GOVARESH JOURNAL
Year:2014 | Volume:19 | Issue:2|Papers Count:11

Advancements in medical science have led to the development of complex surgeries that improve survival in patients with liver disease. Assessments of the indications and contraindications for surgery and risk factors are the most important steps prior to any surgery in this population. Particular attention is essential to assess for the presence of pre-surgical ascites, hepatic encephalopathy and renal dysfunction. The most important risk factors for that increase mortality include anemia, ascites, hepatic encephalopathy, hypoalbuminemia, hypoxemia, concurrent infections, malnutrition, elevated Child Pugh and MELD scores, portal hypertension, prolonged prothrombin time and type of surgery. Advancements in anesthesiology have prevented surgical complications among patients with liver disease. Increased symptoms of liver failure and complications result in high mortality following surgery. This review article presents useful recommendations for safe surgery among patients with liver disease who are surgical candidates.

Background: Cancer stem cells are a subgroup of tumor cells that have the capability for self-renewal and differentiation and are characterized by multiple markers. Several studies have been conducted to identify these cells in colorectal cancer, including stem cell marker CD24. This study has evaluatedtheassociation of CD24 expression with clinicopathologic features and survival in an immunohistochemical(IHC) study that compared colorectal cancer tissues with adjacent normal tissues.Materials and Methods :The expression of CD24 in 50 paraffin embedded samples of colorectal cancer and adjacent normal tissue in patients referred to Imam Khomeini Hospital, Sari, Iran was examined by IHC. We studied the relationship between clinical and pathological features as well as the patient’s condition in terms of metastasis, recurrence, type of treatment and death due to cancer treatment.Results: The 50 cases studied included 25 males and 25 females with a mean age of 57.64± 9.13 years (range: 28-93 years) There were 3 mucinous carcinoma and 47 adenocarcinoma samples. CD24 was positive in 29 cases and negative in 21 cases. CD24 expression correlated with combined surgery and chemotherapy treatment (p= 0.04). A correlation existed with patient survival but it was not statistically significant. The mean survival time of patients according to CD24 expression was 26.64±18.15 in cases that were CD24 negative and 41.75±28.67 months in cases that were CD24 positive. Correlation of CD24 expression with other clinicopathologic factors was not significant (p>0.05).Conclusion: We have observed a relationship between the clinicopathologic feature of combined surgery and chemotherapy treatment to colorectal cancer stem cell marker expression. A nonsignificant correlation also existed with patient survival. To confirm these results, we recommend additional studies with larger sample sizes.

Background: Chronic constipation is a common problem worldwide that negatively impacts quality of life. Because of the effects of psychological and cultural factors on the function of the bowel tract and the vast variety of ethnicities and diet among the Iranian people, the present study describes the occurrence of constipation and its associated factors in Kerman, the largest city in Southeast Iran.Materials and Methods: This was a cross-sectional study conducted in Kerman, Iran from 2011 to 2012 that included 2191 adults who were randomly selected and interviewed face to face using a validated questionnaire based on Rome III criteria. Demographics, cigarette smoking, opium dependence, amount of fiber consumption, physical activity and psychological factors were assessed. Inclusion criteria was ages 15 to 85 years old. Exclusion criteria was the presence of any metabolic and/or neuro-muscular disease that caused constipation. All data were analyzed with Stata11 software, with a confidence interval of 95%. A p-value of £0.05 was chosen for statistical significance.Results : Particiants had a mean age of 44.9 ± 16.2 years. There were 57.42% female participants. The prevalance of chronic constipation was estimated at 9.4% (7.7%-10.6%). Constipation was more prevalent in females, older individuals, those with decreased physical activity, people who were anxious and depressed, and opium addicted individuals (p<0.05). There was no significant difference in terms of cigarette smoking and amount of dietary fiber between constipated and non-constipated individuals (p>0.2).Conclusion: Although the prevalance of constipation in Iran is estimated to be lower than Western countries, new changes in life style can cause an increase in the burden of constipation in the future.

Background: Functional dyspepsia is considered one of the most common digestive diseases with tremendous cost and time expenditures for patients and health systems. An increase in the numbers of inflammatory cells such as mast cells and eosinophils are reported in the gastrointestinal mucosa of these patients. This study aims to determine the effects of histaminic receptor blockage on patients'' clinical symptoms and mast cell counts of gastrointestinal mucosa.Materials and Methods: This study evaluated the effects of combined cetirizine and ranitidine on patients with proton pump inhibitor resistant functional dyspepsia in terms of clinical symptoms and mast cell counts in the gastric mucosa.Results: This study enrolled 31 patients. The patients declared the intensity of their symptoms as severe (in12 patients) and very severe (in 19 patients) which significantly decreased after treatment. Three patients expressed dissatisfaction with the treatment. The mean mast cell count before treatment was 47.25 ± 29.81 and after treatment it was 8.74 ± 10.63, which was an 80.79±19.15% reduction (p<0.001). Postprandial distress syndrome was present in 25 (80.6%) patients and 13 (41.9%) had epigastric pain syndrome. Patients reported adverse events following treatment that included drowsiness (n=7), overeating (n=1), lethargy (n=1) and dry mouth (n=1).Conclusion: Combined treatment with cetirizine and ranitidine in patients with functional dyspepsia showed a significant reduction in the severity and number of mast cells in gastric mucosa and led to a high rate of satisfaction among patients.

