Silicone breast implants and connective tissue diseases: How does current evidence add to the no-association consensus? Systematic review and meta-analysis.

To evaluate the current state of the evidence regarding the association of silicone breast implantation with the onset of connective tissue diseases, constitutional symptoms, and rheumatic serological profile in adult women. A comprehensive search was carried out using MEDLINE, Embase, Web of Science and Scopus, from inception to September 2, 2020. Cohort studies assessing the clinical and serological profile of women with cosmetic breast implants were included. Meta-analyses were conducted using risk ratios. A total of 10 cohorts with overall moderate quality of evidence were included in this systematic review. Exposure to silicone breast implants was slightly associated with the development of rheumatoid arthritis [RR: 1.35; (95% CI 1.08 to 1.68); P = .008; I2 = 0%]. However, no significant differences were exhibited between the breast implant-exposed population and controls regarding the rest of the outcomes. In adult women, exposure to silicone breast implantation is not associated with the onset of constitutional symptoms and most connective tissue diseases. A marginal association with rheumatoid arthritis was exhibited, but the certainty of this result is jeopardized by the significant amount of self-reported data for this outcome. Further research is required to adequately explore the clinical significance of these results.

Curso de reumatologia: aula 7: manifestações neurológicas nas colagenoses / Course of rheumatology: class 7: neurologic manifestations in collagenosis

O propósito deste artigo é focar as principais manifestações neurológicas das doenças difusas do tecido conjuntivo, com ênfase nas suas manifestações clínicas. Os autores discutem as várias complicações do sistema nervoso central e periférico na doença muscular inflamatória (polimiosite e dermatomiosite), policondrite recidivante, esclerose sistêmica, artrite reumatoide, síndrome de Sjõgren, doença mista do tecido conjuntivo (doença de Sharp), lúpus eritematoso sistêmico e síndrome do anticorpo antifosfolipide.

The purpose of this article is to focus on the major nervous system manifestations in connective tissue diseases, with emphasis on their clinica findings. Authors discuss several complications in inflammatory muscle disease (polymyositis an dermatomyositis), relapsing polychondritis, systemic sclarosis, rheumatoid arthritis, Sjõgren syndorme, mixed connective tissue (Sharp disease), systemic lupus erythematosus and antiphospholipid syndrome.

[Bilateral orbital fat prolapse associated with pterygium: case report]. / Prolapso de gordura orbitária bilateral associado a pterígio: relato de caso.

Orbital fat prolapse is an uncommon benign entity that can cause esthetic defects. The authors present a 63-year-old patient with bilateral temporal orbital fat prolapse associated with a bilateral nasal pterygium. Clinical and surgical features are described. The clinical, imaging and histopathological diagnoses are discussed.

Spontaneous and simultaneous bilateral rupture of the quadriceps tendon in a patient with osteogenesis imperfecta: a case report.

Bilateral rupture of the quadriceps tendon is an uncommon and serious injury that usually occurs in middle aged to elderly patients. It is frequently associated with chronic metabolic disorders like diabetes, hyperparathyroidism, gout, chronic renal failure or the chronic use of steroids. We report a case of spontaneous bilateral rupture of the quadriceps tendon in a patient with osteogenesis imperfecta.

Acquired disorders of elastic tissue: Part II. Decreased elastic tissue

Elastic fibers in the extracellular matrix are integral components of dermal connective tissue. The resilience and elasticity required for normal structure and function of the skin are attributable to the network of elastic tissue. Advances in our understanding of elastic tissue physiology provide a foundation for studyng the pathogenesis of elastic tissue disorders. Many acquired disorders are in which loss of dermal elastic tissue produces prominent clinical and histopathologic features have recently been described, including middermal elastolysis, papular elastorrhexis, and pseudoxanthoma-like papillary dermal elastolysis, which must be differentiated from more well-known disorders such as anetoderma, acquired cutis laxa, and acrokeratoelastoidosis.

Acquired disorders of elastic tissue: Part I. Increased elastic tissue and solar elastotic syndromes

Elastic fibers in the extracellular matrix are an integral component of dermal connective tissue. The resilience and elasticity required for normal structure and function of the skin may be attributed to the network of elastic tissue. Advances in our understanding of elestic tissue physiology provide a foundation for studyng the pathogenesis of elastic tissue disorders. Many acquired disorders are nevertheless poorly understood due to the paucity of reported cases. Several acquired disorders in which accumulation or elastotic degeneration of dermal elastic fibers produces prominent clinical and histopathologic features have recenthy been described. They include elasdoterma, linear focal elastosis, and late-onset focal dermal elastosis and must be differentiated from better-known disorders, among them acquired pseudoxanthoma elasticum, elastosis perforans serpiginosa, and Favré-Racouchot syndrome.

