Concepts of granulomatous inflammation

Glucocorticoid therapy in respiratory illness: bench to bedside

Each year, hundreds of millions of individuals are affected by respiratory disease leading to approximately 4 million deaths. Most respiratory pathologies involve substantially dysregulated immune processes that either fail to resolve the underlying process or actively exacerbate the disease. Therefore, clinicians have long considered immune-modulating corticosteroids (CSs), particularly glucocorticoids (GCs), as a critical tool for management of a wide spectrum of respiratory conditions. However, the complex interplay between effectiveness, risks and side effects can lead to different results, depending on the disease in consideration. In this comprehensive review, we present a summary of the bench and the bedside evidence regarding GC treatment in a spectrum of respiratory illnesses. We first describe here the experimental evidence of GC effects in the distal airways and/or parenchyma, both in vitro and in disease-specific animal studies, then we evaluate the recent clinical evidence regarding GC treatment in over 20 respiratory pathologies. Overall, CS remain a critical tool in the management of respiratory illness, but their benefits are dependent on the underlying pathology and should be weighed against patient-specific risks.

Infectious Granulomatous Dermatitis at a Tertiary Care Centre in North Maharashtra: A Histopathological Study

INTRODUCTION

Infectious granulomatous dermatitis is a distinctive entity of chronic inflammation. Recognizing the aetiology of granulomatous lesion is challenging to the dermatopathologist. The definitive diagnosis of the granulomatous lesions of skin with identification of aetiological agent is very essential for specific treatment and an appropriate desirable outcome.

AIM

To study the histomorphology of various granulomatous lesions of skin and classify them, accordingly into different categories.

MATERIALS AND METHODS

A retrospective study of skin biopsies received in the Department of Pathology over a period of five years (June 2009-June 2014) was objectively reviewed. The skin biopsies diagnosed histopathologically as granulomatous dermatitis on H&E stained sections were selected. Complete clinical and relevant history were recorded. Special stains were employed whenever required.

RESULTS

A total of 137 cases exhibited granulomatous reaction pattern. Among the granulomatous lesions of skin, tuberculoid granulomas were seen in 109 cases (79.56%), foreign body type in 12 cases (8.75%), suppurative and necrobiotic granulomas each in 7 cases (5.1%) and histiocytic and mixed inflammatory type each in one case (0.7%). Leprosy was the most common granulomatous lesion in 66.4% of the cases (91/137).

CONCLUSION

Leprosy was the most common granulomatous lesion with Borderline Tuberculoid Leprosy (BTL) as common sub type followed by tuberculoid leprosy. Hence the combination of clinical data and histomorphological findings are essential for establishing an accurate diagnosis of granulomatous lesion of skin.

IN VIVO AND IN VITRO IMMUNOMODULATORY AND ANTI-INFLAMMATORY EFFECTS OF TOTAL FLAVONOIDS OF ASTRAGALUS

Background:

Astragali Radix has long been used to improve immune function in traditional Chinese medicine. However, its main active components and potential immunomodulatory or anti-inflammatory activities have not been elucidated. In the present study, the immunomodulatory and anti-inflammatory activities of total flavonoids of Astragalus (TFA) isolated from Astragali Radix were evaluated by using in vivo animal models and in vitro cell models.

Materials and Methods:

The in vivo Immunomodulatory and anti-inflammatory activities of TFA were assessed by measuring macrophage phagocytic index, delayed type hypersensitivity, serum hemolysin level and immune organ index in mice, ear edema test in mice, paw edema test in rats, vascular permeability test in mice and granuloma test in rats. The in vitro Immunomodulatory and anti-inflammatory activities of TFA were assessed by examining its effect on cytokine and mediator production in un-stimulated and LPS-stimulated murine RAW 264.7 macrophages.

Results:

The results of in vivo experiments showed that TFA enhanced macrophage phagocytic index, delayed type hypersensitivity, serum hemolysin level and immune organ index in mice, and attenuated mouse ear edema, rat paw edema, mouse vascular permeability and rat granuloma formation. The results of in vitro experiments showed that TFA stimulated the production of NO and cytokine TNF-α, IL-Ιβ, IL-6 and IFN-γ in un-stimulated RAW 264.7 macrophages, and inhibited the overproduction of these inflammatory mediators in LPS-stimulated RAW 264.7 macrophages in a dose-dependent manner without exerting cytotoxicity.

Conclusion:

These results of this study indicate that TFA have potential immunostimulatory and anti-inflammatory effects.

