Govaresh
Volume:10 Issue: 4, 2006

Linear endoscopic ultrasonography (EUS) is a proven modality for the diagnosis and treatment of different gastrointestinal lesions. The aim of this study was to describe the role of EUS-FNA in the evaluation of pancreatic and submucosal lesions. Over a 1-year period, in a prospective descriptive study, patients referred to Naft Hospital, underwent linear EUS. Of the 40 linear EUS performed, 32 (80%) patients had pancreatic lesions which 26 (81%) of these cases were referred for pancreatic tumor biopsy. The most of these tumors (73%) were in the head of pancreas. EUS-guided fine-needle aspiration biopsy was performed in all 26 patients successfully without complications, which in 16 (61.5%) of them the diagnosis of pancreatic malignancy confirmed cytopathologically. Sensitivity and specificity of this method in pancreatic lesions were 84% and 100%, respectively. Eight patients (20%) were referred because of submucosal upper gastrointestinal lesions which in 7 (87.5%) of them GIST were diagnosed. Sensitivity and specificity of EUSFNA in submucosal lesions was 100%. No adverse effect of EUS-FNA was observed. EUS-FNA is a safe method with an acceptable accuracy in the evaluation and diagnosis of pancreatic and submucosal lesions. The results of this study are similar to that reported previously from other countries. Performing this new method requires more gastroenterologists and pathologists experience as well as more support from different societies (such as gastroenterology and surgery).

To study the effect of oral garlic on arterial oxygen pressure in children with hepatopulmonary syndrome. Garlic powder in a capsule form was given to 15 children with hepatopulmonary syndrome (confirmed by contrast echocardiography) at the dosage of 1 g/1.73 m2 per day. Patients were evaluated clinically and by arterial blood gas every four weeks. The garlic capsule was administered to 15 patients with hepatopulmonary syndrome. There were 10 boys and 5 girls with a mean age of 9.4 ± 3.9 years. The underlying problems were biliary tract atresia (4 patients), autoimmune hepatitis (4 patients), cryptogenic cirrhosis (4 patients) and presinusoidal portal hypertension (3 patients). Eight patients (53.3%) showed an increase of 10 mmHg in their mean arterial oxygen pressure. The baseline PaO2 was 65.6 ± 12.1 mmHg in the responder group and 47.1 ± 11.2 mmHg in non-responder group. At the end of treatment the mean PaO2 in responders and non-responders was 92.2 ± 7.75 mmHg and 47.5 ± 11.87 mmHg, respectively (P ‹ 0.01). Garlic may increase oxygenation and improve dyspnea in children with hepatopulmonary syndrome.

Gastric outlet obstruction (GOO) due to peptic stricture is one of three known complications of peptic ulcer disease and usually requires therapeutic intervention for symptoms relief. After Benjamin SB who primarily used balloon dilation for treatment of GOO in 1982, some series has been published investigating procedure efficacy with different results. The purpose of this study is to investigate efficacy of balloon dilation in some Iranian patients with GOO and also the probable role of some other factors on responsiveness. 23 patients were enrolled in a 10 month duration prospective case study and followed for mean of 30 weeks. some factors such as gender, age, cigarette smoking, Helicobacter pylori (H.p) infection, stenosis diameter, symptom duration, degree of weight loss, dilation sessions, response to therapy and time to response after procedure were registered for each patient. Mean age was 49.5 years and most patients were in the 5th decade of life. 2 and 23 of patients (8.7% and 91.3%) were female and male, respectively. the most common symptoms among patients were epigastric fullness and heart burn (each 87% of patients), nausea (82.6), vomiting (78.3%) and pain (69.6%). 21 out of 23 patients were asymptomatic at end of study. 18 of 21 patients with response to therapy underwent only one session of dilation. There was not any statistically significant correlation between response to therapy and any one of factors as, gender, H.p infection, cigarette smoking, symptom duration and stenosis diameter. Time to response was shorter in males comparing to females (2.7 vs 8 weeks respectively) (p=0.002). Trans the scope (TTS) balloon dilation of GOO in short term is effective and safe. if in long term, symptom recurrence rate proves to be acceptable, it will be recommended as first line treatment of benign GOO. Also it seems that use of fluoroscopy has not any additional advantage in increasing efficacy of the procedure.

