Dermoscopic features of keloid versus hypertrophic scar

Background: Hypertrophic scars and keloids can be described as variations of typical wound healing

Aim of this study: was to find out the dermoscopic differentiating features between keloids and hypertrophic scars in their recent phases of development in Egyptian population

Patients and Methods: An observational cross-sectional design of 30 cases that assigned according to histopathological analysis into two groups; Keloids and Hypertrophic scars. Then the polarized non-contact mode of a Dermlite© DL3 "Gen, USA" at a magnification of 10 × was used to capture dermoscopic images for both groups. The surface morphology and the dermoscopic criteria were recorded directly from the patients and included vascular structures [Arborizing, linear and comma shaped vessels], erythematous or white patches

Results: Statistical analysis revealed that patients with keloids are more likely to be associated with the presence vascular structures on dermatoscopy. The analysis of types of vascular structures showed that arborizing vessels, in particular, were significantly related to keloids. In contrast, the dominant dermoscopic feature in Hypertrophic scarring was the presence of scarring as presented in the form of erythematous or white patches with scanty or absent vascularization

Conclusions: Dermatoscopy should be considered as a routine investigation of any case with abnormal scarring for a better differentiation between keloids and hypertrophic scars, and hence a better evaluation and treatment of each type

Three-dimensional conformal versus intensity modulated radiation therapy in treatment of nasopharyngeal carcinoma

Background: Nasopharyngeal carcinoma is an endemic disease of Southeast Asia with incidence rates of between 15 and 50 per 100 000. There is an intermediate incidence in North Africa and Far Northern hemisphere while in the West the disease occurs sporadically. In Egypt the incidence rate is low and the peak at age [50-54] is 3.4%, and other age varying between 0.3 and 0.4 per 100 000

Aim of the Work: The aim of this study was to evaluate and compare both techniques as regard their efficacy on tumor response, local control, overall survival and progression free and treatment related toxicity between both techniques

Patients and Methods: This retrospective analysis included 54 patients diagnosed with primary nasopharyngeal carcinoma recruited from the clinical oncology department, Ain Shams University and the International Medical Center during 3 years [January 2014 -December 2016]. They were divided into 2 groups, group A was treated using 3D conformal radiotherapy [CRT] whereas group B was treated using intensity modulated radiation therapy [IMRT]

Results: In general, acute toxicity was tolerable and complete healing was the rule. As a whole, group A showed a higher toxicity profile as compared to group B. IMRT was able to decrease xerostomia and spare at least part of the parotid gland excretory function which was shown in the salivary gland scintigraphy. Results of the dosimetric comparison between both techniques showed that IMRT had a better tumor coverage and conformity index. Homogeneity index was similar in the two groups. Also, doses received by the risk structures, particularly parotids, was significantly less in the IMRT plans than those of 3D-CRT

Conclusion: IMRT is considered as a more advantageous radiation treatment technique as it can deliver high-dose irradiation to defined tumor targets while minimizing the dose delivered to the surrounding normal organs and tissues, thereby improving the therapeutic ratio of radiation therapy. IMRT has been shown to offer superior dose conformity to the tumor target and better sparing of critical organs in the treatment of NPC

Factors affecting quality of life for chronic renal failure patients undergoing hemodialysis

Quality of life is an important issue for dialysis patients due to the multiple stressors and potential loss of life style, which affect them. This study aims to identify factors affecting quality of life for chronic renal failure patients undergoing hemodialysis. The study was conducted in hemodialysis units at Ain Shams Specializes Hospital and Ain Shams University Hospital. One hundred adult patients on hemodialysis had period not less than one year, Data were collected by self administered quality of life scale and patient' assessment sheet to assess a quality of self-care for hemodialysis patients. The most interesting finding of this study was, home condition had a significant effect on spiritual wellbeing and on total quality of life. While socioeconomic status and patient educational levels had a significant effect on physical, psychological, social and total quality of life. Also the total self care score had a significant effect on physical and spiritual well being and the total quality of life. While patient age and sex, had an insignificant effect on the patient quality of life in all items. Further research must focus on developing a quality of life standard assessment approach for chronic renal failure patients under going hemodialysis

Increased prevalence of human papilloma virus type 5 in patients with psoriasis: relation to PUVA therapy or disease severity?

