[Odontogenic foci and systemic diseases. A review]. / Az odontogén góc és a szisztémás betegségek. Irodalmi áttekintés.

The aim of the present review is to provide an up-to-date picture of what we know about the connection between odontogenic foci and non-oral diseases. After a brief historical summary, we give an overview on how the odontogenic focus causes disease in distant areas of the body in general, and then we start the discussion of the particular conditions, such as cardiovascular diseases, pneumonia, diabetes mellitus, metabolic syndrome, rheumatoid arthritis and adverse pregnancy outcomes. The review is centered around the two main odontogenic foci: periodontitis and periapical periodontitis, the latter being a widely recognized but rarely discussed oral focus. Finally, we offer a few considerations that the practicing dentist may find useful when dealing with odontogenic foci. Orv Hetil. 2018; 159(11): 415-422.

[Randomized, controlled clinical trials with observational follow-up investigations for evaluating efficacy of antihyperglycaemic treatment. II. Features of and lessons from the follow-up investigations]. / Antihyperglykaemiás kezelés hatékonyságát megítélo randomizált, kontrollált klinikai tanulmányok obszervációs jellegu utánkövetései. II. Az utánkövetés sajátosságai és diabetológiai tanulságai.

Although the outcomes of the follow-up investigation period of the randomized clinical studies for evaluating the efficacy of a treatment or an antidiabetic drug may be confounded or potentially biased by several factors, the results are widely accepted by the diabetes community. In line with the theory of metabolic memory or metabolic legacy, early and intensive antihyperglycaemic treatment should be provided for all diabetic patients as this strategy can result in beneficial effects even in the long run. The recent cardiovascular safety trials with new, innovative antidiabetic drugs differ in several aspects from the former efficacy studies. Ten cardiovascular safety trials were completed so far enabling to define their unique and common features. It can be anticipated that the era of randomized, controlled efficacy studies with observational follow-up investigations came to an end in diabetes research. Nowadays, cardiovascular safety trials are in the focus of clinical research in diabetology and results of several ongoing studies are expected with interest in the near future. Orv Hetil. 2018; 159(16): 615-619.

[Randomized, controlled clinical trials with observational follow-up investigations for evaluating efficacy of antihyperglycaemic treatment. I. Main results of the studies]. / Antihyperglykaemiás kezelés hatékonyságát megítélo randomizált, kontrollált klinikai tanulmányok obszervációs jellegu utánkövetései. I. A vizsgálatok fontosabb eredményei.

The effect of antihyperglycaemic (antidiabetic) treatment on the late diabetic complications is one of the most important research areas in clinical diabetology. The relationship between glycaemic control and late micro- and macrovascular complications was highlighted by the results of the DCCT (Diabetes Control and Complications Trial) with type 1 and by the UKPDS (United Kingdom Prospective Diabetes Study) with type 2 diabetic patients. In these studies, observational follow-up investigations were also performed after the close-out of the randomized phase of the trial. In addition to these landmark studies, other randomized, controlled efficacy trials were also performed with observational follow-up investigations resulting in the development of the concept of metabolic memory or metabolic legacy. In this article, the main results of the studies are summarized. Orv Hetil. 2018; 159(15): 575-582.

[The role of oxidative stress in the development of diabetic neuropathy]. / Az oxidatív stressz szerepe a diabeteses neuropathia kialakulásában.

Diabetic neuropathy may be one of the most common and severe complications of diabetes mellitus. Oxidative stress plays a pivotal role in the development of microvascular complications of diabetes. The majority of related pathways like polyol and hexosamine, advanced glycation end products, poly-ADP-ribose polymerase, and protein kinase-C all originated from initial oxidative stress. In this review, the authors present the current oxidative stress hypothesis in diabetes mellitus and summarize the pathophysiological mechanisms of diabetic neuropathy associated with increased oxidative stress. The development of modern medicines to treat diabetic neuropathy needs intensive long-term comparative trials in the future. Orv. Hetil., 2016, 157(49), 1939-1946.

[Treatment with inhibitors of new oral direct anticoagulants in patients with severe bleedings or urgent surgical procedures. The new dabigatran antidote: the place of idarucizumab in clinical practice]. / Teendok súlyos vérzés vagy sürgos sebészeti beavatkozás esetén direkt orális antikoaguláns gyógyszerrel kezeltekben. Az új dabigatran-antidótum: idarucizumab helye a klinikai gyakorlatban.

