Nodular regenerative hyperplasia of the liver: report of a case

Nodular regenerative hyperplasia of the liver [NRHL] is characterized by hepatocellular nodules without fibrous septa between the nodules, and has been described in association with certain diseases. The NHRL should be considered in a liver mass and coexisting portal hypertension. We described the case of a 33-year-old Iranian man with NRHL in association with essential thrombocythemia

[ epidemiologic study of microscopic colitis in a university related clinic]

Microscopic colitis has been generally recognized as lymphocytic colitis and collagenous colitis: two inflammatory diseases of large intestine without a definite origin. The colon appears normal by colonoscopy. So, biopsy of the colonic mucosa is mandatory for diagnosis. As a descriptive design we assessed epidemiological, clinical and laboratory findings of patients diagnosed as microscopic colitis from 2001 to 2003, retrospectively. This study had been conducted in one of the University related clinics in Tehran. Results: In this setting, 12 patients were diagnosed as microscopic colitis [3 collagenous colitis, and 9 lymphocytic colitis]. Most of these patients were female [11 patients]. The average of the patients' age at the time of the diagnosis was: 47.6 +/- 18.1 years. The delay of diagnosis was distributed from 2 months to 27 years [average: 8 years]. The most prominent complaint was diarrhea [100%]. Most of the cases were presented as a chronic intermittent manner [6 patients- 50%]. Hyperthyroidism, atrophic gastritis, and type 1 diabetes mellitus, each of them were detected in 3 separate patients. After treatment initiation, recurrence of the disease was not seen during 2 years of follow-up. Most of the time, microscopic colitis is mis-diagnosed as irritable bowel syndrome. Clinical suspicion plays the main role in diagnosis of microscopic colitis cases among patients with watery diarrhea and normal colonoscopy

[Non-alcoholic steatohepatitis [NASH]]

The term "Non- Alcoholic Steatohepatitis [NASH]" is applied when sonographic and pathologic view of liver shows alcoholic hepatitis changes without history of alcohol consumption. Radiologic findings can easily make the diagnosis and liver biopsy confirms the initial suspicion. It is showed that up to 43.5% of patients with asymptomatic abnormal liver transferases levels have some degrees of NASH, which suggest the importance of being familiar with the issue and how to approach and treat it. NASH is commonly accompanied with diabetes mellitus [especially type II], obesity and hyperlipidemia. These findings support the theory in which insulin resistance is the mainstay of NASH pathophysiology. The natural history of NASH is unclear but surely it is far better than alcoholic related liver disease. It is estimated that up to 8% of patients would meet cirrhosis, considering risk factors such as obesity and features found in biopsy specimen. Steatosis, polymorphonuclear lobular inflammation, ballooning degeneration, hyaline- Mallory bodies and cirrhosis are among different pathologies seen in biopsy. It is important to rule out other chronic liver diseases including drug induced liver disease, chronic viral hepatitis, and metabolic and autoimmune liver diseases to establish the diagnosis of NASH. There is no definite treatment for NASH. Therapeutic measures are categorized as reducing risk factors and using hepatocellular protective agents. The former includes weight reduction, treating hyperinsulinemia and diabetes, control of hypertriglyceridemia and leptin. Protective agents are anti-oxidants like vitamin E and/ or C, probucol, silymarin, ursodeoxycholic acid, reducing iron load, N-acetyl cystein, food supplements and cytokines. Increasing rate of NASH is reported among children and adolescences, which could be due to growing amount of obesity in these age groups

[Inflammatory bowel diseases and multiple sclerosis: a look on two cases]

The Inflammatory bowel diseases [IBD] have been found to accompany some neurological syndromes including multiple sclerosis [MS]. Recently, Several studies have reported and discussed the simultaneous presence of IBD and MS in some patients. Thus, in patients with either disease, the presence of signs and symptoms of the other should raise the clinical suspicion of the clinician and warrant special considerations. In this report, we introduce two IBD patients who have concomitant involvement of MS

[Clinical course of ulcerative colitis in patients with and without primary sclerosing cholangitis]

We noticed in our practice that the patients with ulcerative colitis [UC] who have developed primary sclerosing cholangitis [PSC] experience a milder course of colonic disease. Our objective in this study was to define whether there is any difference between UC activity and its course in patients with and without PSC. 19 patients with UC and PSC [8 male, mean age 25] were enrolled. To every patient with UC and PSC, 3 patients with UC alone [totally 57 patients, 28 male, mean age 24] matched for age at onset, duration of the disease, and extension of colonic disease were selected as the control group. We used number of hospitalizations due to activity of UC and number of short corticosteroid administrations in various years of follow-up as variables indicating course and severity of the colonic disease in this period. For comparing trends of UC activity between two groups, we used repeated measures two-way analysis of variances. Mean duration of follow up in case and control groups was 12.2 +/- 5.7 and 11.4 +/- 4.9 years, respectively. Two groups had no significant difference in use of sulfasalazine or aminosalicylates. Number of hospitalizations and courses of steroid therapy because of UC activity decreased significantly over time [p<.000] in both groups and it was significantly higher in controls than in cases [p=.045 and .032, respectively]. Development of PSC in patients with UC might have a positive effect on the colonic disease. Further investigation to evaluate basis of this improvement are warranted