[Tumour lysis syndrome in small-cell lung cancer]. / Tumorlysissyndroom bij kleincellig longcarcinoom.

BACKGROUND: Small-cell lung cancer (SCLC) is a rapidly proliferating malignancy. Dramatic response to chemotherapy can therefore be expected. Unfortunately, tumour lysis prophylaxis is not mentioned in the current Dutch guidelines on SCLC treatment. CASE DESCRIPTION: A 64-year-old female was diagnosed with extensive SCLC and metastases. Shortly after diagnosis, chemotherapy was initiated. Based on Dutch guidelines, no tumour lysis prophylaxis was given. In addition to paraplegia, the patient also developed a clinical tumour lysis syndrome (TLS), and she passed away 5 days after start of treatment. CONCLUSION: Although tumour lysis prophylaxis is not mentioned in SCLC guidelines, tumour lysis in SCLC can occur as reported previously. Retrospectively, based on parameters applied to haematological malignancies, our patient was assessed as being at high risk of developing TLS.

Perineal endometriosis: a case report and review of the literature.

Endometriosis is the presence of endometrial-like tissue outside the uterine cavity, which most commonly affects peritoneal surfaces, ovaries and uterine ligaments. Even it is quite rare, endometriosis may affect the vulva, vagina, rectovaginal septum or perineal region, generally secondary to obstetric or surgical trauma. In this case report, we present a patient with perineal endometriosis in an episiotomy scar. Diagnostic tools used included transvaginal and endorectal ultrasonography (USG), magnetic resonance imaging (MRI) and biopsy. The endometriotic mass was wide-excised together with episiotomy scar. The recovery was uneventful with excellent functional and esthetic results. Six months after operation, woman is asymptomatic. According to the literature and our own experience, wide excision of endometriotic tissue seems to be the best chance of cure with satisfactory functional results and should be recommended.

Perifolliculitis capitis abscedens et suffodiens.

Perifolliculitis capitis abscedens et suffodiens (PCAS) is rare chronic, suppurative and inflammatory scalp disease. Its aetiology and pathogenesis is not completely understood. The treatment is usually difficult and often disappointing. We report a case of 29-year-old male who presented with tender, fluctuant nodules and abscesses, with draining pus and patchy alopecia on his scalp for 3 years. A skin biopsy from scalp lesions revealed features that are characteristic of perifolliculitis. Initially, the patient was treated with periodic incision and drainage of the scalp abscesses. The answer was very poor. When admitted to our department, isotretinoin was started at daily dose of 30 mg, because initially his cholesterol and triglyceride levels were mildly increased. When dose was reduced to 10 mg the levels of cholesterol and triglyceride remained normal. A response to treatment was excellent and rapid. The treatment of PCAS represents usually difficulties and frustration for both the patient and the physician. A long course of isotretinoin can be considered as one of the most effective treatment for PCAS.

High prevalence of testicular adrenal rest tumors, impaired spermatogenesis, and Leydig cell failure in adolescent and adult males with congenital adrenal hyperplasia.

In male patients with congenital adrenal hyperplasia, testicular tumors, or so-called adrenal rest tumors, have been described, but their presence in well controlled patients is thought to be rare. In this study, the prevalence of testicular tumors in 17 adolescent and adult male patients with congenital adrenal hyperplasia (age, 16-40 yr) was investigated. In 16 of 17 patients, one or more testicular tumors, ranging in maximal length from 0.2-4.0 cm, were found on ultrasonography. In 6 patients, the testicular tumors were palpable. Undertreatment, defined as the presence of a salivary androstenedione level (mean of 6 saliva samples collected over 24 h with intervals of 4 h) above the upper reference morning level, was found in 5 of 17 patients at the time of investigation. The other 12 patients were treated adequately or even over treated at the time of investigation. Nevertheless, 11 of these 12 patients showed testicular tumors on ultrasonography. Neither the presence of undertreatment at the time of investigation nor characteristics of the therapeutic regimen (daily dose of hydrocortisone equivalents per body surface, the use of glucocorticoid medication either two or three times a day, or the time of taking the highest glucocorticoid dose either in the morning or the evening) could predict tumor size (maximal diameter of largest tumor). In patients who were heterozygous or homozygous for the deletion or conversion of the CYP21 gene, tumor size was significantly larger than in patients who did not have this genotype. Impairment of Leydig cell function as manifested by decreased plasma levels of T was found in 6 of 17 patients. Semen analysis in 11 patients revealed azoospermia in 3 patients and poor semen quality in 4 patients. We conclude that, when carefully sought for, testicular adrenal rest tumors are frequently present in adolescent and adult males with congenital adrenal hyperplasia and are often accompanied by impaired spermatogenesis and Leydig cell failure.

