Endoskopsko liječenje krvarenja iz gastroezofagusnih varikoziteta

Current concepts of endoscopic treatment of gastroesophageal variceal hemorrhage are discussed. There are two major endoscopic treatments of gastroesophageal varices: endoscopic injection sclerotherapy (EIS) and endoscopic variceal ligation (EVL). EIS and EVL alone are equally effective in controlling acute variceal bleeding; however, EVL is superior to EIS because it achieves variceal obliteration faster and with a lower rate of complications and rebleeding. Considering combined technique of EVL and EIS, it appears that initial EVL followed by long-term EIS on later sessions, when banded varices have become smaller, probably is a wiser approach for safe and long-lasting variceal eradication. Histoacryl as a tissue glue is the only endoscopic treatment that has been proved to be effective for gastric varices. The use of endoscopic clips alone in the treatment of varices remains uncommon. The role of endoscopic ultrasound increases in the evaluation of portal hypertension, and it may gain a role in choosing an optimal treatment approach for individual patients.Prikazane su suvremene mogućnosti endoskopskog liječenja krvarenja iz gastroezofagusnih varikoziteta. Dva su glavna načina endoskopskog liječenja gastroezofagusnih varikoziteta: endoskopska injekcijska skleroterapija i endoskopska ligacija varikoziteta. Endoskopska skleroterapija i ligacija varikoziteta kao samostalne metode podjednako su učinkovite u zaustavljanju akutnog krvarenja iz varikoziteta, no endoskopska ligacija varikoziteta bolja je metoda u odnosu na skleroterapiju jer se njome obliteracija varikoziteta postiže brže i u manjem broju tretmana te s manjim brojem komplikacija. Glede kombinacije ligacije i skleroterapije, inicijalna ligacija, a potom postupci skleroterapije kad podvezani varikoziteti postanju manji, vjerojatno je prikladniji postupak za sigurno i dugotrajno iskorjenjivanje varikoziteta. Obliteracija varikoziteta Histoacrylom jedini je potvrđen i djelotvoran način endoskopskog liječenja varikoziteta želuca. Upotreba endoskopskih klipsa kao samostalan način liječenja još uvijek nije preporučljiva. Uloga endoskopskog ultrazvuka u procjeni portalne hipertenzije raste, a isti može steći ulogu u odabiru najboljeg pristupa liječenju svakog bolesnika pojedinačno

Endoskopsko liječenje krvarenja iz gastroezofagusnih varikoziteta

Current concepts of endoscopic treatment of gastroesophageal variceal hemorrhage are discussed. There are two major endoscopic treatments of gastroesophageal varices: endoscopic injection sclerotherapy (EIS) and endoscopic variceal ligation (EVL). EIS and EVL alone are equally effective in controlling acute variceal bleeding; however, EVL is superior to EIS because it achieves variceal obliteration faster and with a lower rate of complications and rebleeding. Considering combined technique of EVL and EIS, it appears that initial EVL followed by long-term EIS on later sessions, when banded varices have become smaller, probably is a wiser approach for safe and long-lasting variceal eradication. Histoacryl as a tissue glue is the only endoscopic treatment that has been proved to be effective for gastric varices. The use of endoscopic clips alone in the treatment of varices remains uncommon. The role of endoscopic ultrasound increases in the evaluation of portal hypertension, and it may gain a role in choosing an optimal treatment approach for individual patients.Prikazane su suvremene mogućnosti endoskopskog liječenja krvarenja iz gastroezofagusnih varikoziteta. Dva su glavna načina endoskopskog liječenja gastroezofagusnih varikoziteta: endoskopska injekcijska skleroterapija i endoskopska ligacija varikoziteta. Endoskopska skleroterapija i ligacija varikoziteta kao samostalne metode podjednako su učinkovite u zaustavljanju akutnog krvarenja iz varikoziteta, no endoskopska ligacija varikoziteta bolja je metoda u odnosu na skleroterapiju jer se njome obliteracija varikoziteta postiže brže i u manjem broju tretmana te s manjim brojem komplikacija. Glede kombinacije ligacije i skleroterapije, inicijalna ligacija, a potom postupci skleroterapije kad podvezani varikoziteti postanju manji, vjerojatno je prikladniji postupak za sigurno i dugotrajno iskorjenjivanje varikoziteta. Obliteracija varikoziteta Histoacrylom jedini je potvrđen i djelotvoran način endoskopskog liječenja varikoziteta želuca. Upotreba endoskopskih klipsa kao samostalan način liječenja još uvijek nije preporučljiva. Uloga endoskopskog ultrazvuka u procjeni portalne hipertenzije raste, a isti može steći ulogu u odabiru najboljeg pristupa liječenju svakog bolesnika pojedinačno