Background: The Unified treatment approach (UP), an emotion-focused cognitive-behavioral therapy that holds emotional processes as a central target of treatment, is applicable for disorders with strong emotional components. The aim of this study was to examine the effectiveness of emotion regulation intervention derivative from the UP on emotional problems and quality of life among patients with functional gastrointestinal disorders.Materials and Method: The study was a randomized clinical trial. Sixteen patients with functional gastrointestinal disorders were entered in treatment process, in term of the qualification criteria. The intervention was conducted in 12 group sessions during 2 hours. The tests of DASS & SF-36 was used to evaluate the efficiency of intervention. Data were analyzed using descriptive statistics and covariance analysis.Results: The results of the covariance analysis showed that there was significant decrease in severity of depression (p<0.01), anxiety (p<0.05) and stress (p<0.01) and also significant increase in quality of life (p<0.01) in intervention group.Conclusion: Emotional regulation intervention on the basis of the UP was effective in decrease of severity of emotional symptoms (depression, anxiety, stress) and increase of quality of life patients with psychosomatic disorders. So, the UP, transdiagnostic therapy have proper efficacy in improvement emotional regulation and quality of life patients with functional gastrointestinal disorders.

Background: Fecal incontinence is defined as the involuntary loss of fecal material. Fecal incontinence is a particularly embarrassing and distressing condition with significant medical, social and economic implications. The purpose of this article is to review the relevant the role of pelvic floor muscle dysfunction in fecal incontinence.Materials and Mthods :We performed a literature search in PubMed, Scopus, Elsevier, Ovid, CINAHL, Science Direct, ProQuest, Google Scholar, Thompson, EMBASE and Medline databases for the period of 1985-2013. The following keywords were used: puborectalis muscle, anal incontinence, fecal incontinence, pelvic floor muscles, biofeedback, pelvic floor exercise, electrical stimulation.Results: Out of 56 papers, 23 met the criteria for this study. We divided these studies into three categories: 1) the role of pelvic floor muscles in the maintenance of anal continence, 2) the role of pelvic floor muscle dysfunction in fecal incontinence, and 3) the role of pelvic floor muscle retraining in management of fecal incontinence.Conclusion: The results indicate there is adequate evidence to support the role of the pelvic floor muscles in the maintenance of anal continence and any damage or dysfunction to these muscles can affect proper disposal and may lead to incontinence. Prevention of incontinence should attempt at preserving the pelvic floor musculature, particularly in patients with impaired defecatory maneuver, which may play a pathophysiological role in the process. The pelvic floor muscles should be considered a goal of treatment in incontinence and improvement in their function should be included as a key outcome in the evaluation of treatment.

Background: Most diagnostic tests for biliary atresia (BA) are invasive. This study evaluates the sensitivity and specificity of serum tumor necrosis factor-a (TNF-a) for diagnosing extra hepatic biliary duct atresia (EHBA) in infants.Materials and Methods: Infants with cholestasis who were admitted to Children′s Medical Center Hospital were evaluated. A total of 50 infants (20 with EHBA and 30 non-EHBA) were included in this study. We evaluated the definite cause of cholestasis. Intra-operative cholangiography and, if possible, Kasai portoenterostomy were performed in infants with high suspicion for EHBA. Upon admission and prior to surgical intervention, infants had their serum TNF-a levels measured by ELISA. We compared the mean TNF-a level between the two groups, in addition to the sensitivity and specificity of serum TNF-α for diagnosis of EHBA.Results: This study enrolled 28 (56%) male and 22 (44%) female infants. Infants'' mean age was 2.87 months in the EHBA group and 2.6 months in the non-EHBA group. Sensitivity of serum TNF was 60% and its specificity was 76.66% for predicting EHBA. The positive predictive value was calculated as 63.1%, the negative predictive value was 74.1%, and accuracy was 70%. There was a significantly higher mean serum TNF-a level in the EHBA group (220 pg/ml) compared to the non-EHBA group (79.8 pg/ml, p=0.023). Serum TNF-a cut off point for determining EHBA from non-EHBA was calculated as 80 pg/ml. Mean serum TNF-a in males (171.28 pg/ml) was more than females (90.80 pg/ml).Conclusion: There was a significantly higher mean serum TNF-a level in the EHBA group than the non-EHBA group. Serum TNF-α could be a proper test that has comparatively good sensitivity, specificity, positive predictive value and negative predictive value for predicting EHBA.

Eosinophilic gastroenteritis (EGE) was a rare gastrointestinal disease that was seen in all ages usually associated with dyspepsia, diarrhea, vomiting, abdominal pain, blood loss in stools and malabsorption. We reported a six-month-old boy with rectorrhagia, family history of allergy, elevated IgE and eosinophil in blood with normal endoscopy. Because of eosinophilic infiltration in lamina properia in colon, diagnosis of EGE confirmed and oral corticosteroid initiated. Patient had symptomatic response and was doing well. The heterogeneity in the clinical presentation of EGE determined by the site and depth of eosinophilic intestinal infiltration and lower gastrointestinal bleeding, although was rare but may be one the clinical manifestations of disease in patients with allergic eosinophilic gastroenteritis (AEG).