Evaluation of serum HBV viral load, transaminases and histological features in chronic HBeAg-negative hepatitis B patients

Aim: To evaluate the association between biochemical, virologic and histologic features in patients with HBeAg-negative chronic hepatitis B [CHB]

Background: Hepatitis-B e-antigen [HBeAg]-negative is common in Iran, is progressive with poor prognosis. Therefore, it seems necessary to perform a comprehensive evaluation of different spectrum of laboratory measurements accompanying histological findings

Methods: HBeAg- negative CHB patients referring to two university hospitals during two years were enrolled. Alcohol consumption, liver mass, fatty liver and positive results of Anti HDV, Anti HCV or Anti HIV were excluded. The relationship between viral loads, liver enzymes [old and new cutoffs] and histopathological features was analyzed using descriptive and analytic statistical methods

Results: A total of 150 HBeAg-negative CHB [males=110, mean age=38.44 +/- 11.34 years] were assessed. ALT had a significant relation with the logarithm of serum HBV-DNA [P<0.0001], grade and stage on liver biopsy [P<0.001, P=0.034, respectively]. Serum viral load, AST and ALT were independent predictors of histological grade, age was the only independent predictor of the stage of liver fibrosis. There was a significant relationship between serum ALT and stage of liver fibrosis [P<0.0001] when new cutoff values for ALT were considered. We found that age had a significant relation with histological grade but it showed a reverse relation with ALT levels [P=0.009]

Conclusion: In HBeAg-negative CHB, AST had a better prediction for liver necrosis and inflammation. Age could be an independent predictor for liver fibrosis. New cutoff values for ALT had superiority over conventional values to identify higher risk of liver fibrosis

Resolution of bile duct adenoma over follow-up period; a case report

Bile duct adenoma [BDA] is a rare neoplasm of bile ducts with various clinical manifestations and imaging appearances. A few cases of BDA and their predisposing factors have been described. We report a 35-year-old woman with right upper quadrant pain who consumed oral contraceptive pills. Ultrasound study revealed three hypoechoic subcapsular liver masses; two of them were hypodense in computed tomography. Fine needle biopsy of the largest mass showed bile duct adenoma. Liver masses disappeared after discontinuing the pills over a 2-year follow-up. BDAs can manifest in imaging. Although previous studies have not reported tumor resolution over a follow-up period, we suggest paying more attention to predisposing factors in order to give an opportunity for tumor resolution by risk factor elimination

rare case of colon cancer penetrated to the spleen

There is still been no report of splenic involvement in the wake of colon cancer. In this case, air was seen in the spleen and liver following the penetration of colon cancer to the continuous spleen. Colon cancers always do not present with clear and common symptoms. Some times with a non-specific and uncommon symptoms and signs present that would be amazed physicians and researchers. It is very rare that we present, a middle aged man who presented with abdominal pain and rectal bleeding and in our investigation was seen air in spleen and liver in CTscan study. After surgery we found that air in spleen and liver is due to infiltration and invasion of splenic flexure colon cancer to spleen. Has had no cases of invasive colon cancer that causes the air in the spleen and liver have been reported

Gastrointestinal stromal tumors in northeastern iran: 46 cases during 2003-2012

Gastrointestinal stromal tumors [GIST] are the most common mesenchymal tumors of the gastrointestinal [GI] tract. They are usually C-kit positive and seen slightly more common in men. These tumors are seen in the GI tract from the esophagus to the anus with occasional invasion or metastasis. In this retrospective study, we evaluated the prevalence of c-kit positive stromal tumors of the GI tract based on age, site of involvement, size of tumor, local invasion, and Immunohistochemical markers. The study was conducted in Mashhad University of Medical Sciences in Iran during 2003-2012. Of the total 46 patients, 18 [39.1%] were men and 28 [60.9%] were women with a mean age of 58.07 years [range: 18-93]. Common sites of tumor were stomach, small intestine, esophagus and rectum, respectively. The number of mitoses per 50 HPF varied between zero and 160 mitoses. Overall, 23 cases had 5 mitoses 50/HPF [50%] and 23 tumors expressed <5 mitoses/50 HPF [50%]. Local invasion and metastasis were observed in seven cases with extension to liver, pancreas, pregastric tissue, omentum, mesentery and appendix. Positive reaction for CD34, SI00, actin and desmin was seen in 47.8%, 13%, 21.7%, and 4.3% of the patients, respectively. Most patients were women. The prevalence of tumors in the esophagus was higher than the rectum. Invasion and metastasis did not correlate with mitotic rate, site and size of tumor. We suggest evaluation of genetic, racial and geographical or other unknown risk factors

Frequency and risk factors of primary sclerosing cholangitis among patients with inflammatory bowel disease in North-East of Iran

