Tissue Reaction and the Formation of Adhesion after the Use of DS Clip in Laparoscopic Appendectomy.

BACKGROUND AND OBJECTIVES: Titanium DS clips are made to secure the appendiceal stump during laparoscopic appendectomy. The assumption is that they behave like stapler clips in the body, being made from titanium. However, the construction and weight of DS clips differs from staplers. Their biocompatibility may have implications for their clinical use. METHODS: One hundred and twenty rats were randomized into four experimental groups: in the first group the appendiceal stump was secured by Vicryl® ligature, in the second by linear staplers, in the third by Hem-o-lok® plastic clips, and in the fourth by DS titanium clips. Ten animals from each group were sacrificed 7, 28, and 60 days post-surgery. Histopathological data and adhesion formation were assessed. RESULTS: On postoperative day 7, a statistically significant difference was found in the occurrence of inflammation between the Hem-o-lok® and stapler groups. The adhesion score was significantly higher in the Vycril® and Hem-o-lok® in comparison to the DS and stapler groups. On postoperative day 28, a statistically significant difference was found in the occurrence of inflammation between the Vycril® and stapler groups. The adhesion score was significantly higher in the Vycril® than in the DS and stapler groups. On postoperative day 60, there were no statistical differences between any of the groups. The adhesion score was significantly higher in the Hem-o-lok® group in comparison to the DS and stapler groups. CONCLUSION: Staplers and DS clips have advantages over other methods of securing the appendiceal stump, because of their high biocompatibility and lower adhesion score.

Biocompatibility of Plastic Clip in Neurocranium - Experimental Study on Dogs.

AIM: A potential advantage of the use of the plastic clips in neurosurgery is their property of causing fewer artifacts than titanium clips as assessed by computed tomography and magnetic resonance scans. The biocompatibility of plastic clips was demonstrated in the peritoneal cavity, but their behavior in the neurocranium is not known. MATERIAL AND METHODS: Twelve aggressive stray dogs designated for euthanasia were taken for this experimental study. The animals were divided into two groups. In all cases, after anesthesia, a craniotomy was performed, and after opening the dura, a proximal part titanium clip was placed on the isolated superficial Sylvian vein (a permanent Yasargil FT 746 T clip at a 90° angle, while a plastic Hem-o-lok clip ML was placed on another part of the vein). The first group of animals was sacrificed on the 7 < sup > th < /sup > postoperative day and the second group on the 60 < sup > th < /sup > postoperative day. Samples of tissue around the clips were taken for a histopathological evaluation. RESULTS: The plastic clip caused a more intensive tissue reaction than the titanium clip on the 7 < sup > th < /sup > postoperative day, but there was no statistical difference. Even on the 60 < sup > th < /sup > postoperative day there was no significant difference in tissue reaction between the titanium and plastic clips. CONCLUSION: These preliminary results confirm the possibility for the use of plastic clips in neurosurgery. Before their use in human neurosurgery, further studies are needed to investigate the long-term effects of the presence of plastic clips in the neurocranium, as well as studies of the aneurysmal model.

Formation of adhesion after intraperitoneal application of TiMesh: experimental study on a rodent model.

BACKGROUND: After laparoscopic repair of an incisive hernia, intraperitoneal prosthetic mesh, as a foreign material, is a strong stimulus for the development of adhesion, which may be the cause of serious complications. This experimental study compared three different meshes and their ability to prevent the formation of adhesion and shrinkage. METHODS: Ninety rats were divided randomly into three groups: in Group 1 Proceed mesh was implanted, in Group 2 Ultrapro mesh was implanted, and in Group 3 TiMesh was implanted. Mesh samples were fixed as an intraabdominal mesh in the upper part of the abdomen. Ten animals from each group were sacrificed on days 7, 28 and 60 post-surgery. After opening the abdomen, the formation of adhesion was assessed according to the Surgical Membrane Study Group (SMSG) score, the percentage of shrinkage of the mesh was established and inflammatory reaction scored. RESULTS: The SMSG score for adhesion was statistically significantly higher on all the postoperative days in the Proceed and Ultrapro mesh groups than in the TiMesh group which caused milder inflammatory reaction on 60th day than others meshes. The size of the mesh after 7 days was statistically significantly smaller in the Proceed and Ultrapro groups than in the TiMesh group, but after 60 days it was statistically significantly larger than in the TiMesh group. CONCLUSION: The least formation of adhesion was noted in the TiMesh group, in which the highest level of shrinkage was noticed after 28 and 60 days. TiMesh has advantages over the other meshes studied, but a larger size mesh may be recommended for intraperitoneal application.

