Apoptosis in human gastric polyps and adenocarcinomas: a stereological analysis.

BACKGROUND/AIM: The occurrence of apoptotic cells was analyzed in human normal gastric mucosa, polyps and adenocarcinomas. METHODOLOGY: Histological classification was carried out on hematoxylin and eosin stained slides. The tissue was classified as follows: Normal gastric mucosa or adenomatous polyps. Gastric carcinoma specimens were histologically classified according to Lauren's classification into: A: Diffuse adenocarcinoma without metastasis, B: Diffuse adenocarcinoma with metastasis, C: Intestinal adenocarcinoma without metastasis, D: Intestinal adenocarcinoma with metastasis, E: Mixed adenocarcinoma without metastasis and mixed adenocarcinoma with metastasis. The counting of apoptotic cells was performed using the 40X objective with a calibrated eyepiece Weibel's multi-purpose M 42 stereological test system. Each group was evaluated stereologically, determining numeric density of apoptotic cells. RESULTS: The results show the progressive and statistically significant increase of apoptotic numeric densities from normal gastric epithelium to adenomatous polyp and finally to cancer, which contained the highest number of apoptotic cells. Comparing gastric carcinoma with and without metastasis in intestinal and diffuse adenocarcinoma there was statistically significant difference. In these two groups, carcinomas with metastasis contained higher number of apoptotic cells than without metastasis. Gastric cancer according to numeric densities of apoptotic cells can be separated in tree statistically different groups: A: Intestinal type gastric cancer with metastasis (the highest number of apoptotic cells), B: Intestinal type gastric cancer without metastasis and diffuse gastric cancer with metastasis (medium number), C: Diffuse type gastric cancer without metastasis, mixed gastric cancer with and without metastasis (the lowest number of apoptotic cells). CONCLUSION: These results suggest that numeric densities of apoptotic cells are associated with tumor progression in human gastric carcinogenesis and can be used as prognostic mark.

[Perioperative complications in carotid endarterectomy with respect to the stage of the cerebrovascular disease]. / Perioperacijske komplikacije karotidnih endarterektomija s obzirom na stadij cerebrovaskularne bolesti.

Records of perioperative complications following 407 consecutive carotid endarterectomies performed in 366 patients in the 18-year period have been presented. The complications are categorized according to the clinical stage of vascular disease, that is, according to the indications for the surgery. Out of the total number, 46 (11.3%) operations were done in the 1st, asymptomatic stage of disease, for the haemodinamically significant stenoses and ulcerated plaques; 173 (42.5%) in the 2nd clinical stage for hemispheral and nonhemispheral transient ishemic attacks (TIA) and reversible neurologic deficits (RIND); 3 (0.7%) in the 3rd stage which is a progressive cerebrovascular stroke and 185 (45.5%) in the 4th clinical stage of the disease, in patients with previous cerebral infarction and a permanent neurologic deficit. The rate of a temporary and permanent neurologic deficit, as well as mortality in the first stage of the disease equals zero. In the second stage of the disease, the rate of a temporary neurologic postoperative morbidity increases to 1.7%, of a permanent neurologic morbidity to 1.2%, while the rate of mortality is 1.2%. In the 3rd and 4th stage, those rates amount to 66.7%, 0% and 33.3%, and 1.1%, 3.8% and 1.6%, respectively. The rates of perioperative morbidity and mortality are in proportion to the scope of preoperative brain dysfunction. Results of this work suggest the necessity of categorization of patients, candidates for carotid endarterectomy, according to the clinical stage of the disease, which will enable a better comparison with other authors' results, give a more reliable view on the efficacy of the surgical treatment and justify the surgeons' attitude towards indications.(ABSTRACT TRUNCATED AT 250 WORDS)

[Bacterial vaginosis. Epidemiology and risk factors]. / Bakterijska vaginoza. Epidemiologija i faktori rizika.

