The influence of the tooth preparation finish line position on the expression of matrix metalloproteinase-9 and the presence of periodontopathogens in the gingival crevicular fluid

OBJECTIVE

The objective of the study was to determine the concentration of matrix metalloproteinase 9 (MMP-9) and changes in the presence of periodontopathogens in the gingival crevicular fluid before and after tooth preparation with the subgingival and equigingival finish line position.

PATIENTS AND METHODS

The clinical prospective study included 20 subjects with an indication for upper canine preparation, with the subgingival (group 1) and equigingival finish line (group 2). Samples were taken in four observation intervals: 5 minutes before (control samples), as well as 15 minutes, 24 and 72 hours after tooth preparation (experimental samples). Measurement of MMP-9 was done using Enzyme-linked Immunosorbent Assay (ELISA). The presence of bacteria in the gingival fluid was proven by the Polymerase chain reaction (PCR) analysis.

RESULTS

The MMP-9 values did not differ statistically significantly between the groups (p=0.524). The MMP-9 values showed a statistically significant difference in the given observation period (p<0.001) with a significant linear increase in values (p<0.001). A significant quadratic trend recorded a decrease in the MMP-9 values 15 minutes after preparation, and an increase 24 hours after preparation, without a significant difference in the interaction between groups (p=0.392). After preparation, a significant difference in the presence of periodontopathogens was confirmed, i.e., a decrease in the presence of Prevotella intermedia (p=0.025) and Tannerella forsythia (p=0.016) in group 1, and an increase in the presence of Aggregatibacter actinomycetemcomitans in both groups (p=0.029, p=0.026).

CONCLUSIONS

The study is a good basis for determining the influence of tooth preparation on gingival inflammation, with therapeutic (choice of preparation technique) and preventive significance regarding the protection of the periodontal tissue from possible iatrogenic damage.

Pure Camphor and a Thujone-Camphor Mixture as Eco-Friendly Antifeedants against Larvae and Adults of the Colorado Potato Beetle

The Colorado potato beetle (CPB) is a serious pest of economically important Solanaceae species. The use of essential oil compounds in pest management has been proposed as an alternative to harmful chemical insecticides that disturb human health and ecosystem functioning. We examined the antifeedant activity of three concentrations (0.125%, 0.25% and 0.5%) of pure camphor and a thujone-camphor mixture against 3rd instar larvae and adults. Their efficacy was evaluated according to the degree of leaf damage and avoidance of treated leaves by the CPB. Treatment of potato leaves significantly reduced leaf damage compared to the control. Leaf protection increased at higher concentrations of the examined compounds. Camphor was more effective against larvae and the thujone-camphor mixture was more effective against adults. Additionally, adults moved faster towards the control leaf disc in the two-choice olfactometer assay if an alternative disc was treated with a thujone-camphor mixture, whereas larvae responded similarly to the two potential repellents. However, after contact with the leaf disc treated with the highest compound concentration, the larvae escaped faster from the thujone-camphor mixture than from pure camphor. In conclusion, both examined compounds are promising eco-friendly antifeedants, but their efficacy depends on the developmental stage of the beetle, compound type and applied concentration.

Assessment of Sex-Specific Toxicity and Physiological Responses to Thymol in a Common Bean Pest Acanthoscelides obtectus Say

Acanthoscelides obtectus Say (Coleoptera: Chrysomelidae: Bruchinae), is one of the most important pests of the common bean Phaseolus vulgaris L. Without appropriate management it may cause significant seed loss in storages. In search for means of environmentally safe and effective protection of beans we assessed biological activity of thymol, an oxygenated monoterpene present in essential oils of many aromatic plants. We studied contact toxicity of thymol on bean seeds and its effects on adult longevity and emergence in F1 generation. Furthermore, we determined acetylcholinesterase (AChE), superoxide dismutase (SOD), catalase (CAT), mixed-function oxidase (MFO), carboxylesterases (CarE) and glutathione S-transferase (GST) activities in response to 24 h exposure of beetles to sublethal and lethal thymol concentrations. Our results showed that thymol decreased adult survival, longevity and percentage of adult emergence. Higher median lethal concentration (LC50) was recorded in females indicating their higher tolerance comparing to males. Overall, activities of SOD, CAT and CarE increased at sublethal and MFO increased at both sublethal and lethal thymol concentrations. On the other hand, GST and AChE activities decreased along with the increase in thymol concentrations from sublethal (1/5 of LC50, 1/2 of LC50) to lethal (LC50). Enzyme responses to the presence of thymol on bean seed were sex-specific. In the control group females had lower CarE and higher SOD, CAT and GST activity than males. In treatment groups, females had much higher CAT activity and much lower CarE activity than males. Our results contribute to deeper understanding of physiological mechanisms underlying thymol toxicity and tolerance which should be taken into account in future formulation of a thymol-based insecticide.

Potential of Essential Oils from Anise, Dill and Fennel Seeds for the Gypsy Moth Control

The gypsy moth (Lymantria dispar L. (Lepidoptera: Erebidae)) is a serious pest of hardwood forests. In the search for an environmentally safe means of its control, we assessed the impact of different concentrations of essential oils (EOs) from the seeds of three Apiaceae plants (anise Pimpinella anisum, dill Anethum graveolens, and fennel Foeniculum vulgare) on behavior, mortality, molting and nutritional physiology of gypsy moth larvae (GML). EOs efficacy was compared with commercial insecticide NeemAzal®-T/S (neem). The main compounds in the Eos were trans-anethole in anise; carvone, limonene, and α-phellandrene in dill; and trans-anethole and fenchone in fennel seed. At 1% EOs concentration, anise and fennel were better antifeedants and all three EOs were more toxic than neem. Neem was superior in delaying 2nd to 3rd larval molting. In the 4th instar, 0.5%, anise and fennel EOs decreased relative consumption rate more than neem, whereas all three EOs were more effective in reducing growth rate, approximate digestibility and efficiency of conversion of food into body mass leading to higher metabolic costs to GML. Decrease in consumption and metabolic parameters compared to control GML confirmed that adverse effects of the EOs stem from both pre- and post-ingestive mechanisms. The results indicate the potential of three EOs to be used for gypsy moth control.

Repellent activity of Tanacetum parthenium (L.) and Tanacetum vulgare (L.) essential oils against Leptinotarsa decemlineata (Say)

The Colorado potato beetle, Leptinotarsa decemlineata (Say), is one of the most destructive pest species to have developed resistance to most chemical insecticides. We determined the composition and evaluated the potential of Tanacetum parthenium L. and Tanacetum vulgare L. (Asteraceae family) essential oil (EO) application as an alternative eco-friendly control strategy against L. decemlineata. We assessed the antifeedant activity for L. decemlineata larvae and adults by estimating the damage to potato leaves treated with three concentrations of EOs dissolved in ethanol (0.125, 0.25 and 0.5%). Results showed that T. parthenium EO was more effective against larvae, and T. vulgare was more effective against adults. In an olfactometer assay, the time required to choose an untreated leaf disc did not depend on the Tanacetum species, or life stage examined. However, the concentration of EO exhibited a significant effect on the behaviour of both developmental stages. At higher EO concentrations, both third instar larvae and adults require less time to choose an untreated leaf disc. Additionally, T. parthenium EO provoked more rapid movement away from the treated leaf disc than T. vulgare, especially at the highest concentration. Successful modification of L. decemlineata behaviour by the two Tanacetum oils suggests that they possess the potential for use in potato protection.

