increased morbidity rate with the danger of postsplenectomy infections. Current therapeutic strategies established spleenpreserving treatment in cases of trauma and benign lesions [2, 3] . Therefore, we consider that percutaneous drainage or laparoscopic excision should be used instead of total splenectomy as the treatment of choice for splenic benign cysts [2–6] . Besides, it is highly questionable whether the boy’s health condition would be better with asymptomatic splenic benign cyst or without cyst, but also without the spleen. Dear Sir, We commend Bai and Wang [1] for an interesting clinical image of the article ‘a primary splenic cyst in a 10-year-old boy’. They note that CT revealed a large left upper-quadrant spherical cystic mass with a smooth wall and normal splenic tissue which was visualized around all or part of the cyst. However, we wish to highlight certain issues regarding total splenectomy for benign cysts especially in young people. The spleen is important for proper immunologic function, and splenectomy carries an Published online: August 3, 2010

We read with great interest the article by Tang et al published in issue 4 of World Journal of Gastroenterology 2010. The results of their study indicate that percutaneous catheter drainage in combination with choledochoscope-guided debridement is a simple, safe and reliable treatment procedure for peripancreatic infections secondary to severe acute pancreatitis. However, there are some points that need to be addressed, including data about the patients in the study and their clinical characteristics, data about infection and superinfection during the treatment and type of treatment of patients with acute necrotizing pancreatitis.

Aim:  The clinical course and outcome of patients with haemorrhagic fever with renal syndrome (HFRS) caused by Puumala (PUUV) and Dobrava viruses (DOBV) were analyzed and whether it left long‐term consequences on kidney function after 10 years was evaluated.

Increasing gap between demand and availability of human kidneys for transplantation has forced a re-evaluation of the limits on donor age acceptability. The present study included 74 patients who underwent kidney transplantation in University Clinical Centre Tuzla. In an observational cohort study we assessed impact of donor age on post transplant renal function by analyzing following parameters: 24 hour urine output, creatinine clearance (Cr Cl) and glomerular filtration rate (GFR). Depending on donor age recipients were allocated in to two groups. Group I included patients who received renal graft from donors age up to 55 years, and Group II encountered recipients who received renal graft from donors older than 55 years. Our goal was to determine whether donor age over 55 years significantly diminishes renal graft function in first seven post transplant days. No statistically significant difference was found between Group I and II regarding 24 hour urine output. From second to fifth postoperative day creatinine clearance values were higher in the group of patients who received kidney from donors older than 55 years (47+/-19, 1 vs. 44, 4+/-20, 8). On the fifth, sixth and seventh post operative day GFR was significantly higher in patients who received renal graft from donors age up to 55 years (p<0, 0161). Our data showed no significant difference in observed variables between the two groups, thus indicating that utilization of renal grafts from donors' age > 55 years is acceptable and may considerably expand the donor pool.

Bezoars are accumulations of foreign material within the gastrointestinal tract. They most often occur in the stomach, but they may also be found in the small and large intestine. The commonest type of bezoar is the phytobezoar, which is composed of undigested food material. These usually develop in patients who have undergone gastrointestinal surgery or who have impaired gastric motility. There are several ways to remove a bezoar. Medical therapy, with or without endoscopy, surgical removal, and with the development of laparo-scopic surgery, new options for treatment are available. We report here the case of the laparoscopic treatment of gastric bezoar. A patient presented to the hospital with symptoms of gastric obstruction with nausea, vomiting and abdominal pain. Endoscopy revealed a large gastric bezoar, 11 centimeters in diametar localized in antrum with decubital ulceration of the mucosa, but endoscopic extraction was unsuceessful. Therefore the patient underwent a linear laparoscopic gastrotomy and the bezoar was removed with the use of an endobag. Gastrotomy was closed using intracorporeal suturing. There were no intra and postoperative complications. This case demonstrates that laparoscopic extraction of a phytobezoar as an alternative to laparotomy in patients whose disease is not amenable to endoscopic resolution.

