Motives and attitudes of parents toward HPV vaccination: Results from the initial period of HPV vaccine rollout in Serbia

Human papillomavirus (HPV) infection is one of the most common viral infections in sexually active population worldwide, and is the main cause of cervical cancer, which is the fourth most common cancer among women. Serbia ranks third in incidence and mortality rate of cervical cancer in Europe. We conducted a cross-sectional study considering parents' motivation for the HPV vaccination of their children. Statistical analysis included descriptive statistics and a logistic regression model. We found that the strongest motive was "Recommendation from paediatrician" (20.2%), followed by the attitude that HPV vaccine protects against cancers in different localization (15.4%), the motive "It is better to vaccinate a child than expose them to potential risk of HPV infection" (13.3%) and "Feeling anxiety due to a possible infection and cancer in the child" (13.1%). For those parents that vaccinated their child for some other strongest motive, reasons like "Vaccine is free of charge", "Recommendation from friends and family" and motive "My child received all obligatory vaccines, so I want to receive this one as well", were significantly more frequently selected. In the group where paediatricians' recommendation was not a motive for accepting the HPV vaccine, the largest percentage of parents (89.6%) selected motive "HPV vaccine protects against cancers in different localization" and the motive "It is better to vaccinate a child than expose them to potential risk of HPV infection" (78.1%). Paediatrician's recommendation is very important for parents' decision to vaccinate, however, other motives also influenced and had significance in making the parents' decision to vaccinate their children against HPV. Encouraging trust in public health authorities in Serbia, highlighting the advantages of the HPV vaccine and further encouraging healthcare workers to give stronger recommendations can increase the HPV vaccine uptake. Finally, we provided the basis to create more targeted messages that will empower parents to vaccinate their children.

Theory of the Supercurrent Diode Effect in Rashba Superconductors with Arbitrary Disorder

We calculate the nonreciprocal critical current and quantify the supercurrent diode effect in two-dimensional Rashba superconductors with arbitrary disorder, using the quasiclassical Eilenberger equation. The nonreciprocity is caused by the helical superconducting state, which appears when both inversion and time-reversal symmetries are broken. In the absence of disorder, we find a very strong diode effect, with the nonreciprocity exceeding 40% at optimal temperatures, magnetic fields, and spin-orbit coupling. We establish that the effect persists even in the presence of strong disorder. We show that the sign of the diode effect changes as magnetic field and disorder are increased, reflecting the changes in the nature of the helical state.

West Nile virus 'circulation' in Vojvodina, Serbia: Mosquito, bird, horse and human surveillance

Efforts to detect West Nile virus (WNV) in the Vojvodina province, northern Serbia, commenced with human and mosquito surveillance in 2005, followed by horse (2009) and wild bird (2012) surveillance. The knowledge obtained regarding WNV circulation, combined with the need for timely detection of virus activity and risk assessment resulted in the implementation of a national surveillance programme integrating mosquito, horse and bird surveillance in 2014. From 2013, the system showed highly satisfactory results in terms of area specificity (the capacity to indicate the spatial distribution of the risk for human cases of West Nile neuroinvasive disease - WNND) and sensitivity to detect virus circulation even at the enzootic level. A small number (n = 50) of Culex pipiens (pipiens and molestus biotypes, and their hybrids) females analysed per trap/night, combined with a high number of specimens in the sample, provided variable results in the early detection capacity at different administrative levels (NUTS2 versus NUTS3). The clustering of infected mosquitoes, horses, birds and human cases of WNND in 2014-2015 was highly significant, following the south-west to north-east direction in Vojvodina (NUTS2 administrative level). Human WNND cases grouped closest with infected mosquitoes in 2014, and with wild birds/mosquitoes in 2015. In 2014, sentinel horses showed better spatial correspondence with human WNND cases than sentinel chickens. Strong correlations were observed between the vector index values and the incidence of human WNND cases recorded at the NUTS2 and NUTS3 levels. From 2010, West Nile virus was detected in mosquitoes sampled at 43 different trap stations across Vojvodina. At 14 stations (32.56%), WNV was detected in two different (consecutive or alternate) years, at 2 stations in 3 different years, and in 1 station during 5 different years. Based on these results, integrated surveillance will be progressively improved to allow evidence-based adoption of preventive public health and mosquito control measures.

