Pseudotumor in Large Diameter Head Metal-onmetal Total Hip Replacement / Pseudotumor em artroplastia total do quadril metal-metal com cabeça de grande diâmetro

Abstract The authors describe a case of a large diameter head metal-on-metal total hip replacement that evolved with an inflammatory pseudotumor formation. The diagnosis was established bymagnetic resonance imaging (MRI) with suppression of themetal artifact. The treatment consisted on the resection of the abnormal tissue and on the revision to a ceramic on cross-linked polyethylene hip replacement. To this date, no similar case has been reported, in Portuguese language, in the PubMed, Scielo, and Lilacs databases.

Resumo Os autores descrevem caso de artroplastia total do quadril (ATQ) com par tribológico metal-metal e cabeça de grande diâmetro que evoluiu com formação de pseudotumor inflamatório. O diagnóstico foi estabelecido por ressonânciamagnética comsupressão de artefato metálico. O tratamento consistiu na ressecção do tecido anormal e revisão com par tribológico cerâmica-polietileno reticulado. Nenhum caso semelhante em língua portuguesa encontra-se descrito nas bases de dados PubMed, Scielo e Lilacs até a presente data.

Insertion of biodegradable silicon-covered magnesium alloy stent in esophagus, a preliminary in vitro and in vivo study of feasibility and tissue reaction in experimental rabbits / 介入放射学杂志

Objective To study the mechanical properties and degradation behavior of biodegradable silicon-covered magnesium alloy stent in vitro,to investigate the technical feasibility of its implantation into rabbit esophagus and to observe the tissue reaction in vivo.Methods The mechanical compression recovery properties and the degradation behavior of biodegradable silicon-covered magnesium alloy stent were tested in vitro.A total of 30 healthy Holland rabbits were randomly divided into silicon-covered magnesium alloy stent group (n=15) and control group (n=15).For rabbits in the silicon-covered magnesium alloy stent group fluoroscopy-guided insertion of the stent into the lower third segment of esophagus was conducted,while for rabbits in the control group no intervention was adopted.One,2 and 4 weeks after the implantation of the stent,esophagography was performed for all rabbits of both groups,and each time every 5 rabbits from both groups were sacrificed,the specimens were collected and sent for histological examinations.Results In vitro test indicated that biodegradable silicon-covered magnesium alloy stent had good flexibility and elasticity,and in phosphate-buffered saline with pH 4.0 or pH 7.4 it degraded more slowly than bare magnesium alloy stent.In vivo test showed that the stent implantation could be well tolerated by all experimental rabbits.Before stent insertion the esophageal diameter was(9.2±0.8) mm,and at one,2 and 4 weeks after stent insertion the esophageal diameters were (9.7±0.7) mm,(9.6±0.8) mm and (9.6±0.5) mm respectively (P＞0.05).In the silicon-covered magnesium alloy stent group,stent displacement occurred in 6 rabbits in one week (n=l),2weeks (n=1) and 4 weeks (n=4).After stent implantation,the tissue reactions such as esophageal wall injury,collagen deposition,etc.were not obviously different from those in the control group (P＞0.05).Conclusion It is technically feasible to insert silicon-covered magnesium alloy stent into the rabbit's esophagus,the stent can provide sufficient support for at least 2 weeks,the stent displacement rate is low and acceptable,and no severe esophageal wall injury and collagen deposition are observed.

Rat subcutaneous tissue response to calcium silicate containing different arsenic concentrations

