Govaresh
Volume:15 Issue: 3, 2011

Endosonography is a distinct method in evaluating gastrointestinal (GI) structural lesions, particularly in the pancreatobiliary system. This procedure has made a fundamental change in the diagnosis of pancreatic mass lesions through fine needle aspiration (FNA). This study aims to evaluate the results and efficacy of endosonographic fine needle aspiration (EUS-FNA) in patients presenting with solid pancreatic masses. This was a descriptive, prospective, case series study of patients who presented with solid pancreatic masses to Imam Khomeini Hospital, Tehran, Iran over a one year period (from November 20092010-) In order to determine false negative cases, patients were followed for 6 to 12 months. A total of 53 patients underwent EUS-FNA with no complications. The results were diagnostic in 46 (87%) cases. The majority of patients were male (68%) and 81% had a mass in the pancreatic head. Cytopathology results revealed 36 (68%) adenocarcinomas, 7 (13%) other malignancies, 3 (6%) benign lesions and 7 (13%) nondiagnostic cases. The frequency of nondiagnostic results was significantly more in masses smaller than 3 cm (6 vs. 1, p < 0.002). Patients with nondiagnostic results were younger than those with malignant cytopathologies (52 ± 7.5 vs. 66 ± 7.5 years, p < 0.001). Sensitivity, specificity, PPV, NPV and accuracy of EUS-FNA in adenocarcinoma cases were 88%, 100%, 100%, 70% and 90%, respectively. EUS–FNA is an effective and safe procedure in the histopathologic diagnosis of pancreatic tumors.

E-cadherin is a calcium-dependent molecule that contributes to intercellular adhesion. Its proper functioning is important in the maintenance of epithelial structure and integrity. E-cadherin serves as a very important tumor suppressor. In this study, we aim to determine the frequency of E-cadherin expression aberrancy and itsrelationship to the biological behavior of gastric adenocarcinoma.A total of 52 patients with gastric cancer who underwent gastrectomies in Imam Khomeini Hospital were investigated in a cross-sectional study. Their tissues were stained by immunohistochemistry methods toinvestigate the expression of E-cadherin. Patients’ information including age, ge nder, Helicobacter pyloriinfection, lesion location, adenocarcinoma subtype, metastasis, differentiation and regional lymph node involvement, depth of invasion and staging were collected and compared.Age, gender, Helicobacter pylori infection, lesion location, regional lymph node involvement, metastasis, depth of invasion, differentiation and staging did not have a statistically significant relationship with abnormal E-cadherin expression. Abnormal E-cadherin expression was significantly higher in the diffuse sub-type ascompared with the intestinal type (90.9% vs. 48.8%, p = 0.016).The present study assessed the frequency and relationship between abnormal E-cadherin expression and certain biological variables of tumor behavior in Iranian patients with gastric adenocarcinoma. A significant correlation existed only between diffuse sub-typing and reduced E-cadherin expression.Keywords:.

Hepatitis B is still a major health problem in many parts of the world. In some developing countries the most common cause of chronic hepatitis and liver cirrhosis is hepatitis B virus (HBV). The progression of chronic hepatitis B to cirrhosis and hepatocellular carcinoma (HCC) include such viral factors as genotype C and high levels of serum HBV DNA in addition to host factors such as older age, male gender, obesity and diabetes. Other factors that influence progression to cirrhosis and HCC are simultaneous alcohol use, and co-infections with HIV, HDV and HCV. The present study aims to determine the correlations between serum HBV DNA viral load and related factors. In this study, new HBV DNA and ALT levels that enable better separation between different stages of this disease are presented.Chronic hepatitis B patients who presented to the Liver Clinic at Imam Khomeini Hospital in 1388 who were HBsAg positive for more than six months were enrolled in this study. Patients who had previously been treated or those with concurrent HIV, HCV and HDV infections as well as those with autoimmune hepatitis and fatty liver were excluded. Patients’ data, HbeAg state, demographics, liver enzymes, HBV DNA level, smoking history, cirrhosis and disease stage were recorded.In order to better differentiation between non-replicative and reactive chronic hepatitis B patients, statistical analysis was done to distinguish between their HBV DNA levels. Evaluation of the relationships between HBV DNA level and the above mentioned variables was performed.High Levels of HBV DNA correlated with HBeAg positive state, smoking (p=0.005) and elevated liver enzymes (p=0.002). The cut-off value for ALT level that separated HbeAg-positive group (immunoclearance and immunotolerancephases) was set at 42 U/l on the roc curve(r=0.889 area under curve) with 100% sensitivity and 67.7% specificity. The cut-off value for serum HBV DNA levels that differentiated between the Hbe Ag-negative group (non-replicative and reactive phases) was set at 3000 IU/ml on the roc curve (r=0.987 area under curve) with 97% sensitivity and 92% specificity.Coclusion:The present study determined that serum HBV DNA at a level of 3000 IU/ml was a better level for classification of HBeAg-negative patients into the non-replicative and reactive groups.

