Clinical features of Balkan endemic nephropathy.

This paper describes the clinical symptoms and signs of Balkan endemic nephropathy (BEN). The initial asymptomatic period followed by weakness and lassitude during renal insufficiency is emphasized. Non-characteristic lumbar pain may be present and episodes of macrohaematuria may occur. There is no fever, no severe dysuria, and no general disease preceding the symptoms. No oedema of the nephrotic type is recognized. Working capacity is unaffected until the late stage of the disease. In the advanced stages pallor of the skin and xantochromia of palms and soles are noticeable. Blood pressure is normal, but in the advanced phase may be elevated. In the uraemic phase a full uraemic syndrome is found. Urothelial tumours are frequent, occurring in 2-47% of cases; tumour cells may be found in the urine. Proteinuria of tubular type may be found early; in the uraemic phase it is constant. In the urinary sediment there are scarce white and red blood cells (the latter episodically abundant). Bacteriuria is present in about 20% of women patients. Glucosuria (less than 10%) and aminoaciduria (less than 10%) have been reported. In the early stages of BEN the urine concentration capacity is impaired earlier than renal blood flow and glomerular filtration rate. Enzymuria is present in the early phases. Tamm-Horsfall protein may be increased in the urine. Normo- or hypochromic normocytic hyporegenerative anaemia is a frequent finding. Bone marrow and leucocytes are normal. Serum proteins and immunoglobulins are not altered. Complement is normal; anti-glomerular basal membrane and anti-tubular basal membrane are negative. On radiography, kidney size varies from normal to the size of a small contracted kidney. The clinical picture of the disease is that of a slowly progressing tubulo-interstitial chronic nephritis.

[Pulmonary alveolar microlithiasis. A familial presentation in two sisters]. / Microlitiasis alveolar pulmonar. Presentación familiar en dos hermanas.

Alveolar lung microlithiasis is a rare disease of unknown etiology, with familial feature in 50% of the cases. The onset of this disease in 2 sisters is presented.

[How should pharmacodynamic tests for respiratory tract obstruction be evaluated?]. / Kako procijeniti farmakodinamski test pri opstrukciji disnih putova?

The factors that could influence the results of pharmacodynamic testing with beta 2 agonists in lung function diagnostics are discussed. These are: hypersecretion of the mucus, acute respiratory infection, tachyphylaxis of the adrenoceptors, therapy in the past 48 hours, patient's cooperation, and ambient or environmental pollution. The correct application, by inhalation, of selective sympathomimetics is described and differences between the basic values of lung function parameters and those following the salbutamol test are discussed.

[The epidemiologic situation of chronic obstructive lung diseases in the population in Croatia]. / Epidemioloska situacija kronicnih opstruktivnih plucnih bolesti u populaciji Hrvatske.

In the introduction the importance of epidemiologic studies of COPD is indicated, thus stressing the complexity of their realization and high cost of these projects. According to the data that are gathered through every day routine work of health service and health statistics the authors try to find out the place of COPD in the population of Croatia studying the year 1987. In general medicine 24.8% visits due to respiratory diseases have been registered, in occupational medicine 24.8%, school medicine 43.2%, pediatric health care 60.8%. In this number COPD are represented by 8.6% with 111.822 visits, occupational medicine by 3.8% with 18.445 visits, school medicine by 4.2% with 22.629 visits and pediatric health care by 5.5% with 40.961 visits. On the whole in this year in Croatia there were 4.214 visits on 100,000 population due to COPD. According to the data of pneumology service the incidence of COPD is 164 0/0000 and the prevalence 691,6 0/0000. In pneumology stationaries 6.207 patients with COPD or 21.5% were treated. In the proclaimed invalidity the COPD is to be found on the fourth place. In the mortality the respiratory diseases are found on the sixth place out of which half of them are COPD. By the follow-up of these data a lot of time and money is wasted without giving the adequate results. The method of analytically-specialistic register for COPD is explained as a simple, economic and efficient method for studying COPD in the population.

[The present state and future development of permanent pneumonology facilities in Croatia]. / Osvrt na sadasnje stanje i buduci razvoj stacionarnih pulmoloskih ustanova u SR Hrvatskoj.

According to the questionnaire in 28 hospitals for pulmonary diseases and tuberculosis in Croatia together with the series of data from the public health service the present state and future trend of the development of pneumonologic activity are analysed. The wide spectrum of medical institutions is presented-from the type of sanatorium to the highly qualified pulmonary institutions like clinic. Surplus of pulmonary beds is due to the great number of beds from former sanatoria dislocated from great urban centers. By reduction of beds according to the plans proposed the standard-setting of 0.4 beds has been agreed for pulmonary patients on the region of Croatia. The conception of the "acute" and "chronic" bed in pulmonology is explained. Recommendation of categorization of pulmonary institutions is given on the level of community, region and republic together with the suggestions of cadre policy and organisational normatives. The necessity of application of rationalisation and economics in health care as to the planning of beds is indicated. If one proposition is not accepted, the other would follow and always with restriction. Pneumology service should be its fundamental principles of integral medicine, priority and economics in health analyse the most optimal suggestion of its future evolutive development of pneumology and public health service on the whole.

"L'acropathie ulcéro-mutilante familiale" with involvement of the distal mixed nereves and long bones fractures.

Two siblings are described with mutilating lesions of the feet and hands, with sensory disturbances and muscle amyotrophy. The motor and afferent nerve conduction velocities were at the lower limit of normal. The nerve action potentials disappeared, first with percutaneous stimulation of the fingers and later with more proximal direct nerve stimulation. Early in the course of the illness indolent fracture of different long bones appeared in both cases. Histology revealed severe loss of nerve fibres, especially of the thin nonmyelinated ones. Excessive proliferation of Schwann sheaths and endoneurium exceeded the amount of the usual reparation for loss of nerve fibres and could be considered as a specific feature. Obliterative vasculopathy also belongs to the picture of changes in the nerves, skin, and bones.