OBJECTIVE The aim of the study was to investigate plasma D-dimer concentration in patients with liver cirrhosis with and without ascites and to evaluate the impact of ascites depletion on circulating plasma D-dimer levels. METHODS Sixty patients with liver cirrhosis were recruited and categorized into two groups: cirrhotic patients without ascites in group 1 (n = 30) and patients with liver cirrhosis and ascites in group 2 (n = 30). D-dimer levels were measured on day of admission, in patients with ascites D-dimer concentration levels were repeated measured after ascites resolution cofirmed by ultrasonography. RESULTS Mean D-dimer levels showed significant increase in cirrhotic patients decompensated by ascites (626.0 +/- 231.08 microg/L) when compared with healthy controls (140.73 +/- 49.16 microg/L, p < 0.001). There was also a statistically significant increase of mean D-dimer levels in patients with liver cirrhosis and no evidence of ascites (333.4 +/- 109.05 microg/L, p < 0.001). In all patients after ascites resolution D-dimer levels showed significant reduction (437.66 +/- 130.47 microg/L, p < 0.05). Values of D-dimer levels achieved after abdominal paracenthesis (n = 21) where still higher than those in patients without ascites (480.14 +/- 122.85 microg/L, p = 0.001). In cirrhotic patients treated with diuretic therapy (n = 9) circulating D-dimer levels were not significantly different from those in cirrhotic patients without ascites (338.56 +/- 90.55 microg/L, p = 0.96). CONCLUSION The presence of ascites in patients with liver cirrhosis is associated with increased plasmatic fibrinolytic activity. Less aggressive ascites resolution therapy has an greater impact on reducing plasmatic fibrinolytic activity than achieved by abdominal paracenthesis.

BACKGROUND Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the digestive tract. The majority of GISTs are located in the stomach. Only 3-5% of GISTs are located in the duodenum associated with an increased risk of gastrointestinal bleeding as primary manifestation. AIM The aim of our study was to present frequencies of GIST in patients who underwent endoscopic procedures at Gastroenterohepatology Department due to different reasons. We also investigated the most frequent localization of GIST tumors and pathohistologicall pattern of tissue samples. PATIENTS AND METHODS Twenty two patients examined at gastroenterology department were analyzed in the period from 2005 until 2012. All of the patients were endoscopically examined ( gastroscopy, colonoscopy, endoscopic ultrasound). A few patients were referred from surgery where GIST was diagnosed during surgical procedure. Macroscopically noticed changes were pathohistologically analyzed by immunohistochemical staining (Alpha-smooth muscle actin (SMA), CD34, CD117, Ki-67 antigen, cytokeratin i desmin). RESULTS No significant difference in gender distribution of patients with GIST-s was found. We also analyzed the appearance of GIST with respect to mean patient age and no statistically significant difference was found either. However, investigation of tumor localization related to gender of patients we found a difference in gender distribution of tumor localization. In female GIST-s are more often located in the stomach than in men, with a significance level of 0.05. Immunohistochemical analysis of biopsy samples showed that CD 117 is statistically significant more frequent in men than in woman. CONCLUSION Taking in account the small sample size in our investigation over a period of seven years, we are not able to give a definitive conclusion about GIST. Further studies and observations are necessary to give a definite conclusion.

OBJECTIVE To determine different haemostatic tests in patients with various degrees of liver parenchymal damage and to rule out their role in assessing parenchymal hepatocyte dysfunction. METHODS Seventy-five patients with chronic liver disease were included and due to their degree of liver damage categorized into three groups: group one patients with chronic viral hepatitis and early stage of fibrosis (n=30), group two patients with compensated cirrhosis (n=17) and group three patients with decompensated liver cirrhosis (n=28). The following haemostatic tests were measured: activated partial thromboplastin time, prothrombin time, plasma fibrinogen, antithrombin III and protein C and plasma D-dimer. RESULTS Antithrombin III levels showed significant reduction in compensated (83.86 +/- 19.49%) and decompensated cirrhosis (52.64 +/- 14.31%; p < 0.001), while protein C activity exhibited significant decrease in all the patients group, including patients with chronic viral hepatitis (90.58 +/- 11.03, 74.65 +/- 19.56, 41.11 +/- 18.35%; p < 0.001) in comparison with controls. Correlation between antithrombin III (Pearson ro = -.931, p < 0.01) and protein C (Pearson ro = -.789, p < 0.01) and clinical degree of chronic liver disease were found. D-dimer levels were significantly increased in decompensated cirrhosis (832.26 +/- 537.19 microg/L; p < 0.001) and no significant difference was found in group two and three when compared with healthy controls. CONCLUSIONS In advanced chronic liver disease anticoagulant activitiy may reflect hepatocellular dysfunction. Protein C activity may be used as a senstive marker of hepatocellular damage even in those patients with mild liver affection whereas D-dimer levels may be considered as an important sign of decompensation in cirrhotic patients. Further studies are necessary to approve whether these parameters could be used as clinical routine markers of hepatocyte function in chronic liver disease.

INTRODUCTION Endoscopic ultrasonography (EUS) is a well-established method of evaluating patients with gastrointestinal diseases, especially malignancies. EUS is like other similar endoscopy techniques, based on high frequency ultrasonography. This high level technology allows examination of tissue to almost microscopic level, not only in digestive system but its surrounding structures. OBJECTIVE The aim of this study was to determine the contribution of endoscopic experience, based on the number of endosopic ultrasonography examination performed in the three years period, to obtain 80% diagnostic accuracy with staging of the disease in order to achieve a 30-60% change rate in treatment decisions which is accepted standard. RESULTS First group with 210 patients was examined in the first year of work; 325 examined in the second year of work and 295 in the third year. DIAGNOSTIC Accuracy in the first year of work, were 45% (p<0.001 for the choledocholithiasis; p=0.197 for the pancreatic cancer; p=0.195 for LN detection in the gastric cancer). In the second year of work diagnostic accuracy were 78%/p=0.550 for the choledocholithiasis; p=0.228 for the pancreatic cancer; p=0.503 for LN detection in the gastric cancer/. Diagnostic accuracy in the third year of work were 81%/p<0.001 for the choledocholithiasis; p=0.018 for the pancreatic carcinoma; p=0.042 LN detection in the gastric cancer/. CONCLUSION Application of Endoscopic ultrasonography in diagnostics, based on number of EUS examination performed, after three years of work, achieved 80% diagnostic accuracy, compared to standard imaging methods and results of surgery in staging of the disease. EUS results made a change in treatment decisions in 30-60% of patients which is world standard and completely justify use of endoscopic ultrasonography in clinical practice.