Unusual Herpes Simplex Virus Infection Mimicking Foreign Body Reaction After Cosmetic Lip Augmentation With Expanded Polytetrafluoroethylene Threads

BACKGROUND. Adverse reactions after cosmetic lip augmentation with synthetic implant materials include inflammation, infection, and extrusion of and foreign body reaction to the implant. Clinically, all of them are characterized by pain, erythema, swelling, and formation of papules and/or pustules. OBJECTIVE. To describe an unusual herpes simplex virus infection in a 48-year-old female patient after cosmetic lip augmentation with expanded polytetrafluoroethylene threads clinically resembling a foreign body reaction. METHODS. Case report and literature review. RESULTS. A histopathologic examination showed no signs of a foreign body reaction. Instead, herpes simplex virus–specific DNA was demonstrated by polymerase chain reaction from lesional tissue. CONCLUSION. Cosmetic lip augmentation with expanded polytetrafluoroethylene threads may be complicated by a delayed local herpes simplex virus infection clinically mimicking a foreign body reaction to the implant

Imbalance between the endothelial cell-derived contracting factors prostacyclin and angiotensin II and nitric oxide/cyclic GMP in human primary varicosis

1. The role of the endothelium in the vasomotor control of human veins in the lower extremity is little understood. We tested the hypothesis that the production of relaxing and contracting factors is altered in endothelial cells from varicose saphenous veins which may predispose to the decreased vessel tone observed in primary varicosis. 2. We determined the intracellular accumulation of guanosine 3′:5′-cyclic monophosphate cyclic GMP; a measure of nitric oxide production) and the release of endothelin and prostacyclin (measured as its stable metabolite 6-keto-prostaglandin F(1α)) from cultured cells derived from the long saphenous veins of patients with primary varicosis (Varicose saphena group, n=27) or from patients undergoing coronary artery bypass surgery (Healthy saphena group, n=22). In addition, levels of endothelin, angiotensin II, bradykinin, cyclic GMP and cyclic AMP in plasma from patients with primary varicosis and healthy volunteers (n=8–11 in each group) were determined. 3. Although basal cyclic GMP levels were similar, more cyclic GMP accumulated in response to histamine (1–100 μmol l(−1)) in cells from varicose saphenous veins (0.75±0.1 pmol per well) than in cells from veins without varicosis (0.27±0.05 pmol per well). Furthermore, the relaxant potency of nitroprusside (1 nmol l(−1)–300 μmol l(−1)) in vitro was higher for varicose veins (mean EC(50)=5.9 μmol l(−1); n=8) than healthy veins (mean EC(50)=20.0 μmol l(−1); n=7). 4. The production of prostacyclin was significantly less in cells from varicose than healthy saphenous veins (66±8.7 and 121±20.1 nmol g(−1) protein), but the production of endothelin was similar in both groups. Prostacyclin (3 nmol l(−1)–30 μmol l(−1)) consistently contracted rings of varicose saphenous vein in vitro with a mean EC(50) value of 10–20 μmol l(−1) (n=7); the maximum tension generated was ∼50% of that of a completely depolarizing solution of K(+) (120 mmol l(−1)). 5. In plasma from patients with varicose veins, levels of cyclic GMP were higher than in healthy controls (9.2±0.03 and 7.2±0.02 nmol l(−1)), levels of angiotensin II were lower (81±11.5 and 147±21.7 pmol l(−1)), and levels of endothelin, cyclic AMP, and bradykinin were not different. 6. It is concluded that endothelial cells from diseased saphenous veins secrete less constrictor mediators than cells from healthy veins and that in diseased veins the nitric oxide/cyclic GMP system is up-regulated which may shift the balance of vasoactive factors towards vasodilatation and contribute to the development of primary varicosis

Treatment of primary varicose veins by endovenous obliteration with the VNUS closure system: Results of a prospective multicentre study

Background. Radio frequency obliteration of the saphenous veins has been introduced as a less invasive alternative to traditional surgery for varicose veins. Objective. To report the efficacy of obliteration and clinical outcomes following endovenous obliteration of the saphenous vein with limited follow-up to 3 years. Materials and methods. Radiofreq uency obliteration (Closure® system, VNUS Medical Technologies, San Jose, CA) was performed in 330 limbs of 294 patients in a prospective worldwide multicentre study with 31 participating sites. Follow-up duplex ultrasound and clinical examinations were performed at annual intervals. The main outcome measures were the completeness of occlusion of the treated vein segment, presence of reflux and presence of signs and symptoms of venous disease. Results. Before treatment 3.9% of limbs were categorised as CEAP clinical class zero or one. This improved to 82.9% at 1 year, 83.1% at 2 years and 86.8% at 3 years following treatment. Varicose vein free rates were 1 year: 90.1%, 2 years: 87.2%, 3 years: 88.2%. Duplex ultrasound demonstrated a reflux-free rate of about 88% over 3 years. Total occlusion (TO) of veins was 1 year: 81%, 2 years: 80.4% and 3 years: 75%. Partial occlusion (PO, 5 cm open segment) was 1 year: 12.7%, 2 years: 12.2% and 3 years: 7.4%. Partial occlusion did not result in any differences in the symptom severity score, the number of symptom free limbs, or the varicose vein absence rates at any follow-up time point when compared to the total occlusion group. The varicose vein absence rates were significantly lower in the IO group comparing to the TO and PO groups. Conclusions. Radiofrequency saphenous vein obliteration improves the symptoms of varicose veins. The reflux-free rates in the treated veins remain constant over a 3 year follow-up period. There is no difference in clinical outcomes between the TO and the PO limbs, suggesting clinical effectiveness of the PO category. Greater than a 5 cm open segment in treated veins poses a risk of recurrence. © 2004 Elsevier Ltd. All rights reserved