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WHAT ARE THE ODDS?
S52
Abstracts from 10th Congress of the European Federation of Internal Medicine/European Journal of Internal Medicine 22S (2011) S1–S112
is early virological response (EVR), defined as at least 2 log10 IU/ml decrease of HCV RNA level at 12 weeks. In this paper we describe a cohort of patients receiving treatment for chronic HCV infection and the percentage of them achieving sustained virologic response (SVR), defined as the absence of detectable hepatitis C virus RNA at 24 weeks after the end of treatment. Method: 88 patients received treatment with pegylated interferon and ribavirin for 24 or 48 weeks, depending on HCV genotype. For each patient, viral load was performed at 12 weeks, at the end of treatment and 24 weeks after the end of treatment. Results: From a total of 88 patients, 55 (62.5%) had EVR and non detectable viral load at 12 weeks of treatment and 57% of them achieved SVR. 7 patients (7.95%) had EVR with detectable viral load and 70% of them achieved SVR. None of the remaining 26 patients (29.5%) not achieving EVR, achieved SVR Conclusion: Non detectable viral load at 12 weeks of treatment predicted a high percentage of SVR, whereas not achieving EVR correlated with lack of SVR. It is recommended that treatment in patients who do not achieve EVR is withheld until approval of novel therapies. WHAT ARE THE ODDS? José Amado, Cristina Teixeira Pinto, Alexandra Martins, Andriy Krystopchuk, Carlos Cabrita, Idálio Medonça, Pastor Santos Silva”. Hospital De Faro EPE Lymphomas incidence is known to be growing. In Portugal, the incidence of non-Hodgkin lymphomas was 11.2/100000 in 2001 (last available data). Although they aren’t rare diseases, it isn’t a very frequent diagnosis at an internal medicine ward. Nevertheless, the authors diagnosed four cases of lymphoma in only two weeks. The first patient was a 34-year-old male, presenting with nausea, abdominal discomfort and weight loss. The physical exam revealed an abdominal mass and the CT scan showed multiple pathological lymph nodes. His final diagnosis was follicular lymphoma. One week later, a 76-year-old female complaining of asthenia, anorexia and post prandial abdominal pain, was found to have abnormal inguinal nodes on observation adding to further abdominal pathologic lymph nodes on the CT scan, also diagnosed as follicular lymphoma. By the same time, an 84-year-old man was admitted for further investigation of abnormally high leukocytes and lymphocytes. At admission, he only mentioned mild weakness. His CT scan was clean for abnormal lymph nodes but blood immunophenotyping identified a mantle cell lymphoma. Another four days went by and a 64-year-old male was referred for multiple palpable lymph nodes, which, after biopsy, were also diagnosis for mantle cell lymphoma. The authors thereby prove that “whatever can happen will happen” and take the chance to show how important it is for the internist to keep this less frequent diagnosis in mind. Fortunately most palpable lymph nodes are benign but, during these two weeks, the wheel of fortune drew nothing good. THE ROLE OF LIVER BIOPSY IN ESTABLISHING DIAGNOSIS IN A PATIENT WITH FEVER OF UNKNOWN ORIGIN: REPORT OF A CASE Fani Kyriakou1, Nikolaos Nikolaou1, Makrina Koutsouraki1, Georgios Erotokritou1, Ekaterini Parassi2, Nearchos Galanakis1. 11st Department of Internal Medicine, General Hospital of Nikaia “Agios Panteleimon”, Piraeus, Greece; 2Pathology Department, General Hospital of Nikaia “Agios Panteleimon”, Piraeus, Greece Background: Fever of unknown origin (FUO) in the immunocompetent patient has been defined as a febrile illness lasting more than three weeks and extensive diagnostic work up, after one week of hospital stay, has failed to explain the cause. We present the case of a 58-year-old man, that presented to our Hospital, with a 4 month history of fever, weight loss and profuse sweating. He had a known history of chronic hepatitis B and had undergone splenectomy 16 years ago due to traumatic rupture. He reported a previous admission, for the same reason, to another hospital 3 months ago. He had an extensive diagnostic work up, that was not diagnostic. On admission to our hospital, the patient was febrile. Liver function tests were abnormal. An extensive imaging study revealed only mild hepatomegaly. The rest was unremarkable. Methods: The patient underwent liver and bone marrow biopsy. Results: Liver biopsy revealed diffuse non Hodgkin lymphoma of large cells CD20(+), bcl6(+), mum-1(+), CD10(-), bcl2(-), LMP-1(-), ALK-1(-), ki67(+) 90%.
