Gastric cancer staging: EUS and CT.

INTRODUCTION: Gastric cancer is the fourth most common cancer and the second leading cause of death from cancer. Only complete resection of all gross disease with negative microscopic margins (R0 resection) provides a long-term survival benefit, and the overall 5-year relative survival rate is approximately 20%. To improve survival and quality of life, new therapeutic approaches have been introduced. MATERIAL AND METHODS: A total of 277 patients (171 men, 106 women) were included in this analysis. The results from the preoperative EUS and MDCT were compared to the postoperative pathological findings. A radial scanning ultrasonic endoscope was used. In patients with early gastric cancer, especially in cases confined to mucosa, endoscopic resection is performed to avoid unnecessary surgical procedures. To achieve R0 resection for locally-advanced gastric cancer, neoadjuvant treatments have been investigated. RESULTS AND DISCUSSION: Laparoscopic surgery has been shown to improve quality of life for both early and locally advanced gastric cancer. Endoscopic ultrasonography (EUS), which is considered to be the most precise method for locoregional staging, was commonly used for differentiating mucosal lesions from submucosal lesions. By contrast, computed tomography (CT) was used to detect the presence of distant metastasis. The difference in accuracy between the < or = 20-mm group and other groups was statistically significant for both EUS and MDCT (P = 0.026 and P = 0.044, respectively). CONCLUSION: However, recent technological advances with the helical and multi-detector scanners have provided better CT performance.

Predictive value of endoscopic ultrasound in diagnosis and staging of primary gastric lymphoma.

The aim of the paper is to investigate significance of the endoscopic ultrasound (EUS) in diagnostic and staging of gastric lymphoma. Retrospective clinical study was conducted at the Clinic for Hematology and Clinic for Gastroenterology of the University Clinical Center of Sarajevo in the period of years 2002 to 2009. Patients (N = 40) with diagnosis of gastric lymphoma confirmed by pathohistological diagnosis were included in the study. Stage of the disease was determined based on EUS, proximal endoscopy, CT and ultrasound of abdomen, and classified according to the Ann Arbor classification. 39 patients had various types of non Hodgkin lymphoma and one patient had Hodgkin lymphoma. Based on morphological characteristics of gastric tumor visualized with EUS in 16 patients a gastric cancer was suspected. In 40% patients EUS finding was not confirmed by pathohistological finding. Compared both to CT and ultrasound of abdomen, EUS showed statistically significant higher frequency of establishing existence of infiltration (p < 0.001). In patients with primary gastric lymphoma EUS has more significant role in determination of stage of disease spread than for the diagnosis itself. Therefore EUS should be included into algorithm of patient diagnostic protocol when suspected to the malignant gastric disease.

Non-invasive liver fibrosis markers: use of serum levels of cytokines IL 1α and TGF ß1 in management of chronic liver diseases.

AIM: To analyze the usefulness of specified immunological parameters, proinflammatory IL-1α and profibrogenic, antiinflammatory TGF-ß1, along with routinely used laboratory tests, in the differential - diagnostic procedure of chronic hepatitis of infectious and noninfectious etiology. METHODS: A total of 150 subjects were divided into two groups, depending on the infectious or noninfectious etiology of liver damage, and the control group. Apart from standard laboratory tests, the analysis included serum levels of cytokines: IL-1α and TGF-ß1. RESULTS: A high degree of correlation of serum level of IL-1α with viral hepatitis has been found, especially with active replication of genetic material ( HBV-DNA or HCV-RNA-PCR positive), p less 0.01. The highest mean concentration of TGF-ß1 was noted in the group of malignant and toxic hepatitis, p less 0.0001. A negative correlation between the concentration of IL-1α and TGF-ß1 has been found (-0.18). For IL-1 α significant predictive parameters included a previous infection of hepatitis B, lower serum level of TGFß, age, use of alcohol, lower MELD and Chilld-Pugh scores. For TGF-ß1 significant predictive parameters were age, lower MELD and Child-Pugh scores, history of receiving transfusions, lower serum level of IL-1α, higher serum level of fibrinogen. A predictive model has been delivered MELD = (TGF-ß1) x 0,001- (IL-1 α) x 0,085 + CTP x 1,771-2,052; ( ± 2.04, R2=0,61; p less 0,001). CONCLUSION: Inflammatory and immune parameters, analyzed together could significantly contribute to the understanding of chronic liver damage and thus differential diagnostic procedure. IL-1α and TGF-ß1 are important parameters of inflammatory activity and fibrosis evaluation in chronic liver damage.

