Consumption of probiotic yogurt and vitamin D-fortified yogurt increases fasting level of GLP-1 in obese adults undergoing low-calorie diet: A double-blind randomized controlled trial.

Energy restriction and manipulation of macronutrient composition of the diet are the main approaches that are used by people who aim to lose weight. When such strategies are employed, appetite and endocrine regulators of satiety, such as gut peptides, all are deeply affected. The gut microbiota-brain axis controls energy homeostasis in humans by affecting central satiety and gut peptides. The purpose of this study was to evaluate if the synergistic effect of probiotics and vitamin D in yogurt matrix can modulate this effect. In the double-blind, randomized, placebo-controlled trial, 140 obese adults were randomly allocated into four groups: 1) regular yogurt plus low-calorie diet; 2) PY plus low-calorie diet; 3) vitamin D-fortified yogurt plus low-calorie diet, and 4) probiotic and vitamin D co-fortified yogurt plus low-calorie diet. All groups were encouraged to increase their physical activity. Glucagon-like peptide-1 (GLP-1), peptide Tyrosin-Tysrosin (PYY), ghrelin, anthropometric variables, insulin, fasting blood sugar (FBS), insulin resistance/sensitivity, 1,25(OH)2 D3, dietary intake, and physical activity were measured before and after 10 weeks. The difference between groups for GLP-1 after 10 weeks was significant after adjusting for baseline GLP-1 and protein intake as confounders. PY showed the largest effect size (ES) on GLP-1 (p = 14.2) and FBS (p = 14) compared with others. Pairwise comparison of yogurts effect sizes on GLP-1 showed a significant difference in group 1 vs. group 2 (p = .001), group 1 vs. group 3 (p = .003), and group 1 vs. group 4 (p = .048). Vitamin D-fortified yogurt had the largest effect size on the serum level of vitamin D and it showed a significant difference with RY (p = .018) and PY (p = .002). Consumption of vitamin D-fortified yogurt and PY could be regarded as a promising approach during calorie restriction.

The effect of yogurt co-fortified with probiotic and vitamin D on lipid profile, anthropometric indices and serum 25-hydroxi vitamin D in obese adult: A Double-Blind Randomized- Controlled Trial.

Vitamin D deficiency can be regarded as one of the overgrowing health problem in all of the world. Evidence from a clinical trial suggested a role for probiotic bacteria in increasing vitamin D. However, probiotic's effect is strain specific and this effect should be confirmed about different strains. The objective was to determine if yogurt fortification with probiotic bacteria, Lactobillus acidophilus La-B5, Bifidobacterium lactis Bb-12 either alone or in combination with vitamin D can be a complementary treatment for vitamin D deficiency. The end-points were vitamin D, cardio metabolic lipid profile, anthropometric indices (weight, height, waist, hip, fat mass, lean body mass) and dietary intake. A 10-week parallel-group, double-blind, randomized and controlled trial was conducted on 140 obese men and women. The participants were randomly allocated to receive 100 grams either 1) plain low-fat yogurt or 2) probiotic yogurt or 3) vitamin D-fortified yogurt or 4) probiotic and vitamin D cofortified yogurt. All groups received low-calorie diet. Vitamin D increased significantly in group 4 (p = .008), group 3 (p = .001) and group 1 (p = .012 with no difference between groups. Vitamin D-fortified yogurt had the most effect size and showed a significant difference versus plain (p = .018) and probiotic yogurt (p = .002). Regarding lipid profile, there were no significant differences between groups. Data from this study does not support the hypothesis that yogurt fortified with probiotic bacteria, Lactobillus acidophilus La-5 and Bifidobacterium lactis Bb-12 either alone or in combination with vitamin D might impose any increasing effect on serum level of vitamin D in comparison with vitamin D-fortified yogurt.

Neo-adjuvant chemoradiotherapy; an opportunity in sphincter preserving procedure for rectal cancer.

