Role of Liposuction Combined with Subcutaneous Mastectomy in the Surgical Treatment of Gynecomastia

Background: Gynecomastia is one of the common benign male breast diseases, surgical treatment of which remains a controversial issue. Here, we describe successful combined use of liposuction and subcutaneous mastectomy in the treatment of gynecomastia. Aim: To evaluate the effectiveness of the liposuction combined with subcutaneous mastectomy in the treatment of gynecomastia. Materials and Methods: In this retrospective study, a total of 28 patients were included. All the patients had undergone detailed clinical evaluation and appropriate investigations. Information regarding age of onset, etiology, laterality, nipple discharge was collected from patient’s medical records. Twenty of 28 patients had unilateral gynecomastia whereas 8 patients had bilateral gynecomastia. Based on the clinical evaluation and investigations, secondary causes of gynecomastia were ruled out. Subcutaneous mastectomy using infraareolar skin incision combined with liposuction was performed on 26 patients. Two patients underwent only liposuction. Results: Twenty‑four patients (86%) were satisfied with the results of the operative intervention. In 24/28 patients (86%), the indication of surgery was cosmetic reasons and in 4/28 patients (14%), the indication was failure to treatment with danazol. Average age of the patients was 24 (6) years and most of the patients were between 20 and 30 years of their age. The postoperative complications include infection in two patients and contour deformity in two other patients. Conclusions: Liposuction combined with subcutaneous mastectomy is a reliable, versatile, less time consuming and valid procedure for the treatment of gynecomastia. This procedure provides satisfactory aesthetic results.Keywords: Gynecomastia, liposuction, subcutaneous mastectom

CEOT variants or entities: Time for a rethink? A case series with review of the literature

The first detailed description of calcifying epithelial odontogenic tumor (CEOT) are ascribed to Jens Pindborg, but this tumor was described some years previously. Subsequently, CEOT was included in the 1971 WHO classification of odontogenic tumors and a since then number of variants have been described, which have added confusion to the diagnostic criteria. We aimed to survey the literature on the variants of CEOT, in parallel with a review of our single institution experience of CEOTs. Cases identified were collated, including available clinical, radiological and histological information and then reviewed, taking into account changes in the understanding and classifications of odontogenic tumors since initial diagnosis. We identified 26 cases from 1975 to 2017 for which histological material was available. Of these, only 13 (50%) showed the “classic” histological appearance, whilst two cases were identified as recognized variants. In 11 cases, other diagnoses or a differential diagnosis were preferred, with no agreed diagnosis in four of these. The proliferation fraction (Ki67) in the 10 cases tested was 2.1% ± 0.18. These findings illustrate the diagnostic challenges in this group of tumors and highlight the gaps in knowledge. Techniques, such as EWSR1 gene cytogenetic analysis, may be helpful in cases with clear cells. However, in other areas of controversy, including the non-calcifying and Langerhans cell rich variants, further investigation, perhaps utilizing sequencing technologies may be needed to refine the classification. Owing to the relative rarity of these lesions it would be beneficial if future work could be pursued as an international collaboration

A software agent enabled biometric security algorithm for secure file access in consumer storage devices

In order to resist unauthorized access, consumer storage devices are typically protected using a low entropy password. However, storage devices are not fully protected against an adversary because the adversary can utilize an off-line dictionary attack to find the correct password and/or run an existing algorithm for resetting the existing password. In addition, a password protected device may also be stolen or misplaced allowing an adversary to easily retrieve all the stored confidential information from a removable storage device. In order to protect the consumer’s confidential information that has been stored, this paper proposes a mutual authentication and key negotiation protocol that can be used to protect the confidential information in the device. The functionality of the protocol enables the storage device to be secure against relevant security attacks. A formal security analysis using Burrows-Abadi-Needham (BAN) logic is presented to verify the presented algorithm. In addition, a performance analysis of the proposed protocol reveals a significantly reduced communication overhead compared to the relevant literature

A Systematic Approach to Modeling Impedances and Current Distribution in Planar Magnetics

