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1.
Vasc Endovascular Surg ; 56(8): 762-766, 2022 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-35694959

RESUMEN

INTRODUCTION: Angiosarcomas (AS) are rare and aggressive neoplasms originating from the endothelium: they represent less than 2% of all soft tissue sarcomas and usually have a poor prognosis. Although more often primary, different risk factors have been described and some cases are associated with vascular surgery. Materials and Methods: We present the case of an 84-year-old man who developed an AS on his thigh 3 years after a popliteal bypass with autologous saphenous vein. We performed a thorough review of the literature describing the main characteristics of the 25 cases (including ours) of AS associated with vascular surgery reported from 1981 to 2022. Results: Most of the patients were males (21 men vs 4 women) with a range age of 50-84 years. Most of AS are associated with Dacron grafts (12 cases), the overall mean time to onset is 7.8 years after surgery. The most common presenting symptoms are pain (20 cases) and weight loss (10 cases), while cutaneous presentation is uncommon; indeed, violaceous and painful papules, plaques, nodules, and skin ulceration have been found in 3 cases only. Due to unspecific symptoms, differential diagnosis is often difficult and a biopsy for histological confirmation is mandatory. Conclusion: Even if it seems to be a very rare complication, AS should always be considered in patients with compatible symptoms and who have undergone vascular surgery in the past.


Asunto(s)
Hemangiosarcoma , Anciano , Anciano de 80 o más Años , Femenino , Hemangiosarcoma/inducido químicamente , Hemangiosarcoma/diagnóstico por imagen , Hemangiosarcoma/cirugía , Humanos , Extremidad Inferior/patología , Masculino , Persona de Mediana Edad , Tereftalatos Polietilenos/efectos adversos , Resultado del Tratamiento , Procedimientos Quirúrgicos Vasculares/efectos adversos
2.
Ann Vasc Surg ; 70: 444-448, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32592846

RESUMEN

BACKGROUND: The presence of sac enlargement after abdominal aortic aneurysm (AAA) open repair, a condition usually called perigraft seroma (PGS), nearly always has a benign behavior. Some theories implicated for PGS formation include coagulation abnormalities, fibroblast inhibition, low-grade infection, or improper graft handling. METHODS: This is a retrospective study including patients treated for AAA in 2 academic vascular surgery departments from 2007 to 2014, where 1 center preferably used polytetrafluoroethylene (PTFE) grafts whereas the preference of other center was mostly Dacron graft. The definition of PGS was conceived as a fluid collection around the graft on CT scan imaging with a radiodensity ≤25 Hounsfield units, reaching at least 30 mm in diameter and beyond the third postoperative month. Analysis was performed between patients with and without PGS. RESULTS: Seventy-eight patients met the inclusion criteria: 42 received Dacron and 36 PTFE grafts. Twenty-three (29.5%) patients accomplished the PGS diagnosis. Having a PTFE graft was the strongest factor for PGS formation on multivariate analysis. The medium seroma size was 42 mm (range, 30-90.6 mm) and the mean time from AAA repair to PGS detection was 26 months (range, 4-106 months). Three patients of the 23 with PGS required surgical repair, all of them were successfully treated: 2 by endovascular means and the remaining with explantation and Dacron reconstruction. CONCLUSIONS: PGS formation is not an unusual complication after open reconstructions for AAA treatment. This is especially true for PTFE grafts, and thus, closer follow-up is warranted if using this material. Treatment is clearly needed when symptoms appear; however, preventive strategies with either endovascular relining or reopen reconstructions require an individual approach counterbalancing benefits versus risk of the procedures.


Asunto(s)
Aneurisma de la Aorta Abdominal/cirugía , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/instrumentación , Prótesis Vascular/efectos adversos , Politetrafluoroetileno/efectos adversos , Seroma/etiología , Anciano , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tereftalatos Polietilenos/efectos adversos , Diseño de Prótesis , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Seroma/diagnóstico por imagen , España , Factores de Tiempo , Resultado del Tratamiento
3.
Contraception ; 102(6): 430-432, 2020 12.
Artículo en Inglés | MEDLINE | ID: mdl-32866471

RESUMEN

We report a case of severe systemic delayed dermatitis in a patient with nickel-titanium sterilization microinserts placement complicated by uterine perforation and polyethylene terephthalate (PET) exposure. We hypothesize that delayed dermatitis may be caused by the exposure of PET fibers in this patient with underlying autoimmune disorder. Further research on the use of PET and the potential of systemic dermatologic reactions when exposure occurs is needed, especially when considering the inclusion of PET in future implant device development.


