[Results of surgical treatment of ruptured abdominal aortic aneurysms]. / Rezultati hirurskog lecenja rupturirane aneurizme abdominalne aorte.

This paper analyzes results of 5-year surgical treatment of patients with ruptured abdominal aorta aneurysms (1991.-1995.) at the Clinic for Vascular and Transplantation Surgery of the Institute of Surgery in Novi Sad. 105 patients with abdominal aorta aneurysm underwent surgery, whereas in 31 patients there was a suspicion of rupture and it was confirmed by US and CT examination. One of basic factors to decrease mortality in these patients is early diagnosis and surgery before hemorrhagic shock occurs. Results in hemodynamic stabile patients with blood pressure over 100 mmHg and regular diuresis are much better with mortality of 20%. In order to estimate the correlation of hemodynamic state and outcome of the operation, patients were divided into three groups--hemodynamic stable with blood pressure over 100 mmHg and regular diuresis at admission: hemodynamic unstable patients with signs of mild or moderate shock and blood pressure under 100 mmHg and without initial diuresis which was regulated at the beginning of therapy and hemodynamic unstable patients in severe shock and unmeasurable blood pressure. The highest survival rate (10% mortality) and the least complications occurred in the first group of patients. The total mortality of patients after surgery was 48.48%. Timely diagnosis, suspicion of rupture and adequate first and with urgent transfer to a competent surgical institution are key factors in treatment of this disease and its outcome.

Peripheral blood CD5+ B cell subset in the remission phase of systemic connective tissue diseases.

OBJECTIVE: To get a better insight into the level of circulating CD5+ B cells as related to the systemic connective tissue disease activity. METHODS: Peripheral blood CD5+CD19+ cells of patients in the remission phase of systemic lupus erythematosus (SLE) (n = 28), Sjögren's syndrome (SS) (n = 20), rheumatoid arthritis (RA) (n = 26), and 19 control healthy subjects were analyzed by 2-color flow cytometry. RESULTS: In comparison to control group, the patients with SLE had a significant increase in the relative CD19+CD5+ blood cell count (p < 0.0005); this count was also different from the finding in both RA (p < 0.005) and patients with SS (p < 0.05). In contrast, the proportion of B cells expressing CD5 (within an individual B cell population) was significantly increased in all the 3 diseases compared to healthy subjects (SLE, p < 0.0001; SS, p < 0.05; and RA, p < 0.01). In the multivariate discriminant analysis, a discriminant function defined by the CD19+CD5+ subset strongly discriminated SLE, SS and RA from the control, but also SLE from both SS and RA. CONCLUSION: Our findings demonstrated that, in relation to healthy control subjects, the blood CD5+ B subset tended to be elevated in the patients in the remission phase of systemic connective tissue diseases, particularly in SLE.

[Tuberculosis in systemic connective tissue diseases]. / Tuberkuloza u tijeku sistemskih bolesti vezivnog tkiva.

Six female patients who developed tuberculosis during the treatment of connective tissue diseases are presented. Underlying disease--systemic lupus erythematosus, rheumatoid arthritis, and polymyositis--with its numerous immunopathologic processes essentially decreases resistance of the organism to infections. Tuberculosis usually accompanies chronic, exhausting diseases and tends to involve patients with the decreased immunity. The use of glucocorticoids and immunosuppressive agents has been shown to have a significant influence on the suppression of the immune system. Thus, tuberculosis is a dangerous, very often fatal complication in the course and treatment of connective tissue diseases.

Natural killer cell number and activity in remission phase of systemic connective tissue diseases.

The proportions and numbers of peripheral blood mononuclear cell markers and peripheral blood NK cell activity were analyzed and correlated in systemic lupus erythematosus (SLE), rheumatoid arthritis (RA) and Sjögren's syndrome (SS) patients in the remission phase of the diseases. In comparison to the control data, the number of CD56+ cells was significantly increased in RA patients only; the same held true for double-positive cells, i.e., the alterations did not distinguish various subpopulations of NK cells. NK cell activity was significantly decreased in all the three groups of patients, with the complete lack of correlation between the NK cell number and their activity. It is possible that a significantly diminished NK cell activity in these diseases provokes a compensatory production of nonfunctional NK cells.

T cell subset composition in remission phase of systemic connective tissue diseases.

