مهدی پزشکی مدرس

The duodenum is the second most commonly occurring diverticulum in the gastrointestinal tract. Though, the diverticulum can induce various complications, no logical screening has been provided for them so far. In this study, the relative prevalence of duodenal diverticulum and their association with bile ducts in patients with pancreatic biliary disease were studied.
This cross-sectional study was performed on 310 patients who underwent ERCP for various reasons. The presence or absence of duodenal diverticulum and complications were also evaluated.
Of 310 patients, 62 (20%) had duodenal diverticulum and the frequency of diverticulum in the order of prevalence was: type B (39%), type D (26%), type A (21%) and type C (14%). The prevalence of the biliary stones in diverticulum group was significantly higher. The biliary duct stenosis was lower in the group with diverticulum and the mean age was significantly higher. There was no significant difference between the two sexes.
The results of this study showed that the prevalence of duodenal diverticulum in patients who underwent ERCP in gasteroenterology and Hepatology Diseases Center of Qom University of Medical Sciences was higher than the previous studies. There was a significant difference in the incidence of duodenal diverticulum among different age groups. It seems that the diverticulum increase the risk of biliary stones and reduce bile duct stenosis.

Common bile duct (CBD) stones exist among %12 of patients with cholelithiasis. They may result in some complications including pancreatitis and cholangitis. The common therapeutical method is endoscopic sphincterotomy during ERCP(Endoscopic Retrograde Cholangio-Pancreatography) and stones removal. This method does not have a reasonable success rate for stones with a diameter larger than 15 mm and may cause serious complications. The aim of this study was to evaluate the CBD stenting method in the treatment of large CBD stones.
This study was performed on 32 patients who presented to the ERCP unit of Shahid Beheshti hospital in Qom with large CBD stones. Success rate in CBD clearing and rate of some complications including rupture of CBD, pancreatitis, and cholangitis were evaluated after the first ERCP for stent replacement, and the second for its removal.
The success rate in complete CBD clearing was %93.8. A reduction in size and number of stones was seen during a 2-month period, which was statistically significant. No case of CBD rupture and cholangitis was detected and the incidence of pancreatitis was %18.8.
CBD stenting method has a reasonable success rate. It can reduce the size and number of CBD stones significantly.

Pseudomembranous colitis is an advanced form of infection with clostridium difficile, which damage epithelial cells following colonization in the intestine and production of toxins A and B. Diarrhea is the most common clinical manifestation caused by C. difficile, which in these cases, blood is never observed macroscopically in the stool. Antibiotic exposure is the main risk factor for this infection and is especially associated with ampicillin, clindamycine, and 2nd and 3rd generation cephalosporins, such as ceftriaxone, cefotaxime, and ceftazidime. To confirm the diagnosis of infection, assessment of the microorganism toxins in the stool by PCR as well as observation of pseudomembrane in colonoscopy, was performed. In this article, a case of an old patient with diarrhea (pseudomembranous colitis) was presented in this article.
Case Report: The patient is an 85-year-old man with signs of weakness, fatigue, fever and chills, and non-productive cough and diagnosis of pneumonia underwent antibiotic therapy, and in the course of treatment, he demonstrated massive watery diarrhea. Laboratory colonoscopy findings was indicative of infection with C. difficile.

Hepatocellular carcinoma (HCC) is a primary liver cancer that frequently causes mortalities. Transarterial chemoembolization (TACE) is a new palliative treatment for advanced stages of HCC. In this study, we have assessed the results of TACE on a group of Iranian patients with advanced HCC treated at Imam Khomeini General Hospital.This was a case series, cohort study conducted on 36 patients with HCC who met the study criteria. Patients underwent two sessions of TACE at a 4-6 week interval. All patients underwent triphasic computerized scans (CT scan) before treatment and at six weeks after the second session.After at least a one year follow up period, 20 (55.6%) patients died and 16 (41.7%) survived. Survival at 6 months was 58% and at 12 months, it was 33.3%. Post-TACE tumor necrosis (>50%) was significantly associated with 6 (p= 0.029) and 12 (p= 0.00) month survival. There was a significant association between 6 and 12 month survival and Okuda stage (p-V= 0.001 and 0.003), ascites (p-V = 0.058 and 0.012) and branch portal vein thrombosis (p-V= 0. 036 and 0.024). There was no association of WHO criteria to 6 (p-V = 0.139) and 12 (p-V =0.139) month survival.Tumor necrosis less than 50%, presence of ascites and thrombosis of the portal branches are associated with lower survival. Suitable selection and taking into consideration post-TACE tumor necrosis is suggested to enhance survival.