AIM： To study the factors that may affect survival of cholangiocarcinoma in Lebanon. METHODS： A retrospective review of the medical records of 55 patients diagnosed with cholangio- carcinoma at the American Universi...AIM： To study the factors that may affect survival of cholangiocarcinoma in Lebanon. METHODS： A retrospective review of the medical records of 55 patients diagnosed with cholangio- carcinoma at the American University of Beirut between 1990 and 2005 was conducted. Univariate and multivariate analyses were performed to determine the impact of surgery, chemotherapy, body mass index, bilirubin level and other factors on survival. RJ^SULTS： The median survival of all patients was 8.57 mo （0.03-105.2）. Univariate analysis showed that low bilirubin level （〈 10 mg/dL）, radical surgery and chemotherapy administration were significantly associated with better survival （P = 0.012, 0.038 and 0.038, respectively）, in subgroup analysis on patients who had no surgery, chemotherapy administration prolonged median survival significantly （17.0 mo vs 3.5 mo, P = 0.001）. Multivariate analysis identified only low bilirubin level 〈 10 mg/dL and chemotherapy administration as independent predictors associated with better survival （P 〈 0.05）. CONCLUSION： Our data show that palliative and postoperative chemotherapy as well as a bilirubin level 〈 10 mg/dL are independent predictors of a significant increase in survival in patients with cholangiocarcinoma.展开更多
Background and Objective: The outcome of locally advanced and metastatic urothelial carcinoma LA/mUC has improved over the past years with a plethora of new treatments and the approval of immune checkpoint inhibitors ...Background and Objective: The outcome of locally advanced and metastatic urothelial carcinoma LA/mUC has improved over the past years with a plethora of new treatments and the approval of immune checkpoint inhibitors (ICIs), antibody-drug conjugates, and targeted agents, to identify locally advanced metastatic urothelial carcinoma’s current management practices in Lebanon and the implication of the ongoing economic crisis on the medical practice. Methods: An online questionnaire was used to survey ten Lebanese oncologists from six different hospitals, between July 5 and July 11, 2022, requesting information pertaining to their current clinical practice in the pharmacological treatment of locally advanced metastatic urothelial carcinoma. Key Findings: Cisplatin-based chemotherapy was the most frequently reported initial treatment of locally advanced metastatic urothelial carcinoma. Participants reported using immune checkpoint inhibitors in platinum-ineligible patients and those with PDL1 positive tumors. Also, they would not consider the concomitant use of immunotherapy and chemotherapy in the first-line setting. Participants believed that avelumab maintenance is effective in the absence of progression after first-line platinum-based chemotherapy;they would consider initiating it 2 - 10 weeks after completion of chemotherapy. Conclusions and Clinical Implications: After comparing with current international guidelines, this study shows that Lebanese oncologists follow international guidelines and have deep knowledge of recent clinical trials for the management of locally advanced metastatic urothelial carcinoma, regardless of economic crisis challenges.展开更多
AIM： TO investigate the impact of mucin production on prognosis in colorectal cancer, in terms of overall survival （OS） and time to disease progression （TTP） in patients with mucinous compared to those with nonmu...AIM： TO investigate the impact of mucin production on prognosis in colorectal cancer, in terms of overall survival （OS） and time to disease progression （TTP） in patients with mucinous compared to those with nonmucinous colorectal cancer （NMCRC）, matched for age, gender, and tumor stage. METHODS： Thirty five patients with mucinous colorectal cancer （MCRC） were matched for age, gender, and tumor stage with 35 controls having NMCRC. OS and TTP were compared among 4 groups divided according to mucin content： group A （50%-75% mucin）, group B （75%-100% mucin）, group C or controls （〈 50% mucin）. Group D consisted of all patients with tumors having 〈 75% mucin （controls and groups A together）. RESULTS： Median survival in MCRC and NMCRC groups was 46.2 and 112.9 mo, respectively （P = 0.26）. OS in groups A and B was 70.1 and 32.8 mo （P = 0.46）, and in groups B and D was 32.8 and 70.1 mo, respectively （P = 0.143）. TTP in MCRC and NMCRC was 50.17 and 44.77 too, respectively （P = 0.795）. TTP in groups A, B, and D was 70.1, 24.8, and 65.5 too, respectively. Twenty-eight percent of patients with MCRC had poorly differentiated adenocarcinoma versus 8.6% in NMCRC patients （P = 0.028）. CONCLUSION： MCRC is associated with a non-significant decrease in median survival and TTP, particularly when mucin content is 〉 75% of tumor volume. However, it tends to be more poorly differentiated. A larger study matching for stage and grade is needed.展开更多
