OBJECTIVE The aim of the study was to investigate plasma D-dimer concentration in patients with liver cirrhosis with and without ascites and to evaluate the impact of ascites depletion on circulating plasma D-dimer levels. METHODS Sixty patients with liver cirrhosis were recruited and categorized into two groups: cirrhotic patients without ascites in group 1 (n = 30) and patients with liver cirrhosis and ascites in group 2 (n = 30). D-dimer levels were measured on day of admission, in patients with ascites D-dimer concentration levels were repeated measured after ascites resolution cofirmed by ultrasonography. RESULTS Mean D-dimer levels showed significant increase in cirrhotic patients decompensated by ascites (626.0 +/- 231.08 microg/L) when compared with healthy controls (140.73 +/- 49.16 microg/L, p < 0.001). There was also a statistically significant increase of mean D-dimer levels in patients with liver cirrhosis and no evidence of ascites (333.4 +/- 109.05 microg/L, p < 0.001). In all patients after ascites resolution D-dimer levels showed significant reduction (437.66 +/- 130.47 microg/L, p < 0.05). Values of D-dimer levels achieved after abdominal paracenthesis (n = 21) where still higher than those in patients without ascites (480.14 +/- 122.85 microg/L, p = 0.001). In cirrhotic patients treated with diuretic therapy (n = 9) circulating D-dimer levels were not significantly different from those in cirrhotic patients without ascites (338.56 +/- 90.55 microg/L, p = 0.96). CONCLUSION The presence of ascites in patients with liver cirrhosis is associated with increased plasmatic fibrinolytic activity. Less aggressive ascites resolution therapy has an greater impact on reducing plasmatic fibrinolytic activity than achieved by abdominal paracenthesis.

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

AIM To compare two schedules (continuous infusion or bolus i.v. of PPI) in treatment after endoscopic homeostasis of bleeding ulcers. METHODS Patients with gastrointestinal bleeding caused by peptic ulcer, or a recent history (< 24 h before presentation) were included in the study. All cases with actively bleeding ulcers were treated with epinephrine injection and/or thermal coagulation, and randomized to receive intravenous PPIs according to the continuous regimen (in continuous infusion) or the standard regimen (40 mg bolus twice a day for 3 days). RESULTS 69 patients were treated. Bleeding recurred in 5 of 34 patients (14.7%) receiving the intensive regimen, and in 8 of 35 (22.8%) patients receiving the standard regimen. Hemoglobine rate in standard regimen group was 93,5 g/L (SD 23,8), and in intensive regimen group 106,6 g/L (SD 22,4) (p = 0.042). Total protein rate in the standard regimen group was 65,1 g/L (SD 7,3) and in the intensive regimen group 67,7 g/L (SD 8,15), (p = 0.525). Albumin rate in the standard regimen group was 31,0 g/L (SD 5,2), whereas in the intensive regimen group it was 34,8 g/L (SD 7,4), (p = 0.652). Globulin rate in the standard regimen group was 31,0 g/L (SD 5,2) and in the intensive regimen group 32,3 g/L (5,3), (p = 0.875). Fibrinogen rate in the standard regimen group was 11,1 (SD 2,6) and 10,8 g/L (SD 2,4 p = 0.622) in the intensive regimen group. A mean number of units of blood transfusion for patients in the intensive group was 2,18 (SD 0,8) and 1,34 (SD 1,02) in the standard group, with statistical level of difference p = 0.0004, using Student t-test. The duration of hospital stay was 6,4 days (SD 2,8) in the standard group and 5,8 days (SD 2,8) in the intensive group (p = 0.40). There were fewer surgical interventions in the intensive versus standard regimen. CONCLUSION In patients with bleeding peptic ulcers with successful endoscopic hemostasis the standard IPP regimen had advantage for transfusion requirements, but no advantage with respect to in-hospital rates of re-bleeding, need for surgery, length of hospital stay, or death.