Expression of Notch signaling components in cutaneous foreign body and sarcoidal granulomas and fusing macrophages

The evolutionarily conserved Notch signaling pathway affects tissue-specific cell differentiation, proliferation, and apoptosis. In the immune system, Notch has been implicated in the development and function of both adoptive and innate immune cells. Notch signaling is initiated by Notch receptor binding to cognate ligands, which results in the enzymatic cleavage and intranuclear translocation of the intracellular domain of Notch receptor (ICN). Recent murine models of chronic inflammation highlighted a critical role for a Notch ligand, Delta-like ligand (Dll)-4, in granuloma formation. In this study, we aimed to assess Notch-1 receptor activation and Dll4 expression in human cutaneous granulomas and in cultured human macrophages and multinucleated giant cells. ICN1 and Dll4 expression was evaluated by immunohistochemistry of cutaneous foreign body (n = 15) and sarcoidal (n = 19) granulomas. The results showed consistent intranuclear staining for ICN1 in foreign body but not in sarcoidal granulomas and strong cytoplasmic staining for Dll4 in mononuclear histiocytes and multinucleate giant cells in both types of granulomas. Additionally, immunofluorescence confocal microscopy showed ICN1 and Dll4 expression by cultured human macrophages undergoing fusion in the presence of granulocyte-macrophage colony-stimulating factor and interleukin-4. These findings indicate a potential role for the Notch-1-Dll4 signaling pathway in foreign body-induced granulomatous reactions and possibly distinct Notch pathway utilization in sarcoidal granulomas.

Anti-inflammatory effect of the sclerotium of Lignosus rhinocerotis (Cooke) Ryvarden, the Tiger Milk mushroom

Background

The sclerotium of Lignosus rhinocerotis (Cooke) Ryvarden (Tiger Milk mushroom) is used as a traditional medicine to relieve cough, asthma and chronic hepatitis. The traditional uses of the sclerotium are presumably related to its anti-inflammatory effect. The present study was carried out to evaluate the anti-inflammatory activity of the sclerotial powder of L. rhinocerotis (Cooke) Ryvarden (Tiger Milk mushroom) cultivar TM02.

Methods

The anti-acute inflammatory activity of the sclerotial powder of L. rhinocerotis cultivar TM02 was investigated using carrageenan-induced paw edema test while the inhibition of transudative and proliferative phases of chronic inflammation were studied by cotton pellet induced granuloma model. Sprague Dawley rats were used in both studies. The anti-inflammatory activity was also measured by inhibition of lipopolysaccharide induced TNF-alpha production in RAW 264.7 macrophage cells.

Results

Cold water extract (CWE), hot water extract (HWE) and methanol extract (ME) of the sclerotial powder of L. rhinocerotis cultivar TM02 possessed anti-acute inflammatory activity as was measured by carrageenan-induced paw edema test, with CWE being the most potent. The acute anti-inflammatory activity of the cold water extract (CWE) was mainly contributed by its high molecular weight (HMW) fraction isolated by Sephadex G50 gel filtration chromatography. Its protein component was very potent in the inhibition of TNF-alpha production with an IC₅₀ of 0.76 μg/ml. CWE at 200 mg/kg did not inhibit transudative and proliferative phase of chronic inflammation as shown by using the cotton pellet induced granuloma model.

Conclusions

Our results suggested that most of the bioactive substance(s) contributed to the acute-inflammatory activity of the sclerotial powder of L. rhinocerotis cultivar TM02 appear to be in the CWE, particularly its HMW fraction. The anti-inflammatory activity of CWE was mainly contributed by the protein component of the high molecular weight (HMW) fraction and it exhibited strong inhibitory effect on TNF-alpha production but the possibility of synergistic effect between HMW, MMW and LMW fractions cannot be excluded. Future studies will provide new insights into the anti-inflammatory activity of the sclerotial powder.

Non-infectious granulomatous dermatitis: a clinicopathological study

BACKGROUND

Granulomatous dermatitis frequently presents a diagnostic challenge to dermatopathologists because an identical histologic picture is produced by several causes, and conversely, a single cause may produce varied histologic patterns.

METHODS

A retrospective analysis of skin biopsies received over a period of 7 years was performed, and cases of non-infectious granulomatous dermatitis diagnosed on histopathological examination were retrieved.

