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Historically, there has been broad consensus that osseointegration represents a homeostasis between a titanium dental implant and the surrounding bone, and that the crestal bone loss characteristic of peri-implantitis is a plaque-induced inflammatory process. However, this notion has been challenged over the past decade by proponents of a theory that considers osseointegration an inflammatory process characterized by a foreign body reaction and peri-implant bone loss as an exacerbation of this inflammatory response. A key difference in these two schools of thought is the perception of the relative importance of dental plaque in the pathogenesis of crestal bone loss around implants, with obvious implications for treatment. This review investigates the evidence for a persistent foreign body reaction at osseointegrated dental implants and its possible role in crestal bone loss characteristic of peri-implantitis. Further, the role of implant-related material release within the surrounding tissue, particularly titanium particles and corrosion by-products, in the establishment and progression in peri-implantitis is explored. While it is acknowledged that these issues require further investigation, the available evidence suggests that osseointegration is a state of homeostasis between the titanium implant and surrounding tissues, with little evidence that a persistent foreign body reaction is responsible for peri-implant bone loss after osseointegration is established. Further, there is a lack of evidence for a unidirectional causative role of corrosion by-products and titanium particles as possible non-plaque related factors in the etiology of peri-implantitis., (© 2022 The Authors. Periodontology 2000 published by John Wiley & Sons Ltd.)

Oxidized cellulose, used as hemostatic in thoracic surgery, may cause in some cases foreign body reactions, and simulate other diseases. We report the case of a 39-year-old man operated on a middle lobe lobectomy for atypical carcinoid. The follow up chest-CT showed enlarged mediastinal lymph nodes, so endobronchial ultrasound-guided transbronchial needle aspiration was performed suspecting recurrence of the tumor. The cytology results showed amorphous fragments such as foreign body reaction secondary to Pahacel®, used as hemostatic during the surgery. A few days later, the patient was re-operated on suspicion of mediastinitis induced by the endoscopic procedure. The aim of this case is to consider the foreign body reaction to Pahacel®, in patients with postoperative thoracic lymphadenopathy. It is also important to remember that in these patients the endoscopic procedures allow the diagnosis but may cause mediastinitis.

Sarcoidosis is a chameleon disease of unknown etiology, characterized by the growth of non-necrotizing and non-caseating granulomas and manifesting with clinical pictures that vary on the basis of the organs that are mainly affected. Lungs and intrathoracic lymph nodes are the sites that are most often involved, but virtually no organ is spared from this disease. Histopathology is distinctive but not pathognomonic, since the findings can be found also in other granulomatous disorders. The knowledge of these findings is important because it could be helpful to differentiate sarcoidosis from the other granulomatous-related diseases. This review aims at illustrating the main clinical and histopathological findings that could help clinicians in their routine clinical practice.

Rhinoliths are petrified masses formed by accumulation of endogenous or exogenous salts around a nidus. Although rarely formed by the body, the most common cause is foreign bodies forgotten in the nose at childhood. Rhinoliths are rare and have been reported as a single case report in the literature. In this study, 24 different and different cases will be analyzed. Twenty-four interesting patients who were operated for rhinolith in the otorhinolaryngology clinic between 2014 and 2019 and were not seen in the literature before were analyzed retrospectively. The characteristics of these patients such as age, sex, additional pathology, foreign body coexistence, type of anesthesia used, and previous surgical status were analyzed. Fourteen patients were male and 10 were female (58.3% male, 41.7% female). The mean age was 30.4 (minimum 2, maximum 62). Twelve of the foreign bodies were on the right and 12 on the left (50%). Foreign body localization was 13 (54.1%) between the inferior turbinate (IT) and septum and 11 (45.9%) between the middle turbinate and septum. Tissue destruction was seen in 12 (50%; 7 septum, 5 IT) patients. Fifteen patients had additional pathology (mostly septum deviation). General anesthesia was used in 14 patients and local anesthesia was used in 10 (58.3%-41.7%) patients. Two patients (n = 2) had rhinoliths due to forgotten nasal packing after surgery and forgotten silicone nasolacrimal tube after dacryocystorhinostomy surgery. Rhinoliths should be considered with unilateral malodorous runny nose and resistant sinusitis attacks. The diagnosis is rigid endoscope and computed tomography imaging. It usually occurs as a result of forgotten foreign bodies. Rhinoliths may also form as a result of forgotten tampon after previous nose or eye surgery.

