Overexpression of MRP1/ABCC1, Survivin and BCRP/ABCC2 Predicts the Resistance of Diffuse Large B-Cell Lymphoma to R-CHOP Treatment

BACKGROUND

Approximately 40% of patients with diffuse large B-cell lymphoma (DLBCL) experience treatment resistance to the first-line R-CHOP regimen. ATP binding cassette (ABC) transporters and survivin might play a role in multidrug resistance (MDR) in various tumors. The aim was to investigate if the coexpression of ABC transporters and survivin was associated with R-CHOP treatment response.

METHODS

The expression of Bcl-2, survivin, P-glycoprotein/ABCB1, MRP1/ABCC1, and BCRP/ABCC2 was analyzed using immunohistochemistry in tumor specimens obtained from patients with DLBCL, and classified according to the treatment response as Remission, Relapsed, and (primary) Refractory groups. All patients received R-CHOP or equivalent treatment.

RESULTS

Bcl-2 was in strong positive correlation with clinical parameters and all biomarkers except P-gp/ABCB1. The overexpression of MRP1/ABCC1, survivin, and BCRP/ABCC2 presented as high immunoreactive scores (IRSs) was detected in the Refractory and Relapsed groups (p < 0.05 vs. Remission), respectively, whereas the IRS of P-gp/ABCB1 was low. Significant correlations were found among either MRP1/ABCC1 and survivin or BCRP/ABCC2 in the Refractory and Relapsed groups, respectively. In multiple linear regression analysis, ECOG status along with MRP1/ABCC1 or survivin and BRCP/ABCG2 was significantly associated with the prediction of the R-CHOP treatment response.

CONCLUSIONS

DLBCL might harbor certain molecular signatures such as MRP1/ABCC1, survivin, and BCRP/ABCC2 overexpression that can predict resistance to R-CHOP.

Does miliary sarcoidosis really exist? A case report and review of the literature

BACKGROUND

Miliary sarcoidosis is a rare form of sarcoidosis characterized by numerous miliary-like micronodules dispersed throughout the lungs. It has been documented in less than 1% of all sarcoidosis cases. We first described a rare case of miliary sarcoidosis and then conducted a literature review on the subject.

CASE PRESENTATION

A 51-year-old male complained about a progressive loss of appetite, significant weight loss, occasional night sweats, and fatigue. After a thorough clinical exploration, a differential diagnosis of miliary lung disease was suspected - miliary tuberculosis, fungal infection, metastatic pulmonary carcinoma, or sarcoidosis. High-resolution chest computed tomography revealed bilateral diffuse micronodules with mediastinal lymphadenopathy. Histopathological analysis of transbronchial bioptic tissue identified non-caseating epithelioid granulomas, while no malignant cells were found. Lung tuberculosis and fungal infections were excluded. The levels of angiotensin-converting enzyme in the blood, as well as serum's and 24-hour urine calcium levels, were elevated. After a multidisciplinary discussion, the diagnosis of miliary pulmonary sarcoidosis was established. The patient was treated with prednisone for a total of 9 months, with full clinical and radiological recovery. Using PubMed, we also conducted a review of the literature on this topic and discovered only a few case reports of patients with miliary sarcoidosis, with just one systematic review accessible. The key findings of studies investigating patients diagnosed with miliary sarcoidosis are tabularly displayed.

CONCLUSIONS

Miliary sarcoidosis is an uncommon type of pulmonary sarcoidosis that can mimic several entities that manifest as miliary nodules. Most patients require treatment since it can have a significant impact on lung function.

Optical properties of copper helical nanostructures: the effect of thickness on the SPR peak position

In this study, we have investigated the effect of thickness on the structural and optical properties of copper (Cu) helical nanostructures. Thin films with thicknesses of 160 nm, 280 nm, 450 nm, and 780 nm were obtained by e-beam glancing angle deposition. The morphology and the microstructure were studied by field emission scanning electron microscopy, x-ray diffraction and transmission electron microscopy, while for the optical analysis measurements spectroscopic ellipsometry was used. The results show that the deposited structures are porous with nanometer-sized crystallites preferentially oriented along (111) planes, as well as that the diameter of the helices increases with thickness. Detailed analyses of optical properties have demonstrated that the dielectric function of Cu structures is greatly influenced by the films thicknesses. With increasing thickness from 160 nm to 780 nm, the surface plasmon resonance peak was shifted from 1.31 eV to 1.05 eV, which was correlated with the growth mechanism and the size of deposited nanostructures.

Factors associated with frequency of ectopic pregnancy

Background/Aim: Ectopic pregnancy is defined as a pregnancy outside the uterine cavity, most often in the fallopian tube. It is a life-threatening condition and requires early diagnosis and adequate care. Aim of this study was to examine the frequency of ectopic pregnancy, as well as the influence of parity, age of patients and previous in vitro fertilisation (IVF) procedure on the occurrence of ectopic pregnancy. Methods: A retrospective research was conducted in the Clinic for Gynaecology and Obstetrics of the University Clinical Centre of the Republic of Srpska from 1st of January 2016 up to 31 of December 2018, which included 125 hospitalised patients with a confirmed diagnosis of ectopic pregnancy. Data on the age of patients , parity and previous IVF, as well as the method of treatment of patients with ectopic pregnancy were analysed and compared. Results: In the observed period, there were a total of 9781 births and in the same period, 125 patients with a diagnosis of ectopic pregnancy were hospital-ised, which is 1.27 %. Pregnancy did not occur after IVF. Laparoscopy and drug therapy are represented almost equally, depending on the clinical picture and the wishes of the patients and open access was represented only sporadically. Conclusion: According to this research, the onset of ectopic pregnancy is not affected by age, parity and previous IVF, which does not fit into the results of world research. The most common form of treatment in our country is both lap-aroscopy and medical approach and open access occurs only sporadically, which fits into the recommendations of the relevant guides.

Correlation of hysterosalpingography and laparoscopy in the detection of tubal infertility factor

Background/Aim: Around 15-20 % of couples worldwide struggle with infertility, a difficult and aggravating gynaecological issue. Conception occurs in both partners, male and female, as they are both responsible for conception. This study aimed to evaluate the diagnostic accuracy of hysterosalpingography (HSG) in the detection of tubal infertility factors, by comparing the findings of HSG with the findings of laparoscopy (LPSC). Methods: A retrospective study from 1st January 2018, to 31st December 2019, is presented. Infertile patients who underwent LPSC, HSG and ultrasound to evaluate sterility during this timeframe were included in the research. Results: The study involved 63 infertile patients with a mean lifespan of 33.3 ± 4.7 years. The conclusions of LPSC and HSG, in general, were in good correlation and the percentage of agreement among the diagnostic procedures was 77.8 %. In the case of dichotomous categories, there is a good alignment between LPSC and HSG results with a percentage of 85.7 %. Hydrosalpinx: The findings of LPSC and HSG are quite similar. The percentage of agreement among the diagnostic techniques used was 79.2 %. Canal obturation: LPSC and HSG results are in good correlation with a percentage of 78.6 %. Terminal obturation: LPSC and HSG results are also in good agreement with the calculated percentage of 82.1 %. Conclusion: In determining tubal sterility factors, there is considerable consistency between LPSC and HSG results (c = 0.68; 95 % CI 0.54-0.83). There is a good correlation between LPSC and HSG findings of dichotomous categories (ch2 = 0.63; 95 % CI: 0.41-0.86). 86.2 % of subjects with peritubular appendages and 8.8 % of subjects without peritubular appendages had hydrosalpinx, which is a statistically significant difference (ch2 = 37.957; p < 0.001). Between LPSC and HSG data, there is a good agreement in the diagnosis of hydrosalpinx (c = 0.64; 95 % CI: 0.38-0.91).

