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Pneumonitis associated with fluoropolymer waterproofing agents, an entity with few reported cases, can result from occupational exposure. This condition has a rapid onset after exposure, usually resolves with supportive treatment but there could be chronic sequelae. The authors report the case of a 48-year-old male patient admitted to hospital with acute onset of dyspnea and chest pain after using an aerosolized fluoropolymer-containing waterproofing product. He presented tachypnea, leukocytosis, elevated C reactive protein, elevated serum lactate dehydrogenase and hypoxemic respiratory failure. Chest computed tomography revealed bilateral ground-glass opacities with peribronchovascular distribution. The patient was treated with oxygen and corticosteroid therapy, with clinical improvement. This chemical pneumonitis represents a diagnostic challenge since it implies a history of exposure to toxic agents and the pathophysiological mechanisms and safe exposure limits are still unknown.

Abstract: Waterproofing spray-associated pneumonitis (WAP) proceeds to acute respiratory failure and is characterized by diffuse bilateral ground-glass opacities on computed tomography; however, the detailed characteristics of WAP are unknown. Therefore, this study identified the characteristics of WAP from comparisons with those of acute eosinophilic pneumonia (AEP) and hypersensitivity pneumonitis (HP), which show similar features to WAP.Adult patients with WAP, AEP, and HP treated in Fukujuji Hospital from 1990 to 2018 were retrospectively enrolled. Furthermore, data from patients with WAP were collected from publications in PubMed and the Japan Medical Abstracts Society and combined with data from our patients.Thirty-three patients with WAP, eleven patients with AEP, and thirty patients with HP were reviewed. Regarding age, sex, smoking habit, and laboratory findings (white blood cell count, C-reactive protein level, and serum Krebs von den Lungen-6 level), WAP and AEP were not significantly different, while WAP and HP were significantly different. The duration from symptom appearance to hospital visit was shorter in patients with WAP (median 1 day) than in patients with AEP (median 3 days, P = .006) or HP (median 30 days, P < .001). The dominant cells in the bronchoalveolar lavage fluid of patients with WAP, AEP, and HP were different (macrophages, eosinophils, and lymphocytes, respectively).The characteristic features of WAP were rapid disease progression and macrophage dominance in the bronchoalveolar lavage fluid, and these characteristics can be used to distinguish among WAP, AEP, and HP., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Decompressive craniectomy is a commonly performed procedure. It reduces intracranial pressure, improves survival, and thus might have a positive impact on several neurosurgical diseases and emergencies. Sometimes primary skin closure is not possible due to cerebral herniation or extensive skin defects. In order to prevent further restriction of the underlying tissue, a temporary skin expansion might be necessary., Methods and Material: We retrospectively reviewed patients in need for a temporary skin substitute because skin closure was not possible after craniectomy without violating brain tissue underneath in a time period of 6 years (2011-2016). With this study, we present initial experiences of Epigard (Biovision, Germany) as an artificial temporary skin replacement. We performed this analysis at two level-1 trauma centers (Trauma Center Murnau, Germany; University Hospital of St. Poelten, Austria). Demographic data, injury and surgical characteristics, and complication rates were analyzed via chart review. We identified nine patients within our study period. Six patients suffered from severe traumatic brain injury and developed pronounced cerebral herniation in the acute or subacute phase. Three patients presented with non-traumatic conditions (one atypical intracerebral hemorrhage and two patients with extensive destructive tumors invading the skull and scalp)., Results: A total of 20 Epigard exchanges (range 1-4) were necessary before skin closure was possible. A CSF fistula due to a leaky Epigard at the interface to the skin was observed in two patients (22%). Additional complications were four wound infections, three CNS infections, and three patients developed a shunt dependency. Three patients died within the first month after injury., Conclusions: Temporary skin closure with Epigard as a substitute is feasible for a variety of neurosurgical conditions. The high complication and mortality rate reflect the complexity of the encountered pathologies and need to be considered when counseling the patient and their families.

