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2008| October-December | Volume 14 | Issue 4
Online since
October 6, 2008
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ORIGINAL ARTICLES
Past, present and future of colorectal cancer in the Kingdom of Saudi Arabia
Ezzeldin M Ibrahim, Ahmed A Zeeneldin, Tawfik R El-Khodary, Aboelkhair M Al-Gahmi, Bakr M Bin Sadiq
October-December 2008, 14(4):178-182
DOI
:10.4103/1319-3767.43275
PMID
:19568534
Background/Aims:
The crude frequency of colorectal cancer (CRC) is second to breast cancer in the Kingdom of Saudi Arabia (KSA). To assess the future burden of CRC in the country, we designed a model that takes into consideration the recent lifestyle pattern and the growth and aging of the population.
Methods:
We compared CRC statistics for KSA (using data from the National Cancer Registry) with that from the Surveillance, Epidemiology and End Results (SEER) databases of the United States of America (USA). We used the Joinpoint regression program to identify changes in secular trends, while the GLOBOCAN 2002 software was used to project future incidence and mortality.
Results:
Between 1994 and 2003, age-standardized rates (ASRs) for CRC in KSA almost doubled, as compared to a nonsignificant decline in USA. Between 2001 and 2003, while the annual percent change (APC) of CRC incidence in the USA showed a nonsignificant decrease in females, APC in Saudi females showed a nonsignificant rise of six percent. On the other hand, the rising incidence among Saudi males, during the years 1999 to 2003, was significant, with an APC of 20.5%. The projection model suggested that the incidence of CRC in KSA could increase fourfold in both genders by the year 2030.
Conclusions:
In KSA, the present and expected increase in CRC rates is alarming. Pragmatic recommendations to face that challenge are discussed. The present work could serve as a model to study other prevalent types of cancer, particularly in developing countries.
[ABSTRACT]
[FULL TEXT]
[PDF]
[CITATIONS]
[PubMed]
8,995
1,096
35
REVIEW ARTICLE
Assessment of liver fibrosis: Noninvasive means
Thierry Poynard, Rachel Morra, Patrick Ingiliz, Francoise Imbert-Bismut, Dominique Thabut, Djamila Messous, Mona Munteanu, Julien Massard, Yves Benhamou, Vlad Ratziu
October-December 2008, 14(4):163-173
DOI
:10.4103/1319-3767.43273
PMID
:19568532
Liver biopsy, owing to its limitations and risks, is an imperfect gold standard for assessing the severity of the most frequent chronic liver diseases chronic hepatitis C (HCV), B (HBV) non alcoholic (NAFLD) and alcoholic (ALD) fatty liver diseases. This review summarizes the advantages and the limits of the available biomarkers of liver fibrosis. Among a total of 2,237 references, a total of 14 validated serum biomarkers have been identified between 1991 and 2008. Nine were not patented and five were patented. Two alternatives to liver biopsy were the most evaluated FibroTest and Fibroscan. For FibroTest, there was a total of 38 different populations including 7,985 subjects with both FibroTest and biopsy (4,600 HCV, 1,580 HBV, 267 NAFLD, 524 ALD, and 1014 mixed). For Fibroscan, there was a total of 11 published studies including 2,260 subjects (1,466 HCV, 95 cholestatic liver disease, and 699 mixed). For FibroTest, the mean diagnostic value for the diagnosis of advanced fibrosis assessed using standardized area under the ROC curves was 0.84 (95% confidence interval 0.83-0.86), without a significant difference between the causes of liver disease, hepatitis C, hepatitis B, and alcoholic or non alcoholic fatty liver disease. High-risk profiles of false negative/false positive of FibroTest, mainly Gilbert syndrome, hemolysis and acute inflammation, are present in 3% of the populations. In case of discordance between biopsy and FibroTest, half of the failures can be due to biopsy; the prognostic value of FibroTest is at least similar to that of biopsy in HCV, HBV and ALD. In conclusion this overview of evidence-based data suggests that biomarkers could be used as an alternative to liver biopsy for the first line assessment of fibrosis stage in the four most common chronic liver diseases, namely HCV, HBV, NAFLD and ALD. Neither biomarkers nor biopsy alone is sufficient for taking a definite decision in a given patient; all the clinical and biological data must be taken into account. There is no evidence based data justifying biopsy as a first line estimate of liver fibrosis. Health authorities in some countries have already approved validated biomarkers as the first line procedure for the staging of liver fibrosis.
