Like almost every woman, Fiordaliza Pichardo just wanted to look beautiful, so a few years ago, she began getting silicone injections from a woman she met through a friend in order to plump up her thighs and derriere.

She never expected to pay such a high price for her looks.

In March, a day after receiving an injection, Ms. Pichardo, 43, died of what the medical examiner later determined was a silicone embolism in her lungs.

The city’s health department fears that the illegal use of silicone as an alternative to cosmetic surgery is on the rise. The city’s poison control center has received three calls in the last 10 months from doctors who have treated patients injected with silicone; Ms. Pichardo’s case was not among them. In the previous two years, there were only two such cases.

Health department officials say there may be other cases that have gone unreported, since doctors are not legally obligated to report silicone poisoning or even death, and since silicone is hard to detect through X-rays or CT scans. The department was planning Thursday to send an advisory by e-mail and fax to thousands of doctors advising them to watch for silicone poisoning cases.

Nationally, reports of buttock enhancement using silicone and similar thick liquids have surfaced from the Northeast to Miami, and the Food and Drug Administration is also planning to issue a warning on the dangers of such practices, Siobhan DeLancey, a spokeswoman, said Thursday.

“This seems to be kind of an underground occurrence, so it’s difficult to get numbers of actual events and to know exactly what these people are being injected with,” Ms. DeLancey said. “It’s important to note that none of the products that are reportedly being used are approved for this purpose.”

Ms. DeLancey said silicone was not approved for injection into tissues at all, only for use in the eyes and in certain implants where it is contained and cannot leak into tissue. She said the F.D.A. had the ability to conduct criminal investigations, and would encourage victims to come forward “so that we can document the problem.”

Across the Internet, chat rooms, Web sites and blogs have sprung up discussing buttock injections.

The victims have become caught up in an underground beauty industry that uses injections of black-market, medical-grade silicone or industrial-grade silicone as a cheap, fast and easily accessible way to plump up breasts, buttocks, thighs and even wrinkles.

The injections are popular among Latina women and transgender women, who may be unable to afford conventional plastic surgery and who tap into it through unlicensed practitioners working through word of mouth, city officials said.

Although side effects are fairly rare, silicone can migrate through the bloodstream, creating potentially fatal clots in the lungs, as it did in Ms. Pichardo’s case, said Dr. Nathan M. Graber, director of environmental and occupational disease epidemiology for the New York City Department of Health and Mental Hygiene. It can also migrate through tissues, leading to ugly lumps and chronic pain.

The injections are administered at home, in motel rooms, in makeshift offices or at “pumping parties,” where the guests take turns injecting one another, officials said.

Young transgender women often seek out silicone injections because they are a quick way of making bodies more feminine, unlike hormone treatments, which may take years to work, said Dr. Nick Gorton, an emergency room doctor who treats transgender patients at the Lyon-Martin Health Services clinic in San Francisco.

“If you go to a pumping party, you can have it tonight,” Dr. Gorton said. “It’s a big temptation, especially among young people who, when you’re 20, you’re not thinking about your own mortality.”

People are often reluctant to report side effects, because they feel that they are turning in a member of their community, health officials said.

Industrial-grade silicone can be bought at a hardware store. But Dr. Graber said there have been reports of the use of substitutes like castor oil, mineral oil, petroleum jelly and even automobile transmission fluid.

Dr. Suhail Raoof, chief of pulmonary medicine at New York Methodist Hospital, treated a woman with silicone poisoning in 2007. She came in complaining of shortness of breath, chest pain and coughing, reminiscent of pneumonia, he said, and told doctors that she had been injected with about 500 milliliters of silicone in each buttock about half an hour earlier.

Because silicone is not visible on an X-ray or a CT scan, Dr. Raoof said, diagnosis is difficult without a biopsy. Doctors used deduction to diagnose the cause of the woman’s symptoms, and she survived, he said.

Ms. Pichardo was not so lucky.

Ms. Pichardo’s 19-year-old daughter, Marinés Rodriguez, said that her mother began getting silicone injections several years ago after a friend introduced her to a cosmetologist.

Ms. Rodriguez said the cosmetologist went to Ms. Pichardo’s home in the Bronx and to other clients in Manhattan and Miami. A cup of silicone cost $800, and the cosmetologist would inject half a cup to two cups in a single session, Ms. Rodriguez said. Her mother, she said, “didn’t really care about the price. It was more that she knew somebody who had this first.”

