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Treatment of gastroesophageal junction carcinomas have been debated for many years. This type of carcinomas has been classified as either gastric or esophageal carcinomas until Siewert’s classification was established and they were defined as a distinct entity. Risk factors for the development of these cancers are gastroesophageal reflux and Barrett’s esophagus, obesity, Helycobacter pylori infection, smoking, and alcohol. Symptoms of this disease include retrosternal pain, dysphagia to aphagia, and weight loss. Esophagogastroduodenoscopy with biopsy and pathohistological verification as well as CT of the chest and abdomen are crucial in establishing the diagnosis. Adenocarcinoma is predominant histological type of these tumors. The stage of the disease is defined by the TNM classification. Treatment of gastroesophageal junction cancer is complex, multidisciplinary, and multimodal, and involves the use of surgery, chemotherapy, and radiotherapy, alone or in different combinations. Surgery is the major treatment modality for these tumors, especially in local stages. Radiotherapy is used in the treatment of these tumors in all stages of the disease, and especially in the multimodal treatment of locally advanced gastroesophageal junction cancer, both preoperatively and postoperatively, usually in combination with chemotherapy. Chemotherapy is used in the treatment of these cancers as preoperative, postoperative and systemic. Immunotherapy and target therapy, as new promising therapy, is usually applied in a systemic and postoperative approach. Future directions in the treatment of these cancers are directed towards new surgical procedures, new types of immunotherapy, as well as new radiotherapy techniques.

Introduction/Objective. Diabetes mellitus and its chronic complications impair quality of life (QoL) when compared to the one of the general population. The objective of this study was to determine the prevalence of > 14 unhealthy days per month among the patients with diabetes in Serbia and to determine the association of the socio-demographic characteristics and health characteristics with the total of > 14 unhealthy days. Methods. Serbian version of a generic self-administered questionnaire from Centers for Disease Control and Prevention (CDC-HRQOL-4) was used for data collection in all three levels of care. Results. The study involved 4898 patients with diabetes, 2283 (46.6%) men and 2611 (53.4%) women. Overall mean age was 57.3 ± 12.2 years with over one fifth (23.2 %) were younger than 50 years. Multivariate logistic regression analyses indicated that age > 65 (OR:1.575, 95%CI 1.100–2.256), being a woman (OR: 1.287, 95% CI 1.042–1.588), lower education (OR: 1.383, 95%CI 1.091–1.754), felt depressed ≥ 14 days (OR: 3.689, 95% CI 2.221–6.128), felt anxious ≥ 14 days (OR: 1.749, 95% CI 1.113–2.749), poor sleep ≥ 14 days (OR:2.161, 95%CI 1.569–2.988), fair or poor self-rated health ≥ 14 days (OR: 4.322, 95%CI 3.474–5.376) were associated with unhealthy days ≥ 14 days. The strongest negative association was observed between limited physical activity ≥ 14 days and a decrease in the QoL of people with diabetes (OR: 22.176, 95%CI 10.971–44.824). Conclusion. This study highlights association between impaired QoL in patients with diabetes and physical activity limitations. Limited physical activity is the factor with the greatest negative impact on the QoL particularly in older, less educated, and women with diabetes.

Introduction. Neuroendocrine tumors of the pancreas are rare neoplasms. They are divided into two groups: functional and non-functional. Non-functional tumors represent a diagnostic challenge, given that they often remain asymptomatic and are diagnosed as an incidental finding. Case outline. We present a patient in whom the tumor was discovered at the junction of the body and the tail of the pancreas, on the dorsal side. The patient had no specific symptomatology, there was no loss in body weight. Considering the diagnostic procedures conducted and the condition of the patient, we decided to perform laparoscopic enucleation. The procedure was carried out in a safe and efficient manner, so that operative and postoperative recovery was uneventful. The definitive histopathological examination confirmed the finding of a non-functional pancreatic neuroendocrine tumor. Conclusion. Laparoscopic enucleation is an effective and safe treatment modality for neuroendocrine tumors of the pancreas with well-known advantages, as compared to open surgery, but there is always a tendency to improve the already existing results and thus to contribute, not only to treatment, but to the greater comfort of the patient.

