Background: Deep infiltrating endometriosis (DIE) affects rectosigmoid in up to one third of patients. In these cases bowel resection with end-to-end anastomosis is indicated. Our aim was to determine sensitivity, specificity, positive and negative predictive value and accuracy of rectal endoscopic ultrasound (REUS) for preoperative assessment of bowel in patients with DIE. Methods: In this retrospective study we included 72 patients who underwent surgery for DIE between 2004 and 2010 in University Medical Centre Ljubljana, Slovenia and had REUS preoperatively. REUS findings were compared with intraoperative findings and in case of bowel resection also with patohistological findings. Results: Bowel infiltration was found in 29/72 (40%) of patients during surgery. Bowel resection was performed in 23 patients - in all cases patohistological examination confirmed endometriosis. REUS correctly confirmed or excluded endometriosis in 60/72 (83%) of patients, in one patient (1,4%) it was false positive and in 11 patients (15%) it was false negative. Sensitivity and specificity of REUS were 62% and 98%, respectively. Coefficient Kappa between REUS and surgery was 0,63. Conclusions: REUS should be used during preoperative workup of patients with DIE as it can accurately diagnose bowel lesions in approximately 80% of patients. The positive result of REUS is very reliable (specificity 98%), however, negative result should be interpreted with caution due to limited sensitivity (62%) of the examination. Indeed, REUS is false negative in approximately one third of patients. Therefore, additional preoperative examinations should be performed in case of negative result of REUS when bowel endometriosis is suspected.

Maticic, Mojca MD, PhD; Luznik, Zala MD; Stepec, Srecko MD, MSc; Popovic, Peter MD, PhD; Snedec, Nejc MD; Poljak, Mario MD, PhD; Stanisavljevic, Dragan MD Author Information

Background: The aim of our study was to determine clinical and laboratory features, symptom progression and outcome of the disease in Slovenian patients with primary biliary cirrhosis (PBC).Methods: We reviewed medical records of patients with PBC treated at the Clinical Department of Gastroenterology of the University Medical Centre Ljubljana in the period from 1984 to 2010. The diagnosis of PBC was based on the clinical criteria, which were compliant with recent recommendations of the European Association for the Study of the Liver (EASL). Apart from patients’ demographic characteristics, we examined the outcome of the disease, occurrence of symptoms and signs of cirrhosis, as well as concomitant diseases, such as metabolic bone disease, autoimmune diseases and cancer. For data collection we used methods of descriptive statistics.Results: In the group of 169 patients with PBC we found that 96.5 % of patients were females at an average age of 53 years at the time of diagnosis. While 50 % of the patients were asymptomatic, 6 % of patients had liver cirrhosis at the time of diagnosis. In the majority of patients PBC had a slow progression rate.. By the end of the follow-up period, after 8.03 years on average, , 21 % of patients developed liver cirrhosis. Liver transplantation was performed in 8 % of the patients. At the end of the observation period, 54 % were still asymptomatic. Concomitant autoimmune diseases and osteopenia/osteoporosis were found in 42 % of our PBC patients. Most frequent autoimmune diseases were autoimmune thyroid disease and Sjoegrens’ syndrome.Conclusions: In this first investigation of PBC in Slovenian patients we found that the features and course of PBC differ in some aspects from other patients’ populations in the western countries. The difference in our group of patients was an exceptionally low number of males and the high proportion of asymptomatic patients at the end of the observation period. We speculate that the aetiology of liver diseases in male patients in Slovenia is to frequently assigned to excessive alcohol consumption and that this attitude needs to be changed. The high number of asymptomatic PBC patients at the end of the observation period could be due to the consistent treatment with ursodeoxycholic acid.