Button batteries are the second most frequently-ingested foreign bodies and can lead to serious clinical complications within hours of ingestion. The purpose of this study was to analyze the outcomes of 14 children with button batteries lodged in the upper gastrointestinal tract.Totally 14 children with button batteries lodged in the upper gastrointestinal tract were included. The diagnosis was made primarily by the history of button battery ingestion, physical examination and chest-abdomen X-ray examination.The button batteries lodged in the esophagus were removed by esophagoscope, and those in the gastrointestinal tract were under observation. Among 10 children with batteries in the first esophageal stenosis, 9 were cured and 1 suffered from tracheoesophageal fistula. One case of battery in the second esophageal stenosis was dead due to intercurrent aortoesophageal fistula. Two cases of batteries in the third esophageal stenosis were cured after removal, and 1 case of the battery in the gastrointestinal tract discharged spontaneously.Ingested button batteries are mainly lodged in the esophageal stenoses and are easy to cause esophageal injury and severe complications. Early detection, prompt treatment, strengthening observation and regular follow-up after discharge may help to decrease the incidence of complications and improve the outcomes.

Objective: Reaction to sutures is a rare cause of non-healing in clean wounds. Cases of severe reaction to silk sutures have been reported, causing chronic infection and failure of thyroidectomy wound healing. We report a case of retained polyglactin 910 suture presenting with a chronically discharging sinus of the neck after sub-total thyroidectomy., Case: The patient, a 37-year old female, presented with a simple benign multinodular goitre. She had subtotal thyroidectomy and was discharged on day six postoperatively, after satisfactory primary wound healing. The patient observed swelling, pus/discharge and extrusion of the suture in the neck three weeks after surgery. Discharge did not stop after initial wound debridement under local anaesthesia. Computed tomography (CT) scan showed a small area of ring-enhancement soft tissue density, anterior to the right thyroid remnant. Subsequent wound exploration under general anaesthesia revealed a sinus tract extending to the thyroid bed with undegraded strands of thickened polyglactin 910 suture. Suture remnants were removed and the wound healed satisfactorily a week later., Conclusion: Non-healing post thyroidectomy wounds should raise suspicion of a retained suture. Early recognition and surgical intervention will shorten the period of morbidity.

Despite the huge complexity of the foreign body reaction, a quantitative assessment over time of the scar tissue thickness around implanted materials is needed to figure out the evolution of neural implants for long times. A data-driven approach, based on phenomenological polynomial functions, is able to reproduce experimental data. Nevertheless, a misuse of this strategy may lead to unsatisfactory results, even if standard indexes are optimized. In this work, an effective in silico procedure was presented to reproduce the scar tissue dynamics around implanted synthetic devices and to predict the capsule thickness for times before and after experimental detections.

Background: The incidence of the iatrogenic foreign body retained after surgery is extremely low. Iatrogenic foreign body retained is surrounded by normal tissue, which responds to foreign matter to form inflammatory pseudotumors. Surgical sponge or swap is the most common type of foreign body. There were no reports of medical sutures remaining as foreign bodies in the lung parenchyma to form inflammatory pseudotumors., Case Presentation: A CT scan of a 50-year-old female showed an irregular soft tissue mass in the left upper lobe with rough edge and spiculation. After 20 months, the size increased from 2.8 × 1.9 cm to 3.2 × 2.2 cm. The patient underwent a ventricular septal repair surgery for congenital Fallot tetralogy 35 years ago and a left breast surgery for breast cancer. She had a family history of lung cancer. Evaluation of this mass highly suggested a lung malignant lesion. The patient underwent video-assisted thoracoscopic surgery (VATS) lobectomy and her pathology revealed an intrapulmonary inflammatory pseudotumor caused by a medical prolene suture. Based on her medical history and other reports of iatrogenic foreign bodies, we believe that this suture retained from the heart surgery 35 years ago entered the pulmonary artery, moved to the distal branch, and eventually formed an inflammatory pseudotumor in the lung parenchyma. Here we reported and analyze this rare case., Conclusion: We reported a rare case of inflammatory pseudotumor in the lung parenchyma caused by a medical suture, and determined it was a prolene suture retained in the body during a cardiac surgery 35 years ago. Diagnosis of this rare disease required sufficient imaging experience. Besides, appropriate surgical exploration can help with the diagnosis and treatment.

