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Tuberculous lymphadenitis as a cause of obstructive jaundice:A case report and literature review

World Journal of Gastroenterology 2008年第19期14卷 3098-3100页

作者： Radoje Colovic Nikica Grubor rada jesic Marjan Micev Tanja Jovanovic Natasa Colovic Henry Dushan Atkinson Institute for Digestive Diseases First Surgical ClinicClinical Center of Serbia Institute of Microbiology Belgrade School of Medicine Imperial College School of Medicine St Mary’s Hospital

Obstructive jaundice secondary to tuberculosis (TB) is extremely rare. It can be caused by TB enlargement of the head of the pancreas, TB lymphadenitis, TB stricture of the biliary tree, or a TB mass of the retroperitoneum. A 29-year-old man with no previous history of TB presented with abdominal pain, obstructive jaundice, malaise and weight loss. Ultrasonography (US), computer tomography (CT) scan and endoscopic retrograde cholangiopancreatography (ERCP) were suggestive of a stenosis of the distal common bile duct (CBD) caused by a mass in the posterior head of the pancreas. Tumor markers, CEA and CA19-9 were within normal limits. At operation, an enlarged, centrally caseous lymph node of the posterior head of the pancreas was found, causing inflammatory stenosis and a fistula with the distal CBD. The lymph node was removed and the bile duct resected and anastomosed with the Roux-en Y jejunal limb. Histology and PCR based-assay confirmed tuberculous lymphadenitis. After an uneventful postoperative recovery, the patient was treated with anti-tuberculous medication and remained well 2.5 years later. Though obstructive jaundice secondary to tuberculous lymphadenitis is rare, abdominal TB should be considered as a differential diagnosis in immunocompromised patients and in TB endemic areas. Any stenosis or fistulation into the CBD should also be taken into consideration, and biliary bypass surgery be performed to both relieve jaundice and prevent further stricture.

关键词： obstructive jaundice Common bile duct stricture Tuberculous lymphadenitis, Surgical excision, Roux en Y

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Validation of the chronic liver disease questionnaire in Serbian patients

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World Journal of Gastroenterology 2013年第30期19卷 4950-4957页

作者： Dusan Dj Popovic Nada V Kovacevic Darija B Kisic Tepavcevic Goran Z Trajkovic Tamara M Alempijevic Milan M Spuran Miodrag N Krstic rada S jesic Zobair M Younossi Tatjana D Pekmezovic Clinic for Gastroenterology Clinical Centre of Serbia Faculty of Medicine University of Belgrade Institute of Epidemiology Faculty of MedicineUniversity of Belgrade Institute of Statistics and Informatics Faculty of MedicineUniversity of Belgrade Center for Liver Diseases Department of MedicineInova Fairfax HospitalFalls ChurchAnnandale

AIM:To translate into Serbian and to investigate the validity of the cross-culturally adapted the chronic liver disease questionnaire(CLDQ).METHODS:The questionnaire was validated in 103 consecutive CLD patients treated between October 2009 and October 2010 at the Clinic for Gastroenterology,Clinical Centre of Serbia,Belgrade(Serbia).Exclusion criteria were:age 2)and liver *** of the CLDQ was done based on the following parameters:(1)acceptance is shown by the proportion of missing items;(2)internal reliabilities were assessed for multiple item scales by using Cronbach alpha coefficient;and(3)in order to assess whether the allocation of items in the domain corresponds to their distribution in the original questionnaire(construction validity),an exploratory factor analysis was *** validity was determined by comparing the corresponding CLDQ score/sub-score in patients with different severity of the ***:The Serbian version of CLDQ questionnaire completed 98% *** of missing items was 0.06%.The total time needed to fill the questionnaire was ranged from 8 to 15 *** in completing the questionnaire required 4.8% patients,while 2.9% needed help in reading,and 1.9% involved writing *** mean age of the selected patients was 53.8 ± 12.9 years and 54.4% were *** CLDQ score was 4.62 ± ***'s alpha for the whole scale was *** for all domains was above 0.70,except for the domain "Activity"(0.49).The exploratory factor analysis model revealed 6 factors with eigenvalue of greater than 1,explaining 69.7% of cumulative *** majority of the items(66%)in the Serbian version of the CLDQ presented the highest loading weight in the domain assigned by the CLDQ developers:"Fatigue"(5/5),"Emotiona

