Forensic determination of dental age by cementum thickness of human teeth

The purpose of this study was to assess the correlation between the known chronological age and the dental cementum thickness (DCT) in male and female subjects in different age groups.

MATERIAL AND METHODS

The study sample consisted of 57 donor teeth of both sexes. Teeth were classified by donors' sex and divided into three age groups: 10-19, 30-39 and 60-69 years. Tooth roots were cut with transverse ground sections in the apical, middle, and cervical thirds. DCT measurements were made on photomicrographs of light microscope. The correlation between DCT and the chronological age was calculated using the Spearman correlation coefficient.

RESULTS

A positive correlation was found (r=0.47, p <0.001) between DCT and age of the donor. DCT decreased from apical to cervical ground section (median [IQR] apical section 216.72 [128.25-375.00] μm, middle section 158.44 [87.66-284.90] μm; cervical section 96.60 [70.05-165.59] µm). DCT variability was influenced by sex, number of tooth roots and the condition of the tooth crown. The influence differed depending on the location of the section, being most prominent cervically.

CONCLUSION

The present study showed correlation of DCT with age, with significant influence of sex, number of tooth roots, condition of the tooth crown and location of the root section.

The influence of edible coatings and natural antioxidants on fresh-cut potato quality, stability and oil uptake after deep fat frying

The effect of four edible hydrocolloid coatings (carboxymethyl cellulose, chitosan, pectin and gum arabic) on fresh-cut potato's colour, pH and moisture content during storage was studied. Possibility of coating enrichment with natural olive leaf extract and sodium ascorbate was also evaluated. Coatings scored as the best ones straight after coating or during storage for 7 days at 10 ± 1 °C, were used for deep fat frying of potato. Chitosan was shown to cause significant decrease in pH and browning of potato strips. Pectin was classified as good coating alone but in combination with olive leaf extract showed lower quality parameters of fresh-cut samples compared to control. Only carboxymethyl cellulose and gum arabic itself or enriched with olive leaf extract or sodium ascorbate were shown not to affect colour, pH and moisture during storage. Moreover, these coatings significantly reduced fat content in deep fat fried potato strips, without influence on L*, b*, whiteness index (WI), and ΔE.

Emergency Ilio-femoral Bypass during Kidney Transplantation due to External Iliac Artery Dissection: Case Report

Intraoperative iliac artery dissection during kidney transplantation is a rare but serious complication that requires prompt intervention. We present a case of right external iliac artery dissection during deceased donor kidney transplantation. A 57-year-old male patient underwent standard pretransplant evaluation and had no signs of either significant aortoiliac occlusive disease or peripheral arterial occlusive disease. Diabetic nephropathy, arterial hypertension and smoking were the underlying causes of the patient's end-stage renal disease. Transplantation was performed in the standard fashion. The kidney was positioned in the right iliac fossa and the venous end to-side anastomosis was performed first. A significant dissection of the right external iliac artery was found on arteriotomy. Immediate ilio-femoral bypass with a vascular prosthesis was performed. During two years of follow-up the kidney function is stable and there are no signs of lower limb vascular insufficiency.

THE PROSTATE CENTER: MULTIDISCIPLINARITY, ORGANIZATION OF DIAGNOSTIC WORK-UP AND TREATMENT OF PROSTATE CANCER

The aim of this paper is to show the results of prostate cancer treatment in Prostate Center of Department of Urology at the University Hospital Center Zagreb. The answer to growing demands for prostate cancer treatment due to increasing incidence is the formation of specialized, multidisciplinary units/centers that deal mainly with prostate cancer. The need was recognized by European School of Oncology and European Association of Urology, who have proposed their concepts of validating such centers with the aim of promoting high-quality prostate cancer treatment. Following these trends, the Department of Urology at the University Hospital Center Zagreb has established the Prostate Center. This new unit offers specialized and individualized approach to workup, treatment and follow up for prostate cancer patients based on multidisciplinarity. The Prostate Center was also established as a platform for education and research.

[Verification of maxillary and mandibular asymmetry via orthopantogram's analysis]

AIM

The purpose of this study was to analyse the homologous variables' symmetry (horizontal, vertical, angular and of area surface) of the right and left segment in the maxilla and in the mandible of subjects with a normal occlusion and a malocclusion.

METHODS

Two-hundred and two orthopantomograms were analysed (162 with malocclusion, 40 with normal occlusion). These points of reference were used: orbital, condilion, gonion, menton, point A (intersection point between the vertical line passing through the centre of the nasal septum and the horizontal line which links the 2 points O), point B (intersection point between the mandibular margin and the vertical line passing through point O) and point T (intersection point of A-Cn on the maxillary tuberosity).

RESULTS

This study did not confirm any statistically significant differences between the right and left analysed variables studied in both groups.

