Treatment of Complications After Minimally Invasive Breast Augmentation with Aquafilling Gel.

INTRODUCTION: Recent studies have revealed that Aquafilling gel used for breast augmentation causes complications. In this study, we investigated which surgical approach should be used to treat these complications. MATERIALS AND METHODS: This observational cohort study analysed the data of 31 women suffering from complications after breast enlargement with Aquafilling injection who were treated at our department in 2016-2021. Patients underwent either conservative or radical surgery. GraphPad Prism 9 (GraphPad Software, La Jolla, CA, USA) was used for data processing. RESULTS: Approximately 88.89% of patients after conservative surgery required reoperation, while only 22.73% of patients treated radically needed revision surgery. Every patient who underwent an attempt to remove the gel via needle prior to admission required surgery. Seventy-five per cent of them had positive culture swabs, whereas only 26.09% of patients who did not undergo needle aspiration had positive cultures. A positive correlation between the volume of injected filler and the number of symptoms was observed. CONCLUSIONS: In addition to irrigation and drainage, Aquafilling removal should include infiltrated tissue excision during primary surgery. Moreover, needle aspiration of the filler is ineffective, and it may lead to a gel infection. Furthermore, the more filler is injected, the higher the number of complications observed. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Distal Hand Migration of Polyacrylamide Gel after Breast Augmentation: A Case Report and Review of the Literature.

Breast augmentation is one of the most popular cosmetic surgery procedures in the world and it requires a comprehensive study of the methods performed. As less-invasive techniques are sought, tissue fillers have found its purpose in these procedures. However, it has been revealed that some of them may be associated with serious complications. One of them is the Aquafilling/Los Deline gel. A case report of a female patient who developed unprecedented sequelae after Aquafilling injection-distant migration of the gel in the hand-was presented in this study. The patient underwent total gel removal from the left forearm, arm, and both breasts as well as wound debridement and irrigation. We discovered a canal connecting the left breast to the left forearm, created by a polyacrylamide hydrogel dislocation. It was thoroughly revised using an endoscope. Despite the advantages of tissue fillers such as simplicity of use and less invasiveness, certain complications can occur after injection. Although a few of them have been banned due to these sequelae, new ones continue to appear. Every new product should be examined very carefully before it is introduced to the market.

Bilateral DIEP flap breast reconstruction with simultaneous unilateral nipple-sparing mastectomy - case report.

With the steady increase in the incidence of breast cancer in women, treatment that includes not only tumor removal but also breast reconstruction is becoming a more relevant issue for oncologic and plastic surgeons. Mastectomy recently evolved as a form of primary prevention of hereditary breast cancer, commonly performed in combination with simultaneous reconstruction. A case of 44-year-old woman who underwent right mastectomy with adjuvant radiotherapy is presented. Due to the patient's positivity for BRCA1 mutation and her wishes, a risk-reducing mastectomy with nipple-areola complex preservation and bilateral deep inferior epigastric artery perforator flap reconstruction were performed in one-stage. In selected cases this method appears to be the best possible procedure for simultaneous preventative and reconstructive management in patients with genetically determined breast cancer who have undergone mastectomy with radiotherapy.

Autoimmune syndrome induced by adjuvants after breast enhancement with polyacrylamide hydrogel: a study in Poland.

Autoimmune syndrome induced by adjuvants (ASIA) is the spectrum of diseases in which the substances considered inert to the body induce autoimmune reactions and inflammation. Some of the biomaterials recently used in plastic surgery, such as silicone or polyacrylamide hydrogel (PAAG) seem to trigger clinical features of ASIA. The aim of this study was to assess the incidence of these features within a group of women after breast augmentation with PAAG. As many as 30 consecutive patients (26-59 years, mean age 39.5) referred to the Clinic of Plastic Surgery after breast enhancement with PAAG were examined. The validated criteria of ASIA syndrome were employed. Descriptive statistics were chosen based on the distribution of variables. The research was approved by the Bioethical Committee of the Centre of Postgraduate Medical Education in Warsaw, Poland. Within the studied group, 50% of patients (n = 15) fulfilled ASIA diagnostic criteria. Apart from local complications, we encountered various general symptoms, among which fever (n = 13, 43.3%), tingling and numbness of upper extremities (n = 10, 33.3%) and chronic fatigue (n = 9, 30%) were the most common. These symptoms were present on an ambulatory visit, before qualification to the operation of hydrogel removal. All patients undergoing surgical PAAG removal (n = 8) declared alleviation or complete resolution of the symptoms. Polyacrylamide hydrogel breast filling, although limiting the invasiveness of the procedure in relation to silicone breast implants, also carries the risk of developing ASIA symptoms. The removal of PAAG may bring improvement in some cases.

Expression of resistin in the liver of patients with non-alcoholic fatty liver disease.

