GOVARESH JOURNAL
Year:2008 | Volume:13 | Issue:2 (SN 63)|Papers Count:10

Background: The frequency of sonographic report of liver fat infiltration in asymptomatic person is increasing. The aim of this study was evaluation of liver function and detection of frequency of metabolic syndrome and Insulin resistance in asymptomatic persons with fatty liver in sonographic examinations.Materials and Methods: Seventy six patients with fatty liver in sonographic examination and 78 persons with normal sonographic examination who had similar sex, age and body weight were selected. Patients with history of diabetes mellitus, hyperlipidemia, hypertension who took drugs that induced fatty liver such as amiodaron, diltiazem, metotrexate, tamoxifen and patients with positiveserology for HBS-Ag and HCV-Ab were excluded. Blood pressure, BMI, weight, height, liverenzymes, blood lipids, and fasting insulin level and insulin resistance according to HOMA index were evaluated.Results: Mean age was 44.8±9.79 and 42.54±10.7 years for fatty liver patients and normal persons, respectively. Mean systolic and diastolic blood pressures, weight, height, HDL triglyceride, FBS, ALT, 2-hour postprandial glucose level, fasting insulin level and insulin resistance were significantly higher in fatty liver patients compared with normal persons Fifty percent of fatty liver patients but only %18 of normal persons had metabolic syndrome criteria.Conclusion: Insulin resistance and metabolic syndrome are very common in fatty liver persons. It seems that fatty liver is one of the criteria of metabolic syndrome. Patients with fatty liver in sonographic examination should be further evaluated for metabolic syndrome and insulin resistance.

Background: It is claimed that the interaction of altering immune system bowel maturation, and measles vaccine predispose the body to inflammatory bowel diseases Also it is proposed that breast milk components during infancy, regulate mucosal immune activity to antigen and have protective role for ulcerative colitis and Crohn's disease.Materials and Methods: This study was a case-control study. Data were collected from patients' evidences and questionnaires that were filled up by face to face method for each groups of patients (including ulcerative colitis and Crohn's disease)and control groups (including IBS and GERD) They were selected from the patients <40 years who came to 3 clinics in Tehran during 2005 to 2008. Statistical analysis was performed in two steps univariate and multivariate analysis, using SPSS-16 software.Results: Ulcerative colitis group included 143 patients, Crohn's disease group involved 148 cases and control group included 307 patients. Breastfeeding in Ulcerative colitis and Crohn's groups had been less common than in control group (81.1% versus 88.3% and 83.8% versus 88.3% respectively), but the differences were not significant. (P-Values were 0.225 and 0.397 respectively) The difference between ulcerative colitis group and control group in measles vaccination rate (93% versus 89.9% respectively) was not significant (P=0.121). Both Crohn's disease group and control group had vaccination rate of 89.9% (P=0.481). There was not significant correlation between previous exposure to smoking; measles vaccination and breast feeding during infancy with extent and location of gastrointestinal involvement in ulcerative colitis and Crohn's disease (p>0.05). Conclusion: Breast feeding and measles vaccination during infancy do not correlate with later ulcerative colitis or Crohn's disease in adulthood. There was not any correlation between smoking, easles vaccination and breast feeding with extent and location of gastrointestinal involvement in ulcerative colitis and Crohn's disease.

Background: Variceal bleeding is one of the fatal complications of portal hypertension. There are several remedies for this problem but all of them have their own side effects. The treatment of choice is "endoscopic band ligation" but the high cost of the available instrument on the context of its single use design, is considered its only disadvantage (1.600.000 rials per session). Therefore, many patients avoid purchasing the instrument. However, we decided to design a reusable device by reloading the original one, using suitable elastic bands and sophisticated deployer nodes taking into account easy use and high efficacy of this treatment modality.Materials and Methods: Instead of the available granules, a series of special and very suitable nodes was employed for stretching and deployment of the bands. Also, a conical piece was designed to insert bands on cap as a dilator. Hemorrhoid ligation bands (the product of Endo Flex, Germany) were used instead of bands of the original device.Results: Ten node types were consequentially tested on sample and endoscopic device and if suitable, were tested on endoscope and patients thereafter. Node "61"was the fittest among (complete success rate in 429 deployments). The cost of new designed device is equal to 20.000 rials, which is very low compared to the original one.Conclusion: The new designed reloadable band ligator instrument is very economic and according to accomplished experiments, it has the same quality as the original one. Then, it would be suitable for both patient and physician to use new instrument for endoscopic band ligation.

