Dilated common bile duct unexplained on transabdominal ultrasonography; the role of endoscopic ultrasonography and predictors of malignancy

 Background: The aim of the this prospective study was to evaluate  the endoscopic ultrasonography (EUS) in detecting the cause of common bile duct (CBD) dilatation in patients in whom ultrasonography(US) could not indicate  the cause of dilation. Methods: Seventy patients with the search criteria of unexplained dilated CBD (diameter > 7 mm) were examined by EUS. All patients (except 4 patients with pancreatic mass) were further evaluated by ERCP. Results: The following diagnoses were made by EUS and ERCP: choledocholithiasis in 45, pancreato-biliary malignancy (PBM) in 17, papillary stenosis in 5, and no finding in 3 cases. We found that the majority of patients (95.7%) had findings on EUS to explain the etiology of their dilated CBD. The prevalence of pathology is lower (76.9%) in patients with normal liver function tests (LFTs).The yield of EUS is higher (100%) when elevated liver enzymes. Lower hemoglobin levels, larger diameter of CBD and pancreatic duct (PD) and ESR greater than 30 mm/h were independent risk factors for PBM, whereas, patients with previous cholecystectomy, normal LFTs and abdominal pain were less likely to have this diagnosis. Conclusion: the majority of patients referred for EUS for dilated CBD will have an etiology discoveredTherefore, EUS should be the first diagnostic strategy for dilated CBD of unexplained origin, even in patients with normal LFTs. In patients with dilated CBD accompanied by anemia, abnormal LFTs and ESR or dilated PD, malignancy should be considered.   

Post colonoscopy ischemic colitis: a case and literature review

Ischemic colitis is the most common form of intestinal ischemia and is more common in the elderly and among individuals with risk factors for ischemia. Ischemic colitis is a rare complication of colonoscopy. The predisposing conditions for developing ischemic colitis following colonoscopy are connective tissue disease, advanced age and cardiovascular disease. Ischemic colitis may rarely occur following a colonoscopy without these risk factors. The data collection of 22 case of ischemic colitis (21 cases in previous reports and one case in our case) were reviewed.  Here, we report a case of ischemic colitis after a routine colonoscopy in patient without risk factors for ischemia.Conclusion: Colonoscopy could be induced ischemic colitis, that should be brought to attention of gastroenterologist

Neutron dose evaluation of Elekta Linac at two energies (10 & 18 MV) by MCNP code and comparison with experimental measurements

Medical linear accelerators, besides the clinically high energy electron and photon beams, produce other secondary particles such as neutrons which escalate the delivered dose. In this study the neutron dose at 10 and 18MV Elekta linac was obtained by using TLD600 and TLD700 as well as Monte Carlo simulation. For neutron dose assessment in 2020 cm2 field, TLDs were calibrated at first. Gamma calibration was performed with 10 and 18 MV linac and neutron calibration was done with 241Am-Be neutron source. For simulation, MCNPX code was used then calculated neutron dose equivalent was compared with measurement data. Neutron dose equivalent at 18 MV was measured by using TLDs on the phantom surface and depths of 1, 2, 3.3, 4, 5 and 6 cm. Neutron dose at depths of less than 3.3cm was zero and maximized at the depth of 4 cm (44.39 mSvGy-1), whereas calculation resulted  in the maximum of 2.32 mSvGy-1 at the same depth. Neutron dose at 10 MV was measured by using TLDs on the phantom surface and depths of 1, 2, 2.5, 3.3, 4 and 5 cm. No photoneutron dose was observed at depths of less than 3.3cm and the maximum was at 4cm equal to 5.44mSvGy-1, however, the calculated data showed the maximum of 0.077mSvGy-1 at the same depth. The comparison between measured photo neutron dose and calculated data along the beam axis in different depths, shows that the measurement data were much more than the calculated data, so it seems that TLD600 and TLD700 pairs are not suitable dosimeters for neutron dosimetry in linac central axis due to high photon flux, whereas MCNPX Monte Carlo techniques still remain a valuable tool for photonuclear dose studies

The effect of grape-seed oil on diabetes-related hyperglycemia, dyslipidemia, and inflammation in streptozotocin-induced diabetic rats

