BACKGROUND The high prevalence of metabolic syndrome in patients with psychiatric disorders, almost double the prevalence reported for the general population, is worrying. The aim of this study is to investigate the presence of metabolic syndrome and inflammatory marker levels in patients with schizophrenia and recurrent depressive disorder in a Croatian psychiatric sample. SUBJECTS AND METHODS This study included 62 inpatients with schizophrenia and 62 with recurrent depressive disorder treated at the Department of Psychiatry, University Hospital Centre Split, enrolled from November 2011 until May 2012. The cases were compared to 124 healthy subjects from the general population. RESULTS The presence of metabolic syndrome was found in 56.5% of the patients with schizophrenia and 53.2% of the patients with depression, which was significantly more prevalent than in the control group (32.3%). The levels of inflammation markers (i.e., C-reactive protein and PAI-1) were significantly higher among patients with metabolic syndrome. CONCLUSIONS Patients with schizophrenia and recurrent depressive disorder demonstrate a high prevalence of metabolic syndrome that is also related to inflammation processes. In the context of integrative medicine, clinicians and researchers should consider psychiatric patients within a holistic approach.

Introduction. Multiple symmetric lipomatosis, or Madelung's disease, is a rare condition which is characterized with large symmetrical accumulation of noncapsulated fat tissue in upper arms, neck, and shoulder areas. The disease etiology is unknown, with the highest incidence in the Mediterranean region. Case Presentation. Here, we present the case of Madelung's disease with symmetric fat distribution throughout the neck and history of alcoholism. The patient was treated from several diseases associated with alcoholism and hospitalized several times, but the diagnosis of Madelung's disease was omitted. The thyroid gland disease was excluded, while enlargement of the neck adipose tissue was attributed to obesity. Conclusions. This study points out possible diagnostic mistakes when a physician is not aware of a differentiation diagnosis of symmetrically enlarged neck masses, especially in geographic regions with high incidence of this disease.

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

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

their poor general condition and because it would be difficult to discriminate between necrotic and normal tissue during the sur-gery. Besides, the risk of uncontrolled hem-orrhage during or immediately after the surgery would be very high. Open necrosectomy results in signifi-cant deterioration of organ dysfunction scores after the procedure [2]. M IPN is less aggressive compared to open surgery but it is a much more aggressive method com-pared to percutaneous catheter drainage (PCD) using 8- or 10-Fr catheters under ultrasound or CT control (general anes-thesia, progressive dilatation of the drain tract to 30 Fr allowing insertion of a trocar, using grasping forceps for removal of ne-crotic tissue) [1, 3]. P CD seems technically feasible in the vast majority of patients with necrotizing pancreatitis [4, 5] . B-esides, with this method a few catheters can be simultaneously introduced into liquid areas of necroses (into different pancreatic and peripancreatic regions) without gen-eral anesthesia and with fewer traumas, performing vigorous irrigation with simi-lar or better effects than by MIPN. On the basis of our long-term experi-ence [4, 6] , we believe that necrosecto-my (including MIPN) as a primary treat-ment may represent overtreatment of IPN. Therefore, we consider that sole conserva-tive treatment with proper intravenous hy-dration and administration of proper an-tibiotics should be performed at the begin-ning of the disease. PCD with vigorous D e a rE d itor, We read with great interest the article by Ahmad et al. [1] published in issue 1 of Pancreatology 2 011, volume 11. The article describes a case series outlining the expe-rience and results of retroperitoneal mini-mally invasive pancreatic necrosectomy (MIPN) and demonstrates that MIPN can be performed with acceptable morbidity and mortality and with good end results. The authors note that multiple MIPNs may be needed to eradicate the necrosis satisfactorily [1] . However, we wish to highlight certain issues regarding the statement that multiple MIPNs represent the optimal treatment for infected pancre-atic necroses (IPN). In the beginning of acute necrotizing pancreatitis, pancreatic and peripancreatic necroses are solid and the discrimination between necrotic tissue and normal tissue is very difficult. However, during the course of IPN, after the transition from solid ne-crotic tissue to more liquid contents takes place, there is a chance of a higher success rate in evacuating the necrotic tissue from the cavities, regardless of the method that is used. The presence of infection and vigor-ous irrigation can accelerate the process of transition from solid necrotic tissue to more liquid content. In those conditions, patients with necrotizing pancreatitis are not good candidates for surgery because of

