Pseudomyxoma peritonei--case report.

The syndrome pseudomyxoma peritonei is rare, present in only 2/10,000 laparotomies. We report the case of a 58-year-old woman with a primary tumor of the appendix, and secondary involvement of other structures and organs of the abdominal cavity. In our case, we performed maximal surgical reduction of the tumor, with remaining implants on diaphragmatic domes and liver, as we did not have technical conditions to safely perform prolonged surgery which would have included a surgical procedure on the liver and administration of intraoperative chemotherapy. The patient underwent six series of parenteral chemotherapy, but refused the second-look surgery. Even though our patient did not receive intraperitoneal chemotherapy, maximal surgical tumor reduction, and refused second-look surgery, she is still alive and without any major complaints two years after the surgery.

[Effect of autogenic training on glucose regulation and lipid status in non-insulin dependent diabetics]. / Uticaj autogenog treninga na glikoregulaciju i lipidni status kod insulinneza visnih dijabeticara.

INTRODUCTION: The objective of this study was to examine the benefits of autogenic training in patients with type 2 diabetes and 40 diabetics treated with oral antidiabetic agents were assigned to receive autogenic training. Treatment effects on GHb levels, glycemia, lipids and lipid peroxidases were evaluated after 12 weeks. RESULTS: Subjects demonstrated significant improvements of GHb level (8.94 +/- 2.21% vs. 7.9 +/- 2.395) (p < 0.005). Fasting glucose was significantly lower after treatment (11.6 +/- 6.1 mmol/l vs. 8.32 +/- 4.53 mmol/l) (p < 0.005). The serum level of HDL cholesterol was significantly higher after autogenic training (1.21 +/- 0.11 vs. 1.36 +/- 1.42) (p < 0.005). Cholesterol level was significantly lower after training (6.63 +/- 1.66 mmol/l vs. 6.10 +/- 1.12 mmol/l) (p < 0.05). Lipid peroxidase was significantly lower after treatment (4.05 +/- 0.58 vs. 3.69 +/- 1.26) (p < 0.005). CONCLUSION: Autogenic training in selected patients, especially those who are most responsive to stress would provide benefits for glucosE control and lipid metabolism that are not always achieved by conventional treatment.

[Effect of hyperlipoproteinemia on blood fibrinolytic activity and thrombocyte aggregation]. / Uticaj hiperlipoproteinemije na fibrinoliticku aktivnost krvi i agregaciju trombocita.

BACKGROUND AND AIM: An impaired lipid metabolism and macrovascular disease are often associated with diabetes mellitus. Effects of hyperlipoproteinemia on fibrinolytic blood activity and platelet aggregation were investigated in noninsulin-dependent diabetes mellitus. MATERIAL AND METHODS: The study sample consisted of 50 patients with noninsulin-dependent diabetes mellitus, only on dietetic regime. The following was studied: lipids (total cholesterol, HDL cholesterol and total triglycerides) fibrinolytic blood activity and platelet aggregation in patients with increased levels of cholesterol and triglycerides. We used enzymatic methods for lipids, Buckell's method for fibrinolysis (> 180 min) and Crean's method for platelet aggregation (6-8 s). RESULTS: Statistical analysis of the obtained results shows significant changes in lipids. Triglycerides were significantly higher in diabetics with poor control (p < 0.01). Total cholesterol was significantly higher in patients with coronary disease, hypertension and diabetics with occlusive disease of low extremities (p < 0.01). HDL cholesterol was significantly lower in diabetics with coronary heart disease (p < 0.05). Statistical analysis showed significant changes in blood coagulability. Decreased fibrinolytic blood activity (158.10 + 31.3 min v.s. 169.82 + 21.05 min) (p < 0.05), as well as faster platelet aggregation (6.7 + 0.48 sec v.s. 6.8 + 0.93 sec) (p < 0.1) in patients with hypertriglyceridemia compared with the diabetics with normal triglycerides. Other lipids did not influence significantly the fibrinolysis and platelet aggregation in noninsulin-dependent diabetics. CONCLUSION: All of this indicates the importance of the studied factors in the onset of atherosclerosis with patients with noninsulin-dependent diabetes; the latter is relevant to the importance of planned diabetic regime and moderate physical activity in preventing vascular complications of diabetes.

