Sarcina ventriculi is an increasingly common bacterium with a variable pathogenic role. It is often an incidental finding in asymptomatic patients but can also lead to life-threatening conditions, such as gastric perforation and emphysematous gastritis. We report a case of a 14-year-old boy with fatal emphysematous gastritis caused by S. ventriculi, who presented with abdominal pain and vomiting. His medical history included infantile left hemiparesis and operation of patent ductus arteriosus. Emergency surgery was scheduled due to the extremely dilated stomach and gastric pneumatosis, and a total gastrectomy was performed. On the third postoperative day, he suddenly dies, and the diagnosis was confirmed postmortem. This case is an opportunity to review the clinical presentation of emphysematous gastritis and to point out the role of the histopathological examination for the identification of the bacteria.

Colorectal cancer is the third most common malignant tumour in males and the fourth most common malignancy in women in the Republic of Croatia. It is usually manifested as stool forming disorders, feeling that bowel does not empty completely, finding blood in the stool, weight loss and fatigue. In-time diagnosis, confirmed by pathohistological findings, is cornerstone of successful treatment. The decision about treatment is made based on clinical assessment of disease stage and other risk factors, after completion of the diagnostic process. Depending on that, treatment options include surgery, the application of systemic therapy (chemotherapy, immunotherapy) and radiotherapy. The following text presents the clinical guidelines in order to standardize procedures and criteria for the diagnosis, management, treatment and monitoring of patients with colorectal cancer in the Republic of Croatia.

Sažetak.Cilj: Prikazati patohistološko dijagnostičko iskustvo Kliničkog bolničkog centra (KBC) Rijeka u pacijenata s gastrointestinalnim stromalnim tumorom (GIST) dijagnosticiranim u razdoblju od 10 godina te pružiti pregled temeljnih karakteristika ovog mezenhimalnog tumora.Cilj je bio i prikazati osjetljivost DOG1 markera (engl.Discovered on GIST) te ga usporediti s osjetljivošću CD117 i vimentina.Materijali i metode: Iz baze podataka Zavoda za patologiju od 2005.do 2015.godine prikupljeni su podaci o 89 pacijenata s dijagnozom GIST-a.Podaci koje smo statistički analizirali obuhvaćali su dob, spol, lokalizaciju tumora, vrstu stanica (vretenaste ili epiteloidne), imunohistokemijske karakteristike te veličinu i mitotički indeks

Olfactory rehabilitation after a laryngectomy is based on establishing nasal airflow to allow odorant molecules to come into contact with the olfactory mucosa. Currently, the polite yawning technique (PYT) is the gold standard for post-laryngectomy olfactory rehabilitation, but it is usually introduced in patient’s rehabilitation programs one month after the surgery. To prevent loss of valuable time and pathophysiological changes of the nasal and olfactory mucosa, a new device was developed, named the LaryScent. The timely establishment of nasal air flow with LaryScent would prevent histopathological changes and facilitate regenerative processes in olfactory mucosa.

medicina fluminensis 2016, Vol. 52, No. 1, p. 43-48 43 Abstract. Olfactory rehabilitation after a laryngectomy is based on establishing nasal airflow to allow odorant molecules to come into contact with the olfactory mucosa. Currently, the polite yawning technique (PYT) is the gold standard for post-laryngectomy olfactory rehabilitation, but it is usually introduced in patient’s rehabilitation programs one month after the surgery. To prevent loss of valuable time and pathophysiological changes of the nasal and olfactory mucosa, a new device was developed, named the LaryScent. The timely establishment of nasal air flow with LaryScent would prevent histopathological changes and facilitate regenerative processes in olfactory mucosa.

Background: Angiogenesis plays a pivotal role in malignant tumor progression. The count of blood microvessels of the tumor has been recognized as an indicator of malignant potential of the tumors and provides the ability to predict tumors recurrence. The role endoglin in the Dukes B rectal cancer is still unexplored. The aims of this study were to examine immunohistochemical expression of endoglin in resected rectal cancer and investigate the relationship of tumor recurrence and other clinicopathological variables to the endoglin-assessed microvessel density of the tumor tissue and distal resection margins.Methods: The study included 95 primary rectal adenocarcinomas, corresponding to 95 distal and 95 proximal resection margin specimens from surgical resection samples. Tumor specimens were paraffin embedded, and immunohistochemical staining for the CD105 endothelial antigen was performed to count CD105-MVD. For exact measurement of the CD105-MVD used, a computer-integrated system Alphelys Spot Browser 2 was used. Results: The MVD was significantly higher in the tumor samples compared with the distal resection margins (p < 0.0001) and the proximal resection margins (p < 0.0001). There was no significant difference in the MVD between distal and proximal resection margins (p = 0.147). The type of surgical resection was a significant factor for determining the recurrence of tumors (p = 0.0104). There was no significant effect of patients' age, gender, tumor location, grade of differentiation, histological tumor type, and the size and depth of tumor invasion on the recurrence of the tumor. The recurrence rate was significantly higher in the low CD105-MVD group of patients than in the high CD105-MVD group of patients (log rank test, p = 0.0406). Result of the multivariate analysis showed that the type of surgery (p = 0.0086), MVD tumors (p = 0.0385), and MVD of proximal resection margin (p = 0.0218) were the independent prognostic factors for the recurrent tumors.Conclusions: CD105-assessed MVD could help to identify patients with more aggressive disease and increased risk of developing tumor recurrence after surgical treatment in stage II rectal cancer (RC).

