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Objectives Cancer is the second leading cause of mortality in the world, and represents an economic, social and psychological burden. Scientific studies have focused on psychosocial coping mechanisms of patients and on factors improving their quality of life. Thus, the aim of the present study is to analyze the influence that spirituality would have on the quality of life of Lebanese cancer patients and to identify whether the influence on quality of life is mediated through a decreased depression. Methods This is a cross-sectional study targeting cancer patients in the hemato-oncology department of the Hotel-Dieu de France Hospital (Beirut, Lebanon). It is based on a questionnaire composed of three parts: EQ-5D-5L, PHQ-9, and FACIT-Sp-12. Likewise, a control group suffering from chronic diseases and treated in the hospital was questioned. Univariate and multivariate analysis were conducted to assess the relationship between the different questionnaires for controls and for cancer patients. Results Thirty-nine cancer patients and eight control patients were questioned. In the univariate analysis, there was no relationship between depression and spirituality nor for spirituality and quality of life. After controlling for depression, an inverse correlation between quality of life and spirituality was shown. Conclusions Our study is a pilot study which for the first time investigates the implication of depression in a “spirituality-quality of life” association. There is no clear association of spirituality with quality of life. In fact, the physical and psychological burden of chronically ill patients could exceed and render insignificant a possible impact of spirituality on quality of life.

Introduction There is a lack of studies on the optimal anti-tumor necrosis factor (anti-TNF) agent for postoperative prophylaxis of Crohn's disease (CD) recurrence. Therefore, we conducted a network meta-analysis (NMA) of prospective trials to compare the efficacy of anti-TNF agents in the prevention of postoperative endoscopic and clinical recurrence of CD following ileocolonic resection. Methods We searched PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, and recent American gastroenterology association (AGA) meeting abstracts through August 2017. We selected prospective studies comparing anti-TNF agents among each other or to other agents in the setting of postoperative prevention of CD recurrence. We performed a NMA using a frequentist approach with generalized pairwise modeling and inverse variance heterogeneity method. Results We identified 9 studies, including 571 patients and 5 treatment agents, among which 2 anti-TNF drugs (adalimumab and infliximab). Compared with infliximab, our NMA yielded the following results for endoscopic recurrence: adalimumab [odds ratio (OR), 0.92; 95% confidence interval (CI), 0.18-4.75], thiopurines (OR, 4.11; 95% CI, 0.68-24.78), placebo (OR, 4.39; 95% CI, 0.70-27.68), and Mesalamine (OR, 37.84; 95% CI, 3.77-379.42). For clinical recurrence: adalimumab (OR, 1.03; 95% CI, 0.17-6.03), thiopurines (OR, 1.40; 95% CI, 0.20-10.02), placebo (OR, 1.77; 95% CI, 1.01-3.10), and mesalamine (OR, 16.54; 95% CI, 1.55-176.24). Conclusions On the basis of a NMA combining direct and indirect evidence either adalimumab or infliximab may be used in the postoperative prophylaxis of CD recurrence. There is currently a lack of evidence on the use of other anti-TNF agents in this setting.

