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Appendix D
Glossary

A

Abstract Condensation or summary of a scientific article.

Achalasia Failure of the sphincter between the esophagus and stomach to relax during swallowing.

Adaptive immunity Resistance or sensitization to infection or to a foreign substance that is acquired, not innate; depends on experience with the infection or foreign substance; and leads to an ability to react to the infection or substance in the future.

Adenopathy Enlargement of glands; see Lymphadenopathy.

Adipose Pertaining to fat or fatty (e.g., adipose tissue).

Adjuvant Substance that enhances the immune response to an antigen.

Adrenal steroid Hormone of the cortex of the adrenal gland with anti-inflammatory and immunosuppressive activities, among others; a corticosteroid.

Aerobic Requiring oxygen, growing in the presence of oxygen.

Allele Any of different genes at the same location on the chromosome; different genes or alleles are referred to as heterozygous; the same genes or alleles, homozygous, for the gene product or trait.

Alloplastic Pertaining to an inert foreign body used for implantation into tissue.

Anaerobic Growing in the absence of oxygen.

Antibody Immune protein (immunoglobulin) formed in response to, and reacting specifically with, an antigen, or occurring naturally (e.g., immunoglobulin [Ig], IgA, IgD, IgE, IgG, or IgM).

Antigen Any substance capable of inducing a specific or adaptive



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Page 515 Appendix D Glossary A Abstract Condensation or summary of a scientific article. Achalasia Failure of the sphincter between the esophagus and stomach to relax during swallowing. Adaptive immunity Resistance or sensitization to infection or to a foreign substance that is acquired, not innate; depends on experience with the infection or foreign substance; and leads to an ability to react to the infection or substance in the future. Adenopathy Enlargement of glands; see Lymphadenopathy. Adipose Pertaining to fat or fatty (e.g., adipose tissue). Adjuvant Substance that enhances the immune response to an antigen. Adrenal steroid Hormone of the cortex of the adrenal gland with anti-inflammatory and immunosuppressive activities, among others; a corticosteroid. Aerobic Requiring oxygen, growing in the presence of oxygen. Allele Any of different genes at the same location on the chromosome; different genes or alleles are referred to as heterozygous; the same genes or alleles, homozygous, for the gene product or trait. Alloplastic Pertaining to an inert foreign body used for implantation into tissue. Anaerobic Growing in the absence of oxygen. Antibody Immune protein (immunoglobulin) formed in response to, and reacting specifically with, an antigen, or occurring naturally (e.g., immunoglobulin [Ig], IgA, IgD, IgE, IgG, or IgM). Antigen Any substance capable of inducing a specific or adaptive

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Page 516 immune response and of reacting with the products (a specific antibody, specific T lymphocyte, or both) of that response. Apoptosis Programmed cell death. Arthralgia Pain in a joint. Arthritis Inflammation of a joint. Atomic weight Mass in grams of 1 mole (6.02 x 1023 atoms) of an atomic species. Atrophy Wasting of tissues, organs, or the whole body. Augmentation In this report, placement of an implant for the purpose of enlarging or changing the appearance of the breast. Autoantibody Antibody directed against a self-antigen. Autogenous tissue Originating within the body. Autologous Describing a graft in which the donor and recipient is the same individual. Axilla, axillary Armpit, of the armpit. B B lymphocyte Cell representing 1530% of circulating lymphocytes, responsible for antibody. Bias Deviation of results or inferences from the truth, or processes leading to such deviation. Bleed (of implant) Diffusion of silicone fluid into and through the silicone shell of a silicone gel-filled implant. Breast augmentation classification Class I Augmented breast feels as soft as an unoperated one. Class II Breast is less soft and implant can be palpated, but is not visible. Class III Breast is more firm, implant can be palpated easily, and it (or distortion from it) can be seen. Class IV Breast is firm, hard, tender, painful, and cold; distortion is often marked. Bursa Closed sac lined with synovium and filled with fluid found or formed in areas subject to friction (e.g., where a tendon passes over bone). C Capsule Membranous structure, usually dense collagenous connective tissue enveloping another organ, joint, or part; in this report, the capsule found around an implant. Capsulectomy Surgical removal of a capsule. Carcinogenesis, carcinogenicity Production of cancer; ability to cause cancer. Carcinoma Any type of malignant tumor arising from epithelial cells such as lung, intestine, or skin.