Introduction: Psoriatic skin colonization by Human Papilloma Virus [HPV] seems to be restricted mainly to HPV-5 which is a ubiquitous virus that replicates at a high rate in hyper-reactive psoriatic keratinocytes. The aim of the present study was to determine whether the increased prevalence of HPV-5 DNA in psoriatic lesions is related to PUVA [Psoralen and Ultraviolet A] treatment or to disease severity

Subjects and Methods: Thirty psoriatic patients were enrolled in the study after their informed consent. Patients were divided into two groups; group I patients [n =16] had no history of PUVA exposure during the past 6 months, while group II patients [n = 14] are on PUVA treatment. The calculated Psoriasis Area and Severity Index [PASI] score for patients varied between 8 and 66. Among the thirty patients, 22 had severe psoriasis with PASI score >20, five patients had moderate psoriasis with PASI score from 10 to 20 and three patients had mild psoriasis with PASI score < 10. Six patients of group I were on methotrexate treatment. Skin scales from lesions were collected from each patient. A type-specific nested PCR was performed using two sets of primers designed to detect the HPV-5 E6 gene. PCR reactions were done in Light Cycler to achieve optimal sensitivity

Results: In the present study 57% of psoriatic patients had HPV-5 infection in psoriatic lesion. Results showed statistically non significant difference between the two groups of patients regarding the presence of HPV-5 [P>0.05], while the difference between patients with severe psoriasis [PASI > 20] and patients with mild to moderate psoriasis [PASI

Left atrial spontaneous echo contrast before and after percutaneous mitral balloon valvuloplasty: an echocardiographic study

Left atrial spontaneous echo contrast [SEC] is a marker of blood stagnation in the left atrium in mitral valve disease and a forerunner of cardiogenic thromboembolism. To assess the effect of mitral balloon valvuloplasty on SEC visualization in the left atrium [LA] in rheumatic mitral valve disease, 30 patients with rheumatic mitral stenosis [MS] [7 males and 23 females, mean age 30 +/- 10.5 years] were studied by transthoracic echocardiography [TTE] including M-mode, two-dimensional, continuous and pulsed wave Doppler with colour flow mapping for the detection of associated or consequent mitral regurgitation [MR]; as well as transoesophageal echocardiography [TEE] prior to and within one week after balloon valvuloplasty [BV] of the mitral valve. Measurements of LA dimensions, mitral valve area [MVA], mitral valve score [MVS], mean transvalvular pressure gradient [MPG] and fractional shortening [FS] were carried out. TEE was utilized to detect SEC in the LA and determine its grade, as well as to rule out the likelihood of thrombus formation in the LA or left atrial appendage [LAA] and to measure the thickness of the interatrial septum [IAS]. TTE failed to detect SEC in all patients and proved insensitive in this respect. The impact of BV was manifested by a significant reduction of the LA diameter, a significant increase in FS, a significant increase in the 2-D estimated MVA and in the Doppler-estimated MVA and a reduction of MPG. Before BV, only 9 patients [30%] depicted an evidence of associated grade I MR, whereas after BV 21 patients depicted MR of grade 1[80.9%] and grade 11[19.1%], while the remaining 9 patients [30%] revealed no trace of MR. Before BV, a SEC was displayed in all patients [100%], 13 [43.3%] having +1 SEC. 8 patients [26.7%] having +2 SEC and 9 patients [30%] having +3 SEC; whereas after BV, only 9 patients [30%] had SEC. 6 among them [66.7%] depicting +1 SEC and 3 [33.3%] depicting +2 SEC. Thus, 21 patients [70%] were free of SEC post-BV. Before BV, the grade of SEC was a function of cardiac rhythm [the majority of patients with atrial fibrillation "AF" displayed +3 SEC vs. +1 and +2 SEC in those with sinus rhythm], mean transmitral pressure gradient [the higher the MPG the higher the grade of SEC] and fractional shortening [the lower the FS the higher the grade of SEC. p=0.03]. The rate of resolution of SEC post-BV was a function of age, fractional shortening, MPG across the mitral valve, cardiac rhythm [SEC was more common in association with AF than with sinus rhythm] and mitral regurgitation [SEC was more common in patients with MR]; whereas gender and LA diameter exhibited no striking influence on the rate of resolution of SEC post-BV. It was concluded that TEE is greatly superior to TTE in detecting SEC in patients with rheumatic MS pre- and post-BV, that the frequency of SEC detection is related to cardiac dysrhythmia, particularly chronic AF, MPG across the mitral valve, FS and age of the patient. Successful BV is associated with a significant resolution in SEC or reduction in its grade due to the establishment of a wider MVA, hence a lower MPG, better ventricular filling and higher FS. The visualization of SEC should be considered as a prothrombotic state warranting anticoagulation

