GOVARESH JOURNAL
Year:2002 | Volume:7 | Issue:37-38|Papers Count:11

After a hiatus of 30 years an attempt is now being made to re-assess the previously reported very high esophageal cancer incidence rates in the Caspian. Littoral. The extraordinarily high incidence rates found in the eastern side of the Littoral, were re-confirmed five years ago for the Turkoman region, using esophageal balloon cytology supplemented by esophagoscopy of suspected cases. The focus this time was on the Ardabil province in the western side of the Caspian Littoral, where the rates reported 30 years ago were moderately high. A pilot chromoendoscopic screening program was scheduled for 650 asymptomatic adults from a randomly selected part of the city of Ardabil and adjoining villages, to evaluate the overall patterns of esophageal disease and to establish the utility of endoscopy as an esophageal cancer screening tool. 504 healthy volunteers, giving a compliance rate of 77.5%, submitted to esophagogastroscopy without any mishaps. Contrary to expectation, no dysplasia or esophageal cancer was found in 914 satisfactory biopsy specimens. Total absence of esophageal cancer or precursor dysplastic changes in the surveyed population in the western part of the Caspian Littoral was at variance with the cancer registry findings of three decades ago for the western part of the Littoral. A plausible explanation could be the improved socio-economic conditions and life style changes which have taken place in the recent past all along the Caspian Littoral, except in the Turkoman Plain.

Aim: To determine the causes of cirrhosis in Iranian population, and defining the common aetiologies according to patients' sex and age groups. Patients and Methods: 170 patients who were referred to a referral digestive disease centre (Shariati hospital) since 1994-1998 enrolled to a prospective study. All patients had histological and/or clinical and para clinical findings compatible with cirrhosis. Majority of them had complete assessment of history and physical exam oriented for liver disease, liver function tests, abdominal ultrasound and viral serology.Results: Frequency of the causes of liver cirrhosis in our patients (112 M, 58 F, between 7 to 75 years, mean age 44 ± 17.2) were as follow: viral hepatitis type B in 103 patients (60.6%) was the most common cause of cirrhosis, Wilson's disease found in 15 cases (8.8%), autoimmune hepatitis in 14 cases (8.2%), alcoholic liver disease in 6 cases (3.5%), Budd-Chiari syndrome in 6 cases (3.5%), hepatitis C virus infection in 6 cases (3.5%), primary biliary cirrhosis in 2 cases (1.2%); secondary biliary cirrhosis; and confection of HBV and HCV each with 3 cases (1.8%). In 10 patients (5.9%) aetiology of cirrhosis remained unknown.Conclusion: Viral hepatitis B is the most common cause of cirrhosis in Iran. Co-infection of HBV and\HCV is rare. The other causes of liver cirrhosis were Wilson's disease, autoimmune hepatitis, alcoholic liver disease, Budd- Chiari syndrome and hepatitis C infection, respectively. Wilson's disease was the most common cause of cirrhosis in patients less than twenty years of age. Apart from HBV infection that was the most common cause of cirrhosis in both genders, the second aetiology in male patients was Wilson's disease and in female patients was autoimmune hepatitis.

Background: Resistance to metronidazole is one of the most common reason for treatment failure with classic triple therapy. On the other hand clarithromycine is not cost effective for developing countries and resistance to it is increasing. FUR is a very good substitute for these antibiotics with regard to efficacy, lack of resistance and low price (Alim. Pharmacol. Ther. 2000:14; 299, 2001; 15:411), but its high side effects limit its use. The aim of the study was to assess the efficacy of two different dose of FUR in combination with AMOX and OM for H.pylori eradication.Material and method: A total of 123 patients with duodenal ulcer, were randomized and received the following medications for two weeks. Group A: FUR 2x200 mg + AMOX 2x1gr + OM 2x20 mg/day. Group B: FUR 2x50 mg+ AMOX 2x1gr + OM 2x20 mg/day. Control endoscopy was performed after 6 weeks and two biopsy specimens from antrum and two from corpus were taken for a urease test and histology. Eradication was concluded if all two tests were negative for H.pylori.Results: In total, 110 patients completed the study .4patients in group A did not tolerate the regimen on day 8 of therapy and were excluded from the study. Serious complication such as fever, fatigue and dizziness, which occurred in the beginning of second week of treatment (day 8 to 10), were common in group A than group B (19% and 15.9% in A versus 0% in B) The eradication rate by per protocol analysis was significantly higher in A than B (88.9% versus 67.9% respectively, p=0.008). However it was low and not statistically significant, by intention to treat analysis (76.2% in A and 62.3% in B, p=0.09).Conclusion: The regimen with non-reduced dose of Fur in combination with Amox and Om was effective, when the patients tolerated the drugs and completed the study.

