METAL-DEPOSITION IN POSTSURGICAL GRANULOMAS OF THE URINARY-TRACT

Fourteen cases of post-surgical granulomatous inflammation of the urin ary tract were studied to investigate the possible deposition in the t issues of metals derived from the diathermy instruments used. The gran ulomas showed central necrosis, palisaded histiocytes and giant cells. On electronmicroscopy both amorphous material and electron-dense part icles were seen in the granulomas. The former appeared to be necrotic tissue. The particles were metallic in nature. Energy dispersive analy sis of X-rays showed the presence of tungsten, iron, copper, nickel, c hromium, zinc and vanadium. Tungsten particles were always pure. Other single particles contained two or more of the remaining elements, ind icating the presence of alloy metals. Analysis of the diathermy instru ments showed the cutting loops to be pure tungsten and the 'rollerball s' to be of nickel silver containing copper, zinc, nickel, manganese a nd iron. Both the loops and balls are supported on stainless steel wir es containing iron, chromium, nickel, manganese, molybdenum, copper an d vanadium. It is proposed that metallic fragments from the instrument s were deposited in the tissues during the surgical procedures and eli cited an immunological reaction with granuloma formation. Tungsten is probably inert but nickel, chromium, copper and zinc are immunogenic. Under certain circumstances both nickel and chromium may also be carci nogenic.