To identify primary sclerosing cholangitis [PSC] predisposing factors in order to prevent inflammatory bowel disease [IBD] progression to PSC. IBD is commonly associated with PSC and there is no effective therapy for PSC except for liver transplantation. This retrospective study was conducted on 447 IBD patients from IBD Clinics of Ghaem and Emam Reza Hospitals. Data were collected by interview and through a review of the patients' medical records. Patients were divided into two groups: those with IBD and PSC [IBD-PSC] and those without PSC. Variables were compared between two groups and those with statistically significant differences in IBD-PSC group were considered as predictive factors for the development of PSC. The frequency of PSC in IBDs was 4.3% and all were ulcerative colitis. The mean age of patients with PSC was 39.1 +/- 11.33 years. The male to female proportion in PSCs was 3.8:1 and in IBDs was 0.9:1. There were statistically significant associations between PSC and gender, IBD duration and UC extension, mucocutaneous involvement, oral contraceptive pills [OCP] consumption, history of surgery and history of PSC in the first- degree relatives. PSC frequency among IBD patients in North-East of Iran was 4.3%. It is recommended to limit OCP consumption in IBD patients. Identification and modification of probable predisposing risk factors, as well as early diagnosis of PSC are necessary

prognostic role of tumor marker CA-125 in B-cell non-Hodgkin's lymphoma

B-cell non-Hodgkin's lymphoma [NHL] is a common malignancy of lymphoid tissues. Different types of NHL show various behaviors, prognoses, and responses to treatment. Evaluation of disease activity in NHL can be helpful in managing and even increasing the patient's survey. In total, 121 patients [76 males and 45 females], and their age range were 18-53 years, were evaluated in this study. The mean level of serum carbohydrate antigen 125 [CA-125] was 89.3 +/- 18.5 u/ml, ranging from 27 to 135 u/ml. There were significant differences in International Prognostic Index [IPI] score [p=0.002], stage of the disease [p=0.006], mortality rate [p=0.02], and relapse rate [p=0.04] between patients with serum CA-125 level <35 u/ml and patients with CA-125 level >35 u/ml. CA-125 seems to be a useful and reliable tumor marker for monitoring a patient with NHL. It might be the time to consider CA-125 in staging, prognostic scoring, or decision making about NHL treatment

[Relationship between behavioral disorders and quality of life in patients with liver cirrhosis]

Chronic liver disease comprises a wide range of diseases characterized by inflammation of the liver and progression of cirrhosis. This study aims to assess the relationship between behavioral disorders and quality of life in patients with liver cirrhosis. The available sampling method was used to divide participants into two groups of 100 patients and 100 healthy individuals, matched for age, sex and education. Patients with cirrhosis were recruited from a subspecialty clinic in Imam Reza [AS] Hospital in Mashhad. The control group consisted of healthy participants. Participants completed the Beck Depression Inventory, State Anxiety Inventory-Trait Spielberger, Toronto Alexithymia Questionnaire and SF-36 Quality of Life Questionnaire. Research data were analyzed by Pearson correlation and multiple regression analyses. There was no significant difference between the two groups in terms of demographic variables. However significant differences existed between the variables of anxiety, depression and alexithymia. The patient group had higher depression levels compared to healthy controls. Multiple regression analysis showed that behavioral disorders, explain 30% of the variance in quality of life in patients with liver cirrhosis. These findings suggest that behavioral disorders are associated with quality of life in patients with liver cirrhosis. These results also have important implications in the field of psychopathology, prevention, and treatment of patients with cirrhosis of the liverand IV drug abuse, respectively. The prevalence of HIV coinfection amongst patients with hepatitis B or C infections was low. However, further studies with larger populations are required

Hepatitis-C infection incidence among the non-Hodgkin's B-cell lymphoma patients in the Northeast of Iran

Various infectious agents like Ebstein Barr Virus [EBV], HTLV-1 and Helicobacter pylori have known as etiologic factors in different sub-types of lymphoma. Although Hepatitis C virus [HCV] has not only been important for its hepatotropism and hepatitis development, but also in recent years its association with some forms of non- Hodgkin's lymphoma [NHL], especially B cell NHL, has reported. In some countries, the rate of B cell NHL development in HCV infected patients was four times more than general population, and then association between HCV infection and B-NHL has proposed in many studies. To assess this relationship in our geographic region, in a descriptive study; we have evaluated patients with B-NHL in an oncology center in northeast of Iran for HCV infection. Out of 128 B-NHL patients, HCV Antibody test [with third generation ELISA method] was positive in only one patient, which confirmed with Nested PCR technique. Then the frequency of HCV infection in our patients was 0.7%. Respecting to the incidence of HCV infection in general population in Iran, which is between 0.5-1%, we couldn't show higher prevalence of HCV infection in NHL patients than general population, and hence couldn't confirm relation between HCV infection and B-NHL in our region

