Therapeutic Effects of Anti-Tumor Necrosis Factor Monoclonal Antibody on Experimental Uveitis

PURPOSE: We investigated the therapeutic effects of monoclonal anti-TNF antibody (infliximab) on experimental uveitis. METHODS: Twenty New Zealand White rabbits were immunized with Mycobacterium tuberculosis H37Ra antigen and then challenged with intravitreal injection of tuberculin antigen to introduce a uveitis. Then infliximab was injected into rabbit eyes at an intravenous concentration of 5 mg/kg and intravitreal concentrations of 1 mg/0.1mL and 100 microg/0.1mL. As a control, the vehicle was injected intravenously or intravitreally. To evaluate the therapeutic effects, inflammation was assessed by slit lamp biomicroscopy and scored according to the severity of inflammation. The animals were also evaluated by electroretinography and histopathology. RESULTS: Regardless of the administration route, inflammatory activities of anterior chamber and engorgement of vascular structures were reduced in the infliximab treated group compared to control. Different administration routes and different concentrations of infliximab did not affect the therapeutic outcome of the clinical scoring. Intravenous (5 mg/kg) and intravitreal diluted (100 microg/0.1mL) infliximab injection groups showed significant improvement in electroretinographic findings and significant reduction of inflammatory cells with preservation of retinal tissue architecture on histopathologic examination. However, focal loss of the photoreceptor outer segment is observed in intravitreal undiluted (1 mg/0.1 mL) infliximab injected eyes. CONCLUSIONS: Infliximab may be a useful treatment modality to suppress ocular inflammation in experimental uveitis models in rabbits.

Giant Dollish Face of Body Dysmorphic Disorder Patient Resulting from Compulsive Foreign Body Injection

Body dysmorphic disorders can be often diagnosed among the group of patients seeking plastic surgery with excessiveness. For the correction of unrealistic body images tied up in their minds, they have a tendency to choose improper plastic operation or unlicensed procedures rather than the psychiatric intervention. So- called 'illegal injection' performed by the unlicensed has been readily accessible tempting alternatives, which could result in disastrous outcomes due to multiple compulsive injections. Nowadays injection of foreign materials, such as paraffin oil or liquid silicon, is thought to be obsolete in modern medical procedures. Nevertheless, these illegal procedures have been in extensive use among some Asian countries, including Korea, by the unlicensed. Local complication, particularly, granulomatous inflammatory responses of variable severity can occur, despite skillful techniques and even small amount of injection. Futhermore, these lesions frequently persist or recur after treatment. We have a case of a body dysmorphic disorder manifesting severe, huge foreign body granulomas caused by silicon, paraffin and oil injected. Our case was a 38- years-old woman who had multiple huge masses on head and neck which had slowly grown after multiple injections for about 16 years. After a psychiatric intervention, we performed partial resection of masses in cheek and neck area, followed by liposuction of forehead, neck and scalp. A brief history of case and the clinical significance of foreign body injection in body dysmorphic disorder were described.