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McGuire P, Clauw DJ, Hammer J, Haws M, Adams WP. A Practical Guide to Managing Patients With Systemic Symptoms and Breast Implants. Aesthet Surg J 2022; 42:397-407. [PMID: 34687293 PMCID: PMC8922689 DOI: 10.1093/asj/sjab375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Numerous studies have explored the possibility of an association between breast implants and systemic symptoms potentially linked to exposure to silicone. Some studies show no direct association whereas others provide insufficient scientific evidence to prove or disprove an association. Nonetheless, some patients with breast implants remain concerned about the possible role of their implants in systemic symptoms they may be experiencing. This paper provides a practical approach for plastic surgeons in managing patients with breast implants who present with systemic symptoms, including recommendations for patient counseling, clinical and laboratory assessment of symptoms, and/or referral. Integral components of patient counseling include listening attentively, providing unbiased information, and discussing the risks and benefits of options for evaluation and treatment. A thorough history and assessment of symptoms, including appropriate laboratory tests, may identify underlying conditions to expeditiously address patients’ health issues through a specialist referral. Diagnosing and treating disorders that are causing a patient’s symptoms, if unrelated to their implant, would avoid a potentially unnecessary surgery. Ultimately, better information is needed to reliably guide patients in an evidence-based fashion. Long-term follow-up of patients who are explanted to see what symptoms may or may not improve could be useful in educating patients. Control groups in studies prospectively following women with implants for development of systemic symptoms would also be useful because the symptoms reported are common in women without implants. Cases are presented to illustrate the recommendations for a practical approach toward management of women reporting systemic symptoms with breast implants.
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Affiliation(s)
| | - Daniel J Clauw
- Department of Anesthesiology, Medicine (Rheumatology), and Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | | | | | - William P Adams
- University of Texas, Southwestern Medical Center, Dallas, TX, USA
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Shaik Y, Sabatino G, Maccauro G, Varvara G, Murmura G, Saggini A, Rosati M, Conti F, Cianchetti E, Caraffa A, Antinolfi P, Pandolfi F, Potalivo G, Galzio R, Conti P, Theoharides T. IL-36 Receptor Antagonist with Special Emphasis on IL-38. Int J Immunopathol Pharmacol 2013; 26:27-36. [DOI: 10.1177/039463201302600103] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
IL-36 is another family member of IL-1 and induces the production of proinflammatory cytokines and activates MAPK and NFκB pathways. IL-36 is a common mediator of innate and adaptive immune response and is inhibited by IL-36 receptor antagonist (RA). IL-36RA acts on IL-36 receptor ligand which exerts proinflammatory effect in vivo and in vitro. IL-38 binds to IL-36 receptor as does IL-36RA and has similar biological effects on immune cells. IL-38 is also a member of IL-1 cytokine and shares some characteristics of IL-1RA, binding the same IL-1 receptor type I. IL-38 plays a role in the pathogenesis of inflammatory diseases, exerting protective effect in some autoimmune diseases. Both IL-38 and IL-36RA have an anti-inflammatory biological effect, however in some cases have contrary effects.
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Affiliation(s)
- Y. Shaik
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - G. Sabatino
- Neonatology Division, University of Chieti, Italy
| | - G. Maccauro
- Department of Orthopedics, Catholic University of Rome, Italy
| | - G. Varvara
- Dental School, University of Chieti-Pescara, Italy
| | - G. Murmura
- Dental School, University of Chieti-Pescara, Italy
| | - A. Saggini
- Department of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - M. Rosati
- Gynecology Division, Pescara Hospital, Pescara, Italy
| | - F. Conti
- Gynecology Division, Pescara Hospital, Pescara, Italy
| | - E. Cianchetti
- Ortona Hospital, University of Chieti-Pescara, Italy
| | - A. Caraffa
- Orthopeadics Division, University of Perugia, Perugia Italy
| | - P. Antinolfi
- Orthopeadics Division, University of Perugia, Perugia Italy
| | - F. Pandolfi
- Department of Internal Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - G. Potalivo
- Orthopeadics Division, University of Perugia, Perugia Italy
| | - R. Galzio
- Department of Health Sciences, University of L ‘Aquila, Italy
| | - P. Conti
- Immunology Division, Department of Experimental and Clinical Sciences, University of Chieti, Italy
| | - T.C. Theoharides
- Department of Pharmacology and Experimental Therapeutics, Biochemistry and Internal Medicine Tufts University School of Medicine, Tufts-New England Medical Center, Boston, MA, USA
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