[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

[Survey of polyethylene glycol effects on serum electrolytes]

Colonoscopy and bowel preparation caused a number of serum electrolytes changes that may be dangerous in heart and kidney diseases and elderly patients. To determine the effect of serum electrolytes in patients who underwent colonoscopy and bowel preparation with PEG [Polyethylene Glycol] in Tehran Imam Khomeini hospital in 2008. Fifty nine patients who had been selected for elective colonoscopy after the detection of exclusion criteria were assessed prospectively. Serum level of sodium and potassium were analysed before bowel preparation with PEG [T[0], before colonoscopy T[1] and immediately after it T[2]. Serum calcium and phosphorus levels were measured just before and after PEG. Four patients [6.8%] did not follow the research protocol and were excluded. Four patients [6.8%] developed hyponatremia in T[1] that continued in T[2]. There were no significant differences in prevalence of Hyponatremia and means of sodium serum levels in T[0], T[1] and T[2]. Although there was a significant trend to decreased means of potassium levels of T[2] versus T[1] [P<0.01], but the maximum prevalence of Hypakalemia was in T[1] [10.9%] with only 3.8% new Hypokaliemia in T[2] and there was no significant difference. The prevalence of Hypocalcemia after PEG was 24% but there was no significant decrease. 36% of patients developed Hypophosphatemia after PEG preparation with a significant decrease in mean of serum Phosphorus level [P<0.05]. There was no significant relationship between electrolytes changes with age and sex. The serum electrolyte changes showed that preparation with PEG is a risk factor for development of Hypophosphatemia Colonoscopy and preparation with PEG may cause a significant decrease in potassium serum level

[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