Bone marrow biopsy revealed only few elements of large B-cell diffuse lymphoma that could not be diagnostic. Conclusions: It is evident, that in this particular case, the diagnosis was established by liver biopsy. Lymphomatous infiltration of the liver is more common in non Hodgkin lymphoma (NHL) than in Hodgkin’s disease. Rarely, NHL can present as a primary hepatic lymphoma (PHL) and it is of note that chronic hepatitis B that has been linked to PHL. EFFECT OF PREVIOUS STATIN TREATMENT IN THE PROGNOSIS OF PATIENTS WITH FIRST STROKE Ioannis Kyriazis, Emmanouil Mpeliotis, Petros Mitseas, Lamprini Tatsi, Ioanna Eleftheriadou, Ioannis Agrios, Pavlos Sklavounos, Pelagia Koukouli, Theodora Loufa, Apostolos Mavridis. 2nd Internal Medicine Dpt., General Hospital Asclepeion Voulas Aim: Possible favourable effects of previous statins treatment, in the inhospital and finally medium-term and long-term prognosis of patients who had a stroke. Method: 1032 patients, without previous medical history of a stroke, who were hospitalized between 2003-2008 for first stroke, were included in the study. The sample was separated into two groups: the first consisted of patients who followed therapy with statins for at least three months before the stroke and the second consisted of patients who did not take statins at all. The patients’ clinical characteristics were recorded while being hospitalised, as well as the in-hospital mortality. After leaving the hospital, the follow up of the patients included the recording of the medium-term and long-term mortality. Results: Of 1032 patients, 124 (12,02%) were in statins treatment, while the other 908 (88,98%) was not. The in-hospital mortality of patients that received statins was reduced, however not statistically important, compared to those who did not receive statins before but received precociously during hospitalization (2.8% opposite 4.9%, p=0.38). At the medium-term followup during the first 30 days, important reduction in mortality was observed (p=0.029) in those patients who received statins before their hospitalisation: 7 died (7/124, percentage 5.6%) compared to 112 (112/908, percentage 12.3%) patients of the second group. Finally, at the long-term follow-up (medium duration 3.5±0.4 years), 27 (27/124, percentage 21.8%) patients who took statins before the stroke died. Respectively, 202 (202/908, 22.4%) of the patients of the second group died and there was no statistically important difference in the repercussion of long-lasting mortality between the two teams being studied (p=0.876). Conclusions: The preceded use of statins is not related with statistically important reduction of in-hospital mortality in patients with first stroke. On the contrary, an important reduction of medium-term mortality in the first 30 days was recorded after the episode, while the reduction of long-term mortality of the patients who did not take statins before the stroke was not essential. PREVALENCE OF METABOLIC SYNDROME AND RELATED FACTORS IN NON DIABETIC POPULATION Ioannis Kyriazis1, Emmanouil Mpeliotis1, Petros Mitseas1, Lamprini Tatsi1, Ioanna Eleftheriadou1, Ioannis Agrios1, Pavlos Sklavounos1, Despoina Gkeka1, Theodora Loufa1, Konstantinos Korovesis2, Christos Partheniou2, Apostolos Mavridis1. 12nd Internal Medicine Dpt., General Hospital Asclepeion Voulas, Greece; 2Internal Medicine Dpt., Korinthos General Hospital, Greece Aim: Prevalence of metabolic syndrome [M.S] and related risk factors in nondiabetic population. Material And Methods: 617 not diabetics (365F-252M) aged 63,3±5 years were examined. M.S diagnosis, was based on the criteria of NCEP-ATPIII. Results: 52,1% of men and the 50.3% women had M.S. 52,3% of those with M.S had three, 36,2% four and 7,1% had all five risk factors of the syndrome. The most frequent combination (58,3%) was: blood pressure, waist perimeter and triglycerides. The prevalence of M.S increased with increasing BMI for both sexes. Although 5 % of underweight and normal weight males had three or more risk factors for metabolic syndrome, 27 % of overweight males and 69 % of obese males met these criteria. Overweight males were more than six times as likely as underweight and normal weight males to meet the criteria for M.S (OR=6.21 95% CI: 3.94–9.65), and obese males were nearly more than 32 times as likely to meet this criteria (OR=31.71 95% CI: 21.02 –51.08). 7 % of underweight and normal weight females, 30% of overweight females, and 54% of obese females had three or more risk factors for meta-