Objective:: To describe an observed case of spontaneous regression of cholesteatoma in a patient on chronic anti-tumor necrosis factor-alpha (TNF-a) therapy and inspire further research into the role of TNF-a in cholesteatoma., Methods:: Clinical assessment of disease in a single-patient case report., Results:: A 49-year-old woman suffered a severe case of Stevens-Johnson syndrome when she was 12 years old, leaving her with bilateral corneal opacification and tympanic membrane perforations with extensive cholesteatoma. For her corneal opacification, a corneal prosthesis was placed, which was complicated by a foreign body reaction necessitating long-term therapy with infliximab, a monoclonal antibody against TNF-a that is therapeutic in some chronic inflammatory diseases. She was otherwise healthy and took no other medications. While on infliximab, the patient had spontaneous and complete resolution of her cholesteatoma without any surgical intervention., Conclusions:: This surprising case suggests that there may be a prominent role of TNF-a in cholesteatoma pathophysiology and that TNF-a may be an effective target for nonsurgical therapy.

A 12-year-old boy with a past medical history of nickel allergy was referred to our service after sustaining an air rifle injury with a retained BB in his left inferior orbit. On examination, he had a palpable orbital mass and systemic urticaria. Plain films demonstrated a spherical metallic foreign body adjacent to the left inferior orbital rim. Given his worsening systemic reaction despite oral antihistamine therapy, decision was made to remove the foreign body. In the operating room, the Allergan Magna Finder-a prepackaged, sterile device normally used for retrieval of a port used in tissue expansion surgery-was placed over the inferior conjunctiva of the lower eyelid. With the magnet holding gentle anterior traction on the foreign body, it was easily dissected and removed. The patient tolerated the procedure well, and had rapid resolution of his systemic allergic response following removal of the BB.

Foreign modelling agent reactions (FMAR) are the result of the injection of unapproved high-viscosity fluids with the purpose of cosmetic body modelling. Its consequences lead to ulceration, disfigurement and even death, and it has reached epidemic proportions in several regions of the world. We describe a series of patients treated for FMARs in a specialised wound care centre and a thorough review of the literature. A retrospective chart review was performed from January 1999 to September 2015 of patients who had been injected with non-medical foreign agents and who developed cutaneous ulceration needing treatment at the dermatology wound care centre. This study involved 23 patients whose ages ranged from 22 to 67 years with higher proportion of women and homosexual men. The most commonly injected sites were the buttocks (38·5%), legs (18%), thighs (15·4%) and breasts (11·8%). Mineral oil (39%) and other unknown substances (30·4%) were the most commonly injected. The latency period ranged from 1 week to 17 years. Complications included several skin changes such as sclerosis and ulceration as well as systemic complications. FMAR is a severe syndrome that may lead to deadly complications, and is still very common in Latin America., (© 2016 Medicalhelplines.com Inc and John Wiley & Sons Ltd.)

The incidence of complications following total hip arthroplasty is low, but due to the frequency of the procedure, they are quite commonly encountered and require appropriate investigation. Complications include aseptic loosening, infection, foreign body granulomatosis (osteolysis), adverse reactions to metal debris, periprosthetic fracture, heterotopic ossification, hardware failure, and a range of soft tissue complications, all of which may result in pain. Relevant imaging findings are illustrated and the role of various imaging modalities is reviewed. A suggested approach for the radiological investigation of each potential complication is outlined, based on our experience at a specialist referral unit., (Copyright © 2016 Canadian Association of Radiologists. Published by Elsevier Inc. All rights reserved.)

We report a case of lithium battery diaper ulceration in a 16-month-old girl. Gastrointestinal and ear, nose, and throat lesions after lithium battery ingestion have been reported, but skin involvement has not been reported to our knowledge., (© 2015 Wiley Periodicals, Inc.)