Objective: To evaluate the response of rat subcutaneous tissue in implanted polyethylene tubes that were filled with GMTA Angelus and Portland cements containing different arsenic concentrations. Material and Methods: Atomic absorption spectrophotometry was utilized to obtain the values of the arsenic concentration in the materials. Thirty-six rats were divided into 3 groups of 12 animals for each experimental period. Each animal received two implants of polyethylene tubes filled with different test cements and the lateral of the tubes was used as a control group. After 15, 30 and 60 days of implantation, the animals were killed and the specimens were prepared for descriptive and morphometric analysis considering: inflammatory cells, collagen fibers, fibroblasts, blood vessels and other components. The results were analyzed utilizing the Kuskal-Wallis test and the Dunn's Multiple test for comparison (p<0.05). Results: The materials showed, according to atomic absorption spectrophotometry, the following doses of arsenic: GMTA Angelus: 5.01 mg/kg, WPC Irajazinho: 0.69 mg/kg, GPC Minetti: 18.46 mg/kg and GPC Votoran: 10.76 mg/kg. In a 60-day periods, all specimens displayed a neoformation of connective tissue with a structure of fibrocellular aspect (capsule). Control groups and MTA Angelus produced the lower amount of inflammatory reaction and GPC Minetti, the highest reaction. Conclusions: There was no direct relationship between the concentration of arsenic present in the composition of the materials and the intensity of the inflammatory reactions. Higher values, as 18.46 mg/kg of arsenic in the cement, produce characteristics of severe inflammation reaction at the 60-day period. The best results were found in MTA angelus. .

Experimental evaluation of horse hair as a nonabsorbable monofi lament suture.

Background: Success of surgery depends on wound closure and healing. Ancients had coated many suture materials from plant and animal origin. As the quest for natural nonabsorbable, monofi lament surgical suture continues, horsehair has been taken for study, which is mentioned in ancient literature. Objectives: Aim of the study was to evaluate detail mechanical and biophysical properties of horsehair. Materials and Methods: Physical properties, that are diameter, straight pull and knot pull tensile strength, bioburden, sterility tests were performed. Visual and histological wound healing parameters were studied in experimental Wistar rat incision wound model. Two experimental wounds about 5 cm long were created on each side of dorsal midline. Each animal received two sutures-Horsehair 4-0 and Ethilon 4-0. The sutured areas were grossly examined on 3rd and 7th days for visual observations like congestion, edema, infection, wound disruption, and impression of suture material on healed wound and then subjected for histological study. Results: Revealed that horsehair has got diameter of 0.19 mm which complies with the 4-0 size USP standard. Straight pull tensile strength was found 0.5851 ± 0.122 kg and knot pull tensile strength was 0.3998 ± 0.078 kg, which complies with the standards of United State Pharmacopia for class II nonabsorbable suture materials. In vivo study revealed that there was no evidence of edema, congestion, and discharge in both the groups. Wounds healed with minimum impressions of suture material with minimum scar mark. Mean histological scoring shows very mild tissue reaction. Conclusion: Horsehair has got properties of standard suture material except low tensile strength and hence can be used in reconstructive, plastic surgeries, and ophthalmic surgeries.

Local tissue reaction after injection of contrast media on gastric wall of mouse: experimental study for application of contrast media to computed tomography lymphography / 대한외과학회지

PURPOSE: Computed tomography (CT) lymphography is a simple technique of sentinel node navigation but tissue reaction after injection of contrast media has not been reported yet. METHODS: Ninety mice used in this study were divided into three groups: lipiodol, iopamidol, and normal saline. The test compounds were given by submucosal injection to the gastric wall of anesthetized mice. The specimens were subjected to histopathological examination. RESULTS: The mean grades of acute inflammatory response after iopamidol and lipiodol injection were significantly higher than control group. However, there was no significant difference between iopamidol and lipiodol injection. The mean grade of chronic inflammatory response and fibrosis showed no differences between groups. The presence or absence of fibrinoid necrosis and mesothelial hyperplasia showed no statistical differences at each time point between groups. The foam cell, which is similar to human signet ring cell carcinoma, were not identified in normal saline and iopamidol group, but were detected by postoperative day 7 in lipiodol group. CONCLUSION: We conclude that iopamidol and lipiodol when used as a contrast media of CT lymphography is an available material for preoperative sentinel node navigation surgery for gastric cancer with an acceptable incidence of pathological alterations in a mouse model. Our results are potentially useful to clinical (human) application.

