Infection following insertion of a breast implant is relatively uncommon, with an overall incidence of less than 4 percent, but can be devastating. Although its management options may be antibiotic therapy along with active surgical regimen like drainage, mechanical irrigation, debridement and implant removal, the efficacy of aforementioned therapeutic regimen is unclear in some cases, thus can be challenging. In particular cases of being chronic and refractory to therapy, spreading of infection which was originally localized in the periprosthetic space-over adjacent tissues by an aggressive curettage at the early stage appears to play a major role. Months elapse before a complete resolution of the infection, and it can also cause serious physical and mental issues in patients. Based on clinical and operative findings in four cases of a chronic, refractory and recurrent periprosthetic infection following an aggressive initial debridement and curettage, we suggest that surgeon should be watchful against debridement and curettage at the early stage of infection and pay special attention to make an accurate and limited curettage using endoscopy.
Breast Implants ; Curettage ; Debridement ; Drainage ; Endoscopy ; Female ; Humans ; Incidence ; Mammaplasty*

Bleeding frorn the duodenal varix is an unusual event. Upper gastrointestinal endoscopy is the diagnostic procedure of choice in diagnosing duodenal varices. If performed during active bleeding, it can differentiate between esophageal and duodenal varices as the source, which has important therapeutic implications. A thorough examination of the duodenum for varices is important in an upper gastrointestinal hemorrhage. Treatment modalites for bleeding duodenal varices are sclerotherapy, varix suture ligation, portocaval shunt, and duodenal resection. Although endoscopic sclerotherapy has lirnited success in controlling active duodenal varix as initial treatment, endoscopic injection sclerotherapy is a useful first-line therapeutic measure in the treatment of bleeding duodenal varices. In this study we present a case of a ruptured duodenal varix, which was defected by an endoscopy, in a 61-year-old male. An endoscopic examination showed small and nonbleeding esophageal varices and a prominant ulcerated varix was identified in the 2nd portion of the duodenum. Endoscopic sclerotherapy was performed by injecting ethanolamine oleate into the varix. Our report demonstrate that endoscopic sclerotherapy can be efficient even in the presence of acute bleeding and that it can provide a definitive method of curing of a bleeding duodenal varix.
Duodenum ; Endoscopy ; Endoscopy, Gastrointestinal ; Esophageal and Gastric Varices ; Ethanolamine ; Gastrointestinal Hemorrhage ; Hemorrhage* ; Humans ; Ligation ; Male ; Middle Aged ; Oleic Acid ; Sclerotherapy* ; Sutures ; Ulcer ; Varicose Veins*