Govaresh
Volume:16 Issue: 1, 2011

C - reactive protein (CRP) is an acute-phase plasma protein that can be used as a marker of activation of the immune system. In response to several inflammatory reactions,the concentration of CRP increases and recently have been applicated as a cancer detector in some studies. We aimed to evaluate the relation between CRP level and the staging and grading of gastric and colon malignancies that are the most common gastrointestinal cancers.Methods and Materials:In this analytic cross sectional study, 100 patients with gastric and colon cancer referred to Firoozgar hospital from march 2010 to august 2011, were recruited. The diagnosis of cancer was confirmed with multiple biopsies and pathologic study. The exclusion criteria were as follow being febrile or having any clinical evidence of infection, diabetes mellitus, cardiovascular disease, inflammatory bowel disease and autoimmune disease via history and record of the patients. The stage and grade of cancers were determined by two expert pathologists. A 5 cc blood sample was taken from anticobital vein of each patient before any intervention such as surgery, chemotherapy and/or radiotherapy was done and CRP quantitative levels were assessed by ELISA technique. CRP level more than 5 mg/dl was assumed as abnormal. Correlation between CRP and Staging, grading and the location of tumor (gastric and colon malignancies) and the type of tumor (adenocarcinoma and large cell lymphoma) was evaluated.There was no significant correlation between CRP level and the type of tumor (p=0.32) or location of the tumor (p=0.83).A significantly positive correlation was seen between CRP level and the stage of gastric and colon cancers (p=0.02) as well as CRP level and the grade of these tumors(p=0.03).CRP blood level correlates with the staging and grading of the GI cancer and the level of CRP rises as the stage and grade of the tumor developes.

The purpose of this study was to compare alexithymia, anxiety, depression and severity of gastrointestinal symptoms in patients with functional gastrointestinal disorders and psychiatric patients.This was a comparative study. Study subjects consisted of 210 individuals; 129 patients with functional gastrointestinal disorders (FGID) who referred to the Psychosomatic Disorders Clinic (GI) and 81 psychiatric patients who referred to the Mood Disorders Clinic of Noor Hospital, Isfahan, Iran during 1387 (2008). Subject's symptoms were scored according to the Toronto Alexithymia Scale (TAS-20), Hospital Anxiety and Depression Scale (HADS) and Gastrointestinal Symptoms Rating Scale (GSRS). Data were analyzed using multivariate analysis of variance.The results showed significant differences between two group of FGID and psychiatric patients in terms of alexithymia, anxiety, depression and severity of gastrointestinal symptoms.The study showed that in comparison to psychiatric patients, FGID patients have higher rates of alexithymia, anxiety, depression and more severe gastrointestinal symptoms. Alexithymia plays an important role in understanding symptoms and referrals to doctor's offices. Regardless of which treatment is selected by the patients, a high proportion experience concurrent psychiatric and functional somatic symptoms. Therefore, evaluation and attention to this factor is necessary for the treatment of psychosomatic disorders.

Beta-thalassemia patients have a high prevalence for hepatitis C virus (HCV) infection. In developing countries, HCV antibody is reported to be high in this group of patients. This study aims to determine the distribution of HCV amongst beta-thalassemia patients in northern Iran.This study was undertaken from October 2010 to June 2011 on 245 beta-thalassemia patients who referred to hospitals in Mazandaran and Gilan Provinces for blood transfusions. The presence of HCV antibodies in their plasma was measured by ELISA and viral genome was determined by Nested-PCR. SPSS software and the chi-square test were used for statistical analyses.Of the 245 beta-thalassemia patients, 46 (18.8%) were identified by ELISA to have HCV antibodies. Of these, 28 (11.4%) were positive for the viral genome. Overall, this study demonstrated a significant relationship between age, social background, dental work history and foreign travel with viral prevalence.The prevalence of HCV in this study group is reported at 11.4%. In comparison to its prevalence in the society as a whole, less than 1% is quite high. For this reason, utilizing a more proper screening system is essential.

Furazolidone (FZD), a nitrofuran derivative, is an antibacterial agent in use by the medical and veterinary fields. The Chinese have utilized FZD to relieve stomach pain, 5 years before the discovery of Helicobacter pylori. This drug is currently a part of Helicobacter pylori's eradication regimen. However, some carcinogenic and toxic adverse effects associated with FZD have been observed in animal experiments with controversial results, but there is no evidence to support the presence of these adverse effects in humans at a therapeutic dosage. The side effects of FZD can additionally be avoided by shortening its treatment period to 5-7 days. In Europe and North America FZD is not a first line regimen for the treatment of Helicobacter pylori but it is usually used as rescue treatment. In less developed or low-income countries, the FZD-based regimen has been recommended as a first line regimen by the World Gastroenterology Organization. In Iran, FZD when compared to clarithromycin is more effective, less expensive and has better availability.