GIANT AGGRESSIVE ANGIOMYXOMA OF THE VULVA: CASE REPORT.

A 57-year-old multiparous housewife was hospitalized at University Clinical Center with painless, ulcerated, huge tumor of the vulva, which had progressively increased in size during the last five years. It was a firm, ulcerated mass involving the left vulva and measuring 35 cm in diameter. The vaginal orifice was deviated to the right by the tumor. The adnexa and the uterus were normal. The patient underwent total excision of the tumor in general anesthesia, and histology confirmed aggressive angiomyxoma. She had an uneventful postoperative period with satisfactory healing of the wound.

Online combination algorithm for non-invasive assessment of chronic hepatitis B related liver fibrosis and cirrhosis in resource-limited settings.

OBJECTIVE: The use of commercially available noninvasive markers for chronic hepatitis B (CHB) related fibrosis is not widely available in developing countries so clinicians in those countries frequently use free alternatives. We aimed to create an optimized algorithm for selection of patients with the highest probability for presence/absence of significant liver fibrosis and cirrhosis based on the use of multiple free scores. METHODS: We evaluated six free noninvasive markers for CHB related fibrosis against liver biopsy and selected the best thresholds for prediction/exclusion of significant fibrosis and cirrhosis in CHB patients. Algorithm based on four scores and their corresponding thresholds was created. RESULTS: The calculator based on developed algorithm can be found at http://www.chb-lfc.com. We evaluated 211 patients in main group and 65 patients in external validation group. We selected four scores for creation of combination algorithm. The algorithm was able to classify 123/211 (58.3%) patients with a 93.5% accuracy of correct classification for prediction of presence/absence of significant fibrosis in main group. In validation group, the algorithm was able to classify 48/65 (73.8%) of patients with 93.8% (45/48) overall accuracy. When used to predict presence/absence of cirrhosis, the algorithm was able to correctly classify 181/211 (85.8%) and 59/65 (90.8%) of patients in main and validation group, respectively, with an overall accuracy of 97.8% and 98.3%, respectively. CONCLUSION: Developed algorithm based on routine laboratory tests is a usable, applicable and accurate tool for diagnosis of CHB related fibrosis and cirrhosis, suitable for resource-limited settings where more expensive modalities are unavailable.

Thyroid cancer in Tuzla region of Bosnia and Herzegovina: a 10-year study (1999-2008).

Bosnia and Herzegovina (B&H) is one of the Eastern European countries with lacking data on thyroid cancer (TC) epidemiology. We aimed to assess the incidence of TC in Tuzla Canton of B&H during a 10-year period (1999-2008). We retrospectively evaluated 65000 hospital records of both inpatients and outpatients with possible thyroid symptoms residing in Tuzla Canton of B&H (total of 496280 inhabitants) between 1999 and 2008. Patients with histological proof of TC were included in study. Incidence rates were calculated with age standardisation using European standard population. Trends in incidence were evaluated as moving three-year averages. During observed period 117 patients met the diagnostic criteria for TC with male to female ratio of 1:4.85. Median age of all cases was 51 years (interquartile range: 41 to 60) with men in average 9 years older than women at the time of diagnosis. The mean annual standardized incidence was found to be 2.30/10(5) (% 95 CI = 1.38-3.22) inhabitants ranging from 1.0 to 3.2 per 10(5). The average crude incidence in men was 0.82/10(5) and 3.83/10(5) in women. The prevalence of TC, at the end of the observed period was found to be 23.58/10(5) (% 95 CI = 19.3-27.58). There is a slight decline of incidence in our region during the observed period, but with the increase in the latest years of the study. This increase is probably the result of combination of various factors, mainly the better detection of new cases due to wider availability of diagnostics. Based on depicted trends, we believe that in the future years, TC incidence in our region will continue to rise.

Morphometric angiogenesis parameters for indolent and aggressive non-Hodgkin's lymphoma.