Aims: To investigate the expression of metallothioneins (MTs) and free zinc content in gallbladderassociated with cholecystolithiasis. Study Design: Gallbladder tissue samples were obtained from patients, subjected to laparoscopic cholecystectomy, owing to the cholecystolithiasis, verified by hematological examination and by ultrasonography. Operations were performed in clinical stable phase of gallstone disease. Place and Duration of Study: Department of Surgery, Clinical Hospital Center, Departments of Physiology and Immunology and Department of Pathology, Medical Faculty, University of Rijeka, between June 2011 and June 2012. Methodology: In 25 collected gallbladders the degree of inflammation was classified as subacute (SA) or chronic cholecystitis (CC), according to the standard pathohistological analysis and intensity of NF-B expression. The tissue expression of MT-I/II isoforms and free zinc content werevisualized by immunohistochemistry, using the monoclonal anti-MT I+II antibodies and zinc fluorophore-Zinquin. The cell-based staining quantification was performed by Cell F v3.1 software. Results: The data have shown that in 20 patients out of 25 patients the gallstones induced the CC with upregulation of NF-B in gallbladder epithelium, as well as that high inflammation was followed by overexpression MTs and accumulation of Zn. in 15 and 12 out of 20 patients, respectively. Furthermore, histomorphometric analysis revealed that the average grey values for MT I/II in CC arose from 49.8 +/- 3.3 (in SC) to 195.4 +/- 15.5 (in epithelial cells) and from 62.3 +/- 21.0 to 194.8 +/- 20.1 (in stromal cells) (P<0.01). Similarly, average values for zinc ions increased from 25.6+/-7.4 (in SC) to 118.8 +/- 5.7 (in epithelial cells). Besides, in areas of high inflammation several CD3+cells were found in contact with MT+ epithelial, endothelial and monocyte-like cells. Conclusion: The data point to high local activation of MT/zinc network in chronic cholecystitis associated by gallstones, emphasizing its regulatory functions in inflammatory environment.

Background. The role of endoglin in the Dukes B rectal cancer is still unexplored. The aim of this study was to examine the expression of endoglin (CD105) in resected rectal cancer and to evaluate the relationship between microvessels density (MVD), clinicopathological factors, and survival rates. Methods. The study included 95 primary rectal adenocarcinomas, corresponding to 67 adjacent and 73 distant normal mucosa specimens from surgical resection samples. Tumor specimens were paraffin-embedded and immunohistochemical staining for the CD105 endothelial antigen was performed to count CD105-MVD. For exact measurement of the CD105-MVD used a computer-integrated system Alphelys Spot Browser 2 was used. Results. The intratumoral CD105-MVD was significantly higher compared with corresponding adjacent mucosa (P < 0.0001) and distant mucosa specimens (P < 0.0001). There was no significant difference in the CD105-MVD according to patients age, gender, tumor location, grade of differentiation, histological type, depth of tumor invasion, and tumor size. The overall survival rate was significantly higher in the low CD105-MVD group of patients than in the high CD105-MVD group of patients (log-rank test, P = 0.0406). Conclusion. CD105-assessed MVD could help to identify patients with possibility of poor survival in the group of stage II RC.

Pregled bolesti gusterace za studente (akutni i kronicni pankreatitis, secerna bolest, novotvorine).

The aim of this study was to investigate the presence of microaggregates of macrophages (CD-68 positive cells) in macroscopically normal buccal mucosa in patients with inflammatory bowel disease (IBD). Fifty two patients with clinically and pathohistologically diagnosed IBD, thirty patients with Crohn's disease (CD), twenty two patients with ulcerative colitis (UC), and twenty five controls, matched for sex and age, were involved. The occurrence of CD-68 positive cells microaggregates was more frequent in CD patients comparing with UC patients (P = 0.0093), and the controls (P = 0.0001) respectively. There was no statistically significant difference in occurrence of CD-68 positive microaggregates in patients with positive microbiological findings (P = 0.8258). The results suggest that microaggregates of macrophages are more frequently present in apparently normal buccal mucosa in patients with CD than in patients with UC independently of microbiological findings. Therefore, it could be a potential marker for differentiating patients with Crohn's disease from UC patients, when standard tools failed. (doi: 10.5562/cca1779)

