No abstract

Hepatocellular carcinoma is a malignancy that predominantly occurs in the setting of cirrhosis. Its incidence is rising worldwide. Hepatocellular carcinoma differs from most malignancies because it is commonly diagnosed on the basis of imaging features alone, without histologic confirmation. The guidelines from the American Association for the Study of Liver Diseases (AASLD) are a leading statement for the diagnosis and staging of hepatocellular carcinoma, and they have recently been updated, incorporating several important changes. AASLD advocates the use of the Barcelona Clinic Liver Cancer (BCLC) staging system, which combines validated imaging and clinical predictors of survival to determine stage and which links staging with treatment options. Each stage of the BCLC system is outlined clearly, with emphasis on case examples. Focal liver lesions identified at ultrasonographic surveillance in patients with cirrhosis require further investigation. Lesions larger than 1 cm should be assessed with multiphasic computed tomography or magnetic resonance imaging. Use of proper equipment and protocols is essential. Lesions larger than 1 cm can be diagnosed as hepatocellular carcinoma from a single study if the characteristic dynamic perfusion pattern of arterial hyperenhancement and venous or delayed phase washout is demonstrated. If the imaging characteristics of hepatocellular carcinoma are not met, the alternate modality should be performed. Biopsy should be used if neither modality is diagnostic of hepatocellular carcinoma. Once the diagnosis has been made, the cancer should be assigned a BCLC stage, which will help determine suitable treatment options. Radiologists require a systematic approach to diagnose and stage hepatocellular carcinoma with appropriate accuracy and precision.

Systemic lupus erythematosus (SLE) is a chronic, rheumatic, autoimmune disease. No single cause has been identified and the clinical presentation ranges from a chronic debilitating disease to one that is potentially life threatening due to organ dysfunction (D'Cruz 2006). Common symptoms include: painful joints, fever, skin rash, chest pain, and chronic fatigue (Baker et al 2009, Scofield et al 2008). No epidemiological data are available on SLE in the Republic of Ireland (RoI); however, there is a reported incidence rate of 4.71/100,000 of SLE in the United Kingdom (UK), with a higher rate of 7.62/100,000 in Northern Ireland (NI) (Somers et al 2007). SLE is more prevalent among women, with a common age of onset between late teens and early 40s. Acute flare-ups of SLE are managed with medication and rehabilitation (Brown 2006). SLE has a relatively low incidence within the general population in comparison to other inflammatory rheumatic conditions (Somers et al 2007). A need for research into specific issues in relation to SLE is required to assist in planning and delivering suitable interventions for this population (Almehed et al 2010). Fatigue is identified as a symptom of many chronic conditions which interferes with occupational participation (Stout and Finlayson 2011). Law (2002) defined occupational participation as the nature and extent of involvement in activity, and stressed its importance for people with chronic conditions. This exploratory study was aimed at investigating SLE-related fatigue, including management strategies and impact on occupational participation.

ostdural puncture headache (PDPH) is a wellrecognized complication after spinal anesthesia P (1). When conservative treatment or epidural blood patch (EBP) fail, alternative causes of the headache need to be reconsidered. We present a previously unreported association of recurrent PDPH with a Chiari I malformation. Case ReportA 31-yr-old woman (gravida 1, para 0), with an unremarkable medical history, received analgesia for labor via a lumbar epidural catheter. Subsequently, when she required cesarean section for failure of the labor to progress, satisfactory lumbar epidural anesthesia could not be established. Good surgical anesthesia was provided by subarachnoid block, although spinal needle placement proved technically difficult and required several attempts before successful dural puncture with a 22-gauge needle. The surgery and immediate postoperative period were uneventful. Although she reported a mild positional headache, her surgeon discharged her on the third postoperative day. However, over the following several days, the patient's headache became progressively more severe. The headache was associated with mild neck pain, which worsened when the patient was sitting or standing. Moderate relief was obtained by caffeine ingestion. On the sixth postoperative day, although afebrile, she developed hearing changes (echoing), visual disturbances (blurring and color distortion), and nausea. The diagnosis of PDPH was made. An EBP using 15 mL of autologous blood was administered, with marked improvement of all symptoms.The patient had a recurrence of the headache 4 days