Evaluation of the rat tissue reaction to experimental new resin cement and mineral trioxide aggregate cement

OBJECTIVES: New resin cement (NRC) has been developed as a root repairing material and the material is composed of organic resin matrix and inorganic powders. The aim of this study was to compare the rat subcutaneous tissue response to NRC and mineral trioxide aggregate (MTA) cement and to investigate the tissue toxicity of both materials. MATERIALS AND METHODS: Sixty rats received two polyethylene tube-implants in dorsal subcutaneous regions, MTA and NRC specimens. Twenty rats were sacrificed respectively at 1, 4 and 8 wk after implantation and sectioned to 5 microm thickness and stained with Hematoxylin-Eosin (H-E) or von-Kossa staining. The condition of tissue adjacent to the implanted materials and the extent of inflammation to each implant were evaluated by two examiners who were unaware of the type of implanted materials in the tissues. Data were statistically analyzed with paired t-test (p < 0.05). RESULTS: In specimens implanted with both NRC and MTA, severe inflammatory reactions were present at one wk, which decreased with time. At eighth wk, MTA implanted tissue showed mild inflammatory reaction, while there were moderate inflammatory reactions in NRC implanted tissue, respectively. In NRC group, von-Kossa staining showed more calcification materials than MTA group at eighth wk. CONCLUSIONS: It was concluded that the calcium reservoir capability of NRC may contribute to mineralization of the tissues.

Lichenoid tissue reaction/interface dermatitis: Recognition, classification, etiology, and clinicopathological overtones.

Lichenoid tissue reaction or interface dermatitis embrace several clinical conditions, the prototype of which is lichen planus and its variants, drug induced lichenoid dermatitis, special forms of lichenoid dermatitis, lichenoid dermatitis in lupus erythematosus, and miscellaneous disorders showing lichenoid dermatitis, the salient clinical and histological features of which are described to facilitate their diagnosis. Background of lichenoid reaction pattern has been briefly outlined to enlighten those interested in this entity.

FiltekTM Silorane and FiltekTM Supreme XT resins: tissue reaction after subcutaneous implantation in isogenic mice

The aim of this study was to evaluate the tissue compatibility of a silorane-based resin system (FiltekTM Silorane) and a methacrylate-based nanoparticle resin (FiltekTM Supreme XT) after implantation in the subcutaneous connective tissue of isogenic mice. One hundred and thirty five male isogenic BALB/c mice were randomly assigned to 12 experimental and 3 control groups, according to the implanted material and the experimental period of 7, 21 and 63 days. At the end of each period, the animals were killed and the tubes with the surrounding tissues were removed and processed for microscopic analysis. Samples were subjected to a descriptive and a semi-quantitative analyses using a 4-point scoring system (0-3) to evaluate the collagen fiber formation and inflammatory infiltrate. Data were statistically analyzed using the Kruskal Wallis test (?=0.05). The results showed that there was no significant difference between the experimental and control groups considering the three evaluation periods (p>0.05). The silorane-based and the methacrylate-based nanoparticle resins presented similar tissue response to that of the empty tube (control group) after subcutaneous implantation in isogenic mice.

O objetivo do presente estudo foi avaliar a compatibilidade tecidual de um sistema resinoso à base de silorane (FiltekTM Silorane) e de uma resina nanoparticulada à base de metacrilato (FiltekTM Supreme XT), após implantação no tecido conjuntivo subcutâneo de camundongos isogênicos. Um total de 135 camundongos isogênicos BALB/c machos foram randomicamente divididos em 12 grupos experimentais e em 3 grupos controles, de acordo com o material implantado e com o período experimental (7, 21 e 63 dias). Ao final de cada período, os animais foram mortos, sendo os tubos removidos com o tecido circundante e processados para análise microscópica. As lâminas foram submetidas a análise descritiva e análise semi-quantitativa empregando um sistema de escores de 4 pontos (0-3), a fim de avaliar a formação de fibras colágenas e o infiltrado inflamatório. Os dados obtidos foram submetidos à análise estatística por meio do teste de Kruskal Wallis (?=0,05). Os resultados mostraram que não houve diferença estatisticamente significante entre os grupos experimentais e controles, considerando os três períodos de avaliação (p>0,05). As resinas à base de silorane e à base de metacrilato apresentaram resposta tecidual semelhante à do tubo vazio (controle), após implantação no tecido conjuntivo de camundongos isogênicos.