In order to identify the main routes of hepatitis C (HCV) transmission and to determine the HCV genotype distribution and its dynamics during a 15-year period in Slovenia, HCV genotypes were detected using the INNO-LiPA HCV II (Innogenetics) test for serum samples obtained from 1,504 patients representing 72.6% of all patients with chronic hepatitis C diagnosed from 1993 to 2007. HCV genotype 1 was predominant (56%), followed by genotypes 3, 2, and 4, with a prevalence of 37.8%, 5%, and 1.2%, respectively. HCV genotypes 5 and 6 were not detected in any patient. Patients infected with HCV genotype 3 were significantly younger (mean age 28.9 +/- 8.5 years) than those infected with genotype 1 (mean age 38.9 +/- 14.8 years; P < 0.0001) and those infected with HCV genotype 2 (mean age 50.3 +/- 18.2 years; P < 0.0001). Intravenous drug use was identified as the most frequent possible HCV transmission route (34.3%), followed by medical-related transmission such as transfusion of HCV-contaminated blood or blood products, and hemodialysis (12.5%). Being an intravenous drug user was found to be strongly associated with HCV genotype 3 (OR, 3.71 [95% CI, 2.97-4-65]; P < 0.0001) and reporting infection by transfusion of blood or blood products was found to be strongly associated with HCV genotype 1 (OR, 3.28 [95% Cl, 2.18-4.95]; P < 0.0001). During the 15-year period, the proportion of genotype 3 increased substantially, reflecting the fact that the HCV epidemic in Slovenia is driven mostly by intravenous drug use. J. Med. Virol. 81:634-639, 2009. (C) 2009 Wiley-Liss, Inc.

Objectives To determine prospectively the sensitivity and specificity of endoscopic ultrasound (EUS) for detecting common bile duct stones (CBS) in patients with acute biliary pancreatitis in whom transabdominal ultrasound was negative for CBS. Methods In 38 consecutive patients with acute biliary pancreatitis who were negative for CBS by transabdominal ultrasound, EUS was performed before endoscopic retrograde cholangiopancreatography (ERCP). The endoscopist performing ERCP was blind to the results of EUS. The primary goal of EUS and ERCP was to confirm or exclude CBS. The reference standard for CBS was endoscopic extraction of bile duct stones after endoscopic sphincterotomy. When both procedures, EUS and ERCP excluded CBS, it was assumed that there were no CBS and endoscopic sphincterotomy was not performed. The results EUS and ERCP were compared with the McNemar test. Results Twenty-five of the 38 patients (66%) had CBS. EUS and ERCP were false negative in one patient each, EUS was false positive in two patients and ERCP in one patient. The sensitivity of both EUS and ERCP was 96%. The specificity of EUS and ERCP was 85 and 92%, respectively. The difference between EUS and ERCP was not significant (P=0.9). Conclusion EUS proved to be as sensitive as ERCP for detection of CBS in patients with acute biliary pancreatitis. Therefore, EUS could be used as the first-line procedure in patients with acute biliary pancreatitis when therapeutic ERCP is not needed. By this approach a substantial number of unnecessary diagnostic ERCP procedures could be avoided.