In recent decades, Percutaneous endoscopic gastrostomy (PEG), has changed feeding and care of patients who can not feed orally. This outpatient procedure is done in most of the endoscopy wards and provides care, nutrition and medications for these patients outside the hospital. PEG has rare complications and significantly reduces the cost of care and treatment. With invention of this procedure about 30 years ago in the world's gastrointestinal endoscopy centers, we began PEG procedure in Iran. In our experience, neurological diseases especially cerebrovascular events are the most common indication. But trauma especially traffic accidents and tumors of head and neck and esophagus are other indications. After putting the PEG, the patient should be observe under a team including a gastroenterologist, dietician and experienced nurse. Education of patients and caregivers is essential to reduce complications.

Evidence shows that the mortality rate of esophageal cancer (EC) in Ardabil Province is among the highest worldwide. Studies on the epidemiological profile of EC in Ardabil are scarce. We aim to study the characteristics of EC in Ardabil using data from the recently established Ardabil Cancer Registry (ACR). This study has been accomplished based on data collected in ACR between 2004 and 2006. Cases reported to ACR were coded based on the third edition of the International Classification of Diseases for Oncology (ICD-O III). The age-standardized incidence rates (ASR) and the standard rate ratio (SRR) have been calculated for each district in Ardabil Province. A total of 549 new cases of EC were registered within ACR during the study period. The ASR was 19.5 for men and 19.7 for women per 100,000 person-years. The majority of cases (79.1%) were diagnosed based on pathology. The most common morphology of EC was squamous cell carcinoma (SCC, 73%) followed by adenocarcinoma (17.8%). The ASR was significantly higher in northern districts of the province (p < 0.001); highest in Meshkinshahr (27.2/100,000) and lowest in Nir (7.6/100,000). The male:female ratio approximated one in the northern and above 2.5 in the southern districts. Our results demonstrate that the increased incidence of EC in Ardabil is mainly due to an increase in the incidence of esophageal adenocarcinoma (ACE) during recent years. The almost equal incidence of EC among men and women, and its geographical pattern across the province indicate the possible role of environmental risk factors, which need further investigations.

Ulcerative colitis (UC) and Crohn's disease (CD) are chronic inflammatory bowel diseases (IBD) with uncertain etiology thought to be triggered by interactions between various environmental, genetic and immunologic factors. Role of different factors in IBD are controversial. The aim of this study is to determine the possible risk factors in a group of Iranian patients with IBD. Ninety five consecutive cases of CD and 163 cases of UC were included. Age matched controls were randomly selected. A total of 489 controls for UC and 285 controls for CD were enrolled. A standard record concerning many variables was completed. Logistic regression analysis was used to evaluate potential confounding variables. A statistically significant protective effect for smoking in UC was found (OR=0.18 95% CI=0.064- 0.504, p ‹ 0.05). The risk of UC increases with prolonged exposure to OCP (OR=0.99, 95% CI=0.98-0.99, p ‹ 0.05). In patients with CD, 15 cases (15.8%) reported a previous history of appendectomy compared with 19 controls (6.7%) (OR=2.6, 95% CI= 1.2-5.4, p < 0.05). Tonsillectomy was reported by 16 patients (16.8%) with CD compared with 25 controls (8.8%) (OR= 2.1, 95% CI= 1.07-4.1, p ‹ 0.05). The logistic regression analysis showed that both appendectomy and tonsillectomy are risk factors in CD. No association with other variables was found for either disease. Current smoking was a significant protective factor in UC. We observed a relationship between duration of OCP use and UC. Duration of using OCP in UC cases was significantly more than controls. Both appendectomy and tonsillectomy were risk factors in CD in this study.

Roaccutane® (isotretinoin) is used for the treatment of severe forms of acne resistant to adequate standard therapy. Inflammatory bowel disease (IBD) is described as a possible adverse drug reaction in the product information of isotretinoin. In a case study, we report the case of a 30 year old woman with a history of bloody diarrhea, abdominal pain and severe folliculitis/acne which had been treated with isotretinoin. Her clinical features worsened whilst on isotretinoin. Colonoscopy demonstrated diffuse ulcerative pancolitis. Isotretinoin treatment was discontinued and the patient was prescribed 5-aminosalicylic acid and corticosteroids. After a few months, steroids were discontinued and the patient went into clinical and laboratory remission. Evaluation of the possible causal association between isotretinoin treatment and IBD suggested a probable relationship, which should lead to considerable caution while prescribing this drug.

Hepatic inflammatory pseudotumor (IPT) is a rare non-neoplastic process of unknown etiology, generally following a benign inflammatory condition. It is often mistaken as an either primary or metastatic malignancy in imaging studies. We report a 48 year-old female with numerous target lesions (2-4 cm) seen on high resolution ultrasound, spiral CT scan, and MRI in all liver lobes compatible with metastasis. Guided biopsies of the lesions were performed twice, but the pathologies showed no evidence of malignancy. Colonoscopy revealed adenocarcinoma of the colon. This case highlights liver pseudotumor in the differential diagnosis of hepatic tumoral lesions.