GOVARESH JOURNAL
Year:2009 | Volume:14 | Issue:3 (SN 68)|Papers Count:8

Background: Infection with Helicobacter pylori might be related to chronic gastritis, peptic ulcer and gastric Adenocarcinoma. Given the high prevalence of Helicobacter infection in our region, this study was designed to determine the age trend of Helicobacter pylori contamination in Golestan province in 2008.Materials and Methods: This cross-sectional descriptive study was carried out on 1028 residents of Golestan province, which were randomly selected by cluster sampling in 2008. Data were gathered by questionnaires and trial examinations. Blood sampling and titration of anti-H pylori IgG by ELISA were done. SPSS software was used for statistical analysis of the results and was considered significant (P<0.05).Results: Prevalence of H. pylori infection was 66.4% in Golestan. The lowest frequent seropositive group was under 5 year old children (30.6%) and subjects living in Bandar Gaz and Kordkuy cities (44.6% and 31.6%, respectively) and in west of province. The highest frequent seropositive group was 55-64 year old subjects living in east of province, Azadshahr and Kalaleh (77.6% and 76.6%, respectively). There were no significant relations between prevalence of infection, occupation, gender, residency in either urban or rural area and BMI.Conclusion: The prevalence of H. pylori in Golestan was equal to that in other provinces in Iran. The rate of infection was increased by increasing the age up to 25 years of age. It is suggested to set up a research project, to determine the prevalence of pathogenic factors especially VacA, CagA or their anti-bodies in society to disclose the risk associated with H. pylori.

Background: Germline mutations in MMR genes are reported to be present in more than 70% of HNPCC cases. But, there is a paucity of data regarding the importance of defect of MMR system in the gastric cancer in general. So, in this study, we used IHC stain for MLH1, MSH2, PMS2 and MSH6 to reveal profile of MMR expression in patients with gastric cancer.Materials and Methods: This study was performed on 134 patients with gastric cancer who had undergone surgical resection from January 2001 to December 2005. For comparative analyses chi-square test or Fisher’s exact test and t-test were used.Results: Through IHC assay, all of samples from patients had normal stain for MSH2 and MSH6. Except in 5 cases (3.7%) IHC stains for MLH1 and in 4 cases (3%) IHC stains for PMS2 were normal. In comparative analyses there were not any significant differences in variables between subgroups of IHC result.Conclusion: Although, genetic factors are cause of gastric cancer in few patients, and germline mutation may increase the risk of gastric cancer. In this study 3.7% of cases with gastric cancer had abnormal MMR proteins function. It seems that MLH1 and PMS2 have a major role in MMR functions in Iranian patients with gastric cancer, to further clarify this issue, more researchers should be done.

Background: Hepatitis G virus (GBV-C) is a single strand RNA positive virus and is a member of flaviviridae family. Infection with the virus is prevalent add has worldwide distribution. Accurate diagnosis of the virus very important, because of co-infection with other important viruses like HCV, HBV and HIV, it may influence on pathogenesis, disease progression and response to viral therapy.Materials and Methods: In the current investigation a sensitive and accurate and detection of 5'-UTR sequences of Hepatitis G virus (GBV-C) was developed and applied. First genome of the virus was extracted and then, by Reverse Transcription method, cDNA was synthesized. Then, by use of a double stage PCR and two pairs of specific primers, the specified region of the virus genome was amplified and the final product was visualized on agarose gel electrophoresis.Results: Based on five positive samples, the method was developed and optimized. Developed method, sera samples from chronic HCV infected patients, (GBV-C). Finally, it was shown that 31 (43.6%) patients were positive for Hepatitis G virus.Conclusion: Based in the results in the current study, it was shown that the developed assay has performance for diagnosis of Hepatitis G virus infection. Also it was concluded that the infection rate among chronic HCV infected patients is high