Ms. Pichardo came to trust the woman. “She felt that was her friend, nothing could go wrong,” Ms. Rodriguez said.

Ms. Pichardo was last injected on March 17, and died the next day. Doctors thought she had pneumonia, Ms. Rodriguez said, and the family never thought to mention the silicone injections — which were discovered during the autopsy — because they thought they were harmless.

The medical examiner has ruled her death a homicide because she was injected by an unlicensed nonmedical practitioner, said Ellen Borakove, a spokeswoman for the medical examiner. No charges have been filed. Paul J. Browne, a police spokesman, said, “We believe she has fled to the Dominican Republic and we are in discussions with the district attorney as to next steps.”

Ms. Rodriguez said the family was distraught, but found it hard to be angry. The day after her mother died, she said, the cosmetologist visited to pay her condolences. “We didn’t think she did it on purpose,” she said.

和幾乎所有的女人一樣，費(fèi)奧達(dá)尼·皮查多只是想看上去漂亮一些，因此在幾年前，她開(kāi)始從一個(gè)通過(guò)朋友認(rèn)識(shí)的女人那里接受硅膠注射，使大腿和臀部豐滿起來(lái)。

她怎末也沒(méi)有想到為了美貌她會(huì)付出巨大的代價(jià)。

三月，就在接受注射后的一天里，經(jīng)法醫(yī)鑒定43歲的皮查多死于硅膠肺部阻塞。

城市衛(wèi)生部門(mén)擔(dān)心這種代替外科整形手術(shù)的非法使用硅膠事件不停增長(zhǎng)。城市中毒控制中心在近10個(gè)月中就接到三起接收因硅注射致病病例的醫(yī)生打來(lái)的電話；而皮查多并不包括在內(nèi)。在先前的兩年內(nèi)，類(lèi)似的病例僅有兩起。

衛(wèi)生部門(mén)官員說(shuō)也許還有其他病例并沒(méi)有上報(bào)，因?yàn)獒t(yī)生并沒(méi)有法律義務(wù)來(lái)上報(bào)硅膠中毒或者死亡事件，并且硅膠很難用X射線或CT掃描檢測(cè)出來(lái)。該部門(mén)計(jì)劃在星期四通過(guò)電子郵件或傳真向所有的醫(yī)生建議關(guān)注硅膠中毒病例。

在全國(guó)范圍內(nèi)，用硅膠或是類(lèi)似濃稠液體來(lái)提臀的報(bào)道從東北到邁阿密都浮出水面了，發(fā)言人辛普含·德蘭西周三時(shí)說(shuō)，美國(guó)食品及藥物管理局(F.D.A)也計(jì)劃對(duì)這種危險(xiǎn)做法發(fā)出警告。

“這看來(lái)是一個(gè)地下組織，因此很難獲得案例的具體數(shù)據(jù)并弄清楚這些人到底給他們注射了什么，”德蘭西小姐說(shuō)。“需要注意的是，那些據(jù)說(shuō)在使用的產(chǎn)品均沒(méi)有被批準(zhǔn)用于此用途。”

德蘭西小姐說(shuō)硅膠根本沒(méi)有被批準(zhǔn)注入人體組織，只是用在眼睛和某些器官移植中而并不會(huì)泄露到組織中。她說(shuō)F.D.A有能力打擊犯罪組織，同時(shí)也鼓勵(lì)受害者能夠出來(lái)合作，這樣能夠?qū)��?wèn)題記錄下來(lái)。

互聯(lián)網(wǎng)上，聊天室里，網(wǎng)站和博客上都涌現(xiàn)出關(guān)于臀部注射的討論。

受害者被拉入地下美容行業(yè)，將黑市，醫(yī)用或者工業(yè)硅膠注射當(dāng)做一個(gè)廉價(jià)快速方便的方法去隆胸，提臀甚至祛皺。

這種注射流行于那些無(wú)法負(fù)擔(dān)傳統(tǒng)的整形外科或是相信無(wú)證醫(yī)師的口耳相傳的拉丁婦女和變性婦女當(dāng)中，政府官員們說(shuō)。