Asunto(s)
Dermatitis por Contacto/diagnóstico , Níquel/efectos adversos , Tereftalatos Polietilenos/efectos adversos , Esterilización Tubaria/efectos adversos , Titanio/efectos adversos , Perforación Uterina , Útero/cirugía , Adulto , Remoción de Dispositivos , Femenino , Humanos , Níquel/administración & dosificación , Esterilización , Esterilización Tubaria/instrumentación , Esterilización Tubaria/métodos , Titanio/administración & dosificación , Resultado del Tratamiento
4.
Phys Med Biol ; 64(7): 075001, 2019 03 21.
Artículo en Inglés | MEDLINE | ID: mdl-30736021

RESUMEN

Cardiovascular disease is the leading cause of mortality in the United States. Peripheral artery disease (PAD) affects a substantial portion of the elderly population (>70 years). PAD can be symptomatic or asymptomatic, and treatment is directed towards improving functional vessel patency and limb salvage. Revascularization surgical treatments are needed in some cases, and it is not always possible to use autologous veins for vascular grafting. In this case, synthetic materials may be used. Synthetic materials such as expanded polytetrafluoroethylene (ePTFE) and poly (ethylene terephthalate) (Dacron) have been used. These materials are much stiffer compared to normal arterial vessels so developing alternative materials is an active area of research. One such potential material is a p olyvinyl alcohol cryogel reinforced arterial model (PRAM). In this study we used shear wave elastography (SWE) techniques to compare the mechanical behavior of excised aortas and anastomoses formed between the aortas and the Dacron, ePTFE, and PRAM materials. Different initial longitudinal strains (0%-40%) and transmural pressures (20-180 mmHg) were used to test a wide range of parameters that are within physiological ranges. We found that the PRAM materials had similar mechanical behavior in terms of group velocity measured in the vessel wall with respect to the excised aortas compared to the Dacron and ePTFE that had higher values of group velocity. The ratios of the group velocity for the PRAM material with respect to the aortas ranged from 0.83 to 1.13 where the Dacron and ePTFE had ranges of 1.12-2.22 and 1.91-3.10 for the same stretch and pressure ranges. The PRAM materials provide an alternative vascular material with better mechanical matching with excised aortas.


Asunto(s)
Prótesis Vascular/normas , Diagnóstico por Imagen de Elasticidad , Tereftalatos Polietilenos/química , Politetrafluoroetileno/química , Anciano , Anastomosis Quirúrgica/instrumentación , Anastomosis Quirúrgica/métodos , Aorta/cirugía , Arteria Femoral/cirugía , Humanos , Masculino , Tereftalatos Polietilenos/efectos adversos , Politetrafluoroetileno/efectos adversos , Grado de Desobstrucción Vascular
5.
BMC Ophthalmol ; 18(1): 327, 2018 Dec 17.
Artículo en Inglés | MEDLINE | ID: mdl-30558564

RESUMEN

BACKGROUND: We present a case of intrusion of a suture knot 15 years after scleral buckling surgery. CASE PRESENTATION: A 62-year-old woman with high myopia had undergone scleral buckling surgery in her left eye 15 years previously for rhegmatogenous retinal detachment. She recently displayed highly elevated intraocular pressure, with hyphema and vitreous hemorrhage. After the blood was cleared, a ring-shaped protrusion was noted around the equator of the eyeball, with a blue suture knot standing out on its surface and extending into the vitreous cavity at 5 o'clock. The suture knot was removed successfully. Mass spectrometry revealed that the material of the suture was polyethylene terephthalate, or Dacron. One week later, at the place where the suture knot had been located, the choroidal and retinal tissue disappeared and the silicone buckle remained an uncovered intrusion, whereas the rest of the retina was still attached. CONCLUSIONS: The suture knot was possibly the one used to close the drainage port for subretinal fluid, which was covered by the encircling band. During the buckling procedure, covering a nonabsorbable suture, which is usually placed where the sclera is compromised by trauma or the surgical incision, with an encircling band may lead to the intrusion of the suture. Therefore, a soft absorbable suture may be preferable, if possible.


Asunto(s)
Tereftalatos Polietilenos/efectos adversos , Complicaciones Posoperatorias/etiología , Curvatura de la Esclerótica/efectos adversos , Suturas/efectos adversos , Femenino , Humanos , Persona de Mediana Edad , Desprendimiento de Retina/cirugía
6.
J Card Surg ; 33(10): 653-657, 2018 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-30199920

RESUMEN

BACKGROUND: Dacron tube grafts have been used in the surgical management of cardiovascular disease since the 1970s. Complications at the site of the anastomosis have been well described. Non-anastomotic failure is far less common. We present a series of four patients who presented with complications of non-anastomotic failure of woven Dacron tube grafts. METHODS: A retrospective chart review of four patients who presented to our institution between March 2014 and March 2017 with clinical complications of a Dacron tube graft was conducted. RESULTS: All four patients underwent a staged surgical repair for an interrupted aortic arch between the years of 1988 and 2001. All four patients underwent revision of their original interposition graft (Gore-Tex, W.L. Gore & Associates, Flagstaff, AZ) with implantation of a Hemashield woven Dacron tube graft (Maquet, Rastatt, Germany). From 13 to 22 years postimplant of the Dacron tube graft, all patients presented with symptoms or clinical evidence of primary graft failure. Two patients underwent urgent surgical intervention and did not survive. One patient underwent attempted surgical intervention, which was aborted in the setting of profuse bleeding, and ultimately had an endovascular rescue of the tube graft with a Zenith Alpha endograft (Cook Medical, Bloomington, IN). One patient underwent elective endovascular intervention prior to onset of symptoms. CONCLUSION: Non-anastomotic failure of woven Dacron tube grafts can occur in the thoracic aorta in young adults and may be managed with endovascular techniques.


