Usability and acceptability of self-testing for hepatitis C virus infection among the general population in the Nile Delta region of Egypt.

BACKGROUND: Self-testing for hepatitis C virus antibodies (HCVST) may be an additional strategy to expand access to hepatitis C virus (HCV) testing and support elimination efforts. We conducted a study to assess the usability and acceptability of HCVST among the general population in a semi-rural, high-HCV prevalence region in Egypt. METHODS: An observational study was conducted in two hospitals in the Nile Delta region. A trained provider gave an in-person demonstration on how to use the oral fluid HCVST followed by observation of the participant performing the test. Usability was assessed by observing errors made and difficulties faced by participants. Acceptability of HCV self-testing was assessed using an interviewer-administered semi-structured questionnaire. RESULTS: Of 116 participants enrolled, 17 (14.6%) had received no formal education. The majority (72%) of participants completed all testing steps without any assistance and interpreted the test results correctly. Agreement between participant-reported HCVST results and interpretation by a trained user was 86%, with a Cohen's kappa of 0.6. Agreement between participant-reported HCVST results and provider-administered oral fluid HCV rapid test results was 97.2%, with a Cohen's kappa of 0.75. The majority of participants rated the HCVST process as easy (53%) or very easy (44%), and 96% indicated they would be willing to use HCVST again and recommend it to their family and friends. CONCLUSION: Our study demonstrates the high usability and acceptability of oral fluid HCVST in a general population. Further studies are needed to establish the optimal positioning of self-testing alongside facility-based testing to expand access to HCV diagnosis in both general and high-risk populations.

Thoracodorsal artery perforator flap as an autologous alternative to acellular dermal matrix.

BACKGROUND: Thoracodorsal artery perforator (TDAP) flap is one of the relatively new techniques in breast reconstruction. This pedicled flap retains the benefits of perforator flaps as regards minimal donor site morbidity without the need for microvascular anastomosis. Its role in partial breast reconstruction has been well documented. However, there are few reports about the role of this flap in total breast reconstruction. METHODS: This study included 47 cases who presented to the breast unit of the National Cancer Institute of Cairo University from 2013 to 2015. All patients underwent nipple-sparing mastectomy with immediate implant-based reconstruction. The TDAP flap was used to complete the subpectoral pocket for the implants in a way similar to the acellular dermal matrix. RESULTS: Overall complication rate was 14.9%. Capsular contracture occurred in 6.4%.There were no donor site complications. The majority of patients were satisfied with their cosmetic results. Sixty-eight percent rated their result as "excellent" or "good." CONCLUSION: Thoracodorsal artery perforator flap can play a significant role in total breast reconstruction. In settings with limited resources, this flap can serve as an available autologous alternative to acellular dermal matrix.

Batwing versus Wise pattern mammoplasty for upper pole breast tumours: a detailed comparison of cosmetic outcome.

BACKGROUND: The aim of this study is to compare the results of batwing mammoplasty and Wise pattern mammoplasty in the surgical management of upper pole breast tumours. METHODS: This is a retrospective observational study including 126 breast cancer patients who presented between 2009 and 2015 to the National Cancer Institute of Cairo University in Egypt. All patients were candidates for breast conservation, with upper pole tumours, which was defined as tumours between 3 and 9 o'clock. Patients were categorized into two groups. Group A (64) included patients who underwent inferiorly based therapeutic mammoplasty, while group B (62) was designated for patients who had batwing mammoplasty. The results of both groups were compared and analyzed. RESULTS: Wise pattern mammoplasty group had statistically significant higher complication rate. The overall aesthetic result of Wise pattern technique was superior to batwing mammoplasty. However, batwing mammoplasty showed a statistically significant higher rate of patient satisfaction. CONCLUSIONS: Both techniques are valid options for upper pole breast tumours. Wise pattern therapeutic mammoplasty remains aesthetically superior; however, batwing mammoplasty is an easy, simple technique with acceptable results to patients.

