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Volume 5, Number 1, January 2013
"Case Report" A Rare Presentation of Ménétrier’s Disease as Gastroduodenal
Intussusception
Description: Mohammad Mehdi Hayatbakhsh Abbasi, Sodaif Darvish Moqaddam, Abdolreza
Javadi, Moeinadin Safavi.....ABSTRACT..... Ménétrier’s disease is a rare cause of
hypertrophic gastropathy that is usually confined to the gastric body and fundus. It is
characterized by giant rugae, hypoalbuminemia, and foveolar hyperplasia. Here we report the
case of a 26-year-old woman who presented with epigastric pain, postparandial nauseavomiting, and weight loss. Paraclinic evaluation revealed hypoalbuminemia and hypochromic
microcytic anemia. Gastroscopy and barium meal study showed diffuse polypoid, nodular
lesions that affected the entire stomach, invaginating into the duodenum, leading to partial
duodenal obstruction. The histologic, radiologic and endoscopic findings fulfilled the
diagnosis of Ménétrier’s disease. To the best of our knowledge, gastroduodenal
intussusception by Ménétrier’s disease has been rarely described in the literature.
KEYWORDS Menetrier’s disease; Gastroduodenal; Intussusception.....Please cite this
paper as: Hayatbakhsh Abbasi MM, Darvish Moqaddam S, Javadi AR, Safavi M. A Rare
Presentation of Ménétrier’s Disease as Gastroduodenal Intussusception. Middle East J
Dig Dis 2013;5:52-5.....Corresponding Author: Moeinadin Safavi, MD Pathology Department,
Afzalipour Medical School, Kerman University of Medical Sciences, 22 Bahman Blvd,
Kerman, Iran Tel: + 98 341 3222250 Fax:+ 98 341 3222763 Email:
[email protected] Received: 17 Sep. 2012 Accepted: 10 Dec. 2012
"Case Report" Acute Bleeding In Duodenal Gastrointestinal Stromal Tumor
Description: Marjan Mokhtare, Tarang Taghvaei, Hafez Tirgar Fakheri.....ABSTRACT.....
Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the
gastrointestinal tract. The biological pattern of these tumors ranges from benign-appearing
small lesions to malignant sarcomas. Only 3%–5% of GISTs are found in the duodenum. A
duodenal GIST is a rare source of upper gastrointestinal bleeding. A remarkable percentage of
duodenal GISTs are localized in the third and fourth part of the duodenum and may not be
noticed on standard upper endoscopy. Push enteroscopy is sometimes advisable to find these
lesions. Surgical resection either limited or pancreaticoduodenectomy can be the treatment of
choice. In general, adjuvant therapy with imatinib has been proved to extend survival in
patients with GIST. The current case, a 24-year-old male, presented with acute upper
gastrointestinal bleeding from a submucosal ulcerated tumor located in the distal third part of
the duodenum, 3 cm distal from the papilla of Vater. After primary care and blood transfusion
in a local hospital, partial resection of the duodenum was performed as a definitive surgical
therapy. Histopathology showed a GIST with a diameter of 3 cm and moderately malignant
according to tumor grade, and
"Original Article" Etiology and Complications of Liver Cirrhosis in Children: Report of
a Single Center from Southern Iran
Description: Seyed Mohsen Dehghani, Mohammad Hadi Imanieh, Mahmood Haghighat,
Abdorrasoul Malekpour, Zeinab Falizkar.....ABSTRACT..... BACKGROUND Liver cirrhosis
is one of the major causes of hospitalization and mortality in children. A wide spectrum of
disorders including developmental abnormalities, infections, metabolic and genetic disorders
can lead to liver cirrhosis in pediatric patients. Determination of its etiology is important for
treatment, prevention of progressive liver damage, family counseling and prioritizing liver
transplantation. The aim of this study is to evaluate causes of liver cirrhosis in children in
Southern Iran. METHODS We included all cirrhotic children aged less than 18 years who
referred to an outpatient pediatric gastroenterology clinic affiliated with Shiraz University of
Medical Sciences between March 2009 and September 2010 in this cross-sectional study. The
etiology of cirrhosis was determined according to clinical findings, laboratory tests, imaging
studies such as ultrasonography or computed tomography scan, hepatobiliary scintigraphy and
histopathologic examination of the liver biopsy. Cirrhosis with unknown etiology was
considered as cryptogenic. RESULTS A total of 106 cirrhotic children aged between 5 months
to 18 years with a mean age of 8.24 ± 6.12 years that included 60 boys (56.6%) and 46 girls
(43.4%) were enrolled in the study. The most common causes of liver cirrhosis were Wilson
disease (n=22; 20.7%), biliary atresia (n=19; 17.9%), and cryptogenic cirrhosis (n=14; 13.2%).