Abstracts from 10th Congress of the European Federation of Internal Medicine/European Journal of Internal Medicine 22S (2011) S1–S112
is early virological response (EVR), defined as at least 2 log10 IU/ml decrease of HCV RNA level at 12 weeks. In this paper we describe a cohort of patients receiving treatment for chronic HCV infection and the percentage of them achieving sustained virologic response (SVR), defined as the absence of detectable hepatitis C virus RNA at 24 weeks after the end of treatment. Method: 88 patients received treatment with pegylated interferon and ribavirin for 24 or 48 weeks, depending on HCV genotype. For each patient, viral load was performed at 12 weeks, at the end of treatment and 24 weeks after the end of treatment. Results: From a total of 88 patients, 55 (62.5%) had EVR and non detectable viral load at 12 weeks of treatment and 57% of them achieved SVR. 7 patients (7.95%) had EVR with detectable viral load and 70% of them achieved SVR. None of the remaining 26 patients (29.5%) not achieving EVR, achieved SVR Conclusion: Non detectable viral load at 12 weeks of treatment predicted a high percentage of SVR, whereas not achieving EVR correlated with lack of SVR. It is recommended that treatment in patients who do not achieve EVR is withheld until approval of novel therapies. WHAT ARE THE ODDS? José Amado, Cristina Teixeira Pinto, Alexandra Martins, Andriy Krystopchuk, Carlos Cabrita, Idálio Medonça, Pastor Santos Silva”. Hospital De Faro EPE Lymphomas incidence is known to be growing. In Portugal, the incidence of non-Hodgkin lymphomas was 11.2/100000 in 2001 (last available data). Although they aren’t rare diseases, it isn’t a very frequent diagnosis at an internal medicine ward. Nevertheless, the authors diagnosed four cases of lymphoma in only two weeks. The first patient was a 34-year-old male, presenting with nausea, abdominal discomfort and weight loss. The physical exam revealed an abdominal mass and the CT scan showed multiple pathological lymph nodes. His final diagnosis was follicular lymphoma. One week later, a 76-year-old female complaining of asthenia, anorexia and post prandial abdominal pain, was found to have abnormal inguinal nodes on observation adding to further abdominal pathologic lymph nodes on the CT scan, also diagnosed as follicular lymphoma. By the same time, an 84-year-old man was admitted for further investigation of abnormally high leukocytes and lymphocytes. At admission, he only mentioned mild weakness. His CT scan was clean for abnormal lymph nodes but blood immunophenotyping identified a mantle cell lymphoma. Another four days went by and a 64-year-old male was referred for multiple palpable lymph nodes, which, after biopsy, were also diagnosis for mantle cell lymphoma. The authors thereby prove that “whatever can happen will happen” and take the chance to show how important it is for the internist to keep this less frequent diagnosis in mind. Fortunately most palpable lymph nodes are benign but, during these two weeks, the wheel of fortune drew nothing good. THE ROLE OF LIVER BIOPSY IN ESTABLISHING DIAGNOSIS IN A PATIENT WITH FEVER OF UNKNOWN ORIGIN: REPORT OF A CASE Fani Kyriakou1, Nikolaos Nikolaou1, Makrina Koutsouraki1, Georgios Erotokritou1, Ekaterini Parassi2, Nearchos Galanakis1. 11st Department of Internal Medicine, General Hospital of Nikaia “Agios Panteleimon”, Piraeus, Greece; 2Pathology Department, General Hospital of Nikaia “Agios Panteleimon”, Piraeus, Greece Background: Fever of unknown origin (FUO) in the immunocompetent patient has been defined as a febrile illness lasting more than three weeks and extensive diagnostic work up, after one week of hospital stay, has failed to explain the cause. We present the case of a 58-year-old man, that presented to our Hospital, with a 4 month history of fever, weight loss and profuse sweating. He had a known history of chronic hepatitis B and had undergone splenectomy 16 years ago due to traumatic rupture. He reported a previous admission, for the same reason, to another hospital 3 months ago. He had an extensive diagnostic work up, that was not diagnostic. On admission to our hospital, the patient was febrile. Liver function tests were abnormal. An extensive imaging study revealed only mild hepatomegaly. The rest was unremarkable. Methods: The patient underwent liver and bone marrow biopsy. Results: Liver biopsy revealed diffuse non Hodgkin lymphoma of large cells CD20(+), bcl6(+), mum-1(+), CD10(-), bcl2(-), LMP-1(-), ALK-1(-), ki67(+) 90%.
