How to Distinguish Idiopathic Achalasia from Pseudoachalasia?

Achalasia is a disorder characterized by insufficient relaxation of the lower esophageal sphincter and absent peristalsis. It is usually primary (idiopathic) achalasia, but it can also be secondary achalasia (pseudoachalasia). With a review of the literature, epidemiological data was gathered on achalasia in this paper, and followed up with presented etiopathogenetic mechanisms of achalasia. An optimal diagnostic algorithm along with the therapeutic possibilities in achalasia, from endoscopic to surgical methods of therapy, was analyzed. The most common causes of pseudoachalasia and the mechanisms of this disorder are reported. In patients with dysphagia and suspected achalasia, it is important to distinguish idiopathic achalasia from pseudoachalasia, since pseudoachalasia most often occurs due to tumor infiltrations of the lower esophageal sphincter. In this paper, the importance of a timely and accurate diagnosis of pseudoachalasia in relation to idiopathic achalasia was shown.

Anxiety, Depression and Personality Types in Patients with Inflammatory Bowel Disease: Comparisons with Peptic Ulcer and the General Population.

BACKGROUND: To explore corellation of anxiety, depression ant type of personality in inflammatory bowel disease (IBD) and compare with peptic ulcer (PU). SUBJECTS AND METHODS: In this study, prevalence of anxiety, depression and type of personality was investigated in 362 cases divided into three groups: 112 of IBD patients, 122 of peptic ulcer patients and 128 of control group who didn't have any gastrointestinal or psychic complaints. IBD and peptic ulcer diagnosis were established by standard diagnostic procedures (anamnesis, clinical manifestations, laboratory, endoscopy and biopsy in IBD and upper endoscopy in peptic ulcer). Anxiety and depression were established by Hamilton anxiety rating scale (HAM-A) and Hamilton rating test for depression (HAM-D). Type of A/B personality was established by Bortner scale and D type of personality by Denollet scale (DS14). RESULTS: Anxiety was found in 47 (41.9%) and depression in 44 (38.3%) of a total of 112 IBD cases. In group with peptic ulcer anxiety was found in 40 (32.8%) and depression aalso in 40 (32.8%) of total 122 cases. In control group anxiety was diagnosed in 21 (16.4%) and depression in 20 (15.6%) of total 128 cases. Anxiety and depresson were significantly higher in both groups than in control group but anxiety and depression were significantly higher in IBD group than peptic ulcer group. D type of personality was statistically significant in peptic ulcer group. CONCLUSION: Anxiety and depression in IBD and peptic ulcer cases have a greater prevalence compared to the normal population and surprisingly are higher in IBD than peptic ulcer group. D type of personality is associated with peptic ulcer.

Liver transplantation and allergy: transplant-acquired food allergy.

Transplant-acquired food allergy is a well known phenomenon especially linked to liver transplants. Risk factors lie both in transplant recipient and transplant donor - age of recipient and the maturity of immune regulatory mechanisms, family history of atopy in recipient, young age of the donor and atopic history in donor. The exact mechanism has not yet been established and there are many different explanations of this pathophysiologic process. Transplanted liver is a large and well perfused organ, rich in pluripotent hematopoietic stem cells and donor's IgE antibodies that can alter immunological response in the host. Some studies suggest that post-transplant immunosuppression with tacrolimus is linked to an increased occurrence of IgE-mediated sensitization and manifestation of allergic disease. Research in the field of transplant-acquired food allergy is not important only for transplant patients and physicians involved but also for understanding the mechanism of food allergy development in general population and potentially reducing this global health concerning issue.

Type of Cell Separator, Fenwal Amicus vs Fresenius Com Tec, May Influence the Corpuscular Elements Value of the Donor`s Blood.

