Search

The churches commissioned by King (later Emperor) Stephen Dušan, his important dignitaries, and later Serbian rulers-e.g., Holy Archangels near Prizren, Lesnovo, Hilandar, Markov Manastir, Ravanica, and Manasija-often have a narthex or an entrance porch covered by a dome. This architectural element is additionally emphasized by a specific program of painted decoration-as witnessed by several preserved ensembles-which, like the one in the nave's dome, contains some representation of Christ surrounded by members of the heavenly ranks. Through the choice of iconographic elements of Christ or accompanying personages, these compositions are often imbued with a royal subtext. Such an architectural and iconographic solution has its precedents in some Byzantine monuments from the 10th to the 12th century, of which the most important for the Serbian examples, as their potential models, are probably the Athonite katholika and the main church of the Pantokrator Monastery in Constantinople. The prevalence of this architectural element notably increased during the Late Byzantine period, particularly in political entities whose rulers sought independence and even aspired to imperial dignity, such as Epirus, which bordered the Serbian state, and later Mystra. In these Byzantine churches, the specific form of this micro-architectural feature and its strategic placement at the church entrance can be associated with imperial patronage and royal visits. Given the well-supported hypothesis that this paradigm was adopted into Serbian architecture with the same imperial connotation, this study examines its spatial, formal, and iconographic elements, along with its semantic and ideological context. The author's ongoing research of this phenomenon encompasses all preserved and relevant examples within the Serbian Empire, Byzantium, and the broader Byzantine world. However, for the purpose of this article, the discussion will be limited only to Serbian monuments, include an examination of their potential models, and underscore particular nuances in meaning exhibited by their spatial solutions and iconographic programs.

This paper describes and evaluates an application which provides the simulation of the functioning of the central processor (CPU). The simulation provides visual representation of anything occurring both at the level of arithmetic logic units (ALU) for different arithmetic and logical operations and at the level of bits. The evaluation of the application of this simulator in teaching was also conducted. The sample included 95 students from the Faculty of Technical Sciences in Čačak, study program - Information Technologies. The method with parallel groups was applied in this research. One group of students mastered the contents of the ALU in traditional way of teaching, while the other group used the simulator. Their advancement in ALU knowledge was measured by knowledge test specially designed for this research. In the end, the students of both groups evaluated the use of the simulator in teaching. The results of the research showed that students who studied with simulators were more motivated and achieved better results than students who learned the same content in a traditional way.

nema

Introduction. Pancreatic pseudocyst presented as pseudoaneurysm of the splenic artery is a potential serious complication in patients with chronic pancreatitis. Case report. A 42-year-old male patient with a long-standing evolution of chronic pancreatitis and 8-year long evolution of pancreas pseudocyst was referred to the Military Medical Academy, Belgrade due to worsening of the general condition. At admission, the patient was cachectic, febrile, and had the increased values of amylases in urine and sedimentation (SE). After clinical and diagnostic examination: laboratory assessment, esophagogastroduodenoscopy (EGDS), ultrasonography (US), endoscopic ultrasonography (EUS), multislice computed scanner (MSCT) angiography, pseudoaneurysm was found caused by the conversion of pseudocyst on the basis of chronic pancreatitis. The patient was operated on after founding pancreatic pseudocyst, which caused erosion of the splenic artery and their mutual communication. Postoperative course was duly preceded without complications with one year follow-up. Conclusion. Angiography is the most reliable and the safest method for diagnosing hemorrhagic pseudocysts when they clinically present as pseudoaneurysms. A potentially dangerous complication in the presented case was treated surgically with excellent postoperative results.

