Koncentracija interleukina 6 i faktora tumorske nekroze alfa u slini i krvi bolesnika s neaktivnom multiplom sklerozom i supostojećim Hashimotovim tireoiditisom

The concentration of interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-α) in the blood is higher in patients with active multiple sclerosis (MS) compared to those with inactive disease. The concentration of IL-6 and TNF-α in the blood is higher in patients with Hashimoto’s thyroiditis (HT) compared to those with a healthy thyroid. The aim of the study was to assess whether serum IL-6 and TNF-α levels correlated with saliva in patients with inactive MS and whether there was a difference in these groups of patients depending of thyroid status. We also examined the correlation of thyroid stimulating hormone (TSH) levels with thyroid status. The study included 54 patients in the inactive phase of MS. The level of cytokines in the blood was determined by chemiluminescence, and in saliva by ELISA. Blood and saliva IL-6 levels showed positive correlation, while blood and saliva TNF-α levels were not correlated. There was a significantly higher TSH level in patients with inactive MS with positive thyroid antibodies, without therapy, compared with those with negative antibodies.Koncentracija interleukina 6 (IL-6) i faktora tumorske nekroze alfa (TNF-α) u krvi je veća u bolesnika s aktivnom multiplom sklerozom (MS) u odnosu na one s neaktivnom bolešću. Koncentracija IL-6 i TNF-α u krvi je veća kod bolesnika s Hashimotovim tireoditisom (HT) u odnosu na one sa zdravom štitnjačom. Cilj istraživanja bio je procijeniti koreliraju li serumske razine IL-6 i TNF-α s onima u slini kod bolesnika s neaktivnom MS i postoji li razlika među navedenim skupinama bolesnika ovisno o statusu štitnjače. Također smo ispitali korelaciju razine tireoidnog stimulirajućeg hormona (TSH) sa statusom štitnjače kod svih bolesnika. U istraživanje su uključena 54 bolesnika u neaktivnoj fazi MS. Razina citokina u krvi je određena metodom kemiluminiscencije, a u slini metodom ELISA. Pozitivno je korelirala razina IL-6 u krvi i slini, dok razina TNF-α u krvi i slini nije korelirala. Značajno je veća bila razina TSH u bolesnika s neaktivnom MS s pozitivnim protutijelima na štitnjaču, bez terapije, u odnosu na one s negativnim protutijelima

The Role of Endoscopic Resection in the Treatment of Gastrointestinal Neoplasms

Endoskopska mukozna resekcija i submukozna disekcija pripadaju naprednim terapijskim metodama u gastrointestinalnoj endoskopiji. Danas su se ove tehnike etablirale kao prva linija liječenja ranih novotvorina probavne cijevi i time potpuno zamijenile potrebu za kirurškim zahvatom kod ovih bolesnika. Poput drugih tehnika u gastrointestinalnoj endoskopiji i ove metode imaju rizik od komplikacija poput krvarenja, perforacije i postproceduralnih striktura. U tom kontekstu u ovom će se članku prikazat mjesto i uloga endoskopske resekcije u liječenju novotvorina probavne cijevi.Endoscopic mucosal resection and submucosal dissection are advanced therapeutic techniques in gastrointestinal endoscopy. Nowadays, these techniques are fully established as a first-line treatment in early gastrointestinal neoplasms, replacing the need for any major surgical interventions. However, these novel endoscopic techniques also come with a risk of complications, such as bleeding, perforations and post-treatment strictures. The role of endoscopic resection in the treatment of early gastrointestinal neoplasms is discussed in this context

The Role of Endoscopic Resection in the Treatment of Gastrointestinal Neoplasms

Endoskopska mukozna resekcija i submukozna disekcija pripadaju naprednim terapijskim metodama u gastrointestinalnoj endoskopiji. Danas su se ove tehnike etablirale kao prva linija liječenja ranih novotvorina probavne cijevi i time potpuno zamijenile potrebu za kirurškim zahvatom kod ovih bolesnika. Poput drugih tehnika u gastrointestinalnoj endoskopiji i ove metode imaju rizik od komplikacija poput krvarenja, perforacije i postproceduralnih striktura. U tom kontekstu u ovom će se članku prikazat mjesto i uloga endoskopske resekcije u liječenju novotvorina probavne cijevi.Endoscopic mucosal resection and submucosal dissection are advanced therapeutic techniques in gastrointestinal endoscopy. Nowadays, these techniques are fully established as a first-line treatment in early gastrointestinal neoplasms, replacing the need for any major surgical interventions. However, these novel endoscopic techniques also come with a risk of complications, such as bleeding, perforations and post-treatment strictures. The role of endoscopic resection in the treatment of early gastrointestinal neoplasms is discussed in this context

