[Acute meningococcemia in a 4-month-old infant]. / Akutna meningokokcemija cetvoromesecnog odojceta.

INTRODUCTION: What causes meningococcial diseases (MD) is a Gramm-negative diplococcus Neisseria meningitidis (meningococcus). Most frequently it manifests itself in the form of meningitis and meningococcemia. The mortality rate of those suffering from MD has not significantly changed for three decades and ranges from 7% to 19%, and for meningococcemia from 18% to 53%. According to the data presented by domestic authors, of the total of the diseased with bacterial meningitis 75% are children with mortality rate from 6% to 15%. Severe forms of meningococcemia sometimes have extremely rapid development and lethal outcome within a few hours. Key elements for establishing the diagnosis of meningococcemia are presence of hemorrhagic rash with high fever, loss of interest in the environment, loss of consciousness and paleness. CASE REPORT: The boy was admitted to hospital as an emergency case on 29 December 1988 at 11:45. The disease manifested abruptly the day before. He burst into tears easily, would take very little food and in the evening his temperature rose T degree 40.8 degrees C. Before midnight, in the village he was given injections of: lincomycin 300 mg and lasdol 250 i.m. During admittance the infant was agitated, kept moaning. His skin was pail gray with dot-like and spot-like hematoma which were more numerous and intense on the left ear, lower part of the body, scrotum and legs. The infant breathed heavily and fast (FR: 100/min) Cardiologist's finding showed: tahicardia over 200/min, buffled tones, gallop rhythm, pulsating neck veins and edema point to acute heart failure. Large fontanelles remained swollen even after lumbar puncture (LP) and extraction of 15 ml of clear cerebro-spinal fluid. Soon after admittance the boy stopped moaning but didn't cry when pricked and slipped deeper into coma. During the third hour of treatment generalized convulsions began which lasted approximately 10 minutes and stopped after i.v. administered diazepam. The boy remained in coma the second day in lethargy and with swollen fontanelles on the third day, so the first subdural puncture was then performed bilaterally. On that occasion only from the right side 8 ml of reddish liquid was obtained. Right after he was admitted we began permanent transfusion, which lasted 17 days. On the first day he received fresh blood transfusion. He was administered benzinpenicilline, chloramphenicol-succinate, lanatoside, human albumins, dexamethasone.... Blood oxygenation was carried out in the first few days of illness during the exhibited cardio-respiratory failure. DISCUSSION: Among risk factors, which contribute to occurrence of meningococcemia, is also artificial infant food. The reported boy was incorrectly fed with overdiluted cow milk. That and apparent hemostasis brake-down only worsened anemia and increased susceptibility to infections. Although LP was performed when the boy was admitted and the nutritious foundation was soaked with cerebro-spinal fluid, no bacteria were isolated or their presence confirmed in cerebro-spinal fluid colored after Gramm's method, because the child was given linkomycin the previous night. CONCLUSION: On the basis of clinical findings, hemorrhagic rush, convulsions, coma and acute heart failure as well as the laboratory findings it was concluded that it was a case of severe meningococcemia, meningitis and subdural effusion. Listed therapy and six subdural punctures led to full recovery of the patient. Further examination by a pediatrician and a psychologist eliminated the possibility of mental deficiency. The boy is now a good fifth grade elementary school pupil.

[Hospitals and some outstanding physicians of Pancevo]. / Osvrt na bolnice i pojedine znamenite lekare Panceva.

This paper is a retrospection of hospitals and some outstanding physicians who lived in Pancevo, written in the honor of 50th anniversary of "Medical Review". Hospital bed capacity and the process of building hospitals have been: described briefly. Fire and wars have destroyed a lot of written evidence important for Pancevo health services. Nevertheless, the preserved sources let us read about facts that have already or will soon become part of the history of medicine. Apart from this, the paper also contains important details from the life and work of Konstantin Peicic (1802-1882), a famous physician, writer of the first Serbian original medical book "De pauperum aegrorum" (About Treating the Sick and Poor) and many other medical and fine literature works. He had worked in Pancevo for more than 30 years, but after he had retired, he moved to Budapest to become the manager of the Tekelianum in 1874. He spoke Latin, Hungarian, French, Italian, German and of course Serbian language. The paper also gives data on some other physicians: Ljubomir Nenadovic a dentist and a writer, Jovan Jovanovic-Zmaj, a physician and a great Serbian poet and a founder of the journal "Ziza" and assistant of the journal "Pancevac" founded in 1869, and so on. The above mentioned physicians had lived and worked in Pancevo since the first medical institution "Kontumac" was built in 1726, but then others were built too: the first civil hospital in 1803 and the first army hospital in 1830. Modern departments were built in 1965, whereas the Children's Department for Internal Diseases and the Department for Internal Diseases were built in 1974. This retrospection tried to present the history of Pancevo as well as great people from our past who worked there to our readers. They were great physicians, educators and gifted writers.

[Hospitals in Europe and Yugoslavia through the centuries]. / Bolnice u Evropi i kod nas kroz vekove.

The primary object of this paper is to give a retrospective of hospital development in Europe and Yugoslavia for the past twenty-five centuries. The earliest records of hospitals called the "iatreia" date back to the V century B.C., ancient Greece. The sick in those hospitals were treated with drugs as well operated on. The Romans, during the reign of the emperor Augustus, built valetudinaries within military camps. The name "hospital" was introduced in the IV century A.D. and has been used ever since. The first hospital was founded in Cesarea, i.e. in the East Roman Empire in Asia Minor. The chronology of the hospital development in the Middle Ages is given in table 1--"Chronology of Hospital Development in the Middle Ages." St. Sava (Nemanjic) founded the first Serbian hospital in the Monastery of Hilandar about 1199 and in 1208/1209 a hospital in the Monastery of Studenica. In the hospital of the Monastery of St. Arhangel in Prizren, according to the regulations prescribed by tzar Dusan, only curable patients were to be treated. The first hospital in Vojvodina in Bac near Novi Sad dates back to 1234. More data about hospitals in former Yugoslavia are given in table 2--"The Oldest Hospitals in former Yugoslavia" and about the Frontier Hospitals in Vojvodina in table 3--"Frontier Hospitals for the Wounded and Sick in Vojvodina". The first medical high school was established in Salerno in the IX century and the first European University in Bologna in 1088, where the School of Medicine was founded in 1156. The University in Paris was founded in 1107 and in Oxford in 1145.