Govaresh
Volume:12 Issue: 1, 2007

Colorectal cancer is a common and lethal disease with various distribution of Incidence in different part of the world and it is known as the third most common cause of cancer death in the world. Since several studies in the world represented different survival rates for colorectal cancer in this study we aimed to determine the survival of a group of Iranian patients and some related factors retrospectively. We studied patients which were diagnosed pathologically as colorectal cancer referring to Shariati and Mehr hospital between 1374-1382 for surgical resection of tumor and all of them could be contacted by phone to get further information. 237 patients with colorectal cancer were studied. Male to female ratio was 1.25 and 11.8% of patients at the time of diagnosis were younger than 40 years old. Left colon involvement rather than right colon was three times more common and nearly half of patients were diagnosed at stage the of localized tumor. The overall one and five year's survival were 80% and 49% respectively, and had no difference in both sex (p›0.05).Patients with well differentiated tumor or with localized tumor had higher survival rate (respectively p‹0.05 and p=0.000). A significant lower 5 year survival rate was seen in patients with rectosigmoid involvement. according to our findings, 5 year survival rate in Iranian patients was lower than western countries and also we have the higher proportion of young colorectal cancer cases in Iran, so we need to plan regular screening program for finding patients and then follow and treat them extensively.

It is thought that the transmission of hepatitis B virus (HBV) through the endoscopic procedures is a very rare event. The aim of this study is to evaluate the effect of the standard disinfection procedure of the endoscopes and accessories versus conventional disinfection in the transmission of HBV. A prospective survey, comprising 520 consecutive upper gastrointestinal endoscopies was carried out simultaneously at three endoscopy centers in Iran, without altering the routine procedures. At center 1, the standard disinfection procedure (manual brushing of internal channel of the endoscope followed by 20 minutes exposure to 2% glutaraldehyde before the start of endoscopy sessions and at center 2, conventional disinfection (exposure of the endoscope to 2% glutaraldehyde for 4 minutes) was performed. Hepatitis B surface antigen (HBsAg) was tested for all patients; and a questionnaire was lfilled by the patients to obtain information regarding the risk factors for HBV infection. Six months later, HBsAg testing was repeated, and a new questionnaire about HBV risk factors was completed by the patients. A total of 520 patients (273 men and 247 women, Mean age 48.35 years) were enrolled. 311 patients in the standard disinfection groups and 209 patients in the conventional disinfection group underwent upper gastrointestinal endoscopy. 19 patients (10 in the conventional disinfection group, and 9 in the standard disinfection groups) were HBsAg positive (3.7%). On survey for the risk factors of HBV, 14 patients (73.7%) had a history of dental procedures, 2 (10.5%) had positive familial history of HBV, and 2 (10.5%) had a history of blood transfusion. Six months later, the patients were retested for HBsAg. Of those with negative HBsAg, one patient in the conventional disinfection group became HBsAg positive. The probability of transmission of HBV by the endoscope in the conventional disinfection system is very low. In order to document that standard disinfection is preferable over the conventional one, a very large multicenter study is needed.

Colorectal adenocarcinoma is one of the most prevalent and treatable malignancies of the gastrointestinal tract. Pattern of expression of the P53, P21, P16, E-cadherin and |β|-Catenin proteins are shown to be related to the prognosis of this malignancy. We aimed to compare the pattern of expression of these proteins in tumoral and nontumoral mucosal cells of cancer and on-cancer patients in relation to the histological prognostic factors.

2.5 millimeter cylindrical cores were punched out from selected tumoral and non-tumoral areas of the paraffin blocks of 58 colorectal cancer patients and colonic mucosa of 50 colons removed for other reasons. The samples were arrayed in paraffin blocks in groups of 30. Histological sections were evaluated for the expression of the target proteins by immunohistochemical techniques.

P53 was expressed more in tumoral than non-tumoral mucosal cells of the cancer and non-cancer patients (p‹0.001) and was related to vascular invasion (p=0.017). Expression of E-Cadherin was related to poor differentiation (p=0.023) and inversely to vascular invasion (p=0.025). Membranous expression of β-Catenin was inversely related to vascular invasion (p=0.049). Cytoplasmic and nuclear expression of this protein was more in tumor cells (p‹0.001). Also, the cytoplasmic expression of β-Catenin was inversely related to the stage (p=0.013) whereas nuclear expression was related to poor differentiation. (p=0.012). The pattern of expression of P21 and P16 were not found to have any relation with the histological prognostic factors.

It seems that the determination of the pattern of expression of P53, E-Cadherin and β-Catenin in colorectal adenocarcinoma, which is applicable on colonoscopic biopsies, could predict the biological aggressiveness of the tumor which might have therapeutic implications.

