Govaresh
Volume:13 Issue: 3, 2008

Esophageal cancer is one of the major malignancies around the world. It is the 8th high frequency cancer and the 6th leading cause of cancer death worldwide. The etiology of esophageal carcinoma is thought to be related to the exposure of smoking, alcohol, nitrate and low socioeconomic status. In this study, the status of oral health was evaluated in the population living in the north east of Iran.

45862 inhabitants of Gonbad and Kalaleh districts, aged 40-75 years, who had no esophageal cancer, were included in the study, which was part of Golestan Cohort. Oral health status and socioeconomic condition were evaluated by trained physicians.

19362 (42.2%) were male and 26490 (57.8%) were female (mean age was 52.1 ±9.1 years). The mean number of existent teeth, missed teeth, decayed teeth and filling teeth were 13.3 ± 9.4, 18.4 ± 9, 4.7 ± 6 and 0.23 ± 1.1 respectively. There were significant relationship between male, low socioeconomic status and low educational level with poor oral health status.

Oral health was poor among inhabitants of Gonbad and Kalaleh districts, especially in men and was related to low socioeconomic status and illiteracy.

Constipation is a common problemin elderly subjects. Probiotics have been suggested to improve intestinal motility and to reduce fecal enzyme activity. In this study, the effect of lactobacillus acidophilus tablets on elderly subjects was compared with placebo. Materials and Elderly subjects (n = 48) with chief complaint of constipation were enrolled in a randomly double-blind study. The subjects were divided into 2 groups: control group, receiving placebo every 8 hours for one month, and study group, receiving lactobacillus acidophilus tablet every 8 hours for onemonth. Subjectswith lactose intolerance and other pathologic conditions were omitted.At the end of 4 weeks, all subjects were questioned on the relief of constipation and other symptoms. Response to treatment and complications were compared between the two groups. In subjects receiving lactobacillus acidophilus, 50%(13 subjects) respondedwell and had relief of constipation, 23.1%(6 subjects) showed relative response and 26.9%(7 subjects) did not respond. In subjects receiving placebo, 40% (6 subjects) had relief of constipation, 13.3% (2 subjects) responded relatively well and in 46.7% (7 subjects) no responsewas seen (p=0.388).Newsignswere observed in 5 subjects (19.2%) receiving lactobacillus acidophilus and 1 subject (6.7%) receiving placebo.After 4 weeks, 2 subjects (7.7%) receiving lactobacillus acidophilus and 1 subject (6.7%) receiving placebo re-experienced constipation. Some relief of constipation could be observed with lactobacillus acidophilus tablets, but there was no significant difference between the two groups.

Cirrhosis is a pathologically defined entity associated with a spectrumof characteristicmanifestations.The cardinal pathologic features reflect irreversible chronic injury of the hepatic parenchyma and include extensive fibrosis in association with the formation of regenerative nodules.Autonomic dysfunction is a frequent and important complication of cirrhosis. The risk of mortality in cirrhotic patients with autonomic dysfunction is higher than that in cirrhotic patientswithout this complication.This study aimed to determine the frequency of autonomic cardiovascular dysfunction in cirrhotic patients.Materials andThirty cirrhotic patientswho admitted to Shahid SadoughiHospital and thirty healthy persons (control group, matched age and sex) inYazd from Dec 2005 to July 2006 were studied. In both group individuals with renal failure, heart failure and diabetesmellituswere excluded.Drugs that influence the autonomic nervous system were discontinued for 24 hours and then, 3standard autonomic function tests were carried out. Results fromtwo group were collected in a questionnaire and analyzed statistically. Of 30 patients, 24 (80%) were men and 6 (20%) were women. The mean age was 51.9+19.4 years and the mean duration of cirrhosis was 3.8 ± 2.7 years. Twenty-six patients (86.7%) had autonomic neuropathy. Twenty-four out of these twenty-six patients (80%) had parasympathetic dysfunction and two (6.7%) had combined sympathetic and parasympathetic neuropathy. None of themshowed sympathetic dysfunction alone. Four patients (13.3%) didnt have autonomic neuropathy.Therewas significant correlation between the frequency of autonomic neuropathy and the severity of cirrhosis (p‹0.001). Significant correlationwas seen between the frequency of autonomic dysfunction and the duration of cirrhosis (p‹0.01).Therewas no significant correlation between age, sex and the frequency of dysfunction neuropathy (p=0.118 and p=0.16, respectively).To assess the correlation between the etiology of cirrhosis and the prevalence of dysfunction neuropathy, a further prospective study involving a larger number of patients is necessary. More severe and prolonged hepatic failure was associated withmore frequent autonomic neuropathy in patients with cirrhosis.

