Vitamin D status, bone metabolism and bone mass in patients with alcoholic liver cirrhosis.

INTRODUCTION: Osteoporosis is seen in some 12-50 % patients with liver cirrhosis. Detrimental effects of alcohol are exerted directly on the bone cells and indirectly on hormones. Vitamin D is involved in osteoblast differentiation, bone matrix synthesis and bone mineralization, as well as in its decomposition. Vitamin D deficiency has been reported in about 2/3 patients with liver cirrhosis. OBJECTIVE: Determination of vitamin D status, bone metabolic activity and bone mass in patients with alcoholic liver cirrhosis (ALC). METHODS: Thirty male patients with ALC were investigated in the period October 2011- March 2012. Total vitamin D, parathormone, osteocalcin and CrossLaps were determined by the ECLIA method (electrochemiluminiscence immunoassay) using Elecsys 2010 analyzer. Bone mineral density was measured by means of dual-energy x-ray absorptiometry (DXA) using the Lunar Prodigy. Result analysis was performed using descriptive statistics and hypothesis testing, as well as nonparametric one-way analysis of variance, Kruskal-Wallis test, Mann-Whitney U-test, Pearson correlation coefficient. RESULTS: Deficiency in vitamin D (< 50 nmol/l) was noted in 66.66 % patients, with highest prevalence in Child-Pugh C class patients (chi-square = 5.878, p < 0.05). Osteocalcin levels were below the lower limit of normal in 86.7 % patients. CrossLaps was increased in only 20 % patients, but a significant increase was noted in Child-Pugh C class patients. Osteoporosis was diagnosed in 20 % of patients, with no correlation with disease severity and vitamin D status. CONCLUSIONS: Vitamin D deficiency is present in patients with ALC. Decrease in bone formation and bone mass is most probably multicausal (Tab. 2, Fig. 1, Ref. 30).

Tissue microarray analysis of cyclin D1 gene amplification and gain in colorectal carcinomas.

Colorectal cancer is one of the most common neoplastic diseases and one of the leading causes of cancer-related deaths. Elevated beta-catenin levels in colorectal cancer result in the binding of beta-catenin to LEF-1 and increased transcriptional activation of the CCND1 gene. Overexpression of cyclin D1 is observed in one third of colorectal tumors. CCND1 amplification is the main cause of protein overexpression in numerous human carcinomas. In colorectal cancer, however, no CCND1 amplification has been reported so far. The aim of this study was to determine the frequency of CCND1 amplifications and gains in a large number of colorectal carcinomas, arranged in a tissue microarray, in order to assess their role in colorectal cancer development. The copy number changes, detected by fluorescence in situ hybridization, were predominantly gains (7.6%) and only rarely amplifications (2.5%). In colorectal cancer, the CCND1 copy number increase was neither associated with the tumor phenotype (stage and grade) nor with the tumor localization (colon, rectum or sigmoid colon). In conclusion, even in a small number of colorectal tumors, CCND1 gene amplification is a possible mechanism for the increase in cyclin D1 oncoprotein.

Altered epidemiological characteristics of ulcer disease.

Dynamics and distribution of ulcer disease in population in the period 1987-1996 were analyzed on the basis of morbidity and mortality rate registered at clinics and institutes in Novi Sad. During the analyzed period 4.111 cases of ulcer disease were hospitalized and 47 with lethal outcome. Duodenal ulcer (2,739) is twice as frequent as gastric ulcer (1,372). Both localisations of ulcer disease are more frequent in males, and specific morbidity shows constant rise towards the older age groups. Duodenal ulcer shows sudden increase in the age group of over 20, and gastric ulcer in the age group of over 60. Gastric ulcer mortality (1.6%) is higher in comparison to duodenal ulcer mortality (0.9%) and it increases constantly towards the older age groups. Unfavourable result is statistically significantly higher in persons over 60. During the monitored period the increasing trend in duodenal ulcer is sharp, while figures in gastric ulcer are without significant changes. Both localisations have become a frequent health problem in population over 40 years of age.

[Aorto-enteric fistula as a rare manifestation of rupture of an abdominal aortic aneurysm--case report]. / Aortoentericna fistula kao jedan od retkih oblika rupture aneurizme abdominalne aorte--prikaz slucaja.

