[Correlation between insulin-like growth factor-I [Igf-1] levels and severity of liver involvement in patients afflicted with liver cirrhosis]

Insulin-like growth factor [IGF-1] is a polypeptide that 90% of it is secreted by liver. Cirrhosis of liver is a condition accompanied with decreased level of IGF-1, and with progression of the disease the level of IGF-1 may be further decreased. In this study the relation between the degree of IGF-1 and severity of liver disease on the basis of Child-Pugh and Model for end stage liver disease[MELD] score is investigated. In this cross sectional study, 100 cirrhotic patients who were diagnosed on the basis of liver biopsy or clinical criteria, referring to the gastroenterology clinic of Imam Khomeini Hospital in Tehran, Iran during the years 2007-2008 were recruited. Laboratory investigations including IGF-1, CBC, liver Enzymes, Alkaline phosphates, serum Albumin, Creatinine, direct and total Bilirubin were carried out for all the patients. Similarly ultrasound for evaluation of ascites and endoscopy for varices were performed. 100 cirrhotic patients with male to female ratio of 63 to 37 and median age of 44.4 +/- 15 years were enrolled in the study. This study showed a mean IGF-1 level [ +/- standard deviation] equal to 92.95 +/- 91.51 ng/dl. Fourteen patients [14%] had IGF-1 within normal limits while 86 patients [86%] had abnormal IGF-1 level. In all patients the correlation coefficient between IGF-1 and MELD was -0.317 [p=0.001] and correlation coefficient between IGF-1 and Child-Pugh was equal to -0.478 [p<0.001]. The findings of this study showed that IGF-1 could be an index of severity of cirrhosis and can be used to determine the severity of the disease in patients, in particular, when liver biopsy is not possible

[Result and efficacy of endoscopic ultrasound guided FNA in patients with solid pancreatic neoplasm]

Endosonography is a distinct method in evaluating gastrointestinal [GI] structural lesions, particularly in the pancreatobiliary system. This procedure has made a fundamental change in the diagnosis of pancreatic mass lesions through fine needle aspiration [FNA]. This study aims to evaluate the results and efficacy of endosonographic fine needle aspiration [EUS-FNA] in patients presenting with solid pancreatic masses. This was a descriptive, prospective, case series study of patients who presented with solid pancreatic masses to Imam Khomeini Hospital, Tehran, Iran over a one year period [from November 2009-2010] In order to determine false negative cases, patients were followed for 6 to 12 months. A total of 53 patients underwent EUS-FNA with no complications. The results were diagnostic in 46 [87%] cases. The majority of patients were male [68%] and 81% had a mass in the pancreatic head. Cytopathology results revealed 36 [68%] adenocarcinomas, 7 [13%] other malignancies, 3 [6%] benign lesions and 7 [13%] nondiagnostic cases. The frequency of nondiagnostic results was significantly more in masses smaller than 3 cm [6 vs. 1, p < 0.002]. Patients with nondiagnostic results were younger than those with malignant cytopathologies [52 +/- 7.5 vs. 66 +/- 7.5 years, p < 0.001]. Sensitivity, specificity, PPV, NPV and accuracy of EUS-FNA in adenocarcinoma cases were 88%, 100%, 100%, 70% and 90%, respectively. EUS-FNA is an effective and safe procedure in the histopathologic diagnosis of pancreatic tumors

[Evaluation of HBV_DNA level distribution and related factors in chronic hepatitis B patients]

Hepatitis B is still a major health problem in many parts of the world. In some developing countries the most common cause of chronic hepatitis and liver cirrhosis is hepatitis B virus [HBV]. The progression of chronic hepatitis B to cirrhosis and hepatocellular carcinoma [HCC] include such viral factors as genotype C and high levels of serum HBV DNA in addition to host factors such as older age, male gender, obesity and diabetes. Other factors that influence progression to cirrhosis and HCC are simultaneous alcohol use, and co-infections with HIV, HDV and HCV. The present study aims to determine the correlations between serum HBV DNA viral load and related factors. In this study, new HBV DNA and ALT levels that enable better separation between different stages of this disease are presented. Materials and Chronic hepatitis B patients who presented to the Liver Clinic at Imam Khomeini Hospital in 1388 who were HBsAg positive for more than six months were enrolled in this study. Patients who had previously been treated or those with concurrent HIV, HCV and HDV infections as well as those with autoimmune hepatitis and fatty liver were excluded. Patients' data, HbeAg state, demographics, liver enzymes, HBV DNA level, smoking history, cirrhosis and disease stage were recorded. In order to better differentiation between non-replicative and reactive chronic hepatitis B patients, statistical analysis was done to distinguish between their HBV DNA levels. Evaluation of the relationships between HBV DNA level and the above mentioned variables was performed. High Levels of HBV DNA correlated with HBeAg positive state, smoking [p=0.005] and elevated liver enzymes [p=0.002]. The cut-off value for ALT level that separated HbeAg-positive group [immunoclearance and immunotolerance phases] was set at 42 U/l on the roc curve[r=0.889 area under curve] with 100% sensitivity and 67.7% specificity. The cut-off value for serum HBV DNA levels that differentiated between the Hbe Ag-negative group [non-replicative and reactive phases] was set at 3000 IU/ml on the roc curve [r=0.987 area under curve] with 97% sensitivity and 92% specificity. The present study determined that serum HBV DNA at a level of 3000 IU/ml was a better level for classification of HBeAg-negative patients into the non-replicative and reactive groups