INTRODUCTION: During the plateletpheresis procedure the number of thrombocytes in the donor's blood significantly decreases, and the levels of the hematocrit (HCT), hemoglobin (Hgb), and leukocyte (WBC) diminish as well. Influence of the cell separator is one of the factors that affects the levels of HCT, Hgb and WBC. In this study, the goal was to determine the value difference of HCT, Hgb, WBC, and platelets after the platelet pheresis process between performance on Fenwal AMICUS and on Fresenius Com Tec. DONORS AND METHODS: The criteria for participation: male in the age range of 25-45. We have formed two groups: for both groups - 180 separations were performed on 60 participants were the values of hematocrits, concentration of hemoglobin and number of leukocytes were established before and after separation using the double-needle continuous flow cell separation (DN-CFCS) on two different devices, Fenwal AMICUS device and the Fresenius Com Tec. device. To confirm the statistical differences we have used Student t-test for independent or dependent samples, as well as Mann-Whitney U test as non-parametric alternative. To compare differences between the values of four parameters (P1-P2) from two groups (using two devices - Fenwal AMICUS and Fresenius Com Tec) The possibility of errors were accepted for α<0.05, and the difference between groups as statistical relevant were accepted for p<0.05. RESULTS: Statistically significant lower values were noted for all researched parameters after separation on both devices. The statistically significant average values for Hct, Hgb and WBC obtained between two devices, were less than 0.05 (p=0.05). For the platelets (Plt) there was no statistical significant difference (p>0.05 - α=0.05), between average level obtained using either Fenwal AMICUS or Frazenius Com Tec. CONCLUSION: The type of cell separator had the influence on the decrease value of the observed parameters.

Pain Intensity Scales Comparison in Patient with Abdominal Pain.

BACKGROUND: The aim of study was to explore efficiency of the pain rating scales on patients experiencing abdominal pain, determine correlation between the scales and their applicability to general population and determine the minimal clinical important difference in mm on the VAS as discriminatory for difference in pain intensity. SUBJECTS AND METHODS: The study was performed at the Emergency Department of the University Clinical Hospital of Mostar on patients with abdominal pain which started less than 24 hours before, excluding patients under 16 years old, uncooperative patients and those with altered state of consciousness. The sample data were collected from February to May 2010. Hundred patients completed the questionnaire. Two patients, admitted to the Abdominal Surgery Department, were excluded. The patients were asked to sign the informed consent form and assess the level of pain on three scales (VAS, NRS, VRS). RESULTS: The NRS showed a significant difference in assessing the pain intensity in the observed time. By lapse of time, the patients were reporting lower pain intensity (P=0.017). VAS and NRS had high correlation coefficient values, indicating strong correlation and credibility. The NRS showed strong results correlation (r=0.784; P<0.001). Inter-scale correlation was growing over time. Correlation between VAS and NRS was very strong, the strongest in the last measurement (r=0.950; P<0.001). The NRS correlation with VRS (r=0.430; P<0.001) was slightly better than with VAS (r=0.402; P<0.001). The NRS proved to be the most sensitive to changes in pain intensity (SRM=0.305), whereas the VRS showed extremely low responsiveness (SRM=0.185). CONCLUSION: Having proved as the most useful, reliable and efficient pain assessment instrument, the NRS is hereby recommended as method of pain objectification and determining changes in pain intensity.

Tumor Marker CA 125 in the Diagnosis of Active Pulmonary Tuberculosis - A Study of Adults in Mostar, B&H.

BACKGROUND: Tumor marker CA 125 is found in normal mesothelial lung cells and normal bronchial epithelial cells. If destruction of these cells occurs due to inflammation or tumour, CA 125 will be released, and increased in the serum. SUBJECTS AND METHODS: From November 2008 to May 2009 a study analysing CA 125 levels in serum samples from patients who are hospitalized at the Pulmology Department of University Hospital Mostar. Standard laboratory tests, X-ray, sputum examination to BK, and tumour marker CA 125 were performed in all patients. Patients were divided into 5 groups. Comparing clinical and laboratory findings of patients and statistical processing of collected data, conclusions were drown about the role of tumor markers Ca 125 in the diagnosis of pulmonary tuberculosis. RESULTS: This analysis is performed on 220 patients, forty with pulmonary tuberculosis. Of the total number of patients included, there is 60% of the negative findings of tumor marker Ca 125 which is statistically significant (P<0.05). Further analysis of Ca 125 shows that there is 75% of positive findings in active pulmonary tuberculosis, which is a statistically significant difference (P=0.002). Within the group of patients with lung carcinoma, half of the patients showed positive finding of tumor marker CA 125. Statistical analysis showed that sensitivity of CA 125 was 75%, specificity was (68%) and positive predictive value was 12% in patients with active tuberculosis. CONCLUSIONS: The result of this study showed that the increase in serum tumor marker CA 125 is present in active pulmonary tuberculosis as well as in patients with lung cancer.

Attitudes of Students of Medicine, University of Mostar According to Induced Abortion.

