alpha-Glucosidase inhibition (acarbose) fails to enhance secretion of glucagon-like peptide 1 (7-36 amide) and to delay gastric emptying in Type 2 diabetic patients.

AIM: Acarbose is able to enhance GLP-1 release and delay gastric emptying in normal subjects. The effect of alpha-glucosidase inhibition on GLP-1 has been less evident in Type 2 diabetic patients. The aim of this study was to investigate the possible influence of acarbose on GLP-1 release and gastric emptying in Type 2 diabetic patients after a mixed test meal. PATIENTS AND METHODS: Ten Type 2 diabetic patients were tested with 100 mg acarbose or placebo served with a mixed meal that was labelled with 100 mg 13C-octanoic acid. Plasma concentrations of glucose, insulin, C-peptide, glucagon, GLP-1 and GIP were determined over 6 h. Gastric emptying was measured by determining breath 13CO2 using infrared absorptiometry. Statistics repeated-measures anova. RESULTS: Gastric emptying rates (t1/2: 162 +/- 45 vs. 163 +/- 62 min, P = 0.65) and plasma concentrations (increasing from approximately 12 to approximately 25 pmol/l, P = 0.37) and integrated responses of GLP-1 (P = 0.37) were not changed significantly by acarbose treatment. Postprandial plasma glucose concentrations (P < 0.0001) and their integrated responses were lowered by acarbose (by 64%; P = 0.016). The plasma concentrations of insulin and C-peptide were reduced (P = 0.007 and 0.057, respectively) by acarbose, while glucagon was not changed (P = 0.96). GIP plasma concentrations (increasing with placebo from approximately 10 to approximately 85 pmol/l and with acarbose to approximately 55 pmol/l (P < 0.0001) and their integrated responses were significantly lowered (by 43%) by acarbose (P = 0.021). After 2 weeks of acarbose treatment (50 mg t.i.d. for the first and 100 mg t.i.d. for the second week, n = 6), similar results were found. CONCLUSIONS: In hyperglycaemic Type 2 diabetic patients, ingestion of acarbose with a mixed test meal failed to enhance GLP-1 release and did not influence gastric emptying.

[Papillary carcinoma of the thyroid in intrathoracic goiter]. / Papilarni tireoidni karcinom u intratoraksnoj strumi.

Intrathoracic goiter (more than 80% of tissue in the thoracic cavity) represents very rare clinical entity (less than 1% of total number of thyroid gland surgical procedures). Cancer incidence in these goiter is 0-5%. The aim of this article is to present a case report of intrathoracic thyroid papillary carcinoma with multiple compressive syndrome and review of compressive intrathoracic syndrome of thyroid etiology. In our patient we have found: tracheal and oesophageal deviation and compression, superior vena cava syndrome, downhill varices, chylothorax, pericardial effusion, compress of the left a. subclavia, unilateral lesion of recurrent and phrenic nerve, and brachial plexopathy. This was a unique case with multiple compressive syndrome between 3000 patients surgically treated for all kinds of thyroid diseases. Intrathoracic goiter can cause all the known symptoms and syndromes of intrathoracic compression with possibility of rapid deterioration and fatal end.

[Early complications in surgical treatment of thyroid diseases: analysis of 2100 patients]. / Rane komplikacije operativnog lecenja oboljenja stitaste zlezde: analiza 2100 bolesnika.