The presence of peritoneal carcinomatosis arising from gastrointestinal and gynecologic tumors is associated with a poor prognosis. Animal models of peritoneal carcinomatosis are important in the evaluation of new treatment modalities. The purpose of this study was to investigate the effect of local chemoimmunotherapy and hyperthermal intraperitoneal chemotherapy (HIPEC) in an animal model of induced peritoneal carcinomatosis in the mouse. For induction of peritoneal carcinomatosis, cells from transplantable mammary carcinoma (MCa) were implanted intraperitoneally in CBA mice. Seven or 3 days before implantation of MCa cells (5 x 10 (3)) the mice were injected with lyophilized water extract from CAUCALIS PLATYCARPOS L. (CPL; 200 mg . kg (-1)) into the abdominal cavity. Immediately after implantation of MCa cells in the abdominal cavity, mice were treated two times with 2 mL of saline that was heated either at 37 degrees C or 43 degrees C (hyperthermal treatment) and cytostatics (doxorubicin 20 mg . kg (-1), cisplatin 10 mg . kg (-1), mitomycin 5 mg . kg (-1), 5-FU 150 mg . kg (-1)). We followed the survival of animals and the side effects appearing with different forms of treatment. CPL increased the life span of mice with peritoneal carcinomatosis without hyperthermal treatment (ILS% = 32.55 %) but showed no effect on the life span of mice with hyperthermal treatment (ILS% = 1.44). Combined treatment with CPL and cytostatics (CIS, DOX, and MIT) significantly affected the development of peritoneal carcinomatosis and increased the survival of mice (ILS% - 37 degrees C = 144.17, 415.46, and 124.13, ILS% - 43 degrees C = 311.42, 200.74, and 138.33, respectively). However, intraperitoneal chemotherapy with 5-FU alone resulted in greater survival time of mice than the treatment with 5-FU + CPL. Results suggest the synergistic effect of hyperthermia, chemotherapy, and immunotherapy. CPL significantly increases the antitumor activity of the hyperthermic chemotherapy and the survival rate of mice with peritoneal carcinomatosis. The stimulative effect of CPL on immunomodulation may be a possible mechanism which protects mice from developing peritoneal carcinomatosis and reduces the side effects of chemotherapy, increasing the life span of mice.

Purpose: The purpose of this study was to investigate the effect of local chemoimmunotherapy and hyperthermal intraperitoneal chemotherapy (HIPEC) in a mouse model of induced peritoneal carcinomatosis. Material and methods: Peritoneal carcinomatosis in mice was produced by intraperitoneal implantation of MCa cells (5 × 103). Interleukin-2 (4.1 × 104 IU/mouse) was injected into the abdominal cavity of mice at day 7 and 3 before implantation of tumour cells. Immediately after implantation of MCa cells mice were treated twice with 2 ml of saline that was heated either at 37°C or 43°C and cytostatics (doxorubicin 20 mg kg−1, cisplatin 10 mg kg−1, mitomycin 5 mg kg−1, or 5-FU 150 mg kg−1). We followed the survival of animals and side effects appearing with different forms of treatment. Results: Combined treatment with Interleukin-2 (IL-2) and cytostatics (5-FU, CIS or MIT) significantly affected the development of peritoneal carcinomatosis and increased the survival of mice (ILS% – 37°C = 29.88, 199.32, and 108.52, ILS% – 43°C = 62.69, 260.50, and 178.05, respectively). However, intraperitoneal chemotherapy on survival time of mice with DOX + IL-2 was ineffective as compared with DOX alone. Conclusion: We would like to stress that treatment with IL-2 prior to tumour diagnosis is not clinically practical, rather, the manuscript attempts to describe an experimental proof of principle. Results suggest the synergistic effect of hyperthermia, chemotherapy and immunotherapy; IL-2 significantly increases antitumor activity of hyperthermic chemotherapy and survival rate of mice with peritoneal carcinomatosis.

