Phenolic composition and biological activities of geographically different type of propolis and black cottonwood resins against oral streptococci, vaginal microbiota and phytopathogenic Fusarium species

AIMS

A multidisciplinary approach was used to compare phenolic composition, radical scavenging and antimicrobial activity of propolis samples from different geographical localities, and plant resin against various microorganisms.

METHODS AND RESULTS

Using UHPLC-qqqMS quantitative analysis, 28 phenolic compounds were determined. Caffeic and p-coumaric acids were identified as main phenolic acids in poplar propolis samples, except samples from Russia (P6) and China (P7). Radical scavenging activity (applying DPPH spectrophotometric assay) showed the highest activity of Serbian (40·51%) and Chinese (53·21%) propolis samples. Broth microdilution method was used for the oral cavity, fungal phytopathogenic and human vaginal isolates which have been identified at a molecular level. The most sensitive bacterial isolates were Lactobacillus acidophilus (MIC of 0·03-0·13 mg ml^-1 ) and the oral streptococci isolates (MIC values of 0·19-0·13 mg ml^-1 ). The most sensitive fungal phytopathogenic isolate was Fusarium oxysporum (MIC 0·003 mg ml^-1 ). All samples, except propolis from Serbia (P4) and Turkey (P5), showed a strong antifungal activity against Fusarium sporotrichioides, Fusarium subglutinans and Fusarium proliferatum.

CONCLUSION

The results of various tests indicate good radical scavenging and antimicrobial activity against important human and plant pathogens.

SIGNIFICANCE AND IMPACT OF THE STUDY

A detailed propolis analysis is important when proposing a preparation of new biological antimicrobial products which have a positive impact on human health and reduce antibacterial resistance.

Cardiac autonomic nervous system in patients with myotonic dystrophy type 1

The purpose of the present study was to evaluate cardiac autonomic nervous system (ANS) in patients with myotonic dystrophy type 1 (DM1). The function of ANS was studied in 20 patients with DM1 and 15 healthy controls. All subjects were investigated by a battery of six cardiovascular autonomic tests and power spectral analysis of heart rate variability (HRV). Only one patient had normal autonomic function. Two (10%) patients had mild, 10 (50%) moderate and 7 (35%) severe autonomic dysfunction. Thirteen (65%) patients had vagal and 4 (20%) sympathetic hyperactivity. Seven (35%) patients had vagal and 15 (75%) sympathetic dysfunction. Eighteen (90%) patients had orthostatic hypotension. The 24-hour time domain parameters of SDNN (SD of the NN interval) and total power were significantly lower in DM1 patients than in healthy controls (p < 0.05). However, other parameters of HRV, such as SDANN (SD of the mean NN, 5-minute interval), low frequency (LF), high frequency (HF) power and the LF/HF ratio were somewhat lower in patients with DM1 than in controls, but this was not statistically significant. There was no significant relationship between autonomic dysfunction and the severity of the disease or CTG repeat length. There was also no correlation between HRV and age. Our findings suggest that sympathetic dysfunction and vagal predominance may both occur in patients with DM1.

Relationship of serum levels of tumor markers with tissue expression of gene products in ovarian carcinoma

PURPOSE

The aim of this prospective study was to determine serum levels and tissue expression of CA125, CA 15-3, p53, HER-2 and nm23 tumor markers, which are used in the detection and follow up of patients with ovarian carcinoma.

PATIENTS AND METHODS

19 patients with malignant and benign ovarian tumors were included in this study. Serum levels of CA125, CA 15-3 and p53 tumor markers were detected in preoperative and postoperative blood samples using ELISA technique. Tissue expression of p53, HER-2 and nm23 were examined using immunohistochemistry.

RESULTS

All serum tumor markers were elevated in patients with ovarian carcinoma. Serum level of CA 15-3 was increased in patients with ovarian carcinoma (median 48.33 U/ml, normal range 0-36), while it was normal in patients with benign ovarian tumors (median 20.67 U/ml; p >0.05). CA125 serum values were strikingly increased in ovarian carcinoma (median 264.16 IU/ml, normal range 0-35) and benign ovarian tumors (median 119.59 IU/ml; p <0.05). Serum levels of p53 in patients with ovarian carcinoma were increased (median 0.69 U/ml, normal range 0-0.50) compared to patients with benign tumors (0.32 U/ml; p <0.05). Histological HER-2 overexpression was detected in 7 cases, including 4 with strong (score 3+ and 2+) and 3 with weak or no HER-2 expression (score 1+ and 0) in ovarian carcinoma tissue; in benign tumors HER-2 overexpression was detected in 1 case (p >0.05). Strong overexpression of p53 was detected in 3 cases with malignant and none with benign tumors (p >0.05); and strong overexpression of nm23 was detected in 5 cases with malignant and 2 with benign tumors (p >0.05).

CONCLUSION

Serum levels of CA125, CA 15-3 and p53 are strikingly increased, as well as the expression of HER-2 and p53 in carcinomatous tissue. Detection and analysis of multiple tumor-specific markers in serum and tissue can give useful clinical information for the management of ovarian carcinoma and can also improve the sensitivity and specificity of these markers.

