Role of overnight rifampin test in diagnosing Gilbert's syndrome.

BACKGROUND: Gilbert's syndrome (GS) is the most common inherited disorder of bilirubin metabolism. Recent data show that the rifampin test can be used as a diagnostic test but there is controversy about its effect on bilirubin level in normal individuals. We studied the effect of administration of rifampin on serum bilirubin level in patients with GS and in healthy individuals. METHODS: Serum total and unconjugated bilirubin levels were measured in 16 patients with GS and 15 healthy individuals before and after a single 600-mg oral dose of rifampin. RESULTS: In patients with GS, mean (SD) serum total and unconjugated bilirubin level increased from 2.15 (0.49) and 1.56 (0.41) mg/dL, respectively to 3.23 (0.72) (p< 0.001) and 2.52 (0.71) mg/dL (p< 0.001), respectively after rifampin administration, and in healthy subjects from 0.69 (0.13) and 0.34 (0.09) mg/dL, respectively to 1.68 (0.56) (p< 0.001) and 0.84 (0.23) mg/dL (p< 0.001), respectively. Elevation of these levels above the normal cut-off levels had poor accuracy for the diagnosis of GS. However, elevation of total serum bilirubin after rifampin above 2.4 mg/dL was 93.8% sensitive and 93.3% specific for the diagnosis of GS, and elevation of unconjugated bilirubin above 1.3 mg/dL was 100% sensitive and 100% specific. CONCLUSIONS: Rifampin elevates bilirubin level to above normal in GS and healthy subjects. Overnight rifampin test may be useful for the diagnosis of GS if cut-off levels for serum total and unconjugated bilirubin level of more than 2.4 and 1.3 mg/dL are used.

Cancer occurrence in Semnan Province, Iran: results of a population-based cancer registry.

INTRODUCTION: suitable information of different cancers in special geographic areas can help define medical programs for treatment and screening of high-risk groups. AIMS AND METHODS: The provincial health authority reported a high mortality rate from upper GI cancer in the center of Iran. A comprehensive search was undertaken to survey and register all cases of cancer during a 5-year (1998-2002) period among the indigenous population of Semnan Province. Diagnosis of cancer was based on histopathology, clinical or radiological findings, and death certificates. RESULTS: A total of 1732 patients with cancers (mean age 59.41% +/-19.08% years) were found during the study. Of these, 936(54.86%) were in males. Crude rates were 124.8/100,000 and 112.1/100,000 for males and females, respectively. Age-standardized ratios (ASRs) for all cancers in males and females were 156/100,000 and 136/100,000 person-year, respectively. Gastric cancer was the most common tumor with an incidence rate of 19.7 per 100,000 people (ASR=27.5). In upper gastrointestinal cancers, gastric cancer was the most common (47.17%), followed by colon malignancies (8.1%, 9.5 per 100,000 populations), esophagus (6.8%, 7.9 per 100,000 populations), liver (2.4%, and 2.8 per 100,000 populations). In women, breast, uterine and ovary, stomach and skin were the most common cancers. In the child population the most common tumors were of the brain, acute lymphocytic leukemia, and bone. CONCLUSION: Gastric cancer alone constitutes one-sixth of all cancers in Semnan, with the highest ASR incidence rate reported from Iran up to now.