Hypertrophic recurring lichen planus of the external auditory canal

INTRODUCTION

We report a case of unilateral progressive primary hypertrophic lichen planus of the external auditory canal requiring several surgical interventions to deal with constant pruritus, otorrhoea, stenosis and conductive hearing loss.

CASE SUMMARY

A 58-year-old woman was initially treated with meatoplasty for suspected chronic obliterating otitis externa. She remained symptom-free for 5 years, before the disease recurred, affecting other body surfaces as well. Otorrhoea, conductive hearing loss and pruritus worsened, and a canal wall down tympanomastoidectomy was performed, removing the skin of the external auditory canal and the tympanic membrane completely. Lichen planus was confirmed histopathologically.

DISCUSSION

Very few surgical results have been published on stenosis of the external auditory canal caused by lichen planus. Complete medial external auditory canal skin elevation and removal with postoperative split-skin grafting is advised for initial treatment. We discuss treatment options and surgical outcome after initial surgical failure.

Main development trends in public support of business research and development in Czechia

The article aims at identifying main structural characteristics and development trends of business R&D support in the Czech Republic in the period 2007–2015 and their assessment in light of the development of total R&D expenditures in the business sector. Possible impacts of business research support on R&D expenditure from own resources of businesses and on R&D employment are also examined at the level of individual economic sectors. The volume of support annually allocated from the state budget to non-investment R&D activities of businesses culminated between 2009 and 2012. Compared to domestic companies, the companies in foreign ownership obtained only a quarter of public support but their share in total R&D expenditures in the business sector exceeds over a long period the share of domestic companies. Moreover, the difference has further grown in the last years mainly due to rapid increase of private funding from abroad. As regards to the size of businesses the reduction of public funding in the last years occurred primarily in the group of large businesses. However, the decreasing volume of public funding impacted only minimally on large businesses while the reliance of medium and especially small businesses on public resources is considerably higher. Substantial amounts of R&D support from the state budget were allocated particularly to high-tech and medium high-tech industries: manufacture of computer, electronic and optical products; manufacture of machinery; and manufacture of other transport equipment. Unlike in the majority of industrial branches where the absolute annual amounts of public support decreased during the last years, the amounts allocated to the sector of IT services grew significantly. Neither increase of R&D expenditure from own resources of businesses nor increase of R&D employment indicate dependence on the share of domestic public resources in BERD at the level of NACE branches.

Toxicity of twenty-two plant essential oils against pathogenic bacteria of vegetables and mushrooms

ASBTRACT Toxicity of twenty-two essential oils to three bacterial pathogens in different horticultural systems: Xanthomonas campestris pv. phaseoli (causing blight of bean), Clavibacter michiganensis subsp. michiganensis (bacterial wilt and canker of tomato), and Pseudomonas tolaasii (causal agent of bacterial brown blotch on cultivated mushrooms) was tested. Control of bacterial diseases is very difficult due to antibiotic resistance and ineffectiveness of chemical products, to that essential oils offer a promising alternative. Minimal inhibitory and bactericidal concentrations are determined by applying a single drop of oil onto the inner side of each plate cover in macrodilution assays. Among all tested substances, the strongest and broadest activity was shown by the oils of wintergreen (Gaultheria procumbens), oregano (Origanum vulgare), and lemongrass (Cymbopogon flexuosus. Carvacrol (64.0-75.8%) was the dominant component of oregano oils, while geranial (40.7%) and neral (26.7%) were the major constituents of lemongrass oil. Xanthomonas campestris pv. phaseoli was the most sensitive to plant essential oils, being susceptible to 19 oils, while 11 oils were bactericidal to the pathogen. Sixteen oils inhibited the growth of Clavibacter michiganensis subsp. michiganensis and seven oils showed bactericidal effects to the pathogen. The least sensitive species was Pseudomonas tolaasii as five oils inhibited bacterial growth and two oils were bactericidal. Wintergreen, oregano, and lemongrass oils should be formulated as potential biochemical bactericides against different horticultural pathogens.

Regional sectoral structure of the support realised through the Operational Programme Enterprise and Innovation 2007–2013

Within the previous programming period, the Operational Programme Enterprise and Innovation represented the main tool of the EU cohesion policy in the Czech Republic for the support of businesses in manufacturing and related services. The article analyses sectoral structure of realised projects and financial subsidy allocated through the programme at the level of Czech regions. A significant part of branches strongly represented by realised projects in particular regions belongs at the same time to branches considerably concentrated within the same regions. Nevertheless, besides these regionally traditional branches of manufacturing industry and related services, a number of other branches were identified with an above-average representation on projects or financial subsidy within particular regions. In the last part of the text, results of the sectoral structure analysis are looked at from the perspective of smart specialisation areas which form a binding support framework for the area of entrepreneurship, innovation and research in the current programming period. Certain continuity in the importance for regional economies can be noticed in the case of many traditional regional industries - their position strengthened by the investment in the last programming period has been confirmed by inclusion of these branches into the list of smart specialisation areas for the current programming period.

Regionální nástroje na podporu výzkumu, vývoje a inovací – porovnání situace v Česku s příklady dobré praxe ze zemí EU / Regional measures supporting research, development and innovation – comparison of the situation in Czechia with best practices in the EU countries

The article describes the types of regional measures supporting research, development and innovation in Czechia in the context of the typology of regional support measures in the EU countries, based on the Regional Innovation Monitor Plus project. It also presents best practices from European regions, selected according to positive experience with application of the measures at the regional level and the results achieved. In terms of realisation of own research and innovation strategies, Czech regions are limited by strong dependency on support measures implemented from national and European level. Nevertheless, this dependency is typical also for regions in the remaining new member states. Another problem is the low level of cooperation between academic and business sector - in terms of both financial and knowledge flows. This does not allow to fully utilise the potential of territorial proximity within the regions, where innovative companies and excellent research teams can be often found side by side. Appropriate and well-considered application of foreign best practice measures and models (or their elements) of research & innovation support can help to mitigate problems of a concrete region. Furthermore, it has relevance for the development of strategic approaches to regional policy which consider possible cuts in European funding in a long-term horizon.

Regionální nástroje na podporu výzkumu, vývoje a inovací v České republice

V souvislosti s probíhajícím procesem přípravy a implementace Národní výzkumné a inovační strategie pro inteligentní specializaci ČR (RIS3) roste význam regionálních samospráv pro realizaci opatření zvyšujících inovační výkonnost kraje a pro posilování aktivní spolupráce veřejné, podnikové a akademické sféry. Příspěvek přibližuje vybrané typy nástrojů na podporu výzkumu, vývoje a inovací, využívané v krajích České republiky (dále ČR). Vychází přitom zejména z údajů z evropského projektu Regional Innovation Monitor Plus. V souboru zde sledovaných regionálních podpůrných programů a aktivit jsou nejčastěji se vyskytujícím typem nástroje inovační vouchery, jejichž hlavním cílem je posílení spolupráce a přenosu znalostí mezi výzkumnou a podnikovou sférou. V některých českých krajích jsou rovněž využívány dotační a úvěrové programy na podporu inovativních podniků. Celkově nízké prostředky plynoucí z regionální úrovně, malá diverzifikace využívaných podpůrných nástrojů ve většině krajů i nedostatečná evaluace ukončených programů představují hlavní výzvy pro regionální inovační politiku v ČR.