AIM: The present study was designed to assess the impact of neo-adjuvant chemoradiotherapy on the possibility of utilizing sphincter preserving techniques in rectal cancer surgery. BACKGROUND: For both patients and surgeons anal sphincter preserving surgery serves as the ideal procedure to treat rectal cancer. PATIENTS AND METHODS: Patients with rectal cancer who were admitted to Shohadaye Tajrish hospital between 2001 and 2011 and underwent sphincter preserving or non-preserving surgery were identified. They were divided into those who had received neo-adjuvant chemo-radiotherapy prior to surgery and those who didn't, and the type of surgical procedure they underwent was compared between the two arms. Data regarding tumor pathology, tumor size and distance from anal verge before and after neo-adjuvant therapy, together with the duration of chemo-radiotherapy were also assessed. RESULTS: 103 patients with documented rectal cancer were included in our analysis. Among 47 patients who had not received neo-adjuvant therapy, 26 (55%) underwent APR while 15(32%) and 6(13%) patients were treated with LAR and VLAR respectively. Of the 56 patients who had gone through chemo-radiotherapy prior to surgery, 30 (53%) underwent APR while 14 (25%) and 10 (18%) patients were treated with LAR and VLAR respectively. 2 patients had unresectable tumor. Tumor staging before and after neo-adjuvant therapy showed a statistically significant difference (p=0.0001). CONCLUSION: Neo-adjuvant chemo-radiotherpy can decrease tumor size, increase the distance between the tumor and anal verge, and downgrade the staging. However, it does not necessarily increase the possibility of performing sphincter preserving surgery on patients suffering from low-lying tumors.

Ruptured aneurysm of the splenic artery: a rare cause of abdominal pain after blunt trauma.

INTRODUCTION: Splenic artery aneurysms (SAAs) are rare (0.2-10.4%); however, they are the most common form of visceral artery aneurysms. Splenic artery aneurysms are important to identify, because up to 25% of the cases are complicated by rupture. Post- rupture mortality rate is 25% -70% based on the underlying cause. Herein we present a young patient with abdominal pain after blunt abdominal trauma due to rupture of an SAA. CASE PRESENTATION: A 27-year-old male, without a remarkable medical history, who suffered from abdominal pain for 2 days after falling was admitted to the emergency department with hypovolemic shock. Upon performing emergency laparotomy a ruptured splenic artery aneurysm was found. CONCLUSIONS: It is important to consider rupture of a splenic artery aneurysm in patients with abdominal pain and hypovolemic shock.

Comparison of efficacy of side to side versus end to side arteriovenous fistulae formation in chronic renal failure as a permanent hemodialysis access.

BACKGROUND: In candidate patients for permanent hemodialysis or dialysis on a regular basis, an appropriate vascular access has great importance. The best permanent access is AVF (arterio venous fistula). Use of a technique to create AVF with better patency seems to be logical. OBJECTIVES: The present study aimed to compare the efficacy rate of AVFs using two different anastomosis methods; Side to Side (STS) versus End to Side (ETS) and to determine whether the different approaches render any preferences or complications. PATIENTS AND METHODS: Sixty end stage renal disease (ESRD) patients were included in this clinical trial in two assigned groups of 30 patients. In one group end to side method to create AVF was used while in the other group Side to Side technique was applied for access in surgery. Both groups were followed for duration of 6 months to assess patency. For evaluating the quantitive variables, t-test was used while qualitative variables were measured using the chi-square and Fisher`s exact tests. RESULTS: In the 6 months duration, 6 patients (20%) in the STS (side to side) group and 5 patients (16.6%) in the ETS (end to side) group experienced a non-functional AVF. In the ETS group the failure was generally a result of thrombosed access while in the STS group, 4 out of 6 patients with complications, experienced thrombosis while the other 2 patients had venous hypertension. The total failure rate was 18.3% and during the 6 months of follow up no significant difference was detected in the efficacy rate. Nevertheless, in case of longer follow ups, different outcomes could be seen. CONCLUSIONS: This study demonstrated that there was no significant statistical difference between the functional patency rates of fistulae placed by STS or ETS methods.

Effectiveness of aspirin on double lumen permanent catheter efficacy in ESRD.

BACKGROUND: The complications of vascular access are the most imperative etiology for hospitalization, morbidity and mortality in chronic hemodialysis. The most prevalent complication of central catheter is dysfunction due to thrombosis. Aspirin is an anti-aggregative platelet drug that may increase the patency of permanent catheters (perm-cath). OBJECTIVES: The aim of this study was to evaluate the role of Aspirin in perm-cath survival. PATIENTS AND METHODS: This study included a total of 185 ESRD cases according to the inclusion criteria for perm-cath insertion in hemodialysis. One hundred and eighty patients following perm-cath insertion had proper blood flow through perm-cath during hemodialysis. Patients were randomly divided between intervention (80 mg/day Aspirin initiated a day following catheter insertion) and control (placebo) groups. The average time that the perm-cath was functional was noted. Demographic characteristics included comorbidities and past history were also used to address probable influence on perm-cath function and patency. RESULTS: The mean survival time of the catheter in Aspirin group was significantly higher than the control group (5.3 ± 4.7 month versus 3.9 ± 2.7 month, P = 0.012). No significant difference in major complications of Aspirin use (such as GI bleeding) was noted between two groups (P = 0.52). In terms of the patient's demographic characteristics, those of the female gender and a history of diabetes mellitus were found to have significant influence on median survival rate of the catheters (P = 0.021, 0.043 respectively). CONCLUSIONS: These results suggest that Aspirin use following perm-cath insertion might be beneficial for catheter survival. This increased survival time might enable patient's use of AVF maturation for long term dialysis access.