Diagnosis and treatment of chronic viral hepatitis B and C: doctrinary approach.

Association of Gastroenterologists and Hepatologists of Bosnia and Herzegovina based on the experiences of domestic and foreign centers operating in the field of hepatology and accepted guidelines of the European and the U.S. Association for Liver Diseases adopted the consensus for the diagnosis and treatment of chronic viral hepatitis B and C. The guidelines are intended for specialists in gastroenterology and hepatology, and infectious diseases physicians working in primary health care and family medicine, but also other physicians who are confronted with this disease in their practice, with the aim of facilitating and shortening the diagnostic and treatment protocols of patients with chronic viral hepatitis B and C. This ensures faster, more efficient, more rational and cost-effective care of patients with hepatitis, with an emphasis on stopping the deterioration of liver disease to liver cirrhosis and eventually hepatocellular carcinoma. Key words: Chronic hepatitis B and

Percutaneous endoscopic gastrostomy (PEG): retrospective analysis of a 7-year clinical experience.

AIMS: Since its description in 1980, percutaneous endoscopic gastrostomy has become the modality of choice for providing enteral access to patients who require long-term enteral nutrition. This study aimed to evaluate current indications and complications associated with PEG feeding. METHODS: We conducted a retrospective analysis of all patients who referred to our endoscopic unit of the Department of Gastroenterology and Hepatology of the Medical Center University of Sarajevo for PEG tube placement over a period of 7 years. Medical records of 359 patients dealing with PEG tube placement were reviewed to assess indications, technical success, complications and the need for repeat procedures. RESULTS: The indications for enteral feeding tube placement were malignancy in 44% (n=158), of which 61% (n=97) patients were suffering of head and neck cancer and 39% (n=61) of other malignancy. Central nervous disease was the indication in 48.7 % (n=175) of patients. Cerebrovascular accidents (CVA) accounted for 20% (n=73), head injury for 16% (n=59) and cerebral palsy for 11% (n=38). In 6.13% (n=22) of patients minor complications occur which included wound infection (0.8%), inadvertent PEG removal (2.5%) and tube blockage (1.1%). 11 patients experienced major complications including hemorrhage, tube migration and perforation. There were no deaths related to PEG procedure placement and the overall 30-day mortality rate due to primary disease was 15.8%. Oral feeding was resumed in 23% of the patients and the tube was removed subsequently after 6 -12 months. CONCLUSIONS: Percutaneous endoscopic gastrostomy is a save and minimally invasive endoscopic procedure associated with a low morbidity (9.2%) rate, easy to follow-up and to replace when blockage occurs. Over a seven-year period we noticed an increase of 63% in PEG placement at our department.

Hematologic and laboratory parameters in patientis with peptic ulcer bleeding treated by two modalities of endoscopic haemostasis and proton pump inhibitors.

AIM: To compare two schedules (continuous infusion or bolus i.v. of PPI) in treatment after endoscopic homeostasis of bleeding ulcers. METHODS: Patients with gastrointestinal bleeding caused by peptic ulcer, or a recent history (< 24 h before presentation) were included in the study. All cases with actively bleeding ulcers were treated with epinephrine injection and/or thermal coagulation, and randomized to receive intravenous PPIs according to the continuous regimen (in continuous infusion) or the standard regimen (40 mg bolus twice a day for 3 days). RESULTS: 69 patients were treated. Bleeding recurred in 5 of 34 patients (14.7%) receiving the intensive regimen, and in 8 of 35 (22.8%) patients receiving the standard regimen. Hemoglobine rate in standard regimen group was 93,5 g/L (SD 23,8), and in intensive regimen group 106,6 g/L (SD 22,4) (p = 0.042). Total protein rate in the standard regimen group was 65,1 g/L (SD 7,3) and in the intensive regimen group 67,7 g/L (SD 8,15), (p = 0.525). Albumin rate in the standard regimen group was 31,0 g/L (SD 5,2), whereas in the intensive regimen group it was 34,8 g/L (SD 7,4), (p = 0.652). Globulin rate in the standard regimen group was 31,0 g/L (SD 5,2) and in the intensive regimen group 32,3 g/L (5,3), (p = 0.875). Fibrinogen rate in the standard regimen group was 11,1 (SD 2,6) and 10,8 g/L (SD 2,4 p = 0.622) in the intensive regimen group. A mean number of units of blood transfusion for patients in the intensive group was 2,18 (SD 0,8) and 1,34 (SD 1,02) in the standard group, with statistical level of difference p = 0.0004, using Student t-test. The duration of hospital stay was 6,4 days (SD 2,8) in the standard group and 5,8 days (SD 2,8) in the intensive group (p = 0.40). There were fewer surgical interventions in the intensive versus standard regimen. CONCLUSION: In patients with bleeding peptic ulcers with successful endoscopic hemostasis the standard IPP regimen had advantage for transfusion requirements, but no advantage with respect to in-hospital rates of re-bleeding, need for surgery, length of hospital stay, or death.

