AIM： To study the epidemiology of HCC in Lebanon and prognostic factors predictive of early mortality. METHODS： An observational follow-up cohort study of HCC cases diagnosed over a five-year period was carried out....AIM： To study the epidemiology of HCC in Lebanon and prognostic factors predictive of early mortality. METHODS： An observational follow-up cohort study of HCC cases diagnosed over a five-year period was carried out. Multivariate analysis was conducted to identify prognostic factors in comparison to Cancer of the Liver italian Program （CUP） score. Multiple variables including the etiology of underlying liver disease, the demographic characteristics of patients, and the severity of liver disease evaluated by the Child-Pugh score were studied. Tumor parameters included the time of diagnosis of HCC, alpha-fetoprotein level, number and size of nodules, presence of portal vein thrombosis, and treatment modalities. Death or loss of follow-up was considered as an end-point event. RESULTS： Ninety-two patients （mean 60.5 ± 22.3 years） were included. Etiology of underlying disease was hepatitis B, C, and alcohol in 67%, 20%, and 23.5% respectively. Child-Pugh class at diagnosis was A, B, and C in 34.8%, 39.3% and 25.8% respectively. Overall survival was 44.8%, 32.8% and 17.6% at 1, 2 and 3 years respectively （mean F/U 40.2 ± 23.5 mo）. Multivariate analysis identified three predictors of early mortality （〈 6 mo）： bilirubin 〉 3.2 mg/dL （P 〈 0.01）, HCC as first presentation of liver disease （P = 0.035）, and creatinine 〉 1 mg/dL （P = 0.017）. A score based on these variables outperformed the CLIP score by Cox proportional hazard. ROC curve showed both models to be equivalent and moderately accurate.CONCLUSION： HBV is the leading cause of HCC in Lebanon. Independent predictors of early mortality are elevated bilirubin, creatinine and HCC as first manifestation of disease. Prospective validation of a score based on these clinical parameters in predicting short-term survival is needed.展开更多
Adverse reactions to mesalamine,a treatment used to induce and maintain remission in inflammatory bowel diseases,particularly ulcerative colitis,have been described in the literature as case reports.This case illustra...Adverse reactions to mesalamine,a treatment used to induce and maintain remission in inflammatory bowel diseases,particularly ulcerative colitis,have been described in the literature as case reports.This case illustrates an unusual adverse reaction.Our patient developed an isolated fever of unexplained etiology,which was found to be related to mesalamine treatment.A 22-year-old patient diagnosed with ulcerative colitis developed a fever with rigors and anorexia 10 d after starting oral mesalamine while his colitis was clinically resolving.Testing revealed no infection.A mesalamineinduced fever was considered,and treatment was stopped,which led to spontaneous resolution of the fever.The diagnosis was confirmed by reintroducing the mesalamine.One year later,this side effect was noticed again in the same patient after he was administered topical mesalamine.This reaction to mesalamine seems to be idiosyncratic,and the mechanism that induces fever remains unclear.Fever encountered in the course of a mesalamine treatment in ulcerative colitis must be considered a mesalamine-induced fever when it cannot be explained by the disease activity,an associated extraintestinal manifestation,or an infectious etiology.展开更多
Pancreatic tuberculosis is an extremely rare form of extrapulmonary disease. The diagnosis preoperatively is difficult because clinical, laboratory and radiologic findings are nonspecific. Published data indicate that...Pancreatic tuberculosis is an extremely rare form of extrapulmonary disease. The diagnosis preoperatively is difficult because clinical, laboratory and radiologic findings are nonspecific. Published data indicate that these lesions mimic cystic neoplasms of the pancreas and the confirmation of clinical suspicion could only be obtained by an open surgical biopsy. Recently, fine needle aspiration cytology has been shown to be a safe, reliable and cost-effective alternative. We report a new case of a peripancreatic tuberculosis in a 52 year old woman and review the relevant literature, paying special attention to the usefulness of endoscopic ultrasound guided-fine needle aspiration in the diagnosis of abdominal tuberculosis.展开更多
文摘AIM： To study the epidemiology of HCC in Lebanon and prognostic factors predictive of early mortality. METHODS： An observational follow-up cohort study of HCC cases diagnosed over a five-year period was carried out. Multivariate analysis was conducted to identify prognostic factors in comparison to Cancer of the Liver italian Program （CUP） score. Multiple variables including the etiology of underlying liver disease, the demographic characteristics of patients, and the severity of liver disease evaluated by the Child-Pugh score were studied. Tumor parameters included the time of diagnosis of HCC, alpha-fetoprotein level, number and size of nodules, presence of portal vein thrombosis, and treatment modalities. Death or loss of follow-up was considered as an end-point event. RESULTS： Ninety-two patients （mean 60.5 ± 22.3 years） were included. Etiology of underlying disease was hepatitis B, C, and alcohol in 67%, 20%, and 23.5% respectively. Child-Pugh class at diagnosis was A, B, and C in 34.8%, 39.3% and 25.8% respectively. Overall survival was 44.8%, 32.8% and 17.6% at 1, 2 and 3 years respectively （mean F/U 40.2 ± 23.5 mo）. Multivariate analysis identified three predictors of early mortality （〈 6 mo）： bilirubin 〉 3.2 mg/dL （P 〈 0.01）, HCC as first presentation of liver disease （P = 0.035）, and creatinine 〉 1 mg/dL （P = 0.017）. A score based on these variables outperformed the CLIP score by Cox proportional hazard. ROC curve showed both models to be equivalent and moderately accurate.CONCLUSION： HBV is the leading cause of HCC in Lebanon. Independent predictors of early mortality are elevated bilirubin, creatinine and HCC as first manifestation of disease. Prospective validation of a score based on these clinical parameters in predicting short-term survival is needed.
文摘Adverse reactions to mesalamine,a treatment used to induce and maintain remission in inflammatory bowel diseases,particularly ulcerative colitis,have been described in the literature as case reports.This case illustrates an unusual adverse reaction.Our patient developed an isolated fever of unexplained etiology,which was found to be related to mesalamine treatment.A 22-year-old patient diagnosed with ulcerative colitis developed a fever with rigors and anorexia 10 d after starting oral mesalamine while his colitis was clinically resolving.Testing revealed no infection.A mesalamineinduced fever was considered,and treatment was stopped,which led to spontaneous resolution of the fever.The diagnosis was confirmed by reintroducing the mesalamine.One year later,this side effect was noticed again in the same patient after he was administered topical mesalamine.This reaction to mesalamine seems to be idiosyncratic,and the mechanism that induces fever remains unclear.Fever encountered in the course of a mesalamine treatment in ulcerative colitis must be considered a mesalamine-induced fever when it cannot be explained by the disease activity,an associated extraintestinal manifestation,or an infectious etiology.
文摘Pancreatic tuberculosis is an extremely rare form of extrapulmonary disease. The diagnosis preoperatively is difficult because clinical, laboratory and radiologic findings are nonspecific. Published data indicate that these lesions mimic cystic neoplasms of the pancreas and the confirmation of clinical suspicion could only be obtained by an open surgical biopsy. Recently, fine needle aspiration cytology has been shown to be a safe, reliable and cost-effective alternative. We report a new case of a peripancreatic tuberculosis in a 52 year old woman and review the relevant literature, paying special attention to the usefulness of endoscopic ultrasound guided-fine needle aspiration in the diagnosis of abdominal tuberculosis.