Effect of aging treatment on the damping capacity and mechanical properties of Mg-6Al-1Zn alloy.

The damping capacity and mechanical properties of Mg-6Al-1Zn alloy after heat treatment were investigated. The damping characteristics of un-heat-treated, solution treated, and aged Mg-6Al-1Zn specimens were determined by measuring the damping ratio and the logarithmic decrement of free vibrations of a bending beam clamped at one side. The microstructural evaluations confirmed that the ß-Mg17Al12 phase was reprecipitated after aging and increased with an increase in aging time. The peak level of damping ratio and logarithmic decrement was obtained after 34 hr of aging time, over which the damping capacity declined according to increasing amount of strong pining points.

Management of patients with CHB outside the guidelines: Insights from Egyptian cohort with long-term follow-up.

It is alarming that globally, only 2.2% (6.6 million) of patients with chronic hepatitis B (CHB) received treatment in 2019. One contributing factor to this low treatment rate is the complexity and restrictive nature of clinical practice guidelines. Since 1998, we have adopted a "treat-all" approach to patients with CHB. A retrospective study was conducted involving patients with CHB who received treatment from 1998 to 2020 at 2 institutions in Egypt. These patients underwent evaluation through various clinical and laboratory methods, which included testing for liver enzymes and HBV DNA. The study analyzed 1825 patients with HBV, finding that 27.4% had viremia levels under 2000 IU/mL. Most (88%) were HBeAg-negative, with 12% positive. A large portion (77.6%) had normal alanine aminotransferase levels, though 5.6% exceeded twice the upper limit of normal. About 14.2% were diagnosed with liver cirrhosis, and 9.6% with F3 stage fibrosis at enrollment. Notably, 2% (25 cases) lost HBsAg over a median of 52 months. Patients with HBV DNA <2000 IU/mL had a higher HBsAg loss rate (4.2%) compared to those with levels >2000 IU/mL (1.3%). During follow-up, 9.5% (117 patients) experienced decompensation, with a higher incidence in those with HBV DNA <2000 IU/mL (16.8%) than those >2000 IU/mL (7.1%). HCC developed in 5.2% of patients with lower HBV DNA and 2.6% with higher levels, showing significant differences. Liver-related deaths occurred in 2.8% of the cohort, with a slightly higher rate in those with lower initial HBV DNA levels (3.5% vs. 2.5%). The findings suggest a paradigm shift in CHB management toward early and broader eligibility for antiviral therapy. This could improve patient outcomes and address the global treatment gap in CHB management, especially in regions with high CHB prevalence.

Surface quality and dry sliding wear behavior of AZ61Mg alloy using Abbott firestone technique.

Currently, magnesium alloys are widely utilized in diverse sectors due to their unique properties. However, the AZ61Mg alloy, a commonly used magnesium alloy, is known to have poor wear resistance, which limits its applications. To address this issue, researchers have investigated various surface treatment techniques, including the Abbott Firestone method, to improve the wear resistance of this alloy. This study employs response surface methodology (RSM) to examine the effects of pressure and velocity on wear behavior and Abbott Firestone zones of AZ61Mg alloy. Three pressure (0.01, 0.015, and 0.02 MPa) and velocity (0.57, 0.76, and 0.95 m/s) levels are used to conduct dry sliding wear tests at room temperature using a pin-on-disc method with an experimental design technique (EDT). Analysis of variance ANOVA is employed to identify the relationship between the input parameters (pressure and velocity) and the responses (wear rate, Surface Roughness Parameter Rz, and Abbott Firestone zones) of the AZ61Mg alloy. The optimized models for wear rate and Abbott Firestone zones yielded accurate estimations, which can enhance cost-effectiveness and efficiency. The findings indicate that pressure and velocity significantly affect the wear behavior of the AZ61Mg alloy.

Worn surface topography and mathematical modeling of Ti-6Al-3Mo-2Sn-2Zr-2Nb-1.5Cr alloy.