Only vitamin K antagonists could be applied as oral anticoagulants over the past six decades. Coumarols have narrow therapeutic range, and unpredictable anticoagulant effects are resulted by multiple drug interactions. Therefore, regular routine monitoring of the international normalized ratio is necessary. There are two groups of factor-specific anticoagulants: molecules with anti-FIIa (dabigatran) and anti-FXa (rivaroxaban, apixaban and edoxaban) effect. Author summarizes the most important clinical features of the new oral anticoagulants, their indications and the possibilities of laboratory controls. Bleedings are the most important side effects of anticoagulants. This review summarizes the current published evidences for new oral anticoagulants reversal (non-specific and specific) agents, especially in cases with severe acute bleedings or urgent surgery procedures. It reports on how to use inhibitors, the recommended doses and the most important clinical results. The review focuses on idarucizumab - already approved by the U.S. Food and Drug Administration and the European Medicines Agency - which has a key role as the first specific inhibitor of dabigatran.

[Changes in features of diabetes care in Hungary in the period of years 2001-2014. Aims and methods of the database analysis of the National Health Insurance Fund]. / A cukorbeteg-ellátás mutatóinak alakulása Magyarországon 2001-2014 között. Az Országos Egészségbiztosítási Pénztár adatbázis-elemzésének célja és módszertana.

In the last couple of years, database analyses have become increasingly popular among clinical-epidemiological investigations. In Hungary, the National Health Insurance Fund serves as central database of all medical attendances in state departments and purchases of drug prescriptions in pharmacies. Data from in- and outpatient departments as well as those from pharmacies are regularly collected in this database which is public and accessible on request. The aim of this retrospective study was to investigate the database of the National Health Insurance Fund in order to analyze the diabetes-associated morbidity and mortality in the period of years 2001-2014. Moreover, data of therapeutic costs, features of hospitalizations and practice of antidiabetic treatment were examined. The authors report now on the method of the database analysis. It is to be hoped that the upcoming results of this investigation will add some new data to recent knowledge about diabetes care in Hungary. Orv. Hetil., 2016, 157(32), 1259-1265.

[Complications and reoperations following laparoscopic antireflux surgery]. / Szövodmények és reoperációk laparoszkópos antirefluxmutétek után.

Laparoscopic antireflux surgery is an effective treatment for patients with gastro-esophageal reflux disease, when it is refractory to conservative management. In experienced centers the procedure is safe, although complications may develop either during surgery or in the early or late postoperative period, which may necessitate revisional surgery. Between 1998 and 2015 a total of 407 patients underwent laparoscopic antireflux surgery at the Department of Surgery, University of Pécs. This interval was divided into two periods. In the first one, between 1998 and 2006, we operated on 241 patients who were all enrolled in a prospective study. All the diagnostic examinations were carried out at our institution. In the second period 166 patients were treated with minimal invasive surgery and the data were analyzed retrospectively. The 407 patients comprised 161 men and 246 women with a median age of 53,1 years. Hiatoplasty was reinforced with teres ligament in 27 cases, a prosthetic mesh was used in 28 cases and fascia lata in a four cases, when hiatal closures were not considered reliable. In 16 cases (4%) the operation was converted to open procedure, and our mortality rate was 0,5%. Revisional surgery was performed laparoscopically in 39 patients, and thoraco-laparotomy was done in six cases (12%). 5 additional reoperations were performed in patients, who had their primary antireflux surgery in another institution. Our 4% conversion, 12% reoperation and 0,5% mortality rates correspond to the figures published in the literature. In conclusion, this study confirms that laparoscopic antireflux surgery is a safe procedure with very good clinical outcomes. Late complications, such as recurrent reflux disease and reherniation, as well as revisional surgery occured almost exclusively after surgical treatment of the large hiatal hernias.

[Prevention of acute pancreatitis following endoscopic retrograde cholangiopancreatography]. / Az endoszkópos retrográd cholangiopancreatographiát követo heveny hasnyálmirigy-gyulladás megelozése.

Over 14,000 endoscopic retrograde cholangiopancreatographies are performed in Hungary annually, and approximately 1400 patients are calculated to develop pancreatititis including 10 cases with fatal outcome. This article reviews the recent and relevant literature and presents a practical guide based on the authors' own experience for the prevention of pancreatitis following endoscopic retrograde cholangiopancreatography. The authors emphasize the importance of careful consideration of indications, analysis of risk factors, avoiding unnecessary diagnostic intervention, a decrease of the attempts for cannulation, early precut, implantation of pancreatic stent in high risk patients, administration of rectal indomethacin or diclofenac, and adequate intravenous fluid replacement.