CONCLUSION

Orthopantomography may be a useful test in the screening for facial asymmetry.

[Estimating facial asymmetries in individuals with malocclusion and normocclusion]

BACKGROUND

The en face photographs taken in standard conditions were used to examine the facial symmetry in examinees with normocclusion and malocclusion.

METHODS

A total of 80 examinees were included in the study (40 of whom had normocclusion and another 40 had malocclusion) without any prior orthodontic therapy. The face was divided into six squares by the mediosagittal line drawn through the Trihion, Glabella, Subnasals and Gnathion as well as by horizontal lines drawn through the same points. The four lower squares - the middle and the lower thirds of the face were taken into account to analyse facial symmetry. The symmetry between individual squares was measured by applying transparent paper with a millimetre-sized squares web and a planimetry.

RESULTS

The results did not show any asymmetry between left and right parts of the face in either group of examinees.

CONCLUSIONS

A high correlation was established among all the analysed variables.

[Replacement of mycophenolate mofetil with azathioprine in patients with renal transplants]

Numerous clinical studies demonstrated that mycophenolate mofetil (MMF) was significantly more effective in prevention of acute rejection episodes than azathioprine. Since the data supporting the long-term benefits of MMF therapy are not available, and considering the high cost of this therapy, we examined the safety of conversion from MMF to azathioprine in renal transplant patients. In 12 renal transplant patients (4 cadaveric and 8 living related donors) on triple immunosuppressive therapy (prednisone/MMF/cyclosporine) conversion from MMF to azathioprine was done after the first six to twelve post-transplant months. The majority of patients were in the low immunological risk of transplantation, and 7 (58.3%) received antithymocite globulin due to the delayed graft function. The mean follow-up period after the conversion to azathioprine was 6.4 months (range 3-12 months). Acute rejection episode was noticed only in one patient 8 months after the conversion following acute graft pyelonephritis. In all other patients graft function remained unchanged. We have concluded that the conversion from MMF to azathioprine in renal transplant patients on triple immunosuppressive therapy is safe and without detrimental effects on short-term allograft function. Long-term follow-up studies on larger number of patients are needed to confirm these observations.

[Use of mycophenolate mofetil in patients with a transplanted kidney and cyclosporin nephrotoxicity]

Cyclosporine (CsA) nephrotoxicity is an important problem in renal transplant recipients, which can influence long-term graft survival. The safety of conversion from CsA to azathioprine (AZA) remains controversial and can result in higher incidence of acute rejection. Mycophenolate mofetil (MMF) is a new immunosuppressive agent superior to AZA in the prevention of acute rejection. Five patients with cyclosporine nephrotoxicity were converted from CsA/AZA/prednisolon to MMF/prednisolon protocol. All patients had low immunological risk and 4 out of 5 patients received antithymocyte globulin before conversion as the induction therapy or as the treatment for acute rejection. Mean follow-up after conversion was 16.8 months (range 4-32 months). No patient experienced acute rejection during follow-up period. The mean serum creatinine concentration decreased from 219 +/- 44.18 (range 168-280) to 122.6 +/- 48.02 mumol/l (range 72-187 mumol/l) (p = 0.002). Arterial hypertension improved after CsA withdrawal in 20% of patients. We have concluded that, in selected patients with cyclosporine nephrotoxicity, CsA withdrawal with concomitant use of MMF is safe and effective in the improvement of graft function and arterial hypertension.

[Interleukin-1 beta in patients with primary immunocomplex glomerulonephritis]

Interleukin-1 is one of the most important pro-inflammatory cytokines whose role in the pathogenesis of glomerulonephritic process was proved in numerous studies. The aim of this study was to determine the urinary level of this cytokine in patients with primary immunocomplex glomerulonephritis and its significance in diagnosis of this disease. This prospective study comprised a total of 96 patients (84 males and 12 females) with primary immunocomplex glomerulonephritis. The elevated urinary IL-1 beta level was noticed in 43 (49.4%) patients with different histological forms of glomerulonephritis. The mean concentration was significantly higher in patient's group (57.7 +/- 120.7 pg/mg creatinine) (range 1.1-731) compared to control group (10.2 +/- 5.96 pg/mg creatinine) (range 1.6-25.4) (p < 0.05). There was no significant difference in the frequency of elevated urinary IL-1 beta concentration in different patients group based on histological type of glomerulonephritis (chi 2 = 6.377, p > 0.05). On the basis of our results we concluded that the elevated concentration of IL-1 beta in majority of patients with primary immunocomplex glomerulonephritis had suggested its role in the pathogenesis of glomerulonephritic process. The urinary level of IL-1 beta represents a novel, non-invasive parameter in the diagnosis of this disease, but its measurement is not useful in predicting the histological type of primary immunocomplex glomerulonephritis. The results of our study suggest the possibility that urinary IL-1 beta level reflects the activity of glomerulonephritic process and it could be useful in non-invasive monitoring of the disease progression.

