[Treatment of patients with subfulminant forms of viral hepatitis B using prostaglandin E1]. / Lecenje bolesnika sa subfulminantnom formom B-virusnog hepatitisa prostaglandinom E1.

The efficacy of prostaglandin E1 was demonstrated in the treatment of 4 patients with subfulminant hepatitis caused by a virus B. Three patients suffered from hepatic enchepalopathy of the first degree, and the remaining one of the second degree. In three patients the clinical and biochemical improvement came relatively quickly, followed by recovery. In one patient, due to drug intolerance, the treatment was discontinued on the third day. The recurrence of illness was noted with the moderate increase of serum aminotransferases activities without clinical deterioration, necessitating no further use of prostaglandin E1. Prostaglandin E1, applied in the treatment of patients with subfulminant form of hepatitis, has favorable effect on the course of illness.

[Clinical manifestations of infectious erythema in adults]. / Klinicko ispoljavanje infektivnog eritema kod odraslih.

The infectious erythema is usually childhood disease associated with rash and caused by parvovirus B19. At the beginning of 1993., at the Clinic for infectious and tropical diseases of the Military Medical Academy 36 patients were treated for this disease, the average age 21 years. The prodromal phase of illness lasted approximately 2.9 days, the elevated temperature 5.2 days, and 17 patients had temperature above 39 degrees C. The rash was usually maculo-papullous and lasted about 6 days. Four patients had the recurrence of rash. The polyarthralgia appeared for short in six patients and in one patient lasted longer than 4 months. The mild anemia during infectious erythema was observed in 18 patients. IgM antiparvo B19 antibodies were proven in serum in 91.7%, and IgG antibodies in 58.3% of patients.

[Personal experience in the treatment of chronic viral hepatitis B with recombinant interferon B alfa-2]. / Nasa iskustva u lecenju hronicnog virusnog hepatitisa B alfa-2 rekombinantnim interferonom.

Twelve patients were treated with alpha-2 recombinant interferon during 4 months. Patients were given daily dose of 3 million units three times a week. Therapeutic effect expressed as the percentage of HBeAG seroconversion or by the loss of antibodies for the core antigen in IgM fraction and by the core antigen loss from hepatic tissue, was achieved in 41.6% of patients. Corticosteroids, administered before interferon, could improve therapeutic effect. Better response to therapy was observed in patients with higher serum transaminase levels and with histopathologically confirmed chronic hepatitis. Predictive value of each immunological parameter of therapeutic effect requires further study.

Deterioration of mixed cryoglobulinemia during treatment with interferon-alpha-2a.

A 60-year-old female developed mixed cryoglobulinemia associated with liver cirrhosis caused by the hepatitis C virus. During treatment with rIFN-alpha-2a, deterioration of cryoglobulinemia was recognized. The possible mechanisms underlying the deterioration are discussed.

[Dissecting aortic aneurysm as a cause of fever of unknown origin]. / Disekantna aneurizma aorte kao uzrok nejasnog febrilnog stanja.

Dissecting aortic aneurysm is a clinical syndrome commonly with a dramatic course and a fatal prognosis. The disease often has a fatal ending at the very beginning, a few hours after the onset. High temperature happens sometimes, but is rarely a dominant symptom. We presented a case of a patient with a long term febrile state caused by dissecting aortic aneurysm, where pleuropneumenia covered the real nature of the disease. It has been pointed out that dissecting of aorta should be thought of in patients with unclear febrile states, especially if they have difficulties in the area of thorax.

[Endotoxemia in patients with food poisoning]. / Endotoksemija u bolesnika sa alimentarnom toksiinfekcijom.

In 22 patients with alimentary toxoinfection caused by salmonella and other gram-negative bacteria, endotoxemia was proved in 8 (36%) patients. The causative agent of the disease was proved in 11 (50%) of cases. In 6 (54%) patients the causative agent were from salmonella species: S. enteritidis, S. typhimurioum, S. hadar and S. heidelberg. Endotoxemia and positive coprocultures, that is, hemocultures were found in two patients respectively. In two patients with positive coprocultures and hemocultures, endotoxemia was found as well as in two patients with unknown causative agent. In patients with alimentary toxoinfection caused by salmonella and other gram-negative bacteria, endotoxemia occurred relatively often. Early detection of endotoxemia is important for application of urgent therapeutic measures and procedures, especially in immunocompromised patients.

[Clinical characteristics of Lyme disease]. / Klinicke karakteristike lajmske bolesti.