Upper extremity axillary loop grafts: an opportunity in hemodialysis access.

BACKGROUND: Dialysis vascular access complications are considered as significant causes of morbidity in chronic hemodialysis patients. OBJECTIVES: The aim of the present study was a comparison of axillary loop and straight grafts patency and its complications in hemodialysis access. PATIENTS AND METHODS: In this cohort study conducted at Shahid Beheshti Medical University, 77 patients who underwent placement of loop or straight access grafts were included. Demographics, primary and secondary patency rates and complications like thrombosis, infection, bleeding, steal syndrome and other complications were compared in these two groups. The collected data was analyzed by chi-square test, t-test, and logistic regression. RESULTS: Primary patency rate in straight and loop groups after 1 month were 88.9% and 92.3% respectively (P = 0.721), and after 24 months were 31% and 55.5% respectively (P = 0.058). Secondary patency rate in straight and loop groups after 3 months were 75.6% and 92.3% respectively (P = 0.189), and after 24 months were 37.9% and 66.7% respectively (P = 0.044). The frequency of complications were the same among two methods of graft replacement and mal incidence of thrombosis, infection, delayed infection, pseudoaneurysm formation and steal syndrome occurrence ultimate graft failure and venous hypertension were not significantly different (P > 0.05). CONCLUSIONS: Polytetrafluorethylene (PTFE) vascular graft seems to be an appropriate vascular access and is a promising alternative when upper extremity arteriovenous fistulas cannot be constructed. Additionally, there was no significant difference between the two groups for complications and early patency, but late patency was improved in loop group. More study is necessary for a conclusive assessment.

A left paraduodenal hernia causing bowel obstruction: a case report.

A 41-year old mentally retarded patient presented acutely with a 3 day history of vomiting and absolute constipation. Intestinal obstruction was diagnosed following an abdominal x ray. At laparotomy, a left paraduodenal hernia was present, without incarceration of small bowel. The herniated loops were reduced and the hernia orifice closed. The anatomy, treatment and importance of considering this uncommon diagnosis when examining a patient with acute small bowel obstruction are discussed.

Perforated jejunal diverticula- a rare cause of acute abdominal pain: a case report.

Jejunal diverticula have a prevalence of approximately 1% in the general population. Perforation of jejunal diverticulum is a rare. Clinically this diagnosis may be easily confused with other causes of an acute abdomen. In the article, we discuss a 74-year-old man with a 2-day history of constipation and left-sided abdominal pain. The day before admission he developed an abrupt exacerbation his symptoms with pain localized to periumbilical and left lower quadrant. An abdominal computed tomography scan revealed soft tissue stranding within the left upper quadrant, bilateral plural effusions , larger on the left, an opacity with the right and left pulmonary lobes and polypoid lesion with in stomach. Physical examination revealed left upper quadrant fullness. An emergency laparotomy was carried out. This revealed multiple jejunal diverticula, one of which had perforated 40 centimeters distal to the ligament of Treitz.

A patient with cystic lymphangioma in pancreas.

Cystic lymphangioma of the pancreas is extremely rare, accounting for less than 1% of pancreatic tumors. Though congenital, it can affect all age groups. Cystic lympangioma occurs more frequently in females. Patients usually present with epigastric pain and an associated palpable epigastric mass. Complete excision is curative, even though, depending on the tumor location, surgery may be simple or involve extensive pancreatic resection and anastomoses. In this case report, we discuss a 63-year old patient who presented with epigastric pain and on investigation was found to have pancreatic head cystic lymphangioma. At surgery the tumor was completely excised, with preservation of pancreatic duct. Histology and immunohistochemistry confirmed cystic lymphangioma of the pancreas. This case highlights that a diagnosis of cystic lymphangioma of the pancreas should be taken into consideration as a differential diagnosis of pancreatic cystic lesions.

A study of contractility of proximal surgical margin in esophageal cancer.

BACKGROUND: The marginal length from main tumor in esophageal cancer is aconsiderable issue regarding surgical management and adjuvant treatment; so we decided to study the contractility effect on the proximal surgical margin after immersing it in10% buffered formalin as a fixative. METHODS: The proximal marginal length of ten sequential patients with esophageal cancer who underwent transhiatal esophagectomy were studied, on the operating table as fresh specimens, immediately after resection, and next 24, 48 and 72 hours after immersing in 10% buffered formalin. RESULTS: The contraction continued through the day 3, the mean contractility after one day was about 27%, after two days was 33% and after three days was 38%. CONCLUSION: This study shows how the proximal esophageal margin can vary by the time, after immersing in 10% buffered formalin and should be considered in every settings and reporting documents by pathologists.