Asunto(s)
Aorta Torácica/cirugía , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/métodos , Prótesis Vascular/efectos adversos , Procedimientos Endovasculares/métodos , Tereftalatos Polietilenos/efectos adversos , Falla de Prótesis , Adolescente , Adulto , Resultado Fatal , Humanos , Masculino , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento
7.
BMJ Case Rep ; 20182018 May 12.
Artículo en Inglés | MEDLINE | ID: mdl-29754129

RESUMEN

The aim of this study is to describe a case of delayed granuloma formation associated with tendon necrosis in response to Ethibond confirmed by histopathological examination and to review and discuss the related literature. A 40-year-old woman underwent a patellar tendon repair with Krakow-like #5 Ethibond sutures. Four years after the repair, she noticed progressive soreness with knee extension and swelling. An ultrasound examination revealed a proximal partial patellar tendon rupture. Based on these findings, the patient was advised to undergo surgical intervention due to a diagnosis of re-rupture. Tendinosis, fibrosis and necrosis scar tissue surrounding the previous suture were observed and excised, and samples were sent for histopathological and microbiological examination. Stripping of the patellar paratenon was performed. Surprisingly, a giant cell foreign body reaction surrounding the synthetic refringent material, as well as polymorphonuclear cells surrounding the necrotic tendon, was reported.


Asunto(s)
Granuloma de Células Gigantes/patología , Traumatismos de la Rodilla/cirugía , Necrosis/patología , Ligamento Rotuliano/patología , Procedimientos de Cirugía Plástica/efectos adversos , Tereftalatos Polietilenos/efectos adversos , Complicaciones Posoperatorias/patología , Adulto , Femenino , Reacción a Cuerpo Extraño/patología , Células Gigantes de Cuerpo Extraño/patología , Granuloma de Células Gigantes/cirugía , Humanos , Imagen por Resonancia Magnética , Necrosis/diagnóstico por imagen , Necrosis/cirugía , Ligamento Rotuliano/diagnóstico por imagen , Ligamento Rotuliano/cirugía , Complicaciones Posoperatorias/inmunología , Complicaciones Posoperatorias/cirugía , Suturas/efectos adversos , Factores de Tiempo , Resultado del Tratamiento
8.
BMJ Case Rep ; 20172017 Oct 19.
Artículo en Inglés | MEDLINE | ID: mdl-29054946

RESUMEN

An 83-year-old man presented 4 years after right carotid endarterectomy (CEA) with an infection of his prosthetic Dacron patch. Initial scans (CT angiogram and whole body labelled white cell scan) were clear with no infection or collection noted. Systemically, the patient presented well with no recorded fevers. With an occluded left internal carotid artery and severely stenosed vertebral arteries, surgery presented a high risk of major stroke due to the lack collateral supply and this was discussed extensively. The patient subsequently declined surgical management, and he was monitored closely on an outpatient basis. He presented again a year later with ongoing haemoserous ooze from the CEA site. Subsequently a two-stage procedure was performed, where initially a stent was inserted, followed by patch excision and debridement. A muscle flap was then mobilised over the opening. This new approach to carotid patch infections should gain traction over time as a safer alternative for high-risk patients.


Asunto(s)
Implantación de Prótesis Vascular/efectos adversos , Prótesis Vascular/efectos adversos , Endarterectomía Carotidea/efectos adversos , Reacción a Cuerpo Extraño , Tereftalatos Polietilenos , Infección de la Herida Quirúrgica/cirugía , Anciano de 80 o más Años , Implantación de Prótesis Vascular/instrumentación , Implantación de Prótesis Vascular/métodos , Estenosis Carotídea/diagnóstico por imagen , Estenosis Carotídea/cirugía , Reacción a Cuerpo Extraño/diagnóstico , Reacción a Cuerpo Extraño/etiología , Reacción a Cuerpo Extraño/cirugía , Humanos , Infecciones por Klebsiella/diagnóstico , Klebsiella pneumoniae/aislamiento & purificación , Masculino , Tereftalatos Polietilenos/efectos adversos , Tereftalatos Polietilenos/uso terapéutico , Infección de la Herida Quirúrgica/diagnóstico , Tomografía Computarizada por Rayos X
9.
Eur J Vasc Endovasc Surg ; 54(4): 423-429, 2017 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-28757054