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Page 517 CAS number Chemical Abstracts Service number; a method for identifying chemicals. Case control study Epidemiological method that identifies cases of disease and compares their past history of exposure to risk factors to the exposure of similar people without the disease. Caseation Form of necrosis in which tissue contains protein and fat that looks cheese-like. Centimeter One-hundredth of a meter, or approximately four-tenths of an inch. Cephalosporin Broad spectrum antibiotic. Closed capsulotomy Creation of opening in a breast implant capsule by external compression. Clostridia Anaerobic bacterium (e.g., tetanus). Cohort study Epidemiological method that prospectively follows a group with a condition and compares its outcomes to those of a group without the condition. Collagen Protein substance of the white fibers of connective tissue, cartilage, or bone. Confidence interval (CI) Range within which the true value is most likely found .(e.g., 95% CI means value is within range 95% of the time). Connective tissue Collagenous or fibrous tissue surrounding and separating muscles, organs, and other body parts (e.g., fascia). Connective tissue disease Chronic inflammatory disease with presumed autoimmune components involving the musculoskeletal system and multiple other organs (e.g., rheumatoid arthritis, systemic lupus erythematosus, scleroderma). Contracture Shrinkage or reduction in size; in this report, contraction of the breast implant collagenous, fibrous tissue capsule. Cross-sectional study Analysis of a large group at one point in time. Cubic centimeter Unit of volume equal to one-thousandth of a liter, one milliliter, or approximately 1/30 of a fluid ounce. Cytokine Hormone-like, low molecular weight protein secreted by many cell types that regulates cell-to-cell interactions and features of the immune response (e.g., lymphokine, monokine). D Dalton (Da) Unit of mass equal to 1.0 in the atomic mass scale. Deflation In this report, loss of saline from a saline-filled implant with partial or complete implant collapse. Dermatomyositis, polymyositis Chronic inflammatory disease of muscle. Dermis Layer of skin under the epidermis, consisting of a dense bed of vascular connective tissue.

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Page 518 Desmosome Adhesion site between two cells with a dense attachment plaque on both sides. Device In this report, an implant, prosthesis, or appliance designed to perform a specific function, a silicone breast implant. E Edema Accumulation of excessive fluid in tissues. Elastomer In this report, a cross-linked solid silicone reinforced with amorphous silica, an implant shell. Electrolyte Ionizable substance in solution (e.g., salt existing as Na+ and C1-in plasma, tissue fluid, or saline-filled implants). ELISA Enzyme-linked immunosorbent assay, an immunochemical test. Embolus Any plug (often a clot) carried by the circulation from one blood vessel to a smaller vessel that becomes occluded, thus interrupting circulation to the tissue served by that blood vessel. Eosinophil White cell (leukocyte) with lobed nucleus and red-yellow staining granules that is asssociated with allergic or antiparasitic functions. Epidermolysis Loosening of the outermost layers of skin (epidermis) with the formation of blisters. Epithelial Pertaining to cells, usually in layers, that cover internal or external body surfaces and line blood vessels and other cavities in the body. Explant, explantation In this report, an implant removed from the body, the act of doing so. Exudation Oozing of fluid gradually out of body tissue or structure, usually because of injury or inflammation. F Fascia Sheet or band of fibrous, connective tissue that lies under the skin or encloses muscles and other organs. Fibroblast Connective tissue cell that can form collagen. Fibrocystic disease Condition common in women and characterized by pain and multiple cysts in the breast. Fibromyalgia Syndrome characterized by chronic diffuse pain and tender points that occurs predominantly in women. Fistula Abnormal passage between organs or to the body surface. Flora Population of microorganisms, bacteria, or fungi. Formalin Aqueous solution of formaldehyde (37%) used as a tissue preservative or fixative. G Galoctocele Cystic enlargement in the breast that contains milk. Galactorrhea Abnormal lactation. Gammopathy Condition. marked by disturbed immunoglobulin synthesis.

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Page 519 Gavage Forced feeding by stomach tube. Gel In this report, a lightly cross-linked, spongy silicone permeated with a lower weight silicone fluid. Gentamycin Antibiotic that is particularly effective against gram-negative aerobic bacteria. Giant cell (foreign body) Large cell with multiple nuclei distributed throughout the cytoplasm formed by macrophages and seen around foreign bodies. Gram Unit of weight, 1/28th of an ounce, the weight of one milliliter of water at 4°C. Granuloma Nodular chronic inflammatory lesion, consisting of various cells such as mononuclear cells, epithelioid cells, giant cells, lymphocytes, eosinophils, and plasma cells. H Hematoma Localized collection of blood, usually clotted, in an organ, tissue, or body space. Hemosiderin Iron-containing protein, produced by phagocytic digestion of blood iron protein. HEp-2 cells Human epithelial tissue culture cells that provide sensitive assay for antinuclear antibodies. Hepatomegaly Enlargement of the liver. High temperature vulcanized (HTV) In this report, cross-linked silicone molecules producing a higher molecular weight, firmer silicone made at high temperature (115-150°C). Histiocyte Macrophage. Histology Microscopic anatomy. Human adjuvant disease Rheumatic signs or symptoms presumably due to immune or adjuvant response to silicone, as in adjuvant disease in rodents; a misnomer. Human lymphocyte antigen (HLA) Substance capable of inducing immune response and present on most human cells (HLA-A, B, and C) or only on human immune cells (HLA-D) that has been shown to have a strong influence on human transplantation and association with certain human diseases. I Immunofluorescence Tissue microscopic method using antibody labeled with a dye that glows under fluorescent light; direct, the antibody is directed against the test substance itself; indirect, the antibody is directed against an immunoglobulin that reacts with the test substance. Inflammation Local tissue protective response to injury involving

