[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.

[BCG dissemination in a child with normal immunity]. / BCG diseminacija u djeteta s normalnom imunosti.

A fourteen month old girl with BCG dissemination and BCG lymphadenitis is presented. Mycobacterium bovis BCG strain was isolated from axillary fistula and from gastric contents. Pathohystological examination of the lymph mode and cytological examination of the bronchial mucus confirmed granulomatous inflammation. All tests for humoral and cellular immunity were with reference ranges. Antituberculous therapy successfully eliminated Mycobacterium bovis in gastric contents, and healed the wound in the left armpit. As the patient had tuberculoid form of BCG dissemination, the therapy was successful.

[Foreign bodies in the airways in children]. / Strana tijela u disnim putovima djece.

From 1984 to 1998 we treated 22 children (15 male, 7 female) with aspirated foreign bodies in their tracheobronchial tree. Most patients (17/22, 77%) were aged up to 3 years (two children were seven months old). Only 12 (54%) patients had history of aspiration. Most common clinical findings were prolonged expiration and impaired respiration on one side (12 patients, 54%) or impaired respiration on one side (7 patients, 32%). Chest x-rays mostly showed one-sided hyperinflation (64% of cases). 50% of children aspirated walnut into their airways. Foreign bodies in most children were installed tracheobronchially on the left and right side and in one child the foreign body was found in the larynx. The foreign bodies were successfully removed in 19 (85%) patients. In three children foreign bodies were not found on time, bronchial obliteration occurred, so pulmectomy of the left lung, lobectomy of the left lower lobe, or bilobectomy (lower and middle right lobe) had to be done.

[Primary ciliary dyskinesia]. / Primarna cilijarna diskinezija.

The immotile cilia syndrome is a genetic disease characterized by chronic disease of the upper and lower respiratory tract, male infertility and situs viscerum inversus in 50% of affected patients. Abnormalities of ciliary structure are the cause of abnormalities in mucociliary clearance and chronic inflammation consecutively. The boy aged 13 years with clinical manifestations (chronic rhinorrhea, sinuitis, recurrent otitis media, recurrent bronchial inflammation, pneumonia and finally bronchiectasis) has been presented. The boy had a normal visceral status. The diagnosis was confirmed by electron microscopy analysis of cross section of bronchial cilia: numerous abnormalities in microtubules positioning and lack of radiar arms have been found.

[Bronchopneumonia, obstructive bronchitis and bronchiectasis in children with adenovirus infections]. / Bronhopneumonije, opstruktivni bronhitis i bronhiektazije u djece s adenovirusnim infekcijama.

During the five-year period 56 children were treated in hospital due to respiratory infections caused by adenovirus. Clinical, laboratory and radiographic signs of the illness are presented. The infections manifested as the upper respiratory tract infection in 3 patients (5.4%), obstructive bronchitis in 16 patients (28.6%), bronchopneumonia in 32 patients (57.1%) and bronchiectasis in 5 patients (8.9%). Three children were operated: bilobectomy was performed in two cases, and left-sided pulmonectomy in one case. Histologically, bronchiectasis was found in two cases and bronchiolitis obliterans in one case. In this work we tried to show the gravity, importance and consequences of the adenoviral infection of the respiratory tract in children.

[Echinococcal pulmonary cyst with multiple fistulization into the bronchi]. / Ehinokokova cista pluca s visestrukom fistulacijom u bronh.

The case of a 10 year old boy with an hydatid pulmonary cyst was presented. The cyst multiply fistulated into the bronchus. The preoperative diagnostic pathway, the operative treatment and complete postoperative recovery was described.

[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.

[Legionnaires' disease in children]. / Legionarska bolest u djece.

During the first nine months of 1987, the bacteriological and virological tests as well as the indirect fluorescence test to Legionella pneumophila were performed in 40 children with bronchopneumonia (one- or both-sided) or pleuropneumonia and in 10 children with protracted bronchitis. In a 15 month old boy we have proved (by titer dynamics) the infection with Legionella pneumophila serotype 5, and in a 15 month old girl and in a 16 month old boy serotype 1. The infection was sporadic and the possible source of infection was unknown. The course of the disease was not wasting and the infection was accompanied with fever. The patients had an increased sedimentation rate of red cells and leukocytosis. All the other laboratory findings were within normal limits. In seven children seropositiveness 1:256 to Legionella pneumophila serotype 1, and in two children an increased titer to adenovirus was proved. The high titer to Legionella pneumophila in those seven children indicates an early contact with the causal agent. The patients were successfully treated with cefuroxim, which is not the drug of choice. Infection due to Legionella pneumophila in children does not exhibit a clinical or laboratory characteristic features that differ from those of the other respiratory diseases in children. It means that Legionnaires' disease in children with intact immunity is not the wasting illness. We stress the importance of using serologic examination to Legionella pneumophila as a routine procedure in the aetiological diagnosis of respiratory diseases in children.

[Prevalence of arterial hypertension in patients with radiologic signs of chronic pyelonephritis]. / Prävalanz der arteriellen Hypertension bei Patienten mit radiologischen Zeichen einer chronischen Pyelonephritis.

A retrospective study of the prevalence of arterial hypertension in patients with radiological signs of chronic pyelonephritis was done. During six years i.v. urography has been performed in 936 patients, 297 (31.7%) of whom had hypertension, and 123 (13.1%) had radiological signs of chronic pyelonephritis. Out of the patients with chronic pyelonephritis 87 (70.7%) subjects (57 men, 30 women) had arterial hypertension. Bilateral chronic pyelonephritis was radiologically confirmed in 61 (70.1%) and unilateral parenchymal renal disease in 26 (29.9%) of the patients with hypertension. When the diagnosis has been postulated on the basis of radiologically evident changes of kidney parenchym (renal scarring) or the combined calyx-parenchymatous lesions, it could be shown that the frequency of hypertension in these patients was statistically higher (p less than 0.001) than in the group of patients that displayed only isolated calyx lesions. Moderate and pronounced hypertension were more common (52.5%) in patients with bilateral pyelonephritis scarring compared with hypertonic patients having the same, but unilateral changes. Patients with radiological signs of chronic pyelonephritis and hypertension had proteinuria and various degrees of renal failure significantly more often than these with normal blood pressure. On the basis of the presented results the authors concluded that the prevalence of arterial hypertension in patients with chronic pyelonephritis is much higher (70.1%) than in the average population (31.7%). Hypertension is more common and its complications are severe in the patients with chronic fibrose pyelonephritis. In these patients is also frequent chronic renal failure. The observed facts can be explained on the basis of recent knowledge about pathophysiological mechanisms in chronic pyelonephritis (the renin-angiotensin-aldosterone system, renal prostaglandins system and glomerulo-tubular balance).