To the Editor: Oxidative stress, which can be induced by iron overload, may play a pivotal role in the pathogenesis of alcoholic liver disease (ALD) which is characterized by fatty liver, hepatitis, fibrosis, cirrhosis and hepatocellular carcinoma (1). Increasing evidence indicates that ALD is a multifactorial disease in which both environmental and multiple genetic factors play a role. The hemochromatosis (HFE) protein is involved in iron metabolism and the synergistic effect between iron and alcohol is suggested in the progression of alcoholic cirrhosis (2). Therefore, it has been speculated that homoor heterozygous mutations in the HFE gene which increase serum iron levels might contribute to the pathological process. There have been five published reports investigating the relationship between HFE gene mutations and alcoholic cirrhosis in white populations and all of them have failed to detect any association between the C282Y mutation and susceptibility to ALD (3–7). On the other hand, the H63D mutation was investigated in only three studies, with contradictory results (5– 7). A control group of alcoholics without liver disease has not been included in most of the studies cited. The effect of the third common mutation, S65C, on disease susceptibility has not been investigated. The aim of our study was to investigate the contribution of these three HFE genetic polymorphisms to susceptibility for ALD in a sample of Croatian and Slovenian patients. The study included 147 patients with alcoholic cirrhosis and two control groups: 66 alcoholics without cirrhosis and 350 healthy blood donors. The alcoholic groups were well matched for age, sex, origin, and alcohol intake (all consumed more than 80 g of ethanol per day for 5 or more years). There were no significant differences in the sex ratio and age between the patients and controls (p . 0.05). Patients were recruited from the internal clinics of University Medical Centers in Rijeka (Croatia) and Ljubljana (Slovenia). The diagnosis of cirrhosis was based on the clinical, biochemical, and ultrasonographic features. These patients had severe liver disease: all had decompensated, with mean prothrombin time prolongation of 4.5 s on presentation, increasing the risk of liver biopsy. Patients with other causes of cirrhosis and also patients with anemias with ineffective erythropoeisis and hemolysis were excluded by appropriate serologic and biochemical investigations. Alcoholics without cirrhosis had no clinical signs of cirrhosis and had normal plasma levels of bilirubin, albumin, aspartate aminotransferase, and alanine aminotransferase and normal prothrombin time. On ultrasound examination, their liver was normal. They were attending alcoholic support groups in Rijeka and Ljubljana. Healthy control subjects were clinically unaffected individuals (without liver disease or anemia). The study design was approved by the institutional ethics commitees of both centers and informed consent was obtained from all subjects. Genotyping of HFE gene mutations was performed by the polymerase chain reaction/ restriction fragment length polymorphism method as described previously (8, 9). Differences in the frequencies of various alleles between patients with alcoholic cirrhosis and control subjects were performed using the chi-square test and Fisher’s exact test. Table 1 shows the distribution of HFE genotypes and allele frequencies in ALD patients and in both control groups. There were no significant differences in the frequencies of the C282Y and S65C mutations between the ALD patients and control groups. On the other hand, the frequency of H63D heterozygotes was significantly higher (p 1⁄4 0.0019) in ALD patients (31.98%) than in healthy controls (19.14%). The frequency of H63D heterozygotes was also higher in ALD patients (31.98%) than in alcoholics without cirrhosis (22.73%) but failed to reach statistical significance possibly due to the limited number of alcoholics without cirrhosis. There were no

Clinical GeneticsVolume 64, Issue 5 p. 444-446 Hemochromatosis gene mutations in the Croatian and Slovenian populations S. Ristić, S. RistićSearch for more papers by this authorJ. Makuc, J. MakucSearch for more papers by this authorN. Starčević, N. StarčevićSearch for more papers by this authorN. Logar, N. LogarSearch for more papers by this authorB. Brajenović-Milić, B. Brajenović-MilićSearch for more papers by this authorS. Stepec, S. StepecSearch for more papers by this authorI. Pleša, I. PlešaSearch for more papers by this authorM. Kapović, M. KapovićSearch for more papers by this authorS. Milić, S. MilićSearch for more papers by this authorD. Štimac, D. ŠtimacSearch for more papers by this authorM. Crnić-Martinović, M. Crnić-MartinovićSearch for more papers by this authorB. Peterlin, B. PeterlinSearch for more papers by this author S. Ristić, S. RistićSearch for more papers by this authorJ. Makuc, J. MakucSearch for more papers by this authorN. Starčević, N. StarčevićSearch for more papers by this authorN. Logar, N. LogarSearch for more papers by this authorB. Brajenović-Milić, B. Brajenović-MilićSearch for more papers by this authorS. Stepec, S. StepecSearch for more papers by this authorI. Pleša, I. PlešaSearch for more papers by this authorM. Kapović, M. KapovićSearch for more papers by this authorS. Milić, S. MilićSearch for more papers by this authorD. Štimac, D. ŠtimacSearch for more papers by this authorM. Crnić-Martinović, M. Crnić-MartinovićSearch for more papers by this authorB. Peterlin, B. PeterlinSearch for more papers by this author First published: 21 October 2003 https://doi.org/10.1034/j.1399-0004.2003.00169.xCitations: 13Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume64, Issue5November 2003Pages 444-446 RelatedInformation

