Low intensity laser therapy is comparable to bromocriptine-evening primrose oil for the treatment of cyclical mastalgia in Egyptian females.

One of the successful treatments for cyclical mastalgia is bromocriptine evening primrose combination. A double blind study was applied on 80 patients with cyclical mastalgia. They were randomly divided into two groups (A and B). In group A, patients were treated by bromocriptine/evening primrose. To group B, LILT with specified dosimetry was applied, using a device that delivers He-Ne laser combined with 4 infra-red diode laser. Evaluation of treatment was both subjective (using VAS) and objective (studying the degree of drop in plasma cortisol level). The drop of plasma cortisol with treatment was studied using the student -t distribution. A good response was observed in the laser group in 82.5%, compared to 63.9% in the bromocriptine/evening primrose group. There was a significant deference before and after treatment in both groups (P<0.05). This difference was more for the drug treated group than for the laser treated group, but in the latter, it acted on a wider sector of patients. In conclusion, LILT is recommended as a new treatment modality for cyclical mastalgia.

The effect of mastectomy and radiotherapy for breast carcinoma on soft tissues of the shoulder and its joint mobility among Egyptian patients.

Patients with post mastectomy soft tissue shoulder disorders usually benefit from various lines of physiotherapy treatment. However, the controversy about their efficacy persists. The aim of this work was to study and assess the efficacy of each, and to identify the best intervention. One hundred female patients with ipsilateral post mastectomy shoulder problems were enrolled in the study, from September 2003 until December 2004. They were followed up for 32 weeks. Mastectomy, both radical and conservative and axillary lymph node clearance, was the standard surgery applied for operable breast carcinoma in this series. Clinical examination was followed by testing for the shoulder complaint by measuring maximal protrusion at the inferior scapular angle, scapular stabilization and the lift-off tests. Approved physiotherapy modalities were then applied, viz: no treatment (randomly chosen 12 patients), passive and active motion therapy (14 patients), oral diclofenac sodium (19 patients), local triamcinilone injection (40 patients) and manually applied low intensity laser therapy (15 patients). Assessment was by determining overall success rate for each intervention modality. Intervention outcome was assessed at 8, 16, and 32 weeks as shown by physical examination using the healthy shoulder as a reference, and by measuring restricted mobility during passive lateral rotation and glenohumeral abduction. "Success rate" was determined separately for each group at the end of the intervention period. The applied surgery was followed by radiotherapy in 96%, chemotherapy in 24% and both in 11%. The presenting post mastectomy symptoms at the shoulder were pain (100%), shoulder weakness (88%), winging of the scapula (11%) and inability to perform everyday shoulder movements (23%). Evaluation was by overall improvement score. The results were: 14.3% for untreated patients, 43.3% for those treated by motion therapy, 42% for diclofenac therapy, 80.7% for local triamcinolone, and lastly 68% for low intensity laser therapy. All treatment regimens for shoulder disabilities in those patients gave little long-term advantage, local steroid injections were the most effective. Low level laser therapy may augment its effect. It is concluded that all treatment regimens provide little long-term advantage; however, trimcinilone local injections may be the most useful in terms of pain relief and improvement in shoulder movement.

Urine carcinoembryonic antigen determination in urinary bladder bilharziasis predicts carcinoma in patients with premalignant lesions: observation of 43 cases in Egypt.

Both urinary bilharziasis and urothelial neoplasia are associated with increased production of tissue carcinoembryonic antigen (CEA). Urine and serum CEA were determined in 43 patients with urinary bladder carcinoma including 22 post bilharzial and 21 non-biharzial cases, in addition to 10 normal control cases. A significant increase was detected in both urine and serum CEA levels with bladder carcinoma compared to control cases. Urinary CEA was significantly elevated in 86% of bilharzial versus 62% in nonbilharzial bladder carcinoma. Only 10.5% of control cases had urinary CEA elevation. The mean urinary CEA in bilharzial was higher than that of nonbilharzial carcinoma, but the difference was not statistically significant. There was a definite relationship between urine CEA and the stage of malignancy; the higher the stage, the higher the level of urine CEA. No relationship could be detected between the stage of malignancy and serum CEA, or between the grades of malignancy and urine or serum CEA levels. In conclusion, urinary CEA is more useful than serum CEA in the early detection of bilharziasis-associated urothelial carcinoma.