Common bile duct wall thickening due to intramural varices diagnosed by colour Doppler ultrasound.

Cases of common bile duct (CBD) wall thickening due to varicose dilation of intramural veins consequential to portal vein thrombosis (PVT) are rare and present a considerable differential diagnostic problem, as they can mimic cholangiocarcinoma. In such cases, colour Doppler ultrasound (CD US) is a very valuable diagnostic method. There are only a few reports in literature on CD US findings of collateral circulation in a thickened CBD wall following PVT. A patient with obstructive jaundice, a tumour of the pancreatic head, CBD wall thickening, and pre-existing PVT is presented. CD US demonstrated collateral circulation of the thrombosed portal vein in the thickened wall of the common bile duct, thus ruling out a mass in the CBD. Obstructive jaundice seldom occurs with choledocal varices. In this patient, the bile duct obstruction was due to the carcinoma of the pancreatic head.

Peptic ulcer disease in dyspeptic patients with ischemic heart disease: search and treat?

OBJECTIVE: The aim of this study was to determine the prevalence and risk factors for peptic ulcer disease (PUD) in dyspeptic patients with ischemic heart disease (IHD), and to assess whether the healing of PUD before coronary artery bypass grafting (CABG) could reduce the need for urgent postoperative endoscopy. PATIENTS AND METHODS: A series of 894 patients referred to Dubrava University Hospital in Zagreb for elective CABG during the period from May 1998 until April 2001 was prospectively analysed. Dyspepsia was assessed by a questionnaire, PUD by upper gastrointestinal endoscopy, and H. pylori status by histology/Giemsa staining and the rapid urease test. The need for urgent postoperative endoscopy (hematemesis and/or melena, sudden onset of anemia or unexplained epigastric pain) was compared between the prospective study group of 894 patients and a series of 463 patients referred for CABG to Dubrava University Hospital during the period from January 1997 until April 1998. RESULTS: Gastroduodenal dyspepsia predominated in 184 (20.6 %) patients, 142 (77.2 %) of them with Helicobacter (H.) pylori infection and 69 (37.5 %) with verified PUD. Univariate analysis indicated the increased risk of multiple PUD to be related to a previous diagnosis of PUD (OR 3.61, 95 % CI 1.32 - 9.82), H. pylori infection (OR 18.86, 95 % CI 2.31 - 153.98), use of aspirin (OR 5.70; 95 % CI 1.80 - 18.03) and left coronary artery occlusions (3.10, 95 % CI 1.00 - 9.59). Multivariate analysis pointed to H. pylori infection (OR 16.30, 95 % CI 1.57 - 168.53) and left coronary artery occlusions (OR 4.84, 95 % CI 1.05 - 22.30) as independent risk factors for multiple PUD. The OR for urgent postoperative endoscopy due to a major gastrointestinal event was 9.9 (95 % CI 2.2 - 45.1) and the OR for active peptic ulcer with stigmata of recent bleeding was 6.9 (95 % CI 1.4 - 33.1) in the group of patients with IHD who were not submitted to evaluation for dyspepsia prior to elective heart surgery. CONCLUSIONS: In areas with a high prevalence of H. pylori infection, endoscopy and a "search and treat" strategy for IHD patients with dyspepsia before elective cardiac surgery should significantly reduce the need for urgent postoperative endoscopy due to major gastrointestinal events.

Duplex ultrasonography in diagnosis of spigelian hernia with incarcerated jejunal loop.

Spigelian hernia is a very rare anterior abdominal wall hernia with uncharacteristic symptoms and challenging diagnosis. The case of a 76-year-old male patient with colicky pain and vomiting lasting for 24 hours before admission to the hospital is presented. Physical examination of the patient revealed abdominal tenderness and a round-shaped tumefaction of 3 cm in size, located in the left lower abdominal quadrant. X-ray examination of the abdomen, obtained in left lateral position of the patient, showed small bowel ileus with distended jejunal loops. The abdominal ultrasound examination, followed by duplex ultrasonography, revealed a spigelian hernia with ischemic changes of strangulated bowel segment indicating incarceration of the herniated jejunal loop. Preoperative findings were confirmed by intraoperative diagnosis of spigelian hernia and incarcerated jejunal loop with ischemic changes and deserosation, followed by resection of the bowel segment involved and plastic surgical reconstruction of anterior abdominal wall. This case report highlights the role of duplex ultrasonography in the evaluation of circulatory status of potentially incarcerated bowel segment within hernial sac.

Activity of serum angiotensin-converting enzyme as a tumour marker of hepatocellular carcinoma.