Background and Objectives: Per- and polyfluoroalkyl substances (PFASs) are a large group of manufactured nonbiodegradable compounds. Despite increasing awareness as global pollutants, the impact of PFAS exposure on human health is not well understood, and there are growing concerns for adverse effects on kidney function. Therefore, we conducted a scoping review to summarize and identify gaps in the understanding between PFAS exposure and kidney health., Design, Setting, Participants, & Measurements: We systematically searched PubMed, EMBASE, EBSCO Global Health, World Health Organization Global Index, and Web of Science for studies published from 1990 to 2018. We included studies on the epidemiology, pharmacokinetics, or toxicology of PFAS exposure and kidney-related health, including clinical, histologic, molecular, and metabolic outcomes related to kidney disease, or outcomes related to the pharmacokinetic role of the kidneys., Results: We identified 74 studies, including 21 epidemiologic, 13 pharmacokinetic, and 40 toxicological studies. Three population-based epidemiologic studies demonstrated associations between PFAS exposure and lower kidney function. Along with toxicology studies ( n =10) showing tubular histologic and cellular changes from PFAS exposure, pharmacokinetic studies ( n =5) demonstrated the kidneys were major routes of elimination, with active proximal tubule transport. In several studies ( n =17), PFAS exposure altered several pathways linked to kidney disease, including oxidative stress pathways, peroxisome proliferators-activated receptor pathways, NF-E2-related factor 2 pathways, partial epithelial mesenchymal transition, and enhanced endothelial permeability through actin filament modeling., Conclusions: A growing body of evidence portends PFASs are emerging environmental threats to kidney health; yet several important gaps in our understanding still exist., (Copyright © 2018 by the American Society of Nephrology.)

We report the case of a 62-year-old man who used approximately one can of waterproofing spray in an enclosed room and, then, smoked a cigarette. He developed a fever of 39°C with respiratory distress and was transported by ambulance to his usual doctor. Since his respiratory state was very severe, he was transferred to our hospital. The patient had a smoking habit of 20 cigarettes per day for approximately 42 years. Chest computed tomography (CT) on arrival showed ground glass opacity (GGO) in the bilateral lungs with emphysematous change. We diagnosed the patient with acute respiratory distress syndrome (ARDS) because of severe hypoxemia. Based on the symptoms' progress, the cause of ARDS was thought to be lung injury due to waterproofing spray inhalation, and treatment was accordingly initiated. Several reports have described lung injury caused by waterproofing spray inhalation; however, severe cases that progress to ARDS are rare. We believe that the aggravation was caused by smoking after inhaling the waterproofing spray and pre-existing pulmonary lesions, such as emphysema. Education regarding the precautions to be taken when using waterproofing spray is necessary.

Aims: This study examines the intraperitoneal behavior of two cyanoacrylate tissue adhesives: Ifabond ® and a new, non-marketed octyl cyanoacrylate adhesive (OCA) used for the intraperitoneal fixation of a laminar expanded polytetrafluoroethylene (ePTFE) mesh., Material and Methods: In 36 New Zealand White rabbits, 3 × 3 cm (n = 24) or 1.5 × 3 cm (n = 12) fragments of ePTFE mesh (Preclude ® , Gore, Flagstaff, USA) were fixed to the parietal peritoneum using OCA or Ifabond ® . Peritoneal fluid was obtained at the time of implant and at 2 weeks postimplant for determination of the cytokines interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α). At 14 or 90 days postsurgery, the animals were euthanized and the meshes excised to assess host tissue incorporation, the macrophage response, apoptosis and fixation strength (T-peel tensiometry)., Results: Peritoneal fluid IL-6 and TNF-α concentrations were similar in the OCA and Ifabond ® groups. Both adhesives gave rise to adequate mesothelialization of the laminar ePTFE. Macrophage counts were similar for the two study groups, but a significantly increase in macrophage response was observed from 14 to 90 days for Ifabond ® . At 90 days postimplant, apoptotic cell counts was lower for the implants fixed with OCA and a fixation strength was significantly lower for OCA., Conclusions: Despite similar cytokine levels at 2 weeks and similar host tissue incorporation observed for the meshes fixed with the two adhesives, the use of Ifabond ® gave rise to a greater apoptosis rate, although this adhesive provided a stronger fixation bond. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 312-319, 2017., (© 2015 Wiley Periodicals, Inc.)

