فهرست مطالب احمد خداداد

Colonoscopy is an invasive method that is painful for patient especially for children. The aim of this research was to investigate the effect of supermint oral drop (peppermint essence) on the patients’ pain and their satisfaction after colonoscopy. In a clinical trial study, 101 patients candidate for colonoscopy were randomly divided into two groups by convenience sampling. Control group did not receive any drug. Case group received oral drop of supermint 30 minutes before colonoscopy. A standard questionnaire was filled after colonoscopy for pain and satisfaction of the patients. Data were analyzed using SPSS software and t-test. Mean value of pain, duration of colonoscopy in control group was 2.500+0.527 and in case group was 1.625+0.491 (P<0.05). 8 % in control group and 17/6% in case group had high degree of satisfaction. Mean score of satisfaction in case group was 2.607+0.566 that was significantly compared to control group (1.833+0.389) (P<0.05(. The time of colonoscopy in case group was significantly lower than the control group (P<0.05). The results of this study showed that peppermint essence causes reduce pain and increase satisfaction in patients after the colonoscopy.

Background & Objetives: colonoscopy is an invasive method that is painful for patient especially for children. The objective of this research was investigation into the effect of supermint oral drop (peppermint essence) on the patient and colonoscopist group satisfaction during colonoscopy. In this clinical trial study, 101 children candidate colonoscopy (7-14 years old) in children’s medical center were randomly divided into two groups, case(n=51) and control(n=50) respectively. Control group received placebo and about half an hour before the colonoscopy control group case group was administrated 20 oral drops Supermint oil (peppermint oil). A standard questionnaire was filled after the colonoscopy for satisfaction of the patient and colonoscopist group. Data were analyzed using SPSS version 11.5 (T-test and Corraletion). Two percents in control group and 54.9% in case group have a great degree of satisfaction. Besides, degrees of satisfaction in case group was 64.7% that significantly difference with those of control group (2%) (p<0.05). Mean value of pain, duration of colonoscopy in control group was 5/60+1/85 and in case group was 4/20+1/70 and this difference was significant(p<0.05). The results of this study showed that drop Supermint oil on pain relief have a positive influence in during colonoscopy in children, so peppermint essence causes increase in satisfaction in both patient and colonoscopy group.

In diagnosing inflammatory bowel disease، one of diagnostic way is upper gastrointestinal endoscopy، which helps in differential diagnosis of unspecified colitis as well. The aim of this study was to investigate the necessity of upper gastrointestinal endoscopy in patients with inflammatory bowel disease. In this descriptive cross-sectional study، 30 children with definite diagnosis of Crohn''s disease and ulcerative colitis underwent upper endoscopy in Medical Center Hospital from October 2009 to March 2011 and the data were analyzed using SPSS software and T-test. Of 30 children with inflammatory bowel disease، 15 patients were diagnosed with Crohn''s disease and fifteen patients with ulcerative colitis. The present results demonstrated that esophageal، stomach، and duodenum involvements in patients were 93%، 87%، and 26%، respectively. Esophageal، stomach، and duodenum involvements with ulcerative colitis were observed in 80%، 66%، and 20% of patients، respectively. Patients’ involvements with Crohn''s disease were in esophageal (94%)، stomach (80%)، and duodenum (47%). Regarding the high percentage of upper gastrointestinal involvement in patients with inflammatory bowel disease، endoscopy and histopathological examinations seem necessary for all patients irrespective of the type and locality of involvement

One of the factors and tools necessary in managing roadside is rules and regulations without which, the area will face serious challenges in terms of the environment. Recognizing rules of roadside was investigated in the current research, since some perturbations and irregularities related to the ecosystem of roadside are the results of rules and regulations and also complex damages appeared in privacy of the roads due to incomprehensive rules with several executives. So in this research, qualitative research method and library studies are used in order to investigate and recognize legal rights present in privacy of roads. Also using targeted sampling method, 36 members of five villages were investigated in 5-person groups who were the residents of area near the road of Kouhikheyl to Behenmir. The total of the data were analyzed. The results showed that diversity of legislations, imposing legislations by various executives, lack of defining management system and exploiting privacy roadside vegetation, weakness of laws from the environment point of view are the most important challenges in the way of managing the mentioned area. Also sheep grazing without authorization and 8-percent portion of privacy road vegetation in providing local livestock forages indicate lack of supervision of organizations which finally leads to unlimited exploitation in roadside ecosystem.

