Autologous Mastopexy and Autoaugmention of the Breast.

BACKGROUND: Autologous mastopexy is an alternative for patients with small breasts, ptosis and upper pole hollowness, who desire improvement in their breast shape without using an implant. A variety of techniques have been tried throughout the years. Recently the use of autologous fat grafting (AFG) for breast augmentation increased in popularity and showed satisfying cosmetic outcome in enhancement of size, shape and texture of the breast. METHODS: 25 patients with grade 2 ptosis were included in this study. Lower Island Flap Transposition (LIFT) technique was modified and either done alone or in combination with lipofilling, whether at the same setting or as a second stage. Preoperative and postoperative measurements and pictures were documented. RESULTS: Lateral upper pole projection measurements showed an average increase of 28.5% equal to about 1.8 cm. As for the maximum breast projection an increase of about 33% accounting for about 2 cm was documented. CONCLUSIONS: This study shows that the combination of LIFT technique after its modification with AFG has proven to be an effective technique with consistent results for patients presenting with grade 2 ptosis and upper pole hollowness. The addition of AFG to the modified LIFT technique can be considered a step forward in achieving autoaugmentation and autologous mastopexy without using implants.

Efficacy and Cost-effectiveness Comparison of 10-Day, 14-Day Sequential Versus 14-Day Triple Therapies for Treating Helicobacter pylori Infection in Egyptian Patients.

GOALS: The aim of this study was to clarify whether 10-day or 14-day sequential therapy (ST) can replace conventional triple therapy (TT) as a first-line treatment in Egypt. BACKGROUND: Antimicrobial resistance has decreased the eradication rates for Helicobacter pylori infection worldwide. MATERIALS AND METHODS: Patients who tested positive for H. pylori infection were randomly assigned to the 14-day triple-therapy group (n=34), 10-day ST group (n=34), or 14-day ST group (n=35). Sequential treatment includes lansoprazole 30 mg and amoxicillin 1000 mg, both twice for 5 or 7 days, followed by lansoprazole 30 mg, clarithromycin 500 mg, and tinidazole 500 mg, each twice for 5 or 7 days. Triple treatment consists of lansoprazole 30 mg, clarithromycin 500 mg, and amoxicillin 1000 mg, each twice for 14 days. Six weeks after treatment discontinuation, patients were examined by the urea breath test. Eradication rates, the incidence of adverse effects, compliance, and cost-effectiveness were evaluated. RESULTS: The eradication rate was 90% with 10-day ST, 96.7% with 14-day ST, and 63.3% for TT (P=0.001). Mild tolerated adverse effects occurred in the 3 groups. The cost-effectiveness ratio was 2194 LE, 1241 LE, 1157 LE for standard triple therapy, 10-day, and 14-day ST, respectively. CONCLUSIONS: Sequential therapies for 10 or 14 days are more cost-effective than standard TT, with 14-day ST being the most cost-effective. Accordingly, ST might replace TT as a first-line treatment for H. pylori infection in Egyptian patients.

Serum Ferritin level, microalbuminuria and non-alcoholic fatty liver disease in type 2 diabetic patients.

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) was considered one of the most common causes of chronic liver disease and is considered the hepatic manifestation of type 2 diabetes mellitus (T2DM). The factors that lead to marked fibrosis and liver cell injury in NAFLD are still remaining undiscovered. PATIENTS AND METHODS: This study included (40) type 2 diabetic patients with NAFLD and (40) diabetic patients without NAFLD beside 15 healthy persons as a control group. All of them were subjected to full history taking, thorough clinical examination with especial stress on body weight (BW), height, body mass index (BMI), waist-hip ratio, blood pressure. Laboratory tests included serum total cholesterol (TC), triglycerides (TG), low density lipoprotein (LDL) and high-density lipoprotein (HDL), fasting blood glucose (FBG) and 2-h postprandial blood glucose (PBG), serum Ferritin and urine microalbuminuria (MAU). RESULTS: Duration of diabetes, BW, BMI and blood pressure were significantly higher in NAFLD group (P = 0.001). FBG, PBG, TC, TG, LDL, serum Ferritin and MAU were significantly increased in NAFLD group with significant difference between two studied groups as regard HDL. There was a highly significant correlation between serum Ferritin with BW, BMI, duration of diabetes, TC, TG, LDL and MAU. There was a significant correlation between serum Ferritin with age, waist hip ratio, duration of diabetes, SBP, FBG, PBG and HDL. There was a significant correlation between MAU and age, weight, BMI, waist hip ratio, duration of diabetes, DBP, FBG TC, TG, LDL and HDL. CONCLUSION: NAFLD is a common liver disorder in diabetic patients. NAFLD is significantly associated with microalbuminuria and elevated serum Ferritin.

Endoscopic injection sclerotherapy versus N-Butyl-2 Cyanoacrylate injection in the management of actively bleeding esophageal varices: a randomized controlled trial.