Introduction/Objective. The objective was to assess the effectiveness of laparoscopic gastrectomy, analyzing short-term outcomes of laparoscopic radical gastrectomy in treatment of advanced gastric neoplasms. Methods. We performed a prospective cohort observational study, which included 30 patients who underwent elective radical laparoscopic gastrectomy (total or subtotal) for stomach neoplasms, performed in the period between March 2013 and February 2017. Results. Thirteen patients (43%) had been diagnosed with distal gastric tumors, seven (23%) with proximal gastric tumors, four (13%) with pangastric tumors, four (13%) with mediogastric tumors, and two (7%) with bicentric tumors. Mean operation duration was 286 minutes. The average blood loss was 183 mL. Conversion rate was 10% (three patients). Total of seven (23%) patients had postoperative complications, and mean intensive care unit stay was 1 day. Mean hospital stay after surgery was 13.08 days. The average number of harvested lymph nodes was 33.9, and R0 resection was performed in 87% patients. The overall 30-day mortality rate was 0%. Conclusion. Although technically challenging, laparoscopic gastrectomy is a safe and oncologically adequate procedure in the radical surgical treatment of advanced gastric neoplasms.

Introduction/Objective. Recently published studies have addressed the significant impairment of healthrelated quality of life (HRQoL) in patients suffering from gastroesophageal reflux disease (GERD) and functional dyspepsia (FD). To the best of our knowledge, none of the previously published studies have compared the impact of GERD and FD on HRQoL. The aim of the study was to determine the impact of GERD and FD on HRQoL. Methods. The current sample was extrapolated from a large cross-sectional population-based study conducted in primary health care facilities. Primary care physicians and general internists diagnosed GERD according to the Montreal definition for population-based studies. Also, primary care physicians and general internists diagnosed FD based on the Rome III criteria. The Serbian version of the generic self-administered Center for Disease Control and Prevention questionnaire was used. We used the propensity score method to match GERD and FD samples on variables such as age, gender, education, and adherence to therapy. Results. Regarding self-rated health, similar results were obtained from both groups. The Center for Disease Control and Prevention HRQoL questionnaire version 4 further revealed that functional dyspepsia led to greater disturbances of every-day functioning in regard to the criteria of physically healthy, mentally healthy, and activity limitation days. Conclusion. The results of the study have shown significant impairment of HRQoL in both groups, but, surprisingly, patients with FD experienced more limitations to their every-day functioning compared to patients with GERD.

Background/Aim. Gastric contraction modulation (GCM) with the implanted DIAMOND device improves glycemic control and decreases weight. The main aim of this study was to evaluate the early efficacy of GCM using the DIAMOND (previously named TANTALUS) System in the improvement of glycemic control measured by changes in glycosylated hemoglobin (HbA1c). The effects of GCM on weight loss, body mass index (BMI), reduction of the waist circumference and metabolic parameters other than HbA1c were also evaluated. Methods. A total of 18 adult patients with type 2 diabetes were surgically treated at the Department for Minimally Invasive Upper Digestive Surgery, Clinic for Digestive Surgery in Belgrade, Serbia, using gastric pacemaker (DIAMOND System) from November 2014 to March 2016. Out of the total number of patients, 11 finished week 16 visit and were enroled in this prospective cohort study. Results. During the observed period, the average weight loss amounted to 8.05 kg (p < 0.05). The average difference between the baseline fasting glucose level and the level after 16 weeks period is 2.56 mmol/L. Similar findings were noted in fasting insulin levels, with an average decrease of 6.44 m/U/L after 16 weeks. The majority of patients experienced a decrease in HbA1c value: in 4 patients higher than 2%, and in 4 patients up to 2% (p < 0.05). Lower level of fasting insulin with simultaneous decrease in fasting glucose indicates improvement in insulin sensitivity on week 16 [homeostatic model assessment of insulin resistance (HOMA IR) average 5.25]. Conclusion. Gastric stimulation using the DIAMOND System for 16 weeks causes significant early improvement in glycemic control and insulin resistance. There is an additional positive effect on weight loss, body mass index (BMI) and reduction of the waist circumference as a main parameter of the metabolic syndrome.

