Reviews in Clinical Medicine

8-11

Authors: Mitra Ahadi; Negin Masoudifar

Eosinophilic esophagitis (EoE) is a chronic immune condition affecting children and adults. Dysphagia and food impaction are the main symptoms; however, reflux-like symptoms may also be present. The diagnosis of EoE is made with endoscopic evaluation for dysphagia, and its definitive diagnosis requires biopsy confirmation. The criteria for active EoE are defined as the symptoms of esophageal dysfunction, eosinophilic tissue infiltration (eosinophil count of at least 15 eosinophils per high-power field), and exclusion of other possible causes of esophageal eosinophilia. EoE is more prevalent in patients suffering from atopic conditions; therefore, allergic conditions may play an important role in the development of the disease. However, the etiology and pathophysiology of the disease are not completely understood. Elimination diets are considered as the first-line therapy in children; nevertheless, this approach appears to be less effective in adults, who often require steroids. Despite medical treatments, EoE is complicated in some cases by esophageal stricture and stenosis that require additional endoscopic treatments.

16-18

Authors: Alireza Ahmadi; Sepideh Namdar; Sajjad Daneshyar

Occasionally, lymphoma involves the adrenal glands; however, primary adrenal lymphoma (PAL) is rare and only few cases have been reported. We report a case of a 59-year-old female with primary adrenal diffuse large B-cell lymphoma (DLBCL) manifested by weakness, fatigue, anorexia, and hyper pigmentation of skin. The patient initially responded to intravenous hydrocortisone in large doses by total remission of the symptoms. An abdominal computed tomography scan showed a hypodense mass in the right subdiaphragmatic space, which was suggestive of an adrenal gland tumor with adjacent liver involvement. Additionally, a smaller lesion with similar characteristics was found in the left adrenal gland. The results obtained from adrenal gland needle biopsy confirmed the diagnosis of DLBCL. Moreover, primary laboratory findings demonstrated hyponatremia, hyperkalemia, fasting blood sugar level of 153 mg/dl, and alkaline phosphatase level of 663 U/L. The mentioned symptoms and laboratory findings were indicative of adrenal insufficiency. After about 2 months, her level of consciousness decreased and urinary and fecal incontinence occurred. Therefore, brain involvement was suspected, and magnetic resonance imaging of the brain showed heterogeneous enhancement (24.8 mm) in the posterior aspect of the left temporal lobe together with patchy foci of enhancement in around the ventricular areas of the brain that showed metastatic lesions of PAL. This case should remind clinicians that PAL may be a cause of adrenal incidentaloma, especially when the patient presents with the symptoms of adrenal insufficiency.

23-25

Authors: Ali Parsa; Farzad Omidi Kashani; Mohammad Moghaddam; Abdolreza Malek; Ali Birjandinejad

Thumb hypoplasia only in the intrinsic thenar muscles is a rare condition; this defect might be accompanied with cardiac diseases (Holt-Oram syndrome), ocular anomalies, and vascular anomalies of the hand and wrist (Okihiro syndrome). In addition, this condition may be detected in hypereosinophilic syndrome (HES), which gives rise to other hand anomalies, as well. Unilateral or bilateral absence of isolated thenar muscles is another rare abnormality. In this study, we presented a case of Cavanagh’s syndrome in an eight-year-old boy with right-sided thenar hypoplasia who had difficulty in thumb opposition. For the treatment, the patient underwent abductor digiti minimi (ADM) opponensplasty. After three years of follow-up, he regained thumb opposition and was symptom-free. Care must be taken to avoid misdiagnosis of thenar atrophy/hypoplasia with carpal tunnel syndrome in case of children

29-32

Authors: Hamideh khorrampazouh; Seyed Musa al-Reza Hosseini; Mohammadreza Noras

Introduction: Enema or ‘hoqne’ is a therapeutic approach used for a wide range of diseases in the Iranian traditional medicine. The use of this method dates back to thousands of years to Hippocrates and Galen. The aim of this study was to review the history of enema and its methods and indices in the Iranian medicine and other complementary medicine. Methods: This review study was conducted on the Iranian medicine textbooks and articles published in the international databases, including Google Scholar, PubMed, Embase, and Scopus, as well as the Iranian databases, such as SID and Magiran. The searching process was performed using the following keywords: ‘Hoqne’, ‘Enema’, ‘Vasta’, ‘Basta’, and ‘Complementary and Alternative Medicine (CAM)’. There was no limitation regarding the publication data of the included studies. Result: In the Iranian medicine, the term “hoqne” is equivalent to enema. Enema is used in various diseases of the brain, respiratory system, digestive system, urogenital system, and musculoskeletal system, as well as systemic diseases. Enema is one of the five main therapies in the Indian medicine or Ayurveda. In other types of complementary medicine, including Chinese medicine, this procedure has therapeutic applications. Although enema has been recognized as a diagnostic method in modern medicine, it has been considered as a therapeutic approach in the recent years. Conclusion: According to the findings of the reviewed studies, enema is a major therapeutic focus in complementary medicine, part of which has been confirmed in the recent studies. Given the low side effects and high success rate of this treatment, it can be used as a supplemental therapy for the management of poisoning, febrile seizures, prolonged functional constipation, and chronic kidney disease, as well as the prevention of swelling. However, this theory requires further investigation and targeted clinical trials. This method has been recently identified and updated as a preventive and therapeutic modality.