Small bowel obstruction by a terminal ileum carcinoid tumor: a case report

Carcinoid tumors are well differentiated neuroendocrine tumors with secretory components. These tumors are uncommon but the most common primary tumors of the distal small intestine. We present a rare terminal ileum carcinoid tumor presenting with a small bowel obstruction. A 65 years old man presented with intermittent, generalized, dull and colicky abdominal pain accompanied with intermittent nausea, fever and chills for 1 year and post prandial generalized colicky abdominal pain from 5 days prior to admission. He also complained of weight loss and frequent constipations during recent year. His abdomen was soft with mild tenderness in periumbilical, right lower quadrant and left lower quadrant without guarding, rebound tenderness and palpable mass. Laboratory findings indicated anemia, and barium enema showed right lower quadrant mass effect in small intestine. Narrowing of terminal ileum was noted in colonoscopy. Free fluid in lower abdomen and pelvis with 37*28*25 paravertebral hypoechoic pelvic mass, without peristalsis was seen in abdomen and pelvic sonography. After mass localization in abdominal CT scan, laparotomy and excisional biopsy was performed. The diagnosis of carcinoid tumor was confirmed by pathologic report. Carcinoid tumors are rare tumors of the Gastro intestinal tract, however, they are the most common primary tumors of the small intestines. Most of these tumors have a very indolent course and may present with non specific symptoms. In view of the poor prognosis associated with the late diagnosis, it is imperative to think of this differential diagnosis in patients presenting with non specific symptoms and in intermittent partial bowel obstruction

Frequency of YMDD mutations in patients with chronic hepatitis B untreated with antiviral medicines

Investigators were suspicious of tyrosine-methionine-aspartate-aspartate [YMDD] mutations occurred only in patients who were treated by lamivudine. However, YMDD mutations of hepatitis B virus gene [HBV DNA] in patients with chronic hepatitis B [CHB] untreated with antiviral medicines was reported in some studies. The aim of this study was to evaluate YMDD mutations in Iranian Patients with chronic hepatitis B [CHB] untreated with antiviral medicines. In a cross sectional study, 151 adult patients with positive Hepatitis B surface antigen [HBsAg] [78 asymptomatic hepatitis B virus carriers, 73 active chronic hepatitis B patients or cirrhosis patients] were evaluated for YMDD mutants. The patients who were treated with interferon and Lamivudine or Adfovier in one year prior to the study were excluded. YMDD mutations of HBV DNA were detected by PCR-RFLP [PCR Restriction Fragment Length Polymorphism] in a single laboratory. The mean [ +/- SD] age of patients was 37 +/- 4 years. Eighty one [54%] cases were male and 70 [46%] were female. Eight cases [5.3%] out of 151 had YMDD mutations. The type of mutation in all of these patients was YSDD. There was no significant relationship between YMDD mutation and viral load and HDV Ab [p>0.05]. The mutant strains of the YMDD motif of HBV polymerase can be found in some patients without lamivudine treatment. However, in view of rather clinically insignificant YMDD mutation frequency, routine testing for YMDD mutations prior to antiviral therapy is not recommended in these patients

Effects of obstructive sleep apnea syndrome on serum aminotransferase levels and insulin resistance

Patients with obstructive sleep apnea [OSA] are at risk of developing the fatty liver as a result of being overweight. Several studies suggest that OSA per se could be a risk factor for liver injury; and ischemic hepatitis with OSA. The OSA is an independent risk factor for Insulin resistance. Therefore, we investigated liver enzymes and insulin resistance in patients with OSA, and compared with controls. Eighty-one consecutive patients with clinical suspicion of OSA were referred to the Sleep Unit of Masih Daneshvary hospital. On the basis of Polysomnography results patients were divided into two groups. The OSA and non-OSA cases, and also patients without OSA were used as internal controls. The Serum levels of liver enzymes were measured in all patients and abdominal ultrasound examination performed for screening the fatty liver and its grading. Insulin resistance was calculated via homeostasis model assessment [HOMA]. The OSA was present in 41 and absent in 40 patients. Age, sex and body mass indices were not significantly different in two groups. The mean of alanine aminotransferase [ALT] was 31.24 +/- 14.05 IU/L in OSA and 29.97 +/- 8.9 IU/L in non-OSA [p= 0.349] and aspartate aminotransferase [AST] was 29.07 +/- 9.6 IU/L in OSA and 26.85 +/- 6.7 IU/L in non-OSA [p= 0.389]. The mean of HOMA was 2.05 +/- 18.2 in OSA and 1.5 +/- 0.54 in non-OSA [p< 0.001]. This study shows that OSA, independent of overweight conditions, is not a risk factor for abnormal liver enzymes. However, the OSA per se seems to be associated with increase in insulin resistance and severity of fatty liver