Background: Grape-seed oil has diverse biological functions and is beneficial in treating metabolic complications, such as metabolic syndrome, obesity, diabetes, and dyslipidemia. The purpose of this study was to investigate the anti-hyperglycemic, anti-dyslipidemic, and anti-inflammatory effects of Grape-seed oil in diabetic rats. Materials and methods: 16 streptozotocin-induced diabetic Wistar rats were used in this study. Diabetic rats were randomly allocated to either of two groups (n = 8): diabetic rats treated with grape-seed oil or diabetic control. Grape-seed oil (GSO) (25 mg/kg BW) was administered orally for 40 days, and at the end, blood samples were taken directly from the heart. Results: Diabetic rats treated with oil compared to control diabetic rats demonstrated a significant (p = 0.001) decline in serum glucose concentration. High plasma concentrations of TG, LDL, and VLDL were reduced (p = 0.001, p = 0.001, p = 0.001, respectively). Surprisingly, between inflammatory markers, TNF-α was significantly (p = 0.02) increased. Furthermore, GSO-treated diabetic rats experienced a significant (p = 0.014) weight gain during the study. However, total cholesterol, HDL, and CRP levels did not change significantly. Conclusion: Treatment with grape-seed oil ameliorated dyslipidemia and hyperglycemia in diabetic rats. However, further investigations in peculiar clinical studies are required.</p

The effect of grape-seed oil on diabetes-related hyperglycemia, dyslipidemia, and inflammation in streptozotocin-induced diabetic rats

Background: Grape-seed oil has diverse biological functions and is beneficial in treating metabolic complications, such as metabolic syndrome, obesity, diabetes, and dyslipidemia. The purpose of this study was to investigate the anti-hyperglycemic, anti-dyslipidemic, and anti-inflammatory effects of Grape-seed oil in diabetic rats. Materials and methods: 16 streptozotocin-induced diabetic Wistar rats were used in this study. Diabetic rats were randomly allocated to either of two groups (n = 8): diabetic rats treated with grape-seed oil or diabetic control. Grape-seed oil (GSO) (25 mg/kg BW) was administered orally for 40 days, and at the end, blood samples were taken directly from the heart. Results: Diabetic rats treated with oil compared to control diabetic rats demonstrated a significant (p = 0.001) decline in serum glucose concentration. High plasma concentrations of TG, LDL, and VLDL were reduced (p = 0.001, p = 0.001, p = 0.001, respectively). Surprisingly, between inflammatory markers, TNF-α was significantly (p = 0.02) increased. Furthermore, GSO-treated diabetic rats experienced a significant (p = 0.014) weight gain during the study. However, total cholesterol, HDL, and CRP levels did not change significantly. Conclusion: Treatment with grape-seed oil ameliorated dyslipidemia and hyperglycemia in diabetic rats. However, further investigations in peculiar clinical studies are required.</p

The effect of grape-seed oil on diabetes-related hyperglycemia, dyslipidemia, and inflammation in streptozotocin-induced diabetic rats

Background: Grape-seed oil has diverse biological functions and is beneficial in treating metabolic complications, such as metabolic syndrome, obesity, diabetes, and dyslipidemia. The purpose of this study was to investigate the anti-hyperglycemic, anti-dyslipidemic, and anti-inflammatory effects of Grape-seed oil in diabetic rats. Materials and methods: 16 streptozotocin-induced diabetic Wistar rats were used in this study. Diabetic rats were randomly allocated to either of two groups (n = 8): diabetic rats treated with grape-seed oil or diabetic control. Grape-seed oil (GSO) (25 mg/kg BW) was administered orally for 40 days, and at the end, blood samples were taken directly from the heart. Results: Diabetic rats treated with oil compared to control diabetic rats demonstrated a significant (p = 0.001) decline in serum glucose concentration. High plasma concentrations of TG, LDL, and VLDL were reduced (p = 0.001, p = 0.001, p = 0.001, respectively). Surprisingly, between inflammatory markers, TNF-α was significantly (p = 0.02) increased. Furthermore, GSO-treated diabetic rats experienced a significant (p = 0.014) weight gain during the study. However, total cholesterol, HDL, and CRP levels did not change significantly. Conclusion: Treatment with grape-seed oil ameliorated dyslipidemia and hyperglycemia in diabetic rats. However, further investigations in peculiar clinical studies are required.</p

The effect of grape-seed oil on diabetes-related hyperglycemia, dyslipidemia, and inflammation in streptozotocin-induced diabetic rats

Background: Grape-seed oil has diverse biological functions and is beneficial in treating metabolic complications, such as metabolic syndrome, obesity, diabetes, and dyslipidemia. The purpose of this study was to investigate the anti-hyperglycemic, anti-dyslipidemic, and anti-inflammatory effects of Grape-seed oil in diabetic rats. Materials and methods: 16 streptozotocin-induced diabetic Wistar rats were used in this study. Diabetic rats were randomly allocated to either of two groups (n = 8): diabetic rats treated with grape-seed oil or diabetic control. Grape-seed oil (GSO) (25 mg/kg BW) was administered orally for 40 days, and at the end, blood samples were taken directly from the heart. Results: Diabetic rats treated with oil compared to control diabetic rats demonstrated a significant (p = 0.001) decline in serum glucose concentration. High plasma concentrations of TG, LDL, and VLDL were reduced (p = 0.001, p = 0.001, p = 0.001, respectively). Surprisingly, between inflammatory markers, TNF-α was significantly (p = 0.02) increased. Furthermore, GSO-treated diabetic rats experienced a significant (p = 0.014) weight gain during the study. However, total cholesterol, HDL, and CRP levels did not change significantly. Conclusion: Treatment with grape-seed oil ameliorated dyslipidemia and hyperglycemia in diabetic rats. However, further investigations in peculiar clinical studies are required.</p