Background/Aim. Acinetobacter spp. has emerged as nosocomial pathogen during the past few decades in hospitals all over the world, but it has increasingly been implicated as a serious nosocomial pathogen in military hospitals. The aim of this study was to analyze and compare the surveillance data on Acinetobacter nosocomial colonization/infection (NCI) collected during the wartime with the data collected in peacetime. Methods. We conducted a prospective study of incidence of Acinetobacter spp. colonization/ infection. Also, the two nested case-control studies were conducted. The patients with nosocomial infection (cases) were compared with those with nosocomial colonization (controls) during the two different periods, wartime and peacetime. The patients with NCI by Acinetobacter spp. were identified by the case-based surveillance. The surveillance covered all the patients in 6 surgical clinics. Results. During the study periods a total of 166 patients had cultures that grew Acinetobacter spp. and the pooled rates of Acinetobacter spp. colonization and infection were significantly higher in wartime. When patients with NCI in wartime were compared with those with NCI in peacetime significant differences were observed. In the war year, the patients were more significantly males (p < 0.000). In a period of peace, most of the colonization/infections were reported from patients with certain chronic diseases (p = 0.020) and the survival of patients was more significant (p = 0.049). During the peacetime, proportions of Acinetobacter isolates resistent to ciprofloksacin, imipenem and meropenem were significantly higher (p < 0.001). Conclusion. This study provides additional important information about the risk factors of nosocomial Acinetobacter spp. infections in a large cohort of surgical patients. This is also the first study that directly examines epidemiological differences between NCI caused by Acinetobacter spp. during the war and peace period.

Introduction. In some cases of multicystic forms of liver echinococcal disease, the advanced method for treatment of cystic echinococcosis faces great problems relating to the final outcome of the treatment. Case report. In May 2005, a computerized tomography of the abdomen obtained in a 27-year -old famale patient with abdominal pain revealed more than 20 echinococcal cysts measuring up to 6.7 cm in both lobes of the liver. Laboratory analyses found the value of eosinophils 6.8%, gamma globulins 29.9%, immunoglobulin E 29 600 IU/mL and the indirect hemagglutination for echinococcosis 1 : 8 196. The treatment started in December that year with the continuous administration of a daily dose of 800 mg (14.5 mg/kg body weight) of albendazole, but it was terminated two months later due to high serum transaminases values. By the end of 2006, the largest cyst detected in the left lobe of the liver had a diameter of 5.7 cm and the one in the right lobe of the liver measured 4.1 cm. There were lesions of germinative membrane found on both cysts. Six months later, praziquantel at daily dose of 2 500 mg (45.3 mg/kg body waight) was introduced into the therapy, but the treatment was terminated after eight days because of the development of exanthema. The computerized tomography of the abdomen obtained in February 2008 revealed the presence of a large number of echinococcal cysts in the liver. The largest among those cysts measured 3.5 cm while calcifications of the cyst walls were observed on some of them. None of the remaining therapeutic options for further treatmetnt of echinococcal disease could be applied. Conclusion. The presented case confirms medical therapy as the only option for the treatment of some forms of cystic echinococcosis. Benzimidazole carbamates (albendazole, mebendazole) and praziquantel are only efficacious antihelminitics currently available, and when they have to be withdrawn due to serious adverse offects, futher treatment of a patient with liver multicystic echinococcosis is impossible. Because of that there is a need to search for new and more efficient drugs for the treatment of ehinococcal disease.

Background. Budd-Chiari syndrome (BCS) represents partial or total occlusion of the hepatic veins with or without simultaneous obstruction of vena cava inferior (VCI). The symptoms of BCS are abdominal pain, hepatomegaly, ascites, varices of the abdominal wall, sometimes bleeding from the upper part of gastointestinal tract (GIT), lower limbs swelling and jaundice. Primary BSC is a relatively rare condition occurring in one per 100 000 of the population worldwide. Case report. A male patient, 25-year-old, facing tooth postextraction complications, was presented with acute BCS. On admission, physical examination revealed pale-grayish complexion, more pronounced veins over the thorax and abdomen, ascites, enlarged liver rising 8 cm below the right costal arch and having a minor pleural effusion by the right side. The patient was submitted to Doppler sonography and computed tomography (CT) that verified the right leg deep veins thrombosis, as well as the presence of a thrombus in the intrahepatic portion of the VCI. Multislice computed tomography (MSCT) showed occlusion of hepatic veins (Budd-Chiari syndrome) and thrombosis of the VCI in the retrohepatic part 6 cm long. Also, increased values of transaminases and gamma GT and reduced values of albumines and serum ferrum were registered. Molecular examination revealed Factor V Leiden mutation - heterozygote. After preoperative preparations a mesocaval shunt was made using Gore- Tex ring graft of 12 mm. Intraoperatively, the blue enlarged liver was found with almost black zones of tense capsule. After a graft making, liver congestion decreased followed by the change of colour and volume. Within postoperative course metabolic and synthetic liver functions were obvious. Conclusion. In patients with BCS medicamentous treatment does not yield adequate results, but even causes worsening of general condition. Surgical therapy in the presented patient was performed timely regarding the stage of the disease due to which irreversible liver changes were prevented while decompression of the portal system provided time overbridging up to liver transplantation.

