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Background: Recently there have been concerns raised about anaplastic large cell lymphoma (ALCL) associated with breast implants., Objectives: The main aim of this article was to review and analyze the published literature specifically for hematopoietic malignancies associated with breast implants and postulate a hypothesis for their etiology and pathogenesis., Methods: The PubMed database was searched using key words "lymphoma" and "breast implants" for published papers and abstracts on implant-associated hematopoietic malignancies., Results: The authors found 83 published cases reported of lymphomas associated with breast implants in the medical literature. The reported cases involved various subtypes of lymphomas and the majority were ALCL, of which 66 were confirmed as ALK negative; however there was no association with any particular type of implant. The more aggressive cases and reported low death rate appeared to be related to the presence of breast masses at the time of presentation rather than effusion. The remaining reports were occasional case reports of T-cell lymphoma, follicular lymphoma, marginal zone B-cell lymphoma, primary effusion lymphoma and lymphoplasmacytic lymphoma., Conclusions: Considering the many thousands of women that have breast implants every year; the compiled data show that there is a very small risk of developing lymphoma. Increased awareness of association between implants and ALCL is needed globally and prospective patients considering breast implants should be fully informed of the risk. As the behavior of ALCL in these cases was indolent as compared with other primary breast lymphomas, it could suggest an abnormal reactive process., Level of Evidence: 3, (© 2015 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.)

Background: Polyurethane-coated conical implants were introduced by Silimed (US distributor: Sientra, Santa Barbara, California) in 2008 and offer an alternative to round or anatomically shaped implants. By their design and volume distribution, they naturally create central volume and give a reasonable fullness to the upper pole while lifting some ptotic breasts, thus avoiding the need for classical mastopexy., Objectives: The authors discuss the advantages of conical implants as an alternative to conventional silicone implants for women with breast ptosis., Methods: In the 2-year period between December 2010 and December 2012, a consecutive series of 302 women underwent implant-based breast surgery procedures (236 primary augmentations, 59 revisions, and 7 mastopexy-augmentations) with conical polyurethane devices. Implant volumes ranged from 225 to 560 cc, with low- to medium-profile devices predominating. No extra-high-profile implants were used. Only 1 patient had a drain inserted on completion of a revision augmentation., Results: There were no infections (0%) and no wound dehiscence (0%). Four cases required reoperation (1.3%). Patient satisfaction scores were universally high (average, 9.94/10). There have been no capsular contractures to date, but follow-up is short., Conclusion: The modern conical, polyurethane implant has many advantages over the conventional round or anatomically shaped implants and offers patients an ideal compromise between volume, natural upper pole fullness, and a lift without mastopexy scars.

Patients with severe burns are susceptible to infection with Gram-positive organisms including methicillin-resistant Staphylococcus aureus, and often require higher antibiotic dosages compared with other patients. This study examined the pharmacokinetics of a single iv dose of teicoplanin (12 mg/kg) in 15 adults and five children with severe burns. Adults were aged 21-82 years with a median total body surface area (TBSA) burn of 30% (range 15-60%). Children were aged 10 months-l0 years with median TBSA burn of 15% (10-30%). At 12 h, the median serum teicoplanin concentration was 12.8 mg/L (9.027.1 mg/L) in adults and 7.6 mg/L (6.6-l0.8 mg/L) in children, (P < 0.01); at 24 h, the corresponding values were 8.3 mg/L (4.6-l2.9 mg/L) and 5.2 mg/L (4.2-6.0 mg/L). Using a three-compartment model, the median terminal half life in adults was 114 h (47-278 h). Children fitted a two-compartment model with a terminal half-life of 38 h (2l-41 h). The median concentration of teicoplanin in fluid from the burn wound was 60% of the serum antibiotic concentration. A single iv dose of 12 mg/kg of teicoplanin was sufficient to produce therapeutic serum concentrations in burn patients for 24 h, but monitoring of antibiotic levels in serum may be advisable in those with high total clearance, especially children.