The current immunosuppressive treatment of patients with autoimmune hepatitis (AIH) consists of prednisolone and azathioprine. High doses of prednisolone used for disease remission are not universally effective and have serious adverse effects. Some authors have provided evidence of AIH therapy in children and adults with cyclosporine (Neoral) should corticosteroid therapy become ineffective. Preliminary results using cyclosporine in a small group of patients have shown that this drug appears to be a good substitute for corticosteroids. We performed this study to assess the efficacy and safety of cyclosporine in induction of remission in children with AIH. This was a case series, interventional clinical trial that involved children with AIH. twelve children with a median age of 9 years, 3 months who were diagnosed according to international criteria as having definite AIH were recruited. Cyclosporine alone was administered at a dosage of 3.5-5 mg/kg in 3 daily doses for 5 months, followed by low dose prednisolone (0.3 mg/kg/d) for one month, then followed by combined low doses of prednisolone and azathioprine (1.5 mg/kg/d in two doses). Patients discontinued cyclosporine after seven months. Biochemical remission of the disease was established by assessment of serum transaminase activity levels. Growth parameters that included Z-scores for height and weight, and adverse effects of the treatment were recorded. Of the 10 remaining patients, 7 had normalized alanine aminotransferase (ALT) activity levels by 4 months and all patients had normalized ALT levels by 9 months of treatment. Adverse effects of cyclosporine were mild and disappeared during weaning off the medication. Cyclosporine induced biochemical remission of the hepati inflammatory/necrotic process in children with AIH. There were few, well-tolerated adverse effects. Longer follow-up of patients is necessary to establish possible long-term toxicity of cyclosporine.

Constipation is one of the most common reasons a child is referred to a pediatric gastroenterologist. In the vast majority no structural, endocrine, or metabolic etiology is identified and constipation called functional or idiopathic. The aim of this study was to evaluate the role of anorectal monometry in differentiating functional constipation from Hirschprung’s disease in children. This cross sectional study was performed on 69 children aged 6 months– 13 years with chronic constipation, who didn’t response after suitable therapy during one year in children’s Hospital Medical Center. All of children underwent un-prepared contrast enema, considering: transition-zone, retained contrast after 24hr and abnormality of rectal diameter. Rectal biopsy was performed in patients with negative RAIR and suspected to hirschsprung’s disease, and data was analyzed. Sixty nine children with age range 6 months- 13 years (mean age of 53.1±14 months) including 37 girls (53.62%) and 32 boys (46.38%) were studied. Rectoanal inhibitory reflex (RAIR) was present in 54 of the 69 patients (78.26%), and 15 cases (21.73%) with a negative (RAIR), underwent rectal biopsy. In which showed absence of the ganglion cells and intestinal neuronal dysplasia in 13 cases, that was compatible with Hirschsprung’s disease. Rectal manometry was again performed for 2 remained patients who had shown to have normal ganglion cell in their last rectal biopsy, and normal RIAR was determined. Sensitivity, specificity, positive and negative predictive value of the manometric test for diagnosis of Hirschprung’s diseases were 100%, 96%, 88% and 100%, respectively. The results of this study showed that anorectal manometry is the suitable method for diagnosis of functional constipation from Hirschprung’s disease in children. Rectal manometry is recommended before rectal biopsy for all children with refractory chronic constipation who are suspected to have Hirschsprung’s disease.

Allgrove syndrome also known as triple-A syndrome is an autosomal recessive disorder characterized by alacremia, achalasia and ACTH-resistant adrenal insufciency. Although this syndrome is rare, herein we report four cases with different clinical manifestations. They were referred to the gastrointestinal ward during a one year period with complaints of vomiting and dysphagia. The diagnosis of triple-A syndrome was conrmed after careful evaluations for vomiting.

Cystic fibrosis is an inheritant autosomal recessive disease. It is associated with mutations in Cystic Fibrosis Trans Regulator gene (CFTR) and has different presentations.We report two 2 month old female patients, products of a twin delivery presented with anemia, edema, hypoalbuminemia and pneumonia.After some work ups, diagnosis of cystic fibrosis was confirmed. This is an uncommon and interesting presentation of cystic fibrosis, which occurred simultaneously in one twin.

Lower gastrointestinal bleeding (LGIB) in children has many different etiologies and is a serious problem that warrants careful diagnostic work-up.164 colonoscopies were done during one year for determining the etiologies of LGIB in children who was referred to Children's Medical Center Hospital. Analyses of results were based on age, sex, etiology and clinical presentations.of 164 colonoscopies, 34.7% of LGBI were due to polyps which was the most common etiology. Lymphoid nodular hyperplasia (LNH) had a prevalence of 22.5%; in 15.8% of patients, colonoscopic findings were normal. The peak age group of polyps was 4-6 yr; for LNH, it was 1 yr.LNH is more common than polyps in patients presenting with LGIB younger than 3 yrs. In older children, however, polyps are the major cause. Therefore, the diagnostic approach and the need for colonoscopy are different in these two age groups.