Residents of the northeastern region of Iran experience high mortality rates from esophageal squamous cell carcinoma (ESCC). One etiologic factor might be exposure to high levels of polycyclic aromatic hydrocarbons, including benzo(|α|)pyrene (BαP). We examined whether food or water are the major sources of BαP exposure in this population.

We used a dietary questionnaire to assess the daily intake of staple foods (rice and bread) and water in three groups: 40 ESCC cases living in the high-risk area of northeastern Iran, 40 controls from the same area, and 40 controls from low-risk area of southern Iran. We then measured, by high-performance liquid chromatography combined with fluorescence detection (HPLC-FL), the BαP concentration of bread, rice, water in 90 samples obtained from these three groups, and derived the daily intake of BαP by multiplying daily food or water intake by their BαP concentration.

Mean BαP concentration of staple foods and water was similar and within standard levels in both areas, but the daily intake of BαP was higher in controls from the high-risk area than in controls from the low-risk one (91.4 vs. 70.6 ng/day, p‹0.01), and remained significant after adjusting for living place (urban, rural) and indoor PAH sources including smoking, opium, heating and cooking fuel.

Although B‹P levels in staple food and water were not highly elevated, people who lived in the high-risk area may be more exposed to carcinogenic polycyclic aromatic hydrocarbons through their diet.

Hepatitis B virus (HBV) infection is the most common cause of end-stage liver disease in Iran. More than 70% of cases are negative for the hepatitis B e antigen (HBeAg) and have a long-term response to antiviral therapy, as well as a high relapse rate after discontinuing lamivudine or interferon. These features could be due, in part, to genetic variation of the HBV genome. HBV-DNA from serum of 110 patients with chronic hepatitis B, some of whom were complicated by cirrhosis and hepatocellular carcinoma (HCC) was sequenced for basal core promoter and precore region. Twenty four of 110 patients were performed for full genomic analysis. In the first part of study all twenty four strains were classified into subgenotype D1, with 99% bootstrap values. In second part of study we showed that the HBeAg negative patients had a higher frequency of mutations at core promoter regions than HBeAg-positive patients (76.8% vs 26.6%). The frequencies of A1762T and G1764A mutations increased while the frequency of G1757A decreased with advance clinical stage of liver disease (p‹0.001). The double core promoter mutations T1762 /A1764 associated with G1757 conferred significantly higher and more frequent in patients with cirrhosis and HCC. In Iran, all patients with chronic HBV, whether HBeAg positive or HBeAg negative, at the stage of cirrhosis and HCC were genotype D1. High frequency of mutations indicates the relation of antiviral pressure in Iranian population. The A1762T /G1764A double mutation of basal core promoter with A1757G polymorphism can major impacts on viral replication and severity of liver disease.

Foreign body ingestion especially in large sizes is seen in children and people with mental illness like mental retardation. The patient is a 19-year-old woman without mental illness. She swallowed one tooth-brush during tooth- brushing, which passed through the esophagus and went in to the stomach and stuck there. After primary endoscopy, was determined that tooth-brush was adult size and its sides had stuck in the stomach walls. The patient had no systemic symptoms as fever, tachycardia... and abdominal pain.The tooth-brush like ingested one was provided and after testing by snare was determined appropriate way to exit it, then the patient was endoscopied again. By endoscope, snare was put between brush spaces in suitable place, then was gone out. In the pharynx part regarding largeness brush curve, was demanded the patient to swallow her saliva. Tooth-brush was exited by hand successfully and without any complication.

One of the routine methods for diagnosis and treatment of cholelithiasis is endoscopic retrograde cholangiopancreatography. It is an effectivemethod but is associated with some complications (9.8%) which the most common is pancreatitis (5.4%). One of the rare complications is basketimpaction in the common bile duct which is treated with different methods. A 58 years male history of laparoscopic cholecystectomy was referred for endoscopic retrograde cholangiopancreatography. During the extraction of stones, the basket was impacted and the distal part was dissociated from the proximal part. Stent was placed in the common bileduct and with laparatomy and choleducotomy, bascket with stent and remained stone were extracted and choleducoduodenostomy was done.There are several suggested methods for basket removal; as stenting to relieve the obstruction and possibly allow for spontaneous passage of theimpacted stone and basket, endoscopic lithotripsy by percutaneous transhepatic approach, extracorporeal shockwaves to fragment an ampullary impaction, laparoscopic exploration, stone dissolution andsurgical intervention. Treatment must be tailored to the patient's clinical situation and condition, and the modalities that are accessible.