Development of gastroenterology and hepatology in Iran: Part II- advances in research and therapeutic modalities.

Following the establishment of Gastroenterology and Hepatology Fellowship Programs in 1987, significant developments in research and health care delivery have been achieved. The number of published articles has increased significantly and now more than 10 approved research centers are involved in several longitudinal and population based studies in GI epidemiology, viral hepatitis and GI oncology around the country. Before 1987 less than 50 gastroenterologists were working in the country, but now more than 300 gastroenterologists are involved in public and private health care delivery systems.

Development of gastroenterology and hepatology in Iran: part I-training programs and the Iranian association of gastroenterology and hepatology.

During the first half of the 20th century, all subspecialties of internal medicine were managed by general internists and there was no gastroenterologist in Iran.1 The first group of Iranian gastroenterologists who had completed their training program in France started working in Tehran in 1951. Later on, other specialists trained in USA and the United Kingdom joined them.

Crohn's disease and intestinal carcinoma. A report of 11 cases with emphasis on associated epithelial dysplasia.

Eleven patients with intestinal carcinoma complicating Crohn's disease are reported. In the 4 patients with small intestinal carcinoma, carcinomas were poorly differentiated or signet-ring cell type in 3 cases and mucinous type in 1 case. All 4 patients had high-grade dysplasia in the mucosa immediately adjacent to the carcinoma only.

Bile duct carcinoma in patients with ulcerative colitis. Relationship to sclerosing cholangitis: report of six cases and review of the literature.

Six cases of bile duct carcinoma were encountered among 1207 patients with ulcerative colitis, a prevalence rate of 0.5%. The relative risk of bile duct carcinoma in patients with ulcerative colitis was 31.

Liver abscess in Crohn's disease. Report of four cases and review of the literature.

Four patients with liver abscesses and Crohn's disease are described, and reports of 14 cases in the English language literature are reviewed. The incidence of liver abscess in patients with Crohn's disease (114-297 per 100,000) appears to be higher than that of liver abscess in the general population (8-16 per 100,000). Frequently the clinical manifestations of liver abscess are mistaken for a reactivation of Crohn's disease, and diagnosis is delayed.

Colorectal and extracolonic malignancy in ulcerative colitis.

In a review of 1248 cases of ulcerative colitis seen at the Cleveland Clinic that were followed up to 1984 (mean, 14.4 years), 82 patients (6.5%) were subsequently found to have colorectal cancer and 48 (3.

Inflammatory bowel disease and leukemia. A report of seven cases of leukemia in ulcerative colitis and Crohn's disease and review of the literature.

In a review of a large number of patients with inflammatory bowel disease, leukemia was observed in five patients with chronic ulcerative colitis and in two patients with Crohn's disease. In ulcerative colitis patients, there were three cases of acute myelocytic leukemia and one case each of acute lymphoblastic leukemia and chronic granulocytic leukemia. In Crohn's disease patients, there was one case each of chronic granulocytic leukemia and chronic lymphocytic leukemia associated with thrombocythemia.

Course and prognosis of idiopathic ulcerative proctosigmoiditis in young patients.

The course and prognosis of idiopathic ulcerative proctosigmoiditis were studied in 85 young patients whose symptoms had begun before the age of 21 (mean age at onset, 16 years), and the results were compared with those in adults with proctosigmoiditis. Data regarding extension of disease, available in 66 patients, allowed us to identify two groups of patients. Presenting symptoms were the same in both groups.

Hypereosinophilia, ulcerative colitis, sclerosing cholangitis, and bile duct carcinoma.

A case of ulcerative colitis and pericholangitis-sclerosing cholangitis bile duct carcinoma complex associated with hypereosinophilia and possibly the hypereosinophilic syndrome is reported, and the association of eosinophilia with various hepatobiliary and gastrointestinal diseases is discussed. Hypereosinophilia may foretell a more serious underlying condition such as bile duct carcinoma in some patients with primary sclerosing cholangitis.

Ulcerative colitis in Iran: a review of 112 cases.

Despite claims of rarity, chronic ulcerative colitis is being encountered with increasing frequency in developing countries. We report our experience with 112 patients with chronic ulcerative colitis diagnosed during a 10-year period between 1973 and 1982 in Tehran, Iran, and compare the demographic and clinical features of chronic ulcerative colitis on our patients with those reported from other countries. Significant differences included the mild course of the disease, the absence of skin manifestations, and the rarity of colorectal cancer in our patients.

Primary tuberculous granulomatous esophagogastro-duodenitis: a report of a case.

Primary upper gastro-intestinal tuberculosis is a very rare disease. We report the case of a 25-year-old man who presented with a febrile illness and non-specific gastro-intestinal symptoms. The upper gastro-intestinal X-rays showed a normal esophagus and non-specific changes of the stomach and duodenum.

Clinical course and evolution of erythema nodosum and pyoderma gangrenosum in chronic ulcerative colitis: a study of 42 patients.

The authors examined 1132 patients with chronic ulcerative colitis (CUC) seen at the Cleveland Clinic to clarify the relationship between the clinical features of colitis and the incidence and severity of erythema nodosum (EN) and pyoderma gangrenosum (PG). There were 21 patients (2%) with EN and 21 (2%) with PG, both of which affected those with active and extensive colitis. CUC was inactive in only 10% of the EN group and 20% of the PG group; it was left-sided in 20% of the EN group and 15% of the PG group.

Coexisting primary malignant lymphoma and adenocarcinoma of the large intestine in an IgA-deficient boy.

This is a case report of an IgA-deficient adolescent male (14 years old) presenting with coexisting adenocarcinoma and adenomatous polyp of the rectosigmoid, and a primary lymphoma of the cecum (large-cell, histiocytic type). A 14-year-old sister of the patient had died of gastric carcinoma. Her serum immunoglobulins were not measured.

Malakoplakia of the colon and recurrent colonic strictures in a patient with primary hypogammaglobulinemia: an association not previously described.

A nine-year old boy with primary hypogammaglobulinemia and recurrent colonic strictures who developed malakoplakia of the colon is reported on. Such an association has not been reported previously. The development of colonic strictures is not considered a gastrointestinal manifestation of hypogammaglobulinemia.

Alpha-chain disease--a report of eleven patients from Iran.

About one hundred cases of alpha-chain disease have been reported to date from various Mediterranean and Middle-Eastern countries. We report eleven Iranian patients with primary lymphoma of the duodenum and upper small intestine and positive alpha-chain protein in their sera. The clinical, laboratory and pathological findings in these patients are discussed.