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Background and objective Transcatheter arterial embolization is an alternative to surgical management when dealing with recurrent bleeding from a peptic ulcer after a failed endoscopic treatment. The purpose of this study is to analize the effectiveness and outcomes of transcatheter arterial embolization and identify the factors that influenced morbidity and mortality rates. Materials and methods A retrospective single-center analysis was performed of 20 patients who underwent transcatheter arterial embolization for acute upper gastrointestinal bleeding from gastroduodenal ulcers from 2012 to 2015 at the Republic Vilnius University Hospital. We analyzed the association of early rebleeding and mortality with sex, age, number of units of blood components administered to the patients, length of hospital stay, time passed until embolization, therapeutic or prophylactic embolization. Results The embolization procedure had a technical success rate of a 100%. 14 (70%) were prophylactic embolizations and 6 (30%) were therapeutic embolizations. Three patients (15%) had an episode of rebleeding following embolization, 5 (25%) patients died. Patients that died received statistically significant larger number of blood components (p=0.04 for frozen plasma; p=0.01 for packed red blood cells) and patients that survived had a shorter hospital stay (p=0.05). No associations were observed between rebleeding and factors analyzed. Conclusions Transcatheter arterial embolization is a feasible method for the treatment of rebleeding in gastroduodenal ulcer after endoscopic treatment, resulting in high rates of technical and clinical success and low complication rates. Further prospective randomized trials are needed to obtain more evidence.

Kestutis Strupas 1 , Vitalijus Sokolovas 1 , Gintautas Brimas 1 , Marius Paskonis 1 , Jonas Jurgaitis 1 , Jonas Valantinas 1 , Arida Buivydienė 1 , Jūratė Dementavicienė 2 , Artūras Samuilis 2 , Dimitrijus Nepomniascis 2 , Audronė Marcinkutė 3 , Ausrinė Barakauskienė 4 1 Vilniaus universiteto ligoninės Santariskių klinikų Gastroenterologijos, urologijos ir abdominalinės chirurgijos klinika, Santariskių g. 2, LT-08661 Vilnius 2 Vilniaus universiteto ligoninės Santariskių klinikų Radiologijos klinika, Santariskių g. 2, LT-08661 Vilnius 3 Respublikinė tuberkuliozės ir infekcinių ligų universitetinė ligoninė, Birutės g.1/20, LT-08117 Vilnius 4 Valstybinis patologijos centras, P. Baublio 5, LT-08406 Vilnius El pastas: kestas.strupas@mf.vu.lt Echinokokozės – tai parazitinės ligos, sukeliamos kaspinuocio, Echinococcus genties biohelmintų lervų. Europoje yra paplite E. granulosus, sukeliantis cistine echinokokoze (CE), ir E. multilocularis, sukeliantis alveokokine echinokokoze (AE). Sergamumas CE svyruoja nuo 1 iki 220 atvejų is 100 000 gyventojų. Sergamumas AE yra mažesnis – apie 0,3–1,2 atvejų is 100 000 gyventojų. Taciau mirstamumas yra didelis ir siekia > 90%. Echinokokozė specifinių simptomų neturi, o klinika priklauso nuo ligos sukėlėjo, stadijos, darinių dydžio ir lokalizacijos. Liga dažniausiai nustatoma atsitiktinai arba atsiradus komplikacijų. Sergant CE komplikacijas sukelia spaudimo reiskiniai, o sergant AE jas sukelia echinokokas, peraugdamas svarbias organų struktūras. Echinokokozės diagnostikai naudojami serologiniai (ELISA), radiologiniai (sonoskopija, KT, MRT) tyrimai. Nustacius echinokokoze taikomi įvairūs gydymo būdai. Jie priklauso nuo ligos sukėlėjo ir isplitimo. Bendrai abiem sukėlėjams gydyti vartojami benzimidazolo karbamatai (mebendazolis ir albendazolis). Be medikamentinio gydymo, CE atveju galima taikyti PAIR metodą, radiodažnine destrukciją, radikalų chirurginį gydymą. Nustacius AE, atsižvelgiant į isplitimą, taikomas radikalus chirurginis arba paliatyvus gydymas. Kadangi liga Europoje yra paplitus, 1998 metais buvo įkurtas Europos echinokokozės registras. Sergantys echinokokoze ligoniai Lietuvoje stebimi ir gydomi VU Infekcinėje ligoninėje nuo 1997 metų. 2003 m. birželio 6 d. VUL Santariskių klinikose įkurtas Lietuvos echinokokozės registras. 2004 m. rugpjūcio 14 d. Lietuvos echinokokozės registras įtrauktas į Europos echinokokozės registrą. Siuo metu registre yra 76 ligoniai, is jų 18 serga CE, 58 – AE. Radikaliai gydyti 25 pacientai. Paliatyvus gydymas buvo taikytas 39 ligoniams. Septyni ligoniai mirė. Echinokokozė yra reta pavojinga liga. Jos diagnostikos ir gydymo kokybė bei rezultatai priklauso nuo tarpdalykinės gydytojų koordinacijos efektyvumo. Echinokokozės registras garantuoja optimalią ligonių stebėjimo ir gydytojų veiksmų koordinacijos sistemą. Pateikti pirmieji Lietuvos echinokokozės registro duomenys rodo, kad gydymo rezultatai panasūs į pateikiamus Europos echinokozės registro suvestinėje. Pagrindiniai žodžiai: echinokokozė, diagnostika, gydymas, registras Echinococcosis. First results of Lithuania Echinococcosis Registry Kestutis Strupas 1 , Vitalijus