OBJECTIVE: Previous studies have pointed to the changes of serum angiotensin-converting enzyme (SACE) values in patients with liver disease and cancer located in different sites. The aim of this study was to determine the changes in SACE values in patients with hepatocellular carcinoma (HCC) and liver cirrhosis. METHODS: The study comprised 30 patients with HCC (22 men and eight women) of average age 48.6 +/- 9.0 years and 30 patients with liver cirrhosis (21 men, nine women) of average age 49.1 +/- 9.5 years. The control group consisted of 30 healthy volunteers with matching anthropometric characteristics. SACE activity was determined by a spectrophotometric method using synthetic hippuryl-glycyl-glycine as substrate. RESULTS: The mean SACE value was considerably lower in patients with HCC, 22.8 U/ml (95% CI, 22.5-23.9), both those in whom HCC developed in cirrhotic liver (n = 23), 23.7 (22.9-24.5) as well as those with HCC without cirrhosis (n = 7), 21.8 (21.0-22.6), with regard to patients with liver cirrhosis, 37.2 (36.6-37.8) (P < 0.001). There was also a statistically significant difference between healthy, 29.9 (29.4-30.3), and both groups of HCC patients (P < 0.001). No significant differences could be found between the group of HCC patients with and without liver cirrhosis (P < 0.05). In patients with liver cirrhosis SACE value was increased in accordance with the severity of the disease expressed by Child's classification; however, at each stage SACE values were considerably lower in patients with HCC in cirrhotic liver (Child A, 35.8 vs 22.1; Child B, 38.7 vs 24.2; Child C, 40.0 vs 28.3) (P < 0.001). Alfa-fetoprotein (AFP) values did not correlate with the SACE activity. The SACE value was also significantly decreased in patients with HCC whose AFP were not altered. CONCLUSION: The study has shown that SACE values are low in patients with advanced HCC. It may be helpful in detecting HCC in patients with cirrhosis, where it can be difficult to differentiate between small HCC tumours and regeneration nodules.

Histopathologic features of T-cell mediated colonic injury induced with 2,4-dinitrofluorobenzene in BALB/c mice.

The aim of the study was to reveal the histopathologic features of intestinal inflammation as demonstrated in BALB/c mice, using the challenge of 2,4-dinitrofluorobenzene (DNFB) with or without previous sensitization. Forty mice were randomized into 5 groups. Two groups of animals were treated with rectal enema of 0.2% or 1.0% of 2,4-dinitrofluorobenzene solution. Third group was pretreated with 2 sensitizing doses of DNFB. Two control groups were treated with PBS or acetone and vehicle enema only (acetone and olive oil). In order to assess the extent of colonic inflammation and damage, a histopathologic score scale was developed. In contrast to scanty superficial ulcerations and mild edema observed in the control group of animals, edema, ulcerations, hemorrhage, necrosis and infiltration of inflammatory cells were observed in experiment groups treated with enema of DNFB. Total score of lesion as well almost all inflammatory parameters of injury observed were highest in previously sensitized animals. The results of this study clearly demonstrated the pattern of colonic inflammation induced with DNFB using the histopathologic scoring scale system.

Serum selenium concentration in patients with liver cirrhosis and hepatocellular carcinoma.

The aim of the study was to investigate the serum selenium concentration in patients with liver cirrhosis and hepatocellular carcinoma. A total of 59 patients, 49 with liver cirrhosis and 10 with liver cirrhosis and coexistent hepatocellular carcinoma, as well as 202 healthy volunteers entered the study. In the patients with liver cirrhosis and in those with liver cirrhosis and coexistent hepatocellular carcinoma, serum selenium concentrations were significantly lower (39.28 +/- 13.99 and 42.00 +/- 10.59 g/L, respectively), when compared to the group of healthy volunteers (66. 79 +/- 9.13 g/L) (p < 0.001). There was no significant difference in serum selenium concentrations between the two patient groups. In the group of patients with liver cirrhosis positive correlation was found between serum selenium and albumin concentrations, and negative correlation between serum selenium and bilirubin (p < 0.05 and p < 0.01, respectively). There was no correlation of serum selenium concentration with fibrinogen and prothrombin time. Results of the study suggested the possible important nutritive and protective role of selenium in the patients with liver cirrhosis and coexistent hepatocellular carcinoma, as well as the potential need of selenium supplementation in these patients.

[Differences in serum selenium concentration in probands and patients with colorectal neoplasms in Zagreb, Croatia]. / Unterschiede in den Selenkonzentrationen im Serum bei Gesunden und bei Patienten mit kolorektaler Neoplasie in Zagreb, Kroatien.