Purpose: The foreign body reactions are comprised of macrophages and foreign body giant cells and are considered possible risk factors for recurrence in several conditions. The purpose of this study was to determine the effect of pathologically proven foreign body reactions on the recurrence of the auricular keloids., Methods: This study was carried out in 76 cases in 70 patients reaching the pathologic diagnosis of auricular keloids from March 2006 to February 2012. Patients with auricular keloids were included in the study according to the following criteria: The keloid scar was caused by ear piercing and confirmed pathologically; surgical excision with primary closure was performed; and female patients who have not underwent any previous treatments. To compare any differences of recurrence rate between categorical variables (the presence/absence of foreign body reactions), Fisher's exact tests were used. All patients completed the treatment protocol with a follow-up interval of 18 months., Results: Of these patients, 90.9% (69 keloids) had successful irradication of their auricular keloids, whereas 9.2% (seven keloids) had recurrences. Of the seven recurrent cases, two exhibited foreign body reactions at pathology, while five revealed no foreign body reactions (28.6% vs. 71.4%, P = 0.092)., Conclusions: Detection of foreign body reactions in keloid tissue may not predict recurrence in auricular keloids., (© 2015 Wiley Periodicals, Inc.)

We report a case of a 47-year-old man with neurofibromatosis type 1 presenting with a growing and painful lesion within the right thigh, suggesting a malignant peripheral nerve sheath tumor. MRI showed a T2-weighted hyperintense lesion with surrounding edema and contrast enhancement. (18)F-FDG PET/CT demonstrated inhomogeneously increased tracer uptake within the right thigh. Histopathologic evaluation revealed a foreign body with purulent fibroinflammatory reaction. (18)F-FDG PET/CT is a highly sensitive tool for detection of malignant transformation in neurofibromatosis type 1, but false-positive findings may be observed in benign lesions, for example, inflammatory processes.

Background: Aspiration occurs commonly, at times clinically occult, and is recognized to cause a widening spectrum of lung disorders. Presentation of aspiration as a lung mass has not been described., Methods: Among cases of aspiration-related pulmonary diseases diagnosed at Mayo Clinic (Rochester, Minn) from 2007 to 2013, 3 patients were identified to have presented with a solitary lung mass lesion., Results: The age of 3 patients, all men with a history of gastroesophageal reflux disease, ranged from 53 to 65 years. All patients presented with dyspnea, cough, and intermittent fevers. Chest computed tomography in each patient demonstrated malignant-appearing solitary lung mass, cavitated in 2 patients. Two patients underwent positron emission tomography, which showed intense fluorodeoxyglucose uptake in the lung mass for both. Surgical lung resection revealed acute and organizing pneumonia with giant cell reaction to foreign material, consistent with aspiration in all 3 patients. None of these lung masses were located in the "dependent" (posterior or basal) lung zones. These patients were managed with antireflux medical therapy; 1 patient underwent a Nissen fundoplication procedure for recurrent symptoms. No additional aspiration-related complications occurred during the follow-up period ranging from 24 to 84 months., Conclusions: Aspiration-related pulmonary complications can present as a solitary lung mass that may not be located in dependent lung zones, which have traditionally been associated with aspiration-related pulmonary diseases., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Bone wax is commonly used in orthopedic procedures for the hemostatic control of cancellous bone bleeding. Herein, ordinary bone wax was used to stop bleeding intraoperatively at the site of a peroneal tubercle resection. Five months postoperatively, a symptomatic retrofibular mass was removed. Gross examination showed severe peroneal tendon destruction associated with the mass. Microscopic examination diagnosed a bone wax granuloma. To our knowledge, this is the first case of significant tendon and nerve damage resulting from a bone wax foreign-body granuloma.

Background: When a foreign body is placed in bone or soft tissue, an inflammatory reaction inevitably develops. Hence, osseointegration is but a foreign body response to the implant, which according to classic pathology is a chronic inflammatory response and characterized by bone embedding/separation of the implant from the body., Purpose: The aim of this paper is to suggest an alternative way of looking at the reason for marginal bone loss as a complication to treatment rather than a disease process., Materials and Methods: The present paper is authored as a narrative review contribution., Results: The implant-enveloping bone has sparse blood circulation and is lacking proper innervation in clear contrast to natural teeth that are anchored in bone by a periodontal ligament rich in blood vessels and nerves. Fortunately, a balanced, steady state situation of the inevitable foreign body response will be established for the great majority of implants, seen as maintained osseointegration with no or only very little marginal bone loss. Marginal bone resorption around the implant is the result of different tissue reactions coupled to the foreign body response and is not primarily related to biofilm-mediated infectious processes as in the pathogenesis of periodontitis around teeth. This means that initial marginal bone resorption around implants represents a reaction to treatment and is not at all a disease process. There is clear evidence that the initial foreign body response to the implant can be sustained and aggravated by various factors related to implant hardware, patient characteristics, surgical and/or prosthodontic mishaps, which may lead to significant marginal bone loss and possibly to implant failure. Admittedly, once severe marginal bone loss has developed, a secondary biofilm-mediated infection may follow as a complication to the already established bone loss., Conclusions: The present authors regard researchers seeing marginal bone loss as a periodontitis-like disease to be on the wrong track; the onset of marginal bone loss around oral implants depends in reality on a dis-balanced foreign body response., (© 2013 Wiley Periodicals, Inc.)