Fluoropolymer based tile and fabric spray sealants were evaluated for the release of airborne fluoropolymer constituents and volatile organic compounds (VOCs) during typical product use scenarios in a simulated bathroom and a simulated recreational vehicle. Fluoride was quantified after oxygen bomb digestion of airborne spray collected from personal, area, and surface samples. VOCs were quantified by gas chromatography/mass spectrometry (GC/MS) and gas chromatography/flame ionization spectrometry (GC/FID). Tile grout sealant contained approximately 1% acrylic fluoropolymer resin and 90% VOCs not including propellants. VOCs were short- and medium- chain methylated isoparaffinic hydrocarbons. When horizontally spraying a bathroom shower floor, grout spray sealant released a non-detectable amount of fluoride (<0.8 µg/m3) and 400-1400 mg/m3 total VOCs. When vertically spraying a shower wall, up to 2.0 µg/m3 of fluoride and from 1000 to 2300 mg/m3 total VOCs were detected. Fabric spray sealant contained 1% acrylic fluoropolymer resin and approximately 90% VOCs including perchloroethylene (PERC). Fabric spray released from 0.5 to 2.3 µg/m3 fluoride inside a recreational vehicle in the absence of crosswinds and less than 0.5 µg/m3 fluoride in the presence of a 10 mph crosswind. VOC release measured 240-938 mg/m3 without crosswinds and 161-522 mg/m3 with crosswinds. These studies show that fluoropolymer constituents from fluorinated spray sealants were near non-detectable levels in the breathing zone in nearly all samples while VOCs were measured at elevated levels (>400 mg/m3). The toxicological consequences of elevated VOCs during sealant spraying and the effects of certain fluoropolymer constituents are discussed.

We investigated bioadhesion (bacterial and cell adhesion) and biocompatibility of poly(tetrafluoroethylene-co-perfluoro-3,6-dioxa-4-methyl-7-octenesulfonic acid) (Nafion) and compared the results with those obtained with poly(vinylidene fluoride-co-hexafluoropropylene) (PVFHFP). When incubated with bacteria for 4 h to 7 days, Nafion film exhibited scarce bacterial adhesion at 6 h, after which the adhesion gradually increasing to relatively low levels. In contrast, significant bacterial adhesion to PVFHFP film was observed at 4 h, and much higher adhesion levels were shown thereafter. Although HEp-2 human cells adhered normally to both films, reaching confluence in 7-8 days, the cells adhered to Nafion appeared more lively and stable than those to PVFHFP. Subcutaneous implantation in mice revealed that Nafion elicited a mild acute inflammatory reaction without chronic inflammation or tissue necrosis, indicating excellent biocompatibility in mice. PVFHFP, however, provoked a moderate and prolonged acute inflammatory response. These differences in the biological characteristics of Nafion and PVFHFP films may be attributable to the differences in the chemical and physical natures of these polymer films. Nafion film provided a sufficiently solid support, expressing a high surface charge density and good water-wettability. In summary, Nafion is suitable for use in biomedical applications that require biocompatibility with a reduced possibility of post-operative infections.

The use of waterproofing spray has been associated with the development of respiratory symptoms, but the pathogenetic mechanisms are unclear. We describe a case of acute respiratory disease with impaired diffusion developed after the use of a painting primer product spray (stain stop). Further investigation in aerosol-toxicology is needed.

Mesh migration after laparoscopic inguinal hernia repair is an unusual and late complication. We report a 50-year-old man with persistent painless hematuria and urinary infection who underwent bilateral laparoscopic intraperitoneal onlay mesh 4 years ago. Polytetrafluoroethylene (PTFE) prosthesis was used and fixed with tackers. The patient underwent cystoscopy and laparotomy for excision of the migrated PTFE prosthesis into the bladder. This is the first case of PTFE prosthesis migration into the bladder after laparoscopic hernia repair. We also reviewed the literature involving migration of mesh after all inguinal hernial repairs.

Purpose: This study aimed to evaluate the safety and patency rate of bovine mesenterial vein grafts (BMVG) for vascular access (VA) in hemodialysis patients (HDP), compared to expanded polytetrafluorethylene (ePTFE grafts) over a mid- to long-term period., Methods: Patency and complication rate of 23 consecutive HDP with BMVG for VA were compared to a control group consisting of 23 similar HDP with ePTFE grafts. In both groups, the graft was placed preferably in a forearm loop configuration. The same surgeon performed all procedures. All patients were followed over a period of 4 yrs., Results: Graft placement was successful in all patients. Patency rates did not differ significantly in both groups. However, there were less severe complications in the BMVG group., Conclusion: The BMVG is a viable alternative for HD access in patients where autologous construction is not possible, and should be given priority in patients with a failed ePTFE graft or high risk for infection.