[Significance of blood transfusion in the development of cytotoxic antibodies in patients on hemodialysis]

The aim was to evaluate the influence of red blood cells (RBC) transfusion on the development of cytotoxic antibodies (C-Ab) in patients subjected to hemodialyses (HD) and planned for the kidney transplantation. The group of 71 HD patients, of mean age 42 years (19-65), 48 males and 23 females, planned for the kidney information was examined. Out of 71 HD patients, only 42 (59.19%) HD patients (group I) received subcutaneously recombinant human erythropoietin--rhuEPO (Eprex--epoetin-alpha or Recormon SE--epoetin-beta in dosage of 4,000 IU during every HD; i.e. one to three times a week) and they were not treated by RBC transfusion. The other 29 (40.85%) HD patients (group II) received RBC transfusion: 18 (62.07%) HD patients received < 10 units 18 of RBC, 8 (27.59%) HD patients received 10-20 units of RBC; 3 (10.35%) HD patients received > 20 units of RBC. Testing of C-Ab was done in all patients every three months by standard lymphocytotoxicity test on the panel from 20 different lymphocyte donors with definite class I phenotype of antigen HLA. C-Ab was not found in HD patients who were not treated by RBC transfusion. Out of 18 HD patients who received < 10 units of RBC only 3 (16.67%) HD patients developed C-Ab; out of 8 HD patients who received 10-20 units of RBC, in 4 (50%) patients was proved C-Ab; and C-Ab was proved in all 3 HD patients who received > 20 units of RBC. RhuEPO administration is very important for the transfusiologic treatment of HD patients; especially those who are planned for the kidney transplantation. Development of C-Ab is in direct correlation with the number of transfunded units of RBC. HD patients who received 10 or more units of RBC were at great risk to develop C-Ab.

The meaning of air quality and flue gas emission standards for public acceptance of new thermal power plants

For the time being only 30-40% of the electric energy supply in Croatia comes from burning fossil fuel. New capacities of 800-1400 MW for the next decade will have to rely on the exclusive use of fossil fuels in thermal power plants (TPP). Public opinion will probably have a decisive influence on the issuing of construction permissions. The potential adverse effects on air seem to be the main argument against construction of TPPs. The priority is therefore to unambiguously state what air quality is warranted in the influenced area for the whole operation period of a TPP. It is important that the public should understand the real meaning of current air quality standards and emission limits. The only known way to do it today is through comparison with the corresponding standards and limits accepted worldwide. This paper discusses some important aspects of such comparison.

[Serum levels of beta 2-microglobulin in various types of hemodialysis]

beta 2-microglobulin (beta 2 m) is the major constituent of amyloid fibrils in dialysis-related amyloidosis (DRA), which is considered to be one of the most severe adverse effect of long-term dialysis. In this study we evaluated the efficiency of beta 2 m removal during different dialysis procedures. A total of 45 patients undergoing hemodialysis were divided in five groups: cuprophane dialysis (n = 10), high-flux polysulphone dialysis (n = 10), postdilutional hemodiafiltration (n = 10), conventional postdilutional hemofiltration (n = 10) and predilutional on-line hemofiltration (n = 5). Serum level of beta 2 m was determined before and after different procedures using ELISA. In the group of patients on cuprophane dialysis was registered an elevation of beta 2 m and of 16.8 +/- 11.4% on the average. Serum level of beta 2 m was decreased following all other procedures on the average of 40.7 +/- 16.4% after high-flux polysulphone dialysis, 42.0 +/- 13.7% after conventional hemofiltration, 64.7 +/- 9% after hemodiafiltration and 67.9 +/- 10.1% after predilutional hemofiltration. The best removal of serum beta 2 m was realized by predilutional hemofiltration. Also, we have noticed that patients treated with high-flux synthetic membranes in the longer time-period have lower predyalisis value of beta 2 m compared to patients treated with cuprophane membrane. Further long-term studies will be necessary to conclude whether these procedures could be successful prophylactic and/or therapeutic regimen for dialysis-related amyloidosis.

[Urticarial vasculitis--a syndrome with low complement levels and secondary glomerulopathy]

In female patient, aged 41, 3 years ago appeared skin changes of urticarial type, and occasional pain in the joints of shoulders and hands, followed by complete weakness and exhaustion, as well as the occurrence of face and eyelid edema. Laboratory findings confirmed the presence of hypocomplentemia with proteinuria, microhematuria and cylindruria. Histopathologic (HP) finding of skin biopsy was leukocytoclastic vasculitis, and HP finding of the kidneys was mesangioproliferative glomerulonephritis. The regression of skin changes was observed during hospitalization after Dapsone was administered. The therapy started with corticosteroids (Prednisone 40 mg/day with weekly dose from 5 mg to 30 mg). In spite of the therapy, hypocomplementemia and proteinuria up to 335 mg/24 h have maintained for a year in the later controls in an outpatient department. The patient is without discomfort, and renal function is stable.

