Intrafamilial transmission of hepatitis B in Tuzla region of Bosnia and Herzegovina.

OBJECTIVE: To determine (i) the prevalence of HBV infection in families of confirmed chronic carriers, (ii) possible routes of transmission and risk factors for the intrafamilial transmission, (iii) vaccination rate among family members of chronic carriers and (iv) family members with highest risk for infection. METHODS: A total of 172 family members of 67 hepatitis B surface antigen chronic carriers were tested for hepatitis B markers; 716 first-time blood donors from the same area were used as controls. RESULTS: Prevalence of hepatitis B surface antigen was higher (P<0.001) among family members of index cases (12.2%; 21/172) than among controls (3.6%; 26/716) with relative risk of 3.3 (95% confidence Intervals=1.9-5.8; P<0.05). Rate of exposure among family members was 37.8% (65/172); only 8.7% (15/172) had been vaccinated for hepatitis B virus. Difference (P<0.001) in exposure existed among family members; exposure increased with age (rhos=0.34; P<0.001). Prevalences of hepatitis B surface antigen positivity and hepatitis B virus exposure were higher among parents of index cases (P<0.005) and among offspring of female index cases (P<0.001). There were more (P<0.001) hepatitis B surface antigen-positive family members among those with mother-children relationship with index case (13/31; 41.9%) than among those with father-children (19/85; 22.4%) and horizontal (siblings and spouses) relationship (2/56; 3.6%). Significantly more (P<0.001) hepatitis B surface antigen-positive and hepatitis B virus-exposed offspring were found in families where only mother was hepatitis B surface antigen positive. Among family members of HBeAg-positive cases more hepatitis B surface antigen-positive cases and hepatitis B virus-exposed cases have been found (P<0.001). Combination of HBeAg positivity and female sex of index case significantly increased risk for chronic carriage among family members (relative risk=24.06; 95% confidence interval=8.88-65.21; P<0.05). CONCLUSION: In the area studied, both horizontal and vertical transmission exists, but maternal route is predominant. Female sex, HBeAg positivity of index carrier and presence of hepatitis B surface antigen-positive mother inside family increased risk for hepatitis B surface antigen positivity and exposure among family members. Vaccination rate of family members of index cases is alarmingly low.

Hepatitis C infection in risk groups.

Hepatitis C infection is important global health problem with wide spectrum of health, social and economic consequences. The goal of this research was to estimate prevalence of hepatitis C virus infection in risk groups, and to determine association hepatitis C virus (HCV) infection and risk factors. Research included 4627 subjects divided in two groups. Test group included 2627 subjects divided in 4 subgroups with risk for HCV infection: those who received blood transfusion without screening on HCV (it was introduced in 1995) (700); intravenous drug users (60); patients on hemodialysis (168) and health care workers (1699). Control group included 2000 healthy volunteer blood donors. In all subjects anti-HCV antibodies were tested with third generation ELISA test. Positive serum samples were tested for presence of HCVRNA, using reaction of reverse transcription and polymerase chain reaction. In all anti-HCV positive subjects further epidemiological and clinical workup was performed. Prevalence of HCV infection in risk groups was: 4.6% in subjects who have received blood transfusions without HCV blood screening, 35% in intravenous drug users, 58.9% in patients on chronic dialysis, and 0.4% in health care workers. In control group prevalence was low (0.2%). In the group of 158 anti-HCV positive subjects, 73.4% had HCVRNA. The largest number of subjects with HCV infection was in the age group of 30-49 years (45.8%). This study showed that multiple blood transfusions before introducing the blood screening for HCV, longer duration of intravenous drug abuse, longer duration of hemodialysis treatment, larger number of accidental injuries in health care workers are independent and statistically significant risk factors for those groups examined. Results of this study confirm that general screening for HCV infection is recommended in risk groups for HCV infection in order to identify to prevent and to treat it.

Genetics, clinical manifestations and management of FAP and HNPCC.

Colorectal cancer occurs in the familial cancer syndromes in about 2 to 4 percent. The major genetic syndromes are Familial adenomatous polyposis (FAP) and Hereditary nonpolyposis colorectal cancer (HNPCC). FAP is caused by germline mutation of APC gene, and HNPCC is caused by germline mutation in one of five MMR genes. The identification of patients with inherited disease is very important in the management of colorectal cancer. But, it is impractical to test every patient with the disease for these mutations. The clinical and genetical screening programme should be advised for family members at risk and colectomy in affected individuals in purpose to reduce the frequency of colorectal cancer.

[Dilatation of tracheal stenosis with esophageal balloon dilator]. / Dilatacija stenoze traheje ezofagealnim balon dilatatorom.

The solve of tracheal stenosis is problem which occupied a big number of experts. In this article was reported a case in which the problem of tracheal stenosis was solved by balloon dilatator which was used in a treatment of esophageal stenosis. We are thinking that esophageal balloon dilatation of trachela stenosis would be a one of the first steps in the problem solving.

Comparison of postoperative hepatic function between laparoscopic and open cholecystectomy.