Objective: To report a case of proximal occlusion of 2 major cerebral vessels associated with moyamoya network circulation that manifested by spontaneous intraventricular hemorrhage. Design: Case report. Patient and R...Objective: To report a case of proximal occlusion of 2 major cerebral vessels associated with moyamoya network circulation that manifested by spontaneous intraventricular hemorrhage. Design: Case report. Patient and Results: A 36-year-old Syrian man presented with symptoms of sudden-onset headache, neck stiffness, and confusion. The computed tomography scan of his brain showed intraventricular bleeding, and the subsequent 4 vessel angiographies revealed occlusion of the left middle and anterior cerebral arteries with moyamoya appearance in the terminal branches. The coagulation profile showed the presence of heterozygous factor V Leiden mutation. The patient was treated conservatively until resolution of his blood clot, and later he was started on oral anticoagulation. Conclusion: Factor V Leiden mutation may cause large cerebral vessel occlusion with moyamoya syndrome in adults.展开更多
Colorectal cancer is a lethal disease if not discovered early.Even though appropriate screening and preventive strategies are in place in many countries,a significant number of patients are still diagnosed at late sta...Colorectal cancer is a lethal disease if not discovered early.Even though appropriate screening and preventive strategies are in place in many countries,a significant number of patients are still diagnosed at late stages of the disease.The management of metastatic colorectal cancer remains a significant clinical challenge to oncologists worldwide.While cytotoxic regimens constitute the main treatment of choice in this patient population,addition of the five biologics(bevacizumab,cetuximab,aflibercept,panitumumab and regorafenib)to these regimens has improved clinical outcomes.The most commonly used cytotoxic regimens include doublet combinations(FOLFOX/XELOX or FOLFIRI).Many clinical trials have been published and others are underway to compare the biologic agents with one another in order to prove the superiority of one regimen over another.Metastatic colorectal cancer patients have many treatment options;however,the optimal use and sequence of targeted agents remain to be determined.This review entails concise and updated clinical data on the management of metastatic colorectal cancer.The aim of the review is to determine where to fit the five biologic targets into the treatment algorithm of metastatic colorectal cancer patients and to derive treatment sequences that would achieve best clinical outcome based on the current available data.展开更多
Background: Pancreaticoduodenectomy is a challenging surgical intervention that remains the cornerstone in the treatment of localized peri-ampullary pathologies. The concept of treatment standardization has been well-...Background: Pancreaticoduodenectomy is a challenging surgical intervention that remains the cornerstone in the treatment of localized peri-ampullary pathologies. The concept of treatment standardization has been well-established in many high-volume centers in the world. Here, we present our experience in pancreaticoduodenectomy from 1994 to 2015. Methods: We performed a retrospective review of the medical charts of patients who underwent pancreaticoduodenectomy at our institution. Data was entered to SPSS statistical software and analyzed. The Mann-Whitney U and Fisher’s exact tests were used to report statistical differences between groups. Results: Of the 370 patients who underwent pacreaticoduodenectomy, 300 were analyzed. The 1-, 3-, 5- and 10-year survival rates were 85%, 35%, 15%, and 7%, respectively with a 30-day mortality rate of 5.0%(15 patients). The median age of the patients was 61 (13-84) years, with 193 (64.3%) males and 107 (35.7%) females. The median operative time was 300 (130-570) min. The median postoperative length of hospital stay was 12 (5-76) days. Thirty-two patients required re-laparotomies;10 for pancreatic leak, 7 for biliary leak and 15 for control of bleeding. Seventy-five (25.0%) patients developed pancreatic fistulae. Delayed gastric emptying was present in 31 (10.3%) patients. A significant improvement in surgical outcome was observed in cases done after 2008 which indicates the important role of specialized team in surgical management. Conclusions: The number of patients undergoing pancreaticoduodenectomy has been increasing annually over the past twenty-two years in our institution with results comparable to published series from high-volume centers. Through standardization of surgical techniques and perioperative management carried out by a specialist team, our results continue to improve despite the increasing complexity of cases referred to our unit.展开更多