[ABSTRACT]
[FULL TEXT]
[PDF]
[CITATIONS]
[PubMed]
7,488
1,464
23
ORIGINAL ARTICLES
Chronic diarrhea and skin hyperpigmentation: A new association
Khaled Al Qoaer, Ali Al Mehaidib, Sohail Shabib, Mohammed Banemai
October-December 2008, 14(4):187-191
DOI
:10.4103/1319-3767.41742
PMID
:19568536
Background/Aims:
The objective of this study was to describe patients with chronic diarrhea and abnormal skin hyperpigmentation with distinct distribution.
Methods:
This is a retrospective review of children who presented with diarrhea and skin hyperpigmentation. The clinical presentation, laboratory investigations as well as endoscopic and histological data were reviewed.
Results:
Seven patients with chronic diarrhea had abnormal skin hyperpigmentation with distinct distribution and presented in the first two months of life. Six patients had other features such as abnormal hair and facial dysmorphism. Mental retardation was reported in one patient. Consanguinity was positive in six patients, and there was family history of consanguinity in four patients, with two patients being siblings. No significant immunodeficiency was reported. Intestinal biopsies were obtained in six patients and showed active chronic inflammation in three patients, partial villous atrophy in two patients, and eosinophilic infiltrate with mild villous atrophy in one patient. Colonic biopsies showed mild focal colitis in three patients and mild colitis with eosinophilic infiltrate in one patient. Skin biopsies showed a greater number of melanophagies with fibrosis of papillary derma in two patients but skin biopsy was normal in one patient. The hair of two patients was analyzed by electron microscopy, which showed an abnormal pattern with decreased pigmentation and diameter; however, its chemical analysis was normal. Two other patients had trichorrhexis nodosa, but no abnormalities were seen in one patient. Chromosomal number was normal in three patients. One patient died because of sepsis, and only one patient was dependent on total parenteral nutrition.
Conclusions:
We believe that this association might represent a new syndrome with an autosomal recessive inheritance that warrants further studies.
[ABSTRACT]
[FULL TEXT]
[PDF]
[CITATIONS]
[PubMed]
7,877
748
2
Assessment of thrombophilic abnormalities during the active state of inflammatory bowel disease
Maha M Maher, Somaya H Soloma
October-December 2008, 14(4):192-197
DOI
:10.4103/1319-3767.41743
PMID
:19568537
Background/Aims:
Thromboembolic disease has been recognized as a complication of inflammatory bowel disease (IBD). The relative contributions of inherited or acquired thrombophilia and the inflammatory response to the mechanism of this tendency are unclear. Thrombotic events are more common in active disease although significant numbers also occur spontaneously. The aim of this study was to investigate common thrombophilic markers in patients with active IBD.
Methods:
Twenty-six patients with IBD who had active disease, and 40 sex- and age-matched non-IBD patients were recruited into the study. For all the subjects, complete blood counts, C-reactive protein levels, erythrocyte sedimentation rate, International normalized ratio, activated partial thromboplastin time, and levels of lupus anticoagulant, anticardiolipin antibodies (ACA IgG), proteins C and S, antithrombin-III (AT-III), and factor V were measured.