[Indium 111-labeled antibodies in the detection of colorectal carcinoma]

The aim of the study is detection of the recurrences and metastases of colorectal carcinomas using (111)In labelled antibodies B72.3 in 14 patients. With tomography, we can access better distinction of tumour in comparison to other structures and estimation of its size. Other imaging methods (CT, US) have advantage in detection of liver metastases, while immunoscintigraphy is more specific for the assessment of malignant abdominal tumours and extrahepatic metastases. The first results point out that Oncoscint CR-103 can be useful in diagnosis of recurrences and metastases of colorectal carcinoma, viability assessment after radiotherapy and in the choice of the adequate surgical treatment in dependence of the spread of the disease.

Serum HER2 and CA 15-3 in breast cancer patients

PURPOSE

The HER2 oncogene encodes a transmembrane tyrosine kinase receptor. This molecule could be a new marker for prognosis and response to therapy in patients with advanced breast cancer. However, the extracellular domain of c-erbB-2 (HER2) transmembrane receptor undergoes proteolytic cleavage from the fulllength protein by metalloproteases, and is shed into the blood as a circulating antigen. To determine the clinical utility of this oncoprotein, the soluble form of HER2 was assayed in the serum of breast cancer patients.

PATIENTS AND METHODS

Serum levels of breast carcinoma antigens CA 15-3 and HER2 were determined in 60 patients, 40 with localized (group A) and 20 with metastatic (group B) breast carcinoma. CA 15-3 measurements served as "gold standard" to which HER2 diagnostic and/or prognostic value was compared. Sera from 10 healthy women served as controls.

RESULTS

Serum levels of the tested tumor markers HER2 and CA 15-3 were significantly higher in cancer patients compared to controls. CA 15-3 correlated with bulky initial tumor, whereas HER2 showed no differences between healthy individuals and group A patients. The serum levels of the tested markers in group B patients were significantly higher (p <0.001) than the serum levels of patients in group A. Striking increase in serum levels of HER2 was found in 52.7% and CA 15-3 in 52.9% of patients with metastatic cancer. A combination of markers was more sensitive than using one marker alone. In this regard, 90% of the patients with metastasis had at least one of the markers increased.

CONCLUSION

The results of this study suggest that the HER2 oncoprotein may be potentially useful in detecting recurrence of breast cancer. However, to improve sensitivity and specificity in the diagnosis and monitoring of breast cancer, the use of multiple tumor markers should be employed.

[Inhalation of gasoline and damage to health in workers at gas stations]

The aim of this study was to made assessment of chronic health effects in 37 workers exposed to gasoline, and its constituents at gasoline stations between 1985 and 1996. By the study we have involved thirty-seven persons who had been exposed to gasoline for more than five years were examined. The evaluation included a medical/occupational history, hematological and biochemical examination, a physical exam, standardized psychological tests, and ultrasound examination of kidneys and liver. The groups were identical in other common parameters including age, gender (all men), and level of education (P < 0.05). The data were compared to two control groups: 61 gasoline unexposed controls and 25 workers at gasoline stations exposed to organic lead for only nine months. Peripheral smear revealed basophilic punctuated eritrocytes and reticulocytosis. We found in chronic exposed gasoline workers haematological disorders: mild leukocytosis (7 of 37), lymphocytosis (20 of 37), mild lymhocytopenia (3 of 37), decrease of red blood cells count (11 of 37). Results indicated that they have suffered from liver disorders: lipoid degeneration of liver (14 of 37), chronic functional damages of liver (3 of 37), cirrhosis (1 of 37). Ultrasound examination indicated chronic kidney damages (8 of 37). These results significantly differed from those of controls (P < 0.05). In 13 out of 37 workers at gasoline stations exposed to gasoline for more than 5 years the symptom of depression and decreased reaction time and motor abilities were identified. The summary of diseases of workers exposed to organic lead and gasoline are discussed.

Comparative morphological variations and abnormalities of circles of Willis: a minireview including two personal cases

Two rare cases of the circle of Willis are presented. One of them represents a fetal circle of Willis (crown-rump length, or CRL, 17 cm), the other one is adult circle from a male cadaver 65 years of age. Arterial variations and abnormalities of the represented circles of Willis are described. Interpretation of the appearance of variations and abnormalities is based on the acceptable embryological, anatomical, and clinical reports. Summarizing these opinions, we have supplemented them with a hypothesis that arterial variations and abnormalities could preserve their relationships because of constant interaction between primitive arterial remnants and cerebral arteries in postnatal life, unless some pathological lesions appear.

Posttraumatic stress disorder--effects of psychosocial treatment in children

In this paper, the authors were researching on expression of posttraumatic stress disorder symptoms and on effect of psychosocial help to children. Existence, time of appearing, way of going through experience and expression of PTSD symptoms were established. There were methodical used structured interviews, Questionnaire for children (Saigh, 1991) and Estimation scale for engagement of children in group work. Refugee and domicile children of age from 7 to 11 years and from 12 to 16 years old were involved in program of psychosocial care. In this research there were more significant the girls than the boys (p < 0.005). Applied therapy methods have given significant effect in increasing of willing to take part in the dialogue (p < 0.005), in increasing of interest to work in group (p < 0.005) and bigger contribute each one within group (p < 0.005). By that, it is being confirmed that the effect of methodical procedure and therapy treatment at children is successful and applicable in future activities.