This study aims at investigating worn surface topography and mathematical modeling of annealed Ti-6Al-3Mo-2Sn-2Zr-2Nb-1.5Cr alloy using response surface methodology (RSM). The alloy was subjected to three different regimes in order to study their effect on mechanical properties. First regime was applying cold deformation by compression until 15% drop in height at room temperature. The second regime was performing solution treated on the deformed samples at 920 °C for 15 min then air-cooled (AC) to ambient temperature. Third regime was applying aging on the deformed and solution treated specimen for 4 hr at 590 °C followed by air-cooling. Three different velocities (1, 1.5, and 2 m/s) were adopted to conduct dry sliding wear according to the experimental design technique (EDT). Gwyddion and Matlab softwares were used to detect worn surface photographs analytically and graphically. Maximum hardness of 425 HV20 was obtained for AC+Aging specimen, while minimum hardness of 353 HV20 was reported for the annealed specimen. Applying aging process after solution treatment enhanced considerably the wear property and this enhancement reached 98% as compared to the annealed condition. The relationship between input factors (hardness & velocity) and responses (Abbott Firestone zones) was demonstrated using analysis of variance (ANOVA). The best models for Abbott Firestone zones (high peaks, exploitation, and voids) produced accurate data that could be estimated for saving time and cost. The results showed that the average surface roughness increases with increasing sliding velocity for all conditions except AC+Aging condition where the average surface roughness decreased with increasing sliding velocity. The results revealed that at low velocity and hardness, the material gives the highest exploitation zone (86%). While at high velocity and hardness, the material gives the lowest exploitation zone (70%). In general, the predicted results of mathematical model showed close agreement with experimental results, creating that models could be utilized to predict Abbott Firestone zones satisfactorily.

Depression, anxiety, and stress among COVID-19 patients in South Sinai, Egypt: prevalence and associated predictors.

Infectious diseases trigger fear and anxiety among patients leading to disturbance in psychological health of patients. Psychological symptoms were found during SARS-COV-1 epidemic which raise the curiosity about their presence with SARS-COV-2 infection. The current study aimed to estimate the prevalence and severity of psychiatric disorders (depression, anxiety, and stress) among COVID-19 patients and their associated significant predictors. A cross-sectional study was conducted among 382 patients infected with COVID-19 in South Sinai governorate, Egypt, during the period June 2021 through January 2022. Patients with positive PCR test for COVID-19 were included if no more than 6 months have passed after being isolated in the hospital or at home. The patients were being contacted after being cured from COVID-19. The Arabic version of the Depression Anxiety Stress was used to assess the psychological status of patients. Multivariate linear regression analysis was done to detect the predictors of psychiatric symptoms among patients. A total of 382 participants with mean age of 41.5 ± 15.0 years old, of whom 72.5% were males were included in the study. 91.6% of participants had all the three studied psychological disorders; depression, anxiety and stress with most of participants had either severe or extremely severe conditions (13.9 and 75.7 for anxiety, 22.8 and 46.3% for depression, 38.5 and % 19.6 for stress, respectively). Healthcare workers had higher prevalence rates of depression, anxiety and stress. In bivariate analysis, educational level, HCWs and visiting healthcare facility were significantly affecting DASS scores. In linear regression analysis, hospital admission was the main predictor of the three psychological disorders. In Conclusion, majority of patients affected with COVID-19 suffered from symptoms of anxiety, depression and stress within six months after being infected. Hospital admission was found to be the main predictor of the presence of psychiatric disorders with prolonged recovery time from COVID-19 infection. More attention should be paid to COVID-19 patient's mental health as psychological care and presence of psychiatric in the isolation hospitals should be considered.

Enhancement of quasi-static compression strength for aluminum closed cell foam blocks shielded by aluminum tubes.