RESUMEN

OBJECTIVE: The aim was to analyse the incidence and presentation of carotid patch inflammatory reactions following carotid endarterectomy (CEA). METHODS: This was a cohort study using a prospectively maintained database. All patients who underwent elective CEA at a tertiary vascular centre between 2002 and 2016 were included. Computed tomography scan angiogram, duplex scan, and leucocyte scintigraphy were used to assess patients with suspected inflammatory patch complications. Re-intervention procedures and outcomes were noted. Histopathology and organisms cultured from the harvested material during re-intervention were assessed. RESULTS: During the study period, 633 patients underwent elective CEA. Fifty-one underwent eversion endarterectomy: 111 did not require a patch, whereas 471 patients had a patch repair. Four hundred and twenty eight had a Dacron patch repair and 43 a biological patch. Eight patients returned with late Dacron patch inflammatory complications (1.3% of all CEA and 1.9% of Dacron patch closures) after a period ranging from 18 months to 7 years (mean 4.1 ± 2.1 years). Seven of the eight patients underwent surgical re-intervention, and the eighth patient was deemed high surgical risk. One patient underwent a vein bypass, three had vein patch repair, one required internal carotid artery (ICA) ligation after patch excision, and two were managed by debridement, with omohyoid and sternomastoid muscle covering of the patch. The patient who required ICA ligation suffered a fatal stroke. The remaining patients had a satisfactory outcome. All patients showed evidence of foreign body reaction in pathological examination with no pathological organism cultured from swabs or tissue harvested during surgery. CONCLUSION: Late wound complications after CEA may be related to inflammatory reaction of the Dacron patch rather than infection. Infection should be excluded first. Reconstruction with vein is effective. However, debridement with sternomastoid and omohyoid muscle covering of the patch may be considered in high risk patients after exclusion of infection with regular follow-up.


Asunto(s)
Implantación de Prótesis Vascular , Estenosis Carotídea , Endarterectomía Carotidea/métodos , Reacción a Cuerpo Extraño , Tereftalatos Polietilenos , Reoperación/métodos , Anciano , Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/instrumentación , Implantación de Prótesis Vascular/métodos , Estenosis Carotídea/diagnóstico por imagen , Estenosis Carotídea/cirugía , Estudios de Cohortes , Bases de Datos Factuales/estadística & datos numéricos , Diagnóstico Diferencial , Femenino , Reacción a Cuerpo Extraño/diagnóstico , Reacción a Cuerpo Extraño/etiología , Reacción a Cuerpo Extraño/cirugía , Humanos , Irlanda , Masculino , Persona de Mediana Edad , Evaluación de Procesos y Resultados en Atención de Salud , Tereftalatos Polietilenos/efectos adversos , Tereftalatos Polietilenos/uso terapéutico , Ajuste de Riesgo , Infección de la Herida Quirúrgica/diagnóstico
10.
Facial Plast Surg ; 32(5): 520-31, 2016 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-27680524

RESUMEN

Allogenic implants are an effective alternative to autologous grafts in the reconstruction of facial defects. These implants are used to reconstruct a variety of bony and soft-tissue defects, including the frontal and temporal regions; internal orbit; infraorbital rim; malar, paranasal, and nasal regions; mandible; and chin. In comparison to their autologous counterparts, alloplastic materials are more readily available, lack donor-site morbidity, decrease surgical time and cost, and still have relatively good postoperative tissue tolerance. However, these implants are not without their own spectrum of complications. Common solid implant materials include silicone, GoreTex (expanded polytetrafluorethylene; W. L. Gore & Associates Inc., Flagstaff, AZ), MedPor (high-density porous polyethylene; Porex Industries, Fairburn, GA), and Mersilene mesh (nonresorbable polyester fiber; Ethicon, Somerville, NJ). Each of these materials poses certain complication risks based on their surface contour (smooth vs. porous), pliability, and reactivity with surrounding tissue. In addition, certain implant locations within the head and neck are at risk for different postoperative complications. Although there are no evidence-based guidelines for implant reconstruction to help avoid common complications, there are several principles and techniques that are commonly employed by surgeons to help reduce complication rates. These include careful patient selection, proper choice of operative procedure, infection control practices (including pre/intraoperative systemic antibiotics, meticulous aseptic technique, impregnation/soaking of implant in antibiotic, irrigation of implant pocket with antibiotic, careful closure of tissue layers, and postoperative oral antibiotics), preoperative implant shaping, choice of surgical approach, and intraoperative surgical techniques. Larger, controlled trials are needed to confirm the efficacy of the aforementioned techniques in the reduction of postoperative complications.


Asunto(s)
Infecciones Bacterianas/prevención & control , Implantación de Prótesis Maxilofacial/efectos adversos , Implantación de Prótesis Maxilofacial/métodos , Prótesis Maxilofacial/efectos adversos , Complicaciones Posoperatorias/prevención & control , Materiales Biocompatibles/efectos adversos , Humanos , Selección de Paciente , Tereftalatos Polietilenos/efectos adversos , Polietilenos/efectos adversos , Politetrafluoroetileno/efectos adversos , Complicaciones Posoperatorias/etiología , Siliconas/efectos adversos , Mallas Quirúrgicas/efectos adversos
11.
Biomaterials ; 109: 32-39, 2016 12.
Artículo en Inglés | MEDLINE | ID: mdl-27662579

