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Introduction: Seroprevlence of chronic hepatitis C viral infection in correctional facilities ranges from 16% to 49%. However, there are only very limited data available on the course of hepatitis C viral infection and outcomes oftreatment with pegylated interferon plus ribavirin in correctional settings. The aim ofthis study was to assess the feasibility and effectiveness of use of pegylated interferon plus ribavirin treatment in the Serbian correctional setting., Material and Methods: The study sample consisted of the patients with hepatitis C hospitalized in the Special Hospital for Prisoners in Belgrade (Serbia) during 2007-2013. Health authorities approved treatment for 32 patients out of 76 treatment-naive patients referred to this institution. The patients (N=32) received 180 mcg pegylated interferon alfa-2a once a week plus oral ribavirin in dosage of 800 mg or 1000/1200 mg/day for 24 or 48-week treatment. All patients who completed therapy were assessed at the end of an additional 24-week treatment-free period for a sustained virological response., Results: Sustained virological response was achieved in 53.8% of hepatitis C viral infection genotype I patients and in 73.3% and 66.6% of patients with hepatitis C viral infection genotype 3 and 4, respectively. One patient with mixed genotype (1, 2) did not achieve sustained virological response. The overall safety profile of the treatment regimen was very good. The incidence of influenza-like symptoms and depression were low A serious adverse event was recorded only in 6.4% of patients., Conclusion: The results showed that pegylated interferon alfa-2a plus ribavirin given once a week was well tolerated among prisoners and the regimen had the same adherence and effectiveness as in general population.

Introduction: Carcinoid tumors are very common tumors of gastro-intestinal tract even though they are very rare in pancreatic area. A large number of patients with pancreatic carcinoma have nonspecific symptoms of disease which is the main cause of late operative treatment of advanced tumors as well as for a low rate of 5-years surviving (28,9% +/- 16%)., Case Report: A 69-year-old female patient was operated for a 7 cm large carcinoid in pancreatic corpus. Prior to the operation the patient did not have any symptoms of disease. Serotonin and 5-HIAA level was normal before the operation as well as afterwards. In this case distal hemipancreatectomy was done along with celiac, hepatic and lienal lymphadenoctomy. Liver metastasis was not found. The diagnosis of carcinoid was verified by postoperative histopathologic and imunohistochemical analysis., Discussion: According to the experience of other authors, the operative treatment of pancreatic carcinoid is very often undertaken when dimensions of tumor exceed 7 cm. In this stage of disease distant metastases are present in more than 60% of patients. Only 23% of examinated patients have had carcinoid syndrome symptoms. According to this conclusion, the main role of diagnostic procedures is attributed to the computer tomography of abdomen as well as ERCP. The radical resection of pancreas with lymphadenectomy is recommended in order to have a precise histological examination and detect occult lymph node metastases. With radical surgical procedures even at this stage of disease the operation may be curative., Conclusion: Any kind of radical surgical treatment (depending of localizations of tumor, proximal or distal) is the main therapeutic procedure in pancreatic carcinoid.

Introduction: Gastrointestinal stromal tumors are the most common mesenchimal tumors of the gastrointestinal tract. Despite the enormous progress made in the field of diagnostics, most often diagnosis is made during the explorative laparotomy and postoperative immunohystochemical analysis of specimen. The surgical treatment is often indicated, although scarce preoperative diagnosis causes intraoperative dilemma concerning the level of radicality., Material and Methods: In this paper we have analyzed two patients with gastric GIST. The first patient was 59 years old male, with preoperatively diagnosed colonic cancer. Intraoperatively besides the transverse colon cancer, we found intramural gastric tumor. This patient underwent subtotal gastrectomy and subtotal colectomy. The immunohystochemical analysis of gastric tumor proves benign GIST. The second patient was 50 year old male presented with repeated upper GI bleeding. The endoscopic ultrasound showed intramural tumor of the anterior gastric wall, with a visible blood vessel bleeding during endoscopy. After the resuscitation, we performed subtotal gastrectomy. The immunohystochemical analysis proved malignant GIST., Discussion: In the cases with inadequate preoperative diagnoses, the level of resection procedure is based on the size of tumor and the presence of necrosis and bleeding inside the tumor. Tumors larger than 5 cm in diameter with signs of necrosis and bleeding are parameters of malignant nature of GIST, therefore demanding a radical surgical treatment., Conclusion: The surgical resection is a treatment of choice for gastrointestinal stromal tumors. It has been shown that adequate surgical resection correlates with high 5-years survival rates for patients with gastric GIST.

