Significance of color doppler ultrasonography in the assessment of pancreatic carcinoma vascular invasion

Background/Aim. It is highly appreciated to provide exact data on vascular invasion of pancreatic carcinoma relying as much as possible on non-invasive diagnostic procedures. Color Doppler ultrasonography has been proven as an efficient method for clinical staging of pancreatic carcinoma essential for therapeutic decisions. The aim of this study was to provide an analysis of the sensitivity and specificity for color Doppler ultrasonography in patients suffering from pancreatic carcinoma. Methods. We performed color Doppler ultrasonography examination in 43 patients with pancreatic carcinoma prior to the surgery. The findings of ultrasonography on neoplasm vascular invasion were correlated to the findings obtained during the subsequent surgical procedures. An estimation of neoplastic invasion of certain blood vessels including portal vein, celiac trunk, and superior mesenteric artery and vein is critical for decision making regarding surgical treatment. The patients with metastases of pancreatic carcinoma were excluded from the study. Results. Comparing color Doppler and the surgical findings we estimated the sensitivity for detection of neoplastic vascular invasion ranging from 79−93%, whereas the specificity range was from 83−93%. Conclusion. Color Doppler ultrasonography is a sufficiently sensitive and specific method for evaluation of vascular invasion in pancreatic carcinoma patients. Since color Doppler ultrasonography is a non-invasive, radiation free, and inexpensive diagnostic tool, considering also the results of this and similar studies we could strongly recommend its use for an initial presurgical evaluation of vascular invasion in pancreatic carcinoma patients

Congenital intestinal lymphangiectasia

Background. Congenital intestinal lymphangiectasia is a disease which leads to protein losing enteropathy. Tortous, dilated lymphatic vessels in the intestinal wall and mesenterium are typical features of the disease. Clinical manifestations include malabsorption, diarrhea, steatorrhea, edema and effusions. Specific diet and medication are required for disease control. Case report. A 19-year old male patient was hospitalized due to diarrhea, abdominal swelling, weariness and fatigue. Physical examination revealed growth impairment, ascites, and lymphedema of the right hand and forearm. Laboratory assessment indicated iron deficiency anaemia, lymphopenia, malabsorption, inflammatory syndrome, and urinary infection. Enteroscopy and video capsule endoscopy demonstrated dilated lymphatic vessels in the small intestine. The diagnosis was confirmed by intestinal biopsy. The patient was put on high-protein diet containing medium-chain fatty acids, somatotropin and suportive therapy. Conclusion. Congenital intestinal lymphangiectasia is a rare disease, usually diagnosed in childhood. Early recognition of the disease and adequate treatment can prevent development of various complications

Clinical relevance of IL-6 gene polymorphism in severely injured patients

In polytrauma, injuries that may be surgically treated under regular circumstances due to a systemic inflammatory response become life-threatening. The inflammatory response involves a complex pattern of humoral and cellular responses and the expression of related factors is thought to be governed by genetic variations. This aim of this paper is to examine the influence of interleukin (IL) 6 single nucleotide polymorphism (SNP) -174C/G and -596G/A on the treatment outcome in severely injured patients. Forty-seven severely injured patients were included in this study. Patients were assigned an Injury Severity Score. Blood samples were drawn within 24 h after admission (designated day 1) and on subsequent days (24, 48, 72, hours and 7days) of hospitalization. The IL-6 levels were determined through ELSA technique. Polymorphisms were analyzed by a method of Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR). Among subjects with different outcomes, no statistically relevant difference was found with regards to the gene IL-6 SNP-174G/C polymorphism. More than a half of subjects who died had the SNP-174G/C polymorphism, while this polymorphism was represented in a slightly lower number in survivors. The incidence of subjects without polymorphism and those with heterozygous and homozygous gene IL-6 SNP-596G/A polymorphism did not present statistically significant variations between survivors and those who died. The levels of IL-6 over the observation period did not present any statistically relevant difference among subjects without the IL-6 SNP-174 or IL- 6 SNP -596 gene polymorphism and those who had either a heterozygous or a homozygous polymorphism