Plant Diversity of Gornji Kamenjak (Istria, Croatia)

The vascular flora of Significant Landscape Gornji Kamenjak in Istria was investigated in different vegetation periods from 2012 to 2013, and a total of 507 plant taxa (468 species and 39 subspecies) were recorded. Part of them werw previously registered, while some are recorded for the first time. The studied area was poorly investigated in the past, therefore there was a need for this study, representing a very detailed floristic survey of the area. The most dominant families were grasses (Poaceae, 11.8%), legumes (Fabaceae, 10.6%), daisies (Asteraceae, 6.5%) and mints (Lamiaceae, 5.5%). The domination of therophytes (37.0%) indicates that the climate of Gornji Kamenjak shows a high influence of the Mediterranean climate, followed by hemicryptophytes (30.8%) and geophytes (12.6%). We recorded a total of 11 invasive species across the whole investigated area, as well as the occurrence of 15 endangered and 13 endemic plant taxa. The results of our research of autochthonous vascular flora indicate high richness and diversity of plant species in the studied area

Uloga standardne video-kromokolonoskopije u razlikovanju adenomatoznih od neadenomatoznih sitnih kolorektalnih polipa

To date, there are no reliable endoscopic criteria to discriminate a diminutive (<5 mm) colorectal adenomatous from nonadenomatous polyps. Studies have demonstrated the usefulness of high-resolution chromoendoscopy (high-resolution colonoscopy with topically applied indigo carmine dye) in discrimination of adenomatous from nonadenomatous colorectal polyps. However, the clinical utility of standard videocolonoscopy and chromoscopy with indigo carmine dye in differentiating diminutive colorectal polyps has not yet been completely defined. The aim of this study was to determine whether a combination of standard videocolonoscopy and staining with indigo carmine dye could differentiate between adenomatous and nonadenomatous colorectal polyps smaller than 5 mm. Colonoscopy by use of an Olympus EVIS 140 video system was performed in 42 patients in whom colorectal polyps smaller than 5 mm were found. Polyps were sprayed with up to 40 ml of 0.5% indigo carmine dye, and polypectomy was performed, and the material was referred for histology. In 42 patients included in the study, 48 polyps sized <5 mm were detected. Histologic analysis showed 14 of them to be adenomatous and 34 nonadenomatous polyps. Endoscopist\u27s diagnosis was confirmed by histology in 12 of 14 (85.7%) adenomatous and 31 of 34 (91.2%) nonadenomatous colorectal diminutive polyps. The sensitivity, specificity, positive predictive value