Introduction: A few small-scale studies have shown that high levels of various parameters of inflammation were associated with a less efficient response to erythropoetin. The responsiveness to EPO in haemodialysis (HD) patients with relative risk of cardiovascular disease (CVD) remains undetermined. In a retrospective study of HD patients, we compared causes of CV morbidity and mortality in relation to various weekly EPO doses needed for stable hemoglobin (Hb) levels, according to the definition currently suggested by international guidelines., Material and Methods: On the basis of distribution of the weekly EPO doses (lower or higher than the minimally recommended), eighteen HD patients, aged 55.8+/-14.8 years, were divided into two groups with higher (A) and lower (B) EPO doses. We correlated EPO doses with positive (C reactive protein-CRP, fibrinogen, feritin) and negative (albumin, LDL, TIBC) acute phase reactans, BMI, the quality (Kt/V) and duration of HD., Results: We also found a significantly positive corelation between CRP levels on the start of EPO therapy and weekly EPO dose in the univariate linear regression analysis (p-0.290). Higher EPO doses were associated with a lower levels of Kt/V, BMI, residual diuresis and higher levels of CRP, LDL, feritin, age and duration of HD. CRP levels were decreasing in the group with higher EPO doses. This important result can be explained the know EPO effect of endothelial cells apoptosis and inhibiting inflammation induced by HD., Conclusion: Chronic inflammation is a common cause of CVD, hyporesponsiveness to EPO and endothelial dysfuncton in HD patients. Our results suggest a new protective function of EPO.

Introduction: It has been established that measurement of tumor volume, rather than its diameter, is a better indicator of the depth of tumor invasion and lymph node involvement. The present study evaluates the significance of tumor volume as a prognostic factor in gastric cancer., Material and Methods: This prospective clinical trail included 87 patients with gastric cacncer admitted to Surgery Clinic "Dr. Dragisa Misović" in Belgrade from 1998 to 2003. All patients were evaluated by standard diagnostic procedures, and after that underwent radical surgical treatment. Oncologic-surgical principles recommended by Japanese Research Society for Gastric Cancer were respected. Tumor volume was determined by measurement of specimens that had been obtained during surgery and by histopathological analysis. These criteria were analyzed and correlated with the lymph node status and clinicopathological factors., Results: Single-factor analysis showed that lymph node metastases correlated with larger tumor diameter, larger tumor volume, depth of tumor invasion, diffuse and low-grade differentiation of the intestinal type of gastric carcinoma. Using a linear correlation coefficient, it was found that there was a highly significant correlation of tumor volume and number of metastatic nodes in groups between lymph nodes r = 0.567; p < 0.0001 in drainage group 1, r = 0.511; p < 0.0001 in drainage group II, r = 0.579; p < 0.0001 in drainage group III. Also, there was highly significant correlation with the total number of metastatic nodes (r = 0.577; p < 0.0001) and significant correlation with the depth of tumor invasion and tumor diameter (p < 0.05). With 97% sensitivity and 88% specificity, "cut off" point was established by determining the tumor volume above which there were metastases into lymph nodes. In this study that volume was 2750 cmm., Conclusion: Tumor volume can be used as a valuable prognostic factor for advanced gastric cancer, and hopefully it will be calculated preoperatively by 3D-EUS volumetric analysis.