Clinical relevance of IL-6 gene polymorphism in severely injured patients

In polytrauma, injuries that may be surgically treated under regular circumstances due to a systemic inflammatory response become life-threatening. The inflammatory response involves a complex pattern of humoral and cellular responses and the expression of related factors is thought to be governed by genetic variations. This aim of this paper is to examine the influence of interleukin (IL) 6 single nucleotide polymorphism (SNP) -174C/G and -596G/A on the treatment outcome in severely injured patients. Forty-seven severely injured patients were included in this study. Patients were assigned an Injury Severity Score. Blood samples were drawn within 24 h after admission (designated day 1) and on subsequent days (24, 48, 72, hours and 7days) of hospitalization. The IL-6 levels were determined through ELSA technique. Polymorphisms were analyzed by a method of Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR). Among subjects with different outcomes, no statistically relevant difference was found with regards to the gene IL-6 SNP-174G/C polymorphism. More than a half of subjects who died had the SNP-174G/C polymorphism, while this polymorphism was represented in a slightly lower number in survivors. The incidence of subjects without polymorphism and those with heterozygous and homozygous gene IL-6 SNP-596G/A polymorphism did not present statistically significant variations between survivors and those who died. The levels of IL-6 over the observation period did not present any statistically relevant difference among subjects without the IL-6 SNP-174 or IL- 6 SNP -596 gene polymorphism and those who had either a heterozygous or a homozygous polymorphism

Angiotensin-Converting Enzyme Gene Insertion/Deletion Polymorphism in Patients with Chronic Pancreatitis and Pancreatic Cancer

The purpose of this study was to determine the frequency of angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism and to investigate its role as a potential risk factor in patients with chronic pancreatitis and pancreatic cancer. Deletion polymorphism of the 287-bp fragment of intron 16 of the ACE gene results in higher levels of circulating enzyme and therefore may represent a risk factor for disease development. The study included 55 patients with chronic pancreatitis, 45 patients with pancreatic cancer and 128 healthy subjects. The presence of I and D variants in the ACE gene was analyzed by a polymerase chain reaction (PCR) method. Distribution of ACE ID genotypes was analyzed by means of logistic regression. When chronic pancreatitis and pancreatic cancer groups were compared in the univariate analysis, the following factors were identified as statistically significant predictors of pancreatic disease: age, gender, smoking, fat intake, ACE II genotype and ACE DD genotype. However, in the multivariate analysis, only age, gender and smoking were singled out as predictors for the occurrence of pancreatic disease. Our findings indicate that the ACE I/D polymorphism could play a role in the development of chronic pancreatitis and pancreatic cancer through interaction with other genetic and environmental factors

The Clinical Importance of Cystatin C and Hepatic Artery Resistive Index in Liver Cirrhosis

Background: Data suggest cystatin C (CysC) levels and hepatic artery resistive index (HARI) correspond to the progression of chronic liver disease. We aimed to evaluate the clinical significance of these parameters in assessment of fibrosis in patients with liver cirrhosis. Methods: The cross-sectional study included 63 patients with liver cirrhosis. A control group consisted of 30 age- and gender-matched healthy persons. Results: We confirmed significantly higher values of CysC in patients with cirrhosis compared to control group (p = 0.036). Average value of HARI in the examined group was increased (0.72 +/- 0.06) and there was the statistically significant difference compared to controls (0.66 +/- 0.03) (p lt 0.001). We found statistically significant correlation between HARI and CysC in the study group. Analyzing the possibility of distinguishing healthy subjects from patients with fibrosis, we have found that the area under the curve is far greater in the HARI index than CysC. Comparison of CysC among Child-Pugh stages and correlation with a model for end-stage liver disease (MELD) score showed statistically significant results. Conclusion: We confirmed HARI is a more accurate parameter than CysC in discriminating healthy subjects from patients with fibrosis, while CysC could be a better indicator of the stage of liver cirrhosis