Thyroid gland surgery today is not saddled with high incidence of main complications. Miscellaneous surgical institutions with different surgical approach, operative technique and radicality have published reports with great discrepancy in incidence of complications, analyzing them with different methods of diagnosis and result evaluation. In the same way it is well known that higher latitude of operative procedure gave better control of thyroid diseases, but it can be accompanied with more complications. All of that motivate us to analyze complications of operative treatment in our patients under well known criteria, with hypothesis that higher radicality of operative procedure do not increase incidence of complications, and that this incidence is in correlations with results published in world literature. Aim of this nonrandomized study was to analyze results of operative treatment for huge number of consecutively operated patients in our teaching hospital, to analyze and compare results according to group of diseases and operative procedures, and to compare final results with results published in the world literature. Complications of operative treatment were analyzed retrospectively for period 1988-1997 (Group I) and prospectively in period 1998-2002 (Group II). Operations were performed by 20 surgeons and 20 young surgeons during their education. We have analyzed only complications during first 30 days after operation. In Group I there was 1425 patients with 1451 operations (192 thyroid malignancies, 247 hyperthyreosis, 98 reoperations, 13% thyroidectomies and 14.8% lobectomies), with complication rate of 14.3%. Most common complication was recurrent laryngeal nerve injury in 9.3% patients or 6.3% according to number of exposed nerves (nerve at risk), then postoperative hypocalcemia with rate of 4.7% (persistent in 1.3%). In Group II in 675 patients there was 687 operations (96 thyroid malignancies, 111 hyperthyreosis, 35 reoperations, 36.6% thyreoidectomies and 25% lobectomies), with complication rate of 10.7%. Most common postoperative complication was hypocalcemia with 5% rate (persistent in 0.7%), then recurrent laryngeal nerve injury in 4.4% patients or 2.9% according to number of exposed nerves. Incidence of recurrent laryngeal nerve injury in Group II is less frequent than in Group I, highly statistically significant (p < 0.01), while for other complications there is no statistically significant difference. Totally for both groups there was 0.7% tracheotomies, postoperative bleeding in 1.1% of patients, wound hemathoma in 0.5%. wound infections in 0.9%, pneumonia in 0.5%, mortality 0.5% and most common cause of death (8/11) was problem with respiration, Airway obstruction. In Group II complications were less frequent in total thyroidectomies in relation to lobectomy with contra lateral subtotal lobectomy. In both groups and totally incidence of complications was higher in reoperations, in patients with more extensive operative procedure, in malignant diseases and hyperthyreosis. In thyroid gland surgery more extensive operative treatment with improved operative technique (micro dissection, recurrent laryngeal nerve visualization and parathyroid gland preservation), in our teaching hospital, do not have influence on incidence of postoperative complications, even recurrent laryngeal nerve injury was significantly less frequent. This results are in correlation with published results of similar hospitals around the world.

Intrathoracic goiter: analysis of 21 cases.

UNLABELLED: Goiters are classified into: the cervical, retrosternal, substernal and intrathoracic. The aim of research is to analysis of intrathoracic goiters (ITG) which include goiters with more than 80% of tissue in the thoracic cavity and intrathoracic thyroid choristomas. METHODS: In prospective non-randomized study were analyzed 21 consecutive patients operated on for intrathoracic non-toxic benign goiters from 1987-98. Fourteen patients with intrathoracic goiters (more than 80% of tissue in the thoracic cavity) and seven patients with intratoracic choristomas were operated. Two groups of ITG were observed according to the expressed symptomatology and surgical approach and complications of operative treatment were compared to the complications of operative treatment of 986 non-ITG non-toxic benign goiters. RESULTS: ITG represented 1.1% of the whole number of operatively treated thyroid diseases. One third of patients were asymptomatic. Commonly observed symptoms were dispnea, stridor and dysphagia and there was no significant difference in appearance of these symptoms between the two groups of ITG. In 19% of patients correct preoperative diagnosis wasn't assessed. Cervical approach with sternothomy was used in 11 patients, cervical approach with right thoracotomy in seven, right thoracotomy only in two, and cervical approach only in one patient. Thoracic approach was used in 95% of cases and there was no significant difference between the two groups of ITG. Concerning the operative complications, in two patients transient vocal cord paresis and in one patient postoperative bleeding were verified. There was no statistically significant deference in frequency of operative complications between ITG and non-ITG. CONCLUSIONS: ITG are rare, but might present a difficult diagnostic and complex surgical problem. Common clinical presentation and identical surgical approach in operative treatment justify the common review of the two groups of intrathoracic goiters. With adequate and timely performed surgical approach, in specialized institutions, frequency of complications in operative treatment of ITG is not higher if compared to operative treatment of non-ITG.

[Adhesive ileus caused by a peritoneal reaction to starch]. / Adhezivnih ileus izazvan reakcijom peritoneuma na skrob.

Peritoneal reaction caused by glove powder is not so rare in surgical practice. We have presented a case report of a patient who was operated on due to the adhesive bowel obstruction, two years after the total gastrectomy for gastric cancer. Changes found on the peritoneal surface were similar to carcinomatous dissemination, but intraoperative frozen section analysis showed granulomatous lesions caused by foreign bodies. Nature of these changes was confirmed by PAS smear and polarization microscopy. Clarification of the peritoneal changes during relaparotomy is possible only with careful microscopic analysis of these granulomas.

Early angiogenic capabilities of the transposed omental flap after omentomyelopexy.