Serum selenium concentration (scSe) (microgram/l) was comparatively measured in healthy persons (n = 202), patients with colorectal adenoma(s) (n = 44) and colorectal carcinoma (n = 48). In patients with adenoma(s) scSe (59.05 +/- 15) was significantly lower (p < 0.001) compared with scSe in the control group (66.8 +/- 14.43). Hyposelenemia was more pronounced in patients with multiple polyps (n = 11) than in patients with single adenoma (n = 33) (p < 0.05). Patients with colorectal carcinoma had also significant decrease in scSe (50.93 +/- 13.81) compared with the control group (p < 0.001 and with the adenoma patients (p < 0.001). According to the analysis of variance, highly significant differences were found among the cancer patients stratified in Dukes' stages A to D (p < 0.001), indicating a strong negative correlation between extension of cancer and hyposelenemia. Furthermore, hyposelenemia seemed to be more pronounced in the mucinous type of carcinoma than in adenocarcinoma (p = 0.056). This results indicate that hyposelenemia is strongly associated with colorectal neoplasia (including extension and severity of the disease) and that it may not only be a result but also one of tumorogenic factors. That means that selenium supplementation could be important in prevention or even adjuvant therapy of colorectal cancer.

Ulcerative colitis in Zagreb, Yugoslavia: incidence and prevalence 1980-1989.

We present a ten-year incidence of ulcerative colitis in Zagreb, Yugoslavia. The study included both outpatients and inpatients regardless of the extent and severity of the disease. The mean annual incidence rate was 1.5 per 100,000 inhabitants for the period of 1 January 1980 through 31 December 1989. There was no increase in the incidence of ulcerative colitis during the study period. A prevalence rate estimate of 21.4 per 100,000 inhabitants was based on July 1985 official estimated population. The results confirm the low frequency of ulcerative colitis in central Europe.

Epidemiology of Crohn's disease in Zagreb, Yugoslavia: a ten-year prospective study.

A ten-year prospective study of Crohn's disease was carried out in Zagreb, Yugoslavia. It included both inpatients and outpatients regardless of the extent and severity of the disease. The mean annual incidence rate was 0.7 per 100,000 between 1 January 1980 and 31 December 1989. There was no increase in the incidence of Crohn's disease during the study period. The prevalence of Crohn's disease was 8.3 per 100,000 on 31 December 1989. The results confirm the low frequency of Crohn's disease in central and southern Europe.

[Cigarette smoking and ulcerative colitis--is there a causal relationship?]. / Pusenje cigareta i ulcerozni kolitis--postoji li uzrocna veza?

The relation between cigarette smoking and ulcerative colitis was assessed in a case-control study of 235 cases of ulcerative colitis and 311 age- and sex-matched control subjects admitted to the hospital for conditions unrelated to smoking. Smoking habits and daily number of cigarettes smoked were analysed. We found significantly less number of smokers and more ex-smokers in the ulcerative colitis group. The intensity of smoking was equal in both groups. It was noted that pancolitis occurred more frequently in the ex-smokers group. The intensity of smoking did not influence the extension and clinical course of ulcerative colitis. For ulcerative colitis, the relative risk for nonsmokers was 7.4. The study revealed a positive correlation between nonsmoking and ulcerative colitis, higher incidence of pancolitis among ex-smokers and higher relative risk of ulcerative colitis for never-smokers. Various possible causes of influence of smoking on ulcerative colitis are discussed.

[Ultrasonically guided biopsy of intra-abdominal changes. Report of the results of a 5-year study]. / Ultrazvukom vodene ciljane biopsije intraabdominalnih promjena. Prikaz rezultáta petogodisnjeg rada.

Ultrasound guided biopsies of intraabdominal changes have been performed in 215 patients within a five-year period. The most frequent pathologic changes were liver neoplasms--liver metastases in 51 patients, angiomas in 16 and primary carcinomas in 17. The most frequent extrahepatic pathologic changes were pancreatic diseases in 22 patients and colonic carcinomas in 17 patients. This method of biopsy enables most rapid and reliable diagnosis and it is also simple and safe.

[A rare opening of great biliary ducts - esophagobiliary communication (author's transl)]. / Die seltene Einmündungsanomalie der grossen Gallengänge - Osophagobiliäre Kommunikation.

A case report of a congenital esophagobiliary communication with atresia of left ductus hepaticus is presented. The communication of the esophagus with the duct of the left liver lobus was examined by giving Esophotrast into esophagus and by intravenous cholangio-cholecystography and tomography. Atresia of the left ductus hepaticus was detected by intraoperative cholangiography. The case is presented because of its rarity and it has only an embryological explanation.