and negative predictive value of standard videochromocolonoscopy in distinguishing between adenomatous and nonadenomatous polyps sized <5 mm were 85.7%, 91.2%, 80% and 93.9%, respectively. The likelihood ratios (LR) were 0.157 (LR-) and 9.74 (LR+). In conclusion, standard videocolonoscopy combined with indigo carmine dye is a reliable method to differentiate adenomatous from nonadenomatous colorectal polyps sized <5 mm. Such a technique could limit the requests for unnecessary biopsies and repeat colonoscopy, thus significantly reducing the cost of colorectal cancer screening.Danas ne postoje pouzdani endoskopski kriteriji koji bi razlikovali sitne (<5 mm) kolorektalne adenomatozne od neadenomatoznih polipa. Ranije su studije pokazale korisnu uporabu visoko-rezolucijske kromoendoskopije (visoko-rezolucijska kolonoskopija s topičkom primjenom indigo crvene boje) u razlikovanju adenomatoznih od neadenomatoznih kolorektalnih polipa. Ipak, klinička upotreba standardne video-kolonoskopije i kromoskopije s indigo crvenom bojom u razlikovanju sitnih kolorektalnih polipa nije još potpuno utvrđena. Namjera ovoga ispitivanja bila je utvrditi može li se kombinacijom standardne video-kolonoskopije i bojanja indigo crvenom bojom razlikovati adenomatozne od neadenomatoznih kolorektalnih polipa manjih od 5 mm. Kolonoskopija uz primjenu video sustava Olympus EVIS 140 izvedena je u 42 bolesnika u kojih su nađeni kolorektalni polipi manji od 5 mm. Polipi su poprskani 0,5%-tnom indigo crvenom bojom u količini do 40 mL, izvedena je polipektomija i provedena histološka analiza. U 42 bolesnika uključenih u ispitivanje nađeno je 48 polipa manjih od 5 mm. Histološka analiza pokazala je postojanje 14 adenomatoznih i 34 neadenomatoznih polipa. Endoskopist je ispravno predvidio histološki nalaz u 12 od 14 (85,7%) adenomatoznih, te u 31 od 34 (91,2%) neadenomatoznih kolorektalnih sitnih polipa.Osjetljivost, specifičnost, pozitivna prediktivna vrijednost i negativna prediktivna vrijednost standardne video-kromokolonoskopije u razlikovanju adenomatoznih od neadenomatoznih polipa manjih od 5 mm bile su 85,7%, 91,2%, 80%, odnosno 93,9%. Omjer vjerojatnosti (LR) iznosio je 0,157 (LR-) i 9,74 (LR+). Standardna video-kolonoskopija u kombinaciji s indigo crvenom bojom pouzdana je metoda za razlikovanje adenomatoznih od neadenomatoznih kolorektalnih polipa manjih od 5 mm. Ovakvom bi se tehnikom mogli smanjiti zahtjevi za nepotrebnim biopsijama i opetovanim kolonoskopijama, te tako značajno sniziti troškovi probiranja na kolorektalni karcinom

Uloga standardne video-kromokolonoskopije u razlikovanju adenomatoznih od neadenomatoznih sitnih kolorektalnih polipa

