Even though pancreatic cancer is not such a common diagnosis, its treatment is very expensive and it has a great economic impact to the health system. 5-year survival rates after excessive surgical treatment is only 5%, which imposes more careful selection of patients that have to be surgically treated. According to experience from some medical centers all over the world, EUS is considered as a high sensitive diagnostic method for establishing a diagnosis of pancreatic cancer and evaluation of TNM staging. The main purpose of this survey is to present our experience in using of EUS as a diagnostic method in establishing a diagnosis of pancreatic cancer, as well as to evaluate how reliable this method is in preoperative evaluation if tumor could be successfully resected. We examined the group of 63 patients with pancreatic cancer, which were surgically explored after EUS examination. We wanted to compare TNM status before and after the surgical treatment. All patients were examined by Olympus equipment for endoscopic ultrasound with radial probe working with the frequency of 7,5 and 12 MHz at the Department for Endoscopic Ultrasound of the Clinic for Gastroenterology and Hepatology, Clinical Center of Serbia. Evaluation of pancreatic tumor extension to local organs (pancreas, duodenum, choledochus, stomach, colon and large veins) was performed for all patients. All regional lymph nodes were also explored. Due to low penetration ability of the probe working with the frequency of 7.5 MHz, EUS is not a suitable method for evaluation of M stage (figure 8,9). Patients were divided in different groups, specified by TNM status. For 10 patients resection was estimated as a probably successful solution, but only 8 of them was surgically treated. According to this, our estimation was 79.7% accurate, which is in accordance to results obtained from other medical centers all over the world.
The most important aim of the work done by the Stability Pact for South Eastern Europe of the European Community is the improvement of research and education capabilities in the universities and institutes involved. Especially the students of Power Electrical Engineering need a more practice oriented education as requested by the local companies. Therefore in the here presented cooperation between the University of Be lgrade, Serbia and the University of Rostock, Germany the measurement, modeling, identification and simulation of exis ting hydro and thermal power plants in Serbia form the main content of students work needed for creating diploma theses accepted at both universities. For this reason, after agreements with the Electric Power Company EPS, the 368-MW-HPP-Bajina Bašta at the river Drina was selected to perform measurements necessary for constructing a dynamic simulation model of the plant as part of diploma theses for two students of the University of Belgrade.
Corticosteroids and the 5-aminosalicylate (5-ASA) drugs still constitute the mainstays of therapy, with azatioprine/mercaptopurine an established second-line agent for resistant disease. Primarily nutritional therapy has a place for some patients with Crohn's disease, and alternative immunosupressants are finding their own disease. The medical management of inflammatory bowel diseases is poised to enter to new era if the current promise shown by investigatory immunomodulatory regimes translates into confirmed effective therapy.
INTRODUCTION:Cavernous haemangioma is the most often found benign liver tumour. Its size usually does not change, although there are cases in which it grows. Large haemangiomas can cause hepatomegaly, pain in the right subcostal area, and spontaneous ruptures. By modern diagnostic procedures they are detected more often and therefore gained more diagnostic importance. Cavernous haemangiomas, especially giant ones, can be treated surgically (enucleation or resection of a part of the liver), by embolization or by other procedures. The aim of the study was to determine the important role of embolization in the treatment of symptomatic haemangiomas with risk of rupture.MATERIAL AND METHODS:Over a period of 5 years, at the Department of Gastroenterology and Hepatology, haemangioma was discovered in 35 of 178 patients with focal liver lesions. Eighteen (51%) patients were males and 17 (49%) females. In 21 (60%) patients, the size of the tumour was 2-4 cm, in 10 (29%) 5-10 cm, and in 4 more than 10 cm. Ultrasonography, computerized tomography, celiacography, scintigraphy with blood pool and ultrasound guided liver biopsy were used to diagnose haemangiomas. Polyvinyl-alcohol (Ivalon) was used for embolization. Through femoral catheter truncus coeliacus was reached, a. hepatica was catheterized, contrast was injected, and then microembolization of peripheral branches was performed. In 10 patients, because of the size of haemangioma, symptoms or localization, and a high risk of bleeding, embolization was performed. Biochumoral parameters were analyzed on the first, the second and the seventh day after the intervention. Within the period of five years, control ultrasound examinations were performed in all patients, and results were compared. In 9 patients control liver scintigraphy with blood pool was carried out.RESULTS:Embolization was performed with polyvinyl-alcohol. During angiography which followed, avascular zones were