GOVARESH JOURNAL
Year:2005 | Volume:10 | Issue:1|Papers Count:11

Introduction and Aims: Prior investigators have proposed microlithiasis as a causative factor for occult gallbladder diseases.Endoscopic ultrasonography (EUS) is potentially far more sensitive than transabdominal ultrasonography (TUS) in visualizing small stones. The aim of this study was to investigate the role of endoscopic ultrasounography (EUS) in the diagnosis of microlithiasis in patients with upper abdominal pain and normal transabdominal ultrasonography (TUS).Materials and Methods: Thirty-five patients with biliary-type abdominal pain and normal TUS were prospectively studied. All patients underwent radial EUS by means of an echoendoscope (Olympus, GF-UM20).Results: Of 35 patients, 33 revealed to have gallbladder sludge or small stones, and 21 had common bile duct (CBD) sludge or microlithiasis. Nine patients dropped during the follow-up, however, of the remaining, 13 underwent combined endoscopic biliary sphincterotomy and cholecystectomy, 10 subjected for cholecystectomy and 3 received biliary sphincterotomy alone. In a postoperative follow-up of 9.2 months, 25 patients (96.2%) became symptom-free.Conclusions: EUS is an important diagnostic tool in patients with unexplained biliary colic. Cholecystectomy with or without ES are effective treatment modalities in these settings.

Introduction and Aims: Although a few studies have done in our country in the field of hepatitis D, its risk factors are not clearly known.This study was conducted with the aim of assessing the relative frequency and risk factors of HDV and the correlation between HDV and severity of liver damage.Materials and Methods: This was a cross sectional study. 280 HBsAg positive subjects (including 102 inactive carriers, 155 patients with chronic active hepatitis and 23 cirrhotic subjects were assessed for Anti HDV Ab, risk factors (blood transfusion, surgery, tattoo, war injury, dentistry interventions and endoscopy) and severity of liver damage (ALT, AST, Platelet).Results: From all subjects, 16 patients (5.7%) were affected with HDV.2 inactive carriers (2%), 12 patients with chronic active hepatitis (7.7%) and 2 cirrhotics (8.7%) were Anti HDV Ab positive. History of tattoo (p=0.054), war injury (p=0.025), dentistry interventions (p=0.064) and endoscopy (p=0.028) were more reported in Anti HDV Ab positives than negatives. Anti HDV Ab positive was correlated with higher pathological score (p=0.017) and grade (p=0.012) and lower platelet count (p=0.083).Conclusions: Our results indicate that the severity of liver disease is independent of serum levels of hepatitis D virus. The correlation between serum titers of hepatitis B virus and severity of liver disease clearly require further investigation.

The patient was a 22-year-old female with ataxia-telangiectasia presented with progressive dysphagia to solid food from 2 months ego.She had lost 17 kg in that period. Physical findings were cachexia, telangiectasias of sclera, ataxia in limbs movements and epigastric tenderness. There was a tumoral lesion in gastric lesser curvature with extension to esophagogastric junction in endoscopy. Pathologic report of biopsy was signet cell adenocarcinoma which confirmed by IHC. Aortic involvement was detected in endoscopic ultrasonography and tumor was unresectableso we only inserteda metal stent for paliation.

Cholangiopathy and chronic diarrhea are relatively common manifestations of AIDS. Cryptosporidium parvum infection is the most common cause of AIDS cholangiopathy globally. This is the first report of documented Cryptosporidium parvum infection in a patient with AIDS in Iran. The patient was a 39-year-old man from Afghanistan with watery diarrhea, crampy periumbilical abdominal pain and 20 kg weight loss during the past 6 months. He was cachectic with a distended, tympanic abdomen. Laboratory findings were significant for hypokalemia, markedly elevated serum alkaline phosphatase and lymphopenia. Bilirubin and other liver function tests were in normal range. Stool exam was positive for giardia cysts, WBC and trace RBC's. Sonography showed dilated common bile duct and normal intrahepatic ducts. In ERCP there was papillary stenosis, dilated common bile duct and multiple small strictures in intrahepatic ducts. Endoscopy showed candida esophagitis, gastritis and duodenitis. Oocysts of cryptosporidium parvum were seen on duodenal biopsy. His HIV-Ab was positive. He was treated with fluconazol, metronidazol, paramomycin and UDCA and referred to a special center for antiretroviral therapy.

Introduction and Aims: Gastroesophageal reflux disease (GERD) is very common in western countries. GERD is increasing, has profound effects on health economics, disturbs the patient's health-related quality of life, and increases the risk for development of esophageal adenocarcinoma. GERD is considered to be infrequent in developing countries. This study was performed to determine the prevalence of GERD among Iranians.Materials and Methods: Major GERD symptoms (heartburn and acid regurgitation) were assessed through an interview by trained general practitioners in three different Iranian populations in 2002: Tehran University freshmen (n=3008), healthy blood donors in Tehran (n=3517), and participants in Golestan cohort study on esophageal carcinoma in Gonbad, north-east of Iran (n=1066). Presence of heartburn or acid regurgitation was considered as GERD and their frequencies were calculated during the last 12 months prior to recruitment.Results: Three episodes per week or more of GERD symptoms were recorded in 2.1% of university freshmen (mean age 19.1±2.1 years), 4.7% of blood donors (mean age 37.3±10.8 years), and 18.4% of the cohort study participants (mean age 51.3 ± 11.7 years). One to two episodes of GERD symptoms a week were reported in 5.1% of the university freshmen, 5.6% of blood donors and 12.7% of the cohort study participants.Conclusions: GERD symptoms are frequent among Iranians. There was also a trend toward increasing frequency of GERD with increasing age. A GERD symptom is more prevalent in Iran than other Asian countries and is comparable to that of western countries.

There is a well-recognized relationship between aplastic anemia and viral hepatitis. Clinically apparent hepatitis precedes aplastic anemia by a period of weeks to months. Hepatitis is an infrequent cause of aplastic anemia and is usually severe and fatal if untreated. The clinical features and, particularly the response to immunosuppressive therapy strongly suggest that immune mechanisms mediate the marrow aplasia. The cause of the hepatitis is unknown, but it does not appear to be due to any of the known hepatitis viruses.In this study we present two cases of hepatitis associated aplastic anemia (HAAA) at the ages of 10-11 years old.They both received immunosuppressive therapy, Anti thrombocytic globulin and Cyclosporine. They achieved a persistent clinicohematological remission.