Hereditary neuropathy with liability to pressure palsies associated with central nervous system myelin lesions

Hereditary neuropathy with liability to pressure palsies (HNPP) is an autosomal dominant disorder most commonly caused by a 1.5-Mb deletion in chromosome 17p11.2 which contains the peripheral myelin protein-22 (PMP22) gene. Mutations resulting in functional loss of one PMP22 gene copy are less frequent. We present a 51-year-old patient with a l.5-Mb deletion in chromosome 17p11.2 who exhibited signs of peripheral as well as central nervous system lesions. He gave a history of recurrent episodes of limb numbness and weakness with spontaneous but incomplete recovery since age 20. His father and two brothers had similar symptoms. Neurological examination revealed signs of multiple mononeuropathy associated with frontal lobe, corticospinal tract and cerebellar dysfunction, as well as signs of initial cognitive impairment. Electrophysiological investigations showed a demyelinating peripheral nerve disease with multiple conduction blocks and conduction disturbances in both optic nerves. Magnetic resonance imaging of the brain revealed multiple subcortical and periventricular foci of myelin lesions. The association of central and peripheral nervous system lesions in this patient indicates a possible role of PMP22 not only in peripheral but also in central nervous system myelin structure.

The assessment of the analytic group treatment efficiency according to Yalom's classification

The authors expose the assessment of therapeutic factors during group analytic treatment. In the methodology of research several measuring instruments were applied. In this study it will be exposed the results obtain by Yalom's questionnaire containing 60 items. Three small analytic groups were followed up, encompassing 20 group members. By self-evaluation they ranked the assessment of every of 12 therapeutic factors according to their importance. The variability of results was shown more inside then among groups. The highest-ranking therapeutic factors the group members sorted out were: self-understanding, family re-enactment, cohesiveness and universality. The factor of identification was the lowest ranking in all groups.

[Molecular characteristics of the thalassemia syndrome and prenatal diagnosis in a high risk family]

The diagnosis of thalassaemia maior has been established in a 6 months old infant by screenig tests. The sick child and his parents were included in the study. Reverse dote blot and allelle-specific PCR confirmed that the mother was heterozygous for mutation in the first intone of beta-globin chain at position 110-beta-IVSI-110. By gap-PCR it was established that the father was heterozygous for haemoglobinopathy Lepore. The child was double heterozygous for both mutations. During the next pregnancy, in the 11th week, faetal DNA was extracted from chorion villous. Fetus was heterozygous for haemoglobinopathy Lepore and carried the same mutation as the father. The parents the accepted information that the second child will be a silent carrier of mutation.

[The upper thoracic outlet vascular syndrome]

A 16 patients with 20 vascular TOS have been evaluated at the our Institute. Fourteen of them were female, and 2 male patients, with average age of 33.1 (18-44) years. 19 of them had congenital, and one acquired TOS after trauma at neck-shoulder region. 13 cases had arterial, and 7 venous TOS. In 10 cases a cause of TOS was cervical rib, in one scar tissue after clavicle fracture, while in 9 soft tissue anomalies. Eight cases with arterial TOS had a hand ischemia, one TIA and 5 periodical symptoms only during the arm hyperabduction. Two cases with venous TOS also had symptoms and signs during arm hyperabducrtion only, while five patients had axillary-subclavian deep venous thrombosis (DVT). All patients underwent CW-Doppler, Duplex-ultrasonographic and angiographic examination in normal position of the arm and during the hyperabduction. The four aneurysms of the subclavian artery, two poststenotic dilatation of the subclavian artery were found as well as one thrombosis of the axillary artery and 8 brachial artery embolism. The operative treatment consists from decompression and vascular procedure. A decompression procedure include 10 resections of the cervical rib, three transaxilary and 6 supraclavcular resection of the first rib, as well as one scalenectomy. A vascular procedures included 8 transbrachial thrombembolectomy and 4 resection and replacement of subclavian artery aneurysms. Four early complications were noticed: two partial pneumothorax, and two transiet medianus nerve paresis. The follow-up period was between one and six years (mean 3 years). In this period one (12.5%) late arterial occlusion was found. The vascular TOS is more rare than neurogenic, however in mostly cases requires surgical management.

[The popliteal artery entrapment syndrome]

The authors are presenting 8 patients with 9 cases of popliteal artery entrapment syndrome. There were one female, and 7 male patients with average age of 36.4 (25-54) years. Six cases were manifested with acute, 2 with chronic foot ischemia, while one case was asymptomatic. For diagnosis a combination of Doppler sonography and transfemoral angiography, was used. Eight cases were operated using posterior, while in one medial approach to the popliteal artery. The types I and IV of the popliteal artery entrapment syndrome were found in one case, type II in two cases, type III in 4 cases, while in one case a type of syndrome had not to be identified. During the operation the resection of the anomalous muscle and reconstruction of the popliteal artery, were done in 8 cases. In one case muscle resection or arterial reconstruction, were not necessary. The early potency rate and limb salvage, were 100%, while long term potency rate after mean follow up period of 6.3 years was 83.5%. The acute or chronic foot ischemia in health, young persons without typical atherosclerotical risk factors, suggests on popliteal artery entrapment syndrome.

[Diagnostic problems in patients with myasthenia gravis]

Myasthenia gravis (MG) is an antigen-specific autoimmune disease in which antibodies directed against nicotinic acetylcholine receptors of the postsynaptic muscle membrane (nAChR) impair neuromuscular transmission. MG is clinically characterized by abnormal muscle fatigue and weakness. The initial symptoms and signs are often unrecognized. Therefore, we analyzed the diagnostic errors and duration of diagnostic delay in patients affected with MG (n = 444) in a ten-year period (January 1, 1983-December 31, 1992) in Yugoslavia. The initial diagnosis was correct in 44.4% of patients and erroneous in 38.4%; 17.2% of patients were admitted without an initial diagnosis. The average duration of diagnostic delay was 11 months. We present the differential diagnostic difficulties in MG and discuss the principles of diagnostic strategy which may reduce the risk of diagnostic errors in MG.