Background: Prolongation of QT interval is one of the most important abnormalities in cardiovascular system of cirrhotic patients. The aim of this survey was determination of propranolol effect on frequency adjusted QT interval (QTc).Materials and Methods: Thirty six cirrhotic patients (M/F=20/16, mean age: 56±3.8 years) and 40 healthy age and sex matched controls (M/F=25/15, mean age: 58±2.4 years) were evaluated for blood pressure, heart rate and QTc before and 90 minutes after receiving 40 mg propranolol, orally. Results: Prolonged QTc (more than 0.440 S1/2) was seen in 27 cirrhotic patients (75%) in contrast with to 2 (5%) ones in healthy control group (P<0.001). In cirrhotic group, mean QTc before and after propranolol administration were 0.470±0.024 S1/2 and 0.44±0.008 S1/2, respectively (P<0.001). In responder patients (those with 25% reduction in basal cardiac rate), mean QTc before and after propranolol administration were 0.482±0.005 S1/2 and 0.430±0.009 S1/2, respectively (P<0.05). In non-responders, mean QTc before and after propranolol administration were 0.461±0.012 S1/2 and 0.453±0.011 S1/2, respectively (P>0.05).Conclusion: Non-selective beta blockers (such as propranolol) reduce QTc in cirrhotic patients. The effect of propranolol on QTc was related to 25% decrease in heart rate.

Background: This study aimed to evaluate psychometric characteristics (diagnostic validity and reliability) of quality of life questionnaire in irritable bowel syndrome (IBS-QOL) which is a popular inter-cultural measure.Materials and Methods: According to ROME II criteria 126 patients were included by the caring physician in Alzahra and Noor hospital clinics in Isfahan, Iran.Results: Eight scales of the questionnaire and total quality of life measure showed good internal reliability (Cronbach alpha=0.93 for the whole questionnaire,0.88 for dysphoria,0.67 for activities interference, 0.72 for body image ,0.57 for health worry, 0.57 for food abstinence, 0.71 for social reaction, 0.76 for sexual worry ,0.62 for interpersonal relations). The validity was measured against another quality of life questionnaire (IBS-QOL-36) and a significant correlation was found (r=0.61. p<0.01 to evaluate diagnostic accuracy 40 patients were compared with 40 healthy subjects. Except for body image scale other parts of questionnaire and the global quality of life were significantly different between these two groups (p<0.05).Conclusion: Generally, Farsi version of IBS-QOL questionnaire was found to be a valid and reliable mean to study patients with irritable bowel syndrome.

Gastric cancer is the most common GI cancer. It has a very high incidence rate in the northeastern Iran. Contrary to western countries and Japan, the incidence of gastric cancer has been increasing in Iran during the past two decades.Helicobacter Pylori infection is the most important risk factor for developing gastric cancer. However, the presence and influence of other environmental and genetic cancer is considered necessary. Poverty, low consumption of fresh fruits and vegetable, high nitrate in the food and heavy smoking are among the most important risk factors.Primary prevention with H. Pylori eradication especially in countries like Iran where a large number of people are infected is still in doubt. Using Pepsinogen as a predictive factor for gastric cancer is still under investigation. Currently, there are several studies assessing the precision of measuring serum Pepsinogen 1 and 2 in relation with mucosal atrophy of gastric body and antrum in Iranian patients. The results of these studies and other prospective investigations can be a big help in identification of gastric cancer risk factors and prediction of its incidence.

The coexistence of Waldenstrom's macrglobulinemia and cryptogenic cirrhosis has been rarely reported. We describe a 72-year-old man with compensated cryptogenic cirrhosis whose major clinical presentation was hyperviscosity syndrome.Serum protein electrophoresis revealed the presence of an IgM-kappa spike. Lambda light chain was found in urine. Bone marrow biopsy was performed, which showed at least 22% infiltration with atypical plasma cells. No bone lesion was found. ByWaldenstrom's macroglobulinemia diagnosis, patient treated with melphalan, thalidomide and dexamethasone. After three weeks of treatment, his symptoms disappeared and serum immunoglobulineM decreased below 1000mg/dl.

Aggressive fibromatosis or desmoid tumors, histologically indicated by small bundles of spindle cells in a fibrous background, are uncommon benign tumors without metastasis. They are recurrent and aggressive and their recurrence and severity is exacerbated following surgical operation. Based on previous reports, these tumors rarely present as intra-abdominal abscesses. Herein, a 54-year-old woman is presented who was referred with abdominal pain, fever, high ESR, and leukocytosis. On further evaluation, an intra-abdominal abscess was detected adjacent to splenic flexure of colon. Two months following antibiotic therapy, she carne back with the same clinical presentation. In CT-scan, an abdominal mass was detected. Based on a CT-guidedbiopsy, presence of mesenteric fibromatosis was reported. The patient underwent a surgical operation and the tumor was resected.