Govaresh
Volume:10 Issue: 3, 2005

Northeast Iran has one of the highest rates of esophageal cancer in the world which is mainly squamous cell carcinoma (E SCC). Celiac disease (CD) has been identified as a risk factor for ESCC. The aim of this study is to determine the prevalence of CD in Gonbad at northeast Iran and probable relation between celiac and ESCC. fourteen hundred inhabitants of north eastern Iran were randomly selected. The subjects underwent blood sampling for determination of IgA antibodies against tissue transglutaminase (anti-TTG). Subjects with positive anti-TTG underwent an interview, upper endoscopy and duodenal biopsy. The duodenal biopsies were classified according to Marsh criteria. A total of 1209 subjects (female: 699) with mean age of 50±11.7 years were studied. Twelve subjects (female: 9) had a positive anti-TTG (1%). Four patients did not accept endoscopy. Eight cases underwent endoscopy and duodenal biopsy. Four, two and two subjects had Marsh III, II and I respectively. Flatulence and diarrhea (the most symptoms) were in five and four subjects and characteristic skin manifestation was reported in three subjects. One subject was already diagnosed as CD. although prevalence of ESCC in northeast Iran is significantly higher than central Iran, the prevalence of gluten sensitive enteropathy is the same (1%). It dose not appear that CD has any impact on the prevalence of ESCC in Iran.

The aim of this study was to assess epidemiology of colorectal cancer (CRC) in Isfahan, Iran. Data were gathered from hospital documents of hospital admissions for colonoscopy, surgery, chemotherapy or radiotherapy due to colorectal cancer during 1996-2003. 1100 cases with colorectal cancer in seven years were detected and reviewed. Our minimum incidence rate estimation was 1.3 per 100,000 in 1996, 3.7 /100,000 in 2001 and 3.1 / 100,000 in 2003. One third of CRC cases were diagnosed between thirties to fifties in both genders in our province with a peak incidence in the fifties for females and in the sixties for males. CRC in more than 85% of the patients was left sided. The one, five and seven year's survival rates were 97%, 43% and 21% respectively. A significant lower survival rate was seen in right colon in oppose to the left colon (13% vs. 40%) (p‹0.05) after five years of follow up. Incidence of CRC in Isfahan Proviene is increasing. Rectum is the most common site (61.6%) for CRC. Many of Iranians who have CRC are young Regarding to fact program, Screening is recommended earlier than Western countries.

In developing countries primary antibiotic-resistance and poor compliance are the main causes of helicobacter pylori (HP) eradication failure of standard regimens. To investigate eradication rate, patient's compliance and tolerability of a 1-wk Azithromycin based quaruple therapy versus the 2-wk conventional therapy. A total of 129 HP-positive patients were randomized to either omeprazole 20mg, bismuth subcitrate 240 mg, azithromycin 250 mg, metronidazole 500 mg, all twice daily for 1- wk (BOAzM) or omeprazole 20mg, bismuth subcitrate 240 mg, amoxicillin 1g, metronidazole 500 mg all twice daily for 2-wk (B-OAM). HP infection was defined at entry by histology and rapid urease test and cure of infection was determined by negative urea breath test. HP eradication rates of B-OAzM and B-OAM were74.1% and 70.4% respectively at intention to treat and per-protocol analysis 78.1%versus 75.7% respectively. incidence of poor compliance was lower, although not significant, in patients randomized to B-OAzM than for B-OAM (3.5% versus 4.3 %) but intolerability was similar in two groups (35% versus 33.3%). 1-wk azithromycin based quadruple regimen achieves an HP eradication rate comparable to that of standard 2-wk quadruple Therapy and is associated with same patient's compliance and complications.

In endemic regions visceral leishmaniasis is one of the most common opportunistic infections in HIV positive patients. Simultaneous infection with leishmania and HIV has been reported in some countries but there's no such report from Iran in medical literature. Patient was a 27-year-old man admitted with chief complaints of intermittent abdominal pain, anorexia and vomiting since 6 months ago. He also mentioned mild night fevers, watery diarrhea and severe weight loss during this time. He was of low socioeconomic status, was unemployed and had a history of imprisonment 4 years ago. Physical examination revealed low-grade fever (T=38.1ºC) and severe cachexia (Weight=41 Kg, Height=165 cm). Oropharyngeal candidiasis was evident in oral examination. In upper GI endoscopy, candidal esophagitis and duodenal nodularity were seen. Candidal plaques were also visible in duodenal mucosa. Microscopic evaluation of duodenal biopsy material showed partial blunting of the villi. Abundant macrophages containing intracytoplasmic microorganisms had infiltrated and expanded the lamina propria. High magnification view revealed leishmania amastigotes with nuclei and kinetoplasts. Leishman bodies were also observed in bone marrow aspiration specimen. Serologic studies (latex agglutination and Immunofluorescence antibody) were positive for Leishmania infantum. Serology for HIV antibody was also positive. CD4+ cell count was 80/μl. The diagnosis was acquired immunodeficiency syndrome with simultaneous visceral leishmaniasis involving intestinal mucosa.