The clinical and pathological characteristics and survival of patients with advanced ovarian cancer

Introduction: Ovarian cancer has the highest mortality rate of all gynaecologic malignancies. The aim of this study was the evaluation of the clinical pathological characteristics and survival analysis of primarily operated patients with advanced stages of malignant epithelial ovarian tumour. Methods: The research was conducted as a cohort study with 59 patients with FIGO stage III and IV, which were primarily operated between 1 January 2008 and 31 December 2010 (three years). Age, comorbidities, BMI, presence of ascites, the level of the marker CA-125, histopathology and FIGO stage were analysed. The survival rate was estimated at the level of 1, 3 and 5 years. Results: The median age was 53 years (range 29-86). The most common histopathological type was serous (66.1 %) and the most common FIGO stage was 3a (49.2 %). Optimal cytoreduction was performed in 35.5 % of patients, 84.7 % of patients survived for one year, 44.1 % three years and 37.3 % for five years. The median survival was 26.25 months (range 0-91). Chi-square test showed significant difference between the number of months of survival and: the value of CA125 (t = 2.004, p = 0.050), cytoreduction (p < 0.001) and FIGO stage (p < 0.01). Conclusion: According to the results of this study, optimal cytoreduction and FIGO stage significantly influence survival (p < 0.001). Optimal cytoreduction (< 2 cm of residual disease) had the highest prognostic value for survival. A total five-year survival in this study was 37.3 %.

Effects of elevation gradient and aspect on butterfly diversity on Galičica Mountain in the Republic of Macedonia (south–eastern Europe)

The patterns of butterfly diversity and community changes in relation to elevation are an interesting and well–covered topic in ecology, but the effects of aspect have rarely been evaluated. Here we studied the changes in butterfly species richness and communities along the elevation gradient and aspect of Galičica Mountain. As expected, species richness changed with altitude, showing a bimodal pattern with two peaks and a declining trend towards higher altitude. Changes were well–correlated with the area in each altitudinal zone, while the effects of productivity were less clear. Butterfly communities at higher altitudes were the most distinct when grouped according to β diversity estimates, followed by mid– and low–altitude communities. Indicator species were found in mid–altitudes and for the combination of low–mid and mid–high altitudes, but not among aspects. Overall, aspect produced a less conclusive effect on species richness and community composition. South and north accounted for most of these differences despite dominant western and eastern and exposition of the mountain slopes. The community temperature index declined with altitude and on the northern aspect, showing these areas hosted more cold–adapted species. Notes on butterfly conservation are provided as 23 species known from historical surveys have not been recorded recently. Data published through GBIF (Doi: 10.15470/jacl7y).

Genome-wide meta-analysis identifies novel loci associated with free triiodothyronine and thyroid-stimulating hormone

PURPOSE

Thyroid hormones are essential for the normal function of almost all human tissues, and have critical roles in metabolism, differentiation and growth. Free triiodothyronine (fT3), free thyroxine (fT4) and thyroid-stimulating hormone (TSH) levels are under strong genetic influence; however, most of the heritability is yet unexplained.

METHODS

In order to identify novel loci associated with fT3, fT4 and TSH serum levels we performed a genome-wide meta-analysis of 7 411 206 polymorphisms in up to 1731 euthyroid individuals from three Croatian cohorts from Dalmatia region: two genetically isolated island populations and one mainland population. Additionally, we also performed a bivariate analysis of fT3 and fT4 levels.

RESULTS

The EPHB2 gene variant rs67142165 reached genome-wide significance for association with fT3 plasma levels (P = 9.27 × 10^-9) and its significance was confirmed in bivariate analysis (P = 9.72 × 10^-9). We also found a genome-wide significant association for variant rs13037502 upstream of the PTPN1 gene and TSH plasma levels (P = 1.67 × 10^-8).

CONCLUSION

We identified a first genome-wide significant variant associated with fT3 plasma levels, as well as a novel locus associated with TSH plasma levels. These findings are biologically relevant and enrich our knowledge about the genetic basis of pituitary-thyroid axis function.

Familial tauopathy with P364S MAPT mutation: clinical course, neuropathology and ultrastructure of neuronal tau inclusions

AIMS

This report presents the clinical course, neuropathology and ultrastructure of neuronal tau inclusions of four Slovene relatives with P364S MAPT mutation.

METHODS

The clinical history of three out of four P364S MAPT mutation carriers was taken. After formalin fixation, thorough sampling of the central nervous system was followed by paraffin embedding, H&E, Gallyas, Bielschowsky and immunostaining with AT8, anti-3R, anti-4R tau, anti-amyloid-β, anti-TDP43 and anti-alpha-synuclein antibodies. The distribution and density of different types of neuronal tau inclusions were semiquantitatively assessed. In addition, the ultrastructure of neuronal tau inclusions was analysed.

RESULTS

Macroscopic examination of the brains was unremarkable. Microscopically, neuronal tau inclusions of almost all known types were widespread and distributed fairly uniformly in all cases. Pick bodies and swollen neurones were found in only one family member. Mutant tau was composed of 3R and 4R isoforms, with a slight predominance of 3R tau. Composite neuronal tau inclusion (CNTI), found in all four relatives, was a hallmark of the P364S MAPT mutation. CNTI showed compartmental differences in H&E and Gallyas staining, tau isoforms immunolabelling and ultrastructure, displaying fuzzy fibrils in the core and paired twisted tubules at the periphery.

CONCLUSIONS

P364S MAPT mutation is characterized clinically by a variable combination of frontotemporal dementia, parkinsonism and motor neurone disease of short duration, and neuropathologically by a widespread uniform distribution of all known neuronal tau inclusions in one family member. Two-compartment CNTI is a unique characteristic of the P364S MAPT mutation.

