Incidence of obesity and hepatic steatosis is increasing worldwide. Almost one quarter of western countries population suffer from non alcoholic fatty liver disease (NAFLD). The aim of this study was to investigate the frequency and predictors of nonalcoholic steatohepatitis (NASH) in patients with unexplained alanine aminotransferase activity elevation (ALT), and therefore avoid unnecessary biopsies in cases of simple steatosis. Earlier studies provided different results and have not answered the question how to distinguish NASH from simple steatosis. Ultrasound (US), computed tomography (CT) and magnetic resonance (MRI) can detect steatosis with great sensitivity level, but not NASH. This study included 50 patients (18 women and 32 men) with mean age 43 +/- 9 years, and with defined selected biochemical, anthropometric and hormone biomarkers. The average BMI was 27.1 +/- 3.81 (kg/m2), insulin resistance HOMA IR 3.89 +/-3.81. All patients underwent liver biopsy and NASH was staged by NASH activity score (NAS) from 1 to 8. Results are compared to pathohistological finding as relevant method. The results show that 90% of patients (n=45) had NAFLD (minimal stage at least), and 15 (30%) had nonalcoholic steatohepatitis (NASH). High triglyceride, low HDL and high ferritin serum levels correspond with NASH. As in earlier studies, insulin resistance as basic mechanism of NAFLD and NASH was confirmed.

Among other symptoms, multiple sclerosis can also produce symptoms of affective and cognitive disorders. The majority of patients have certain cognitive dysfunctions, and the' most common affective disorder is reactive depression. The aim of the study was to determine the correlation of the Mini-Mental State (MMS) and Beck Depression Inventory (BDI) scale scores with the Expanded Disability Status Scale (EDSS) score in patients with multiple sclerosis treated at University Department of Neurology, Sarajevo University Clinical Center in Sarajevo. We evaluated 50 randomly selected patients with various types of multiple sclerosis using the MMS, BDI and EDSS instruments. The study included 33 women and 17 men (66% : 34%), mean age 40.74 years (SD 9.236). The mean value of EDSS score was 3.98, ranging from 1.0 to 8.5 in women and from 1.0 to 6.5 in men. BDI scale scores showed a mean value of 12.56. The mean MMS score in baseline sample was 26.88. Statistically significant positive correlation was found between age and EDSS score, and negative correlation between EDSS and MMS, as well as between BDI and MMS. Study results indicated older patients with multiple sclerosis to have a higher EDSS score with more pronounced cognitive disturbances. There was no statistically significant correlation between EDSS score and depression.

Technical systems for endoscopy diagnostics are suitable for application of computer technology. Endoscopic methods can make use of hardware-software packages for the digitalization of images, after which it is possible to store and subsequently analyze, as well as transfer pictures to the local information and communication systems. After installation of these packages follow up of the examination is on the computer monitor, and the examination of patient receives the additional quality and speed. Endoscopic methods enable provision of following functions: Entering basic demographic data about patients, Following use of material, invoice production, etc. Recording video in real time, Review of existing material, image analysis, sequences, Image processing and printing preparation, Creation of own interface, or appearance of doctor’s reports, Data back-up from the software, recording on CD or DVD media,Conversion into any format and recording of data directly on CD or DVD, Easy access to previous patients examinations, Statistical data analysis. analysis and interpretation as basis for writing scientific and professional articles, Networking possibilities with other users. Special advantages for users of these methods are: Safer work for doctors and patients, Application of teleeducation system in process of knowledge transfer to the large number of participants (video conferences, workshops with transfer of “live” image and immediate analysis and comments) Functional dynamic analysis, Possibility for additional consultation or teleconsultation with other experts, Possibility to send image on distance using internet. Imaging views from endoscope, radiological (CT, MRI) or ultrasound obtained during the examination of the patients can be stored on appropriate media. In radiology and gastroenterology used are Pacs / Ris (System for archiving and communicating through images/ Radiology information system) systems. It is a system for work with images, and their purpose is to exclude use of films and start digital data processing. With this project, it is possible to transfer complete series of recordings with modalities such as CT, MRI, and diascopy, endoscopy ultrasound, to a system for archiving and communications, and after that all doctors who are in the network can view the images, give their opinions and seek the opinions of colleagues. This kind of software allows the processing and postprocesing (analysis) of recordings with the help of appropriate tools–zoom, filtering, invert, three-dimensional reconstruction, etc., all with the goal of more accurate diagnosis when viewing recordings. Such analysis is particularly important in the preparation or during the surgeries, and three-dimensional reconstruction of the liver is particularly important in preparation for transplantation. Network access is possible from any networked computer. With this software it is possible to seek via Internet the opinion of radiologists or gastroenterologist from