The effect of IL 28 B polymorphism on sustained virology response (SVR) in patients with Hepatitis C genotype 1 varies among races. Multiple studies have shown that the SVR is two or three times higher in patients with CC genotype compared to those with TT genotype. This study aims to assess the relationship between IL 28 B polymorphism and SVR in Iranian patients.In a cross-sectional study, 48 patients with Hepatitis C genotype 1 who underwent PCR testing six months following treatment were divided into two groups, SVR positive and negative in order to compare IL 28 B polymorphism.The SVR rate was higher in patients who presented with high baseline ALT levels, independent of IL 28 B genotype (p=0.023). Logistic regression analysis showed a higher SVR rate in patients with CC genotype compared to TT genotype (p=0.007, OR=29.333, CI=2.558–336.387), however no significant difference was noted between TC and TT genotypes (p=0.177, OR=2.887, CI=0.618-13.496). Additionally, there was a significant difference between CC and non-CC groups (TC, TT) in SVR rate (p=0.017, OR=13.750, CI=1.602– 118.061). A high SVR rate was seen in the C group (CC, TC) when compared with the TT genotype (p=0.036, OR=4.923, CI=1.111–21.816). The sensitivity, specificity,PPV and NPV of the IL 28 B genotype in predicting SVR was 88.8%, 38%, 64.8% and 72.8%, respectively. In addition; although the CC genotype was positive, the sensitivity and NPV were increased to 91.6% & 95.2% respectively.This study confirms the relationship between IL 28 B genotype and SVR rate in the patients with Hepatitis C genotype 1. It seems; IL 28 B genotype could be the reasonable Lab.test for treatment plan of the problematic cases of the patients with ChronicHepatitis C.

Liver lesion is a common condition, which often detect incidentally. A large proportion of liver masses can be diagnosed by progression in imaging modalities.Although, definite diagnosis of liver mass’s nature can be made by biopsy of lesion and histopathologic examination, but with imaging findings, we can approach to the diagnosis.In this study, we review many valuable articles and scientific references to define main aspects of diagnosis of liver masses.

Obscure gastrointestinal (GI) bleeding is defined when the source of GI bleeding could not be determined by upper endoscopy, colonoscopy or barium small bowel transit. In this report, a 41 year-old man presented with a history of over ten recurrent episodes of melena since four years prior to admission. The source of bleeding was not detected by multiple upper and lower GI endoscopies.During the last admission, other investigations which included small bowel transit, abdominal radioisotope scan and double balloon enteroscopy up to the mid-jejunum were all inconclusive. For more evaluation, an exploratory laparatomy and intra-operative endoscopy were planned. On laparatomy, a tumoral mass of 7 cm diameter was found on the inferior aspect of the stomach. The tumor was attached to the gastric wall by a 2 cm pedicle and connected into the gastric lumen via a small orifice which was not visible on endoscopic view. The tumor was resected with the surrounding gastric wall. Pathologic report favored pedunculated gastrointestinal stromal tumor (GIST) and confirmed with the positive CD117 antigen.Therefore, in the approach of patients with obscure GI bleeding, rare causes such as extramural pedunculated GIST should be considered.

Cystic fibrosis (CF) is an autosomal recessive disorder chiefly characterized by respiratory and gastrointestinal symptoms. This study investigates whether omega-3 fatty acid affects quality of life in children with CF.

This was a single-blind, pilot study undertaken at the Cystic Fibrosis Center of Sarvar Children Hospital, Mashhad, Iran from March 2009 until September 2009. In this study, 11 patients aged 2-12 years were assigned to ingest 3 capsules of fish oil daily for 3 months. Each capsule contained fish oil (1 gr), eicosapentaenoic acid (180 mg) and docosahexaenoic acid (120 mg). At the beginning of the study and after the treatment period, questionnaires were used to determine the quality of life of all patients, both totally and separately, in four domains [physical (PH), emotional (EM), social (SOC) and school functioning (SCH)]. Wilcoxon test compared the scores before and after treatment intervention. p < 0.05 was considered significant.

Peptic ulcer disease and its complications have long been studied but the coexistence of two major complications in a kissing ulcer is uncommon. We present our experience with this entity and review the related literature. A 27 year old man was suffering from concomitant major complication of duodenal kissing ulcer, huge anterior perforation and uncontrolled posterior bleeding, presenting as hemorrhagic shock to emergency department. The posterior ulcer containing pulsatile bleeding from gastroduodenal artery oversewed and the ruptured anterior ulcer converted to pyloroplasty followed by truncal vagotomy. Presence of anterior perforated duodenal ulcer in a patient of bleeding peptic ulcer is an uncommon presentation that needs a high degree of suspicious for preoperative and intraoperative diagnosis.