Objective: Expenditures for drugs are increasingly burdening already insufficient funds for health protection. This is especially evident in less developed European countries such as Bosnia and Herzegovina. The question is whether such analyses can help save funds for financing treatment for diseases, with an emphasis on a more rational choice of drug for appropriate indication, whereby clinical complications of hypertension would be prevented and patients would have quality of their lives improved. Aim: Focus of research has been set on analysis of use of antihypertensive drugs in Bosnia and Herzegovina in the time-period January 2013–March 2015. Use of all drugs for treatment of hypertension in that time-period in the country has been shown in an unbiased manner. Methods: The study is designed as retrospective-prospective comparative research of use of antihypertensive drugs in BiH in a certain time-period. Data are collected from relevant drug utilisation database which has been established in Bosnia and Herzegovina since 2013. Results: We have calculated financial expenditure for prescribed antihypertensives in the time- period of 2013, 2014 and Q1 2015. Use of antihypertensives at the country level for this time-period is BAM 200,242,218. At the country level, physicians are most often opting for combination therapy: ACE inhibitors + diuretics (20.2%) and ACE inhibitors + Ca channel antagonists (18.0%). Conclusion: In this research, it has been shown that modern drugs are used for treatment of hypertension in Bosnia and Herzegovina. These drugs are used in the same order as they are prescribed in developed countries.

additional support for its pathogenicity. Her sons were referred for genetic testing for HNF1A mutations, given implications for screening and surveillance for HA and DM. On her last follow-up 12 months after surgery she remained completely asymptomatic, with small stable lesions in the left liver lobe on imaging. Biallelic inactivation of the HNF1A gene was identified in 10 of 16 patients with HA, as well as 3 heterozygous germline mutations in 2002, suggesting a link between MODY-3 and HA.3 Shortly after, 2 French families with HNF1A germline mutations were described,4 confirming that biallelic inactivation caused hepatic adenomatosis. Importantly, incomplete penetrance for both MODY-3 and adenomatosis was observed. Our patient did not have abdominal symptoms or complaints, and no significant liver function test abnormalities, despite a large tumor burden. Only 1 previously reported case of MODY-3 diabetes and asymptomatic hepatic adenomatosis has been described in a French family. The consequence of hemorrhage in lesions >5 cm, with consideration for empiric surgical resection, emphasizes the need to recognize the entity of hepatic adenomatosis in families with MODY-3. Although there are no consensus guidelines for hepatic adenomatosis, surveillance for both growth of lesions and for transformation to hepatocellular carcinoma should be considered. We present the first case of hepatic adenomatosis associated with the HNF1A 1340 C>T (p.P447L) variant, leading to haploinsufficiency and hepatic adenomatosis with young-onset diabetes in the proband, and young-onset diabetes in other generations. The discovery of HNF1A mutation in patients with hepatic adenomatosis should prompt clinical evaluation for glucose intolerance and specifically MODY. Conversely, special consideration should be given to counseling and screening for hepatic adenomatosis in patients with young onset DM, particularly without autoantibodies. Specifically, patients with a personal or strong family history of DM at a young age or a family history of hepatic adenomatosis should be examined for germline mutations in the HNF1A gene.

Dear Editor, Patients with communication between pancreatic pseudocysts (PPC) and pancreatic duct (PD) require a longer duration of drainage, due to the short-term drainage resulting in very high recurrence rates. However, with prolonged drainage period, the risk of septic complications is also potentially increased.1-3 The aim of the study was to evaluate the results of prolonged percutaneous catheter drainage (PCD) in the treatment of recurrent PPC with PPC-PD communication, including its outcome and complications.

formed the only prospective study of a treatment for mesenteric panniculitis with thalidomide.3 Patients in that study showed a clinical response to thalidomide. However, use of thalidomide to treat mesenteric panniculitis is costly and the drug is associated with multiple side effects. Other commonly used treatments for mesenteric panniculitis include the use of corticosteroids, immunosuppressant agents, and hormonal therapy such as tamoxifen.4 These have the potential for causing serious and life-threatening side effects. LDN seems to have promise for the treatment for Crohn’s disease and several other autoimmune and inflammatory conditions such as multiple sclerosis.1,2,5 This dose of naltrexone is safe with minimal side effects and no immunosuppressant properties. A rat model study showed that a low dose of naltrexone stimulates endogenous opioid growth factor (OGF) and receptor release.6 This increases tissue concentrations of endogenous (Met)-enkephalin (OGF) and endorphins.7 In turn, these lower doses of naltrexone may block the synthesis of tumor necrosis alpha, an important mediator of chronic inflammation. Use of objective measurements of disease severity and quality of life (MPSAS and FANLTC) changes the current management paradigm in this disease, where retrospective anecdotal reports have dictated the current medical therapy. LDN is safe and well tolerated in patients with symptomatic mesenteric panniculitis. In this study, 2 of the 3 patients had symptomatic improvement with treatment. Further studies are in progress. Grigory Roginsky, MD* Aimee Alexoff, BSwz Eli D. Ehrenpreis, MD, FACGzy *Department of Medicine zCenter for the Study of Complex Diseases NorthShore University HealthSystem Evanston yDepartment of Gastroenterology NorthShore University HealthSystem Skokie wDepartment of Biology, Loyola University Chicago, Chicago, IL