[Significance of inflammatory cytokines in the pathogenesis of IgA nephropathy]

Prospective study was performed on the concentrations of inflammatory cytokines IL-1, TNF and IL-6 in serum and urine (ELISA tests) were determined in the scope of total clinical-laboratory and histologic treatment in 59 patients with primary IgA nephropathy. Control group consisted of 20 healthy subjects. IL-6 was not detected either in serum of patients with IgAN, or in control examinees. TNF alpha and IL-1 beta were detected in control patients' sera and in patients with IgAN, but detected concentrations were not significantly different. IL-1 beta in urine was detected in 82.8%, TNF alpha in 90.0%, and IL-6 in 40% of our patients with IgAN. The concentrations of IL-1 beta were significantly higher compared to IL-1 beta concentrations in urine of healthy subjects and significantly correlated with the severity of glomerular and tubulointerstitial changes, as well as with the degree of proteinuria. Direct and indirect toxicity of TNF alpha on renal structures was confirmed in significantly higher concentrations of that cytokine in urine of patients with mesangial sclerosis of different percentage compared to the patients with isolated mesangial hypercellularity. Also in the patients with index of chronic lesion over 7 significantly higher TNF alpha concentrations in urine were found compared to the patients with lesion index 0-3 and 4-7. Creatinine clearance was in negative correlation with TNF alpha concentrations in urine of our patients with IgAN. Concentrations of IL-6 in urine were in correlation neither with laboratory parameters of renal function, nor with the degree of histologic changes.

Treatment of IgA nephropathy with nephrotic syndrome using pulse doses of IgG

This paper presents the preliminary results of the treatment of nephrotic syndrome in IgA nephropathy (IgAN) using pulse doses of IgG. Diagnosis was established only by percutaneous ultrasonically-guided renal biopsy, as well as on the basis of typical immunofluorescence and light microscopy findings. Histopathologic changes were classified according to the World Health Organization classification for IgAN, by determination of average glomerular, vascular and interstitial fibrosis indices and the degree of tubular atrophy. IgG therapy was administered in three patients with nephrotic syndrome associated with IgAN characterized by minimal histological changes, i.e., by diffuse mesangioproliferative glomerulonephritis. Initial IgG pulse dose was 0.4 g/kg, given as slow intravenous infusion during three consecutive days in the course of the three-month period. Maintenance therapy consisted of intramuscular IgG in the doses of 2.5 g twice a month, for the next three months. After a six-month treatment, clinical and biochemical remission was achieved in patients with minimal histologic changes, but in other two patients with diffuse mesangioproliferative glomerulonephritis, the effect of the therapy consisted of reduced proteinuria by more than 50%, with the renal function restored to the level before therapy. Transient increase in the serum creatinine level was found in two patients. These preliminary results with IgG pulse therapy, although obtained on a small number of patients, suggest the drug's potent immunomodulatory properties, but its complexity and levels of actions should be further investigated.

[Prognostic value of determination of the presence and histologic grade of the intraductal component in invasive ductal carcinoma of the breast after conservative treatment]

In recent years, breast-conserving therapy and radiation therapy have become an important treatment option for patients with stage I and II invasive breast cancer. The results of long-term retrospective studies have demonstrated that this treatment can provide a high level of local tumor control with satisfactory cosmetic results. Numerous studies have shown that the presence of extensive intraductal component (prominent intraductal carcinoma) is highly associated with subsequent local recurrence. In this article we have stressed the value of the determination of the presence and the histologic grade of prominent intraductal component of invasive ductal breast carcinoma in the determination of the extent of surgery. We also point out the possibility of determination of prominent DCIS on frozen sections.

[Treatment of nephrotic syndrome in IgA nephropathy with IgG pulsed doses]

The preliminary results of nephrotic syndrome treatment in IgA nephropathy (IgAN) with pulse IgG doses have been presented. The diagnosis of IgAN has been made exclusively by percutaneous ultrasonically guided biopsy of kidneys, on the basis of characteristic finding of immunofluorescent and light microscopy. Histopathological changes were classified upon the Classification of World Health Organization for IgAN with the calculation of average glomerular, vascular and indices of interstitial fibrosis and tubular athrophy. The therapy with IgG was applied in 3 patients with nephrotic syndrome in complex of IgAN with minimal histologic changes, i.e. diffuse mesangioproliferative glomerulonephritis. Initial pulse dose of IgG was 0.4 g/kg and it was administered in slow intravenous infusion for three days running during three months. The therapy of maintenance consisted of intramuscular administration of IgG in the dose of 2.5 g, twice a month, for the next three months. After the six-month treatment, clinical and biochemical remission was achieved in the patient with minimal histologic changes, and in the other two patients with diffuse mesangioproliferative glomerulonephritis the effect of therapy was revealed in proteinuria decrease for over 50% and the preserved renal function on the level before the therapy has started. Temporary increase of creatinine serum concentration was registered in two our patients. Preliminary results of pulse therapy with immunoglobulin G, although obtained on the small patient number, imply its powerful immunomodulatory features, which complexity and action levels should be more investigated.