Aortoenteric fistula represents a communication between aortic and duodenal lumen. It is a very rare complication of aortic aneurysmal disease as well as aortic prosthetic surgery. There are only few surgeons who have seen more than one case of aortoenteric fistula. At the Institute of Surgery one case of aortoenteric fistula was treated. It was well diagnosed at the Institute for Internal Medicine, and then presented to the vascular surgeon who operated immediately. The whole diagnostic and therapeutic procedure was well done, but stenosing carcinoma of ascendent colon was found during the operation. Resection were done leading to the dehiscence of bowel anastomosis and fatal outcome for the patient. This case is instructive in a diagnostic and surgical manner.

[Diseases of the upper segment of the gastrointestinal tract and Helicobacter pylori infection]. / Oboljenja gornjih segmenata gastrointestinalnog trakta i infekcija Helicobacterom pylori.

Helicobacter pylori infection is the most frequent infection in humans. It is assumed that over 50% of total world population suffer from this infection. Chronic gastritis is the most usual consequence of this infection. Development of peptic ulcer appears in case of 10 to 20 percent of infected people with the increased risk of malignancy. In the group of 819 examined patients at the Clinic for gastroenterology and hepatology of the Institute for internal diseases, the presence of helicobacter pylori was confirmed in case of 69.18% of patients. The infection was equally observed in both sexes and its frequency was higher with the increase of age, reaching its peak in the sixth decade of life (75.24%). The highest frequency was found in patients with duodenal ulcer (84.85%) and hyperplastic stomach polyp (81.82%) and lowest in case of resected stomach (56.52%). We also establish the dependence of the type and degree of pathohistological changes and the Helicobacter pylori infection.

[Helicobacter pylori in patients with diseases of the upper part of the gastrointestinal tract]. / Helicobacter pylori u bolesnika sa oboljenjima gornjih delova gastrointestinalnog trakta.

Among the patients subjected to esophoagogastroduodenoscopy because of different clinical indications, 108 were examined for the presence of Helicobacter pylori in the antral gastric mucosa. Microbiological analysis of the antral gastric mucosa biopsies were conducted by direct microscopy, the urease test and by growing in nutritious media. Positive findings were recorded in 38 (86.36%) patients with endoscopically diagnosed chronic gastritis, 29 (80.56%) patients with duodenal ulcer and 19 (67.86%) patients with ventricular ulcer. The majority of the positive findings were recorded by direct microscopy--86 (79.63%) while the bacterial culture was positive in 66 (61.11%) cases.

[The postoperative status of the gastroduodenum--clinical and endoscopic analysis of 2 years' of hospital data]. / Postoperativna stanja gastroduodenuma--klinicka i endoskopska analiza dvogodisnjeg hospitalnog materijala.

In 72 patients operated on for gastric ulcer, hospitalized at the Clinic of Gastroenterology and Hepatology in Novi Sad within two years (1989, 1990) we analyzed clinical disorders, biochemical status and endoscopic findings. 75% of the patients were males and 25% females, mean age being 49 years. In 70.83% the two-thirds Billroth II resection was performed, in 15.28% the two thirds Billroth I resection, in 9.72% truncal vagotomy with pyloroplasty, while in 4.17% supraselective vagotomy was carried out. The mean period of time after the operation was 12 years. The majority of patients complained about gastrointestinal disorders, and manifest hemorrhage was detected in 4.17% of the patients. The symptoms of the afferent loop syndrome and early dumping syndrome were verified in one patient from each group. The endoscopic finding was normal in only 2.78%, reflux esophagitis in 6.94%, chronic gastritis with and without erosions in 86.11%, chronic anastomositis in 69.44%, recurrent ulcer in 29.16% out of which hemorrhagic ulcer was found in 4.17%. Malignant neoplasm of the stomach stump was endoscopically evidenced and histologically proved in 2.78%. Multiple associated endoscopic changes were found in 58.33%. The analysis indicates the diversity of postoperative disorders after one of the operations on gastroduodenum, requiring postoperative follow ups of the patients with subjective discomfort, appropriately set diagnosis and individual therapeutical approach to prevent more serious complications.