[Risk of maternal and fetal disease among women older than 40 years]. / Magzati és anyai betegségek kockázata 40 évesnél idosebb édesanyák esetén.

A rising trend in advanced maternal age has been observed over the last few decades. Several studies have assessed the association between advanced maternal age and adverse pregnancy outcome, including miscarriage, stillbirth, pre-eclampsia, gestational hypertension, gestational diabetes mellitus, preterm birth, delivery of a small- or large-for-gestational-age neonates and elective or emergency Cesarean section. These studies reported contradictory findings. The aim of the present paper is to summarize the evidence-based information regarding advanced maternal age and pregnancy outcomes.

[Are there cardiovascular adverse effects of inhaled anticholinergics?]. / Van-e cardiovascularis mellékhatásuk az inhalációs antikolinerg szereknek?

The purpose of this review is to discuss the cardiovascular risk associated with inhaled anticholinergics in chronic obstructive pulmonary disease. Several meta-analyses of data for tiotropium raised the possibility of an increased risk for arrhythmia, angina, myocardial infarction, etc. This review includes the data of retrospective studies of databases using databases, randomized controlled trials, and meta-analyses of clinical trials. The conclusions of studies were inconsistent. In most clinical trials the incidence of cardiovascular adverse events was similar in active treatment and placebo groups, especially in patients with previous cardiovascular diseases. Considering meta-analyses, there is little, if any, evidence for the association between anticholinergics and the development of cardiovascular symptoms. The author discusses the presence and function of cholinergic receptor subtypes in human heart, and cardiac functions controlled by the autonomic nervous system via these receptors, their possible role, and pharmacokinetic properties of inhaled anticholinergics. The author concludes that it is not possible to find evidence of increased cardiovascular harm of inhaled anticholinergics.

[Primary, single-stage arterial switch operations at a newly-established, comprehensive congenital cardiac center performed in the neonatal age and beyond]. / Újszülöttkorban és késobb végzett primer artériás switchmutétek eredményei egy újonnan létrehozott, átfogó congenitalis szívközpontban.

INTRODUCTION: Outcome of arterial switch operation for transposition of the great arteries with/without ventricular septal defect is a service key-performance-indicator. AIM: The aim of the authors was to assess patient characteristics and parameters in the perioperative course. METHOD: In the setting of a newly-established, comprehensive tertiary-care center, primary complete repair was performed including associated anomalies, e.g. transverse arch repairs. Patients with d-transposition were grouped according to coexistence of ventricular septal defect. RESULTS: 118 arterial switch operations were performed between 2007 and 2014 with 96.62% survival (114/118). Ventricular septal defect and repair of associated anomalies did not yield worse outcome. Left ventricular re-training with late presentation necessitated mechanical circulatory support for 4.5±1.5 days. CONCLUSIONS: D-transposition is suitable for standardization of clinical algorithm and surgical technique. Quality standards contribute to excellent outcomes, minimize complications, and serve as blueprint for other neonatal open-heart procedures. Availability of mechanical circulatory support is key for single-stage left ventricular re-training beyond the neonatal period.

[Types and management of perforations occurring during endoscopic retrograde cholangiopancreatography]. / Az endoszkópos retrográd cholangiopancreatographia során kialakult perforációk típusai és kezelésük.

The authors discuss the incidence of perforation related to endoscopic retrograde cholangio-pancreatography, which is relatively uncommon (0.3-1%) among other types of complications. Perforations can be classified into three types based on their forms and locations. Having reviewed the literature the authors conclude that the most common type is periampullary perforation and the less frequent one is peritoneal perforation. The former usually heals after conservative treatment, while the latter needs an operation. The authors emphasize the important prognostic role of timely diagnosis and surgical treatment if alarming signs (peritoneal, septic) are present. Known predisposing factors, when the procedure needs more careful attention, are also summarized (postoperative status, needle knife papillectomy, intramural contrast media, long lasting examination). After reviewing their own cases, the authors establish that the incidence of perforation in their own centre was four per thousand (10/2400), out of which nine were periampullar and one peritoneal type. In 6 cases operation was necessary, and there was no mortality. The authors conclude that individually tailored therapy can largely reduce the 30-40% mortality rate reported in earlier studies.

