[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.

[Vasculitis]. / Vaskulitis.

The term "vasculitis" encompasses a heterogeneous group of clinicopathologic entities characterized by inflammation and damage of blood vessels. Many attempts have been made to classify vasculitis into categories that will facilitate patients diagnosis and management since the first attempt by Zeek in 1952. The classification scheme that will be used in this review was proposed by the 1993 Chapel Hill Consensus Conference and has been widely accepted.

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.

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.

[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.

Carotid artery reconstruction and routine use of intraluminal shunt.

Complications of carotid artery reconstruction were reviewed in two groups of patients. In group A (213 patients, operation 1978-85) the surgical procedure varied according to intraoperatively measured back pressure in the internal carotid artery (ACI), with temporary intraluminal shunt when the ACI pressure was < 50 mmHg, but no shunt when the pressure was higher. In group B (339 patients, operation 1986-93), shunt was used in all cases. The incidence of complications was higher in group A than in group B (21.6% vs 13%). Temporary or permanent neurologic deficit occurred in 11.3% of the group A patients and in 5.6% of the group B patients. Routine use of temporary intraluminal shunt thus resulted in fewer complications of carotid artery surgery and allowed the surgeon to work undisturbed, a prerequisite for a successful outcome.

Renal vascular resistance in autosomal dominant polycystic kidney disease. Evaluation with color Doppler ultrasound.

PURPOSE: The purpose of this study was to evaluate the performance of color duplex Doppler ultrasonography in the assessment of renal vascular resistance (RVR) by measuring resistive indices (RIs) and pulsatility indices (PIs) in patients with autosomal dominant polycystic kidney disease (ADPKD), and to correlate the measured values with renal function and the presence of arterial hypertension. MATERIAL AND METHODS: In 42 patients with ADPKD and 65 control subjects, RIs and PIs were measured by means of color duplex Doppler sonography and correlated with clinical and laboratory findings and with morphological abnormalities at B-mode ultrasonography. RESULTS: Mean RI in the control subjects was 0.59 +/- 0.03 (+/-SD) and in the patients 0.71 +/- 0.11, (p < 0.01). Mean PI in the controls was 1.00 +/- 0.11 and in the patients 1.69 +/- 0.21, (p < 0.01). Elevated RIs and PIs heralded a progression of ADPKD. Doppler indices correlated significantly with renal function tests and morphological changes in the affected kidneys at ultrasound. Significantly higher RIs (p < 0.01) and PIs (p < 0.04) were measured in hypertensive ADPKD patients as compared to normotensive patients. Correlation of patient age and Doppler indices did not reach statistical significance. CONCLUSION: Doppler indices do reflect the increased RVR in patients with ADPKD and they correlate with renal function disturbance, with the development of systemic arterial hypertension, and with ultrasonographic abnormality of the kidney in these subjects.

Effect of cyclophosphamide on tumor cell sensitivity to the action of immunological effectors.

A single sublethal dose of cyclophosphamide (CY) given to mice with Ehrlich ascites carcinoma (EAC) kills tumor cells and inhibits tumor growth for the first five days after its administration. From day 7 on, treated tumor cells reassume their growth, but their transplantability in normal recipients is greatly reduced for further three weeks more. On the other hand, the transplantability of untreated (control) and CY-treated cells in T cell-deficient mice is similar. Experiments with criss-cross immunization and challenge have shown that CY-treated cells are equally, or even less, immunogenic than un-treated cells. On the other hand, CY-pretreated cells are several times more sensitive to immunological attack of passively transferred immune spleen cells. These data show that CY does not increase the tumor cell immunogenicity but only increases its sensitivity to immunological attack.

[Acute pancreatitis caused by Ascaris lumbricoides in acute renal failure: case report]. / Akutni pankreatitis uzrokovan Ascaris lumbricoidesom uz akutno zatajenje bubrega: prikaz bolesnice.

A 26-year-old female patient with severe acute pancreatitis caused by Ascaris lumbricoides and consecutive acute renal failure is described. Acute pancreatitis is mostly caused by gallstones and acute or chronic alcohol ingestion. Ascariasis as an etiologic factor of acute pancreatitis does not occur very often except in the tropical and subtropical regions, where it is widely distributed. The goal of this case report was to worn the clinicians to pay attention to this, in our country rarely occurring cause of acute pancreatitis. In special circumstances of great migration of refugees and displaced persons with very low hygienic standards this rare possibility should be taken into account.

Intrarenal duplex Doppler sonographic evaluation of unilateral native kidney obstruction.

RIs were measured in intrarenal arteries in 66 kidneys of 33 examinees without renal impairment and in 42 kidneys of 21 patients with unilateral urinary obstruction. The mean RI in normal kidneys was 0.593 +/- 0.040. Patients with unilateral obstruction had a mean RI of 0.709 +/- 0.039 in obstructed kidneys and a mean RI of 0.591 +/- 0.033 in contralateral nonobstructed kidneys. Statistically significant differences have been noticed in the groups of normal versus obstructed kidneys (P < 0.001) and of obstructed versus contralateral nonobstructed kidneys (P < 0.001). The mean dRI was 0.118 +/- 0.034 in patients with unilateral obstruction, and it was 0.014 +/- 0.012 in examinees without renal impairment (P < 0.001). A comparison of RI values between the right and left kidneys in a patient with unilateral obstruction proved more useful than using a 0.7 RI cutoff value in a Doppler sonographic diagnosis of unilateral obstruction.

[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.