Aim. The aim of the present paper is to compare the use ofArtificial Neural Network (ANN) to APACHE II, MOF, TISS-28 and MPI scoring system in prediction of peritonitis-relateddeath in patients with perforative peritonitis. Patients andmethods. A prospective study was performed of 145 patientswith perforative peritonitis, treated in the Surgical IntensiveCare Unit. The main outcome of this study was peritonitisrelateddeath. The Levenberg-Marquardt method was usedfor training, and 16 variables for entrance into the ArtificialNeural Network. Sensitivity and specificity of scoring systemsare graphically shown for the different values of cut-off pointswith the receiver-operating characteristic curve (ROC) curve.Results. We tested 92 cases in a network and found that theAPACHE II system predicted the lowest number of wrongassessments with a score of 12, with all the other scoringsystems predicting 19 wrong assessments. The area underthe curve for the first postoperative day was 0.87 for TISS-28score, 0.86 for APACHE II score, 0.83 for MOF and 0.72 forMPI score. The highest rate of correlation between the observedand the expected mortality rate was in the APACHEII system. This demonstrated that TISS-28 and APACHE IIare significantly better than other systems (P<0.01). In addition,this discriminatory ability was also retained on the thirdand seventh postoperative days. Conclusion. APACHE II issuperior in the prediction of patient outcome to the ArtificialNeural Network and other tested scoring systems.

To the Editor: We read the editorial of Professors Matko and Ana Marusic in the December issue of the Croatian Medical Journal (CMJ) (1). With regret we learned that the policy of the editorial board of CMJ, which created one outstanding, general medical journal, is questioned. We have been reading the CMJ for many years and published several articles in it. We consider Prof. Marusic not only the editor of an excellent journal, but the teacher of medical writing as well. We were aware that, because of our lack of experience, the article we were sending was incomplete, but we were also aware that it would not have the destiny like in other journals, as Prof. Marusic would correct the article with us. The comments in his char acteristic, amusing way what to correct, omit, or add, were making the article better and better… After attending Prof. Marusic’s workshop of medical writing, some on us published the articles in very prestigious journals. We are very grateful to him for his help. Prof. Marusic placed his editorial board at the disposal of the postgraduate students of Tuzla Medical University School of Medicine, as the assistance during the writing of articles which even do not have to be sent to the CMJ – with the wish to expand the awareness of necessity

The appendicitis is one of the most common entities that could be met at surgical department. Chronic pelvic pain of right iliac fossa is common and it causes disability and distress and results in significant costs to health services. Often, investigation by laparoscopy reveals no obvious cause for pain. There are several possible explanations for chronic pelvic pain including undetected irritable bowel syndrome, the vascular hypothesis where pain is thought to arise from dilated pelvic veins in which blood flow is markedly reduced and altered spinal cord and brain processing of stimuli in women with chronic pelvic pain. As the pathophysiology of chronic pelvic pain is not well understood, its treatment is often unsatisfactory and limited to symptom relief. We aimed to identify and review treatments for chronic pelvic pain related to appendicitis. Frequently ultrasound and CT scan cannot confirm the diagnosis of chronic appendicitis due to non significant swelling of vermiform appendix. The study excludes patients with a diagnosis of pelvic congestion syndrome, those with pain known to be caused by gynecological disorders or irritable bowel syndrome. Detailed history, clinical examination, and serological and radiological investigations failed to reveal the cause of the pain in all cases. We presumed that pain is caused by chronic appendicitis with appendicolithiasis and that removal of appendix will result in symptom relief. We performed study with 75 patients treated by laparoscopic appendectomy. Duration of symptoms ranged from 3 to 48 months, with a mean of 13.1 months. All patients included in this study had right iliac fossa pain lasting more than three months. We performed radiological contrast studies to verify appendicolithiasis of irregularity of appendicular wall. Patient with mild symptoms were excluded, only patients that have symptoms that cause disability were operated. We compared pain according to localization, duration and character. We evaluated the pain one month after operation and compared its characteristics with preoperative pain. There is strong evidence that postoperative pain is significantly lower in operated patients and most of them are without any symptoms after operation.

Peritonitis signifies inflammation of peritoneum, whose cause is not specific. It can be regarded as local equivalent of systemic inflammatory response which is seen after any trigger of inflammation and referred to as "systemic inflammatory response syndrome (SIRS)". Intraabdominal infection is actually peritonitis caused by bacteria (local systemic inflammatory process caused by bacteria and their toxins). It can be regarded as a local equivalent of systemic sepsis. Because most of clinically significant peritonitis are caused by bacteria, both of terms are used simultaneously. Peritonitis takes place together with many, complex pathophysiological changes on systemic and cellular level. Consequences of peritonitis depend on the result of the battle between two main forces: the patient's systemic and peritoneal defense on one side, and the nature and duration of contamination on other side.

Locally advanced colorectal canter may require an intraoperative decision for the block resection of surrounding organs or structures to achieve complete tumour removal. This decision must weigh the risk of complications and death of multivisceral resection against a potential survival benefit. Little is known about the prognostic factors and their influence on the outcome of multivisceral resection for colorectal cancer. We demonstrate our experience with multivisceral resections for the primary colorectal cancer. Patients undergoing multivisceral resection for primary colon or rectal cancer between I-I.2000-I-VII.2003 were identified from retrospective database. Multivisceral resection was performed in 41 of 378 patients with a median age of 61 years. Postoperative rates of complications and death in 41 patients were 30.9% and 12.1%. Histologic tumour infiltration was shown in 58.3% of patients with curative resection. Multivisceral resection is safe, and long-term survival after curative resection is similar to that after standard resection. As the palliative resections cannot be predicted accurately at the time of surgery, every effort should be made to achieve complete tumour resection.