[Late complications and treatment options of aortic coarctation operated in childhood]. / Gyermekkorban operált aortacoarctatiók késoi szövodményei és ellátásuk.

INTRODUCTION: The prevalence of congenital aortic coarctation is 4 in 10 000 live birth. Aortic coarctation is typically located in the aortic isthmus, but it may occur at atypical sites. Treatment options include both surgical and endovascular interventions. In patients undergoing surgical or endovascular intervention late complications such as recoarctation or aortic aneurysm may develop. AIM: The aim of the authors was to analyse their own experience in late complication and treatment options of aortic coarctation operated in childhood. METHOD: Retrospective analysis of data of 32 patients treated between 1980 and 2014 for late complications 8-42 years after surgical treatment of aortic coarctation. RESULTS: In 28 patients aneurysm formation after isthmic patch plasty was found. Two patients had aortobronchial fistula, 2 patients showed anastomosis disruption and 2 patients had graft stenosis. During operation hybrid solution was performed in 23 patients, isthmic aorto-aortic inlay graft interposition in 5 patients, aorto-aortic bypass in 2 patients, subclavio-aortic bypass in 2 patients, graft patch plasty in one patient and ilio-renal bypass in one patient. Complications included severe intraoperative bleeding in one patient and pneumothorax in one patient. No early or late mortality occurred. CONCLUSIONS: The authors conclude that life long control is mandatory in order to detect late complications in patients who underwent operation of aortic coarctation in childhood.

[Experience with implanted ports for venous access between 2005 and 2012]. / Vénás portkatéter beültetésével szerzett tapasztalataink 2005-2012 között.

INTRODUCTION: During chemotherapy of cancer patients, vein inflammation may develop which may lead to pain and difficulty in blood sampling. The use of implanted venous access ports may overcome these problems. With a correct use of needles, venous port membrane may be pierced 2000-2500 times. AIM: The aim of the authors was to analyze their experience with venous access ports and evaluate whether insertion of venous ports occurred in an optimal time. METHOD: A retrospective study of 63 patients who received venous access ports between 2005 and 2012 was carried out. Complication rate and the time of venous port insertion were analysed. RESULTS: Of the 63 patients, the venous access port was removed in 22 patients because it was no longer required (n = 14) due to the development of complications (n = 8). 24 patients died from the underlying disease and 17 patients are still alive with the venous port in place. CONCLUSIONS: In the period studied patients with venous access ports had an improved quality of life. However, the authors conclude that venous access ports were not inserted in an optimal time.

[Clinical nutrition therapy in patients with short bowel syndrome in line with principles of personalized medicine]. / Klinikai táplálásterápia rövidbél-szindrómában a személyre szabott orvoslás elvei szerint.

Home parenteral nutrition administered in selected care centres has been financed in Hungary since January, 2013. The authors discuss diagnostic issues, treatment and nutrition therapy of short bowel syndrome patients in line with the principles of personalised medicine. The most severe form of short bowel syndrome occurs in patients having jejunostomy, whose treatment is discussed separately. The authors give a detailed overview of home parenteral feeding, its possible complications, outcomes and adaptation of the remaining bowel. They describe how their own care centre operates where they administer home parenteral nutrition to 12 patients with short bowel syndrome (5 females and 7 males aged 51.25±14.4 years). The body mass index was 19.07±5.08 kg/m2 and 20.87±3.3 kg/m2, skeletal muscle mass was 25.7±6.3 kg and 26.45±5.38 kg, and body fat mass was 14.25±8.55 kg and 11.77±2.71 kg at the start of home parenteral nutrition and presently, respectively. The underlying conditions of short bowel syndrome were tumours in 4 patients, bowel ischaemia in four patients, surgical complications in three patients, Crohn's disease in one patient, and Crohn's disease plus tumour in one patient.

[Changing times - changing diseases. Review of the neuropathological autopsy documentations at the Markusovszky University Teaching Hospital (1964-2014)]. / Változó idok - változó betegségek. A Markusovszky Egyetemi Oktatókórház neuropatológiai autopsziás anyagának áttekintése (1964-2014).

