BACKGROUND. In the past, reactions or misplacement of soft tissue fillers has been fraught with anxiety because time has been the main thrust for improvement in spite of ancillary treatments. Hyaluronidase is an enzyme that dissolves hyaluronic acid in the skin and also assists in the management of granulomatous foreign-body reactions to hyaluronic acid. These reactions may be caused by allergy to the material or immunologic response to the protein contaminants in the hyaluronic acid preparations. Dissolution of material in erroneous placement of material and in allergic reactions can be a time saver and a deterrent to patient dissatisfaction. OBJECTIVE. To evaluate the use of hyaluronidase in the treatment of both allergic reactions and the erroneous misplacement of hyaluronic acid in the skin. METHODS. A case of persistent granulomatous reaction to injectable hyaluronic acid and a case of hyaluronic acid erroneous misplacement with their successful subsequent treatments using intracutaneous hyaluronidase are reported, along with illustrative examples of hyaluronidase use. RESULTS. The use of hyaluronidase reduced the patient discomfort within 24 to 48 hours, deterring any patient anxiety or patient dissatisfaction. CONCLUSIONS. Hyaluronidase has a place in the treatment of allergic reactions to hyaluronidase and in the erroneous misplacement of the material.
The nuclei of the locus coeruleus and subcoeruleus were examined in human brains from individuals of 14 to 87 years. Serial counts were performed on every tenth Nissl stained paraffin section of melanin containing cells within the entire length of these nuclei. After 63 years, the neuronal population in these nuclei decreased 40%. This significant decrease in cell number is the first reported for a brain stem structure. In view of the relation of these noradrenaline containing cells to the catecholaminergic system and the widespread projections between these nuclei and other central nervous system structures, this decrease may be a factor in alteration of some central nervous system activities with increasing age.
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