RESUMO
BACKGROUND: Budd-Chiari syndrome (BCS) is defined as hepatic venous outflow obstruction(HVOO). BCS is an uncommon, life-threatening liver disorder. This studydescribes the clinical and etiological characteristics in addition to the longtermoutcome of BCS in a single referral center in Tehran, Iran. METHODS: We reviewed long-term outcome of patients who were diagnosed with BCSbetween 1989 and 2012 at Shariati Hospital, a tertiary hospital affiliated withTehran University of Medical Sciences, Tehran, Iran. The diagnosis was confirmedby at least two imaging techniques. A comprehensive analysis of theclinical and paraclinical manifestations, etiology and long-term outcome of thedisease was conducted. RESULTS: Seventy one patients (43 female) with a diagnosis of Budd-Chiari syndromewere identified during the 22 year period of study. The age were ranged from17 to 64 years (median: 29 years). We excluded 16 patients because of incompleteinformation or follow up. The remaining 55 cases were the subjects ofthis study. Underlying etiologies consisted of congenital thrombophilia factorsin 50% (28 cases) which was defined as protein C deficiency (12 cases),protein S deficiency (3 cases), antithrombin deficiency (3 cases) and factor VLeiden mutation (10 cases). Etiology was unknown in 18% (10 cases). Acquiredcauses of thrombophilia were observed in 25% (14 cases) that consistedof 9 cases of myeloproliferative disease and 5 cases of autoimmune diseases.In 3 cases pregnancy was the only etiology. The main clinical presentationswere abdominal pain in 33 (60%), abdominal distention in 21 (38.2%), andjaundice in 10 (18%) cases. The main clinical signs were ascites (76.4%), splenomegaly(34%), hepatomegaly (25.5%) and deep vein thrombosis (1.8%). All55 patients were treated with anticoagulants (heparin followed by warfarin)and supportive care. Two cases underwent mesocaval shunt surgery, 2 patientsrequired transjugular portosystemic shunt (TIPS) and 5 were referred for livertransplantation. A total of 17 (30%) patients died during 22 years of follow up. CONCLUSION: BCS, although uncommon in Iran, is a challenging liver disease with an importantburden. Medical therapy that includes anticoagulation seems to be effectivein most cases although the prognosis is guarded. In long-term followup, 40% of cases will need liver transplant or die from end stage liver disease.
RESUMO
Knee osteoarthritis (OA) is a common degenerative joint disorder and a major cause of pain and disability. The hypothesis tested in this study was that the passion fruit peel extract (PFP), a flavonoid-rich dietary supplement, would reduce symptoms due to knee OA. Thirty-three OA patients were enrolled in a randomized, double-blind, placebo-controlled trial with parallel-group design. Patients received either placebo or PFP pills (150 mg, daily) in a double-blinded fashion for 2 months. The OA clinical symptoms were evaluated monthly with Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index. In the PFP group, there was a significant improvement in total WOMAC score and WOMAC subscale score of physical function after 30 days and pain after 60 days. At 60 days, reductions of 18.6%, 18%, 19.6%, and 19.2% in pain, stiffness, physical function, and composite WOMAC score, respectively, were self-reported in the PFP group. Whereas, in the placebo group, the self-reported WOMAC scores increased in every category. The results of this study show that PFP substantially alleviated osteoarthritis symptoms. This beneficial effect of PFP may be due to its antioxidant and antiinflammatory properties.