Purpose: To investigate and relate the ultrashort-term and long-term courses of determinants for foreign body reaction as biocompatibility predictors for meshes in an animal model., Materials and Methods: Three different meshes (TVT, UltraPro, and PVDF) were implanted in sheep. Native and plasma coated meshes were placed bilaterally: (a) interaperitoneally, (b) as fascia onlay, and (c) as muscle onlay (fascia sublay). At 5 min, 20 min, 60 min, and 120 min meshes were explanted and histochemically investigated for inflammatory infiltrate, macrophage infiltration, vessel formation, myofibroblast invasion, and connective tissue accumulation. The results were related to long-term values over 24 months., Results: Macrophage invasion reached highest extents with up to 60% in short-term and decreased within 24 months to about 30%. Inflammatory infiltrate increased within the first 2 hours, the reached levels and the different extents and ranking among the investigated meshes remained stable during long-term follow up. For myofibroblasts, connective tissue, and CD31+ cells, no activity was detected during the first 120 min., Conclusion: The local inflammatory reaction is an early and susceptible event after mesh implantation. It cannot be influenced by prior plasma coating and does not depend on the localisation of implantation.

Objectives: Myospherulosis is a foreign body reaction induced by the application of oil-based ointments. Myospherulosis in the ear is extremely rare. Only 4 cases have been described, all of which occurred after (repeated) mastoid surgery., Methods: We present a case of persistent otorrhea and conductive hearing loss caused by myospherulosis in the middle ear following tympanoplasty., Results: The patient underwent revision middle ear surgery with removal of abnormally thick, pale tissue in the middle ear. Histology showed a foreign body reaction with signs of myospherulosis., Conclusions: Myospherulosis is a very rare complication of the use of oil-based ointments. Surgeons should be aware that these products might cause a foreign body reaction leading to myospherulosis. In patients who have chronic otorrhea after previous mastoid or middle ear surgery, myospherulosis should be considered in the differential diagnosis.

Keloids are the result of an overgrowth of dense fibrous tissue that usually develops after healing of a skin injury. Despite their common occurrence, keloids remain one of the most challenging dermatologic conditions to successfully treat. They are often symptomatic, do not usually regress spontaneously, and tend to recur after excision. Prevention of keloids is essential. A previous history of keloid development should be elicited. Wound closure with minimal tension and application of adjunctive therapies before abnormal healing is paramount. Education regarding wound care should be given in order to prevent infection and foreign body reactions. Elective surgery should be avoided in patients predisposed to developing keloids. In this article, we review recent advances in medical and surgical treatment of keloids.

Acute mechanical symptoms due to excess retained cement in the posterior compartment of the knee joint following unicondylar knee arthroplasty (UKA) are uncommon. Infection, aseptic loosening, polyethylene wear and progressive arthritis are well-documented complications of UKA procedure. We present a patient with acute pain and 'clicking' sensation in the knee joint due to cement extrusion in the posteromedial compartment after UKA. Full functional recovery was achieved after arthroscopic removal of the cement debris. Of retrospectively screened 43 UKA cases, asymptomatic cement extrusion was detected in 8 patients in the posteromedial compartment on direct X-rays. Careful inspection of components is essential to minimize the risk of cement extrusion into the posterior compartment and perioperative fluoroscopy may be helpful during UKA procedure.