Background/Aim. Modern treatment of cystic echinococcosis, except for surgical treatment and percutaneous drainage of cyst considers also administration of albendazole as a type of individual therapy. However, clinicians fear of the serious adverse effects of high doses of albendazole, first of all the elevation of serum transaminases activity, very frequently results in subdosing of albendazole and wrong conclusions its efficacy and safety. The aim of this study was to investigate adverse effects of a longterm, continual administration of high doses of albendazole in the treatment of patients with echinococcal disease. Methods. A total of 42 patients (mean age 40.4 ± 18.3 years) with echinococcal disease were included in the study. They were treated with continual administration of high doses of albendazole within the period of 4 to 6 months. The subgroups of 27 and 15 patients were treated with 15-20 mg/kg/day and with 21-25 mg/kg/day albendazole, respectively. The patients in the control group (18 with surgical treatment, 6 with percutaneous drainage of cyst) were treated with 800 mg albendazole per day (< 15 mg/kg body weight) in the cycles of 28 days (1-3 cycles) and a two-week pause between them. Results. In the study group adverse effects of albendazole were registered in 20 (47.6%), whereas in the control group in 6 (30.0%) of the patients. In both subgroups elevated activity of serum transaminases were found more frequently in the study group compared to the control one (35.7% vs 25%, p < 0.05), especially in the patients who were treated with higher doses of albendazole. The patients in the study group, compared to the patients in the control group had significantly higher mean activity of serum alanin aminotransferase in the course of the second and third month of the therapy (p < 0.05). Administration of albendazole due to adverse effects was stopped in 3 (7.1%) of the patients in the study group. Two (4.8%) of them had a very high activity of serum transaminases and one had a muscle pains and high activity of serum creatine kinase. After the interruption of the therapy we documented a normalization of serum enzyme levels in all the patients. Conclusion. Longterm, continual administration of high doses of albendazole in the patients with echinococcal disease results in significant elevation of serum transaminases activity, compared to the patients treated with albendazole in the cycles, but in the majority of the patients serum transaminases activity was normalizated by the end of a 6-month period.

Background/Aim. Chronic echinococcocal disease is the parasite human disease caused by the penetration of larval (asexual) stages of the canine tapeworm (Echinococcus granulosus) in the liver of humans. After the penetration of the parasite, the host organism react by activating complement- depending immune response. The aim of this study was to elucidate the influence of larval form of Echinococcus granulosus in the liver on the activity of antioxidative defense enzymes in the blood of patients before and after the surgical intervention. Methods. We investigated the activity of antioxidative defense enzymes: copper/zinc containing superoxide dismutase (CuZn SOD), catalase (CAT), glutathione peroxidase (GSH-Px), glutathione reductase (GR) and glutathione-S-transferase (GST) in the blood of patients before and after the surgical intervention in respect to the controls, clinically healthy persons. Results. Our results showed that the activity of the GSH-Px was significantly decreased in the plasma of the patients with echinocococal disease before the surgery in respect to the controls. The activity of GST was significantly higher in the blood of the patients after the surgery in comparison to the controls. Conclusion. Chronic liver echinoccocal disease caused significant changes of some antioxidative defense enzymes, first of all Se-dependent enzyme GSH-Px, which could be a suitabile biomarker in the biochemical evaluation of the disease. This work represents a first comprehensive study of the activity of antioxidative defense enzymes in cronic liver echinococcocosis in the patients before and after the surgical intervention in respect to the clinically healthy persons.