RESULTS

Out of a total of 586 cases of granulomatous dermatitis, 71 cases (12.11%) were categorized as non-infectious granulomatous dermatitis on the basis of clinicopathological findings. Further subcategorization was done based on morphology of granulomas as epithelioid granulomas; 15 cases of sarcoidosis, 21.1%, one case of Crohn's vulvitis, 1.4%, necrobiotic granulomas; 11 cases of granuloma annulare, 15.4%, two cases of rheumatoid nodule, 2.8%, 10 cases of foreign body granulomas, 14.0%; 32 cases of miscellaneous group, 45%.

CONCLUSIONS

Morphology alone is seldom specific and cannot be used as a diagnostic tool for identification of specific diseases. Adequate clinical data and work up in combination of pathological resources can help in elucidation of specific etiology of granulomatous dermatitis. Mohan H, Bal A, Dhami GP. Non-infectious granulomatous dermatitis: a clinicopathological study.

Characterization of the inflammatory response to biomaterials using a rodent air pouch model

Using a rodent air pouch, the inflammatory responses to biomaterials with distinct physical properties and chemical compositions were compared. The polymers examined were expanded poly(tetrafluoroethylene) (ePTFE), silicone, low-density polyethylene (LDPE), poly(L-lactic acid) (PLLA), poly(desaminotyrosyl-tyrosine ethyl carbonate) [poly(DTE carbonate)], and poly(desaminotyrosyl-tyrosine benzyl carbonate) [poly(DTBzl carbonate)]. We found that implantation of disks (4.5-4.8 mm) of these materials into rodent air pouches for 2 days had no effect on the number or type of cells recovered relative to sham controls. With each of the materials, macrophages were the predominant cell type identified (60-75%), followed by granulocytes (20-25%) and lymphocytes (10%). Implantation of poly(DTE carbonate), ePTFE, LDPE, or poly(DTBzl carbonate) into the pouches for 2 days caused an increase in release of superoxide anion by the pouch cells. Cells from pouches containing poly(DTE carbonate) also released more hydrogen peroxide and were more phagocytic. In contrast, PLLA and silicone had no effect on the functional activity of cells recovered from the pouches. Prolonging the implantation time of poly(DTE carbonate) or PLLA to 7 days did not alter the number or type of cells isolated from the pouches. However, cells from pouches containing poly(DTE carbonate) for 7 days continued to produce increased quantities of superoxide anion relative to sham control pouch cells. These results suggest that the air pouch model is a highly sensitive method and therefore useful for evaluating the functional responses of inflammatory cells to biomaterials.

Delayed-hypersensitivity granulomatous reaction induced by blepharopigmentation with aluminum-silicate

Blepharopigmentation has been introduced during the last decade as a technique for creating a permanent line along the eyelid margin, thus simulating a cosmetic eyeliner. Complications related to this procedure are mostly reported in the opthalmologic literature describing infectious, allergic, or technical problems. We report a case of a woman who underwent blepharopigmentation with aluminum-silicate and in whom a delayed hypersensitivity granulomatous reaction developed.

Histoarchitecture of schistosomal granuloma development and involution: morphogenetic and biomechanical approaches

The authors present morphogenetic and biomechanical approaches on the concept of the Schistosoma mansoni granulomas, considering them as organoid structures that depend on cellular adhesion and sorting, forming rearrangement into hierarchical concentric layers, creating tension-dependent structures, aiming to acquire round form, since this is the minimal energy form, in which opposing forces pull in equally from all directions and are in balance. From the morphogenetic point of view, the granulomas function as little organs, presenting maturative and involutional stages in their development with final disappearance (pre-granulomatous stages, subdivided in: weakly and/or initial reactive and exudative; granulomatous stages: exudative-productive, productive and involutional). A model for the development of granulomas was suggested, according to the following stages: encapsulating, focal histolysis, fiber production, orientation and compacting and involution and disintegration. The authors concluded that schistosomal granuloma is not a tangled web of individual cells and fibers, but an organized structure composed by host and parasite components, which is not formed to attack the miracidia, but functions as an hybrid interface between two different phylogenetic beings.

Tissue response to chronically stimulated implanted epimysial and intramuscular electrodes

Twenty-four epimysial and 16 intramuscular electrodes were implanted in five adult dogs for periods ranging from 11 to 50 months. Chronic stimulation was applied to half of the electrodes for eight weeks near the end of the implantation period. The tissue response was rated by the amount and appearance of the fibrous tissue and inflammatory cells seen in the capsule lining the region of the electrode. The encapsulation tissues were composed primarily of collagen and fibroblasts and some macrophages and few other inflammatory cells. The epimysial electrodes exhibited more variation between and within electrodes, but had more of the better scores than the intramuscular electrodes. No difference in the distribution of scores was measured between the control and stimulated groups for the epimysial electrodes. While the scores for the intra-muscular electrodes varied very little, variance was sufficient to indicate a trend for poorer ratings with the application of chronic stimulation. Fibrous capsules were generally thinner under the epimysial electrodes than around the intramuscular electrodes. For both electrode types, the thickness was not correlated with the application or level of chronic stimulation. Thickness was shown to be positively correlated to the degree of loss of the sutures used to anchor the epimysial electrodes.