STRUCTURE AND DISTRIBUTION OF LEADING ZOONOSES IN VOJVODINA IN 2000-2009 PERIOD

The data show that from more than 1.400 today known microorganisms, that cause infections in human population, 61% is of animal origin. The list of known zoonoses is enlarged every day, new diseases are recognized and discovered. Because of this, zoonoses are significant health and economical problem in the world. The participation of these diseases in national pathology of the inhabitants of certain area depends on the presence and number of foci, type of reservoir species, application and efficency of prophylactic measures. The goal of this paper is to analyze the structure and distribution of leading zoonoses in the population of AP Vojvodina. The analysis is made according to the data from the register of infectious diseases - Center for Disease Control and Prevention, Institute for Public Health of Vojvodina. The period included in this study is from 2000 to 2009. From 70 infectious diseases, which are to be declared according to national legislative, half of them are zoonotic diseases. In this analysis we treat only zoonotic diseases and vector borne zoonotic diseases registered in past 10 years. In the period included in this study 15 zoonotic diseases and vector borne zoonoses have been registered in AP Vojvodina. The highest level of incidence is for lyme disease, with the average 9,91/100.000 and trichinellosis with the average 6.40/t 100.000 (Table 1). Toxoplasmosis, Q fever, leptospirosis and echinococcosis have been registered in Vojvodina regularly, and the average incidence is below 1/100.000. The range from minimal to maximal registered incidence shows that there was not a significant difference in epidemiological situation of these diseases. Other zoonoses have been registered rarely and occasionally, as autochthonous or imported diseases (leishmaniasis). In this group of diseases 41 deaths have been registered. Most of it was caused by tetanus and leptospirosis. The lethality rate of tetanus was 54.55% and the patients were of the oldest age. Lethality rate from leptospirosis was 12.0%, and unlike tetanus, the patients belonged in the middle age group. The registered incidences of zoonoses in human population do not present the real situation because of the diagnostic and rapid recognition of symptoms. Some vector borne zoonotic diseases, like for example tick born meningoencephalitis and West Nile Virus fever, which regularly occur in Europe and surrounding countries, have not yet been registered in our region and Serbia. However, the risk from the infections and a possibility of occurrence is not eliminated.

Differential expression of KCNQ1 K+ channel in tubular cells of frog kidney

The aim of this study was to evaluate KCNQ1 K⁺ channel expression in the frog kidney of Rana esculenta. KCNQ1 K⁺ channel, also known as KvLQT1, is the pore forming α-subunit of the I_Ks K⁺ channel, a delayed rectifier voltage-gated K⁺ channel, which has an important role in water and salt transport in the kidney and gastrointestinal tract. The expression of KCNQ1 K⁺ channel along tubular epithelium differs from species to species. In the present study the expression of KCNQ1 K⁺ channel in the frog kidney has been demonstrated by immunohistochemistry. The presence of KCNQ1 K⁺ channel was demonstrated in the epithelial cells of distal convoluted tubule and collecting duct. However, the pattern of expression of KCNQ1 K⁺ channel differs between distal convoluted tubules and collecting duct. All epithelial cells of distal convoluted tubules revealed basolateral expression of KCNQ1 K⁺ channel. On the contrary, only the single cells of collecting duct, probably intercalated cells, showed diffuse cell surface staining with antibodies against KCNQ1 K⁺ channel. These findings suggest that KCNQ1 K⁺ channel has cell-specific roles in renal potassium ion transport.

[Effects of the immunization program in Vojvodina]

INTRODUCTION

With the widespread use of active immunization, significant results have been achieved in the control and prevention of numerous communicable diseases. The Expanded Programme on Immunization of the World Health Organization is intended to strengthen national programs for the reduction in the incidence and mortality rates and global elimination or eradication of communicable diseases. The aim of this paper is to analyze results of the immunization program in Vojvodina. MATERIAL DND METHODS: The results of the immunization program were analyzed on the basis of the incidence rates, since the introduction of the mandatory reporting system, till 2006. The analysis included immunization coverage against diphtheria, tetanus, pertussis, poliomyelitis and measles as well as reported cases of missed opportunities in the period from 1997 to 2006.