Usefulness of laboratory data in estimation of Crohn's disease activity.

Crohn's disease (CD) is a chronic inflammatory disease characterized by unpredictable and severe course. Most clinicians use simple laboratory parameters of inflammatory activity such as erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), the number of leukocytes (Le) and platelet count to assess disease activity. The aim of this paper was to determine the value of various laboratory parameters in the assessment of Crohn's disease activity. The study included 36 patients, 15 men and 21 women, treated for Crohn's disease at the Gastroenterohepatology Clinic, Clinical Centre, University of Sarajevo, in period 2006 and 2007. Assessed patients were divided into three groups, according to the degree of disease activity, which was determined using the Crohn's Disease Activity Index (CDAI). Mild disease (MD) was present in 15, moderately severe disease (MSD) in 14, and severe disease (SD) in 7 patients. Statistical significance of association between values of laboratory parameters with the degree of severity of illness was investigated using the 95% Confidence Interval test. CRP showed a statistical significance for the relationship between MD-MSD (95% CI 6,645-74,333) and the relationship between MD-SD (95% CI 4,114-135,278), while the relationship between MSD-SD was not statistically significant. MPV showed statistical significance only for the relationship between MD-MSD (95% CI 0,060-2,909). Sedimentation rate and the number of red blood cells showed statistical significance for the relationship MD-SD (95% CI 10,638-62,943 and 0,077-1,080). Haemoglobin, hematocrit and platelet count showed statistical significance for the relationship between MD-MSD and MD-SD. Number of leukocytes did not show any statistically significant relationship with clinical activity of disease. The most reliable indicators of activity of Crohn's disease in this study were CRP, MPV, haemoglobin, hematocrit and platelet count, while leukocyte number did not correlate with disease activity. Neither parameter was sensitive enough to distinguish the relationship between moderately severe disease and severe disease. Until finding a "gold standard" for assessment of clinical disease activity, various laboratory and other parameters must be combined and compared with other indicators, such as endoscopic findings and radiological results.

Proton pump inhibitors after endoscopic hemostasis in patients with peptic ulcer bleeding.

BACKGROUND: Peptic ulcer bleeding is a common and potentially fatal condition. For patients with bleeding peptic ulcers that display major endoscopic stigmata of recent hemorrhage, a combination of endoscopic and pharmacologic therapy is the current standard management. OBJECTIVE: To show our experience with management of peptic ulcer bleeding. PATIENTS: Patients who presented with gastrointestinal bleeding caused by peptic ulcer or recent history (< 24 h before presentation) of hematemesis and/or melena admitted to our hospital emergency departments, and patients whose ulcer hemorrhage started after hospitalization for an unrelated medical or surgical condition. METHODS: Patients with actively bleeding ulcers and those with nonbleeding visible vessel or adherent clot were treated with epinephrine injection and/or endoscopic hemoclips, and randomized to receive intravenous pantoprasole according to the continuous regimen (dose of 5 x 40 mg in continuous infusion of 8 mg/h for 72 h) or the standard regimen (40 mg bolus of PPI twice daily for 3 days). After the infusion, all patients were given 40 mg PPI twice daily orally. The primary end point was the in-hospital rebleeding rate, as discovered by the repeated endoscopy. RESULTS: Bleeding recurred in 5 of 34 patients (14.7%) receiving the intensive regimen, and in 8 of 35 (22.8%) patients receiving the standard regimen. Hemoglobin (g/l) rate in standard regimen group was 93.5 +/- 23.8, and in intensive regimen group 106.6 +/- 22.4 (P = 0.042). Mean units of blood transfused for all patients in group were 71.8 +/- 45.8 in the intensive and 45.3 +/- 50.2 in the standard regimen group (P = 0.0257). The duration of hospital stay was 6.4 +/- 2.8 in standard group and 5.8 +/- 2.8 in the intensive group (P = 0.40). CONCLUSIONS: In patients with bleeding peptic ulcers with successful endoscopic hemostasis the standard PPI regimen had advantage on transfusion requirements, but no advantage with respect to in-hospital rates of rebleeding rates, need for surgery, length of hospital stay, or death, which corresponds with recent studies.