Background and Aims: Hepatic steatosis seems to be a risk factor for poor response to interferon and ribavirin therapy in patients with chronic hepatitis C. The aim of this study was to determine presence of hepatic steatosis in chronic hepatitis C and its influence on early virological response in patients treated with combined antiviral therapy (pegylated interferon and ribavirin). Methods: We studied 96 patients treated at Gastroenterohepatology Department, in the period of four years (2005-2009). There were 71 males and 25 females enrolled in this study. 72 patients had genotype 1, 5 patients had genotype 2, 17 patients had genotype 3 and 2 patients had genotype 4. Liver histology was evaluated in order to establish presence of inflammation, fibrosis and steatosis. HCV RNA levels in sera were measured by real time PCR. Early virological response (EVR) was defined as negative serum HCV RNA at week 12. In order to measure the effect influence of steatosis on early response to therapy, as well as genotype and response to therapy, we calculated relative risk and the corresponding p-value after 12 and 48 weeks. Results: The overall rate of EVR was 70%. The rate was significantly lower in the group with steatosis, regardless of the presence of micro or macrosteatosis, amounting to 60%. Serum cholesterol level was significantly higher in females than in males (7.4±0.7 vs. 5.1±0.3 mg/mL). The values of relative risks (and p-values) for effect of steatosis on the response are RRS12=8.4615 (2.87E-05), and RRS48=0.9844 (0.7399), while the values for the effect of genotype to therapy were RRG12=1.3378 (0.7543), and RRG48=3.5862 (0.2709). Conclusions: Our findings suggested that hepatic steatosis may have a strong influence on interferon therapy response in the sence that it is eight times more probable to not respond in the presence of steatosis. The presence of steatosis was highly associated with progressive disease and failure to achieve the EVR; therefore it can be a predictor of poor response to antiviral therapy.

Crohn's disease (CD) is a chronic inflammatory disease characterized by unpredictable and severe course. Most clinicians use simple laboratory parameters of inflammatory activity such as erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), the number of leukocytes (Le) and platelet count to assess disease activity. The aim of this paper was to determine the value of various laboratory parameters in the assessment of Crohn's disease activity. The study included 36 patients, 15 men and 21 women, treated for Crohn's disease at the Gastroenterohepatology Clinic, Clinical Centre, University of Sarajevo, in period 2006 and 2007. Assessed patients were divided into three groups, according to the degree of disease activity, which was determined using the Crohn's Disease Activity Index (CDAI). Mild disease (MD) was present in 15, moderately severe disease (MSD) in 14, and severe disease (SD) in 7 patients. Statistical significance of association between values of laboratory parameters with the degree of severity of illness was investigated using the 95% Confidence Interval test. CRP showed a statistical significance for the relationship between MD-MSD (95% CI 6,645-74,333) and the relationship between MD-SD (95% CI 4,114-135,278), while the relationship between MSD-SD was not statistically significant. MPV showed statistical significance only for the relationship between MD-MSD (95% CI 0,060-2,909). Sedimentation rate and the number of red blood cells showed statistical significance for the relationship MD-SD (95% CI 10,638-62,943 and 0,077-1,080). Haemoglobin, hematocrit and platelet count showed statistical significance for the relationship between MD-MSD and MD-SD. Number of leukocytes did not show any statistically significant relationship with clinical activity of disease. The most reliable indicators of activity of Crohn's disease in this study were CRP, MPV, haemoglobin, hematocrit and platelet count, while leukocyte number did not correlate with disease activity. Neither parameter was sensitive enough to distinguish the relationship between moderately severe disease and severe disease. Until finding a "gold standard" for assessment of clinical disease activity, various laboratory and other parameters must be combined and compared with other indicators, such as endoscopic findings and radiological results.

The role of ferritin in fibrogenesis of liver parenchyma in patients with alcoholic liver disease has been investigated in previous studies. Ferritin was shown to be an indirect marker of ferum deposition in liver parenchyma in alcohol liver disease. The aim of the present study was to examine the role of nitric oxide (NO) in the pathogenesis of alcoholic liver disease as well as the influence of NO on iron (ferritin) metabolism in patients with alcoholic liver disease. Serum concentrations of NO and iron markers (iron, total iron binding capacity, ferritin) were measured in 30 male patients (aged 20-60 years) with alcoholic liver disease, as well as from a control group (30 male patients (aged 20-60 years) without liver disease). NO concentration was detected by measuring production of nitrates and nitrites using classical colorimetric Griess reactions. There was a statistically significant increase in serum NO concentration in patients with alcoholic liver disease compared to the control group (mean +/- SEM; 41,2 +/- 25,3 vs. 28,9 +/- 12,3 mmol/dm3, respectively; p<0,03). Similarly, serum iron levels (18,7 +/- 8,2 vs. 13,2 +/- 10,2 g/100 cm3, respectively; p<0,03) and serum total iron binding capacity (51,3 +/- 13,9 vs. 41,4 +/- 11,4 micromol/dm3, respectively; p<0,005) were also significantly higher in patients with alcoholic liver disease compared to control patients. The serum concentration of ferritin was 27% higher in patients with alcoholic liver disease than in the control group; however this was not statistically significant (283,2 +/- 291,0 vs. 222,9 +/- 252,0 g, respectively; p<0,4). There was no correlation between NO and ferritin in the investigated groups. These results suggest a possible role of NO and iron in the pathogenesis of alcoholic liver disease. NO and iron may be used as non-invasive predictors of liver damage. Also the role of iron in sera, and its deposition in liver parenchyma, could be used in clinical practice, especially in regards to assessing the fibrogenesis of liver parenchyma induced by ferritin.

