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Objective: Chronic liver diseases, including cirrhosis, may develop in obese patients. Steatosis and non-alcoholic steatohepatitis (NASH) are risk factors for progression to fibrosis. To date, diagnosis of steatosis and NASH relies on liver biopsy. The aim of the study was to identify serum markers of steatosis and NASH in obese patients using SELDI–TOF ProteinChip. Patients: Eighty obese non-alcoholic patient candidates for bariatric surgery and devoid of hepatitis B and C infection were selected. Serum samples were collected before surgery and at 6 months after surgery for 33 of these patients. Wedge liver biopsy was performed at the time of bariatric surgery. Twenty-four serum samples from healthy blood donors served as controls. The protein profiles of each serum were assessed using SELDI–TOF ProteinChip technology and were compared according to liver histological lesions. Results: Twenty-four obese patients (30%) had nonsignificant liver lesions, 32 (40%) had significant steatosis and 24 (30%) had NASH. Comparison of serum protein profiles according to liver lesions identified three peaks (CM10-7558.4, CM10-7924.2 and Q10-7926.9) the intensity of which significantly increased according to the severity of the liver lesions (steatosis and NASH) and returned to normal after bariatric surgery. None was correlated with either liver function tests or metabolic parameters. Identification using immunoSELDI assay characterised these peaks as the double charged ions of a- and b-haemoglobin subunits. Conclusion: The differential proteomic method demonstrated changes in serum protein profiles in obese patients according to severity of liver lesions. Free haemoglobin subunits may serve as a serum biomarker of the severity of liver damages.

The hepatitis C virus (HCV) epidemic was forecasted through 2030 for 15 countries in Europe, the Middle East and Asia, and the relative impact of two scenarios was considered: increased treatment efficacy while holding the annual number of treated patients constant and increased treatment efficacy and an increased annual number of treated patients. Increasing levels of diagnosis and treatment, in combination with improved treatment efficacy, were critical for achieving substantial reductions in disease burden. A 90% reduction in total HCV infections within 15 years is feasible in most countries studied, but it required a coordinated effort to introduce harm reduction programmes to reduce new infections, screening to identify those already infected and treatment with high cure rate therapies. This suggests that increased capacity for screening and treatment will be critical in many countries. Birth cohort screening is a helpful tool for maximizing resources. Among European countries, the majority of patients were born between 1940 and 1985. A wider range of birth cohorts was seen in the Middle East and Asia (between 1925 and 1995).

Background and objective Intravenous administration of compound sodium lactate (CSL) 30 ml kg−1 to women undergoing gynaecological laparoscopy reduced the incidence of vomiting, nausea and antiemetic use when compared with 10 ml kg−1. The aim of this study was to evaluate the effect of intravenous fluid administration on nausea and vomiting after thyroidectomy. Methods With ethics committee approval, 100 patients scheduled for thyroid surgery were included in this prospective, controlled, double blind study. Patients were randomized into two groups: the CSL-10 group (n = 50) received CSL 10 ml kg−1 and the CSL-30 group received CSL 30 ml kg−1; the administration of fluid was completed by the end of surgery. Standardized anaesthesia was performed. The incidence of nausea and vomiting and need for antiemetics and analgesic therapy were assessed by a blinded observer at 0.5, 2, 6, 12, 18 and 24 h after surgery. Patients' satisfaction was also recorded (0–100). Results The incidence of nausea (64%) was similar in both groups (P = 0.1). The incidence of vomiting was 34% in the CSL-10 group and 32% in the CSL-30 group (P = 0.83). Antiemetics (P = 0.84) and analgesic consumption (P = 0.72) did not differ significantly between the two groups. Patients' satisfaction was also comparable (P = 0.39). Conclusion Intravenous administration of CSL 30 ml kg−1 to patients undergoing thyroidectomy did not reduce the incidence of nausea, vomiting and antiemetic use when compared with CSL 10 ml kg−1.

Background: Epigastric pain is a common presenting complaint encountered in urgent care settings. Although peptic, biliary, and pancreatic pathologies are the most frequent findings, other rare diagnoses also can be found. Objectives: We report an unusual case of acute epigastric pain in which abdominal ultrasound was of great support in revealing the diagnosis. Case Report: A 64-year-old man presented to the Emergency Department after rapid onset of acute epigastric pain. Abdominal ultrasound showed a multi-cystic heterogeneous mass between the stomach and the liver. Abdominal computed tomography scan confirmed the gastric origin of the mass and showed torsion signs. Urgent laparotomy was performed with tumor excision. The diagnosis of pedunculated exophytic gastric stromal tumor was made and long-term follow-up was arranged. Conclusions: Acute presentation revealed the presence of the tumor, which was excised surgically.

To study the epidemiology of HCC in Lebanon and prognostic factors predictive of early mortality.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 (CLIP) 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.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): bilirubin3.2 mg/dL (P0.01), HCC as first presentation of liver disease (P = 0.035), and creatinine1 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.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.

A 31 year old woman presented with vaginal faecal discharge and anal pain. Her past medical history was significant for a 20 year history …

An 82 year old non-diabetic man on haemodialysis three times a week presented with a two day history of epigastric pain with nausea, fatigue, and a cold painful …

The VIPoma syndrome is rare. It is usually caused by a neuroendocrine tumor located in the pancreas. Somatostatin analogs and interferon-a can be helpful in the symptomatic control of the disease, but the efficacy of chemotherapy in metastatic disease is limited. We report the case of a 32-yr-old patient who had a primary intestinal VIPoma with peritoneal carcinomatosis and hepatic metastases. Somatostatin analogs and conventional chemotherapy regimens were not effective on VIPoma syndrome and tumor progression. The combination of 5- fluorouracil and interferon-alpha was associated with a major clinical improvement and tumor regression. Further investigations should evaluate the place of such a combination as a first line treatment for patients with metastatic neuroendocrine tumors.

t m n w a m 39-year-old man presented with a 6-year history of ecurrent episodes of nonfebrile, diffuse, crampy, abominal pain, nausea, and bloating, with normal bowel ovement. These episodes occurred 1 to 2 times per ear, lasting 36 hours, and resolved spontaneously. In the revious 6 months he noted an increase in frequency and everity of recurrences along with a weight loss of 6 kg 10% of body weight). He had an unremarkable past edical history without any abdominal surgery or liver isease, and he wasn’t taking any medication. On examnation, the abdomen was flat with mild nonspecific iffuse tenderness. There was no palpable mass. Bowel ounds were weak. Routine blood analysis was normal. pper gastrointestinal endoscopy and colonoscopy with erminal ileoscopy were normal. Contrast-enhanced CT of the abdomen showed a hickening of the last 20 cm of the distal jejunum surounded by a moderate dilatation of the proximal jejuum and by a conglomeration of ileal loops (A). The last 0 cm of the ileum were normal, as was the colon. A mall-bowel followthrough revealed a bowel wall thickning of a distal jejunal loop without mucosal abnormalties followed by a “cauliflower-like” disposition of the leum loops situated 10 cm above the ileocecal valve (B, rrowheads). An abdominal MRI confirmed the images f the CT scan. f

A 60 year old female underwent total colonoscopy for recurrent painless haematochezia. She reported no past medical history of abdominal or anorectal symptoms. Physical examination was unremarkable. …

A 52 year old man with a known history of renal stones presented with symptoms and signs of right renal colic. No fever or infectious signs were noted. Right ureteral …

A 55 year old woman with no significant past medical history presented with abdominal pain and vomiting. She was totally asymptomatic before this episode. Twenty four hours prior …

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.