[INFECTION IN DIALYSIS AND AFTER KIDNEY TRANSPLANTATION].

Almost 4500 patients are being treated with renal replacement therapies in Croatia. Infections are frequent in the population treated with dialysis and kidney transplantation, being one of the most common causes of morbidity and mortality in these patients. In dialysis patients, infections are usually related to dialysis access (usually central venous dialysis catheter or peritoneal catheter). In kidney transplant recipients, infections are most common in the early postoperative period. Prevention, early recognition, as well as appropriate treatment of infection are all crucial for better survival of these patients, with ever more other medical specialties being involved in their management.

Calibration of a 1D/1D urban flood model using 1D/2D model results in the absence of field data.

Recently increased flood events have been prompting researchers to improve existing coupled flood-models such as one-dimensional (1D)/1D and 1D/two-dimensional (2D) models. While 1D/1D models simulate sewer and surface networks using a one-dimensional approach, 1D/2D models represent the surface network by a two-dimensional surface grid. However their application raises two issues to urban flood modellers: (1) stormwater systems planning/emergency or risk analysis demands for fast models, and the 1D/2D computational time is prohibitive, (2) and the recognized lack of field data (e.g. Hunter et al. (2008)) causes difficulties for the calibration/validation of 1D/1D models. In this paper we propose to overcome these issues by calibrating a 1D/1D model with the results of a 1D/2D model. The flood-inundation results show that: (1) 1D/2D results can be used to calibrate faster 1D/1D models, (2) the 1D/1D model is able to map the 1D/2D flood maximum extent well, and the flooding limits satisfactorily in each time-step, (3) the 1D/1D model major differences are the instantaneous flow propagation and overestimation of the flood-depths within surface-ponds, (4) the agreement in the volume surcharged by both models is a necessary condition for the 1D surface-network validation and (5) the agreement of the manholes discharge shapes measures the fitness of the calibrated 1D surface-network.

Radical perineal prostatectomy: the first experience.

OBJECTIVE: to present relatively uncommon surgical procedure for the treatment of localized prostate cancer. MATERIAL AND METHODS: Six patients with localized prostate cancer (PCa) underwent perineal radical prostatectomy (PRP) from 2006 to 2010. The average age was 65 +/- 5.2 years. The average preoperative PSA was 7.8 +/- 1.3 ng/ml. Two patients had pT2b stage, while four had pT2c stage. Gleason score ranged from 4-7. RESULTS: All patients had negative surgical margins. Average operative time was 109 +/- 20 minutes and average blood loss was 525 +/- 180 ml. The urethral catheter was removed after 12 days in all patients except one, who required prolonged catheterization due to urinary fistula. All patients were continent after three months. Average postoperative PSA was 0.07 +/- 0.03 ng/ml. CONCLUSION: Perineal radical prostatectomy is valuable surgical procedure that provides good oncological results as well as urinary and sexual function.

Alternative respiration of fungus Phycomyces blakesleeanus.

Respiratory characteristics of germinating spores, developing mycelium and mitochondria of the fungus Phycomyces blakesleeanus were investigated by means of oxygen Clark-type electrode. The effects of respiratory inhibitors and metabolic compounds on oxygen consumption were tested. It was demonstrated that P. blakesleeanus apart of cyanide-sensitive respiration, CSR, possess alternative respiration, (cyanide-resistant respiration, CRR) which is constitutive and whose capacity decreases during development. Maximum is observed for activated spores where CRR capacity is significantly greater than CSR. After treatment with antimycin A, a third type of respiration insensitive to antimycin A and low concentration of SHAM (sufficient for inhibition of CRR), but sensitive to cyanide and high concentration of SHAM, has been expressed.

[Off-pump myocardial revascularization (OPCAB) in patients with post-infarction unstabile angina, low ejection fraction and renal disfunction].

