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Background: Gastrointestinal hemorrhage is a frequent medical problem and a significant cause of morbidity and mortality. The aim of this prospective, cohort study, which was carried out at our institution, was to establish the causes of hemorrhage from the digestive tract and mortality during a 10-year period.Patients and methods: The study includes patients with emergency endoscopy of the upper gastrointestinal tract and other diagnostic procedures of the digestive tract due to gastrointestinal hemorrhage between January 1, 1994 and December 31, 2003.Results: 6416 patients were investigated: 2452 women (38.2 %) and 3964 men (61.8 %). The average age of our patients was 59.3 years (a 1–106 year span, SD ± 17.2). In 2142 patients (33.4 %), endoscopic investigation of the upper digestive tube revealed signs of acute or traces of previous hemorrhage. Different methods of endoscopic hemostasis were carried out in 1486 cases (23.2 %). Sequelae of ulcer disease were the cause of hemorrhage in 36.4 % of investigated patients. Frequent causes of hemorrhage were also inflammatory, hemorrhagically-erosive changes of the gastric and duodenal mucosa (16.6 %), esophageal reflux disease (11.2 %), ruptured esophageal varices (10.7 %). Less frequent causes of hemorrhage from the upper digestive tract were different tumors (3.8 %), Mallory-Weiss tear (2.9 %), polyps (1.4 %) and Dieulafoy lesion (1.3 %). In 13.7 % of patients the cause of hemorrhage was in the large bowel and in 0.4 % in the small intestine. More than half of our patients (53.4 %) were aged over 60, 11.4 % older than 80 years. The total mortality of our patients was 9.9 %, the majority of them (8.5 %), were older than 60 years, with concommitant diseases and complications during treatment.Conclusions: In the observed period, sequelae of ulcer disease were the most significant cause of gastrointestinal hemorrhage. Hemorrhages are frequent in elderly patients who usually have significant medical conditions which increase mortality.

Background: Treatment of dyspeptic patients is a diagnostic and therapeutic problem frequently encountered by general and family practitioners, by internists and gastroenterologists.Aims: In our study we attempted to assess the prevalence of dyspeptic symptoms in patients over 60 who are regular users of nonsteroidal antiinflammatory drugs.Patients and methods: This is a prospective cohort study based on an interview during examination in the OPC, the results obtained by the diagnostic procedures and follow-up. It was carried out between 1999 and 2003 at a family practitioner’s and a gastroenterologic OPC. In patients who were regular users of nonsteroidal antiinflammatory drugs, we established the prevalence of dyspeptic symptoms, the most often used drugs and the type of diagnostic procedure applied to define the cause of dyspepsia. The control group was composed of patients over 60 who were also exhibiting dyspeptic symptoms but not using any NSAID.Results: The study comprised 50 patients, 27 women and 23 men, the mean age was 67.3 years, the range 60–80 years. The control group comprised 50 patients, 28 women and 22 men, the mean age was 66.6 years, the range 61–80 years. All patients of the study group had used NSAR or preparations of acetylsalicylic acid during the past 3 months. There were no statistically significant differences between the patients of both groups as regards the number and use of other drugs, p = 0.65. The average score of dyspeptic complaints in our study group was 3.02, SD ± 0.6, and 70% of patients wished to use H2 antagonists or proton pump inhibitors for these complaints. In patients of the control group, the average score of complaints was 2.72, SD ± 0.7, and they also took drugs for the alleviation of their complaints more rarely.Conclusions: Nonsteroidal antiinflammatory drugs belong among the important causes of dyspepsia in the elderly. When making decisions about the various diagnostic procedures for defining the etiology of dyspepsia, we must be guided by a good knowledge of the symptoms as well as of our patients.

Background. Interventional endoscopy has largely reduced mortality in patients with peptic ulcer hemorrhage.Study aims. To evaluate the efficacy and safety of endoscopic hemostasis with argon plasma coagulation and injection sclerotherapy in bleeding peptic ulcer and determine the mortality of patients in a prospective, controlled study.Patients and methods. The study includes 100 patients with peptic ulcer hemorrhage (male 63, female 37, av. age 57.1 years, SD ± 16, span 26–80; gastric ulcer 50 patients, duodenal ulcer 50 patients) in the period between 1 Jan. 1999 and 15 May 2000 treated in our institution. The bleeding activity was determined according to Forrest classification. Fifty patients were randomized to receive argon plasma coagulation (ARCO 2000 Electro Surgery unit, group A) and in fifty patients injection sclerotherapy (sclerosing with diluted adrenalin 1:10,000 plus polidocanol 1%, group B) was performed. The groups did not differ with respect to age, sex, site, severity of bleeding, use of NSAID and additional diseases.Results. Clinically and endoscopically diagnosed reebleding occured in 7/50 patients (14%) in group A and in 9/50 patients (18%) in group B; p = 0.78. The majority of reebleding occured within 48 hours after endoscopic hemostasis, group A 4/7 (57.1%), group B 7/9 (77.7%), p = 0.74. Repeated endoscopic hemostasis did not prove successful in 8 patients (group A 3/50, 6%, group B 5/50, 10%), p = 0.71. Seven patients were treated operatively. The total mortality rate was 9% (9/100 patients, group A 4/50, 8%, group B 5/50, 10%), p > 0.05. Only one patient died due to peptic ulcer hemorrhage, other 8 patients died due to concomitant diseases.Conclusions. Argon plasma coagulation seems to be an effective and safe alternative to injection sclerotherapy and other hemostatic modalities in peptic ulcer hemorrhage.

