A single-blinded comparative study between the use of glycolic acid 70% peel and the use of topical nanosome vitamin C iontophoresis in the treatment of melasma

Background Melasma is a common pigmentary disorder. Despite the availability of a wide range of skin‐lightening treatments, melasma of skin remains a therapeutic challenge. Objective The aim of this study was to evaluate the efficacy and safety of nanosome vitamin C iontophoresis and to compare the therapeutic effects of nanosome vitamin C iontophoresis vs. glycolic acid peel 70% in the treatment of melasma in Egyptian women. Methods This study included 14 patients of melasma with skin type IV–V taken for a right–left comparison study of six sessions. Glycolic acid 70% peel was applied on the right side, whereas nanosome vitamin C was applied by iontophoresis on the other side. The results are evaluated using the melasma area and severity index score and with photographs at baseline and after six sessions. Also the photographs were evaluated by two single‐blinded physicians before and after sessions. Results Both sides were improved, but the side treated with nanosome vitamin C showed better results. Side effects were few and transient. Conclusion We concluded that nanosome vitamin C is a new, safe and effective, easy and painless method in the treatment of melasma.     

Metals detected by ICP/MS in wound tissue of war injuries without fragments in Gaza

Background  

The amount and identity of metals incorporated into "weapons without fragments" remain undisclosed to health personnel. This poses a long-term risk of assumption and contributes to additional hazards for victims because of increased difficulties with clinical management. We assessed if there was evidence that metals are embedded in "wounds without fragments" of victims of the Israeli military operations in Gaza in 2006 and 2009.     

Impact of computed tomography image and contact force technology on catheter ablation for atrial fibrillation

AIM:To investigate the impact of using computed tomography(CT) and contact force(CF) technology on recurrence of atrial tachyarrhythmia after atrial fibrillation(AF) ablation.METHODS: This non-randomized study included 2 groups of patients. All patients had symptomatic recurrent paroxysmal or persistent AF and were treated with at least 1 anti arrhythmic medication or intolerant to medication. The first group included 33 patients who underwent circumferential pulmonary veins isolation(PVI) for AF during 2012 and 2013 guided by CT image integration(Cartomerge, Biosense Webster, Diamond Bar, CA, United States) of left atrium and pulmonary veins into an electroanatomic mapping(EAM) system(CT group) using standard irrigated radiofrequency catheter(Thermo Cool, Carto, Biosense Webster, Diamond Bar, CA, United States) or irrigated catheter with integrated CF sensor(Smart Touch, Carto, Biosense Webster, Diamond Bar, CA, United States). The second group included immediately preceding 32 patients who had circumferential PVI by standard irrigated catheter(Thermo Cool) using only EAM(Carto) system(EAM group). Linear lesions were performed according to the discretion of operator. RESULTS: Sex, age, and persistent AF were not different between groups. PVI was achieved in all patients in both groups. Linear ablations including cavo-tricuspid isthmus and or roof line ablation were not different between groups. Free of atrial tachyarrhythmia during follow-up of 24 mo was significantly higher among CT group compared to EAM group(81% vs 55%; respectively; P = 0.027). When 11 patients from CT group who had ablation using Smart Touch catheter were excluded, the difference between CT group and EAM became non significant(73% vs 55%; respectively; P = 0.16). Sub analysis of CT group showed that patients who had ablation using Smart Touch catheter tend to be more free of atrial tachyarrhythmia compared to patients who had ablation using standard irrigated catheter during follow-up(100% vs 73%; respectively; P = 0.07). Major complications(pericardial effusion, cerebrovascular accident/transient ischemic attack, vascular access injury requiring intervention) did not occurred in both groups.CONCLUSION:These preliminary results suggest that CT image integration and CF technology may reduce the recurrence of atrial tachyarrhythmia after catheter ablation for AF.     

Sustained release from inert matrices I. Effect of macrocrystalline cellulose on aminophylline and theophylline release

The release of aminophylline and theophylline embedded in a matrix composed of different ratios of microcrystalline cellulose and glyceryl monostearate (or propylene glycol monostearate) was investigated. The result indicated that drug release within a certain period follows a diffusion-controlled matrix model, where the drug quantity released was proportional to the square root of time. The release rate was found to increase with increasing microcrystalline cellulose—glyceryl monostearate ratio. The logarithm of the rate constant was proportional to the fraction of microcrystalline cellulose in the matrix. The tablets prepared using solvent-evaporated matrix showed quicker release than those prepared from fused ones. Propylene glycol monostearate achieved similar, but somewhat quicker release, than glyceryl monostearate.     

Pheochromocytoma in children and adolescents: a clinical spectrum

Purpose

The purpose of the study was to identify the spectrum of disease characteristics of pheochromocytoma in children.

Methods

Records of 21 consecutive children diagnosed with pheochromocytoma were reviewed. Patients' age, sex, presentation, associated conditions, diagnostic and imaging modalities used, preoperative preparation, operative details, outcome, and follow-up were recorded.

Results

The study included 21 children. Patients were diagnosed clinically and confirmed by biochemical tests. Tumors were localized by imaging studies and all were confirmed pathologically. Patients included 17 with adrenal and 4 with extra-adrenal tumors including 1 in the urinary bladder. Seventeen had sporadic and 4 had familial pheochromocytoma. Associated manifestations were the predominant features in 1 of the 4 patients with familial pheochromocytoma. The patient with bladder pheochromocytoma presented with gross hematuria. Hypertension and visual disturbances were prominent findings in the other patients with sporadic form. Two patients (1 sporadic and 1 familial) had malignant pheochromocytoma. One patient with benign pheochromocytoma had multiple recurrences in chromaffin-containing sites. All patients were treated surgically. Seventeen patients were treated preoperatively with alpha-adrenergic blockade. Two patients continued to have significant visual disturbances. One patient with malignant pheochromocytoma died of the disease, and 1 with recurrent pheochromocytoma had neurologic consequences.

Conclusions

Pheochromocytoma in children has unique characteristics. To our knowledge, this series is one of the largest reports of adrenal pheochromocytoma in children. It also reflects the spectrum of pheochromocytoma in this age group.