Aluminum closed cell foam blocks are created with a volume of 1 inch3 which consist of aluminum foam parts shielded with part of aluminum tube and in some types reinforced with inner aluminum tubes. Blocks have been made to overcome some existing problems in metallic foam used to protect some applications parts from impacts as a sacrificial part. Metallic foam has three main categories sandwich panels, filled tubes and corrugated sheets. Quasi-static compression tests have been applied on 12 blocks with different shapes and compared with pure aluminum foam blocks as a reference. Results display the enhancement of mechanical properties of blocks like yield strength (SY), crushing strength (Sc) and densification strength (Sd), compression at strain 70%, as well as absorbed energy (area of compression under the curve). The highest value for yield strength (5.87 MPa) was registered for Finger phalanxes cube block (FP-0.1 Sq.). While the highest value for densification strength (21.7 MPa) was registered for spine cylinder block (SV8-0.17 C25). The registered results for samples apparent the highest value for energy dissipation density (Edd) is 40.52 J/in3 (91% enhancement) and crushing strength (8.61 MPa) was registered for Finger phalanx cylinder block (FP-0.17 C25). The lowest value for Edd is 14.16 J/in3 (less than pure aluminum foam block value by 33%), SY = 0.42 MPa, Sc = 3.21 MPa, and Sd = 4.46 MPa, registered for thin wall Ear canal cylinder block (EC8-0.075 C26.5). Best mechanical properties had been achieved for Finger phalanx cylinder block (FP-0.17 C25) and spine cylinder block (SV8-0.17 C25).

Influence of Microstructure and Alloy Composition on the Machinability of α/ß Titanium Alloys.

A comparative study was conducted for the machining of two α/ß titanium alloys, namely Ti-6Al-4V (Ti64) and Ti-6Al-7Nb (Ti67), using wire electric discharge machining (WEDM). The influence of cutting speed and cutting mode on the machined surfaces in terms of surface roughness (Ra), recast layer (RL), and micro-hardness have been evaluated. Rough cut (RC) mode at a cutting speed of 50 µm/s resulted in thermal damage; Ra was equal to 5.68 ± 0.44 and 4.52 ± 0.35 µm for Ti64 and Ti67, respectively. Trim-cut mode using seven cuts (TRC-VII) at the same speed decreased the Ra to 1.02 ± 0.20 µm for Ti64 and 0.92 ± 0.10 µm for Ti67. At 100 µm/s, Ra reduced from 2.34 ± 0.28 µm to 0.88 ± 0.12 µm (Ti64), and from 1.42 ± 0.15 µm to 0.90 ± 0.08µm (Ti67) upon changing from TRC-III to TRC-VII. Furthermore, a thick recast layer of 30 ± 0.93 µm for Ti64 and 14 ± 0.68 µm for Ti67 was produced using the rough mode, while TRC-III and TRC-VII modes produced layers of 12 ± 1.31 µm and 5 ± 0.72 µm for Ti64 and Ti67, respectively. Moreover, rough cut and trim cut modes of WEDM played a significant role in promoting the surface hardness of Ti64 and Ti67. By employing the Response Surface Methodology, it was found that the machining mode followed by cutting speed and the interaction between them are the most influential parameters on surface roughness. Finally, mathematical models correlating machining parameters to surface roughness were successfully developed. The results strongly promote the trim-cut mode of WEDM as a promising machining route for two-phase titanium alloys.

Effect of heat treatment atmospheres on microstructure evolution and corrosion resistance of 2205 duplex stainless steel weldments.