Other causes were autoimmune hepatitis (n=12; 11.3%), idiopathic neonatal hepatitis (n=10;
9.4%), hepatorenal tyrosinemia (n=9; 8.5%), glycogen storage disease (n=6; 5.7%), and
progressive familial intrahepatic cholestasis (n=4; 3.8%). CONCLUSION Considering the
most common etiology of liver cirrhosis in children in this part of Iran we suggest testing for
Wilson disease in all cirrhotic children. KEYWORDS Cirrhosis; Children; Wilson disease;
Biliary atresia.....Please cite this paper as: Dehghani SM, Imanieh MH, Haghighat M,
Malekpour A, Falizkar Z. Etiology and Complications of Liver Cirrhosis in Children: Report
of a Single Center from Southern Iran. Middle East J Dig Dis 2013;5:41-6.....Corresponding
Author: Seyed Mohsen Dehghani, MD Associate Professor of Pediatric
Gastroenterology,Gastroenterohepatology Research Center, Shiraz Transplant Research
Center, Nemazee Teaching Hospital, School of Medicine, Shiraz University of Medical
Sciences, Shiraz, Iran Tel: +98 711 626 1775 Fax:+98 711 647 4298 Email:
[email protected] Received: 18 Oct. 2012 Accepted: 22 Dec. 2012
"Original Article" Obtaining Informed Consent in an Illiterate Population
Description: Mahnaz Alaei, Akram Pourshams, Najmeh Altaha, Goharshad Goglani, Elham
Jafari.....ABSTRACT..... BACKGROUND Esophageal cancer is highly prevalent among the
Turkman people in Northeastern Iran. In order to evaluate its etiology, there is an on-going
prospective cohort study in this area involving approximately 50000 subjects over the age of
40 years. The majority of these subjects are illiterate, thus obtaining informed consent is very
important and difficult. METHODS Initially, we explained the aim and study method to
religious leaders and health-sanitary officials. One week prior to obtaining informed consent,
potential participants were given adequate information about the research process by trained
health personnel at their own home. Thus, participants had sufficient time to consider the
research and consult with local health personnel, religious authorities, family, neighbors,
friends and those who previously participated in the study. Potential participants could observe
the research process directly and then be included in the study if they agreed. RESULTS A
total of 50045 individuals agreed to participate in the study, of which 70% were illiterate.
There were no refusals due to the medical ethical aspects of this study. CONCLUSION The
method of awareness in this study can be a useful pattern for research on elderly and illiterate
individuals who are participants in research studies in Iran and other countries. KEYWORDS
Medical ethic; Illiterate; Old age; Informed consent.....Please cite this paper as: Alaei M,
Pourshams A, Altaha N, Goglani G, Jafari E. Obtaining Informed Consent in an Illiterate
Population. Middle East J Dig Dis 2013;5:37-40.....Corresponding Author: Elham Jafari, MD,
MPH Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical
Sciences,N. Kargar St, Tehran 14117, Iran Tel: + 98 21 82415170 Fax:+ 98 21 82415400
Email: [email protected] Received: 10 Sep. 2012 Accepted: 28 Nov. 2012
"Systematic Review" Epidemiological, Demographic, and Colonic Extension of
Ulcerative Colitis in Iran: A Systematic Review
Description: Ali Akbar Shayesteh, Mehdi Saberifirozi, Shifteh Abedian, Vahid
Sebghatolahi.....ABSTRACT..... BACKGROUND Ulcerative colitis (UC), as the prototype of
inflammatory bowel disease of the large bowel, is increasing in Iran and other developing
countries. There are few studies that discuss the properties of this disease Iran. The result of
this review may provide a general consensus about the epidemiological features of UC in Iran.
