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Biomedical subjects

Rajko Ostojić

Publications and source records attributed to Rajko Ostojić.

12 recordsLinked to original sources
PubMed2006

Esomeprazole versus pantoprazole for healing erosive oesophagitis.

The aim of this study was to compare the efficacy of esomeprazole and pantoprazole with regard to healing and relief from gastroesophageal reflux disease-related symptoms. I this multicentre, randomized, single-blind study 180 patients (ITT population) diagnosed with endoscopically proven GERD grade A,B,C received esomeprazole (40 mg once daily (o.d.), n = 90) orpantoprazole (40 mg o.d., n = 90). Healing and relief from GERD-related symptoms were assessed at first and final visit (after 4 or 8 weeks of treatment). Esomeprazole 40 mg provided significantly greater healing than pantoprazole 40 mg after 4 weeks of treatment in patients with EE (77.8% vs. 72.2%). Esomeprazole-treated patients were healed after up to 8 weeks of treatment similar those treated with pantoprazole (92.2% vs. 91.1%). The proportion of heartburn-free days was similar in patients treated with esomeprazole and to those treated with pantoprazole.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed2005

[Treatment of recurrent HCV infection after liver transplantation].

End-stage liver disease associated with hepatitis C virus (HCV) infection is the most common indication for orthotopic liver transplantation (OLT) and accounts for 50% of these procedures in Spain and 42% of OLT performed in the United States. Recurrent infection with HCV after OLT, however, is almost universal and is associated with substantial morbidity, mortality, and graft loss. In contrast to immunocompetent individuals, HCV infection in immunosuppressed transplant recipients usually has an accelerated course. Acute hepatitis develops in approximately 75% of HCV recipients in the first six months following OLT. By the fifth postoperative year, over 80% of HCV-infected liver transplant recipients will develop histologic evidence of chronic allograft injury secondary to hepatitis C, with up to 30% developing cirrhosis. While the choice of calcineurin inhibitor has not been clearly shown to affect the histologic recurrence of hepatitis C or the frequency of rejection in HCV-infected recipients, cumulative exposure to corticosteroids is associated with increased mortality, higher levels of HCV viremia and more severe histologic recurrence. There have been no well-controlled, large, prospective, multicenter and randomized clinical trials to determine the optimal approach to the treatment of recurrent HCV infection following OLT. Most published studies were small, lacked controls, had short follow-up periods, and were devoid of histologic analysis. Furthermore, most of the published studies are largely incomparable due to differences in the definition of recurrent hepatitis C, timing of anti-HCV therapy administration relative to transplantation, the drugs and doses used and regimens employed, and the study end points assessed (i. e. biochemical, virologic and histologic end points have not all been consistently investigated). In lieu of large studies in post-transplant patients, monotherapy with conventional interferon or monotherapy with pegylated interferon should be considered in recipients with histologically confirmed recurrence of HCV infection. The role of hepatitis C immunoglobulin and new imunosuppression agents in the management of post-transplant HCV infection is still evolving.

Hepatitis C↗
PubMed2005

[Retreatment of patients with chronic hepatitis C].

Impressive gains have been made in the treatment of chronic hepatitis C virus (HCV) infection during the past decade. As the treatment for chronic hepatic C has improved, the question has arisen as to whether patients who failed previous HCV treatment regimens should be retreated. Several recent studies involving retreatment have established that a small but significant increase in sustained virologic response (SVR) resulted when nonresponders to prior interferon monotherapy were retreated with interferon and ribavirin. Given the superior results observed with pegylated interferon and ribavirin in the treatment of naive population, it is now appropriate to consider whether retreating previous relapsers and nonreponders, particularly nonresponders to conventional interferon and ribavirin, will be effective. Such treatment would be most advantageous for patients with advanced fibrosis or cirrhosis who are at the highest risk of developing complications of advanced liver disease, including hepatocellular carcinoma. Namely, there is no doubt that interferon-based regimens may reduce hepatic inflammation in the abscence of SVR. For this reason, patients with advanced liver disease receive histologic benefit from therapy in addition to the potential benefit of viral eradication, because progression of fibrosis to cirrhosis is a function of hepatic inflammation. A number of investigator-initiated clinical trials have been started to study response in prior nonresponders and relapsers retreated with pegylated interferon and ribavirin. From the data obtained from these trials, so far is clear that combined therapy can clear HCV-RNA in a significant number of prior nonresponders (25% to 40%) while on treatment, yet the rate of SVR appears to be by far lower (20%). Better results have been reported with relapsers to prior combination therapy. Moreover, preliminary results from the HALT-C trial have shown that maintenance therapy with pegylated interferon and ribavirin can significantly delay fibrosis progression and reduce the risk of hepatic decompensation and hepatocellular carcinoma and the need of liver transplantation. According to these results, many authors have proposed a course of combination therapy with pegylated interferon and ribavirin for relapsers and nonresponders with advanced fibrosis and cirrhosis.

