To evaluate the usefulness of spin-echo T2 and T1-weighted images and contrast-enhanced dynamic gradient-echo images in differentiating between hepatocellular carcinoma and dysplastic nodules in cirrhotic livers. Method: Thirty-eight patients with liver cirrhosis underwent spin-echo T2 and T1-weighted and contrast-enhanced dynamic gradient-echo imaging. 16 small hepatocellular carcinomas (< 3 cm) in 16 patients and 12 dysplastic nodules (> 1 cm) in 12 patients were included in this study. Spin-echo sequences and dynamic examination were compared for characterisation of liver lesions. Results: On combined SE T2 and T1-weighted images and dynamic MR images, the most common appearances were hyperintensity on T2-weighted images (63%), hyperintensity on T1-weighted images (50%) and hypervascularity (88%) for hepatocellular carcinomas. All of the dysplastic nodules were isointense on T2-weighted images and except one, all dysplastic nodules enhanced similar to the liver parenchyma. Conclusion: In the differential diagnosis of focal lesions in cirrhotic liver, contrast enhancement features are as diagnostic as the signal intensity of the lesions on spin-echo sequences. Hyperintensity on T2-weighted images and hypervascularity on dynamic contrast- enhanced MR imaging are statistically significant features of HCCs developing in cirrhotic livers.

In the present study, we retrospectively evaluated the ratio of pulmonary venous to mitral A velocity (PV-A/A) in patients with left ventricular (LV) systolic dysfunction with three specific types of LV filling patterns. Method:Transthoracic and transesophageal echocardiography were performed in 44 patients with LV systolic dysfunction in sinus rhythm, aged 20 to 73 years (mean 54±12), and in 11 control subjects without cardiovascular disease aged 24 to 69 years (mean 53±7). Patients were divided into three groups according to LV filling pattern: Group I; those with an impaired relaxation filling pattern (E wave/A wave <1, n=16), group II; those with a pseudonormal filling pattern (1< E/A<2 , n=12) and group III; those with a restrictive filling pattern (E/A> 2, n=16). Results: The control group and the three patient groups were not different with respect to age, gender and heart rate. All patient groups showed significantly lower LV ejection fraction than the control group, and was lowest in group III. The mitral peak A wave velocity was significantly lower in group III than in the first, control and second groups (p<0.001, p<0.01and p<0.05, respectively) and was highest in group I. The pulmonary A wave velocity did not differ among groups I, III and the controls, and was higher in group II than in the controls (p<0.01). The PV-A/A ratio was significantly higher in group III than in the control, groups I and II (p<0.001, p<0.001and p<0.05, respectively). The ratio did not differ between the controls and group I, but were lower compared to the group II (p<0.05). Conclusion: An increased ratio of PV-A/A was noted in subjects with LV systolic dysfunction with restrictive and pseudonormal LV filling patterns. This supports the idea that the PV-A/A ratio reflects LV filling pressures.

In this study, we evaluated a Random Amplified Polymorphic DNA (RAPD) method, in the subtyping of H. influenzae in middle ear effusions (MEE), obtained from 33 patients with otitis media with effusion (OME) admitted to 3 medical centers in Beirut, Lebanon. Method: RAPD was initially evaluated on 15 H. influenzae isolates using three 10 mer primers along with a 21 mer primer. Results: Primer 1 (10 mer) and Primer 2 (20 mer) were the most discriminatory when used in conjunction and were selected to be used on DNA lysates obtained from 33 MEE samples positive for H. influenzae by PCR. Conclusion: Our data have shown that 4 RAPD patterns were obtained on DNA of H. influenzae isolates and a single RAPD pattern was seen on H. influenzae DNA from MEE samples. This indicates that a single strain may have been implicated in these infections. Studies are underway to determine the prevalence of H. influenzae as the etiology of otitis media with effusion in Lebanon and subtype the organism to determine a possible multi-strain involvement.

The aim of this study was to determine reference values for the venous cord blood insulin, growth hormone and cortisol levels and also find out the correlations of these three hormones with the birthweight and placental weight. Method: One hundred and eightythree healthy mothers and their full-term neonates were included in the study. The placental weights and birthweights were measured by the same digital scale. Venous cord blood insulin, growth hormone and cortisol levels of infants were analysed using enzyme-immunological, immunoluminometric and radioimmunoassay methods, respectively. Results : The mean insulin level was found 6.01±3.67 µU/ml (0.5-18), mean growth hormone level 20.07±8.38 (8.6-40) ng/ml and mean cortisol level 13.6±7.87 (2.4- 40) µg/dl. We found that the venous cord blood insulin levels were in linear correlation with both birthweight and placental weight (r=0.39, p<0.05 and r=0.35, p<0.05 respectively) but such correlation did not exist when growth hormone or cortisol was concerned. Conclusion: We consider the values we have obtained as data to be used for our own reference. Moreover, it was shown that cord blood insulin values were in linear correlation with birthweight and placental weight but such correlation did not exist for growth hormone and cortisol.

The purpose of this study was to evaluate neonates with meconium stained amniotic fluid and to investigate whether pulmonary disease and mortality were significantly greater in infants with thick meconium. Method: We evaluated 278 meconium stained neonates between January 1993 ? February 1999. Amniotic fluid was defined as thin (221 neonates) or thick (57 neonates) by a pediatrician. Results: Compared to neonates with thin meconium, those with thick meconium appeared to have significantly greater rates of acidemia, low APGAR scores at the 1th and 5th minutes, more need for resuscitation and higher mortality rate. Meconium aspiration syndrome and hypoxic ischemic encephalopathy were also significantly higher in infants with thick meconium. Conclusion: Amniotic fluid with thick meconium may cause more respiratory and other complications in neonates than amniotic fluid with thin meconium. Therefore, tracheal suction is recommended for infants born depressed and with thick meconium stained amniotic fluid.

The aim was to investigate the prevalence of hypertension in Van. Method: A total of 2010 subjects (586 male, mean age: 44.8 ± 14.9; 1424 female, mean age: 39.1 ± 14.1) between the ages of 20-74, were sampled from a target population of 315,866 according to systematic sampling technique. Blood pressure of each participant was measured by using Erka® sphygmomanometer for two times with a 3 minutes interval by a physician and an average was obtained. Results: Hypertension prevalence was 34.9 % (males: 33.3 %, females: 35.5 %, p> 0.05) according to 140/90 mmHg criterium and 19.1 % (males: 14.5 %, females: 21.0 %, p < 0.001) according to 160/95 mmHg criterium. Mean systolic and diastolic blood pressures were 129.97± 27.78 mmHg (95% CI: 128.7, 131.2) (males: 128.20 ± 24.30 (95 % CI: 126.2, 130.2), females: 130.70 ± 29.10 (95 % CI: 129.2, 132.2), p = 0.013) and 81.95 ± 14.24 mmHg (95 % CI: 81.3, 82.6) males: 81.10 ± 13.0 (95 % CI: 80.0, 82.2), females: 82.30 ± 14.70 (95 % CI: 81.5, 83.1), p = 0.07), respectively. Conclusion: In Van, hypertension is a serious health problem and efficient public health measures and education programs are needed.