Primary hydatid cyst of the spleen: A rare case report and literature review.

Hydatidosis is an endemic disease in certain areas in the world particularly in the Mediterranean, the Middle East, and South America, caused by a cestode known as Echinococcus granulosus. Humans are the accidental intermediate hosts. The liver and the lungs are the most commonly involved organ. If the parasite passes through the pulmonary capillary bed, the hydatid cyst may develop at any site in the body like bone, pancreas, brain, kidney, and orbit. Isolated spleen hydatid cyst is very rare. We hereby report one observation of isolated hydatid cyst of the spleen in a patient living in non-endemic area and without any potential risk.

The role of double-guidewire technique in preventing postendoscopic retrograde cholangiopancreatography pancreatitis.

BACKGROUND AND STUDY AIMS: Postendoscopic retrograde cholangiopancreatography (ERCP) complications increase with repeated cannulation attempts. We evaluated several advanced biliary cannulation techniques, which have been used when the standard approach fails, to increase the success rate and decrease post-ERCP complications. We aimed to evaluate the use of double-wire technique in terms of success rates and effects on post-ERCP pancreatitis (PEP) and to assess the value of pancreatic duct stenting following needle-knife sphincterotomy in difficult biliary cannulation. PATIENTS AND METHODS: A single-center, retrospective, randomized study was conducted on patients who underwent ERCP in Notre Dame De Secours University Hospital at Byblos, Lebanon, after obtaining the hospital's ethics committee approval. Patients were divided into three groups. The first group consisted of patients who had an ERCP and was divided into two subgroups, namely, one usingdouble-guidewire technique (DGT) only and another using an extra technique of precut with double-guidewire and pancreatic plastic stent placement. The second group of patients who had only ERCP was the control group. Finally, the third group endured the precut technique alone. RESULTS: We could not prove any significant association between the intervention and the occurrence of pancreatitis when comparing double-wire technique plus ERCP to ERCP alone. When DGT with a pancreatic plastic stent was used, the incidence of PEP was significantly lower than that in other techniques. CONCLUSION: DGT has a neutral effect on the reduction of PEP compared with the classic ERCP, but the technique can decrease the time of examination and increase success in difficult cases. ERCP using the double-guidewire with placement of a pancreatic plastic stent can contribute to decreasing PEP.

Does rectal ketoprofen prevent post ERCP pancreatitis?

BACKGROUND AND STUDY AIMS: Endoscopic retrograde cholangiopancreatography (ERCP) is a commonly used procedure in the management of pancreatic and biliary diseases. Acute pancreatitis is the most common complication following ERCP. Among many medications, nonsteroidal anti-inflammatory drugs (NSAIDs) were subject of numerous trials concerning post ERCP pancreatitis (PEP) prophylaxis. By inhibiting phospholipase A2, these drugs could intervene in the pathogenesis of the disease therefore limiting its occurrence. The use of some rectal NSAIDs agents was shown, to be advantageous in preventing this complication but there were not enough data on ketoprofen. The aim of this study was to assess the efficacy of rectal ketoprofen prophylactic administration in reducing the risk of PEP. PATIENTS AND METHODS: The study was a non randomized retrospective single center study conducted between 2014 and 2018 on 242 patients divided into control and trial group receiving 100 mg of rectal Ketoprofen 30 mins before ERCP. PEP was defined as a new or exacerbated abdominal pain, in association with an elevation of serum lipase at least three times higher than the normal upper limit within and lasting more than 24 h after the procedure requiring a re-admission or a prolongation of the hospital stay. This endpoint was determined by comparing the number of patients presenting PEP in the NSAIDs group vs. the control group using Fisher exact test, with p < 0.05 representing a significant statistical value. RESULTS: Pancreatitis developed in 6% after ERCP, 5 of them being in the trial group and 9 in the control group. Additionally, statistical calculations showed a non significant difference between the two groups in the prevalence of PEP. CONCLUSION: Rectal ketoprofen administration before ERCP does not have any effect in preventing pancreatitis post ERCP.

Severity of diabetic retinopathy at the first ophthalmological examination in the Lebanese population.

AIM: To determine the percentage and stage of diabetic retinopathy at the first ophthalmological examination after the patient's diagnosis with type 2 diabetes mellitus. METHODS: A retrospective descriptive study was conducted at 'Clinique du Levant' hospital between 2006 and 2016. A total of 484 randomly selected patients were included. Data were collected and analyzed for selected variables (sex, age, sources of referral, and duration of diabetes). RESULTS: In total, 119 (24.6%) patients had diabetic retinopathy. Among them, 43 had proliferative diabetic retinopathy (8.9%). About 16.7% of the included patients had macular edema, which was severe in 6.2%. The average age of patients was 62.1 years with an average of 8.3 years of diabetes. About 55% were men, while 45% were women. The patients with no referral source presented 8.9 years after the onset of diabetes, whereas patients referred by general practitioners and secondary medical professionals presented after 5.8 and 5 years, respectively (p < 0.05), but they represented only 23.2% of diabetics. Women presented earlier than men (7.3 versus 9.1 years; p = 0.012). About 82.6% were symptomatic, 44.1% had a visual impairment on Snellen charts that was severe in 11.2%. Also, 37.8% of the patients had a visually significant cataract. The duration of diabetes was the only dependent variable, p < 0.0001. The average age, sources of referral, and sex were not related to the severity of retinopathy. CONCLUSION: Diabetics with a more severe diabetic retinopathy are presenting late to the ophthalmology clinics. There is a need to promote outreach programs for people with diabetes for early detection of diabetic retinopathy in Lebanon.