The results of 3000 fit tests : a prospective study led at Saint Joseph University of Beirut

Introduction: In terms of frequency, colorectal cancer is the 3rd cancer in Lebanon with 1093 incidences registered in 2015. However, to this date not a single screening campaign has been organized in the country. Fecal immunochemical test [FIT] is a technique being more and more advised in screening. This being said, we found it useful to organize a screening campaign using FIT in order to determine the prevalence of colorectal cancer in a population of 3000 healthy Lebanese in order to extract useful data

Material and Methods: Healthy Lebanese adults of average risk of developing colorectal cancer between 45 and 80 years old. Procedure: 3000 sampling tubes were distributed. Numerous presentations were done to explain the screening modalities and its importance. In order to preserve the sample quality, patients were asked to return the tubes within 3 days of doing the test. Once the hemoglobin quantification has been done at the medical genetics unit [UGM] of Saint-Joseph University, patients with stool hemoglobin of more than 80ng/ml were contacted and answered few questions then were asked to undergo a colonoscopy. Follow-up is still ongoing as well as sampling kits distribution

Results o Out of the 3000 distributed tests, 705 were returned [23.5 percent]. 528 were presented with enough data to be studied and out of them 459 answered the inclusion criteria. The cohort median for age was 56 years old [45-80]. Sex ratio F/M 2.3, among them 4 percent had personal cancer history, 14 percent had familial history of colorectal cancer and 20 percent underwent colonoscopies at least once in their life. Out of the 459 patients, 278 [60.5 percent] showed 0 ng/ml, 137 [29.8 percent] showed 1 to 79 ng/ml, 3 [0.6 percent] showed 80 to 99 ng/ml meaning they are at intermediate risk, 33 [7.1 percent] showed 100 to 800 ng/ml considered as a positive value and finally 8 [1.7 percent] showed over range values. Among the 44 positive patients we contacted 41, directly or by their referent physician. Out of the 8 [18 percent] colonoscopies results received so far, 5 had hemorrhoids causing false positive results. One had ulcerative ileitis. For the remaining 2, tubular adenomas of low grade were discovered, while for one of them a carcinoma was discovered

Conclusion: While it was hard for us to quantify people for whom a free FIT was proposed, the low restitution rate among those who accepted to undergo the test shows the urgent necessity of establishing sensitization and screening campaigns. This takes a particular dimension knowing that some patients with positive FIT refused further investigations

The Merit of Tyrosine Kinase inhibitors in the adjuvant setting of high-risk renal cell carcinoma Ameta-Analysis

Background: Loco-regional renal cell carcinoma [RCC] accounts for 15 to 20 percent of patients with RCC, with a risk of post-surgical relapse of 40 percent [1,2]. Following the adoption of tyrosine kinase inhibitors [TKIs] as the first-line treatment of metastatic RCC, multiple studies evaluated Sunitinib [3,4] and Pazopanib [5] in the adjuvant setting of high-risk resected RCC. However, these studies have yielded inconclusive results, and there are currently no meta-analyses combining the results of all trials evaluating TKIs in the adjuvant setting of high-risk RCC. The aim was to perform a meta-analysis to evaluate and compare the possible benefit of Sunitinib and Pazopanib on diseasefree survival [DFS] in the adjuvant setting of high-risk RCC

Methods: This meta-analysis included all the phase 3 randomized controlled trials [ASSURE 3, S-TRAC 4 and PROTECT 5] evaluating Sunitinib and Pazopanib in the adjuvant setting of high-risk RCC. A random-effects model was preferentially used to pool the data using the inverse variance method and a subgroup analysis including Sunitinib and Pazopanib subgroups was used in order to account for heterogeneity and allow comparison of the two subgroups. Two variations of the same analysis were undertaken as sensitivity analyses : first with a fixed-effects model, second while excluding the results of the ASSURE study. The primary outcome was the comparison of disease-free survival [DFS] between TKIs and placebo. Hazard ratios were reported along with their 95 percent confidence intervals [95 percentCI]

Results: A total of 3447 patients from the three trials were included in the analysis. There was a tendency for a significant overall effect of both TKIs on DFS; however, this tendency only reached the threshold for statistical significance in the fixed-effects model [HR = 0.91; 95 percentCI = 0.83-0.99; p = 0.03] but not in the random-effects model [HR = 0.85; 95 percentCI = 0.72-1.01; p = 0.06, Figure 1]. Significant between-study overall heterogeneity was observed [p = 0.07; I2 = 58 percent] and the subgroup analysis showed that this was largely due to the heterogeneity within the Sunitinib subgroup [p = 0.05; I2 = 73 percent, Figure 1]. Moreover, a sensitivity analysis excluding the ASSURE study led to results which were markedly more homogeneous [p = 0.48; I2 = 0 percent]. While the test for overall effect was found to be significant in the Pazopanib subgroup [HR = 0.80; 95 percentCI = 0.65-0.98; p = 0.03] but not in the Sunitinib subgroup [HR = 0.90; 95 percentCI = 0.67-1.19; p = 0.45], there was no significant difference between the subgroup effects [p = 0.51; I2 =0 percent; Figure 1]