Synthetic scleral reinforcement materials: I. Development and in vivo tissue biocompatibility response

The surgical treatment of pathological myopia involves the placement of a band cut from donor sclera around the back of the globe to provide support and to prevent elongation that leads to retinal detachment and blindness. In the search for a synthetic material that would overcome the disadvantages of the donor tissue band, we tested 11 types of bands made from 14 polymers in rabbit eyes. Bands were cut from porous and solid materials, as well as porous materials coated with solids and solid materials with porous patches affixed to the posterior surface. Criteria for suitability and biocompatibility included ease of placement and suturing, stable positioning, and absence of long-term tissue response on a cellular level. Testing included evaluation by the surgeons performing the implantations, measurement of the distance between the band and the globe, determination of fibrous capsule thickness and amount of collagen deposition, and enumeration of macrophages accumulated at the band/capsule interface. Based on the results of these studies, two of the porous materials (expanded polytetrafluoroethylene and porous polyurethane fabric) and two of the composite materials (porous polyurethane fabric coated with polyacrylonitrile and silicone with microvilli cut into the posterior surface) were selected for further study.

Cellular reaction on the intraperitoneal injection of four types of polylactide particulates

Four types of polylactide particulates, P-L-LA 100, 250, 550 KD and a P-DL-LA 400 KD were injected into the peritoneal cavity of mice. The inflammatory reaction showed an increase in cell number (mainly neutrophilic granulocytes) up to 48 h after which the cell numbers decreased below the control (phosphate-buffered saline). All four polylactide particulates aggregated and intermingled with inflammatory cells. The aggregates remained throughout the investigation period of 6 months. Quantitative measurements showed that standardization of the particle form and size is essential. From this study and other experiments in which calcium phosphates and asbestos were injected intraperitoneally, it is concluded that the inflammatory response observed in the peritoneal cavity is related to the type of material injected and probably to form and size of the individual particles, but not to molecular weight.

Cell-ingrowth in a silicone plombe. Interactions between biomaterial and scleral tissue after 8 years in situ: a SEM and TEM investigation

A male patients (42 years) who had been treated for retinal detachment by the implantation of a silicone plombe into the sclera, returned to the clinic 8 years after implantation because of inflammation of the tissue and partial protrusion from the sclera. After removal of the plombe this was processed for TEM and SEM and examination of the plombe material after 8 years in situ could be carried out in order to get information about the cell-biomaterial interface. A large proportion of the silicone pores was filled with cellular material, including macrophages, giant cells and erythrocytes thus indicating a foreign body granuloma. The external surface of the pores showed a granular osmiophilic dense amorphous layer including extracellular debris. Engulfing of silicone particles by macrophages and the evidence of long-term tissue response suggest partial biodegradation of the silicone and certainly not complete inertness as was formerly claimed.

Enzymatic activity toward poly(L-lactic acid) implants

Tissue reactions toward biodegradable poly(L-lactic acid) implants were monitored by studying the activity pattern of seven enzymes as a function of time: alkaline phosphatase, acid phosphatase, alpha-naphthylacetyl esterase, beta-glucuronidase, ATP-ase, NADH-reductase, and lactate dehydrogenase. Cell types were identified by their specific enzyme patterns, their morphology and location. Special attention was paid to the enzyme patterns of macrophages, fibroblasts and polymorphonuclear granulocytes (PMNs), being involved in foreign body reactions or inflammatory responses. One day after implantation, an influx of neutrophilic and eosinophilic granulocytes was observed, coinciding with activity of alkaline phosphatase (PMN's) and beta-glucuronidase (eosinophils). From day 3 on, macrophages containing ATP-ase, acid phosphatase and esterase could be observed. From day 7 on, lactate dehydrogenase, the enzyme normally involved in the conversion of lactic acid, and its coenzyme NADH-reductase were observed in macrophages and fibroblasts. These two enzymes demonstrated more activity than expected on basis of wound-healing reactions upon implantation of a nonbiodegradable, inert biomaterial (as, e.g., Teflon). It is concluded that the biodegradable poly (L-lactic acid) used in these implantation studies is tissue compatible, and evokes a foreign body reaction with minor macrophage and giant cell activity, as observed during this 3-week implantation period. Most enzyme patterns were simply due to a wound-healing reaction. The slightly increased levels of LDH and NADH suggest the release of lactic acid from the implant, and thus confirms the biodegradable nature of this polymer.