The effects of post heat treatment atmosphere on microstructure and corrosion resistance of duplex stainless steel welded joints were investigated. Post weld heat treatment (PWHT) was carried out with and without protective atmospheres. Nitrogen and argon are used as protective gases individually. Detailed microstructure examination (optical and SEM) demonstrates that nitrides precipitates are highly observed in the welded zones for nitrogen protected samples. An observed drop of ferrite volume fraction in post weld heat treated samples compared with welded samples without heat treatment leading to corrosion resistance enhancement of heat treated welded joints. An exception for using nitrogen as heat treatment atmosphere a decreased corrosion resistance of weldments is investigated due to nitride precipitates. An increase in the weld zone hardness for post weld heat treated samples compared with base alloy. The initial hardness of duplex stainless steel was 286 Hv while average hardness of weld zone was 340, 411, 343, and 391 Hv for as welded, PWHT using air, argon, and nitrogen atmospheres, respectively. Weld zone hardness increased to 33, 44, 20, and 37%. A significant decrease in the ultimate tensile strength and elongation after PWHT. The initial Ultimate tensile strength duplex stainless steel base material was 734.9 MPa while Ultimate tensile strength of the welded joints was 769.3, 628.4, 737.8, and 681.4 MPa for the following conditions: as welded, PWHT using air, argon, and nitrogen atmospheres, respectively.

Mathematical modeling of wear behavior and Abbott Firestone zones of 0.16C steel using response surface methodology.

The effects of applied pressure and running velocity on wear behavior as well as Abbott Firestone zones of low carbon steel (0.16C) were evaluated using response surface methodology (RSM). At room temperature, three different pressures (0.5, 1.5, and 2.5 MPa) and three different velocities (1.5, 2.25, and 3 m/s) were used to conduct dry sliding wear trials utilizing the pin-on-disc method according to the experimental design technique (EDT). The experiments were created using central composite design (CCD) as a starting point. The relationship between input factors (pressure and velocity) and responses (wear rate and Abbott Firestone zones) of 0.16C steel was demonstrated using analysis of variance (ANOVA). The best models for wear rate as well as Abbott Firestone zones produced accurate data that could be estimated, saving time and cost. The results revealed that pressure had the greatest impact on the alloy's dry sliding wear behavior of the two variables studied. In general, the predicted result shows close agreement with experimental results and hence created models could be utilized for the prediction of wear behavior and Abbott Firestone zones satisfactorily.

Phyllodes tumors of the breast: Adjuvant radiation therapy revisited.

BACKGROUND: Phyllodes tumors (PT) are rare entity and surgical resection is the cornerstone of treatment. No standard of care exists regarding adjuvant treatment especially radiation therapy (RT). PATIENTS AND METHODS: We analyzed all patients with non-metastatic, resected phyllodes tumors who presented to our institution from January 2005 through December 2019. Primary study endpoints included local recurrence free survival (LRFS) and overall survival (OS). RESULTS: One hundred and eight patients were analyzed (patients with incomplete treatment and follow up data were excluded). Fifty patients had benign phyllodes, 26 patients had borderline and 32 patients had malignant phyllodes. In the benign group, no significant difference in LRFS was observed between patients who received adjuvant RT (n = 3) and those who did not (5-year LRFS 100% vs. 85% respectively, p = 0.49). The 5 year OS for patients who received RT was 60% vs. 89% for those who did not (p 0.40). In the borderline/malignant group, adjuvant RT significantly improved five year LRFS (90% in the RT group vs. 42% in the no RT group, p = 0.005). The 5 year LRFS in patients treated with margin negative breast conserving surgery and RT was 100% vs. 34.3% in patients who did not receive RT (p 0.022). Patients treated with mastectomy and RT had a 5 year LRFS of 100% vs. 83% for patients who did not receive RT (p 0.24). On multivariate analysis, radiation therapy was independently associated with decreased hazard of local failure (HR 0.21, CI 0.05-0.89, p = 0.03). No difference in OS was found between the RT and no RT groups (5-year OS was 52% vs. 45% respectively, p 0.54). CONCLUSION: The results of the current study confirm the excellent prognosis of benign phyllodes tumors; warranting no further adjuvant treatment after margin-negative surgical resection. For patients with borderline/malignant phyllodes tumors, adjuvant radiation therapy significantly improved LRFS after margin negative wide local excision; however, patients treated with mastectomy did not attain the same benefit from adjuvant irradiation.

Once Daily Versus Twice Daily External Beam Accelerated Partial Breast Irradiation: A Randomized Prospective Study.