Background. A possible association of esophageal reflux disease with peptic ulcer, Helicobacter pylori infection or the results of eradication, has not been elucidated. It is an alarming fact that in developed countries the incidence of esophageal adenocarcinoma, which is associated with reflux disease, is increasing.Aim. The aim of the study was to establish the prevalence of esophageal reflux disease after eradication of H. pylori infection in patients with hemorrhaging and nonhemorrhaging peptic ulcer of stomach or duodenum.Patients and methods. Study was approved in 1998 by the Slovenian Medical Ethics Committee (No. 90/09/98). Prospective, controlled and randomized, carried out between 1998– 2000.The study included 80 patients (50 male and 30 female, av. age 57.5 years, SD ± 17.1, range 22–80 years) in which endoscopy confirmed hemorrhage from peptic ulcer of stomach or duodenum and HP infection. The control group was made up of 80 patients (50 male and 30 female, av. age 56.8 years, SD ± 16.8, range 19–80 years) with peptic ulcer of stomach or duodenum and H.pylori infection in the same period of time. In all cases the recommended drug combinations were used in the treatment of the infection: a proton pump inhibitor, omeprazol (4 weeks), and combination of antibiotics, claritromycin and metronidazole or with regard to the antibiogram (1 week). The therapeutic success was ascertained endoscopically four weeks after inclusion in the study. Infection eradication was confirmed by the rapid urease test and histologic investigation of the gastric mucosa. One year later, in the course of follow-up, in patients with endoscopic investigations, 24-hour pH-metry or fiberoptic spectrophotometric bilirubin determination, bilimetry, we tried to establish signs of esophageal reflux disease.Results. Four weeks after inclusion in the study the success of infection eradication was 92.5% in the study group while in the control group reached 91.25%, p > 0.05. Endoscopic investigation performed one year after inclusion in the study revealed a recurrence of H. pylori infection in 4 patients (5%, 4/80) from the study group and in 5 (6.25%, 5/80) from the control group, p > 0.05. During endoscopy we confirmed esophagitis in 8 patients from the study group (8/76, 10.5%) and in 9 patients (9/75, 12%) from the control group, p > 0.05. The findings of the 24-hour pH-metry confirmed acid reflux in 11 patients (11/76, 14.4%) from the study group and in 10 patients (10/76, 13,1%) from the control group, p > 0.05. Fiberoptic spectrophotometric bilirubin determination showed alkaline reflux in 3 patients (3/76, 3.9%) from the study group and in one patient (1/75, 1.3%) from the control group, p > 0.05. Conclusions. The results confirm that after eradication of H. pylori infection, esophageal reflux disease occurs significantly more often in patients with peptic ulcer of the duodenum as compared to those with peptic ulcer of the stomach. The development of complications is not affected by whether the peptic ulcer had manifested itself with complications or not.

Background. The explanation of peptic ulcer etiology has changed significantly in the past decade after the clarification of the significance of Helicobacter pylori infection.Aim. To evaluate the effectiveness of Helicobacter pylori eradication in patients with hemorrhaging peptic ulcer and patients with peptic ulcer without complications.Study ethics. The study was approved in 1998 by the Medical Ethics Committee of the Republic of Slovenia (No. 90/09/98).Type of study. Prospective, controlled and randomized study, carried out between 1998–2000.Patients and methods. The study included 80 patients (50 male and 30 female, av.age 57.5 years, SD ± 17.1, range 22– 80) in which endoscopy confirmed hemorrhage from peptic ulcer of stomach or duodenum and Helicobacter pylori infection. In all cases endoscopic hemostasis was performed: injection sclerotherapy with diluted adrenalin 1:10,000 and 1% polidocanol or argon plasma coagulation. The control group was made up of 80 patients (50 male and 30 female, av.age 56.8 years, SD ± 16.8, range 19–80) with peptic ulcer of stomach or duodenum and Helicobacter pylori infection. Infection was confirmed by a rapid urease test and histologic investigation of the gastric mucosa. In all cases the recommended drug combinations were used in the treatment of the infection: a proton pump inhibitor, omeprazol (4 weeks), and combination of antibiotics, claritromycin and metronidazole or with regard to the antibiogram (1 week). The therapeutic success was ascertained endoscopically four weeks after inclusion in the study. Infection eradication was confirmed by the rapid urease test and histologic investigation of the gastric mucosa.Results. Four weeks after inclusion in the study the success of infection eradication was 92.5% in the study group, in the control group it was 91.3% (p > 0.05). In 6 patients (7.5%, 6/ 80) from the study group and in 7 (8.8%, 7/80) from the control group we introduced a replacement treatment for the infection. Final treatment of the infection according to the antibiogram was required in two patients (2/80, 2.5%) from the study group and in 3 (3/80, 3.8%) from the control group. Control endoscopy showed the peptic ulcer had healed in 71/ 80 patients (88.8%) from the study group and in 68/80 patients (85%) from the control group (p > 0.05). Endoscopic investigation performed one year after inclusion in the study revealed a recurrence of Helicobacter pylori infection in 4 patients (5%, 4/80) from the study group and in 5 (6.3%, 5/80) from the control group (p > 0.05). Of these 9 patients we found peptic ulcer recurrence in only one patient (1.3%, 1/80) from the study group and in one (1.3%, 1/80) from the control group. Both patients has used preparations of acetylsalycilic acid prior to endoscopic investigation.Conclusions. The findings of our study confirm that during the observed period of time, one year, the reinfection rate with Helicobacter pylori was 5.6%. In this period we did not observed rebleeding due to peptic ulcer and only two patients had a recurrence of ulcer disease.