Simultaneous gastric adenocarcinoma and gastrointestinal stromal tumor of the stomach: a case report.

Simultaneous a collision tumor of stomach consisting of adenocarcinoma and Gastrointestinal Stromal Tumor (GIST) is very rare based on our knowledge. This coexistence has rarely been reported in literatures. We report a case of 64-year-old woman who has diagnosed with prepyloric poorly-differentiated diffuse signet-ring cell type adenocarcinoma and has undergone an elective D2 total gastrectomy. During operation another mass in fundic body region has found. The pathologic examination of the mass has shown GIST. Immunohistochemical staining for CD117 and Desmin was positive whilst that for S100 was negative. This case reports the simultaneous two tumors development of different histotypes and natures in the same organ.

Peutz-Jeghers syndrome without mucocutaneous pigmentation: a case report.

Peutz-Jeghers syndrome is a rare condition characterized by mucocutaneous pigmentation, polyposis and an increased cancer risk at a number of gastrointestinal and extra intestinal organs. We present a patient with a history of gastrointestinal bleeding with no mucocutaneous pigmentation. Upper and lower gastrointestinal endoscopy revealed multiple polyps located in the deuodenum and colon. Histopathological evaluation of the polyps revealed hamartomatous polyps of Peutz-Jeghers syndrome.

Deep femoral artery branch pseudoaneurysm after orthopedic procedure requiring surgical treatment: a case report.

Pseudoaneurysms (PSA) of deep femoral artery (DFA) have been reported following penetrating and blunt trauma to the thigh and orthopedic procedures of the proximal femur. We describe a case of pseudoaneurysm of DFA as a late complication of limb trauma which was confirmed by exploration in an urgent surgery. After two operations successful surgical repair was performed.

Ligature versus transvenous endovenorrhaphy for closure of side-to-side arteriovenous fistula created for hemodialysis.

PURPOSE: To report a novel technique for arteriovenous fistula (AVF) closure in side-to-side fistulas. MATERIALS AND METHODS: One hundred and sixty-two patients with side-to-side AVFs, who were candidates for AVF closure, were randomly divided into two groups: group A (84 patients) who underwent AVF ligature and group B (78 patients) who underwent AVF closure using transvenous endovenorrhaphy technique. Both procedures were conducted by the same surgical team. The patients were followed up for 6 months. RESULTS: Of 124 patients with proximal AVFs, 65 (52%) subjects underwent ligation and 59 (42%) transvenous endovenorrhaphy. Of 38 patients with distal AVFs, half underwent ligation and for the remainder, transvenous endovenorrhaphy was done. Failure of AVF closure was detected in 28 (17%) patients; 25 (89.28%) were in group A and 3 (10.71%) were in group B. All of these recurrences were successfully treated by transvenous endovenorrhaphy technique. CONCLUSION: We claim that significant lower failure rate of transvenous endovenorrhaphy makes it the technique of choice, especially for side-to-side AVFs.

The Effect of Antiplatelet Drugs on the Patency Rate of Arterio-venous Fistulae in Hemodialysis Patients.

Although arterialovenous fistulae (AVF) is considered to be vital for chronic kidney disease (CKD) patients, but they may cause complications and problems. For instance they may fail soon after their creation. The most important cause of failure in these cases is intrafistula thrombus formation. Whereas anti-platelet drugs are not routinely used after fistulae creation, we conducted this study to determine the effect of these drugs (aspirin and dipyridamol) on the patency of AVFs. From Sep 2003 to Aug 2007, all CKD patients who needed AVF for hemodilysis were included in our study. After fistulae creation, they were randomly divided in 3 groups. The first group was received aspirin and the second one with dipyridamol and the third one was the control group that received placebo. Each group consisted of 130 patients. Exclusion criteria were bleeding tendency, active peptic ulcer disease, pregnancy, lactation, use of anticoagulant and or non steroidal anti-inflammatory drugs, hepatic insufficiency and history of significant side effects from aspirin or dipyridamol. The patency of AVF in the control, aspirin and dipyridamol groups were obtained 69.2%, 70.8% and 75.4% respectively. Although the patency in the aspirin and the dipyridamol group were 1.6% and 6.2% more than the control group, but there was no statistically significant difference between them and placebo (The p-value was 0.892 for the aspirin group and 0.332 for the dipyridamol group). Our study showed that neither the aspirin nor the dipyridamol can be effective on the patency of AVF after 72 h even within six months period.