Lobus v. azygos (lobe of the azygos vein, azygos lobe) is an accessory lobe of the right upper lobe of the lung that corresponds to the anatomical variety. The presence of expansive lesions in it represents unusual radiographic findings. This paper presents the case of a patient with an extensive expansion process in azygos lobe, radiologically diagnosed by standard radiography (X-ray) and Multislice Computed Tomography Scan (MSCT). The process was subsequently treated surgically and confirmed histologically as a non-small-cell lung adenocarcinoma.

We read with great interest the editorial article by Meshikhes AWN published in issue 25 of World J Gastroenterol 2011. The article described the advantages of emergency laparoscopic appendectomy compared with interval appendectomy as a new safe treatment modality for the appendiceal mass. The author concluded that the emergency laparoscopic appendectomy was a safe treatment modality for the appendiceal mass, and might prove to be more cost-effective than conservative treatment, with no need for interval appendectomy. However, we would like to highlight certain issues regarding the possibility of percutaneous catheter drainage to successfully treat the appendiceal mass, with no need for appendectomy, too.

Objective: To report an uncommon method of managing pancreatic fistulas and retroperitoneal abscess. Clinical Presentation and Intervention: A 50-year-old man was admitted with fever, abdominal pain, periumbilical fistula and pus in stool. Five months before admission, he underwent urgent necrosectomy (7 days after onset of pain) and subsequently two more surgeries for necrotizing pancreatitis. Ultrasound revealed fluid collection in the retropancreatic space. After evacuation of pus, contrast medium instilled through a catheter showed a retroperitoneal abscess cavity, retroperitoneal-periumbilical and retroperitoneal-sigmoidal fistulas. After percutaneous drainage and iodine irrigation, the abscess collection and fistulas disappeared. Conclusion: In this case, percutaneous drainage was a successful option in the management of pancreatic fistulas and a retroperitoneal abscess.

To The Editor: We commend Chung et al for an interesting original article reporting on the safety, efficacy, and long-term outcome of percutaneous cholecystostomy (PC) as of a definitive treatment for acute acalculous cholecystitis (AAC). They concluded that PC is an effective procedure and a good alternative for patients unfit to undergo immediate surgery because of the existence of severe sepsis or an underlying comorbidity. This is an excellent article with a strong impact on clinical practice. Traditionally, acute cholecystitis is mainly treated by surgical approach 1–3 but, in patients with poor general condition surgical treatment may carry a high risk of complications associated with major morbidity and mortality. Only limited data are available on PC treatment of AAC and little is known about the safety of PC in critically ill patients. Therefore, Chung’s study, which evaluates the feasibility and clinical outcome of PC in patients with AAC is of a high importance. However, AAC comprises <10% of all cases of acute cholecystitis. In over 90% of cases, acute cholecystitis is caused by cholecystolithiasis. Therefore, it is important to answer whether PC should be limited only to AAC. We had several cases of acute cholecystitis in patients with poor general condition, caused by cholecystolithiasis, which were successfully treated by PC and so we wish to add some comments regarding this topic. Our initial intention was for PC to be used as a temporizing measure whereas, awaiting resolution of sepsis and optimization of comorbidities before performing elective surgery. But, majority of those cases required no further surgical treatment after PC. Therefore, we believe that ultrasound-guided PC should be considered a reasonable option in the therapeutic spectrum for both acalculous and calculous cholecystitis and a good alternative for patients unfit to undergo immediate surgery because of severe sepsis or an underlying comorbidity.

In this paper we are presenting the application of Multislice CT Scan (MSCT) as a part of radiological treatment in a female patient with avascular necrosis of head and neck of the right femur, which occurred as a consequence of developmental hip dysplasia. The left hip joint of the patient was previously replaced by a prosthetic implant.

