Epstein-Barr-virus-positive large B-cell lymphoma associated with breast implants: an analysis of eight patients suggesting a possible pathogenetic relationship.

Breast implant anaplastic large cell lymphoma (ALCL) is a T-cell neoplasm arising around textured breast implants that was recognized recently as a distinct entity by the World Health Organization. Rarely, other types of lymphoma have been reported in patients with breast implants, raising the possibility of a pathogenetic relationship between breast implants and other types of lymphoma. We report eight cases of Epstein-Barr virus (EBV)-positive large B-cell lymphoma associated with breast implants. One of these cases was invasive, and the other seven neoplasms were noninvasive and showed morphologic overlap with breast implant ALCL. All eight cases expressed B-cell markers, had a non-germinal center B-cell immunophenotype, and were EBV+ with a latency type III pattern of infection. We compared the noninvasive EBV+ large B-cell lymphoma cases with a cohort of breast implant ALCL cases matched for clinical and pathologic stage. The EBV+ large B-cell lymphoma cases more frequently showed a thicker capsule, and more often were associated with calcification and prominent lymphoid aggregates outside of the capsule. The EBV+ B-cell lymphoma cells were more often arranged within necrotic fibrinoid material in a layered pattern. We believe that this case series highlights many morphologic similarities between EBV+ large B-cell lymphoma and breast implant ALCL. The data presented suggest a pathogenetic role for breast implants (as well as EBV) in the pathogenesis of EBV+ large B-cell lymphoma. We also provide some histologic findings useful for distinguishing EBV+ large B-cell lymphoma from breast implant ALCL in this clinical setting.

Poly-4-Hydroxybutyrate (P4HB) Scaffold Internal Support: Preliminary Experience with Direct Implant Opposition During Complex Breast Revisions.

BACKGROUND: The GalaFLEX scaffold is a mesh composed of resorbable poly-4-hydroxybutyrate (P4HB) monofilament fibers that aids in providing immediate internal soft tissue support, similar to that offered by an underwire bra, after breast reduction, lift, or augmentation. OBJECTIVES: Our goal was to explore the possibility of using GalaFLEX as an internal support to prevent future sagging, predominantly in the lower pole of the breast. This preliminary study investigated GalaFLEX as a direct alternative to implants in a variety of complex revisional breast cases. Our intention was to establish a safety and efficacy profile in an effort to promote further investigation. METHODS: A retrospective case series of 5 patients over 2 years were evaluated. Inclusion criteria were capsular contracture with concerns over soft tissue coverage and future ptosis, along with complicated muscle coverage deficits secondary to plane switching. RESULTS: A retrospective review of photographs taken at the most recent follow-up consistently showed retention of implant position and soft implants. Additionally, patients presented with a mean ± SD Baker Grade Contraction score of 2.8 ± 0.9189 preoperatively compared with a score of 1 ± 0 postoperatively. CONCLUSIONS: This preliminary study shows the initial safety of GalaFLEX but indicates the need for a multicenter, exhaustive study. Its versatility for complex revisional cases combined with acceptable aesthetic outcomes makes GalaFLEX an invaluable tool for plastic surgeons to consider.

Combining Microfocused Ultrasound With Botulinum Toxin and Temporary and Semi-Permanent Dermal Fillers: Safety and Current Use.

BACKGROUND: A microfocused ultrasound system with visualization (MFU-V) is currently indicated for use as a noninvasive dermatological aesthetic treatment to lift the eyebrows, lax submental and neck tissue, and improve lines and wrinkles of the décolleté. OBJECTIVE: To determine the existence of any safety signals when combining MFU-V with botulinum toxin-A and/or semipermanent and temporary dermal fillers. MATERIALS AND METHODS: A retrospective chart review was performed using subjects who received aesthetic treatments including incobotulinumtoxinA injection, cohesive polydensified matrix hyaluronic acid (CPM HA) dermal fillers, and calcium hydroxylapatite (CaHA) dermal fillers within 6 months of treatment with MFU-V in the same or different anatomic areas. RESULTS: All subjects (N = 101; 96 female; 25-70 year old) received MFU-V, 18% received incobotulinumtoxinA injections, and 81% were treated with CPM HA and/or CaHA fillers. Seven adverse events (7%) were reported: bruising/purpura (n = 4), swelling (n = 1), paresthesia (n = 1), and herpes simplex virus (HSV) outbreak (n = 1). Only the HSV outbreak was considered to be related to combined treatments. CONCLUSION: Although limited by relatively few subjects, the results of the present study suggest that the safety profile of MFU-V combined with other aesthetic products is consistent with the safety profiles of the individual treatments.