PURPOSE: The aim of the current study was to compare toxicity, cosmesis, and local control between the once daily and the twice daily fractionation schemes for external beam accelerated partial breast irradiation. METHODS AND MATERIALS: From December 2012 to June 2018, we enrolled 113 patients with ductal carcinoma in situ or invasive breast cancer, node negative disease, and tumors less than 3 cm in size to receive accelerated partial breast irradiation (APBI) to a total dose of 38.5 Gy over 10 fractions given either once (oAPBI) or twice daily (tAPBI). Sixty patients were included in the tAPBI arm and 53 patients were included in the oAPBI arm. RESULTS: Median follow-up was 74 months (range, 24-105). The median pain score during treatment was 3 out of 10 in the oAPBI and 5 in the tAPBI (P = .001). No differences were observed in GIII early skin toxicity (P = .4) or GI early pulmonary toxicity (P = 1.0) between the 2 treatment arms. GIII late skin toxicity developed in 3.8% and 11.7% of patients in the oAPBI and tAPBI arms, respectively (P = .001). GIII subcutaneous fibrosis developed in 1.9% and 8.3% of patients in the oAPBI and tAPBI, respectively (P = .001). The rate of patients with adverse cosmesis (poor/fair) was 7.5% at 12 months and at 24 months in the oAPBI arm compared with 21.7% and 26.7% in the tAPBI arm (P = .03 and .008, respectively). CONCLUSIONS: oAPBI is a safe, well-tolerated schedule with more favorable outcomes than the tAPBI schedule with regards to late toxicity and cosmesis.

Metformin alters peripheral blood mononuclear cells (PBMC) senescence biomarkers gene expression in type 2 diabetic patients.

BACKGROUND: Although there is increasing evidence showing that cell senescence is increased in circulating PBMC in type 2 diabetes mellitus (T2DM), the data are contradictory. This study examined several senescence biomarkers, including LMNA/C transcript variants, p16INK4a, p53, and p21Cip1/WAF, in PBMC of T2DM patients and the effect of Metformin on these senescence markers. METHODS: Blood samples were obtained from 30 lean, 30 obese, 20 newly diagnosed type 2 diabetes mellitus (T2DM), and 30 T2DM on Metformin. PBMC were isolated and mRNA expression of the senescence biomarkers were quantified by RT-qPCR. The effect of ectopic expression of LMNA and LMNC in human monocytic cells lines (THP-1 and U937) on several inflammatory mediators were also examined. RESULTS: LMNA expression was significantly higher in PBMC of obese and T2DM patients. LMNC expression was significantly inhibited in T2DM patients. LMNAΔ10 and Progerin mRNA expression was not detected in PBMC of all groups. Expression of p16INK4a, p21Cip1/WAF and p53 were inhibited significantly in T2DM. Metformin treatment reverted LMNA, LMNC, and p53 expression levels to normal levels. Upregulation of LMNA in monocytic THP-1 and U937 cell lines induced CD68, TNFα, CCL2, IL-6 and NOS2. CONCLUSIONS: These data support the notion that LMNA may mediate senescence in PBMCs of T2DM by upregulating inflammatory pathways. Metformin may exert its anti-inflammatory property by modulation of senescence mediator LMNA.

Indolent keratitis due to fungus of Malbranchea species. A case report.

INTRODUCTION: Keratitis caused by saprophytic fungi is on the rise in rural areas, often caused by ocular trauma with wooden objects. Early detection of causative organisms and sustained, supervised management can prevent visual disabilities. CASE PRESENTATION: A middle-aged patient from a rural, semi-arid region who presented with pain, redness, and a foreign-body sensation in his left eye resulting from a corneal ulcer induced by trauma from a wooden stick. Due to a history of uncontrolled diabetes and progression of his corneal lesions, he was admitted to our institution for treatment of infectious keratitis. Microbiological examination of corneal scrapings revealed thin, septate hyaline hyphae without conidia or conidiophores, and the patient was diagnosed with a fungal keratitis caused by a Malbranchea species. Though the patient initially responded to treatment with topical natamycin, his condition worsened. He was subsequently successfully treated with topical amphotericin B (1 mg/mL) twice hourly and systemic antifungals. Four months after discharge, the patient returned with symptom recurrence. CONCLUSION: We report the case of a patient with a Malbranchea species causing a rare and recurrent fungal keratitis with corneal infiltrates, subsequently cured by medical management with salvaging of his vision. In patients with a suspected fungal keratitis, early treatment is crucial and should be combined with tight glycemic control for as long as 6 months after presentation to avoid recurrence.