[Acute renal insufficiency in hemorrhagic fever with renal syndrome]

In the Clinic for Nephrology of Military Medical Academy, 116 patients with hemorrhagic fever with renal syndrome (HFRS) have been treated in the period from January 1989 to December 1995. The patients were hospitalized with advanced acute renal failure (ARF). The largest number of our patients got ill from HFRS from the middle of March till the end of May and during August when the other frequency elevation was noticed. Most frequently the disease has the course that is followed up by phases. Positive finding of antibodies to HFRS virus was noticed in all 116 patients (Hantaan 45%, Belgrade 35%, Puumala 20%). According to clinical symptoms, signs and syndromes that follow up HFRS, the most of our patients were with more severe disease type. The ARF treatment with dialysis was necessary in 45% our patients. The most severe clinical forms were caused by Belgrade strain. Very favorable effect of "an early dialysis" to the disease course and outcome was observed. By this approach in HFRS therapy, the patient's mortality was decreased to 0.86%. The development of chronic renal failure as HFRS sequela is possible, but not so frequent.

[Characteristics of membranous glomerulonephritis]

The diagnosis of primary glomerulonephritis was made in 20 patients from January 1990 to December 1995. They were followed-up up to 5 years. Various therapeutic modalities were applied: 12 patients were treated with pronison per os, in 5 patients (42%) the disease remission was achieved, the other 5 (42%) patients had frequent recurrences of nephrotic syndrome, while 2 patients (16%) were with renal failure. In 7 patients at the beginning of treatment "pulse" methil prednisolone of 500 mg/48 h and 200 mg/48 h of cyclophosphamide was administered per os. Remission was achieved in 5 (71%) patients, and renal failure developed in 1 patient. Four patients, refractery to previous therapy, were treated with cyclosporin A and remission was achieved in 1 patient with proteinuria less than 2 g/d. The other patient had relapses of nephrotic syndrome, and renal failure has developed in the other two patients. Corticosteroids are drugs of choice in the treatment of lighter forms of MGN. In case of resistence to corticosteroid therapy or the progression of renal failure, cyclophosphamide should be included in the therapy, but in the patient refracte to this treatment, therapy with cyclosporin A should be attempted.

[Posttraumatic acute renal insufficiency]

Acute renal insufficiency is a severe, but most frequent reversible illness followed by sudden onset, oliguria or anuria of indefinite duration, by rapid increase in decomposition products of protein catabolism in serum, by acidosis and fluid balance and electrolytes disorder. The aetiologic factors of acute renal insufficiency are various. A very significant aetiological factor in the appearance of acute renal insufficiency is a trauma caused by any kind or type of weapons, arms or instruments [1-5, 6, 9-13, 15]. Of a total number of injured persons who were treated in our institution (4,086 injured persons), 251 (6.14 percent) were with acute renal insufficiency, and of that number with all signs and symptoms of acute renal insufficiency 37 (0.9 percent) were treated with haemodialysis. Of the number of dialysed patients 30 (80 percent) patients had oliguric form of acute renal insufficiency and 7 (19 percent) were with non oliguric form of acute renal insufficiency. The most frequent injuries were to abdomen and then to extremities, liver, chest and kidneys. The smallest percentage concerned isolated injuries in extremities. According to a pathogenic mortality mechanism, the highest mortality was in patients with haemorrhagic syndrome and in septic condition, and the minimal in patients with other syndromes, such as crush syndrome, etc. In 25 (68 percent) patients acute renal insufficiency was associated with haemorrhagic syndrome, in 7 (18.9 percent) with crush syndrome and in 5 (13.5 percent) with septic condition. In 36 (97 percent) patients haemodialysis was performed and in 1 (3 percent) subject peritoneal dialysis. The reason for such a small number of peritoneal dialysis are severe injuries to abdomen and chest, since this type of dialysis could not be performed for technical reasons. In 27 (73 percent) patients haemodialysis was performed as a type of intermittent heparinization. In 5 (14 percent) patients heparinization was a type of continual heparinization. Thanks to prompt haemodialysis together with medical therapy and surgical treatment, the mortality rate in our patients was lower in comparison to mortality rate in other centres (Table 3). The main causes of acute renal insufficiency in our patients were: Acute tubular nercosis, peripheral blood flow insufficiency (hypovolaemia, cardiovascular failure), and postrenal insufficiency (excretory obstruction, intrarenal obstruction, urinary organ ruptures, haemorrhagic shock) and the underlaying kidney disease. Acute renal insufficiency can be divided into acute renal insufficiency, primary parenchymal renal insufficiency and postrenal azotaemia [1-6, 9, 12, 13]. During the therapy of these patients it is important to evaluate the dehydration degree of patients by clinical and laboratory parameters. In case of hypovolaemia the complete compensation of fluid should consist of infusion together with administration of diuretics. The central venous pressure should be maintained at the values in a range from 6 to 8 cm H2O. In case of oliguric acute renal insufficiency the fluid intake should be equal to diuresis plus every other loss of fluids. Diet should be high-caloric with carbohydrates in the amount of 100 mg, and that amount should be given three to four times daily (both parenterally and orally) together with restriction of potassium intake due to a well known effect of potassium on myocardium function. Dosage of drugs which are eliminated via kidney should be managed promptly by parenteral administration of antibiotic agents [7, 8, 13-16]. Haemodialysis should be started at the very beginning of the patients admission to the hospital and should be associated with anticoagulant therapy for avoiding haemorrhages. Thanks to haemodialysis performed in time, the mortality rate in our patients was reduced in comparison to health centres where haemodialysis was delayed. Thanks to such treatment of patients with many severe injuries in whom the mortality rate is usuall