Aim. To provide a retrospective analysis of our results and experience in primary surgical treatment of subjects with war liver injuries. Methods. From July 1991 to December 1999, 204 subjects with war liver injuries were treated. A total of 82.8% of the injured were with the liver injuries combined with the injuries of other organs. In 93.7%, the injuries were caused by fragments of explosive devices or bullets of various calibers. In 140 (68.6%) of the injured there were minor lesions (grade I to II), treated with simple repair or drainage. There were complex injuries of the liver (grade III-V) in 64 (31.4%) of the injured. Those injuries required complex repair (hepatorrhaphy, hepatotomy, resection debridement, resection, packing alone). The technique of perihepatic packing and planned reoperation had a crucial and life-saving role when severe bleeding was present. Routine peritoneal drainage was applied in all of the injured. Primary management of 74.0% of the injured was performed in war hospitals. Results. After primary treatment, 72 (35.3%) of the injured were with postoperative complications. Reoperation was done in 66 injured. Total mortality rate in 204 injured was 18.1%. All the deceased had significant combined injuries. Mortality rates due to the liver injury of the grade III, IV and V were 16.6%, 70.0% and 83.3%, respectively. Conclusion. Complex liver injuries caused very high mortality rate and the management of the injured was delicate under war circumstances (if the injured reached the hospital alive). Our experience under war circumstances and with war surgeons of limited knowledge of the liver surgery and war surgery, confirmed that it was necessary to apply compressive abdominal packing alone or in combination with other techniques for hemostasis in the treatment of liver injuries grade III-V, resuscitation and rapid transportation to specialized hospitals.

Background. It has been established that many patients with chronic hepatitis C have elevated serum iron, feritin levels and iron deposits in the liver. Therefore, the liver damage due to hepatitis C virus may be aggravated with iron overload. In many studies higher levels of iron in the blood and the liver were connected with the decreased response to interferon-alfa therapy for chronic viral hepatitis C. Recent introduction of pegylated interferons plus ribavirin has improved the therapeutic response, so it is now possible to cure more than 50% of the patients. Case report. Three patients with chronic hepatitis C and iron overload were presented. Iron reduction therapy using phlebotomy or eritrocytapheresis with plasmapheresis was done at different times in regard to specific antiviral therapy or as a sole therapy. Conclusion. It has been shown that iron reduction, sole or combined with antiviral therapy, led to the deacreased aminotransferase serum activity and might have slow down the evolution of chronic hepatitis C viral infection.

Aim. To determine the possibility of preoperative evaluation of the feasibility of laparoscopic cholecystectomy based on the standard preoperative examinations and findings. Methods. During 1997, 100 consecutively operated patients with the diagnosis of chronic calculous cholecystitis were followed up. Sex and age, and the results of blood count, sedimentation rate, ultrasonography (US), and intravenous cholangiography (IVC) were monitored. Based on adhesions, fibrosis in Calot’s triangle and pericholecystitis, surgical interventions were classified as minor and major. Results. Minor operations were performed in 57, and major in 43 patients. Earlier surgical interventions had been carried out in 8 (18.6%) patients from the major surgery group, while 9 (15.79%) patients had undergone minor surgery. Out of 57 patients with minor surgery, IVC verified the contrast medium filling of the gallbladder in 55 (96.49%) of the patients. Tense gallbladder or wall stratification was not revealed by ultrasonography in any of the patients from this group. Out of 43 patients with major surgery, the gallbladder was not filled with the contrast medium during IVC in 34 (79.07%) patients, while the stratified and tense gallbladder was found by US in 2 (4.65%) patients. The mean sedimentation rate was 14.3 in the patients with minor surgery, and 23.5 in major surgery group. Mean WBC in the patients with minor surgery was 7.4 × 109. The patients with major surgery had slightly increased mean value of the white cell count. It was 8.3 × 109. Conclusion. Statistically significant difference (p ≤ 0.05) was found between the variables of the IVC, sedimentation rate, the white blood count, and the earlier operations. No significant difference was found between other analyzed variables.