BACKGROUND: Aim of this study was to establish attitudes of medical students on induced abortion and connection of those attitudes with religiousness, length of their studies, sex and various circumstances of pregnancy. SUBJECTS AND METHODS: In total, 148 students of the first, second, fifth and sixth year of medical faculty participated in the research. The study was conducted at the Medical Faculty of the University in Mostar. While collecting the data, we used a survey taken over from literature. The data were tested with adequate statistical methods afterwards. RESULTS: 81.1% of students would perform an abortion under certain circumstances (χ2=57.189; P<0.001). Most students answered that they would perform an abortion in case that a fetus had malformations (χ2=3.892; P=0.49) or if the mother's life were endangered (χ2=47.676; P<0.001). By comparison of students' readiness to perform an abortion under various circumstances of pregnancy depending on length of medical education, statistically significant difference was proved in the following circumstances: rape (χ2=6.097; P=0.014) and if the pregnancy would endanger mother's mental health (χ2=4.488; P=0.034). Students with shorter medical education expressed more liberal attitudes in the above stated circumstances. By comparison of students' readiness to perform an abortion under various circumstances of pregnancy depending on religiousness statistically significant difference was proved in the following circumstances: in case of 'abortion on demand', no matter the reason (χ2=11.908; P=0.012), teenage pregnancy (χ2=33.308; P<0.001) and if the pregnancy would interfere with mother's career χ2=35.897; P<0.001). Unreligious students expressed more liberal attitudes. CONCLUSION: Influence of length of medical education and sex on attitudes on abortion was not proved statistically. Impact of religiousness on that attitude cannot be commented due to very small share of unreligious students in the sample.

Correlation of clinical and endoscopic indices in IBD patients in University Clinical Hospital Mostar.

BACKGROUND: To explore correlation between clinical and endoscopic indices in inflammatory bowel disease (IBD) patients. SUBJECTS AND METHODS: There were 112 patients with inflammatory bowel disease. All patients with diagnosed IBD was established a degree of clinical and endoscopic disease activity. CDAI (Crohn's disease activity index) was used as clinical and SES-CD (Simplified Endoscopic Crohn Disease Index) as endoscopic index for Crohn's disease. For ulcerative colitis Truelov & Witts index was used as clinical and Baron as endoscopic activity index. Correlation of clinical and endoscopic indices were compared in Crohn disease (CD) and ulcerative colitis (UC). Patients were analyzed by clinical entities - CD and UC, according to sex, age, parameters of anemia, duration of disease and education. RESULTS: In the total of 112 IBD patients there were 69 patients diagnosed as ulcerative colitis (61.6%) and 43 as Crohn's disease (38.4%). There were 58 (51.8%) women and 54 (48.2%) men. Comparison between endoscopic and clinical indices in CD and UC demonstrated no significant differences in ilnness activity. Endoscopic and clinical disease activity was associated with a higher inflammatory parameters (CRP and leucocytes, L) and lower parameters of hemoglobin (Hb) and MCV. CONCLUSION: Our research has established a good correlation between clinical and endoscopic index of disease activity in the CB and UC in inflammation. Clinical indices can be used for monitoring inflammation.

IMP3 protein is an independent prognostic factor of clinical stage II rectal cancer.

Immunohistochemical level of IMP3-protein in patients with rectal cancer in clinical stage II (141), were correlated with sociodemographic, pathohistological and clinical indicators and duration of overall-survival and progression-free-survival. Vascular invasion was associated with IMP3-positive immunostaining (p < 0.001). Vascular invasion ratio in the group of poorly-differentiated-tumors was 21 times higher than in the group of well-differentiated-tumors. IMP3-positive patients lived 2.2 times shorter than negative (p < 0.001). Patients with well-differentiated-tumors lived 1.7 times longer than the subjects with poorly-differentiated-tumors (p < 0.001). Patients without vascular invasion lived 2.7 times longer than the subjects with vascular invasion (p < 0.001). The risk of mortality was 2.3 times higher for IMP3 positive patients (p = 0.027) and 10.4 higher for the patients with vascular invasion (p < 0.001). IMP3-negative participants had 2.3 times longer free interval without disease (p < 0.001). The free interval without disease was 3.6 times longer in the group without vascular invasion (p < 0.001). The risk of disease relapse in the IMP3 positive group was 5.3 times higher (p < 0.001) and with vascular invasion was 8 times longer (p < 0.001). The risk of disease relapse was 6.8 times higher in the group with vascular invasion (p < 0.001). Patients with rectal cancer and high IMP3-protein level will have a shorter overall survival relative to patients without or with low levels of IMP3. The analysis of IMP3 expression by immunohistochemistry pointed IMP3 as an independent prognostic factor of clinical stage II rectal cancer.