UNLABELLED: The purpose of this study is to present our experience in off-pump myocardial revascularization in patients with post-infarction unstable angina, left ventricular low ejection fraction and renal dysfunction. MATERIAL AND METHODS: From January 1998. until march 2002, at the Institute for Cardiovascular Diseases in Clinical Centre of Serbia, we have operated 20 patients with post infarction unstable angina, echocardiographicaly proved low ejection fraction (less than 30%) and renal dysfunction (Serum Creatinin 150 micrograms per liter) using this method. All patients were male and they were between 52 and 79 years old. Preoperative characteristics, surgical treatment and postoperative course are presented. RESULTS: There was no hospital mortality, as well as important morbidity. There was no worsening of the renal and myocardial function. Postoperative ICU stay was from 1 to 2 days. Postoperative hospital stay was between 3 and 7 days. CONCLUSION: Off-pump myocardial revascularization is safe and effective procedure in all patients with left ventricular low ejection fraction and renal dysfunction.

[Congenital adrenal hyperplasia]. / Kongenitalna adrenalna hiperplazija.

INTRODUCTION: Congenital adrenal hyperplasia is generally considered to be a rare disease; however, the incidence of severe forms of CAH is probably greater than 1 in 10,000 people and the incidence of milder forms is probably 10 times higher. It is a group of autosomal recessive disorders of adrenal steroidogenesis caused by a genetic disorder in one of the steroidogenic enzymes. These disorders impair cortisol synthesis, resulting in stimulation of pituitary proopiomelanocortin and hypersecretion of adrenocorticotropin, which in turn causes adrenal growth. A genetic disorder in one of the steroidogenic enzymes interferes with normal steroid hormone synthesis. The sings and symptoms of the disease derive from a deficiency of the steroidal end product and from the effects of the accumulated steroidal precursors proximal to the disordered step. Because five enzymatic steps are involved in cortisol biosynthesis, there are five distinct CAH syndromes. CAH-SYNDROMES: 21-Hydroxylase deficiency is the most common variant of CAH, accounting for about 90% of all cases. The clinical syndrome is consequence of defective 21-hydroxylation of progesterone and 17-OH progesterone, with resulting deficient production of both cortisol and aldosterone. The disease occurs in a wide spectrum of clinical variants, including a severely affected form with defect in aldosterone biosynthesis ("salt-wasting" type), a form with apparently normal aldosterone biosynthesis ("simple virilizing" type) and a mild "nonclassic" form that may be asymptomatic or may be associated with symptoms of androgen excess developing during childhood or at puberty. In "classic" forms ("salt-wasting" and "simple virilizing") sings of androgen excess often are prominent. The key measurement for the diagnosis of 21-hydroxylase deficiency is basal plasma 17-OH progesterone. It will be elevated and will hyper-respond to ACTH stimulation. 11 beta-hydroxylase deficiency is the second most frequent cause of CAH. The abnormality is an inherited deficiency of 11 beta-hydroxylase enzyme of the adrenal cortex with consequences in impaired conversion of 11-deoxycortisol to cortisol and of deoxycorticosterone to corticosterone and aldosterone. About two thirds of patients with the severe, "classic" form have hypertension, often beginning within the first few years of life. Patients with mild ("late onset" or "nonclassic") form have normal or, at most, mildly elevated blood pressure. Signs of androgen excess are also often prominent. The diagnosis can be confirmed by demonstrating marked accumulation of deoxycorticosterone and 11-deoxycortisol in plasma and their tetrahydrometabolites in urine. 17 alpha-hydroxylase/17, 20 lyase deficiency is the second of two hypertensive forms of CAH. Deficient 17 alpha-hydroxylation of pregnenolone and progesterone result in decreased secretion of cortisol and sex steroids, but increased secretion of sodium-retaining corticoids (corticosterone and deoxycorticosterone). Females present with normal external genitalia but failure to develop secondary sex characteristics and primary amenorrhea. Males frequently fail to develop masculine external genitalia fully (male pseudohermaphroditism). Both sexes have hypertension, hypokalemic alkalosis, and failure to progress into puberty. The diagnosis can be established by the demonstration of elevated plasma deoxycorticosterone and corticosterone 3 beta-hydroxysteroid dehydrogenase is rare cause of CAH. Patients with this biosynthetic defect have deficient production of adrenal glucocorticoids, mineralocorticoids, and testicular testosterone. However, they have excessive production of 5-adrenal androgens. In "classic" form, affected newborns present with symptoms and sings of adrenal insufficiency of varying degree and ambiguous genitalia in both sexes. The "late onset" form is a mild type of disorder. It has been described in women with hirsutism and menstrual abnormalities and may be quite common. (ABSTRACT TRUN