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Page 520 dilation of blood vessels, fluid exudation, and migration of white cells. Innate immunity Immunity based on the genetic constitution of the individual, nonspecific and not requiring or enhanced by prior exposure. Interstitial Relating to spaces in tissue. Intraperitoneal Within the abdominal cavity. In vitro In an artificial (e.g., laboratory) environment. In vivo Within the living body. L LC50 Concentration that kills half of the cells. LD50 Mean lethal dose. Leakage (of implant) Loss of implant filler through a breach in the implant shell (as opposed to bleed or gel fluid diffusion). Liter Volume equal to 1.0567 quarts, a thousand cubic centimeters or milliliters. Low bleed In this report, an implant or implant shell fabricated to lessen bleed, or gel fluid diffusion, into and through the silicone elastomer shell. Lumen Interior space, for example, the inside of a breast implant. Lymphadenopathy Enlargement of lymph glands or nodes. M Macrophage Monocytic cell in tissue that is large, ingests foreign bodies, and is involved in immune and other tissue functions. Macroscopic Visible with the unaided eye. Mesenchymal Pertaining to tissues formed of embryonic connective tissue (e.g., connective tissue, blood and lymphatic vessels). Meter Length equal to 39.37 inches. Methylprednisolone Synthetic adrenal cortical steroid. Microgram One-millionth of a gram. Microscopic Extremely small, visible only with a microscope. Microsurgical flap Mass of tissue, dissected free and connected to blood vessels at a new site by using low-power microscopic magnification. Milligram One-thousandth of a gram. Milliliter One-thousandth of a liter, or one cubic centimeter. Millimeter One-thousandth of a meter, or 4/100 of an inch. Modulus In this report, stiffness or hardness of silicone, adjustable by cross-linking. Molecular Weight Sum of atomic weights of all the atoms that constitute a molecule. Monoclonal Derived from a single cell. Monocyte Mononuclear phagocytic cell formed in bone marrow and transported to tissues to become a macrophage.

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Page 521 Morphea Localized scleroderma, characterized by thickened dermal fibrous tissue plaques. Musculocutaneous flap Compound flap of skin and muscle with adequate blood supply to permit a sufficient graft to be transferred. Myalgia Pain in a muscle or muscles. Mycobacteria Slow-growing bacteria with certain staining characteristics (e.g., tuberculosis). Myeloma, multiple myeloma Plasma cell tumor or plasma cell malignancy originating in bone marrow and producing an abnormal protein, usually a monoclonal IgG. Myositis Inflammation of a voluntary muscle. N Nanogram One-billionth of a gram. Nanometer One-billionth of a meter. Necrosis Pathologic death of one or more cells, a tissue, or an organ. Neoplasia Abnormal tissue growth; benign tumor or cancer. Neuritis Inflammation of a nerve with pain, tenderness, anesthesia, and paralysis. Neuropathy Functional disturbance or pathological change in the peripheral nervous system, generally not inflammatory. O Odds ratio Estimate of the relative risk, usually calculated for data from case control studies. Omentum Membrane (of peritoneum) that passes from the stomach to the intestine. Open capsulotomy Incision or opening in a breast implant capsule made by an open surgical approach. Osmotic pressure Pressure required to stop solvent from moving through a membrane toward the higher concentration of solute. P Parenteral Given by injection into other than the gastrointestinal tract. Parts per million (ppm) Concentrations of vapors in air are usually expressed in ppm, a gas volume ratio, which can be converted to mass concentration (e.g., mg/m3) by dividing molecular weight in grams x concentration in ppm by 0.0245. Pectoral muscles (pectoralis major, pectoralis minor) Muscles from the front of the chest to the upper arm, collar bone, and shoulder blade that rotate the arm toward the midline and pull it forward and downward; when used to cover an implant, the implant is referred to as submuscular or subpectoral. Pedicle Stalk in a flap through which the blood supply passes. Peer reviewed Examined by those with expertise for accuracy, relevance, and other measures of scientific quality.