Background: Adherence to therapy in chronic diseases such as inflammatory rheumatic diseases (CIRD), inflammatory bowel diseases (IBD) and psoriasis (Pso) is a major condition to achieve positive outcomes. Patient support programs (PSPs) were developed to improve the quality of care and enhance adherence to therapy. Objectives: To evaluate the perception of patients treated for inflammatory chronic diseases towards PSPs. Methods: All available PSPs were identified at the national level, and their services were classified into categories: financial, logistic, educational, and emotional support. Consecutive adult patients with CIRD, IBD and Pso, enrolled in a PSP for more than 3 months, were interviewed by a trained medical student. Demographic data, disease and treatment characteristics were collected at the physician’s clinic. Global satisfaction was estimated using a 5-points Likert scale, adherence to treatment was measured by the Compliance Questionnaire for Rheumatology (CQR), PSPs services were classified according to their importance to the patient using a 5-points Likert scale. An open questionnaire identified the patients’ perceptions qualitatively. Predictive factors of satisfaction were identified. Results: Forty-seven patients were included in the study, 53% were males, with a mean age of 49.8 years (SD 15.2) (Patients’ characteristics in Table 1). The majority declared that the PSP was very useful (95.7%) and were highly satisfied with the programs (97.9%). Higher attributes were assigned, by decreasing order, to: financial (copay program, providing of free samples), logistic (hotline, refrigerating box), educational (educational material) and emotional support. Nursing services and telephone reminders were rated as least important (Figure 1). Most open comments gave higher appreciation to financial support (54%), followed by education (38%) and logistics (8%). High appreciation of education was associated with lower age, type of treatment and PSP. Shorter treatment duration was associated with appreciation of educational material, emotional support and telephone reminders. Conclusion: Patients were highly satisfied with PSP programs, and ranked the financial support as the most important followed by logistics, whereas education, nursing services and telephone reminders were found less important. Lower age and shorter treatment duration were associated with higher appreciation of education and support. References [1] Rubin D, Mittal M, Davis M, et al. Impact of a Patient Support Program on Patient Adherence to Adalimumab and Direct Medical Costs in Crohn’s Disease, Ulcerative Colitis, Rheumatoid Arthritis, Psoriasis, Psoriatic Arthritis, and Ankylosing Spondylitis. J Manag Care Spec Pharm. 2017;23(8):859-67. [2] Gangi A, Clewell J, Shillington A. The impact of patient support programs on adherence, clinical, humanistic, and economic patient outcomes: a targeted systematic review. Patient Preference and Adherence 2016:10 711–725. [3] Van den Bosch F, Ostor A, Wassenberg S, et al. Impact of Participation in the Adalimumab (Humira) Patient Support Program on Rheumatoid Arthritis Treatment Course: Results from the PASSION Study. Rheumatol Ther (2017) 4:85–96. Disclosure of Interests: None declared

Objective Traumatic life events are important risk factors for eating disorders (ED). War has been associated, in military populations, with an increased post-service incidence of ED and an increased mean body mass index. We hypothesize that a modification of eating behavior (EB) related to stress during wartime may increase the risk of developing an ED later on among civilians exposed to war stress during adulthood. Methods This descriptive cross-sectional study was performed in a group of 303 undergraduate young adult students of both sexes from Lebanon, 6 months after the July 2006 war. Modification of EB during wartime, sociodemographic and other potential risk factors were assessed retrospectively. Students were then screened for ED using the SCOFF questionnaire. Results SCOFF was positive in 31.4% of the students, with a mean value 41.6% higher among subjects who reported an altered EB during the war. Among subjects with a positive SCOFF screening, 71% had experienced a change of EB during wartime. Alteration of EB during war was related to an odds ratio for a positive SCOFF screening of 2.6 (95% CI 1.54–4.34) and 1.8 (95% CI 1.01–3.21) for non-adjusted and adjusted analysis, respectively. Conclusions Modification of EB related to stress during wartime is associated with an increased risk of eating disorders. Early detection and treatment of eating disorders may be improved by routinely evaluation of EB modification in patients with a past history of war exposure.