Antiviral Agents↗
PubMed2004

Palliative treatment of hepatocellular carcinoma with percutaneous ethanol injection using tumor's feeding artery occlusion under the ultrasonic color Doppler guidance.

We evaluate the efficacy of PEIT in patients with HCC using duplex color Doppler US. The study included 27 HCC patients admitted to the University Hospital Centre Zagreb, between 1993 and 1997. PEIT was performed for ablation of tumor supplying vessels in HCCs of < 5 cm in diameter, and as a palliative measure for tumor feeding vessel obliteration in larger tumors. The efficacy of PEIT was evaluated with duplex color Doppler US, and controlled by dynamic CT scan (16 patients) or selective angiography of hepatic artery (11 patients). All patients had well vascularized tumors before PEIT, and after therapy 25 of them showed absent or minimal tumor vascularization. Recanalization of the tumor feeding vessel was detected with Doppler US within 9 months after therapy. Study results suggested that duplex color Doppler US should be the method of choice in the evaluation of PEIT as well as in the follow-up of HCC patients after PEIT.

Adult↗
PubMed2003

[Linear endoscopic ultrasound in the diagnosis of diseases of the digestive system].

This article reviews the recent literature on the role of endoscopic ultrasonography (EUS) as diagnostic and therapeutic tool, defines it's place in the algorithm of diagnostic procedures and informs how to treat gastroenterologic patients evaluated by EUS. Endoscopic ultrasonography utilizes the technology of endoscopy to introduce high-frequency ultrasound probes in the upper or lower part of gastrointestinal tract to visualize gastrointestinal wall and adjacent structures. Longitudinal endoscopic probe is different, compared to radial probe, and advantage is use of Doppler technique. This method has came out as an important modality for the diagnosis and staging of benign and malignant lesions of the gut wall and surrounding structures of the mediastinum, abdomen and pelvis. It is also used as a diagnostic tool for the evaluation of submucosal masses of the upper gastrointestinal tract and the rectosigmoid, for locating pancreatic endocrine tumors, and for the assessment of vascular disease. The widest application of EUS is, however, in the diagnosis and staging of esophageal, gastric, rectal, and pancreaticobiliary carcinoma. EUS has been shown to change the approach to clinical management in a significant proportion of patients to a less costly, risky, or invasive strategy.

Digestive System Diseases↗
PubMed2003

[Liner interventional endoscopic ultrasound in diseases of the digestive system].

The evident advantages of the endoscopic ultrasound, upon the complementary imaging methods, as are transabdominal ultrasound, the spiral CT, the nuclear magnet resonance, potentioned by the development of the techniques for the taking of biopsies, and the possibilities of the microinvasive surgical approach to the environment organs and tissues. Besides the standard achievement of the material for the cytologic and pathohistologic analysis is opened the possibility of the therapeutic application of the medicaments, that is the drainage collection in the abdomen and by "stapler" technique of the establishing of the anastomoza.

Digestive System Diseases↗
PubMed2003

[Primary sclerosing cholangitis: case report of a young patient with an atypical diagnostic process in complications of the disease].

The primary sclerotic colangitis is the chronic disease of the liver which in its finish very often requires the liver transplantation. The disease gets diagnosed mainly in males of middle age and is often joined with the inflammation disease of the intestines. The course of the disease not rarely is complicated by the stenosis of the liver ducts or by the occurrence of the concrements. In the presented case it is the word about the young patient in which the is the diagnosis made with the atypical way primarily from the reason that the biopsy of the liver is performed too early and the patohystologic changes were non specific. Immediately after the graft is being developed the biliary peritonitis because of the injury of the gallbladder so is done the cholecystectomy. Only in the later course is performed the endoscopic retrograde colangiography, during which are getting the typical changes of the biliary trunk for the primary sclerotic colangitis. The underlying disease in the demonstrated patient is complicated by the recidivens occurrence of the concrements of the choledokus and stenoses of the bladder ducts primarily for the left slice what, up to new, always successfully was treated by the extraction of the concrements and the dilatation of the liver ducts by endoscopic way.

Adolescent↗
PubMed2003

[Autoimmune hepatitis].

