Economic and medical advantages of digestive tract endoscopy

U ovom radu analizirana je medicinska i financijska vrijednost određenih dijagnostičkih i opera tivno-terapijskih zahvata (kod gastroenterohepatoloških bolesnika) koji se mogu obaviti endoskopskim i rendgenološkim, odnosno kirurškim putem. To je dosta važno s obzirom na sve lošije financijsko stanje u zdravstvu. U pogledu dijagnostike digestivnih bolesti, endoskopiji treba dati primat nad rendgenologijom, jer osim medicinskih prednosti (nema žračenja bolesnika, mogućnost vizualnog pregleda i uzimanja uzorka za histološku analizu), ona je i jeftinija. S obzirom na doktrinski stav da, iako imamo pozitivan rendgenološki nalaz, produženje dijagnostike mora biti endoskopijom uz uzimanje uzoraka za histološku analizu, dolazi do dupliranja pretraga, a time do gubitka velike sume novca. Iz toga je jasno da je ušteda više nego očita primjenom samo primarne endoskopije. Prednost operativno-terapeutskih endoskopskih zahvata nad kirurškim su očite, kako u medicinskom (niska smrtnost, manje komplikacija, kraći period rehabilitacije, humaniji pristup), tako i u financijskom pogledu. Iz svega toga proizlazi da svako ulaganje u razvoj endoskopije znači više obavljenih dijagnostičkih i operativnih endoskopskih zahvata, a time ukidanje rendgenoloških i kirurških, što će doprinijeti ogromnoj uštedi novca.The paper analyzes medical and financial values of certain diagnostic and therapeutic procedures in patients with gastroenterohepatic diseases which can be performed endoscopically, radiographically or surgically. Considering the miserable financial condition of the health care system, this comparison is very important. In the diagnostics of digestive diseases endoscopy must be preferred to radiography, since in addition to medical advantages (no radiation of the patients, possibility of visual examination and sampling for histological analysis), it is cheaper, as well. Besides, following of the doctrine that in case of positive radiograms the diagnostics must be continued by endoscopy and taking samples for histological analysis duplicates the examinations and causes a considerable loss of money. Thus, primary endoscopy evidently means economization. The therapeutical endoscopic procedures have the advantage over surgery, both from the medical (low mortality, less complications, shorter period of rehabilitation and humane treatment) and the financial point of view. Accordingly, any investment into the development of endoscopy means more diagnostic and therapeutical endoscopic procedures performed as well as the abolition of radiographic and surgical procedures, which would contribute to saving considerable amounts of money

Comparison between famotidine (20 mg at bed time) and ranitidine (150 mg at bed time) in the prevention of duodenal ulcer relapse

Famotidin u dozi od 20 mg navečer uspoređivanje s ranitidinom u dozi od 150 mg navečer u prevenciji recidiva duodenalnog ulkusa u tijeku 6 mjeseci. Ispitivanjem je obuhvaćen 71 bolesnik. Bolesnici su bili podijeljeni vi dvije skupine. Prva skupina od 40 bolesnika poslije zalječenja akutnog napada bolesti liječena je ranitidinom vi dozi 150 mg navečer, a druga skupina od 31 bolesnika famotidinom od 20 mg navečer. Bolesnici iz obje skupine uz ove su lijekove uzimali i antacid. Nakon tri mjeseca u prvoj skupini zabilježen je jedan recidiv a u drugoj skupini nije bilo recidiva. U prvoj skuipini poslije šest mjeseci bila svi tri recidiva, a u drugoj bila su dva recidiva dvanaesničnog vrijeda. Dva od tri bolesnika u prvoj skupini i oba bolesnika u drugoj skupini s recidivom dvanaesničnog vrijeđa bili su pušači. Statistički značajnih odstupanja vi CKS, koncentraciji ureje, kreatinina i transaminaza vi krvi poslije 3 i 6 mjeseci nije bilo ni u jednoj skupini bolesnika. Nisvi zabilježene ni značajne popratne pojave pri uzimanju oba lijeka.Famotidine given in a 20-mg dose at bed-time was compared to ranitidine administered in a dose of 150 mg at bed-time in the prevention of duodenal ulcer relapse during a six-month period. Seventy-one patients were included in the study. Patients were divided into two groups. Group 1 consisting 40 patients, after curing of acute illness, were treated with ranitidine, 150 mg at bed time, whereas group 2 consisting of 31 patients were treated with famotidine 20 mg at bed-time. Patients from both groups were additionally treated with antacide. After 3 months, one and no cases of relapse were recorded in groups 1 and 2, respectively. After 6 months, three cases of duodenal ulcer relapse were recorded in group 1 and two cases in group 2. Two out of three patients in group 1 and both patients in group 2 with duodenal ulcer relapse were smokers. There were no statistically significant differences between the two groups of patients in RBC, urea concentrations, creatinine and transaminases in blood after 3 and 6 months. No adverse side-effects were observed during the administration of either drug studied