The high prevalence of eating disorders in Arab countries indicates a need for an Arabic language screening tool. This study aimed to validate an Arabic version (A-SCOFF) of the British SCOFF questionnaire, a brief tool for the screening of eating disorders in primary health care. After translation and back-translation the A-SCOFF was given to 123 female patients [mean age 32 (SD 8.8) years] visiting primary health-care centres in Beirut. Each patient was evaluated by an eating disorders specialist blinded to A-SCOFF results. The validated Arabic version of the Mini International Neuropsychiatric Interview and the DSM-IV criteria for eating disorders were used as diagnostic references. The best diagnostic threshold for the A-SCOFF was found to be at 2 positive answers with a sensitivity of 80.0%, a specificity of 72.7% and an area under the curve of 80.0%. The A-SCOFF questionnaire is accurate and reliable for the early detection of eating disorders in this high-risk population.التحقق من صحة النسخة العربية لاستبيان سكوف (SCOFF) الخاص بتحري اضطرابات الأكل.انطوان عون، جاد عزام، فلورا الجبور، ساني حليس، داني دهام، شربل العم، خليل حنين، بيار دشلوت.إن ارتفاع معدل انتشار اضطرابات الأكل في البلدان العربية يجعل من الروري وجود أداة للتحري باللغة العربية. وقد هدفت هذه الدراسة إلى التحقق من صحة النسخة العربية (A-SCOFF) لاستبيان SCOFF البريطاني؛ وهي أداة مخترة لتحري اضطرابات الأكل في الرعاية الصحية الأولية. فبعد الترجمة والترجمة العكسية تم إعطاء A-SCOFF إلى 123 مريضة ]متوسط أعمارهن 32 (SD 8.8) سنة[ من اللواتي يَزُرْنَ مراكز الرعاية الصحية الأولية في بروت. وتم تقييم كل مريضة من قبل متخصص باضطرابات الأكل لا يعرف نتائج A-SCOFF. واستخدمت النسخة العربية المصادق عليها لمعاير المقابلة العصبية النفسية الدولية المصغرة ومعاير DSM-IV (الدليل التشخيصي الإحصائي الرابع) الخاصة باضطرابات الأكل كمراجع تشخيصية. فوجد أن أفضل عتبة تشخيصية لل A-SCOFF عى إجاباتن إيجابيتن كانت ذات حساسية مقدارها 80.0% وخصوصية مقدارها 72.7% ومنطقة تحت المنحنى مقدارها 80.0% . ولقد خلصنا أن الاستبيان A-SCOFF دقيق وموثوق للكشف المبكر عن اضطرابات الأكل لدى هذه الفئة السكانية ذات الخطورة العالية.Validation de la version en langue arabe du questionnaire SCOFF pour le dépistage des troubles alimentaires.La forte prévalence des troubles alimentaires dans les pays arabes indique la nécessité d’un outil de dépistage en langue arabe. La présente étude visait la validation de la version en langue arabe (SCOFF-A) du questionnaire SCOFF britannique, un outil succint pour le dépistage des troubles alimentaires en soins de santé primaires. Après traduction et rétrotraduction, le questionnaire SCOFF-A a été administré à 123 patientes (âge moyen 32 ans [ET 8,8 ans]) consultant dans des centres de soins de santé primaires à Beyrouth. Chaque patiente a été évaluée par un spécialiste des troubles alimentaires n’ayant pas eu connaissance des résultats au questionnaire SCOFF-A. La version en langue arabe validée du bref entretien neuropsychiatrique Mini International Neuropsychiatric Interview et les critères du DSM-IV pour les troubles alimentaires ont été utilisés en tant que références diagnostiques. Le meilleur seuil diagnostique pour le questionnaire SCOFF-A a été déterminé à deux réponses positives avec une sensibilité de 80,0 %, une spécificité de 72,7 % et une aire sous la courbe de 80,0 %. Le questionnaire SCOFF-A est précis et fiable pour le dépistage précoce des troubles alimentaires dans cette population à haut risque.

Keywords: Candida; hepatic candidiasis; kidney;liver; mycosis; transplantationThe incidence of hepatic candidiasis is difficultto estimate because of diagnostic difficulties. Itsfrequency was 7% in a study of 562 adult patientswith leukaemia [1]. Hepatic candidiasis (HC), alsoreferred to as chronic disseminated candidiasis,hepatosplenic candidiasis and granulomatous hepaticcandidiasis, affects almost exclusively patients under-going remission induction chemotherapy or bonemarrow transplantation for acute leukaemia [2].It occurs on recovery following prolonged episodesof bone marrow dysfunction and neutropenia [1].Theliver,spleenandsometimesthekidneysareinfectedwith Candida. Occasionally, patients with other typesof immunosuppression (aplastic anaemia, lymphoma,sarcoma or liver transplantation) may develophepatosplenic candidiasis [3]. This is the first reportedcase of HC in a kidney transplant recipient.

Drug-induced liver injury (DILI) represents liver damage from various therapeutic drugs. Antimicrobials are among the most common causes of DILI. We report a case of hepatic toxicity due to Trimethoprim-sulfamethoxazole (TMP-SMX) in a patient who underwent renal transplantation. Diagnosis has been made after a careful history taking, exclusion of competing etiologies and reversal of biochemical abnormalities after withdrawal of the antibiotic. TMP-SMX liver toxicity is well known but remains unpredictable and is rarely reported.