THE OVER-THE-SCOPE-CLIP FOR THE TREATMENT OF THE DIGESTIVE TUBE LEAKS AND TEARS: A CASE-SERIES

Oštećenja probavne cijevi terapijski su izazov za liječnike koji se bave gastrointestinalnom endoskopijom. Nedavno je u kliničku praksu uvedena endoskopska stezaljka za nekirurško liječenje fistula, perforacija, anastomotskih propuštanja i refraktornih krvarenja. U članku prikazujemo iskustva o primjeni stezaljke u našoj seriji bolesnika. Endo­skopska stezaljka primijenjena je kod devet ispitanika (šest muškaraca, tri žene, medijan dobi 72 godine, raspon 58 – 86 godina). Indikacije za primjenu stezaljke uključivale su: krvarenje iz gornjeg dijela probavne cijevi (neuspjeh endoskopske hemostaze kod pet ispitanika te velik promjer krvne žile kod jednog ispitanika), endoskopsko liječenje fistula probavne cijevi kod dva ispitanika te liječenje ijatrogene perforacije sigme kod jednog ispitanika. Upotrebljavane su stezaljke s oštrim i tupim zupcima i dvostruki hvatač. Kod svih ispitanika iskorištena je samo jedna stezaljka i nije se rabila dodatna endoskopska terapija. Registrirana je 100%-tna tehnička primjena stezaljke. U podgrupi bolesnika s krvarenjima klinički uspjeh iznosio je 50%, a kod ispitanika s perforacijama i fistulama 67%. Prosječno vrijeme praćenja bolesnika bilo je 34 dana (raspon 3 – 452). Endoskopska stezaljka siguran je i učinkovit pribor za endoskopsko liječenje oštećenja probavne cijevi. Ipak, klinički uspjeh procedure bio je manji u podgrupi bolesnika s krvarenjem iz gornjeg dijela probavne cijevi, uglavnom zbog primjene stezaljki s oštrim zupcima.Digestive tube damages represent a therapeutic challenge for the gastrointestinal endoscopists. Recenty, a novel device – the-over-the-scope clip (OTSC) – has been introduced for non-surgical treatment of gastrointestinal perforations, fistula, anastomotic leaks and refractory gastrointestinal bleeds. This study aimed to evaluate the therapeutic efficacy of OTSC in our case series. A total of nine patients were included (six males, medain age 72 years, range 58-86). The indications were upper gastrointestinal bleeding (refractory to standard endoscopic treatment: five patients, a vessel with a large caliber: one patient), fistula in two patients, and iatrogenic perforation of the sigmoid colon in one patient. Atraumatic and traumatic versions of OTSCs with twin graspers were used. All of the patients were treated with only one OTSC, and none of the patients required additional endoscopic treatment. The OTSC procedure had 100% technical success. In a subgroup of patients with perforation and fistulae, the clinical success was 67%, whereas in those with the bleedings it was 50%. The median follow-up was 34 days (range: 3-452). OTSC is a safe and effective device for closure of perforations and leaks. However therapeutic efficacy was subopimal in patients with the upper gastrointestinal bleedings possibly due to the application of the sharp-teeth OTSC

Liječenje oštećenja probavne cijevi primjenom endoskopske stezaljke: prikaz serije bolesnika [The over-the-scope-clip for the treatment of the digestive tube leaks and tears: a case-series]

Digestive tube damages represent a therapeutic challenge for the gastrointestinal endoscopists. Recenty, a novel device – the-over-the-scope clip (OTSC) – has been introduced for non-surgical treatment of gastrointestinal perforations, fi stula, anastomotic leaks and refractory gastrointestinal bleeds. This study aimed to evaluate the therapeutic effi cacy of OTSC in our case series. A total of nine patients were included (six males, medain age 72 years, range 58-86). The indications were upper gastrointestinal bleeding (refractory to standard endoscopic treatment: fi ve patients, a vessel with a large caliber: one patient), fi stula in two patients, and iatrogenic perforation of the sigmoid colon in one patient. Atraumatic and traumatic versions of OTSCs with twin graspers were used. All of the patients were treated with only one OTSC, and none of the patients required additional endoscopic treatment. The OTSC procedure had 100% technical success. In a subgroup of patients with perforation and fi stulae, the clinical success was 67%, whereas in those with the bleedings it was 50%. The median follow-up was 34 days (range: 3-452). OTSC is a safe and effective device for closure of perforations and leaks. However therapeutic effi cacy was subopimal in patients with the upper gastrointestinal bleedings possibly due to the application of the sharp-teeth OTSC

