Dropped gallstones during laparoscopic cholecystectomy

Laparoscopic cholecystectomy [LC] is one of the most commonly performed surgeries worldwide. Stones can be spilled from the gallbladder during LC. These stones can be left in the peritoneal cavity or trapped at the trocar site. The potential late sequelae and associated morbidity are not well documented. Every effort should be made in order to avoid spillage of stones during dissection of the gallbladder through the abdominal wall. We describe one case that underwent LC and presented with dropped gallstones

Efficacy of endoscopic ultrasound guided fine needle aspiration in patients with solid pancreatic neoplasms

Endosonography is a distinct method for evaluating the structural lesions of the gastrointestinal [GI] tract, particularly the pancreatobilliary region. This procedure has made a fundamental change in the diagnosis of pancreatic mass lesion through providing fine needle aspiration. This study aims at evaluating the results and efficacy of endoscopic ultrasound fine needle aspiration [EUS-FNA] in patients with pancreatic solid mass. The present study is an observational, prospective case series nature, evaluated patients with pancreatic solid mass referred to Imam Khomeini educational hospital in Tehran for a duration of one year since November 2010. In order to determine the false negative cases, the patients were followed-up from 6 to 12 months. EUS-FNA was conducted on all 53 patients without any complication. The majority of patients included in the study were males [68%] and 81% of patients had a mass in the head of pancreas. The result of cytopathology revealed 36 adenocarcinomas [68%], 7 other malignancies [13%], benign lesions [6%] and 7 non-diagnostic cases [13%]. The frequency of non-diagnostic results was significantly high in masses smaller than 3 cm [6 vs. 1, P < 0.002]. Patients with non-diagnostic result were younger than those with malignant cytopathology [52 +/- 7.5 vs. 66 +/- 7.5 years, P < 0.001].. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of this procedure concerning Adenocarcinoma were 88%, 100%, 100%, 70% and 90%, respectively. EUS - FNA is an effective and safe procedure in histopathologic diagnosis of pancreatic tumors. This procedure is useful in all pancreatic mass cases including resectable and non-resectable ones

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

Helicobacter pylori and peptic ulcer in cirrhotic patients

H.pylori infection increases the risk of peptic ulcer in cirrhotic patients. The role of H.pylori in inducing peptic ulcer disease in chronic liver disease patients remains controversial. The objective was to see if etiology of peptic ulcer in cirrhotic patients is related to H.pylori infection. Sixty cirrhotic patients were enrolled in the study. Peptic ulcer was detected in patients by means endoscope. Sera from patients were tested for Helicobacter pylori antibodies by a commercial ELISA kit. t student and fisher test was used for statistical analysis. Active peptic ulcer was detected in nine cirrhotic patients. Of the nine patients with peptic ulcer eight [88.9%] tested positive for Helicobacter pylori antibodies and of the remaining 51 patients, 31[60.8%] tested positive for Helicobacter pylori antibodies. Helicobacter pylori infections in our series of cirrhotic patients with peptic ulcer seems to show the same pattern as described in cirrhotic patients without peptic ulcer [P=0.078]. The suggestion that the etiology of the peptic ulcer in cirrhotic patients could be related to Helicobacter pylori infection was not confirmed by our study

Efficacy of Lamivudine therapy on decompensated liver cirrhosis due to chronic hepatitis B

The aim of this study was to determine the effect of lamivudine on liver function and clinical status of the patients with decompensated cirrhosis arising from hepatitis B virus [HBV]. In a clinical trial on the basis of liver consideration in 55 patients with cirrhosis that had positive HBsAg and HBV DNA, Child-Pugh score more than 8 and some other criteria were treated with lamivudine. In these patients, serum level of bilirubin, albumin, ALT, AST and also the PT-INR were controlled at the beginning of study and then at intervals of 2 to 6 months and finally 12 months after the start of treatment. Five patients died in the first 6 months of treatments. The following results are related to 50 patients being under treatment with lamivudine at least for a period of 6 months. In these patients mean Child-Pugh score was decreased from 11 +/- 2 to 7 +/- 1 [P < 0.0001]. All of the patients tolerated this drug very well. Lamivudine can be effective in improvement of liver function in patients with decompensated liver cirrhosis resulting from HBV, but for determination of proper period of treatment, further studies are necessary

effects of liver dysfunction on serum lipoprotein levels in patients with cirrhosis and chronic hepatitis

The liver plays a main role in the production and metabolism of lipoproteins, and then impaired lipid metabolism is often seen in patients with liver cirrhosis and chronic hepatitis [CH]. As a result, plasma lipid levels could be as useful indicators of liver function and patient's prognosis especially in liver cirrhosis. We measured the lipoprotein levels in 77 consecutive patients with liver cirrhosis and CH. 47 men [61%] and 30 women [39%] with mean age 43years [SD=16.4] and mean BMI 26[SD=4.2] have been recruited as patients group. Child score and MELD scale was determined in patients group. The control group was age and sex matched with patients group. In case group, the levels of HDL LDL, TG, and total cholesterol were significantly lower than control group [p <0.0001]. In patients with cirrhosis, the levels of LDL, HDL and total cholesterol were progressively lower when comparing patients in Child class A with patients in class C [p<0.0001].This difference was more significant in LDL and total cholesterol and between upper Child scores similarly decreasing in LDL, HDL, and total cholesterol level was observed when MELD score increased [P<0.0001]. There is a correlation between plasma lipid levels and liver function, so it may be mentioned as an accessible and reliable indicator of liver function in cirrhotic and CH patients