RESULTS

Poliomyelitis has not been reported in Vojvodina since 1963, diphtheria since 1978 and measles in the period from 2001 to 2006. Sporadic cases of pertussis have been reported in unimmunized children of the youngest age, and tetanus in unimmunized elderly population. Vaccination coverage against poliomyelitis, diphtheria, tetanus and pertussis was above 96%. Vaccination coverage against measles was lower (95% vaccination, 87% revaccination). The highest proportion of missed opportunities was caused by not responding to immunization calls (46.6%).

CONCLUSION

These results can be maintained by up-to-date (UTD) immunization and high vaccination coverage without territorial and population differences. Data on the total number of children without up-to-date vaccination cannot be obtained on the basis of administrative coverage follow-up. It is necessary to establish follow-up mechanisms for UTD immunization, which would reveal the number of children at risk from vaccine preventable diseases and characteristics of unimmunized population.

[Epidemiological characteristics of tetanus in Vojvodina]

INTRODUCTION

Vojvodina is an endemic area for tetanus.

MATERIAL AND METHODS

Epidemiological characteristics of tetanus were analyzed based on registered cases of disease and death in the period 1960-2004, and epidemiological investigation of 50 registered cases during the last 10 years of this period. Epidemiological characteristics were analyzed chronologically, demographically and topographically.

RESULTS AND DISCUSSION

During the period of observation, the incidence rate of tetanus declined steadily. Due to immunization and extremely high coverage, tetanus has been practically eliminated in the age group of younger than 29 years. Neonatal tetanus and tetanus in the age group 30-59 years has been reduced to individual cases. Today, tetanus is a problem of the elderly population. Tetanus deaths occur statistically more often among persons older than 66 years. The average case fatality rate during the period of observation was 33.1%. The vaccination history in the majority of investigated cases was unknown (52%) or they have never been vaccinated (28%) because they were mainly elderly people born before introduction of mandatory immunization. Tetanus most often occurs after minor wounds, because of which patients do not seek medical attention. In the majority of cases tetanus occurred after limb injuries.

CONCLUSION

Tetanus in Vojvodina is a problem among unimmunized elderly people. It mostly occurs after minor injuries or after contamination of chronic skin lesions. Mandatory vaccination of older age groups should contribute to further reduction in the incidence rate of tetanus.

Solitary fibrous tumors of the pleura

Two cases of female patients with solitary fibrous tumor of the pleura are described. Chest radiography and computed tomography showed the presence of a giant mass with inhomogeneous density in the hemithorax in both cases. Transthoracic needle biopsy of the masses showed benign fibrous tissue. Both patients underwent thoracotomy. The tumors arose from the visceral pleura, were peduncular, appeared well-circumscribed with exterior surface smooth, firm and multinodular. The size of tumors were 16x11x6 cm and 15x11x4.5 cm, weighed 650 g and 573 g and both were successfully resected. The pathological diagnosis was benign solitary fibrous tumor of the pleura. Seven years after the operations the clinical condition and chest radiography are normal in both women.

[Biomechanical characteristics of spinal cord tissue--basis for the development of modifications of the DREZ (dorsal root entry zone) operation]