Background. Postoperative recurrence of the liver hydatid disease befalls approximately 10−30% of patients. Preoperative or postoperative therapy with albendazole in single therapeutic protocol (800 mg/d, within 28 days) indicated the need to evaluate the hydatid cyst liquid protoscoleces viability. Morphological changes of protoscoleces following the treatment with drugs are not well known. Aim. To estimate the viability of protoscoleces after preoperative or postoperative albendazole therapy, and their ability for cystic metamorphosis. Methods. A prospective, randomized clinical trial included 30 patients with liver hydatid disease, treated with albendazole and surgically (I group), and 30 patients in the control group treated only surgically (II group). The concentration of albendazole and its active metabolite albendazole sulphoxide in the cysts contents were determined using HPLC. Estimation of protoscoleces viability was based on the established micromorphologic criteria, and compared between the patients treated with albendazole, and the patients treated only surgically. Biological assessment of the viability was performed on protoscoleces with uncertain signs of the disturbed viability (unchanged structure, evaginated, without movements) using intraperitoneal injection of 1 ml of protoscoleces prepared suspension to AO type of rats. Results. The concentration of albendazole in cysts' contents ranged from 0 to 64.9 μg/ml, and of its active metabolite from 0.5 to 40.8 μg/ml. The presence of fully viabile protoscoleces in the albendazol treated patients was significantly lower than in the control group. A significant difference was noticed in the presence of disintegrated protoscoleces without movements in the albendazol treated group, compared to the control group. Biological assessment of the viability showed incapability of these protoscoleces for cystic metamorphoses. Conclusion. Low viability of parasites due to medicamentous therapy is very useful and important to surgeons, because the fertility of cysts is lower, and the risk of the disease recurrence is reduced.

Introduction. Tumescent local anesthesia (TLA) is widely used for ambulatory surgery. Patients with transplanted organs are on immunosuppressive therapy and with risk for organ rejection or severe infection. Case report. Saphenectomy with phlebectomy on the left leg under TLA was performed in a patient with kidney transplantation performed four years ago. A combination of 35 mg of 1% prilocaine-hydrochloride, 5 mL of 8.4% sodium bicarbonate and 500 μg of epinephrine in 460 mL of normal saline was used for TLA. Overall 750 mL of the solution was used. The patient had satisfactory postoperative analgesia and was discharged home on the same day. Blood levels of urea, creatinine, estimated glomerular filtration rate (eGFR) and tacrolimus concentration, measured preoperatively and on the second postoperative day, were in a regular range. Prilocaine blood concentrations determined on the 4th, 10th and 16th postoperative hours, were below toxic levels. Conclusion. TLA in a kidney-transplanted patient performed for saphenectomy with phlebectomy proved to be a safe and reliable anesthesia method.

Background. Despite improved diagnostic modalities, potent antibiotics, modern intensive care, and aggressive surgical treatment, more than one third of patients still die of severe secondary peritonitis. Clinical difficulties in the treatment of abdominal sepsis were related to inherent problems of limited clinical signs and the rapid spread of infection. An inflammatory process is often well under way before the presence of clinical signs and symptoms of sepsis. The aim of this prospective study was to assess diagnostic and prognostic significance of protein C in abdominal sepsis. Methods. Twenty-two patients with severe intraabdominal infections with sepsis syndrome were treated surgically as compared to 15 patients with hernia repair (control group). During the study, the following parameters were analyzed daily: protein C, AT III, plasminogen, alfa-2 antiplasmin, HMWK, C5a and C5-B9 complement, C1-inhibitor, CRP. Results. The mean APACHE II score was 17 points, with actual mortality rate of 23%. Each parameter evaluated in the abdominal sepsis group differed from the one evaluated in the control group to a great extent (p=0.001). The results and multivariate regression statystical analysis confirmed the following parameters as sensitive biological markers of septic cascade (p£0.0001-0.026): protein C, AT III, HMWK, C1-inhibitor and C5-B9 complement. According to the results the low level of protein C consistently correlated with disease severity and suggested the development of septic shock and poor outcome. Conclusion. Early diagnosis of plasma proteolytic disturbances was very important, from the diagnostic and predictive point of view, in abdominal sepsis. According to the results protein C was the most significant marker of sepsis and early predictor of the outcome of septic complications during severe intraabdominal infections (r=0.761; p=0.0001).