seen. There was no statistically significant difference between biochumoral parameters before and after embolization. Five years after the embolization, a reduced size of haemangioma was found in 8 patients. The echosonographic appearance of the tumour was changed in almost all patients. All clinical symptoms disappeared. There was no bleeding. In 8 of 9 patients liver scintigraphy with blood pool was performed, and there were no "warm fields."DISCUSSION:Due to modern diagnostic procedures, haemangiomas are now more often detected. However, ultrasonography is not always specific in discovering haemangiomas. Liver scintigraphy does not always reveal the typical shape of these tumours. Every procedure has its advantages and disadvantages. Once haemangioma is detected, it is the question how to treat it. Experience of most hepatologists suggests that interventions should be performed only in case of symptomatic haemangiomas, progressively growing haemangiomas, and in case of the high risk of bleeding. Embolization of the hepatic artery, previously used only as the first part of surgical procedures is now used as the only procedure in the treatment of these tumours. Some authors reported pain and fever after this intervention, which were also noticed in our patients. The reported agranulomatous arteritis with eosinophilic infiltration was not found in our patients. There were no significant changes in biochumoral analysis; this finding confirmed that there was no necrosis around embolized haemangioma. On the basis of the follow-up of our patients we came to the conclusion that embolization of haemangioma, performed by an experienced radiologist, is a very useful procedure in the therapy of symptomatic haemangiomas and haemangiomas with a high risk of bleeding.
The term focal liver changes usually applies to benign and malignant primary and secondary tumours. However, according to echotomographic findings, tumour-like diseases, such as focal nodular hyperplasia and diseases caused by bacteria, fungi, protozoa and parasites may also be included. Improvement in echotomographic technique and use of echohistogram have recently enabled provision of data determining the aetiology, i.e. pathohistological structure of changes with computerized analysis. The study included 178 patients with circumscribed liver lesions: thirty patients had primary carcinoma, 39 had secondary carcinoma, 41 had cystic disease, 35 hemangioma, 10 focal steatosis, 23 had other circumscribed lesions, as well as 175 subjects with healthy liver. The examinations were performed using the real-time ulstrasound apparatus (Toshiba SA 100 A). Echohistograms were obtained by placing certain amount of liver tissue onto X and Y axes, to be processed and graphically presented by the apparatus. X axis showed the number of particles (N) of liver tissue on certain surface, while Y axis showed the average value (M) and maximal value (Max) of particles. Analysis of echohistographic parameters evidenced the following: mean distribution values of M, Max and N differed in different pathological conditions (Tables 1 and 2). Correlation analysis of the studied parameters revealed different values among the studied groups of patients (Table 3, Figure 1). Analysis of echohistograms and their parameters revealed differences between the tissues of the "healthy" and "affected" liver which may be significant in diagnosis of circumscribed liver changes. N/Max:N/M ratio was higher in normal liver when compared to the studied groups of patients (except for N/M subration in focal changes). Our study, as well as the studies performed by aforementioned authors, evidenced close correlation of the appearance of echohistograms and parameter ratio with density, homogenicity and greatly with vascularization of the studied tissue. It has also been evidenced that the interrelations between the echosistographic parameters are in a complexly interwoven, and partly in aetiology, or it is better to say in relations between the healthy tissue and pathological liver changes. However, it must be concluded that the series of the described cases is small to enable establishment of diagnostic criteria exclusively based on echohistograms. Similar analysis of echohistograms in circumscribed liver diseases was not evidenced in the referential literature published so far. We consider the method useful and believe that the future development of computerized ultrasound extensions will enable differentiation of lesions.
Atrial natriuretic paptide (ANP) a potent hormone with important role in sodium homeostasis has been widely investigated in experimental and clinical hepatology during last years. High serum levels are found in decompensated liver cirrhosis, condition characterised with extremely low sodium urinary excretion. This paradoxal finding is poorly understood until nowdays. High tone of sympathetic nerve activity independently increase hormone secretion in cirrhosis. Refractory ascites, rare and discouraging complication of advanced cirrhosis, can be succesfully treated, in carefully selected patients, with repeated intravenous bolus or continous infusions of ANR Serum concentrations of ANP may be used as noninvasive marker of disease activity in compensated and decompensated patients. High levels in still compensated patients predict ascites formation in soon course.