Biocompatibility evaluation of a new bioresorbable pin for membrane fixation

The aim of this study was to morphometrically analyze the tissue response to a customized pin obtained from devitalized bovine cortical bone (DBCB-pin) implanted in the subcutaneous tissue of rats, as well as to assess its microstructural aspect by scanning electron microscopy (SEM). The pins were implanted in the subcutaneous tissue of 20 rats, which were killed at 7, 14, 28 and 60 days (5 rats/period) after implantation. In the subcutaneous tissue, DBCB-pin promoted the formation of a fibrous capsule. At 7 days, capsule showed thickness of 70 ± 3.2 µm with higher density of newly formed capillaries and smaller density of collagen fibers. Between 14 and 60 days, more organized fibrous capsule exhibited smaller thickness (53 ± 5.5 µm) with higher density of fibroblasts and collagen fibers. In this period, a small and slow bioresorption of the DBCB-pin by macrophages and rare multinucleated giant cells without tissue damage was observed. The thickness of DBCB-pin resorbed was in mean only of 9.3 µm. During all experimental periods not occurred presence of immune reaction cells as lymphocytes and plasma cells. It was concluded that the pin derived from cortical bovine bone was well tolerated by subcutaneous tissue of rats and slowly resorbed could be an alternative material for membrane fixation in the guided tissue regeneration procedures.

O objetivo deste estudo foi analisar morfometricamente a resposta tecidual a um pino obtido a partir de osso bovino desvitalizado cortical (DBCB pinos) implantado no tecido subcutâneo de ratos, bem como para avaliar o seu aspecto microestrutural por microscopia eletrônica de varredura (MEV). Os pinos foram implantados no tecido subcutâneo de 20 ratos, que foram sacrificados aos 7, 14, 28 e 60 dias (5 animais / período) após a implantação. No tecido subcutâneo, o pino DBCB promoveu a formação de uma cápsula fibrosa. Aos 7 dias, a cápsula apresentou espessura de 70 ± 3,2 μm com maior densidade de capilares neoformados e menor densidade de fibras colágenas. Entre 14 e 60 dias, a cápsula fibrosa apresentava-se mais organizada e exibiram menor espessura (53 ± 5,5 μm) com maior densidade de fibroblastos e fibras colágenas. Nesse período, foi observada uma bioreabsorção pequena e lenta dos pinos DBCB por macrófagos e raras células gigantes multinucleadas, sem dano tecidual. A espessura dos pinos DBCB reabsorvidos foi em média de apenas 9,3 µm. Durante todos os períodos experimentais não ocorreu presença de células como linfócitos e células plasmáticas. Concluiu-se que o pino derivado de osso bovino cortical foi bem tolerado pelo tecido subcutâneo de ratos e reabsorvido lentamente, sendo um potencial material alternativo para fixação da membrana nos procedimentos de regeneração tecidual guiada.

Electron Microprobe Analysis and Tissue Reaction around Titanium Alloy Spinal Implants

STUDY DESIGN: A retrospective study of tissue surrounding titanium alloy spinal implants was performed using histological and electron microprobe analysis. PURPOSE: To identify the metal debris generated by spinal implants, and then to evaluate the electron microprobe analysis results and the histological response of soft tissue surrounding the spinal implants. OVERVIEW OF LITERATURE: Microscopic metal particles from the soft tissue surrounding joint arthroplasty have been shown to activate a macrophage response that leads to bone resorption and increased inflammation. The effect of unintended wear particles in spinal instrumentation remains a clinical concern. METHODS: Ten patients (average age, 51.3 years), 6 men and 4 women, who had undergone previous lumbar fusions using pedicle screw instrumentation and who were now undergoing revision surgery were included in the study. The tissues obtained from the adjacent area of these implants were analyzed by light microscopy, immunohistochemistry and scanning electron microscope. After the removing the spinal implants, the changes of back pain and the spinal fusion were assessed. RESULTS: There were metal particles in the soft tissue in 7 cases. Histological finding observed mild chronic inflammation surrounding the deposition of the metal particles and the anti Cotrel-Dubousset 68 positive macrophages were observed at tissue adjacent to the metal particles in 5 patients. Scanning electron microscopy of the specimens showed metallic debris within the tissue and mapping of the metallic particles revealed the distribution of titanium in the tissue in 5 cases. Nine patients had successful relief of back pain after removing the spinal implants. Improvement of the back pain may be an association macrophage response rather than the metal particle. CONCLUSIONS: The presence of metallic particles generated from spinal implants may serve as the impetus for a late-onset inflammatory response and late operative site pain.