Inovační výkonnost ČR v mezinárodním srovnání Innovation Union Scoreboard v letech 2004–2014

Potřeba mezinárodního porovnání inovační výkonnosti se zvyšuje spolu s rostoucím významem vytváření, uplatňování a šíření inovací pro výkonnost a konkurenceschopnost národních ekonomik. Základní analytický nástroj pro porovnání inovační výkonnosti evropských zemí představuje Innovation Union Scoreboard (IUS). Cílem příspěvku je shrnutí vývoje pozice ČR v IUS v průběhu posledních deseti let. Článek se zároveň podrobněji věnuje inovační výkonnosti ČR dle jednotlivých ukazatelů a identifikuje hlavní silné a slabé stránky českého inovačního systému. V souhrnném porovnání států podle inovační výkonnosti je ČR po celé období řazena do třetí ze čtyř výkonnostních skupin, do skupiny tzv. mírných inovátorů. Vývoj inovační výkonnosti ČR vzhledem k průměrné inovační výkonnosti EU lze nicméně charakterizovat jako převážně konvergenční. Hlavní slabiny českého inovačního systému byly identifikovány v nižší dostupnosti finančních zdrojů i kvalifikovaných pracovních sil pro výzkum a vývoj a další znalostně náročná odvětví, jakož i v nedostatečném využívání nástrojů ochrany práv duševního vlastnictví.

[Prosthetic rehabilitation in patient with forced class III malocclusion]

The paper presents clinical case of 63 years old edentulous patient with slight class III malocclusion. For 15 years he was using inadequately fabricated dentures causing forced severe class III malocclusion. Forced progeny was corrected by newly fabricated dentures which restored normal orofacial function and facial harmony.

Ecologically acceptable usage of derivatives of essential oil of sweet basil, Ocimum basilicum, as antifeedants against larvae of the gypsy moth, Lymantria dispar

Abstract Ethanol solutions of five fractions obtained from essential oil of sweet basil Ocimum basilicum L. (Lamiales: Lamiaceae) (F1-F5) were tested for their antifeedant properties against 2(nd) instar gypsy moth larvae, Lymantria dispar L. (Lepidoptera: Lymantriidae), in laboratory non-choice and feeding-choice experiments. Prior to bioassays, the chemical composition of each fraction was determined by gas chromatography analyses. Significant larval deterrence from feeding was achieved by application of tested solutions to fresh leaves of the host plant. The most effective were were F1 (0.5%), F4 (0.05, 0.1, and 0.5%), and F5 (0.1 and 0.5%), which provided an antifeedant index > 80% after five days. A low rate of larval mortality was observed in no-choice bioassay. In situ screening of chlorophyll fluorescence as an indicator of plant stress level (assessed by the induced fluorometry) confirmed that the tested compounds did not cause alternations in the photosynthetic efficiency of treated leaves.

Larvicidal and antifeedant activity of some plant-derived compounds to Lymantria dispar L. (Lepidoptera: Limantriidae)

Ethanol solutions of essential oil of Ocimum basilicum and its main component, linalool (both isomer forms), all in three concentrations, as well as botanical standard Bioneem (0.5%), were tested for their toxicity and antifeedant activity against the second instar gypsy moth larvae in the laboratory bioassay. The essential oil of O. basilicum was subjected to gas chromatography analysis, and totally 37 compounds were detected, of which linalool was predominantly present. All tested solutions showed low to moderate larvicidal effect in both residual toxicity test and in chronic larval mortality bioassay. Chronic mortality tests showed that obtained mortality was a consequence of starving rather than ingestion of treated leaves. However, antifeedant index achieved by application of tested solutions in feeding choice assay was remarkable. Foliar application of all tested compounds deterred feeding by L2 in the same percent as Bioneem. Antifeedant index was relatively high at all tested treatments (85-94%); moreover, the larval desensitization to repelling volatiles has not occurred after five days of observation. Low toxic and high antifeedant properties make these plant-derived compounds suitable for incorporation in integrated pest management programs, especially in urban environments.

[The Lesch-Nyhan syndrome]

Deficiency of hypoxanthine phosphoribosyltransferase (HPRT) has a broad spectrum of clinical manifestations, from the complete enzyme defect, the Lesch-Nyhan syndrome with severe neurological deficiency to the partial defect associated only with uric acid overproduction and its consequences. We present a 5-year old boy with Lesch-Nyhan syndrome. He came to our hospital because of abdominal pain, vomiting and gross haematuria. At the age of 8 months he was categorized as a "cerebral palsy" patient due to involuntary movements and high degree of spastically and tonic spasms. He remained incapable of sitting or standing alone. The patient's brother and two uncles were also categorized as "cerebral palsy" cases and died at the age of 8-14 years. Clinical examination revealed hyperuricaemia and hyperuricosuria, radiolucent renal and urinary bladder stones. HPRT enzyme activity was totally absent, while adenine phosphoribosyl transferase activity was increased compared to control. The patient was treated with allopurinol, urinary alkalization, low-purine diet and adequate hydration while he was in hospital. However, his parents refused further treatment and follow-up. The most important issue is whether the healthy sisters of the patients are heterozygotes for HPRT deficiency. This DNA analysis is now in progress.

Hyponatremic hypertensive syndrome

We report on a 4-year-old girl with hyponatremic-hypertensive syndrome (HHS), a rare entity in childhood. The girl was referred to us from a local hospital with a history of recurrent fever, vomiting, and seizures. On admission she was markedly dehydrated. Initial investigations revealed severe hyponatremia (serum Na 120 mmol/l), hypochloremia (serum Cl 68 mmol/l), and mild hypokalemia (serum K 3.3 mmol/l), while serum calcium and magnesium were normal. Serum urea was 5 mmol/l and serum creatinine was 62 mumol/l. Despite hyponatremic dehydration, her urine output was high (2050 ml/24 h), as was her urinary sodium (168 mmol/24 h). She had massive transient proteinuria (maximal 1642 mg/24 h) while being severely hypertensive (blood pressure 210/160 mmHg). Further investigations revealed right kidney scarring, hyper-reflexive bladder dysfunction, massive brain infarcts, and myocardial left ventricular hypertrophy. Renal arteries were normal on arteriography. Blood pressure control resulted in normalization of serum and urinary electrolytes and decrease of proteinuria. Hyponatremia and transient massive proteinuria in this patient seem to be caused by high-pressure-forced diuresis due to malignant renoparenchymal hypertension.