BACKGROUND: The management of acute esophageal variceal bleeding remains a clinical challenge. Band ligation is the main therapeutic option, but it may be technically difficult to perform in active bleeders. This may necessitate an alternative therapy for this group of patients. This study was conducted to assess the safety and efficacy of sclerotherapy versus cyanoacrylate injection for management of actively bleeding esophageal varices in cirrhotic patients. METHODS: This prospective study included 113 cirrhotic patients with actively bleeding esophageal varices. They were randomly treated by endoscopic sclerotherapy or cyanoacrylate injection as banding was not suitable for those patients due to profuse bleeding making unclear endoscopic visual field. Primary outcome was incidence of active bleeding control and secondary outcomes were incidence of six weeks rebleeding, complications, and mortality among the studied patients. RESULTS: Initial bleeding control was significantly higher in cyanoacrylate versus sclerotherapy groups (98.25, 83.93% respectively, P = 0.007). No significant differences between sclerotherapy and cyanoacrylate groups regarding rebleeding (26.79, 19.30% respectively, P = 0.344), complications, hospital stay or mortality rate were observed. CONCLUSIONS: Based on this single-center prospective study, both of these therapies appear to have relatively favorable outcomes, although cyanoacrylate injection may be superior to sclerotherapy for initial control of active bleeding. TRIAL REGISTRATION: [ClinicalTrials.gov Identifier: NCT03388125 ]-Date of registration: January 2, 2018 "Retrospectively registered".

Evaluation of serum DNA integrity as a screening and prognostic tool in patients with hepatitis C virus-related hepatocellular carcinoma.

BACKGROUND: Hepatocellular carcinoma (HCC) is a common malignancy in Egypt due to the high frequency of hepatitis C virus (HCV) infection among the general population. Circulating free DNA is a potential molecular marker for the diagnosis and prognosis of malignant tumors. DNA released from apoptotic cells usually consists of short uniform fragments while DNA released from cancer cells is longer. The ratio of long DNA fragments to total DNA (DNA integrity) may be a potential marker for early detection of HCC and its progression in HCV patients. METHODS: Sera from 25 patients with HCV-related HCC, 25 patients with chronic HCV infection, and 15 healthy volunteers were examined for Alu repeats by quantitative real-time PCR (qPCR) using 2 sets of primers of 115 and 247 base pairs. DNA integrity was calculated as the ratio of 247-bp to 115-bp Alu fragments. RESULTS: Compared with healthy volunteers and HCV patients, significantly higher DNA integrity was found in HCC patients. DNA integrity was associated with tumor size, TNM stage, vascular invasion, lymph node involvement, and distant metastasis. DNA integrity had a higher sensitivity and specificity in discriminating HCC from HCV patients than total DNA. Patients with high DNA integrity had a significantly shorter overall survival and high DNA integrity was shown to be an independent prognostic factor for survival in HCV-related HCC. CONCLUSIONS: DNA integrity is a promising molecular biomarker for detecting HCC in patients with chronic HCV infection; it reflects the progression and metastatic potential of the tumor, and high DNA integrity is associated with short overall survival in HCV-related HCC.

Molecular detection of survivin expression, antiapoptotic gene, and other prognostic markers, how they are correlated and how it could be of prognostic value in chronic myeloid leukemia patient.

Chronic myeloid leukemia (CML) is a malignant disease of heampoitic stem cell resulting from clonal expansion of leukemic myeloid cells. Survivin is a recently identified member of the inhibitor of apoptosis protein family. The aim of the work is to analyze the expression of survivin in CML patient in chronic, accelerated and blastic phases and its correlation with other prognostic markers. The study included 50 CML patients (24 females and 26 males) and 10 healthy individuals (4 female and 6 male) as a control group. The studied groups were classified into group (I), 10 healthy individuals as a control group, group (II), 20 CML patients in chronic phase, Group (III), 15 CML patients in accelerated phase and Group (IV), 15 CML patients in blastic phase. The groups were subjected to clinical history and examination, CBC, ESR, BM aspiration (only patients), determination of serum survivin, IL-6 and beta2M levels by ELISA and survivin gene expression by quantitative real time PCR. There was a significant increase of survivin expression in patients as compared to controls (p < 0.001). The accelerated and blastic phases of the disease showed the highest significance (p < 0.001) than the chronic phase. Serum markers; survivin, IL6 and beta2M showed significant increase in the blastic phase, accelerated phase and chronic phase (p < 0.001, p < 0.001 and p < 0.001) respectively. A significant positive correlation was found between level of survivin expression and the other prognostic markers; high leucocytic count (r = 0.52), high peripheral basophile count (r= 0.81) and high peripheral blast cell count (r = 0.66), high level of serum survivin (r = 0.87), beta2 M (r = 0.76) and IL-6 (r= 0.90). On the other hand, a significant negative correlation was found between the survivin expression and hemoglobin concentration (r = 0.50). In conclusion, survivin is expressed in most cases of CML patients and its over expression is associated with bad prognosis.