[Cataract surgery in children]

INTRODUCTION

Cataract extraction in children has improved and became more popular over the past few decades but, due to particular features of children's eyes, still remains controversial--especially regarding the intraocular lens implantation.

INDICATIONS FOR OPERATION

In contrast to adults, indications for cataract surgery in children are much more difficult to determine. Since subjective visual acuity cannot be obtained, greater reliance must be placed on the morphology and location of the lens opacity, and the behavior of the child. Forced preferential looking and visual evoked potentials can be helpful, but they should not be the only criteria.

CORRECTION OF POSTOPERATIVE APHAKIA

In management of pediatric cataract, correction of postoperative aphakia is still an incompletely resolved problem. Conventionally, optical correction is achieved by spectacles or contact lenses. The power of both spectacles and contact lenses can be readily adjusted to compensate for ocular growth. The success of both depends significantly on parental compliance and the child's acceptance. Hutchinson reported that 44% children with aphakia stopped wearing glasses or contact lenses 2 months after surgery. Contact lens wearing can also result in a number of corneal complications, including infectious keratitis, corneal vascularization and hypoxic corneal ulceration. IOL implantation is theoretically superior to glasses and contact lenses since it provides almost immediate optical correction which is much more reliable because it does not depend on parental or child's compliance. Still, there are many controversies about IOL implantation in infants and young children like IOL-size, material, IOL power calculation, prevention and management of secondary cataract, as well as long term safety of IOLs in children's eyes. Although short-term anatomic results after cataract extraction and primary IOL implantation in children are excellent and stable, long-term follow-up is necessary to answer questions about the long-term safety of implants in children's eyes.

POSTOPERATIVE COMPLICATIONS

A higher incidence of postoperative inflammation and opacification of the optical axis has been reported after pediatric cataract surgery. Posterior capsular opacification is almost an unavoidable complication in children's eyes if the posterior capsule is left intact. Several methods have been proposed in order to keep the optical axis clear in infants and young children. Comparison of posterior capsulectomy with and without anterior vitrectomy showed that posterior capsular opacification rates are diminished only after combined posterior capsulectomy and anterior vitrectomy and not after capsulectomy alone. Posterior capsulorhexis with optic capture seems to effectively prevent posterior capsular opacification. This technique eliminates the need for anterior vitrectomy and ensures the centration of the intraocular lens. Glaucoma and retinal detachment are late complications of pediatric cataract surgery. On average glaucoma develops 6.8 years after cataract operation. Retinal detachment develops several decades after cataract extraction.

AMBLYOPIA

The functional results after pediatric cataract surgery depend not only on the anatomic success of the operation and postoperative maintenance of a clear optical axis, but even more on aphakic visual rehabilitation. Children's eyes with cataract severe enough to require cataract extraction usually have some degree of amblyopia already present prior to surgery. In unilateral pseudophakia amblyopia develops postoperatively unless the fellow eye is occluded or optically and/or pharmacologically penalized. Immediate optical correction is desirable because prevention and/or therapy of amblyopia should be initiated directly after surgery. Parental compliance with occlusion therapy and not successful surgery are major determinants of a good visual outcome in unilateral aphakic/pseudophakic children.

The rat beta (b miny)-globin promoter: nuclear protein factors and erythroid-specific induction of transcription

We show that the rat adult beta (b miny)-globin gene is transcriptionally active. The - 100-bp promoter region contains control elements that are important for the induction of transcription in rat erythroleukemia (REL) cells. By using DNaseI footprinting and gel mobility shift assays, we have shown that the CCAAT box, a regulatory element from an analyzed promoter region, binds NF-Y and GATA-1 transcription factors. Another regulatory element from this region, betaDRE, binds erythroid-specific and ubiquitous factors from REL cells. Although both the CCAAT box region and betaDRE element bind the same protein factors before and after induction of REL cells, we show by South-Western blot analysis that the concentrations of 150-kDa, 70-kDa and 60-kDa factors binding to the betaDRE are increased in DMSO-induced REL cells.

[Somatization in post-traumatic stress disorders in soldiers during the war in Bosnia-Herzegovina]

While researching psychological disorders in soldiers during the war in Bosnia, besides the psychiatric simptomatology in post trauma stress disorder (PTSD), we analyzed also expressed somatic symptoms. The sample consists of 164 soldiers from the first front lines, divided into three groups: Group A (N = 51), soldiers who during the war asked for psychological and/or psychiatric help, group B (N = 51) soldiers who are after the war on stationary or clinical treatment and group C (N = 62) soldiers who during and after the war, did not ask for psychiatric help even though they had psychiatric problems. With the trauma questionnaire and obvious PTSD symptoms the degree of the traumatic experience and the structure of PTSD was determined, and with the self-evaluation health condition questionnaire the subjective health condition evaluation during the prewar, war and the time after the war was determined with expressed physical disorders. Another important difference was determined (P < 0.01) between soldiers who had a high stress level and suffered from PTSD, who asked during and after the war for psychological and/or psychiatric help (groups A and B) and soldiers who suffered less from PTSD and who did not ask for professional help during nor after the war (group C). 60.8% soldiers in group C and 42.1% in group B during the war, and 41.3% in group A and 92.2% in group B after the war, points out their weak or very weak health condition compared with the soldiers from group C, where 1.6% during the war and 9.7% after the war pointed out their weak or very weak health condition. Somatic symptoms are mainly in conjunction with the cardiovascular system, 47.1% in group A and 78.4% in group B, also gastrointestinal system, 50.9% in group A and 37.3% in group B, followed by back pains, 31.4% in group A and 43.1% in group B. The first signs of somatic symptoms are in direct connection with first signs of traumatic experience and first signs of PTSD symptoms. The results confirm previous researches and that is that soldiers with traumatic experiences which they can hardly bare and who suffer for a long period of time from PTSD have also the biggest number of somatic symptoms.