Correlation of Specimen/Breast Volume Ratio to Cosmetic Outcome After Breast Conserving Surgery.

Breast conserving surgery (BCS) is currently the standard of care for early breast cancer. One of the key determinants for the line of treatment in breast cancer is the size of the tumor in relation to the breast size. The aim of this study is to determine the effect of the ratio of the excised specimen to breast volume on the cosmetic outcome after conventional BCS. This is a retrospective study conducted on female patients with early stage breast cancer who underwent BCT at National Cancer Institute, Cairo University. The study included 41 patients with stage I and II breast cancer. Breast volume was calculated using mammography, and ratio of the specimen to breast volume was determined. This ratio was correlated with the cosmetic outcome using the BCCT.core software. Thirty-six out of the 41 breast cancer patients completed the study. Favorable outcome (excellent + good) was detected in 52.7% of patients, while 47.3% had unfavorable outcome (fair + poor). Breast volume, tumor site, patients' age, and weight did not seem to alter the cosmetic result. The only statistically significant factors affecting the cosmetic outcome were the specimen volume and the ratio of the specimen to the normal breast volume (p = 0.006 and 0.019 respectively). In order to obtain a satisfactory cosmetic outcome after conventional BCS, the ratio of the excised specimen to breast volume has to be seriously considered.

The role of thoracodorsal artery perforator flap in oncoplastic breast surgery.

BACKGROUND AND AIM: Thoracodorsal artery perforator flap (TDAP) is one of the relatively new techniques in breast reconstruction. In this study, we try to evaluate the outcome of this flap in oncoplastic procedures. METHODS: This study included 40 patients of stage II breast cancer who underwent partial mastectomy with skin excision at the National Cancer Institute of Cairo University between 2011 and 2014. The resultant defects were immediately reconstructed using the thoracodorsal artery perforator flap. Operative time and complication rates were recorded. The cosmetic outcome was assessed through a questionnaire. RESULTS: The mean operative time was 227min. The total complication rate was 20% with flap congestion being the most common complication. The cosmetic outcome was acceptable with 80% of patients rating their outcome as either good or excellent. The subjectively assessed functional outcome showed a mean time of 10days postoperative for patients to regain their full range of shoulder movements. CONCLUSION: Thoracodorsal artery perforator flap can play a significant role in oncoplastic surgery and breast reconstruction with acceptable cosmetic and functional outcome.

Invasive duct carcinoma of the forearm: a rare case of distant, isolated 'carcinoma en cuirasse'.

Cutaneous metastasis (carcinoma en cuirasse) is a condition that results from a tumor spreading via lymphatic or vascular embolization, direct implant during surgery or skin involvement by contiguity. Contralateral distant cutaneous breast cancer has never been reported before and hence, the nature and management of such rare cases remains challenging. We aim to present a case of left-sided 'distant' cutaneous metastatic invasive duct carcinoma affecting the distal upper extremity (contralateral side) two and half years (disease-free) following treatment for right breast cancer (right mastectomy + chemoradiation). A complete metastatic work-up excluded the presence of any underlying disease. Clinical examination revealed a fungating, irregular ulcer that bled easily on touch involving the left forearm. The ulcer was excised totally and the raw area reconstructed using a split thickness graft. The patient had uneventful postoperative course and now remains disease-free for almost 1 year with no evidence of local recurrence.