Plasma beta-endorphin level in cases of premenstrual syndrome

The concentrations of plasma B-endorphin and serum prolactin, progesterone, estradiol and cortisol in 14 women complaining of premenstrual tension syndrome [P.M.S] and 14 normal women were measured at 25th day of the cycle followed by endometrial biopsy using Novak curette. There was significant elevation in prolactin and significant reduction in B-endorphin levels in cases of P.M.S. when P.M. S patients were classified according to prolactin level, hyper-prolactinaemic patients [serum prolactin > 20 ng/ml] had significantly higher level of B-endorphin compared to norm oprolactinaemic patients P < 0.01, while according to endometrial pattern, patients with luteal phase defect showed significant elevation of prolactin and B-endorphin compared to cases with normal secretory activity pattern. Nevertheless at all circumstances B-endorphin levels in P.M.S patients were significantly lower than normal. It is included from this study that, B-endorphin depletion can be considered, as a marker of P.M.S. and it may have an etiological effect on it

Copper and zinc levels in premature rupture of membranes and premature Labour

Sixty women in labour were included in this study, 30 patients with premature rupture of membranes [PROM], 15 full term and 15 premature delivery, and 30 patients without PROM, 15 full term and 15 premature delivery. Serum copper and zinc were measured in maternal and cord blood samples in all studied groups. Maternal and fetal copper showed a significant decrease in cases with PROM both in term and preterm when compared to that of patients without PROM while there was no significant change in serum copper levels between the groups with pre term and term labour. Maternal Zinc levels were significantly decreased in the group of premature labour when compared to those in term labour irrespective of presence or absence of PROM. So, it is concluded that copper deficiency may have a role in PROM, while zinc deficiency may be related to the initiation of preterm delivery

Endocrinologic and ultrasonographic study in early pregnancy loss

Fifteen cases of early pregnancy loss [EPL] and 10 cases with normal singleton pregnancy has been followed up by ultrasonography as well as assessment of serum Estradiol [E[2]] progesterone [P. human chorionic gonadotropin [HCG] and human placental lactogen [HPL] starting as early as 3 weeks from the last menstrual period till the occurrence of abortion or till 12 weeks of pregnancy. The results showed that 73.3% of cases of EPL were anembryonic pregnancy. The results of hormonal assay showed that in the first 4 - 6 weeks of pregnancy hormone levels were not significantly different in the EPL from that in the control group and this denotes that the corpus luteum function is normal in EPL. IT is the placenta which fails to contribute to hormone production in EPL and this placental failure occurs earlier [between 6-8 weeks] in respect to steroid production but the ability of the placenta to produce HCG and HPL is preserved although at a considerably lower level than normal during the first 8- 10 weeks. So ultrasonography is mandatory in the management of EPL and hormone prophylaxis seems unnecessary, as the corpus luteum function is normal

