Port site recurrence after laparoscopic cholecystectomy

BACKGROUND: Gallbladder cancer diagnosis is usually at a later stage. Only 1% of gallbladder cancers are discovered fortuitously at infra-clinic stage when histological exam of cholecystectomy specimen. Laparoscopic cholecystectomy was realised for gallbladder lithiasis or polyps. Port site metastasis after laparoscopy was reported. The aim of our study is to report our series of port site metastasis complicating gallbladder cancer discovered fortuitously after laparoscopic cholecystectomy. METHODS: From 1 January 1994 to 31 December 2004, 2562 laparoscopic cholecystectomy was carried out. Ten gallbladder cancers were diagnosed than the incidence was 0.39%. RESULTS: Gallbladder cancer diagnosis was carried out by histology in 8 cases, and when port site metastasis in two cases whereas histological exam of cholecystectomy specimen was negative. Recurrence of gallbladder cancer was in port site in 4 cases. The mean rate survival of patients with port site metastases was 19 months.     

Pharmacokinetics of diltiazem in severe renal failure

The acute effects of a single dose of diltiazem (Tildiem), a calcium antagonist, were studied in 9 patients with severely impaired renal function (GFR between 0.03 and 0.87 ml/s/1.73 m2). Control measurements were made of inulin and PAH clearance, creatinine, blood pressure, heart rate and ECG. Following administration of diltiazem 120 mg, 7 blood samples were collected in the first 12 h and after 24 h, 32 h, 48 h; urine was collected for the first 12 h, 12-24 h and 24-48 h, and blood pressure, heart rate and ECG were recorded after 6 h. Diltiazem and its main metabolite, desacetyldiltiazem, had a pharmacokinetic profile similar to that in patients with normal renal function (peak plasma concentration, half-life and urinary excretion). Diltiazem is normally eliminated in the urine to a small extent, because it is metabolized, and this also applies to desacetyldiltiazem, which is probably further metabolized.     

HLA-DRB1/DQB1 susceptibility for autoimmune polyglandular syndrome type II and III in south of Tunisia

Objectives

The aim of our study was to investigate the association of HLA-DRB1 and HLA-DQB1 alleles with autoimmune polyglandular syndromes (APS) type II and III in a southern Tunisian population.

Patients and methods

Sixty-two unrelated patients with APSII (n = 20) and APSIII (n = 42) and 146 healthy controls were genotyped for HLA class II alleles (DRB1*, DQB1*) by PCR-SSP technique.

Results

An increased frequencies of HLA-DQB1*03:02 (P = 0,02; OR = 2.98) in APSII patients, HLA-DRB1*03 (P = 3 10⁻⁶; OR = 4.28) and HLA-DQB1*02:01 (P = 0.04; OR = 1.95) in APSIII patients were found compared to healthy controls. Study of the HLA-DRB1*;DQB1* haplotype frequencies showed a higher occurrence of DRB1*04;DQB1*03:02 and DRB1*03;DQB1*02:01 in APSII patients (P = 4 10⁻³; OR = 3.31 and P = 0.03; OR = 2.74 respectively) whereas APSIII was only associated with DRB1*03;DQB1*02:01 (P = 7.2 10⁻⁸, OR = 4.71).

Conclusion

Our data suggest that the variation in class II HLA alleles and haplotypes could be a genetic factor involved in the susceptibility of APS syndrome.     