[20 years' experience in the treatment of children with terminal renal insufficiency in Yugoslavia]

The first specialized haemodialysis (HD) paediatric centre in former Yugoslavia was established at the University Children's Hospital in Belgrade in January 1980. A total of 194 children (F: 98, M: 96), aged less than 19 years (10.12 +/- 4.23), were treated for renal replacement therapy (RRT) over 20 years. Average annual incidence rate was 1.59 per million of child population (pmcp) aged less than 19 years for the period 1980-1990 (former Yugoslavia) and 2.85 pmcp aged less than 19 years for the period 1990-2000 (present Yugoslavia). Reflux nephropathy was the most frequent underlying disease and accounted for 37.06% of total cases, while other primary renal diseases were: glomerulonephritis (GN) 17.26%, cystic/hereditary familial nephropathy 12.69%, congenital disease 11.68%, interstitial nephritis 5.58%, non-recovered tubular necrosis 3.55%, secondary GN 1.52% and 10.66% remained with doubtful diagnosis. HD was the first RRT in 84.02%, peritoneal dialysis (PD) in 14.43% and pre-emptive transplantation in 1.55% of all patients. A total of 53 patients (27.3% of total terminal renal failure (TRF) patients) received 56 kidney transplants (58.93% live related, 37.50% cadaveric, 3.57% live-non related). Actual survival in RRT was 64.53% 5 in years; 51.68% in 10 and 48.23% in 15 years. Patient survival in HD was significantly better over the last ten-year period than in the first ten-year period (35.88% vs. 75.75%; p < 0.005) as well as the survival of transplanted patients in the same two periods (67.62% vs. 95.45%). Graft survival was 79.85% in 5 and 70.50% in 10 years. Cardiovascular complications were the most common cause of death of patients on RRT (56.10 posto) followed by infection (24.39). On December 31, 1999, 54 patients on RRT were alive less than 19 years: 75.92% in HD; 22.22% with functioning graft and 1.85% on automatic PD. This is the first national-wide long-term study of incidence and aetiology of paediatric TRF and outcome of paediatric RRT in Yugoslavia.

[The captopril test--an aid in the detection of scarring nephropathy as a cause of arterial hypertension in children]

Renal scarring with and without vesicoureteral reflux (VUR) has been now recognized as an important cause of paediatric hypertension for many years [1-5]. However, its pathogenesis has still remained uncleared. The widespread concept implicated the activation of renin-angiotensin system finding a powerfull support in higher peripheral plasma renin activity (PRA) in children with reflux nephropathy than in controls [6, 7] and in beneficial antihypertensive effects of ACE inhibitors. The latter, in form of captopril, has also been used in captopril test and in renal scintigraphy and isotope renography following the administration of captopril to provide evidence for renin dependent hypertension [8, 9]. Published studies of captopril test have centred on the identification of renovascular as opposed to essential hypertension [10-18, 20-22]. The aim of our study was to assess the usefulness of captopril test in differentiation between hypertensive children with renal scarring from those with essential hypertension. We studied blood pressure (BP) and PRA responses to a single dose of captopril in two groups of hypertensive children. Group A consisted of 29 patients, 14 boys and 15 girls, who had renal scaring as demonstrated by renal 99mTc dimercaptosuccinid acid scan (99m Tc DMSA) and/or intravenous pyelography. Group B included 19 patients, 19 boys and 10 girls who had arterial hypertension, while clinical examination excluded renal and other definable causes of BP elevation, and they were therefore considered to have essential hypertension. At the time of the study all patients had normal glomerular filtration rate and were not salt depleted. They did not receive any antihypertensive medication for at least two weeks. The test was performed in the morning in fasting sitting patients. At the start of the test a small vein in the hand or forearm was cannulated to permit blood sampling. BP was measured 10, 20, and 30 minutes before captopril administration to get baseline BP (mean of these three measurements) and to allow the children to become accustomed to the test procedure. A single oral dose of captopril 0.64 +/- 0.04 mg/kg body weight was given to patients from group A and almost the same dose of captopril, 0.63 +/- 0.05 mg/kg body weight, to patients from group B. The patients remained sitting and BP was measured every 15 minutes during an hour. Blood for PRA was drown in the sitting position (17 patients from group A and 16 patients from group B) before and one hour after the dose of captopril. Samples of blood for basal PRA were collected from 16 patients from group A and in 14 patients from in B in lying position after waking up in the morning. PRA was measured by radioimmunoassay using a commercially available kit, SB-REN 2, from CIS Bio International. According to the criteria of Muller et al. [10] the captopril test was positive if the post-captopril PRA (ng/ml/h) was greater than or equal to 12 with an increase of greater than or equal to 10 and relative increase of greater than or equal to 15% (400% if initial PRA was < 3). The results of our study are presented in Tables 1 and 2 and in Graphs 1 and 2. The age of patients, doses of captopril, initial BP and PRA before the use of captopril did not much differ between studied groups. Fall of BP and PRA increase were highly significant (p < 0.001) both in group A and group B. However, the hypotensive reaction of diastolic BP and MAP were more pronounced in group A (14.45 +/- 1.67% and 15.81 +/- 1.62%) than in group B (6.95 +/- 2.21% and 8.96 +/- 1.75%; p < 0.01), but there were no significant differences in PRA and systolic BP changes and positive results of captopril test between the studied groups. Hypotensive responses of diastolic BP and MAP greater than 10% of initial values were found to be more frequent in group A (79.32% and 79.31%) than in group B (26.61% and 31.57 degrees %; p < 0.001 and p < 0.01). Diastolic BP and MAP were directly related to the dose of cap

[Renal tubular function in children with hypercalciuria]

INTRODUCTION

Renal stone disease is commonly due to hypercalciuria [1, 2], which may be assessed either from a 24-hour urinary collection or from the fasting first morning urine. Hypercalciuria during childhood has been defined by a 24-hour calcium excretion greater than 3.5 mg/kg per day and/or calcium to creatinine ratio greater than 0.20 [3]. The alteration in the calcium transporting systems plays a pathogenetic role in promoting hypercalciuria [4, 5]. Since calcium reabsorption along the nephron is intimately related to that of other electrolytes and substances, it can be hypothesized that patients with hypercalciuria may have other renal tubular defects. The aim of the study was to investigate proximal tubular function (tubular reabsorption of sodium, potassium, phosphate and glucose) and distal tubular function (urinary concentrating capacity and acidifying capacity) in children with hypercalciuria.

PATIENTS AND METHODS

Two groups of children were studied: hypercalciuric group included 23 children with hypercalciuria (10 males, aged 11.9 +/- 4.1 years), of whom 6 with nephrolithiasis, and control group included 42 healthy children (20 males, aged 11.2 +/- 3.8 years). All subjects had normal serum values for calcium, sodium, potassium, phosphate and glucose, as well as normal renal function. The urinary excretion of calcium, sodium, potassium, phosphate, glucose and creatinine was measured in a 24-hour urine specimen by standard laboratory methods. Urine osmolality and urinary specific gravity were measured following 12-hour water-deprivation test. A short ammonium chloride loading test was performed in 3 patients with urinary pH above 5.5. The fractional excretion of sodium, tubular phosphate reabsorption and renal threshold phosphate concentration were calculated according to standard formula. Statistical analysis was performed using the t-test and analysis of variance (ANOVA). Kruskal-Wallis method was used to compare urinary phosphate excretion between two groups.