[IgA nephropathy--IgA1 disease]

The aim of this study was to prove the increased IgA1 production in patients with IgA nephropathy compared to the control group of healthy subjects, by determination of serum subclasses IgA, IgA1 and IgA2 levels. That with the exclusive presence of IgA1 in kidney tissue, justified the assertion that IgAN was IgA1 disease. Eighteen patients with IgA nephropathy, 15 male and 3 female, average age 17-54 (mean +/- SD = 34.1 +/- 5.18) were included in the prospective study. The diagnosis was proved by immunofluorescent assay of bioptic kidney material obtained by ultrasonically guided biopsy. The total serum IgA and IgA1 and IgA2 subclasses levels were determined in the patients and healthy conscripts from the control group. The methods of immunonephelometry and radial immunodiffusion were used. Increased IgA values were found in 22.75% and of IgA1 subclass in 38.85% patients. Patients with IgA nephropathy had significantly higher IgA1 values (p < 0.01), compared to the control group. There was no significant difference in IgA2 subclass levels. Renal function did not significantly affect IgA1 and IgA2 subclasses values.

[Endemic nephropathy in the region of Bela Crkva in Banat]

The village of Kusić is situated 8 km southwestern of Bela Crkva, at the very border, separated from Romania by the river Nera. Due to frequent disease occurrence in the village Kusić, the pelustration of population was done in 1978 and 1989, and during the later follow-up, many patients were examined either in hospital or in outpatient clinics. The aim was to confirm a suspicion on the existence of the focus of endemic nephropathy in the village of Kusić. In 1978 and 1989 abnormal proteinuria was found in 17.7% and 16.7% examines from the village of Kusić, respectively-significantly higher than in surrounding villages: Grebenac, Vracev Gaj, Banatska Palanka and Kruscica (p < 0.01). Slow progression to the lasser degree of anemia was found in the patients with proteinuria, compared to the control group. Eight of 10 regularly dialyzed patients died, and in 4 patients urothelial carcinoma was diagnosed. In all of them nephroureterectomy was performed, and one patient with advanced disease died 6 months after surgery. On the basis of cited data, by their comparison and further prospective observation of the patients from the village of Kusić, it was concluded that the new focus of endemic nephropathy existed in southeastern Banat.

[Ultrasound guided percutaneous biopsy of the kidney]

In the course of 5 years, 582 ultrasound guided percutaneous renal biopsies were performed in 558 patients. Kidney tissue was obtained in 507 patients (90.9%), and in 485 (86.9%) the obtained sample was sufficient to establish the diagnosis. Complications following renal biopsies were observed in 221 patients, or 38% of total biopsies. There were 212 (36.4%) clinically moderate complications. The most frequent ones were asymptomatic hematomae (32.6%), and infrequently lumbar pain (2.4%) and hematuriae lasting less than 12 hours (1.4%). In 9 patients 10 (1.7%) serious clinical complications in the form of hematuria lasting more than 12 h (1%), large perirenal hematomae (0.5%) and urinary infections (0.2%). In the older age group and in patients with pronounced renal failure no significant difference in the incidence of complications was observed. Ultrasound guided percutaneous renal biopsy is a safe diagnostic method, and the associated complications do not seriously curb its use. The therapy of complications is primarily conservative, and only rarely surgical.