Autoimunski hepatitis: savremeni stavovi o dijagnostici i lečenju

Autoimunski hepatitis (AIH) je imunološki posredovana progresivna nekroinflamacijajetre, koja se karakteriše hipergamaglobulinemijom, autoantitelimai histološki graničnim hepatitisom. Prvi put je opisan 1950. godine, kada jepokazano da adekvatno lečen AIH ima dobru prognozu, dok u suprotnomvodi u terminalnu insuficijenciju jetre. Bolest prolazi kroz periode remisije iegzarcebacije, a ređe se manifestuje akutnom insuficijencijom jetre. Dijagnozase zasniva na kombinaciji biohemijskih, seroloških i histoloških parametara,kao i isključenju drugih oboljenja jetre.Standardna terapija AIH se sastoji od primene kortikosteroida i azatioprina.Pokazano je da ova terapija ima uspeha kod oko 80% pacijenata. U poslednjevreme se sve više ispituju alternativne terapijske metode kod pacijenatakoji nisu reagovali na standardnu terapiju ili je došlo do razvoja neželjenihefekata. U grupi lekova tzv. „druge linije“ za lečenje AIH su mikofenolatmofetil, ciklosporin, takrolimus i dr

A review of current methods in the diagnostics of morphological changes in chronic pancreatitis

Chronic pancreatitis is a disease with well-defined histopathology, however, the diagnosis is not based on the grading of histological changes, but on the features registered by the methods of morphological and functional diagnostic procedures. The correct diagnosis of chronic pancreatitis is easy in advanced stages, but difficult in early stages of the disease. In this review, we present the current methods used (echosonography, computer tomography, magnetic resonance, endoscopic retrograde cholangiopancreatography, endoscopic echosonography) in the diagnostics of chronic pancreatitis

Correlation between findings of echosonography and endoscopic retrograde cholangiopancreatography examination in chronic pancreatitis patients

Background/Aim. Chronic pancreatitis is defined as an amount of chronic inflammatory lesions that lead to the destruction of pancreatic tissue and fibrosis development, whereas the later stages of the illness are characterized by the destruction of the endocrine portion of the organ. Although the results of different studies are abundant, chronic pancreatitis still remains enigmatic, both in its diagnostic and therapeutic aspect. To test the correlation between the findings of echosonography and endoscopic retrograde cholangiopancreatography (ERCP) examination in chronic pancreatitis patients. The observed degree of correlation may serve for the validation of echosonography as a diagnostic tool in chronic pancreatitis patients. Methods. We collected and analyzed data on morphological features in chronic pancreatitis patients revealed by echosonography as well as endoscopic retrograde cholangiopancreatography. Results. 35 patients 34−73 years of age were included in this study. In 60% (21 subject) history was subjective for alcohol abuse. significant correlation has been found between alcohol abuse and chronic pancreatitis (χ2 = 6.896; p < 0.05). Correlation between groups of chronic pancreatitis patients diagnosed by echosonography and endoscopic retrograde cholangiopancreatography was highly significant (p = 0.799; p < 0.01). Conclusion. Echosonography was proved to be a suitable first choice imaging method for the examination of patients when chronic pancreatitis was suspected. Echosonography might provide conclusive information on the morphology of pancreatic canalicular system, as well as on the state of pancreatic parenchyma

Rectosigmoid prolapse - a case report

Introduction. Many factors have been indentified as a possible cause of rectal prolaps. Despite the fact that it is not a lifethreating condition, its clinical presentation varies, and sometimes it can present as an emergency. We presented a patient with prolapse of an unusually large segment of the rectosigmoid colon caused by chronic constipation, as an incarcerated segment repaired surgically. Case report. A 62-year-old female patient was referred to the Emergency Department in bad condition with severe pain in the perianal region. On examination a complete rectal prolaps as well as a part of sigmoid colon were found. Macroscopically, the prolapsed segment appeared edematous, livid, with ulcerations. An attempt to manually reduce prolapse failed, therefore resection of 50 cm of sigmoid colon with rectopexy had to be performed. No complications occurred and the patient was without symptoms six months later. Colonoscopy did not reveal any abnormality. Conclusion. Although the preoperative management and preparation of the patient was limited, emergancy surgical intervention for such a case was the strategy of choice due to magnitude of the prolapsing segment. It provided a successful and permenant solution