RESULTS

Table 1 summarizes urinary excretion of electrolytes in children with hypercalciuria compared with healthy controls. We found that urinary sodium excretion was significantly increased in patients with hypercalciuria when compared with controls (p < 0.05). Urinary phosphate excretion was significantly higher in patients with hypercalciuria in comparison to controls, and this was accompanied by a significant lowering of the tubular phosphate reabsorptive threshold (p < 0.05). Urinary potassium excretion tended to be lower, although not significantly, in the hypercalciuric children than in normal subjects. Table 2 shows the mean values +/- standard deviation of urinary specific gravity, urinary osmolality and urinary pH. Urinary specific gravity mean value was significantly lower in patients with hypercalciuria in comparison to controls (p < 0.05). Urinary pH was found below 5.5 in all patients. Glycosuria was detected in 3 patients (13.3%). As shown in Graph. 1, a significant correlation between the urinary excretion of calcium and sodium was demonstrated in both groups of children (r = 0.29; p < 0.01).

DISCUSSION

The present study shows that children with hypercalciuria have significantly higher urinary sodium and urinary phosphate excretion in comparison to controls, while urinary potassium excretion is normal in both groups of children. According to some recent reports [6-9], these findings may indicated defects of the renal tubular transport of sodium and phosphate which may be interpreted as a cause or a consequence of the alteration of the calcium transporting system. Defects in both proximal and distal renal tubular functions have been demonstrated in patients with nephrolithiasis, particularly those with hypercalciuria. Proximal renal tubular defects include defects in sodium, fluid, phosphate and glucose reabsorption, which were evident also in our patients. (ABSTRACT TRUNCATED)

[Continuous ambulatory measurement of blood pressure in children--personal experience]

Ambulatory blood pressure monitoring (ABPM) during normal daily activities and during night, when the patient is asleep, is a new method of measuring blood pressure (BP) in children, used for better diagnosis and treatment of hypertension. Compared to casual BP measurements, it documents normal daily BP variations, BP during sleep, the influence of emotional and physical stress on BP and is a better predictor of hypertension associated with end-organ damage. However, the experience in ABPM in children is still limited. In our country ABPM has been used since recently, and first results are referred to children with end-stage renal failure.

SUBJECTS AND METHODS

ABPM was performed in two groups of children: group A consisted of 61 children, aged 14.3 +/- 2.9 (mean +/- SD) yrs in whom intermittent outpatient BP measurements (for at least 3 months) suggested the diagnosis of hypertension (according to the data of Second Task Force); group B consisted of 52 patients (pts), aged 12.8 +/- 4.6 yr with renal disease. Four pts from group A (6.6%) and 20 pts from group B (38.5%) received antihypertensive therapy (captopril, nifedipine, furosemide and propranolol ). All children from group A and half of the children from group B had normal renal function. Eighteen pts from group B were on chronic haemodialysis (34.6%). Blood pressure was recorded during a 24-hour period except in haemodialyzed pts (48 h) (Table 1). Results of BP measurements are presented as the mean values of BP during a 24-hour period, during normal daily activities and during sleep. We used the age- and gender-appropriate 95th percentile from the Task Force Study as the daytime upper-limit of normal and 10% lower for the upper-limit at night. According to BP load (the percentage of BPs exceeding the upper limits of normal for age), children were assumed to have mild-to-moderate hypertension (BP load between 20% and 40%) or severe hypertension (BP load more than 40%). The success of antihypertensive therapy was evaluated after 1-3 months in 11 pts (twice in 10 pts and three times in one pt).

RESULTS

In group A 39.4% of pts were normotensive and 36.1% were without antihypertensive therapy, 58.4% of normotensive and 40.5% of hypertensive pts had blunted circadian BP rhythm (nocturnal BP reduction of less than 10% of diurnal values) (Graph. 1). In group B 38.5% of pts were normotensive and 27% were without antihypertensive therapy. In the group of normotensive pts alteration of circadian BP rhythm was found in 40% of pts with normal renal function, 80% of pts with chronic renal failure and in 100% of pts with terminal renal failure, while in the hypertensive group, altered circadian BP rhythm had 68%, 100% and 92% of pts, respectively (Graph 2). Mild-to-moderate hypertension had 54% of hypertensive pts from group A and 37.5% of hypertensive pts from group B. Severe hypertension was more frequent in group B (62.5%) comparing to group A (46%). The effectiveness of antihypertensive therapy was assessed in 11 pts. In 69.2% of pts BP became normal or was significantly decreased, in 23.1% of pts BP was not changed and 7.7% of pts had higher values of BP.

DISCUSSION

ABPM is very useful for diagnosing white coat hypertension. Like other authors, we have pointed out that more than one third of pts who were hypertensive according to usual BP measurements had normal 24-hour BP and we classified them as white coat hypertensives. More than a half of the pts had blunted circadian BP rhythm, and as it is not certain whether they will become hypertensive in adulthood they should be periodically controlled. There are several proofs that results of ABPM have a better correlation with hypertensive end-organ damage; therefore ABPM is used for assessing the severity of hypertension. In our former work, we showed excellent correlation of BP with left ventricular mass index in children with end-stage renal failure. (ABSTRACT TRUNCATED)

[Serum osteocalcin in children with chronic renal insufficiency]

The research of the bone metabolism has undergone a long evolution which began with the use of radioisotopes in calcium kinetic studies and went through the determination of several humoral parameters like alkaline phosphatase (ALP), hydroxyproline and intact immunoreactive parathyroid hormone (iPTH) and finally to the assay of a new serum and urinary parameters of bone metabolism, like osteocalcine (OC) and procollagen and collagen metabolites. The X-ray study of the skeleton, densitometric techniques, computerized tomography, scintigraphy and NMR are used for visualization of bone changes, but bone biopsy and histomorphometry provide the most precise evaluation [1]. Disorders of bone and mineral metabolism in children with chronic renal failure (CRF) are an almost regular occurrence; so early discovery and treatment of these changes are very important [2]. The aim of this study was to measure the serum OC level in children with CRF and terminal renal failure (TRF), treated with chronic haemodialysis, and to evaluate the significance of OC compared to other humoral parameters of renal osteodistrophy, such as ALP and iPTH.

MATERIALS AND METHODS

We studied the fasting levels of OC in three different groups of children: group A consisted of 18 patients with TRF; group B consisted of 12 patients at different stages of CRF, and group C consisted of 32 healthy children, all of the approximately same age. Clinical characteristics of the examinded children are presented in Table 1. Of 30 patients, 26 were treated with calcium carbonate and 21 with vitamin D analogues. None were treated with aluminium hydroxide. Additional parameters included serum calcium, phosphate, ALP and body height, while serum concentrations of iPTH and ionized serum calcium were measured only in group A. Serum OC was measured by radioimmunoassay using OSTK PR RIA (CIS), while ELISA-PTH (CIS) radioimmunoassay was used to determine iPTH plasma levels. Statistical analyses were performed using Kolmogorov-Smirnov test to confirm normal distribution, the Pearson and Spearman rank sum test for correlation between variables of interest, while analysis of variance was used to compare the findings.

RESULTS

Serum OC levels were significantly different in all groups (p < 0.01); they were three times higher in group A than in group C. Similar increase was noticed in plasma iPTH, assuming that "normal" uremic iPTH was raised up to threefold above normal range (between 10 and 60 pg/ml) [2]. However, the total serum ALP activity was not sensitive as OC and iPTH, since ALP increases were less as compared to them. OC was age related only in group A (p < 0.01), with a positive correlation between OC and duration of haemodialysis (p < 0.05), as well as between OC and serum phosphate (p < 0.05), but there was no correlation between OC and growth retardation (expressed by SDS), bone age and current therapy for renal osteodistrophy. A direct correlation between OC and ALP was found only in healthy children (p < 0.01), while in groups A and B it was remarkable, although not statistically significant (p = 0.08) (Graphs 1, 2, 3). In group A, ALP and iPTH were directly correlated (p < 0.001), but the correlation of OC with iPTH was less significant (p = 0.06). In patients with CRF no correlation was found between glomerular filtration rate and OC.