Autoimmune hepatitis is an unresolving, hepatocellular inflammation of unknown cause that is characterized by the presence of periportal hepatitis on histologic examination, tissue autoantibodies in serum, and hypergammaglobulinemia. By international consensus, the designation autoimmune hepatitis has replaced alternative terms for the condition. Three types of autoimmune hepatitis have been proposed based on immunoserologic findings. Type 1 autoimmune hepatitis is characterized by the presence of antinuclear antibodies (ANA) or smooth muscle antibodies (SMA) (or both) in serum. Seventy percent of patients with type 1 of autoimmune hepatitis are women. This type is the most common form and accounts for at least 80% of cases. Type 2 is characterized by the presence of antibodies to liver-kidney microsome type 1 (anti-LKM1) in serum. Patients with this type of autoimmune hepatitis are predominantly children. Type 3 autoimmune hepatitis is characterized by the presence of antibodies to soluble liver antigen (anti-SLA) in serum. There are no individual features that are pathognomonic of autoimmune hepatitis, and its diagnosis requires the confident exclusion of other conditions. The large majority of patients show satisfactory response to corticosteroid (usually prednisone or prednisolone) therapy. For the past 30 years it has been customary to add azathioprine as a "steroid sparing" agent to allow lower doses of steroids to be used and remission, once achieved, can be sustained in many patients with azathioprine alone after steroid withdrawal. Patients with autoimmune hepatitis who have decompensated during or after corticosteroid therapy are candidates for liver transplantation.

Autoantibodies↗
PubMed2002

Treatment of deep vein thrombosis with oral anticoagulants in patients with malignancy: prospective cohort study.

AIM: To assess the outcome of deep vein thrombosis in patients with malignancy after 6 months of oral anticoagulant therapy, and to compare it with international normalized ratio (INR). METHOD: Thirty-one patients with malignancy (13 with hematological and 18 with solid tumors) and deep vein thrombosis (29 leg thrombosis and 2 upper extremity thrombosis) were included into a prospective cohort study that lasted from March 2000 until May 2001. The presence of malignant tumors was histologically proved and documented, and deep vein thrombosis was proved by ultrasound or venography. Patients were treated with heparin during the acute phase, and with oral anticoagulant therapy during further 6 months. INRs and ultrasound examination performed during the acute event were repeated one month and 6 months afterwards for the needs of analysis. RESULTS: Twenty-four patients concluded the study. Clot resolution was achieved in 13 patients after 6 months of therapy. The patients with INR>2 (n=10) had better clot resolution than those with INR<2 (n=3); p=0.012. There was no statistically significant difference in the outcome of thrombosis with regard to the INR level after a month of therapy (p=0.555). Three patients experienced bleeding, one patient had recurrent thrombosis, and two patients suffered pulmonary embolism. CONCLUSION: Appropriate anticoagulation during 6 months after the acute deep vein thrombosis enhances the rate of the complete clot resolution. The INR values can be used as predictive of complete recovery from the thrombosis. Complications are comparable with those reported for patients without malignancy.

Administration, Oral↗
PubMedDate not supplied

[First online continuing tele-education in gastroenterology in Croatia].

The expansion and popularity of the Internet created the expansion of tele-medicine, with tele-education as its important part. Such on-line distance learning is especially important for diseases being in the focus of public health interest, as diseases of the gastrointestinal, hepatobiliary and pancreatic system due to their frequency. Therefore, in this study is shown the "TIGEL project of tele-interventional gastroenterology" that was launched in May 2001 at the Center for Interventional Gastroenterology, Department of Gastroenterology, University Department of Medicine, Zagreb University Hospital Center. The project includes creation of a web site at the server of the Zagreb University School of Medicine (www.mef.hr/edumed/gastro/index.html), and among the most important goals of the project is continuous medical tele-education in gastroenterology. Beside description of the project, one of the founders of continuous on-line medical education in Croatia, this work describes many advantages but also some still unsolved questions considering medical tele-education, a very promising but still developing way of education.

Croatia↗
PubMedDate not supplied

[Percutaneous endoscopic gastrostomy: 5-year experience at out center (1997-2002)].

Gauderer and Ponsky first described percutaneous endoscopic gastrostomy (PEG) in 1979. It was introduced as a routine method in the Division of Gastroenterology, University Hospital Rebro, Zagreb, in 1995. Over the years the number of PEG insertions has increased significantly. We reviewed the available literature and compared the results with our experience according to indications, complications and efficacy of the procedure. We inserted PEG in 86 patients from January 1, 1997 until January 31, 2002. There were 40 females and 46 males. The most frequent indication for PEG insertion was a neurological condition (60/86). There were no deaths directly related to the procedure. One patient had a leakage of PEG feeding into the peritoneal cavity that caused severe peritonitis and required urgent laparatomy within 24 hours of the PEG insertion. Two patients had local infection and the tube had to be removed. The antibiotic prophylaxis has been given to 65 patients. Our experience confirms that PEG is a relatively safe and well tolerated procedure.

Adolescent↗