Electron microscopic study of the endometrium in dysfunctional uterine bleeding

Fifty endometrial biopsies has been taken during the episode of bleeding from women with diagnosed dysfunctional uterine bleeding [DUB], and the endometrial pattern has been studied by light microcopy. The anovulatory endometrium comprised 90% of cases. The ultrastructure of the endometrium in 20 of these cases representing the various endometrial patterns encunted has been studied by electron microscopy. The ultrastructural findings related to the bleeding problem in the study cases were as follows: [a] cell organelles were poorly developed in the proliferative and atrophic endometrium with variable development in the hyperplastic endometrium and they were only well developed in the secretory type. [b] Excessive fibrosis was found in all cases of hyperplastic and atrophic endometrium, in half of the cases in the proliferative type and only in one fourth of cases in the secretory type. [c] The blood vessels were abundant in the hyperplastic and very superficial with very thin fibrosed wall in the atrophic endometrium. The deficient development of cell organelles, the excessive fibrosis and the abnormal vascularity could be factors behind the bleeding problem in DuB

Endocrinologic and Ultrasonographic study in early pregnancy loss

Fifteen cases of early pregnancy loss [EPL] and 10 cases with normal singleton pregnancy has been followed up by ultrasonography as well as assessment of serum Estradiol [E2], progesterone [P], human chorionic gonadotropin [HCG] and human placental lactogen [HPL] starting as early as 3 weeks from the last menstrual period till the occurrence of abortion or till 14 weeks of pregnancy. The results showed that 73.3% of cases of EPL were anembryonic pregnancy. The results of hormonal assay showed that in the first 4 - 6 weeks of pregnancy hormone levels were not significantly different in the EPL from that in the control group and this denotes that the corpus luteum function is normal in EPL. It is the placenta which fails to contribute to hormone production in EPL and this placental failure occurs earlier [between 6 - 8 weeks] in respect to steroid production but the ability of the placenta to produce HCG and HPL is preserved although at a considerably lower level than normal during the first 8 - 10 weeks. So ultrasonography is mandatory in the management of EPL and hormone prophylaxis seems unnecessary, as the corpus luteum function is normal

Gastric varices: magnitude, imaging and endoscopic management

This study evaluated the magnitude of gastric varices among patients presented to Kasr El Aini Hospital by variceal bleeding. The value of abdominal ultrasonography in recognition of the gastric varices was discussed. Also this work reports the results of a trial comparing ethanolamine oleate 5% as sclerosant agent and the tissue adhesive bucrylate in the endoscopic management of patients with bleeding gastric varcies. In the present study 65 out of 970 patients with variceal bleeding had primary gastric varices [6.7%]. Gastric varices alone were found in 5 cases [0.5%]. Eleven patients [2.9%] developed secondary gastric varices after complete eradication of the oesophageal varices in 376 patients. Abdominal ultrasonography was done for 50 patients with oesophago - gastric varices [20 patients with oesophageal varices, 10 with oesophgeal varices with gastric extension and 20 patients with primary gastric varices].Twenty five patients were examined before and after sclerotherapy. We found statistical positive relations between gastric varcies and gastro-splenic and coronary collaterals as detected by sonography and also between sclerosis of oesphageal varices and the increase in the diameter of the splenic vein and the development of gastrosplenic collateral. From the ultrasonography and the radiological results a hypothesis of gastric varix formation is postulated. Tissue adhesive bucrylate is the drug of choice if compared with ethanolamine oleate in management of patients with bleeding gastric varices. Initial control of the total bleeding episodes was significantly high in patients in the bucrylate therapy [93.3%] compared to the sclerosis group [52.6%]. Better survival and bleeding free survival in the bucrylate group compared to the sclerosis group [P < 0.05]. Eradication of varcies was significantly high in the bucrylate group [80.9%] compared to 7.1% in the sclerosis group