RESUMEN

Macrophages play a key role in the foreign body response. In this study it was investigated whether obesity affects the acute response of macrophages to biomaterials in vitro and whether this response is associated with biomarkers in blood. CD14 + monocytes were isolated from blood from obese and age and gender matched lean persons. Monocyte subsets were determined based on CD14 and CD16 on their surface. C-reactive protein (CRP) was measured in peripheral blood. The response of monocyte-derived macrophages to polypropylene (PP), polylactic acid (PLA), polyethylene terephthalate (PET) monofilament, and PET-multifilament (mPET) in culture was based on cytokine production. More IL-6 (for PET), less CCL18 (all materials) and IL-1ra (for PLA) was produced by macrophages from obese patients than lean subjects. Body mass index, serum CRP and to a lesser extend percentages of monocyte subtypes correlated with IL-6, TNFα, CCL18, and IL-1ra production. Taken together, monocyte-derived macrophages of obese patients respond more pro-inflammatory and less anti-inflammatory to biomaterials than macrophages from lean subjects, depending on the material. These results are a step towards personalized medicine for the development of a model or even a blood test to decide which biomaterial might be suitable for each patient.


Asunto(s)
Materiales Biocompatibles/efectos adversos , Macrófagos/efectos de los fármacos , Monocitos/patología , Obesidad/patología , Adulto , Biomarcadores/metabolismo , Proteína C-Reactiva/metabolismo , Estudios de Casos y Controles , Células Cultivadas , Citocinas/metabolismo , Femenino , Reacción a Cuerpo Extraño/sangre , Humanos , Proteína Antagonista del Receptor de Interleucina 1/metabolismo , Interleucina-6/metabolismo , Macrófagos/metabolismo , Masculino , Persona de Mediana Edad , Obesidad/sangre , Poliésteres/efectos adversos , Tereftalatos Polietilenos/efectos adversos , Polipropilenos/efectos adversos , Factor de Necrosis Tumoral alfa/metabolismo
12.
J Drugs Dermatol ; 15(7): 897-9, 2016 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-27391643

RESUMEN

BACKGROUND: Angiosarcoma is an uncommon, malignant neoplasm often found in skin and soft tissue. Epithelioid angiosarcoma (EA) is a rarer, more aggressive form of angiosarcoma most common in men in their seventh decade. Dacron®, a polymer comprised of polyethylene terephthalate used in endografts for abdominal aortic aneurysm repairs, has been a suspected carcinogen associated with EA. Currently, three case reports exist in the literature purporting Dacron®-associated epithelioid angiosarcoma. Herein we report a case of Dacron®-associated EA.
CASE: A 64-year-old male with a recent history of a repaired type 2 endoleak and Dacron® endograft for his AAA presented with a painful skin eruption, fever, and weight loss. On exam, erythematous and violaceous papules and nodules were present on the patient's lower back. Biopsy revealed atypical, epithelioid cells forming vascular channels in a sheet-like and infiltrative pattern. These results and subsequent immunostaining were consistent with the diagnosis of EA. A bone marrow biopsy confirmed metastatic angiosarcoma.
CONCLUSION: This case further highlights Dacron® as a rare, but, potential carcinogen associated with EA.

J Drugs Dermatol. 2016;15(7):897-899.


Asunto(s)
Aorta Abdominal/cirugía , Rechazo de Injerto/complicaciones , Tereftalatos Polietilenos/efectos adversos , Sarcoma/inducido químicamente , Sarcoma/etiología , Rechazo de Injerto/diagnóstico , Rechazo de Injerto/prevención & control , Humanos , Masculino , Persona de Mediana Edad , Sarcoma/diagnóstico
13.
Ann Diagn Pathol ; 21: 21-8, 2016 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-27040926

RESUMEN

Angiosarcoma may rarely arise near an inert foreign body material including vascular grafts and metal joint prostheses. Sixteen such cases have been reported since 1972 but mostly in the radiologic or surgical literature without detailed histologic or molecular analyses. We herein describe the clinicopathologic and molecular features of 2 new cases and reanalyzed 3 previously reported cases of angiosarcoma that developed in association with Dacron grafts for vascular repair (n=3) or related to orthopedic metal prostheses for joint replacement (n=2). All patients were men aged 50 to 84 years (median, 71 years). Mean time to development of angiosarcoma was 9 years (range, 4.6-17 years). Symptoms were recurrent bleeding/loosening of prosthesis for suspected infection (in the joint prosthesis cases) and fatigue, weight loss, and abdominal symptoms in the Dacron-associated cases. Four patients died of disease within 1 to 24 months (mean, 8 months). One patient was alive after radical surgery, radiochemotherapy, and embolization of pulmonary metastases (17 months). Histologically, all tumors were high-grade epithelioid neoplasms with a predominant solid growth pattern and variable vasoformation. All tumors expressed CD31, ERG, FLI-1, and variably pancytokeratin (diffuse in 3 cases), but none expressed D2-40, MDM2, or CDK4. Fluorescence in situ hybridization analysis revealed no MDM2 or CDK4 alterations. MYC was expressed in all cases, but only 1 case was MYC amplified by fluorescence in situ hybridization. Angiosarcomas are exceedingly rare fatal complications of long-standing metal and Dacron prostheses. Awareness of their morphology and frequent cytokeratin expression is necessary to avoid misdiagnosis as metastatic carcinoma. Limited awareness of their existence explains delayed clinical diagnosis in most of cases. Absence of MDM2/CDK4 alterations underlines their distinction from intimal-type sarcomas.