AIM To confirm the efficiency and toxicity of two chemiotherapeutic protocols- Cisplatin Gemcitabin (CDDP, Gemcitabin) and Cisplatin, Vinorelbin (CDDP, Vinorelbin) in advanced non-small cell lung cancer (NSCLC). PATIENTS AND METHODS Retrospectively were analyzed and treated a total of 60 patients (two groups with 30 patients) for advanced or metastatic NSCLC during the period from January 2005 to January 2007. The patients were treated with chemiotherapeutic protocols CDDP, Vinorelbin and CDDP, Gemcitabin for four weeks. The chemiotherapy was administered intravenously. RESULTS Although registered response rates were a bit lower than in previously published trials, they were not significantly different in two arms (26% vs. 15%) (p = 0.485). Statistically different were therapeutic responses in SD (CDDP, Vinorelbin 44% vs. CDDP, Gemcitabin 93,3%) (P < 0.001) and OS (CDDP, Vinorelbin 10.83% vs. CDDP, Gemcitabin 21.00%) (p < 0.05). Cisplatin, Vinorelbin regimen has shown a higher hematologic (9% vs. 7%), and total toxicities (p = 0.0029). CONCLUSION In this investigation of two groups of patients, Cisplatin, Gemcitabin regimen has shown better efficiency and toxicity profile. Preferred regimen could be Cisplatin, Gemcitabin.

Most of the foreign bodies which enter oesophagus will pass through it freely, while 10-20% of them in most cases remain in physiological and pathological narrowings what requires an intervention. These patients are urgently sent to departments of otolaryngology, gastroenterology, thoracic surgery and general surgery. In adults the most common foreign body is a bone or a lump of meat. Different techniques for extraction of foreign body from oesophagus have already been described: rigid and flexible endoscopy, by Foley catheter, and most recent method of laparoscopic surgery. In our study, we have shown a case where we performed an extraction of foreign body from distal oesophagus by combining endoscopic and laparoscopic method, after an unsuccessful attempt of extraction of foreign body by only endoscopic methods.

Diaphragm injuries are diagnosed in the acute phase of blunt trauma only in 10% of cases--more often they are presented as hernia. Traumatic diaphragmatic hernia presents unique obstacles to a minimal invasive approach. However, with the proper training and equipment, most of these hernias are amenable to laparoscopic approach. These patients can expect the same well-known benefits of laparoscopic approach. We report here the case of a 56-year-old man, admitted to hospital with symptoms of vomiting, abdominal pain and dispnea who sustained blunt abdominal trauma in a high speed motor vehicle accident nine months ago. X-ray and CT scans confirmed suspected strangulated diaphragmatic hernia which contained stomach, colon, majoromentum and spleen in left hemithorax. The urgent laparoscopic procedure was performed--omentum, colon and stomach were taken backthrough diaphragmatic defect but the spleen was tightly fixed in thoracal cavity and splenectomy was performed. The diaphragmatic defect was repaired with interruptured sutures. This case proves that laparoscopic repair of diaphragmatic hernia is effective, but this should be carried out with caution, sometimes it needs additional complex procedure in emergency setting like splenectomy in this case.

Prevalence of hepatitis C virus (HCV) genotypes in Bosnia and Herzegovina (B&H) is an issue that is not sufficiently researched and there is a need for studies that would explore this in detail.The aim of this study was to determine the distribution of HCV genotypes in the group of patients with chronic hepatitis C and also in the group of first time blood donors that tested positive for anti HCV antibodies during the blood screening process. Our secondary goal was to compare the proportions of HCV genotypes between these two groups.We analyzed 75 blood samples of patients with confirmed chronic hepatitis C. We also analyzed 13/16082 blood samples of first time blood donors found to be HCV positive during the blood screening process. We also determined HCV genotype in HCV RNA positive samples.We have found that genotype 1b was more prevalent in chronic hepatitis C patients (52/75; 69,3%) than in first time blood donors (6/13; 46,1%), however this difference was not statistically significant (c2=1,721; df=1; p=0,19). Genotype 1a was more prevalent in the group of first time blood donors (3/13; 23,1%) than in the group of chronic hepatitis C patients (3/75; 4%), but this was also with limited statistical significance (c2=3,71; df=1; p=0,054). We have not found any significant difference in prevalence of genotypes 1a (p=0,2) and genotypes 3 (p=0,70) when compared between chronic patients (3/75 and 16/75; respectively) and first time blood donors (3/13 and 4/13; respectively). Our study confirmed domination of genotype 1b in the region of northeastern B&H which is in accordance with HCV genotype prevalence in other countries in our part of Europe.

