Bilateral breast implant associated chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL): A case report.

INTRODUCTION: An estimated 30.000 breast implants are placed in the Netherlands annually. An increasing amount of reports have linked implants to the rare anaplastic large cell lymphoma (ALCL). Other implant-related lymphomas, such as those of B-cell lineage, are much rarer. PRESENTATION OF CASE: A 62-year-old female presented with pain and Baker grade III capsular contraction of the right breast. Subpectorally placed textured anatomical implants had been in situ for 26 years after cosmetic augmentation. Magnetic Resonance Imaging (MRI) showed bilateral implant leakage. Explantation of both implants confirmed bilateral leakage after which symptoms went into remission. Three months later our patient noticed an erythematous area, scar swelling and serous fluid leakage on the lateral side of the inframammary fold of the right breast. Siliconomas were excised bilaterally together with a partial capsulectomy on the left. Histopathology and immunohistochemical analysis showed monotonous small cell B-lymphocytic infiltration (CD20+, CD5+, CD23+, ALK-) in both capsules, highly suggestive for chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL). DISCUSSION: CLL/SLL are classified as nearly the same disease. The primary difference is the localization; CLL is found the bone marrow and blood whereas SLL is predominantly in the lymph nodes and spleen. There are no previous descriptions of bilateral CLL/SLL found in periprosthetic capsules. CONCLUSION: Breast implants are increasingly linked to various malignancies. In most cases, including our patient, implant explantation together with long-term follow-up suffices. MRI yields additional value in early stage diagnosis. More research is required to further optimize multidisciplinary care and improve patient outcomes.

[Local anaesthetics containing epinephrine for use in the hand and fingers]. / Lokale anesthesie met adrenaline in hand en vingers.

In the Netherlands there is no consensus regarding the addition of epinephrine (adrenaline) to local anaesthetics for use in the fingers. This is based on the persistent belief that the addition of epinephrine to local anaesthetics for use in the fingers is contraindicated due to the risk of ischaemic complications. Ischaemic complications arising from the use of modern anaesthetics containing epinephrine have, however, never been described. The addition of epinephrine results in a reduced arterial blood-flow and has several benefits, such as reduced blood loss and extended duration of anaesthesia. Local anaesthesia containing epinephrine enables relatively extensive surgical procedures to be carried out on the extremities without the customary use of a tourniquet. Preoperative threat of reduced circulation in the fingers is a contraindication for the use of local anaesthetics with added epinephrine.

Hypothenar hammer syndrome: distal ulnar artery reconstruction with autologous descending branch of the lateral circumflex femoral artery.

Repetitive trauma to the hypothenar eminence can cause the ulnar artery to become aneurysmal, thrombose, or send emboli to the digital arteries. The symptoms and signs are also known as the hypothenar hammer syndrome. We postulate that an arterial autograft is a superior conduit to the traditional vein graft. In this article, we report 3 cases (2 in 1 patient) of reconstruction of the distal ulnar artery with the descending branch of the lateral circumflex femoral artery (LCFA). Two patients, ages 45 to 50 years, had severe ischemic complaints of the ulnar fingers. Arteriograms confirmed occlusion of the distal ulnar artery without direct perfusion of the superficial palmar arch. All reconstructions were carried out with the descending branch of the LCFA. From the ulnar artery at wrist level to the superficial palmar arch and the involved common digital arteries. Patency was certified during follow-up with color-coded Duplex sonography at 6 to 28 months. Preoperative complaints like cold intolerance and other ischemic symptoms disappeared.

Nerve decompression surgery as treatment for peripheral diabetic neuropathy: literature overview and awareness among medical professionals.

Peripheral diabetic neuropathy (PDN) is one of the major complications arising in patients with diabetes. Since PDN is traditionally considered an irreversible disorder, treatment has been aimed to prevent the development of complications. In a novel concept, however, it is postulated that decompression surgery of the affected nerve may reverse the natural course of PDN. In this review, we will discuss experimental and human studies that addressed the value of nerve decompression surgery in PDN. Furthermore, we report on the awareness of this novel treatment strategy among medical professionals that are primarily involved in diabetes care.