Asunto(s)
Biomarcadores de Tumor/metabolismo , Prótesis Vascular/efectos adversos , Carcinoma/diagnóstico , Hemangiosarcoma/diagnóstico , Prótesis Articulares/efectos adversos , Tereftalatos Polietilenos/efectos adversos , Anciano , Anciano de 80 o más Años , Vasos Sanguíneos/patología , Carcinoma/etiología , Diagnóstico Diferencial , Hemangiosarcoma/etiología , Humanos , Inmunohistoquímica , Hibridación Fluorescente in Situ , Articulaciones/patología , Queratinas/metabolismo , Masculino , Persona de Mediana Edad
14.
Hand Surg Rehabil ; 35(1): 27-33, 2016 02.
Artículo en Inglés | MEDLINE | ID: mdl-27117021

RESUMEN

The purpose of this study was to evaluate patients who were treated with trapeziectomy and Dacron interposition in our hospital and to describe the incidence of foreign body reactions. Between 2004 and 2010, 10 women with trapeziometacarpal osteoarthritis underwent Dacron interpositional arthroplasty. One patient had surgery in both hands. Implants were removed in two patients, 5 and 8 years postoperatively. Histological analysis confirmed the presence of a foreign body reaction with giant cells in both cases. At a mean follow-up of 9 years, seven patients with the implant still in place were available for review and clinical examination. Mean DASH score was 32 and mean VAS for pain and satisfaction was 1.6 and 8.8, respectively. Mean grip strength was 11.4kg and mean key pinch strength was 1.5kg. Recent radiographs were available in nine hands. Seven out of nine hands had radiological signs of a foreign body reaction with bone erosion. A severe reaction occurred in three patients. We no longer use the Dacron implant and recommend careful monitoring of all patients in whom this implant has been used.


Asunto(s)
Articulaciones Carpometacarpianas/cirugía , Reacción a Cuerpo Extraño/etiología , Osteoartritis/cirugía , Tereftalatos Polietilenos/efectos adversos , Complicaciones Posoperatorias , Hueso Trapecio/cirugía , Adulto , Anciano , Artroplastia , Articulaciones Carpometacarpianas/diagnóstico por imagen , Femenino , Reacción a Cuerpo Extraño/diagnóstico por imagen , Humanos , Persona de Mediana Edad , Osteoartritis/diagnóstico por imagen , Complicaciones Posoperatorias/diagnóstico por imagen , Estudios Retrospectivos , Hueso Trapecio/diagnóstico por imagen
15.
Carcinogenesis ; 36(1): 168-76, 2015 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-25411358

RESUMEN

Identification of early perturbations induced in cells from non-cancerous breast tissue is critical for understanding possible breast cancer risk from chemical exposure. We have demonstrated previously that exposure to the ubiquitous xenoestrogens, bisphenol A (BPA) and methyl paraben, promotes the hallmarks of cancer in non-malignant human high-risk donor breast epithelial cells (HRBECs) isolated from several donors. Here we show that terephthalic acid (TPA), a major chemical precursor of polyethylene terephthalate (PET) containers used for the storage of food and beverages, increased the ERα: ERß ratio in multiple HRBEC samples, suggesting an estrogenic effect. Although, like BPA and methyl paraben, TPA also promoted resistance to tamoxifen-induced apoptosis, unlike these chemicals instead of inducing an increased S-phase fraction, TPA treatment arrested cell proliferation. DNA-PK, ATM and members of the MRN complex, known to be involved in DNA damage sensor and effector proteins, were elevated indicating induction of DNA strand breaks. Early DNA damage checkpoint response, mediated through p53/p21, led to G1 arrest in TPA-exposed cells. Removal of TPA from the growth medium resulted in the rapid induction of BCL2, increasing the ratio of anti-: pro-apoptotic proteins, together with overexpression of Cyclin A/CDK2 proteins. Consequently, despite elevated p53(pSer15) and H2AX(pSer139), indicating sustained DNA damage, TPA exposed cells resumed robust growth rates seen prior to TPA exposure. The propensity for the perpetuation of DNA aberrations that activate DNA damage pathways in non-malignant breast cells justifies careful consideration of human exposure to TPA, particularly at vulnerable life stages.