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Introduction: Morbid obesity is associated with a number of ventilatory and cardiovascular disorders and increased risk for cardiovascular diseases, which can be improved by weight loss. Cardiopulmonary testing (CPET) is proposed for the objective evaluation of the effects of bariatric surgery in morbid obese patients. Aim: To evaluate the change of CPET and hemodynamic parameters in patients treated with bariatric surgery. Methods: We performed CPET in 250 morbid obese patients during for the preoperative assessment. We analyzed 50 patients (37 women, mean age 38±10 years) before and 6 months after bariatric surgery. All patients underwent CPET (treadmill, Bruce protocol) with expiratory gas analyses. Results: The mean weight before treatment was 126.69 ±19.21kg, and BMI was 43.8 ± 5.4 kg/m2. Averaged body weight reduction was -29, 6 kg, and BMI -10 kg/m2 after 6 months follow-up, with significant difference in comparison to baseline values (43.8±5, 4 vs 33.9±14, 3; p

Background/Aim. Recent population based studies have proved that patients with functional dyspepsia (FD) have a significantly impaired health-related quality of life HRQoL as compared to general population. The aim of the study was to evaluate the impact of FD on (HRQoL) in patients treated in primary healthcare settings in Serbia. Methods. The study involved 1,448 patients with FD. The diagnosis was made by a general practice physician or gastroenterologist using the Rome III diagnostic criteria. The Serbian version of the questionnaire for the assessment of HRQoL of the U.S. Department of Health and Human Services’ Centers for Disease Control and Prevention (HRQoL-4 item CDC) was used for data collection, while descriptive statistical measurements were applied to calculate standard deviation, frequency as well as multiple logistic regression model. Results. Out of the total number of patients, 41.8% assessed their health condition as seriously disordered or poor. The mean values of health disorder duration over the last 30 days was 11.8 days, disordered physical health 7.2 days, mental disorder 6.3 days, and activity limitation 5.1 days. Also, 29.7%, 15.2%, 12.8% and 10.7% of the patients reported ≥ 14 unhealthy days, ≥ 14 physically unhealthy days, ≥ 14 mentally unhealthy days and ≥ 14 activity limitation days, respectively. Conclusion. From patients’ perspective, FD has a significant impact on HRQoL. In this study, 41.8% of the patients described their health status as fair or poor, and FD significantly affects all aspects of life, both mental and physical. The recognition of that impact is probably the most important step towards appropriate treatment and decreasing HRQoL impairment in patients with FD.

Bariatric surgery is the most efficient treatment for obesity and comorbidities. This treatment modality is the most potent for weight reduction with long-term weight maintenance and positive metabolic effects. The effect on weight loss and possible side effect depends of type of surgery. Micro and macronutrient deficiencies can occur after malapsorptive procedures. Iron deficiency occurs in almost half of patients following RYGB (Roux-en-Y gastric bypass). The main causes of iron deficiency are insufficient meat ingestion and lack of hydrochloric acid after removal of pylorus. B12 deficiency occured 6 months after RYGB in patients with oral supplementation of B12. Bone turnover increased three months after RYGB, and the levels of bone turnover markers increased 200% in next 12-18 months. Impaired vitamin D absorption leads to decreased calcium absorption and secondary hyperparathyroidism with lower bone mineral density. After the bariatric surgery, testosterone level becomes higher and all sexual quality indicators improving. Malapsorptive procedures with nutritive deficiency can cause oligo-astenozooteratospermia and male infertility. Due to the same reason pregnancy is not recommended in the first year bariatric surgery. Possible side effect of pregnancy within 12 months after surgery is fetal growth retardation. There is twice higher incidence for developing alcohol or other addition after bariatric surgery then in non-operated obese patients. The frequency of depressive episodes and suicide attempt is higher after bariatric surgery.

Introduction. Recent data from the studies conducted in the Western countries have proved that patients with gastroesophageal reflux disease have significantly impaired health-related quality of life compared to general population. Objective. The study is aimed at evaluating the burden of reflux symptoms on patients’ health-related quality of life. Methods. The study involved 1,593 patients with diagnosed gastroesophageal reflux disease. The Serbian version of a generic self-administered Centers for Disease Control and Prevention questionnaire was used. Statistical analyses included descriptive statistics, Pearson chi-square test and a multiple regression model. Results. Among all participants, 43.9% reported fair or poor health. Mean value of unhealthy days during the past 30 days was 10.4 days, physically unhealthy days 6.4 days, mentally unhealthy days 5.3 days and activity limitation days 4.3 days. Furthermore, 24.8% participants reported having ≥14 unhealthy days, 14.9% had ≥14 physically unhealthy days, 11.8% reported ≥14 mentally unhealthy days, and 9.4% had ≥14 activity limitation days. Conclusion. This study addressed complex relationships between reflux symptoms and patients’ impaired everyday lives.

