sclerosing cholangitis
در نشریات گروه پزشکی-
بیماری پاژه استخوان یک اختلال متابولیک استخوانی است که با نواحی موضعی از تشدید تولید و چرخه استخوانی با ایجاد استخوان زیاد و بی نظم مشخص می شود. جذب و تشکیل سریع استخوان منجر به ایجاد بافت استخوانی نامنظم می شود. اکثر موارد به طور تصادفی در رادیوگرافی یا به عنوان افزایش مجزای آلکالین فسفاتاز سرم تشخیص داده می شود. کلانژیت اسکلروزان اولیه یک اختلال پیشرونده مزمن با علت ناشناخته است که با التهاب، فیبروز و تنگ شدن مجاری متوسط و بزرگ در درخت صفراوی داخل کبدی و/ یا خارج کبدی مشخص می شود. همراهی هر دو بیماری با بیماری های دیگر گزارش شده ولی گزارش اندکی از همراهی این دو بیماری با هم وجود دارد. این همراهی می تواند پزشک را با چالش مهمی برای هر دو بیماری مواجه کند زیرا هر دو بیماری منجر به افزایش آلکالن فسفاتاز می شوند. در اینجا، یک مرد 52 ساله که در ارزیابی به علت درد شکم و افزایش آلکالن فسفاتاز، وجود بیماری پاژه فمور نیز تشخیص داده شد، معرفی می شود. برای بیمار زولدرونیک اسید 5 میلی گرم تجویز شد. شش ماه بعد بیمار شکایتی از درد لگن نداشت. گرافی فمور بدون تغییر باقی ماند و آلکالن فسفاتاز بیمار کاهش یافته و به محدوده طبیعی رسید. یافته های آزمایشگاهی، تصویربرداری و بافت شناسی بیمار مورد بررسی قرار گرفت. به نظر می رسد در بیماران با آلکالن فسفاتاز بالا و سیروز صفراوی اولیه، وجود درد یا دفرمیتی استخوان و مفاصل باید با تصویربرداری بررسی شود تا وجود بیماری های همراه تشخیص داده شود.
کلید واژگان: بیماری پاژه، کلانژیت اسکلروزان، آلکالن فسفاتاز، زولدرونیک اسید، چرخه استخوانیPaget's disease of bone is a metabolic bone disorder characterized by localized areas of increased bone production and cycle with excessive and irregular bone formation. Rapid bone resorption and formation lead to irregular bone tissue. Most cases are diagnosed incidentally on radiographs or as an isolated elevation of serum alkaline phosphatase. Primary sclerosing cholangitis is a chronic progressive disorder of unknown etiology characterized by inflammation, fibrosis, and narrowing of medium and large ducts in the intrahepatic and/or extrahepatic biliary tree. The association of both diseases with other diseases has been reported, but there are few reports of the association of these two diseases together. This association can present the physician with an important challenge for both diseases because both diseases lead to an increase in alkaline phosphatase. Here, we present a 52-year-old man who was also diagnosed with Paget's disease of the femur on evaluation for abdominal pain and elevated alkaline phosphatase. Zoledronic acid 5 mg was prescribed for the patient. Six months later, the patient did not complain of hip pain. The femur graph remained unchanged and the patient's alkaline phosphatase decreased and reached the normal range. Laboratory findings, imaging, and histology of the patient were explained. It seems that in patients with high alkaline phosphatase and primary biliary cirrhosis, the presence of pain or deformity of bones and joints should be checked with imaging to detect the presence of co-morbidities.
Keywords: Paget Disease, Sclerosing Cholangitis, Alkaline Phosphatase, Zoledronic Acid, Bone Turnover -
Background
There are several scolicidal agents for inactivation of hydatid cyst protoscolices during surgery, but most of them are associated with adverse side effects such as sclerosing cholangitis (SC) and liver necrosis. The present study aimed to evaluate the adverse effects of Eucalyptus essential oil to induce SC in animal models.
Materials and MethodsEighteen rabbits weighting 2000–3500 g were included in three groups for this study. About 0.3 ml of Eucalyptus essential oil (1%), or 5% hypertonic saline, or normal saline was injected for 5 min in the gallbladder. After 4 months, the liver, common bile duct, and duodenum were resected and immediately sent for cholangiography and pathologic studies.
ResultsAccording to pathological studies, inflammation is more common in Eucalyptus and hypertonic saline groups. Due to cholangiographic studies, stricture was slightly higher in the hypertonic saline group than the Eucalyptus group.
ConclusionThus, 1% Eucalyptus essential oil is at least as safe as 5% hypertonic saline, but for clinical uses, it must be confirmed with further studies.
Keywords: Eucalyptus essential oil, sclerosing cholangitis, scolicidal agents -
BackgroundMagnetic resonance cholangiography (MRC) has gained popularity for diagnosing primary sclerosing cholangitis (PSC). We determined the accuracy of MRC compared with endoscopic retrograde cholangiography (ERC) for diagnosing PSC.Materials And MethodsThis retrospective case-control study was conducted on patients referred to an outpatient gastroenterology clinic from 2001 to 2013. Patients with established diagnosis of PSC who had undergone MRC and ERC within a 6-month interval were included. Controls were selected from patients who had undergone imaging for reasons other than PSC evaluation. Disease outcome at the study time and liver biochemistry data at diagnosis and 1-year thereafter were retrieved. Diagnostic accuracy of MRC in comparison with ERC was evaluated.ResultsA total of 46 definite PSC patients (age at diagnosis = 36.8 ± 11.6 years, 33 male) were found. Diagnostic imaging for PSC was ERC alone in 12, MRC alone in 23, and ERC plus MRC in 11 patients. Controls were 89 patients mostly with bile stones. The sensitivity, specificity, and positive and negative likelihood ratios of MRC was 90.9%, 95.5%,20.23, and 0.10, respectively. Early PSC was found more frequently by MRC compared with ERC (30.4% vs. 8.3%, P = 0.146). No significant difference was found between imaging modalities with regards to patients’ outcome (P = 0.786) or liver biochemistry at diagnosis or 1-year thereafter (P >0.05).ConclusionStarting diagnostic imaging for PSC with MRC seems better and may provide diagnosis of PSC at its earlier phase. Further studies with larger sample of patients and longer follow-ups are warranted.Keywords: Cholangiography, diagnosis, magnetic resonance imaging, sclerosing cholangitis, sensitivity, specificity
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