Dermalive, an injectable skin filler composed of a combination of synthetic hyaluronic acid and acrylic hydrogel particles was recently developed for soft tissue augmentation. Dermalive produces longer term results than temporary injectable fillers and is associated with a reportedly low incidence of adverse reactions. We describe a marked local reaction to the injection of Dermalive in the nasolabial fold developing within 4 months with histological confirmation of a granulomatous response. To our knowledge there has been only one previous report of a local granulomatous reaction to Dermalive.

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gastritis associated with Camp-vlobacrer pylori. APMIS 97:Three cases of granulomatous inflammation in gastric biopsies showing Campylobacter pylori infestation are described. This type of reaction to Campylobacterpylori has not previously been described, and occurred in I . 1% of gastric biopsies containing Campylobacter-like organisms (CLO), in this series of all gastric biopsies submitted for histological examination during one year. Two other cases each showed a mucosal granuloma: one was a patient with Crohn's disease and the other had foreign body giant cells in a biopsy of the edge of a healing gastric ulcer. Each of our three CLO-positive cases with granulomas showed scanty CLOs only. Thus, although granulomatous inflammation associated with CLOs is uncommon as a proportion of all CLO-positive gastric biopsies, these currently represent the commonest condition associated with granulomas in gastric biopsies, in our experience.

Summary lodised oil (lipiodol) al., 1985). Lipiodol, an iodinated derivative of poppyseed oil, has been in use for over a decade as a vehicle for targeted cytotoxic or radiotherapeutic treatment of unresectable HCCs. When injected into the hepatic artery the oil is retained by HCCs for several weeks to over a year, but is cleared from normal liver parenchyma within 7 days (Nakakuma et al., 1979). Trials using lipiodol in conjunction with cytotoxic drugs such as doxorubicin, epidoxorubicin, aclarubicin, 5-fluorouracil, mitomycin, cisplatin and SMANCS (a polymer of neocarzinostatin with styrene and maleic acid), or radioisotopes such as 131I have yielded improved survival rates (Bhattacharya et al., 1994). Lipiodol ultra fluid (Laboratoire Guerbet, Roissy Charles de Gaulle, France) is manufactured by ethyl trans-esterification of poppyseed oil, and consists of mono-, di-and tri-iodinated ethyl esters of linoleic (73%), oleic (14%), palmitic (9%) and stearic (3%) acid (I Chastin Laboratoire Guerbet; personal communication) with an iodine content of 37-39% by weight.Hypotheses attempting to explain lipiodol retention in HCCs fall into two major categories. One suggests that lipiodol is retained within the tumour blood vessels, which may be due to an altered electrostatic charge on the endothelial cell surface causing lipid adsorption, or impaired exit of lipid droplets due to altered drainage channels, embolisation being determined by droplet size. The other proposes that lipiodol lodges in the extracellular space, as tumour vessels are more 'leaky' than usual, and because lymphatics are absent in HCCs. Uptake by the reticuloendothelial cells in the liver, spleen, marrow and lungs is the probable route by which lipiodol is cleared when administered systemically, and HCCs may be unable to clear lipiodol because they lack a reticuloendothelial Kupffer cell component. There have been relatively few investigations into the role of the tumour cells (Javitt, 1990). HUVECs were used instead of tumour endothelium. They share a common embryological origin with hepatic sinusoidal endothelium (Hamilton and Mossman, 1976) and also have several surface markers in common with the tumour endothelium in HCCs, namely Ulex Europeus Lectin, Factor VIII and QBendlO (Dhillon et al., 1992). Monolayers of Hep G2 and HUVECs grown on tissue culture chamber slides were exposed for 4, 8, 24 and 32 h to culture media containing 1%, 2% and 4% of lipiodol by volume [in human subjects, bolus injection of 10 ml lipiodol over a period of 1 min into the hepatic artery, which has an average flow of 500 ml min-' (Tygstrup et al., 1962) is likely to yield a lipiodol concentration of 2% in the hepatic arterial blood reaching the tumour]. The iodised oil which is heavier than water, initially remained suspended as fine droplets in the aqueous medium following vigorous agitation and then settled as droplets on the surface of the cell monolayer. Following exposure to lipiodol the monolayers were stained by a silver nitrate impregnation technique adap...

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We report three cases of hepatobiliary cystadenoma with mesenchymal stroma in which oestrogen receptor immunostaining was carried out, after using a microwave method of antigen retrieval. In one of the tumours immunoreactivity for oestrogen receptors was demonstrated within the mesenchymal stromal cells. The presence of oestrogen receptors supports the theory that oestrogens act as tumour promoters and may explain the female predilection.

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