INTRODUCTION: Nearly 6000 autoptic studies were carried out during the last 50 years at the Laboratory of Neuropathology, Markusovszky University Teaching Hospital, Hungary. AIM: The aim of the authors was to present those previously frequent and often fatal conditions that can be prevented or treated today. METHOD: Retrospective analyses of the neuropathological documentations. RESULTS: Measles-related subacute sclerosing panencephalitis caused death in 13 cases, the last occurred in 1991. The mandatory vaccination against the causative virus has eliminated this severe neurological complication. Fourteen lives were lost due to herpes simplex encephalitis, including the last case seen in 1999. Feasibility of early diagnosis and the availability of acyclovir therapy resulted in better outcome without fatality. Tuberculous meningitis still occurred in most recent years, although only sporadically. Recognition of this condition is not straightforward due to its rarity, and considerations for this disease are often omitted from the routine differential diagnosis. The generally low mortality rates in tick borne encephalitis further dropped after the introduction of vaccination. Altogether only 8 such cases were documented. The last fatal cases of neurolues were seen in the 1990s. However, syphilis itself has not disappeared, and the number of cases with newly acquired infection continues to rise. The introduction of intrathecal methotrexate and radiotherapy made possible the prevention or effective treatment of meningeal leukosis. A careful coordination of these treatment modalities, however, is important as nervous system complications may develop in the form of disseminated necrotizing leukoencephalopathy that is also reflected in the records. CONCLUSIONS: The 50-year neuropathology documentation reflects changes in the occurrence of diseases, and it calls attention to those disorders which can be prevented or treated today, but may represent diagnostic challenges.

[Effectiveness and safety of total thyroidectomy in the management of benign multinodular goiters]. / A total thyreoidectomia hatásossága és biztonságossága a jóindulatú multinodularis golyvák kezelésében.

BACKGROUND: The appropriate surgical procedure for benign multinodular goiters is debated. We report our clinical experience of performing total thyroidectomy for multinodular goiters, focusing on the outcome and complications to evaluate the efficacy and safety. MATERIAL AND METHODS: The medical records of 264 patients who underwent total thyroidectomy for multinodular goiter between 2000 and 2006 were reviewed retrospectively. We examined the indications for operation, average hospital stay, early and late postoperative complications, the results of the final pathology in particular the frequency of incidental thyroid cancers and the recurrence rates after an average 6.2 years follow-up. The results were compared to literature data. RESULTS: The indications for surgery were compression and/or dislocation of the trachea in 174 (65.9%) patients, hyperthyreodism in 74 (28%) and cosmetic problems in others. The mean hospital stay was 4 days. Thirty-one patients (11.7%) had transient hypocalcaemia, but only 1 (0.3%) was symptomatic, and only 4 (1.5%) had permanent hypocalcaemia. Other complications included hematoma 4 (1.5%), temporary unilateral recurrent laryngeal nerve palsy 7 (2.6%), permanent unilateral laryngeal nerve palsy 2 (0.75%), and seroma in 8 (3%) cases. Incidental thyroid carcinomas were found on hystology in 9 (3.5%) patients. No recurrence was observed during the follow-up. CONCLUSION: Total thyroidectomy may be the procedure of choice for the surgical management of benign multinodular goiter.

[Complications of esophageal reconstruction]. / A nyelocsopótlás szövodményei.

Esophageal cancer is the most common cause of esophageal resections. Esophageal replacement is still a significant challenge for surgeons, because complications can be expected in over 50% and death also occurs between 4-7%. Complications can be divided into early and late categories and into general and specific complications. From a surgical point of view, early and late specific complications are the most important aspects. Between 1993 and 2012, 540 esophageal resections were performed due to malignant tumors at the Department of Surgery, Medical Center of the University of Pécs. Stomach was used for replacement in 445 cases, colon in 38 cases, and jejunum in 57 cases. The anastomosis with stomach replacement was located to the neck in 275 cases and to the thorax in 170 cases. The colon was pulled up to the neck in each case. There were 29 cases of free jejunal replacements located to the neck, and 28 cases with a Roux-loop reconstruction located to the thorax. In the case of gastric replacement, anastomotic insufficiency developed in 55 cases, graft necrosis occurred in 8 cases, and early anastomosis stricture developed in 30 cases. These numbers are 3 conduit necrosis and 2 strictures in cases of colonic replacements. There was one anastomosis failure in the case of a thoracic jejunum replacement. Also one conduit necrosis was observed in the free jejunal neck transplantation group. Among late special complications, dysphagia is the most important, the causes of which were found in the order of frequency: anastomotic stricture, conduit obstruction, peptic and ischemic stricture, foreign body, local recurrence, functional causes, new malignant tumor in the esophageal remnant after resection and malignant tumor emerging in the replaced organ. Causes may overlap each other, and their treatment may be conservative, endoscopic or surgical. Surgical treatment is usually the last option to restore the ability to swallow and can present a significant challenge even to experienced centers. Orv Hetil. 2023; 164(7): 243-252.

