Syndrome of inappropriate secretion of antidiuretic hormone due to malignant thymoma.

The authors present the case of a 51-year-old female with a syndrome of inappropriate secretion of antidiuretic hormone (SIADH) due to a malignant thymoma. Laboratory examinations of the patient showed hyponatremia, plasma hypoosmolarity in the presence of concentrated urine and normal urine excretion of sodium. CT revealed a mass lesion in the mediastinum. A biopsy of the mediastinal mass was performed and the diagnosis of thymoma with SIADH was established. This is a rare description of a malignant thymoma associated with SIADH.

Doppler visualization of ureteric jets in unilateral hydronephrosis in children and adolescents.

OBJECTIVE: to evaluate Doppler visualization of ureteric jets in the assessment of unilateral kidney collecting system dilatation in children and adolescents. METHODS AND PATIENTS: color Doppler ultrasonography was performed in 27 patients with hydronephrosis (11 female, 16 male, age range 3-21 years, mean age 10.5+/-4.4). Nine had acute obstruction due to ureteral calculus, seven had obstructive hydronephrosis due to uretero-pelvic junction (UPJ) stenosis, and 11 had non-obstructive hydronephrosis. Doppler was also performed in 32 healthy children (15 boys and 17 girls, age 2-17 years, mean age 7.8+/-3.9), who represented the control group. RESULTS: in the control group jets were visible in 57 out of 64 ureteric units (89%). The mean frequency of jets in healthy children was 4.1 jets per min. In all children with hydronephrosis, jets were visible in 25 out of 27 normal ureteric units (92.6%), and their mean frequency was 4.5 jets per min. In children with acute unilateral colic, ureteric jets were completely absent in eight of nine patients (89%). In children with obstructive hydronephrosis, due to UPJ stenosis, jets were absent in five out of seven patients (71.4%), and in children with non-obstructive hydronephrosis jets were absent in three out of eleven patients (27.3%). When jets are visible, their frequencies are much lower on the obstructed side as compared with normal side, while in cases of nonobstructive dilatation frequency of jets is similar on both sides. CONCLUSION: absence of jets in patients with acute obstruction due to ureteral calculus, strongly correlates with high-grade obstruction. In children with UPJ stenosis, presence of ureteric jet does not exclude significant obstruction, but the frequency of jets on the obstructed side is much lower as compared with the unaffected side. When there is absence of jet from the dilated side or significant asymmetry in jet frequency, hydronephrosis is likely to be obstructive.

[Dermatomyositis and malignant disease--case report]. / Dermatomiozitis i maligna bolest--prikaz bolesnika.

The case of patients with dermatomyositis and malignant disease has been described. The diagnosis of malignant disease was made after death of the patient, when the malignant undifferentiated cells were found in the ascites. We think that dermatomyosistis was caused by malignant disease. The similar cases of disease were described and published in the literature.

Hypokalemic metabolic alkalosis--three case reports.

The two most common forms of inherited normotensive hypokalemic metabolic alkalosis are Bartter's and Gitelman's syndromes. Bartter's syndrome typically present with normal or increased calcium excretion. Hypomagnesemia occurs in only one third of affected individuals. In contrast, hypomagnesemia and hypocalciuria are considered hallmarks of Gitelman's syndrome. In most patients, the symptom of muscle weakness and polyuria occur early in life, which may be attributed to potassium depletion. Despite hyperaldosteronism, the patients tend to be normotensive, which is at least explained by vascular hyperresponsiveness to prostaglandins. Therapeutic approaches to Bartter's and Gitelman's syndromes include potassium supplementation, prostaglandin synthesis inhibitors (nonsteroid anti-inflammatory agents), aldosterone antagonists and converting enzyme inhibitors. Three patients with hypokalemia, normal blood pressure, metabolic alkalosis, hyperreninemia and hyperaldosteronism are described. Two patients had Bartter's syndrome and one patients had Gitelman's syndrome.

Doppler sonographic renal resistance index in healthy children.

The objective of the study was to determine the values of Doppler resistance indices (RIs) in intrarenal arteries in healthy children. Color duplex Doppler sonography of intrarenal arteries was performed in 163 children and 58 adult patients, with the absence of clinical or laboratory pathologic changes of the urinary tract. All patients were classified following results of exploratory data analysis into three age groups: (a) 51 children between 2 and < 6 years of age; (b) 112 children 6-16 years of age; and (c) adults. The RIs were compared between different age groups. The mean RI +/- 1 SD values in group 1 were 0.705 +/- 0.018 (range 0.67-0.75), in group 2 0.605 +/- 0.029 (range 0.55-0.65), and in the adult group 0.604 +/- 0.035 (range 0.54-0.68). In the group of the youngest children (group 1), the RIs were significantly higher (p < 0.01) in comparison with the other group of children and the adult group. No statistically significant difference was observed between the group of children 6-16 years of age and the adult group. RI < 0.70 was noted in all children above 6 years of age; however, in younger children, RI > or = 0.70 was observed in 72.5% (37 of 51) of children. Resistance index in early childhood was considerably higher as compared with older children and the adult population: Apparently the RI value drops to adult level at approximately 6 years of age. The utilization of a threshold RI value of 0.70 for the increased renal vascular resistance in adults can also be applied to children over 6 years of age.

Renal vascular resistance in essential hypertension: duplex-Doppler ultrasonographic evaluation.

