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BACKGROUND A dramatic rise in the rate of clostridium difficile infection (CDI) in patients with inflammatory bowel disease (IBD) has been reported in recent years. METHODS In this observational case control study, 65 patients were included and were divided into two groups of IBD + CDI as case group and IBD without CDI as control group. RESULTS 35 patients who had positive test for clostridium difficile were assigned to the case group. The control group consisted of 30 patients with negative test for clostridium difficile. Pancolitis was seen in the cases more statistically significant than the controls and proctitis was seen more among the controls than the cases (p = 0.001). The cases were on immunosuppressive (p = 0.001) and antibiotic (p = 0.02) therapy more than the controls. Colonoscopic findings revealed more severe and extensive inflammation among the cases versus milder inflammation among the controls, but these differences were not statistically significant (p = 0.2). Colectomy was seen in 10% of controls and none of the cases and this difference was statistically significant (p value = 0.05). More fecal calprotectin were seen among the cases than the controls and this difference was statistically significant (p < 0.05) CONCLUSION This study showed more clostridium difficile infection among the patients on antibiotic or immunosuppressive therapy. Pathological investigation revealed more severe and extensive in- flammation among the cases than the controls. Cases had clinically more severe signs and symptoms with higher mayo scores than the controls. ESR (Erythrocyte sedimentation rate) and fecal calprotectin were higher in patients with positive clostridium difficile infection and serum albumin was lower in such patients. [ABSTRACT FROM AUTHOR]

Upper gastrointestinal bleeding (UGIB) is a common medical condition that presents with hematemesis (vomiting of blood or coffee ground -like material) and/or melena (black, tarry stools). Gastroduodenal ulcer disease, erosive esophagitis, esophagogastric varices, and erosive gastritis/duodenitis account for most of the cases. Ectopic varices are varices develop at sites other than the esophagus and stomach for example duodenal, rectal, and peristomal varices. Ectopic varices are relatively rare; however, approximately 5% are related to gastrointestinal bleeding. Duodenal variceal bleeding is a rare cause of gastrointestinal bleeding. Here we report a case of UGIB due to duodenal varices in a 44-year-old woman who admitted to the hospital because of melena, nausea, and vomiting from 3 weeks earlier. Two esophagogastroduodenoscopic examination and one colonoscopic examination were normal. Computed tomography (CT) of the abdomen revealed ectopic varices in the duodenum. Endoscopic cyanoacrylate was injected and bleeding was controlled. The patient did not experience rebleeding after one month. [ABSTRACT FROM AUTHOR]

Background: Distinguishing low-grade from high-grade gliomas can aid in optimal treatment planning and prognostication. Diffusion-weighted imaging (DWI) and magnetic resonance spectroscopy (MRS) have been applied in several studies for noninvasive glioma grading. However, these studies focused on limited aspects of these imaging techniques and used different study setups, resulting in occasionally inconsistent and incomparable conclusions in the literature. Objectives: This study was designed to introduce the optimal imaging setup and the most reliable and applicable imaging parameters in glioma grading, using DWI and MRS. Patients and Methods: During this prospective study, using a 3T-MR scanner, 55 glioma patients underwent brain MRS with short, intermediate, and long echo times (TEs), as well as DWI using low, intermediate, and high b-values. Postoperatively, all of the specimens were graded pathologically using light microscopy. Results:We found that Max (Chol/Cr)/ Min (NAA/Cr) ((maximum choline to creatine ratio)/(minimum N-acetyl aspartate to creatine ratio)), followed by Max (Chol/ Cr), both in long-TE, were the most reliable metabolite ratios on MRS for accurate glioma grading. These had values for area under the curve (AUC) of 0.92 (P < 0.05) and 0.89 (P = 0.001), respectively, compared to conventional MR imaging (cMRI), which had an AUC of 0.83 (P < 0.05). DWI at maximal accuracy showed an AUC of 0.80 (P < 0.05). Conclusion: Max (Chol/Cr)/Min (NAA/Cr) in long-TE was the most reliable of all of the MRS parameters studied, while DWI showed no superiority over cMRI in glioma grading. No significant differences existed among the various b-values applied, or between the minimum and mean tumor apparent diffusion coefficient values used in DWI-based glioma grading. [ABSTRACT FROM AUTHOR]