DISCUSSION

OC is a bone-derived noncollagenous protein of low molecular weight (about 5800 D), containing residues of the vitamin K dependent amino acid gamma-carboxyglutamic acid and is synthesized by osteoblasts and odontoblasts. Calcitriol is a potent stimulator of OC synthesis, acting at the transcriptional level and increasing mRNA severalfold. OC is found mainly in bone, but nanomolar concentrations circulate in the blood. Its serum levels are an expression of the bone formation process and are age related (higher in the neonatal and adolescent period). ABSTRACT TRUNCATED.

Endothelin-1 in acute renal failure

To study the pathological significance of circulating endothelin (ET) in ARF, we measured plasma ET in seven children (mean age 8.8 +/- 4.4 years) with ARF in the most severe phase and 3.7 +/- 3.5 months later in the recovery period. Twenty-seven healthy children were included in the study as controls. Plasma ET level was measured by highly sensitive and specific radioimmunoassay for ET-1 and ET-2 (ET-1/2, Biomedica, Vienna). Plasma ET was significantly higher in the most severe phase of ARF (4.75 +/- 4.08 fM/ml) than in the recovery period (0.78 +/- 0.24 fM/ml; p < 0.01), but comparing to plasma ET in the healthy children, the difference was only of borderline statistical significance (Pf, 0.0573). Since plasma concentrations of creatinine did not correlate with plasma ET in patients, either in acute or in the recovery phase of disease, we concluded that decreased GFR is not the main factor determining an increased ET in ARF. We suggest that elevated plasma ET in ARF may be secondary to vascular endothelial dysfunction and speculate that enhancement synthesis of endothelial relaxing factor (EDRF) inhibits ET synthesis during the recovery period. We did not find any relationship between plasma ET and blood pressure (BP) in patients with ARF, so we conclude that circulating ET is not the main factor determining BP in ARF.

[Kidney transplantation in children]

During the last 14 years, since the opening of the Center for Childrens' Hemodialysis the University Children's Hospital of Belgrade, 174 children with terminal renal failure were treated by chronic hemodialysis. Of these, only 35 patients (20.1%), 14 girls and 21 boys, mean age 12.6 +/- 4.9 years, were transplanted. The average waiting time for transplantation was 24.6 months (range 0-120 months). Twenty-five patients were transplanted with paternal kidney, the others were cadaveric transplantations. More than half of transplantations were done abroad. Of 35 patients, 20 were under follow-up for over 6 months (45.7 +/- 7.2 range 6 to 102 months). Five year patient survival was 94.1% and the graft survival over the same period was 76.4%. 45.7 +/- 7.2 months after transplantation the outcome was the following: 11 patients (55%) had GFR over 60 ml/min/1.73 m2, 5 patients (25%) had GFR from 25 to 60 ml/min/1.73 m2, 2 patients (10%) returned to chronic hemodialysis, 1 patient was retransplanted and 1 patient died. All patients with GFR of over 60 ml/min/1.73 m2 are well psychosocially rehabilitated, 62.4% are normotensive without antihypertensive therapy, and only 9.9% are growth retarded.

[Cystic tumefaction in the minor pelvis--the agenesis-dysplasia syndrome (case report)]

Ectopic kidney often shows signs of parenchyma maldifferentiation. Multicystic or dysplastic kidney is usually associated with congenital urogenital and skeletal system anomalies. In the Unilateral form of the agenesia-dysplasis syndrome, the kidney, if it is present, is small dysplastic and usually cystically changed. Ipsilateral uterus horn or vaginal agenesia are the most frequently associated anomalies. Case report. A six years old girl was clinically examined due to recurrent urinary tract infections. On ultrasound, the left kidney was enlarged, while the right kidney was absent in normal position. Cystic mass 4x5 cm was seen in the pelvis. The right kidney was not seen on IVP. CT scan showed a cystic formation in the pelvis, described as cystically changed dysplastic kidney. Pelviceal mass was extirpated. Exploration of the genital system revealed vaginal arch blinded in the hypoplastic right uterus horn. On pathohystology tumefaction corresponded to the dysplastic kidney.

IN CONCLUSION

unilateral renal aplasia or dysplasia may indicate genital anomalies having in mind the hereditary character of unilateral form of the agenesia-dysplasia syndrome therefore, it could be helpful in prenatal diagnosis of cystic pelvic mass of fetus in families with this syndrome.

[Jeune's syndrome (3 case reports)]

Jeune's syndrome or asphyxiating thoracic dystrophy is an autosomal recessive osteochondrodysplasia with multisystem involvement. In patients who survive neonatal period in the main clinical feature progressive renal failure is. Renal lesions are variable but is familial juvenile nephronophtisis the most frequent one. We present three patients with Jeune's syndrome phenotype and chronic tubulointerstitial disease. All patients developed terminal renal failure in the eyrly childhood. Renal histology, examined in two cases, was consistent with juvenile nephronophtisis in one case and with renal dysplasia in other case. All our patients had hepatic fibrosis and two of them had pigmentary retinophaty. We want to underline the importance of regular check-up of children with typical phenotype by pediatrician-nephrologist as wel as possibility of prenatal diagnosis of Jeune's syndrome.

[Vesicoureteral reflux as a familial disease]

Vesicoureteral reflux and reflux nephropathy are causes of end-stage renal failure in 43 percent of our patients on haemodialysis. Aiming at early discovering of vesicoureteral reflux and preventing reflux nephropathy, we started an investigation of the familial character or the primary vesicoureteral reflux in the families of 44 our patients with the diagnosed anomaly. Investigations which consist of urinalysis, urine culture and ultrasound of kidneys have so far been carried out for siblings of our patients in ten families. Complete investigations, including voiding cystourethrogram where indicated, have been carried out in five families. Familial vesicoureteral reflux ascertained in three families.

[Cystic kidney disease--genetics, pathogenesis and clinical aspects in children]

This paper reviews recent studies producing insight into genetics and cellular abnormalities causing kidney cysts, their growth and development. Clinical features of various cystic kidney diseases in our patients are described. Special attention has been paid to those rarely reported in our literature. Important discovery concerns location of the gene for autosomal dominant polycystic kidney disease (ADPKD) 1 and 2 on the short arms of chromosome 16 and 4 respectively, as well as for autosomal recessive polycystic kidney disease (ARPKD) on chromosome 6 and for juvenile nephronophtisis on the short arm of chromosome 2. Two basic abnormalities necessary for cyst formation are increased: epithelial cell proliferation and altered fluid transport. Mitogenic action of epidermal growth factor (EGF) is significantly increased and EGF receptors have been demonstrated on apical as well as on basal surface of cyst lining epithelium. TGF-beta shows marked loos of inhibitory activity with regard to EGF. Cystic epithelium has altered polarity; Na-K-ATP-ase is located exclusively on the apical cell membrane. Tubular basement membrane shows alteration in structural components. Complex medullar cystic disease--nephronophtisis, complex as well as the hepatorenal complex of nephoronophtisis--congenital hepatic fibrosis are emphasized in this paper. The later has proved to be rather frequent in our population. We described a distinctive variant of hepato-renal disorder in 4 patients and reviewed 5 similar patients in the literature. The main characteristics are progressive tubulointerstitial nephritis and cholestatic liver disease. We strongly suggest that this variant represents a new syndrome (Popović-Rolović M, Kostić M, Sindić M. et al Progressive tubulointerstitialnephritis and chronic cholestatic liver disease.