Histomorphometric characteristics of immune cells in small intestine of pigs perorally immunized with vaccine candidate F18ac nonenterotoxigenic E. coli strain

Colidiarrhea and colienterotoxemia caused by F4⁺ and/or F18⁺ enterotoxigenic E. coli (ETEC) strains are the most prevalent infections of suckling and weaned pigs. Here we tested the immunogenicity and protective effectiveness of attenuated F18ac⁺ non-ETEC vaccine candidate strain against challenge infection with F4ac⁺ ETEC strain by quantitative phenotypic analysis of small intestinal leukocyte subsets in weaned pigs.We also evaluated levamisole as an immune response modifier (IRM) and its adjuvanticity when given in the combination with the experimental vaccine. The pigs were parenterally immunized with either levamisole (at days -2, -1 and 0) or with levamisole and perorally given F18ac⁺ non-ETEC strain (at day 0), and challenged with F4ac⁺ ETEC strain 7 days later.At day 13 the pigs were euthanatized and sampled for immunohistological/histomorphometrical analyses. Lymphoid CD3⁺, CD45RA⁺, CD45RC⁺, CD21⁺, IgA⁺ and myeloid SWC3⁺ cell subsets were identified in jejunal and ileal epithelium, lamina propria and Peyer’s patches using the avidin-biotin complex method, and their numbers were determined by computer-assisted histomorphometry. Quantitative immunophenotypic analyses showed that levamisole treated pigs had highly increased numbers of jejunal CD3⁺, CD45RC⁺ and SWC3⁺ cells (p<0.05) as compared to those recorded in nontreated control pigs.In the ileum of these pigs we have recorded that only CD21⁺ cells were significantly increased (p<0.01). The pigs that were treated with levamisole adjuvanted experimental vaccine had significantly increased numbers of all tested cell subsets in both segments of the small intestine. It was concluded that levamisole adjuvanted F18ac⁺ non-ETEC vaccine was a requirement for the elicitation of protective gut immunity in this model; nonspecific immunization with levamisole was less effective, but confirmed its potential as an IRM.

Increased number of intestinal villous M cells in levamisole -pretreated weaned pigs experimentally infected with F4ac⁺ enterotoxigenic Escherichia coli strain

Immunoprophylaxis of porcine postweaning colibacillosis (PWC) caused by enterotoxigenic Escherichia coli (ETEC) expressing F4 fimbriae is an unsolved problem. Just as ETEC strains can exploit intestinal microfold (M) cells as the entry portal for infection, their high transcytotic ability make them an attractive target for mucosally delivered vaccines, adjuvants and therapeutics. We have developed a model of parenteral/oral immunization of 4-weeks-old pigs with either levamisole or vaccine candidate F4ac⁺ non-ETEC strain to study their effects on de novo differentiation of antigen-sampling M cells. Identification, localization and morphometric quantification of cytokeratin 18 positive M cells in the ileal mucosa of 6-weeks-old pigs revealed that they were: 1) exclusively located within villous epithelial layer, 2) significantly numerous (P< 0.01) in levamisole pretreated/challenged pigs, and 3) only slightly, but not significantly numerous in vaccinated/challenged pigs compared with non-pretreated/challenged control pigs. The fact that levamisole may affect the M cells frequency by increasing their numbers, makes it an interesting adjuvant to study development of an effective M cell-targeted vaccine against porcine PWC.

Histomorphometric evaluation of intestinal cellular immune responses in pigs immunized with live oral F4ac+ non-enterotoxigenic E. coli vaccine against postweaning colibacillosis

Enterotoxigenic Escherichia coli (ETEC) infection is the most common type of porcine postweaning colibacillosis (PWC). Among fimbriae of porcine ETEC strains the best studied family of fimbriae are the members of F4 adhesins, existing in at least three variants: ab, ac, ad. Active immunization against porcine PWC is difficult due to: i) ETEC strains are only one of the essential predisposing factors, ii) the success of vaccinal antigen uptake depends on the presence of enterocyte receptors for F4 adhesins, iii) the intestinal immune system may react with tolerance or hypersensitivity to the same antigens depending on the dose and form of the vaccinal immunogen, and iv) kinetics of the specific immune responses may be different in the case of F4 (earlier) and the other ETEC adhesins, particularly F18 (later). The aim of this study was to test the effectiveness of a live attenuated F4ac+ non-ETEC vaccine against porcine PWC by analyzing quantitative differences in the small intestinal lymphoid and myeloid cell subsets of immunized (with or without levamisole given as an adjuvant) vs control non-immunized pigs. Four week-old pigs were intragastrically immunized with a vaccine candidate F4ac+ non-ETEC strain 2407 at day 0, challenged 7 days later with a virulent F4ac+ strain ETEC 11-800/1/94, euthanatized at day 13 and sampled for immunohistology. Non-immunized pigs received saline at day 0 and were processed as the principals. Immuno-phenotypes of lymphoid and myeloid cell subsets were demonstrated within jejunal and ileal mucosa by immunohistochemical avidin-biotin complex method and corresponding morphometric data were analyzed using software program Lucia G for digital image analyses. Monoclonal antibodies reactive with surface molecules on porcine immune cells such as CD3, CD45RA, CD45RC, CD21 and SWC3 enabled clear insight into distribution patterns and amount of these cells within the gut-associated lymphoid tissues (GALT) examined. The numbers of jejunal and ileal cell subsets tested were significantly increased (at P<0.5 or lower) in both principal groups (vaccinated or levamisole primed-vaccinated) of pigs, compared to those recorded in the control non-vaccinated pigs. Based on the histomorphometric quantification of porcine intestinal immune cells from the GALT compartments tested, it is possible to differentiate the responses of pigs immunized by an experimental mucosal vaccine from those of non-immunized pigs.

Photothermal microscopy: a step from thermal wave visualization to spatially localized thermal analysis

The calculation of photothermal response detected by a photothermal microscope is presented. By using a technique based on Green's functions and integral transforms, a model for laser-induced temperature distribution functions has been derived. The mathematical method for solution of inverse problem is proposed. It suggests that photothermal microscopy, besides imaging subsurface of solids, has the potential for quantitative thermal analysis of various samples.

Littoral-cell angioma as a rare cause of splenomegaly

We report the case of a littoral-cell angioma of the spleen, a recently described benign vascular tumour, whose imaging and pathological characteristics have been discussed only by a few authors. The diagnosis was made after elective splenectomy. The CT images, scintigraphy and histological specimens are presented, and differential diagnoses discussed.

[Gastrointestinal stromal tumor of small intestine--case report]

Gastrointestinal stromal tumor is a form of mesenchimal neoplasm that may be present in all parts of gastrointestinal system. We are reviewing diagnostic and therapeutic algorithms for patient with diagnosed gastrointestinal neoplasm of small intestine, experiencing repeated episodes of painful bleeding from gastrointestinal trackt.

