Solid pseudopapillary neoplasm of pancreas; a case series and review literature

Background: Information regarding solid pseudopapillary neoplasm [SPN] of the pancreas is limited in Iran. We aimed to review the clinicocytopathological features and follow-up of patients with SPN of pancreas who were diagnosed in a single center in Iran

Method: Seven patients with SPN of the pancreas were diagnosed during January 2010 to March 2015 at the Digestive Disease Research Institute of Tehran University of Medical Sciences. The patients were reviewed prospectively

Results: Six out of the 7 patients were female and the mean age of all the patients was 29.4 years ranging from 15 to 61 years. The most common clinical presentation was nonspecific abdominal pain [N=6]. The tumors were located mostly in head and neck of the pancreas. SPN was diagnosed in all patients by fine needle aspiration through endosonography [EUS-FNA]. All patients underwent surgery. Histological findings of surgical tissues were consistent with EUS-FNA. The postoperative follow-up period of about 14 months was uneventful

Conclusion: SPN of the pancreas is a rare pancreatic tumor which affects primarily young women. EUS-guided FNA could play an important role in preoperative diagnosis of SPN of the pancreas

Clinical and pathological features of non-functional neuroendocrine tumors of pancreas: a report from Iran

Pancreatic neuroendocrine tumors [PNETs] are rare tumors with variable malignant potential, prognosis, and survival. We aimed to assess the characteristics of patients with non- functional PNET in our hospital. From Nov 2010 to Nov 2013, all patients who came to endosonography unit of Shariati hospital, Tehran, Iran, and had pancreatic lesions were assessed. Tumor samples were obtained through fine needle aspiration. Various characteristics of the non- functional PNET were recorded and patients were followed up to three years. Twenty eight non func-PNET cases, aged 37-72 years were identified, 15 [53.6%] of whom were men. Fifteen [53.6%] tumors were located in the head and 5[17.8%] in the body of the pancreas. The mean tumor size was 3.9 Cm and 10.7%, 28.6%, 32.1%, and 28.6% of the patients were at stages I, II, III and IV, respectively. Of the patients, 12 [43%] underwent surgery, 3 [10.7%] received chemotherapy, and 13 [46.4%] received no treatment. During the mean follow-up of 16 months, the disease had progressed in 3 [10.7%] patients and 10 [35.7%] had died. In univariate analysis, tumor size>3Cm and Ki-67>20% were correlated with survival rate but not in multivariate analysis. Iranian patients with non- functional PNET present similar characteristics to world patients. There is a need to establish efficacy of tumor samples which are obtaining through fine needle aspiration for assessing tumor grading

Cysclosporine-A versus prednisolone for induction of remission in auto-immune hepatitis: interim analysis report of a randomized controlled trial

Corticosteroids are used to induce remission in auto-immune hepatitis. They are not universally effective; therefore, alternative treatments are needed. In this study Cysclosporine-A has been compared with prednisolone as an alternative treatment in a randomized controlled trial. This paper is an interim analysis of an ongoing clinical trial. Sixteen years and older consenting patients were enrolled. Group-A received prednisolone and group-B cyclosporine-A according to a preset protocol and followed at regular intervals for 48 weeks. Final assessment was done at week 48. Primary outcome was response rate as defined below. [Complete response] was defined as achieving AST and ALT in the normal range and absence of any clinical signs of deterioration, and partial response was defined as a decrease in AST and ALT by less than half of their original values but not to within normal limit. Non-responding ones at week eight were switched to the other arm. Thirty-nine patients were enrolled [24 group-A, 9 male]. Mean AST and ALT at baseline were higher in group-B, but other variables were comparable. At week 12, 34.8% and 64.3% of group-A and B had achieved AST and ALT in the normal range less than 40 IU/L]respectively [P=0.081]. Corresponding figures at week 48 were 50.0% and 47.6% 0=0.62 and48 respectively]. At week 12, 86.9% and 85.7% of patients had AST and ALT levels less than twice upper normal limit in groups-A and B respectively [p=0.54 and 0.42]. Corresponding figures at week 48 were 90.0% for both groups. There was one treatment failure in group-B which did not respond to prednisolone either. Serious adverse events [death and liver transplantation] occurred in group-A only. Serum creatinine did not change during the study period in either group. According to our data, Cyclosporine-A is as effective as prednisolone for induction of remission in AIH. Adverse event and serious adverse were more common with prednisolone

Probiotic vs. placebo in irritable bowel syndrome: a randomized controlled trial

This study assesses the potential effect of Lactobacillus reuteri as a single strain probiotic preparation [Biogaia[R]] on irritable bowel syndrome [IBS]. Patients diagnosed with IBS who fulfilled Rome III criteria and consented to participate in this study were randomized to receive either the probiotic or an identical placebo once daily for four weeks. Patients used a questionnaire to record any symptoms and adverse reactions over a one-week run-in period and during the final two weeks of intervention. For each group, we calculated the differences between mean scores of the variables and compared the results between groups. Frequency of defecation increased in the Biogaia[R] group and decreased in the placebo group meaningfully. But There were no significant difference in the two groups in other terms of bloating, sense of urgency for defecation, abdominal pain, stool shape, quality of defecation, sense of incomplete evacuation, and treatment satisfaction. The frequency of defecation increased in the Biogaia[R] group and decreased in the placebo group, however this study did not classify patients according to diarrhea or constipated subgroups, the efficacy of this drug is not clear. Hence Lactobacillus reuteri was not better than placebo in controlling IBS symptoms in this study. However, considering the significant placebo effect in IBS patients, it may be necessary to conduct studies with larger numbers of participants to better assess the possible beneficial effects of Biogaia

[Indications and prevalence of disorders in a referral clinic for endoscopic ultrasonography]

Endoscopic ultrasonography [EUS] has a pivotal role in staging and diagnosis of different gastrointestinal [GI] disorders. Although this equipment is not readily available and not all gastroenterologists are trained in this technique, the importance and efficacy of this imaging modality is obvious for all gastroenterologists. We report the indications and prevalence of lesions visualized by EUS, in a EUS center. We evaluated the demographic characteristics, indications, and recorded EUS diagnosis of patients during a 5 year [2007-2011] period. During the study period, 3198 patients [51.2% males] underwent EUS. Upper GI endosonography, within which, pancreatobiliary disorders followed by gastric cancer were the most common indications for patient referral. The rate of patient referral for EUS increased yearly. EUS is an accurate method for the diagnosis of different GI abnormalities. The most common cause for patient referrals are benign pancreatobiliary disorders