Percutaneous endoscopic gastrostomy (PEG), the modality of choice for long-term enteral access, is generally a safe procedure but can be associated with many potential complications.Report two different and late complications of PEG in two patients fed at home, leading them to the emergency department.A 75-year-old man and a 14-year-old young man with PEG presented to the emergency department with two different complications related to the gastrostomy tube. The first patient developed fever and deterioration in mental status due to parietal abscess which developed secondary to the migration of the internal button of the gastrostomy tube in the abdominal wall. He was treated with antibiotics and the gastrostomy tube was extracted. The second one presented upper gastrointestinal bleeding due to intestinal perforation at the level of the internal button of the gastrostomy tube. Bleeding and perforation were treated conservatively and he had a good evolution.Persons taking care of patients with PEG tube must be aware of potential complications. The position and the permeability of the tube must be systematically checked before feeding and medical advice should immediately be asked for in case of doubt or in the presence of any alarming sign.

We are reporting the rare case of splenic artery aneurysm of 4 cm of diameter presenting as a sub mucosal lesion on gastro-duodenal endoscopy. This aneurysm was treated by endovascular coil embolization and stent graft implantation. The procedure was uneventful. On day 1, the patient presented an acute severe epigastric pain and cardiovascular arrest. Abdominal computed tomography scan showed an active leak of the intravenous contrast dye in the peritoneum from the splenic aneurysm. We performed an emergent resection of the aneurysm, and peritoneal lavage. Postoperatively, hemorrhagic choc was refractory to large volumes replacement, and intravenous vaso-active drugs. On day 2, he presented massive hematochezia. We performed a total colectomy with splenectomy and cholecystectomy for ischemic colitis, with spleen and gallbladder infarction. Despite vaso-active drugs and aggressive treatment with Factor VIIa, the patient died after uncontrolled disseminated intravascular coagulation.

Von Hippel-Lindau disease is a genetic disorder characterized by neoplasms with multiple organ involvement, the pancreas being involved in about half of the cases. Conservative treatment is indicated because the disease is usually asymptomatic with long-term follow-up.We herein present the case of a 64-year-old man with von Hippel-Lindau disease who presented with obstructive jaundice which resulted as being caused by a fibro-cystic pancreatic nodule. In addition, we reviewed the literature concerning pancreatic involvement in von Hippel-Lindau disease with emphasis on their presentation, type of lesions and appropriate management, especially in cases with obstructive jaundice.Conservative management is advocated in the majority of VHL disease patients with pancreatic involvement, but surgery is sometimes required, especially when patients are symptomatic (obstructive jaundice, upper gastrointestinal bleed).

L'achalasia is the best known primary motor disorder of the esophagus in which the lower esophageal sphincter (LES) has abnormally high resting pressure and incomplete relaxation with swallowing. Pneumatic dilatation (PD) remains the first choice of treatment. Our aim was to report, in a retrospective way, our experience in treating with pneumatic dilatation 41 achalasia patients admitted to the gastroenterology unit at Hôtel-Dieu de France (HDF) hospital between 1994 and 2004. A total of 46 dilatations were performed in 41 patients with achalasia [20 males and 21 females, the mean age was 46.8 years (range, 15-90)]. All patients underwent an initial dilatation by inflating a 35 mm balloon to 7 psi three times successively under fluoroscopic control. The need for subsequent dilatation with the same technique or for surgical treatment was based on symptom assessment. The mean follow-up period was 36.7 months (3 mo-7 years). Among the patients whose follow-up information was available, a satisfactory result was achieved in 29 patients (80.5%) after only one or two sessions of pneumatic dilatation. Esophageal perforation as a short-term complication was observed in one patient (2.17%). Seven patients were referred for surgery (one for esophageal perforation and six for persistent or recurrent symptoms). In conclusion, performing balloon dilatation under fluoroscopic observation is simple, safe and efficacious for treating patients with achalasia. Referral to repeated PD or to surgical myotomy should be discussed in case of no response to a first session of PD.