The proportions and numbers of peripheral blood mononuclear cells bearing T-cell markers (CD3/HLA-DR, CD4/CD29, CD4/CD45, CD8/CD56) were analyzed using two-color flow cytometric analysis in patients with systemic lupus erythematosus (SLE), rheumatoid arthritis (RA) and Sjögren's syndrome (SS) in the remission phase of the diseases. The number of T cells (CD3+) in the blood was significantly decreased in SLE patients only; in these patients, but also in RA patients, an increased number of activated T cells (CD3+ HLA-DR+) was found. The number and proportion of helper T cells (CD4+) were decreased in SLE and SS, and normal in RA patients. In contrast, helper-inducer (CD4+ CD29+) and suppression-inducer (CD4+ CD45+) cells were both significantly increased in RA patients, decreased in SLE (only CD4+ CD45+ significantly) and unchanged in SS patients. Interestingly, however, the proportions of helper-inducer cells relative to total helper (CD4+) cell pool were significantly increased in all three groups of patients, whereas the proportion of suppression-inducer (CD4+ CD45+) cells was significantly decreased, but in SLE patients only. It is thus possible that this parameter is most pertinent to the disease status in the model studied. The population of CD8+ cells appeared more abundant in SLE patients, and the pool of CD8+ CD56+ cell was significantly enlarged in RA patients. It appears that the remission phase of disease in RA, SLE and SS patients still contains a substantial activation of the immune system, but the respective mechanisms are quite different in RA patients on one side, and SLE and SS patients on the other side.(ABSTRACT TRUNCATED AT 250 WORDS)

[The mastocytosis syndrome]. / Sindrom mastocitoze.

A female patient with the history and clinical signs suggesting cutaneous and systemic mastocytosis is reported. The diagnosis of cutaneous mastocytosis was confirmed by the Darier's sign as well as by histologic analysis of the skin. An X-ray film of the bones showed an infiltration of the mast cells into the skeletal system what was also cytologically and histologically proven. The patient was treated only symptomatically because of the benign course of the disease. A current literature data on mastocytosis syndrome are discussed.

[Vascular aspects of experimental transplantation of the kidney in dogs]. / Vaskularni aspekti eksperimentalne transplantacije bubrega na psima.

Organ transplantation is predominantly vascular surgical procedure. Vascular aspects of renal transplantation are important in all surgical phases of this procedure: --donor-nephrectomy (living-related or cadaver nephrectomy)--include nephrectomy undamaged kidneys, each with good length of renal artery (with or without aortic patch), renal vein (with or without caval patch) and ureter --organ-ex situ-surgery (bench surgery) sometimes is necessary after cold perfusion with Collins solution --implant surgical procedure, which include--dissection of recipient vessels (localisation.) --venous anastomosis (type and technique) --arterial anastomosis (type and technique) --use of vascular grafts (autografts or alografts) for kidney revascularisation during implantation (???) In the period 1987-1988, in our Experimental Surgery Unit a total of 20 dogs were operated (experimental kidney autotransplantation) under the same surgical team. The aims of those experimental autotransplantations were: training of the surgical team for routine human renal transplantations and usefulness of vascular grafts (autografts or allografts) for kidney revascularisation. We divided animals into the three groups: The first group (5 dogs)--revascularisation using AUTOVENOUS grafts The second group (5 dogs)--revascularisation using ALLOGRAFTS (Dacron or e-PTFE-Goretex grafts) The third group (10 dogs)--direct revascularisation without vascular grafts (control group) The best results were in the third group (no early vascular thrombosis) especially with end-to-end arterial anastomosis (we prefer it) and end-to-side venous anastomosis. Unfortunately in the second group, results were bad (vascular anastomotic thrombosis in the all cases during the first 48 hours).(ABSTRACT TRUNCATED AT 250 WORDS)

[Etiopathogenesis of progressive systemic sclerosis]. / Etiopatogeneza progresivne sistemne skleroze.

Progressive systemic sclerosis (PSS) is a systemic disease of connective tissue involving the skin and internal organs characterized by fibrotic and degenerative changes. The disease is usually progressive, incurable and always leads to death. Several hypotheses about the etiopathogenesis of PSS exist which try to explain the cause of morphological changes of the connective tissue. The first theory advocates evolution of the primary lesion within the blood vessels, the second considers the primary event to be an abnormality of collagen metabolism manifested by fibrosis. The third postulates on an autoimmune basis for the disease, and the fourth is based on the disfunction of autonomic nervous system. All the theories are partly linked and represent the morphological, biochemical and immunological aspects of the pathogenesis of this disease.