Mechanical properties of the spinal cord tissue--biological basis for the development of the modality of the DREZ surgery lesioning technique Succesful treatment of the chronic neurogenic pain of spinal cord and cauda equina injury origin remains a significant management problem. The mechanism of this pain phenomenon has been shown to be related to neurochemical changes that lead to the state of hypereactivity of the second order dorsal horn neurons. The DREZ surgery (Dorsal Root Entry Zone lesion), designed to destroy anatomy structures involved in pain generating thus interrupting the neurogenic pain mechanism, as a causative procedure in treating this chronic pain, has been performed by using different technical modalities: Radiofrequency (RF) coagulation technic, Laser, Ultrasound and Microsurgical DREZotomy technic. The purpose of the study was to assess the possibility for the establishment of the lesioning technic based on the natural difference in the mechanical properties between the white and gray cord substance. We experimentally deteminated mechanical properties of the human cadaveric cord white versus gray tissue for the purpose of testing possibility of selective suction of the dorsal horn gray substance as a DREZ lesioning procedure. Based on the fact of the difference in tissue elasticity between white and gray cord substance we established a new and simple DREZ surgical lesioning technique that was tested on cadaver cord. For the purpose of testing and comparing the size and shape of the DREZ lesion axchieved the DREZ surgery has been performed on cadaver cord by employing selective dorsal horn suction as a lesioning method. After the procedure cadaver cord underwent histological fixation and analysis of the DREZ lesions achieved. Our result revealed that the white cord substance with longitudinal fiber structure had four time higher dynamical viscosity than gray substance of local neuronal network structure (150 PaS versus 37.5 PaS) that provided possibility for the safe and selective suction of the gray substance of the dorsal horn. Technic includes incision of the dorsolateral sulcus according to Sindous Microsurgical DREZotomy technic than suction under visual control of the dorsal horn gray matter using succer adopted from the lumbar puncture nidle. Operative experimental testing and hystological analysis confirmed expected size and shape of the DREZ lesion performed by dorsal horn suction as DREZ lesioning technique. The utility, selectivity and safety of this technic has been provided by the natural mechanical properties of the cord tissue itself. Application of the Dorsal horn suction as a DREZ lesioning in humans confirmed this technic as a safe and reliable DREZ lesioning method.

[Surgical treatment of rare anatomic variations and anomalies of the thyroid gland]

Choristoma and thyroid gland malpositions are embryonal disorders. The aim of this article is ten years analysis of their diagnostic and operative treatment. In 1425 thyroidectomies we have found: one lingual, intratracheal, intracardial thyroid and ovarial struma; six separated intrathoracic goitre and 10 mostly intrathoracaly (80%) situated goitre; 1.4% out of all. Correct preoperative diagnosis we have in lingual thyroid, two intrathoracal thyroid and in all mostly intrathoracal thyroids, and in others after histopathological examination. Operative approach was: collar incision with medial sternotomy in nine, collar incision with lateral thoracotomy in three, right thoracotomy in two, and only collar incision in one. There were two operative complications, one recurrent nerve lesion and one mediastinal haematoma. There was no hypocalcaemia and mortality. Thyroid gland anomalies are very rare and associated with lot of problems in diagnostic and treatment. In specialised institutions frequency of operative complications is the same like in routine thyroid gland surgery.

Kidney ectopeptidases in gentamicin and mercuric chloride-induced acute renal failure

The clinical use of gentamicin is associated by nephrotoxicity in over 10% of patients. However, the biochemical events responsible for proximal tubular injury and acute renal failure (ARF) are still unclear. In the present study, effects of gentamicin and, comparatively, of mercuric chloride upon rat kidney cortex ectopeptidases were studied. Gentamicin was given i.p., 100 mg/kg daily for up to 6 days, mercuric chloride i.p. once 2.5 mg/kg to rats studied after 3 days. Kidney cortex aminopeptidase N decreased significantly after 3 and 6 days' treatment (p < 0.01), however, angiotensinase A significantly decreased after 3 (p < 0.01), and much more after 6 days of gentamicin treatment (p < 0.001). Dipeptidylpeptidase IV activity was significantly decreased only after 6 days of treatment with gentamicin. In mercuric chloride-induced ARF all three peptidase activities were markedly decreased (p < 0.001). These results suggest that gentamicin-induced decrease in ectopeptidase activities could compromise vasoactive and other biologically active peptides handling, with important consequences upon renal function and metabolism.

Radionuclide voiding pattern in children with unstable bladder

BACKGROUND

The purpose of this study was to investigate bladder function parameters by means of quantitative radionuclide cystography (QRC) in anxious, irritable children with unstable bladder.

METHODS

Quantitative radionuclide cystography was performed in 18 children aged between 8 and 12 years, without evidence of neurologic and nephrologic disorders. Findings were compared with those obtained in 10 healthy children aged between 7 and 10 years. The dynamics of the bladder emptying were studied after intravenous injection of 37 MBq/10 kg b.w. 99mTc-diethylenetriaminepentaacetic acid (DTPA) in the posterior views. Images of 90 frames every 2 sec. were stored in the 64 x 64 computer matrix during voiding. The patients voided into a container and the volumes were measured.