There is much evidence about importance of angiogenesis in development and progression of solid tumors. The role of angiogenesis, as an indicator of higher malignant potential in non-Hodgkin's lymphoma, is not clear at the moment. Morphometric characteristics of microvessels in lymph node sections, in previously untreated patients with small lymphocytic lymphoma/chronic lymphocytic leukemia (SLL/CLL) and diffuse large B-cell lymphoma (DLBCL), were studied and relationship between angiogenesis and histological malignancy grade of NHL was also evaluated. Lymph node biopsies samples of 30 newly diagnosed patients with SLL/CLL (n=30) and DLBCL (n=30) were studied. All samples were fixed in 10% buffered formalin solution and embedded in paraffin. Microvessels were visualized by immunohistochemical staining for anti F-8 antibody. In the area showing the most intense vascularization (i.e. the "hot spot"), microvessel density (MVD), total vascular area (TVA), as well as the size related parameters were estimated, by using image analysis program "analysSIS'. Number and size-related microvessels angiogenic morphometric parameters were statistically higher in group with DLBCL compared with SLL/CLL: MVD (p = 0.002), TVA (p < 0.0001), area (p < 0.0001), perimeter (p < 0.0001), minor axis length (p < 0.0001) and major axis length (p < 0.0001). It is to be noted that positive correlation existed between TVA and MVD in DLBCL and SLL/CLL. The present study supports the view that angiogenesis correlate with histological grade of NHL.

Interleukin 18 expression in the primary breast cancer tumour tissue.

AIM: To investigate the presence and expression levels of the IL-18 in the primary breast cancer tissue in relation to the unchanged breast tissue in same patients and the breast tissue in patients with benign breast disease, as well as the correlation between the IL-18 expression levels and pathohistological factors, including the correlation between IL-18 expression and the estrogens and progesterone receptor status. METHODS: This prospective randomized study was conducted at the Policlinic for Laboratory Diagnostics of the University Clinical Centre of Tuzla. 50 patients with invasive ductal breast cancer and 20 patients with benign breast diseases were included in the study. The tree-step immunohistochemical staining was used for testing the levels of IL-18 expression and hormone receptor status. RESULTS: IL-18 was present in the breast cancer tumour, in the surrounding unchanged tissue of the same patients and in the breast tissue of patients with benign breast tumour and other benign breast disease. The expression of this interleukin was significantly higher in breast cancer tumour tissue as compared to its expression in surrounding unchanged tissue of the same patients (p < 0.05), whereas IL-18 expression was not significantly higher in breast cancer tumours compared to its expression in breast tissue of the patients with benign breast diseases (p = 0.057). There was no significant correlation between IL-18 expression and the lymph node status, and between IL-18 expression and the pathohistological factors. CONCLUSION: The results suggest possible involvement of IL-18 in complex mechanisms of breast carcinogenesis.

Hepatitis C virus genotypes in chronic hepatitis C patients and in first time blood donors in northeastern Bosnia and Herzegovina.

Prevalence of hepatitis C virus (HCV) genotypes in Bosnia and Herzegovina (B&H) is an issue that is not sufficiently researched and there is a need for studies that would explore this in detail.The aim of this study was to determine the distribution of HCV genotypes in the group of patients with chronic hepatitis C and also in the group of first time blood donors that tested positive for anti HCV antibodies during the blood screening process. Our secondary goal was to compare the proportions of HCV genotypes between these two groups.We analyzed 75 blood samples of patients with confirmed chronic hepatitis C. We also analyzed 13/16082 blood samples of first time blood donors found to be HCV positive during the blood screening process. We also determined HCV genotype in HCV RNA positive samples.We have found that genotype 1b was more prevalent in chronic hepatitis C patients (52/75; 69,3%) than in first time blood donors (6/13; 46,1%), however this difference was not statistically significant (c2=1,721; df=1; p=0,19). Genotype 1a was more prevalent in the group of first time blood donors (3/13; 23,1%) than in the group of chronic hepatitis C patients (3/75; 4%), but this was also with limited statistical significance (c2=3,71; df=1; p=0,054). We have not found any significant difference in prevalence of genotypes 1a (p=0,2) and genotypes 3 (p=0,70) when compared between chronic patients (3/75 and 16/75; respectively) and first time blood donors (3/13 and 4/13; respectively). Our study confirmed domination of genotype 1b in the region of northeastern B&H which is in accordance with HCV genotype prevalence in other countries in our part of Europe.

Risk factors for intrafamilial spread of hepatitis B in northeastern Bosnia and Herzegovina.