BACKGROUND/AIMS:Gastrointestinal stromal tumors (GISTs) have fairly recently been identified as a new type of tumor, thanks to advances in immunohistochemistry. Aim of our work was to investigate and describe GISTs in our hospital in a 10-year period.METHODOLOGY:Records of patients treated for GIST were analyzed and data describing demographics, comorbidities, primary tumor site, initial symptoms, immunohistochemical characteristics, method of detection and grade of malignancy were shown for each patient.RESULTS:A total of 31 patients were analyzed. There was 54.8% of women and 46.7% of men with GIST. The mean age was 61.9±12.8 years. Predominant symptoms and signs were abdominal pain and anemia, bloody stool or melena, even though a significant portion of patients did not have any, or only mild symptoms. Stomach was the most frequent location of the tumor. CD117 was positive in all but two biopsy specimens.CONCLUSIONS:We observed approximately the same incidence of GISTs as in other published data. However, we reported less asymptomatic cases at the time of diagnosis. Also, we reported more women diagnosed with GIST in our population. Even though many tumors were diagnosed by other methods, immunohistochemistry remains the definitive diagnostic method.

Background and purpose: The incidence of gastric cancer decreases but despite declining, it still remains the second cause of death of all malignancies worldwide. Morphometric methods are independent prognostic variables in various cancers and there have been encouraging results in using it for estimating the prognosis of gastric cancer. Aim of this study was to evaluate the influence of nuclear area (morphometric method), on the survival of patients with intestinal type of gastric cancer. Materialsandmethods: Seventy-four patients who had undergone gastric resections for adenocarcinoma of the stomach in the University Hospital Center, Rijeka, Croatia, were analyzed in this study. None had received pre-operative radiotherapy or chemotherapy. Age, gender, tumor size, tumor depth into the stomach wall (T-category) presence or absence of metastases to regional lymph nodes (N-category) or distant organs (M-category) and nuclear area of tumor cells were estimated. All patients were followed up for at least 36 months or to death. Results: Univariate analysis showed that gender (P = 0.009), nuclear area (P = 0.017), TNM (P = 0.001) and size of the tumor (P = 0.024) have influence on the survival. Patients age at the time of diagnosis showed no influence on the survival in univariate analysis (P = 0.089). In multivariate analysis only TNM (P = 0.048) and size of the tumor (P = 0.020) are independent prognostic factors for planning further therapy. Conclusions: According to our results, reliable prognostic factors in patients with intestinal type of gastric cancer are still TNM and size of the tumor; nuclear area showed no influence on the outcome of the disease.

Treatment in Hirschsprung's disease allied disorder (HAD) is surgical. In HAD, surgery is always a question. We investigated the value of ganglia/nerve fibers ratio in prediction of the need for invasive procedures in HAD. Sections of full thickness bowel specimens of 14 patients were stained with antibodies marking ganglia (Anti-Neuron-Specific Enolase, Anti-NSE) and marking nerve fibers (S-100). Six out of seven patients indicated for surgery had low ganglia/nerve fibers ratio. Five out of seven patients, not showing the need for surgery, had high ganglia/nerve fibers ratio. We propose that a lower ganglia/nerve fiber ratio can be used as a predictor of increased need for surgery in HAD.

Incidence of obesity and hepatic steatosis is increasing worldwide. Almost one quarter of western countries population suffer from non alcoholic fatty liver disease (NAFLD). The aim of this study was to investigate the frequency and predictors of nonalcoholic steatohepatitis (NASH) in patients with unexplained alanine aminotransferase activity elevation (ALT), and therefore avoid unnecessary biopsies in cases of simple steatosis. Earlier studies provided different results and have not answered the question how to distinguish NASH from simple steatosis. Ultrasound (US), computed tomography (CT) and magnetic resonance (MRI) can detect steatosis with great sensitivity level, but not NASH. This study included 50 patients (18 women and 32 men) with mean age 43 +/- 9 years, and with defined selected biochemical, anthropometric and hormone biomarkers. The average BMI was 27.1 +/- 3.81 (kg/m2), insulin resistance HOMA IR 3.89 +/-3.81. All patients underwent liver biopsy and NASH was staged by NASH activity score (NAS) from 1 to 8. Results are compared to pathohistological finding as relevant method. The results show that 90% of patients (n=45) had NAFLD (minimal stage at least), and 15 (30%) had nonalcoholic steatohepatitis (NASH). High triglyceride, low HDL and high ferritin serum levels correspond with NASH. As in earlier studies, insulin resistance as basic mechanism of NAFLD and NASH was confirmed.