RESULTS

The parameters evaluated were: functional bladder capacity (ml)--FBC, expected bladder capacity (ml)--EBC, percentage of EBC (%), voided urine volume (ml)--VV, residual urine (ml)--RU, voiding time (sec)--VT, average flow rate (ml/sec)--AFR and peak flow rate (ml/sec)--PFR. There was a statistically significant difference between controls and children with unstable bladder in the following parameters: FBC 288 +/- 33 vs. 244 +/- 27 ml (p < 0.001), % of EBC 99 +/- 6 vs. 82 +/- 6% (p < 0.0001), VV 265 +/- 37 vs. 202 +/- 35 ml (p < 0.0001), RU 22 +/- 11 vs. 48 +/- 19 ml (p < 0.007), AFR 13 +/- 5 ml/sec vs. 9 +/- 4 ml/sec. (p < 0.01) and PFR 19 +/- 2 vs. 13 +/- 3 ml/s (p < 0.0001), respectively. The VT obtained from the control group of 23 +/- 9 s did not differ significantly from the value of children with unstable bladder of 28 +/- 14 s.

CONCLUSION

The results show that quantitative radionuclide cystography is a simple, noninvasive method, which allows a good separation of patients with unstable bladder from the children with normal voiding pattern.

Fungus-like hyphochytrids associated with human disease

We report two cases, with liver and brain abscess, respectively, where fungus-like organisms belonging to the Hyphochytriomycota were found at the site of inflammation together with Peptococcus in the first and Cysticercus cellulosae in the second case. This is the first time these groups of organisms have been reported in human material. The role of hyphochytrids in human pathology remained uncertain as they were found together with already known human pathogens.

[Experimental study of the pathogenesis of frostbite. Part III. Significance of energy status of muscle tissue in the pathogenesis of frostbite]

The authors have investigated energy status of muscle tissue of the lower legs of Wistar rats subjected to freezing, as well as the dependence of ultrastructure changes in muscle tissue mitochondria on the intensity of freezing. The animals were divided into three experimental groups: two groups were exposed to cryoinjury of different intensity, while the third was the control one. Cryoinjury was applied over an experimental after thawing were taken samples of muscle tissue for the analysis of content of energy phosphates and carbohydrates' metabolites, respectively, as well as for morphometric analysis of mitochondria volume out of frozen right and unfrozen left lower legs. Results obtained from different experimental groups were compared mutually and with control group that was not exposed to cryoinjury, respectively. It was found that the freezing in muscle tissue caused hydrops degeneration of mitochondria, depletion of energy reserves, reduction of energy status and the activation of mechanism of anaerobic metabolism. All these alterations were proportional to the intensity of freezing and considerably influenced contractility function of muscle cells, causing prolonged spasm of arterioles in thawed tissue, i.e., rigor congelationis that was primarily defined as an important factor in the pathogenesis of ischemic impairment of thawed tissues.

[Lateral orbitotomy in the approach to an orbital dermoid cyst]

The choice of surgical approach for the resection of orbital tumor is as a rule determined by the tumor position in the orbital space and the best choice is the most direct approach to orbital tumor. Lateral orbitotomy as the extracranial orbital approach is favorable for radical resection of the tumor, which growth is limited to the anterior, lateral and superolateral orbital segment.

[Experimental study of the pathogenesis of frostbite. Part II. Role of the sympathetic-adrenergic system in tissue reperfusion immediately after thawing]

The authors have investigated the role of sympathetic-adrenergic system in reperfusion of muscular tissue of the feet of Wistar rats immediately after thawing using alpha adrenergic blocker phentolamine methanesulfonate (Regitin). Cryoinjury was applied over an experimental model of local, controlled freezing of different intensity for certain experimental groups. Blood flow through microcirculation was measured by scintigraphy, following Tc-99m-pertechnetate clearance that was given in muscular mass of frozen right, as well as unfrozen left feet of rats. Results obtained in some experimental groups were compared mutually, as well as with the control group that was not exposed to cryoinjury. The investigations have revealed that immediately after thawing existed significant reduction, non-dependent of the intensity of freezing, in blood flow in microcirculation of both frozen and unfrozen feet of rats compared to the control group. Significant increase of microcirculatory blood flow in unfrozen feet was caused by blockade of sympathetic-adrenergic system, while the blood flow remained unchanged in the frozen ones. The reduction of blood flow in microcirculation of frozen tissues immediately after thawing was not associated with sympathetic-adrenergic factor.