To date, there are no reliable endoscopic criteria to discriminate a diminutive (<5 mm) colorectal adenomatous from nonadenomatous polyps. Studies have demonstrated the usefulness of high-resolution chromoendoscopy (high-resolution colonoscopy with topically applied indigo carmine dye) in discrimination of adenomatous from nonadenomatous colorectal polyps. However, the clinical utility of standard videocolonoscopy and chromoscopy with indigo carmine dye in differentiating diminutive colorectal polyps has not yet been completely defined. The aim of this study was to determine whether a combination of standard videocolonoscopy and staining with indigo carmine dye could differentiate between adenomatous and nonadenomatous colorectal polyps smaller than 5 mm. Colonoscopy by use of an Olympus EVIS 140 video system was performed in 42 patients in whom colorectal polyps smaller than 5 mm were found. Polyps were sprayed with up to 40 ml of 0.5% indigo carmine dye, and polypectomy was performed, and the material was referred for histology. In 42 patients included in the study, 48 polyps sized <5 mm were detected. Histologic analysis showed 14 of them to be adenomatous and 34 nonadenomatous polyps. Endoscopist\u27s diagnosis was confirmed by histology in 12 of 14 (85.7%) adenomatous and 31 of 34 (91.2%) nonadenomatous colorectal diminutive polyps. The sensitivity, specificity, positive predictive value and negative predictive value of standard videochromocolonoscopy in distinguishing between adenomatous and nonadenomatous polyps sized <5 mm were 85.7%, 91.2%, 80% and 93.9%, respectively. The likelihood ratios (LR) were 0.157 (LR-) and 9.74 (LR+). In conclusion, standard videocolonoscopy combined with indigo carmine dye is a reliable method to differentiate adenomatous from nonadenomatous colorectal polyps sized <5 mm. Such a technique could limit the requests for unnecessary biopsies and repeat colonoscopy, thus significantly reducing the cost of colorectal cancer screening.Danas ne postoje pouzdani endoskopski kriteriji koji bi razlikovali sitne (<5 mm) kolorektalne adenomatozne od neadenomatoznih polipa. Ranije su studije pokazale korisnu uporabu visoko-rezolucijske kromoendoskopije (visoko-rezolucijska kolonoskopija s topičkom primjenom indigo crvene boje) u razlikovanju adenomatoznih od neadenomatoznih kolorektalnih polipa. Ipak, klinička upotreba standardne video-kolonoskopije i kromoskopije s indigo crvenom bojom u razlikovanju sitnih kolorektalnih polipa nije još potpuno utvrđena. Namjera ovoga ispitivanja bila je utvrditi može li se kombinacijom standardne video-kolonoskopije i bojanja indigo crvenom bojom razlikovati adenomatozne od neadenomatoznih kolorektalnih polipa manjih od 5 mm. Kolonoskopija uz primjenu video sustava Olympus EVIS 140 izvedena je u 42 bolesnika u kojih su nađeni kolorektalni polipi manji od 5 mm. Polipi su poprskani 0,5%-tnom indigo crvenom bojom u količini do 40 mL, izvedena je polipektomija i provedena histološka analiza. U 42 bolesnika uključenih u ispitivanje nađeno je 48 polipa manjih od 5 mm. Histološka analiza pokazala je postojanje 14 adenomatoznih i 34 neadenomatoznih polipa. Endoskopist je ispravno predvidio histološki nalaz u 12 od 14 (85,7%) adenomatoznih, te u 31 od 34 (91,2%) neadenomatoznih kolorektalnih sitnih polipa.Osjetljivost, specifičnost, pozitivna prediktivna vrijednost i negativna prediktivna vrijednost standardne video-kromokolonoskopije u razlikovanju adenomatoznih od neadenomatoznih polipa manjih od 5 mm bile su 85,7%, 91,2%, 80%, odnosno 93,9%. Omjer vjerojatnosti (LR) iznosio je 0,157 (LR-) i 9,74 (LR+). Standardna video-kolonoskopija u kombinaciji s indigo crvenom bojom pouzdana je metoda za razlikovanje adenomatoznih od neadenomatoznih kolorektalnih polipa manjih od 5 mm. Ovakvom bi se tehnikom mogli smanjiti zahtjevi za nepotrebnim biopsijama i opetovanim kolonoskopijama, te tako značajno sniziti troškovi probiranja na kolorektalni karcinom

Plant Diversity of Gornji Kamenjak (Istria, Croatia)

The vascular flora of Significant Landscape Gornji Kamenjak in Istria was investigated in different vegetation periods from 2012 to 2013, and a total of 507 plant taxa (468 species and 39 subspecies) were recorded. Part of them werw previously registered, while some are recorded for the first time. The studied area was poorly investigated in the past, therefore there was a need for this study, representing a very detailed floristic survey of the area. The most dominant families were grasses (Poaceae, 11.8%), legumes (Fabaceae, 10.6%), daisies (Asteraceae, 6.5%) and mints (Lamiaceae, 5.5%). The domination of therophytes (37.0%) indicates that the climate of Gornji Kamenjak shows a high influence of the Mediterranean climate, followed by hemicryptophytes (30.8%) and geophytes (12.6%). We recorded a total of 11 invasive species across the whole investigated area, as well as the occurrence of 15 endangered and 13 endemic plant taxa. The results of our research of autochthonous vascular flora indicate high richness and diversity of plant species in the studied area