Intra-tumoral bleeding, rupture and thrombosis are common complications of hemangioma but spontaneous and self limited rupture and fever is a very rare presentation of hemangioma. This report is about a 38-year-old woman with sever abdominal pain and high fever came for evaluation. In US she had a liver mass of about 15 cm in left lobe with possibility of being hemangioma and, CT scan and MRI confirmed diagnosis of hemangioma. She had persistently abdominal discomfort and fullness in upper abdomen and referred for surgery. Left lobectomy and resection of hemangioma was done successfully.

Non-alcoholic steatohepatitis is a form of chronic hepatitis. Fatty degeneration may involve liver focally or as a whole. The patient was a 41-year-old woman who was diabetic and admitted in Buali hospital in Ghazvin because of right flank pain, fever, vomiting and diarrhea. The patient was treated as pyelonephriris. Liver function tests were as below: ALT: 62 (40) AST: 54 (40), Alkaline Phosohatase: 378 (306). Imaging study of liver and kidney showed multiple masses in liver that documented again in CT scan of abdomen. Liver biopsy was performed ultrasonography guided. Macrovesicular fatty changes were seen histologically and documented again by review of liver specimens. No any malignant structure was identified. The patient was treated as diabetic patients. Focal fatty infiltration can be misdiagnosed as liver metastasis; it is seen as nonspherical lesion in CT scan, without mass effect, with density similar to water. Guided biopsy of the liver can help to have the correct diagnosis.

Endoscopic therapies can decrease the morbidity of patients with high risk peptic ulcer. The aim of this study was to evaluate the beneficial effects of oral omeprazole therapy in patients with bleeding peptic ulcer who received combined endoscopic treatment (epinephrine injection and Argon Plasma Coagulation). Eighty six patients with bleeding from gastric, duodenal or stomal ulcers and endoscopic stigmata of recent bleeding were enrolled in our study. All patients received injection of epinephrine (1:10,000) and also their ulcers were treated with Argon Plasma Coagulator. The patients then randomly assigned to receive oral omeprazole (40 mg every 12 hours) or placebo. Five (11.6%) of 43 patients in the placebo group had rebleeding; but no rebleeding was detected among 43 patients in omeprazole group (p= 0.05). One patient in the Placebo group underwent surgery for control of his rebleeding; but none of the patients in omeprazole group needed surgery. One patient in the placebo group and none of the patients in the omeprazole group died. The average hospital stay was 5 days in the omeprazole group and 5.8 days in the placebo group. Addition of oral omeprazole to combined endoscopic therapy significantly reduces recurrent bleeding rates.

Major thalassemia is the most common form of anemia requiring blood transfusion in Iran. Since ribavirin provokes anemia in the treated patients, interferon monotherapy may be an appropriate treatment in major thalassemic patients. The aim of this study was to determine the safety and efficacy of interferon monotherapy in thalassemic patients with hepatitis C virus infection. Forty major thalassemic patients (20 male), with hepatitis C infection (detectable HCV RNA«by qualitative PCR««amplification assay) and elevated liver enzymes were enrolled. Liver biopsy was done for all patients. Then the patients were treated with interferon (3 MU, three times per week) for six months. They were followed by HCV RNA at the end of treatment, and at 6, 12, 24, 36, and 48 months later. Primary outcome measure was sustained virologic response defined by undetectable serum HCV RNA 6 months after end of treatment. Secondary endpoint was negative HCV RNA at the end of follow up (48 months posttreatment). Mean age of the patient at the beginning of the study was 17. 37±5 years. Three patients discontinued treatment because of interferon side effects. Twenty six (65% on intention to treat analysis) had undetectable HCV RNA 6 months after end of treatment but eleven of them became HCV RNA positive on follow up. Finally, 15 patients (37. 5%) had undetectable HCV RNA at the end of follow up. Interferon monotherapy is an effective treatment for major thalassemic patients with HCV infection. Definition of sustained virologic response for hepatitis C may require revision in high risk patients.