Tissue Reaction in Response to Augmentation of Soft Tissue Defects According to the Dermis Graft Materials in Rabbits

The augmentation of soft tissue defects is one of the critical problems in the oral and maxillofacial surgery. Various types of graft materials, both autologous and non-autologous, have been used for the augmentation of soft tissue in the facial region. However, it is not easy to choose an ideal material for soft tissue augmentation because each has its advantages and disadvantages. An ideal graft material should meet the following criteria : it should not leave a scar at the area from which it was taken; should have less likelihood of causing infection; should feel natural after implanted; and should be not absorbed. Among the materials meeting these criteria, human dermis and artificial dermis are commonly used for clinical purposes. The present study was aimed to investigate and compare the resorption rate and the histological change following the use of the autologous dermis, the human homogenous dermis Alloderm(R), and the artificial dermis Terudermis(R) to reconstruct the soft tissue defect. Twenty mature rabbits of either sex, weighing about 2 kg, were used. Each rabbit was transplanted with the autologous dermis, Alloderm(R), and Terudermis(R) size 1 x 1-cm at the space between the external abdominal oblique muscle and the external abdominal oblique fascia. They were then divided into 4 groups (n=5 each) according to the time elapsed after the surgery: 1, 2, 4, and 8 weeks. The resorption rate was calculated by measuring the volume change before and after the transplantation, and H-E stain was preformed to observe the histological changes. The resorption rate after 8 weeks was 21.5% for the autologous dermis, 16.0% Alloderm(R), and 36.4% Terudermis(R), suggesting that Alloderm(R) is the most stable while Terudermis(R) is the most unstable. In microscopic examinations, the autologous dermis graft was surrounded by inflammatory cells and showed foreign body reactions. The epidermal inclusion cyst was observed in the autologous dermis graft. Terudermis(R) and Alloderm(R) demonstrated neovascularization and the progressive growth of new fibroblast. The results suggest that Terudermis(R) and Alloderm(R) can be availably for substituting the autologous dermis.

Comparative Study of Tissue Response of Various Suture Materials in Rats / 대한치주과학회지

The purpose of this study is to evaluate histologically the tissue response and resorption of various nonresorbable and resorbable suture materials used for periodontal surgery, using a subcutaneous model on the dorsal surface of the rat. In this study, 10 Sprague-Dawley male rats (mean BW 150gm) were used and the commercially available materials included polyglactin 910, pain gut, nylon, e-PTFE. Animals were sacrificed at 3 days, 1, 2 and 4 weeks after implantation of various nonresorbable and resorbable suture materials. Specimens were prepared with Hematoxylin-Eosin stain for light microscopic evaluation. The results of this study were as follows: 1. Resorption : The resorption of plain gut was showed at 1 week after implantation, was lost their structure and almost resorbed at 4 weeks. The resorption of polyglactin 910 was started at 2 weeks and slowly absorbed untill 4 weeks. 2. Tissue response : Plain gut showed persistent and severe inflammatory reactions from 3 days to 4 weeks. Polyglactin 910, e-PTFE and nylon showed mild inflammatory reactions. Suture material should be biocompatible and be able to be functioned until tissue tensile strength reaches maximum level. In this study, polyglactin 910, nylon and e-PTFE are considered to be proper suture materials for periodontal surgery.