Background. Adverse effects of nonsteroidal antiinflammatory drugs (NSAIDs) are a common cause of digestive tract hemorrhage.Study aims. The purpose of the study was to ascertain the percent of patients taking NSAIDs with upper digestive tract hemorrhage.Type of study. Prospective, analytical.Patients and methods. The study includes patients in which urgent endoscopic investigations of the upper digestive tract were carried out due to gastrointestinal hemorrhage between 1 January 1994 and 31 December 1998.Results. 3366 patients were investigated: 1222 women and 2144 men; the average age of our patients was 57.5 years (SD ± 17.1, a 2–97 year span). In 2905 patients (86.3%) the source of bleeding was confirmed in the upper gastrointestinal tract. Among our patients 55% were aged over 60 years, 26.7% were older than 80 years. Sequelae of peptic ulcer disease were the most significant cause of gastrointestinal hemorrhage, in 47.7% of our patients (1387/2905). In the last week prior to bleeding, 19% of patients (552/2905) were taking regularly NSAIDs, corticosteroids, salycilates or anticoagulant therapy at least in single daily dose. The majority of patients, 94.5%, were taking NSAIDs or salycilates. Among NSAIDs they were taking most often ketoprofen, diclofenac or naproxen/ naproxen natrium, less often ibuprofen, nabumeton, etodolac or piroxicam.Conclusions. Upper digestive tract hemorrhage is a serious complication of NSAIDs medication, particularly in older patients

One of the factors involved in the colorectal cancer development is intracellular oxidative stress and antioxidative imbalance. The study aimed to explore the link between oxidative stress measured by the activity of antioxidative markers and lipid peroxidation product malondialdehyde (MDA) as possible cancer predictors of colorectal cancer by using several statistical methods. The study included 50 adult colorectal cancer patients of both genders. MDA level, the activity of antioxidative markers superoxide dismutase and catalase, and glutathione concentration were determined in patient sera. There was no age difference between male and female patients (p=0.579), and no gender differences according to cancer site (p=0.995), stage (p=0.083), and size (p=0.245). Th ere were no differences in the levels of studied enzymes. Correlation analysis of antioxidative markers and MDA with cancer size and patient age revealed strongest individual correlation between the MDA and cancer size variables (r=-0.56).

Abstract Background Limbal stem cells (LSCs) are crucial for the regeneration of the corneal epithelium in patients with limbal stem cell deficiency (LSCD). Thus, LSCs during cultivation in vitro should be in highly homogeneous amounts, while potency and expression of stemness without tumorigenesis would be desirable. Therefore, further characterization and safety evaluation of engineered limbal grafts is required to provide safe and high-quality therapeutic applications. Methods After in vitro expansion, LSCs undergo laboratory characterization in a single-cell suspension, cell culture, and in limbal grafts before transplantation. Using a clinically applicable protocol, the data collected on LSCs at passage 1 were summarized, including: identity (cell size, morphology); potency (yield, viability, population doubling time, colony-forming efficiency); expression of putative stem cell markers through flow cytometry, immunofluorescence, and immunohistochemistry. Then, mitotic chromosome stability and normal mitotic outcomes were explored by using live-cell imaging. Finally, impurities, bacterial endotoxins and sterility were determined. Results Expression of the stemness marker p63 in single-cell suspension and in cell culture showed high values by different methods. Limbal grafts showed p63-positive cells (78.7 ± 9.4%), Ki67 proliferation (41.7 ± 15.9%), while CK3 was negative. Impurity with 3T3 feeder cells and endotoxins was minimized. We presented mitotic spindles with a length of 11.40 ± 0.54 m and a spindle width of 8.05 ± 0.55 m as new characterization in LSC culture. Additionally, live-cell imaging of LSCs (n = 873) was performed, and only a small fraction