Polyacrylamide gel treatment of antiretroviral therapy-induced facial lipoatrophy in HIV patients.

BACKGROUND: Today, highly active antiretroviral therapy is lifesaving for most HIV-infected patients, but the treatment can result in facial lipoatrophy, which changes the face so radically that patients may develop severe psychological and social problems. Since 2001 polyacrylamide gel (PAAG) has been used successfully in HIV patients abroad. This article describes the results of a Danish study. METHODS: Forty HIV patients recruited from two major referral hospitals in the capitol area of Copenhagen, Denmark, each received a series of PAAG gel injections (small deposits in several sessions) with a 14-day interval. Patient satisfaction, injector's evaluation, evaluation by an external specialist in plastic surgery, and long-term aesthetic effect and complications were registered with follow-up until 2 years. RESULTS: All patients were very satisfied or satisfied with the result. The injector found the result very satisfying in 33 cases and a slight irregularity in 7. The external specialist found improvement in all cases with a one-grade reduction of the lipoatrophy in 11 cases, a two-grade reduction in 20, and a three-grade reduction in 3 cases. No filler-associated complications were recorded. CONCLUSION: This study has shown that PAAG can normalize contours in patients suffering from facial lipoatrophy within 3-6 sessions, with a mean amount of gel per session of 1.8 ml and a mean total amount of 8.8 ml. The results are in accordance with those of other large studies, confirming a high degree of biocompatibility and safety.

[Primary mucinous carcinoma of the skin--a literature review]. / Primaert mucinøst karcinom i huden--en oversigt over litteraturen.

Primary mucinous carcinoma of the skin (PKMK) is a rare malignant tumour of the sweat glands. It is often misdiagnosed as it has an uncharacteristic gross appearance - and may microscopically resemble a cutaneous metastasis from a mucinous carcinoma of the breast, gastrointestinal tract, lungs, ovaries or prostate. The recurrence rate is high, but mortality is low. A MEDLINE literature search was performed for reports on PKMK. A total of 228 cases were identified. These are presented with regard to tumour characteristics and clinical features as well as histopathological and immunohistochemical findings.

The diagnosis of silicone breast-implant rupture: clinical findings compared with findings at magnetic resonance imaging.

The objective was to evaluate the usefulness of clinical examination in the evaluation of breast-implant integrity, using the diagnosis at magnetic resonance imaging (MRI) as the "gold standard." Fifty-five women with 109 implants underwent a breast examination either just before or shortly after an MRI examination. Twenty-four of 109 implants were clinically diagnosed with possible rupture or rupture. Eighteen of the 24 implants were ruptured according to the MRI examination (75%). Eighty-five implants were clinically classified as intact, and 43 of these were actually ruptured at MRI (51%). The sensitivity of the clinical examination for diagnosing rupture was thus 30% and the specificity 88%. The positive predictive value of a clinical diagnosis of rupture was 75%, and the negative predictive value was 49%. In this study, we found that when a clinical examination is used as the sole diagnostic tool to identify implant rupture, neither the sensitivity nor the specificity is acceptable.