Conclusion: Our analysis showed that Pazopanib and Sunitinib could still have a potential role in the armamentarium of adjuvant treatment in high-risk RCC. However, it failed to demonstrate a significant difference between these agents in this setting

Ressecçäo cirúrgica de metástases pulmonares: estudo prospectivo em 182 pacientes / Surgical removal o pulmonary metastasis: prospective study in 182 patients

Objetivo. O presente estudo visa avaliar os resultados do tratamento cirúrgico de metástases pulmonares, além de tentar identificar mais precisamente os subgrupos de pacientes que se beneficiariam mais da operaçao. Casuística e Método. O estudo é uma análise prospectiva de pacientes com história de tumores primários, submetidos à ressecçao de nódulos pulmonares com suspeita ou diagnóstico de metástases, para determinar os resultados desta abordagem, e investigar a influência de fatores prognósticos potenciais sobre a probabilidade de sobrevida global ou livre de doença. Foram incluídos neste estudo todos os pacientes (n=182) com neoplasias malignas prévias, e submetidos a toracotomia. Resultados. Os pacientes submetidos à ressecçao pulmonar de nódulos suspeitos de metástases reveleram a ausência de qualquer neoplasia em 34 deles (18,6 por cento), seis deles (3,2 por cento) apresentaram um segundo tumor primário de pulmao. A sobrevida global dos pacientes foi de 28 por cento em 56 meses. A sobrevida livre de doença de 56 meses foi de 9 por cento. A análise multivariada mostrou que a sobrevida global dos pacientes foi influenciada pelo intervalo livre de doença (menor que 1,5 ano, p=0,002), pela ressecçao completa (p=0,039), e pelo número de nódulos maqlignos ressecados (menor que três nódulos, p=0,016). A sobrevida livre de doença foi significativamente afetada pela ressecçao completa das metástases (p=0,0001) e pelo número de nódulo malignos ressecados (menor que três nódulos, p=0,004). Conclusao. A ressecçao cirúrgica de metástases pulmonares beneficia um grupo selecionado de pacientes; estudos complementares sao necessários para se definir o valor da associaçao de outras modalidades terapêuticas na sobrevida destes pacientes.

Puberdade precoce associada a cisto de III ventriculo: relato de caso. / Puberty precocious associated with third ventricle cyst: a case report

Os autores relatam 1 caso de cisto do III ventriculo, associado a hidrocefalia congenita, determinando aparecimento de puberdade precoce em uma crianca do sexo feminino, com 6 anos de idade.Sao discutidos aspectos relacionados com a etiologia do pocesso, bem como o mecanismo de formacao, alem da forma de tratamento instituido

Meningeoma de fossa posterior com expansao extracraniana em crianca. Registro de um caso. / Meningioma of the posterior fossa with extracranial expansion in a child: report of a case

Os autores relatam caso de meningeoma de fossa posterior com projecao extracraniana em criancas de 3 anos de idade, submetido a terapeutica cirurgica com boa evolucao e remissao completa dos sinais e sintomas neurologicos apresentados. A raridade do tipo e localizacao do tumor nessa faixa etaria justificam a apresentacao e registro do caso

Termocoagulacao percutanea em neuralgia do trigemeo. / Thermocoagulation percutaneous in trigeminal neuralgia

Os autores relatam os resultados obtidos em 25 pacientes estudados no periodo de abril de 1981 a setembro de 1982, portadores de neuralgia do trigemeo, tratados pelo metodo de termocoagulacao por radiofrequencia. Destes, 24 tinham neuralgia essencial do trigemeo e apenas 1 tinha neuralgia atipica do trigemeo. Nos primeiros, nao houve recorrencia de dor apos o procedimento e no paciente com quadro atipico foi necessario repetir o ato cirurgico apos 72 horas da primeira intervencao, quando, entao, o paciente ficou completamente assintomatico. Todos os doentes foram acompanhados em ambulatorio por um periodo minimo de 6 meses. A simplicidade do metodo, a baixa incidencia de complicacoes quando comparada a outras tecnicas, alem da possibilidade de o procedimento ser realizado ambulatorialmente e o baixo tempo de permanencia hospitalar permitem recomendar este metodo como sendo de escolha para o tratamento cirurgico da neuralgia do trigemeo

Meningeoma ectopico do calvario: registro de um caso. / Ectopic meningioma of the calvarium: report of a case

Os autores relatam um caso de meningeoma ectopico de calvario, submetido a tratamento cirurgico com boa evolucao. Comentam alguns aspectos referidos na literatura, ressaltando as caracteristicas radiologicas. Justificam o presente relato pela infrequencia do mesmo, bem como pelo bom prognostico quando submetido a tratamento adequado