Peritoneal carcinomatosis is prognostically a very bad sign and common cause of death in patients with gastrointestinal and gynecologic tumors. The aim of this study was to explore and compare different models of locoregional immunochemotherapy, hyperthermial intraperitonal chemotherapy (HIPEC) in animal model of induced peritoneal carcinomatosis in mice. Material and methods: CBA mice were injected with mammary carcinoma (MCa) cells intraperitoneally (ip) inducting peritoneal carcinomatosis. In preventional model biological response modifiers (BRM), interleukin-2 (IL-2) at dose of 4.1 x 104 IU/mouse was injected into abdominal cavity seven and three days before injection of tumor cells, respectively. Immediately after the injection of tumor cells, heated saline at 37°C or at 43°C was injected ip (hyperthermia treatment). Following this mice were ip treated with doxorubicin (DOX) 20 mg kg-1, cisplatin (CIS) 10 mg kg-1, mitomicyn (MIT) 5 mg kg-1, 5- fluorouracil (5-FU) 150 mg kg-1 either separately or in combination of them. In therapeutic model cytostatics were injected on day 5 after injection of tumor cells. Hyperthermia treatment was performed immediately before injection of cytostatic drugs. Results: Results showed significant difference in surviving time (engl. increased life span ; ILS%) of mice pretreated with IL-2 and treated with hyperthermic chemotherapy compared with control: IL-2+ CIS (ILS%=260, 50) ; IL-2+ DOX + CIS (ILS%=200) ; IL-2 + MIT (ILS%=178, 05) ; IL-2 + CDL (ILS%=70, 20) ; IL-2+ DOX (ILS%=67, 92) ; IL-2 + 5-FU (ILS%=62, 69) ; IL-2+ 5-FU+ DOX (ILS%=55, 22). Treatment with IL-2+ 5-FU+ CIS was shown to be toxic to mice since all mice died before control group. Conclusion: The results suggest the synergistic effect of hyperthermia, chemotherapy and immunotherapy ; IL-2 significantly increases antitumor activity of hyperthermic chemotherapy and survival rate of mice with peritoneal carcinomatosis. It is likely that stimulative effect of IL

Background/aims: Peritoneal carcinomatosis is prognostically a very bad sign and common cause of death in patients with intestinal and stomach carcinoma as well as other gastrointestinal and gynecologic tumors. During a tumor surgery risk of peritoneal carcinomatosis is high because tumor cells are "dropping off" from the tumor surface which infiltrates serosa of abdominal cavity in which it has been developed, so iatrogen peritoneal carcinomatosis develops. The aim of this study was to explore and compare different models of locoregional immunochemotherapy, hyperthermial intraperitonal chemotherapy (HIPEC) in unique animal model of induced peritoneal carcinomatosis in mice. Material and methods: CBA mice were injected with mammary carcinoma (MCa) cells into abdominal cavity and consecutive peritoneal carcinomatosis was induced. In so called prevention model biological response modifiers (BRM), plant extract from Caucalis platycarpos (CDL) at dose of 200 mg kg-1 was injected into abdominal cavity seven and three days before injection of tumor cells, respectively. Immediately after the injection of tumor cells we rinsed abdominal cavity with saline that was heated to 37°C or 43°C (hyperthermial treatment) and injected cytostatics: doxorubicin (DOX) 20 mg kg-1, cisplatin (CIS) 10 mg kg-1, mitomicyn (MIT) 5 mg kg-1, 5- fluorouracil (5-FU) 150 mg kg-1 either separately or in combination. In therapeutic model BRMs were injected on day 5th after injection of tumor cells. Hyperthermia treatment was performed immediately before injection of cytostatic drugs. Results: Combination of doxorubicin and plant extract CDL was very effective in prevention consindering survival and pathological signs of peritoneal carcinomatosis. Doxorubicin as a drug of choice alone or in combination with either CDL or 5-FU or cisplatin with reinforced influence caused by hyperthermia, popped up among therapy models. Conclusion: These investigations suggest the synergistic effect of hyperthermia, chemotherapy and immunotherapy with plant extract from Caucalis pltycarpos. The possible mechanism of this treatment should be investigated.