Objective: In respect to prevalence of chronic hepatitis B (CHB) and importance of its treatment as a preventive factor to community transmission of this disease, we designed this study to evaluate liver enzyme and virologic indexes after one year treatment with Lamivudine.Methods: This research is a single group time series design from the quasi-experimental studies. Eighty CHB patients with elevated ALT, HbeAg or HBV DNA positive and liver histologic changes, whom reffered to Tehran Hepatitis Center (2001), were selected. The sequential liver enzyme test were performed at 0,3,6 and 12 month after start of treatment and also HbeAg or HBV DNA were evaluated at 0,6 and 12 month. HBV DNA was evaluated with qualitative Polymerase Chain Reaction (PCR).Results: Eight patients excluded for not to continue participation regularly. From 72 patients, 63 (87.5%) were male. The mean of patients age was 40.2. ALT and AST level decreased in 4 sequential times and both in 12 month were normal. These changes were significant by repeated measurement ANOVA (P<0.001). Also 66% of patients became HbeAg negative in 12 month and 77.7% became HBV DNA (PCR) negative (P<0.001). The relation between ALT decrease and history of Interferon therapy was not significant (P=0.64).Conclusion: In this study, we found that one year Lamivudin therapy in CHB, cause significant decrease in ALT and AST; it also causes much effect in both HbeAg positive and HbeAg negative patients. History of already Interferon therapy did not affect in response to Lamivudine.

Background: Serum Amylase elevation has been detected in some patients with inflammatory bowel diseases and recently some studies have elicited a relationship between amylase elevation and disease extent and activity.Material and Methods: 212 patients (101 male and 100 female) with Inflammatory Bowel Disease (including 193 patients with UC and 19 patients with CD) whose diseases were confirmed by colonoscopy and histology were enrolled prospectively. Exclusion Criteria included: Pregnancy, CHF, Malignancy, Renal Failure, Diseases of Salivary Glands, Ruptured Peptic Ulcer, Peritonitis, and Cholecystitis. For all patients serum and urine amylase levels were measured and a detailed questionnaire was filled.Results: Hyperamylasemia was observed in 16.0% of patients (15.5% of patients with UC and 21.0% of patients with CD). In 13.7% of patients (13.5% of UC patients and 15.8% of CD patients) urine amylase elevation was detected. There was no significant relationship between serum/urine amylase and disease extent, and activity, smoking habit, drug usage, extraintestinal involvement and history of colectomy. No significant association was found between serum amylase and extent or activity of CD, too. We found a significant relationship between urine amylase and activity, and not extent, of CD (p value: 0.005).Conclusion: An increase of serum/urine amylase levels is seen in some of patients with inflammatory bowel disease; but the pathophysiology of this finding and its association with extent and activity of disease is open to further investigations.

Autoimmune hepatitis (AIH) is one of causes of chronic liver diseases. It is an unresolving inflammation of liver tissue and characterized by elevated transaminases, hypergammaglobulinemia, and circulating autoantibodies. The disorder occurs mostly in females (F:M ratio is 3.6 to 1) and is a relatively uncommon disorder with point prevalence of 8-16.8 per 100 000 population in western countries. Hiostologic hallmarks are interface hepatitis (also called piecemeal necrosis), and portallymphoplasmacytic infiltration.Dignostic criteria are based on excluding other etiologies of chronic liver disease,such as viral hepatic (A, B, C), metabolic disorders eg Wilson disese,drug induced hepatitis and alcoholic liver disease. Conventional autoantibodies are Antinuclear antibody (ANA), Smooth muscle antibody (SMA) and Anti liver kidney microsomal 1 (Anti LKM1).Some cases have combined clinical, laboratory or histologic features of Primary Biliary Cirrhosis (PBC) or Primary Sclerosing Cholangitis (PSC) with AIH and are known as overlap syndrome. Standard treatments of AIH as the most successful treated form of chronic hepatitis are based on immunosuppression with corticosteroids alone or in combination with azathioprine.