Introduction. At the Department of Minimally Invasive Upper Digestive Surgery of the Hospital for Digestive Surgery in Belgrade, hybrid minimally invasive esophagectomy (hMIE) has been a standard of care for patients with resectable esophageal cancer since 2009. As a next and final step in the change management, from January 2015 we utilized total minimally invasive esophagectomy (tMIE) as a standard of care. Objective. The aim of the study was to report initial experiences in hMIE (laparoscopic approach) for cancer and analyze surgical technique, major morbidity and 30-day mortality. Methods. A retrospective cohort study included 44 patients who underwent elective hMIE for esophageal cancer at the Department for Minimally Invasive Upper Digestive Surgery, Hospital for Digestive Surgery, Clinical Center of Serbia in Belgrade from April 2009 to December 2014. Results. There were 16 (36%) middle thoracic esophagus tumors and 28 (64%) tumors of distal thoracic esophagus. Mean duration of the operation was 319 minutes (approximately five hours and 20 minutes). The average blood loss was 173.6 ml. A total of 12 (27%) of patients had postoperative complications and mean intensive care unit stay was 2.8 days. Mean hospital stay after surgery was 16 days. The average number of harvested lymph nodes during surgery was 31.9. The overall 30-day mortality rate within 30 days after surgery was 2%. Conclusion. As long as MIE is an oncological equivalent to open esophagectomy (OE), better relation between cost savings and potentially increased effectiveness will make MIE the preferred approach in high-volume esophageal centers that are experienced in minimally invasive procedures.

Introduction. Bleeding from esophageal varices is a serious medical problem because of the risk of recurrent bleeding and high mortality rate (17-54%). Gastroesophageal varices develop in 50% of cirrhotic patients with portal hypertension, but can also develop in other pre- or post-hepatic causes of portal hypertension. Case report. We reported a 48-year-old female patient with portal hypertension caused by mesenterial vein thrombosis due to congenital thrombophilia. The patient was hospitalized several times because of recurrent gastroesophageal bleeding. Thrombosis of portal, lienal and mesenteric veins was diagnosed using multislice computed tomography (MSCT) angiography. Sclerotherapy and/or variceal ligation could not be used due to variceal size and distribution. Beta blockers were ineffective. Balloon tamponade and octreotide were used in each massive bleeding episode. Carvedilol therapy was introduced but rebleeding occured. Surgical treatment was considered a high risk procedure due to massive thrombosis of mesenterial veins, patient's general condition and high risk of postoperative thrombotic events. Thus, long-acting somatostatin analogue - Sandostatin® LAR was initiated at a dose of 30 mg im/month. The patient responded to the therapy well and variceal bleeding did not occur for the following 3 months. After 3 months another episode of gastric variceal hemorrhage occurred and surgical treatment was reconsidered. Total gastrectomy was performed in order to prevent repeated bleeding from large gastric varices and the patient recovered successfully, and after 1 year is symptom-free. Conclusion. Long-lasting somatostatin analogue was used for the first time in treatment of gastroesophageal variceal hemorrhage in the patient with prehepatic portal hyperten-sion. It was effective as temporary therapeutic option allowing the improvement of the patients general condition and adequate planning of elective surgical procedure. Futher reports are needed in order to compare efficacy in treatment of patients with variceal bleeding, where poor outcome is expected. [Projekat Ministarstva nauke Republike Srbije, br. III41004]

