[Systemic necrotizing vasculitis: case report]. / Sistemski nekrotizirajuci vaskulitis: prikaz slucaja.

Systemic vasculitis presents a group of clinically pathologic syndromes with acute inflammatory process in its basis which commonly occurs on small blood vessels destroying their walls with fibrinoid necrosis. It often occurs on several organs and systems depending on the form, size and number of the diseased blood vessels. This paper is a case report on a female patient suffering from a serious systemic necrotizing vasculitis with clinically demonstrated ulceronecrotizing skin changes and purpura together with appearance of coronary ischemia; rhythmic disorders of heart rate and gastrointestinal bleeding and cardiac arrest in one moment. It contains a description of the course of the disease and a good result after application of immunosuppressive therapy with high doses of corticosteroids, cyclosporin A and plasmaphereses.

[Anti-proteinuria effects of nonsteroidal anti-inflammatory drugs in patients with nephrotic syndrome: an illusion or a read improvement?]. / Antiproteinuricni efekat nesteroidnih antiinflamacionih lekova u bolesnika s nefrotskim sindromom: privid ili stvarno poboljsanje?

In order to examine the antiproteinuric effect of non-steroidal antiinflammatory drugs in patients with nephrotic syndrome, we performed a parallel determination of the daily proteinuria, strength of glomerular filtration and of the effective renal plasmatic flow in basal conditions and after a 7 day ibuprofen therapy at a daily dose of 1200mg (3 x 400mg) in a group of 12 patients with idiopathic glomerulonephritis. In all patients ibuprofen therapy induced a significant decrease of the existing proteinuria, but this decrease was accompanied by the decrease of clearance rate of 99mTc-DTPA and 131J-hipuran clearance, that is by decrease of strength of glomerular filtration (averagely 24.29%) and effective renal plasmatic flow (averagely 18.74%). It can be concluded that the decrease of proteinuria in patients with nephrotic syndrome after ibuprofen therapy (as well as other non-steroidal antiinflammatory drugs) is primarily the result of worsening of hemodynamic conditions in the kidney, that it is caused by the reduction of the renal blood flow and by the strength of glomerular filtration in conditions of cycloxygenetic activity inhibition in the kidney.

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[Successful treatment of acquired F:VIII C inhibitor after delivery using plasmapheresis and high doses of immunoglobulins]. / Uspesno lecenje stecenog inhibitora F:VIII C nakon porodaja primenom plazmafereze i visokih doza imunoglobulina.

Three months after delivery a patient 34 years of age was admitted to the Clinic of haematology in Novi Sad because of sudden massive bleeding from the left ankle, left lower leg as well as for having small haematomas visible at forearms. Examining the mechanism of haemostasis, a diagnosis was made: acquired inhibitor VIII:C coagulation factor. Concentrate of VIII coagulation factor was used in treatment, as well as plasmaphaeresis, high doses of immunoglobulins and immunosuppressive drugs: prednisone and azathioprime. The result was a very quick recovery of the clinical state with loss of inhibitor to VIII: C coagulation factor. Three years after the treatment the patient has no difficulties and no antibodies to VIII:C coagulation factor.

Effects of nonsteroidal antiinflammatory drugs on renal plasma flow and glomerular filtration rate in patients with glomerulonephritis.

We investigated the effects of NSAIDs (Ibuprofen) on renal plasma flow (RPF) and glomerular filtration rate (GFR) in patients with glomerulonephritis. The study included 98 patients (53 men and 45 women) with idiopathic glomerulonephritis. All of the patients received Ibuprofen 1200 mg (3x400) during 7 days. Before and after the treatment with Ibuprofen ERPF (clearance of 131I-Hippuran) and GFR (clearance of 99mTc-DTPA) were determined. In our patients administration of Ibuprofen was associated with a significant reduction in renal plasma flow and glomerular filtration rate. In patients with reduced renal function the decrease in RPF and GFR after Ibuprofen was significantly greater than in patients with normal renal function.

[Immunologic characterization of autoreactivity to nuclear antigens in patients with systemic lupus erythematosus]. / Imunoloska karakterizacija autoreaktivnosti prema nuklearnim antigenima u bolesnika sa sistemskim eritemskim lupusom.