Situs inversus is a rare congenital disorder characterized by transposition of the major thoracic organs and all the visceral organs in the abdomen to the opposite side of the normal place in the body. Herein we present a 73-year-old woman with a history of situs inversus totalis who was referred with the complaints of abdominal pain caused by pancreatitis and large common bile duct due to choledochal sludge. Laboratory tests of serum amylase, aspartate aminotransferase, alanine aminotransferase, and alkaline phosphatase were 960 IU/L, 207 IU/L, 119 IU/L, and 263 IU/L, respectively. The radiographic evaluation confirmed situs inversus totalis, enlarged liver, and dilatation of the intra- and extrahepatic bile duct. The distal end of the common bile duct (CBD) was smoothly tapered. Endosonography also confirmed CBD microlithiasis. Endoscopic retrograde cholangiopancreatography (ERCP) was done to remove microlithiasis. Our Challenge was on ERCP techniques in the position of the patient and endoscopy team. We believe ERCP can be safely performed in usual position with minor modification. [ABSTRACT FROM AUTHOR]

Background: Improvements in imaging techniques has led to an increase in the number of diagnosed pancreatic cysts. Although most of the detected cases are benign, a significant percentage of them are malignant or are potentially malignant. Currently, endosonography, and analysis of cyst morphology, fine needle aspiration (FNA) of the cyst contents, and measurement of the amylase and carcinoembryonic antigen (CEA) levels of the aspirated fluid are the common methods used for evaluating such lesions (80% accuracy in the final diagnosis). We have used these same techniques to analyze cystic lesions of the pancreas, in two referring centers in Iran. Materials and Methods: This is a descriptive case series study. In addition to demographic information and findings of the cystic morphology, we determined the cytology of the centrifuged sediments of cystic fluid aspirations, and the amylase and CEA levels of the fluid. Results: Sixty eight patients were included in the study with an average age of 51 years. 68% of the participants were female (n=46). Analysis of the lesions was performed based on the cytology findings as well as the other results (CEA, amylase, cyst morphology, and history of pancreatitis). The patients who were diagnosed as having pseudocysts were the youngest group, with an average age of 41 years, and those with cystic adenocarcinoma were the oldest group, with an average age of 62 years. The most common types of lesions were pseudocysts (n=18, 26.5%), mucinous cystic neoplasms (n=11, 16%), serous cyst adenomas (n=10, 14.7%), intraductal papillary mucinous neoplasms (n=9, 13.2%), and cystic adenocarcinoma (n=9, 13.2%). The most common location of cysts was the head of pancreas (n=25, 35.2%). Excluding the neuroendocrine tumors, all other types of lesions were more common in women than men. Septation in the cysts was observed in cystic adenocarcinomas, serous cystadenomas, and intraductal papillary mucinous neoplasms (IPMNs). Lesions smaller than 2 cm were found most frequently in IPMNs, endocrine tumors, and simple tumors whilst pseudocysts were all greater than 2 cm in maximum diameter. Conclusion: 47% of the patients in this study had malignant or premalignant lesions, which despite being asymptomatic, they needed follow-up imaging or surgery. Endosonography played an important role in the diagnosis of the cystic tumors of the pancreas. Diagnosis of premalignant lesions and providing appropriate treatment increase patients' life expectancy. Diagnosis of benign cysts, leads to fewer unnecessary surgeries. [ABSTRACT FROM AUTHOR]

Background. Helicobacter pylori is highly adapted to the gastric environment where it lives within or beneath the gastric mucous layer. The aim of this study was to evaluate whether the addition of N-acetyl cysteine to the treatment regimen of H. pylori infection would affect eradication rates of the disease. Methods. A total of 79 H. pylori positive patients were randomized to two therapeutic groups. Both groups received a 14-day course of three-drug regimen including amoxicillin/clarithromycin/omeprazole. Experimental group (38 subjects) received NAC, and control group (41 subjects) received placebo, besides three-drug regimen. H. pylori eradication was evaluated by urea breath test at least 4 weeks after the cessation of therapy. Results. The rate of H. pylori eradication was 72.9% and 60.9% in experimental and control groups, respectively (P=0.005). By logistic regression modeling, female gender (OR 3.68, 95% CI: 1.06–5.79; P=0.040) and treatment including NAC (OR 1.88, 95% CI: 0.68–3.15; P=0.021) were independent factors associated with H. pylori eradication. Conclusion. The results of the present study show that NAC has an additive effect on the eradication rates of H. pylori obtained with three-drug regimen and appears to be a promising means of eradicating H. pylori infection. [ABSTRACT FROM AUTHOR]

Here, we present a case of a 78-year-old man that underwent gastrointestinal endoscopy because of one- month history of dysphagia to liquids and solid foods with accompanying weight loss. On endoscopy, there was distal esophageal stenosis. Multiple biopsies were obtained. Histologic examination of the samples revealed normal tissue. The stenosis was treated by dilatation and abdomino pelvic computed tomography scanning was performed to search for an underlying malignant lesion that showed a mass adjacent to distal esophagus. We did endosonography- guided fine needle aspiration of the mass. It was a squamous cell carcinoma (SCC). Malignancy is a challenging diagnosis in patients with dysphagia and near normal endoscopy. To our knowledge, there are a few reports of SCC to cause it. [ABSTRACT FROM AUTHOR]