Epidemiological and clinical characteristics of myasthenia gravis in Belgrade, Yugoslavia (1983-1992)

This is the first epidemiological study of myasthenia gravis (MG) in the area of Belgrade. During the survey period (1983 1992), 124 incidental cases of MG were observed, producing an average annual incidence rate of 7.1 per million population (women, 8.3; men, 5.8). Age and sex specific incidence rates for females demonstrated a bimodal pattern, with the first peak in the age group between 20 and 40, and the second peak in the age group 70-80. The age-specific rates for males showed unimodal pattern, reaching a maximum in the age group between 60 and 80. There was a tendency of more frequent disease appearance in the urban as opposed to the suburban districts. On the prevalence day, December 31, 1992, the point prevalence rate was 121.5 per million (women, 142.5; men, 98.8). Only for incidental cases, the point prevalence rate was 77.1 (women, 83.2; men, 70.4). The average annual mortality rate was 0.47 per million (females, 0.52; males, 0.42), while cumulative lethality was 5.6 (women, 5.6; men, 5.7). Most frequently initial symptoms were ocular, occurring in 58% patients. Through the period of investigation ocular symptoms were generalized in 68%, most frequently in the first 2 years (62.5%). Thymoma was confirmed in 11.3% of patients. In this group there was equal presence of both sexes, older median age at onset, and more severe clinical course of MG. Associated autoimmune disease was found in 17 out of 124 incidental cases (13.7%). The most common were thyroid diseases (7.3%). Family history of MG was recorded in 2 cases belonging to 1 family (1.6%).

Pathohistological changes in endomyocardial biopsy specimens in patients with myotonic dystrophy

BACKGROUND

Endomyocardial biopsies in patients with myotonic dystrophy (MD) have, so far, shown changes such as myofibrillar degeneration, mitochondrial abnormalities, focal myocarditis, fibrosis and fatty infiltration of the myocardium and the conduction system.

METHODS

This study presents the results of endomyocardial biopsy in 10 patients with MD. Endomyocardial biopsy was carried out using King's bioptome.

RESULTS

In two patients with servere MD biopsy specimens showed changes compatible with border line myocarditis. In five patients with moderate to severe forms of MD fibrosis and fatty infiltration of the myocardium were found in addition to degenerative changes and hypertrophy of muscle fibers. Three patients with mild MD had non-specific degenerative and hypertrophic myocardial changes. The histological changes described above were present in patients without cardiological symptoms and in those with normal ECG and echocardiographic findings. Only two of the 10 patients in whom endomyocardial biopsy was done complained of fatigue and occasional palpitations while the rest were asymptomatic. One patient with focal myocarditis had ECG signs of left bundle branch block and echocardiographic evidence of reduced left ventricular contractility. Five patients with signs of endomyocardial fibrosis only had an abnormal Q wave on ECG recordings. The remaining five patients with border line myocarditis i.e. with degenerative and hypertrophic myocardial changes had normal ECG and echocardiographic findings.

CONCLUSIONS

These results stress the significance of endomyocardial biopsy in detecting myocardial pathologic changes in patients with MD.

[Antibiotic sensitivity of bacteria isolated from the urine of children with urinary tract infections from 1986 to 1995]

In adults and in children urinary system infections are mostly caused by gram-negative and rarely by gram-positive bacteria. Of gram-negative bacteria the most frequent cause of infections are Escherichia coli, Klebsiella species, Proteus mirabilis, Pseudomonas aeruginosa, Acinetobacter, Serratia etc., and of gram-positive bacteria Enterococcus, Staphylococcus, Streptococcus agalactiae. In rare cases the cause of infection may also be Pneumococcus and Haemophilus influenzae.

AIM OF THE STUDY

The aim of the study was to investigate the sensitivity to antibiotics of gram-negative bacteria as the predominant cause of urinary infections.

METHOD OF THE STUDY

We isolated 20,615 bacterium species from urine of children hospitalized or treated as outpatients at the University Children's Hospital in Belgrade. Urine was collected classically, i.e. by taking the second clean stream into a sterile test tube or by Uricult test. The samples were cultured on blood plates and endo-agar. Identification was done by standard bacteriologic methods and when findings were dubious API-20E (bioMerieux) was used. Bacterium sensitivity to nine antibiotics (ampicillin, cephalexin, cefotaxime, chloramphenicol, gentamicin, amikacin, co-trimoxazole, nalidixic acid and nitrofurantoin) was assessed with disc diffuse method on Müller-Hinton agars.

