Comparative analysis of accuracy of diagnosis of chronic periapical lesions made by clinical and histopatological examination.

INTRODUCTION: The preliminary diagnosis of chronic periapical lesions is made on the basis of clinical symptoms and radiographs, which is a reliable diagnostic tool, but it has only a subsidiary role since histopathological verification is essential for the definitive diagnosis. This study was aimed at diagnosing removed chronic periapical lesions and classifying them by size as well as at comparing the clinical diagnoses with histipathological results. MATERIAL AND METHODS: The study included 34 patients diagnosed with chronic periapical process by applying clinical examination and radiography. The removed chronic periapical lesions were processed according to classical histological technique and analyzed by hematoxylin and eosin staining protocol. RESULTS: According to histopathological analysis 53% of chronic periapical lesions were periapical granulomas and 47% were radicular cysts. The size of the lesions ranged from <9 mm (70% of lesions), 9 to 20 mm (18% of lesions) and >20 mm (12% of lesions).The histopathological examination revealed that clinical diagnosis was wrong in 26% of cases. CONCLUSION: A statistically significant difference between clinical and histopathological diagnosis has been found. The histopathological findings strongly suggest the necessity of complete curettage of lesions sizing >20 mm in order to prevent recurrences.

[Choice of surgical suture material used in oral cavity-clinical study].

INTRODUCTION: Historical data on closing and suturing of surgical wound describe a wide range of various suture materials. The choice of the surgical catgut, i.e. type and diameter, depends on the localization, characteristics and condition of the tissue to be treated. From the standpoint of oral-surgical practice the following clinical parameters are of the outstanding importance regarding the choice of suture material: accumulation of soft deposits on the sutures, decubitus of the adjacent soft tissues and dehiscence of the operative wound. AIM: The aim of this research was to determine the correlation between different types of suture materials and accumulation of soft deposits on the sutures, decubitus of the adjacent soft tissues and dehiscence of the operative wound. MATERIAL AND METHODS: Our prospective clinical study included 150 patients distributed into three groups of 50 subjects. The surgical procedure performed on each patient involved resection (aplicoectomy) of the tooth root end in the intercanine sector of the upper jaw. The following suture materials were applied: BLACK SILK 5-0, NYLON 5-0 and VICRYL 5-0. The effects of the selected sutures were evaluated by using several parameters: accumulation of soft deposits, wound dehiscence and decubitus of the adjacent soft tissues. The effects of the applied sutures were recorded on days 2, 5 and 7 after the surgery. CONCLUSION: The comparison of cited parameters of the investigated materials of ter suture of oral cavity mucosa revealed that none of the used material was ideal; however a certain preference might be given to the synthetic monofilament suture materials.

[Therapy of lupus nephritis with mycophenolate mofetil].

INTRODUCTION: Mycophenolate mofetil is an immunosuppressive agent used in transplantation and subsequently in a variety of autoimmune conditions. It inhibits both B and T lymphocyte proliferation, and also has nonimmune effects on the kidney. The major experience in systemic lupus erythematosus has focused on proliferative lupus nephritis. MATERIALS AND METHODS: In our study we treated 8 female patients having proliferative lupus nephritis with combination therapy of prednisone (1 mg/kg body weight) and mycophenolate mofetil (2 g per day). Complete remission was defined as a value for urinary protein excretion that was less than 0.5 g per 24 hours, with normal urinary sediment, a normal serum albumin concentration and improved or stable serum creatinine. Partial remission was defined as a daily proteinuria below 2g in the previously nephrotic patient or minimum 30% from starting values, with normal urinary sediment, serum albumin of minimum 30 g/L and stable serum creatinine. RESULTS: Two patients had a complete remission after 7 and 2 months respectively. Five patients had a partial remission after 5.2 +/- 4.3 months of therapy. One patient did not react to therapy. There were no side effects during the course of therapy. DISCUSSION: Considering the fact that 7/8 patients have had nephrotic range proteinuria and that 50% of patients were refractory on standard induction therapy, the results of this study are a good indicator of value of mycophenolate mofetil in the therapy of proliferative forms of lupus nephritis. CONCLUSION: Mycophenolate mofetil has satisfactory results in the treatment of proliferative forms of lupus nephritis with minimal side effects.

[Therapy of lupus nephritis with mycophenolate mofetil].