[Treatment of the thoracic outlet vascular syndrome]. / Tretman vaskularnog sindroma gornjeg otvora grudnog kosa.

INTRODUCTION: The title "Thoracic Outlet Syndrome" (TOS) was introduced by Peet in 1956 [1]. In 1958 Charles Rob defined TOS as a "set of symptoms that may exist due to compression on the brachial plexus and on subclavian vessels in the region of the thoracic outlet" [2]. Compression due to cervical rib was first described by Galenus and Veaslius in the 2nd century A.D. The first unsuccessful resection of the cervical rib in patients with TOS was performed by Coote in 1861 [4]. In 1905 Murphy first made a successful resection of the cervical rib in patients with TOS and subclavian artery aneurysm [5]. He also removed the normal first rib in patients with TOS using the supraclavicular approach for the first time [6]. In 1920 Law described ligaments and other structures originating in soft tissue associated with TOS [8], while Adson and Coffey in 1927 emphasized the role of the scalene anticus muscle in TOS [3]. Ochsner, Gage and DeBakey in 1935 named it the "scalenus anticus syndrome", and made the first successful resection of the anterior scalene muscle [9]. In 1966 David Ross introduced the transaxillary resection of the first rib to relieve TOS [11]. The aim of the paper is to describe the treatment of patients with vascular TOS. MATERIAL AND METHODS: Over a six-year-period (1990-1997) 12 patients with vascular TOS were evaluated at our Centre. Seven (58%) were female and 5 (42%) male patients, average age 33.1 years. Eleven of them had congenital TOS, and one acquired TOS after trauma at neck-shoulder region. Seven patients had arterial and 5 venous TOS. Two patients with arterial TOS had ischaemia of the upper extremity due to embolism of the brachial artery. In one of them axillary artery was completely thrombosed, and in the other postenotic dilatation of the subclavian artery was present. The other 5 patients with arterial TOS demonstrated only hand pain and radial puls during hyperabduction of the arm. One of our patients with venous TOS had also symptoms and signs of hand oedema during hyperabduction, while four patients had axillary-subclavian deep venous thrombosis (DVT). All patients underwent CW-Doppler and Duplex-ultrasonographic examination. The results were positive in all patients with arterial TOS. The angiographic (selective arteriography of the subclavian artery) examination showed the same results. Diagnostic procedures were performed in normal position of the arm and during hyperabduction. The angiography also revealed: one aneurysm of the subclavian artery, one poststenotic dilatation of the subclavian artery with brachial artery embolization, and one thrombosed axillary artery with brachial artery embolization (Figure 1). In five patients the angiogram was normal in normal position of the arm, but showed arterial flow obstruction at the thoracic outlet during hyperabduction (Figures 2a and 2b). In patients with venous TOS Duplex ultrasonographic examination was performed. The cervical rib caused TOS in four of our patients and clavicle fracture calus in one case. In 7 patients bone anomalies were not found (Figure 3). The operative treatment was carried out in 3 patients with venous and 7 patients with arterial TOS. In two patients with DVT of the axillary-subclavian segment, 6 months after standard anticoagulant therapy, decompressive procedures were performed (one resection of the cervical rib, and one transauxillary resection of the first rib). In the case of venous TOS without DVT, a supraclavicular resection of the first rib was performed immediately after diagnosis. In 5 patients with arterial TOS without morphologic changes on the arterial system, a decompressive procedure was done. The following procedures were carried out: one scalenotomy, one supraclavicular and three transaxillary resections of the first rib. (ABSTRACT TRUNCATED)

[Immunopathology of the antiphospholipid syndrome]. / Imunopatalogija antifosfolipidnog sindroma.