Asunto(s)
Neoplasias de la Mama/inducido químicamente , Neoplasias de la Mama/patología , Mama/patología , Daño del ADN/efectos de los fármacos , Resistencia a Antineoplásicos/efectos de los fármacos , Ácidos Ftálicos/efectos adversos , Tereftalatos Polietilenos/efectos adversos , Antineoplásicos Hormonales/farmacología , Apoptosis/efectos de los fármacos , Western Blotting , Mama/efectos de los fármacos , Neoplasias de la Mama/metabolismo , Ciclo Celular/efectos de los fármacos , Proliferación Celular/efectos de los fármacos , Células Cultivadas , Receptor alfa de Estrógeno/metabolismo , Receptor beta de Estrógeno/metabolismo , Femenino , Depuradores de Radicales Libres/efectos adversos , Humanos , Tamoxifeno/farmacología
16.
J Hand Surg Am ; 39(10): 2016-9, 2014 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-25172386

RESUMEN

PURPOSE: To report the incidence of foreign body reactions associated with placement of a polyethylene mesh implant in patients treated with trapiezectomy for trapeziometacarpal osteoarthritis. METHODS: Between November 2008 and September 2012, 70 hands in 66 adults with stage IV trapeziometacarpal osteoarthritis had a trapiezectomy with interposition of a spacer made of polyethylene terephthalate mesh (Anchois Ligastic, Orthomed SA, St Jeannet, France). Out of these 70 implants, 8 implants (11%) in 8 patients (mean age, 60 y; range, 49-75 y) were removed because of persistent swelling, synovitis, and pain. RESULTS: The mean interval between primary and revision surgery was 14 (range, 5-27) months. Histological analysis in all cases showed a foreign body giant cell reaction. Two hands showed bone resorption or carpal bone cysts similar to silicone particle synovitis. The cysts resolved after implant removal and bone grafting. CONCLUSIONS: In the light of these results and the available literature, we recommend not using this material for interposition in the treatment of osteoarthritis of the trapeziometacarpal joint. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.


Asunto(s)
Materiales Biocompatibles/efectos adversos , Articulaciones Carpometacarpianas/cirugía , Reacción a Cuerpo Extraño/cirugía , Prótesis Articulares/efectos adversos , Osteoartritis/cirugía , Tereftalatos Polietilenos/efectos adversos , Anciano , Artroplastia de Reemplazo/efectos adversos , Remoción de Dispositivos , Femenino , Reacción a Cuerpo Extraño/etiología , Reacción a Cuerpo Extraño/patología , Humanos , Masculino , Persona de Mediana Edad , Mallas Quirúrgicas/efectos adversos , Hueso Trapecio/cirugía
17.
Biochem Biophys Res Commun ; 433(1): 115-20, 2013 Mar 29.
Artículo en Inglés | MEDLINE | ID: mdl-23485466

RESUMEN

Macrophages are important in foreign body reactions. We devised a culture model with human primary macrophages to evaluate the acute response of macrophages to biomaterials. First we selected proteins representative for pro-inflammatory (M1) or anti-inflammatory/repair (M2) response of monocytes isolated from blood of healthy human donors by exposing them to LPS+IFNγ or IL-4. A relative M1/M2 index was calculated using IL-1ß, IL-6, tumor necrosis factor (TNF)α, monocyte chemotactic protein (MCP)-3 and macrophage inflammatory protein (MIP)-1α as M1 markers, and IL-1 receptor antagonist (IL-1RA), CCL18, regulated and normal T-cell expressed and secreted (RANTES), and macrophage-derived chemokine (MDC) as M2 markers. Then monocytes were cultured for 3days on 4 materials selected for known different foreign body reactions: Permacol™, Parietex™ Composite, multifilament polyethylene terephthalate and multifilament polypropylene. Macrophages on polypropylene produced high levels of anti-inflammatory proteins with a low M1/M2 index. Macrophages on Parietex™ Composite produced high levels of inflammatory and anti-inflammatory proteins, with a high M1/M2 index. Macrophages on polyethylene terephthalate also resulted in a high M1/M2 index. Macrophages on Permacol™ produced a low amount of all proteins, with a low M1/M2 index. This model with human primary macrophages and the panel of read-out parameters can be used to evaluate the acute reaction of macrophages to biomaterials in vitro to get more insight in the foreign body reaction.


Asunto(s)
Materiales Biocompatibles/efectos adversos , Reacción a Cuerpo Extraño/etiología , Reacción a Cuerpo Extraño/fisiopatología , Macrófagos/fisiología , Células Cultivadas , Quimiocina CCL3/biosíntesis , Colágeno/efectos adversos , Citocinas/biosíntesis , Reacción a Cuerpo Extraño/genética , Expresión Génica , Humanos , Mediadores de Inflamación/metabolismo , Macrófagos/efectos de los fármacos , Ensayo de Materiales , Modelos Biológicos , Monocitos/efectos de los fármacos , Monocitos/fisiología , Tereftalatos Polietilenos/efectos adversos , Polipropilenos/efectos adversos
18.
Int Orthop ; 37(2): 327-35, 2013 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-22976592