[Circadian rhythm of blood pressure and daily hormonal variations]. / Cirkadijalni ritam krvnog pritiska i dnevne hormonalne varijacije.

As the mortality rate due to cardiovascular complications has increased, knowing the importance of the diurnal cycle of blood pressure, ambulatory blood pressure was recorded in 50 noninsulin-dependent diabetics aged 45 to 65 years. The diurnal cycle of the serum levels of cortisol, prolactin and growth hormone were determined by RIA (radioimmunoassay) method and urinary catechlamines by radioenzymatic method. The obtained results showed significantly higher blood pressure values during sleeping periods in patients with severe hypertension and consequently significantly lower night/day ratio of cortisol and urinary catecholamines as well as increased prolactin. In diabetic patients with autonomic neuropathy blood pressure values were significantly higher during night, but without changes in regard to hormones. It can be concluded that glucocorticoid hormones and catecholamines might be associated with the control of diurnal cycle of blood pressure in patients with severe hypertension.

[Response of pancreatic polypeptide to a protein test meal in the evaluation of diabetic autonomic neuropathy]. / Odgovor pankreaticnog polipeptida na proteinski test obrok u proceni dijabetesne autonomne neuropatije.

In normal subjects, the early human pancreatic polypeptide increase induced by food is mainly dependent on vagal activity. Parasympathetic function and plasma human pancreatic polypeptide response to a protein rich meal were evaluated in 105 insulin nondependent diabetic patients: 20 only with autonomic neuropathy (group A), diagnosed by clonidin test and tests of cardiovascular reflexes, 35 patients with neurophysiological evidence of polyneuropathy (group B), 30 patients with autonomic neuropathy and polyneuropathy (group C) and 20 patients without any sign of neuropathy (group D). Plasma human pancreatic polypeptide levels were determined by radioimmunoassay using an anti-human pancreatic polypeptide antiserum. Blood was taken at 0, 45 and 60 minutes after the beginning of the meal. In groups A and C, the meal induced human pancreatic polypeptide increase was significantly lower than in group D (45. min:, 65.8 + 16.2(A), 54.0 + 19.2 pg/ml (C) in regard to 130.0 + 27.6 pg/ml (D); 60, min: 55.2 + 15.6 (A), 37.0 + 11.2 pg/ml (C) in regard to 121.7 + 15.4 pg/ml (D). In group B patients had a marked increase of peptide, similar to that in diabetics without neuropathy. These results suggest that diabetic autonomic neuropathy is associated with the dysfunction of human pancreatic polypeptide secretion and that evaluation of his response to test meal may be a sensitive and simple method for the assessment of parasympathetic impairment in diabetics.

[Functional, organic and histologic changes in the stomach in diabetic patients in relation to the presence of diabetic neuropathy]. / Fukcionalne, organske i histoloske promene zeluca u dijabetesnih bolesnika u odnosu na prisustvo dijabetesne neuropatije.

Functional, organic and histological gastric changes were investigated in relation to the presence of autonomic neuropathy in 105 noninsulin-dependent diabetics (20 with autonomic neuropathy, 35 with peripheral neuropathy, 30 with both peripheral and autonomic neuropathy and 20 without neuropathy) and 40 control persons. The diagnosis of autonomic neuropathy was assessed by parasympathetic test of cardiovascular reflexes and peripheral neuropathy by classical neurological examination and EMG (Electromyogram). All subjects were examined by radiologic and endoscopic methods with gastric biopsy specimens for histologic and immunocytochemical analysis. The results of investigation showed that functional abnormalities, hiatus hernia (55%) and pylorospasm (50%) occur more frequently in patients with autonomic neuropathy. Gastritis, duodenal ulcer (5%) and polyps (25%) are significantly more frequent. Atrophic gastritis type A (20%) was more frequent in diabetics with autonomic neuropathy than in other diabetics, as well as other types of gastritis. Immunocytochemical analysis showed the presence of rare, pale ECL (Extensor Caudae Lateralis) cells in corpus and pale, hypogranulated G cells in antrum and hyperplasia and metaplasia of EC (Embryonal carcinoma) cells in antrum of the stomach. Functional, organic and histologic changes in patients with diabetic autonomic neuropathy suggest that the systemic investigation of the Gut is very important in such patients.

