Liver abscess is a rare complication of sigmoid diverticulitis and must be considered within the differential diagnosis. We report a case of a male patient, age 71, admitted to our hospital with chief complaints of a dull pain in upper right abdominal quadrant, fever and weakness of approximately 5 months duration. He had a history of a surgery 18 years ago after an episode of diverticulitis. Physical examination and biochemistry on initial work-up revealed tenderness on palpation in upper right abdomen, leukocytosis and a 39 degrees C fever. Ultrasound examination revealed round structure with low echo properties in the right lobe of the liver. Further CT scan examination confirmed an abscess collection. We performed ultrasound guided percutaneous catheter drainage with intravenous administration of broad spectrum antibiotics, resulting in a successful treatment of a liver abscess. Colonoscopy confirmed sigmoid diverticulitis which was the most likely the source of bacterial invasion through portal venous system.

AIM To analyze the results of ultrasound guided percutaneous needle aspiration (PNA) and percutaneous catheter drainage (PCD) in the treatment of splenic abscess. METHODS Thirty-six patients (14 females and 22 males, with an average age of 54.1 +/- 14.1 years) with splenic abscess were treated with ultrasound guided PNA and/or PCD. Patients with splenic abscess < 50 mm in diameter were initially treated by PNA and those with abscess > or = 50 mm and bilocular abscesses were initially treated by an 8-French catheter drainage. The clinical characteristics, underlying diseases, organism spectra, therapeutic methods, and mortality rates were analyzed. RESULTS Twenty-seven patients had unilocular and 9 bilocular abscess. PNA was performed in 19 patients (52.8%), and 8 of them (42.1%) required PCD because of recurrence of abscess. In 17 patients (47.2%), PCD was performed initially. PCD was performed twice in six patients and three times in two. PNA was definitive treatment for 10 and PCD for 21 patients. One patient with PCD was referred for splenectomy, with successful outcome. In all 4 deceased patients, malignancy was the underlying condition. Twenty-one patients (58.3%) underwent 33 surgical interventions on abdomen before treatment. Cultures were positive in 30 patients (83.3%). Gram-negative bacillus predominated (46.7%). There were no complications related to the procedure. CONCLUSION Percutaneous treatment of splenic abscess is an effective alternative to surgery, allowing preservation of the spleen. This treatment is especially indicative for the patients in critical condition postoperatively. We recommend PNA as primary treatment for splenic abscesses < 50 mm, and PCD for those > or = 50 mm in diameter and for bilocular abscesses.

AIM: To analyze the results of ultrasound-guided percutaneous needle aspiration (PNA) and percutaneous catheter drainage (PCD) in the treatment of pyogenic liver abscesses. Methods: 71 patients (42 females and 29 males, average age 56.2±12.3) with pyogenic liver abscesses were treated with ultrasound guided PNA and/or PCD. Patients with liver abscess <50 mm and ≥50 mm in diameter were initially treated with PNA and with 8-French catheter drainage, respectively. The clinical characteristics, underlying diseases, organism spectra, therapeutic methods, and mortality rates were analyzed. Results: PNA was performed in 35 patients (49.3%) as initial treatment. In 14 patients needle aspiration was a definitive and successful treatment, while 17 out of 35 patients (48.6%) had a recurrence of abscess and required continuous catheter drainage. After PNA three patients were referred for surgery. In 13 patients PCD applied after PNA was a definitive and successful treatment, but 4 patients had to be transferred for surgery in this specific group. In 36 patients (50.7%) PCD was performed initially. In 12 patients PCD was performed twice. In all 7 deceased patients malignancy was the underlying condition. Forty-one patients (57.7%) underwent surgical interventions in the abdomen before percutaneous treatment. Cultures were positive in 54 patients (76 %). There were no complications related to the procedure. Conclusion: Ultrasound-guided percutaneous treatment of liver abscess is a safe and effective alternative to surgery, especially in critically ill patients. We recommend PNA and PCD as primary treatments for liver abscesses <50 mm and ≥50 mm in the longest diameter, respectively.