INTRODUCTION: Mycophenolate mofetil is an immunosupressive agent used in transplantation and subsequently in a variety of autoimmune conditions. It inhibits both B and T lymphocyte proliferation, and also has nonimmune effects on the kidney. The major experience in systemic lupus erythematosus has focused on proliferative lupus nephritis. MATERIALS AND METHODS: In our study we treated 8 female patients with proliferative lupus nefritis with combination therapy of prednisone (1 mg/kg body weight) and mycophenolate mofetil (2 g per day). Complete remission was defined as a value for urinary protein excretion that was less than 0.5 g per 24 hours, with normal urinary sediment, a normal serum albumin concentration and improved or stable serum creatinine. Partial remission was defined as a daily proteinuria below 2 g in a previously nephrotic patient or minimum 30% from starting values, with normal urinary sediment, serum albumin of minimum 30 g/L and stable serum creatinine. RESULTS: Two patients had a complete remission after 7 and 2 months respectively. Five patients had a partial remission after 5.2+/-4.3 months of therapy. One patient did not react on therapy. There were no side effects during the course of therapy. DISCUSSION: Considering the fact that 7/8 patients have had nephrotic range proteinuria and that 50% of patients were refractory on standard induction therapy, results of this study are good indicator of value of mycophenolate mofetil in the terapy of proliferative forms of lupus nephritis. CONCLUSION: Mycophenolate mofetil gives satisfactory results in the treatment of proliferative forms of lupus nephritis with minimal side effects.

[Correlation between sera levels of sICAM-1 and sVCAM-1 and severity of kidney lesions in patients with lupus nephritis].

INTRODUCTION: Adhesion molecules are essential for cellular interactions and are important in the activation and adhesion of cells. Studies have shown that elevated levels of solubile ICAM and VCAM are related to disease activity in patients with various acute and chronic inflammatory diseases. Our aim was to investigate the correlation between the levels of sICAM-1 anti sVCAM-1 and the degree of disease activity and severity of lupus nephritis. MATERIAL AND METHODS: Using the ELISA procedure, we determined the sera levels of sVCAM-1 and sICAM-1 in 80 patients with SLE and in group of 27 healthy volunteers. RESULTS: Patients with SLE had significantly higher sera levels of adhesion molecules comparing to the controls (p<0.001). There was a high positive correlation between the sera levels of sVCAM-1 and concentration of anti-ds DNA antibodies in patients with SLE (p<0.001), and there was also a negative correlation between the sera levels of sVCAM-1 and concentration of C3 and C4 component of complement (r=-0.64, r=-0.58). In the group of patients with lupus nephritis, significantly higher sera concentrations of sVCAM-1 were detected compared patients without nephritis. Patients with class III and IV kidney changes had significantly higher levels of sVCAM-1 compared to the patients with class II kidney changes. In the group of patients with activity index of kidney changes (AI) over 4 sVCAM-1 the sera levels were significantly higher compared to the group with AI <4. CONCLUSION: The sera level of sVCAM-1 is a reliable parameter to evaluate the autoreactivity degree in SLE. In the same time, sVCAM-1 sera level can be used as a reliable marker to evaluate the renal lesion extensivity in SLE.

[Quality of life in patients with chronic renal failure].

INTRODUCTION: Hemodialysis and transplantation are performed not only to replace renal function, but also to improve patients' quality of life. The aim of our investigation was to compare the quality of life in patients with chronic renal failure (CRF) before and after the introduction of active therapy. MATERIAL AND METHODS: We tested 76 patients (pts): 20 pts on conservative therapy (CT), 21 pts on chronic hemodialysis and 35 pts with renal transplantation. A questionnaire (combining two questionnaires) was used to investigate the physical, emotional and social aspects of health. RESULTS: In regard to physical health of transplantation patients (TP) it was established that work capacity and activities were less damaged, whereas physical activity was highest in pts on CT. Social activity was limited in a higher percentage in TP (40%) than in hemodialysis patients (HD) (19%), while family relationships were most damaged in pts on HD (28.57%). Discomforts were most common in pts on HD. The highest percentage of pts estimated their health status as good or average, but their health status improved after transplantation in 82.86% that is in 57.14% after HD. It was similar with the quality of life: 28.57% of kidney transplant patients rated their quality of life as very good, and 54.28% rated it as good: 38.09% of HD patients rated their quality of life as very good, whereas only 5% of CT patients rated it as very good, and 20% as good.

[Major characteristics of immunoglobulin A nephropathy]. / Glavne karakteristike imunoglobulin A nefropatije.

INTRODUCTION: Immunoglobulin A nephropathy (IgAN) is one of the most common forms of primary glomerulonephritis in many countries. Most clinical features of IgAN point to a renal problem, such as recurrent macroscopic hematuria or asymptomatic microscopic hematuria and proteinuria. Pathologic features of IgAN present with different types and different degrees of glomerular, tubulointerstitial and vascular lesions. The aim of this study was detailed analysis of clinical and laboratory findings, as well as findings of immunofluorescence and light microscopy. We also investigated associations between these factors. MATERIAL AND METHODS: We investigated 60 patients who underwent renal biopsy. The study was partly retrospective and partly prospective. RESULTS: The average age of patients was 34.19 years. Male female ratio was 2.33:1. IgAN was most frequently asymptomatic (83.33%) as microhematuria and proteinuria, while gross hematuria was found in 16.667%. Renal biopsy material was analyzed by light microscopy revealing changes in all glomerular structures. Immunofluorescence microscopy demonstrated dominant IgA deposits. This study established association of glomerulosclerosis with clinical features of disease. DISCUSSION AND CONCLUSIONS: IgAN frequently develops in the 4th decade of life, mostly in males and presents as asymptomatic (83.33%). Pathohistological changes include all glomerular structures. There is no specific serological test for IgAN, but pathological changes affect clinical features of the disease, as proteinuria and increase of creatinine concentration.