Sokolovas 1 , Gintautas Brimas 1 , Marius Paskonis 1 , Jonas Jurgaitis 1 , Jonas Valantinas 1 , Arida Buivydienė 1 , Jūratė Dementavicienė 2 , Artūras Samuilis 2 , Dimitrijus Nepomniascis 2 , Audronė Marcinkutė 3 , Ausrinė Barakauskienė 4 1 Vilnius University Hospital "Santariskių klinkos", Department of Gastroenterology, Urology and Abdominal Surgery, Santariskių str. 2, LT-08661 Vilnius, Lithuania 2 Vilnius University Hospital "Santariskių klinkos", Department of Radiology, Santariskių str. 2, LT-08661 Vilnius, Lithuania 3 National Tuberculosis and Infectious Diseases University Hospital, Birutės str. 1/20, LT-08117 Vilnius, Lithuania 4 National Pathology Center, P. Baublio str. 5, LT-08406 Vilnius, Lithuania E-mail: kestas.strupas@mf.vu.lt Echinococcosis is a zoonotic infection caused by larval stages of cestodes belonging to the genus Echinococcus. Cystic echinococcosis (CE), caused by Echinococcus granulosus, and alveolar echinococcosis (AE), caused by E. multilocularis, are mostly spread in Europe. The annual incidence rates of CE vary between 1 to 220 per 100,000 population. The incidence of AE cases is lower and varies between 0.3–1.2 per 100 000 population, but morbidity reaches up to 90%. Echinococcosis has no specific symptoms, and its clinical presentation depends on many factors such as the type of parasite, stage of disease, localisation in the organ and its extent. Symptom-free echinococcosis is diagnosed occasionally or with appearance of complications. In case of CE, complications appear due to organ compression and in case of AE due to overgrowth of important organ structures. The diagnostic repertoire includes imaging techniques (US, CT, MBR) and immunodiagnostic tests. Chemotherapy with benzimidazoles (mebendazol or albendazol) is common in the treatment of bouth types of the disease. Treatment options for CE include surgery, PAIR and RFA. For AE, the first choice of treatment is radical surgical resection of the entire parasitic lesion or palliative treatment for inoperable cases. Because of the wide distribution of echinococcosis in Europe, the European Echinococcosis Registry was established in 1998. Lithuanian patients with echinococcosis were started to treat in 1997 at the Vilnius University Hospital of Infectious Diseases. On 6 June 2003, the Lithuanian Echinococcosis Registry was established at Vilnius University Hospital Santariskių Klinikos, and on 14 August 2004 it joined the European Echinococcosis Registry. Until 2007, 76 cases of echinococcosis were registered in the Lithuanian Echinococcosis Registry, including 18 cases of CE and 58 of AE. Radical surgical treatment was applied to 25 patients and palliative treatment to 39 patients. Seven patients died during the period of 4 years due to extention of the disease. Echinococcosis is a rare and dangerous disease. To enhance its treatment and diagnostic abilities, coordination among various specialists is necessary, and it is ensured by the Echinococcosis Registry. The first results of treatment presented in the Lithuanian Echinococcosis Registry are similar to the results presented in the European Echinococcosis Registry. Key words: echinococcosis, diagnosis, treatment, registry

Three-dimensional (3D) liver visualization is a new tool in liver surgery planning. In most cases, plain or two-dimensional radiological images are hardly perceptible and understandable by the clinician. 3D visualization helps in the perception and interpretation of radiological images. 3D liver visualization are is mostly used before living related liver transplantation and in extended liver resections. In this article, we discuss the usefulness and employment of 3D visualization in clinical practice. Method We observed the whole 3D liver image formation process using OrgaNicer program and present a case report on 3D liver visualization employment in the clinical practice of Vilnius University Santariðkiø Cinics Hospital. Results Benefits of 3D liver visualization: helps in easy perception of difficult liver anatomy and anatomical liver variations; helps to define the surgical plan of liver resection and the extent of operation; precise liver volume calculation increases the safety of the operation. Disadvantages of 3D liver visualization: it is necessary to obtain good quality computer tomography images; long duration (40 to 240 min); a wide range of different specialists and their close cooperation are needed; the lack of defined clinical indications for visualization. Conclusions The new tool for liver surgery planning opens new perspectives in liver surgery, but the difficult course of the process, problems with integration into practice and the lack of clinical indications restrict its use. To increase its employment, indications for three-dimensional liver visualization must be defined and attention must be paid to increasing the quality of small volume liver resection using the new tool.