Background. Eosinophilic gastroenteritis (EGE) is a rare disorder of unknown etiology, characterised by infiltrating eosinophils into one or more layers of gastrointestinal tract and various gastrointestinal manifestations. Signs and symptoms are related to the layer and extent of bowel involved with eosinophilic infiltration bowel with mucosa, muscle, subserosa or all three affected. Steroid therapy remains the corner stone of treatment.Patients and methods. This paper describes a case of 70-yearold male patient with eosinophilic mucosal disease of upper intestinal wall repeatedly admitted because of epigastralgias, nausea, vomiting and losing weight. Because of hypereosinophilia, a biopsy of duodenal mucosa was performed, despite the normal endoscopic appearance. Numerous eosinophilic infiltrates were histologically confirmed in mucosa and submucosa and remission followed metilprednisolon therapy.Results. After two years signs of ilness reapearred, and again metilprednisolon therapy was followed by remission which still last.Conclusions. EGE needs to be recognized by the clinician because it can masquerade as the irritable bowel syndrome. The diagnosis of EGE is confirmed by a characteristic biopsy. Treatment is empiric and gauged to the severity of the clinical manifestations.

U randomiziranom, otvorenom klinickom ispitivanju uspoređivala se djelotvornost dvojnog lijecenja azitromicinom i ranitidin bizmut citratom i trojnog lijecenja azitromicinom, amoksicilinom i ranitidin bizmut citratom u eradikaciji Helicobacter pylori i cijeljenju ulkusa duodenuma ili želuca. Bolesnici s pozitivnim nalazom H. pylori, utvrđenim CLO testom, a kasnije dokazanim u patohistoloskim preparatima i 13C ureja izdisajnim testom, u kojih je endoskopski utvrđen duodenalni ili želucani ulkus, bili su ukljuceni u klinicko ispitivanje nakon potpisanog informiranog pristanka. Prema randomizacijskoj listi bolesnici su bili lijeceni ranitidin bizmut citratom 2x400 mg/7 dana i azitromicinom l g na dan/3 dana (skupina A) ili ranitidin bizmut citratom 2x400 mg/7 dana, azitromicinom l g na dan/3 dana i amoksicilinom 2x500 mg dva puta na dan/7 dana (skupina B). Kontrolna gastroskopija pri kojoj se utvrđivalo zacjeljenje ulkusa i eradikacija H. pylori ucinjena je 4 tjedna nakon zavrsetka lijecenja. Eradikacija H. pylori (negativan nalaz H. pylori CLO testom, 13C ureja izdisajnim testom i u histoloskim preparatima) postignuta je u 56/72 (78%) bolesnika lijecenih azitromicinom i ranitidin bizmut citratom i u 62/72 (86%) lijecenih azitromicinom, amoksicilinom i ranitidin bizmut citratom. Zacjeljenje ulkusa zabilježeno je u 67/72 (92%) bolesnika iz skupine A i u 69/72 (96%) bolesnika iz skupine B. Blage gastrointestinalne nuspojave koje nisu zahtjevale prekid lijecenja zabilježene su u 3 bolesnika iz skupine A i 2 bolesnika iz skupine B. Trojno lijecenje ranitidin bizmut citratom, azitromicinom i amoksicilinom postiže visoki postotak eradikacije H. pylori i izljecenje ulkusa, jednostavno se primjenjuje i dobro se podnosi.

Genotyping of hepatitis C virus (HCV) isolates is of particular interest for epidemiology. Because of extreme genome variability of HCV genome, each genotyping method should be evaluated in local setting before being introducedas a routine diagnostic procedure or a tool for large-scale epidemiological studies. This comparative study of four most widely used HCV genotyping assays, employed on 40 HCV isolates in Slovenia, showed that none of them was realy suitable for genotyping Slovenian HCV isolates. Thanks to its satisfactory sensitivity, specificity and simplicity, the line probe assaywas found to be the most appropriate tool for both routine and large-scale epidemiological studies. Using this assay the prevalence of HCV genotypes in Slovenia was studied on 226 individuals infected with HCV Significant differences in HCV genotype distribution observed between epidemiological groups in Slovenia indicate a close relationship between individual HCV genotypes in Slovenia was studied on 226 individuals infected with HCV. Significant differences in HCV genotype distribution observed between epidemiological groups in Slovenia indicate a close relationship between individual HCV gentoypes and certain routes of viral transmission.