Severe acute pancreatitis (SAP), which is the most serious type of this disorder, is associated with high morbidity and mortality. SAP runs a biphasic course. During the first 1-2 wk, a pro-inflammatory response results in systemic inflammatory response syndrome (SIRS). If the SIRS is severe, it can lead to early multisystem organ failure (MOF). After the first 1-2 wk, a transition from a pro-inflammatory response to an anti-inflammatory response occurs; during this transition, the patient is at risk for intestinal flora translocation and the development of secondary infection of the necrotic tissue, which can result in sepsis and late MOF. Many recommendations have been made regarding SAP management and its complications. However, despite the reduction in overall mortality in the last decade, SAP is still associated with high mortality. In the majority of cases, sterile necrosis should be managed conservatively, whereas in infected necrotizing pancreatitis, the infected non-vital solid tissue should be removed to control the sepsis. Intervention should be delayed for as long as possible to allow better demarcation and liquefaction of the necrosis. Currently, the step-up approach (delay, drain, and debride) may be considered as the reference standard intervention for this disorder.

This paper deals with problems of the academic community in Bosnia and Herzegovina. This is a country in transition where a complex interrelation between politics and the academic community negatively impacts functioning of the academic community. Inability to implement internationally recognized criteria in the process of acquisition of scientific and academic titles has been a crucial problem. This paper seeks to identify causes of the community's perplexed state; its failure to carry out the quintessential reforms in higher education based on the implementation of internationally recognised criteria and the lack of responsibility among those who make political decisions, which are important for the development and advancement of the academic community.

AIM To determine the efficiency and safety of talc pleurodesis in treating the malignant pleural effusion and recurrent spontaneous pneumothorax. METHODS The study included 54 patients with malignant pleural effusion and recurrent spontaneous pneumothorax, who underwent talc pleurodesis using the "talc slurry" method of pleural talc obliteration. RESULTS Pleurodesis was successful in 52 (96%) patients. The average duration of thoracic drainage was 4.4 days. Procedure complications included higher body temperature, pneumonia and pleural effusion separation. All of the patients had satisfying radiological findings at the point of discharge and three months later. There was no death outcome related to the procedure of pleurodesis itself. CONCLUSION Our study has proved the efficiency and simplicity of talc pleurodesis in treating symptomatic malignant pleural effusions and cases with recurrent spontaneous pneumothorax.Appropriate patient selection and compliance with surgical principles during the procedure make this method safe, efficient and successful in treating pleuropulmonal diseases. Large particle talc should be used for pleurodesis because of the minimum risk of complications.

Purpose: To evaluate the efficacy, long-term outcome, and safety of percutaneous cholecystostomy (PC) in high-risk surgical patients. Methods: This was a retrospective descriptive review of the medical records of 36 patients who underwent PC for acute cholecystitis (AC) at a single institution between 2000 and 2011. Primary outcomes were overall morbidity, mortality, and need for interval cholecystectomy. Results: PC was initially successful, and symptoms disappeared within 3 days in all patients. Seven patients (2 during hospitalization and 5 during follow-up) died, 6 for a reason unrelated to AC, and 1 succumbed to a sepsis-related condition caused by uncontrolled cholecystitis progression. Elective cholecystectomy was performed in 6 patients. PC was a definitive treatment in 63.9% of patients. Conclusions: PC is a safe and efficient treatment option for patients with AC who are less eligible for surgery. After patients recover from PC, further treatment such as cholecystectomy may not be needed.

T he commendable multicenter study by Dr Tiwari et al1 focuses on the comparison of outcomes of laparoscopic and open appendectomy (OA) in management of uncomplicated and complicated appendicitis. The authors conclude that laparoscopic appendectomy (LA) is superior or comparable to OA in terms of several surgical outcome measures for both uncomplicated and complicated appendicitis, across most illness severity groups and so they recommend it as the preferred technique, irrespective of appendicitis diagnosis or disease severity. On the basis of our long-term experience,2 we would like to highlight certain issues regarding the possibility of percutaneous catheter drainage (PCD) as the treatment modality that can successfully solve acute perforated appendicitis in some patients. Authors specified that the study1 results have clearly demonstrated superiority of LA over OA, as it had shown to be a safe, efficacious, and cost-effective method for complicated (mostly perforated) and uncomplicated appendicitis.

References 1 Saito M, Seo Y, Yano Y, Miki A, Yoshida M, Azuma T. A high value of serum des-g-carboxy prothrombin before hepatocellular carcinoma treatment can be associated with long-term liver dysfunction after treatment. J Gastroenterol 2012; 47:1134–1142. 2 Toyoda H, Kumada T, Osaki Y, Tada T, Kaneoka Y, Maeda A. Novel method to measure serum levels of des-gamma-carboxy prothrombin for hepatocellular carcinoma in patients taking warfarin: a preliminary report. Cancer Sci 2012; 103:921–925. 3 Murata K, Suzuki H, Okano H, Oyamada T, Yasuda Y, Sakamoto A. Cytoskeletal changes during epithelial-to-fibroblastoid conversion as a crucial mechanism of des-gamma-carboxy prothrombin production in hepatocellular carcinoma. Int J Oncol 2009; 35:1005–1014. 4 Copple BL. Hypoxia stimulates hepatocyte epithelial to mesenchymal transition by hypoxia-inducible factor and transforming growth factor-betadependent mechanisms. Liver Int 2010; 30:669–682.

To evaluate the prognostic value of acute fluid collections (AFC) diagnosed by conventional transabdominal ultrasound in the early assessment of severity acute pancreatitis (AP).

about the evalu-ation of the results of percutaneous cholecys-tostomy tube (PCT) versus cholecystectomyfor acute cholecystitis (AC) comparing theiroutcomesovertime.Theyhaveconcludedthat“among patients with AC, PCTs were placedin older patients with increased comorbiditiescompared to cholecystectomy. Mortality ratesafter PCT decreased over time.”We congratulate the authors for theirextensiveexperienceintheapplicationofbothmethods and for the good results, especiallywhen using PCT during the second time pe-riod (over the more recent decade). However,we wish to highlight certain issues regardingthe study design and interpretation of the re-sults. In the “Methods” section, authors spec-ified that “patients who underwent operativemanagement of AC immediately before andafter each patient who underwent PCT place-mentservedascontrols,andwerematched2:1with PCT cases (143 patients).” It is not clearwhy the authors compared the patients sub-jected to cholecystectomy versus PTC, basedon the timing of intervention [especially inthe retrospective study design in which theyhad a great series (1559 patients) treated op-eratively, who were candidates for the controlgroup]. In this way, they got 2 very hetero-genic groups of patients for whom the onlything in common was that they had AC (seetheir Table 1) with too many uncontrolledconfounders. It is clear that the PCT group(Table 1) had more severe patients with sev-eral comorbidities and so it is logical to ex-pect a higher number of complications anddeaths in this group, which again is not di-rectly related to the type of treatment but isa consequence of uncontrolled confoundersassociated with their bad general condition.