RESULTS

Based on the obtained results, Escherichia coli species sensitivity to amikacin, gentamicin, cefotaxime, nalidixic acid and nitrofurantoin ranged from 90 to 100%; sensitivity to co-trimoxazole and chloramphenicol ranged from 70 to 80%, to cephalexin from 50 to 60%, while to ampicillin it was only 20%. Klebsiella species sensitivity to nalidixic acid and cefotaxime was 70-85%; to amikacin, cefotaxime, co-trimoxazole and gentamicin 60-80%; to cephalexin and chloramphenicol 40-50%, and to ampicillin only 5-15%. Proteus species showed sensitivity to amikacin, gentamicin, cefotaxime and nalidixic acid of 90-95%; to co-trimoxazole and chloramphenicol 70-80%; to cephalexin and ampicillin 40-50%, and to nitrofurantoin 10%. Pseudomonas aeruginosa species showed the highest level of sensitivity to amikacin (40-50%), and somewhat lower to gentamicin (10-40%), and a very low sensitivity to other antimicrobial drugs (10-25%).

DISCUSSION

It may be noted from the above data that gram-negative bacteria are the cause of urinary infections in about 90% of cases, while gram-positive bacteria are the cause in only 10%, which is in accordance with data from literature. Of all antibiotic drugs ampicillin (a wide spectrum penicillin) had a very significant role in the therapy of urinary infections. However, the long-term usage of ampicillin led to increased resistance to the drug in infections caused by Escherichia coli. Natural resistance to ampicillin of Klebsiella species limited its usage when penicillin was first introduced. Proteus mirabilis species, especially those isolate in primary infection, are often sensitive to amino penicillin. Contrary to Proteus mirabilis, indole-positive Proteus and Providentie species show a high resistance to these antibiotics. Due to the crisis in our country and the lack of other antibiotics, ampicillin was widely used. The wide use of the drug caused evident resistance of Escherichia coli and Proteus mirabilis to this antibiotic. A fall in the sensitivity of Klebsiella to cephalexin, gentamicin, amikacin and co-timoxazole, which occurred in 1992, has been explained by intrahospital circulation of multiresistant Klebsiella species. The sensitivity of isolated gram-negative bacteria Escherichia coli, Klebsiella species, Proteus mirabilis and Pseudomonas aeruginosa was the most prominent to aminoglycosides (amikacin and gentamicin). The most frequent mechanism of enterobacterial resistance to trimethoprim and co-trimoxazole involves dihydrofolate reductase enzyme. Comparative studies related to the administration of co-trimoxazole have shown that the difference in the efficacy between thes

[The HLA-DR phenotype in Croatian children with gluten enteropathy]

Several studies of HLA and gluten enteropathy (GE) in European countries have found an association between this disease and certain DR phenotypes. However, no studies of DR phenotypes have been published in GE coming from Croatia. Therefore, we have studied HLA-A, B and DR specificities in 94 unrelated children with GE and in a group of healthy controls. In GE there was significant increase in the frequencies of A1 (61.70% v 24.50%; p < 0.0001) and B8 antigen (70.21% v 20.51%; p < 0.0001) compared with controls. The most frequent DR antigen was HLA-DR3 (87.23% v 18.82% in controls) with the relative risk of 29.65. The distribution of DR phenotypes in GE showed that the most frequent one was DR3/other DR (54.26%) and in decreasing order DR3/DR7 (17.02%), DR3/X (15.96%) and DR5/DR7 (8.51%). These phenotypes account for 95.75% of patients studied. A further 3.19% have DR4/DR5 phenotype. However, due to the frequency of certain antigen in controls, only phenotypes DR3/DR7 (relative risk: 28.92), DR3/X (relative risk: 13.29) and DR3/ other DR (relative risk: 10.04) were significantly associated with GE. The present study emphasizes the importance of studying the HLA-DR phenotypes in patients with GE.

[Antiphospholipid antibodies in a female patient with the Sneddon syndrome]

Sneddon was the first one to describe the association of cerebrovascular insult (CVI) and skin changes by livedo reticularis type. Angiography of this patient revealed normal brain blood vessels, occlusive changes or the changes similar to those in moya-moya disease. Computed tomography (CT) of the brain most frequently revealed ischemic lesions and/or diffuse atrophy of the brain, although the normal finding was also possible. Considering the frequent finding of the increased titer of anticardiolipin antibodies (ACA) in those patients, those antibodies could be the most important in the pathogenesis of Sneddon's syndrome. A case of female patient, aged 66 years, with livedo reticularis and recurrent CVI was presented in this study. By panangiography were revealed normal blood vessels of the brain, by scintigraphy two ischemic lesions and by CT ischemic lesions with pronounced cortical and subcortical reductive changes. In laboratory findings were observed increased immunocomplexes and the presence of lupus-like anticoagulants, increased ACA titer, the increase in fibrinogen value associated with increased ESR. The result of bone marrow examination was normal, while the borreliosis test was negative. Vasculitis was excluded by skin biopsy. Solid improvement was noticed after the immunosuppresive therapy was administered, but in the last disease exacerbation with new CVI, the outcome was lethal 3 years since the disease onset.

[Modern microsurgery of the eye]

On the basis of obtained results on the University Eye Clinic of Novi Sad, the modern aspects of the most frequent microsurgical operations in ophthalmology are presented. Cataract operations with endocapsular implantation of IOL result in improvement of visual function and daily activities in 98% of patients. Vitreoretinal surgery leads anatomical and functional improvement in 50% to 85% of all cases in correlation with pathology. Different laser microsurgical techniques are used in vascular retinal diseases, corneal refractive surgery, prevention and treatment of glaucoma, secondary cataract treatment, and treatment of diabetic retinopathy.