Abnormal immune reactivity, with a production of multiple autoantibodies specially against the components of a nucleoplasm is one of the hallmarks of systemic lupus erythematosus (SLE). Our investigations were conducted on 102 patients with SLE, classified according to the criteria of ARA, aiming to better characterize the overall incidence of anti-nuclear antibodies in SLE, to determine the type of immunofluorescent staining of the nuclei, and to characterize the fine specificity of such antibodies using modified ELISA procedure. Results of our investigation show that 95% of patients with SLE have detectable anti-nuclear antibodies. Predominant pattern of nuclear staining is homogeneous, followed by a speckled type, while the rim (peripheral) pattern is relatively infrequent. Anti-nuclear antibodies showed the highest reactivity against native DNA (70% of patients), which was followed by binding to SS-A, eRNP and SS-B antigens. Interestingly, using ELISA procedure we could observe the reactivity against Sm antigen only in 5% of SLE patients. In patients who showed homogeneous or rim pattern of nuclear staining the predominant type of reactivity was against native DNA, while in patients with speckled type most frequent binding to non-histone proteins was observed. The most frequently observed individual pattern of ANA reactivity was of polyreactive type.

[Malignant epilepsy in children: therapy with high doses of intravenous immunoglobulin]. / Maligne epilepsije dece: terapija visokim dozama intravenskog imunoglobulina.

22 children with intractable childhood epilepsy (ICE) showing no response to conventional drugs of hormone (ACTH, Synacten) therapy were administered i.v. immunoglobulin (ENDOBULIN immuno) at a dosage of 400 mg/kg on the first and 15th day and subsequently every 3 weeks for 6 months. 12/22 patients showed IgG2 subclass deficiency. A significant reduction in attacks, or even absence of attacks was observed in 13/22 children after 6 months of i.v. immunoglobulin therapy. Most of this children showed IgG2 subclass deficiency. The reduction of attacks after i.v. immunoglobulin therapy correlated with the improvement or normalization of the EEG finding. As for the psychomotor development, no major changes were noticed with respect to the condition prior to the therapy, but in children with IgG2 deficiency, there is no further psychomotor deterioration. 6 months after the last i.v. immunoglobulin dose positive therapeutic effect remained in 5/22 children, with 3 children the therapy was repeated because of recidive attacks and worse EEG findings, and proved effective. Light worsening of the EEG findings was found in 3/22 children, 2/22 dropped out, 1/22 child died of intercurrent infection, and in girl the attacks ceased entirely 4 months after the last i.v. immunoglobulin dose. With other children the condition remained unchanged. According to the authors opinion, i.v. immunoglobulin has its own place in ICE treatment, and it is evident in all cases where the classical antiepileptic and/or hormone therapy was unsuccessful, especially in children with IgG2 subclass deficiency, that is, in all the epilepsy cases where a great number of attacks is imperilling the psychomotor development in children, independently of type.

[Personal experience in the immunomodulation of immunothrombocytopenic purpura in children using high doses of i.v. immunoglobulin]. / Nasa iskustva u imunomodulaciji kod imunotrombocitopenijske purpure u dece primenom visokih doza i.v. imunoglobulina.

Twenty-three child patients with immunothrombocytopenic purpura ITP were treated with high doses of immunoglobulins for intravenous application. The dose applied was 400 mg/kg during five consecutive days. The immunological status of all patients was determined previously, and beside the normal values of the IgG serum, a deficit of the IgG2 subclass was discovered in 12 patients. The therapy effect was satisfactory in 19 patients, and 4 had an absence of a satisfactory response to therapy. There was an interesting observation that all patients with a good response to therapy had a deficit of the IgG2 subclass, while with all the other patients without a satisfactory response to therapy the, IgG2 subclass had normal values. On the basis of the results observed it can be concluded that i.v. immunoglobin therapy in high doses has it's place in the immunothrombocytopenia treatment of children, and especially of patients with an IgG2 subclass deficit.

[Intravenous immunoglobulin in the treatment of malignant epilepsy in children]. / Intravenöses Immunoglobulin bei der Behandlung von malignen Epilepsien bei Kindern.

15 children with malignant epilepsy showing no response to conventional antiepileptic drugs or hormone therapy were administered intravenous immunoglobulin (Endobulin, Immuno) at a dosage of 400 mg/kg per day on the 1st and 15th day and subsequently every three weeks for 6 months. 7 of these 15 patients showed IgG2 subclass deficiency. A significant reduction in attacks, or even absence of attacks was observed in 10 out of 15 children after six months of intravenous immunoglobulin therapy. Apart from one patient with ringchromosomopathy, all the children with IgG2 subclass deficiency responded to this therapy. The reduction of attacks after i.v. immunoglobulin therapy correlates with the improvement or normalization of the EEG findings. At present, the authors consider the number of patients still too small to make a final assessment, but they believe that intravenous immunoglobulin holds an important position in the treatment of malignant epilepsy in childhood.

[Possibilities in the practical use of computers in the selection of candidates for kidney transplantation]. / O nekim mogucnostima prakticne primene racunara u izboru kandidata za transplantaciju bubrega.