METHODS This was a qualitative, systematic review that investigated the incidence,
prevalence, and demographic properties of UC in Iran. We evaluated all published studies in
the PubMed database, IranMedex, Magiran, and Scientific Information Database (SID) that
pertained to the epidemiology and demographic features of UC in Iran from January 1987 to
January 2012. After searching with defined keywords and implementing the inclusion and
exclusion criteria, 11 case series and 2 case-control studies fulfilled the criteria for inclusion.
RESULTS The estimated prevalence of UC is 15 per 105 persons, and the reported incidences
were 3.04 and 3.25 per 105 persons in two Iranian provinces. The disease was more commonly
observed in women and people in their fourth decade of life. Cigarette smoking conferred
protection and familial association seemed to be similar to developed countries. UC did not
appear to be more common among the higher socioeconomic class. In addition the proximal
colon and rectum were less commonly involved. CONCLUSION Although the data is limited,
the prevalence and incidence of UC in Iran shows an increasing pattern similar to other
countries in the region. There is no clear association with socioeconomic status. Milder forms
of the disease are common in Iran. A comprehensive nationwide data bank is needed for a
better definition of the disease characteristics. KEYWORDS Ulcerative colitis; Prevalence;
Incidence; Demography; Iran.....Please cite this paper as: Shayesteh AA, Saberifirozi M,
Abedian S, Sebghatolahi V. Epidemiological, Demographic, and Colonic Extension of
Ulcerative Colitis in Iran: A Systematic Review. Middle East J Dig Dis 2013;5:2936.....Corresponding Author: Ali Akbar Shayesteh, MD Institute for Infectious Disease of
Digestive System, Imam Khomeini Hospital, Azadegan Ave, Ahvaz, Iran Telefax: + 98 611
2921839 Email: [email protected] Received: 15 Oct. 2012 Accepted: 10 Dec. 2012
"Original Article" A Comparison of Impulse Oscillometry and Spirometry Values in
Patients with Gastroesophageal Reflux Disease
Description: Esmaeil Eidani, Seyed Jalal Hashemi, Hanieh Raji, Mehdi Hosaini
Askarabadi.....ABSTRACT..... BACKGROUND The relationship between gastroesophageal
reflux (GERD) and airway diseases is still a matter of debate. Oscillometry is an objective,
independent tool for the evaluation of airway resistance. The main purpose of this study is to
compare spirometry and oscillometry results before and after treatment by a proton pump
inhibitor (PPI) in a group of GERD patients who have no respiratory symptoms. METHODS
This study was performed on patients with endoscopically diagnosed reflux esophagitis who
had no pulmonary symptoms. Patients received omeprazole 40 mg, twice a day for 12 weeks.
Spirometry and oscillometry were performed before and after treatment. Impulse oscillometry
(IOS) was performed by a force oscillation instrument. We recorded respiratory resistance at 5
Hz (R5) and 20 Hz (R20), resonant frequency (Fres), and distal capacitive reactance (X5) for
each patient. RESULTS Included were 30 patients (17 males; 13 females) whose mean age
was 32 years. According to the Los Angeles Classification, 16 patients had grades B or C
esophagitis and 14 had grade A. Although all patients had normal spirometry results, 50% had
increased airway resistance according to oscillometric findings. After treatment with
omeprazole, only 16.3% had abnormal oscillometry results (p=0.004). Spirometry results
[forced expiratory volume at the first second (FEV1); forced vital capacity (FVC); FEV1/FVC;
and mean forced expiratory flow 25%-75% (FEF 25%-75%)] showed significant further
improvement compared to pretreatment normal values (p
"Original Article" Evaluation of N-acetyl Cysteine for the Prevention of Postendoscopic Retrograde Cholangiopancreatography Pancreatitis: A Prospective Double Blind
Randomized Pilot Study
Description: Pezhman Alavi Nejad, Eskandar Hajiani, Jalal Hashemi, Abdol Rahim
Masjedizadeh, Ali Akbar Shayesteh, Vahid Sebghatollahi.....ABSTRACT..... BACKGROUND
Acute pancreatitis is the most common serious complication of endoscopic retrograde
cholangiopancreatography (ERCP) that can occasionally be fatal. Multiple drugs have been
examined for the prevention of this side effect, with generally uncertain results. This study is
an effort to prevent this complication by the use of oral N-acetyl cysteine (NAC). METHODS
A total of 100 patients who were candidates for ERCP were divided randomly into two groups.
