Lipoprotein(a) Is the Best Single Marker in Assessing Unstable Angina Pectoris.

This study evaluated whether statin therapy changed a diagnostic validity of lipid and inflammatory markers in ischemic heart disease (IHD) patients. Levels of lipids, lipoproteins, apolipoproteins, inflammatory markers, and atherogenic indexes were determined in 49 apparently healthy men and women, 82 patients having stable angina pectoris (SAP), 80 patients with unstable angina (USAP), and 106 patients with acute ST-elevation myocardial infarction (STEMI) treated or not treated with statins. Diagnostic accuracy of markers was determined by ROC curve analysis. Significantly lower apoA-I in all statin-treated groups and significantly higher apoB in statin-treated STEMI group compared to non-statin-treated groups were observed. CRP showed the best ROC characteristics in the assessment of STEMI patients. Lp(a) is better in the evaluation of SAP and USAP patients, considering that Lp(a) showed the highest area under the curve (AUC). Regarding atherogenic indexes, the highest AUC in SAP group was obtained for TG/apoB and in USAP and STEMI patients for TG/HDL-c. Statins lowered total cholesterol, LDL-c, and TG but fail to normalize apoA-I in patients with IHD.

[Efficiency of a combined peginterferon alpha-2a and ribavarin therapy in intravenous opiate substances abusers with chronic hepatitis C].

BACKGROUND/AIM: The most important ethiology factor of chronic liver disease that progresses into terminal insufficiency is hepatitis C virus (HCV) infection. Intravenous (iv) drug abuse is the main cause for spreading HCV. Thus the therapy for such patients is of extreme importance in reducing the incidence of the disease. The aim of the study was to establish efficacy of a combined therapy with peginterferon alpha-2a and ribavirin in iv opiate substances abusers having chronic HCV infection in relation to sex, age, genotype and level of fibrosis and duration of HCV infection before the treatment. METHODS: Thirty one iv opiate substances abusers with chronic hepatitis C (HHC) were enrolled in the examination. The patients were divided according to the genotype into two groups. The patients with genotypes 1 and 4 (n = 18) were treated for 48 weeks, while those with genotypes 2 and 3 (n = 13) for 24 weeks. PCR HCV RNA, genotype determination and liver biopsy were done to each patient. RESULTS: A stabile virological response was achieved in 93.5% of the patients, so the therapy demonstrated statistically significant efficacy i. v. opiate substances abusers with HHC (p < 0.001). There was no statistically significant difference in therapeutic response among patient groups formed according to the genotype, sex, duration of the disease and level of fibrosis (p > 0.05). CONCLUSION: Therapy of of iv opiate substances abusers with HHC has its specificities, and these patients need special treatment. Efficacy of the therapy was equivalent in patient groups formed according to the sex, genotype, level of fibrosis and duration of HCV infection. A combined therapy with peginterferon alfa 2a and ribavirin has high level of success in the treatment of these patients.

[Efficacy of antiviral therapy in patients with hemophilia and hepatitis C virus infection].

INTRODUCTION: HCV infection was common cause of morbidity and mortality in patients with hemophilia before 1986. We wanted to investigate the effect of treatment with combination therapy in HCV positive patients with hemophilia. MATERIAL AND METHODS: The research included totally 13 persons afflicted with hemophilia and HCV infection out of 21 tested. The patients were submitted to laboratory and clinical tests as well as genotypization, whereby a different hepatitis C virus genetic adherence was observed. Parallel with this subcategory the other one was put into comparison, consisting of 12 patients afflicted with chronic C hepatitis, marked as non-hemophilics. The both subcategories were treated with combination antiviral therapy (peginterferon alpha-2a and ribavirin) during 48 weeks for genotype 1 and 4, in reference to 24 weeks for genotype 2 and 3. Within the treatment, clinical and laboratory side-effects were noticed, which did not require therapy interruption. A more frequent hemorrhage during the therapy was found within the hemophilics, rather than before initiliazing it. RESULTS: After the statistical processing of the results (Students' t-test), statistically significant difference among these two subcategories was noticed as values for ALT (***p<0.0001) after 24 weeks of therapy, red blood cells (*p<0.05), haemoglobin and haematocrite (***p<0.0001) 24 weeks after therapy completing By PCR examination of the patients, 6 months after the end of treatment, a sustained viral response (SVR) of the same percentage was registrated within both subcategories, which is even greater than what the other authors have described. DISCUSSION: Main results were without important difference between two subgroups, except for higher number of spontanuous bleeding in group with hemophilia, which was somewhat expected. Most importantly, we didn't find any difference in SVR rates between groups. CONCLUSION: HCV positive patients with hemophilia could be successfully treated with combination therapy of peginterferon alfa-2a and ribavirin.