Evaluation of autosomal dominant polycystic kidney disease by DTPA renal scintigraphy

Sixty patients with previously documented autosomal dominant polycystic kidney disease (ADPKD) were investigated using dynamic kidney scintigraphy with 99mTc-diethylenetriaminepentaacetic acid (DTPA). Patients were subdivided in respect of glomerular filtration rate (GFR) as follows: PKD I group (normal GFR), PKD II group (moderately reduced GFR), and PKD III (severely reduced GFR). Scintigraphic features, time activity curves, excretion parameters, global and individual kidney functions were analyzed. Because of GFR dependent sensitivity, in advanced renal failure being only 0.1, and low reproducibility (11% intraobserver, 22% interobserver), 99mTc-DTPA dynamic kidney scintigraphy cannot be generally recommended for the diagnosis of ADPKD, but has to become a routine method for functional evaluation of both global and individual renal functions, as well as degree of excretion disturbances in ADPKD patients.

[Experimental study of the pathogenesis of frostbite. Part I. Pathohistologic and ultrastructural changes in tissues immediately after thawing]

Histopathologic and ultrastructural changes in the tissues of frozen extremities of Wistar rats were investigated immediately after thawing. Three experimental groups were formed: two were exposed to cryoinjuries of different intensity, while the third was the control one. Cryoinjury was caused by experimental model of local, controlled freezing of hind, right extremities. Immediately after thawing the tissue samples were taken from frozen right and unfrozen left extremities, in which histopathologic and ultrastructural changes were compared mutually and with control group, respectively. It was observed that the freezing directly caused ultrastructural and histopathologic damage of the tissues that were manifested immediately after thawing and were proportional to the intensity of freezing. Simultaneously, in the tissues existed complex circulatory disorders manifested in open arteriovenous shunts, venous congestion and microcirculatory insufficiency caused by evident spasm of arteriolae that could be considered to be very significant pathogenetic factor in ischemic damage of unfreezed tissues.

Elevated tumour markers in patients with Balkan endemic nephropathy

Balkan nephropathy (BEN) is commonly associated with urothelial cancer. Urothelial cancer is manifested in the advanced stage of disease. The aim of this study was to facilitate early detection of urothelial cancer in BEN patients and their family members living in an endemic region by using tumour markers, carcinoembryonic antigen (CEA) and tissue polypeptide antigen (TPA), and a putative marker, ferritin. Fifteen BEN patients with normal renal function, 17 with renal failure (BEN-RF), 13 healthy members of their families (HFM), 14 patients with glomerulonephritis (GN) and 12 healthy controls (C) were studied. Serum CEA levels in BEN patients were within normal limits, however, in BEN-RF patients they were significantly increased over HFM (p<0.05). Serum TPA levels in BEN and BEN-RF patients were significantly higher than in the C and HFM groups (p<0.05). Urinary CEA was not significantly different between the groups studied. Urinary TPA levels in HFM (median 125 U/l, BEN (236 U/l) and BEN-RF (275 U/l) were significantly increased over C (30 U/l), however, TPA levels were increased also in GN patients (437 U/l). None of the BEN patients studied developed urothelial cancer during the ten years' follow-up. Markedly elevated urinary TPA-like levels in all patients studied (HFM, BEN, BEN-RF, GN) suggest that urinary TPA may not be a reliable tumour marker. However, the clinical relevance of high TPA levels in BEN patients should be evaluated.