Adipokines are cytokines that presumably connect the pathologies of metabolic syndrome. One of the adipokines is resistin, the role of which in insulin resistance, obesity, and non-alcoholic fatty liver disease (NAFLD) needs to be determined. Liver biopsy specimens were obtained intraoperatively from 214 obese patients. Histological assessment was based on NAFLD activity score according to Kleiner. Statistical analysis involved semi-quantitive immunohistochemistry assessment of resistin staining and: NAFLD status in obese patients compared with a non-obese control group, selected clinical data (age, sex, body mass index - BMI), selected biochemical data, comorbidities (hypertension, type 2 diabetes mellitus, dyslipidaemia), and metformin treatment in patients with type 2 diabetes mellitus. Resistin expression was observed in the histiocytes of inflammatory infiltrate, Kupffer cells, and histiocytes surrounding the hepatocytes with steatosis. There was a positive correlation between the total expression of resistin and: (1) NAFLD advancement (NAFLD Activity Score- NAS), (2) AST, ALT, BMI, glucose, insulin, Homeostasis Model Assessment (HOMA), LDH, GGT, triglycerides (TG), and glycated haemoglobin (HbA1c). Resistin expression was more intense in patients with type 2 diabetes mellitus and dyslipidaemia and less intense in the control group. Resistin probably plays a role in the pathogenesis of hepatic insulin resistance and aggravates pathologic changes in the liver of patients with NAFLD.

Results of liver transplantation in the Department of General, Transplant and Liver Surgery at the Medical University of Warsaw in patients with chronic hepatitis B and C viruses infection.

INTRODUCTION: Cirrhosis related to hepatitis C virus (HCV) and hepatitis B virus (HBV) infection is the most frequent indication for liver transplantation worldwide. Progress in prophylaxis of posttransplant HBV recurrence has led to major improvements in long-term outcomes of patients after liver transplantation. Conversely, impaired posttransplant survival of patients with HCV infection was reported in several studies, mainly due to recurrence of viral infection. The purpose of this study was to compare long-term results of liver transplantation between patients with HBV monoinfection, HCV monoinfection and HBV/HCV coinfection. MATERIAL AND METHODS: A total of 1090 liver transplantations were performed in the Department of General, Transplant and Liver Surgery in cooperation with the Department of Immunology, Internal Medicine, and Transplantology at the Transplantation Institute Medical University of Warsaw between December 1994 and May 2012. After exclusion of patients with cirrhosis of non-viral etiology, patients with malignant tumors, and patients with acute liver failure, the final study cohort comprised 209 patients with HBV (HBV+/HCV- subgroup; n = 56) or HCV (HBV-/HCV+ subgroup; n = 119) monoinfection or HBV/HCV coinfection (HBV+/HCV+; n = 34). These subgroups of patients were compared in terms of long-term results of transplantations, defined by 5-year patient and 5-year graft survival estimates. RESULTS: Overall and graft survival rates after 5-years for the whole study cohort were 74.5% and 72.6%, respectively. Five-year overall survival was 70.4% for patients within the HBV+/HCV- subgroup, 77.8% for patients within the HBV-/HCV+ subgroup, and 68.5% for patients within the HBV+/HCV+ subgroup. The corresponding rates of graft survival were 67.0%, 76.3%, and 68.5% for patients within the HBV+/HCV-, HBV-/ HCV+, and HBV+/HCV+ subgroups, respectively. Observed differences were non-significant, both in terms of overall (p = 0.472) and graft (p = 0.461) survival rates. CONCLUSIONS: Both overall and graft survival rates after liver transplantations performed in the Department of General, Transplant and Liver Surgery in cooperation with the Department of Immunology, Internal Medicine, and Transplantology at the Transplantation Institute Medical University of Warsaw in patients with HBV and HCV infection are comparable to those reported by other European and American centers. In contrast to other studies, obtained results do not confirm the negative impact of HCV infection on long-term outcomes of patients.

Bilateral risk-reducing mastectomy - surgical procedure, complications and financial benefit.

Risk-reducing mastectomy is a recognized prophylactic treatment for women at high and very high risk of breast cancer development in many countries. In surgical treatment, mastectomy with simultaneous reconstruction is preferred. The most common method is simultaneous reconstruction with the use of implants, but an equivalent method with a comparable or lower complication rate is simultaneous reconstruction with own tissues, taking into account free tissue flaps. The patient should be informed about the high risk of complications, possible deterioration of the life quality and high rate of corrective reoperations. In order for this form of the most effective and financially measurable health prophylaxis to be actually implemented, it is necessary to rationally evaluate the procedure and differentiate its costs depending on the type of reconstruction performed.

C4d in acute rejection after liver transplantation and its usefulness in differential diagnosis between acute liver rejection and hepatitis C recurrence.