Planar magnetic components using printed-circuit-board windings are attractive due to their high repeatability, good thermal performance and usefulness for realizing intricate winding patterns. To enable higher system integration at high switching frequency, more sophisticated methods that can rapidly and accurately model planar magnetics are needed. This paper develops a lumped circuit model that captures the impact of skin and proximity effects on current distribution and electromagnetic fields in planar magnetics. This enables accurate predictions of impedances, losses, stored reactive energy and current sharing among parallel windings. This lumped model is also a circuit domain representation of electromagnetic interactions. It can be used to simulate circuits incorporating planar magnetics, to visualize the electromagnetic fields, and to extract parameters for magnetic models by simulations. The modeling results match with previous theories and finite-element-modeling results. A group of planar magnetic devices, including transformers and inductors with various winding patterns, are prototyped and measured to validate the proposed approach.Texas Instruments IncorporatedMassachusetts Institute of Technology. Center for Integrated Circuits and System

Giant Thermomechanical Bandgap Engineering in Quasi-two-dimensional Tellurium

Mechanical straining-induced bandgap modulation in two-dimensional (2D) materials has been confined to volatile and narrow modulation due to substrate slippage and poor strain transfer. We report the thermomechanical modulation of the inherent bandgap in quasi-2D tellurium nanoflakes (TeNFs) via non-volatile strain induction during hot-press synthesis. We leveraged the coefficient of thermal expansion (CTE) mismatch between TeNFs and growth substrates by maintaining a high-pressure enforced non-slip condition during thermal relaxation (623 to 300K) to achieve the optimal biaxial compressive strain of -4.6 percent in TeNFs/sapphire. This resulted in an enormous bandgap modulation of 2.3 eV, at a rate of up to ~600 meV/%, which is two-fold larger than reported modulation rate. Strained TeNFs display robust band-to-band radiative excitonic blue photoemission with an intrinsic quantum efficiency (IQE) of c.a. 79.9%, making it promising for energy efficient blue LEDs and nanolasers. Computational studies reveal that biaxial compressive strain inhibits exciton-exciton annihilation by evading van-Hove singularities, hence promoting radiative-recombination. Bandgap modulation by such nonvolatile straining is scalable to other 2D semiconductors for on-demand nano(opto)-electronics

Phytochemical analysis of selected medicinal plants

Four medicinal plants including Ranunculus arvensis, Equisetum ravens, Carathamus lanatus and Fagonia critica were used for the study. All the plants were biologically active and were used for different types of ailments. Keeping in view their importance, this work was carried out to investigate the quantitative determination of their crude phytochemicals, vitamins and protein contents. The quantitative determination of crude phytochemicals (alkaloids, total phenols, flavonoids and saponins) vitamins (riboflavin, vitamin C, niacin and pectin) and protein were determined in the aforementioned herbs. The phytochemicals including alkaloids, total phenols, flavonoids and saponins were determined quantitatively using literature methods. Vitamins were measured using a UV/ visible spectrophotometer (UV- 1601 Shamidzu) and the protein was determined by the Micro KJeldahl’s method (Horwitz et al., 2000). The studied plants showed variable amounts of phytochemicals, vitamins and protein contents. The study is very important, in that it intended to show the contents of the studied medicinal herbs and also provide a scientific data base line which is of particular importance for the local practioners as well as for the local people using these herbs for a variety of body disorders.Key word: Phytochemical analysis, medicinal plants, Pakistan

Heavy metals and inorganic constituents in medicinal plants of selected Districts of Khyber Pakhtoonkhwa, Pakistan

Heavy metals such as Cr, Fe, Zn, Mn, Ni, Pb, Cu and Cd, and inorganic ions like HCO3-, CO32-, Ca2+, Mg2+, Cl-, Na+, SO42-, NO3-, Fe2+ and F- were investigated in medicinally important plants: Taraxacam officinale, Cichorium intybus and Figonia critica, applying atomic absorption spectrophotometer techniques. In the studied herbs, there were variable amounts of heavy metals and inorganic ions. The purpose of this study was to standardize heavy metals contamination in various indigenous medicinal plants and to create awareness among the public regarding its safe use at collection areas (containing high level of heavy metals) and their adverse health effects.Key words: Medicinal plants, inorganic constituents, heavy metals, atomic absorption spectrophotometer

Analysis of chemical constituents in medicinal plants of selected districts of Pakhtoonkhwa, Pakistan