We read with great interest the article by Serman LJ et al. [1] about evaluation of the structural changes in the rat placenta during the last third of gestation, assessed by stereology. The authors concluded that the absolute volume of the whole placenta as well as the labyrinth had increased from day 16 to day 19 of gestation. In contrast, the volume density of glycogenic cells and trophoblast giant cells was higher on gestation day 16 than on day 19, probably due to the intensive trophoblast invasion during that time. Since stereological analysis assigns numerical values to analyzed structures, such outcomes ensure valid and exact comparison of healthy and pathologically altered tissue. In addition, comparison can be done between the tissues in different developing phases of an organ, as it was represented in this article.

A pancreatic pseudocyst (PPC) is typically a complication of acute and chronic pancreatitis, trauma or pancreatic duct obstruction. The diagnosis of PPC can be made if an acute fluid collection persists for 4 to 6 wk and is enveloped by a distinct wall. Most PPCs regress spontaneously and require no treatment, whereas some may persist and progress until complications occur. The decision whether to treat a patient who has a PPC, as well as when and with what treatment modalities, is a difficult one. PPCs can be treated with a variety of methods: percutaneous catheter drainage (PCD), endoscopic transpapillary or transmural drainage, laparoscopic surgery, or open pseudocystoenterostomy. The recent trend in the management of symptomatic PPC has moved toward less invasive approaches such as endoscopic- and image-guided PCD. The endoscopic approach is suitable because most PPCs lie adjacent to the stomach. The major advantage of the endoscopic approach is that it creates a permanent pseudocysto-gastric track with no spillage of pancreatic enzymes. However, given the drainage problems, the monitoring, catheter manipulation and the analysis of cystic content are very difficult or impossible to perform endoscopically, unlike in the PCD approach. Several conditions must be met to achieve the complete obliteration of the cyst cavity. Pancreatic duct anatomy is an important factor in the prognosis of the treatment outcome, and the recovery of disrupted pancreatic ducts is the main prognostic factor for successful treatment of PPC, regardless of the treatment method used. In this article, we review and evaluate the minimally invasive approaches in the management of PPCs.

Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is the most common complication of endoscopic retrograde cholangiopancreatography. The incidence of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis varies substantially and is reported around 1%-10%, although there are some reports with an incidence of around 30%. Usually, PEP is a mild or moderate pancreatitis, but in some instances it can be severe and fatal. Generally, it is defined as the onset of new pancreatic-type abdominal pain severe enough to require hospital admission or prolonged hospital stay with levels of serum amylase two to three times greater than normal, occurring 24 h after ERCP. Several methods have been adopted for preventing pancreatitis, such as pharmacological or endoscopic approaches. Regarding medical prevention, only non-steroidal anti-inflammatory drugs, namely diclofenac sodium and indomethacin, are recommended, but there are some other drugs which have some potential benefits in reducing the incidence of post-ERCP pancreatitis. Endoscopic preventive measures include cannulation (wire guided) and pancreatic stenting, while the adoption of the early pre-cut technique is still arguable. This review will attempt to present and discuss different ways of preventing post-ERCP pancreatitis.

Objective: To determine types and frequency of side effects of antihypertensive drugs in patients with diabetes mellitus (DM) type 2 and hypertension. Subjects and Methods: We performed a prospective study of 79 patients with DM type 2 and hypertension, randomly selected by systematic sampling, who were followed over a period of six months. Patients were assessed at baseline and once a month measuring following parameters: types of used antihypertensive drugs and frequency of side effects, the values (mmHg) of systolic (SBP) and diastolic blood pressure (DBP). Results: Out of 79 patients, 48/79 (60.8%) were males and 31/79 (39.2%) were females. The median age in males was 53 years (IQR=48 to 55 years), in females was 53 years (IQR=49 to 56 years). There was no statistically significant difference in median age between males and females (P=0.368). There is a statistically significant difference in the values of SBP [χ2(5)=312.296, P<0.001] and DBP [χ2(5)=216.051, P<0.001] over a period of six months follow-up. The drug side effects were noted in 9/79 (11.4%) patients between 1-2 months, in 6/79 (7.6%) between 2-3 months, in 1/79 (1,3%) between 3-4 months. The most common side effect was cough (11/79 or 13.9%) associated with the combination of ACE inhibitor and thiazide diuretics. In 5/79 (6.3%) patients there were reports of: flushing, palpitations, headache, dizziness and leg edema associated with Ca blockers. Conclusion: The most common side effect of antihypertensive treatment was cough (13.9%) associated with the combination of ACE inhibitor and thiazide diuretic.

The management of liver abscess (LA) has shifted toward intravenous broad‐spectrum antibiotics and image‐guided percutaneous needle aspiration (PNA) or percutaneous catheter drainage (PCD).