Test for obscure bleeding vs colonoscopy in the prevention of colorectal cancer.

INTRODUCTION: Colorectal cancer is one of the most common forms of cancer and its frequency has been on the constant and significant increase over the past 20 years. Prevention aiming for early precancerous detection, results in huge financial savings in the health care system. METHODOLOGY AND TEST SUBJECTS: Prospective randomized clinical research was conducted on 150 randomly chosen asymptomatic persons over the age of 50, with positive family history. All test subjects were given a Haemoccult test and colonoscopy examination. Primary objective of the research was to detect precancerous symptoms of colorectal cancer or large intestine cancer in the early stage of the disease when it is therapeutically curable. Secondary objective was to prove that colonoscopy represents an obligatory examination of the large intestine, as well as to introduce a Haemoccult test as a regular diagnostic procedure on the level of primary and secondary health care for asymptomatic patients over the age of 50. RESULTS: Out of 80/230 test subjects who did not fully complete the examination, 62 (77.5%) did not respond to the test reading for obscure bleeding, whereas 18 of them did not consent to be given a colonoscopy examination. Two registered neoplasm were found in the rectosigmoid colon, and the polyps were found in rectosigmoid colon in over 2/3 of the patients. In 125/150 test subjects, the test for obscure bleeding was negative (p < 0.001), but the colonoscopy procedure proved that 11 patients had precancerous changes (polyps). This proved that the test was not highly sensitive and it was recommended that it should be conducted in combination with colonoscopy. Patients with positive test (n = 14) had 8 normal colonoscopy results, but the difference was not significant. CONCLUSION: Application of the test for detection of obscure bleeding once a year, in combination with flexible colonoscopy every 5 years, significantly reduces the risk of colorectal cancer inception.

Application of nutritional screening tests for determining prevalence of hospital malnutrition.

INTRODUCTION AND OBJECTIVE: Many illnesses are related to the loss of appetite or the inability to intake food in a regular fashion. The consequence of long-term or even short-term non-intake of food leads to damaging of organ functions and tissue. Tissue consumption, which is speeded up through metabolic effects of inflammatory mediators, is a characteristic which is identified as clinical malnutrition. The objective of this paper is to offer leading guidelines for uncovering the risk of malnourishment, whilst suggesting several standards which are practical for general use with patients and health workers. METHODOLOGY AND TEST SUBJECTS: This, systematically planned, descriptive, biannual (2006-2007) prospective clinical research, included in total 2.200 hospitalised patients at Clinical Centre University of Sarajevo. Test subjects were hospitalised patients with precisely determined diagnosis, for the purpose of evaluating test subjects' nutritional status and the prevalence of hospital malnourishment. RESULTS: According to MUST test, total of 58% of test subjects were malnourished. The test relied more on the subjective evaluation of the patient and was not proved as acceptable for general screening. According to NRS 2002 test, total of 52.04% of test subjects from other clinics were malnourished. Test was suitable because the "yes" and "no" answers were acceptable for the patient and the final screening was simple. According to MNA test, total of 55.3% from all test subjects were malnourished, but the test was not suitable because the answers were more subjective and as such, unacceptable for both patients and doctors. CONCLUSION: More than 55% of test subjects were in the clinical malnourishment, which was proved with all three tests. The highest risk of malnutrition among patients with internal illnesses is carried by oncology patients. BMI must be routinely conducted on first examination. NRS 2002 test is suitable and acceptable for the patient.

Pretherapeutic staging of the esophageal cancer using endoscopic ultrasound.