Abundant in blood and lymph vessels, capable to adhere to the surface of every lesion, with capillary overgrowing in 4-6 hours, omentum represents almost very suitable organ for revascularization of the ishaemic nervous tissue. Angiographic study of the omentum, especially of the surgically developed omental flap have been rarely performed in clinical practice. The aim of this study was evaluate the angiographic features of the omental flaps after omentomyelopexy. Omentomyelopexy based on the left gastroepiploic vessels was performed in 100 patients of different levels spinal cord injuries. In order to study the omental flap's vascularization, selective angiography of the splenic artery was performed in three patients at the 10th postoperative day. In one patient, angiographic finding showed the establishment of anastomosis between omental flap's arteries and vertebral and spinal artery and in that way, almost incredible angiogenic capabilities of omentum have been proved. Besides confirmation of vitality and good vascularization of the extraperitonealy transposed omental flap, an extraordinary angiogenic capabilities of the omentum have been proved as early as at the 10th postoperative day. To our best knowledge the angiographic findings of this kind have not been published so far.

[Surgical treatment of Crohn disease of the small intestine]. / Hirursko lecenje Kronove bolesti tankog creva.

The evolution of the surgical treatment of Crohn's disease has three attainable aims: to be minimal, safe and therefore timely. Conservative surgery is increasingly the trend in surgical treatment of small-bowel Crohn's disease. Patients with Crohn's disease are managed non-surgically until complications of the disease or failure to thrive or significant side effects of medication occur, and then--at this point--surgery usually occurs. Once a complication has developed, it is not recommended to wait for this to become further complicated. Resectional surgery and strictureplasty for Crohn's disease of the small bowel are today methods of choice. Laparoscopic intestinal surgery is going to be of a great significance. Abdominal surgery for Crohn's disease is not curative and forms only part of a lifetime management of the patient.

Comparative analysis of polychlorinated biphenyl decomposition processes in air or argon (+oxygen) thermal plasma.

Thermal plasmas may solve one of the biggest toxic waste disposal problems. The disposal of polychlorinated biphenyls (PCBs) is a long standing problem which will get worse in the coming years, when 180000 tons of PCB-containing wastes are expected to accumulate in Europe (Hot ions break down toxic chemicals, New Scientist, 16 April 1987, p. 24.). The combustion of PCBs in ordinary incinerators (at temperature T approximately 1100 K, as measured near the inner wall of the combustion chamber (European Parliament and Council Directive on Incineration of Waste (COM/99/330), Europe energy, 543, Sept. 17, 1999, 1-23.)) can cause more problems than it solves, because highly toxic dioxins and dibenzofurans are formed if the combustion temperature is too low (T<1400 K). The paper presents a thermodynamic consideration and comparative analysis of PCB decomposition processes in air or argon (+oxygen) thermal plasmas.

[Left-sided gallbladder and hypoplasia of the right hepatic lobe--a rare congenital anomaly]. / Levostrana zucna kesa i hipoplazija desnog lobusa jetre--retka kongenitalna anomalija

Ectopic gallbladder, followed by other abnormalities in the anatomy of liver, biliary-pancreatic system, and portal vein is very rare congenital defect. The patient with left-sided gallbladder, complicated chronic calculous cholecystitis and hypoplasia of the right lobe of liver was presented. The diagnosis of this abnormality was confirmed intraoperatively. After cholecystectomy, postoperative course in the patient was uneventful.

Infected late false aneurysm of the superficial femoral artery. Case-report.

A 24-year-old Croatian soldier sustained a comminuted fracture of the femur and after stabilization with AO external fixation an infected late false aneurysm of the superficial femoral artery developed. The aneurysm was extirpated and the artery reconstructed using the saphenous vein.

[Use of the Hemoccult Test in the detection of colorectal cancer]. / Primena Hemoccult-testa u detekciji kolorektalnog raka.

Hemoccult-test was performed in 3,000 inhabitants of Ruma aged 40-75 years. The response rate was 94%. Hemoccult was positive in 2% of cases. After detailed diagnostic procedures (rectosygmoidoscopy, colonoscopy or double-contrast irrigography) colerectal carcinoma was found in 3 and polyps in 6 subjects. Positive predicted value was 5.3% for colorectal cancer and 10.7% for polyps. Due to the used methodological approach our study failed to answer the question whether early detection of colorectal carcinoma by Hemoccult-test influenced the reduction of mortality rate in this malignoma, but it revealed the motivation of examined population for early detection of the colorectal cancer.