Review article: the changing epidemiology of hepatocellular carcinoma in Canada.

The aim of this study was to examine the incidence of and mortality caused by hepatocellular carcinoma over the last 20 years in Canada, including the associated risk factors hepatitis C, diabetes and obesity. Databases from the Surveillance & Risk Assessment Division of Health Canada & Statistics Canada were analysed for trends in both age-adjusted incidence of and mortality due to hepatocellular carcinoma from 1984 to 2001. The epidemiological impact of hepatitis C, diabetes and obesity on hepatocellular carcinoma was also assessed. The incidence of hepatocellular carcinoma increased from 4.0 per 100,000 in 1984 to 5.5 in 2,000 for males, and from 1.6 per 100,000 in 1984 to 2.2 in 2,000 for females. Mortality rates showed a 48% increase in males and 39% increase in females. The incidence of hepatitis C increased sharply in 1995 and remained elevated until 2,000 with an average value of 85.4 per 100,000 in males and 45.4 per 100,000 in females. This increase is likely due to the widespread testing for hepatitis C. The prevalence of obesity and diabetes has increased in recent years and probably contributes to the increased incidence of hepatocellular carcinoma. The incidence of hepatocellular carcinoma in Canada has increased in the past 20 years and is associated with a rise in the incidence of hepatitis C, obesity and diabetes.

Hypersensitivity pneumonitis from Pezizia domiciliana. A case of El Niño lung.

A previously healthy woman developed severe dyspnea and was found to have restrictive lung disease and evidence of alveolitis. Open lung biopsy revealed extrinsic allergic alveolitis (hypersensitivity pneumonitis). The etiology was not initially apparent, but a home inspection showed an unusual mushroom growing in the patient's basement. Air sampling and serum precipitins against the fungal antigens confirmed that Pezizia domiciliana was the cause of the patient's hypersensitivity pneumonitis. This is the first described case of hypersensitivity pneumonitis cause by P. domiciliana. We speculate that unprecedented rainfall and flooding of the patient's basement as a result of El Niño rains produced ideal factors for the growth of this fungus.

Polymyalgia, hypersensitivity pneumonitis and other reactions in patients receiving HMG-CoA reductase inhibitors: a report of ten cases.

Ten patients who take hydroxy-methylglutaryl coenzyme A reductase inhibitors, or statin medications, and experience adverse reactions are described. All patients experienced various manifestations of hypersensitivity while receiving the drugs. One patient is described with hypersensitivity pneumonitis, which was graphically demonstrated by both high resolution computerized axial tomography and open lung biopsy.

The effect of dapsone in steroid-dependent asthma.

We studied the steroid-sparing effect of dapsone in 10 subjects with chronic asthma in a preliminary open trial. Dapsone was chosen because it inhibits neutrophil function and possesses anti-inflammatory effects in a variety of disorders. The study group consisted of 10 subjects with stable, steroid-dependent asthma, aged 23 to 80 years, with normal glucose-6-phosphate dehydrogenase levels. Average daily baseline prednisone dose ranged from 5 to 60 mg. Dapsone, 100 mg, twice daily, by mouth, was started after a 1-month baseline period. Baseline steroid dose, symptom scores, and daily peak flow rates were compared to the latest available 4-week period of dapsone treatment. Average cumulative monthly prednisone dose was reduced from 428 mg to 82 mg (p less than 0.02). Five of 10 patients stopped steroids by month 6 and two additional patients by month 13. Two additional patients demonstrated a coincidental 74% reduction in steroid dose, and one patient demonstrated no response. Clinical parameters remained stable despite steroid reduction. These preliminary data suggest dapsone may have steroid-sparing effects in chronic asthma.