Potential use of Doppler perfusion index in detection of occult liver metastases from colorectal cancer.

Many clinical and preclinical studies demonstrated that measurements of liver hemodynamic [Doppler perfusion index (DPI)] may be used to accurately diagnose and predict liver metastases from primary colorectal cancer in a research setting. However, Doppler measurements have some serious limitations when applied to general population. Ultrasound is very operator-dependent, and requires skilled examiners. Also, many conditions may limit the use of Doppler ultrasound and ultrasound in general, such as the presence of air in digestive tract, cardiac arrhythmias, vascular anomalies, obesity and other conditions. Therefore, in spite of the results from clinical studies, its value may be limited in everyday practice. On the contrary, scientific research of the DPI in detection of liver metastases is of great importance, since current research speaks strongly for the presence of systemic vasoactive substance responsible for observed hemodynamic changes. Identification of such a systemic vasoactive substance may lead to the development of a simple and reproducible laboratory test that may reliably identify the presence of occult liver metastases and therefore increase the success of adjuvant chemotherapy through better selection of patients. Further research in this subject is therefore of great importance.

[Laparoscopic transgastric cystogastrostomy of pancreatic pseudocyst: a case report]. / Laparoskopska transgastricna cistogastrostomija pseudociste gusterace: prikaz bolesnika.

Pancreatic pseudocyst is one of the most common complications of acute pancreatitis. Symptomatic or complicated pseudocysts require treatment. The basic principle of pseudocyst treatment is its drainage. The best method is internal drainage by establishing communication between pseudocyst and stomach or small intestine. With advances in endoscopic technology it is now possible to drain pseudocyst efficently in neighboring stomach or duodenum, however the surgical internal drainage of pancreatic pseudocysts that has been carried out as open operation for decades, remains the criterion standard against which all other therapies are measured. In recent years, several methods of laparoscopic internal drainage of pancreatic pseudocysts have been published. Initial results are encouraging, although the number of patients operated using these methods is still small and there is no clear evidence that laparoscopic internal drainage is beneficial for the patients. In this case report we present our first case of laparoscopic internal drainage of pancreatic pseudocyst. The pseudocyst developed as a complication of acute pancreatitis. Laparoscopic internal drainage with cholecystectomy was carried out on 4th of April, 2005. The patient recovered without complications and during first year of follow-up no recurrence of pseudocyst was observed.

[Laparoscopic surgery in acute abdominal trauma]. / Laparoskopska kirurgija kod akutne ozljede trbuha.

In the past few years, laparoscopy has been increasingly used in patients with acute abdominal trauma. This metod in experienced hands enables direct eye visualisation of abdominal cavity, ensures accurate and early diagnosis and leads to prompt decision on the therapy. Reviewing the literature, laparoscopy in acute abdominal trauma is a safe and accurate procedure to yield diagnosis, enable laparoscopic interventions and help avoid unnecessary laparotomy. In acute abdominal trauma, laparoscopy is mostly used as a diagnostic method, not so often as a therapeutic method, but an expanding range of therapeutic interventions is available. We show our early results with diagnostic and therapeutic laparoscopy from January 1st 2003 to March 31st 2004, stressing therapeutic laparoscopy. We performed 79 laparoscopic explorations in patients with diagnosis of acute abdomen. 7 of them were explored because of acute abdominal trauma. In 3 patients there was no need for intervention after laparoscopic exploration, in 1 patient we electrocoagulates smaller bleeding from the spleen and in other 3 patients we made conversion to open surgery procedure, because of III-IV grade liver or spleen injury. In our group we didn't have injuries of any other internal abdominal organs. Laparoscopic treatment of acute abdominal trauma with spleen or liver injury is applicable in I-III grade liver injury and I-II grade spleen injury, while in greater injuries it is necessary to make conversion to laparotomy.

[Blast injury to the spleen and pancreas after a non-penetrating gunshot wound--result after 12 years]. / Ratna ozljeda slezene i gusterace nastala bocnim udarnim valom metka--rezultat nakon 12 godina.

