Benign Hepatic Tumors: From Incidental Imaging Finding to Clinical Management / 가정의학회지

Benign hepatic tumors (BHTs) are commonly detected as incidental finding mainly due to the frequent utilization of imaging modalities, including ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI). Rigorous clinical evaluation, with a particular focus on chronic liver disease (CLD) or risk factors for CLD, medication history, physical examination for signs of CLD, blood tests, and a review of past liver radiology constitute the initial steps in the evaluation of a new liver lesion. Further, contrast-enhanced imaging using US, CT and MRI, can be used depending on the clinical scenario and their availability. The contrast-enhanced MRI provides detailed tissue assessment while avoiding exposure to radiations, although it is scarcely available and expensive. While the liver tissue-specific protocols ensure precise diagnosis, a biopsy is recommended in selected or doubtful cases. Further, most BHTs, such as hemangiomas, are harmless and do not require special management or followup, the hepatic adenomas and large or atypical cases of focal nodular hyperplasia are clinically relevant and require management/follow-up. In such cases, it is favorable to have a multidisciplinary team approach, which includes hepatologist, radiologist, hepatobiliary surgeon, and pathologist. This review aims to elaborate the current understanding of BHTs, and provide a practical guidance for primary care and practitioners of family and internal medicine for the disease evaluation and management.

Benign Hepatic Tumors: From Incidental Imaging Finding to Clinical Management / 가정의학회지

Benign hepatic tumors (BHTs) are commonly detected as incidental finding mainly due to the frequent utilization of imaging modalities, including ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI). Rigorous clinical evaluation, with a particular focus on chronic liver disease (CLD) or risk factors for CLD, medication history, physical examination for signs of CLD, blood tests, and a review of past liver radiology constitute the initial steps in the evaluation of a new liver lesion. Further, contrast-enhanced imaging using US, CT and MRI, can be used depending on the clinical scenario and their availability. The contrast-enhanced MRI provides detailed tissue assessment while avoiding exposure to radiations, although it is scarcely available and expensive. While the liver tissue-specific protocols ensure precise diagnosis, a biopsy is recommended in selected or doubtful cases. Further, most BHTs, such as hemangiomas, are harmless and do not require special management or followup, the hepatic adenomas and large or atypical cases of focal nodular hyperplasia are clinically relevant and require management/follow-up. In such cases, it is favorable to have a multidisciplinary team approach, which includes hepatologist, radiologist, hepatobiliary surgeon, and pathologist. This review aims to elaborate the current understanding of BHTs, and provide a practical guidance for primary care and practitioners of family and internal medicine for the disease evaluation and management.

Choice of Anaesthetic Technique for Cesarean delivery in Tripoli Medical Centre

There has been a sustained growth in cesarean delivery rate worldwide. From the early reports of maternal deaths from obstetric anaesthesia, it became clear that potential hazards threaten the mother and child whenever an anaesthetic needs to be administered. General anaesthesia for cesarean section is regarded as a special technique comparatively to most commonly used regional technique. There remain very few obstetric situations where general anaesthesia is essential. The aim of our study is to assess the incidence of regional and general anaesthesia in elective and emergency cesarean sections in Tripoli Medical Centre and to compare it with the incidence in other countries. A retrospective study of 1103 patients undergoing cesarean sections during 6 months of 2004 in Tripoli Medical Centre have been performed.817 parturients [74%] have been operated for emergency indications and 286 parturients [26%] as scheduled cases.599 parturients [54.3%] have been operated under general anaesthesia and 504 parturients [45.7%] under spinal anaesthesia.56.8% of parturients operated for emergency indications have been operated under general anaesthesia and 43.2% under spinal anaesthesia.42.7% of elective cesarean sections were performed under general anaesthesia and 52.8% under spinal anaesthesia. The incidence of general anaesthesia for cesarean delivery in Tripoli Medical Centre is 54.3%. This incidence is ten times higher than in some countries in Europe. Misjudgements are common among anaesthesiologists in selection of anaesthetic technique for cesarean section. especially for a scheduled procedure. There is still unjustified negative attitude of many obstetricians and parturients to regional anaesthesia for cesarean delivery