[Modern trends in the treatment of ulcer disease (clinical study of nizatidine "Galitidine")]. / Savremeni trendovi u lecenju ulkusne bolesti (Klinicko ispitivanje nizatidina "Galitidina").

By an analysis of nizatidine vs ranitidine activity, the authors show a contemporary controlled approach to the treatment of ulcer disease. In a prospective, randomized, double-blind, parallel comparative, multicentric study, the treatment of duodenal ulcer was carried out in 120 patients with H2-receptor blockers, nizatidine and ranitidine. The treatment lasted one or two months with endoscopic control of the results. The recovery of the ulcer nische in patients who received nizatidine, 150 mg twice daily over a month, was achieved in 89.75% of the cases, while in those who at the same time received ranitidine twice daily ulcer was suppressed in 84.61% of the patients; in those who received Nizatidine, 300 mg once daily it was suppressed in 88.24% of the patients. Statistically, x2 = 2.177 with p > 0.3 which shows that there is no statistically significant differences between the groups although the first group shows the best results. Adverse effects of the drugs were not observed.

Distribution of polyamine oxidase activity in rat tissues and subcellular fractions.

The activity of polyamine oxidase (PAO) in rat tissues, and its subcellular distribution, were assayed using a simple polarographic method. The highest PAO activity was measured in the liver and the lowest in the skeletal muscle. In liver, kidney and uterus the highest specific PAO activity was found in the light mitochondrial fraction. PAO was not found in the microsomal fraction except in the kidney.

[Therapy of resistant ascites using the peritoneojugular (Leveen shunt)]. / Terapija rezistentnog ascita peritoneojugularnim (Le Veen) santom.

Since 1984 the peritoneovenous shunt has been installed in 33 patients (10 females - 30.3%; 23 males - 69.7%) of the average age of 54 +/- 8, all in the phase of therapeutically resistant ascites (alcoholic cirrhosis 28 - 84.85%; 4 - 12.12% posthepatitic cirrhosis; and 1 - 3.03% hepatic amyloidosis). The control group consisted of 39 patients (11 females - 28.2% and 28 males - 71.8%) treated in an identical time span with the strict conduction of medicament-diet therapy. The aim of this study was to check the value of this method on our own clinical-patient material, and therefore establish the incidence of complications. By the use of a unique protocol we followed mortality, morbidity, body weight, belly circumference, diuresis, the ultrasonographic finding of the abdominal cavity and the complications which appeared. Out of the group operated on 19 (57%) of the patients died, and so did all the control group patients as well. The average life duration was 275 +/- 810 days in the group operated on, and 44 +/- 29 (p less than 0.005) in the control group. All those alive (14.33-42.42%) lived longer than six months. Six patients lived longer than one year (42.85%), 4 (28.47%) longer than two years, and one (7.14%) longer than three years. There is a statistically significant decrease in body weight, belly circumference, diuresis increase and the consequent ascites withdrawal. DIC occurred in 2 patients, shunt malposition in 2, saccular dilatation in 1, plastic peritonitis in 6, and ileus in 1 patient. Not one of the listed complications resulted by death.(ABSTRACT TRUNCATED AT 250 WORDS)

Pharmacokinetics and quantitative characterization of cefotiam excretion after intravenous administration to patients after cholecystectomy.

Six patients, aged 52 to 71 years, with T-tube drainage of the common bile duct and a urinary catheter after cholecystectomy, were studied in order to evaluate the urinary and biliary excretion and pharmacokinetics of cefotiam in the early postoperative period. Each patient received cefotiam 1 g i.v. as a bolus injection. Cefotiam in plasma, urine, and bile were determined by HPLC. A 2-compartment open model with elimination from the central compartment satisfactorily fitted the plasma levels of the drug. The renal clearance of cefotiam (CLR = 133 ml/min) was an order of magnitude greater than its biliary clearance (CLB = 11.8 ml/min). Glomerular filtration was the main mechanism for elimination of cefotiam. The values of CLR and CLB in relation to the total plasma clearance (CL = 138. ml/min) demonstrated the negligible role of metabolism in elimination of cefotiam in these patients.