Assessment of early epirubicin cardiotoxicity in women with breast cancer

BACKGROUND

Anthracycline-containing chemotherapy has been the most frequently observed cause of iatrogenic cardiac damage in patients with breast cancer. The purpose of this study was to evaluate by radionuclide ventriculography whether a mean cumulative dose of epirubicin (MCDE) induced left ventricular (LV) systolic or/and diastolic dysfunction in 32 patients treated for breast cancer.

MATERIALS AND METHODS

Thirty-two patients with breast cancer according to chemotherapeutical trials received MCDE of 360 m/m2. All patients were studied before and after they completed chemotherapy with radionuclide ventriculography at rest. Systolic and diastolic left ventricular parameters were assessed.

RESULTS

Diastolic left ventricular parameters and R-R intervals significantly differed before and after completed chemotherapy in our patients: peak filling rate (PFR: 2.8 +/- 0.6 vs. 2.2 +/- 0.7 EDV/sec) and time to filling rate (TPFR: 182 +/- 48 vs. 2.25 +/- 50 msec), R-R: 723 +/- 51 vs. 620 +/- 45 msec, p < 0.01. Ejection fraction, as a systolic parameter/did not significantly differ before and after completed chemotherapy (EF: 59 +/- 7 vs. 58 +/- 6%), p > 0.05.

CONCLUSION

Our results indicate that left ventricular diastolic dysfunction even at an MCDE of 360 mg/m2 may be an early sign of epirubicin cardiotoxicity.

Therapy of rapidly progressive glomerulonephritis with immunosuppressive agents

Rapidly progressive glomerulonephritis is a kidney disease leading to sudden and definitive damages of the renal parenchyma and progressive impairment of its function until the complete failure. Histological findings of the changes are characterized with dominant glomerular lesions with crescentic formations. Early and intensive immunosuppressive therapy with pulse doses of steroids (Solumedrol 1.5 to 2.5 g), followed by Prednisolone 1 mg/kg every other day and cytostatic drugs (cyclophosphamide 1-2 mg-kg/every other day) discontinues the processes of specific and non-specific inflammation in the kidney and could enable regeneration of the kidney tissues with favorable outcome of the disease. Immunosuppressive therapy should be gradually lowered after two months, and applied for at least three to six months.

Epidemiological and clinical characteristics of ALS in Belgrade, Yugoslavia

We present the results of the first epidemiological study of ALS in Belgrade. The distribution of 58 newly discovered cases in a 7-year survey period (1985-1991) showed that the average annual age-adjusted incidence rate was 0.42 per 100,000 population (95% confidence interval, 0.18-0.83). The rate for males was 1.5 times higher than the rate for females. The greatest age-specific average incidence rate was observed in patients between 60 and 64 (3.66 per 100,000 population; 95% confidence interval, 2.17-5.78). The actual age-adjusted prevalence rate on December 31, 1991 was 1.07 per 100,000 (95% confidence interval, 0.71-1.71). The mean age at onset of the disease was 56.2 +/- 9.8 and it ranged from 24 to 74. We studied the natural course of the disease through the mean duration and cumulative probability of survival. The mean duration of the disease was 27.7 +/- 18.2 months. The cumulative probability of survival was 27% for the whole population in a 5-year interval. Elderly patients and those with bulbar signs at onset had a poorer prognosis. Patients under 49 at onset and those with the spinal form of the disease survived longer.

Molecular evidence for increased hematopoietic proliferation in the spleen of the b/b laboratory rat

The splenomegaly and the appearance of a significant number of CFU-E (erythroid colony-forming units) and BFU-E1 (erythroid burst-forming units) in the Belgrade laboratory rat (b/b) spleen prompted us to analyse further the molecular evidence for increased hematopoietic proliferation in the b/b spleen. Messenger RNAs (mRNAs) specific for globins, proteins for iron transport and deposition and the band 3 protein were used in rat erythropoietic tissues as markers for proliferation and erythroid differentiation. In the b/b spleen, all mRNAs analysed display an erythroid-specific pattern of expression. This analysis also revealed an enhanced level of mRNA for ferritin in the +/b spleen, whereas erythrocyte-specific mRNA production was normal.

[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.

[Renal function and histologic findings in immunoglobulin A nephropathy]

We investigated 28 patients with IgA nephropathy. Discriminatory analysis was the method used to determine discriminatory power of certain clinical and pathohistological parameters. Semiquantitatively were determined pathohistological parameters: glomerular index in range 0-10, vascular index 1-4, interstitial fibrosis 0-10, interstitial infiltration 0-3, tubular atrophy 0-3. Nephrotic syndrome (symbolic value), quantitative proteinuria and creatinine clearance at the time of biopsy and year after (continual variable) were used as clinical parameters. Discriminatory power was determined as a degree of decreasing Shennon's entropy by distinction of patients according to value of creatinine clearance at the time of biopsy, and a year after biopsy. Discriminatory power was measured in he information measurement units (bit). Based on discriminatory-predictive analysis we determined that glomerula changes and interstitial fibrosis had an equal effect (discriminatory power) on renal function at the time of biopsy and a year latter, as well as predictive value of these histological parameters and creatinine clearance at the time of biopsy.

