Therapy-resistant vitiligo; treatment with autologous epidermal grafting using the tops of suction blisters-modified technique

Current treatment of vitiligo has been disappointing. In this study, emphasis was placed on treating the most refractory types of vitiligo, namely the segmental and focal varieties, none of which had responded satisfactorily to topical corticosteroids and topical or systemic psoraien and exposure to ultraviolet tight. [PUVA therapy]. Autologous epidermal grafting using the tops of suction blisters was the offered treatment to those resistant cases. Suction Mister epidermal grafting is a useful modality for treatment of resistant and stable vitiligo; however, the original apparatus is expensive one. This study attempts to develop a cheap and small apparatus, which can be assembled in the physician's, own office. Prospective study. National Hepatoiogy and Tropical Medicine Research Institute [NHTMR 1]. Twenty patients with therapy-resistant segmental or focal type of vitiligo were treated with autologous epidermal grafting using the tops of suction blisters. The epidermis was separated from underlying dermis by vacuum suction on the donor area. On the recipient area, similar blisters were raised by freezing of the skin. The busier roof induced by suction was removed and transplanted to the blister bed prepared on the depigmented area. The ventose machine used in obstetric delivery was connected to aluminum cups especially designed for that purpose and applied to obtain the suction blisters from the donor area. Ten parents exhibited almost complete repigmentation / [80%-100% improvement] at the grafted site within I to 3 months, in two patients a 70% response was achieved, while another faur patients did not respond to the treatment. Four patients lost follow up. Repigmentation that was noted in the recipient areas was retained at 1.5 years follow up. The donor areas healed well, with minimal hyperpigmentatian in most, of the cases. No unwanted effects were met with cases treated. Our results suggest that autologous epidermal grafting using the tops of suction blisters is a good treatment for the [therapy-resistant] segmental and/or focal type of vitiligo. Epidermal grafting leaves no scarring at all. The technique appears to be safe, simple, and effective. Introducing this simple suction device made the procedure also cheap and suitable to be applied on outpatient bases in our community in Egypt

Immunomodulatory therapy for hepatocellular carcinoma

Hepatocellular carcinoma is probably the most common solid human malignancy in the world and its incidence in Egypt has dramatically increased during the last decade. In spite of the availability of different strategies for treating hepatocellular carcinoma in the form of surgical resection, transarterial embolization, percutaneous ethanol injection therapy, radiofrequency wave ablation and chemotherapy, a considerable percentage of cases were found not fit to go into one of all these modalities. On the other hand, the aqueous extracts of the European mistletoe plant [Viscum album] have been used for years for systemic nonspecific stimulation of the immune system in cancer therapy. This study tried to assess the effect of mistletoe [Viscum album] on the natural history of unresected HCC, on one side, and its role in preventing postoperative recurrence after surgically resected cases, on the other side. Thirty-three patients with advanced unresectable HCC represented the first group in this study and 10 cases of post surgical resection were included in the second group. Mistletoe proved itself as a save medication easily tolerable with minimal side effects, it improves the quality of life through immunological pathway, but in this study it failed to demonstrate any significant effect in the progression or limitation of the size of the tumor nor on prevention of recurrence after postoperative resection

Role of diagnostic laparoscopy in management of hepatobiliary malignancy: Prospective analysis

In this study, 100 patients were subjected to diagnostic laparoscopy [DL] to assess the respectability of their hepatocellular carcinoma. All patients were considered to be candidates for resection on the basis of preoperative imaging studies. Seven laparoscopic cases were incomplete due to adhesions. Eighteen patients were found to be unresectable at laparoscopy. Of the remaining 75 patients, 11 turned to be unresectable at open exploration yielding 14.7% false-negative rate. Laparoscopy identified 18 of 29 patients with unresectable disease. Laparoscopy was most accurate for identifying liver cirrhosis, peritoneal disease, additional hepatic disease and verifying the actual size of the tumor which is not accurately determined by the imaging techniques. On the other hand, laparoscopy was the least accurate method for vascular invasion and lymph node metastases. Adding laparoscopic ultrasound [LUS] to the DL technique can be valuable in tracing vascular invasion or finding additional hepatic tumors

Promising early results for keloid treatment with intralesional colchiciae a clinical and histopathological study

In a clinical trial, 14 cases with keloids were treated by local infiltration of colchicines. The results were evaluated objectively and subjectively. Lesional biopsy was obtained before and after treatment and examined by light microscopy. Marked reduction of the size of the lesions and decrease of such complaints as itching and erythema were noted. Favorable results were obtained according to the patients in 83.4% and according to the opinion of the medical examiner in 91.7% of cases. Systemic complications of colchicines absorption, i.e. nausea, did not occur in any patient. Histopathologic examination of the lesions after colchicines infiltration reveled marked reduction in the density of collagen bundles which are widely dispersed throughout the dermis. Intralesional infiltration of colchicines is safe and effective treatment of keloids