Alkaloids, flavonoids and saponins were determined in the Teraxacam officinale, Cichorium intybus and Figonia tritica. Quantative determinations of crude alkaloids, flavonoids and saponins (g kg-1) and their percentages (%) were determined in C. intybus, T. officinale and F. critica collected from Kohat, Mardan, Nowshera and Peshawar regions. Thin layer chromatography (TLC) study of the alkaloids, flavonoids and saponins were carried out with different solvent systems and color of the spot and Rf value of each constituent was determined. Among the samples of C. intybus, relatively higher contents of alkaloids (14 g kg-1) were found in the sample collected from Mardan region, followed by the sample gathered from Nowshera which is equal to 13.8g kg-1. Higher contents of flavonoids were found in C. intybus collected from Kohat region which was 23.48 g kg-1. The other remaining samples of C. intybus ranged in the decreasing order of 19.7, 17.2 and 10.0 g kg-1 for the ones collected from Nowshera, Mardan and Peshawar, respectively. The overall saponin contents remained almost low as compared to the alkaloid and flavonoid contents.Key words: Alkaloids, flavonoids, saponins, TLC study, medicinal plants

Analysis of lesion localisation at colonoscopy: outcomes from a multi-centre U.K. study

Background: Colonoscopy is currently the gold standard for detection of colorectal lesions, but may be limited in anatomically localising lesions. This audit aimed to determine the accuracy of colonoscopy lesion localisation, any subsequent changes in surgical management and any potentially influencing factors. Methods: Patients undergoing colonoscopy prior to elective curative surgery for colorectal lesion/s were included from 8 registered U.K. sites (2012–2014). Three sets of data were recorded: patient factors (age, sex, BMI, screener vs. symptomatic, previous abdominal surgery); colonoscopy factors (caecal intubation, scope guide used, colonoscopist accreditation) and imaging modality. Lesion localisation was standardised with intra-operative location taken as the gold standard. Changes to surgical management were recorded. Results: 364 cases were included; majority of lesions were colonic, solitary, malignant and in symptomatic referrals. 82% patients had their lesion/s correctly located at colonoscopy. Pre-operative CT visualised lesion/s in only 73% of cases with a reduction in screening patients (64 vs. 77%; p = 0.008). 5.2% incorrectly located cases at colonoscopy underwent altered surgical management, including conversion to open. Univariate analysis found colonoscopy accreditation, scope guide use, incomplete colonoscopy and previous abdominal surgery significantly influenced lesion localisation. On multi-variate analysis, caecal intubation and scope guide use remained significant (HR 0.35, 0.20–0.60 95% CI and 0.47; 0.25–0.88, respectively). Conclusion: Lesion localisation at colonoscopy is incorrect in 18% of cases leading to potentially significant surgical management alterations. As part of accreditation, colonoscopists need lesion localisation training and awareness of when inaccuracies can occur

Comparative analysis of knowledge, attitudes and perceptions about induced abortions among medical and non-medical students of Karachi

Objectve: To determine the knowledge, attitudes and perceptions regarding induced abortions among university students of Karachi and compare these aspects among medical and non-medical students. STUDY Design: Cross sectional opinion survey. Methods: The study is a cross sectional opinion survey of medical and non-medical students from four educational institutions of Karachi using a pretested questionnaire. Results: Of the 381 students interviewed, 201 were medical and 180 were non-medical. More medical students were aware of the correct definition of induced abortion. An encouraging finding was the awareness of our study population about the only legally acceptable circumstance for induced abortion in Pakistan, that is, if conceptus is a risk to maternal health (p \u3c 0.001). More medical students cited complications that were technical like uterine perforation (p \u3c 0.001), cervical trauma (p \u3c 0.001), DIC (p \u3c 0.001), and sepsis (p \u3c 0.001). More medical students thought induced abortion to be a health issue (p=0.001) as compared to non-medical students. Most of the medical students felt the need to modify Pakistan\u27s law regarding abortion (p=0.008) especially for fetal anomalies (13.9%) and rape (7%).CONCLUSION: Though medical students were more knowledgeable about induced abortions as compared to the non-medical population, there is a need to improve awareness regarding induced and unsafe abortions and their consequences