Fault lineaments are the main input data in earthquake engineering and seismology studies.This study presents a digitally-based active fault map of the Kerman region in central-east Iran which experienced several deva...Fault lineaments are the main input data in earthquake engineering and seismology studies.This study presents a digitally-based active fault map of the Kerman region in central-east Iran which experienced several devastating earthquakes on poorly exposed and/or not identified active faults.Using Landsat 8 data,we have carried out the image-based procedures of fault mapping,which include applying the contrast stretching technique,the principal component analysis,the color composite technique,the spectral rationing,and creating the false-color composite images.Besides,we have cross-checked the resulting map with the geological maps provided by the Geological Survey of Iran to decrease the associated uncertainties.The resulting map includes 123 fault segments,still,a part of which has been expressed in the previously compiled active-fault maps of Iran.Indeed,the new one is mapping the poorly exposed active faults,so-called secondary faults,which are able to produce strong events.These faults are primarily associated with poorly defined areas that accommodate low levels of seismicity;however,sporadic strong events are likely to occur.It has also been investigated that these kinds of faults are seismogenic and are able to produce destructive events.In total,the outcome of this study can also be jointed with seismic studies for investigating parts of the earthquake activity in central-east Iran,in particular for the fault-based approaches in impending earthquake-resistant buildings.展开更多
文摘AIM： To study the factors that may affect survival of cholangiocarcinoma in Lebanon. METHODS： A retrospective review of the medical records of 55 patients diagnosed with cholangio- carcinoma at the American University of Beirut between 1990 and 2005 was conducted. Univariate and multivariate analyses were performed to determine the impact of surgery, chemotherapy, body mass index, bilirubin level and other factors on survival. RJ^SULTS： The median survival of all patients was 8.57 mo （0.03-105.2）. Univariate analysis showed that low bilirubin level （〈 10 mg/dL）, radical surgery and chemotherapy administration were significantly associated with better survival （P = 0.012, 0.038 and 0.038, respectively）, in subgroup analysis on patients who had no surgery, chemotherapy administration prolonged median survival significantly （17.0 mo vs 3.5 mo, P = 0.001）. Multivariate analysis identified only low bilirubin level 〈 10 mg/dL and chemotherapy administration as independent predictors associated with better survival （P 〈 0.05）. CONCLUSION： Our data show that palliative and postoperative chemotherapy as well as a bilirubin level 〈 10 mg/dL are independent predictors of a significant increase in survival in patients with cholangiocarcinoma.
文摘Background and Objective: The outcome of locally advanced and metastatic urothelial carcinoma LA/mUC has improved over the past years with a plethora of new treatments and the approval of immune checkpoint inhibitors (ICIs), antibody-drug conjugates, and targeted agents, to identify locally advanced metastatic urothelial carcinoma’s current management practices in Lebanon and the implication of the ongoing economic crisis on the medical practice. Methods: An online questionnaire was used to survey ten Lebanese oncologists from six different hospitals, between July 5 and July 11, 2022, requesting information pertaining to their current clinical practice in the pharmacological treatment of locally advanced metastatic urothelial carcinoma. Key Findings: Cisplatin-based chemotherapy was the most frequently reported initial treatment of locally advanced metastatic urothelial carcinoma. Participants reported using immune checkpoint inhibitors in platinum-ineligible patients and those with PDL1 positive tumors. Also, they would not consider the concomitant use of immunotherapy and chemotherapy in the first-line setting. Participants believed that avelumab maintenance is effective in the absence of progression after first-line platinum-based chemotherapy;they would consider initiating it 2 - 10 weeks after completion of chemotherapy. Conclusions and Clinical Implications: After comparing with current international guidelines, this study shows that Lebanese oncologists follow international guidelines and have deep knowledge of recent clinical trials for the management of locally advanced metastatic urothelial carcinoma, regardless of economic crisis challenges.
文摘AIM： TO investigate the impact of mucin production on prognosis in colorectal cancer, in terms of overall survival （OS） and time to disease progression （TTP） in patients with mucinous compared to those with nonmucinous colorectal cancer （NMCRC）, matched for age, gender, and tumor stage. METHODS： Thirty five patients with mucinous colorectal cancer （MCRC） were matched for age, gender, and tumor stage with 35 controls having NMCRC. OS and TTP were compared among 4 groups divided according to mucin content： group A （50%-75% mucin）, group B （75%-100% mucin）, group C or controls （〈 50% mucin）. Group D consisted of all patients with tumors having 〈 75% mucin （controls and groups A together）. RESULTS： Median survival in MCRC and NMCRC groups was 46.2 and 112.9 mo, respectively （P = 0.26）. OS in groups A and B was 70.1 and 32.8 mo （P = 0.46）, and in groups B and D was 32.8 and 70.1 mo, respectively （P = 0.143）. TTP in MCRC and NMCRC was 50.17 and 44.77 too, respectively （P = 0.795）. TTP in groups A, B, and D was 70.1, 24.8, and 65.5 too, respectively. Twenty-eight percent of patients with MCRC had poorly differentiated adenocarcinoma versus 8.6% in NMCRC patients （P = 0.028）. CONCLUSION： MCRC is associated with a non-significant decrease in median survival and TTP, particularly when mucin content is 〉 75% of tumor volume. However, it tends to be more poorly differentiated. A larger study matching for stage and grade is needed.