Since variceal bleeding due to portal hypertension is associated with a high mortality rate, effective treatment leads to improved survival. Endoscopic sclerotherapy is an effective treatment for bleeding esophageal varices, but it is associated with significant complications. To determine the efficacy and safety of endoscopic sclerotherapy, we evaluated the patients with variceal bleeding who underwent sclerotherapy in our center. This study was a case-series study in which, we evaluated 79 patients who referred for esophageal variceal bleeding and underwent sclerotherapy and completed the questionnaire. From79 patients, 52 (65.8%) weremale, and 27 (34.2%) were female. The rate of success (arrest of acute bleeding by endoscopic sclerotherapy) was 100%, but it was 55.7%for long-termsclerotherapy; 53.3%of patients with liver disease, and 64.7%of patients with extraheaptic portal hypertension had suitable response; 58.3%of patients with ChildA, 83.3%of those with Child B and 14.3%of Child C cirrhotic patients demonstrated appropriate response. In fundal varices, 15.2% were improved, 21.5% were accelerated and 43.3% showed no significant changes. During treatment, 31.6%had one of the complications of sclerotherapy. The rates of rebleeding and mortality were 54.4% and 8.9%, respectively.Although sclerotherapy reduced themortality attributable to acute variceal bleeding, but the long-term effectiveness of sclerotherapy was not very high.

The present article is a brief presentation of various aspects of scientific misconduct in medical papers. The best approach for prevention of scientific misconduct in medical journals is the application of accepted codes of publication ethics.

Lipomas are rare gastric tumors that comprise less than 1% of gastric tumors. These tumors are usually without clinical manifestations, but sometimes they may present with severe symptoms like bleeding,intussusception, or abdominal pain. In endoscopic assessment, they manifest with subm ucosal masses with intact epithelium. Endosonography and CT scan can help in diagnosis. Surgical resection of the mass and pathologic examination confirm the diagnosis. This case report, presents a patient that referred with upper gastrointestinal bleeding (melena). Endoscopic examination revealed a submucosal mass with intact epithelium. Endosonography detected a mass with increased echogenicity that was suggestive of lipoma. The patient underwent a surgical operation for resection of the mass and the diagnosis of lipoma was confirmed by pathology. Although gastric lipomas are rare, they should be considered in evaluation and differential diagnosis of gastric bleeding due to submucosal masses. Endosonography can differentiate lipomas precisely before surgery among submucosal lesions.

Gastric bezoars are gastric masses, which rarely cause intestinal obstruction by passing through the small bowel. In this article, we report a 56 year-old man with no history of gastric surgery who presented with intestinal obstruction. The obstruction seemed to be in terminal ileum. Colonoscopy was done and a movable mass was noted, which was extracted from the cecum by colonoscope resulting in relieve of symptoms. Pathologic examination of the defecated mass led to diagnosis of phytobezoar.

Celiac disease (CD) may be misdiagnosed as Irritable Bowel Syndrome (IBS) resulting in long delays in diagnosing CD. There are contradictory reports on the association of CD with IBS.Appropriateness of screening all patients with IBS for CD and how to screen them are still under question. In a cross-sectional study, 328 IBS patients (Rome II) referred to the Poursina Hakim Gastroenterology Clinic were investigated for CD. Total serum anti-tissue transglutaminase IgA (anti-tTG IgA) concentration was measured in all patients. In IgA deficient cases, antigliadin antibody (AGA) IgG concentration was also measured. Moreover, in patients who underwent upper endoscopy (as their necessary workup) duodenal biopsies were taken. Fifty-eight patients were excluded. The remaining patients were 166 (61.5%) women and 104 (38.5%) men with the mean age of 35.3 years (SD = 11.8). No one had positive serological test of IgAantitTG antibody. Five patients were IgA deficient; none of them had positive IgG AGA. Duodenal biopsies were taken in 60 patients and pathologic evaluation showed 53Marsh 0, threeMarsh I, threeMarsh II, and one Marsh IIIa. Only the patient with Marsh IIIa adhered to gluten-free diet (GFD) which led to decrease in severity of symptoms. In patients who did not adhere to GFD, no one had positive serological test after 12 months of follow-up. Prevalence of CD in patients with IBS referred to outpatient gastroenterology clinic might be significant but serum anti-tTG IgAantibody is not helpful in detecting CD in these patients. Further studies are needed to clarify this issue.

Hydatid cyst is an infectious parasitic disease often caused by Echinococcus granulosus, or to a lesser extent by Echinococcus alveolaris. The liver is the organ most frequently involved. We report a case with hydatid cyst of the liver and lung that many years after surgery developed bronchobiliary fistula and biloptysis. The patient had been operated 2 times previously but yet the problem was present. Endoscopic retrograde cholangiopancreatography (ERCP) was used successfully for treatment.We present the result of ERCP and endoscopic sphincterotomy in the management of biliary hydatid disease. Bronchopleural fistula after hydatid cyst surgery could be cured by ERCP and sphincterotomy with or without stent insertion.