Lipoprotein lipase gene polymorphism and lipid profile in patients with hypertriglyceridemia.

AIM: To assess lipid profile and the genotype distribution of lipoprotein lipase gene polymorphism at Pvu II polymorphic site within the intron between exons 6 and 7 in patients with hypertriglyceridemia. METHODS: Pvu II polymorphism was determined in 116 hypertriglyceridemic patients and 50 normolipidemic controls from Zagreb, Croatia. DNA was extracted from peripheral blood mononuclear cells. Polymerase chain reaction was used for amplification of 6th intron, which was then restricted with Pvu II-restriction endonuclease. Serum lipid and lipoprotein fractions were determined by standard enzymatic methods. Cholesterol concentrations in HDL subfractions, HDL2 and HDL3, were determined after precipitation with polyethyleneglycol. Apolipoproteins (apo) A-I and B were determined by immunonephelometry. RESULTS: Triglycerides showed a positive correlation with total cholesterol (r=0.222, 95% CI=0.041-0.389, p=0.017) and inverse correlation with HDL-cholesterol (r= -0.278, 95% CI= -0.449 to -0.088, p=0.005), especially with HDL3-cholesterol (r= -0.333, 95% CI= -0.497 to -0.147, p=0.001). The respective frequencies for genotypes /, +/, and +/+ were 22, 58, and 36 in the patient group, and 17, 17, and 16 in the control group. Serum triglycerides in the patient group, expressed as median in mmol/L, were 3.30 (range, 2.60-10.90), 3.60 (range, 2.50-21.50), and 3.99 (range, 2.50-15.56), respectively. Serum concentration of triglycerides differed significantly between the +/+ and / genotype (p=0.043). CONCLUSION: There is an association between genetic variation at the locus for lipoprotein lipase and high serum triglyceride levels. This might prove useful in the detection of individuals susceptible to the development of hypertriglyceridemia, as well as a marker in the analysis of this genetic defect in patient families.

[TORCH infections in mothers as a cause of neonatal morbidity]. / TORCH infekcije majki kao uzrok neonatalnog morbiditeta.

When possible, diseases by expectant mothers and newborns, like long-term disabilities also, should be prevented by establishing early diagnoses, evaluation and implementation adequate therapy. The major goal of medical care is prevention of disorders with provision of adequate prenatal care for the expectant mother and precautions regarding the exposure to teratogenic infections. The range of pathological conditions produced by infections agents is wide, and the difference between maternal and fetal effects caused by any one agent is also important. Some maternal infections, especially during the early gestation, can result in fetal loss or malformation because the ability of the fetus to resist infectious organisms is limited and the fetal immunologic system is unable to prevent the disemination of infectious organisms to the various tissues. These infections are responsible for significant congenital neonatal morbidity as for as compromises a child's quality of life and infertility and sterility. One group of microbial agents--generally known as TORCH infections can cause remarkably similar manifestations, and is uncommon to test all when a prenatal infection is suspected. We analysed the practice of TORCH analyses with our patients and their mothers during last year (1999th) at the Pediatric Clinic and Clinic of Gynecology and Obstetrition-UCC Tuzla. At this time there were 5.028 deliveries. Out of short figure 544 or 10.8% newborns were early born and 245 or 4.8% were hypotrophic and 62 were still-born or 12.3 from 1000 deliveries. TORCH infection was analysed only in few cases. In the same period there were 3.457 children treated at the Pediatric Clinic in Tuzla. Only in 20 cases or 0.58% TORCH was made. Three or 15% were with remarkable sequeles like microcephaly, cerebrospinal liquid abnormality, seizures, hepatomegaly, cirrosis etc. TORCH analysis was made with all mothers. Only one was serologic CMV positive and we started with the therapy. History of four mothers or 20% have data about spontaneous abortions, and in other four or 20% we found data about early deliveries. The prevention of conatal infections was not made by any one. In our small group we made TORCH because of evident problems that were suspected of conatal infections. We concluded that there is a big risk of untreated maternal infections with women in fertile age in Bosnia and Herzegovina. This problem is not enough present in our medical practice.