BACKGROUND Peptic ulcer bleeding is a common and potentially fatal condition. For patients with bleeding peptic ulcers that display major endoscopic stigmata of recent hemorrhage, a combination of endoscopic and pharmacologic therapy is the current standard management. OBJECTIVE To show our experience with management of peptic ulcer bleeding. PATIENTS Patients who presented with gastrointestinal bleeding caused by peptic ulcer or recent history (< 24 h before presentation) of hematemesis and/or melena admitted to our hospital emergency departments, and patients whose ulcer hemorrhage started after hospitalization for an unrelated medical or surgical condition. METHODS Patients with actively bleeding ulcers and those with nonbleeding visible vessel or adherent clot were treated with epinephrine injection and/or endoscopic hemoclips, and randomized to receive intravenous pantoprasole according to the continuous regimen (dose of 5 x 40 mg in continuous infusion of 8 mg/h for 72 h) or the standard regimen (40 mg bolus of PPI twice daily for 3 days). After the infusion, all patients were given 40 mg PPI twice daily orally. The primary end point was the in-hospital rebleeding rate, as discovered by the repeated endoscopy. RESULTS Bleeding recurred in 5 of 34 patients (14.7%) receiving the intensive regimen, and in 8 of 35 (22.8%) patients receiving the standard regimen. Hemoglobin (g/l) rate in standard regimen group was 93.5 +/- 23.8, and in intensive regimen group 106.6 +/- 22.4 (P = 0.042). Mean units of blood transfused for all patients in group were 71.8 +/- 45.8 in the intensive and 45.3 +/- 50.2 in the standard regimen group (P = 0.0257). The duration of hospital stay was 6.4 +/- 2.8 in standard group and 5.8 +/- 2.8 in the intensive group (P = 0.40). CONCLUSIONS In patients with bleeding peptic ulcers with successful endoscopic hemostasis the standard PPI regimen had advantage on transfusion requirements, but no advantage with respect to in-hospital rates of rebleeding rates, need for surgery, length of hospital stay, or death, which corresponds with recent studies.

Th e role of ferritin in fi brogenesis of liver parenchyma in patients with alcoholic liver disease has been investigated in previous studies. Ferritin was shown to be an indirect marker of ferum deposition in liver parenchyma in alcohol liver disease. Th e aim of the present study was to examine the role of nitric oxide (NO) in the pathogenesis of alcoholic liver disease as well as the infl uence of NO on iron (ferritin) metabolism in patients with alcoholic liver disease. Serum concentrations of NO and iron markers (iron, total iron binding capacity, ferritin) were measured in  male patients (aged – years) with alcoholic liver disease, as well as from a control group ( male patients (aged – years) without liver disease). NO concentration was detected by measuring production of nitrates and nitrites using classical colorimetric Griess reactions. Th ere was a statistically signifi cant increase in serum NO concentration in patients with alcoholic liver disease compared to the control group (mean ± SEM; , ± , vs. , ± , mmol/dm, respectively; p<,). Similarly, serum iron levels (, ± , vs. , ± , g/ cm, respectively; p<,) and serum total iron binding capacity (, ± , vs. , ± , μmol/dm, respectively; p<,) were also signifi cantly higher in patients with alcoholic liver disease compared to control patients. Th e serum concentration of ferritin was  higher in patients with alcoholic liver disease than in the control group; however this was not statistically signifi cant (, ± , vs. , ± , g, respectively; p<,). Th ere was no correlation between NO and ferritin in the investigated groups. Th ese results suggest a possible role of NO and iron in the pathogenesis of alcoholic liver disease. NO and iron may be used as non-invasive predictors of liver damage. Also the role of iron in sera, and its deposition in liver parenchyma, could be used in clinical practice, especially in regards to assessing the fi brogenesis of liver parenchyma induced by ferritin.