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Page 522 Periosteum Connective tissue layer covering bone. Peritoneal cavity Abdominal cavity lined with peritoneum, a smooth thin membrane investing its organs and walls. pH Symbol for acidity (less than 7) or alkalinity (greater than 7); pH 7 is neutral. Phagocytic, phagocytosis Pertaining to cells that ingest microorganisms, cell fragments, or small particles, the process in which this occurs. Pharmacokinetic Pertaining to movement of drugs within the body. Plasma cell Cell derived from a B lymphocyte that is active in producing antibody. Pneumonitis Inflammation of the lung. Pneumothorax Accumulation of air in the chest cavity, inside the chest but not in the lung. Polyclonal Derived from different cells. Polymer Substance of high molecular weight made up of a chain of repeated units. Polymorphism Occurrence in more than one form, varying genes, or alleles at the same chromosomal location. Polymorphonuclear Having a deeply lobed nucleus that appears multiple, as in a polymorphonuclear leukocyte, an acute inflammatory, circulating white cell. Popliteal Back of the knee. Prosthesis Device or artificial substitute for a body part. Ptosis Prolapse or drooping. R Radiolucent Relatively penetrable by x-rays. Radiopaque Relatively impenetrable by x-rays. Raynauds phenomenon Sudden reversible pallor of fingers, hand, toes, or tip of the nose caused by cold. Reconstruction In this report, reforming of the breast with an alloplastic device, autogenous tissue, or both. Relative risk Ratio of disease incidence in those with a risk factor to incidence in those without the risk factor. Renal Pertaining to the kidney. Rheumatoid arthritis (RA) Chronic inflammatory disease of unknown cause affecting multiple joints. Room temperature vulcanized (RTV) In this report, cross-linked silicone molecules producing a higher molecular weight, firmer silicone made at room temperature. Rupture In this report, a breach of any size in the integrity of a silicone breast implant shell.

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Page 523 S Sarcoma Malignant tumor of connective tissue, formed by proliferation of mesodermal cells. Scleroderma (Ssc) Chronic inflammatory disease characterized by thickening, tightening, nonpitting hardening of the skin of both extremities and trunk. Sensitivity True-positive results as a proportion of the total of true-positive and false-negative results (i.e., the likelihood of detecting a condition). Seroma Cystic accumulation of serous (similar to blood serum) fluid in tissue. Shunt Passage or anastomosis between two natural channels; diversion of an accumulation of fluid to an absorbing or excreting system. Sicca Dryness. Silica, amorphous Very finely divided, noncrystalline silicon dioxide. Silica, crystalline Silicon dioxide in organized crystalline form. Silicon Shiny silvery element with an atomic weight of 28. Silicone Compound or polymer of silicon, oxygen, and carbon (e.g., polydimethylsiloxane, PDMS). Sjogrens syndrome (SS) Chronic inflammatory disease, or syndrome accompanying other diseases, and characterized by dryness of the mouth and eyes. Specificity True-negative results as a proportion of the total of true-negative and false-positive results (i.e., the likelihood that a positive result is accurate). Steroid See Adrenal steroid. Subcutaneous Beneath the skin, but above the fascia and muscle. Subglandular (retroglandular) In this report, referring to the position of a breast implant under the mammary gland, but on top of the muscles of the chest. Submammary (retromammary) Subglandular. Submuscular (retromuscular) In this report, referring to the position of a breast implant wholly or partially under the muscles on the front of the chest (e.g., pectoralis major, pectoralis minor, or serratus anterior). Subpectoral (retropectoral) Submuscular. Syndrome Aggregate of signs and symptoms that together constitute the picture of a disease. Systemic lupus erythematosus (SLE) Chronic inflammatory disease affecting multiple organs, joints, kidney, heart, and blood vessels. T T lymphocyte Cell representing 70-85% of circulating lymphocytes that produces cytokines and is responsible for cellular immunity, delayed hypersensitivity, and graft rejection.

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Page 524 Teratogen Agent that causes abnormal fetal development. Titer Amount of a substance that can be manipulated by serial dilution (e.g., 1:40, 1:80, 1:160). Toxic shock syndrome Infection, primarily with Staphylococcus aureus, often around foreign bodies, characterized by diarrhea, flaking skin rash, fever, shock, and substantial mortality. Triamcinolone Synthetic adrenal cortical steroid. U Urethra, urethral Canal from the urinary bladder to the exterior of the body, pertaining to this canal. V Vasculitis Inflammation of a blood vessel or vessels (e.g., as seen in connective tissue disease). Visceral peritoneum Membrane lining the internal organs of the abdominal (peritoneal) cavity. References Dictionary of the Rheumatic Diseases, American Rheumatism Association, 1988. Dorlands Illustrated Medical Dictionary, W. B. Sanders Company, 1994. Segen, J. C., The Dictionary of Modem Medicine, Parthenon Publishing Group, 1992. Stedmans Medical Dictionary, Williams and Wilkins, 1995.