Introduction: Forgotten indwelling ureteral stents can cause significant urological complications. Only few cases are reported after kidney transplantation., Materials and Methods: We present a case of a 39-year-old woman, transplanted in 1993 and referred to our Transplant Center 8 years later, because of a serious urinary tract infection with renal function impairment. Abdominal CT scan showed pyelonephritis and hydronephrosis in the transplanted kidney and the presence of a calcific ureteral stent, which had been forgotten in situ for 8 years. The stent was removed, but it was impossible to replace it with a new stent both retrogradely and anterogradely, because of a tight obstruction of the mid ureter. So a uretero-ureteral anastomosis with up urinary tract was performed., Results: No intra- or post-operative complications occurred. At 9 years' follow-up, the patient shows an optimal renal function, with no urinary tract infection., Discussion: A forgotten ureteral stent in a transplanted kidney can cause a lot of complications and can lead to graft loss. The prosthesis may cause an irreversible ureteral damage, so, as in our experience, forgetting a ureteral stent can result in a complex surgery.

The spacer placement is a prevalent procedure to separate the surrounding normal tissues from locally recurrent rectal tumor before the application of radiotherapy. However, complications could occur due to the foreign nature of the spacer. This report describes a case of 60-year-old man who had undergone radiotherapy two years earlier for a recurrent rectal tumor and presented with small bowel obstruction. A spacer was used before radiotherapy. Radiological assessment and laparotomy revealed the presence of the spacer inside the small bowel lumen. It is possible that the spacer established contact with the intestine, elicited local inflammatory reaction that facilitated the complete penetration of the intestinal wall without causing any clinical symptoms.

Study Design: Comparative study., Objective: To compare periprosthetic tissue reactions observed after total disc replacement (TDR), total hip arthroplasty (THA), and total knee arthroplasty (TKA) revision surgery., Summary of Background Data: Prosthetic wear debris leading to particle disease, followed by osteolysis, is often observed after THA and TKA. Although the presence of polyethylene (PE) particles and periprosthetic inflammation after TDR has been proven recently, osteolysis is rarely observed. The clinical relevance of PE wear debris in the spine remains poorly understood., Methods: The number, size, and shape of PE particles, as well as quantity and type of inflammatory cells in periprosthetic tissue retrieved during CHARITÉ TDR (n = 22), THA (n = 10), and TKA (n = 4) revision surgery were compared. Tissue samples were stained with hematoxylin/eosin and examined by using light microscopy with bright field and polarized light., Results: After THA, large numbers of PE particles of size less than 6 μm were observed, which were mainly phagocytosed by macrophages. The TKA group had a broad size range with many larger PE particles and more giant cells. In TDR, the size range was similar to that observed in TKA. However, the smallest particles were the most prevalent with 75% of the particles being less than 6 μm, as seen in revision THA. In TDR, both macrophages and giant cells were present with a higher number of macrophages., Conclusion: Both small and large PE particles are present after TDR revision surgery compatible with both THA and TKA wear patterns. The similarities between periprosthetic tissue reactions in the different groups may give more insight into the clinical relevance of PE particles and inflammatory cells in the lumbar spine. The current findings may help to improve TDR design as applied from technologies previously developed in THA and TKA with the goal of a longer survival of TDR.

This paper reports 3 cases of rhinoliths 20, 14, and 45 years in duration respectively observed during the last 3 years. Rhinoliths caused difficulty of nasal breathing on the side of their localization accompanied by serous discharge from the nose and atrophy of turbinate bones; moreover, they provoked the development of maxilloethmoidal sinusitis, nasal polyps, and deviation of the nasal septum. The surgical removal of the rhinoliths promoted elimination of these complications. A new classification of rhinoliths distinguishing between 4 groups of these stone-like structures is proposed.

Implantation of biomaterials and devices into soft tissues leads to the development of the foreign body response (FBR), which can interfere with implant function and eventually lead to failure. The FBR consists of overlapping acute and persistent inflammatory phases coupled with collagenous encapsulation and currently there are no therapeutic options. Initiation of the FBR involves macrophage activation, proceeding to giant cell formation, fibroblast activation, and collagen matrix deposition. Despite the recognition of this sequence of events, the molecular pathways required for the FBR have not been elucidated. We have identified that the acute inflammatory response to biomaterials requires nucleotide-binding domain and leucine-rich repeat-containing 3 (Nlrp3), apoptosis-associated speck-like protein containing CARD (Asc), and caspase-1, as well as plasma membrane cholesterol, and Syk signaling. Full development of the FBR is dependent on Asc and caspase-1, but not Nlrp3. The common antiinflammatory drug aspirin can reduce inflammasome activation and significantly reduce the FBR. Taken together, these findings expand the role of the inflammasome from one of sensing damage associated molecular patterns (DAMPs) to sensing all particulate matter irrespective of size. In addition, implication of the inflammasome in biomaterial recognition identifies key pathways, which can be targeted to limit the FBR.