Assessment Relationship between Body-esteem and perceived Social Support in Patients with Ostomy

Introduction: Colorectal cancer is a progressive gastrointestinal disease that leads to the insertion of an ostomy for patients. On the other hand, the manifestations and complications caused by the insertion of the ostomy cause many physical and mental problems for the patient. The aim of this study was to investigate the relationship between body-esteem and perceived social support in patients with ostomy in the Iranian Ostomy Association. Methods: This descriptive-correlational study was performed on 350 patients with ostomy referring to the Iranian Ostomy Association in Tehran. The Convenient method was used for sampling. The data collection tool was a Body-esteem Scale and Nortous social support questionnaire. Data were analyzed by SPSS software version 16 and independent t-test, ANOVA, Pearson correlation coefficient and Tukey test. Results: The mean and standard deviation of Body-esteem and perceived social support of patients were 42.57 ± 10.24 and 131.17 ± 15.45. According to the findings of this study, the mean score of Body-esteem and social support in patients with ostomy was moderate. There is a direct and significant relationship between social support and Body-esteem (r = 0.13, P = 0.006). Conclusions: Since the perception of social support has considerable effect on Body-esteem, it is recommended that nurses, by identifying high-risk groups in terms of receiving and understanding social support, continuously examine the patient's support needs and improve their level of Mental health and also by connecting patients with the community, families and groups of friends pay attention to this psychological dimension. Keywords: Ostomy, Body-esteem, Social Support, Colorectal Cance

Mixed Endometrial Epithelial Carcinoma: Epidemiology, Treatment and Survival Rates-A 10-Year Retrospective Cohort Study from a Single Institution

Mixed endometrial carcinoma (MEEC) refers to rare endometrial tumours that are composed of two or more distinct histotypes, at least one of which is serous or clear cell. The aim of this study was to evaluate the epidemiology, treatment outcomes and survival rates of patients with mixed endometrial carcinoma. The medical records of 34 patients diagnosed with MEEC between March 2010 and January 2020 were reviewed retrospectively. Clinicopathological variables and treatment strategies were assessed, and overall survival and disease-free survival rates were evaluated. The histology of endometrioid and serous component was found in 26 (76.5%) patients, followed by serous and clear-cell components (5/34, 14.5%) and mixed endometrioid serous and clear-cell components (3/34, 8.8%). The median age at diagnosis was 70 years (range 52-84), and the median follow-up time was 55 months. The 5-year disease-free survival and the 5-year overall survival were 50.4% and 52.4%, respectively. Advanced disease stage was identified as an independent predictor of inferior disease-free (&lt;0.003) and overall survival (p &lt; 0.001). Except for stage, none of the traditional prognostic factors was associated with disease recurrence or death from disease. MEECs represent rare high-risk endometrial carcinomas with significant diagnostic and treatment challenges. Undoubtedly, the implementation of a molecular analysis can offer further diagnostic and management insights

The Prognostic Characteristics and Recurrence Patterns of High Grade Endometrioid Endometrial Cancer: A Large Retrospective Analysis of a Tertiary Center

High grade endometrioid endometrial cancer (HGEEC) is a heterogeneous group of tumors with unclear prognostic features. The aim of the present study is to evaluate the independent risk factors for recurrence and mortality and to describe the recurrence patterns of HGEEC. Ninety-six consecutive cases of HGEEC treated with primary surgery in a single Tertiary Center were retrospectively reviewed. Clinicopathological and treatment details were recorded, and all patients were closely followed up. Disease-free, overall and cancer-specific survival rates were 83.8%, 77.8% and 83.6%, respectively. Cervical stromal involvement was independently related to recurrence (HR = 25.67; 95%CI 2.95-223.30; p = 0.003) and cancer-related death (HR = 15.39; 95%CI 1.29-183.43; p = 0.031) after adjusting for other pathological and treatment variables. Recurrence rate was 16%, with 60% of these cases having lung metastases and only one case with single vaginal vault recurrence. 81.81% of the recurrences presented with symptoms and not a single recurrence was diagnosed in routine follow-up clinical examination. In conclusion, the recurrence pattern may suggest that patient-initiated follow-up (PIFU) could be considered a potential alternative to clinical-based follow-up for HGEEC survivors, especially for patients without cervical involvement and after two years from treatment. Additional caution is needed in patients with cervical stromal involvement