Bacterial vaginosis (BV) is a change in vaginal ecosystem where lactobacilli dominate, flora is absent or greatly reduced, and replaced with a mixed, predominantly anaerobic flora, consisting of Gardnerella vaginalis, Mycoplasma hominis, Mobiluncus spp, Bacteroides spp, Prevotela spp, Peptostreptococcus spp, Fusobacterium spp and Porphyromonas spp. The concentration of bacteria increases from 100 to 1000 fold in women with BV compared to healthy women. BV has been formerly known as nonspecific vaginitis, Haemophilus vaginitis, Corynebacterium vaginitis, Gardnerella vaginitis and anaerobic vaginintis. BV is the most prevalent form of vaginal disturbances in reproductive age women. The average incidence of BV varies: 10-35% in patients visiting gynaecological wards, 10-30% in patients visiting obstetric wards and 20-60% in patients visiting services of sexually transmitted diseases. A typical clinical symptom of BV is malodorous vaginal discharge. However, more than 50% of all women with BV are asymptomatic. BV has been associated with many gynaecological and obstetric complications such as cervicitis, salpingitis, endometritis, postoperative infections, urinary tract infections, pelvic inflammatory disease, mild abnormal Pap smear results and possible link with cervical intraepithelial neoplasia, preterm delivery, premature rupture of the membranes, chorioamnionitis and postpartum endometritis. Factors that increase the risk of BV are multiple partners, exposure to semen, prior trichomoniasis, intrauterine device usage, smoking, indigent population and frequent use of scented soap. Diagnosis of BV is established by Amsel's criteria of which three of four are the following: presence of homogeneous discharge, vaginal fluid pH > 4.5, positive amine test and microscopic analysis of Gram stained smear of vaginal discharge where "clue" cells (epithelial vaginal cells covered with mass of adherent bacteria, mostly coccobacilli) should be detected. The treatment of patients with BV consist of metronidazole or clindamycin, per os or intravaginally. The treatment of asymptomatic women and male sex partners of women with BV is controversial. The aim of the study was to establish the occurrence rate of BV in our women and potential factors increasing the risk of BV. We examined 166 women at the Institute of Microbiology and Immunology, University School of Medicine, Belgrade. Diagnosis of BV was established by Amsel's criteria. Each woman filled in a special questionnaire. Pregnant women were excluded. BV was diagnosed in 25% (33/166) of women. BV was more common among women with multiple partners. The most prevalent clinical symptom of BV was malodorous vaginal discharge. Vaginal symptoms became more evident after intercourse. Taking into consideration the occurrence rate of BV and its connection with numerous gynaecological and obstetric sequelae, and taking into account that the diagnosis of BV is quick, simple and inexpensive, we suggest that the examination of BV in women becomes a usual procedure.

[Hemostasis and treatment of stress hemorrhage in the upper gastrointestinal tract of trauma patients]. / Blutstillung und Behandlung von Stressblutungen im oberen gastrointestinalen Trakt bei Verwundeten.

Despite the use of H2-receptor antagonists for the prevention of stress lesions, 32 (9%) of the 354 wounded treated at the surgical intensive care units presented with upper gastrointestinal bleeding. 28 (87.5%) patients underwent endoscopic examination. The types of hemorrhage (capillary, venous and arterial bleeding) and the efficacy of hemostasis were analyzed. The bleeding ceased spontaneously in 17 (53.1%) patients, and 3 (9.4%) died in spite of all the endoscopic and surgical procedures undertaken.

[Surgical treatment of gastroduodenal ulcers from 1968 to 1978]. / Nase iskustvo kirurskog lijecenja gastroduodenalnih ulkusa u 10 godina od 1967. Do 1978.

Authors ten years experience and results in the surgical treatment of the gastroduodenal ulcer on Surgical clinic "Dr. M.Stojanovic" in Zagreb is esposed. During this period 1226 patients with the gastroduodenal ulcer operated, 804 from them with chronic, and 422 with acute complications as are perforation and bleeding. On the first period of time patients with the duodenal ulcer were operated by combined operative methods selective gastric vagotomy and antrectomy, and after 1975 by PSV with or without drainage procedure depent of the passage of the duodenum. The most of the patients with the gastric ulcer were operated by the Billroth I method of resection. PSV with suture of the perforated or bleeding ulcer of the duodenum is recommanded. 200 patients with chronic or acute complicated ulcer were operated by PSV with no death complication. All patients are normally tested before operation and 3 months, 12 months, and every year after operation. The results achieved by this method of the surgical treatment of the gastroduodenal ulcer are satisfied and harmonize with the modern therapy of ulcer disease.