Clinical characteristics of Lyme disease were analysed in 22 patients. Erythema migrans was found in 20 (91%), arthralgia in 18 (81%), neuralgia in 8 (36%), encephalitis in 3 (13%), carditis in 2 (9%) and arthritis in 2 (9%) patients. The positive antibody titer was found in 14 (63%) patients. Favourable effects of antibiotic therapy was achieved in all patients. Erythema migrans has been manifested up to 12 days after tick sting and arthralgia, arthritis, neuralgia, hepatitis and chronic dermatitis within a year. Carditis and encephalitis have been developing from a month to ten years after tick sting. Lyme borreliosis is commonly manifested as a systemic disease. Together with the skin, most commonly have been involved ankle joints, heart and nervous system. The time from tick sting to the onset of first signs of the diseases varies by the involved organs.

[Changes in thyroid hormone levels in patients with acute viral hepatitis]. / Promene nivoa hormona stitaste zlezde u bolesnika sa akutnim virusnim hepatitisom.

In 10 patients with acute viral hepatitis A or B the dynamics of the concentrations of the thyroid hormones thyroxine (T4), triiodothyroxine (T3) and their coefficient T3/T4, and thyroid stimulating hormone (TSH) in all phases of hepatitis have been studied. In acute phase and in the fully developed clinical picture of the diseases, the increased T4 values and decreased values of T3, T3/T4 coefficient and TSH were found. These changes are explained by the slowed down deiodinization of T3 and T4 in hepatocytes as well as by the disturbed secretion of the thyroid hormone in hepatitis and they could be of some value in diagnosis and prognosis.

[Modern therapy of Lyme disease]. / Savremena terapija lajmske bolesti.

The treatment of Lyme disease is placed in the centre of more than one medical discipline. So far the efficacy of antibiotic therapy application showed various results. The results of the treatment of two groups of the patients with Lyme disease were presented in the paper. The first group of twenty two patients was treated three weeks by the regime I, and the second group of nine patients was treated eight weeks by the regime II. During 3-year follow up 50% of the patients from the first group and 22% of the patients from the second group had recurrences. The total number of the recurrences in the second group was eight times less than the total number of the recurrences in the first one. The application of antibiotic therapy in the treatment of Lyme disease during eight weeks and more can contribute to the falling number of recurrences.

[Morphologic characteristics of HBV markers and products of iron metabolism in liver tissue in patients with hepatitis B virus]. / Neke morfoloske karakteristike markera HBV i produkata metabolizma gvozda u tkivu jetre bolesnika sa B virusnim hepatitisom.

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

[Dissecting aortic aneurysm as the cause of a fever of unknown origin]. / Disekantna aneurizma aorte kao uzrok nejasnog febrilnog stanja.

Dissection of the aortic aneurysm is a clinical syndrome with the most dramatic course and bad prognosis. Fever is a frequent occurrence, but rarely a dominant symptom. The patient with a prolonged fever caused by dissecting aneurysm of the aorta in whom pleuropneumonia masked the real diseases has been presented.

[Use of the ELISA immunoenzyme test and indirect immunofluorescence in the diagnosis of a toxoplasmosis epidemic]. / Primena imunoenzimskog testa ELISA i indirektne imunoflurescencije u dijagnozi epidemije toksoplazmoze.

Etiologic agent of lymphadenitis outbreak in one our military environment was detected by two serologic tests: ELISA (enzyme-linked immunosorbent assay) and indirect immunofluorescence test (IIF) both specific for IgM and IgG antibody detection in toxoplasmosis diagnosis. IgM-ELISA analysis of the first serum sample taken from a group of 79 soldiers with lymphadenitis was positive in 65 examinees (82.28%) and IgG-IIF technique in 52 (65.82%). In a group of 33 soldiers from the same unit with no signs of the disease IgM-ELISA test was positive in 12 (36.36%) and IgM-IIF in 9 (27.27%). In a group of 40 officers from the unit with the disease outbreak specific IgM antibodies were found by both tests only in the head cook. IgM antibodies were not found in a control group of 102 healthy soldiers from other units of the same garrison. Results of this investigation thermal injury showed variations in immune response to infection in dependence on trauma effect duration (in dependence on the phase). In the early posttraumatic phase organism is capable to react effectively to the inoculated infective agent and in the late posttraumatic phase this reaction is much less effective. Authors conclude that these results may influence upon the thermal injury management strategy in dependence on the trauma effect duration.

[Immunomodulation during viral infections]. / Imunomodulacija u toku virusnih infekcija.

The paper provides a survey of immunomodulation mechanisms in the course of viral infections. The importance of viruses in the disturbance of immunological homeostasis has been pointed out. Virally induced immunomodulation can arise by: a mechanism of complete or abortive viral replication in the lymphocytes and macrophages, by soluble viral factors, by the influencing of antigen-presenting cells, and by excessive suppressor T-lymphocyte stimulation. Viral infections present a real danger to the integrity of the immunological system, and this demands a follow-up and an adequate interpretation of the arisen disorders.