Production of the antiphospholipid antibodies is usually associated with the development of antiphospholipid syndrome. The caracter of this syndrome is: venous and arterial thromboses, pregnancy loss, thrombocytopenia and some damages of blood-vessels. We have studies 150 pts with Systemic Lupus Erythematosis, 100 women with unknown for pregnancy loss and 36 pts with Sneddons Sy. Antikardiolipin antibodies were determined by the standard ELISA method, Lupus Anticoagulant by 4 phospholipid-depent coagulation test using the snake poison. The significant correlation (p<0,110) was found between antiphospholipid antibodies and development of antiphospholipid syndrome by the pts with autoimmune patology.

Comparative in vitro study of nonoxynol-9: effects on human, bull and boar spermatozoa.

Spermicidal activity of different dilutions of nonoxynol-9 (nonyl-phenoxy-polyethoxy-ethanol) on human, bull and boar spermatozoa was studied using the modified Sander-Cramer method. The results obtained showed that differences in spermatozoal resistance among the mentioned species to nonoxynol-9 were statistically very significant (P much less than 0.0005): bull greater than man greater than boar. The results obtained were compared to available literature results.

[Primary malignant melanoma of the trachea]. / Primarni maligni melanom traheje.

The paper gives a case report of the primary malignant melanoma of the trachea in a 61 years old patient with micrometastasis in the right upper lobe of the lung. The diagnosis was made after autopsy. Macroscopically, a polypoid, greyish, partly dark brown tumor was found 6 cm above the tracheal bifurcation on the site of connection between the membranous and cartilaginous part. The tumor was fixed to the trachea wall with a very narrow long stalk, causing long dispnoic attacks worsening in a back lying position particularly. Histologically, both the primary tumor and its secondary deposit in the right lobe were found to have similar appearance as a malignant melanoma elsewhere. Melanin pigment was found in abundance here and there and easily detected already in preparations stained by the hematoxylin--eosin method. The large polypoid tumor caused an obstruction of the trachea and finally suffocation.

[Exogenous lipoid pneumonia with abscess mimicking a lung tumor]. / Apscedirajuca egzogena lipoidna pneumonija pod slikom plucnog tumora.

A case of abscessing exogenous lipoid pneumonia is reported. After the onset of respiratory symptoms, 68-year-old male was admitted to our hospital. Physical and X-ray examination suggested malignant lung tumor. After false positive finding of fine needle transthoracic biopsy, the right middle lobectomy was performed. Histological examination showed an unexpected finding of lipoid pneumonia and thereafter information of accidental petroleum aspiration was obtained.

Increased beta-adrenergic receptor complement in androgen-induced mouse kidney hypertrophy.

Treatment of female mice with testosterone propionate led to a pronounced, but gradual increase in kidney beta-adrenergic receptor complement. The specific binding of [125I]iodohydroxybenzylpindolol rose 2-3-fold above the control levels after 8-12 days of the treatment. No significant changes were detected prior to the fourth day of androgen administration. No gross changes in either the binding strength or cooperativity of the binding were apparent in membrane preparations from treated animals. Averages of the high-affinity binding constant estimates were 1.3 +/- 0.3 nmol in controls, vs. 1.6 +/- 0.5 nmol in treated animals (15 groups each) in competition with pindolol, with the Hill slope factors of 0.98 +/- 0.08 for controls, and 0.91 +/- 0.07 for the treated animal membrane preparations. Scatchard estimates of the binding constants in self-competed [125I]iodohydroxybenzylpindolol binding were about 160 pmol in both control and treated animals. Competition experiments using isoproterenol also indicated similar dissociation constants (151 +/- 16 nmol) for control and treated groups. Na+/K+-activated ATPase (EC 3.6.1.3) was also found to be increased at the 12th day of the androgen treatment (to 74% above control levels).