Histopathology of residual rectal carcinoma following preoperative radiochemotherapy

Preoperative radiotherapy with (CRT) or without chemotherapy (RT) in the management of patients with locally advanced rectal carcinoma is increasingly accepted as therapeutic modality to reduce local recurrence and improve survival, decrease tumor size and/or stage, has less toxicity compared to postoperative therapy, improves sphincter preservation and the ability to perform a curative resection. In a brief review of literature we discussed the possible prognostic role of most important pathologic parameters and their clinical implications. At present, predictive value of tumor response to neoadjuvant therapy remains uncertain, whether evaluated as five-point histological tumor regression grade (TRG) or recently proposed three-point rectal cancer regression grade (RCRG). However, most reports emphasize reduced local reccurence rates and disease-free survival advantage in patients with complete tumour regression or tumour down-staging, occuring in up to 20% and 60% of cases, respectively. Patients with advanced post-treatment tumour stage (ypT3/4), positive lymph nodes (ypN1/2), vascular invasion, positive circumferential resection margin, clearance < 2mm, or absence of tumor regression are shown to have poor clinical outcome. Among CRT-induced morphological features, only "fibrotic-type" stromal response with minimal inflammatory infiltrates and absence of surface ulceration are correlated to recurrence-free survival. Preliminary unpublished results of a pilot study from our multidisciplinary prospective trial relate to correlation of histopathologic parameters and morphologic changes to rectal cancer regression grade (RCRG). Therefore, we studied 22 consecutive patients, mean age 56 (range 23-69) years, with transmural cT3/4 stage and were subgrouped as follows: RCRG-1 (7 patients, 31.8%), RCRG-2 (9 patients, 40.,9%) and RCRG-3 (6 patients, 27,2%). In addition, 14 patients (63%) showed tumour downstaging and only 1 patient (4.5%) nodal down-staging after ypTNM restaging. There was the predominance of fibrotic-type stroma (16 patients, 72.8%) versus fibro-inflammatory response (6 patients, 27.2%), frequent tumoral necrosis (13 patients, 59%) but infrequent surface ulceration (5 patients, 22.7%) and peritumoural eosinophylic infiltration as well as endocrine cell differentiation (4 patients, 18%). The second aim of our study was to investigate determinants of radiosensitivity, i.e. the relationship between proliferative activity indices (Ki-67 and PCNA) as well as the induction of apoptosis (p53) and the tumour regression (RCRG) after neoadjuvant CRT. The interaction between Ki-67 and PCNA immunoexpression levels and the benefit of CRT was significant for Ki-67 (p = 0.03), but not for PCNA (p = 0.08) and p53 levels (p = 0.4). In a conclusion, high percentage of Ki-67-positive tumor cells in the preoperative biopsy predicts an decreased treatment response after preoperative CRT of rectal cancer. However, long-term follow-up and large studies are necessary to establish the value of regression grade and the need for its prediction by reliable biological markers.

Investigating the Role of 2-Phenylpropenal in Felbamate-Induced Idiosyncratic Drug Reactions

Felbamate (2-phenyl-1,3-propanediol dicarbamate, FBM) can cause aplastic anemia and hepatotoxicity. The mechanism of FBM-induced toxicities is unknown; however, it has been proposed that 2-phenylpropenal, a reactive metabolite of FBM, is responsible. The pathway leading to this metabolite involves hydrolysis of FBM to 2-phenyl-1,3-propandiol monocarbamate (MCF), oxidation to 3-carbamoyl-2-phenylpropionaldehyde (CBMA), and spontaneous loss of carbon dioxide and ammonia. We made a polyclonal antibody against 2-phenylpropenal bound to protein and confirmed its specificity using ELISA. We attempted to develop an animal model of FBM-induced aplastic anemia and/or hepatotoxicity, and we also used the antibody to try to detect covalent binding of 2-phenylpropenal using immunoblotting. However, none of the animals developed evidence of bone marrow or liver toxicity, and we were unable to detect covalent binding, possibly because significantly less 2-phenylpropenal is formed in rodents than in humans. As this type of idiosyncratic drug reaction is believed to be immune-mediated, we also studied the potential of FBM and its metabolites to stimulate an immune response using the reporter antigen popliteal lymph node assay in female Balb/c mice. We found that neither FBM nor MCF induced an immune response in popliteal lymph nodes (PLNs). However, CBMA treatment appeared immunogenic, causing footpad inflammation, hardening, scab formation, and an increase in thickness. The PLN cell count in CBMA-treated mice increased 8-fold as compared to control, FBM-, or MCF-treated mice. Immunohistochemical analysis of the CBMA-exposed PLNs revealed germinal center formation, indicating B cell proliferation, later confirmed by flow cytometry. Most of the cells expressing the activation surface marker CD54 were B cells. We also found that CBMA treatment caused an increase in the production of IgM and IgG1 antibodies as well as IL-4 and IFN-gamma cytokines. Our findings indicate that 2-phenylpropenal is a very potent immunogen, supporting its possible involvement in the FBM-induced hepatotoxicity and aplastic anemia.

A kinetic model of aqueous-phase alkali hydrolysis of 2,4,6-trinitrotoluene

Alkali hydrolysis of 2,4,6-trinitrotoluene (TNT) was studied using batch experiments with starting pH values 11 and 12 in glass conical flasks covered with aluminum foil. Isothermal (25 and 40 degrees C) as well as non-isothermal experiments were conducted. Experiments starting at pH 12 resulted in >95% reduction in the concentration of TNT; those starting at pH 11 had a maximum reduction of 20-25% in TNT concentration. In all the experiments, one major stable intermediate was produced but it could not be identified. The experimental data were used to determine the overall stoichiometry of TNT and hydroxyl ions. Approximately 100 M (standard deviation 11.4) of hydroxyl ions were consistently consumed per mole of TNT. However, control experiments showed that all but 13 M (standard deviation 2) of hydroxyl ions were consumed in reactions not related to TNT. A simple kinetic model involving formation of the intermediate was proposed to account for changes in concentrations of TNT and hydroxyl ions. The rate constants and activation energies of the reactions were identified using isothermal data and the kinetic model was then used to predict the experimental data in the non-isothermal experiments reasonably well.

Stimulation of growth factor synthesis in skin wounds using tissue extract (G-90) from the earthwormEissenia foetida

Growth factors are biologically-active mediators that bind to specific receptors on target cells and regulate genes involved in cell growth, wound healing and regeneration. In the case of wound healing, a proper wound dressing is needed to cover the wound area, protect the damaged tissue, and if possible to activate cell proliferation and stimulate the healing process. In this study we examined the efficacy of a glycolipoprotein tissue homogenate extract from Eisenia foetida (G-90) to activate signal transduction pathways, leading to wound healing. We measured the activation of EGF and FGF in healthy skin, in wounds with physiological healing and in wounds treated with G-90. The activation of EGF and FGF was measured during the first 24 h of wound healing under both physiological conditions and treatment with G-90. In both cases an increased concentration of EGF and FGF was observed 6 h after wounding. In comparison with healthy skin, the concentration of EGF increased 10-fold and FGF five-fold in wounds treated with G-90 (10 ng ml(-1)). Healing in physiological conditions resulted in a two-fold increase of EGF and 1.5-fold of FGF.