RESUMEN

PURPOSE: Based on the revival of artificial ligaments containing polyethylene terephthalate, this study aimed to evaluate objective intra-articular findings within scheduled second-look arthroscopy, patient-reported clinical outcome and stability after isolated augmented ACL reconstruction with polyethylene terephthalate (Trevira®) augmented patella-bone-tendon-bone graft. METHODS: In a retrospective analysis of our institutional database, we found 126 patients with polyethylene terephthalate (Trevira®) augmented ACL reconstruction. All these patients underwent standardised second-look arthroscopic evaluation when removal of the augmentation became necessary. These second-look arthroscopic analyses focused on graft integration and remodelling in line with the polyethylene terephthalate augmentation. Arthroscopic re-examination comprised a graft evaluation including a structural and functional classification according to the Marburger Arthroscopy Score (MAS). Additional clinical evaluation was performed via the IKDC score and the scores of Tegner and Lysholm. Instrumental anterior laxity testing was carried out with a KT-1000™ arthrometer. Furthermore, a correlation analysis between the clinical parameters, the instrumental stability assessment and the corresponding arthroscopic graft condition was performed. RESULTS: The arthroscopic evaluation showed rupture of 87 (69 %) of 126 augmentation devices. In 27 (31 %) of these 87 cases, synovial reactions were found particularly in the anterior compartment. An intact synthetic augmentation with signs of graft integration with intact synovial coating was only found in 30 %. Evaluation according to the MAS showed good to excellent structural and functional characteristics in 88 % of patients. Presence of a type III graft (MAS) was found in an additional 11 %. A rudimentary (type IV) graft was only detected once. Eighty-five percent of patients were graded A or B according to IKDC score. The Lysholm score was 92.4 ± 4.8. Correlation analysis demonstrated a significant relationship between clinical outcome according to the IKDC score (p<0.05), instrumental stability performance according to the KT-1000™ assessment (p<0.05) and the corresponding arthroscopic graft evaluation according to the MAS. CONCLUSION: Graft integration and remodelling has complex and multi-factorial origins, particularly with artificial augmentation. Correlation analysis showed a significant relation between clinical condition, instrumental stability performance and arthroscopic graft constitution. The release of polyethylene terephthalate fibres caused inflammation of synovial tissue of the knee. Characteristic sub-clinical graft changes of structural, morphological and functional qualities of the inserted graft appear on second-look arthroscopy despite good clinical results.


Asunto(s)
Reconstrucción del Ligamento Cruzado Anterior/métodos , Materiales Biocompatibles/efectos adversos , Tereftalatos Polietilenos/efectos adversos , Adulto , Artroscopía , Plastía con Hueso-Tendón Rotuliano-Hueso , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Segunda Cirugía
19.
J Vasc Surg ; 56(6): 1721-3, 2012 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-22819750

RESUMEN

Patch angioplasty using synthetic materials such as Dacron and polytetrafluoroethylene has become the standard of care after carotid endarterectomy. This method has been shown to reduce recurrent stenosis and stroke as compared to primary closure. Complications, including infection and pseudoaneurysm, are very rare. Another complication that has been described in two case reports to date is the late rejection of a polytetrafluoroethylene patch. We present the first reported case of a late Dacron patch expulsion 4 years after carotid endarterectomy. The patient was managed conservatively after a selective carotid arteriogram demonstrated no evidence of stenosis or pseudoaneurysm formation.


Asunto(s)
Angioplastia , Prótesis Vascular/efectos adversos , Estenosis Carotídea/cirugía , Endarterectomía Carotidea , Tereftalatos Polietilenos/efectos adversos , Falla de Prótesis/etiología , Anciano , Estenosis Carotídea/complicaciones , Estenosis Carotídea/diagnóstico , Femenino , Humanos , Factores de Tiempo
20.
Obstet Gynecol ; 119(2 Pt 2): 431-433, 2012 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-22270428

RESUMEN

BACKGROUND: Erosion and fistula formation are known complications of nonabsorbable materials in gynecologic surgery. The majority are diagnosed within months after surgery. CASE: A 45-year-old woman who had recurrent vaginal discharge for 4 years presented with a suprapubic abscess with a fistulous retropubic tract into the right side of the vagina 22 years after a bladder neck suspension with Dacron buttresses. The abscess was incised and drained, and the buttresses were removed (suprapubically and vaginally). The patient recovered well with antibiotics. The vagina and suprapubic skin were closed by second intention. CONCLUSION: Erosion and fistula formation can present more than two decades after using permanent material in pelvic reconstructive surgery. These complications should be included in the differential diagnosis of unexplained pelvic symptoms.


Asunto(s)
Absceso Abdominal/etiología , Complicaciones Posoperatorias/etiología , Mallas Quirúrgicas/efectos adversos , Fístula Vaginal/etiología , Absceso Abdominal/diagnóstico , Absceso Abdominal/terapia , Adulto , Femenino , Humanos , Persona de Mediana Edad , Tereftalatos Polietilenos/efectos adversos , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/terapia , Falla de Prótesis/efectos adversos , Factores de Tiempo , Incontinencia Urinaria de Esfuerzo/cirugía , Fístula Vaginal/diagnóstico , Fístula Vaginal/terapia , Adulto Joven
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