[Correlation of inflammatory cytokines in the urine and serum with clinico-laboratory and pathohistologic features in patients with IgA nephropathy]

Complete examination of 21 patients with IgA nephropathy included determination urine and serum IL-6, TNF alpha and INF gamma levels by ELISA (Luzernachen, Luzern Switzerland). Control group included 15 healthy volunteers. Urine IL-6 levels ranging 37-274.1 pg/ml were detected in 15 (71.2%) patients with IgA nephropathy. IL-6 serum levels were undetectable. In the control group serum and urine levels were also undetectable. Correlation between the IL-6 level and proteinuria degree and endogenous creatinine clearance rate has not revealed statistically significant relationship. In relation to histologic groups (minimal changes, focal glomerulonephritis, mesangial proliferative, diffuse sclerosing) patients with minimal changes had (statistically) significantly higher IL-6 urine levels than the third and fourth group. Average the urine levels were 145.8 +/- 166.6 pg/ml and the serum ones were 148 +/- 101 pg/ml. In relation to the control group (statistically) significant difference was not found. Correlation between TNF alpha level and proteinuria degree and creatinine clearance rate has revealed (statistically) significant relationship (p < 0.05). Average interferon gamma serum levels in lgA nephropathy patients were 312.0 +/- 111.8 and in comparison with the control group (statistically) significant difference was found (p < 0.01). The obtained results suggest the important role of cytokine production disregulation associated with the pathogenesis of IgA nephropathy.

[Nephrotic proteinuria in poststreptococcal glomerulonephritis]

Nephrotic proteinuria in acute poststreptococcal glomerulonephritis is rare. In 62 patients aging from 18 to 22 years, proteinuria of > 3 g/24 hrs was found ins 5 (8%) patients, 0.3 to 3 g/24 hrs in 36 (58%) and 0.15 to 0.3 g/24 hrs in 21 (34%) patients. Proteinuria in many patients disappeared after 3 months and in later follow up it was found in about 30% of patients. Out of 5 patients with proteinuria of > 3 g/24 hrs 3 had persistent pathological urinary analysis, 2 patients were rebiopsied after 5 and 3 years from the disease onset, the morphological changes were moderate. In 2 patients after acute phase had been over came to the clinical healthy (with normal urinary analysis) lasting for 2 years and in the rebiopsy less marked pathological changes were described. Immunofluorescent analysis in the all patients were negative. Patients with initial nephrotic proteinuria in poststreptococcal glomerulonephritis have bad prognosis and often develop chronic disease.

[Epidemiology of poststreptococcal glomerulonephritis in the military population]

Acute poststreptococcal glomerulonephritis appears often in children and our interest is the incidence of the disease in young adults (aged 18 to 22 years) especially in military people. In Nephrology Clinic of the Military Medical Academy (In the period from 1978 to the end of 1993) 153 patients were treated and sporadic cases developed after respiratory infection. Only 5 patients developed the disease after skin infection with Streptococcus B hemolyticus group A. A large number of patients acquired the disease in the period from February to April and from October to December and most of them in the time interval from 5 to 7 years. A substantial, number of patients were treated in 1982 (13), followed by 22 in 1989, and the trend continued in 1990 (24 patients) while only 6 patients presented in 1993. So, the incidence of the disease in the military population is not high (10 +/- 6 patients year and it was sporadic cases and more after respiratory infection.

[Serum and urinary interleukin-6 levels in patients with primary glomerulonephritis]

Several studies have suggested that the measurement of urinary interleukin-6 (IL-6) is a helpful tool for diagnosis and monitoring the progression of glomerulonephritis. The aim of this study was to determine if IL-6 level might reflect the histological type of glomerular lesions. We performed a prospective study of 43 patients who underwent renal biopsy in our hospital. There were 35 male and 8 female patients with median age of 30.5 years (range 19-50). Included among these were 13 cases of IgA nephropathy, 11 cases of membranoproliferative glomerulonephritis, 6 cases of poststreptococcal glomerulonephritis, 6 cases of mesangial proliferative glomerulonephritis, 5 cases of membranous nephropathy and 2 cases of C3 nephritis. IL-6 was measured by ELISA (Lucernachem, Switzerland). IL-6 was not detected in the serum and rine of 15 healthy controls. IL-6 was elevated in the urine of 30 patients with different histological types of glomerular lesions (range 3.7 to 433.3 pg/ml) but was not detected in the urine of remaining 13 patients. The presence of IL-6 in the urine in absence of raised serum IL-6 suggests that urinary IL-6 was produced by the kidney. We have concluded that urinary IL-6 level can be considered as a marker of glomerulonephritis but not one that is very specific for any particular histological type of primary glomerulonephritis. Thus, the urinary IL-6 level is not a useful tool in the differential diagnosis of primary glomerulonephritis. We need further studies to determine whether urinary IL-6 level could by considered for monitoring of disease activity and therapy.

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.