[Urinary bladder dysfunction and vesicoureteral reflux in patients with enuresis]

We present preliminary results of prospective study on 38 children (aged 4-15 y.) with enuresis. The aim of the study was to document the association between bladder disfunction and urinary tract abnormalities. Enuresis was more common in girls (71%). Twenty one children (44.7%) suffered from secondary, and 17 (55.3%) from primary enuresis. High incidence of enuresis (31.6%) or voiding dysfunction, renal lithiasis, constipation of other kidney disease (42%) were disclosed among family members of children with enuresis. Urodynamic studies revealed bladder dysfunction in 84.0% of children with enuresis mostly in the form of dyssingeric (45.5%) or unstable/hyperactive bladder (45.5%). In 9% of patients bladder dysfunction as in the form of inadequate bladder with small and poor detrusor contractions often associated with large residue. Ultrasonography revealed dilatation of pyelocaliceal system in 13.2%, and vesicoureteral reflux was confirmed in 10.5% of patients. We stress out high incidence of bladder dysfunction among children with enuresis as well as among their family members.

[The effect of hemodialysis on endothelin-1 plasma levels in children with terminal renal insufficiency]

We analysed the effect of hemodialysis (HD) on endothelin (ET) plasma level in children with terminal renal failure. Twenty-five patients (pts) and 27 healthy children as controls were included in the study. There was no difference in ET plasma levels in pts before HD (1.97 +/- 1.45) and controls (2.08 +/- 1.47), but ET increased in plasma of pts after HD (4.10 +/- 3.66). To estimate the relationship of volume depletion or depuration on ET plasma level changes in pts during HD, ET was measured at three time points of HD (before ultrafiltration-UF, after UF, and after HD without fluid removal) in 10 pts. ET level was not significantly changed after UF (1.93 +/- 2.25 vs 1.71 +/- 1.50; ns), but was significantly increased after depuration (4.46 +/- 3.56; p < 0.05). There was no correlation between ET and blood pressure in controls and pts in either period of testing, neither with plasma renin activity, left ventricular mass index, and body weight changes during HD.

[Continuous blood pressure monitoring over a 24-hour period in children with terminal renal failure treated with hemodialysis]

Recent evidence suggests that circadian blood pressure changes are common in patients with impaired renal function and has excellent correlation with end-organ damage. The aim of this paper was to: 1) evaluate if children with end-stage renal failure have altered circadian blood pressure rhythm; 2) assess whether pre- or postdialytic blood pressure is representative for the average interdialytic blood pressure; 3) assess whether pre- or postdialytic blood pressure is representative for the average interdialytic blood pressure; 3) determine influence of pre-, post and interdialytic blood pressure. Ambulatory blood pressure monitoring was performed in two groups of patients: group A-13 children with end-stage renal failure, aged 15.15 +/- 5.58 years, on chronic haemodialysis from 2 to 156 (mean 45.3) months, 4 of whom were hypertensive and 9 normotensive; group B-19 children with chronic hypertension (essential or renal hypertension) aged 15.28 +/- 2.27 years. 84.62% of children from group A and 31.58% from group B (p = 0.0037) had blunted circadian blood pressure rhythm (a nocturnal reduction of blood pressure is less than 10% of daytime values). Pre- and postdialytic systolic, diastolic and mean arterial blood pressure did not differ significantly and were in correlation with interdialytic blood pressure (r = 0.9; p < 0.01). Pre-, post- and interdialytic blood pressures correlated well with left ventricular mass index (r = 0.6; p < 0.05), but were not in correlation with the degree of hypervolemia (p < 0.05).

[Treatment of duodenal ulcer with famotidine and proglumide]

In an open study the clinical efficacy of famotidine 40 mg on a duodenal ulcer was compared to that of proglumide 1600 mg. The study included 106 patients with acute duodenal ulcer, divided into two groups: A-famotidine and B-proglumide. There were no significant differences between the groups in baseline characteristics. Due to different reasons nine patients were excluded from analysis. Duodenal ulcer diagnosis and healing were determined exclusively by endoscopy. Ulcer healing was observed after four weeks in 40/49 (81.6%) patients in group A and 35/48 (72.9%) patients in group B and in 46/49 (94%) and 40/48 (83.3) after eight weeks, respectively. There were no statistically significant differences between the healing rates for both groups (p > 0.05). The reduction of ulcer related symptoms and antacid consumption was equal in both groups. No adverse effects were reported in the group A, but there were three patients with transient skin rush in the group B. Reported adverse effects were minor and did not merit exclusion from the study. It was concluded that the efficacy of famotidine 40 mg vs. proglumide 1600 mg was similar, although famotidine had proportionally better effect than proglumide. These findings supported the hypothesis that famotidine suppressed acid secretion stronger than proglumide.

[Significance of endothelin in arterial hypertension in children]

Concentration of plasma endothelin and the activity of Na(+)-K(+)-ATP-ase were determined in 3 different groups of children: the 1st group comprised 13 children with essential hypertension, aged 12.9+/-4.8; the 2nd group concerned 16 children with renal hypertension, but with preserved global renal function, aged 13.7+/-2.8, and the 3rd group consisted of 27 healthy children, aged 11.6+/-6.3 years. Plasma endothelin concentrations were measured by radioimmunological method, using a set manufactured by "Biomedica". The activity of Na(+)-K(+)-ATPase was determined in erythrocyte haemolysate by measuring the quantity of released inorganic phosphate in samples with and without ouabaine. Concentration of plasma endothelin was not significantly different between the children with arterial hypertension and healthy children, and there was no significant correlation between endothelin concentration and blood pressure in either of the 3 groups of children. The activity of Na(+)-K(+)-ATP-ase was significantly decreased only in the 1st group of children. There was no evidence of correlation between the Na(+)-K(+)-ATPase activity and blood pressure or plasma endothelin either in healthy, or in hypertensive children.

CONCLUSION

Endothelin in blood circulation has no significance in regulating blood pressure in healthy children. It also has no direct role on the development of essential and renal hypertension in children. The activity of Na(+)-K(+)-ATP-ase is decreased in children with essential hypertension, but it seems that it has no direct impact on hypertension. Endothelin in circulation and Na(+)-K(+)-ATP-ase activity are not interdependant.