[Relation between pyloric dysmotility and serum levels of gastrin, somatostatin and vasoactive intestinal polypeptide in patients with non-insulin dependent diabetes mellitus]. / Odonos pilorusnog dismotiliteta i serumskih vrednosti gastrina, somatostatina i vazoaktivnog intestinalnog polipeptida u bolesnika s insulinnezavinim dijabetes melitusom.

Serum levels of gastrin, somatostatin and vasoactive intestinal polypeptide were evaluated in 105 noninsulin dependent diabetics (25 of them had a pyloric dysfunction). The serum levels were determined by RIA and blood was taken before and after the test meal. The basal gastrin level was significantly higher in patients with the pyloric dysfunction (p < 0.001). 45 minutes later the serum levels of vasoactive intestinal polypeptide and somatostatin were significantly higher in diabetics with the pyloric dysfunction (p < 0.001). The serum levels of gastrin, somatostatin and vasoactive intestinal polypeptide were impaired in diabetics with the pyloric dysfunction and might be associated with its pathogenesis.

[Dynamic scintigraphy of gastric emptying in non-insulin dependent diabetics with autonomic neuropathy]. / Dinamska scintigrafija praznjenja zeluca u insulinnezavisnih osoba s dijabetesom koje imaju autonomnu neuropatiju.

To ascertain whether gastric emptying of solids is affected by visceral autonomic neuropathy, 30 noninsulin-dependent diabetics (10 with autonomic neuropathy, 10 with peripheral and 10 without neuropathy) and 10 control subjects were studied. Subjects were screened by clonidine test and two parasympathetic tests of cardiovascular reflexes to identify the presence of autonomic neuropathy. The peripheral neuropathy was diagnosed by classic neurological examination and EMG. Delayed gastric emptying was assessed by dynamic scintigraphy, using 99mTc labeled ham and eggs. The gastric emptying of solids was markedly delayed in diabetics, particularly in diabetics with poor metabolic control (p < 0.01) and those with autonomic and peripheral diabetic neuropathy (p < 0.05). The results of our study suggest that dynamic scintigraphy may be a more sensitive method than other tests for autonomic dysfunction of the gut in diabetics with the early manifestation of diabetic gastroparesis.

[Laparoscopic cholecystectomy]. / Laparoskopska holecistektomija.

The author presents a new surgical procedure-laparoscopic cholecystectomy. Comparing the time interval from introduction to widespread adaption of other new operations this century, such as vagotomy and open cardiac procedures, it took remarkably little time for the surgical community to accept laparoscopic cholecystectomy. To perform endoscopic surgery, surgeons had to improve eye-hand coordination, adapt to a new tactile sensation and lack of depth perception. The laparoscopic cholecystectomy is "here to stay". The author reports preintervention program as well as the procedure and its technique with necessary instruments. Laparoscopic cholecystectomy is a recently developed alternative to open cholecystectomy that is rapidly gaining popularity because patients have experienced reduced stay in hospital, decreased wound pain and early return to normal activity.

[Chilaiditi syndrome]. / Chilaiditijev sindrom.

The paper deals with a patient who was admitted through the surgical emergency service under the suspicion of subphrenic abscess. From the moment of admittance the patient was carefully followed. Laboratory tests were repeated several times. The following examinations were performed within a very short period of time: a posteroanterior X-ray of the chest and both subphrenic spaces, an ultrasonogram of the upper abdomen, a CT scan of the upper abdomen, roenthgenography of the gastroduodenum with gastrografin, an esophagogastroduodenoscopy and irrigography. Apart from the interposition of the colon between the liver and the diaphragm, no other pathological changes were found. Clinical follow-ups of the lungs and the abdomen were normal. The patient was discharged in a good general condition.