Endoscopic ultrasonography in patients with chronic liver disease: a case control study

The portal system and azygos vein are the main drainage systems during portal hypertension. This study aims to compare the diameter of these veins by endoscopic ultrasonography [EUS] in patients with and without chronic liver disease [CLD]. During one year, patients with CLD enrolled as the study group. Patients who underwent EUS for other reasons during the same period served as controls. In cases with CLD, we assessed the relationship between degrees of hepatic dysfunction [Child-Pugh class], history of variceal bleeding, presence of hyponatremia, thrombocytopenia, and endoscopic grading of varices with the sizes of the portal, splenic, and azygos veins on EUS. During the study period, there were 63 patients [20 females and 43 males] with CLD and 85 control subjects [42 females and 43 males] enrolled. The mean ages of cases was 45.60 +/- 14 years and controls was 48.5 +/- 15 years. The most common cause of CLD was post-necrotic cirrhosis due to hepatitis B virus. Patients with CLD had significantly higher mean portal, splenic, and azygos vein diameters than the control group [p < 0.001]. With azygos, portal, and splenic vein diameters of 10, 11 and 9 mm, sensitivity for the diagnosis of portal hypertension was 66%, 71%, and 66%, while specificity was 94%, 99% and 99%, respectively. Splenic and portal vein dilation, and thrombocytopenia significantly correlated with variceal bleeding [p < 0.05]. EUS allows for the collection of valuable quantitative data from the portal system, the diagnosis of portal hypertension, and follow up of patients with CLD

Comparison of metronidazole and placebo in control of gaseous symptoms in patients with functional bowel disorders; a randomized double- blind controlled study

To compare the efficacy of metronidazoie versus placebo in the control of gaseous symptoms in patients with functional bowel disease. In the absence of organic or systemic diseases, all cases with chief complaints of bloating and normal laboratory tests were consecutively enrolled in this double-blind study. Lactase deficiency and bacterial overgrowth were ruled out by the lactose breath test. Patients were randomly assigned to receive either metronidazole or placebo. Demographic characteristics as well as frequency and severity of the patients' scores [mean total symptom score] before and after therapy, their compliance and drug adverse effects were evaluated. A 50% decrease in the total symptom scores was defined as effective treatment. During one year, 46 patients [17 males, 29 females, mean age: 38.9 +/- 9.9 years] were enrolled in the study. A total of 23 patients received metronidazole [cases] and 23 received placebo [controls]. Two patients in the metronidazole group did not tolerate the drug and one patient in the placebo group did not continue with follow-up. Patients responded similarly to both regimens: 59% of patients in the placebo group and 52.2% of patients in the metronidazole group had a 50% decrease in their total symptom score [p = 0.64]. Side effects of metronidazole were frequent, but tolerable. Bad taste in the mouth and anorexia were the most common complaints in the metronidazole group. This study showed no difference between placebo and metronidazole in relief of bloating and other related complaints in patients with functional bowel disease

[Plasma levels of the NT-pro BNP in patients presenting with heart failure]

In view of the high morbidity and mortality of patients with congestive heart failure, early diagnosis is of paramount importance. To assess the diagnostic and prognostic utility of plasma levels of the NT-Pro BNP in patients presenting with heart failure this study was carried out. This cross-sectional study was performed on patients with heart failure admitted in the cardiology ward of Taleghani Medical Center during a certain period from 2005- 2006. Subjects with acute coronary syndrome, hyperthyroidism, renal failure [GFR<60], severe valvular stenosis, severe pulmonary disease, ARDS, hepatic cirrhosis, primary hyperaldosteronism and the candidates for heart transplant were excluded from the study. Blood samples were collected and plasma levels of NT-Pro BNP were measured by ELISA method [Biomedica- crop, Bratislava Slovakia]. Results were documented and analyzed using SPSS software. Mann- Whitheny and KrusKall-Wallis tests were utilized for analysis. Values were analyzed for confounding variables [e.g age, sex, blood pressure, and ischemic heart disease and NYHA class]. 79 patients full filled the criteria of inclusion. 70% were males and mean age of patients was 63 +/- 14 years. Mean plasma NT-Pro BNP level was 421 +/- 387. In subjects <60 years of age, the mean levels were 309 +/- 300, and among those >/= 60 years it was 486 +/- 419, [P<0.05]. With advancing clinical stage, the mean plasma level of NT-Pro BNP increased 6 folds, [p<0.01], whereas with advancing NYHA class it increased 4 folds [P<0.01]. It seems that plasma NT-Pro BNP level is a suitable indicator of the severity of heart failure

[Causes of minimal bright red bleeding per rectum in patients who referred to the gastroenterology clinic of Loghman Hakim Hospital [September 2003-March 2006]]

Minimal bright red bleeding per rectum [MBRBPR] is a common complaint in adult patients. Most studies have not been performed in patients with strictly minimal BRBPR, and there are no evidence-based recommendations for this group of patients. Patients with complaints as small amounts of red blood after wiping or a few drops of blood in the toilet bowl after defecation not intermixed with stool were consecutively enrolled. Those with a history of inflammatory bowel disease, colorectal cancer, adenomatous polyps, significant weight loss, anemia, strong family history of colorectal cancer and not consenting for colonoscopy were excluded. Patients underwent total colonoscopy or rectosigmoidoscopy plus double contrast barium enema [age>40] or a minimum of rectosigmoidoscopy [to the splenic flexure in patients aged < 40]. two-hundred twenty patients were eligible in the study period. Normal findings were found in 23 [10.5%]. There was at least one distal lesion in the remaining patients. From 11 patients with a proximal lesion, 10 had the same lesion in distal colon and there was only one patient with an adenomatous polyp near the hepatic flexure and hemorrhoids. In patients with anorectal pathologies [n=189], there was a concomitant colonic lesion in 25 [13.2%]. All patients with clinically significant lesions [IBD, polyp or cancer] located over 30 cm from anus were aged more than 40 years. The causative lesions for MBRBPR are located in the distal colon. Rectoscopy [40 years or less] or flexible rectosigmoidoscopy [over 40 years] seem to be the appropriate evaluation in these patients