A 41-Year-Old Man with Two Types of Metachronous Peptic Ulcer Complication due to Zollinger-Ellison Syndrome—Regression of Pancreatic Primary after Chemoembolization of Hepatic Metastases: A Case Report

Introduction. Gastrinoma should be suspected when the peptic ulcer(s) is postbulbar, multiple, refractory, or recurrent, or ulcer is associated with nephrolithiasis, hypocalcaemia, or erosive esophagitis. The majority of gastrinomas are malignant. Case Presentation. The patient is a 41-year-old Iranian man who has been in good health until 36 months ago when duodenal perforation and two bouts of upper GI bleeding (GIB), each two months apart occurred. He also mentioned mild watery diarrhoea and decreased appetite. Serum gastrin level was elevated. Abdominal CT scan revealed pancreatic mass and three enhancing hepatic masses. CT-guided pancreatic biopsy revealed monotonous cells. Chemoembolization of hepatic metastases was done. New ct images 6 months later showed nearly total regressed hepatic and pancreatic lesions. Conclusion. Beside previously defined situations that take gastrinoma into account as the etiology of PUD, accumulation of PUD complications is highly suggestive of Zollinger-Ellisone syndrome (ZES). Regression of pancreatic primary after chemoembolization of hepatic metastases is unexplainable at the present time

Consequences of stenting and endoscopic papillary balloon dilatation in treatment of large and multiple common bile duct stones

BACKGROUND Although stenting for the treatment of large and multiple common bile duct stones has been acceptable to everyone, its efficacy and outcome have not been studied in comparison with other endoscopic procedures. The purpose of this study was to compare the consequences of stenting and endoscopic papilla balloon dilatation for the treatment of large and multiple common bile duct stones. METHODS In a double-blind clinical trial, of 431 patients with bile duct stones referred to the treatment center, 64 patients with multiple common bile duct stones (≥ 3) and more than 15 cm were selected for the study, then by random allocation rule the participants were allocated in two groups. They were entered into two different endoscopic papillary balloon dilatation (EPBD) and common bile ducts stenting treatments so that both procedures were performed by a person. Both groups were assessed from the point of views therapeutic outcomes such as duct cleaning, pancreatitis, isolated pain, and duct rupture. Data were collected by a self-made questionnaire that was used before and after the procedure to obtain the needed information. Then data were analyzed using SPSS software version 22 and descriptive and analytical tests were used as appropriated. RESULTS Although the duct cleaning and the complete removal of the stones in the stenting treatment procedure was 93.8%, and in EPBD was 78.3%, no significant difference was observed between the two groups (p = 0.14). Pancreatitis significantly increased after the first and second endoscopic retrograde cholangiopancreatography (ERCP) in the stent group compared with EPBD (p = 0.02). Also, the most frequent cases of isolated pain were in the endoscopic group EPBD (p = 0.0). However, the occurrence of perforation after first ERCP and EPBD was zero, but in the second stage of ERCP, 3.3% of the patients had perforations (p = 0.99). The results indicated that the shape of the stone (circular and angled) was not effective in the result of treatment in the two groups. CONCLUSION The results of this study indicated that in case of experience and skill in conducting the ERCP, common bile duct stenting is still the first line of treatment for large and multiple stones of the common bile ducts

Prevalence of Hepatitis D Virus Infection Among Hepatitis B Virus Infected Patients in Qom Province, Center of Iran

Background: Hepatitis D virus (HDV) is a defective RNA virus that depends on the hepatitis B surface antigen (HBsAg) of hepatitis B virus for its replication, developing exclusively in patients with acute or chronic hepatitis B. There are little data regarding the routes of HDV transmission in Iran. The risk factors for HDV infection in Iran are blood transfusion, surgery, family history, Hejamat wet cupping (traditional phlebotomy), tattooing, war injury, dental interventions, and endoscopy.Objectives: We performed this study to determine the prevalence of hepatitis D in the general population of Qom province and the potential risk factors for acquiring HDV.Patients and Methods: This cross-sectional study collected 3690 samples from 7 rural clusters and 116 urban clusters. HBs antigen was measured, and if the test was positive, anti-HDV was measured. Ten teams, each consisting of 2 trained members, were assigned to conduct the sampling and administer the questionnaires. The data were analyzed using SPSS.Results: Forty-eight subjects (1.3%) suffered from hepatitis B, and 1 HBsAg-positive case had HDV infection. The prevalence of hepatitis D infection in Qom Province was 0.03%. The prevalence of hepatitis D infection in HBsAg-positive cases was 2%. Our anti-HDV-positive case had a history of tattooing, surgery, and dental surgery. There was no significant relationship between tattooing, surgery history, or dental surgery and hepatitis D infection.Conclusions: The prevalence of hepatitis D in Qom is the the lowest in Iran, similar to a study in Babol (north of Iran)

