Inflammatory bowel disease (IBD) has many extraintestinal manifestations, and skin lesions are one of the most frequently described extraintestinal findings. Reports indicate an incidence of cutaneous manifestations ranging from 2 to 34%, Cutaneous manifestations are usually related to the activity of the bowel disease but may have an independent course. In this review we aim to address the various cutaneous manifestations associated with IBD, their impact on the disease course, and the treatment options available.

Spontaneous rupture of the spleen is a well-described occurrence in many diseases, being most commonly found in malaria. Exact incidence of this complication is not clear. In this article, we discuss pathology, diagnostic approach and therapeutic options in a patient with malarial splenic rupture. Ruptures of malarial spleens do heal and attempts at splenic lavage/conservative approach should be the aim in their management. Splenectomy should be reserved for those patients with severe rupture or those with continued or recurrent bleeding.

Background/Aims: Irritable bowel syndrome (IBS) is the most common functional gastrointestinal disorder, and its definite etiology is still unclear. It has been shown that personality characteristics can affect the disease presentation and attitude of patient toward symptoms. This study was undertaken to evaluate the personality characteristics in patients with IBS in Shiraz, southern Iran. Materials and Methods: In a cross-sectional study, the personality characteristics of 60 patients with IBS and 55 healthy persons were compared using Minnesota II Multiphasic Personality Inventory (MMPI-2). The cases were selected from patients who were referred to the Mottahari clinic affiliated to the Shiraz University of Medical Sciences. Results: The patients recorded the highest scores on the hypochondriasis and psychoasthenia scales. The scores of the patient on the scales of lie, infrequency, hypochondriasis, depression and hysteria showed significant elevation in comparison to those of the control group. Furthermore, the scores on clinical scales in male subjects were higher for psychopathic-deviate, paranoia and social introversion scales in comparison to the males in the control group. Female subjects recorded lower scores on the social introversion scale in comparison to the females in the control group. Male subjects also recorded a higher score on the psychopathic-deviate, paranoia, psychoasthenia and social introversion scales in comparison to females. Female subjects had a relatively higher score on the masculinity/feminity scale. Based on the clinical interview using DMS-IV criteria, the most prevalent symptoms were anxiety and depression in patients with IBS. Conclusion: Due to the high prevalence of anxiety and depression in patients with IBS, psychotherapy and pharmacotherapy of these patients is recommended.

Background/Aims: Paraoxon, an organophosphate metabolite of the insecticide parathion inhibits the enzyme, acetylcholinesterase (Achase). Organophosphates affect the heart, visual system, nervous system and muscles. In this present study, we investigate the effects of the chronic consumption of paraoxon on gastric acid and pepsin secretion in N-mari rats. Materials and Methods: This study was performed from April 2003 to May 2004 in the Physiology department of Baghiatalah University of Medical Sciences, Tehran, Iran. It was performed on three groups of female N-mari rats (10 /group) each weighing 200-250 g. The first group received 0.05 mg/kg/day paraoxon subcutaneously for one month. The second group received the same chronic doses of ethyl alcohol (96%) (solvent of paraoxon) and the third group (control) received no drugs. After tracheostomy and laparatomy, gastric secretions were collected with a tube via the duodenum. Pentagastrin (25 µg/kg, i.p.) was used as a gastric stimulator. Acid and pepsin secretions were measured by titration and the Anson method, respectively. The stages of the measurements were basal (first and second), stimulated and returned-basal. Results: Basal acid secretion in the paraoxon group was greater than those in the alcohol and control groups (14.61 ± 1.46, 7.18 ± 0.28 and 7.88 ± 0.26 µmol/15 min, respectively, P < 0.001)). Although pentagastrin-stimulated acid secretion in all the three groups was greater than that of the basal state, there were no significant differences among the three groups. Basal pepsin secretions in the paraoxon group were greater than those in the alcohol and control groups (2.97 ± 0.32, 1.19 ± 0.25 and 0.55 ± 0.06 µg/15 min, respectively). Pentagastrin-stimulated pepsin secretion in the paraoxon group was significantly greater than those in the alcohol and control groups (3.22 ± 0.38, 2.22 ± 0.46 and 1.09 ± 0.66 µg/15 min, respectively, P < 0.001). Conclusion: Chronic exposure to paraoxon results in the increased secretion of gastric acid and pepsin.

Background/Aims: To analyze the potential correlation of a positive family history of gastroesophageal reflux disease (GERD) and the history of headaches as a risk factor for and complication of the disease. Materials and Methods: Three thousand and six hundred subjects were selected by cluster random sampling from all seven districts of Shiraz city, who were invited for interview. In five months, 1956 subjects participated in this study. A questionnaire organized into three sections of demographic, signs and symptoms of GERD, headache and family history of GERD was completed for each patient. Social and demographic variables were also recorded. Results: The presence of GERD symptoms (72%) had a significant correlation with a positive family history of the disease ( P = 0.000). Patients showed a variable frequency of headache, ranging from once daily (16.7%), three to five times a week (5.6%), once-twice a week (26.7%), once to three times a month (15.0%) and less than once a month (8.3%). There was a significant correlation between the headaches and the GERD symptoms ( P = 0.000). Conclusion: A positive family history of GERD can be considered as a risk factor for the disease and the presence of headache at the time of diagnosis as a complication of this disease. Therefore, in the management of GERD, attention should be given to these factors.