In the NAC (N) group, patients received 1200 mg NAC with 150 cc water orally 2 h before
ERCP. In the placebo (P) group, 150 cc water was prescribed as a placebo. We measured
serum amylase and lipase levels before and 24 h after ERCP. The prevalence of pancreatitis
and duration of admission in each group were determined and compared. RESULTS In group
N there were 5 (10%) cases of pancreatitis, whereas in group P there were 14 (28%) cases,
which was significant (risk reduction ratio: 2.8; p=0.02).The average admission time was
1.16±0.55 days in group N and 1.18±0.44 days in group P, which was not significant.
CONCLUSION There were significant differences in the prevalence of acute pancreatitis
between the two groups. In addition, the number of need to treat (NNT) consisted of five cases
for NAC. With regards to the above results and the safety profile of NAC, it could be used as a
therapeutic agent for the prevention of post-ERCP pancreatitis. We recommend that the results
of this study be verified by additional clinical trials. KEYWORDS Pancreatitis; ERCP; Nacetyl Cysteine; Amylase; Lipase.....Please cite this paper as: Alavi Nejad P, Hajiani E,
Hashemi J, Masjedizadeh AR, Shayesteh AA, Sebghatollahi V. Evaluation of N-acetyl
Cysteine for the Prevention of Post-endoscopic Retrograde Cholangiopancreatography
Pancreatitis: A Prospective Double Blind Randomized Pilot Study. Middle East J Dig Dis
2013;5:17-21.....Corresponding Author: Pezhman Alavi Nejad, MD Division of
Gastroenterology and Hepatology, Department of Internal Medicine, Ahvaz Jundishapur
University of Medical Sciences, Imam Hospital, P.O. Box 89, Ahvaz, Iran Telefax: + 98 611
2921839 Email: [email protected] Received:19 Oct. 2012 Accepted:10 Dec.
2012
"Review Article" The Useage of Opioids and their Adverse Effects in Gastrointestinal
Practice: A Review
Description: MahmoudReza Khansari, MasourReza Sohrabi, Farhad
Zamani.....ABSTRACT..... Opium is one of the oldest herbal medicines currently used as an
analgesic, sedative and antidiarrheal treatment. The effects of opium are principally mediated
by the μ-, κ- and δ-opioid receptors. Opioid substances consist of all natural and synthetic
alkaloids that are derived from opium. Most of their effects on gastrointestinal motility and
secretion result from suppression of neural activity. Inhibition of gastric emptying, increase in
sphincter tone, changes in motor patterns, and blockage of peristalsis result from opioid use.
Common adverse effects of opioid administration include sedation, dizziness, nausea,
vomiting, constipation, dependency and tolerance, and respiratory depression. The most
common adverse effect of opioid use is constipation. Although stool softeners are frequently
used to decrease opioid-induced bowel dysfunction, however they are not efficacious.
Possibly, the use of specific opioid receptor antagonists is a more suitable approach. Opioid
antagonists, both central and peripheral, could affect gastrointestinal function and
visceromotor sensitivity, which suggests an important role for endogenous opioid peptides in
the control of gastrointestinal physiology. Underlying diseases or medications known to
influence the central nervous system (CNS) often accelerate the opioid’s adverse effects.
However, changing the opioid and/or route of administration could also decrease their adverse
effects. Appropriate patient selection, patient education and discussion regarding potential
adverse effects may assist physicians in maximizing the effectiveness of opioids, while
reducing the number and severity of adverse effects. KEYWORDS Opium; Analgesic ;
Opioid; Gastrointestinal motility.....Please cite this paper as: Khansari MR, Sohrabi MR,
Zamani Farhad. The Useage of Opioids and their Adverse Effects in Gastrointestinal Practice:
A Review. Middle East J Dig Dis 2013;5:5-16.....Corresponding Author: Farhad Zamani, MD
Gastrointestinal and Liver Disease Research Center (GILDRC), Firoozgar Hospital, Tehran,
Iran Tel: + 98 21 82141633 Fax:+ 98 21 88940489 Email: [email protected]
Received: 11 Oct. 2012 Accepted: 15 Dec. 2012