Anti-endomysial and anti-tissue transglutaminase serological test compared with small bowel biopsy in the diagnosis of celiac disease

Celiac is an autoimmune disease that is characterized by an immune-system-related damage in the intestinal tissue after consumption of gluten. There is not any general agreement for gold standard. The Purpose of this study was the evaluation of specificity and sensitivity of anti-endomysial [EMA] and anti-tissue transglutaminase [TTG] Serological test compared to small-bowel biopsy. In the cross sectional study, we took blood specimen from 1825 patients with gastrointestinal disease. All the samples were tested by TTG and EMA kits using ELISA. The patients were studied in two groups. First, the individuals whom their serologic test was positive but their tissue condition was normal and second, those with positive serologic test with pathologic tissue results that show they have celiac disorder. The mean of EMA and TTG shows that the level of antibodies in group 2 is significantly higher than that of the first group [P <0.001]. There is positive correlation between modified marsh criteria of small-bowel biopsy and the two tests. The Sensitivity of EMA and TTG tests for celiac diagnosis is 92%. The specificity of EMA, TTG tests are 100% and 98.5%, respectively. EMA-IgA serology with cut-off point of more than 66 together with TTG-IgA serology with cut-off point of above 30 can be helpful to distinguish a wide range of patients who need small-bowel biopsy

Can ultrasound predict the presence of retained products of conception following first-trimester spontaneous abortion?

The incidence of retained products of conception [RPOC] has been reported as 1-3% and ultrasound has an important role in their diagnosis and selection of patients for surgical management. The aim of this study is to identify that ultrasound is a predictor of the presence of retained product of conception [RPOC] within the uterine cavity in women with the clinical diagnosis of incomplete first trimester abortion. hundred patients with a diagnosis of incomplete abortion and RPOC based on clinical and sonographic findings were enrolled. The gold standard test was pathologic reports of samples obtained during dilatation and curettage. Endometrial thickness and homogenesity of the endometer were determined by sonography. The sensitivity and specificity of the measurements for detecting RPOC were assessed. Histopathological reports confirmed the diagnosis of RPOC in 71 patients [71%]. Mean endometrial thickness with RPOC was 16.3 mm versus 12.1 mm without RPOC. Heterogenic endometrium was seen in 56 out of 71 patients [78%]. The sensitivity and specificity of the endometrial thickness greater than 11.25mm for detecting RPOC were 81% and 45%, respectively. Regarding the endometrial thickness and heterogenic endometer, 13.5 mm had the best performance criteria with 60% and 63% sensitivity and specificity, respectively. An endometrial thickness of 11.25 mm or more detected by sonography had the best diagnostic efficacy, considering the heterogenecity with the thickness of the endometrium, 13.5 mm had the best performance criteria for detection of RPOC following first trimester spontaneous abortion

[Management of infected femoral pseudoaneurysm in intravenous drug abusers]

A plan for management of infected arterial pseudoaneurysm has evolved from our experience with forty two cases of such aneurysms treated between 1378 and 1382. Clinical data of 42 patients with femoral pseudoaneurysm resulting from addictive drug injection who presented in emergency department of Sina Hospital between 1378 and 1383 were retrospectively reviewed. All patients were men with the mean age of 36.9 years. Twenty eight patients were referred from other medical centers. The mean time of delay in presentation was 17.3 days. The mean duration of drug injection was 14 months. Primary repair and emergent vascular bypass were performed in 3[7.1%] and 2[4.8%] patients, respectively. 5[11.9%] patients undergone delayed revascularization. Thirty two [76.2%] patients returned to their normal lifestyle without any vascular bypass. One patient required amputation and one patient died due to sepsis and acute renal insufficiency. Management of infected femoral pseudoaneurysms is simple ligation of the external iliac or femoral artery. When Doppler is not available 'Operation Room and postoperative Direct Observation' is recommended in such patients to avoid unnecessary revascularization surgery