hasan salmanroghani

Duodenal diverticula are pouches of the mucosa, submucosa, and scattered muscle cells that extend through the intestinal wall. In this study, we aimed to classify the papilla position according to presence of PAD and evaluate the impact of papilla position on the success rate and post ERCP complication in the patients with PAD.

This cross-sectional study was performed on 1260 patients with bile duct problems underwent ERCP. Patients with diverticulum were considered as the first group and the patients without diverticulum as the second group. In this study, SPSS Version 18 software, Chi-square and Students T-test were used, respectively.

239 patients had peripheral diverticula. The mean age of participants was 68.9±10.3. In 239 patients with diverticulum Type 1=48.2%, Type 2 =37.6%, Type 3 =5.1%, Type 4 =9.1% the success rate in Type 1 was 97% (p-value: 0.003). In the patients with type 3, the cannulation was difficult and had a low success rate, with more complications.

Classification of PAD can predict success rate in the patients with PDA, and can predict post ERCP complication rates.

Most common causes of lower gastrointestinal bleeding (LGIB) in young patients are benign perianal lesions, but serious colorectal disease may be underlying etiology in this group. The aim of this study was identification of LGIB etiologies in the patients under 40 years old.
Materials: In this retrospective descriptive study, which has been done during 2012-2013, 333 young patients (less than 40 years old) with lower GIB referred to Endoscopy Ward of Yazd Shahid Sadoughi Hospital assessed by colonoscopy with or without histopathology.
Resultus: In this study, 57% of patients were males. Majority of them were between 30-40 years old. The most common presentation was hematochezia (49%) and the most common cause was internal hemorrhoid (17%). Other causes included: inflammatory bowel disease (15%), polyp (9%), infectious colitis (8%), anal fissure (6%), colon cancer (4%), solitary rectal ulcer (4%), vascular lesion (2%), aphtus lesion (1.1%), diverticulosis (0.6%) ,anal tuberculosis (0.3%) and normal colon (33%).
Considerable number of our cases had inflammatory bowel disease and malignancy. Seven patients had serious disease and simple anal disease simultaneously.
Significant portion of LGIB in the patients less than 40 years old are due to serious colorectal disease. So, careful approach and appropriate timing for colonoscopy is recommended.

Providing ways for long-term feeding is essential for those who are not able to ingest. Percutaneous endoscopic gastrostomy (PEG) is a type of enteral feeding methods. The aim of this study was to evaluate the complications, indications, and one-year survival of this method in patients who underwent PEG.
The cross-sectional study was carried out on 97 patients (census sampling) who had referred to Shahid Sadoughi Hospital in Yazd (Iran) for PEG tube placement in the period of March 2014 to March 2016. Data were collected using a researcher-made questionnaire and were analyzed using SPSS software version 18.
Cerebrovascular accident (CVA) was the most reason to refer to the hospital (52 cases, [%53.6]) followed by head and neck trauma (32 cases [33%]), head and neck tumors (6 cases, [6.2%]), ischemic encephalopathy (5 cases, [5.2%]), and burning (head trauma) (2 cases [1.2%]). Wound infection was observed in eight cases (8.2%), aspiration in three cases (1.3%), bleeding in three cases (3.1%), external leakage in two cases (2.1%), unplanned removal in two cases (2.1%), subcutaneous abscess in one patient (1%), and recurrent vomiting in one patient (1%). One year survival was measured 83.5%.
PEG tube is a very convenient feeding method. Its complications are limited compared with its benefits and it is useful for patients who have trouble in ingestion for a long time. Early discharge from the hospital, especially the intensive care units, reduces costs and length of hospital stay.

Definite treatment of pancreatic adenocarcinoma is surgical resection. Absence of early symptoms in most patients leads to late diagnosis and treatment. This study aims to evaluate resectability of the pancreatic adenocarcinoma at the time of the diagnosis in Iran.

The present study which is of a descriptive, prospective and case series nature, has been studying the resectability of the pancreatic adenocarcinoma by multi-detector computerized tomography, endoscopic ultrasonography, laparoscopy and/or laparotomy in 157 patients for the duration of 2 years since November 2009.

A total of 157 patients were enrolled in this study. Majority of them (68%) were male. The mean age was 67 years. Final diagnosis obtained 1-12 (2.7 ± 1.6) months after beginning of the symptoms. The lesion situated in the head of the pancreas in 127 cases (81%). Vascular invasion, lymphadenopathy, liver metastasis and peritoneal involvement were seen in 88%, 57%, 43% and 19% of the patients, respectively. According to imaging, tumor was resectable in 10 (6%) patients but laparoscopy and/or laparotomy revealed that only five cases (3%) were actually resectable. After 24 months, only 8 patients were alive; 5 cases of them had been treated by Whipple surgery and other 3 cases were under the chemotherapy. At 1 and 2 year survival rate of the patients was 11% and 5%, respectively.

Majority (97%) of the pancreatic adenocarcinomas are unresectable at the time of diagnosis. Thus, meticulous preoperative assessment of patients is essential in patients to avoid major surgery in unresectable cases.

