Govaresh
Volume:12 Issue: 2, 2007

Many patients with gastrointestinal malignancies undergo false treatments and incorrect diagnostic studies before diagnosis. This study considered all possible causes to propose prior solutions. Patients with gastrointestinal malignancies (esophageal, gastric, and colorectal) who were admitted for the first surgery were assessed. The delay of diagnosis and treatment and responsible factors were analyzed from patient's history by interview and reviewing paraclinical data, patient's records, and pathology report. 109 patients were assessed with esophageal cancer (42 patients), gastric cancer (35 patients), and colorectal cancers (32 patients). Mean duration "from being symptomatic to admission" was 348 days and the mean duration "from being symptomatic to surgery" was 366 days. The most important parts of the delay were: "not being referred by general practitioners" (124 days), "incorrect medical treatment by specialists (100 days), inadequate endoscopy (58 days) and ignoring symptoms by patients (41 days). The mean duration of incorrect medical treatment by general practitioners in gastric cancer was more in compare to esophageal cancers (p-value= 0.01). Inadequate endoscopy resulted in more delay in esophageal and gastric than colorectal cancers (p-value= 0.016). Need to repeat endoscopy in patients with esophagus, gastric and colorectal cancer were 43%, 51%, and 22% respectively (p-value= 0.040). The most important part of delay in surgical treatment of gastrointestinal malignancies was related to incorrect outpatient treatments by general practitioners and specialists. It seems that the best solution to reduce time of diagnosis in gastrointestinal malignancies is continuing education for physicians, especially general practitioners.

Gastroesophageal reflux (GER), defined as passage of gastric contents into the esophagus, and GER disease (GERD), defined as symptoms or complications of GER, are common pediatric problems. The value of commonly used diagnostic tests for GER is examined to define the most sensitive and specific test that is the least invasive as well. We conducted this cross sectional prospective study to compare the accuracy of barium meal (BM) and sonography (US) in diagnosing GER with the gold standard test, PH monitoring (pH-m). Fifty children (1 mo- 15 yr) with GERD symptoms were enrolled. After filling the informed by their parents, BM, US and 24 hr PH-m were done by one physician who were blinded to each others. Patients with positive pH-m had Positive US and BM 90% (p = 0.004) and 50% (0.02) respectively and in those with negative pH-m the negative rate of us was 60% (p = 0.004) and negative rate of BM was 65% (P = 0.02). The rates of false positive and false negative were 60% and 10% in US and 65% and 50% in barium meal respectively. True positive and negative results were 90% and 40% for US and 50% and 35% for BM, respectively. The sensitivity and specificity rates were 90% and 40% for US and 50% and 35% for BM. The positive and negative predictive values were 69% and 72% for US and 53% and 31% for BM respectively. Ultrasonography is much more sensitive and specific than barium meal in diagnosing GER with higher positive and negative predictive value. US is a safe, reliable and cost- effective procedure, so it could be used as the primary mode in diagnosing GER and use 24 hr pHm for follow up of resistant to treat patients.

1.3% of people in Iran are positive for anti-HBc antibody.The objective of this study is to determine the rate of seroconversion in those with persistent isolated anti-HBc after vaccination. In a quasi-experimental study, 94 persons with isolated anti-HBc antibody who were referred to Tehran Blood Transfusion Organization between 2002 and 2004 were selected through a convenient sampling. They were given recombinant hepatitis B vaccine on 0, 1 and 6 months. Immunization was defined by anti-HBs antibody titer |≥|10 mIU/mL, 1-2 months after administration of the last dose. Response to HB vaccination consisted of 28%, 62% and 76% after each injection, respectively. The total response rate was 80% (n=75). Nineteen (20%) persons were negative for anti-HBs even after three doses of HB vaccination. Factors associated with decreased response to vaccination were positive anti-HBe (OR=6.4, P=0.008), history of bloodletting (OR=3.1, P=0.039) and prior history of being HBsAg positive (OR=5.6, P=0.002). Although there were some differences between the response rates after each vaccine injections observed in our study and similar ones, the total response was nearly the same.