Synovial remodeling process induced by type V collagen immunization in rabbits.

The pathogenesis of diffuse connective tissue diseases is still unknown despite studies of the autoimmunity aspects related to extracellular matrix elements, mainly the collagens. Articulations are frequently affected by the synovitis process in these diseases. The objective of the present study was to verify the morphologic aspects of the synovial membrane of rabbits immunized with type V collagen, which has some particular characteristics 75 days after the first antigen inoculation and when compared to control animals. The synovial membrane of the animals sacrificed after 75 days of immunization presented an intense remodeling phenomenon along the connective tissue screen and interlobular septa of the adipose-muscle tissue screen compartment. The remodeling process determined type I and III collagen fiber depositions in the vascular and connective tissue compartments of the synovial membrane. The nutrient vessels of the adipose-muscle compartment showed a similar remodeling process, which resulted in small vessel occlusion. Few residual inflammatory foci consisting of monocytes and eosinophils were observed. Thus, our experimental model reproduces morphologic changes in different tissues, characterized by an extracellular matrix remodeling process similar to those observed in many diffuse connective tissue diseases such as systemic lupus erytematosus and scleroderma. Therefore, this model could be useful in understanding the pathogenesis and the treatment of these diseases.

Biochemical indicator for evaluation of connective tissue abnormalities in Menkes' disease.

Metabolites of collagen metabolism were analyzed in patients with Menkes' disease. The urinary deoxypyridinoline level was significantly low in the patients with Menkes' disease, indicating that it is a good marker of lysyl oxidase activity, which is related to the connective tissue abnormalities.

[Infection and reactive arthritis: clinico-bacteriological correlation in seronegative arthropathies]. / Infección y artritis reactivas: correlación clínico bacteriológica en artropatías seronegativas.

The aim of this study was to search infections that trigger reactive arthritis. Eighty-six patients with seronegative arthritis (SNA) were studied; 32 had reactive arthritis, 21 ankylosing spondylitis, 7 psoriatic arthritis and 26 undifferentiated seronegative oligoarthritis. As controls, 70 patients with connective tissue diseases (CTD) and 55 healthy volunteers (HV) were studied. Serological evidence for infection with Chlamydia trachomatis was studied with micro immunofluorescence, looking for L2 and BED serotypes and serological evidence for Yersinia infection, using a commercial kit. Stool cultures were done in seven patients with recent diarrhea, and endourethral or endocervical cultures in 35 individuals. Serotypes L2 or BED were positive in 23 of 83 patients with SNA, 3 of 39 patients with CTD and 4 of 55 HV (p < 0.03). IgG class antibodies against L2 were detected in 17% of SNA patients, 2.6% of CTD patients and 5.4% of HV (p < 0.05). IgM class antibodies were detected in 6 SNA patients, 0 CTD patients and 2 HV (NS). Twelve of 35 cultures were positive for Chlamydia. As a whole 30% of SNA patients has serological or bacteriological evidence for Chlamydia infection. Serology for Yersinia was positive in 39 of 81 SNA patients, 1 of 54 CTD patients and 3 of 51 HV (p < 0.01). Rates of infections were similar among male, female, HLA B27 positive and HLA negative subjects. It is concluded that SNA patients have a high prevalence of infections by Chlamydia trachomatis or Yersinia enterocolitica.

Arterial connective tissue alterations in thalassemia major: a biochemical study of a case with severe iron overload.

A biochemical analysis of glycosaminoglycans and collagen was performed in arteries of a 15-year old teenager who died of beta thalassemia major. The patient presented the severe clinical complications resulting from hemochromatosis, which was evidenced at autopsy and by histological examination. The arteries under study comprised the thoracic and abdominal aortas and the iliac and pulmonary arteries, which were compared with the same arteries from normal individuals. Data on total glycosaminoglycan and total collagen, including the determination of the relative contents of the different glycosaminoglycans, suggest an as yet undescribed fibrotic process in the thalassemic arteries. Also altered were the proportions of the disaccharides making up chondroitin sulfate and heparan sulfate. A reduction in the molecular weight of arterial heparan sulfate, presumably with free radical involvement, was also detected. These changes in the extracellular matrix may be ascribed to the presence of large amounts of iron in the tissue, and as such they should be expected in other disorders with chronic iron overload.