INTRODUCTION Colorectal cancer is one of the most common forms of cancer and its frequency has been on the constant and significant increase over the past 20 years. Prevention aiming for early precancerous detection, results in huge financial savings in the health care system. METHODOLOGY AND TEST SUBJECTS: Prospective randomized clinical research was conducted on 150 randomly chosen asymptomatic persons over the age of 50, with positive family history. All test subjects were given a Haemoccult test and colonoscopy examination. Primary objective of the research was to detect precancerous symptoms of colorectal cancer or large intestine cancer in the early stage of the disease when it is therapeutically curable. Secondary objective was to prove that colonoscopy represents an obligatory examination of the large intestine, as well as to introduce a Haemoccult test as a regular diagnostic procedure on the level of primary and secondary health care for asymptomatic patients over the age of 50. RESULTS Out of 80/230 test subjects who did not fully complete the examination, 62 (77.5%) did not respond to the test reading for obscure bleeding, whereas 18 of them did not consent to be given a colonoscopy examination. Two registered neoplasm were found in the rectosigmoid colon, and the polyps were found in rectosigmoid colon in over 2/3 of the patients. In 125/150 test subjects, the test for obscure bleeding was negative (p < 0.001), but the colonoscopy procedure proved that 11 patients had precancerous changes (polyps). This proved that the test was not highly sensitive and it was recommended that it should be conducted in combination with colonoscopy. Patients with positive test (n = 14) had 8 normal colonoscopy results, but the difference was not significant. CONCLUSION Application of the test for detection of obscure bleeding once a year, in combination with flexible colonoscopy every 5 years, significantly reduces the risk of colorectal cancer inception.

INTRODUCTION AND OBJECTIVE Many illnesses are related to the loss of appetite or the inability to intake food in a regular fashion. The consequence of long-term or even short-term non-intake of food leads to damaging of organ functions and tissue. Tissue consumption, which is speeded up through metabolic effects of inflammatory mediators, is a characteristic which is identified as clinical malnutrition. The objective of this paper is to offer leading guidelines for uncovering the risk of malnourishment, whilst suggesting several standards which are practical for general use with patients and health workers. METHODOLOGY AND TEST SUBJECTS: This, systematically planned, descriptive, biannual (2006-2007) prospective clinical research, included in total 2.200 hospitalised patients at Clinical Centre University of Sarajevo. Test subjects were hospitalised patients with precisely determined diagnosis, for the purpose of evaluating test subjects' nutritional status and the prevalence of hospital malnourishment. RESULTS According to MUST test, total of 58% of test subjects were malnourished. The test relied more on the subjective evaluation of the patient and was not proved as acceptable for general screening. According to NRS 2002 test, total of 52.04% of test subjects from other clinics were malnourished. Test was suitable because the "yes" and "no" answers were acceptable for the patient and the final screening was simple. According to MNA test, total of 55.3% from all test subjects were malnourished, but the test was not suitable because the answers were more subjective and as such, unacceptable for both patients and doctors. CONCLUSION More than 55% of test subjects were in the clinical malnourishment, which was proved with all three tests. The highest risk of malnutrition among patients with internal illnesses is carried by oncology patients. BMI must be routinely conducted on first examination. NRS 2002 test is suitable and acceptable for the patient.

Patients with verified early stage of the esophageal carcinoma are presented with a very good prognosis, however all over the world patients present themselves with advanced stages thus minoring the chances for survival. Data obtained form the USA programmes are presenting information about 5 year survival period in 14% of the cases. On the other hand, prospective multi centric European study refers to the same period in 10%. UK studies are presenting age-standardized relative rate of survival at 25% for the first 2 years and corresponding 4,8%-6,3% for the 5 year period. Prognoses are deteriorating with the progression of the primary tumor, thus patients in stage IV are facing 5 year survival period in less than 5 % of the cases. 5 year survival period for patients, who underwent surgery in N0 stage, is 40%-60% comparing to 5%-17% for those in confirmed N1 stage. Patients who undergo surgery in confirmed T3N1 stage are faced with 5 year survival period in 8%-10% of the cases, emphasizing the fact that these tumors are operable, but rarely curable by surgery itself. Neo adjuvant therapy use is increasing for the patients in stages IIB and IIC (local progression of the tumor), aiming to decrease the size of the primary cancer prior to surgery thus increasing the rate of long term survival. Our experiences brought out in this study correlate with the foreign results thus aging stressing the fact that the exact staging of the tumor is the basics for the treatment as well as the right choice of the patients for surgery treatment, and those who need neo adjuvant therapy.