Congenital hepatic fibrosis leading to cirrhosis and hepatocellular carcinoma: a case report

<p>Abstract</p> <p>Introduction</p> <p>Congenital hepatic fibrosis is an uncommon cause of portal hypertension. Despite the presence of portal hypertension, hepatocellular and renal function are usually well preserved. Congenital hepatic fibrosis is included in the group of congenital diseases of fibropolycystic disorders. These include a broad spectrum of clinical diseases which are usually accompanied by hepatic involvement.</p> <p>Case presentation</p> <p>We report the case of a 27-year-old Iranian woman with congenital hepatic fibrosis leading to cirrhosis and subsequently hepatocellular carcinoma.</p> <p>Conclusion</p> <p>Advanced cirrhosis was diagnosed and our patient was scheduled for liver transplantation. During preparation for transplant, a hepatic mass was discovered which was found to be hepatocellular carcinoma. Radiofrequency ablation was performed and our patient was referred for transplantation.</p

Unexpected Regression of a Pancreatic Gastrinoma after Arterial Chemoembolization of its Hepatic Metastases: Case Report

Background and Objectives: Gastrinoma is a rare cause of peptic ulcers and should be suspected when manifestations, ulcer site, and response to treatment are not normal. Gastrinomas are mostly malignant and liver is the most common site of their metastasis. Arterial chemoembolization (obstruction by blood clotting with chemicals) and arteries that feed metastases, is used as a method to reduce the symptoms. Appropriate response is seen in more than half of the patients, although it is short term. Case report: The patient is a 42-year old man, who was healthy until 4 years ago that experienced acute abdominal pain due to duodenal ulcer rupture and two episodes of acute upper gastrointestinal bleeding due to perforation of two separate duodenal ulcers within 2 months of each other. He also complained of mild diarrhea and loss of appetite at that time. Laboratory examinations showed increased serum level of gastrin. Abdominal CT scan showed a small pancreatic head mass and three hepatic mass with increased contrast medium absorption. In CT-guided biopsy report, pancreatic head mass and uniform and apparently benign cells similar to islet cell tumor, were seen. Chemoembolization of liver metastasis arteries was performed, which after 6 months, CT scan showed almost complete regression of metastases and also primary pancreatic lesion

واکاوی تأثیر اخلاق بر سلامت معنوی از منظر قرآن و روایات

سابقه و هدف: تأثیر اخلاق بر سلامت معنوی امری پذیرفتنی است و علاوه بر مؤیّدداشتن از قرآن و روایات، بسیاری از پژوهشگران داخلی و خارجی نیز به آن اذعان کرده و آثاری را در این­ باره نگاشته­اند؛ گرچه مخالفت­هایی نیز با این مسئله شده است. هدف پژوهش حاضر تبیین تأثیر اخلاق بر سلامت معنوی از منظر قرآن و روایات بود. روش کار: روش این پژوهش توصیفی-تحلیلی است که با استناد به آیات قرآن و روایات معصومان (ع) انجام شده است. برای نگارش این­ مقاله علاوه‌بر استفاده از منابع مزبور، مقالات در پایگاه‌های اطلاعاتی جست‌وجو و مقالاتِ همسو مطالعه و بررسی شد. مؤلفان مقاله تضاد منافعی گزارش  نکرده‌اند. یافته‌ها: در قرآن و روايات اعتنای زیادی به اخلاق شده است و میزان فراوانی این ­دست از آموزه­ها بعد از آموزه­های عقائدی و در وهلۀ دوم قرار دارد. از نگاه آموزه­های اسلامي، اخلاق از جهات مختلف بر سلامت روانی جامعه تأثير مي­گذارد. از جنبۀ فردي، اهتمام به فضايل و اجتناب از رذايل اخلاقي -برخلاف دیدگاه برخی از اندیشمندان غربی- آرامشِ واقعی فردي را به همراه دارد. اخلاق از جنبۀ اجتماعي، امنيت­افزایی و آرامش­زایی می‌کند و از آسيب­هاي اجتماعي در جامعه مي­كاهد. اخلاق اقتصادي با استفادۀ صحيح از نعمت­هاي الهي و كمك به قشرهای آسيب­پذير جامعه، علاوه بر سلامت­افزایی جسماني و معنويِ فردی، سلامت اجتماعي را نیز به لحاظ زدودن آسيب­هاي اجتماعي و اقتصادي ناشي از فقر فراهم مي­نمايد. نتیجه‌گیری: برای کاهش اختلالات روحی-روانی افراد و به حداقل رساندنِ بزهکاری­های اجتماعی، می­توان از ترویج بجا و شایستۀ اخلاق و آموزه­های اخلاقی به­عنوان یکی از قوی‌ترین کاهنده­ها بهره گرفت تا سلامت معنوی فرد و جامعه تضمین گردد