[Determination of the level of urinary tract infection in children by antibodies coating bacteria from urinary sediment]

The article deals with the evaluation of the significance of surface antibodies in urinary sediment bacteria by direct immunofluorescence in children with urinary tract infection caused by Escherichia coli (E. coli), so as of determination of location of the infection. Sixty five children were studied, aged from 1 to 16.5 years. Based on the recognized criteria in literature, all patients were classified into three groups: chronic pyelonephritis (CP)--10 patients, acute pyelonephritis (AP)--34 patients, and lower urinary tract infections (LUTI)--21 patients. On the basis of the analysis of the relationship among the three groups of patients in relation to the absence or various presence rates (up to 5%, 6-10% and 11-15% respectively) of fluorescent antibodies in urine sediment, and using the Fischer's test of absolute probability, we obtained a highly significant difference (p = 0.00006) only between the groups AP and LUTI. This difference caused the presence of fluorescence in the AP group and its absence in the LUTI group. By adding the positive fluorescence findings we found that it was present in 80% of CP patients, in 91.17% of AP patients, and in 14.28% of LUTI patients. chi2 test showed a highly significant difference (chi2 = 34.79; p < 0.01), which confirmed that bacterial fluorescence was most often present in the urine of AP patients and absent in LUTI patients. Bacterial fluorescence was significantly more frequent in CP patients in relation to LUTI patients. These results indicate that the method for detecting surface antibodies in urine bacteria, aimed at determinig the location of infection, is more reliable and noninvasive as compared to other methods.

[The influence of protein and phosphorous restricted diet supplemented with essential aminoacids (EAA) and their alpha-keto-analogues (KAA) on nutritional status of children with chronic renal failure (CRF)]

The purpose of the study was to establish the influence of protein restricted diet supplemented with EAA/KAA on nutritional status of children with CRF. Seven childredn (four girls and three boys), aged from 7 years and eight months to 14 years and two months, with glomerular filtration rate of 42.6-9.2 ml/min/1.73 m2 and proteinuria of 0.025-1.125 g/24 h, who were on conservative treatment and who lived at home, were observed for six months. In prescribing energy value and protein intake WHO recommendations were used for healthly children (age for height). Through food 80-90% of energy and 80-85% of protein needs were provided. The remaining energy and proteins were provided by glucodextrin and EAA/KAA supplements respectevely. Average daily phosphorous intake amounted to about 550-800 mg. The obtained results showed that stunting and kwashiorkor like aminoacid disbalance were the prominent nutritional problems. This dietary regimen had a beneficial effect on all studied parameters. especially on height standard deviation score which increased from 1.71 +/- 2.6 to 1.5 +/- 4.3 (t = 2.809, p < 0.05); total essential/nonessential aminoacid score increased from 0.38 +/- 0.2 to 0.56 +/- 0.2 (t = 2.763, p < 0.05). The ratio between plasma concentration of four nonessential (glycine+serinet glutamine+taurine) to four essential (leucine+isoleucine+valine+methionine) amino acids decreased from 3.82 +/- 1.2 to 2.7 +/- 0.4 (t = 2.528, p < 0.05). Lymphocyte count increased from 1.809 x 10(9) +/- 0.268 x 10(9)/l to 2.314 x 10(9) +/- 0.922 x 10(9)/l (t = 2.431, p < 0.05). No significant changes were found in the values of relative body weight, arm circumpherence, triceps skinfold thickness, total plasma protein, albumin, transferine, complement C3 and plasma valin/glycin and phenylalanine/thyrosine ratio. It should be noted that the significant changes were not found in the results of these latter anthropometric biochemical parameters in relation to their primary almost insignificant values.

[Clinical significance of serotypization of Escherichia coli isolated in children urinary tract]

The paper deals with the study of 65 children, aged from 1 to 16,5 years (7 years and 5 months +/- 2 years and 7 months), with urinary tract infection caused by Escherichia coli (E. coli). All patients were classified into three groups according to accepted criteria from literature (clinical features, urographic characteristics, immunological analyses and laboratory signs of inflammatory reaction: (1) 10 patients with chronic pyelonephritis (CP); (2) 34 patients with acute pyelonephritis (AP), and (3) 21 patients with lower urinary tract infection (LUTI). Using 7 antisera antigen preparations O1, O2, 04, O7, O11, O15 and O18, 46 (70.8%) isolated strains were serotyped, while 19 (29.2%) isolated strains of E. coli remained unserotyped. None of the patients showed the presence of more than one serotype in urine. Due to the small number of cases in some groups and low number of serotype strains within the groups, break-down of serotype by patient groups was not done. The prevalent serogroup was O7 found in 22 (47.8%) patients, then O11 in 9 (19.6%), O1 in 4 (8.7%), O15 in 4 (8.7%), O4 in 3 (6.5%), O2 in 2 (4.3%) and O18 in 2 (4.3%) patients. Serogroup O7 was present in all three groups of patients. Statistical analysis showed that the incidence of serogroup O7 was not significantly different (p > 0.05); this suggests that a specific serogroup does not cause only one type of infection. Having in mind that all existing antisera were not used, the possibility of intra-hospital infection provoked by O7 serogroup should be taken into consideration.

Characteristics of thiamin transport in the isolated perfused guinea pig heart

The cellular uptake of (14C)-thiamin hydrochloride was studied in the isolated perfused guinea pig heart, using the rapid single circulation, paired-tracer technique, in which D-(3H)-mannitol serves as an extracellular marker. Cellular uptake of this vitamin was estimated by directly comparing venous dilution profiles of (14C) and (3H) radioactivities in the absence and presence of unlabelled thiamin hydrochloride and pyrithiamin hydrobromide. The maximal cellular uptake (Umax) of thiamin was very low (5.31 +/- 1.79%), while in the presence of 10 mM unlabelled thiamin and 1 mM pyrithiamin, Umax was significantly greater (9.71 +/- 1.57% and 12.30 +/- 0.82%, respectively). Our data suggest that there is a saturable mechanism of sarcolemmal thiamin transport out of myocardial cell, while this transport into the cell is unsaturable.

[Emergencies in arterial hypertension in children]

From March 1982 to March 1992 at the Nephrology Department of Belgrade University Children's Hospital 25 patients (16 females and 9 males, aged from 1.5 to 14 years) were treated for hypertensive emergency. Twenty patients had chronic severe hypertension of whom in 19 it was of renal origin. Five patients had acute hypertension during acute poststreptococcal glomerulonephritis. In 15 patients hypertensive emergency was manifested by neurologic disorders, while in the other patients signs of cardiac failure prevailed. Deterioration of renal function was observed in 9 patients and 2 had sec. haemolytic-uremic syndrome. Three patients died during hypertensive crisis, and the others were successfully treated. The fact that in 50% of patients chronic hypertension could not be revealed until the occurrence of hypertensive emergency, suggests the need of its early detection during systemic check-up.

Progressive tubulointerstitial nephritis and chronic cholestatic liver disease

We report the clinical and morphological features of a distinctive hepatorenal disorder in four patients and review the five similar patients in the literature. The main clinical characteristics were early onset of cholestatic liver disease and progressive tubulointerstitial nephritis leading to renal death in early childhood. Liver histology showed disturbed architecture with nodular and acinar formations and portal fibrosis and bile duct proliferation. Histological abnormalities in the kidney were severe interstitial fibrosis and tubular atrophy and dilatation, while the typical features of nephronophthisis were lacking. These clinical and morphological characteristics distinguish our patients from the majority described, as having nephronophthisis and congenital hepatic fibrosis or any other known syndrome with concomitant hepatorenal involvement. We suggest that the association of cholestatic liver disease and progressive tubulointerstitial nephritis represents a new syndrome.