Results:
The International normalized ratio, activated partial thromboplastin time, and levels of proteins C and S were comparable between the two groups. However, antithrombin-III levels were significantly lower in the IBD group as compared with that in the healthy control group (
P
< 0.001). ACA IgG was detected in one patient in the IBD group. Factor V Leiden mutation was present in 3.8% of the patients in the IBD group, whereas the prevalence was 2.5% in the control group. Significantly elevated platelet counts were observed in patients with active Crohn's disease compared with that in the control group (
P
< 0.001), but they were not significantly increased in active ulcerative colitis (
P
= 0.231).
Conclusions:
The present study failed to establish a strong association between the common thrombophilic markers and the active clinical course of IBD, with the exception of high platelet counts and lower levels of AT-III in the IBD group as compared with those in the control group. All other parameters of thrombophilia were comparable between the two groups.
[ABSTRACT]
[FULL TEXT]
[PDF]
[CITATIONS]
[PubMed]
6,138
577
4
Prevalence of gastroesophageal reflux disease and its association with
Helicobacter pylori
infection in chronic renal failure patients and in renal transplant recipients
Ibrahiem S Abdulrahman, Abdulaziz A Al-Quorain
October-December 2008, 14(4):183-186
DOI
:10.4103/1319-3767.41741
PMID
:19568535
Background/Aims:
The prevalence of gastroesophageal reflux disease (GERD) in chronic renal failure patients and in renal transplant recipients (RTR) has been a subject of discussion in the last few years. Our aims are to clarify this association and its relation to
Helicobacter pylori
infection, and also to identify possible pathogenic factors in the development of this disease in both groups.
Methods:
The study involved 40 end-stage renal disease (ESRD) patients with upper gastrointestinal (GI) symptoms (group I), 36 patients who had undergone kidney transplantation and had similar symptoms (group II), and 44 age- and sex-matched controls with the same upper GI symptoms (group III). All patients were subjected to esophagogastroduodenoscopy, and biopsies were obtained from the antrum for histological evaluation and identification of
H. pylori
.
Results:
The prevalence of GERD in the first two groups was similar (77.5 vs. 75.0%,
P
= 0.412), while it was significantly lower in the control group (38.6%,
P
< 0.01).
H. pylori
infection was present in 40.0, 36.1 (
P
> 0.05) and 75% (
P
< 0.01 and < 0.001) of the patients in groups I, II, and III, respectively . Multivariate logistic regression analysis in groups I and II showed that high serum creatinine (Odds ratio [OR] = 6.78, 95% Confidence Interval (CI) = 1.12-45.82), immunosuppressive therapy (OR = 5.78, 95% CI = 1.01-32.5), and absence of
H. pylori
infection (OR = 3.58, 94% CI = 1.11-18.6) were significantly associated with GERD. The duration of ESRD correlated significantly with the prevalence of GERD in group I.
Conclusions:
This study showed a similar prevalence of
H. pylori
infection and GERD in ESRD and RTR patients. GERD prevalence was higher in these two groups than in the controls. Renal transplantation, chronic renal disease, immunosuppressive therapy, and the absence of
H. pylori
infection seem to be risk factors for the development of GERD.
[ABSTRACT]
[FULL TEXT]
[PDF]
[CITATIONS]
[PubMed]
5,996
705
3
LETTERS TO THE EDITOR
Inflammatory fibroid polyp of the cecum can be treated by endoscopic resection
Musthafa Chalikandy Peedikayil, Hindi N Al Hindi, Mohamed Awad Said Rezeig
October-December 2008, 14(4):212-213
DOI
:10.4103/1319-3767.43281
PMID
:19568543
[FULL TEXT]
[PDF]
[PubMed]
5,638
404
-
ORIGINAL ARTICLES
Serum hyaluronic acid as a noninvasive marker of hepatic fibrosis in chronic hepatitis B
Bita Geramizadeh, Katayoun Janfeshan, Mehdi Saberfiroozi
October-December 2008, 14(4):174-177
DOI
:10.4103/1319-3767.43274
PMID
:19568533
Background/Aims:
Chronic hepatitis B is a serious global health problem. Liver biopsy is currently recommended as the gold standard for the evaluation of the degree of fibrosis in patients with chronic hepatitis B. This procedure, however, is invasive and has potential complications. In this study, we attempted to validate the level of hyaluronic acid as a simple laboratory test to discriminate between patients with and without significant fibrosis in chronic hepatitis B.