SPONTANEOUS FALLOPIAN TUBE EVISCERATION IN PROCIDENTIA AND PERFORATING CARCINOMATOUS VAGINAL WALL ULCER – CASE REPORT

Background. Total prolapse of female pelvic organs is not only painful and troublesome because of difficulties with micturition and defecation but it could be very dangerous since prolapsed vagina presents a predilection area for ulcer and/or rupture of different etiology and with evisceration of abdominal content. Eviscerations usually occur rarely, but when they do occur, it is important to intervene quickly. Most frequent is the evisceration of small bowel, rarely omentum and sporadically other abdominal structures. Neither in literature nor on the internet there were not any examples of primary eviscerated fallopian tube which was not a consequence of preceeding gynecological-surgical procedure found. Methods. 77-year-old woman was appointed to our out patient department with diagnosis of Prolapsus uteri totalis and Dolores abdominalis. In history there was prevulvar bulge in the size of an apple, which persisted for 20 years, and almost disappeared when lying supine. Three days before admission to the hospital the bulge was exceedingly enlarged by straining and did not diminish when lying supine. The patient walked only hardly and could not sit. Micturition and defecation was possible only in the upright position. There were also difficulties while placing the patient on a gynecologic chair, because between her legs there was a bulge in the size of 14 × 10 × 9 cm3 with fallopian tube hanging out (Figure 1). On the outermost part of total uterovaginal prolapse the outer ostium of the cervical canal was recognizable. The bulge was fully stretched, painful and unreponible. Around a hole where a fallopian tube exits, vagina was eritematous, rough folded – swollen and vulnerable (Figure 2). In outpatient department eviscerated fallopian tube and prolapsed vagina with its contents were aseptically treated and Dalacin and Orho Gynest crème were applicated. Foley catheter was inserted. Prolapsed vagina with uterus and other contents remained stretched even after catheterization and unreponible likewise. In surgical procedure Steckel´s incision was used to avoid widely the area of vagina where tube exits. We did not try to repone the tube, so pouch of Douglas was opened first and after that uterovesical pouch as well. Hysterectomy with bilateral adnexectomy in situ and almost total vaginectomy has been made. In lower part of abdominal cavity there were not any pathological signs. Peritoneal cavity was closed with circular suture. Vesicorrhaphy in three layers and minimal rectorrhaphy with kolpoperineoplasty were made. Postoperative course of treatment was without complications. After eight days our patient has been discharged from the hospital. Pathohistologic findings were: Invasive squamous cell carcinoma of the vagina, large cell and keratinizing. Invasive growth is present near the opening through which a part of the uterus prominates. Maximal thickness of invasive growth is 0.8 cm, on the borders there is not any cancerous tissue left. Considering the pathologic findings, the patient has been appointed to the Gynecologic – oncologic counsel at University Department of Gynecology, Ljubljana. Diagnosis was Ca. vaginae stadium I.. State after vaginal histerectomy with colpectomy. The lesion removed with safety border. As for therapy; considering the age of the patient, consilium decided for observation. Conclusions. Because of the perforated vagina and opened path to the abdominal cavity the total uterine prolapse in this case was a life-threatening emergency. The fallopian tube partly closed the communication and it also acted as a wedge so the prolapsed uterus and vagina could not repone. An urgent operation has been necessary – we resolved the procidentia and removed the cancer

TMPRSS2:ERG gene aberrations may provide insight into pT stage in prostate cancer

Background: TMPRSS2:ERG gene aberration may be a novel marker that improves risk stratification of prostate cancer before definitive cancer therapy, but studies have been inconclusive. Methods: The study cohort consisted of 202 operable prostate cancer Slovenian patients who underwent laparoscopic radical prostatectomy. We retrospectively constructed tissue microarrays of their prostatic specimens for fluorescence in situ hybridization, with appropriate signals obtained in 148 patients for subsequent statistical analyses. Results: The following genetic aberrations were found: TMPRSS2:ERG fusion, TMPRSS2 split (a non-ERG translocation) and ERG split (an ERG translocation without involvement of TMPRSS2). TMPRSS2:ERG gene fusion happened in 63 patients (42 %), TMPRSS2 split in 12 patients and ERG split in 8 patients. Association was tested between TMPRSS2:ERG gene fusion and several clinicopathological variables, i.e., pT stage, extended lymph node dissection status, and Gleason score, correcting for multiple comparisons. Only the association with pT stage was significant at p = 0.05: Of 62 patients with pT3 stage, 34 (55 %) had TMPRSS2:ERG gene fusion. In pT3 stage patients, stronger (but not significant) association between eLND status and TMPRSS2:ERG gene fusion was detected. We detected TMPRSS2:ERG gene fusion in 64 % of the pT3 stage patients where we did not perform an extended lymph node dissection. Conclusions: Our results indicate that it is possible to predict pT3 stage at final histology from TMPRSS2:ERG gene fusion at initial core needle biopsy. FISH determination of TMPRSS2:ERG gene fusion may be particularly useful for patients scheduled to undergo a radical prostatectomy in order to improve oncological and functional results

Significance of nuclear factor - kappa beta activation on prostate needle biopsy samples in the evaluation of Gleason score 6 prostatic carcinoma indolence

The goal of our study was to find out whether the immunohistochemical expression of nuclear factor-kappa beta (NF-κB) p65 in biopsy samples with Gleason score 3 + 3 = 6 (GS 6) can be a negative predictive factor for Prostate cancer (PCa) indolence