Aluminum-induced granulomas in a tattoo

A patient who developed localized, granulomatous reactions in a tattoo is described. With the use of scanning electron microscopy and energy dispersive x-ray microanalysis, both aluminum and titanium particles were found in the involved skin sections. Intradermal provocation testing with separate suspensions of aluminum and titanium induced a positive response only in the case of aluminum. Examination by scanning electron microscopy and energy dispersive x-ray microanalysis of the provoked response established aluminum as the only nonorganic element present in the test site tissue. This is the first report of confirmed aluminum-induced, delayed-hypersensitivity granulomas in a tattoo.

Histopathology of chromoblastomycosis

A study aimed at determining the histopathologic appearance of chromoblastomycotic lesions was undertaken. Biopsies from 26 patients with the disease were examined. It was found that 23 cases (88.46%) exhibited the organized mixed mycotic granuloma - OMMA -, a granuloma modified by the presence polymorphonuclear neutrophils - PMN's. An equal proportion of cases exhibited pseudoepitheliomatous hyperplasia, with the epithelium playing an important role in the transepidermic elimination of the fungus. Healing of the lesions took place by fibrosis which was observed in 21 (80.77%) patients; this type of reaction was more common in the deeper areas of the dermis.

Biodegradable hollow fibres for the controlled release of drugs

Biodegradable hollow fibres of poly-L-lactic acid (PLLA) filled with a suspension of the contraceptive hormone levonorgestrel in castor oil were implanted subcutaneously in rats to study the rate of drug release, rate of biodegradation and tissue reaction caused by the implant. The in vivo drug release was compared with the release in vitro using different release media. Fibres, disinfected with alcohol showed a zero-order release, both in vitro and in vivo, for over 6 months. Fibres, either gamma-sterilized or disinfected with alcohol were harvested at time intervals ranging from 1 d to 6 months after implantation. Molecular weights of PLLA, tensile strengths, and remaining amounts of drug were determined as a function of time. The tissue reaction can be described as a very moderate foreign body reaction with the initial presence of macrophages, which are gradually replaced by fibroblasts which form a collagen capsule. Molecular weight determinations of PLLA showed a decrease from an initial Mw of 1.59 X 10(5) to 5.5 X 10(4) in 4 months (after alcohol sterilization). A gradual decrease in fibre strength with time was observed which did not significantly impair the release rate of levonorgestrel.

Effect of implantation site on phagocyte/polymer interaction and fibrous capsule formation

Implants of Silastic, Estane, polypropylene oxide and an HPOE/PBT segmented polyether polyester copolymer were qualitatively and quantitatively evaluated, with respect to interaction with mononuclear and multinucleated phagocytes as well as fibrous capsule formation, after implantation at three sites in the rat middle ear. The volume of the phagocyte exudate surrounding the implants, the degree of implant degradation and fragmentation and the thickness of the fibrous capsules were found to be correlated with the implantation site. From these findings, it can be concluded that it is important to assess the biological performance of a biomaterial at carefully chosen implantation sites.

Sarcoidosis versus foreign-body granulomas

A 42-year-old man developed a papulonodular exanthema 10 years following an injury from a shell explosion. The differential diagnosis between sarcoid-like, foreign-body granulomas and Boeck's sarcoid was inconclusive by histology, but x-ray spectroanalytic examination revealed silicon particles within the epitheloid cell granulomas.

Histopathology of cutaneous and mucosal lesions in human paracoccidioidomycosis

Biopsies from cutaneous and mucosal lesions from 40 patients with active paracoccidioidomycosis, were studied histopathologically. All cases exhibited chronic granulomatous inflammation and 38 also presented suppuration; this picture corresponded to the mixed mycotic granuloma (MMG). Pseudoepitheliomatous hyperplasia and the transepidermic (or epithelial) elimination of the parasite, were observed in all cases. In paracoccidioidomycosis elimination takes place through formation of progressive edema, accompained by exocytosis. The edema gives rise to spongiosis, microvesicles and microabscesses which not only contain the fungus but also, various cellular elements. Cells in charge of the phagocytic process were essentialy Langhans giant cells; PMN's, epithelioid and foreign body giant cells were poor phagocytes. An additional finding was the presence of fibrosis in most biopsies.