[Experience in the development of information systems at the canton level]. / Iskustva u razvoju informacijskog sistema na cantonalnom nivou.

In the aim of need and necessity of stronger orientation and more efficient aim realization 35 Strategy SZO (health information system) country members should have the health information system able to provide information support to their National strategy "Health for All until 2005". Such a health information system should provide the information support for the planning process, monitoring and health evaluation, health care and work in public-health services sector. The experiences in the work of information system organization in Tuzla Canton Public Health Institute should be seen from two aspects: Aspect of the information system significance in the framework of the social-medical, epidemiological, hygiene-ecological and other activities of the Institute; Aspect of the information system development within the Public Health facilities of Canton in relation to the automatic data processing important for registration, tracking and recognition of success and population health care needs. From the aspect of establishing the information system in the area of Tuzla Canton and the Public Health Institute role, there is a need for adequate high technology technical equipment, with the task to enable practical realization of defined projects and in such a way, varied acceleration of work giving as a result usable information. The canton Public Health Institute needs as follows: necessary resources for free information system work; to provide free computer access to all; to ensure connection with other PHI through communications. In this way the canton Public Health Institute information system would be connected with other information systems in the field of health. In would be a base for development of integrated health information system. The information system is desirable aim for the work of Public Health Institute, method of selection and leading content of modernization. Analysing the Bill of Law on Health Care, a defectiveness has been noticed, since the information system is not regulated. Therefore, the need to be issued by Lay is of great importance. A statement that all projects on local information systems, started before war or during the war have been stooped, joins to the aforesaid, and also a series of independent information system in different health segments, which are not connected into one, unique information system. In any case, this disparaged the quality of medical decision making and therefore, providing of high-quality services at all levels of health work.

[Evidence law in health care, development of a health care information system and use of automatic processing of information]. / Zakon o evidencijama u oblasti zdravstva, mogucnosti razvoja zdravstveno informacijskog sistema i primjene automatske obrade podataka.

The aim of work is to analyse the state of health-statistic and information system within the Federation of Bosnia and Herzegovina, analyse the Program on health statistic research important for the entire country, analyse the Law on records in the field of health and present how deficient it is, as well as to propose the set of other data, based on our own research, that could fill noticed defects in the practice, provide the use of computer technology in data tracking from the Law on issued records in the field of health within the activity as an example for others--health statistic sheet, form 3-21-61/A, and to present further possibilities and recommendations for development of health information system. The used method of work is descriptive analysis of methodological approach to the health statistic information system of Bosnia and Herzegovina (taken from the former Yugoslavia). We have also applied the data from the statistic records (retrospective analysis) of the registered cases from the neurological ward of the Neurological Clinic Tuzla for December 1997. In such a way we formed the data base and presented the statistic data processing ideological project including modern computer technologies.

Contact allergy and psoriasis.

The study was conducted over a two-year period and included 48 psoriatic patients with palmar and plantar lesions and 61 psoriatic patients without palmar and plantar lesions who served as controls. The objective was to establish the incidence of contact sensitization and its importance as the causative factor in palmar and plantar psoriasis. The most frequent contact allergens were: nickel sulphate, mercapto mix, balsam of Peru, potassium dichromate, mercury mix and fragrance mix. Patch tests were positive in 41.7% psoriatics with palmar-plantar psoriasis and in only 6.6% of psoriatics without palmar-plantar involvement. The study showed an increased incidence of contact allergy in patients with palmar-plantar psoriasis.

[Evaluation of the effect of local corticosteroids in the phototherapy of psoriasis]. / Evaluacija djelovanja lokalnih kortikosteroida u fototerapiji psorijaze.

An open clinical trial was carried out in order to establish to what extent the application of topical corticosteroids with the UVB therapy influences the complete dosage of the UVB radiation required for the clearing of psoriasis and the duration of remission. Out of 30 patients who were administered the suberythemogenic UVB dosage, 15 received a topical corticosteroid and 15 an indifferent ointment (u. emolliens). Although the therapeutic response was initially somewhat more immediate in the corticosteroid--UVB group, there is no statistically significant difference between these two groups in the total UVB dosage required for the remission of the disease. The patients in the topical corticosteroid--UVB group remained in remission longer than the patients in the control group receiving no local corticosteroid.