Background. This paper presents our first experience in the treatment of primary anal fissure by injection of botulinum A toxin into the internal sphincter. Methods. The study group of the retrospective study included 12 outpatients (8 females and 4 males), mean age 42 (range 18-60). During the period 2000-2003, after unsuccessful conservative treatment, patients were treated with the injections of botulinum A toxin, 100 units on both sides of the anal fissure laterally into the internal anal sphincter (50 units on either side). The patients were clinically evaluated 3, 7, and 30 days, and 3 and 6 months after the treatment. Results. Three fissures had healed after a month, and seven after 3 months. Two remained unhealed, but asymptomatic. There was no incontinence of flatus or faeces after 3 months of the treatment. After temporary healing, two fissures relapsed after 6 months, and these patients had the adequate tonus of the anal sphincter muscles. Except for the temporary incontinence, there were neither other side-efects, nor serious complications. Conclusion. Injection of botulinum A toxin achieved good results in the treatment of anal fissure. The appropriate use makes this method safe as an alternative to surgical treatment of anal fissure.

Correlation of standard path morphological prognostic parameters, primary tumor size and axillary nodal status with new prognostic factor in breast carcinoma: tumor suppressor gene p53 was analyzed. The studied sample included 65 women who underwent surgery for breast carcinoma at the Surgical Clinic of Clinical Center Banja Luka, from January 1st 1997 till January 1st 1999. Statistical data analysis was performed and correlation of prognostic factors was determined. The majority of authors in this field agree that the primary tumor size and axillary nodal status are the two most important prognostic factors. These factors are the best predictors of prognosis and survival of women who had the tumor and were operated on. Tumor markers were immunohistochemically determined in the last ten years and, according to the majority of authors, are still considered the additional or relative prognostic factors in breast carcinoma. Their prognostic value and significance increase almost daily. Most frequently determined tumor markers are bcl-2, pS2, Ki-67 and p53. There was a positive, directly proportional relationship between primary tumor size and tumor suppressor gene p53, but there was no positive correlation between the axillary nodal status and tumor suppressor gene p53. Significance of determination of new tumor markers as the prognostic factors was emphasized. These markers represent a powerful tool in the early detection and prevention of breast carcinoma.

Aim. To determine the possibility of preoperative evaluation of the feasibility of laparoscopic cholecystectomy based on the standard preoperative examinations and findings. Methods. During 1997, 100 consecutively operated patients with the diagnosis of chronic calculous cholecystitis were followed up. Sex and age, and the results of blood count, sedimentation rate, ultrasonography (US), and intravenous cholangiography (IVC) were monitored. Based on adhesions, fibrosis in Calot's triangle and pericholecystitis, surgical interventions were classified as minor and major. Results. Minor operations were performed in 57, and major in 43 patients. Earlier surgical interventions had been carried out in 8 (18.6%) patients from the major surgery group, while 9 (15.79%) patients had undergone minor surgery. Out of 57 patients with minor surgery, IVC verified the contrast medium filling of the gallbladder in 55 (96.49%) of the patients. Tense gallbladder or wall stratification was not revealed by ultrasonography in any of the patients from this group. Out of 43 patients with major surgery, the gallbladder was not filled with the contrast medium during IVC in 34 (79.07%) patients, while the stratified and tense gallbladder was found by US in 2 (4.65%) patients. The mean sedimentation rate was 14.3 in the patients with minor surgery, and 23.5 in major surgery group. Mean WBC in the patients with minor surgery was 7.4 x 109. The patients with major surgery had slightly increased mean value of the white cell count. It was 8.3 x 109. Conclusion. Statistically significant difference (p ≤ 0.05) was found between the variables of the IVC, sedimentation rate, the white blood count, and the earlier operations. No sig-nificant difference was found between other analyzed variables. [ABSTRACT FROM AUTHOR]