Skull metastasis from Hepatocellular carcinoma, specially as the first presentation is very rare. We report a case with a history of head trauma in Bam earthquake and craniotomy due to lytic tumor of the skull, presented with upper gastrointestinal symptoms which Hepatocellular carcinoma with skull metastasis was revealed. the patient was infected with hepatitis B virus without cirrhosis.

Available drugs are not able to eradicate intracellular viral DNA in patients with hepatitis B virus (HBV) infections. HBsAg vaccine could induce immunity and subsequently eradicate Hepatitis B virus in proportions of these patients. Our aim was to evaluate the efficacy of HBsAg as a mode of therapy in inactive carriers. Forty two consecutive patients of inactive carriers were enrolled. All patients underwent liver biopsies. The modified Ishak score of all cases were less than 4. Twenty microgram of recombinant HBsAg vaccine injected intradermally 3 times (at 0, one and 6 months). Biochemical and serological variables evaluated initially and 6 months after the last injection. The mean age was 39.6 ± 11.12. Male/female ratio was (67.4%). Two out of 42 cases lost their HBsAg (4.74%). The difference was significant comparing to one percent annual spontaneous HBsAg loss (p=0.014). In addition serum albumin level was significantly increased after vaccination (p=0.009). Rest of the biochemical and serological variables had no significant changes comparing pre and post vaccination. Intradermal injection of HBV surface antigen vaccine could induce significant HBsAg loss. This mode of therapy is cheap, physiologic and without complication. However, the results of this study should be confirmed in further large controlled trial.

Colonoscopy is used for both diagnostic as well as therapeutic purposes in patients with lower GI symptoms. The aim of this study was to assess the clinical manifestations and to determine the colonoscopic findings of children with lower GI symptoms attending a pediatric hospital in Tehran. During a 5-year period (1996-2001), all children less than 16 years of age, who had undergone colonoscopy in the Gastroenterology Department of the Children's Hospital Medical Center in Tehran (Iran), were studied in respect to presenting symptoms, colonoscopic and pathologic findings, and the size, number and site of polyps if they were present. Among the 694 children (431 boys, 263 girls) less than 16 years of age who entered this study, 49.4%, who underwent colonoscopy, were aged between 1 and 5 years. Hematochezia, rectal prolapse, diarrhea, constipation, abdominal pain, fever, growth retardation, Clubbing, history of ulcerative colitis and polyps were present in 93.2%, 5.9%, 2.7%, 0.6%, 3.7%, 2.6%, 1.4%, 0.6%, 1.4%, 0.7% of the patients, respectively. Polyps, nodular lymphoid hyperplasia (NLH), granularity ulceration (suggestive for ulcerative colitis), suggestive for crohn's disease, mucosal edema, fragility, ulcer, solitary rectal ulcer, cobblestone appearance, vascular disorders, fissure, fistula and anal tags were present in 34.6%, 16.7%, 15.1%, 0.9%, 1.9%, 0.6%, 2.4%, 3.7%, 0.4%, 0.6%, 3%, 0.6% of the patients, respectively; 23.1% of the children had normal colonoscopic findings. Among the 240 cases found to have polyps on colonoscopy, 209, 18, 7, 4, 2 cases were reported as juvenile polyps, hamartoma, hyperplastic, lymphoid and necrotic in type, respectively. Of the 232 patients with polyps, 197 had a solitary polyp, 22 had 2 to 4 polyps, and 13 had more than 5 polyps. In respect to site, polyps were more frequent in the rectum, rectosigmoid region, left colon, diffuse, and right colon in decreasing order of occurrence. Colonoscopy is performed more frequently in children with hematochezia and rectal prolapse. Polyps, NLH and ulcerative colitis were the most frequent findings in the colonoscopies performed.

Protein losing enteropathy (PLE) as an initial finding of lymphoma, is extremely rare in childhood. We describe clinical and pathological features of an unusual case of gastrointestinal lymphoma presented with PLE as a sole manifestation. Differential diagnosis in children presenting with PLE is critical because early diagnosis and treatment are important for survival in patients with lymphoma.

Generalized lipodystrophy is a rare disorder in children characterized by absence of subcutaneous adipose tissue. We evaluated 10 patients with generalized lipodystrophy by skin and liver biopsy. Eight patients with steatohepatitis and cirrhosis were treated with Ursobile (uorsodeoxycholic acid) and vitamin E. In follow-up, serum triglyceride level was decreased.