[Histopathology of tegumentary leishmaniasis caused by Leishmania braziliensis braziliensis. 3. Cellular reactions in tissues]

Os A.A. analisam as alterações histopatológicas observadas em 378 casos de Leishmaniose Tegumentar da localidade de Três Braços Estado da Bahia, dos quais 307 eram de portadores de lesões exclusivamente cutâneas, 54 de portadores de lesões exclusivamnte mucosas e 17 de portadores de lesões cutâneo-mucosas. A infiltração histiolinfoplasmocitária, na maioria dos casos, parece desempenhar o papel de resposta celular inespecífica à presença de um irritante tecidual, porém, nos casos de forma mucosa, não se pode afastar a possibilidade de que esse infiltrado esteja participando de uma reação de tipo autoagressivo. O plasmócito constitui um elemento quase constante nas lesões desenvolvidas, mas não tem sido observado nas lesões residuais, quer em via de cura ou já cicatrizadas; sua presença nestes casos denota, quase sempre, tendência à recidiva. Os mastdcitos foram observados em lesões tanto da forma cutânea como da forma mucosa, mas predominavam nas primeiras. Seu número foi significantemente maior no padrão de Reação Exsudativa e Neerótico Granulomatosa, onde os fenômenos necróticos são bem desenvolvidos. Os eosinófilos apresentaram associação significativa com os mastócitos, confirmando a existência de um eixo bidirecional entre estás duas células, o qual deve participar da modulação inflamatória, na Leishmaniose Tegumentar. Dois tipos de reação granulomatosa foram observados: um desorganizado, em relação, muitas vezes, com a necrose tissular, e outro organizado, mais raro, do tipo tuberculóide. O primeiro foi interpretado como de origem pós-necrótica, surgindo com a redução da carga parasitária, propiciada pelos fenômenos necróticos: eliminado o antígeno e mantidos os níveis de anticorpos, surgem as condições necessárias ao estabelecimento do granuloma, semelhante àquele observado nas lesões por imunocomplexo em excesso de anticorpos. O outro tipo de reação foi o granuloma de células epiteliódes, que surgiu em dois grupos de pacientes. Nos pacientes jovens, com doença de curto tempo de evolução e intradermorreação não exacerbada, este tipo de granuloma talvez seja a expressão da Hipersensibilidade Granulomatosa Específica, descrita por EPSTEIN (1977). No outro grupo de pacientes, havia em todos intradermorreação exacerbada. Nestes casos a hipersensibilidade granulomatosa, associando-se ã hipersensibilidade mediada por células — agora ampliada pelo seqüestro do antígeno —, reforçaria o processo granulomatoso, através da reverberação do estímulo antígênico; isso tornaria o tratamento mais difícil e pior o prognóstico para o caso.

Quantitative characterization of cells at the interface of long-term implants of selected polymers

Comprehensive understanding of the relationship between biologic response and biomaterial characteristic requires quantitative evaluation of the cells at the interface of the material and descriptions of ultrastructural features of these cells. The purpose of this study was to qualitatively and quantitatively characterize the long term in vivo tissue and cellular response to two polymeric materials presently employed in the fabrication of surgical implants. Ultrahigh molecular weight polyethylene (PE) and polysulfone (PSF) particles were implanted subcutaneously into rats for 100-118 weeks. Specimens were embedded in paraffin and ERL embedding medium in preparation for light and transmission electron microscopy. Percentage of the particle surface covered by various cell types was determined using a computer interactive image analysis system. PE and PSF particles were sequestered within a subcutaneous fibrous capsule. Cell types present included macrophages, fibroblasts and giant cells characteristic of a foreign body granuloma. Statistical comparison of the percent particle surface covered by each cell type revealed no significant difference between PSF and PE. However, surface texture appeared to influence the tissue response. TEM confirmed the identity of the cells at the interface and consistently revealed a layer of amorphous extracellular substance including cell debris on the material surface. Results evidence the tissue compatibility of PE and PSF and indicate no significant difference in the tissue response to these polymers.

Cutaneous foreign body granulomas associated with intravenous drug abuse

Intravenous drug abuse is a serious medical problem in the United States. We report a new cutaneous manifestation of drug abuse: the development of foreign body granulomas. These may develop months to years after the last intravenous injection and should be considered a possible cutaneous manifestation of systemic talc granulomatosis.