Yang et al. have reported a significantly higher incidence of hip fracture in patients on PPI, and such incidence increases with therapy duration and with PPI dose [9]. Regarding these data, we hypothesized that long-term therapy with PPI is associated with decreased bone density, and consequently with increased incidence of its clinical manifestations: osteoporosis, fractures, and hip fractures. We also hypothesized that mechanism of action of these drugs is not through their effect on vacuolar ATPase in osteoclasts, but rather through decrease in calcium absorption in the small intestine. As a result, there is less calcium in the human organism available for mineralisation of bone tissue and consequently, bone density decreases. However, we recognize that further studies are necessary to measure exact bone density change by DXA absorptiometry or ultrasound in patients on long-term PPI therapy. Supplementary research is also needed in order to identify the exact mechanism of action of these drugs on bone density change.

BACKGROUND Continuous glucose monitoring systems can monitor moment-to-moment changes in blood glucose concentration, which cannot be detected by intermittent self-monitoring. Continuing monitoring systems may lead to improved glycemic control. We evaluated a microdialysis technique for improving glycemic control in type 1 diabetes patients treated by different means of basal insulin substitution. PATIENTS AND METHODS Fifty-two type 1 diabetic patients on twice daily NPH and pre-meal aspart insulin were randomized in two groups: the continuation of NPH (n=26) (group 1) or once daily glargine (n=26) (group 2). 48-hour GlucoDay registrations were started at the beginning and after 4 months. RESULTS At baseline, time spent in the euglycemic range (glucose between 3.9 and 8.0 mmol/L) was 37.96±6.81% for the NPH group and 35.83±6.24% for the glargine group. At endpoint, time in the euglycemic range increased in both groups (51.02±7.22% and 57.29±10.27%, P<0.001 vs. before treatment for both groups). Time spent in the hypoglycemic range (glucose <3.9 mmol/L) was 9.98±2.57% for the first group and 10.24±3.55% for the second group at baseline. At endpoint, time in the hypoglycemic range decreased in both groups (8.00±2.13% and 6.59±2.04%, P<0.001 vs. before treatment for both groups). CONCLUSION The analysis of the GlucoDay data gave us information about glycemia other than HbA1c and self-monitoring of blood glucose, such us a peakless activity profile and the lower percentage of time spent in the hypoglycemic range in the glargine-treated group.

Pancreatic fistula most commonly occur as a consequence of resective procedures and pseudocyst drainage, and rarely as a consequence of splenectomy. Conservative treatment can have good results, but it is long lasting and demands long hospitalization. In case of conservative treatment failure, operative treatment is indicated, but this has significantly higher percentage of morbidity and mortality. In selected cases, conservative treatment with somatostatine or octreotide, along with endoscopic procedure including the use of fibrin glue, significantly accelerates sanation of the fistula and reduces the length of hospitalization. We report a case of exterior pancreatic fistula due to splenectomy following blunt abdominal trauma, which were successfully treated with conservative (infusion, antibiotics, enteral nutrition, and octreotide) and endoscopic therapy. During ERCP papillotomy was performed, and good external drainage using drainage catheter was important in the patient outcome. Considering the initial secretion of 300 mL/24 h, our patient had a high output fistula. Despite that, fistula was quickly resolved after treatment. Our opinion is that octreotide therapy and unobstructed drainage of pancreatic duct into the duodenum were the most important in the rapid resolution of the fistula.

Factors underlying genetic predisposition for development of sporadic colorectal cancer are largely unknown. The fact that this cancer is more common in patients suffering from inflammatory bowel disease raises the question of the relationship between chronic inflammation and cancer. Toll‐like receptors 2 (TLR2) and 4 (TLR4) are critical in initiating innate immune response and inflammation toward various bacteria commonly found in the intestine. Recent evidence about the association of polymorphisms in these genes with ulcerative colitis and Crohn’s disease, as well as other inflammatory conditions, was the basis for our investigation of their role in sporadic colorectal cancer. We assessed genotype and allele frequencies of TLR2 GT microsatelite polymorphism, TLR2 Arg753Gln, TLR4 Asp299Gly and TLR4 Thr399Ile polymorphisms in 89 colorectal cancer patients and 88 age‐ and sex‐matched controls. The frequency of TLR2 GT microsatelite alleles with 20 and 21 GT repeats was decreased (p = 0.0044 and p = 0.001, respectively), while the frequency of the allele with 31 GT repeats was increased (p = 0.0147) in patients. The mutant allele Asp299Gly of TLR4 gene was slightly more frequent in colorectal cancer patients (p = 0.0269). In conclusion, we report an association of microsatelite GT polymorphisms of TLR2 gene and Asp299Gly polymorphism of the TLR4 gene with sporadic colorectal cancer among Croatians.