Lassa fever convalescent plasma (LFCP) has been administered to 27 patients in hospitals at Jos and Vom, Nigeria. Among serologically or virologically confirmed cases of Lassa fever (LF) given plasma on or before the 10th day, all eight survived, as did two of three possible LF cases. Of eight patients given LFCP after the 10th day, five died, as did all three possible LF cases. LFCP was also administered to five patients subsequently shown not to have LF, and to a suspected case contact; all survived without complications of therapy. There were 15 cases of LF during this time who did not receive plasma; 11 survived. Most cases of LF who received plasma and survived showed a rapid response to therapy, in contrast with the gradual recovery in those who did not receive LFCP.

Patients admitted with fever to four Liberian hospitals were tested for Lassa fever (LF) by means of the indirect fluorescent antibody technique and by virus isolation. The incidence of LF and presumptive LF among consecutive febrile adult patients was 14% and 17% in two hospitals located in the interior; no cases of LF were found among 24 consecutive patients in a hospital near the coast. In the three inland hospitals the incidence of confirmed or presumptive LF among the patients in whom the diagnosis was seriously considered varied from 13% to 36%. Lassa virus was isolated from 17 patients out of the 59 cases found in this survey. LF is a common cause of fever in northern Liberia. The diagnosis depends upon the readiness of the staff to consider the diagnosis, the collection of blood specimens at appropriate times, and the preservation of sera at sub-freezing temperatures to permit survival of active virus and its subsequent recovery in an appropriate laboratory.

In a study to assess the epidemiological and clinical aspects of endemic Lassa fever (LF) in Liberia at Curran Lutheran Hospital (CLH), 44 cases were diagnosed by virological and serological techniques over a 22-month period. During one calendar month, testing of febrile patients admitted to the medical-surgical ward revealed six cases of LF, 13% of all febrile cases and 17% of those who were tested. As the study progressed the diagnostic skills of the hospital staff improved. The most common mistake was the diagnosis of a case of LF as pneumonia; the most potentially serious diagnostic problem was differentiating LF from typhoid fever, a readily treatable infection. LF may also mimic other diseases such as aseptic meningitis, pelvic inflammatory disease, gastroenteritis or arbovirus infection. We found a previously unreported symptom of LF, rib tenderness typical of costochondritis. The mortality rate in the medical-surgical ward was 5.4%; the over-all case-fatality rate was 13.6%. Women outnumbered men by nearly three to one, and had a higher mortality particularly noted in the pregnant. LF is common at CLH, and as many as 100 cases may occur annually at this hospital.

The efficacy of passive immunization for treatment of Lassa Fever (LF) is believed to depend on the titre of the neutralizing antibody infused. For the purpose of identifying optimal donors of LV-immune plasma, a population of LF-convalescent patients in Liberia was tested for prevalence of neutralizing antibody. Minimally protective titres, expressed as a log10 neutralization index, (LNI), were established in animal models as LNI greater than 2. LNI titres for 26 donors, tested eight or more months after illness, were modest: 16 titred 1 less than LNI less than 2, 4 titred 2 greater than LNI less than 3, and only 4 titred LNI greater than 3. Sequentially obtained plasma from six donors indicated that the LNI response was delayed relative to the indirect fluorescent antibody (IFA) response, that high titres (LNI greater than 3) occurred only after seven months and in only two of six patients. Most of the unselected LV-immune plasma will require concentration to therapeutically useful LNI titres. In a passive immunization experiment, guinea-pigs were protected by a late convalescent plasma (LNI = 4.8, IFA = 320) but not by an early plasma, (LNI = 0.6, IFA = 640), thus supporting the selection of immune plasma on the basis of the LNI. Cross serological testing with LV strains and convalescent plasma from patients in Sierra Leone, Liberia and Nigeria suggested that these LV strains were indistinguishable by cross-IFA, but were readily distinguishable by cross neutralization tests. Geographical matching of LV and plasma origins may thus be a factor in selection of optimal plasma for passive immunization of Lassa fever.