Endoscopic polypectomy is now an established procedure for the resection of colorectal polyps. One of the serious complications associated with colonoscopic polypectomy is hemorrhage. Several factors appear to be associated with increased risk of hemorrhage including patient age and colorectal polyp size, location, and morphology (thick stalk or sessile). In particular, resection of large polyps is associated with a higher risk of serious complications. Bleeding most often occurs within the first 24 hours. More than 95% of cases of bleeding can be treated endoscopically by epinephrine injection, heater probe, or band ligation, alone or in combination. Several methods have been proposed for the prevention of hemorrhage after polypectomy. The most interesting approach is the use of a detachable snare (Endoloop) which allows endoscopic ligation of the stalk of a large, pedunculated polyp. In order to avoid the more severe consequences of bleeding, we use a detachable snare in two patients with a pedunculated polyp with a large head and stalk (2 cm). In a third patient receiving anticoagulant, a detachable snare was chosen to safely and completely remove a large pedunculated polyp1.5 cm. In conclusion, colonoscopic polypectomy with Endoloop is safer than conventional polypectomy alone for resection of large, pedunculated polyps, especially in patients with liver disease, coagulopathy and receiving anticoagulant.

Rectal Dieulafoy's lesion is an unusual cause of abrupt and massive lower gastrointestinal hemorrhage. It is characterized histologically by a caliber-persistent submucosal artery that protrudes through a minute mucosal defect. Various theories and risk factors have been proposed to explain the occurrence of bleeding but none is completely satisfying. We present two cases of rectal Dieulafoy's lesion which were treated efficaciously by a simple injection of a sclerosing agent in the first case and by a combination of epinephrine injection and thermal probe coagulation in the second leading to a complete and rapid disappearance of the abnormal vessel.

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.

Insulinoma is the most common endocrine tumors of the pancreas. The diagnosis is suspected by clinical symptoms and confirmed by biologic tests. Because the majority of insulinomas have a small size, the real problem is the localization of these tumors. The non invasive radiologic exams (US, CT Scan, angiography or RMI) are not sensitive for the topographic localization of insulinomas. The invasive exams like per operative US and palpation of the parenchyma or dosage of insulin by transhepatic catheterization of portal vein or in hepatic vein after intrarterial stimulation are very sensitive. The only noninvasive preoperative exam with high sensitivity to localize insulinomas is endoscopic ultrasonography (EUS). We report a case of insulinoma localized by EUS with review of the literature.

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

Anomalous pancreaticobiliary junction with cystic dilatation of the biliary tract is usually associated with carcinoma arising from the cyst wall. We report an extracystic location of biliary carcinoma in the presence of anomalous pancreaticobiliary junction and cysts in a patient with obstruction of the origin of the left hepatic duct who underwent hepatobiliary resection. Cholangiocarcinoma was found to have arisen in a noncystic left hepatic duct, in conjunction with cystic dilatation involving both the cystic and common bile ducts. The present case supports a relationship between anomalous pancreaticobiliary junction and biliary carcinogenesis that may affect the extracystic biliary tree.

The practical role of gastric biopsy in the management of gastritis is controversial.To estimate the yield of endoscopic biopsies in the clinical, endoscopic and pathologic approach of gastritis.Prospective study of 250 consecutive patients who underwent an upper G.I. endoscopy between July 1996 and January 1997, for upper G.I. symptoms, miscellaneous manifestations requiring an upper G.I. endoscopy or presenting a gastritis on EGD performed for other indications. Every patient had 6 biopsies: 2 in the antrum, 2 in the corpus, and 2 in an intermediate zone.After defining the abnormal elemental endoscopic and pathologic patterns, gastric mucosa was endoscopically normal in 57 cases (22.8%) and abnormal in the remaining of the 250 cases (77.2%). The pathologic findings were normal in 69 cases (27.6%) and abnormal in the remaining 181 cases of 250. H. pylori was found in 126 cases (50.4%), 10 cases of which (7.9%) had normal pathology. There was no significant correlation between clinical symptoms, endoscopy and pathology. There was a correlation between endoscopic abnormalities and tobacco use (P = 0.0073), NSAIDs use (P = 0.0001) and the presence of H. pylori (P0.0001). There was also a correlation between pathologic findings, tobacco use (P = 0.0015), NSAIDs use (P = 0.0022) and the presence of HP (P0.0001). On the other hand, there was a correlation between the presence of an inflammatory infiltrate in H. pylori gastritis (P = 0.0007) and its absence in NSAIDs use (P = 0.0003). The correlation between endoscopy and pathology existed only for certains patterns: erosion and ulcerations (P = 0.0002), purpuric (P = 0.033), congestion (P0.0001) and mosaic (0.0095).Gastric biopsy brings no important practical supplement to endoscopic examination except in revealing the presence of H. pylori. It adds nothing to endoscopy in helping explain the clinical symptoms. But it is obvious that it may reveal some serious pre-malignant dysplasia or malignant gastric lesions (maltoma, linitis plastica). This did not occur during our study.