AIM To investigate hospital morbidity and incidence of colorectal cancer (CRC) in the Tuzla Canton between 2000 and 2004, as well as mortality incidence and degree of disease progression. METHODS A total of 383 patients were enrolled in this study, all of them with CRC. Pathohistological analyses were performed in all patients after colonoscopy. Afterwards, the patients underwent surgery and obtained material was also pathohistologically analyzed in order to perform the Astler-Coller classification and the classification of the location of CRC. RESULTS In the period 2000-2004 in the Tuzla Canton there were 383 newly diagnosed patients with CRC. The average age of the patients was 62 ± 12 years, and the incidence was equally distributed per genders. Rectal tumour was noted in 145 (37.9%) patients, and in 238 (62.1%) tumor was found elsewhere in the colon. Average incidence of the CRC was 15.73/100,000, with a dramatic increase in incidence in 2003 of 27.40/100,000. The average mortality incidence during the study was 6.89/100,000, and the largest number of the patients (339, 88.6%) was in an advanced stage of the disease. CONCLUSIONS There has been a significant increase in the number of newly detected cases of CRC in the Tuzla Canton during 2000- 2004, which implies the need for initiating a National Early CRC Detection Programme.

99 43rd European Pancreatic Club (EPC) Meeting June 22–25, 2011, Magdeburg, Germany Guest Editor: Halangk, W. (Magdeburg) (available online only) 276 Erratum 277 IAP Society News 278 EPC Society News No. 3

We commend Heinzow et al. for an interesting original article about the evaluation of technical results and clinical outcome rates of the singlestep versus multi-step endoscopic ultrasonography (EUS)-guided endoscopic transmural drainage in patients with symptomatic pancreatic pseudocysts (PPC) of >4 cm size [1]. In a retrospective design of the study, they compared the results of 16 patients with PPC who had undergone single-step EUSguided transmural drainage with a cohort of 22 patients who had undergone multi-step EUSguided transmural drainage of PPC. Primary clinical success rate was 88% for single-step drainage and 90% for the multi-step approach (n.s.). The mean procedure time was 36 ± 9 min in the singlestep group compared with 62 ± 12 min for the multi-step access (p < 0.001). They concluded that the use of single-step cystostomy appears useful in managing selected patients with symptomatic PPC as it is effective and time-saving. We congratulate the authors for their excellent results and low complication rate, without major complications.However,wewish to highlight certain issues regarding the design and discussion section of the study. It is very surprising that the authors compared the clinical outcome and procedure time between singleand multi-step groups because they are very similarmethods to achieve the clinical outcomes and it is clear that multi-step procedure must last longer. The recovery of disrupted pancreatic duct has been recognized as the main prognostic factor for successful treatment of PPC regardless of the treatment used. We believe that prolonged catheter drainage leads to the recovery of pancreatic duct and resolution of PPC in majority of cases regardless of the type of drainage performed, i.e., percutaneous or endoscopic. In the introduction and discussion section, authors specified that surgery has been the therapy of choice in the treatment of symptomatic PPC for many years. However, this treatment involves considerable surgical trauma and general anesthesia, accompanied by substantial morbidity and mortality [1]. In Figure 1, the authors specified that several pseudocyst recurrences were treated by percutaneous catheter drainage (PCD). However, PCD was not discussed as an alternative method in the treatment of PPC despite the fact that several reports evaluated the efficacy of percutaneous management of PPC, with good results [2–7]. Besides, PCD is performed in local anesthesia and with procedure time between 5 and 15 min, only. It is true that the advantage of endoscopic approach is that it creates a permanent pseudocysto-gastric track, with no spillage of pancreatic enzymes in contrast to PCD, thereby reducing the risk of formation of pancreatico-cutaneous fistulas. However, in the case of infective complications or other drainage problems, the monitoring, catheter manipulation and the analysis of cystic content are very difficult or impossible with endoscopic, unlike with PCD approach.

Association of Gastroenterologists and Hepatologists of Bosnia and Herzegovina based on the experiences of domestic and foreign centers operating in the field of hepatology and accepted guidelines of the European and the U.S. Association for Liver Diseases adopted the consensus for the diagnosis and treatment of chronic viral hepatitis B and C. The guidelines are intended for specialists in gastroenterology and hepatology, and infectious diseases physicians working in primary health care and family medicine, but also other physicians who are confronted with this disease in their practice, with the aim of facilitating and shortening the diagnostic and treatment protocols of patients with chronic viral hepatitis B and C. This ensures faster, more efficient, more rational and cost-effective care of patients with hepatitis, with an emphasis on stopping the deterioration of liver disease to liver cirrhosis and eventually hepatocellular carcinoma. Key words: Chronic hepatitis B and