred when injecting liquid silicone into facial defects. Because not enough negative pressure can be generated in this needle and syringe to draw up the viscous silicone oil, we describe a convenient and easy method for filling this 3/10 cc diabetic syringe with Silikon 1000.

RESULTS

We have found that by using the Becton Dickinson 3/10 cc insulin U-100 syringe, our technique of injecting minute amounts of Silikon 1000 is facilitated because each widely spaced cross-hatch on the side of the syringe barrel is easy to read and measures exact amounts of the silicone oil. These lines of the scale on the syringe barrel are so large and clearly marked that it is virtually impossible to overinject the most minute amount of silicone.

CONCLUSION

Sequential microdroplets of 0.01 cc or less of Silikon 1000 can be measured and injected with the greatest ease and precision so that inadvertent overdosing and complications can be avoided.

[Treatment of patients with proliferative diabetic retinopathy and serotonin insufficiency]

30 patients (19--female and 11--male) with proliferative diabetic retinopathy (DR) were examined. The age of patients and of the controls ranged from 25 to 72 years. The duration of diabetes mellitus amounted on the average to 16.4 +/- 4.1 years. The cause of diabetes mellitus was evaluated for the moment of examination as of mean severity and in the stage of subcompensation. Ophthalmologically, relapsing hemophthalmias and extensive preretinal hemorrhages in the eye fundus were typical for this group of patients. Standard techniques were used to determine the index of erythrocytes deformability and the concentration of serotonin in the blood plasma. All patients were prescribed intramuscular injections of 1% ATP solution, 2 ml daily during 2 weeks. Pentoxifillin was prescribed perorally, 0.2 g x 3 times per day during 30 days, enterogel--15 g x 3 times per day during 7 days. The simultaneous administration of pentoxifylline and enterogel normalized the erythrocytes elasticity and the concentration of serotonin in the blood plasma. Clinically, it led to an improvement of visual acuity (0.18 +/- 0.008) and to resorption of hemorrhages in the eye fundus. The obtained results are indicative of the advisability to use simultaneously pentoxifylline, enterogel and ATP in a comprehensive medication treatment of proliferative DR with chronic serotonin insufficiency.

A case of acute pneumonitis induced by injection of silicone for colpoplasty

Silicone fluid (polymethylsiloxane) is a liquid polymer that had been widely used in breast augmentation and other cosmetic procedures. However, many adverse reactions after silicone injections into human beings have been reported including adverse pulmonary sequelae. We report a case of a 46-year-old woman who suffered from acute pneumonitis that was induced by illicit injection of silicone into the vaginal wall for colpoplasty. The pulmonary involvement was documented by transbronchial lung biopsy and bronchoalveolar lavage where examination with the electron microscope disclosed the presence of large quantities of pleomorphic cytoplasmic inclusions in alveolar macrophages. Clinicians should be aware of this unusual complication of injection of silicone.