Kliničke karakteristike bolesnika s dvostrukim pilorusom [Clinical characteristics of patients with a double pylori]

Double pylorus (DP), is a form of gastroduodenal fistula, which consists of a short accessory canal from the gastic antrum to the duodenal bulb, and mostly occrus in the background of peptic ulcer disease. Prevalence, as well long-term follow-up of patients with DP is less elucidated in western countries. Aim of our study was to analyse demografic, clinical and endoscopic characteristics in our case-series. During 2008-2013. a total of 23836 upper endoscopies were performed in 16759 patients. DP was diagnosed in 6 patients (prevalence of 0.04%). The follow-up period was f 8 to 72 months. In 87% DP was a complication of the upper gastrointestinal bleeding. In 83% cases opening of the fistula was on lesser curvature of gastric antrumu. During follow-up period the fistula healing did not occur in any of our patients. DP is a very rare entity, with a benign course of the disease Associated comorbidity and use of ulceriform medications plays important role in persistence of DP, wheras possible eradication of Helicobacter infection in this background remains elusive

CLINICAL CHARACTERISTICS OF PATIENTS WITH A DOUBLE PYLORI

Dvostruki pilorus (DP) oblik je gastroduodenalne fistule koji se sastoji od kanala koji spaja antrum želudca s dvanaesnikom i najčešće nastaje u sklopu peptičke ulkusne bolesti. Prevalencija ovog entiteta, kao i longitudinalno praćenje ovih bolesnika u zemljama zapadne hemisfere nepoznati su. Proveli smo retrospektivno ispitivanje s ciljem analize demografskih, kliničkih i endoskopskih karakteristika bolesnika s DP-om. U periodu od 2008. do 2013. godine učinjeno je 23.836 ezofagogastroduodenoskopija kod 16.759 bolesnika. Otkriveno je 6 bolesnika s DP-om (prevalencija 0,04%), koji su praćeni od 8 do 72 mjeseca. Kod 87% bolesnika radilo se o komplikaciji krvarenja iz gornjeg dijela probavne cijevi. U 83% slučajeva orificij fistule bio je smješten na maloj krivini antruma želudca. Tijekom vremena praćenja nismo registrirali cijeljenje fistula. Zaključujemo da je DP vrlo rijedak entitet, s benignim tijekom bolesti. Prisutnost komorbiditeta i ulcerogeni lijekovi imaju važnu ulogu u nastanku DP-a, dok vrijednost eradikacije Helicobatera pylori u ovom kontekstu ostaje nejasnaDouble pylorus (DP), is a form of gastroduodenal fistula, which consists of a short accessory canal from the gastic antrum to the duodenal bulb, and mostly occrus in the background of peptic ulcer disease. Prevalence, as well long-term follow-up of patients with DP is less elucidated in western countries. Aim of our study was to analyse demografic, clinical and endoscopic characteristics in our case-series. During 2008–2013. a total of 23836 upper endoscopies were performed in 16759 patients. DP was diagnosed in 6 patients (prevalence of 0.04%). The follow-up period was f 8 to 72 months. In 87% DP was a complication of the upper gastrointestinal bleeding. In 83% cases opening of the fistula was on lesser curvature of gastric antrumu. During follow-up period the fistula healing did not occur in any of our patients. DP is a very rare entity, with a benign course of the disease Associated comorbidity and use of ulceriform medications plays important role in persistence of DP, wheras possible eradication of Helicobacter infection in this background remains elusive