Choroid plexus tumors: a review of 28-year experience

The aims of the study were to review the patients with choroid plexus tumor (CPT) treated in Slovenia between 1972-1999, to calculate the incidence of CPTs, and to evaluate treatment results in respect to tumor histology and mode of therapy. Cancer Registry of Slovenia database was used for patientś identification. Histological specimens and medical records were reviewed. Twelve patients (7 females, 5 males), 0.8-43 years old (median 6.1 years; <15 years: 10/12,83%) with CPT, representing 0.36% of all intracranial tumors registered during the period under study, were identified. Considering children less than 15 years old only, the corresponding percentage was 3.69. There were eight papillomas (CPPs) and four carcinomas (CPCs) with no difference in age distribution between the groups. Of seven patients with gross tumor resection in CPP group, one patient died of postoperative meningitis and one had local recurrence 1.6 years after surgery; the latter is disease-free 17.9 years after re-operation. One patient with macroscopic residue after surgery is alive and asymptomatic after 16.5 years. In the CPC-group, only the patient who received adjuvant BEP chemotherapy and craniospinal irradiation following incomplete surgery is alive with no signs of disease after 6.5 years. Ten-year disease-specific survival for all CPTs and for CPP subgroup was 73% and 100%, respectively. In Slovenia, CPTs represent 0.36% of intracranial tumors. In children, the incidence is 3.69%. CPPs are twice as frequent as CPCs. In CPPs, the treatment of choice is surgery alone. After incomplete surgery, wait-and-see policy seems to be justified. For CPCs, adjuvant multiagent chemotherapy and craniospinal radiotherapy following surgery should be considered.

Amniotic fluid embolism with involvement of the brain, lungs, adrenal glands, and heart

The case of a healthy 31-year-old woman in the 40th week of second pregnancy is presented. During preparation for an emergency caesarean section, she developed an amniotic fluid embolism (AFE) with unusual and unique features. The acute onset of disease with cardiorespiratory failure with hypotension, tachycardia, cyanosis, respiratory disturbances and loss of consciousness, suggested at first a pulmonary thromboembolism, but the appearance of convulsions led to the diagnosis of AFE. The patient died after 5 days due to an untreatable brain edema. At autopsy, AFE with the usually associated disseminated intravascular coagulation was found in the lungs, brain, left adrenal gland, kidneys, liver and heart. Eosinophilic inflammatory infiltrates were found in the lungs, hepatic portal fields and especially in the heart, suggesting a specific hypersensitivity reaction to fetal antigens. Moreover, intravascular accumulation of macrophages in the lungs also favored a non-specific immune reaction to amniotic fluid constituents.

Local recurrence and five year survival after abdominoperineal resection of the rectum due to rectal carcinoma

In the period 01.01.1991-12.31.1996, 523 operations due to rectal carcinoma were performed on the First Surgical Clinic, the Third Department for Colorectal Surgery. Most common localization of tumor was in the distal third of the rectum 65.2%. In the middle third, there were 28.9% and in the upper, intraperitoneal third 5.9%. We performed 286 low anterior stapled resections, 93 anterior resections with hand-sewn anastomosis and 144 Abdominoperineal excisions of rectum (Miles procedure). Pathohistological examination revealed adenocarcinoma in all cases. In this study we analyzed local recurrence and five-year survival after long-term follow-up in the group where Miles procedure was carried out as a potentially curative procedure (except 4.9% cased with Dukes D stage). There were 74.3% males and 23.7% females median age 59.2 years. According to Dukes classification there were 4.9% in stage A, 47.2% in stage B, 43.1% stage C, and 4.9% stage D. There were 4(2.7%) postoperative deaths. Recurrence of the disease was registered in 44 (30.5%) patients. Local recurrence alone was found in 14 (9.7%) patients, while distant spread was registered in 30 (20.8%) patients. At present, the median follow-up is at 72.9 months. Analysis by the Kaplan-Meier's test shows cumulative survival of 61%, and disease free survival of 63.4% at 60 months of the follow-up. Dukes C is associated with a very poor prognosis; survival after 60 months of follow up shows cumulative Survival of 0.35 while Dukes B has far better prognosis (0.86). Analysis of disease free survival by Dukes stage shows that Dukes C has the worst prognosis (disease free survival 0.36 after 60 months), while stage B has much better prognosis (0.84). Local recurrence analysis by the Kaplan-Meier's test shows disease free survival of 84.9% at 60 months of follow-up. Analysis of local recurrence by Dukes stage shows 1.00% disease free survival for cases in stage A, 0.94 for Dukes B and 0.66 for Dukes C, while overall comparison between groups regarding local recurrence using the Wilcoxon (Gehan) statistic shows statistically significant difference (p-0.005). There is no statistical difference between Dukes A and Dukes B cases in distribution of local recurrence.

[The role of strictureplasty in the treatment of Crohn's disease]

Crohn's disease is pandigestive disease of unknown aethiology, with tendency to reccurrences. Until now it is impossible to heal this disease either by medical or surgical treatment. All unfavourable consequences of this disease are result of inadequate treatment of complications which are leading to systemic weakening, with further progression of morbid process. Therefore, the principle of timely and minimal invasive surgical procedure has been generally adopted. Introduced in eighties, strictureplasty is a procedure of such characteristics. During the period 1980-2001 this method was used in 1/3 of 126 patients with Crohn's disease. There were 79 strictureplaties performed, 9 long and 70 short. Out of these 42, 12(28.6%) were postoperative recurrences, and there was one case of duodenal strictureplatsty. Postoperative small bowel fistulae were not observed, and there was no mortality in this group. During the follow up period of at least 5 years, in only two cases (4.76%) some functional disturbances of digestive functions were observed, without indications for reoperation. In this article indications and details of operative technique are discussed.

[Late results of splenectomy in patients with chronic immune thrombocytopenic purpura]

Splenectomy is definitive treatment for idiopathic thrombocytopenic purpura (ITP) because it removes both the sites of autoantibody producing cells and also the major site of platelet destruction. The purpose of this study was to evaluate long term results of splenectomised patients with ITP and to determine predictor factors for good response. A 167 patients with chronic ITP (136 females, 31 males), median aged 35 years (17-74) was splenectomised after 2 to 160 months (Median 12) from diagnosis of ITP. Indications for splenectomy were: 6 weeks of steroid therapy with platelet count below 10 x 10(9)/l or 3 months with platelet count under 30 x 10(9)/l, or treatment with prednisone above 30 mg more of 6 months to increase platelet count over 30 x 10(9)/l, or repeated relapses. Postoperative complications developed in 16 patients (9.5%), 3 of them died (1.8%) due to thromboembolism and 17 patients discontinued later controls. During follow up to 172 months (Median 62) 111/147 splenectomised patients were in remission (75.5%), 99 in complete (above 100 x 10(9)/l), 12 in partial (50-100 x 10(9)/l) and 36 patients (24.5%) were relapsed (below 50 x 10(9)/l). Remission was achieved in 79/88 patients (89.8%) with good response to prednisone before splenectomy toward 32/62 patients (51.6%) with poor response to prednisone (p < 0.01). Remission was obtained in 9/11 patients (81.8%) who responded well to intravenous immune globulin (0.4 g/kg x 5 d) and only in 1/8 who did not (p < 0.05). Higher response rate was achieved in patients under 40 years of age (81.6%) than in older ones (63.4%) (p < 0.05). No difference was shown between sex and time intervals (3, 6, 12, 24, 36 or over 36 months) from diagnosis to splenectomy. Splenectomy is an effective treatment of refractory ITP with response rate of 75.5% after median follow up of 62 months. In our patients better results on splenectomy were associated with age less than 40 years, good responses to steroid, and intravenous immune globulin.