The sera of 844 Liberian hospital staff memebers were positive for Lassa Virus (LV) antibodies in a survey using the indirect fluorescent antibody technique (IFAT). In two hospitals in Lofa County near the Sierra Leone border, the prevalence, 15.4%, was significantly higher than the 8.4% in seven others. There were near differences between the prevalence among laboratory workers, 15.3%, and other workers, 7.7%, and between midwifery students, 21.2%, and midwives, 4.2%, suggesting their infection from patients or their blood products. However, the over-all prevalence among those with patient contacts was the same as that among those without direct patient contact; most LV infections were apparently acquired from sources other than patients in hospital. This finding, the lack of evidence of hospital outbreaks and the presence of comparable prevalences in all age groups suggest that LV infections occur on a continuing basis in this population. In one hospital the comparison of the results of IFAT and complement fixation tests revealed some who reacted by one technique and not by the other. In one person the titre by IFAT had dropped from 1:32 to undetectable levels in two years. This finding prompts caution in the interpretation of results.

Six villages in Lofa County, north-west Liberia, and one near the coast were surveyed for the presence of indirect fluorescent antibodies (IFA) to Lassa virus (LV). Prevalences were similar among males and females, and among various age groups. The prevalence of IFA positive sera, 6.4%, in two roadside villages was significantly higher than in two matched villages "in the bush", 1.9%. It was also higher in Gbanwei, a roadside village which did not maintain traditional sanitary measures, than in Zuwulo, similarly located but with maintenance of clean-swept areas without shrubbery or rubble between the houses. In another pair of villages, the one adjacent to a Mission Clinic with a very high prevalence of IFA positive staff members had significantly higher prevalence, 14.1%, than did the other, a roadside village with 5.1% seropositives. LV antibodies were also found in 4.3% of the inhabitants of a small coastal village near Robertsfield International Airport. Though LV infections are more common in villages in which traditional practices have been modified, they are present even in villages which are relatively unchanged. In the former they appear to be continuous while sporadic in the latter. The prevalences of IFA in the villages with the highest rates are about one third of what is found in personnel of hospitals near them, suggesting that hospital staff members acquire infections from patients as well as from the communities in which they live.

Sixty-three virus isolates were obtained by inoculation of Vero cells with sera from 50 hospital in-patients in Liberia with acute febrile illnesses. 57 of the isolates were presumptively identified as Lassa virus (LV) by direct fluorescent antibody (DFA) staining of inoculated Vero cells. These, and six additional isolates obtained only by titration of supernatant fluids from inoculated Vero cells, were definitively identified as LV in a neutralization test. Two additional LV isolates were obtained from a patient's sera from Nigeria. By cross-neutralization tests, the Nigerian LV strains were serologically identical to the prototype Nigerian LV strain (PP) but were distinct from both a reference LV strain from Sierra Leone (SL), and from the Liberian (LIB) strains isolated in this study. The LIB and SL strains were closely related to each other, but not to the Nigerian LV strains. LIB LV strains were tested for virulence in strain 2 and 13 guinea-pigs, and a spectrum of virulence was observed which correlated only approximately with disease severity for human patients. Two human-lethal isolates killed all inoculated strain 2 and 13 guinea-pigs, whereas nine isolates from mildly ill patients were benign for guinea-pigs. Yet some LV isolates from severely ill or lethally infected patients, especially those from pregnant women and infants, were totally benign for guinea-pigs. These data suggest that antigenically distinct LV strains exist in nature, and that antigenically indistinguishable LV isolates may differ in virulence potential for various hosts.

Serological testing of hospital personnel by the indirect fluorescent antibody (IFA) technique was used to indicate the distribution of Lassa virus (LV) activity in Liberia. Determination of the places of origin of the staff members as well as the sites of the hospitals indicated that LV is active in throughout Liberia. Prevalences of IFA varied from 3.8% at the J. J. Dossen Hospital on the coast in the south-east to 22.3, 23.5 and 40.4% in Lofa County hospitals inland in the north-west. Rises in LV antibody prevalences, high prevalences and relatively high IFA titres in hospital personnel suggest the LV activity is particularly high in Lofa, Grand Cape Mount and Nimba Counties.