Introduction: Multiorgan resection for a malignancy is a very complicated procedure, but there is always the question: does it work? In everyday clinical practice gastric cancer in phases III and IV is rather frequent. Unfortunately, our patients are under the age of 55 years. D2 lymphadenectomy is not as extensive as D2 +/ or D3, so one must ask himself if multiorgan resection is worth the risk, Material and Methods: We evaluated two groups of patients: group I consisted of 34 patients who underwent total or subtotal gastrectomy, systematic lymphadenectomy and resection of one or more organs; group II (control) consisted of 167 patients who underwent total or subtotal gastrectomy and systematic lymphadenectomy. These two groups of patients were analzyed in regard to: Bormann's classification, histopathologic type, early mortality, early postoperative complications, lymph node dissection and long-term survival., Results: According to Bormann's classification the most common type of carcinoma in both groups was ulcerovegetativ tumor (70.6% in I and 58% in II). In the first group of patients a great number of patients had poorly differentiated adenocarcinomas (47%), while in the second group the most common histologic type was well differentiated intestinal carcinoma (28%). Patients with multiorgan resections had higher rates of early postoperative mortality and morbiditiy (mortality--14.7% and complications--26.5%) than patients in control group (mortality--4.8% and complications--11.4%). The most frequent causes of postopertive mortality and morbidity were anastomotic leakage and wound infections in both groups. Metastatic lymph node invelvement was higher in the first group (41%), than in the second (28%). Long-term survival was best in the control group (38.5 months). Patients with multiorgan resection had better survival (25.4 months) than inoperable cases (only 5 months)., Discussion: Patients undergoing multiorgan resection usually have advanced gastric cancer with tumor infiltration in surrounding structures. Only these cases are absolute indications for this radical operation, because patients have better chances for survival., Conclusion: Multiorgan resections are extensive procedures with high rates of postoperative mortality and morbidity, but represent the only way for better survival of patients with advanced gastric cancer.

Introduction: Surgical techniques and postoperative care for gastric cancer have significantly improved in recent years. However, whether postoperative morbidity and mortality rates after gastrectomy for gastric cancer have been reduced or not in recent years is still unclear. In this study we would like to point out the role of systematic lymphadenectomy in postoperative mortality and morbidity., Material and Methods: In this investigation we analyzed two groups of patients. The first group of 126 patients with gastric carcinoma underwent peritumor lymphadenectomy DI. The second group of 114 patients with gastric carcinoma underwent more radical types of lymphadenectomy (D2, D2+, D3). In this study we analyzed differences between these two groups of patients in regard to. 1) early postoperative mortality, 2) early postoperative complications and 3) long-term postoperative complications., Results: Early postoperative mortality rate was 4.76% in D1 group and 5.26% in group with systematic lymphadenectomy (SL). 14.3% of patients in D1 group and 15.7% of patients in SL group had postoperative complications. The most frequent complications in D1 group were non-surgical complications of the respiratory system. In SL group the most common postoperative complications were anastomotic leakage (5/18, 27.77%) and wound infection (6/18, 33.3%). The most common long-term complications in both groups were: ventral postoperative hernia, anemia, small bowel obstruction and gallbladder calculosis., Discussion: Early postoperative death occurred in patients with stage IV gastric cancer. The rates of anastomotic leakage, as main cause of early postoperative mortality and morbitity in patients with systematic lymphadenectomy, were reduced in the last few years with stapling surgery., Conclusions: There were no significant differences in the postoperative mortality and morbidity rates between the two analyzed groups in our investigation.

Introduction: Formation of lymphatic metastasis is an important prognostic factor in treatment of gastric carcinoma. In this paper we would like to point to the importance of systematic lymphadenectomy in regard to extent of metastatic lymph node involvement in patients with gastric carcinoma., Material and Methods: This investigation included 114 patients with diagnosis of gastric carcinoma undergoing systematic lymphadenectomy. We analyzed metastatic lymph node involvement considering: 1. tumor localization; 2. histopathologic type; 3. depth of tumor invasion; 4. extent of lymph node resection; 5. stage of disease., Results: In the course of this study, 2100 lymph nodes were extracted by systematic lymphadenectomy (18.42 lymph nodes per patient on average). Out of this number, about 27% of lymph nodes were involved with metastasis, and 60% of positive lymph nodes belonged to the first, 25.7% to the second, 10.2% to the third and 3.8% to the fourth drainaged group. The most frequent localization (over 56%) of tumors was the distal third region of stomach. Histopathologically, most common type of carcinoma was intestinal carcinoma, with metastasis in first and second drainage group. A great number of patients have tumors with infiltration of the serosa. Those patients had metastases in lymph nodes in over 42%. Most patients (58%) belonged to IV stage of disease and presented with highest number of involved metastatic lymph nodes in all drainage groups., Discussion: In our patients high metastatic involvement of all four drainage groups of lymph nodes was established. Up to date standard lymphadenectomy (D1) which has been performed increased the length of survival of these patients., Conclusion: By systematic lymphadenectomy we removed a great number of metastatic lymph nodes with beneficial effect on survival of patients with gastric carcinoma.