Effects of Fluoxetine, Nortriptyline and Amitriptyline in IBS patients

Background: Irritable Bowel Syndrome (IBS) is the most common cause of GI-man visits. Recent trend was seen towards neurotransmitters, however these drugs are expensive. We have determined the effects of fluoxetine, nortriptyline and amitriptyline in IBS patients referred to a private GI clinic in Tehran in 2000. Materials and Methods: 173 patients had entered this clinical trial. Diagnosis was made according to the Rome criteria. Patients were concurrently allocated in three groups. Fluoxetine 20 mg/d, amitriptyline 25 mg/d and nortriptyline 25 mg/d were given to individuals of each group, respectively. Pre- and post-test data were collected and recorded in a checklist. Results: The study population included 53 cases as the “Constipation group”, 57 as the “Diarrhea group” and 63 as the “Abdominal Pain group”. 50 patients received fluoxetine, 69 nortriptyline and 54 received amitriptyline. Fluoxetine has effectively increased the defecation times of constipated individuals (From 2.56/week to 12/week, P<0.02), but was ineffective for diarrhea individuals (NS). Amitriptyline has improved the defection pattern of constipated and diarrhea individuals (2.31/week to 6.54/week and 17.26/week to 11.79/week, respectively, P<0.02). Nortriptyline had the same effect as amitriptyline (2.67/week to 6.33/week and 20.64/week to 12.23/week, respectively, P<0.01). Fluoxetine and TCAs were significantly improved the abdominal pain, bloating and general performance of affected patients. Amitriptyline has shown more side effects than nortriptyline and fluoxetine (P<0.01). Conclusion: Fluoxetine was shown to be more effective than TCAs in constipated patients, however in patients with diarrhea it seems to be less effective

Value Of Fine Needle Aspiration In Diagnosing Abdominaland Retroperitoneal Masses Of Children

The aim of this study was to evaluate the role of fine needle aspiration cytology in the diagnosis of abdominal and retroperitoneal masses in children on this study. In 53 cases of childhood abdominal and retroperitoneal masses within a 4 year period (1998-2001) preoperative fine needle aspiration was done under the guide of CT scan. 2 pathologists reviewed fine needle aspiration smears. In all of the cases the gold standard for diagnosis was the tissue specimen, which showed 37 malignant, 2 benign neoplastic and 12 nonneoplastic diseases.This study showed that the sensitivity and specificity of fine needle aspiration cytology for the diagnosis of malignancy and benignity (positive or negative for malignancy) is 97.2% and 81.2% respectively. It was 100% accurate for the diagnosis of cell type in neuroblastoma-ganglioneuroblastoma, hepatoblastoma and Wilm's tumor, 77% accurate for lymphoma and 57% for germ cell tumors. There was no complication in any of the cases after f! ine needle aspiration. So fine needle aspiration is a reliable and sensitive method for the preoperative diagnosis of malignant pediatric abdominal and retroperitoneal masses and we recommend doing FNA cytology as a routine method for the diagnosis of such cases