The spleen is the most frequently injured organ in adults who sustain blunt abdominal trauma. The aim is to report on a patient with non-penetrating gunshot traumatic injury to the spleen and pancreas, and to evaluate the result after 12 years A soldier with gunshot wound of the left lateral abdominal wall was admitted to the Military Hospital in Mostar in the year 1993. The patient was hemodynamically unstable and underwent emergency surgery. On wound exploration, there was no abdominal penetration. Because of hemodynamic instability, we decided to perform emergency laparotomy and abdominal exploration. The spleen and distal pancreas were shattered. Splenectomy and hemostasis were performed. The peritoneum was closed and the abdominal wall wound healed secondarily. The patient was in good condition postoperatively. Now, after 12 years, the patient is free from any sequel of the war injury. Blast injury to the spleen can result from non-penetrating abdominal gunshot wounds despite the absence of injury to the peritoneum. In war conditions, the diagnosis and indications are usually based on clinical findings only because special investigations, including ultrasound and CT are not readily available. The management of splenic injury has been rapidly modified over the last decade, with ever more emphasis on splenic salvage and nonoperative management, however, these procedures cannot be performed in war conditions. War injuries to the spleen are life threatening and emergency open splenectomy is the only solution.

Altered iron metabolism, transferrin receptor 1 and ferritin in patients with colon cancer.

In this study, the level and distribution of transferrin receptor 1 (TfR1) and ferritin in colorectal carcinoma and in normal colon epithelium has been determined relative to the tumor stage and iron status of patients using immunohistochemical staining methods. While the majority of carcinoma patients were anemic, no relationship between the level of colon tissue ferritin and TfR1 and the systemic parameters of iron metabolism was evident. Furthermore, no association between ferritin content and the grade of colorectal carcinoma was observed. However, a relationship between the expression of TfR1 and the grade of colorectal carcinoma was observed. In this case high expression of TfR1 was found in colorectal carcinoma samples of Dukes A or B grade, and well differentiated colorectal carcinoma cells. In comparison, weak or no expression of TfR1 was observed in carcinoma samples of Dukes C or D grade with poorly differentiated cells and in carcinoma samples that had lymph node infiltration and distant metastasis.

Common bile duct obstruction caused by the hydatid daughter cysts.

Echinococcosis is a human parasitary disease. In 2002, 29 new cases of liver echinococcosis were recorded in Croatia. Liver is the most common site of hydatid cysts. Nine patients with echinoccocal liver disease were operated in our department in 2002. Here we present a case where a patient with verified hydatid cyst in the left liver lobe developed high fever, jaundice, nausea, vomiting and pain in the upper abdomen. The symptoms were initially ascribed to the acute cholangitis. After unsuccessful antibiotic treatment, computerized tomography and endoscopic retrograde cholangiopancreatography (ERCP) were performed, demonstrating daughter cysts in the common bile duct. During ERCP, papilotomy was made and daughter cysts were extracted. Hydatid cyst was surgically removed, and a communication between the cyst and left hepatic duct was noted during surgery. Pericystectomy, choledochotomy, removal of remaining daughter cysts from the common bile duct, and sutures of left hepatic duct were performed. The patient recovered fully after the surgery. One of the possible complications of the liver hydatid cysts is the communication between cyst and the biliary tree. Such communications are usually asymptomatic, but symptoms can also mimic acute cholangitis and jaundice, which may lead to the misdiagnosis of the patient's condition.

[Laparoscopic repair of a cholecystoduodenal fistula--a case report]. / Laparoskopsko zbrinjavanje kolecistoduodenalne fistule--prikaz slucaja.

Although cholecystoduodenal fistula is traditionally considered a contraindication for laparoscopic cholecystectomy, literature search reveals reports of cholecystoduodenal fistulae successfully repaired laparoscopically, regardless whether cholecystoduodenal fistula was diagnosed before or during operation. Here we present a case of preoperatively diagnosed and confirmed cholecystoduodenal fistula that was successfully repaired during elective laparoscopic cholecystectomy using an Endo-GIA 35 stapling device. Thus we side with the growing number of surgeons who do not consider cholecystoduodenal fistula to be a contraindication for laparoscopic cholecystectomy.