[Allergic granulomatous angiitis]. / Alergijski angiitis i granulomatoza.

Allergic granulomatous angiitis (AGA)--Churg-Strauss syndrome, is a rare autoimmune disease characterized by three distinct clinical phases: prodromal, eosinophilic, and vasculitic, and most of respiratory symptoms and signs begin in the first two phases of the disease. Two female patients of different age, who fulfilled the diagnostic criteria for AGA, and were in different phases and with the different duration of the disease are presented. The first patient (24 years of age) was admitted to the hospital due to aggravation of asthma, heart failure, and polyneuropathy. The second one (45 years of age) was also hospitalized due to the worsening of asthma, polyneuropathy, and fever. Both were treated continuously with glucocorticoids. The older patient also received a total of six pulse doses of cyclophosphamide. Satisfactory response to such a treatment was achieved in both cases.

[Primary localized cutaneous amyloidosis--lichen amyloidosis]. / Primarna lokalizovana kutana amiloidoza--lichen amyloidosus.

This case report presented a female patient with primary-localized-cutaneous-amyloidosis in the form of lichen amyloidosus. Primary-localized-cutaneous-amyloidosis is a rare idiopathic dermatosis caused by abnormal deposition of amyloid composed primarily of degenerated keratin filaments. In order to establish the final diagnosis, detailed clinical and laboratory investigations were performed, with a particular emphasis on pathohistological analysis of skin specimens, special stains, and electron microscopy.

[Breast carcinoma with melanocytic differentiation]. / Karcinom dojke sa melanocitnom diferencijacijom.

Azzopardi and Eusebi were the first to describe pigmented breast cancers in 1977. They postulated that the mammary cancer might become colonized by melanocytes at the expense of the epidermis, which was focally depleted of melanocytes, and that it occurred in most cases of breast cancers in which tumor cells reached the dermal-epidermal interface. Other authors suggested melanocytic differentiation of tumor cells. In this paper a case of a patient with ductal invasive breast cancer with partial melanocytic differentiation was presented, documented by HMB-45 and melan-A reactivity of tumor cells. Tumor was positive with antibodies for estrogen and progesterone receptors, pancytokeratin, negative with antibodies for S-100 protein and vimentin. Masson-Fontana reaction was negative. It was concluded that pigmented tumors should be differentiated from tumors with partial melanocytic differentiation, and that clinical significance of melanocytic differentiation should be analysed on larger number of cases.

[Epithelioid vascular tumor]. / Epiteloidni vaskularni tumor.

Epithelioid vascular tumors are neoplasms formed by endothelial cells, morphologically similar to epithelial cells. Morphological shape of the cells in this tumors varies from benign to malignant forms, causing the diverse biological potential of the tumors. This case-report presents immunophenotypically interesting epithelioid vascular tumor of the upper vena cava manifested in thrombotic complications. It is characterized by solid growth of tumor cells and the attempt of forming vascular channels. According to immunophenotype, tumor cells corresponded to endothelial cells with low proliferative potential and vasoformative capability of forming intracellular lumina. For that reason this tumor manifested similarity with epithelioid hemangioendothelioma. However, it differentiated from the hemangioendothelioma by benign cytomorphological characteristics of tumor cells, absence of pathological mitoses, more intensive inflammatory infiltrate with eosinophylia and good tissue control, of tumor growth because of the presence of pericites. According to histological features and histochemical analyses the diagnosis of this tumor was established as an intravascular, solid, epithelioid hemangioma.