Methods:
This study included 93 patients with chronic hepatitis B who had undergone percutaneous liver biopsy from 2003 to 2006. At the time of biopsy, a sample of serum was taken for the hyaluronic acid (HA) assay. Histological assessment consisted of the semiquantitative analysis of the degree of fibrosis according to the criteria proposed by the Ishak system. These findings were then compared by using statistical analysis.
Results:
HA levels and stage groups of fibrosis were well correlated (Spearman r = 0.945,
P
< 0.005). There was a significant increase in HA levels when considering S0 to S6. The mean values of HA concentrations were 59.7 ± 10.5 ng/mL for stages 0-2, 149.4 ± 15.9 ng/mL for stages 3-4 , and 284.5 ± 14.5 ng/mL for the last group (stages 5-6). There were significant differences between the three groups. Serum HA levels of cases with extensive fibrosis were significantly higher than in those with mild and moderate fibrosis (
P
= 0.0001,
P
= 0.0005, and
P
= 0.0001, respectively).
Conclusion:
Serum HA level is a precise predictor of extensive liver fibrosis in chronic hepatitis B. HA is well correlated with the stage of fibrosis and can reflect the severity of fibrosis. Thus, it can be used as a noninvasive test to monitor these patients.
[ABSTRACT]
[FULL TEXT]
[PDF]
[CITATIONS]
[PubMed]
4,579
696
11
CASE REPORTS
Fasciola hepatica
: A cause of obstructive Jaundice in an elderly man from Iran
Mohsen Moghadami, M Mardani
October-December 2008, 14(4):208-210
DOI
:10.4103/1319-3767.43279
PMID
:19568541
Fascioliasis is a zoonotic infection caused by
Fasciola hepatica
. Humans can become accidental hosts of this parasite by ingesting contaminated drinking water or plants in endemic area. The north of Iran is one of the regions. This disease is rarely seen with jaundice caused by obstruction of the biliary tree. We report a case of human fascioliasis with obstructive jaundice who was diagnosed using endoscopic retrograde cholangiopancreatography (ERCP). This report confirms the diagnostic role of ERCP in patients with obstructive jaundice caused by biliary fascioliasis.
[ABSTRACT]
[FULL TEXT]
[PDF]
[CITATIONS]
[PubMed]
4,561
665
9
EDITORIAL
Serum hyaluronic acid: A promising marker of hepatic fibrosis in chronic hepatitis B
Gamal Shiha
October-December 2008, 14(4):161-162
DOI
:10.4103/1319-3767.43272
PMID
:19568531
[FULL TEXT]
[PDF]
[CITATIONS]
[PubMed]
3,748
631
3
ORIGINAL ARTICLES
The effect of piroxicam on the formation of postoperative, intraabdominal adhesion in rats
Hemmat Maghsoudi, Behnam Askary
October-December 2008, 14(4):198-201
DOI
:10.4103/1319-3767.43276
PMID
:19568538
Background/Aims:
Peritoneal adhesions are fibrous bands of tissues formed between organs that are normally separated and/or between organs and the internal body wall after peritoneal injury. Antiinflammatory agents were used to reduce the initial inflammatory response to tissue injury and, hence, the subsequent formation of adhesion. The aim of this study was to investigate the effect of intraperitoneal instillation of piroxicam on intraperitoneal adhesions.
Methods:
Eighty Wistar rats were subjected to standardized lesion by using the scraping model and were randomly divided into four groups. Group I (control) received no treatment; groups II, III, and IV received 10-12.5 mL of 0.05, 0.1, and 0.2 mg/mL piroxicam solution, respectively, after surgery. On the 14th postoperative day, the adhesion intensity score, inflammatory cell reaction, and the number of adhesion bands were determined.