BACKGROUND: Acute liver graft rejection is still a common complication after liver transplantations. The diagnostics of this process is based on histological findings, resembling the presentation of HCV infection. Correct differentiation between acute rejection and recurrent HCV hepatitis is very important because of differences in treatment. From the practical point of view, C4d could be used in liver transplantology for differential diagnostics of acute graft rejection and recurrence of HCV infection. MATERIAL AND METHODS: The study was performed in liver graft biopsies obtained from 57 patients with acute rejection and from 26 patients with hepatitis C recurrence. The sections were probed immunohistochemically using antibody specific to C4d. The following parameters were analyzed statistically: the percentage of immunoreactive biopsies, the localization of C4d deposits, and the relationships between C4d-positive biopsies with acute rejection and hepatitis C recurrence. RESULTS: Within liver graft biopsies with acute rejection and hepatitis C recurrence, the immunoreactivities of C4d were present almost exclusively along venous, arterial, and arteriolar endothelium in the portal spaces. C4d deposits were found in 33 patients with acute rejection (57.9%) and in 17 patients with hepatitis C recurrence (65.38%). The study demonstrated no statistically significant difference in C4d expression in liver biopsies from acute graft rejection patients as compared with HCV infection recurrence (chi-squared =1.5566774 df=1 p=0.45560). Both groups demonstrated positive reactions within biopsies. CONCLUSIONS: Our results suggest that C4d deposits are insufficient in differentiation between both examined liver pathologies, but could be a useful marker in the diagnostics of acute liver rejection with humoral component.

Is tumour size a contraindication to laparoscopic adrenalectomy? Case report.

The authors present a case report of a patient with a large, hormonally silent tumour of the right adrenal gland. Due to the patient's numerous strains, the necessity of two gynaecological operations, and treatment of broken bones, adrenalectomy was contraindicated for 2 years. After that time, the size of the tumour reached 18 cm × 12 cm. The patient was selected for laparoscopic adrenalectomy, which was successful. The size of the tumour and performed abdominal surgery did not constitute substantial obstacles, and the less invasive procedure was additionally justified by computed tomography and magnetic resonance imaging results, which demonstrated a benign lesion.

1000 liver transplantations at the Department of General, Transplant and Liver Surgery, Medical University of Warsaw--analysis of indications and results.

THE AIM OF THE STUDY: was to analyze indications and results of the first one thousand liver transplantations at Chair and Clinic of General, Transplantation and Liver Surgery, Medical University of Warsaw. MATERIAL AND METHODS: Data from 1000 transplantations (944 patients) performed at Chair and Clinic of General, Transplantation and Liver Surgery between 1994 and 2011 were analyzed retrospectively. These included 943 first transplantations and 55 retransplantations and 2 re-retransplantations. Frequency of particular indications for first transplantation and retransplantations was established. Perioperative mortality was defined as death within 30 days after the transplantation. Kaplan-Meier survival analysis was used to estimate 5-year patient and graft survival. RESULTS: The most common indications for first transplantation included: liver failure caused by hepatitis C infection (27.8%) and hepatitis B infection (18%) and alcoholic liver disease (17.7%). Early (< 6 months) and late (> 6 months) retransplantations were dominated by hepatic artery thrombosis (54.3%) and recurrence of the underlying disease (45%). Perioperative mortality rate was 8.9% for first transplantations and 34.5% for retransplantations. Five-year patient and graft survival rate was 74.3% and 71%, respectively, after first transplantations and 54.7% and 52.9%, respectively, after retransplantations. CONCLUSIONS: Development of liver transplantation program provided more than 1000 transplantations and excellent long-term results. Liver failure caused by hepatitis C and B infections remains the most common cause of liver transplantation and structure of other indications is consistent with European data.

Combined therapy: surgery and intraoperative HDR brachytherapy for locally advanced and recurrent rectal cancer. Practical experience of Brachytherapy Department in Warsaw.

PURPOSE: Patients with locally advanced and recurrent rectal cancer have a dismal prognosis. The aim of proposed combined therapy - surgery and intraoperative brachytherapy, is to improve results of already applied methods and to define optimal group of patients for this treatment. We introduce practical experience of Brachytherapy Department in Cancer Centre - Institute in Warsaw. MATERIAL AND METHODS: Patients with primary T4NxM0 rectal cancer and isolated local pelvic recurrence were qualified for therapy. Between January 2005 and September 2008, 13 patients were included: 4 with primary cancer and 9 with recurrence, median age of 56. After surgical resection intraoperative radiotherapy was delivered with boost of high dose rate brachytherapy of 20Gy dose to the tumor bed. RESULTS: Primary point of the study is to evaluate impact of applied therapy on local control (LC), overall survival (OS) and disease free survival (DFS). Median follow-up is 16 months. Four of the patients died and 3 survivors are disease-free. There was no case of perioperative mortality. CONCLUSIONS: A multimodality approach, using surgical resection with intra operative brachytherapy improves local control as well as patients survival in comparison with historical treatment group. Combined therapy is related to high morbidity, but low mortality. The preliminary observations seem to correspond with other authors data.