Hepatitis C virus (HCV) is a major cause of liver disease. Infection with HCV is a global public health problem. The virus is classified into 6 genotypes and more than 80 subtypes named as a, b, c, etc. HCV genotyping has been an important parameter for the treatment of HCV infection.. The main aim of this study was to estimate the prevalence of HCV genotypes in Yazd, central province of Iran. In addition, the study investigated whether there was any association between HCV load and genotypes..Patients and This descriptive cross-sectional study was performed on samples suspicious of HCV infection from March 2010 to June 2013. Peripheral blood sample was obtained and screened for anti-HCV antibodies using Enzyme-Linked Immunosorbent Assay (ELISA). Then sera of anti-HCV positive samples were analyzed using quantitative polymerase chain reaction method. Plasma samples were used to determine the HCV genotypes of 1a, 1b, 2, 3, and 4 in 191 infected patients.. One hundred fifty-two out of 191 (79.6%) samples were from male patients. The mean of the patients’ age was 40.7 ± 11.9 years (range 21-75 years old). Sixty- three (33%) patients were included in 31-40 years group. The mean number of HCV in infected patients was 2.92 × 106 ± 1.85 × 106 copies/mL (Min: 508; Max: 2.75 × 108 copies/mL). HCV genotype 3 was the predominant genotype (50.3%) followed by subtypes 1a (38.7%) and 1b (6.8%). The distribution of other HCV genotypes showed genotype 2 in 1.6% and mixed genotypes in 2.6% of positive samples. Genotype 3 was predominant in all age groups except 21-30 years of age group. We were unable to find any significant difference between mean viral load of the patients infected with genotype 3 and those infected with genotype 1 (1a and 1b).. Findings of the present study showed that HCV genotype 3 was the predominant genotype followed by the subtypes 1a and 1b in Yazd, central province of Iran. In addition, there was no difference between HCV load and genotypes 1 and 3. HCV genotyping is recommended in other provinces of Iran..

Iran is an endemic region for hydatid disease. Primary pancreatic hydatosis is a rare event; severe acute pancreatitis related to pancreatic hydatid cyst is extremely rare. We present the case of a patient with severe acute pancreatitis and hydatosis of the pancreas without liver or lung involvement. All etiologies for acute pancreatitis were excluded. The patient underwent a distal pancreatectomy which led to the diagnosis of pancreatic hydatosis. Since hydatid disease is endemic in some regions, it should be considered as one of the underlying etiologies for inflammation or infection of the pancreas (acute pancreatitis).

There is a relationship between specific genotypes of Helicobacter pylori cagA and vacA genes and the increased risk of peptic ulcer diseases and gastric cancer. These genes also possess strong patterns of geographical differentiation. The present study aims to determine the patterns of variation of the virulence genes in Iran and their association with clinical status.Sequence fragments for cagA and vacA were obtained from a total of 147 H. pylori isolates from diverse geographical and ethnic sources within Iran. We used phylogenetic methods to determine the patterns of allelic diversity, and the relationship between evolutionary lineages and clinical status.Phylogenetic analyses of Iranian cagA gene disclosed four lineages, whereas the vacA gene had two distinct lineages. The cagA lineage II showed extensive genetic diversity compared with lineage I. cagA lineages III and IV disclosed mixed ancestries with recombinant nucleotides that originated from lineages I and II. Iranian strains with vacA lineage II genotype were significantly cagA+ (> 90%, p = 0.0) and correlated with a higher rate of peptic ulcers in infected individuals (p =0.003). Most strains in the cagA lineage I showed a vacA lineage II genotype (p = 0.003) and significantly correlated with an increased risk of peptic ulcers in infected individuals (p = 0.022). Strains with cagA lineage III genotype significantly correlated with gastritis (p = 0.0).The increased level of allelic diversity in the virulence genes shows strong evolutionary dynamics, resulting in the emergence of new clonal genealogies of the cagA gene within Iran. Particular lineages of the Iranian cagA and vacA genes correlate with peptic ulcer diseases.

The frequency of sonographic report of liver fat infiltration in asymptomatic person is increasing. The aim of this study was evaluation of liver function and detection of frequency of metabolic syndrome and Insulin resistance in asymptomatic persons with fatty liver in sonographic examinations. Seventy six patients with fatty liver in sonographic examination and 78 persons with normal sonographic examination who had similar sex, age and body weight were selected. Patients with history of diabetes mellitus, hyperlipidemia, hypertension who took drugs that induced fatty liver such as amiodaron, diltiazem, metotrexate, tamoxifen and patients with positiveserology for HBS-Ag and HCV-Ab were excluded. Blood pressure, BMI, weight, height, liverenzymes, blood lipids, and fasting insulin level and insulin resistance according to HOMAindex were evaluated. Mean age was 44.8±9.79 and 42.54±10.7 years for fatty liver patients and normal persons, respectively. Mean systolic and diastolic blood pressures, weight, height, HDL triglyceride, FBS, ALT, 2-hour postprandial glucose level, fasting insulin level and insulin resistancewere significantly higher in fatty liver patients compared with normal persons Fifty percent of fatty liver patients but only %18 of normal persons had metabolic syndrome criteria. Insulin resistance andmetabolic syndrome are very common in fatty liver persons. It seems that fatty liver is one of the criteria of metabolic syndrome.Patients with fatty liver in sonographic examination should be further evaluated for metabolic syndrome and insulin resistance.