BACKGROUND: Accurate estimations of hepatitis B virus transmission risk for any region in Bosnia and Herzegovina are not clearly established. We aimed to determine levels of risk associated with intrafamilial transmission of hepatitis B infection within families in our region. PATIENTS AND METHODS: Family members of 81 chronic carriers of hepatitis B surface antigen (>6 months positive and considered as index case) were tested for hepatitis B markers. For family members, we recorded their age, sex, and family relationship to the index case, and vaccination status. RESULTS: The proportion of HBsAg positive family members was 25/207 (12.1%), while the proportion of family members with evidence of exposure to HBV was 80/207 (38.6%). Only 17/207 (8.2%) family members had evidence of past HBV vaccination. Age was found to be a significant predictor of HBV exposure of family members (odds ratio 1.05, 95% CI 1.03-1.07, P<.001). In a multivariate analysis, HBsAg positivity was associated with a female index case (odds ratio 11.31, 95% CI 3.73-34.32, P<.001), HBeAg positivity in the index case (odds ratio 5.56, 95% CI 1.80-17.23, P<.005) and being a mother of the index case (odds ratio 9.82, 95% CI 2.43-39.68, P<.005). A female index case (odds ratio 4.87, 95% CI 2.21-10.72, P<.001), HBeAg positivity in the index case (odds ratio 3.22, 95% CI 1.15-9.00, P<.05) and being a mother of the index case (odds ratio 3.72, 95% CI 1.19-11.64, P<.05) were also risk factors for HBV exposure among family members. The combination of HBeAg positivity and female index case was a significant predictor for HBsAg positivity of family members (odds ratio 70.39, 95% CI 8.20-604.61, P<.001). CONCLUSIONS: Children of HBeAg positive mothers are at highest risk for becoming chronic carriers themselves and generally, the combination of female sex and HBeAg positivity dramatically increases the chances of HBV transmission within the family.

[Case report of successful treating of refractory form of chronic lymphatic leukemia in Binnet C stage by using anti-CD52 antibodies]. / Uspjesno lijecenje refrakterne forme hronicne limfaticne leukemije u stadiju Binnet C primjenom antiCD52 antitijela.

Chronic lymphatic leukemia (CLL) is the most frequent type of leukemia in western world, and a choice of treatment modality depends on current stage of disease. Clinical condition of patient considered as Binnet C stage, requires treatment. Standard polyhemiotherapy (FC protocol) does not always warrant adequate and satisfactory response. This case report reviews the patient with CLL in Binnet C stage, who did not respond on FC protocol in expected way, meaning, hematological and medullar response was not detected. Twelve weeks therapy of monoclonal antiCD52 antibody (MabCampath) was than applied, resulting in normalization of all parameters of disease activity, which was desired effect of the therapy. Administration of monoclonal antiCD52 antibody is justified in case of resistance on conventional previously applied means of therapy.

Direct immunofluorescence and immunohistochemistry in diagnostics of glomerulonephritis.

The needle biopsies from 60 transplanted and native kidneys have been processed and a prospective analysis of pattern, intensity and distribution of immunoglobulin deposits (IgA, IgG and IgM) and complement components (C3c and C1q) identified in these lesions has been carried out by immunohistochemistry with three step immunoperoxidase, in the period from 2000 to 2004. Those deposits were previously detected and analyzed by immunofluorescence. The samples consisted of 30 renal biopsies, previously diagnosed with glomerulonephritis and positive immunofluorescence and 30 renal biopsies without morphologic changes and deposits on immunofluorescence. 78,7% of the analyzed samples showed the identical results of the deposits of immunoglobulin and components of the complement with both, immunohistochemistry and immunofluorescence method. Sensitivity of the immunohistochemistry method with three step immunoperoxidase for all analyzed immunoglobulin and complement components is high (0,93), while specificity for the same method is 0,79. Standardized method of the three step immunoperoxidase on the paraffin embedded, formalin fixed needle renal biopsies could successfully replace the immunofluorescence method in diagnostic of GN, with the emphasis on a follow up and control of each single step in the procedure of the method.

Association of Hodgkin's lymphoma with Epstein Barr virus infection.