[Surgical treatment of hematologic disorders of the spleen]

Splenectomy--the surgical removal of spleen is being performed in cases of: traumatic spleen rupture, as part of other surgical procedures, number of hematological, infectious and metabolic disorders. During the years 1988.-2001., there were 396 splenectomies performed at the First surgical clinic, for the cause of: autoimmune disorders 187 (47.34%), lymphoproliferative diseases 89 (22.59%). Hodgkin disease 35(8.94%), myeloproliferative disease 39 (9.95%), as part a of "staging" laparotomy 37(9.34%), other hematological disorders 7(2.20%). The spleen of [table: see text] 244 patients weighted 500-1500 g(61.62%), in 56 patients (14.14%) weighted less than 500 g, and in 96 patients (24.24%) spleen weighted more than 1500 g. Patients with thrombocytes less than 40,000/l 16 (4.04%) were perioperativly treated with fresh thrombocytes. Postoperative morbidity and mortality were registered in 54 (13.64%), i.e. 8 (2.02%) patients. Delayed results depended on primary disorder, comorbidities and supportive therapy. In this article, the particularities of the operative procedure were discussed, as well as importance of cooperation of surgeon and hematologist in perioperative treatment.

[Autotransplantation of the spleen]

Auto transplantation of the spleen can be performed in the patients with traumatic rupture of the spleen, in whom spleen could not be conserved in the other way. The right indication for this method is isolated rupture of the spleen (concvasation or complete devascularisation). This method is not recommended in the endangered patients, patients with previous disease of the spleen as well as in the patients with the perforation of the other abdominal organs at the same time. Auto transplantation was performed in 12 patients with isolated splenic rupture and hematoperitoneum, 11 men and one woman. The majority of patients are younger. In 8 patients, autotransplant was placed into big omentum, in three into lipomatous tissue surrounding left kidney, and in one into anterior abdominal wall. In all the patients from this group, following analysis were taken: MCV (middle volume of erythrocytes), HTC, Hb, Le, Glucose, urea, creatinin, sodium, potassium, alkali phosphatasis, target cells, Howell Jolly's bodies, Heinz's bodies, IgG, IgA, IgM, C3, C4, T3, T4, T8, B, segmentated, eosinophiles, lymphocytes, reticulocytes, thrombocytes, fibrinogen, PT, APTT, aggregation of thrombocytes and aggregation of thrombocytes on collagen. The same parameters were taken in 12 patients with surgery similar to splenectomy and in 12 after splenectomy. After splenectomy, there was decrease of the immunologic defending abilities of the organism because of the loss of the childrens function of the spleen, decreased level of the opsonines and tutsin, which leads to the impaired phagocytosis, decreased concentration of IgM and T and B lymphocytes, while in patients after auto transplantation the results were physiological. The most important thing in the assessment of the function of the autotransplanted spleen is scintigraphic investigation using 99mTc-denaturated red blood cells. In our study, auto transplant function was assessed in 10/12 patients by scintigraphy. Five years after surgery, no one patient was proved to have postsplenectomic sepsis.

[Recurrence of immunologic thrombocytopenic purpura due to hypertrophy of retained accessory spleens]

Idiopathic thrombocytopenic purpura is an autoimmune disease in which macrophages of reticuloendothelial system, mainly in the spleen, remove platelets covered by autoantibodies from circulation. By removing the spleen 60-80% of patients are cured. Partial remission is achieved in 10-20% cases. Very few patients do not react on splenectomy. Recurrency of idiopathic thrombocytopenic purpura in a splenectomized patient after already achieved complete remission, may be caused by hypertrophy of one or more of the retained accessory spleens. We present 3 patients, 41, 23 and 44 year old, in whom splenectomy for ITP had been performed 10, 3 and 11 years earlier. After full remission which lasted 10, 2.5 and 10.5 years a full recurrency of ITP took place with signs of severe thrombocytopenia and haemorrhagic syndrome. Using ultrasonography, computed tomography and scintigraphy accessory spleen/s, were discovered. By their removal, a full remission was achieved in all 3 patients, but full favorable effect appeared approximately three months after surgery during which period additional steroid therapy was necessary.

[Cesarean section combined with splenectomy in severely resistant immune thrombocytopenia]

Immune thrombocytopenic purpura (ITP) associated with pregnancy often involves considerable risk both for mother and child, and usually worsens in the third trimester of gestation. Pregnancy and delivery are especially difficult in patients with severe ITP (platelet count below 20 x 10(9)/L), who are resistant to prednisone and high dose intravenous immunoglobulin (IVIgG). In those cases we applied cesarean section (CS), to prevent intracranial haemorrhage due to fetal/neonatal ITP, and splenectomy at the same time as an effective therapeutic strategy for ITP. We present 5 patients (4 with chronic ITP and 1 with ITP associated with HIV infection), aged 21-35 years, with severe ITP (platelet count 2-10 x 109/L), resistant to prednisone (1-2 mg/kg), and 2/3 were resistant to IVIgG (0.4 g/kg x 5 d). Four patients with severe resistant ITP were supported with 1-2 doses of platelets from cell separator before CS and 1-3 dose during splenectomy. One patient increased platelet count to 55 x 109/L after treatment with IVIgG and splenectomy following CS were done without platelet transfusion. Splenectomy was performed immediately after CS in all patients, and two of them were hysterectomised (one with HIV infection). After splenectomy, platelet count was normalised in all patients, and they had no haemorrhage, wound haematoma formation or any adverse events. But ITP relapsed in 2/5 patients after 1-2 months. Two newborns had severe thrombocytopenia, which solved spontaneously after 3 days in one or after treatment with IVIgG in other. We propose that splenectomy following cesarean section should be considered as approach for delivery and treatment option for mothers with severe resistant ITP.