[Epizootiologic situation of rabies in 1997. Urbanization of sylvatic rabies in Yugoslavia]

The Federal Republic of Yugoslavia is situated on the border of a great sylvatic rabies epizootics occurring in central and eastern Europe. That is the reason why a relatively small number of rabid animals have been registered. In 1997, 124 rabid animals, mainly red foxes, were identified. In recent years red fox rabies epizootics in Yugoslavia has annually spread 15-20 km to the south. Rabies in domestic animals, especially dogs, was characterized with furious clinical forms and dog-to-dog transmission typical of urban rabies. Sylvatic rabies has been almost completely eradicated in some countries of western Europe in the last years, mostly due to the method of oral vaccination of foxes-the main vector of rabies.

[Correlation of cytologic and pathohistologic findings in ultrasonically-guided thin-needle biopsy of abdominal and retroperitoneal organs]

The ultrasonically guided fine needle biopsy is cheap, very sensitive and specific method for the diagnosis of nonpalpable deep-seated lesions. During 1992 in the institute of Radiology of Military Medical Academy in Belgrade 87 biopsies of abdominal and 81 biopsies of retroperitoneal organs were performed for the cytological and histopathologic analysis. Deficient material was obtained in 15.4% of the cases. A good correlation between cytologic and histopathologic findings was observed, with diagnostic concordance in 90.8%. In 9 cases with falsely positive cytological diagnosis at the first examination, the diagnosis of malignancy was later confirmed by other diagnosis procedures. Diagnostic difficulties and the significance of adequate biopsy were particularly stressed.

[Repair of a severed nerve with denatured muscle graft--preliminary results of a new surgical technic]

In Neurosurgical Clinic of Military Medical Academy prospective study about the use of denatured muscle graft in nerve repair is in progress, based on numerous experimental and sporadic clinical literature data. The first, experimental part of the investigation is directed to operative technique details and also to find out the manner and duration of muscle denaturation which provide ideal conditions for regenerating axons sprouting. It is concluded that greater pectoral muscle have to be muscle graft donor for nerve defects shorter than 6 cm, and sartorius muscle for those longer than 6 cm. Denaturation for 30 seconds in liquid nitrogen and after that in distilled water for 3 minutes results in micromorphological status in muscle graft which is optimal for axonal regeneration. In the second, clinical part of the work reparations of missile neurotmesis of radial nerve with denatured muscle grafts are performed. Preliminary results 9 months after operation are quite comparable with results after sural nerve graft reparation.

[Personal experience with ex tempore diagnosis of neurosurgical biopsies using the smear method]

The results obtained by the use of the smear method were analyzed in ex tempore diagnostics of 240 neurosurgical biopsies, done in the period from 1991 to 1993. Thirty three different pathologic lesions were found that had their special morphology on smears, indicating the high specificity of this method. In 226 cases (94.17%) the diagnosis was established correctly, but in 14 cases (5.83%) it was not: in three cases the diagnosis was falsely negative and in 11 falsely positive. The main causes of the diagnostic errors were analysed and they included the subjective factors and uncommonness of the analyzed tissue samples. The accuracy of 94.17% enabled sufficiently reliable use of this method in ex tempore diagnostics of neurosurgical biopsies.

[Hemangiopericytoma of the lungs]

Six patients, three women and 3 men with lung hemangiopericytoma treated at the Military Medical Academy in the period 1971-1991 are reported. The youngest patient was 20 years, the oldest 69 years. Surgical treatment was performed in all patients, 3 lobectomies, one bilobectomy, one wedge resection and one extirpation. Multiple hemangiopericytoma was found in one patient which consisted of three separate tumours in the right lung. The other had solitary lesions. Malignant hemangiopericytoma, was found in 4 patients, one of them had metastases in the mediastinal lymphatic glands. Four patients are alive and are under control for nine years in the average without signs of recurrence.