Concurrent validity of the Arabic version of General Medication Adherence Scale using two validated indirect adherences measures in Saudi patients with non-communicable diseases

PurposeThis study aimed to evaluate the concurrent validity of the Arabic version of the General Medication Adherence Scale (GMAS) using two validated scales namely Adherence to Refills and Medications Scale (ARMS) and Medication Adherence Rating Scale (MARS) in Saudi patients with non-communicable diseases.MethodsA cross sectional study was conducted for 2 months in out-patient departments at a tertiary care hospital in Khobar, Saudi Arabia. The study collected data from patients with chronic illnesses through convenience sampling. Pearson correlation (ρ) was conducted to report concurrent validity of GMAS. A correlation coefficient value ≥ 0.5 with p-value < 0.01 was considered threshold for establishing concurrent validity. The study was approved by an ethics committee (IRB-2019–05-002).ResultsA total of 406 patients responded to the study. The average age was 42.4 ± 5.94 years, and most patients were females (53.7%), married (70%), graduates (65.3%), employed (39.9%) and, had a monthly family income > SAR 10,000, i.e., USD 2666.2 (56.4%). The mean adherence scores obtained from MARS, ARMS and GMAS were 7.09, 19.9, and 27.4. The correlation (ρ) between GMAS and MARS scores was 0.65, and between GMAS and ARMS scores was −0.79, p < 0.01 for both comparisons.ConclusionThe concurrent validity of GMAS-AR was established in this study that would further substantiate psychometric properties of the scale in this population.     

Disseminated erythematous lupus with bilateral diaphragmatic involvement

The diaphragm is an unusual localization for disseminated erythematous lupus and is generally not recognized. We present the case of a 34-year-old woman who developed bilateral pain in the base of the thorax 15 days before hospitalization without any bronchial signs and NYHA stage II dyspnea. The patient's general health status remained satisfactory and the physical examination was normal except for diffuse inflammatory joint pain and cutaneous photosensitivization. The chest x-ray disclosed ascension of both hemidiaphragms with retracted lungs associated with bilateral basal atalectasia. The diagnosis of lupus with diaphragmatic involvement was retained due to the clinical presentation with diffuse joint pain, photosensitization with facial erythema, pericardial effusion and elevated antinuclear antibody and lymphopenia (1 100/mm3). Lung function tests revealed a restrictive syndrome. Oral corticosteroids 1 mg/kg/d enabled clinical and functional improvement. In light of this observation we discuss the pathogenic mechanisms of this uncommon localization of lupus and the difficulty of establishing a sure diagnosis.     

Primary-care physicians' views about the use of home/self blood pressure monitoring: nationwide survey in Hungary

OBJECTIVE: To obtain unbiased views of primary-care physicians about home blood pressure monitoring (HBPM). METHODS: A mail survey was conducted in a random sample (n = 700) of all Hungarian primary-care physicians (n = 5112). Items in the questionnaire related to the extent and indications for use of HBPM, to the significance attributed to its results, to the methods of its use, and to concerns physicians had with HBPM. RESULTS: Of the 700 questionnaires, 405 (58%) could be analysed. HBPM was popular among the respondents: 60% of them had more then 50 patients on HBPM, 90% of them were recommending its use either 'often' or 'almost all the time', and 75% of them considered the results of HBPM of either 'considerable' or of 'extreme importance'. The most frequent indications for use were white-coat hypertension (97%), assessing 24-h drug effects (87%), improving compliance (82%), suspicion of hypotension (63%), and resistant hypertension (61%). Physicians actively recommended devices with an upper-arm cuff (83%), equipped with a built in memory (63%). Most respondents (67%) had someone in their offices to teach the patient the correct measurement technique. Surprisingly, 65% of the physicians only reviewed the data to obtain a 'general picture' and did not analyse the data. Most of the respondents (78%) encouraged their patients to call their offices, and 90% of them did receive a call. Main concerns with HBPM were the use of non-validated devices (75%), and patient preoccupation with blood pressure (55%). Areas for suggested improvements were the need for patient training facilities (48%), established measurement protocols (44%) and better methods of displaying readings (30%). CONCLUSIONS: We found an unexpected popularity in the use of HBPM among primary-care physicians. In order to fully exploit the benefits of HBPM, the concerns raised (validated devices, patient preoccupation) and areas to be improved upon (patient training, better methods of displaying results) will have to be addressed by researchers, societies and the industry.