[Survey the laparoscopic, biochemical and clinical findings in patients with exudative ascites of unknown origin]

Introduction: The etiology of exudative ascites cannot always be diagnosed accurately. Laparoscopy could be used as an appropriate diagnostic modality in these cases

Objective: Evaluate the laparoscopic, biochemical and clinical findings in patients with exudative ascites of unknown etiology

Materials and Methods: In a case-series study, we studied the data of 67 patients with exudative ascites of unknown etiology who under went diagnostic laparoscopy in endoscopy ward of Imam Khomeini Hospital from 2002 to 2005. Demographic data; complaints; clinical, laboratory and laparoscopic findings were evaluated and the accurate etiology of exudative ascites was determined. Man Whitney and Fischer's exact test were used for statistical analysis. P values less than 0.05 was considered significant

Results: The most common cause of exudative ascites was carcinomatous peritonitis then tuberculosis and lymphoma. Tuberculosis peritonitis was the most common etiology of exudative ascites in afghan immigrants. Abdominal masses were only palpated in cases of malignancy. Uniform micronodules and fibrous bands were observed in tuberculous peritonitis. Icter was observed in half of the patients with Budd-chiari Syndrome and lymphoma. Hepatomegaly was mostly seen in Budd-chiari Syndrome and neoplasms

Conclusion: Carcinomatous peritonitis, tuberculosis and lymphoma were the most common causes of exudative ascites of unknown etiology

Clinical manifestations of irritable bowel syndrome in Iranian men and women: a comparative study

Irritable Bowel Syndrome [IBS] is one of the most prevalent gastrointestinal disorders which includes the majority section of general practitioners or gastroenterologists visits. The type or prevalence of clinical signs and symptoms of the syndrome may be different among males and females. we decided to assess and compare the frequency of different signs and symptoms of IBS in men and women. It is a cross sectional study which was performed in a private gastroenterology clinic in Tehran. 76 males and 116 females who suffered from Irritable Bowel Syndrome were selected, and the clinical signs and symptoms were compared. Finally, the data were analyzed using Chi-Square test. Among the gastrointestinal signs, abdominal pain, nausea, belching, and bitter taste with women/men ratio equal to 1.2, 2, 1.7, and 1.4 respectively [p<.05] were more prevalent in females, while flatulence and mucus discharge were observed in males more than females [men/female ratio 1.3, 1.6 respectively] [p<.05]. Extragastrointestinal manifestations such as palpitation, anxiety, and depression were more common in females [women/men ration 1.7, 1.3, and 1.7 respectively]. The sensitivity of ROME II criteria in males and females was 96.3% and 92% respectively, while the sensitivity of Manning criteria was 93.4% in men and 80.2% in women. Clinical manifestations of Irritable Bowel Syndrome are different between males and females. It seems that Manning criteria is more diagnostic in men suffering IBS

multicenter study to evaluate the safety and efficacy of heberon [interferon alfa-2b] in combination with ribavirin for the treatment of chronic hepatitis C in Iran

interferon and ribavirin is the most effective treatment for chronic hepatitis C today. The aim of this study was to evaluate the efficacy and safety of thrice-weekly Heberon [interferon alfa-2b] in combination with ribavirin as first-line treatment of chronic hepatitis C.A total of 97 treatment-naive patients received Heberon three million units thrice-weekly subcutaneously in combination with ribavirin for 12 months. Serum HCV RNA levels were measured before and during therapy and 6 months after the end of therapy. End-of-treatment and sustained virological responses was defined as an undetectable HCV-RNA level at the end of treatment, and 6 months after treatment was completed [end of follow-up], respectively.In an intent-to-treat analysis, HCV-RNA was undetectable at the end of treatment in 49.5% of patients. At the end of follow-up, sustained virological response was 36.1%. Combination treatment was generally well tolerated. Six patients stopped therapy because of side effects: severe cytopenia [n=4], depression [n=1], and hyperthyroidism [n=1]. Common side effects of therapy include: Flu-like syndrome [85.6%], generalized alopecia [41.2%], injection site inflammation [37.1%], mood changes [36%], anorexia [34%] and weight loss [32%].Heberon as an IFN product in combination with ribavirin for treatment of patients with chronic hepatitis C is relatively safe, feasible, and potentially efficacious. It has comparable results in achieving end-of-treatment and sustained viro-logical responses in chronic hepatitis C

Safety and efficacy of interferon alfa for the treatment of chronic hepatitis C infected subjects with transfusion dependent thalassemia in Iran

