Drug induced liver injury: causative agents and predictors for the outcome - a retrospective study at Tanta University Hospital, Egypt.

OBJECTIVE: Drug induced liver injury is a rare but an important cause of acute liver failure. It is associated with significant morbidity and mortality. This study aimed to analyze this disorder, causes, different patterns, and outcomes in Egyptian patients. PATIENTS AND METHODS: This retrospective study collected data of 87 patients diagnosed with drug induced liver injury from 2019 through 2020 at Tanta University. Pattern of liver injury was classified as hepatocellular, cholestatic, and mixed. Data including Model for End-Stage Liver Disease (MELD), Glasgow coma scale, and Poison Severity Score were statistically analyzed. Predictors of mortality and fulminant hepatic failure were determined. RESULTS: Participants were 46 females and 41 males with age ranging from 12-70 years. 39 patients had hepatocellular liver injury, 15 cholestatic, and 33 mixed. Fulminant hepatic failure was diagnosed in 40 patients. Acetaminophen was the most common causative agent. Overall mortality was 17%. Dead patients had significantly deteriorated liver functions (Model for End-Stage Liver Disease). On multivariate logistic regression analysis, Model for End Stage Liver Disease and SO2 independently predicted mortality, and Model for End Stage Liver Disease and random blood glucose were predictors of fulminant hepatic failure development. CONCLUSIONS: Drug induced liver injury is an important health problem in Egypt. Further studies are needed to know the natural history of this disorder. Acetaminophen is one of the most common leading causes. The MELD score is a useful predictor of the outcome of drug induced liver injury such as fulminant hepatic failure and mortality.

[Sonography of the liver following CT staging of patients with lung cancer: a retrospective analysis]. / Sonografie der Leber nach CT-Staging von Patienten mit Bronchialkarzinom: eine retrospektive Analyse.

PURPOSE: Liver lesions are frequently detected in the CT staging of lung cancer patients and may require further investigation. The aim of our study was to assess the value of an ultrasound (US) examination of the liver in addition to routine CT staging. MATERIALS AND METHODS: In this retrospective study we included 174 consecutive patients with lung cancer who underwent US of the liver in addition to contrast-enhanced CT of the thorax and upper abdomen. The reports of the examinations were evaluated for the presence of liver lesions. Based on CT and US standard criteria, liver lesions were grouped into unequivocal cysts, hemangiomas, metastases and undefined lesions. RESULTS: With CT, liver lesions were detected in 56 / 174 patients (32 %). These included 24 cysts in 11 patients, 2 hemangiomas in 2 patients and 18 patients with liver metastases. In 31 patients, 66 small (< 1.5 cm) hypodense lesions were detected, which could not be further defined by CT. Using US, 21 of these 66 liver lesions were confirmed as benign (cysts, hemangiomas), and two lesions were diagnosed as metastases. In 2 patients US revealed metastases that were not visible on the CT scans. CONCLUSION: The study demonstrates that a complementary US of the liver in patients with lung cancer may reveal information relevant for treatment. Therefore, liver US may play an important role in the staging of lung cancer. When equivocal small liver lesions are detected with CT, a complementary US examination may help to diagnose these lesions or detect metastases not visible on the single-phase staging CT of the liver.

Cervical ultrasound (US) and US-guided lymph node biopsy as a routine procedure for staging of lung cancer.

PURPOSE: To assess the value of routine ultrasound evaluation and US-guided fine-needle aspiration biopsy of supraclavicular lymph nodes for the diagnosis, staging and treatment of patients with lung cancer. MATERIALS AND METHODS: 300 consecutive patients with lung cancer were evaluated with high-resolution ultrasound for the presence of pathological lymph nodes (criteria: short-axis >or= 5 mm, rounded shape, missing echogenic hilum). Suspicious lymph nodes were biopsied under ultrasound guidance if the result could influence further patient management RESULTS: In 41 of 257 NSCLC patients (16 %) and 15 of 43 (35 %) SCLC patients, enlarged lymph nodes were detected, in particular in patients with a CT stage N2 or N3 (NSCLC) or extensive disease (SCLC). 16 lymph node biopsies were positive for malignancy, 4 biopsies were negative for malignancy or not diagnostic. US had a higher sensitivity for the detection of pathological lymph nodes than CT. CONCLUSION: Routine ultrasound evaluation of supraclavicular lymph nodes reveals suspicious lymph nodes in a high number of patients with lung cancer. High-resolution US is superior to CT in the detection of pathological lymph nodes. Ultrasound-guided biopsy proves malignancy and thereby a N3 or M1 stage. Thus, more invasive and expensive diagnostic procedures can be avoided.