[10 years' of production and use of human rabies immunoglobulin in Yugoslavia]

Application of the rabies immunoglobuline is a compulsory part of the prophylaxis of rabies in all severe, transdermal lesions caused by rabies infected animals. Sylvatic rabies has spread in the past few years throughout the whole Yugoslavia, and human cases of rabies have also been reported in other East European countries. In order to achieve the highest level of rabies prophylaxis, apart from postinfective rabies vaccination, it is necessary to provide passive immunization using specific antibodies against rabies. After successful immunization of the young, healthy volunteers in 1990, National Blood Transfusion Institute, in cooperation with the Pasteur Institute from Novi Sad, prepared the first quantities of immunized plasma by plasmapheresis procedure and human rabies immunoglobuline. Without national production, sufficient quantities of human rabies immunoglobuline could not be provided, since the price on the world market is rather high (over $1000 per patient).

Scavenger activity of Allium psekemense B. Fedtsch

In the present study the antioxidative properties of the bulbs, leaves and stalks of Allium psekemense B. Fedtsch were investigated. The activities of antioxidant enzymes (superoxide dismutase, catalase, peroxidase, glutathione peroxidase), quantities of malonyldialdehyde, superoxide and hydroxyl radicals and reduced glutathione and also the content of total flavonoids, chlorophylls a and b, carotenoids, vitamin C and soluble proteins were determined. The results indicate that extracts from all plant organs exhibited antioxidant activity. The highest antioxidant activity was observed in the leaves. Furthermore, the ESR signal of DMPO-OH radical adducts in the presence of the leaf phosphate buffer (pH 7) extract was reduced by 54.3%.

Radical hysterectomy for stage IB1 cervical carcinoma: lymph node metastasis as a prognostic factor

PURPOSE

Lymph node metastasis is one of the most important factors influencing prognosis and further therapy in patients with cervical carcinoma. The aim of this study was to confirm the impact of nodal metastasis od disease-free interval in women with stage IB1 cancer of the uterine cervix.

PATIENTS AND METHODS

From June 1986 to December 1999 269 patients with stage IB1 cervical carcinoma were operated on. Two hundred thirty-six (87.84%) patients had class III and 33 (12.16%) class II radical hysterectomy, according to Piver's classification.

RESULTS

The median number of the removed lymph nodes was 21. Positive lymph nodes were found in 71 (25.28%) patients. All patients with positive lymph nodes received postoperative adjuvant external beam radiotherapy. Patients with bulky nodal disease received also chemotherapy.Overall 5-year disease-free interval in 212 patients was 80%. Five-year disease-free interval for patients without lymph node metastasis was 91%, while it was 40% in those with lymph node metastasis (p < 0.0001).

CONCLUSION

Surgical staging of cervical cancer, which includes pelvic and para-aortic lymphadenectomy,together with pathological data, can provide potentially useful information for the radiation oncologist and precise analysis of survival and prognostic risk factors.

[Protective colostomy or ileostomy?] ]

A group of patients is presented, where colorectal or coloanal anastomosis after resection was performed together with concomitant covering colostomy (102) or ileostomy (25), during the period 1985-2000. Covering colostomy was most often performed upon hepatic flexure (82.1%) and upon sigmoid colon (8.9%). The incidence of complications during performing or closure of colostomy was 6.8% with one case (0.8%) of death due to unsuccessful protection of primary anastomosis. The incidence of complications in covering ileostomy was 16%, with 3 (12%) deaths. Authors are analysing the data from literature about indications and technique of covering enterostomies, comparing them with their experience and concerning the choice of appropriate protective procedure. They came to conclusion that the reason for covering procedure has been in many instances reasonable, and that in the question of protection both methods are comparable, but covering ileostomy has potentially more dangerous complications. Therefore as a method of anastomotic protection authors are generally recommending covering colostomy except in technically specific cases.

Effect of earthworm (G-90) extract on formation and lysis of clots originated from venous blood of dogs with cardiopathies and with malignant tumors

The stability of homeostasis is important to keep a balance between coagulation and fibrinolysis. A disorder of homeostasis leads to different physiological changes and causes different diseases such as cardiopathies and malignant tumors. Cardiopathies is characterized by a hypercoagulation. In the malignant tumors, besides the hypercoagulation due to plasminogen activators (PA) formed inside the tumor, a disorder of homeostasis leads also to acceleration of the fibrinolysis. The variety of internal and external factors in both cases determine the deviation of time for the clots formation, as well as the lyses of blood and fibrin clots. In this study the venous blood as well as the blood and the fibrin clots, derived from healthy dogs, the dogs with cardiopathies and with malignant tumors, were examined for the time of coagulation and fibrinolysis by adding different substances. In these experiments we used a glycolipoprotein extract from earthworm tissue homogenate (G-90) and the proteolytic enzymes P I and P II, isolated from G-90. The efficacy of the tested substances was comparable with the clinically administered anticoagulants. The most significant differences in clotting time among the three tested groups of dogs were obtained by application of the original G-90. The results suggest a possibility that G-90, along with the fibrinolytic enzymes and other biologically active factors, also contains a factor that decelerates the formation of clot in a specific medium, such as the blood from the dogs with malignant tumors.

[Importance of splenectomy in the treatment of patients with hairy cell leukemia]

"Hairy cell" leukemija (HCL) je retka i neuobicajena forma hronicne limfoidne leukemije sa ne-predvidljivim tokom. Splenomegalija je najucestaliji klinicki nalaz a vecina drugih manifestacija je direktna posledica citopenije i splenomegalye. Splenektomija kao terapijski tretman, eliminise ne samo efekat "pooliranja" krvnih celija u slezini, vec dovodi i do uklanjanja glavnog mesta leukemijske celijske proliferacije. U nasem radu retrospektivno smo analizirali 38 bolesnika sa dijagnozom HCL kod kojih je splenektomija primenjena kao prva linija terapije. Rezultati lecenja bolesnika sa HCL-om primenom splenektomije su pokazali da je 22/38 bolesnika (58%) i dalje u hematoloskoj remisiji (u periodu pracenja od 7 godina) primenom samo ovog terapijskog modaliteta, a da je 16/38 bolesnika (42%) progrediralo krace ili duze vreme nakon splenektomije i nastavilo lecenje alfa interferonom kao drugom linijom terapije. Medijana duzine remisije nakon splenektomije je bila 36 meseci. Medjutim, analiza veceg broja klinickih i hematoloskih parametara definisala je prognosticki povoljnu grupu bolesnika sa HCL-om kod koje je splenektomija kao inicijalno lecenje dovela do dugotrajne hematoloske remisije (medijana: 72 meseca). S druge strane, kod prognosticki nepovoljne grupe bolesnika sa HCL-om splenektomija je kao inicijalno lecenje dovela do kratkotrajne hematoloske remisije (medijana: 6-7 meseci) i bolesnici su ubrzo nastavili lecenje alfa interferonom. Na osnovu nasih rezultata a uzimajuci u obzir i literaturne podatke, inicijalna splenektomija imala bi najveci uspeh kod grupe bolesnika sa HCL-om sa povoljnom prognozom i vrednostima hematoloskih parametara: hemoglobin > 110 g/l, broj trombocita > 130xl0^9/l i stepen infiltracije kostne srzi < 70%. Kod bolesnika sa nepovoljnom prognozom i vrednostima hemoglobina < 90 g/l, broja trombocita < 60xl0^9/l i stepena infiltracije kostne srzi 90%, efekat splenektomije je kratkotrajan, tako da je svrsishodnije inicijalno primeniti sistemsku terapiju alfa interferonom ili purinskim analozima.