Echinococcosis is zoonosis transmitted by dogs in livestock-raising areas and accidentally affects man. Disease is endemic in certain parts of the world, including our country particularly region of Herzegovina. The most frequent site of hydatid cysts in the liver (78 %), followed by the lungs (17 %), and less frequently, the spleen, kidneys, heart, bones, central nervous system, and elsewhere. The diagnosis is based on clinical features, imaging examinations and serology. In the treatment of hydatidosis, three options are available: surgery, medical treatment by benzimidazole carbamates and percutaneous drainage. Drug therapy has scolicidal activity bat are clinically effective in less than 30 % of patients with hepatic hydatidosis. Surgery is no longer the treatment of first choice for hydatidosis located in abdomen. Percutaneous drainage associated with albendazole therapy is safe and efficient treatment for hydatid cysts in abdomen and retroperitoneal space. Surgery should be reserved for patient with hydatid cysts where PAIR with albendazole therapy can not be performed. Moreover, a multidisciplinary approach is advisable to assure a better clinical management to patients with cystic echinococcosis and eradication of hydatidosis. The socio-economic impact of cystic echinococcosis is reviewed with special reference to the following topics: consequences in man and livestock, costs and benefits of control programmes and economic procedures for evaluating control programmes. The durability of control programs is the corner stone for obtaining a significant decrease of hydatid infection. Many consequences in man and livestock are difficult to evaluate from an economic point of view, because some basic data are difficult to obtain in our country. Health education represents essential elements in the control and eradication campaigns of echinococcosis/hydatidosis.

Celiac disease is intolerance to gluten that classically produces chronic diarrhea with a picture of malabsorption and a total villous atrophy. These elements regress completely in a sequential way under a prolonged gluten-free diet. We describe a case of a 35-year-old woman affected by celiac disease who presented atypically, with features including hypoproteinaemia (38g/L) with dominant hypoalbuminaemia (12g/L), weight loss, strong psychoneurotic component and amenorrhoea. These manifestations for the first time were diagnosed as irritable bowel disease and after immunology diagnostic as celiac disease. Current research on celiac disease has pointed out the biologically significant role of antigliadin antibodies IgG and IgA and antibodies to tissue transglutaminase (tTg).

The aim of this study was to evaluate the results of single-session sclerotherapy with mixture of alcohol and polidocanol and a subsequent injection of albendazole for devisceration of hydatid cysts in the spleen. Eight patients (four women and four men, average age 22.9+/-11.4 with hydatid cyst in the spleen were treated with 10 minutes time of exposure to mixture of ethanol 95% and polidocanol 1%. After that, 2 to 5 ml of albendazole was injected into the cyst cavity. Two patients had 2 cysts. At follow-up the patients were examined with clinical and biochemical examinations, ultrasonography, and serologic test for echinococcal antibody titres. The mean hospital stay was 2.5+/-0.93 days. During the follow-up period, mean cyst diameter decreased from 46+/-16.4 mm to 13.6+/-16.26 mm. In all ten cysts, a reduction of post procedural recolection of fluid over 40% was observed. Five cysts (50%) disappeared during the follow-up period. All cysts (5) smaller then 50 mm in diameter disappeared during follow-up period. After an initial rise, the echinococcal-antibody titres fell progressively and at the last follow-up were negative (< 1: 160) in 7 (88%) patients. No complications were observed, except for pain, fever and urticaria during the first 24-hours after the procedure. Sclerotherapy using only one session and 10 min time of exposure to the mixture of ethanol and polidocanol, and a subsequent injection of albendasole solution represents an effective treatment of hydatid cysts in the spleen. This procedure is even more efficacious for hydatid cyst with diametar smaller then 50 mm.

AIMS In recent year's percutaneous drainage has been used successfully to treat the hydatid cysts. We performed a controlled trial to present the successful appliance of this method in the treatment of abdominal and retroperitoneal hydatid diseases. METHODS In a prospective study, we have assigned 84 patients (51 women and 33 men, average age 45.7 +/- 16.7 with hydatidosis to treatment with percutaneous drainage. Of these, 72 patients had hepatic cysts, seven had renal hydatid cysts and five patients had hydatid cyst in the spleen. Albendasole (10 mg per kilogram of body weight per day for eight weeks) was administered to the patients. Serial assessments included clinical and biochemical examinations, ultrasonography and serologic tests of echinococcal-antibody titers. RESULTS The mean hospital stay was 5.8 (+/- 3.1) days. Over a mean follow-up period of 24 months, the mean cyst diameter decreased from 81.4 (+/- 32.6) mm to 11.8 (+/- 14.5) mm. After 24 months follow-up period 62 cysts (74 percent) disappeared. After an initial rise, the echinococcal-antibody titers fell progressively and at the last follow-up were negative (< 1:160) in 73 patients (87 percent). There were procedure related complications in 29 patients (four patients had abscessus, six hypotension, seven urticaria, ten fever and two strong abdominal pain in the first hour after intervention). CONCLUSIONS Percutaneous drainage, combined with albendasole therapy, is an effective and safe method for the treatment of the abdominal and retroperitoneal hydatid cysts and requires a shorter hospital stay then surgery treatment.