Prosthetic reinforcements markedly reduce the risk of hernia recurrence. However, the implantation of meshes is related to an inflammatory foreign body reaction (FBR) with serious complications (i.e., persistent seroma, wound infection, mesh migration, entrapment, chronic pain). Adrenal hormones profoundly modify inflammatory response. Their effects on FBR however, remain ill defined. We therefore studied the FBR to polyvinylidenfluoride (PVDF) mesh material that was coated with four different substances: hydrocortisone (COR) or mifepristone (MIF), which respectively stimulate and block the glucocorticoid receptor, and aldosterone (ALD) or spironolactone (SPI), which respectively stimulate and block the mineralocorticoid receptor. The coated substances were released from the meshes within 24 h. Seven, 21, and 90 days after implantation, the specimen was evaluated for collagen formation, granuloma size, inflammatory activity, and angiogenesis. COR and SPI coating protected from inflammatory response, while ALD and MIF coating showed little difference to the control group. The COR and SPI groups showed smaller granuloma sizes at all time points, as well as a reduced number of inflammatory cells (p < 0.001) at day 90, and decreased collagen formation starting after 21 days (p < 0.05). There was a negative correlation for angiogenesis with inflammation around foreign body structures. In summary, these results suggest that early and temporary stimulation of the glucocorticoid receptor or blockade of the mineralocorticoid receptor have beneficial effects on FBR in the long term., (Copyright © 2011 Wiley Periodicals, Inc.)

Ultrasound activated resorbable pin osteosynthesis (UARPO) has recently shown favourable results in operations on children suffering for craniosynostosis. However, data on complications coming with this new technique in children suffering from craniosynostoses are scarce and have only been assessed retrospectively so far. It has been the aim of the present study to prospectively follow up children undergoing craniosynostosis surgery with a focus on complications related to UARPO materials. Ten pediatric patients (3 female/7 male) were operated due to craniosynostosis at an average age of 9.1±3.8 months using UARPO (SonicWeld/Resorb-X, KLS Martin, Tuttlingen, Germany). Clinical followup evaluations were carried out 1, 3, 6, 9, 12 and 18 months after surgery according to signs of local infection, stability of the remodeled cranial vault and the palpability of the osteosynthesis material. If secondary surgery was necessary, the indication was documented and evaluated by histological and wound smear examinations. No intra-operative or postoperative complications during the inpatient period occurred. 3 patients needed secondary operation due to a localized chronic swelling at the former incision site which developed 3, 9 and 12 months after the operation. Histological examinations yielded a giant cell formation surrounding the resorbable materials in all cases. Additionally, the wound smear showed a bacterial infection in one site. The current prospective study is the first in the field. It reveals a high percentage of delayed foreign body reactions with UARPO, bearing the need of secondary surgery. It seems that this high complication rate found in the present prospective study may weigh out the advantages of UARPO.

Background: Ingested foreign bodies present problems due to the related complications, perforation being the most frequent., Material and Method: This is a descriptive study of two cases of ascending colon perforation by numerous ingested fruit stones. The main symptoms were abdominal pain with tenderness in the lower right quadrant., Results: In both cases the diagnosis was made at operation, with right hemicolectomy and termino-lateral ileo-colic anastomosis. Post-operative outcome was uneventful with the exception of a wound infection. The possible mechanism of the delayed perforation is discussed. Diagnosis and treatment modality alternatives in foreign body ingestion and the literature data are reviewed., Conclusions: Delayed perforations by ingested fruit stones can be difficult to diagnose preoperatively but if operated in due time are curable by resection of the affected bowel.

We present an interesting case of tracheobronchial foreign body aspiration. A 29-year-old healthy female, with no history of pulmonary disease, presented on multiple occasions to healthcare providers with wheezing and cough. She was repeatedly diagnosed and treated for asthma with acute exacerbations. Upon further evaluation, the patient was subsequently found to have a tracheobronchial foreign body causing her symptoms. This case report highlights a clinical approach to wheezing illnesses and reviews the diagnosis and management of tracheobronchial foreign body aspiration.