关键词： Chronic liver disease Quality of life Questionnaire Validation Factor analysis

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Right liver lobe/albumin ratio:Contribution to non-invasive assessment of portal hypertension

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World Journal of Gastroenterology 2007年第40期13卷 5331-5335页

作者： Tamara Alempijevic Vladislava Bulat Srdjan Djuranovic Nada Kovacevic rada jesic Dragan Tomic Slobodan Krstic Miodrag Krstic Clinic for Gastroenterology Hepatology Institute for Digestive DiseasesClinical Centre of Serbia6 Dr Koste Todorovica St.11000 BelgradeSerbia

AIM： To study the value of biochemical and ultrasonographic parameters in prediction of presence and size of esophageal varices.METHODS： The study includes selected cirrhotic patients who underwent a complete biochemical workup, upper digestive endoscopic and ultrasonographic examinations. Albumin/right liver lobe diameter and platelet count/spleen diameter ratios were calculated. The correlation between calculated ratio and the presence and degree of esophageal varices was evaluated.RESULTS： Ninety-four subjects （62 males, 32 females）, with a mean age of 52.32 ± 13.60 years, were studied. Child-Pugh class A accounted for 42.6%, class 13 37.2%, whereas class C 20.2%. Esophageal varices （OE） were not demonstrated by upper digestive endoscopy in 24.5%, while OE grade Iwas found in 22.3% patients, grade Ⅱ in 33.0%, grade m in 16.0%, and grade iV in 4.3%. The mean value of right liver lobe diameter/ albumin ratio was 5.51± 1.82 （range from 2.76 to 11.44）, while the mean platelet count/spleen diameter ratio was 1017.75 ± 729.36 （range from 117.39 to 3362.50）, respectively. Statistically significant correlation was proved by Spearman＇s test between OE grade and calculated ratios. The P values were 0.481 and -0.686, respectively.CONCLUSION： The right liver lobe diameter/albumin and platelet count/spleen diameter ratios are noninvasive parameters providing accurate information pertinent to determination of presence of esophageal varices, and their grading in patients with liver cirrhosis.

关键词： Liver cirrhosis Esophageal varices Portal hypertension Ultrasonography

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Biochemical markers for non-invasive assessment of disease stage in patients with primary biliary cirrhosis

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World Journal of Gastroenterology 2009年第5期15卷 591-594页

作者： Tamara Alempijevic Miodrag Krstic rada jesic Ivan Jovanovic Aleksandra Sokic Milutinovic Nada Kovacevic Slobodan Krstic Dragan Popovic Institute for Digestive Diseases Clinical Centre of Serbia 11000 Belgrade Serbia

AIM: To evaluate different biochemical markers and their ratios in the assessment of primary biliary cirrhosis (PBC) stages. METHODS: This study included 112 patients with PBC who underwent a complete clinical investigation. We analyzed the correlation (Spearman's test) between ten biochemical markers and their ratios with different stages of PBC. The discriminative values were compared using areas under receiver operating characteristic (ROC) curves. RESULTS: The mean age of patients included in the study was 53.88 ± 10.59 years, including 104 females and 8 males. We found a statistically significant correlation between PBC stage and Aspartate aminotransferase (AST), Alanine aminotransferase (ALT) to platelet ratio (APRI), ALT/platelet count, AST/ALT, ALT/AST and ALT/Cholesterol ratios, with the values of Spearman's rho of 0.338, 0.476, 0.404, 0.356, 0.351 and 0.325, respectively. The best sensitivity and specificity was shown for AST/ALT, with an area under ROC of 0.660. CONCLUSION: Biochemical markers and their ratios do correlate with different sensitivity to and specificity of PBC disease stage. The use of biochemical markers and their ratios in clinical evaluation of PBC patients may reduce, but not eliminate, the need for liver biopsy.

关键词： Primary biliary cirrhosis Disease stage Fibrosis Biochemical markers

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