Background: Oral dietary supplementation is becoming increasingly popular as an addition to classical approaches for the prevention and treatment of hemorrhoidal disease. Aim: To examine the effect of orally administrated alpha lipoic acid (ALA), known for its antioxidant and anti-inflammatory properties, in the treatment of patients with permanent symptoms of hemorrhoidal disease. Methods: Patients with second- and third-degree hemorrhoids (n = 100) were enrolled into a randomized, open label, single-center trial. The study group (n = 50) was treated with 200 mg of orally administered ALA once a day during the 12-week period, the control group (n = 50) did not receive any treatment. Results: There were no significant differences in demographics, diagnosis, or exposure to major risk factors between the study and placebo group at baseline. ALA significantly improved subjective efficacy variables, such as pain and discomfort (p < 0.01) as well as objective signs of the disease, such as bleeding (p < 0.01), in comparison to the control group. Furthermore, the 3-month treatment significantly reduced the number of patients with positive C-reactive protein (CRP) value (serum CRP > 5 mg/L) from 18% before to only 2% after the treatment (χ2 = 4.65; p < 0.01). Average leukocyte count has also been significantly reduced in the treatment group (p < 0.01) from 7.29 × 109/L before to 6.18 × 109/L after treatment. Conclusions: The obtained results indicate that ALA is effective in the treatment of second- and third-degree hemorrhoids. Larger, double-blind controlled trials are needed to confirm the results and to investigate optimal treatment regimens.

ABSTRACT The aim: of this study was to compare two methods of polypropylene mesh fixation for inguinal hernia repair according to Lichtenstein using fibrin glue and suture fixation. Material and Methods: The study included 60 patients with unilateral inguinal hernia, divided into two groups of 30 patients – Suture fixation and fibrin glue fixation. All patients were analyzed according to: age, gender, body mass index (BMI), indication for surgery–the type, localization and size of the hernia, preoperative level of pain and the type of surgery. Overall postoperative complications and the patient’s ability to return to regular activities were followed for 3 months. Results and discussion: Statistically significant difference in the duration of surgery, pain intensity and complications (p<0.05) were verified between method A, the group of patients whose inguinal hernia was repaired using polypropylene mesh–fibrin glue and method B, where inguinal hernia was repaired with polypropylene mesh using suture fixation. Given the clinical research, this systematic review of existing results on the comparative effectiveness, will help in making important medical decisions about options for surgical treatment of inguinal hernia. Conclusions: The results of this study may impact decision making process for recommendations of methods of treatment by professional associations, making appropriate decisions on hospital procurement of materials, as well as coverage of health funds and insurance.

Primary rectal adenocarcinoma metastatic to the breast is an exceedingly rare event. Its management differs from that of primary breast cancer, as illustrated by this case. A 63-year-old woman presented with a breast lump 30 months after abdominoperineal resection for rectal adenocarcinoma, stage T₃N₁M₀ (stage III), followed by standard postoperative radiochemotherapy. The patient underwent a mammography and ultrasonography. A CT scan of the abdomen showed metastatic disease. An excisional biopsy of the breast lump was performed; morphological features were identical to the original rectal cancer. Immunohistochemical results were negative for estrogen and progesterone receptors and gross cystic disease fluid protein-15, and intensity positive for cytokeratin 20 and carcinoembryonic antigen. The patient died after treatment with palliative chemotherapy. Metastatic disease from rectal carcinoma to the breast is a marker for disseminated metastatic spread with poor prognosis.

Most attacks of acute pancreatitis are self limiting, and the patients recover completely within days or weeks. In a few cases, however, the course is severe, with development of organ failure (single or multiple) and local complications such as necrosis, abscesses, and pseudocist. Between 01.01.2001-01.06.2004, 286 cases of acute pancreatitis were treated in our clinic. The purpose of this study is to represent indication for operative treatment of acute pancreatitis and its complications, according to the Atlanta classification. According to our date, the most frequent cause are changes on biliary tract. Of these 286 patients, 247 suffered from a mild or moderate type of acute pancreatitis and responded fully to medical treatment (215 patients) or to biliary tract surgery (32 patients). The hospital mortality of this group of patients was 2.4%. Surgery was indicated when the patients developed signs of an acute abdomen (9 patients), pancreatic pseudocyst (7 patients), progressiv icterus (2 patients), infection of pancreatic necrosis (10 patients), and pancreatic abscess (7 patients). Four patients with pancreatic necrosis were stable, and they had conservative treatment. The most difficult decision in the management of these patients is whether surgery is required and which of the complementary approaches to necrosectomy and drainage is appropriate. The hospital mortality of patients with severe acute pancreatitis was 28.2%. Multiple organ failure was the predominant cause of death.

Locally advanced colorectal canter may require an intraoperative decision for the block resection of surrounding organs or structures to achieve complete tumour removal. This decision must weigh the risk of complications and death of multivisceral resection against a potential survival benefit. Little is known about the prognostic factors and their influence on the outcome of multivisceral resection for colorectal cancer. We demonstrate our experience with multivisceral resections for the primary colorectal cancer. Patients undergoing multivisceral resection for primary colon or rectal cancer between I-I.2000-I-VII.2003 were identified from retrospective database. Multivisceral resection was performed in 41 of 378 patients with a median age of 61 years. Postoperative rates of complications and death in 41 patients were 30.9% and 12.1%. Histologic tumour infiltration was shown in 58.3% of patients with curative resection. Multivisceral resection is safe, and long-term survival after curative resection is similar to that after standard resection. As the palliative resections cannot be predicted accurately at the time of surgery, every effort should be made to achieve complete tumour resection.