BACKGROUND Diabetics have a 3-fold risk for cardiovascular diseases compared with non-diabetics. This study was designed to evaluate cerebral hemodynamic changes related to type 2 diabetes mellitus (DM) with transcranial Doppler ultrasonography (TCD). TCD is a highly sensitive and specific method of quick bedside assessment of cerebrovascular circulation hemodynamics. PATIENTS AND METHODS In a prospective study, we compared a group of 100 patients with the diagnosis of type 2 diabetes mellitus (aged 48 to 67 years) and an age- and sex-matched control group of 100 healthy subjects without diabetes mellitus. We measured flow velocities (Vm) and the Gosling pulsatility index (PI) of the middle cerebral artery (MCA). RESULTS The rate of TCD abnormalities was significantly higher in diabetic patients than in healthy control subjects (55% vs. 11%, P<0.05). The PI was significantly higher in diabetic patients than in healthy controls (P<0.001). Atherosclerotic changes were found in 34.0% and 71.4% of patients suffering from diabetes for <5 and ≥5 years, respectively. CONCLUSION This study suggests that TCD is a useful marker for the detection of diabetic cerebrovascular changes. The duration and type of diabetes were found to have an impact on the development of pathologic cerebrovascular changes.

From Clinical Hospital Split, *Department of Gastroenterology and Hepatology, †Department of Nephrology, ‡Department of Pathology, §Department of Microbiology, Split, CroatiaCorrespondence:Prof. Izet Hozo MD, PhDDepartment of Internal Medicine,Clinical Hospital Split, Soltanska 1, Split, CroatiaTel: 385-21-55-76-58Fax: 385-21-55-76-58Izet.Hozo@st.htnet.hrAccepted for publicationNovember 2004

The concept of "dysthanasia" is still partially known in the world academic community. The concept is opposite to the concept of "euthanasia", incomparably more often mentioned, but without doubt much less often practiced in health-care institutions, especially in intensive care units. The objective of this article is to expound fundamental theoretical and practical aspects of dysthanasia, as well as to encourage discussion about this actual topic. The article discusses the position of dysthanasia within the objectives of contemporary medicine, as well as according to the definition of health by the WHO the definition of illness by the Hastings Center and the Recommendation No. 1418 of the Council of Europe Parliamentary Assembly. It concludes with comments on certain examples of possible dysthanasia from the world history and two actual examples from our clinical practice.

Lipomas are the most common mesenchymal benign tumor of the colon. They are usually asymptomatic but may cause bleeding, obstruction, intussusception, or abdominal pain. The diagnosis can be made by colonoscopy, barium enema examination, and by computed tomography (CT). We have reported a case of large submucosal lipoma of the ascending colon with intestinal obstruction. At laparotomy there was an intussusception descending colon, and subtotal colectomy was performed.

AIM To describe the cohort of Croatian workers monitored for micronuclei in peripheral blood lymphocytes and validate predictive value of micronuclei for the risk of cancer development. METHODS Between 1985 and 1999, peripheral blood lymphocytes were analyzed with in vitro micronucleus assay in a cohort of 200 subjects occupationally exposed to genotoxic agents. The follow-up for cancer incidence and mortality was performed through the Croatian National Cancer Registry and records of occupational medicine physicians. Micronucleated cell frequency values were compared by Kruskal-Wallis test. RESULTS The median micronucleated cell frequency value in the cohort was 49 (range, 30-79) per thousand cells. Micronucleated cell frequency was significantly higher in men than in women, which could be attributed to the different distribution of exposures. Micronucleated cell frequency increased with age for both sexes. Smoking habit had no influence on micronucleated cell frequency. The follow-up identified four cases of cancer. Three of them belonged to the highest micronucleated cell frequency tertile. CONCLUSION Due to a small number of cancer cases, the predictive value of micronuclei for the risk of cancer development in the cohort of Croatian workers was not estimated, but 4 identified cases were more than expected in a similar non-exposed group. The Croatian cohort will contribute to the pooled analysis of the current European study of predictive value of micronuclei for the risk of cancer development.