Endoscopic ultrasound (EUS) and Magnetic Endoscopic Cholangiopancreatography (MRCP) are important supplementary methods used for endoscopic extraction of common bile duct stones. The technical characteristics of both methods are excellent. If EUS is used for diagnostic purposes in diagnostic of biliary tree disorders there are almost no adverse consequences compared with other indication for this method. Nevertheless, the results are related to experience of physician. Advance of EUS compared to MRCP is its sensitivity and specificity even in cases where stones are small and dilation of biliary tract is minor. The role of EUS and ERCP in reveal of biliary tree stones and disorders is clearly defined. Comparasion of these two methods should be prospective and used in cases where definitive diagnosis is unclear. If EUS reveal stones in biliary tree then ERCP should be done in same session. Beside its role in excluding biliary pancreatitis, EUS can be used for examination of patient with acute and recurrent pancreatitis and is excellent for revealing ductal and parenchymal abnormalities of pancreas.

INTRODUCTION Endoscopic ultrasonography (EUS) is a well-established method of evaluating patients with gastrointestinal diseases, especially malignancies. EUS is like other similar endoscopy techniques, based on high frequency ultrasonography. This high level technology allows examination of tissue to almost microscopic level, not only in digestive system but its surrounding structures. OBJECTIVE The aim of this study was to determine the contribution of endoscopic experience, based on the number of endosopic ultrasonography examination performed in the three years period, to obtain 80% diagnostic accuracy with staging of the disease in order to achieve a 30-60% change rate in treatment decisions which is accepted standard. RESULTS First group with 210 patients was examined in the first year of work; 325 examined in the second year of work and 295 in the third year. DIAGNOSTIC Accuracy in the first year of work, were 45% (p<0.001 for the choledocholithiasis; p=0.197 for the pancreatic cancer; p=0.195 for LN detection in the gastric cancer). In the second year of work diagnostic accuracy were 78%/p=0.550 for the choledocholithiasis; p=0.228 for the pancreatic cancer; p=0.503 for LN detection in the gastric cancer/. Diagnostic accuracy in the third year of work were 81%/p<0.001 for the choledocholithiasis; p=0.018 for the pancreatic carcinoma; p=0.042 LN detection in the gastric cancer/. CONCLUSION Application of Endoscopic ultrasonography in diagnostics, based on number of EUS examination performed, after three years of work, achieved 80% diagnostic accuracy, compared to standard imaging methods and results of surgery in staging of the disease. EUS results made a change in treatment decisions in 30-60% of patients which is world standard and completely justify use of endoscopic ultrasonography in clinical practice.

OBJECTIVE To evaluate the influence of the laparoscopic tehnique in healing of hernia from the perspectives of time to full recovery, return to work and complications. TYPE OF STUDIES: Randomized, prospectiv study. All relevant factors, should be important to evaluate operative method. Laparoscopic operative treatment has several advantages over classical operative techniques. Main advantage is less tissue damage and consequently less possibility of postoperative complications. Furthermore, period of rehabilitation for patient is shorter, with less pain and shorter period for recovering. PATIENTS AND METHODS A group of 60 qualified patients was formed with non complicated inguinal hernia. Patients of both gender, aged 19-68, were preoperatively examined. Intraoperative wounds during operation were defined as an intraoperative complications. In postoperative course complications were divided on immediate, early and late postoperative. Patients were re-examined during hospitalization, in the periods of one month, six month, one year and two years after operation. RESULTS We had no intraoperative complications. Two immediate complications were observed scrotal swelling and hematoma. Two early postoperative complications were also noted a general disuric complication and purulent wound inflammation. As well we have noted only one late complication; pain in inguinal region. We had two relapsing hernias. Duration of hospital treatment was 1-7 days with average of 2,5 days for examined group. Overall absence was 10 day and patients were back to job under full physical activities. CONCLUSION In non complicated inguinal hernia, laparoscopic tehnique have less complications than classic methods, shoter time to full recovery and to return to work.