文摘Objective: To report a case of proximal occlusion of 2 major cerebral vessels associated with moyamoya network circulation that manifested by spontaneous intraventricular hemorrhage. Design: Case report. Patient and Results: A 36-year-old Syrian man presented with symptoms of sudden-onset headache, neck stiffness, and confusion. The computed tomography scan of his brain showed intraventricular bleeding, and the subsequent 4 vessel angiographies revealed occlusion of the left middle and anterior cerebral arteries with moyamoya appearance in the terminal branches. The coagulation profile showed the presence of heterozygous factor V Leiden mutation. The patient was treated conservatively until resolution of his blood clot, and later he was started on oral anticoagulation. Conclusion: Factor V Leiden mutation may cause large cerebral vessel occlusion with moyamoya syndrome in adults.
文摘Colorectal cancer is a lethal disease if not discovered early.Even though appropriate screening and preventive strategies are in place in many countries,a significant number of patients are still diagnosed at late stages of the disease.The management of metastatic colorectal cancer remains a significant clinical challenge to oncologists worldwide.While cytotoxic regimens constitute the main treatment of choice in this patient population,addition of the five biologics(bevacizumab,cetuximab,aflibercept,panitumumab and regorafenib)to these regimens has improved clinical outcomes.The most commonly used cytotoxic regimens include doublet combinations(FOLFOX/XELOX or FOLFIRI).Many clinical trials have been published and others are underway to compare the biologic agents with one another in order to prove the superiority of one regimen over another.Metastatic colorectal cancer patients have many treatment options;however,the optimal use and sequence of targeted agents remain to be determined.This review entails concise and updated clinical data on the management of metastatic colorectal cancer.The aim of the review is to determine where to fit the five biologic targets into the treatment algorithm of metastatic colorectal cancer patients and to derive treatment sequences that would achieve best clinical outcome based on the current available data.
文摘Background: Pancreaticoduodenectomy is a challenging surgical intervention that remains the cornerstone in the treatment of localized peri-ampullary pathologies. The concept of treatment standardization has been well-established in many high-volume centers in the world. Here, we present our experience in pancreaticoduodenectomy from 1994 to 2015. Methods: We performed a retrospective review of the medical charts of patients who underwent pancreaticoduodenectomy at our institution. Data was entered to SPSS statistical software and analyzed. The Mann-Whitney U and Fisher’s exact tests were used to report statistical differences between groups. Results: Of the 370 patients who underwent pacreaticoduodenectomy, 300 were analyzed. The 1-, 3-, 5- and 10-year survival rates were 85%, 35%, 15%, and 7%, respectively with a 30-day mortality rate of 5.0%(15 patients). The median age of the patients was 61 (13-84) years, with 193 (64.3%) males and 107 (35.7%) females. The median operative time was 300 (130-570) min. The median postoperative length of hospital stay was 12 (5-76) days. Thirty-two patients required re-laparotomies;10 for pancreatic leak, 7 for biliary leak and 15 for control of bleeding. Seventy-five (25.0%) patients developed pancreatic fistulae. Delayed gastric emptying was present in 31 (10.3%) patients. A significant improvement in surgical outcome was observed in cases done after 2008 which indicates the important role of specialized team in surgical management. Conclusions: The number of patients undergoing pancreaticoduodenectomy has been increasing annually over the past twenty-two years in our institution with results comparable to published series from high-volume centers. Through standardization of surgical techniques and perioperative management carried out by a specialist team, our results continue to improve despite the increasing complexity of cases referred to our unit.
基金the financial support of Kerman Provincial Gas Corporation&National Iranian Gas Company to conduct this research via Funding Sources of #062570 and#062571.
文摘Fault lineaments are the main input data in earthquake engineering and seismology studies.This study presents a digitally-based active fault map of the Kerman region in central-east Iran which experienced several devastating earthquakes on poorly exposed and/or not identified active faults.Using Landsat 8 data,we have carried out the image-based procedures of fault mapping,which include applying the contrast stretching technique,the principal component analysis,the color composite technique,the spectral rationing,and creating the false-color composite images.Besides,we have cross-checked the resulting map with the geological maps provided by the Geological Survey of Iran to decrease the associated uncertainties.The resulting map includes 123 fault segments,still,a part of which has been expressed in the previously compiled active-fault maps of Iran.Indeed,the new one is mapping the poorly exposed active faults,so-called secondary faults,which are able to produce strong events.These faults are primarily associated with poorly defined areas that accommodate low levels of seismicity;however,sporadic strong events are likely to occur.It has also been investigated that these kinds of faults are seismogenic and are able to produce destructive events.In total,the outcome of this study can also be jointed with seismic studies for investigating parts of the earthquake activity in central-east Iran,in particular for the fault-based approaches in impending earthquake-resistant buildings.