¿Por qué se produce la interfase de tejido conjuntivo alrededor de un implante? / Why does the connective tissue interphase is produced around implants?

La investigación del prof. P.I. Branemark ha permitido el desarrollo de sólidas bases científicas en el empleo de la implantación óseo integrada, lo que determinó un cambio radical en el tratamiento de los pacientes parcial y totalmente desdentados

Current status of silicone breast implants.

The current status of the silicone breast implants which have recently come under scrutiny by the FDA and received much unfavorable media coverage is reviewed. The gel-filled breast implants which in 1976 were "grandfathered" by the FDA have now been required to provide scientific evidence of safety and effectiveness by July 9, 1991. The possible risks of silicone breast implants include capsular contracture, interference with early tumor detection by routine mammography, development of sarcomas in laboratory animals (no human cases are reported), silicone gel leakage and connective tissue disease. In the less frequently used polyurethane covered implants, the degradation of the polyurethane to diaminotoluene (TDA) has caused liver cancer in laboratory animals, yet at present, this type of implant has been voluntarily removed from the market by the manufacturer. After reviewing the available evidence, the American Society of Plastic Surgery still considers silicone breast implants reliable and safe.

Current status of silicone breast implants

The current status of the silicone breast implants which have recently come under scrutiny by the FDA and received much unfavorable media coverage is reviewed. The gel-filled breast implants which in 1976 were "grandfathered" by the FDA have now been required to provide scientific evidence of safety and effectiveness by July 9, 1991. The possible risks of silicone breast implants include capsular contracture, interference with early tumor detection by routine mammography, developments of sarcomas in laboratory animals (no human cases are reported), silicone gel leakage and connective tissue disease. In the less frequently used polyurethane to diaminotoluene (TDA) has caused liver cancer in laboratory animals, yet at present, this type of implant has been voluntarily removed from the market by the manufacturer. After reviewing the available evidence, the American Society of Plastic Surgery still considers silicone breast implants reliable and safe

Doença mista do tecido conjuntivo: estudo clínico e laboratorial em 15 casos / Mixed connective tissue disease: clinical and laboratory study of 15 cases

Os autores fazem um estudo retrospectivo de 15 pacientes com diagnóstico de doença mista do tecido conjuntivo. Säo pacientes brasileiras, todas do sexo feminino, de 22 a 56 anos. Os sinais e sintomas mais freqüentes em nossa casuística säo: poliartrite 14(93%), dedos "em salsicha" 11(73%), fenômeno de Raynaud 11 (73%), rigidez matinal 7 (47%), febre 7 (47%), fraqueza muscular 8 (53%), acometimento digestivo (epigastralgia, pirose, gastrite, úlcera oral e perianal, peritonite, disfagia) 7 (47%), acometimento pleuropulmonar (dor torácica, dispnéia e derrame pleural) 6 (40%), rash cutâneo 5 (33%), vasculite 5 (33%), acometimento cardíaco (precordialgia, taquicardia, pericardite, derrame pericárdico e insuficiência cardíaca congestiva 5 33%). Os achados laboratoriais mostraram: FAN positivo em 100% dos casos, com padräo predominantemente pontilhado 13 (87%). AntiDNA nativo presente em 4 pacientes (27%), anti-RNP positivo em todos os soros testados. O fator reumatóide IgM foi positivo em 4(27%), Sm 5/15 (33%), SSA 1/14 (7%), SSB 2/15 (13%). IgG aumentada em 14/14 (100%). IgM aumentada em 9/14 (64%), IgA aumentada em 5.14 (36%). C3 reduzido em 7/14 (50%), C4 reduzido em 2/14 (14%)

Etiopatogenia das doenças difusas do tecido conjuntivo / The etiopathogenesis of diffuse connective tissue diseases

Os autores apresentam os elementos que se acredita estarem envolvidos na etiopatogenia das Doenças Difusas do Tecido Conjuntivo. Demonstram a participaçäo de fatores imunológicos, constitucionais e exógenos e explicam os mecanismos fisiopatológicos detalhando aspectos da reaçäo inflamatória que produzem lesäo tecidual. Comprova-se que o substrato anatomopatológico (recrose fibrinóide) que reúne doenças com algumas características clínicas comuns näo participa de modo ativo na etiopatogênese mas elas permanecem interrelacionadas através do tripé defeito imune x constituiçäo genética x agentes externos. A apresentaçäo de variados antígenos nucleares relacionados com manifestaçöes clínicas específicas é sugerida como uma proposta futura para classificaçäo destas doenças