This paper points out some problems appearing in the selection of candidates for the cadaveric kidney transplantation treats basic issues regarding medical and other references important for making decision in the process of candidate selection, emphasizes the significance of data base for prepared candidates and presents the specific example of the applications of APLLE II C in the practice of the clinic for nephrology. The data for each candidate are grouped in two sections: A. PERSONAL DATA 1. Family name and surname 2. Year of birth 3. Place of residence 4. Address 5. Telephone number 6. Register number of case history 7. Date of enlisting B. BASIC MEDICAL DATA 1. Blood type 2. HLA tipization of tissue: A, B, C, DR 3. Cytotoxic antibodies 4. Urgency priority 5. Date of eventual previous transpl. 6. Special remarks This mode of Candidate selection provides the availability of all relevant data at one place: objectivity and high efficiency. Creation of such data base in every Yugoslav Kidney Transplantation Center would "at the time" mean the formation of YU Information System, thus providing a possibility of choice of the most appropriate cadaveric Kidney recipient on Yugoslav level at any time.

[Radionuclide functional tests in transplanted kidneys]. / Radionuklidno funkcijsko ispitivanje transplantiranog bubrega.

Results of 140 combined first-pass and dynamic functional renal studies were clinically evaluated in 50 patients with a transplanted kidney. The renal handling of three different nephroaffine radionuclides, namely the glomerular agent (99m Tc-DTPA), the predominantly tubular agent (99m TcMAG3) and combined glomerulo-tubular agent (99m Tc-PAHIDA) was also analysed in various dysfunctions of renal transplants. It has been concluded, that the clinically most useful information at all levels of the overall renal function has been given by 99m TcMAG3. However, the behaviour of glomerular and tubular agents in postischaemic acute tubular lesion was found to be discordant which in turn could be valuable differential-diagnostic information, and out of this reason their successive application is essential. The combined firstpass and dynamic functional renal studies have been judged as a helpful diagnostic tool in the follow-up of patients who have undergone kidney transplantation, provided that its results are interpreted in the light of clinical and other relevant findings.

[Allogenic transplantation of bone marrow in hematologic diseases. Preparation and completion of transplantation at the Hematology Clinic in Novi Sad]. / Alogena transplantacija kostne srzi u hematoloskim oboljenjima. Pripreme i izvodenje transplantacije na Klinici za hematologiju u Novom Sadu.

The paper deals with the results of clinical preparations for the application of allogenic bone marrow transplantation at the Clinic of Hematology in Novi Sad. The obligation of the definite treatment of patients below 45 years by allogenic and autologous bone marrow transplantation results from the acceptance of the Yugoslav protocols for acute leukaemia treatment. Thus immunogenotypical analyses, so far performed in patients with severe aplastic anaemia have been extended to patients with acute leukaemia as well and then to patients with chronic myelogenous leukaemia, high risk lymphocYtic lymphoma and myeloma multiplex with resistance to standard chemotherapy and their potential sibling donors. The bone marrow transplantation Unit has been set up, the team of specialists has been formed and educated and the protocol for allogenic transplantation with Busulfan and cyclophosphamide combination for pretransplant conditioning has been adopted. In research work concerning the field of bone marrow transplantation a particular emphasis has been put on the working out of a mathematical model for optimal timing of bone marrow transplantation in patients with acute myelogenous leukaemia.

[3 case reports of patients with malignant epilepsy treated with high doses of intravenous immunoglobulin]. / Prikaz tri bolesnika sa malignim epilepsijama lecenih visokim dozama intravenskog imunoglobulina.

Three patients with malignant epilepsia were presented. They were treated by i.v. immunoglobulin in the dose of 400 mgr/kg/bw at O, 15-day and 3-week intervals. Duration of treatment lasted 5 weeks in one child and 6 months in two children. One child had normal values of IgG2 subclass while two children showed the deficiency of this subclass. In all three children i.v. immunoglobulin therapy led to a remarkable improvement in respect both to the reduction of attacks and EEG. Due to the aggravation observed 6 months after the last dose of i.v. immunoglobulin, the therapy was repeated and led to the improvement in two children. It was pointed out in conclusion that i.v. immunoglobulin had its place in the treatment of malignant epilepsia in children.

[The importance of beta-2 microglobulin determination in the urine in the detection of tubular proteinuria]. / Znacaj odredivanja beta-2 mikroglobulina u urinu u detekciji proteinurije tubulskog tipa.

In 38 patients with the positive finding of protein in the urine the determination of beta-2 microglobulin concentration was made in addition to the simultaneous determination of albumin, IgC and transfer in the urine and the calculation of differential protein clearance values for the identification of tubular proteinuria. Only 4 (10.53%) patients had proteinuria of tubular type, 16 patients had proteinuria of glomerular type, while proteinuria of the mixed glomerulo-tubular type was found in 18 (47.37%) patients. The safe separation of tubular proteinuria from that of glomerular type was made possible by the determination of beta-2 microglobulin concentration in the urine in the framework of detailed investigation.