Patients with verified early stage of the esophageal carcinoma are presented with a very good prognosis, however all over the world patients present themselves with advanced stages thus minoring the chances for survival. Data obtained form the USA programmes are presenting information about 5 year survival period in 14% of the cases. On the other hand, prospective multi centric European study refers to the same period in 10%. UK studies are presenting age-standardized relative rate of survival at 25% for the first 2 years and corresponding 4,8%-6,3% for the 5 year period. Prognoses are deteriorating with the progression of the primary tumor, thus patients in stage IV are facing 5 year survival period in less than 5 % of the cases. 5 year survival period for patients, who underwent surgery in N0 stage, is 40%-60% comparing to 5%-17% for those in confirmed N1 stage. Patients who undergo surgery in confirmed T3N1 stage are faced with 5 year survival period in 8%-10% of the cases, emphasizing the fact that these tumors are operable, but rarely curable by surgery itself. Neo adjuvant therapy use is increasing for the patients in stages IIB and IIC (local progression of the tumor), aiming to decrease the size of the primary cancer prior to surgery thus increasing the rate of long term survival. Our experiences brought out in this study correlate with the foreign results thus aging stressing the fact that the exact staging of the tumor is the basics for the treatment as well as the right choice of the patients for surgery treatment, and those who need neo adjuvant therapy.

Evaluation of the diagnostic accuracy of the endoscopic ultrasonography results in the patients examined in a period of three years.

INTRODUCTION: Endoscopic ultrasonography (EUS) is a well-established method of evaluating patients with gastrointestinal diseases, especially malignancies. EUS is like other similar endoscopy techniques, based on high frequency ultrasonography. This high level technology allows examination of tissue to almost microscopic level, not only in digestive system but its surrounding structures. OBJECTIVE: The aim of this study was to determine the contribution of endoscopic experience, based on the number of endosopic ultrasonography examination performed in the three years period, to obtain 80% diagnostic accuracy with staging of the disease in order to achieve a 30-60% change rate in treatment decisions which is accepted standard. RESULTS: First group with 210 patients was examined in the first year of work; 325 examined in the second year of work and 295 in the third year. DIAGNOSTIC: Accuracy in the first year of work, were 45% (p<0.001 for the choledocholithiasis; p=0.197 for the pancreatic cancer; p=0.195 for LN detection in the gastric cancer). In the second year of work diagnostic accuracy were 78%/p=0.550 for the choledocholithiasis; p=0.228 for the pancreatic cancer; p=0.503 for LN detection in the gastric cancer/. Diagnostic accuracy in the third year of work were 81%/p<0.001 for the choledocholithiasis; p=0.018 for the pancreatic carcinoma; p=0.042 LN detection in the gastric cancer/. CONCLUSION: Application of Endoscopic ultrasonography in diagnostics, based on number of EUS examination performed, after three years of work, achieved 80% diagnostic accuracy, compared to standard imaging methods and results of surgery in staging of the disease. EUS results made a change in treatment decisions in 30-60% of patients which is world standard and completely justify use of endoscopic ultrasonography in clinical practice.

Randomized trial of TEP laparoscopic hernioplasty versus Bassni inguinal hernia repair.

OBJECTIVE: To evaluate the influence of the laparoscopic tehnique in healing of hernia from the perspectives of time to full recovery, return to work and complications. TYPE OF STUDIES: Randomized, prospectiv study. All relevant factors, should be important to evaluate operative method. Laparoscopic operative treatment has several advantages over classical operative techniques. Main advantage is less tissue damage and consequently less possibility of postoperative complications. Furthermore, period of rehabilitation for patient is shorter, with less pain and shorter period for recovering. PATIENTS AND METHODS: A group of 60 qualified patients was formed with non complicated inguinal hernia. Patients of both gender, aged 19-68, were preoperatively examined. Intraoperative wounds during operation were defined as an intraoperative complications. In postoperative course complications were divided on immediate, early and late postoperative. Patients were re-examined during hospitalization, in the periods of one month, six month, one year and two years after operation. RESULTS: We had no intraoperative complications. Two immediate complications were observed scrotal swelling and hematoma. Two early postoperative complications were also noted a general disuric complication and purulent wound inflammation. As well we have noted only one late complication; pain in inguinal region. We had two relapsing hernias. Duration of hospital treatment was 1-7 days with average of 2,5 days for examined group. Overall absence was 10 day and patients were back to job under full physical activities. CONCLUSION: In non complicated inguinal hernia, laparoscopic tehnique have less complications than classic methods, shoter time to full recovery and to return to work.

[Imaging procedures in gastroenterology]. / Slikovne procedure u gastroenterologiji.

