Ante Bilić

Ultrasonically guided percutaneous fine needle aspiration biopsy of the hepatic and pancreatic focal lesions : accuracy of cytology in the diagnosis of malignancy

Ultrasonically guided percutaneous fine-needle aspiration biopsies were carried out on 153 patients with focal liver and pancreatic lesions, and were subsequently evaluated cytologically. A correct diagnosis of malignancy was made in 66 of 74 patients with proven hepatic malignancy, and in 38 of 41 patients with proven pancreatic malignancy, showing an overall accuracy of 92% and 94%, respectively. The specificity of the procedure was 100%. Ultrasonically guided fine-needle aspiration biopsy followed by cytological examination appears indispensable in diagnosis and differentiation between benign and malignant hepatic and pancreatic focal lesions.

How to treat an extensive form of primary intestinal lymphangiectasia

We report a case of a 42-year-old man with a rare disorder known as primary intestinal lymphangiectasia, which is characterized by dilated intestinal lymphatics that lead to the development of protein-losing enteropathy. The patient presented with a grand mal seizure caused by malabsorption-derived electrolytes and a protein disorder. Signs of the disease, including chronic diarrhea and peripheral edema, manifested 10 years ago, but a diagnosis was never made. The diagnosis was suspected because of the clinical manifestations, laboratory tests, imaging and endoscopic findings. Hyperemic and edematous mucosa of the small intestine corresponded to scattered white spots with dilated intestinal lymphatics and whitish villi in the histological specimen of the biopsied jejunal mucosa. Although numerous therapeutic strategies are available, only octreotide therapy proved to be an effective means of therapeutic resolution in this patient. Although the patient had a partial remission following the use of a slow release formula of octreotide, his prognosis, clinical course, and future treatment challenges are yet to be determined.

Predictive role of serum procollagen III peptide and Knodell’s index in survival prognosis of patients with hepatitis B virus liver cirrhosis

SummaryObjectiveThe objective of the study was to improve the accuracy of survival prognosis in patients with liver cirrhosis using procollagen III peptide (PIIIP), as a marker of inflammation and fibrogenesis, and Knodell’s histologic activity index (KI) in addition to previously used prognostic factors.Patients and methodsFive-year survival was followed in a group of 75 patients with hepatitis B virus (HBV) liver cirrhosis (patients testing anti-HBe positive and HBV-DNA negative). There were 31 patients with compensated cirrhosis and 44 with decompensated cirrhosis. The diagnostic procedure included clinical laboratory, ultrasound and pathohistologic examination. We combined PIIIP and KI with other significant variables to achieve the highest possible sensitivity, specificity and accuracy for survival prognosis in HBV liver cirrhosis. The models were compared using ROC analysis.ResultsAt the end of the five-year period of survival follow-up, there were 39 survivors and 36 patients had died (only three died from an extrahepatic cause). In the quantitative model, the discriminant canonical function (DCF) identified PIIP, bilirubin, prothrombin time, ascites and KI as statistically significant parameters in the prognosis of five-year survival. Calculation of the score based on DCF yielded an accuracy of 89.3%. In the semiquantitative model, the analysis of variance identified PIIIP, bilirubin, albumin, pro-thrombin time, alkaline phosphatase, ascites and KI as significant variables. When PIIIP was added to the clinicohistologic diagnosis, Child-Pugh score and KI, the level of accuracy improved by 12% (from 78% to 90%), 11% (from 79% to 90%) and 10.6% (from 80% to 90.6%), respectively. When calculated with the three biochemical parameters (alkaline phosphatase, PIIIP and bilirubin) and KI identified by DCF, the accuracy was 90.6%.ConclusionCombining PIIIP and KI with other prognostic parameters is useful in achieving a better precision of survival prognosis in patients with HBV liver cirrhosis.

Influence of various factors on functional dyspepsia

SummaryAim of the research is to establish the prevalence of dyspepsia in Osječko-baranjska County, to establish its specific characteristics and to determine the effect of demographic, anthropometric, and socioeconomic factors. It is a cross-sectional and case control study conducted in 2010 on systematic sample of 900 subjects between 20 and 69 years of age. Every subject was sent an invitation letter and a Rome III diagnostic questionnaire for one of the disorders. A scoring algorithm was used to confirm or exclude the diagnosis of functional dyspepsia (FD). The chi-square test, t-test and logistic regression were used for analysis.Prevalence of dyspepsia was recorded in 16, 56 %, of subjects. There is no statistically significant difference in prevalence of dyspepsia male and female. The prevalence of dyspepsia increases with age. Correlation with the place of birth was proven. There is no correlation between the current place of residence (rural area and town) and dyspepsia. There is a correlation with marital status. Correlation between stool forms was proven. There were a greater number of subjects that had at least one alarm symptom or some of the psychosocial factors and they often suffered from a chronic disease. The risk for dyspepsia increases with age, body mass index (BMI), and poorer health. Logistic regression showed the following as statistically significant for dyspepsia: place of birth and self-assessment of one’s health. FD presents a significant health problem. Rome III survey questionnaire proved to be an acceptable method for diagnosing this functional disorder in clinical-consilliary and primary health care for persons showing signs of alarm and needing further diagnostic treatment.

Ultrasonic investigation of parametric values of portal vein diameter in healthy subjects and patients with chronic diffuse liver disease.

INTRODUCTION Portal vein in healthy subjects and in patient with chronic diffuse liver disease was investigated by the combination of real-time technique and Doppler impulsive system. PATIENTS AND METHODS Control group consisted of 99 healthy subjects of median age of 36,8, and with life raging span from 14 to 77 yrs. Experimental group consisted of 55 patients with histologically proved liver disease approximately aged 48,1 yrs. And with life span from 11 to 77 yrs. In 15 patients, portal hypertension was proved, by the measurement of Wedged hepatic venous pressure (WXVP). RESULTS VP diameter was normally distributed in healthy subjects, variable with E(X) = 11,202 mm and SD = 1, 2534. The mentioned variable was also normally distributed in experimental group with E(X) = 10, 8 mm and SD = 1, 4832. VP diameter in healthy subjects did not statistically significantly differ from that one of the patient with chronic diffuse liver disease, which in contradictory to the generally accepted concepts. According to our results, portal vein diameter should not be taken as a parameter of portal hypertension.