Cutaneous manifestation of silicone dissemination from a PIP implant--a case for prophylactic explantation?

The recent withdrawal of PIP (Poly Implant Prosthese, France) implants for breast augmentation enforced by the Medicines and Healthcare products Regulatory Agency (MHRA) on 31st March 2010 has ignited speculation into possible side effects relating to an unauthorized gel fill content. Local and migratory silicone granulomata and regional lymphadenopathy are well reported in the literature. Gel bleed from high cohesive gel implants with similar effect is also well known. However dissemination to sites distant from the breast manifest as cutaneous abnormalities in a patient implanted with a PIP product raises concern. We report such a case.

A modification in technique of abductor digiti minimi (Huber) opponensplasty.

Abductor digiti minimi opponensplasty is a well-established method of restoring opposition following median nerve trauma or in congenital deficiency of thenar intrinsic musculature. The abductor digiti minimi is detached distally and rerouted through a subcutaneous tunnel for insertion into the area of the thumb metacarpophalangeal joint. The pivot point for this rotation is the pisiform bone and it is at this site that the ulnar nerve is vulnerable to compression by the transferred muscle. We describe a modification of technique which involves complete islanding of the muscle without re-insertion of its proximal end. This eliminates the possibility of this complication without detracting from the efficacy of opposition produced by the transferred muscle.

A snake in the clinical grass: late compartment syndrome in a child bitten by an adder.

Snakebite envenomation is an uncommon condition in the UK, but requires vigilance with regard to both the systemic effects of the venom and the locoregional impact on the soft tissues. We describe a case requiring delayed fasciotomies for closed compartment syndrome of the leg and thigh, and discuss in detail the controversies surrounding decompression in such a case. Adder bites are uncommon in the UK, but can result in envenomation of varying severity. Apart from the numerous possible systemic effects that require attention, there are local effects that, very rarely, can be limb threatening. Of these, elevated limb compartment pressures are of paramount importance, and recognition of closed compartment ischaemia is vital if the limb is to be saved by surgical decompression. Guidelines on threshold compartment pressures and fasciotomies are indistinct regarding snakebite, with diagnostic emphasis still placed on clinical signs and symptoms. In the paediatric setting, measurement of compartment pressures is a valuable adjunct to clinical suspicion in the diagnosis of acute compartment syndrome secondary to snakebite.

Effects of Pluronic F-68 on 2-deoxyglucose uptake and amino acid incorporation into chick embryonic fibroblasts in vitro.

The effects of the nonionic surfactant Pluronic F-68 on 2-deoxyglucose uptake and amino acid incorporation in vitro into chick embryonic fibroblasts prepared from day 7 embryos have been studied. During early culture growth (3-10 days), Pluronic supplementation at 0.05% (w/v), but not at 0.1%, stimulated 2-deoxyglucose uptake by 20%-30% above control levels. Pluronic also markedly increased amino acid incorporation, maximally at 3 days of culture (200%-300% above control levels with 0.1% and 0.05% Pluronic, respectively), but to a lesser extent thereafter. These effects of Pluronic were seen only when freshly-prepared solutions were used; 'aged' solutions produced no comparable stimulation of 2-deoxy-glucose uptake or amino acid incorporation.