Resolution of bile duct adenoma over follow-up period; a case report

Bile duct adenoma [BDA] is a rare neoplasm of bile ducts with various clinical manifestations and imaging appearances. A few cases of BDA and their predisposing factors have been described. We report a 35-year-old woman with right upper quadrant pain who consumed oral contraceptive pills. Ultrasound study revealed three hypoechoic subcapsular liver masses; two of them were hypodense in computed tomography. Fine needle biopsy of the largest mass showed bile duct adenoma. Liver masses disappeared after discontinuing the pills over a 2-year follow-up. BDAs can manifest in imaging. Although previous studies have not reported tumor resolution over a follow-up period, we suggest paying more attention to predisposing factors in order to give an opportunity for tumor resolution by risk factor elimination

relationship between diaphragmatic movements in sonographic assessment and disease severity in patients with stable chronic obstructive pulmonary disease [COPD]

Introduction: Pulmonary hyperinflation in patients with chronic obstructive pulmonary disease [COPD] can increase the breathing rate and reduce diaphragmatic movements by pushing the diaphragms downward and limiting their movements; this, in fact, can affect the breathing process. The purpose of this study was to compare diaphragmatic movements in COPD patients and healthy ones and to evaluate the relation of diaphragmatic movements and COPD severity in patients

Materials and Methods: This cross- sectional study was performed in Ghaem hospital, Mashhad Iran. Twenty-five COPD patients [case group] were selected, based on the inclusion and exclusion criteria. The patients' demographic and clinical characteristics along with factors related to pulmonary function were recorded. Patients were referred for sonography after pulmonary evaluation. The status of the left portal vein or one of its branches at the end of a deep expiration and a deep inspiration was considered as a marker. Twenty-five healthy non-smoker subjects, who were matched with the patients in terms of age and sex, were studied as the control group for the comparison of sonographic findings of the diaphragms

Results: The current study included 25 healthy subjects and 25 COPD patients, with the mean age of 59.2 +/- 12 years; approximately 84% of the subjects were males. Evaluation of the rate of diaphragmatic movements by sonography showed the mean of 42.08 +/- 12.15mm and 73.28 +/- 15.19mm in the case and control groups, respectively, which showed a statistically significant difference between them [P=0.02]. Statistical analysis indicated the relationship between the rate of diaphragmatic movements with factors related to airway obstruction. However, no relationship was observed between the rate of diaphragmatic movements and the factors associated with pulmonary hyperinflation or air retention

Conclusion: The rate of diaphragmatic movements as a parameter for determining exercise capacity in COPD patients could help with a better understanding of activity limitations in these patients

[Study of celiac disease in patients with non alcoholic fatty liver disease in northeast of Iran]

Non alcoholic fatty liver disease probably is the most common liver disorder in the world. The causes of NAFLD may be divided into two board categories: drugs and metabolic abnormalities. Because previous studies reported relationship between celiac and NAFLD/ we have studied this association in this article. This study was performed between September 2007 and December 2008. We measured human anti-tissue transglutaminase IgA antibody titratage by ELISA technique in 95 NAFLD inflicted patients, with out any risk factors for NAFLD, then patients with positive ATTG underwent upper endoscopy with duodenal biopsy. Positive ATTG was found in 6 out of 80 patients [7.5% Endoscopy was performed in 6 patients. Duodenal biopsy was normal in 2 patients [33.3%] and 4 patients [66.7%] had abnormal duodenal biopsy. Two patients were in Marsh stage 1 and one in Marsh stage 2 and another one in Marsh stage 3. None of them had symptoms suggestive of celiac disease. This present study shows that positive ATTG is not rare in patients with NAFLD. We recommend serum ATTG should be check in patients with NAFLD without any obvious etiology, also upper endoscopy with duodenal biopsy should be taken for all patients with positive ATTG