Autoimmune/inflammatory syndrome induced by adjuvants (ASIA), medical treatment of severe systemic compromise: case report

Case description: A 42-year-old woman with severe pulmonary and mediastinal inflammatory involvement, secondary to infiltration of a silicone-related allogenic material with systemic migration. Clinical findings: The patient developed esophageal and bronchial stenosis, recurrent infections, malnutrition, and respiratory deterioration, making surgical removal of the allogenic material impossible. Treatment and outcome: Clinical and radiological improvement was achieved after treatment with multiple intravenous and oral immunomodulators. Clinical relevance: Autoimmune/inflammatory syndrome induced by adjuvants (ASIA) is a heterogeneous disease resulting from exposure to allogenic substances in a susceptible subject. These substances cause autoimmune or autoinflammatory phenomena. Since ASIA was described ten years ago, its diagnostic criteria are still under discussion, with an uncertain prognosis. The ideal therapy is based on eliminating the causative substance, but this is not always possible. Therefore, it is necessary to start an immunomodulatory treatment, using it in this patient, a scheme that had not been previously reported in the literature.

Descripción del caso: Mujer de 42 años con compromiso inflamatorio pulmonar y mediastinal severo, secundario a infiltración de un material alogénico relacionado con la silicona con migración sistémica. Hallazgos clínicos: La paciente desarrolló estenosis esofágica y bronquial, infecciones recurrentes, desnutrición y deterioro respiratorio, imposibilitando la extracción quirúrgica del material alogénico. Tratamiento y resultado: Mejoría clínica y radiológica lograda tras un tratamiento con múltiples inmunomoduladores intravenosos y orales. Relevancia clínica: El síndrome autoinmune / inflamatorio inducido por adyuvantes (ASIA) es una enfermedad heterogénea que resulta de la exposición a sustancias alógenas en un sujeto con susceptibilidad genética. Estas sustancias inducen fenómenos autoinmunitarios o autoinflamatorios. Desde que ASIA fue descrito hace 10 años, sus criterios diagnósticos continúan en discusión, con un pronóstico incierto. El tratamiento idóneo se basa en eliminar la sustancia causante, pero no siempre es posible, por lo cual se hace necesario iniciar un tratamiento inmunomodulador, empleándose en esta paciente un esquema que no había sido reportado previamente en la literatura.

The effect of three different investing materials on complete denture flasking deformation / 中国基层医药

Objective To investigate the effect of different investing materials on the complete denture flasking deformation.Methods The denture wax casts were invested by plaster,dental stone,and dental stone together with silicone,respectively.8 trial dentures were randomly chosen from above each group,and 4 reference points were selected in the cast.The conventional water bath polymerization system was used for the process.The distance between reference points were measured before and after thermally processing the Acrylic base.F test and Kruskal-Wallis H test were applied for statistical analysis.Results The distance between A and B (F =3.768,P =0.040) and the mean of total distance among O,A,B and C(F =4.830,P =0.019) had statistically significant differences among the three groups.The deformation variance of Group 1 (a conventional plaster) between 175μm and 267μm was maximum.The deformation values of Group2 (a dental stone) was appropriate with Group3 (a dental stone + a silicone).Smoothness (x2 =17.575,P ＜ 0.01) was statistically different among the three groups.Conclusion The flaskingprocess with the plaster had the maximum movement.The process with dental stone showed the minimal toothmovement,the process with the dental stone along with with thesilicone caused a similar movement as from the single dental stone but resulted in a smoother denture surface.