correlation between iron deficiency anemia and blood lead level

Lead is considered to be one of the major environmental pollutants which has a dangerous impact on health. The objective of this study was to investigate the relationship between elevated blood lead level and iron deficiency anemia among a group of students in preparatory schools in an industrial area in Cairo [Amiria] and to compare them with a similar group in a non industrial Area [Nozha]. This study was carried out on two hundred children who were classified into two groups. The first group consisted of 120 children chosen from preparatory schools of Amiria zone [industrial area] in Cairo, Egypt. The second group consisted of 80 children chosen from preparatory schools in a non industrial area [Nozha]. We excluded the students with chronic diseases as renal failure, congenital diseases or tumors. Also children with history of bleeding tendency or history of parasitic infestation were excluded. A self-administered questionnaire was filled by each student which included personal and socio demographic data and symptoms of anemia as headache or easy fatigue. Each student was subjected to complete clinical examination and biochemical tests including Hb, serum iron, serum ferritin and blood lead level. The ages of the studied group ranged from 11-15 years and there was no significant difference between the two groups as regards socio-demographic characteristics. Easy fatigability was a common symptoms of anemia [35.8%] in the group from the industrial area, pallor was found in 72.5% of them while [78.7%] of the students from the non -industrial area showed -ve signs of anemia. And there was highly statistically significant difference [P=0.0000 left arrow] between the two studied groups as regards the symptoms and signs of anemia. Compared with the children from the non-industrial area, this study showed a statistically significant decrease in Hb, serum iron and serum ferritin levels in the children from the industrial area. Ninety percent of students from the industrial area [Amiria] were anemic according to their hemoglobin level [< /=11 micro g/dl] as compared to 15% only in the non industrial area [Nozha]. Blood lead concentration showed highly significant negative correlation with hemoglobin level in the children from the industrial area and the same association was shown with serum iron level and serum ferritin. So we need to strengthen our efforts towards prevention of lead exposure by reducing lead in the environment. The children at high risk from high lead exposure should be screened at least once every season; schools should be built away from sources of pollution especially factories and also factories must be transferred to industrial zones away from inhabited area

Pattern of cancer at Asir Central Hospital, Abha, Saudi Arabia

Six hundred ninety-seven histologically confirmed cases of cancer were seen in the three-year period, 1987 to 1989, at Asir Central Hospital in Abha, Saudi Arabia. Percentage [crude relative] frequencies of cancer at various sites were determined. The most common cancer sites among males were skin, liver, lymphoid tissue [i.e., non-Hodgkin's lymphomas], bladder, blood [leukemias], stomach, colon, esophagus, central nervous system, and prostate. Skin cancer was also the most common cancer among females, followed by the breast, lymphoid tissue [non-Hodgkin's lymphomas], blood [leukemias], thyroid, stomach, colon, oral cavity, esophagus, and cervix

Hyperglycemia: cause of post-operative restlessness

Hyperglycemia during general anaesthesia and surgery is a known phenomenon. Post-operatively it is also one of the causes of restlessness and prolonged recovery. We report a case of hyperglycemia in a 24 years old female patient, who became restless and confused in the recovery room after an uneventful appendicectomy

role of metal ions on the pharmacological properties of herbal drugs used as antibacterial agents

Various cobalt [II], copper [II], nickel [II] and zinc [II] metal complexes of citrullus and cuminum cyminum plant extract have been synthesized and screened against a number of bacterial species such as streptococcus pyogenes, escherichia coli, bacillus tuberculi, gonococcus, pseudomonas aeruginosa and bacillus subtilis. The pharmacological assay show the metal complexes to be more potent antimicrobials than the pure plant extract

Effects of metal ions on the antimicrobial activity of zizyphus sativa

Co[ll], Ni[ll], Mn[ll] and Zn[II] complexes of the extract of Zizyphus sativa fruit have been prepared and tested against bacterial species Escherichia coli, Proteus vulgaris, Staphylococcus aureus, Pseudomonas aeruginosa and Bacillus subtilis. The antimicrobial studies significantly show the metal-extract to be more potent antibacterial than the uncomplexed extract