Background: Sulfur mustard (SM) has acute and chronic effects on skin and mucosal surfaces. The aim of the study was to evaluate the frequency of esophagitis in a historical cohort of veterans who had been exposed to SM in Iran-Iraq war nearly 25 years ago. Methods: One hundred two veterans with dyspepsia and/or heartburn underwent esophago-gastroduodenoscopy. Of them, 52 cases had been exposed to SM and had chronic mustard lung disease. Controls included 50 veterans without SM exposure. Esophagitis was defined according to standard criteria. Results: 81.6% of cases and 70.6% of controls had heart burn and/or regurgitation (p= 0.224). Esophagitis was seen in 40% of cases and 26.5% of controls (p= 0.155). Conclusion: Based on our findings, SM exposure seems not to be associated with increased esophagitis. [ABSTRACT FROM AUTHOR]

Background: Approach to the small intestine has been difficult even with newer methods. Double-balloon enteroscopy (DBE) has been created for diagnostic and therapeutic interventions in diseases of the small intestine. Small intestinal diseases have different etiologies in each country. The DBE has been introduced in recent years in Iran. Our aim was to study the indications and results of DBE in some academic centers in Iran. Methods: Fifty-five patients with symptoms and signs related to small intestine without definitive diagnosis but with previous workup were enrolled in the study. The DBE was performed in three different medical universities in Iran. Results: The mean age of the patients that underwent the DBE was 47.2 ± 17.3 years. Abdominal pain (54.5%) and occult gastrointestinal bleeding (23.6%) were the most common presentations. Small bowel lesions were detected in 26 patients (47.3%); the most common lesions were ulcer (46.2%) and polyps (19.2%). Crohn's disease (12.7%) was the commonest diagnosis found in DBE procedure. Patients presenting with abdominal pain or lower hemoglobin level were more likely to be diagnosed (both p≤ 0.05). Small intestinal diseases were ultimately diagnosed in 47.3% of the patients. Twenty percent of the patients had another disease outside the small bowel. Conclusions: DBE is an effective and relatively safe diagnostic and therapeutic option for small bowel evaluations. Accurate selection of patients and more experience technicians and physicians will improve the efficacy of this procedure in Iran. [ABSTRACT FROM AUTHOR]

Pancreatic neuroendocrine tumors are rare neoplasms that comprise 1-2% of all pancreatic tumors. However, they are the second most common solid pancreatic neoplasms. They have a wide range of imaging appearances and they can show common to very rare imaging presentations. Most of the time they are solitary well-marginated enhancing solid mass arising in a certain aspect of the pancreas. We present a case report of a 41-year-old female who underwent clinical work-up for abdominal pain, loss of appetite and weight loss for the past year. Ultrasound, computed tomography, and magnetic resonance imaging show diffuse homogenous pancreatic enlargement without contour deformity or a focal mass. Lymphoma and autoimmune pancreatitis were suggested based on imaging findings but IGg4 level and other lab data were normal. Endoscopic ultrasonography confirmed the diffuse enlargement of the pancreas without peripheral structures involvement. The pathological results of multiple fine-needle aspiration biopsy from all parts of the enlarged pancreas revealed a low-grade neuroendocrine tumor., (Copyright Journal of Radiology Case Reports.)

Introduction: Renal colic is caused by colicky spasms of ureters. As has been shown in previous experiments, glycerol trinitrate (TNG) can inhibit these muscular spasms., Objective: This study was performed to assess the pain relieving effect of TNG among patients referred due to renal colic pain to the emergency department (ED)., Methods: This study is a randomized, placebo-controlled study on 60 patients with renal colic who were referred to the ED, who were diagnosed clinically to have renal colic, and their pain was more than 5 based on a visual analogue scale (VAS). The patient's pain was recorded at the moment of clinical diagnosis, and each one received one capsule, either 0.4 mg TNG or placebo, plus a 100 mg indomethacin suppository. The pain score was re-assessed after 5 and 30 min. The values were recorded and compared using SPSS-16 software., Results: Sixty patients with a mean age of 35.75 ± 11.99 years were enrolled (73.3% male). Patients in the two groups were matched for age (p = 0.290), sex (p = 0.559), and the presence of microscopic hematuria (p = 0.292). Pain relief from the start point until the end of the intervention was statistical different in all studied patients (p < 0.05); but the comparison between the two groups showed no significant difference in this regard (p = 0.440)., Conclusion: It is likely that adding TNG to an indomethacin suppository had no significant effects on better pain management of patients referred with renal colic to the ED., Competing Interests: None declared.