Introduction. Repair of hiatal hernias has been performed traditionally via open laparotomy or thoracotomy. Since first laparoscopic hiatal hernia repair in 1992, this method had a growing popularity and today it is the standard approach in experienced centers specialized for minimally invasive surgery. Objective. In the current study we present our experience after 200 consecutive laparoscopic hiatal hernia repairs. Methods. A retrospective cohort study included 200 patients who underwent elective laparoscopic hiatal hernia repair at the Department for Minimally Invasive Upper Digestive Surgery, Clinic for Digestive Surgery, Clinical Center of Serbia in Belgrade from April 2004 to December 2013. Results. Hiatal hernia types included 108 (54%) patients with type I, 30 (15%) with type III, 62 (31%) with giant paraesophageal hernia, while 27 (13.5%) patients presented with a chronic gastric volvulus. There were a total of 154 (77%) Nissen fundoplications. In 26 (13%) cases Nissen procedure was combined with esophageal lengthening procedure (Collis-Nissen), and in 17 (8.5%) Toupet fundoplications was performed. Primary retroesophageal crural repair was performed in 164 (82%) cases, Cleveland Clinic Foundation suture modification in 27 (13.5%), 4 (2%) patients underwent synthetic mesh hiatoplasty, 1 (0.5%) primary repair reinforced with pledgets, and 4 (2%) autologous fascia lata graft reinforcement. Poor result with anatomic and symptomatic recurrence (indication for revisional surgery) was detected in 5 patients (2.7%). Conclusion. Based on the result analysis, we found that laparoscopic hiatal hernia repair was a technically challenging but feasible technique, associated with good to excellent postoperative outcomes comparable to the best open surgery series.

Introduction. Laparoscopic Heller­Dor operation, a standard method in the treatment of achalasia, has been performed at the Center for Esophageal Surgery of the First Surgical Clinic since April 2006. Objective. The aim of this study was to present this surgical procedure and initial experiences after 36 consecutive laparoscopic Heller­Dor operations. Methods. This partly retrospective, partly prospective study presented our results after laparoscopic Heller­Dor operation (presentation of the treatment method). We performed a standard anterior esophagocardioymiotomy, without releasing the posterior aspect of the cardia, and anterior partial fundoplication. The type and severity of symptoms and their duration were evaluated based on questionnaires fulfilled by patients. The diagnosis was made based on radiological, endoscopic and manometric findings. Laparoscopic surgery as the method of treatment was evaluated based on the duration of surgery, intra­ and postoperative complications, time interval until the initiation of oral feeding, length of hospital stay, need for additional therapeutic measures after the operation and effect of surgery on the severity of symptoms. Results. Preopereratively, dysphagia was the predominant symptom in all patients, while regurgitation was much lower (44%). The average duration of operation was 127 minutes. Postoperative hospitalization lasted on the average 5.7 days. From 36 treated patients, 34 (94.4%) considered that the effect of treatment was good or excellent. Postoperative dysphagia was present in two patients (5.6%) and was successfully solved by balloon dilatation. Conclusion. Laparoscopic Heller­Dor operation is an effective and safe surgical procedure in resolving symptoms of achalasia and today presents the method of the first choice in the treatment of this disease.

Introduction. Hemostatic abnormalities in liver cirrhosis are complex and multifactorial and may predispose to prolonged hemorrhage following invasive procedures. Due to increased perioperative bleeding risks, patients with cirrhosis should undergo elective surgery after making medical preparations. It has been shown that 1-deamino-8-D-arginine vasopressin (DDAVP), desmopressin, can be used as a safe and effective remedy in preventing and treating bleeding in cirrhotics. However, there is still scarce information of adequate test(s) for assessing effects of DDAVP in platelet dysfunction. The use of platelet function analyzer-100 (PFA-100) allows more reliable assessment of impaired primary hemostasis as well as follow-up of hemostatic changes induced by DDAVP effects. Case Outline. In a 49-year-old male with ethylic liver cirrhosis and prolonged bleeding time scheduled for elective left side inguinal hernia repair, we carried out PFA-100 testing to investigate the patient’s platelet functional status. Results were affirmative for the presence of platelet functional problems. By standard coagulation tests the patient was also identified as having secondary hemostasis. Preoperatively, PFA-100 was used to test the patient’s response to a standard dose of DDAVP, which was favorable. The patient was operated after medical preparations with DDAVP and vitamin K. Neither bleeding complications nor side effects of DDAVP were recorded in the perioperative period. Conclusion. The PFA-100 is a simple and reliable test for the assessment of primary hemostasis as well as in monitoring of DDAVP therapy.