The role of Epstein Barr virus (EBV) in the onset of Hodgkin's lymphoma has been a subject of ongoing research. However, confirmation of EBV oncogenic involvement was not possible due to the small number of neoplastic cells characteristic for this type of tumor. Presence of EBV infection in neoplastic and non-neoplastic cells was analyzed in 81 cases of Hodgkin's lymphoma. In neoplastic cells, using an immunohistochemical method, latent membrane protein 1 (LMP1) was found in 33,3% of cases, while in situ hybridization results demonstrated the presence of EBER RNA in 48,1% of the cases. EBER RNA was found in non-neoplastic lymphocytes in 38,3% of cases. EBV is most frequently associated with Hodgkin's lymphoma in the first and seventh decade of life, specifically the nodular sclerosis subtype. No apparent difference was observed in the association of Hodgkin's lymphoma with EBV between genders, or in relation to clinical stage of the disease and average age of the patient. However, association with childhood age is significantly greater in comparison to adults. EBV associated disease shows a significantly greater prevalence in T lymphocytes. Slightly more abundant are cytotoxic T lymphocytes, which are also more frequently in contact with Reed-Sternberg cells, although there is no difference in number and positioning of histiocytes. Variations between the data on the association of EBV with Hodgkin's lymphoma among studies from different parts of the world suggest that factors of age, gender, ethnic background and social status might present biological modifiers of EBV influence on the pathogenesis of this neoplasm. The differences in non-neoplastic infiltrate EBV+ and EBV- lymphoma indicate the effect of the virus on the immune interaction of tumor and host in this disease.

Cystatin C as a potential marker for relapse in patients with non-Hodgkin B-cell lymphoma.

The concentration of cysteine protease inhibitor cystatin C was determined in sera from 59 patients with non-Hodgkin B-cell lymphoma using ELISA. The sera from 43 age and sex matched healthy blood donors served as controls. Cystatin C was significantly increased in sera of patients without therapy (mean 1136+/-SE 105.7ng/ml, p=0.00001) and with therapy (mean 1073+/-52ng/ml, p=0.001) compared to controls (mean 819+/-28ng/ml). The highest levels were determined in sera of patients with a relapse (mean 1680+/-196ng/ml). By using immunofluorescence staining and confocal microscopy we determined immature dendritic cells as a major population of cystatin C positive cells in affected lymph nodes. Our study reports for the first time that cystatin C is a potential marker for relapse in patients with non-Hodgkin B-cell lymphoma.

Hepatitis C infection in risk groups.

Hepatitis C infection is important global health problem with wide spectrum of health, social and economic consequences. The goal of this research was to estimate prevalence of hepatitis C virus infection in risk groups, and to determine association hepatitis C virus (HCV) infection and risk factors. Research included 4627 subjects divided in two groups. Test group included 2627 subjects divided in 4 subgroups with risk for HCV infection: those who received blood transfusion without screening on HCV (it was introduced in 1995) (700); intravenous drug users (60); patients on hemodialysis (168) and health care workers (1699). Control group included 2000 healthy volunteer blood donors. In all subjects anti-HCV antibodies were tested with third generation ELISA test. Positive serum samples were tested for presence of HCVRNA, using reaction of reverse transcription and polymerase chain reaction. In all anti-HCV positive subjects further epidemiological and clinical workup was performed. Prevalence of HCV infection in risk groups was: 4.6% in subjects who have received blood transfusions without HCV blood screening, 35% in intravenous drug users, 58.9% in patients on chronic dialysis, and 0.4% in health care workers. In control group prevalence was low (0.2%). In the group of 158 anti-HCV positive subjects, 73.4% had HCVRNA. The largest number of subjects with HCV infection was in the age group of 30-49 years (45.8%). This study showed that multiple blood transfusions before introducing the blood screening for HCV, longer duration of intravenous drug abuse, longer duration of hemodialysis treatment, larger number of accidental injuries in health care workers are independent and statistically significant risk factors for those groups examined. Results of this study confirm that general screening for HCV infection is recommended in risk groups for HCV infection in order to identify to prevent and to treat it.

[Association between chronic gastritis in childhood, Helicobacter pylori and ABO blood groups]. / Povezanost hronicnog gastritisa u djetinjstvu sa Helicobacter pylori i ABO krvnim grupama.

Gastritis can be defined in the simplest way such as inflammation of gastric mucous membrane. There are numerous causes of gastritis and the most often is Helicobacter pylori infection. Studying of the blood groups also includes the question of their connection with certain diseases. Up to date it has been explained the role that blood groups have in haemolytic disease of newborn infant but for other diseases we know little, it is insufficient or we know nothing. The aim of this work was to analyze connection of chronic gastritis in childhood, Helicobacter pylori and ABO blood groups. It has been treated 68 patients out of which 57 (83%) were Helicobacter pylori positive (Hp+) and 11 (17%) were Helicobacter pylori negative (Hp-). Thirty patients had chronic gastritis out of which 22 (73%) were Hp+ and 8 (27%) Hp-. It prevailed blood group A and O, comparing with other blood group phenotypes connected with gastritis.