Causes of persistently elevated alanine aminotransferase levels in patients who presented to two referral hospitals in Mashhad, Iran during 2011

Worldwide, chronic liver disease is a major cause of morbidity and mortality. Causes of elevated serum alanine aminotransferase [ALT] levels vary depending on the population under study. The aim of this study is to evaluate the frequency and causes of persistently elevated ALT levels in patients of the Gastroenterology [GI] Clinics in Ghaem and Emam Reza Hospitals in Mashhad, Iran. A total of 100 consecutive patients with persistently elevated ALT levels that referred to the GI Clinics at Ghaem and Emam Reza Hospitals in 2011 were studied. Elevated levels were defined as ALT >/= 40 U/L at least twice within six months. A comprehensive history that included previous surgeries, transfusion, alcohol consumption and medications was obtained. Patients underwent physical examinations, laboratory analyses and ultrasonography studies. When necessary, liver biopsies were performed. Patients' mean age was 44.4 +/- 11.83 years. Females comprised 62% of cases. Patients presented with the following conditions: non-alcoholic fatty liver disease [NAFLD, 55%], hepatitis B [17%], autoimmune hepatitis [13%], hepatitis C [4%], autoimmune hepatitis and hepatitis C [2%], overlapping autoimmune disease [2%], Wilson disease [1%], celiac disease [1%], alcoholic hepatitis [1%], primary biliary cirrhosis [PBC, 1%], primary sclerosing cholangitis [PSC, 1%], and cryptogenic [2%]. NAFLD was the most common cause of persistently elevated serum ALT levels in this study.

Splenic artery aneurysm as an unusual cause of new onset ascites: a case report

Splenic artery aneurysm [SAA] is a rare and potentially life-threatening clinical entity that carries a risk of rupture and peritoneal hemorrhage. When ruptured, it typically manifests as abdominal pain with hemodynamic instability. This is a report about a 29-year-old male admitted for evaluation of recent-onset ascites following the spontaneous resolution of a transient episode of severe epigastric and left upper quadrant pain with syncope the preceding day. Paracentesis revealed bloody fluid. Abdominal computed tomographic angiography [CTA] and magnetic resonance venography [MRV] showed a three centimeter SAA. During admission, prompt exploratory laparotomy was performed that revealed excessive intraperitoneal hemorrhage due to a ruptured SAA. The pathology report confirmed that the SAA had developed secondary to atherosclerosis. Careful history taking together with appropriate imaging tests and emergent surgical intervention led to a timely diagnosis and the patient's survival.

[ effect of hydroalcoholic extract of salvia officinalis L. on the inflammatory reduction in male mice]

Resistance of microorganisms to chemical drugs makes the medicinal plants to be considered in folk medicine. Antidepressants, antimicrobials, antinociceptives and antioxidants effects of Salvia officinalis L. have been evaluated. In this study, the anti-inflammatory like effect of Salvia officinalis L. hydroalcoholic extract was studied on the inflammation induced byxylene in the right ear of male mice. In the experimental groups, 0.03ml of xylene was injected subcutaneously in the right ear of mice weighing 20-25 g. 30 minutes before xylene injection, Salvia officinalis L. extracts in doses of 10, 50, 100, 150 mg / kg and dexamethasone 15mg/ kg were administered intraperitoneally. The inflammation was measured according to the weight difference of a plug with 6mm of thickness in treated and non- treated ears of mice. After treatments, white blood cells of animal's serum were counted. The results showed that Salvia officinalis L. hydroalcoholic extract reduces inflammation comparable with dexamethasone effect. The hydroalcoholic extract of Salvia officinalis L. has anti-inflammatory effect and this effect may be due to flavonoid and terpene components in plant

[ case report of primary glomus tumor of stomach in a 59 year old man]

Primary gastric Glomus tumour is rare and much less frequent than gastrointestinal stromal tumors[GIST].at least 150 of them have been reported in articles, but no one had been published in Iran. Patient was a 59 years old man with the chief complains of sense of epigastric fullness after meal. Endosonography showed a hypoechoic mass in muscularis mucosa with 29_14 mm dimentions. patient underwent wedge resection of gastric tumour. In microscopy, sheets and nodules of round to polyhedral uniform cells with bland round to oval nuclei in the background of branched hemangiopericytoma-like vascular stroma with hyalinised wall were seen. Smooth Muscle Actin, desmin, chromogranin and CD117 were determined immunohistochemicaly, the first marker was positive and the reminders were negative. Primary gastric Glomus tumour is essentially a benign neoplasm, in order to prevent unnecessary radical surgery, its differentiation from others malignant lesions is mandatory