THE OVER-THE-SCOPE-CLIP FOR THE TREATMENT OF THE DIGESTIVE TUBE LEAKS AND TEARS: A CASE-SERIES

Oštećenja probavne cijevi terapijski su izazov za liječnike koji se bave gastrointestinalnom endoskopijom. Nedavno je u kliničku praksu uvedena endoskopska stezaljka za nekirurško liječenje fistula, perforacija, anastomotskih propuštanja i refraktornih krvarenja. U članku prikazujemo iskustva o primjeni stezaljke u našoj seriji bolesnika. Endo­skopska stezaljka primijenjena je kod devet ispitanika (šest muškaraca, tri žene, medijan dobi 72 godine, raspon 58 – 86 godina). Indikacije za primjenu stezaljke uključivale su: krvarenje iz gornjeg dijela probavne cijevi (neuspjeh endoskopske hemostaze kod pet ispitanika te velik promjer krvne žile kod jednog ispitanika), endoskopsko liječenje fistula probavne cijevi kod dva ispitanika te liječenje ijatrogene perforacije sigme kod jednog ispitanika. Upotrebljavane su stezaljke s oštrim i tupim zupcima i dvostruki hvatač. Kod svih ispitanika iskorištena je samo jedna stezaljka i nije se rabila dodatna endoskopska terapija. Registrirana je 100%-tna tehnička primjena stezaljke. U podgrupi bolesnika s krvarenjima klinički uspjeh iznosio je 50%, a kod ispitanika s perforacijama i fistulama 67%. Prosječno vrijeme praćenja bolesnika bilo je 34 dana (raspon 3 – 452). Endoskopska stezaljka siguran je i učinkovit pribor za endoskopsko liječenje oštećenja probavne cijevi. Ipak, klinički uspjeh procedure bio je manji u podgrupi bolesnika s krvarenjem iz gornjeg dijela probavne cijevi, uglavnom zbog primjene stezaljki s oštrim zupcima.Digestive tube damages represent a therapeutic challenge for the gastrointestinal endoscopists. Recenty, a novel device – the-over-the-scope clip (OTSC) – has been introduced for non-surgical treatment of gastrointestinal perforations, fistula, anastomotic leaks and refractory gastrointestinal bleeds. This study aimed to evaluate the therapeutic efficacy of OTSC in our case series. A total of nine patients were included (six males, medain age 72 years, range 58-86). The indications were upper gastrointestinal bleeding (refractory to standard endoscopic treatment: five patients, a vessel with a large caliber: one patient), fistula in two patients, and iatrogenic perforation of the sigmoid colon in one patient. Atraumatic and traumatic versions of OTSCs with twin graspers were used. All of the patients were treated with only one OTSC, and none of the patients required additional endoscopic treatment. The OTSC procedure had 100% technical success. In a subgroup of patients with perforation and fistulae, the clinical success was 67%, whereas in those with the bleedings it was 50%. The median follow-up was 34 days (range: 3-452). OTSC is a safe and effective device for closure of perforations and leaks. However therapeutic efficacy was subopimal in patients with the upper gastrointestinal bleedings possibly due to the application of the sharp-teeth OTSC

CLINICAL CHARACTERISTICS OF PATIENTS WITH A DOUBLE PYLORI

Dvostruki pilorus (DP) oblik je gastroduodenalne fistule koji se sastoji od kanala koji spaja antrum želudca s dvanaesnikom i najčešće nastaje u sklopu peptičke ulkusne bolesti. Prevalencija ovog entiteta, kao i longitudinalno praćenje ovih bolesnika u zemljama zapadne hemisfere nepoznati su. Proveli smo retrospektivno ispitivanje s ciljem analize demografskih, kliničkih i endoskopskih karakteristika bolesnika s DP-om. U periodu od 2008. do 2013. godine učinjeno je 23.836 ezofagogastroduodenoskopija kod 16.759 bolesnika. Otkriveno je 6 bolesnika s DP-om (prevalencija 0,04%), koji su praćeni od 8 do 72 mjeseca. Kod 87% bolesnika radilo se o komplikaciji krvarenja iz gornjeg dijela probavne cijevi. U 83% slučajeva orificij fistule bio je smješten na maloj krivini antruma želudca. Tijekom vremena praćenja nismo registrirali cijeljenje fistula. Zaključujemo da je DP vrlo rijedak entitet, s benignim tijekom bolesti. Prisutnost komorbiditeta i ulcerogeni lijekovi imaju važnu ulogu u nastanku DP-a, dok vrijednost eradikacije Helicobatera pylori u ovom kontekstu ostaje nejasnaDouble pylorus (DP), is a form of gastroduodenal fistula, which consists of a short accessory canal from the gastic antrum to the duodenal bulb, and mostly occrus in the background of peptic ulcer disease. Prevalence, as well long-term follow-up of patients with DP is less elucidated in western countries. Aim of our study was to analyse demografic, clinical and endoscopic characteristics in our case-series. During 2008–2013. a total of 23836 upper endoscopies were performed in 16759 patients. DP was diagnosed in 6 patients (prevalence of 0.04%). The follow-up period was f 8 to 72 months. In 87% DP was a complication of the upper gastrointestinal bleeding. In 83% cases opening of the fistula was on lesser curvature of gastric antrumu. During follow-up period the fistula healing did not occur in any of our patients. DP is a very rare entity, with a benign course of the disease Associated comorbidity and use of ulceriform medications plays important role in persistence of DP, wheras possible eradication of Helicobacter infection in this background remains elusive