Bone marrow biopsy revealed only few elements of large B-cell diffuse lymphoma that could not be diagnostic. Conclusions: It is evident, that in this particular case, the diagnosis was established by liver biopsy. Lymphomatous infiltration of the liver is more common in non Hodgkin lymphoma (NHL) than in Hodgkin’s disease. Rarely, NHL can present as a primary hepatic lymphoma (PHL) and it is of note that chronic hepatitis B that has been linked to PHL. EFFECT OF PREVIOUS STATIN TREATMENT IN THE PROGNOSIS OF PATIENTS WITH FIRST STROKE Ioannis Kyriazis, Emmanouil Mpeliotis, Petros Mitseas, Lamprini Tatsi, Ioanna Eleftheriadou, Ioannis Agrios, Pavlos Sklavounos, Pelagia Koukouli, Theodora Loufa, Apostolos Mavridis. 2nd Internal Medicine Dpt., General Hospital Asclepeion Voulas Aim: Possible favourable effects of previous statins treatment, in the inhospital and finally medium-term and long-term prognosis of patients who had a stroke. Method: 1032 patients, without previous medical history of a stroke, who were hospitalized between 2003-2008 for first stroke, were included in the study. The sample was separated into two groups: the first consisted of patients who followed therapy with statins for at least three months before the stroke and the second consisted of patients who did not take statins at all. The patients’ clinical characteristics were recorded while being hospitalised, as well as the in-hospital mortality. After leaving the hospital, the follow up of the patients included the recording of the medium-term and long-term mortality. Results: Of 1032 patients, 124 (12,02%) were in statins treatment, while the other 908 (88,98%) was not. The in-hospital mortality of patients that received statins was reduced, however not statistically important, compared to those who did not receive statins before but received precociously during hospitalization (2.8% opposite 4.9%, p=0.38). At the medium-term followup during the first 30 days, important reduction in mortality was observed (p=0.029) in those patients who received statins before their hospitalisation: 7 died (7/124, percentage 5.6%) compared to 112 (112/908, percentage 12.3%) patients of the second group. Finally, at the long-term follow-up (medium duration 3.5±0.4 years), 27 (27/124, percentage 21.8%) patients who took statins before the stroke died. Respectively, 202 (202/908, 22.4%) of the patients of the second group died and there was no statistically important difference in the repercussion of long-lasting mortality between the two teams being studied (p=0.876). Conclusions: The preceded use of statins is not related with statistically important reduction of in-hospital mortality in patients with first stroke. On the contrary, an important reduction of medium-term mortality in the first 30 days was recorded after the episode, while the reduction of long-term mortality of the patients who did not take statins before the stroke was not essential. PREVALENCE OF METABOLIC SYNDROME AND RELATED FACTORS IN NON DIABETIC POPULATION Ioannis Kyriazis1, Emmanouil Mpeliotis1, Petros Mitseas1, Lamprini Tatsi1, Ioanna Eleftheriadou1, Ioannis Agrios1, Pavlos Sklavounos1, Despoina Gkeka1, Theodora Loufa1, Konstantinos Korovesis2, Christos Partheniou2, Apostolos Mavridis1. 12nd Internal Medicine Dpt., General Hospital Asclepeion Voulas, Greece; 2Internal Medicine Dpt., Korinthos General Hospital, Greece Aim: Prevalence of metabolic syndrome [M.S] and related risk factors in nondiabetic population. Material And Methods: 617 not diabetics (365F-252M) aged 63,3±5 years were examined. M.S diagnosis, was based on the criteria of NCEP-ATPIII. Results: 52,1% of men and the 50.3% women had M.S. 52,3% of those with M.S had three, 36,2% four and 7,1% had all five risk factors of the syndrome. The most frequent combination (58,3%) was: blood pressure, waist perimeter and triglycerides. The prevalence of M.S increased with increasing BMI for both sexes. Although 5 % of underweight and normal weight males had three or more risk factors for metabolic syndrome, 27 % of overweight males and 69 % of obese males met these criteria. Overweight males were more than six times as likely as underweight and normal weight males to meet the criteria for M.S (OR=6.21 95% CI: 3.94–9.65), and obese males were nearly more than 32 times as likely to meet this criteria (OR=31.71 95% CI: 21.02 –51.08). 7 % of underweight and normal weight females, 30% of overweight females, and 54% of obese females had three or more risk factors for meta-