Results:
There were no rats with grade 0 adhesions in the control group. There were 10 rats (50%) with grade 2 and eight rats (40%) with grade 3 adhesions. The adhesion intensity (
P
< 0.0001) and the number of adhesion bands (
P
< 0.001) were significantly lower in groups III and IV. No significant difference was observed in the adhesion intensity or the number of adhesion bands between groups I and II.
Conclusions:
Intraperitoneal instillation of piroxicam solution might be useful for preventing peritoneal adhesions.
[ABSTRACT]
[FULL TEXT]
[PDF]
[CITATIONS]
[PubMed]
3,795
487
5
CASE REPORTS
Jejunal lipoma with intermittent intussusception revealed by partial obstructive syndrome
Saad Rifki Jai, Fatimazahra Bensardi, Farid Chehab, Driss Khaiz, Abdelmajid Bouzidi
October-December 2008, 14(4):206-207
DOI
:10.4103/1319-3767.43278
PMID
:19568540
Jejunojejunal intussusceptions are not very common in adults, and unlike in children, a lead point is usually found. The clinical presentations in adults tend to be more chronic or intermittent, and they include obstructive syndrome, abdominal cramps, gastrointestinal bleeding, or palpable abdominal mass at physical examination. These unspecific symptoms often lead to late diagnosis after many investigations or even only after an inappropriately extensive surgery. We report the rare case of a 37-year-old female with intermittent bowel obstruction due to jejunojejunal intussusception secondary to the lipoma. The main clinical signs of this uncommon pathology are presented together with the necessary paraclinical investigations that enable surgical treatment.
[ABSTRACT]
[FULL TEXT]
[PDF]
[PubMed]
3,800
399
-
ORIGINAL ARTICLES
Multiple primary cancers of the colon, rectum, and the thyroid gland
Ahmad Zubaidi
October-December 2008, 14(4):202-205
DOI
:10.4103/1319-3767.43277
PMID
:19568539
The major concern in the case of cancer, whether one or in worse case more than one, is the extent of treatment required and the prognosis. This article reports three cases with two cancers: colorectal cancer and thyroid cancer, in the same patient at the same time. It also discusses the related clinical presentation and management of the cancers, and a review of literature has been presented.
[ABSTRACT]
[FULL TEXT]
[PDF]
[CITATIONS]
[PubMed]
3,621
503
2
LETTERS TO THE EDITOR
Gall bladder perforation as a complication of typhoid fever
Anand Pandey, Ajay N Gangopadhyay, Vijayendra Kumar
October-December 2008, 14(4):213-213
DOI
:10.4103/1319-3767.43282
PMID
:19568544
[FULL TEXT]
[PDF]
[CITATIONS]
[PubMed]
3,452
468
5
RADIOLOGY QUIZ
Tender thigh in a patient with
Crohn's disease
Abdulwahed Al-Saeed, Ahmed Helmy, Hamad Al-Ashgar, Khalid Al-Kahtani
October-December 2008, 14(4):214-215
DOI
:10.4103/1319-3767.43283
PMID
:19568545
[FULL TEXT]
[PDF]
[PubMed]
2,446
307
-
LETTERS TO THE EDITOR
Intestinal obstruction due to Bochdaleck´s hernia in an adult
Miguel Echenique Elizondo, Borja Aguinagalde
October-December 2008, 14(4):211-212
DOI
:10.4103/1319-3767.43280
PMID
:19568542
[FULL TEXT]
[PDF]
[CITATIONS]
[PubMed]
2,293
320
2
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© Saudi Journal of Gastroenterology (Official journal of The Saudi Gastroenterology Association) | Published by Wolters Kluwer -
Medknow
Online since 15
th
October, 2006