Inflammatory bowel disease (IBD) may begin as early as the first year of life. The objective of the present study was to determine the characteristics and clinical course of children with early-onset IBD.The records of patients with IBD admitted to Children Medical Center Hospital during 2003-2006 were screened for those with disease onset before the first year of life and who had a follow-up of at least 2 years.12 patients (8 boys, 4 girls) were identified. 9 had Crohn's disease. All of the patients had colitis. One of parents had IBD in 9 patients; 2 had a positive family history for IBD. 7 patientshad weaned of breast fed when the gastrointestinal symptoms started. 10 patients had a severe onset of disease requiring total parenteral nutrition, and steroid followed by azathioprine. 3 patients with Crohn's disease needed surgery; another 3 with Crohn's disease died during the study. Of those with ulcerative colitis, one is in complete remission.The prevalence of inflammatory bowel disease in infancy is unknown, but appears to be increasing. The course of the disease seems more severe.

Caustic ingestion can result in severe gastrointestinal tract burns and important complications such as esophageal stricture. early diagnostic endoscopy is usually recommended routinely in all children after caustic ingestion. The aim of this study was to determine the predictive value of clinical symptoms and ingested material types and quantity as markers of severe esophagogastric lesions and eventual complications. 72 children were admitted after accidental caustic ingestion. The clinical symptoms; ingested product type and quantities, endoscopic data and outcome were prospectively analyzed. 36 patients had no symptoms (group B), others presented with one or more early symptoms (vomiting, hematemesis, drooling, respiratory distress) and/or oropharyngeal burns (group A). In group A, stronger substances were ingested in higher quantities. In group B, 23 patients ingested ‹20cc and 13 patients |"|20cc and in group A, one patient ‹20cc and 35 patients ingested |"|20cc. The proportion between patients who ingested ›20cc was 2.7 more in group A to B (35/13=2.7). In group A the relationship between the amount of the caustic agent and degree of GI damage was pvalue=0.036, but it was pvalue=0.492 in group B. Severe GI injuries in endosocpy were seen in 32 cases (77.8%), and 17 of them developed complications (47.2%). 3 patients had esophageal perforation in acute phase, in one case of them perforation was in both esophageal and gastric. 17 patients had stenosis (16 cases had esophageal stenosis and one case was associated with gastric inlet obstruction and in another one with esophago-pleural fistula) and one case had gastric outlet obstruction. In group B no severe burn and complication were seen. Between substance property and quantity, early symptoms with GI burn and complication was coherence (p‹0.05). In conclusion, diagnostic endoscopy is not necessary in asymptomatic children after accidental caustic ingestion.

We aimed to determine the frequency of liver copper storage diseases in Iranian children with cryptogenic chronic liver disease (CLD). One-hundred and twenty children (52 girls, 70 boys; age range: 3 months-14 years) with CLD who attended Children's Medical Center in Tehran, Iran during the years 1997 through 1999, were enrolled. All viral, metabolic and autoimmune causes of CLD were excluded in them, all underwent slit lamp examination for KF ring by an experienced ophthalmologist, and liver biopsy done on all of them. In addition to the routine histopathologic examination, the liver biopsy specimen was checked for its copper content with proton-induced X-ray method (PIX-E). Eight (6.6%, 4 girls, 4 boys, age: 6 to 14 years) of the 122 children with CLD had no identifiable cause despite extensive evaluation. All 8 had cirrhosis on liver biopsy and elevated hepatic copper content (mean 31 times normal). None had KF rings and all had normal serum Ceruloplasmin levels. NICC was diagnosed for all by the absence of KF ring, normal serum ceruloplasmin levels and pathognomic histopathologic findings. Mean hepatic Cu level showed a 7-fold increase in children with CLD other than NICC. Mean serum ceruloplasmin level was 45 mg/dl in NICC and 31 mg/dl in CLD patients. Mean 24-hour urinary Cu excretion was 225 mg and 76 mg in NICC and CLD patients, respectively. All patients with NICC (n=8) had the history of using cooking utensils made of copper. Four of these were from one family. According to our data 6.6% of Iranian children with CLD who diagnosed as cryptogenic cirrhosis suffer from NICC, Therefore early diagnosis and appropriate treatment with D-Penicillamin are important for survival in patients with NICC. Hence it is suggested that all children with cryptogenic cirrhosis be assessed for NICC.