Up to 30% of Iranian adult multi-transfused thalassemic patients are infected with hepatitis C virus [HCV] which can intensify the progression of liver disease caused by iron overload in this group of patients. Our aim was to assess the biochemical and virological response of interferon alfa [INF-alpha] and its safety in thalassemic patients with chronic HCV infection. This trial was a single center, open label, single treatment prospective study of INF-alpha[Heberon alfa R, 3 MU, every other day] for a period of 12 months. 29 subjects, 13 to 56 years old [mean +/- SD: 25.1 +/- 10.4 years], whose serum HCV-RNA was positive and mean AlT remained greater than 1.5 times upper limit of normal in the last 6 months before the study were enrolled. A percutaneous liver biopsy was performed before treatment and all patients underwent monthly assessment for adverse events and monitoring of serum ALT. Qualitative serum HCV -RNA was obtained in months 3 and 6 and at the end of therapy. Pretreatment liver biopsy showed mild fibrosis in 33.3%, moderate fibrosis in 56.7% and cirrhosis in 10% of patients. Siderosis was severe in 14 patients [46.7%]. Two nonsplenectomized patients discontinued INF because of mild cytopenia, which resolved in less than one week after interruption of therapy. The following were some of the important adverse events observed during the study period: Flu syndrome in 29[100%], chills or fever>39°C in 14[48%], local pain in 14[48%], transient gastrointestinal symptoms in 13[44%], weakness in 5[17%], local induration in 3[10%] and edema in 2[7%] of the patients. By the end of 12 months of therapy, 15 patients out of 27 [55.6%] had a normal ALT and negative HCV -RNA [complete end-treatment response], they were followed up for a mean duration of 10.5 months [range: 6 to 22 months] and in 8 of them [53.3%] the condition relapsed [abnormal ALT with positive PCR]. Viral clearance was a delayed event in our patients [29% by the end of month 3 and 63% by month 7] but ALT normalization occurred in 94% of responders by the end of month 3. Our experience indicates that the cure of HCV -related liver disease in thalassemic patients is not an unrealistic aim and may be achieved with a safe and inexpensive INF preparation [Heberon Alfa R] in a sizeable portion of cases. As opposed to non-thalassemic patients, in whom most viral responses happen in the first 3 months of therapy, in this group of thalassemic patients we found that maximum virologic response happened between 3 to 6 months of therapy. Although INF-alpha is an effective drug for initial treatment in thalassemic patients infected with HCV, its efficacy with the above dose and duration, for maintaining long term remission is under question

efficacy and safety of interferon alfa for treatment of chronic hepatitis B infected subjects in Iran

This preliminary study was designed to evaluate the effects of Heberon Alfa for the treatment of chronic hepatitis B infected subjects in Iran. A single center, open label, single treatment prospective study of Interferon Alfa [Heberon Alfa], 5 million units every other day for a period of 4 months, was performed between 1996 to 1998. A total number of 30 patients with histologically documented chronic hepatitis and positive serum HBsAg were included in the study. Serum ALT of all patients was greater than 1.5 times normal before start of therapy. Effect of therapy on aminotransferase activity and HBsAg, HBeAg seroconversion was monitored and all the patients underwent a second liver biopsy at the end of the study period. Mean age of patients was 35.5 +/- 12 [17 to 60 years old] and 73% of patients were mate. Most patients experienced adverse effects, but none warranted stopping the treatment. No serious or unexpected adverse event was reported during the study period. Thrombocytopenia was recorded in 2 patients. Liver biopsy showed a decrease in hepatic inflammation in 53.5% of patients, no change in 36.7% and increase in hepatic inflammation in 10% of patients after the treatment. Serum ALT returned to normal in 18 patients [60%], decreased in 7 patients [23.3%] and didn't change in 5 patients [16.7%]. There was a strong correlation between serum ALT normalization and histological improvement. HBsAg became negative in 5 patients [16.6%]. 10 patients had positive HBeAg prior to therapy, which became negative in 4 of them [40%] by the end of the study. The current study confirms the result of other clinical trials and indicates that Heberon Alfa is a safe and effective drug for the treatment of chronic hepatitis B infected subjects with histologically documented chronic hepatitis

Primary pancreatic lymphoma: a case report and literature review

Primary pancreatic lymphoma is a rare extranodal manifestation of any histopathologic subtype of B cell non-Hodgkin's lymphoma that predominantly involves the pancreas. It comprises less than 0.2% of pancreatic malignancies and less than 0.7% of non-Hodgkin's lymphomas. This lymphoma is almost never suspected clinically. It is usually diagnosed by surgical exploration for suspected adenocarcinoma because this kind of lymphoma resembles pancreatic adenocarcinoma, a much more common disease, in clinical presentation and radiologic appearance. Differentiation is, however, essential because of different clinical management and outcome. This report describes an interesting case of primary pancreatic lymphoma and review of the literature to elucidate features that suggest this entity