[Malignant renal cysts]

Malignant renal cysts are extremely rare. Their symptomatology has been the same as of renal tumors or common renal cysts (pain, hematuria, elevated blood pressure, palpable tumor, subfebrile temperatures). Diagnostic procedures applied, which have been the same as for tumors or solitary renal cysts, comprise the following: plain x-ray IVP, retrograde ureteropyelography, scintigraphy, echotomography and diagnostic cyst puncture, arteriography, CT. Preoperative diagnosis of malignant cyst has been rather rare, i.e. the operative is more frequent during surgical exploration. In our study malignant renal cyst was present in six (8.5%) patients; in three (4.3%) patients malignant cyst was preoperatively suggested by echotomographic findings, in three (4.3%) patients the diagnosis was established intraoperatively.

[Cyclosporine in the treatment of primary focal-segmental glomerulosclerosis]

Cyclosporin A (CyA) was administered at the Clinic of Nephrology, CCS, in treatment of 8 patients with steroid-resistant nephrotic syndrome (NS) caused by focal segmental glomerulosclerosis (FSG), Cyclophosphamide (CP) treatment was attempted in 6 of these cases, but without success. Prior to the onset of CyA therapy, CP treatment was interrupted, and the dose of prednisone was reduced to 0.4 mg/kg/48 h. CyA was applied in the initial dose of 5 mg/kg/bw/24h, and then adjusted so that CyA blood level was 80-120 ng/ml. Although CyA treatment caused proteinuric decrease in most of the patients (from 12.1 g/24 h to 8.2 g/24 h), complete NS remission was achieved in only one patient, the same as the incomplete one. The female patient with a positive response to CyA treatment behaved as "CyA-dependent" and each discontinuation of CyA therapy soon led to recurrent NS. Insignificant CyA effect on NS or renal function was registered in 4 patients, and the therapy was interrupted in two cases due to renal function impairment. Apart from nephrotoxicity, other CyA side effects were absent.

[The importance of the sonographic image in the differential diagnosis of acute rejection in kidney transplantation]

Between October 1987 and October 1992 110 biopsies of transplanted kidney. Histologic examination showed 36 cases of acute rejection (Ac), 19 cases of chronic rejection (Chr), 16 cases of acute tubular necrosis (ATN) and 39 cases of cyclosporin nephrotoxicity. Sonographic characteristics as: hyperechogenicity of the cortex, hypoechogenicity of central pyelovascular zone, large and sonolucent pyramids, spherical configuration of renal allograft, were coelating with histologic and relevant clinic sings of disease. The results show statistically significant correlation with sonographic sings of acute rejection and relevant histologic and clinical findings. There was no correlations in other groups of diseases. These results confirm ultrasound as the primary imaging tool and an invaluable diagnostic modality in the renal transplant patient.

[Renal size as an ultrasonographic parameter in the differential diagnosis of primary and secondary glomerulopathy]

Between October 1987. and October 1992. 289 biopsies of the kidney in patients with glomerular diseases were performed. Pathohistologic analysis showed 218 cases with primary and 71 cases with secondary glomerular diseases. In all patients kidneys were measured by ultrasound examinations. The results showed significant difference in longitudinal diameter of kidneys in patients with primary from those with secondary glomerular diseases. These results can help a nephrologist to diagnose glomerular disease.

[Frequency of electrocardiographic changes in patients with myotonic dystrophy]

Cardiac abnormalities are frequently associated with myotonic dystrophy (MD), and electrocardiographic (ECG) changes are not rare in these patients. The most common ECG abnormalities are PQ or QT interval prolongation, low P wave amplitude, ST elevation or depression, negative T waves, conduction and rhythm abnormalities. We analysed ECG changes in 42 patients with MD. ECG abnormalities were obvious in 24 (57%) patients. The most prevalent ECG changes were sinus bradycardia and low P wave amplitude, occurring in 23 (55%) patients. Nineteen (45%) patients had QTc prolongation. PQ prolongation occurred in 16 (38%) patients, abnormal Q waves in 9 (21%), intraventricular conduction defects in 7 (16%) and QRS prolongation or T wave changes in 4 (9%) patients. We found no ST alterations. ECG changes were more frequent in patients with severe disease, but it was not statistically significant. There was no correlation between age and ECG abnormalities in our patients.

[Treatment of myasthenia gravis with intravenous immunoglobulin G (IVIG)]

In the two past years 25 patients with generalized myasthenia gravis (MG) were treated with high-dose intravenous immunoglobulin G (IVIG) at the Institute of Neurology in Belgrade. The patients were affected with severe forms of MG (IIB, III and IV according to Osserman's classification) refractory to all previous treatment. All patients received IVIG, 250-350 mg/kg during five consecutive days. An immediate positive effect was mild and recorded 12-15 days later in only 37.5% patients. On the contrary, 92% patients showed delayed improvement which was effective for over six months. Distribution and severety of the disease decreased as expressed by reduced Besinger mean clinical score from 12.3 to 5.7 after six months. Immunologic parameters before and after IVIG treatment did not differ significantly. An increase of IgG was observed in 88% of patients. IVIG side effects were infrequent, usually mild, and qualitatively different from those induced by other therapies (azathioprine, corticosteroids). The authors emphasize the beneficial delayed effect of IVIG on the course of MG which resulted in significant reduction of the dose of additional immunosuppressive agents. The absance of immediate therapeutic effect of IVIG does not justify this mode of treatment in acute deterioration and crisis of MG.