Finite element modeling of electromagnetic signal propagation in a phantom arm

Improving the control of artificial arms remains a considerable challenge. It may be possible to graft remaining peripheral nerves in an amputated limb to spare muscles in or near the residual limb and use these nerve-muscle grafts as additional myoelectric control signals. This would allow simultaneous control of multiple, degrees of freedom (DOF) and could greatly improve the control of artificial limbs. For this technique to be successful, the electromyography (EMG) signals from the nerve-muscle grafts would need to be independent of each other with minimal crosstalk. To study EMG signal propagation and quantify crosstalk, finite element (FE) models were developed in a phantom-arm model. The models were validated with experimental data collected by applying sinusoidal excitations to a phantom-arm model and recording the surface electric potential distribution. There was a very high correlation (r > 0.99) between the FEM data and the experimental data, with the error in signal magnitude generally less than 5%. Simulations were then performed using muscle dielectric properties with static, complex, and full electromagnetic solvers. The results indicate that significant displacement currents can develop (> 50% of total current) and that the fall-off of surface signal power varies with how the signal source is modeled. Index Terms-Control, electromyography (EMG), finite element (FE), modeling, prosthesis.

The role of overlapping sphincteroplasty in traumatic fecal incontinence

Fecal incontinence is one of the most distressing conditions. Even there is a great variety of etiologic factors, they can be systematized in two main categories; fecal incontinence with normal and fecal incontinence with abnormal function of pelvic floor muscles. The latter is more interesting for surgeons since this category includes the great majority of surgically caused and surgically correctable fecal incontinences. Disruption of the anal sphincter caused by obstetric injury, anorectal operations or external trauma is the commonest cause of fecal incontinence. In the period 1990-1999, 53 patients with fecal incontinence caused by sphincter injury were treated on the third department for colorectal surgery, First Surgical Clinic. There were 43 females and 10 males with a mean age of 36.1 years (range 18-64). Causes of fecal incontinence were: obstetric trauma 38 patients. (71%), fistulotomy 9 (17%), war injuries 3 (6%) and nonspecific 3 (6%). The severity of incontinence was graded by Browning--Parks's classification. There were no patients in group A and B, in group C were 11 patients and in D group 37 patients. Wexner score system was also utilized preoperatively and postoperatively to determine continence function more precisely. Clinical exam, anoscopy and special investigations, such as anal manometry, EMG and defecography were carried out in all cases. Period between injury and repair was between 6 months and 20 years. Severe pudendal neuropathy was present in 17 patients. Five patients had oostomies performed at the time of injury. In three cases was present traumatic cloaca and in one case rectovaginal fistula. Overlapping sphincter repair technique was carried out in all cases. Full bowel preparation and antibiotics were prescribed. Anterior sphincteroplasty was performed in 39 cases, lateral in 7, posterior in 3 and anterior sphincteroplasty + posterior plication of puborectalis (Parks operation) in 4 patients. Protective colostomy was not performed in any case. The outcome of the procedure was considered as excellent, good, fair and poor (excellent when full control of solid and liquid stool and flatus was achieved, good when there was continence to feces but not to flatus, fair when patients could control only solid feces and poor when only partial control of solid feces was obtained). The overall functional results were as follows: Excellent in 25 patients (47.2%), good in 12 (22.7%), fair in 11 (20.7%) and poor in 5 (9.4%). Wound infection occurred in 9 (16.9%) patients, leading to disruption of sutures in three patients with consequent poor results. Two of them were reoperated. The duration of follow-up was from 5 to 60 months. We conclude that an overlapping sphincteroplasty is a method of choice in treating fecal incontinence caused by trauma. The best results are achieved with anterior sphincteroplasty. Results of posterior sphincteroplasty were disappointing. If present, pudendal neuropathy directly influences the outcome of sphincteroplasty. Manometric studies correlate with the clinical outcome.

Long-term results after low anterior stapled anastomosis

In the period 01.01.1991-12.31.1996, 286 low anterior stapled resections of the rectum due to rectal carcinoma were performed at the First Surgical Clinic, the Third Department for Colorectal Surgery, Belgrade. There were 57% males and 43% females, median age 59.6 years. The most common localization of tumor was in the distal third of the rectum 181 (63%). In the middle third, there were 89 (31%) and in the upper, intraperitoneal third 16 (6%). Histopathological examination revealed adenocarcinoma in all cases. All operative specimens were examined by one pathologist and classified according to the Gunderson-Sosin modification of Dukes classification. There were 14 (4.9%) in stage A, 167 (58.4%) in stage B (B1,B2,B3), 89 (31.1%) stage C (C1,C2,C3) and 16 (5.6%) stage D. According to Broders classification, there were 129 (45%) well differentiated, 142 (50%) moderately and 15 (5%) poorly differentiated tumors. Anastomotic dehiscence was found in 17 patients (5.95%), mostly conservatively treated, except in 6 cases where spreading peritonitis developed requiring operative treatment. There were 9 (3.1%) postoperative deaths, a half of them with specifically operation related mortality. Recurrence of the disease was registered in 47 (18%) patients, out of 260 who were regularly followed up (26 were lost). Local recurrence alone was found in 21 (8.0%) patients, while distant spread was registered in 22 (8.46%) patients. Local and distant spread was found in 4 (1.5%) cases. At present, the median follow-up is at 54 months. Analysis by the Kaplan-Meier's test shows cumulative survival of 66% at 71 months of the follow-up. Seventy four percent of patients with curative operations exhibit no signs of recurrence at 5 years.

[Surgical treatment of ulcerative colitis--"pouch" or ileorectal anastomosis]

Treatment of Ulcerative Colitis was always a challenge for a therapeutist. The therapy of the disease is usually conservative but when refractory or complications occur, surgical treatment is the only appropriate solution. Evolution of surgical techniques in treatment of Ulcerative colitis from bipolar colostomies, by-pass procedures, partial resections, colectomies, proctocolectomies to recent restorative procedures with the ileal-pouch and preservation of the continuity of digestive tract, shows the severity of the disease and explains the dilemmas which surgeons had in choosing the appropriate operation. Inauguration of ileal reservoir in late seventies, brought a new advancement in postoperative results measured by better function and quality of life. Even the ileal reservoir proved its superiority in surgical treatment of Ulcerative colitis, some dilemmas still persist. Should be rectum and continuity of digestive tract preserved by ileal-rectal anastomosis or by restorative coloproctocolectomy and ileal-pouch-anal anastomosis?