Thyroid hormone profiles in experimental acute renal failure

Thyroid hormone profiles were determined in two groups of dogs made uremic, either by i.v. uranyl nitrate 10 mg/kg BW injection or by bilateral ureteral ligation, and in one group of sham-operated animals. Each group consisted of 6 dogs and served as its own control. From blood samples taken in 12-h intervals up to 144 h for uranyl nitrate-injected dogs and 96 h for operated dogs, serum levels of T4, T3, fT4, fT3, rT3, and cortisol were measured by radioimmunoassays. The results obtained in both groups of uremic dogs showed an initial sharp fall of T4, T3, fT4, and fT3 followed by a plateau or retarded decrease. In sham-operated dogs the fall of these hormones was slight and of short duration. Reverse T3 had a tendency to increase in all groups examined, but a significant elevation was recorded only after bilateral ureteral ligation. In this group cortisol serum levels were found the highest, being also significantly increased in the other two groups. The temporal coincidence of the most marked alterations in T3, rT3, and cortisol serum concentrations indicates a significant role of stress in thyroid dysfunction. Although serum creatinine rise and weight loss were not parallel with thyroid hormone alterations, the involvement of uremic compounds and malnutrition in this process is also quite clear. Thus, the data presented suggest simultaneous influences of uremic toxins, stress, and malnutrition on the induction of thyroid dysfunction in dogs made uremic by uranyl nitrate injection or bilateral ureteral ligation.(ABSTRACT TRUNCATED AT 250 WORDS)

[Etiologic factors in fetal intrauterine growth retardation]

The authors studied the incidence of individual aetiological factors which may cause intrauterine interruption of foetal development. The research concerned 26 pregnant women hospitalized in the Ward for Pregnancy Pathology of the Department of Gynaecology and Obstetrics over the period from 1986-1989. The majority of women with this manifested EPH gestosis: essential hypertension was observed in 3 patients (12%). Particular attention was paid to the final stage of delivery and to the Apgar Score. Discussion includes the results of other authors. In the conclusion the importance and significance of this problem are stressed--within the scope of perinatal medicine--in view of the high morbidity and mortality rates among infants.

Chondroma of the cervical spinal canal. Case report

The authors report a case of cervical spinal canal chondroma in a 28 year-old man. The tumor was removed completely. Only about 10 similar cases are reported up to now.

[Carcinoma in situ in cryptorchid testes in post-pubertal patients]

The pathohistologic analysis of testis sections of 37 postpuberty patients with different types of cryptorchism is performed. The tissue samples were taken during orchiopehy, fixed in Bouin's solution and treated by the standard histologic techniques. The morphologic criteria are presented for identification of the presence of the so called carcinoma in situ cells found in two cases. Besides, in 13 patients rare, mainly single, atypical germinative cells were found in a smaller number of the seminiferous tubules. It has been concluded that the presence of carcinoma in situ cells in undescended testes of some patients and considering the simple way of sampling, lack of complications and high reliability of the diagnostic procedure, it is absolutely justified to take routine biopsy of testes during orchiopexy in each postpuberty and perhaps prepuberty patient.

[Pulmonary thromboembolism--an autopsy study with clinico-pathologic correlations]

The study comprised 3.629 autopsies performed at the Institute of Pathology and Forensic Medicine of the M.M.A. in the period 1980-1990. Pulmonary thromboembolism (PTE) was found in 533 (14.68%) of autopsied cases, that is, 10.88% of all causes of death. In the studied period there is an increased frequency of all PTE, especially of those with fatal outcome (p < 0.05). Of the total number of PTE found at autopsy (533), clinical diagnosis was established in 136 (25.51%), and of all fatal PTE found at autopsy (395) the clinical diagnosis was established in 123 (31.14%) during life. The clinical diagnosis of PTE was confirmed by autopsy in 42.42% of cases. Operations and neoplasms are the most frequent conditions in which PTE is occurred while myocardial infarction is the most frequently misdiagnosed for PTE during establishment of clinical diagnosis.

[Morphologic characteristics of HBV markers and products of iron metabolism in liver tissue in patients with hepatitis B virus]

In the histomorphologic analysis of 126 liver biopsies with hepatitis B virus (HBV) infection the authors have met some difficulties in the interpretation of findings of three biopsies which showed the presence of hemosiderine and ferritin deposits in hepatocytes. The lack of cells with the appearance of "ground glass", that is, ground glass hepatocytes which are one of the important features of HBV infection and aberration from the standard features in some histochemical stainings are noticed in all three biopsies. Since only few authors have noticed the same problem, it is possible that these results open new ways in the study of pathogenesis of HBV infection in the liver and its relationship with iron metabolism.