[The association between diabetes complications and symptoms of depression and anxiety]. / A cukorbetegség szövodményeinek összefüggése a depressziós és szorongásos tünetekkel.

INTRODUCTION: The bidirectional relationship between diabetes and depression results in severe disease burden. Co-occurring depression is associated with a higher rate of diabetes complications. These complications impair quality of life, however, their impact on depressive symptoms is controversial. OBJECTIVE: In our cross-sectional study, we aimed to investigate whether the presence of diabetes complications is associated with depressive and anxiety symptoms among patients with type 2 diabetes in general practice. METHOD: We obtained patient history, anthropometric, socioeconomic, laboratory parameters. For symptom assessment, the Beck Depression Inventory (BDI) and the Hamilton Anxiety Scale (HAM-A) were used. We collected data between September 2018 and February 2020. RESULTS: We included 338 consecutive patients with type 2 diabetes. The mean age of the sample was 63.98 ± 11.51 (years ± SD), 61.2% of participants were female. We found significant univariate association between diabetes complications and older age, less physical activity, higher body mass index, insulin therapy, higher HbA1c, higher creatinine and carbamide concentrations, worse depressive and anxiety symptoms. In multivariate analysis, diabetes complications and certain socio-demographic factors (female gender, lower education, rural-dwelling) were the determinants of higher BDI and HAM-A scores. CONCLUSION: Among primary care patients with type 2 diabetes, the prevalence of depressive and anxiety symptoms was higher and more severe in patients with diabetes complications. The recommended screening for affective disorders among patients with diabetes is especially justified if complications are present. Orv Hetil. 2023; 164(3): 79-87.

The effect of preoperative biliary stent on postoperative complications after the resection of pancreatic head tumour / A preoperatív biliáris sztent hatása a posztoperatív szövodményekre hasnyálmirigyfej-daganat miatt végzett reszekciós mutéteink kapcsán

Introduction. A preoperative biliary stent is often inserted because of obstructive jaundice due to pancreatic head tumour. However, it can also be the source of complications too. Aim and method. We retrospectively analyzed our operations which were performed between 01.10.2017 and 31.12.2019 for pancreatic tumour in association with stent related mortality and morbidity. The multiresistant bacteria and the spectrum of microorganism of intraoperative bile samples were investigated. Results. 82 patients were operated on with pancreatic tumour. There were 63 pancreatic head resections, and 19 palliative operations. 63 pancreatic head resections were analyzed. There were 36 open and 27 laparoscopic operations. Extended operation was needed in 12 cases (5 portal vein resections, 2 splenectomies, 1 right hepatolobectomy, 1 right hemicolectomy, 2 liver metastasectomies and 1 hepatic artery resection). The average age of 36 stented patients of which 24 were men and 12 women were 65 and 64 years respectively. The average age of 27 non-stented patients of which 14 were men and 13 were women, were 67.9 and 58 years respectively. The bile culture proved to be positive 30/36(83%) in the stented group and 13/27(48%) in the non-stented group (P = 0.005). The 3 most common bacteria were E coli, Enterococcus fecalis and Klebsiella pneumoniae in both groups followed by the yeast of Candida. 8 multiresistant bacteria were noticed in the stented group. 6 were ESBL producing (P = 0.033) and 2 vancomycine resistant (P = 0.5) bacteria. 3 patients of the stented group and 2 patients of the non-stented group were lost during the first 30 days. There were 4/0 wound infections, 6/2 haemorrhages, 2/2 pancreatic fistulas, and 2/3 abdominal abscesses in the stented vs. non stented groups. The average length of stay was 19.47 days in the stented and 14.62 days in the non-stented groups (P = 0.14). Conclusion. With regard to the fact that biliary stent changes the bacterial flora it is important to choose the proper antibiotic prophylaxis to reduce morbidity. On the basis of our own results and the literature an effective antibiotic therapy is suggested against enterococcus and ESBL producing bacteria. The prophylaxis against yeast in particularly in immunocompromised cases should also be considered. Regular antibiotic resistance check-up is essential.