Although gastroesophageal reflux disease (GERD) is a common disorder, its etiologies are still largely unknown. There are limited data on the association between psychological status and GERD in the world, in general, and in Iran, in particular. This study was conducted to determine the role of psychological factors in causing GERD. 1,016 randomly-selected subjects were invited for a face-to-face interview. 1,000 persons participated in this study (age range: 18-40 years). Those who reported heartburn and/or regurgitation, at least once a week, during the last 12 months were defined as GERD patients. Controls were persons who did not complian of those symptoms. The psychosocial status was assessed by a reliable general health questionnaire for Iranian, GHQ-28. The prevalence of "at least weekly GERD" was 12.3%. Somatic disorders (OR: 3.50; 95% CI: 2.17-5.66), anxiety (OR: 4.02; 95% CI: 2.51-6.43), social disorders (OR: 1.95; 95% CI: 1.21-3.17), and depression (OR: 3.29; 95% CI: 1.95-5.50), increasing age and obesity were associated with developing GERD. The prevalence of GERD in northern Iran is more than that in most Asian countries and is comparable to Western countries. The result of this study indicates significant association between psychiatric disorders with reflux symptoms. The psychosocial factors may play important roles in the production of GERD symptoms.

Autoimmune pancreatitis (AIP) is a rare disorder that may be present as common bile duct stricture. The patient was a seventy-year-old man with presentations as recurrent abdominal pain and jaundice, elevated Billirobin (Bil) and elevated Alkaline Phosphatase (ALKP) in association with the presence of hetrogenesity of the pancreatic head and dilated intra and extra hepatic bile ducts in CT. Such clinical features confirmed the diagnosis of cancer the head of pancreas, therefore, was taken common bile duct stent for him. The patient came back with continuation recurrent abdominal pain and normal (Bil, ALKP and tumor markers) but remarkable elevated IgG4 and anti nuclear antibody. The patient was biopsied of hetrogenesity of the Pancreatic head by Endoscopic Ultra Sonographic (EUS)-guided. In the pathology of the pancreatic head, was observed fibrosis with Lymphoplasmacitic infiltration without the presences of malignancy. Finally, the patient was treated with the diagnosis of autoimmune Pancreatitis and was gone out bile duct stent.

There is evidence of a possible etiological role of human papillomaviruses (HPVs) in the development of colorectal cancer. Loss of p53 tumor suppressor gene function has been found in many malignancies and it can occur in a variety of ways, including gene mutation and interaction with the E6 protein of oncogenic HPVs. The objective of this study was to determine the prevalence of HPV infection and p53 overexprssion in colorectal cancer (CRC) tissue samples and its association with tumor histopathologic characteristics.60 tissue sections from patients with CRC were investigated by immunocytochemistry techniques for aberrant expression of p53 using the streptavidin-biotin-peroxidase method with monoclonal antibodies. The HPV status was also analyzed using type-specific primers for HPV16/18 by polymerase chain reaction (PCR).Overall, 21 (35%) of 60 patients were found positive for HPV DNA; HPV 18 was detected in 19 (32%) and HPV16 in 11 (18%) of 60 samples. An abnormal expression of tumor-suppressor protein p53 was observed in 29 (48%) samples. p53 overexpression was observed in 15 (71%) of 21 HPV-positive and in 14 (36%) of 39 HPV-negative patients (p=0.009). Similar significant difference was found in p53 overexpression in HPV18-positive patients (p=0.007) but not in those positive for HPV 16 (p=0.261). HPV DNA presentation was not significantly associated with histopathologic characteristics including tumor stage (p=0.509), grade (p=0.668), peri-neural invasion (p=0.265) and lympho-vascular invasion (p=0.275).p53 inactivation caused by HPV infection may play a role in the pathogenesis of colorectal cancer. There is no association between HPV infection and histopathologic characteristics.

Takayasu's arteritis and Crohn's disease co morbidity seems to be rare. To our knowledge, no patient with Crohn - Takayasu syndrome has been reported yet from our region. Herein we present a 22 year old Iranian woman previously diagnosed with Crohn's disease with subsequent development of Takayasu's arteritis.