紐約市健康及心理保健部門(mén)的環(huán)境與職業(yè)流行病學(xué)主任納丹.M.戈伯說(shuō)，雖然副作用相當(dāng)?shù)暮币?jiàn)，但是硅膠可以通過(guò)血液轉(zhuǎn)移到肺部中形成一個(gè)致命的凝塊，正如皮查多的案例中出現(xiàn)的一樣。硅膠也同樣會(huì)通過(guò)組織轉(zhuǎn)移引起難看的腫塊和慢性疼痛。

官員說(shuō)，這種注射通常實(shí)施于家里，汽車(chē)旅館，臨時(shí)辦事處或者在“幫聚會(huì)”中，來(lái)賓相互給他人注射。

年輕的變性婦女通常會(huì)尋找硅膠注射因?yàn)榭梢钥焖俚淖屔眢w變得女性化，不像激素療法需要幾年的時(shí)間產(chǎn)生作用，一位在舊金山里昂馬丁公共診所治療變性患者的急診醫(yī)生尼克.戈登說(shuō)道。

“如果你想去幫聚會(huì)，你今天晚上就可以做到。”尼克.戈登說(shuō)。“這是一個(gè)巨大的誘惑，特別是在20歲的年輕人當(dāng)中，你不會(huì)去想自己致命的可能性這種問(wèn)題”

人們總是不情愿去報(bào)道負(fù)面消息，因?yàn)檫@他們覺(jué)得他們與群體成員背道而馳，衛(wèi)生部官員說(shuō)。

工業(yè)級(jí)硅膠在硬件商店就可以買(mǎi)到。但是戈登醫(yī)生說(shuō)有報(bào)道稱(chēng)會(huì)用蓖麻油，礦物油，凡士林甚至是機(jī)動(dòng)車(chē)傳動(dòng)油來(lái)代替工業(yè)硅膠。

紐約教會(huì)醫(yī)院肺內(nèi)科主任蘇.羅孚 2007年時(shí)治療過(guò)一個(gè)硅膠中毒婦女。她來(lái)抱怨說(shuō)呼吸急促，胸部疼痛并且咳嗽，讓人想起肺炎。并告訴醫(yī)生她大概半小時(shí)前給每個(gè)臀注射了500毫升的硅膠。

羅孚說(shuō)，因?yàn)楣枘z無(wú)法在X射線或是CT掃描中被發(fā)現(xiàn)，若不用活組織檢查很難診斷。醫(yī)生用排除法來(lái)診斷這個(gè)女人的癥狀而最后治愈了。

但是皮查多就沒(méi)有這么幸運(yùn)了。

皮查多19歲的女兒，瑪麗蓮.羅德琳說(shuō)她的母親幾年前經(jīng)朋友介紹到一個(gè)美容師那里接受硅膠注射。

羅德琳說(shuō)美容師到布隆克斯區(qū)皮查多的家里來(lái)，也去曼哈頓和邁阿密的其他客戶家里。一杯硅膠花費(fèi)800美元，美容師每次會(huì)注射半杯到兩杯。羅德琳說(shuō)她母親并不在乎錢(qián)，而是她認(rèn)識(shí)其他以前做過(guò)的人。

皮查多相信了這個(gè)女人。“她覺(jué)得那是她的朋友，都不會(huì)錯(cuò)的”羅德琳說(shuō)。

皮查多最后一次注射是在3月17日，第二天死亡。醫(yī)生猜測(cè)她患有肺炎，羅德琳說(shuō)，家人也從沒(méi)有想到和硅膠注射有關(guān)，因?yàn)樗麄冇X(jué)得這是無(wú)害的，直到尸檢發(fā)現(xiàn)真相。

醫(yī)學(xué)鑒定人員認(rèn)定她的死亡是謀殺因?yàn)榻o她注射的是沒(méi)有醫(yī)學(xué)執(zhí)照的從業(yè)醫(yī)師，法醫(yī)鑒定發(fā)言人Ellen Borakove說(shuō)。沒(méi)有指控記錄在案，警察發(fā)言人保羅 J.布萊恩說(shuō)，“我們相信她已經(jīng)逃往多米尼加，我們?cè)谕�地區(qū)律師討論如何進(jìn)行下一步行動(dòng)。”

羅德琳說(shuō)她的家庭不甚其擾，但是很難因此生氣。在她母親死后美容師還前來(lái)哀悼，她說(shuō)，“我們不覺(jué)得她這是有目的的行為。”