Spinal subdural hematoma revealing hemophilia A in a child: A case report

BACKGROUND: Intraspinal bleeding especially in the form of subdural hematoma is rare in hemophiliacs. In the present case, we report a neglected hemophilic A child with such a problem and discuss its management options. CASE PRESENTATION: A 9-year old hemophilic A boy presented with quadriparesis, confusion and meningismus after a fall 4 days previously. There was no sign of direct trauma to his back. His CT Scan and MRI showed spinal extramedullary hematoma extended from C5 to L2. We corrected the factor VIII level, but two days later, the patient's lower limbs weakened to 1/5 proximally as well as distally. We performed a laminectomy from T11 to L2, according to the level of the maximal neurological deficit and recent deterioration course. The subdural hematoma was evacuated. The hematoma in other spinal levels was managed conservatively. In the week following the operation, the patient's neurological status approached normal. CONCLUSION: This case calls attention to the clinical manifestation, radiological features and management options of the rarely reported intraspinal hematoma in hemophilic children. Although this case has been managed operatively for its hematoma in the thoracolumbar region, at the same time it can be considered a successful case of conservative management of intraspinal hematoma in the cervicothoracic region. Both conservative and surgical management could be an option in managing these patients considering their neurological course

Prospective Acid Reflux Study of Iran (PARSI): Methodology and study design

<p>Abstract</p> <p>Background</p> <p>Gastroesophageal reflux disease is a common and chronic disorder but long term, prospective studies of the fate of patients seeking medical advice are scarce. This is especially prominent when looking at non-erosive reflux disease (NERD) patients.</p> <p>Methods</p> <p>We designed a prospective cohort to assess the long term outcome of GERD patients referring to gastroenterologists. Consecutive consenting patients, 15 years of age and older, presenting with symptoms suggestive of GERD referring to our outpatient clinics undergo a 30 minute interview. Upper gastrointestinal endoscopy is performed for them with protocol biopsies and blood samples are drawn. Patients are then treated according to a set protocol and followed regularly either in person or by telephone for at least 10 years.</p> <p>Discussion</p> <p>Our data show that such a study is feasible and follow-ups, which are the main concern, can be done in a fairly reliable way to collect data. The results of this study will help to clarify the course of various subgroups of GERD patients after coming to medical attention and their response to treatment considering different variables. In addition, the basic symptoms and biological database will fuel further molecular epidemiologic studies.</p

Overlapping gastroesophageal reflux disease and irritable bowel syndrome: Increased dysfunctional symptoms

AIM: To investigate the association of gastroesophageal reflux disease (GERD) and irritable bowel syndrome (IBS) in Iranian patients and examine the prevalence of functional symptoms of the gastrointestinal tract in patients presenting with either IBS, GERD or both

Prospective Acid Reflux Study of Iran (PARSI): Methodology and study design-2

<p><b>Copyright information:</b></p><p>Taken from "Prospective Acid Reflux Study of Iran (PARSI): Methodology and study design"</p><p>http://www.biomedcentral.com/1471-230X/7/42</p><p>BMC Gastroenterology 2007;7():42-42.</p><p>Published online 20 Nov 2007</p><p>PMCID:PMC2212633.</p><p></p> after one week. If patient is better with the previous prescription, patient should back to the previous dosage and continue till the next visit

Prospective Acid Reflux Study of Iran (PARSI): Methodology and study design-0

<p><b>Copyright information:</b></p><p>Taken from "Prospective Acid Reflux Study of Iran (PARSI): Methodology and study design"</p><p>http://www.biomedcentral.com/1471-230X/7/42</p><p>BMC Gastroenterology 2007;7():42-42.</p><p>Published online 20 Nov 2007</p><p>PMCID:PMC2212633.</p><p></p>Presenting just by minor symptoms

Prospective Acid Reflux Study of Iran (PARSI): Methodology and study design-1

<p><b>Copyright information:</b></p><p>Taken from "Prospective Acid Reflux Study of Iran (PARSI): Methodology and study design"</p><p>http://www.biomedcentral.com/1471-230X/7/42</p><p>BMC Gastroenterology 2007;7():42-42.</p><p>Published online 20 Nov 2007</p><p>PMCID:PMC2212633.</p><p></p> junction across the z-line, C: Cardia, D: Body, E: Antrum