OBJECTIVE: In this prospective study, we evaluated the effects of pneumoperitoneum on hepatic function during laparoscopic (LC) and open cholecystectomy (OC). SUBJECTS AND METHODS: One hundred patients who underwent LC (n = 50) or OC (n = 50) were included in the study. The groups were similar in age, sex, weight and height. Following liver function tests (total bilirubin; gamma-glutamyltransferase, GGT; alkaline phosphatase, ALP), aspartate aminotransferase (AST), alanine aminotransferase (ALT) and lactate dehydrogenase (LDH) were obtained preoperatively and at 24 and 48 h postoperatively. Similar anesthesiologic protocol was used for both LC and OC. During LC, the intra-abdominal pressure was maintained within the conventional range of 12-14 mm Hg. RESULTS: Total bilirubin, ALP, GGT and LDH levels remained unchanged from baseline in both groups without significant difference between them. A higher number of patients had increased values of ALT (26/50 vs. 5/50) and AST (23/50 vs. 6/50) in LC compared to OC group. Although the difference was statistically significant (p < 0.000 for ALT and p = 0.0004 for AST) the increased level decreased at 48 compared to 24 h. CONCLUSION: The results indicate that LC is associated with transient elevation of ALT and AST. The disturbances in the function of the liver after LC are self-limited and not associated with any morbidity in patients with a normal liver function.

[Endoscopic therapy of biliary obstruction]. / Endoskopska terapija bilijarne obstrukcije.

Obstructive jaundice is consequence of several diseases of biliary ducts which cause biliary stasis. Constant finding is jaundice on skin and visible mucosal areas, acholic stool and dark urine. Obstruction could be permanent or intermittent. It could have rapid course with severe symptoms: biliary colics, signs of acute biliary ducts inflammation, acute pancreatitis or with atypical upper abdominal disorders. Asymptomatic biliary obstruction implies malignant disease. After initial clinical evaluation (history of disease, physical examination, biochemical analyses, ultrasound orientation) treatment of choice in diagnostic and management of biliary obstruction is endoscopic retrograde cholangiopancreatography (ERCP) proceeded with endoscopic sphincterotomy of sphincter Oddi. Further procedures depend on cause of obstruction.

[Interventional ultrasound in the treatment of acute pancreatitis]. / Intervencijski ultrazvuk u tretmanu akutnog pankreatitisa.

OBJECTIVE: The objective of this study is to evaluate the possibilities of interventional ultrasonography in the treatment of liquid collections created during and after an acute pancreatitis. PATIENTS AND METHODS: Ultra-sound controlled percutaneous drainage of peripancreatic liquid collections was done in 58 patients (44 men and 14 women, average age 47.8 within the span of 15-68) in the period between May 1995 and September 2001. Pseudocystitis of pancreas formed after an acute pancreatitis was drained in 19 cases, abscess collections were drained in 14 cases, and in 25 cases a catheter was entered in peripancreatic liquid collections and steatonecrotic masses in the initial phase of acute haemorrhagic necrotic pancreatitis. Pigtail catheters 5 to 7 F were placed to serve for drainage and instillation of medicaments. RESULTS: In the group of patients to whom a catheter was placed in liquid collections and steatonecrotic masses, two lethal outcomes were recorded. However, they were not the result of the intervention, but of emboly of lungs and coagulopathy. One patient with peripancreatic abscess collections was operated after the intervention. In other patients, ultra-sound controlled percutaneous drainage was successful. Before our intervention 22 patients had been operated, five of them twice and two of them three times. CONCLUSION: Ultra-sound controlled percutaneous drainage gives an important contribution in the treatment of the hardest forms of acute pancreatitis and represents a safe and less aggressive method in the treatment of liquid collections and steatonecroses formed during an acute pancreatitis.

[Diagnostic and therapeutic possibilities of interventional echotomography in gastroenterology]. / Dijagnosticke i terapijske mogucnosti interventne ehotomografije u gastroenterologiji.

Interventional ultrasound includes all diagnostic and therapy procedures controlled by ultra sound. In this manner, conventional ultrasound diagnostics which has a very important diagnostic role in gastroenterology increases its potential in diagnosis and gives an important contribution in the therapy of abdominal organs diseases. Diagnostic interventional ultrasonography enables sampling from solid and cystic changes for histological or cytological analyses. This procedure enables a more precise injection of contrasts in biliary or pancreatic ducts in the situations when it cannot be done by ERCP. Potential of interventional ultrasonography in the therapy is seen in the possibility to place the needle or the catheter into cystic and abscess changes in order to drain pathological collections and inject medicaments into pathological changes. The procedure is relatively simple and therefore considerably less aggressive compared to surgical treatment. Being very economic and efficient it became an important method in diagnostics and therapy of gastroentrological diseases.

[Balloon dilatation in esophageal stenosis]. / Primjena balon dilatacije u stenozama jednjaka.

The most frequent causes of the stenosis are as follows: Schatzki rings, structures as the complications of GERB', postcorrosive and postoperative at nosis. The Balloon dilatation is one from the therapeutic procedures of stenosis of the esophagus. By the clinic research is included 12 patients with the stenoses of the esophagus of the various cause. It is used the balloon dilatator (Olympus) of the diameter 16 and 18 mm, and the analysis 40 mm. In 11 patients the balloon dilatation was successful and led to the walking of the esophagus for endoscope. Only in one patient the dilatation was unsuccesful, because was applied two years after the occurrence of the stenosis caused by the corrosive esophagisitis. It is concluded that the balloon dilatation of the therapeutic procedures of the choice in stenosis of the esophagus.