Introduction. In the past two decades, the increased frequency of distal esophageal adenocarcinoma, esophagogastric junction and proximal gastric adenocarcinoma has been observed. The vast majority of these tumours are diagnosed in advanced stages, when the prognosis is poorer than in other gastric cancers. Objective. The aim of our study was to analyze the demographic and clinicopathological characteristics of patients operated on for Barrett's, cardia and distal gastric adenocarcinomas, as well as to study the influence of manifestations of each cancerogenetic indication on the studied clinicopathological parameters and to analyze the 5-year survival rate of patients surgically treated for cardia adenocarcinoma in relation to the patients operated on for distal gastric adenocarcinoma. Methods. We analyzed gender and age, tumour type, depth of tumour invasion, involvement of blood and lymph vessels in 66 patients surgically treated at the Centre for Oesophageal Surgery of the Institute for Digestive Diseases of the Belgrade Clinical Centre. Results. Except for significant differences in the depth of tumour invasion during surgery, there were no other statistically significant differences between the studied groups of patients. In the patients operated on for Barrett's and cardia cancers, the tumours invaded more deeply the wall layers, i.e. they were significantly more invasive than the distal gastric tumour. The lymph node involvement was present in 87.5% of patients with Barrett's cancer, in 80% with cardia cancer and in 87% with distal gastric cancer. The 3-year survival rate of patients operated on for cardia cancer was 47.4% and the 5-year survival rate was 31.6%, while the 3-year survival rate of patients operated on for distal gastric cancer was 46.2% and the 5-year survival rate was 34.6%. These differences were not statistically significant (Wilcoxon 0,036; p=0,85). Singly, the patients' gender, cancer type and the degree of tumour differentiation had no influence on the length of patients' postsurgical survival rate. Conclusion. At the time of diagnosis cardia cancer and cancers developed at the location of the Barrett's oesophagus, developed significant deeper per continuitatem than gastric cancer. There were no other differences in regard to the analyzed clinicopathological parameters among the tumours of these three locations, and there was no difference between the 3-year and 5-year survival rate between the patients operated on for gastric cancer and cardia cancer. Each studied clinicopathological parameter had no influence on the illness course.

Introduction. Splanchnic artery aneurysms are uncommon but important vascular entity because nearly 25% of all cases present as surgical emergency. Objective. The purpose of our study was to present nine patients operated on at the Institute of cardiovascular diseases, as well as literature review of clinical presentation of the disease. Method. There were three splenic artery aneurysms, two celiac trunk aneurysms, and one aneurysm of the hepatic, superior mesenteric, inferior mesenteric and gastroduodenal artery. All patients were males, mean aged 67.5 years (60-73). In four patients, splanchnic artery aneurysm was discovered accidentally during routine ultrasonographic and angiographic examinations of the abdominal aorta. At that time, arteriovenous fistula was diagnosed in a patient No 1; it was formed after rupture of the splenic artery aneurysm into the splenic vein. Three aneurysms were manifested by abdominal pain and palpable pulsating abdominal mass. Two patients were admitted as urgent cases in the state of hemorrhagic shock and signs of intraabdominal bleeding due to rupture of the splenic and hepatic arteries. In 7 cases, diagnosis was made preoperatively by means of ultrasonography and angiography; in two patients, accurate diagnosis was confirmed during surgery. Results. Proximal and distal ligation of the artery was performed in a patient with rupture of the splenic aneurysm into the splenic vein that caused arteriovenous fistula. Gastroduodenal artery aneurysm was treated by trans-aneurysmatic ligation of its "entering" and "exiting" branches. Aneurysms of distal part of the superior mesenteric and splenic artery were resected without further reconstruction. Partial resection of the aneurysm and endoaneurysmorrhaphy was carried out in one case of celiac trunk aneurysm, and in another, after aneurysm resection, the restoration of blood flow through the hepatic and lienal artery was achieved by Dacron grafts. In a patient with the inferior mesenteric artery aneurysm, the resection of aneurysm was followed by reimplantation of medial part of the artery into bifurcated Dacron graft which replaced abdominal aorta. In 5 patients, some of additional surgical procedures were performed. There were 4 reconstructive procedures of abdominal aorta and one splenectomy. The patient with ruptured hepatic artery aneurysm died during surgery due to uncontrolled hemorrhage. In other patients, there was neither morbidity nor mortality in the early postoperative period (first 30 days after surgery). Mean follow up was 1 to 5 years (mean 3.4 years). One patient died after 5 years due to myocardial infarction. CONCLUSION Although the introduction of precise diagnostic procedures (computerized tomography, magnetic resonance imaging, spiral scan) make diagnosis easier, the splanchnic artery aneurysms are still difficult to detect due to their uncommon clinical presentations.