Duplex Doppler ultrasonography has been validated as a noninvasive method to evaluate hemodynamic features of renal blood flow in renal and intrarenal arteries in patients with various renal diseases. The significance of duplex Doppler sonography in the evaluation of renal vascular resistance in essential hypertension has not yet been clearly determined. The aim of the present study was to evaluate the renal vascular resistance in patients with essential hypertension by measuring intrarenal arterial resistance (RI) and to correlate RI with renal functional tests and other clinical and laboratory data. Duplex Doppler ultrasonography was used to measure RIs in intrarenal arteries in 128 patients with essential hypertension and 61 age-matched normotensive control examinees. The renal vascular resistance index (RI) was determined by use of Doppler ultrasound. Hypertension was classified according to the 1997 Joint National Committee Guidelines (JNC-VI). Mean RI in hypertensive patients was 0.66 +/- 0.05 (+/- sd) and in healthy controls 0.60 +/- 0.03 (+/- sd) (p = 0.0001). RI correlated significantly with patient's age (r = 0.577, p = 0.001), duration of hypertension (r = 0.335, p= 0.001), stage of hypertension according to the JNC-VI classification (r = 0.315, p = 0.006), creatinine clearance (r = -0.383, p = 0.001), systolic blood pressure (SBP, r = 0.41, p = 0.001) and mean blood pressure (MBP, r = 0.30, p = 0.002). RI values did not correlate significantly with plasma renin concentration (r = -0.198 NS), diastolic blood pressure (DBP, r = 0.17, p = 0.06), and cardiac pulse (r = -0.10, p = 0.16). Multiple regression analysis showed that independent variables for RI were the patient's age (multiple R = 0.53, signif. F = 0.001) and systolic blood pressure (multiple R = 0.57, signif. F = 0.03). The renal Doppler resistance index (RI) is increased in essential hypertension and it correlates with renal functional tests as well as with patient's age, duration of hypertension, with a stage of hypertension according to the JNC-VI classification, and with systolic and mean blood pressure. The increased renal vascular resistance (RI) in hypertensive patients could be a sign of developing hypertensive nephrosclerosis and consequently renal failure. The utilization of the renal vascular resistance index (RI), provides a new noninvasive parameter in the followup of patients with essential hypertension.

Pleural mesothelioma and membranous nephropathy.

Underlying malignancy has been thought to be responsible for 5-10% of the cases of membranous nephropathy in adults, with the risk being highest in patients over the age of 60 years. Solid tumors such as carcinomas of lung or colon, are most often involved. It is presumed that tumor antigens are deposited in the glomeruli; this is followed by antibody deposition and complement activation, leading to epithelial cell and basement membrane injury and proteinuria due to the associated increase in glomerular permeability. We describe a patient with a resistant nephrotic syndrome and massive proteinuria due to membranous nephropathy associated with pleural mesothelioma.

[Case report of a patient with knee gout]. / Prikaz bolesnika s gonagrom.

A 46-years old male presented with an attack of gout (knee arthritis or gonagra). It is interesting that the patient was HLA B27 positive antigen found a couple of years ago, but on admission he had a normal findings of uric acid in serum, while cytological examination of synovial fluid obtained from knee joint no urates were found. Therefore, diagnostically besides gout arthritis a reactive arthritis as well as other connective tissue diseases were considered. In further diagnostic procedure arthroscopy was performed and in biopsy specimen from the cyst of lateral condyle of right femur urates were found. One day after the arthroscopy was performed a clear clinical picture of podagra developed. After the diagnosis was made the treatment of gout arthritis with Indometacyn began, and with improvement of inflammation, surgery was performed--cyst excochelation of lateral condyle of right femur with filling of the defect with an autologous graft from iliac crest.

[Evaluation of mean volume of urinary erythrocytes in the evaluation of the cause of hematuria. Relation between pH and urinary osmolarity]. / Znacenje srednjeg volumena eritrocita (MCV) urina u procjeni podrijetla hematurije. Odnos prema pH i osmolalnosti urina.

A new method for differentiation of glomerular from nonglomerular hematuria is presented. Mean volume of erythrocytes in glomerular hematuria is decreased, and these erythrocytes are abnormally small in size, so called microcytes. On the other hand, in nonglomerular hematuria the volume of erythrocytes is the same as the volume of erythrocytes in the peripheral blood from the same patient. Those are normocytes. A statistically significant difference in volume of erythrocytes was found between glomerular and nonglomerular erythrocytes. The osmolality and pH of urine had no influence on volume of erythrocytes in hematuria. Our results show that the analysis of mean corpuscular volume of urine erythrocytes may be helpful in determining the origin of hematuria.

[Rhabdomyolysis: case report and review of the literature]. / Rabdomioliza: prikaz bolesnika i pregled literature.

We report a case with rhabdomyolysis, myoglobinuria and acute renal insufficiency. Rhabdomyolysis has been due to toxic effect of ethanol and excessive physical activity. The characteristics of rhabdomyolysis, the outlines of therapy and prevention of recurrence of rhabdomyolysis have been described.

[The tumor lysis syndrome: case report and review of the literature]. / Sindrom lize tumora: prikaz bolesnika i pregled literature.

Tumor lysis syndrome is specific acute renal failure. This syndrome is usually a complication of cytostatic therapy in patients with acute lymphoblastic leukemia and lymphoblastic lymphoma. Tumor cell lysis following chemotherapy may lead to metabolic complications and renal failure. We report herein, two patients with acute lymphoblastic leukemia who developed tumor lysis syndrome after chemotherapy. Furthermore, we describe important measures to prevent tumor lysis syndrome in high risk patients.