Imaging Accuracy in Diagnosis of Different Focal Liver Lesions: A Retrospective Study in North of Iran.

INTRODUCTION: Focal liver lesions (FLLs) are incidentally detected masses found in daily abdominal imaging which are necessary to be characterized, because of the potential of being malignant. There are several imaging methods, such as ultrasonography (US), computed tomography (CT scan), and contrast enhanced magnetic resonance imaging (MRI). Here, we evaluate and compare the diagnostic accuracy (i.e., sensitivity and specificity) of these imaging methods for the diagnosis of FLLs. MATERIAL AND METHODS: In this retrospective study, patients with focal liver lesions included and based on the gastroenterologist decision, in 79 patients different imaging methods were used to determine the nature of FLLs: the US, CT scan, and MRI. At the next step, fine-needle aspiration biopsy (FNA) was performed in all cases, and the results about the true nature of FLLs compared with different imaging results. The chi-square test and McNemar test were used. RESULTS: Ultrasound diagnosis of benign and malignant was obtained with 82% diagnosis accuracy, 100% sensitivity, 71.4% specificity, 100% negative predictive value, and 69.2% positive predictive value (PPV) compared with the biopsy. Also, the results of benign and malignant masses in CT scan were obtained with diagnostic accuracy of 95%, 100% sensitivity, 80% specificity, 93.9% positive predictive value, and 100% negative predictive value. MRI performed only in 2 cases with similar results to pathology. CONCLUSION: It seems that CT scan is more appropriate and useful in the diagnosis of hepatic masses due to its higher diagnostic accuracy than the ultrasound.

Gallstone disease founded by ultrasonography in functional dyspepsia: prevalence and associated factors.

The aim of this study was to evaluate the frequency of gallbladder stone in functional dyspepsia (FD) by abdominal ultrasonography and to determine the factors associated with this frequency in Guilan province. A total of 195 subjects who referred to outpatient clinic of Razi Hospital, a tertiary referral center (Guilan, Iran) to evaluate FD were included in this study. They were interviewed by using a questionnaire and underwent ultrasonography. Among the 195 subjects were 18.5% male and 81.5% female. The overall frequency of Gallstones (GS) was 19% (37/195) with 17% males and 83% female. In patients with dyspepsia, the presence of fatty liver evidenced by ultrasonography was 67% (131/195). From 131 patients with fatty liver disease 24 (18.3%) have been reported GS. The most frequent symptom in all participants as well as patients with GS and patients with fatty liver was abdominal pain (69.7%, 81% and 66%, respectively) followed by excess flatus. Risk factor associated with increased odds ratios (ORs) for the development of gall stones was diabetes mellitus (OR = 2.63). It also showed that gallbladder wall thickening was more common in patients with GS (OR = 36.63). GS disease was not significantly related to the age, gender, fatty liver, renal stone, history of hypertension (HTN) and hyperlipidemia (HLP), alcohol consumption and smoking status. Patients with FD especially if they have diabetes should be referred for upper abdominal ultrasonography for screening and early detection of GS disease.

Anti-cyclic citrullinated peptide antibodies in ulcerative colitis, and its relation with disease activity.

BACKGROUND: Ulcerative colitis an inflammatory bowel disease (IBD) and chronically idiopathic immune related that associates with extraintestinal manifestations such as arthritis. Despite of the highly specificity of anticyclic citrullinated peptide (CCP) antibodies for rheumatoid arthritis, their role in IBD remains unclear. There are only a few studies on the prevalence of anti-CCP antibodies in patients with IBD. This study aimed to assess the prevalence of anti- CCP antibodies in ulcerative colitis and to investigate possible associations with their clinical and laboratory characteristics Methods: In this cross-sectional study, 93 consecutive patients with ulcerative colitis referred to gastroenterology clinics in Razi referral hospital of Rasht, Iran, from September 2010 to September 2011. Rheumatologic examination, demographic data and clinical presentation of patients were recorded on specially prepared data sheets. Blood sample was collected for assessment of anti-CCP and other laboratory tests. Data were analyzed by the Chi square test, Fisher Exact test and student t test, using the SPSS 20 software for Windows, and P value less than 0.05 was considered significant. RESULTS: Of 93 patients, anti-CCP antibodies detected in 10.8% of cases (CI 95%: 4.5-17.1%). There were a significant relation between the prevalence of anti CCP positivity and aphthous ulcers and ocular manifestations whereas other parameters were not significantly related. CONCLUSION: Anti CCP may have a possible role in some ulcerative colitis manifestations but there was no association between the presence of these antibodies and activity or extension of inflammatory colitis. We suggest other studies especially molecular studies to investigate other aspects of these antibodies in IBD patients.

Double-balloon Enteroscopy: The results of a new experience in Iran.

BACKGROUND: Approach to the small intestine has been difficult even with newer methods. Double-balloon enteroscopy (DBE) has been created for diagnostic and therapeutic interventions in diseases of the small intestine. Small intestinal diseases have different etiologies in each country. The DBE has been introduced in recent years in Iran. Our aim was to study the indications and results of DBE in some academic centers in Iran. METHODS: Fifty-five patients with symptoms and signs related to small intestine without definitive diagnosis but with previous workup were enrolled in the study. The DBE was performed in three different medical universities in Iran. RESULTS: The mean age of the patients that underwent the DBE was 47.2 ± 17.3 years. Abdominal pain (54.5%) and occult gastrointestinal bleeding (23.6%) were the most common presentations. Small bowel lesions were detected in 26 patients (47.3%); the most common lesions were ulcer (46.2%) and polyps (19.2%). Crohn's disease (12.7%) was the commonest diagnosis found in DBE procedure. Patients presenting with abdominal pain orl ower hemoglobin level were more likely to be diagnosed (both p≤ 0.05). Small intestinal diseases were ultimately diagnosed in 47.3% of the patients. Twenty percent of the patients had another disease outside the small bowel. CONCLUSIONS: DBE is an effective and relatively safe diagnostic and therapeutic option for small bowel evaluations. Accurate selection of patients and more experience technicians and physicians will improve the efficacy of this procedure in Iran.