Tubulointerstitial dysfunction in early post-transplant period.

Dysfunction of a transplanted kidney may develop at any time in the post-transplant period. The aim of this study was to differentiate levels of early dysfunction of a transplanted kidney. The study included 45 examinees undergoing kidney transplantation. They were divided into four groups, in regard to length of hospitalization and post-transplant complications: group I (up to 15 days, complication-free); group II (up to 15 days, with complications); group III (up to 30 days); group IV (up to 60 days). The control group included patients undergoing abdominal surgery, without uropoetic system disorders. The following parameters were examined on a daily basis a month after transplantation on average: creatinine clearance, creatinine and urea. Statistical analysis of these parameters revealed the following levels of renal dysfunction: control group--circulatory tubular dysfunction without azotemia; group I--polyuric acute tubular necrosis; group II and group III--severe or moderately severe polyuric acute tubular necrosis and group IV--polyuric acute tubular necrosis.

[Radioconstrast nephropathy]. / Radiokontrastna nefropatija.

INTRODUCTION: Hospital-acquired acute renal failure increased in the last years from about 5 to 6.4%, while mortality remained high and according to newest investigations it is about 60% on average. Radiocontrast-induced nephropathy is the third cause of death in hospital-acquired acute renal failure. RISK FACTORS FOR RADIOCONTRAST-INDUCED NEPHROPATHY: Risk factors for radiocontrast-induced nephropathy include: the existing kidney disease, diabetes, dehydratation, multiple myeloma, older age and earlier kidney damage by contrast substances. COURSE OF RADIOCONTRAST-INDUCED NEPHROPATHY: The clinical course of radiocontrast-induced nephropathy may manifest from asymptomatic picture to development of oliguric form of acute renal failure. PREVENTION AND TREATMENT MODALITIES OF RADIOCONTRAST-INDUCED NEPHROPATHY: Modalities of prevention and treatment of radiocontrast-induced nephropathy are as follows: adequate hydration of patients, appropriate application of diuretics, calcium channel blockers nonionizing radiocontrast and preventive haemodialysis. EXPERIMENTAL STUDIES IN PREVENTION AND TREATMENT OF RADIOCONTRAST-INDUCED NEPHROPATHY: Experimental studies indicate application of atrial natriuretic peptide, endothelin, prostaglandin. CASE REVIEW: Two patients treated at the Clinic for Nephrology and Clinical Immunology in Novi Sad, presented with radiocontrast-induced nephropathy. In one patient it appeared after panaortography and in the second after computerized tomography of the abdomen. In both cases aggravation occurred due to already existing renal failure caused by radiocontrast substances. CONCLUSION: The problem is particularly important because there is a large number of patients in whom there is a risk of radiocontrast-induced nephropathy and it is necessary to carry out adequate prophylaxis and accurate assessment of kidney function before application of radiocontrast substances.

[Immunoglobulin A nephropathy and disease prognostic factors]. / Imunoglobulin A nefropatija i faktori prognoze bolesti.

INTRODUCTION: Immunoglobilin A nephropathy (IgAN) is a clinicopathological entity characterized by diffuse glomerular mesangial deposition of IgA as the predominant immunoglobulin. Renal biopsy reveals a spectrum of changes in glomerula, tubulointerstitium and blood vessels. 20-50% of all patients develop end-stage renal failure 20 years after onset of disease. The aim of this study was to investigate the incidence of IgAN and to analyze clinicopathological changes and prognosis of IgAN. MATERIAL AND METHODS: The study included 60 patients with biopsy-proved IgAN without some other systemic diseases or Henoch-Schonlein purpura. We analyzed clinical features of the disease, laboratory findings, findings of immunofluorescence and light microscopy and prognosis of IgAN. The study is partly retrospective and partly prospective. RESULTS AND DISCUSSION: Incidence of the disease in the period 1981-1997 was 9.78%. At the moment of renal biopsy 63.16% of patients had normal renal function, 31.58% had stage I and 5.25% had stage II chronic renal failure. At the end of study 21.05% of investigated patients were included into the worse stage of renal failure in regard to the initial stage. Progression of renal damage correlated with special tubulointerstitial damage and heavy proteinuria. CONCLUSIONS: In this study we found severe histopathological changes in the group with already impaired renal function and these changes correlated with laboratory findings, clinical features and prognosis. Normal renal function at the moment of renal biopsy pointed to risk for further damage. Changes in the tubulointerstitium and mesangium, heavy proteinuria and hypertension affect the disease prognosis. Evolution to the higher stage of renal failure was 1.24% per year and this requires long-term follow-up of patients with IgAN.