[Prevalence of osteopenia and osteoporosis in patients with celiac disease in northeastern Iran]

Celiac disease is an autoimmune disorder which causes malabsorption in genetically susceptible patients who consume gluten. Celiac disease is not limited to the gastrointestinal system, and exhibits different signs and symptoms in other organs. Malabsorption of calcium and vitamin D can cause osteomalacia and secondary hyperparathyroidism. Celiac disease is no longer a rare disease and is more frequent in the Middle East. It is expected that 1% of the in general population has celiac disease. This study aims to determine the prevalence of osteopenia and osteoporosis in Iranian patients with celiac disease. Individuals with intestinal and extra-intestinal problems who had positive serologic tests for anti-tissue transglutaminase or antiendomysial antibody were offered endoscopic duodenal biopsy to confirm their diagnoses of celiac disease. Biopsy-proven celiac disease patients between the ages of 20 to 60 years were enrolled. Exclusion criteria were as follows: 1] the use of drugs such as corticosteroids, anticonvulsants, heparin, cyclosporine, statins, and beta -blockers, 2] the presence of any neoplasm, and 3] any metabolic disorder such as diabetes, hyperthyroidism, Cushing's, and immobility. After obtaining informed consents, we evaluated 76 patients diagnosed with celiac disease. All enrolled patients underwent BMD measurement of the hip, femoral neck, and spine using dual-energy X-ray absorptiometry [bone densitometry with DEXA scan]. A total of 76 patients with celiac disease of ages 20 to 60 years old [mean: 33 years old] underwent bone densitometry. Of these, 66% were female and 33% were male. There were 44 patients [57%] who had normal bone density in the spine, 17 [22.4%] who had osteopenia, and 15 patients [20%] had osteoporosis. In the femoral neck, 38 patients [50%] had normal bone densitometry, 25 [32.9%] had osteopenia, and 12 [15.8%] had osteoporosis. Low bone mineral density [osteoporosis or osteopenia] was seen in 48% of our patients in the femoral neck and 43% in the spine. The prevalence of osteoporosis among celiac disease is much higher than the general population. Of the study patients, 55% had osteopenia in the femoral neck or spine and 36% had osteoporosis in the femoral neck or spine. The prevalence of osteoporosis is elevated enough to justify a recommendation for osteoporosis screening of all patients with celiac disease

[Brief review: budd-chiari syndrome in Iran]

Budd-Chiari syndrome [BCS] is a rare syndrome caused by hepatic venous outflow obstruction. The etiology of BCS differs between western and eastern countries. This article is a review of all published articles in Iranian and international journals regarding different aspects of BCS [prevalence, etiology, and conventional treatments] in Iran. In this review, by accessing Med-line and Iran-medex, we have analyzed all relevant articles of BCS. In Iranian and international journals, two original articles and five case reports have been published regarding diagnosis and treatment of BCS in Iran. Some Iranian articles have discussed BCS in Iran. According to these articles, nowadays it is not possible to estimate the prevalence and incidence of BCS in Iran, nor is it possible to define the underlying etiology. The current overview of BCS treatment in Iran is unclear. However, it seems that angioplasty treatment for the removal of mechanical obstructions, such as web obstruction, has been developed in Iran and is generally accepted by Iranian physicians. Web obstruction, according to one Iranian article is the most common underlying cause of BCS among Iranian patients. The lack of available investigations about the status of BCS in Iran necessitates multi-center studies

Accuracy of gray-scale and color doppler sonography in diagnosis of hepatic hemangioma, hepatocellular carcinoma and liver metastasis

Distinguishing cavernous hemangioma from malignant neoplasms represents a diagnostic challenge. Knowledge of the entire spectrum of gray-scale ultrasonography [US] and color Doppler appearances of these tumors is important. The objective of this study was to determine the diagnostic accuracy of gray-scale US and color Doppler appearances of liver tumors. 88 patients with 93 focal hepatic lesions were prospectively studied with gray-scale and color Doppler US. The final diagnoses of the liver lesions as confirmed by pathology or 99mTc-red blood cell scintigraphy were 41 hemangiomas, 15 hepatocellular carcinomas [HCCs] and 37 metastases. 87.8% of hemangiomas and 66.7% of HCCs were hyperechoic, while 54.1% of metastases were hypoechoic. In lesions < 3 cm in diameter, the sensitivity and specificity of the hyperechoic pattern for differentiation of hemangioma from metastasis and HCC were 94.1% and 80.0%, respectively. They were higher than the lesions with a diameter ?3 cm [83.3% and 45.9%, respectively, both P=0.001]. Posterior acoustic enhancement was seen in 78% of hemangiomas [P<0.001], as compared to 24.4% in metastases and 13.3% in HCCs. 10 hemangiomas had an echogenic rim. The peripheral hypoechoic rim, named as the target sign, was seen in 37.8% of metastases, 26.7% of HCCs and 2.4% of hemangiomas [P<0.001]. Most hemangiomas [85.4%] showed no lesional blood flow, while most HCCs [80%] had both intraand peri-lesional vascularity [P<0.001]. There was intratumoral blood flow in 86.7% of HCCs. Lesional flow, whether intratumoral or peritumoral or both, was seen in all 14 patients with HCC while absence of the lesional flow was not noted in any of the HCCs. Most hemangiomas had no detectable blood flow in color Doppler US. Almost all HCCs had intra- and/or peri-tumoral vascularity in color Doppler sonography, so the probability of hepatocellular carcinoma is low in a hepatic mass without intra- or peri-lesional vascular blood flow. So these findings together with morphological criteria may help narrow down the differential diagnosis in certain clinical conditions