Oxidized low-density lipoprotein is associated with viral load and disease activity in patients with chronic hepatitis C.

BACKGROUND: The mechanisms of liver injury in chronic hepatitis C virus (HCV) infection are poorly understood. Recent evidence suggests that oxidative stress and lipid-peroxidation play a major role. The purpose of this study was to determine the serum level of oxidized low-density lipoprotein (ox-LDL), and evaluate its association with different clinically valuable parameters of liver disease in patients with chronic hepatitis C. METHODS: Forty-five untreated chronic hepatitis C patients and 45 healthy adult volunteers, matched for age, sex and BMI, were enrolled. Blood samples were collected after 12 h of fasting, and serum bilirubin, albumin, liver aminotransferases, lipid profile, prothrombin time and ox-LDL were measured. Viral load of HCV was determined in patients. Liver biopsy was performed in patients and the stage of fibrosis and grade of necroinflammatory activity were determined. Healthy controls did not undergo liver biopsy. RESULTS: Ox-LDL was significantly higher in HCV patients (42.54 ± 3.82 vs. 30.98 ± 1.66 µ/l, P < 0.01). Ox-LDL was significantly correlated to viral load (r = 0.457, P < 0.01), and grade of inflammation (r = 0.293, P < 0.05) in HCV patients. Ox-LDL was significantly higher in cirrhotic vs. noncirrhotic patients. No significant association was found between ox-LDL and Child-Pugh classification, serum albumin, liver enzymes, or prothrombin time. CONCLUSION: This study provided new data from an in vivo setting which suggests the contribution of ox-LDL to HCV pathogenesis. Our results encourage further clinical studies to evaluate the potential diagnostic and therapeutic implications of ox-LDL in HCV patients.

Inflammatory myofibroblastic tumor of the small bowel: a case report.

Inflammatory Myofibroblastic Tumor (IMT) is a rare neoplastic lesion with tendency toward local aggressive behavior and recurrence. The tumor most commonly occurs in the pulmonary system of children and young adult, although it may rarely develop in older patients and other organs. Symptoms are non-specific and depend on the location of the tumor. The gastrointestinal tract is rarely the primary site of origin for this lesion. We report an unusual presentation of this rare lesion in a 58 year old woman with intussusception and partial intestinal obstruction.

Quality of life in patients with gastric cancer: translation and psychometric evaluation of the Iranian version of EORTC QLQ-STO22.

BACKGROUND: Disease and treatment related events, can adversely affect the quality of life of patients with cancer. The purpose of this study was to translate and validate a gastric cancer specific health related quality of life questionnaire (EORTC QLQ-STO22) for Iranian patients suffering from gastric cancer. METHODS: Forward-backward procedure was applied to translate the English language version of the EORTC QLQ-STO22 into Persian (Iranian language). Then, the questionnaire and the EORTC core quality of life instrument (QLQ-C30) were administered to a sample of patients with confirmed diagnosis of gastric cancer. All patients filled in questionnaires before and after one month of treatment. Patients were divided into two groups based on intension of treatment (curative vs. palliative). Reliability and validity of the module was tested by internal consistency and known group comparisons, respectively. RESULTS: In all, 105 patients were entered into the study. Cronbach's alpha for multi-item scales (to test reliability) ranged from 0.54 to 0.87. The questionnaire discriminated well between clinically distinct subgroups of patients both before and after treatment lending support to its convergent and clinical validity. CONCLUSION: Overall, the Iranian version of the EORTC QLQ-STO22 demonstrated a good reliability and clinical validity to support its use in combination with core questionnaire in outcome studies of gastric cancer in Iran. However, using the QLQ-STO22 in a wide range of Iranian patients with gastric cancer should allow further confirmation for its psychometric properties.

Effect of oral naltrexone on pruritus in cholestatic patients.

AIM: To determine the efficacy and potential complications of oral naltrexone used in the treatment of pruritus in cholestatic patients and to compare them with other studies. METHODS: Thirty-four enrolled cholestatic patients complaining of pruritus were studied. In the initial phase, pruritus scores during day and night were evaluated. Subsequently, patients were given a placebo for one week followed by naltrexone for one week. In each therapeutic course (placebo or naltrexone) day and night pruritus scores were distinguished by a visual analogue scale (VAS) system and recorded in patients' questionnaires. RESULTS: Both naltrexone and placebo decreased VAS scores significantly. Naltrexone was more effective than placebo in decreasing VAS scores. Both day and night scores of pruritus decreased by half of the value prior to therapy in thirteen patients (38%). Daytime pruritus improved completely in two patients (5.9%), but no improvement in the nighttime values was observed in any patient. Sixteen patients (47%) suffered from naltrexone complications, eleven (32%) of them were related to its withdrawal. Complications were often mild. In the case of withdrawal, the complication was transient (within the first 24-28 h of therapy) and self-limited. We had to cease the drug in two cases (5.9%) because of severe withdrawal symptoms. CONCLUSION: Naltrexone can be used in the treatment of pruritus in cholestatic patients and is a safe drug showing few, mild and self-limited complications.