Recent achievements in fields of physics, microelectronical devices and informatical sciences opened huge possibilities of applications in medical specialities. Spread imaging over routine high-resolution instruments continue to be in focus of scientific researches varying from simple staining techniques to most sophisticated photodynamical techniques. Magnetic resonance imaging and computed tomography are radiological specialties, however; we mentioned them for promising achievements in computed data analysis and further improvements of virtual colonoscopy. During the last few years techniques of magnifying endoscopy have been improved including trials with narrow band endoscopy, autoflourescence endoscopy, elastic scattering spectroscopy and laser confocal microscopy. In many indications capsula endoscopy have been applied successfully.

[Laparoscopy and robotics]. / Laparoskopija i robotika.

Telerobotics is a wide term and include multiple directions and aspects in its development. When speaking of different aspects of its development, one should think of its functionality, construction aspects, communication aspects, implementation safety and acceptance by the environment. Robotics is a science dealing with possibilities of implementing different tasks, through mechanical instruments, controlled by humans. Telesurgery does not include only aspects of teleconference but assists in surgical procedures, i.e. enables for the part of surgical procedure to be performed through electronic commands on bigger distances. Currently, two robotic systems are employed in clinical practice. One is ZEUS system, constructed by the Computer Motion and manufactured by AESOP. Second one is Da Vinci surgical system. For laparoscopic robotic telesurgery, identical set of apparatus and instruments as the one used in a routine laparoscopic surgical procedures is needed. In all reports, authors refer to safe and successful surgical method. Recovery of the patient is identical as in classic laparoscopy. No statistically significant difference has been found in the duration of the surgery between robotic and classic laparoscopy. When counting used instruments, it was found that less instruments were used in the robotic laparoscopy. From presented studies related to the robotic laparoscopy, it can be seen that there is an intention to present this method as safe and usable. One thing is sure--this method is the first step toward new model of planning and performing surgical procedures with only one goal--to help the patient.

Portal hypertensive gastropathy (PHG).

Portal hypertenisive gastropathy (PHG) and GAVE syndrome are recently discovered entities who can be associated with bloodloss from gastrointestinal tract at patients with or without liver cirrhosis. PHG will be developed at 65% of patients with portal hypertension caused by liver cirrhosis but it could be developed at portal hypertension which is not caused by the liver cirrhosis. PHG is often assosiated with portal hypertension patients and presence of esofageal and /or gastric varices. Mechanism of pathogenesis PHG is still not completely cleared up, but regulation of gastric nitric oxide level, postaglandins, tumor necrosis factor (TNF) and epidermal growth factor production could be important factors in development of portal hypertensive gastropathy. Mechanisms who participate in originating of Gastric Antral Vascular Ectasia (GAVE) are also not completly clear. Classic characteristics of this syndrome are red, often haemorrhagic lesions most often located in stomach antrum, and who could result in blood loss. More than 70% of patients with GAVE syndrome have no cirrhosis or portal hypertension. But when liver cirrhosis is present, it is very difficult to make difference between GAVE and PHG. This review will be focused on incidence, clinical importance, etiology, pathofisiology and treatment of PHG, and how to differentiate between GAVE syndrom and PHG in a case that there exists.

[Differences in the postoperative course and treatment in patients after laparoscopic and standard cholecystectomy]. / Razlika u postoperativnom toku i tretmanu pacijenata nakon laparoskopije u odnosu na klasicnu holecistektomiju.

The laparoscopic surgical technique differs significantly from the classical operative technique especially concerning the post-operative treatment of the patient. Introducing a new operative technique called for an adjustment of the patients' treatment on the ward. The laparoscopic operative technique has a number of advantages in comparison with the classical operative technique. The main advantage is less damage done to the tissue, which reduces the possibility of post-operative complications. Furthermore, the rehabilitation of the patient is faster. Patients experience far less pain and the recovery period is shorter. Consecutively, this means fewer days in hospital, fewer days on sick leave, a faster recovery and returning to work sooner. Patients operated on using the laparoscopic operative technique are mobilised sooner, they start their nutrition sooner, the set of laboratory tests that are conducted is different, the time of post-operative stay at the clinic is shorter. In this paper we have analysed only operations of the holecyst over a period of one year, comparing two different operative methods. Our objective was to compare the time of post-operative mobilisation of the patient as well as the time when they start taking in liquids and food. Especially emphasised in the paper are operations with complications that call for a different treatment. In the period under analysis we did 728 holecystectomies, of which 114 were done laparoscopically. We paid special attention to the analysis of data concerning the post-operative mobilisation of the patient and the start of nutrition. The results we obtained testify in favour of the significantly shorter post-operative period without peroral nutrition following a laparoscopic holecystectomy. The period when the patient is mobilised is also different and should be given special attention. Based on this, we can conclude that at the Abdominal Surgery Clinic in Sarajevo, over the course of one year, the period of post-operative mobilisation of the patient after laparoscopic holecyctectomy has been shorter in comparison with the classical operative method.