Background/aims: Peritoneal carcinomatosis is prognostically a very bad sign and common cause of death in patients with intestinal and stomach carcinoma as well as other gastrointestinal and gynecologic tumors. During a tumor surgery risk of peritoneal carcinomatosis is high because tumor cells are "dropping off" from the tumor surface which infiltrates serosa of abdominal cavity in which it has developed, so iatrogen peritoneal carcinomatosis develops. The aim of this study was to explore and compare different models of locoregional immunochemotherapy, hyperthermial intraperitonal chemotherapy (HIPEC) in unique animal model of induced peritoneal carcinomatosis in mice. Material and methods: CBA mice were injected with mammary carcinoma (MCa) cells into abdominal cavity and consecutive peritoneal carcinomatosis was induced. In so called prevention model biological response modifiers (BRM), interleukin-2 (IL-2) at dose of 4.1 x 104 IU/mouse was injected into abdominal cavity seven and three days before injection of tumor cells, respectively. Immediately after the injection of tumor cells we rinsed abdominal cavity with saline that was heated to 37°C or 43°C (hyperthermial treatment) and injected cytostatics: doxorubicin (DOX) 20 mg kg-1, cisplatin (CIS) 10 mg kg-1, mitomicyn (MIT) 5 mg kg-1, 5- fluorouracil (5-FU) 150 mg kg-1 either separately or in combination. In therapeutic model cytostatics were injected on day 5th after injection of tumor cells. Hyperthermia treatment was performed immediately before injection of cytostatic drugs. Results: Results of these studies showed significant difference in surviving time (engl. increased life span ; ILS%) of mice pretreated with IL-2 and treated with hyperthermic chemotherapy compared with control: IL-2+ CIS (ILS%=260, 50) ; IL-2+ DOX + CIS (ILS%=200) ; IL-2 + MIT (ILS%=178, 05) ; IL-2 + CDL (ILS%=70, 20) ; IL-2+ DOX (ILS%=67, 92) ; IL-2 + 5-FU (ILS%=62, 69) ; IL-2+ 5-FU+ DOX (ILS%=55, 22). Treatment of mice with IL-2+ 5-FU+ CIS was toxic to mice ; all mice died before control group. Conclusion: The results suggest the synergistic effect of hyperthermia, chemotherapy and immunotherapy ; IL-2 significantly increase antitumor activity of hyperthermic chemotherapy and survival rate of mice with peritoneal carcinomatosis. It is likely that stimulative effect of IL-2 on hematopoiesis, differentiation and proliferation on stem cells as well as immunomodulation may be possible mechanism which protect mice from development of peritoneal carcinomatosis and reduce side effect of chemotherapy treatment increasing life spin of mice. However, the exact antitumor mechanism mechanisms of hyperthermic chemoimmunotheraphy effectiveness have to be elucidated.

Background/aims: Peritoneal carcinomatosis is prognostically a very bad sign and common cause of death in patients with intestinal and stomac carcinoma as well as other gastrointestinal and gynecologic tumors. During a tumor surgery risk of peritoneal carcinomatosis is high because tumor cells are "dropping off" from the tumor surface which infiltrate serosa of abdomenal cavity in which it has been developed, so iatrogen peritoneal carcinomatosis develops. Considering the fact that mean surviving of patients with peritoneal carcinomatosis is between 2.2 and 8.8 months and five years survival period has been found less than 2%, therapeutic and prophylactic modalities which would eventually stop or slow down occurance and development of peritoneal carcinomatosis are investigated. The aim of this study was research and compare different models of locoregional immunochemotherapy, hyperthermial intraperitonal chemotherapy (HIPEC) in unique animal model of induced peritoneal carcinomatosis in mice. Material and mathods:CBA mice were injected with mammary carcinoma (MCa) cells into abdomenal cavity and consequtive peritoneal carcinomatosis was induced. In so called prevention model biological response modifiers (BRM), combination of IL-2 and plant extract from Caucalis platicarpos (CDL) was injected into abdominal cavity seven and three days before injection of tumor cells, respectively. Immediately after the injection of tumor cells we rinsed abdomenal cavity with saline that was heated to 37°C or 43°C (hyperthermial treatment) and injected cytostatics (doxorubicyn, cisplatin, mitomicyn, 5-FU) either separately or in combination. In therapeutic model BRMs were injected on day 5th after injection of tumor cells ; hyperthermia treatment was performed immediately before injection of cytostatic drugs. Results: Combination of doxorubicyn and plant extract CDL was very effective in prevention consindering survival and pathological signs of peritoneal carcinomatosis. Doxorubicyn as a drug of choice alone or in combination with either CDL or 5-FU or cisplatin with reinforced influence caused by hyperthermia poped up among therapy models. Conclusion: Excellent results can be obtained by combing hyperthermia, doxorubicyn and plant extract CDL in prevention and treatment of peritoneal carcinomatosis. When hyperthermia and combination of cytostatics are used drug dosage should be reduced to at least to avoid or to decrease side effects but still keep antineoplastic effect. Naturally, to check these results huge controled clinical studies in more cooperative groups should be conducted.