To study the effect of oral garlic on arterial oxygen pressure in children with hepatopulmonary syndrome. Garlic powder in a capsule form was given to 15 children with hepatopulmonary syndrome (confirmed by contrast echocardiography) at the dosage of 1 g/1.73 m2 per day. Patients were evaluated clinically and by arterial blood gas every four weeks. The garlic capsule was administered to 15 patients with hepatopulmonary syndrome. There were 10 boys and 5 girls with a mean age of 9.4 ± 3.9 years. The underlying problems were biliary tract atresia (4 patients), autoimmune hepatitis (4 patients), cryptogenic cirrhosis (4 patients) and presinusoidal portal hypertension (3 patients). Eight patients (53.3%) showed an increase of 10 mmHg in their mean arterial oxygen pressure. The baseline PaO2 was 65.6 ± 12.1 mmHg in the responder group and 47.1 ± 11.2 mmHg in non-responder group. At the end of treatment the mean PaO2 in responders and non-responders was 92.2 ± 7.75 mmHg and 47.5 ± 11.87 mmHg, respectively (P ‹ 0.01). Garlic may increase oxygenation and improve dyspnea in children with hepatopulmonary syndrome.

There are only a very small number of reports which discuss subtype, sex distribution, clinical features and laboratory characteristics of autoimmune hepatitis in children. The aim of this study was both to define the clinical features, biochemical and histological findings and also to determine the age and sex related distribution of autoimmune hepatitis (AIH). Data of 30 children presenting with AIH (20 girls and 10 boys) have been analyzed for their clinical, serological, and histological profile. The most common presenting signs or symptoms were jaundice (60%), abdominal mass (23.4%) and constitutional symptoms (weakness, anorexia and paleness) (6.7%). About 10% of patients had an acute hepatitis like clinical presentation. Twenty two children (73.3%) (15 girls, 7 boys, 2.1:1) had AIH type 1 and 4 patients (13.3%) type 2 due to specific autoantibodies. Four children could not be classified. In liver biopsy, 100% of patients had interface hepatitis and fibrosis with or without cirrhosis were found in 60%.In our cohort the prevalence of AIH was 2:1 in girls. Type 1 was the most frequent diagnosis (73.3%) and was more prevalent in older children. Patients with type 2 were younger. The clinical presentation of AIH in children was unspecific and each type could only be differentiated by the determination of the specific autoantibodies.

Achalasia, a Neurologic disease, causes incomplete relaxation of lower esophageal sphincter (LES) and aperistalsism of esophagus. There are several methods of treatment including: medical, botolinum injection, Balloon dilatation and surgery. In adults, balloon dilation is well recognized for the first line treatment, whereas in children there are several but limited studies that elucidate its efficacy in this group too, and several validate centers use it for the first line treatment, in pediatric achalasia. Yet, we aimed to evaluate the success rate of balloon dilatation for the treatment of pediatric achalasia in Iran and have a base line study in our country. twenty - five pediatric patients (12 boys, 13 girls) from 4.5 months to 14 yrs old with average (9.25 ± 4.61 yrs) in two hospitals affiliated to Tehran Medical University, treated with balloon dilation appropriate with age (TTS or achalasia specific balloon rigiftex) under direct vision endoscopy from 1997-2003. These patients undergo follow up after one, two, and then every six month with average 36. 7 months. If any recurrence of symptoms occured, with greater size balloon treatment were done. Improvement for children over 5 yrs old include: sum of symptom score after treatment to pre- treatment lower than 50% and the reccurrence upper than 50%. For achalasia under 5 yrs old improvement include: no vomiting, improvement of relaxation of LES and normal movement of it with breathing and no esophageal inflammation on endoscopy. All patients during treatment and 6 hours later were under direct controlling for any side effects (bleeding, perforation, etc). In this study any child with previous surgery on esophagus were excluded. In this study 39 dilation for 25 patients were done (1.56 for every patient). About 48% (12 patient) one, 48% (12 patient) two, and one patient undergo three dilation. One patient (4%) after two dilation had symptoms of achalasia and suffered from it, but because of refusal from third one, accepted as treatment failure and referred for surgery. Five pediatric patients were under 5 yrs old, that all of them (100%) improved after treatment and did not have any problem until our follow up. Over all 96% of patients respond to balloon dilation treatment that with respect to vantrappen table: 64% excellent, 8% good and 24% had moderate response. During our study there were no serious side effects. Balloon dilatation for treatment of pediatric achalasia is very effective and safe and can repeat for several times under direct endoscopy.