Cronkhite-Canada syndrome (CCS) is a rare, non-familial disorder of unknown etiology associated with alopecia, cutaneous hyperpigmentation, gastrointestinal polyposis, onychodystrophy, diarrhea, weight loss and abdominal pain. The prevalence of gastrointestinal malignancy in CCS patients is about 13%, and especially is high in colorectal and gastric areas; 5 year mortality rate is 55%.In this report, a 74 year old man is described who had dysgeusia, skin hyperpigmentation, onycholysis, abdominal pain, chronic diarrhea, progressive weight loss and episodic melena since one year ago. He underwent upper endoscopy and colonoscopy. Diffuse polyposis were seen in stomach, duodenum and from rectum to cecum. Pathology of biopsy specimens showed hamartomatous polyps, compatible with Cronkhite-Canada syndrome. Although CCS is a rare acquired syndrome, it should be considered in differential diagnosis of gastrointestinal polyposis with diarrhea and skin changes. These patients need careful follow up to identify associated malignancies.

Cytomegalovirus (CMV) infection can cause colitis which is usually manifested with fever, weight loss, anorexia and abdominal pain. Watery diarrhea can be the only manifestation. CMV colitis usually cannot be diagnosed according to the clinical findings. Moreover, endoscopic appearance can exactly mimic pseudo-membranous colitis. Here by, we are presenting a patient with fever and watery diarrhea receiving immunosuppressive treatment due to rheumatoid arthritis who had received antibiotics. Pseudo-membranous colitis was revealed during colonoscopy and subsequently metronidazole and vancomycine treatment initiated but no improvement was observed. Finally, according to the positive CMV antibody and the presence of CMV antigen diagnosis was confirmed and valganciclovir for CMV colitis was administered.

Compared to western countries, pancreatic cancer has a relatively low incidence in Iran. It is rarely diagnosed before the fifth decade in Iran and most of the patients are older than 60 at the time of diagnosis like to the western countries, where pancreatic cancer is a disease of advanced age. The incidence of the disease in some young patients suggests a possible role of genetic defects, which is probably due to high consanguineous marriages in Iran. Despite many efforts in improving diagnosis and treatment of pancreatic cancer, this disease has still dismal prognosis. The analysis of the spatial spread of the pancreatic cancer in Mazandaran and Golestan, two provinces in the Caspian Sea region in the north of Iran, which comprise a low incidence of pancreatic cancer, showed that the disease, unlike other gastrointestinal tract cancers, does not exhibit high incidence clusters in the region. Our knowledge about the molecular and cellular pathology of the pancreatic cancer has progressed, and many agents including anti-EGFR, anti-VEGF, and immunotherapeutic agents have been applied for the treatment of the disease. However, surgery remains the only curative approach and further research is paramount to identify novel diagnostic and predictive biomarkers for early diagnosis and treatment stratification. Pancreatic cancer requires an interdisciplinary approach which involves surgery, pathology, radiology, gastroenterology, oncology, and palliative care provided in dedicated, specialized centers.

Background: Primary pancreatic lymphoma (PPL) is a rare condition and its differentiation from most commonly adenocarcinoma is very important because of different prognosis and treatment strategies. The aim of this study was presenting different aspects for differentiating PPL from pancreatic adenocarcinoma.Materials and Methods: During 14 months, 5 patients who underwent endoscopic ultrasonograph in our ward were recorded. Demographic characteristics, laboratory and imaging findings were evaluated. Literature review was done.Results: The duration of symptoms was between one to two months. The primary presenting symptoms were abdominal pain, weight loss, jaundice and pruritus. All patient except one, diagnosed as primary pancreatic lymphoma by EUS-guided fine-needle aspiration. Occasional presence of B-symptoms, larger size of the lesion, less occurrence of invasion to the large vessels despite larger size, less occurrence of obstructive jaundice (in spite of greater frequency in the head of the pancreas) and normal or lower titer of CA19-9 may be useful keys for differentiating primary pancreatic lymphoma from pancreatic cancer.Conclusion: Although cytology or tissue histology is fundamental forth diagnosis, clinical, laboratory and imaging findings may be valuable tools for differentiation PPL from pancreatic adenocarcinom.