Shoelace Breast Cast.

Implant malposition after breast augmentation surgery remains a common complication. Several surgical options exist to correct the resultant deformity; however, all involve additional risks, costs, and the increased potential for patient dissatisfaction. In my practice, I have developed a nonsurgical therapy using shoelaces, which, when tied and placed in a certain fashion, can correct this deformity. When worn continuously, the shoelaces act as an external breast cast that allows the inframammary fold to be set and heal in the correct position. I have achieved great success in using this nonsurgical technique, and it allows me to be aggressive in cases where I need to raise the inframammary fold because I know that I can easily correct if the fold is lowered too much.

Acute adipocyte viability after third-generation ultrasound-assisted liposuction.

BACKGROUND: Although clinical evidence of successful autologous fat transfer (AFT) using third-generation ultrasound-assisted liposuction (UAL) is readily available, no study has quantified adipocyte viability using standardized methods. OBJECTIVES: The authors assess acute adipocyte viability following fat aspiration as a first step in determining the overall efficacy of using third-generation UAL for AFT. METHODS: Lipoaspirate samples were collected from patients who underwent elective liposuction procedures at multiple surgery centers. Patients with a history of bleeding disorders, diabetes, human immunodeficiency virus, or lipoatrophy disorders were excluded. The UAL system (VASER; Sound Surgical Technologies, Inc, Louisville, Colorado) was set at 60% amplitude in pulsed mode with vacuum aspiration of 15 in Hg or less. Laboratory analysis included free lipid volume, viability via lipolysis and propidium iodide staining, and cytological analysis, including cell surface protein examination and hematoxylin and eosin staining. RESULTS: The lipolysis assay revealed metabolically active adipocytes with a mean (SD) correlative viability of 85.1% (11%). Direct measures of acute viability via propidium iodide staining resulted in a mean (SD) viability measure of 88.7% (3.5%). Both mean values are within the historical range reported from syringe and vacuum-assisted lipoaspiration. Aqueous and lipid contents were favorably reduced after washing and filtering (Puregraft system; Cytori Therapeutics, Inc, San Diego, California). Cellular phenotypes identified were primarily white blood cells or vascular endothelial and vascular associated cells. CONCLUSIONS: Adipose tissue acquired via third-generation UAL is viable at harvest and is potentially a suitable source for autologous fat grafts. These results confirm reported clinical successes utilizing third-generation ultrasound lipoaspirate for AFT.

Malar augmentation with a polymethylmethacrylate-enhanced filler: assessment of a 12-month open-label pilot study.

