What is the Right Therapeutic Approach to Biliary Choledochal Cyst?

We report a case of biliary cyst type II which, independently of its a priori benign nature, caused numerous complications such as recurrent cholangitis and pancreatitis, as well as subsequent hepatic fibrosis and the potential danger of choledochocele perforation. Although they are benign, biliary/choledochal cysts can cause numerous disorders such as cholestasis, leading to cholangitis and pancreatitis and biliary sepsis, and due to chronic inflammation of the biliary system even cholangiocarcinogenesis. Our findings showed that sometimes this type of biliary cyst (according to the available literature the rarest and most benign type), as well as type I cyst, should undergo timely radical excision. In our patient, timely choledochocele resection would have certainly contributed to the reduction of subsequent complications, as well as to obviating repeated invasive diagnostic and surgical procedures.

Kinetics of Ischemia-Modified Albumin Following Exercise-Induced Myocardial Ischemia.

BACKGROUND: Ischemia-modified albumin (IMA) is a potentially valuable biochemical marker of myocardial ischemia. The aim of our study was to define the kinetics and to determine the diagnostic value of IMA in detection of myocardial ischemia by using a model of exercise-stress induced transitory ischemia. METHODS: The study included 43 consecutive patients with positive exercise stress test and coronary artery disease confirmed by coronary angiography (ischemic group) and 22 healthy volunteers with negative exercise stress test (control group). IMA plasma levels were measured before and at nine time points after exercise over a 6-hour period. RESULTS: IMA kinetics was significantly different between the ischemic and control group (p = 0.03). In the ischemic group, IMA plasma levels peaked between the 3rd and 4th hour after exercise. However, due to large interindividual differences in the time-to-peak IMA values, a standard IMA kinetics curve could not be defined for the patients with transitory myocardial ischemia. On the other hand, with the cutoff value of a 10.6% relative increase, sensitivity and specificity of IMA for the detection of myocardial ischemia were sufficiently high at 81% and 82%, respectively. CONCLUSIONS: Although an optimum time for the detection of recent myocardial ischemia by a single IMA sampling could not be defined, serial measurements of IMA can be a useful biochemical tool for the detection of myocardial ischemia in patients with doubtful exercise stress test results.

Celiac disease and fulminant T lymphoma detected too late in a 35-year-old female patient: case report.

UNLABELLED: Celiac disease is the most common chronic gastroenterological autoimmune disease characterized by gluten intolerance. The diagnosis of celiac disease and enteropathy-associated T cell lymphoma is often made when it is too late.Case report describes a 35-year-old female patient managed for one year under the diagnosis of inflammatory bowel disease and admitted to our hospital for exacerbation of the underlying disease. However, inflammatory bowel disease was ruled out by diagnostic work-up, while the clinical picture and the findings obtained raised suspicion of lymphoma. The patient's condition was additionally complicated by fulminant course of the disease and ileus. CONCLUSION: Early diagnosis and appropriate treatment of the disease, and follow up of family members are crucial to prevent intestinal lymphoma development.

[Colorectal cancer in Krapina-Zagorje County: the Zabok General Hospital experience]. / Kolorektalni karcinom u Krapinsko-zagorskoj zupaniji--iskustva Opce bolnice Zabok.

AIM: To analyze data and current experience in diagnosing and treating colorectal cancer at Zabok General Hospital in Krapina-Zagorje County during a 5-year period (2002-2006). METHODS: Retrospective study of 265 cases of colorectal carcinoma treated at Departments of Internal Medicine and of Abdominal Surgery, Zabok General Hospital, and analysis of epidemiological data obtained from the Croatian Public Health Institute for this County. RESULTS: The incidence rate of this malignancy in Krapina-Zagorje County was between 47.8 and 52 per 100 000, which puts our County at the bottom of the list of all Croatian counties. During the study period, the incidence rate was on a decrease and mortality rate increased, which could be attributed to the late diagnosis of this malignancy (3 months of the occurrence of the first alarming symptoms). Most patients were men, average age 68. The most common symptoms were rectal bleeding, abdominal pain, anemia and changes in defecation habits. The average hospitalization was 13 and 17 days at Departments of Internal Medicine and of Abdominal Surgery, respectively. The most common tumor seats were rectum and sigmoid colon. Colorectal cancer was mostly diagnosed in an advanced stage of disease. More than one third of patients (35.2%) were admitted to the hospital with bowel obstruction or perforation. According to Duke's classification, most patients were in stage C (39.5%), D (22.7%) and A (6.9%). Histologic studies revealed adenocarcinoma in all but one case that proved to be lymphoma. CONCLUSION: We conclude that Zabok General Hospital has valuable experience in diagnosing and treatment of colorectal cancer, with high rank performance since 68.0% of patients from Krapina-Zagorje County are managed at this hospital.