Background/Aim. Most studies of esophageal and gastric adenocarcinomas have shown a very high rate of p53 gene mutation and/or protein overexpression, but the influence of the tumor site upon the frequency of p53 protein expression has not been evaluated (gastroesophageal junction, Barret's esophagus, and antrum). The aim of our study was to analyze the correlation between the selected clinico-pthological parameters, and p53 protein overexpression in regards to the particular tumor location. Methods. The material comprised 66 surgical specimens; 10 were Barrett’s carcinomas, 25 adenocarcinomas of the gastric cardia (type II adenocarcinoma of the esophagogastric junction - EGJ), and 31 adenocarcinomas of the antrum. Immunostaining for p53 protein was performed on formalin-fixed, paraffin-embedded tissue sections, using the alkaline phosphatase - antialkaline phosphatase (APAAP) method. The cases were considered positive for p53 if at least 5% of the tumor cells expressed this protein by immunostaining. Results. There was no significant difference observed between the studied groups in regards to age, sex, Lauren’s classification and tumor differentiation. There was, however, a significant difference observed in the depth of tumor invasion between Barrrett’s adenocarcinoma and adenocarcinoma of the cardia compared with the adenocarcinoma of the antrum. Namely, at the time of surgery, both Barrett’s adenocarcinomas and adenocarcinomas of the cardia, were significantly more advanced comparing with the adenocarcinomas of the antrum. Overexpression of p53 was found in 40% (4/10) of Barrett’s adenocarcinomas, 72% (18/25) of adenocarcinoma of the cardia and 65% (20/31) of adenocarcinoma of the antrum. No significant differences in p53 expression in relation to sex, type (Lauren) of tumor, depth of invasion, lymph node involvement, or tumor differentiation were observed in any of the analyzed groups of tumors. Patients with more advanced Barrett’s adenocarcinoma and in the cases of lymph node invasion revealed tendency for the greater p53 positivity compared with the early forms and lymph node-negative cases; however, this difference was not significant according to the statistical analysis. With regard to adenocarcinoma of the cardia, higher rates of p53 positivity were recorded in poorly differentiated, more advanced cases with lymph node invasion. Nevertheless, none of these differences was statistically significant. On the contrary, in the patients with adenocarcinoma of the antrum, greater p53 positivity was revealed in early forms without lymph node involvement, but the observed difference was not statistically significant. Conclusion. No significant differences in p53 protein expression in terms of sex, type (Lauren) of tumor, depth of invasion, lymph node involvement, or tumor differentiation were observed in any of the analyzed groups of tumors (Barrett’s adenocarcinoma, adenocarcinoma of the cardia and adenocarcinoma of the antrum).

Micrometastasis is a microscopic (less than 2 mm) deposit of malignant cells separated from the primary tumor. The incidence and importance of occult perigastric lymph node involvement were analyzed in 26 pNO patients using the prospective method. The occult lymph node involvement was detected by immunohistochemical method using the anticyto-keratin 8/18 antibody. Prevalence of clinically significant occult lymph node involvement (Mi+) was statistically significant, and found in 38.5% of pNO patients. Out of tumor characteristics analyzed as possible predictors of occult lymph node involvement, the histological grade (GH) and the involvement of lymphatic vessels within gastric wall (pLl) had significant effect on the respective evaluation. The patients with histological grade 3 and 4 had occult lymph node involvement more often than those with grade 1 and 2 (p