UNLABELLED Delayed kidney graft function and acute rejection in the early post-transplant period affect both short and long-term allograft survival. Allograft rejection, as an inflammatory state, results in increased erythropoietin resistance, which leads to decreased haemoglobin (Hb) level. We conducted this study to evaluate whether inflammation in the early post-transplant period could predict later anemia.This is a retrospective cohort study based on the analysis of 64 existing clinical records. PREDICTOR White blood cells (WBC) count obtained by the end of the first week post-transplant (W1). Covariates: Donor's age, recipient's age and sex. OUTCOME Anemia identified at 12 months (M12) post engraftment. Median WBC count at W1 was 9,5 x103/microL (5th - 95th percentile 5,2 x103/microL -17,8 x103/microL). Mean Hb values at M12 were 129,9 +/- 20,3 g/L, in males 136,2 +/- 20,1 g/L and in females 119,4 +/- 16,2 g/L. The significant correlation was found between WBC at W1 and Hb at M12. Pearson coefficient of correlation r was -0,26, and 95% confidence interval (CI) for r was -0,47 to -0,015 (p=0,03). Univariate logistic regression showed significant association between WBC at W1 and Hb at M12 (OR 1,20; 95% CI 1,04 to 1,39, p=0,01). After the adjustment for donor's and recipient's age by transplantation and recipient's sex, multiple regression showed that WBC count remained predictive of anemia at M12 (OR 1,17; 95% CI 1,01 to 1,36, p=0,03). Early post-transplant inflammatory response predicts later anemia in kidney transplant recipients. An increase in WBC count in the first week post-transplant by 109/L increases the risk for anemia after twelve months by 17%.

Objective To evaluate the relationships between simple renal cysts and arterial hypertension and whether their evacuation decreases the blood pressure (BP). Methods In a cross-sectional design, we analyzed 184 study participants with cysts and compared hypertensive and nonhypertensive among them. Outcomes were the number, the size and the location of a cyst. In a cross-over design, we first evaluated the change in absolute value of SBP, DBP and mean BP in 62 hypertensive patients who underwent percutaneous evacuation of a cyst and then the decrease of BP as a categorical variable that comprised all study participants. Results There were 55% giant renal cysts among hypertensive and 24% among nonhypertensive patients (P = 0.0001). The prevalence rates of multiple and peripheral cysts in hypertensive and nonhypertensive patients were similar to those of single and perihilar cysts, respectively. Significant differences in SBP, DBP and mean BP were found between pretreatment readings and 3 days, 1 month, 3 months and 6 months after cyst evacuation (P < 0001). The differences were significant in all hypertensive patients (P < 0.001). There were less hypertensive patients 3 days after treatment than before treatment (P < 0.0001). Conclusion An apparent association between the size of a simple renal cyst and hypertension was found, and aspiration of cysts resulted in a reduction of BP. Location and number of cysts were not related to BP.

The aim of this study was to evaluate whether anemia identified earlier than 3 months postengraftment in modern era could be predictive of anemia at 12 months. Cross-sectional and cohort studies based on retrospective analysis of existing clinical records were performed. Data on recipient's age at transplantation, follow-up serum creatinine (SCR) and hemoglobin (Hb) on day 7 (D7), at month 1 (M1) and at month 3 (M3) postengraftment were collected. Outcome was anemia identified at 12 months (M12) postengraftment. There were 75 patients on D7, 74 at M1 and 61 at M3. Multiple linear regression model that included recipient's age at transplantation, Hb and creatinine on D7 and tested the risk for anemia at M12 retained only the age in the model, with the coefficient of 0,84 (P=0,001). The same model at M1 retained Hb and age, with the coefficients of 0,26 (P=0,03) and 0,81 (P=0,0002), respectively and at M3 it retained Hb and age, with the coefficients of 0,41 (P=0,004) and 0,70 (P=0,003), respectively. Anemia identified at M1 after renal transplantation is predictive of anemia at M12.