Laparoscopic ventral hernia repair requires an intraperitoneal prosthetic; however, these materials are not without consequences. We evaluated host reaction to intraperitoneal placement of various prosthetics and the functional outcomes in an animal model. Mesh (n = 15 per mesh type) was implanted on intact peritoneum in New Zealand white rabbits. The mesh types included ePTFE (DualMesh), ePTFE and polypropylene (Composix), polypropylene and oxidized regenerated cellulose (Proceed), and polypropylene (Marlex). Adhesion formation was evaluated at 1, 4, 8, and 16 weeks using 2-mm mini-laparoscopy. Adhesion area, adhesion tenacity, prosthetic shrinkage, and compliance were evaluated after mesh explantation at 16 weeks. DualMesh had significantly less adhesions than Proceed, Composix, or Marlex at 1, 4, 8, and 16 weeks (P < 0.0001). Marlex had significantly more adhesions than other meshes at each time point (P < 0.0001). There were no statistically significant differences in adhesions between Proceed and Composix meshes. After mesh explantation, the mean area of adhesions for Proceed (4.6%) was less than for Marlex (21.7%; P = 0.001). The adhesions to Marlex were statistically more tenacious than the DualMesh and Composix groups. Overall prosthetic shrinkage was statistically greater for DualMesh (34.7%) than for the remaining mesh types (P < 0.01). Mesh compliance was similar between the groups. Prosthetic materials demonstrate a wide variety of characteristics when placed inside the abdomen. Marlex formed more adhesions with greater tenacity than the other mesh types. DualMesh resulted in minimal adhesions, but it shrank more than the other mesh types. Each prosthetic generates a varied host reaction. Better understanding of these reactions can allow a suitable prosthetic to be chosen for a given patient in clinical practice.

Background: Heavy tamponades for pathologies in the lower part of the retina are a new development, and different tamponades have recently come into clinical use: semifluorinated alkanes (F(6)H(6), F(6)H(8)) and their oligomers (OL62HV)., Method: Nine patients had been operated on using F(6)H(8) (n=5) and by OL62HV (n=4). In all cases the reasons for using the tamponades were complicated retinal detachments in the lower part. In three cases the use was primary and in six cases tamponades were used after reoperations. In all cases the endotamponade was removed within 6 weeks. Fluorescein angiography (FLA) was performed in the F(6)H(8) group., Results: In the F(6)H(8)group dispersion developed in two of the three aphacic patients. In two out of five cases soft epiretinal membranes and cellular material could be found between the substance and the lower periphery. In two membranes examined by light microscopy, cystic cells and amorphous material could be found. In one case (PDRP, aphacic) cyclophotocoagulation had to be performed because of persistent elevated IOP. FLA was unremarkable. In the OL62HV group, severe recurrent PVR reaction occurred in the lower periphery (2/4) and unusual precipitates were observed (4/4). In one case, after a normal postoperative period (VA 0.05 after 5 days) an extensive cellular reaction on the complete surface of the tamponade occurred. After 5 weeks VA was no light perception. During removal of the oligomer unusual adherent cellular components were found on the surface of the retina. The retina appeared necrotic, showed constricted retinal vessels and there was optic atrophy. Histologically, fluffy epiretinal material and a lens capsule obtained from one eye filled with OL62HV resembled the appearance with F(6)H(8)., Conclusion: Heavy endotamponades on the basis of semifluorinated alkanes can lead to an unusual biological reaction and need further investigation before clinical use.