[Incidence of malignancies of the colon treated at the Clinic for Abdominal Surgery at the University Clinical Center in Sarajevo in the prewar (1987-1991) and postwar (1996-2000) period]. / Incidenca malignoma kolona, lijecenih na Klinici za abdominalnu hirurgiju Klinickog centra Univerziteta u Sarajevu u predratnom (1987.-1991.) i poslijeratnom (1996.-2000.) periodu.

Malignant tumours are important health problems today. In most countries they are second cause of death in general population. In this work it was presented epidemiology of rectal cancer which are treated in Abdominal Surgery Department at University Clinical Center in Sarajevo of Bosnia and Herzegovina. This is only part of complete investigation of incidence malignants in Bosnia and Herzegovina. Our study is a retrospective and observation two five years periods. First is between 1987.g. and 1991.g., and second is between 1996 and 2001.g. During first period in Abdominal Surgery Department, we had 668 cases of abdominal malignant and 225 of these cases were carcinoma colorecti. In the second period we had 831 cases of abdominal malignant and 311 of these cases were carcinoma colorecti. When we compared our data with other referents from East Europe, we can say that the results mostly the same, and when we compared first five years period (1987-1991), with second five years period (1996-2001), there are also no statistically significant increase.

[Endoscopic ultrasonography of the upper digestive tract]. / Endoskopska ultrasonografija gornje probavne cijevi.

Endoscopic Ultrasonography, or EUS, has joined medical techniques of endoscopy with high frequency ultrasound technique, known as ultrasound. This removable achievement allows physician for microscopic tissue examination, not only in digestive system, but also in its surroundings by highly frequent technique. Endoscopic ultrasonography detects all kinds and nature of possible abnormalities, including and information, which are necessary for proper diagnosis and optimal treatment. In experience hands, EUS can detect abnormalities, which are undetectable during any other techniques of examination. EUS is applied from inside the body, near or even touching the examined surface, so the precise, highly frequent energy of showing the images can be used. The sonography, MRI, CT techniques must show the inner organs through outside surface of body, loosing the resolution during process. The superior resolution of EUS shows 5 layers of digestive tract, almost equally good as by microscope; none of other techniques allows showing of intestinal wall equally good as this one. By EUS liquid has been proved with 90% of precision in diagnosis of operative degrees of pancreas tumours. CT in this case has shows only 50% of precision. Highly skilled surgeons are aware of application of these diagnostics techniques in preoperative cases so the surgical removement of tumours is going to be more effective. The precision of EUS findings are of critical importance for the utilisation of maximum of new treatment having in mind that abnormalities could be diagnosed and characterised without operative intervention. To be able to focus on specific anatomic surfaces, there is need of great knowledge, skillfulness and praxis during the manipulation with EUS instrument. The years of experience are needed to be able to achieve high standard of expertise. The accuracy of results varies, depending on physicians diagnostic experience, sub-optimal results are not going to be a good guide during treatment planning. Endosonographist must be in position to document at least 80% of accuracy in diagnosis and determination of disease stage in order to achieve 30-60% changes in plans treatment.

[Endoscopy of the lower part of the digestive system]. / Endoskopija donjeg dijela probavnog sistema.

Examination of lower part of digestive system by colonoscopy is necessity in occult fecal hemorrhage occurrence, hematochesis, unresolved loss of blood iron and suspicious finding of large bowel X-ray barium study. By therapeutical colonoscopy, haemorrhage from neoplasms and angiodysplastic changes are controlled, foreign bodies are removed as well as routine polipectomics. Balloon dilation of large bowel stenosis, and palliative treatment of unoperable stenoses lead to improvement in quality of life with significant cost-benefit effects. Follow-up of patients on high-risk for colorectal neoplasms increased early diagnosis of neoplasms.