[Significance of renal biopsy in patients with isolated microhematuria]

Retrospective study included 30 patients with isolated microhematuria in which renal biopsy was performed. Renal biopsy provided diagnosis in 28 (98.3%) cases, and histological finding was normal in only 2 (6.7%) patients. The most frequent finding was IgA nephritis found in 15 (50%) patients, while the other forms of glomerulonephritis were less frequent. In our patients there were no indications for steroid therapy. It was concluded that renal biopsy had great diagnostic value and that it should be preferred to invasive urologic-radiologic diagnostic procedures particularly when it is to be performed transcutaneously.

[Clinical and morphologic characteristics of adult IgA nephropathy]

Within the period 1987-1992 IgA nephropathy was diagnosed at the Nephrology Clinic of the Military Medical Academy in 61 patients aged from 17 to 41 years (mean +/- SD = 24.31 +/- 6.39). The aim of the study was to evaluate their importance as markers of progressive forms of IgA nephropathy by analysis of mutual relationship of clinical-laboratory and histopathological characteristics. Clinical form of the disease with recurrent macroscopic hematurias existed in 30 (49.2%) patients, and oligosymptomatic form in 31 (50.8%) patients. Acute renal failure of reversible oliguric character had 5 (8.2%) patients. Patients with recurrent macroscopic hematurias had more progressive course of IgA nephropathy which could be indirectly seen from the parameters of the global renal function. The most frequent histological form of IgA nephropathy was diffuse mesangioproliferative glomerulonephritis registered in 30 (49.2%) patients.

[Acute renal insufficiency in poststreptococcal glomerulonephritis and its significance in evaluation of disease development in adults]

Importance of ARF occurring in the acute phase of PSGN in the disease evolution is still disputable because reported results are varying and even contradictory. Examination included 44 patients between 18 and 22 with the acute phase of PSGN. The serum creatinine levels over 124 mmol/l were found in 17 patients, while 27 of them were without ARF in the acute phase of the disease. The aim of the study was, after diagnosing APSGN, to form groups of patients according to the ARF presence and to examine its influence in the initial phase of PSGN on its evolution and prognosis. On the basis of clinical parameters, pH changes, renal rebiopsy and ARF associated with the type of evolution, severity of clinical presentation and pH changes it was shown that occurrence of ARF in the acute phase of PSGN was of no significant importance for clinical presentation of the disease, but it could have some influence on the degree of morphologic changes found by renal rebiopsy.

[Hypertension in patients with post-streptococcal glomerulonephritis]

Sixty two patients with poststreptococcal glomerulonephritis (PSGN), aged 18-22 (mean = 19 +/- 0.5 years) were examined and treated at the Clinic of Nephrology of the M.M.A. from the beginning of 1986 to the end of 1990. Hypertension (diastolic pressure over 13 kPa, that is, 97.5 mmHg) in the acute phase was found in 59 (95.16%) patients, being of milder degree and short-term course. Transient increase of blood pressure required sometimes a short therapy (with furosemide mainly). With normalization of the glomerular filtration rate, withdrawal of edema, and normalization of the plasma volume, the blood pressure has been also normalized in the majority of patients (within 3-5 days). Observing PSGN evolution in the period from 2 to 5 years, hypertension was found in 3 (6.8%) of 44 patients. All three patients had the clear clinical evolution (proteinuria and erythrocyturia) without signs of renal insufficiency. The rebiopsy of the kidneys showed milder morphologic changes which were more manifested compared to the group without hypertension. Hypertension was present in the majority of patients in acute phase of PSGN while it was rarely found during the evolution of the disease and its presence has been poor prognostic sign in evolution since it contributed to development of glomerulosclerosis and later on renal insufficiency.

[Early treatment of acute nephrotic syndrome in patients with acute post-streptococcal glomerulonephritis]

In the period of five years 54 patients with acute poststreptococcal glomerulonephritis were treated. Acute nephritic syndrome was manifested in 45 (almost 4/5 of all) patients. Edema and hematuria were found in all patients, hypertension in 89%, and acute renal failure in 49% of patients with the acute nephritic syndrome. For successful treatment of acute nephritic syndrome of decisive importance have been application of measures intended primarily to correction of positive sodium and water balance by dietetic regimes, diuretics and antihypertensives and rest, while the application of the dialysis has not been necessary even in patients with acute renal failure.

[Management of pregnancy in a patient on chronic hemodialysis]

Conception and fetal survival are possible in patients undergoing long term hemodialysis. We report a case of successfully managed pregnancy complicated by maternal chronic renal failure requiring hemodialysis, severe intrauterine growth retardation and polyhydramnios. Pregnancy was terminated by cesarean section at 30 weeks' gestation due to premature labor. A normal-appearing female weighting only 1000 gr was delivered. The infant is now more than a year old and is developing normally.