Background/Aims: Gastroesophageal reflux disease (GERD) may occur with acid, bile or in a mixed form. Endoscopic injury and mucosal metaplasia are a known sequelae to pathological GERD. The aim of the study was to determine the contribution of acid and duodenogastroesophageal reflux to endoscopic severity in patients with GERD and Barrett's esophagus (BE). Materials and Methods: Ninety-one patients complaining of reflux symptoms were studied with upper gastrointestinal endoscopy and graded to nonerosive reflux disease (NERD), erosive reflux disease (ERD) and BE. Esophageal manometry and simultaneous ambulatory 24-h esophageal pH and bilirubin monitoring (Bilitec 2000) were performed in all patients. Results: Seventy-one patients (78.0%) had ERD (Savary-Miller (grade I-III), 11 patients (12.1%) had NERD and 9 patients (9.9%) had BE, which were suspected endoscopically and diagnosed by histological esophageal biopsy. Combined 24-h esophageal bilirubin and pH monitoring revealed the following: 39 patients (42.9%) had mixed acid and bile reflux, 16 (17.6%) had pathological acid reflux alone, 18 (19.8%) had bile reflux alone and 18 patients (19.8%) showed no evidences of abnormal reflux. The percentage of the total time of the bilirubin absorbance > 0.14 in 71 patients with ERD was (8.18±11.28%) and in 9 patients with BE was (15.48±30.48%), which was significantly greater than that in 11 patients with NERD (4.48±8.99%), P<0.05 and P=0.01 respectively. All the BE patients had abnormal esophageal bile reflux (bile alone (3 patients)); and mixed bile and acid (6 patients)); 44 of 71 patients (61.97%) with ERD had abnormal esophageal bile reflux (alone (13 patients) and mixed bile and acid (31 patients)); meanwhile, 15 of them (21.2%) had abnormal acid exposure alone. Despite 11 patients having NERD, four patients (36.4%) had abnormal esophageal bile reflux and two of them had mixed reflux of bile with acid. Conclusion: We believe that the Bilitec method reliably identifies the presence of bilirubin and quantitatively detects the duodenogastroesophageal reflux of bile. Mixed reflux (acid and bile) is the chief pattern of reflux in our GERD patients. Bile reflux either alone or along with acid reflux contributes to the severity of erosive and nonerosive reflux diseases as well as in BE.

Background/Aims: In this study, we aimed to determine the levels of malondialdehyde (MDA) in patients with inflammatory bowel disease (IBD) to investigate its contribution to tissue injury in IBD. Materials and Methods: Forty-two patients with IBD (24 cases of Crohn's disease and 18 cases of ulcerative colitis) and 38 matched healthy subjects (control group) were considered for study. MDA levels were quantified by the measurement of thiobarbituric acid reactive substances. Results: Plasma MDA levels of Crohn's disease patients were significantly higher than the control group, but not higher than the ulcerative colitis patients. Plasma MDA levels of patients with ulcerative colitis were higher than the control group but not significant. Conclusion: Increased levels of plasma MDA in IBD is an important indication of oxidative stress. Patients with Crohn's disease are more susceptible to oxidative stress than patients with ulcerative colitis.

Primary hydatid cyst in the head of pancreas is rare. We report a case of a 26-year-old patient, who presented with obstructive jaundice. The imaging studies, while demonstrating a fusiform dilatation of the common bile duct, was unhelpful in identifying the etiology. A pancreatic head cyst was discovered at the time of surgery. Diagnosis was confirmed by subsequent serology and identification of scolices on microscopic examination. From the reported data, we discuss the diagnostic and therapeutic modalities of this rare disease.

Diverticula on the left side of the colon, especially in the sigmoid colon are a common occurrence in the West. However, right-sided diverticula are less common, being reported from Asian countries like China, Hong Kong, Japan, Singapore and India. Diverticula of the transverse colon are very rare with very few cases reported in literature. We report a case of perforated true diverticulum of the transverse colon in a sixty-two year-old lady.

Synchronous tumors are well documented in the gastrointestinal tract. Various combinations have been studied. There are a few studies, which highlight the incidental finding of the yellow beauty-the "carcinoid" of the duodenum simultaneously occurring with the venomous "diffuse gastric adenocarcinoma". This is a report one such case in a 58 year-old man, who unfortunately died on the 4 ^th postoperative day due to cardiopulmonary arrest.

There are several indications for the use of albumin in patients with decompensated cirrhosis and its role has existed in clinical practice for many decades. While the drug enjoys immense popularity, it yet attracts intensive debate amongst clinicians and pharmacologists alike. Regardless of its pharmacological properties, its clinical use in cirrhotic patients has its fair share of proponents and opponents. At present, in the setting of cirrhosis this debate centers around the treatment of spontaneous bacterial peritonitis, in patients with ascites treated with large volume paracentesis, and in those with hepato-renal syndrome. With the evolving evidence it has become imperative to shed old dogmas and address this issue in the light of evidence-based medicine. This article gives a representative view of albumin use in the above conditions across both sides of the clinical divide.

Intraluminal endoscopic surgery is a recent innovation to minimally invasive surgery. This technique provides access to the peritoneal cavity through a natural orifice. The technique holds the promise for "incisionless," less invasive procedures without the risk of postoperative sequelae as in the standard surgical approach, particularly in high risk patients. The hope of combining the skill and experience of endoscopists and surgeons into a defined specialty has attracted worldwide attention. It is anticipated that the skill sets required will be a hybrid that includes laparoscopic skills as well as endoscopic expertise. The studies in animal models of natural orifice translumenal endoscopic surgery (NOTES) have demonstrated the safety and feasibility of various types of intraabdominal surgeries, including transgastric liver biopsy, cholecystectomy, tubal ligation and peritoneoscopy amongst others. This review discusses the evolution of NOTES, the types of procedures performed and the challenges that lie ahead in the further development of this technique.