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سال:1395 | دوره:21 | شماره:1 |تعداد مقالات:10

Background: Improvements in imaging techniques has led to an increase in the number of diagnosed pancreatic cysts. Although most of the detected cases are benign, a significant percentage of them are malignant or are potentially malignant. Currently, endosonography, and analysis of cyst morphology, fine needle aspiration (FNA) of the cyst contents, and measurement of the amylase and carcinoembryonic antigen (CEA) levels of the aspirated fluid are the common methods used for evaluating such lesions (80% accuracy in the final diagnosis). We have used these same techniques to analyze cystic lesions of the pancreas, in two referring centers in Iran.Materials and Methods: This is a descriptive case series study. In addition to demographic information and findings of the cystic morphology, we determined the cytology of the centrifuged sediments of cystic fluid aspirations, and the amylase and CEA levels of the fluid.Results: Sixty eight patients were included in the study with an average age of 51 years.68% of the participants were female (n=46). Analysis of the lesions was performed based on the cytology findings as well as the other results (CEA, amylase, cyst morphology, and history of pancreatitis). The patients who were diagnosed as having pseudocysts were the youngest group, with an average age of 41 years, and those with cystic adenocarcinoma were the oldest group, with an average age of 62 years. The most common types of lesions were pseudocysts (n=18, 26.5%), mucinous cystic neoplasms (n=11, 16%), serous cyst adenomas (n=10, 14.7%), intraductal papillary mucinous neoplasms (n=9, 13.2%), and cystic adenocarcinoma (n=9, 13.2%). The most common location of cysts was the head of pancreas (n=25, 35.2%). Excluding the neuroendocrine tumors, all other types of lesions were more common in women than men. Septation in the cysts was observed in cystic adenocarcinomas, serous cystadenomas, and intraductal papillary mucinous neoplasms (IPMNs). Lesions smaller than 2 cm were found most frequently in IPMNs, endocrine tumors, and simple tumors whilst pseudocysts were all greater than 2 cm in maximum diameter.Conclusion: 47% of the patients in this study had malignant or premalignant lesions, which despite being asymptomatic, they needed follow-up imaging or surgery. Endosonography played an important role in the diagnosis of the cystic tumors of the pancreas.Diagnosis of premalignant lesions and providing appropriate treatment increase patients’ life expectancy. Diagnosis of benign cysts, leads to fewer unnecessary surgeries.

Helicobacter pylori (H. pylori)infection is common among humans and plays a major role in the etiology of peptic ulcer disease with significant morbidity in patients with HIV-1 on antiretroviral therapy. There are conflicting prevalence patterns of H. pylori in HIV-1 infected patients using various methods of detection. The noninvasive technique used for detection of H. pylori infection is inexpensive and convenient with no complications.Materials and Methods: We aimed to determine the prevalence of H. pylori infection among patients infected with HIV-1 on antiretroviral therapy using H. pylori stool antigen.139 patients infected with HIV-1 were recruited, stool samples were collected and the H. pylori stool antigen (HpSA) test was used to detect H. pylori antigen.Results: 46.8% of the respondents were positive for H. pylori and 53.2% were negative, 18 (13%) were men and 47 (33.8%) were women. HpSA is a relatively simple, inexpensive, and time-saving non-invasive test for the detection of H.pylori infections in patients infected with HIV-1.Conclusion: We also observed that the prevalence of H. pylori was low in these patients compared with the general population.However, more studies using H. pylori stool antigen test are needed in these patients in the North-Central, Nigeria to further evaluate the infection rate.

Vitamin D deficiency is believed to cause variety of abnormalities such as liver stiffness and fibrosis. It is also shown that vitamin D deficiency may result in chronic liver disease or liver cirrhosis. In this study, we aimed to systematically review the literature wherein the relationship between vitamin D deficiency and the severity of chronic liver disease or liver cirrhosis had been investigated.Materials and Methods: PubMed, Scopus, and Google scholar were searched using the following search method (((vitamin D deficiency OR vitamin D insufficiency OR insufficient vitamin D)) AND (chronic liver disease OR chronic hepatitis OR cirrhosis OR liver cirrhosis)) AND (severity OR intensity)to evaluate the role of vitamin D deficiency or vitamin D inadequacy in the occurrence and severity of chronic liver disease. Articles were collected and the data were extracted.Results: Totally, 641 articles were found through searching the databases and reference list scanning. Of the collected documents, only 19 articles with 4895 studied patients were included and analyzed. The results of this study showed that almost 80% of patients with chronic liver disease had severe vitamin D deficiency.Conclusion: Vitamin D deficiency is associated with the occurrence of chronic liver disease. The severity of liver cirrhosis is also associated with the level of 25 (OH) D in progressive liver disease.

With an occurrence of 7%, appendicitis is one of the most common abdominal emergencies requiring surgery. Since the variation in positions and length of the appendix may produce varying symptoms and signs which mimic other diseases, having knowledge of the variations in the position of the appendix is of significant importance.Here, we present a 77-year-old man with acute appendicitis presenting with lower abdominal pain, fever, chills, and dysuria.Physical examination revealed tenderness and rebound tenderness in the left lower quadrant more pronounced in the right lower quadrant with leukocytosis on blood tests. Both ultrasonography and abdominopelvic computed tomography scan demonstrated a severe inflammation at paracecal mesenteric fat with extension to para sigmoid portion which was in favor of diverticulitis rather than appendicitis. A 2-week treatment with intravenous antibiotic regimen was initiated for the patient and from the second day of antibiotic therapy, the patient’s fever and abdominal pain improved. A second CTscan performed three weeks after completion of a 14-day course of antibiotics, revealed a dilated long appendix (diameter: 12mm, length: 10 cm) with extension of its tip to the medial wall of sigmoid. Physicians should consider appendicitis when evaluating an acute abdomen to prevent any delay in diagnosis of atypical presentations and decrease the mortality and morbidity related to the complications.

Despite the fact that hepatic involvement is frequently seen in systemic primary amyloidosis, major hepatic symptoms as primary manifestation and severe impaired liver function are rare. Herein, we report a 38-year-old woman with primary hepatic amyloidosis, and severe portal hypertension. The patient had ascites and markedly elevated alkaline phosphatase level at presentation. She had a rapid downhill course resulting in death. In case of an unexplained intrahepatic cholestasis or portal hypertension the possibility of amyloidosis should be considered and a Congo red staining should be performed.