A 65-year-old laundryman who suffered from cough, fever, and dyspnea was admitted to our hospital. Laboratory finding disclosed leukocytosis of peripheral blood, elevated CRP, and hypoxemia. Chest X-ray films showed diffuse interstitial nodular shadows in both lungs. The patient was given a diagnosis of pneumonia and treated with oxygen inhalation, antibiotics, and steroids. The abnormal findings disappeared rapidly, and the patient was discharged after 11 days. However, he was readmitted 3 days later with the same chest X-ray film findings as observed before. Examination of bronchoalveolar lavage fluid disclosed an increased neutrophil count. Transbronchial lung biopsy specimens revealed alveolar collapse, which was considered to have contributed to hypoxemia and ventilation perfusion mismatch. However, no signs of infiltration of inflammatory cells into alveolar walls, or of acute-phase interstitial edema, were observed. Environmental studies supported a strong relationship between the patient's symptoms and clothes waterproofing agent. From these findings, we reasoned that the inhalation of aerosol waterproofing agent containing fluoroplastics can induce respiratory failure.

The objective of this study was to determine whether pulmonary function is acutely affected by moderate exposure to ski waxing. Ten healthy nonsmoking young adult volunteers were exposed to 45 min of ski waxing in a small unventilated room. The exposure occurred in pairs with one individual performing the waxing while the other overlooked the waxing process. During the period of waxing, two pairs of cross-country skis were waxed with a paraffin wax and then scraped and brushed, and two pairs of cross-country skis were waxed with a fluorinated wax and then brushed. Spirometry and single-breath carbon monoxide lung diffusion capacity (DLCO) were measured immediately before and after exposure to ski waxing, and again 5-6 h after waxing. A subset of five subjects repeated the measurements on a separate day without receiving exposure to ski waxing. Data were analyzed with repeated measures ANOVA. Exposure to ski waxing induced no significant changes in spirometry and DLCO measurements. We conclude that moderate exposure to ski waxing has no significant acute effect on lung function.

Previous studies have demonstrated the potential use of microporous, biocompatible materials to improve the long-term stability of keratoprosthesis. To determine the factors that will influence corneal tissue ingrowth into biocompatible, microporous materials, we have compared three types of fluorocarbon polymers--Impra, Gore-Tex, and Proplast--after intrastromal implantation in rabbit corneas. Despite similar physicochemical structures, a great difference was observed in histologic and ultrastructural cross sections after 4- and 8-month follow-ups. For Gore-Tex, we observed extrusion of the implant and infiltration of necrotic and inflammatory cells. All implants of Proplast also led to significant corneal damage resulting in extrusion of the material. Through the use of electron and light microscopy and image analysis, this study demonstrates the presence of cell differentiation and collagen synthesis in the pores of the Impra implant. Apart from biocompatibility, this experiment demonstrates the influence of pore size, porous microorganization, and biomechanical factors on prosthetic corneal material. Only Impra offers satisfactory interface, allowing fibroblastic cells and neocollagen synthesis into its pores, and it can become transparent.

A series of 34 children with 40 primary refluxing ureters were treated endoscopically with a subureteric injection of polytetrafluoroethylene paste (Polytef). The amount injected ranged between 0.1 and 0.8 ml (mean 0.3). A single injection cured the reflux in 26 ureters (65%) and the grade of reflux improved in a further 9 ureters. Seven ureters required a second injection and reflux was cured in 6 of these. The overall cure rate was therefore 80% after the second injection. There was one complication due to self-limiting ureteric obstruction following injection. The procedure is quick, easy to perform and effective. We have some reservations about the long-term efficiency and safety of subureteric Polytef injection in children.

It is well known that inhalation of pyrolysis products of perfluorinated hydrocarbons (e.g. Teflon) may result in polymer-fume fever and even pulmonary oedema. A new type of ski wax has recently been introduced, a powder consisting of low-molecular perfluorinated hydrocarbons. We report a case history of a man who developed an attack of polymer-fume fever and pulmonary oedema after smoking cigarettes contaminated with this ski wax. Inhalation of vapour from ski waxes melted at low temperatures may also be harmful to the lungs.

Three subjects, all smokers, handling stainless steel tubes suffered repeated attacks of general malaise, chills, and fever lasting for several hours, mainly after gas soldering. Provocations by rubbing smoking tobacco against a tube produced similar attacks, and leucocytosis, after a few hours. The presence of fluorine on the tubes and in the febrifacient tobacco was shown. A fluorocarbon polymer lubricant was suspected of causing the attacks. Heating (1000 degrees C) of the tubes eliminated the effect.