Introduction. In some cases of multicystic forms of liver echinococcal disease, the advanced method for treatment of cystic echinococcosis faces great problems relating to the final outcome of the treatment. Case report. In May 2005, a computerized tomography of the abdomen obtained in a 27-year -old famale patient with abdominal pain revealed more than 20 echinococcal cysts measuring up to 6.7 cm in both lobes of the liver. Laboratory analyses found the value of eosinophils 6.8%, gamma globulins 29.9%, immunoglobulin E 29 600 IU/mL and the indirect hemagglutination for echinococcosis 1 : 8 196. The treatment started in December that year with the continuous administration of a daily dose of 800 mg (14.5 mg/kg body weight) of albendazole, but it was terminated two months later due to high serum transaminases values. By the end of 2006, the largest cyst detected in the left lobe of the liver had a diameter of 5.7 cm and the one in the right lobe of the liver measured 4.1 cm. There were lesions of germinative membrane found on both cysts. Six months later, praziquantel at daily dose of 2 500 mg (45.3 mg/kg body waight) was introduced into the therapy, but the treatment was terminated after eight days because of the development of exanthema. The computerized tomography of the abdomen obtained in February 2008 revealed the presence of a large number of echinococcal cysts in the liver. The largest among those cysts measured 3.5 cm while calcifications of the cyst walls were observed on some of them. None of the remaining therapeutic options for further treatmetnt of echinococcal disease could be applied. Conclusion. The presented case confirms medical therapy as the only option for the treatment of some forms of cystic echinococcosis. Benzimidazole carbamates (albendazole, mebendazole) and praziquantel are only efficacious antihelminitics currently available, and when they have to be withdrawn due to serious adverse offects, futher treatment of a patient with liver multicystic echinococcosis is impossible. Because of that there is a need to search for new and more efficient drugs for the treatment of ehinococcal disease. [ABSTRACT FROM AUTHOR]

Background/Aim. Modern treatment of cystic echinococcosis, except for surgical treatment and percutaneous drainage of cyst considers also administration of albendazole as a type of individual therapy. However, clinicians fear of the serious adverse effects of high doses of albendazole, first of all the elevation of serum transaminases activity, very frequently results in subdosing of albendazole and wrong conclusions its efficacy and safety. The aim of this study was to investigate adverse effects of a longterm, continual administration of high doses of albendazole in the treatment of patients with echinococcal disease. Methods. A total of 42 patients (mean age 40.4 ± 18.3 years) with echinococcal disease were included in the study. They were treated with continual administration of high doses of albendazole within the period of 4 to 6 months. The subgroups of 27 and 15 patients were treated with 15-20 mg/kg/day and with 21-25 mg/kg/day albendazole, respectively. The patients in the control group (18 with surgical treatment, 6 with percutaneous drainage of cyst) were treated with 800 mg albendazole per day (< 15 mg/kg body weight) in the cycles of 28 days (1-3 cycles) and a two-week pause between them. Results. In the study group adverse effects of albendazole were registered in 20 (47.6%), whereas in the control group in 6 (30.0%) of the patients. In both subgroups elevated activity of serum transaminases were found more frequently in the study group compared to the control one (35.7% vs 25%, p < 0.05), especially in the patients who were treated with higher doses of albendazole. The patients in the study group, compared to the patients in the control group had significantly higher mean activity of serum alanin aminotransferase in the course of the second and third month of the therapy (p < 0.05). Administration of albendazole due to adverse effects was stopped in 3 (7.1%) of the patients in the study group. Two (4.8%) of them had a very high activity of serum transaminases and one had a muscle pains and high activity of serum creatine kinase. After the interruption of the therapy we documented a normalization of serum enzyme levels in all the patients. Conclusion. Longterm, continual administration of high doses of albendazole in the patients with echinococcal disease results in significant elevation of serum transaminases activity, compared to the patients treated with albendazole in the cycles, but in the majority of the patients serum transaminases activity was normalizated by the end of a 6-month period. [ABSTRACT FROM AUTHOR]