BACKGROUND: Most filler procedures in the United States are performed with hyaluronic acid (HA) derivatives. Artefill (Suneva Medical, Inc, San Diego, California), the only polymethylmethacrylate (PMMA)-enhanced dermal filler approved by the US Food and Drug Administration (FDA), has been well tolerated by patients for treatment of nasolabial folds and has a safety profile similar to other approved fillers. OBJECTIVES: The authors investigate the safety and efficacy of Artefill for malar augmentation. METHODS: This prospective, multisite, open-label study included a total of 24 patients with age-related lipoatrophy. Only patients with mild to moderate lipoatrophy were considered candidates for treatment. Artefill was injected in the supraperiosteal layer of the malar region, at a maximum volume of 6 mL (3 mL/side). Touch-up injections were performed at weeks 4 and 6, up to a maximum total volume of 8.8 mL. Standardized assessments of results were made at 2, 6, and 12 months. Outcome measures included the Global Aesthetic Improvement Scale (GAIS), change in malar lipoatrophy grade, and patient satisfaction. Standardized photographs of each patient were collected. RESULTS: Average patient age was 48 ± 5 years. Average volume of injections was 5.55 ± 1.87 mL. Based on both the patient- and physician-rated GAIS, 95.8% of study participants were reported as being "improved" or "very much improved." The change in malar lipoatrophy grade was significantly improved from baseline to 1 year by 0.96 ± 0.98 (P < .0003). Patients also reported high levels of satisfaction, with 87.5% being "satisfied" or "very satisfied." There were no reported adverse safety events in the study. CONCLUSIONS: Artefill demonstrated improvement in malar atrophy with a high level of patient satisfaction and an excellent safety profile. The absence of any adverse events in our study patients was notable, and we believe this is a result of the uniform nature of the PMMA particles in the Artefill and the strict and sterile manner in which this PMMA dermal filler is produced.

Recovery of surface bacteria from and surface sanitization of cantaloupes.

Practical, effective methods that could be implemented in a food service establishment (restaurant or delicatessen) for the surface sanitization of cantaloupes were microbiologically evaluated. Cantaloupes (Cucumis melo L. var. reticulates) were immersed in an inoculum containing Salmonella enterica serovar Poona or Pantoea agglomerans at ca. 10(4) to 10(5) CFU/ml. An efficient method for the recovery of bacteria from the cantaloupe surface was developed and validated. The method consisted of washing the entire melon with Butterfield's buffer containing 1% Tween 80 in a plastic bag placed inside a plastic pail affixed to an orbital shaker. Levels of S. enterica Poona recovered by washing the entire melon were significantly higher than those recovered by the more common laboratory method of blending the rind. P. agglomerans can be used as a non-pathogenic proxy for S. enterica Poona. A three-compartment surface sanitization method consisting of washing with an antimicrobial soap solution, scrubbing with a brush in tap water, and immersion in 150 ppm of sodium hypochlorite reduced the initial level of recoverable viable bacteria by 99.8%. When examined separately, scrubbing with a vegetable brush in tap water, washing with soap, and dipping in chlorine were found to reduce the bacterial load by 70, 80, and 90%, respectively.

Participant blinding and gastrointestinal illness in a randomized, controlled trial of an in-home drinking water intervention.

We conducted a randomized, triple-blinded home drinking water intervention trial to determine if a large study could be undertaken while successfully blinding participants. Households were randomized 50:50 to use externally identical active or sham treatment devices. We measured the effectiveness of blinding of participants by using a published blinding index in which values >0.5 indicate successful blinding. The principal health outcome measured was "highly credible gastrointestinal illness" (HCGI). Participants (n=236) from 77 households were successfully blinded to their treatment assignment. At the end of the study, the blinding index was 0.64 (95% confidence interval 0.51-0.78). There were 103 episodes of HCGI during 10,790 person-days at risk in the sham group and 82 episodes during 11,380 person-days at risk in the active treatment group. The incidence rate ratio of disease (adjusted for the clustered sampling) was 1.32 (95% CI 0.75, 2.33) and the attributable risk was 0.24 (95% CI -0.33, 0.57). These data confirm that participants can be successfully blinded to treatment group assignment during a randomized trial of an in-home drinking water intervention.

Number of Clostridium botulinum Spores in Honey.

A dialysis-enrichment culture method for detecting Clostridium botulinum spores in honey is described. The method was used to survey 55 honey samples representative of 53 lots being sold at retail and 186 honey collections from 154 individual producers. Based on finding the organism in at least one of three 25-g test portions of a sample, one type A and one type B positive were found among the retail samples. Type A spores were found in collections of five different producers and type B in those of five others. Five of 13 different lots from one producer were positive for type A spores. One producer sample had both types A and B spores. Maximum most probable number by the five-tube method was seven botulinum spores (upper 95% confidence limit of 17) per 25 g of sample.