Renal failure in cirrhosis has multiple etiologies and numerous aggravating factors with evidence of worsening of prognosis. Our study was performed on 130 cirrhotic patients hospitalized in HDF between January 1st, 1994, and December 31st, 1999. We have evaluated the causes of renal failure and the relation of different aggravating factors with the onset of renal failure. Causes of renal failure included drug-induced renal failure, organic nephropathy, pre-renal azotemia, acute tubular necrosis and hepato-renal syndrome. Among the aggravating factors, lactulose was found to alter renal function (p = 0.0175). We studied the survival with respect to the serum creatinine levels and to the severity of liver disease. Three-year survival was respectively 59% and 42% in case of Child A and Child B patients with creatinine lower than 90 micromol/L. No three-year survivors were noted in these subsets of patients when creatinine level was higher than 90 micromol/L (p = 0.0247 and p = 0.0121 respectively). No difference in survival was noted in Child C cirrhosis. The occurrence of renal failure is a factor of bad prognosis in cirrhotic patients irrespective of Child's classification. In patients with Child A and Child B cirrhosis, a serum creatinine level higher than 90 micromol/L is a bad prognostic factor with a significantly decreased survival rate. This factor does not affect survival in Child C cirrhosis because of mortality related to cirrhosis complications.

Dieulafoy's lesion is a rare and important cause of gastrointestinal hemorrhage. It is a relatively large artery which lies in close proximity to the mucosal surface. Hemorrhage is often torrential and life threatening. Endoscopy is the most sensitive diagnostic test. Many reports described successful hemostasis utilizing a variety of endoscopic modalities in95% of cases. We report an upper gastrointestinal hemorrhage in a patient with Dieulafoy lesion treated successfully by injection, and a literature review.

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

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 mesalamine-induced 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.

Background Colonoscopy has a great impact on diagnosis and management of the diseases of the colon. In general it's a safe and accurate procedure. No evaluation has been done of any endoscopic practices in a country where the practice of medicine is totally private. Objectives Prospective audit of technical success and complication rates of both therapeutic and diagnostic colonoscopy. Setting One endoscopy unit of a Lebanese university hospital. Patients and design 407 consecutive colonoscopies were evaluated over a 6-month period. Data were recorded for age and sex of the patients, indication of the colonoscopy, presence of comorbidities, patients risk stratification, administrated dose of anesthetic drugs. Data concerning the procedure itself were also monitored. Intervention Completion rate as well as complications reported during or post colonoscopy. All patients were called back by phone 48 hours and 1 month later to identify any related post-procedural complication. Results 407 patients underwent colonoscopy. All patients were sedated with midazolam, propofol and fentanyl. The overall caecal intubation rate was 99.99%. 70 snare polypectomies and 29 cold forceps excision were performed as well as 5 coagulations with Argon Plasma Coagulation. The most important post-procedural complication was chemical colitis in 2 cases. Limitations Patients and endoscopists satisfaction was not evaluated. It's an audit of a single tertiary French affiliated hospital. It does not necessarily reflect what's really happening on a national level. Conclusion This audit enabled us to change some of our practices; i.e. rinsing method of endoscopes. It stimulated the team to keep a high performance level without neglecting the risk of potential complications.

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 17 year old woman presented to the emergency room after accidental ingestion of a toothbrush. The patient tearfully admitted that she had been self inducing vomiting to control her weight for the …

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 …

A 45 year old woman presented with longstanding dyspepsia associated with oedema and a 4 kg weight loss over the previous six months. She gave no history of haematemesis or blood in stool, …

A 24 year old woman was admitted for severe and recurrent vomiting. Her complaints began 12 months earlier when she started by having occasional postprandial vomiting …

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.