The most frequent causes of the stenosis are as follows: Schatzki rings, structures as the complications of GERB', postcorrosive and postoperative at nosis. The Balloon dilatation is one from the therapeutic procedures of stenosis of the esophagus. By the clinic research is included 12 patients with the stenoses of the esophagus of the various cause. It is used the balloon dilatator (Olympus) of the diameter 16 and 18 mm, and the analysis 40 mm. In 11 patients the balloon dilatation was successful and led to the walking of the esophagus for endoscope. Only in one patient the dilatation was unsuccesful, because was applied two years after the occurrence of the stenosis caused by the corrosive esophagisitis. It is concluded that the balloon dilatation of the therapeutic procedures of the choice in stenosis of the esophagus.

UNLABELLED The aim of this work is to show possibilities of treating echinococcus cyst, with special emphasis on PAIR method, showing two different cases (hydatid and multilocular cyst). MATERIAL AND METHODS In the period of three years in our department it has been treated 7 children who had cystic echinococcosis of different type, different localization, different number of cystic changes as well as different curing methods. Four patients were treated by PAIR method. Prior to all these patients were treated as per certain therapy scheme, conservatory by albendazole and then exposed to PAIR method. RESULTS Two completely cured (Echinococcus granulosus), third(Echinococcus multilocularis) in final phase and fourth at the early beginning of cure treatment (E. granulosus). There were no complications such as febrile, rupture and possible dissemination. CONCLUSION Hydatidosis is still primarily surgical disease but open surgical procedures are rapidly losing on their importance in therapy sense, comparing with new treating methods of percutaneous aspiration under sonographic and CT guidance, with pre-medication with albendazole.

Interventional ultrasound includes all diagnostic and therapy procedures controlled by ultra sound. In this manner, conventional ultrasound diagnostics which has a very important diagnostic role in gastroenterology increases its potential in diagnosis and gives an important contribution in the therapy of abdominal organs diseases. Diagnostic interventional ultrasonography enables sampling from solid and cystic changes for histological or cytological analyses. This procedure enables a more precise injection of contrasts in biliary or pancreatic ducts in the situations when it cannot be done by ERCP. Potential of interventional ultrasonography in the therapy is seen in the possibility to place the needle or the catheter into cystic and abscess changes in order to drain pathological collections and inject medicaments into pathological changes. The procedure is relatively simple and therefore considerably less aggressive compared to surgical treatment. Being very economic and efficient it became an important method in diagnostics and therapy of gastroentrological diseases.

OBJECTIVE The objective of this study is to evaluate the possibilities of interventional ultrasonography in the treatment of liquid collections created during and after an acute pancreatitis. PATIENTS AND METHODS Ultra-sound controlled percutaneous drainage of peripancreatic liquid collections was done in 58 patients (44 men and 14 women, average age 47.8 within the span of 15-68) in the period between May 1995 and September 2001. Pseudocystitis of pancreas formed after an acute pancreatitis was drained in 19 cases, abscess collections were drained in 14 cases, and in 25 cases a catheter was entered in peripancreatic liquid collections and steatonecrotic masses in the initial phase of acute haemorrhagic necrotic pancreatitis. Pigtail catheters 5 to 7 F were placed to serve for drainage and instillation of medicaments. RESULTS In the group of patients to whom a catheter was placed in liquid collections and steatonecrotic masses, two lethal outcomes were recorded. However, they were not the result of the intervention, but of emboly of lungs and coagulopathy. One patient with peripancreatic abscess collections was operated after the intervention. In other patients, ultra-sound controlled percutaneous drainage was successful. Before our intervention 22 patients had been operated, five of them twice and two of them three times. CONCLUSION Ultra-sound controlled percutaneous drainage gives an important contribution in the treatment of the hardest forms of acute pancreatitis and represents a safe and less aggressive method in the treatment of liquid collections and steatonecroses formed during an acute pancreatitis.