Background: RefluxStop™ is an implantable, non-active, single use device used in the laparoscopic treatment of GERD. RefluxStop™ aims to block the movement of the LES up into the thorax and keep the angle of His in its original, anatomically correct position. This new device restores normal anatomy, leaving the food passageway unaffected.Methods: In a prospective, single arm, multicentric clinical investigation analyzing safety and effectiveness of the RefluxStop™ device to treat GERD, 50 subjects with chronic GERD were operated using a standardized surgical technique between December 2016 and September 2017. They were followed up for 1 year (CE-mark investigation 6-months). Primary safety outcome was prevalence of serious adverse events related to the device, and primary effectiveness outcome reduction of GERD symptoms based on GERD-HRQL score. Secondary outcomes were prevalence of adverse events other than serious adverse events, reduction of total acid exposure time in 24-h pH monitoring, and reduction in average daily PPI usage and subject satisfaction.Results: There were no serious adverse events related to the device. Average GERD-HRQL total score at 1 year improved 86% from baseline (p < 0.001). 24-h pH monitoring compared to baseline showed a mean reduction percentage of overall time with pH < 4 from 16.35 to 0.80% at the 6-month visit (p < 0.001), with 98% of subjects showing normal 24-h pH. At 1 year: No new cases of dysphagia were recorded, present in 2 subjects, which existed already at baseline. Regular daily PPI usage occurred in all 50 subjects at baseline. At 1-year follow-up, only 1 subject took regular daily PPIs due to a too low placement of the device thereby prohibiting its function. None or minimal occasional episodes of regurgitation occurred in 97.8% of evaluable subjects. Gas bloating disappeared in 30 subjects and improved in 7 subjects.Conclusion: The new principle of RefluxStop™ is safe and effective to treat GERD according to investigation results. At 1-year follow-up, both the GERD-HRQL score and 24-h pH monitoring results indicate success for the new treatment principle. In addition, with the dynamic treatment for acid reflux, which avoids compressing the food passageway, prevalence of dysphagia and gas bloating are significantly reduced.Trial Registration: ClinicalTrials.gov , NCT02759094 . Registered 3 May, 2016. [ABSTRACT FROM AUTHOR]

Copyright of Medical Gazette / Medicinski Glasnik is the property of Specijalna bolnica za bolesti stitaste zlezde i bolesti metabolizma Zlatibor and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Medical Gazette / Medicinski Glasnik is the property of Specijalna bolnica za bolesti stitaste zlezde i bolesti metabolizma Zlatibor and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Chirurgica Iugoslavica is the property of Association of Yugoslav Surgeons and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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Background. Esophageal replacement is major procedure with high risk for perioperative allogeneic blood transfusion (ABT), especially in pediatric patients due to nutritive deficiency, anemia, small body weight and blood volume. Autologous blood policy is particularly important in female children. Methods. We present treatment strategy with the aim of avoiding ABT, that have been applied in two female pediatric patients with caustic stricture of thoracic esophagus. The patients were 7 and 8 years old, with body weight 34 and 23.5kg, respectively. Pro- tocol was based on the stimulation of haematopoetic system with erythropoietin, iron therapy and preoperative autologous blood donation (PABD). In the first patient, with a history of previous retrosternal bypass esophagocoloplasty and extraction of necrotic colonic graft, delayed reconstruction - transhiatal subtotal esophagectomy and gastric pull-up with cervical anastomosis were performed. In the second patient, repeated ineffective dilatations of esophageal stricture were reason for retrosternal left colon interposiotion and exclusion of native esophagus. Results. No adverse events were attributed to preoperative blood donation period. No allogenic blood products were used during perioperative period. Both patients had uneventful postoperative course. Conclusion. In specialized institutions for esophageal surgery, PABD with administration of erythropoietin and iron therapy, enable bloodless esophageal replacement, even in children [ABSTRACT FROM AUTHOR]

Abstract Inflammatory myofibroblastic tumor has been defined as a histologically distinctive lesion with uncertain behaviour. The term inflammatory myofibroblastic tumor more commonly referred to as “pseudostumor ”, denotes a pseudosarcomatous inflammatory lesion that contains spindle cells, myofibroblasts, plasma cells, lymphocytes and histiocytes. It exhibits a variable biological behavior that ranges from frequently benign lesions to more aggressive variants. Inflammatory myofibroblastic tumor mostly occurs in the soft tissue of children and young adults, and the lungs are the most commonly affected site, but it has been recognized that any anatomic localization can be involved. Inflammatory myofibroblastic tumors in adults are very rare, especially in the stomach. We present a case of a 43-year old woman with primary inflammatory myofibiroblastic tumor in the stomach and a review of the literature.