Sternum resection and chest wall reconstruction with metaacrilate implant in tuberculosis.

We report a case of successful sternum and ribs/cartilage resection and chest wall reconstruction with a methacrylate implant produced using a three-dimensional model in a patient with a tuberculotic mass in this region. Clinical and radiologic follow-up 2 years after surgery showed excellent cosmetic and functional outcome.

Homogeneity, flatness, and "large" extra dimensions.

We consider a model in which the Universe is the direct product of an ordinary (3+1)-dimensional space--a brane where all the standard model fields are confined-and a compact hyperbolic manifold. The decay of massive Kaluza-Klein modes leads to the injection of bulk entropy into the observable Universe. The large statistical averaging inherent in the collapse of the initial entropy onto the brane smoothes out any initial inhomogeneities in the distribution of matter and of three-curvature.

Smallest nanotube: breaking the symmetry of sp(3) bonds in tubular geometries.

We describe how sp(2) carbon, threefold coordinated by other carbons, can be replaced by sp(3) carbon, also threefold carbon coordinated, to produce extremely small-diameter ( approximately 0.4 nm) carbon nanowires with only minimal bond-angle distortion. Under a naming convention analogous to that for ordinary carbon nanotubes, the smallest sp(3) tubes have wrapping indices (3,0) and (2,2). These systems have large band gaps and a stiffness larger even than that of traditional sp(2)-bonded carbon nanotubes. They therefore form the stiffest one-dimensional systems known.

[The importance of the sonographic image in the differential diagnosis of acute rejection in kidney transplantation]. / Znacaj sonografske slike u diferencijalnoj dijagnostici akutnog odbacivanja transplantisanog bubrega.

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]. / Velicina bubrega kao ultrasonografski parametar u diferencijalnoj dijagnozi primarne i sekundarne glomerulopatije.

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.

[Malignant renal cysts]. / Maligne ciste bubrega.

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.

[Idiopathic membranoproliferative glomerulonephritis (structural-functional relationship)]. / Idiopatski membranoproliferacioni glomerulonefritisi (strukturno-funkciona zavisnost).

We investigated 12 patents with idiopathic membranoproliferative glomerulonephritis. Discriminatory analysis was used for structural functional relationship in order 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 (continual variable) were used as clinical parameters. Discriminatory power was determined as a degree of decreasing Shennon's entropy dy distinction of patients according to value of creatinine clearance at the time of biopsy. Discriminatory power was measured in the information measurement units (bit). The most powerful was glomerular index (discriminatory power 0.29) in moderately reduced glomerular filtration rate (creatinine clearance 80 ml/min) at the time of biopsy. In severely reduced glomerular filtration rate (creatinine clearance 40 ml/min) vascular index had the greatest discriminatory power (0.24) while interstitial infiltration and interstitial fibrosis had less powerful discriminatory power (0.13). Negative predictive value of reduced glomerular filtration rate at the time of biopsy in membranoproliferative glomerulonephritis has been confirmed in other studies.

[Cyclosporine in the treatment of primary focal-segmental glomerulosclerosis]. / Ciklosporin u lecenju primarne fokusno-segmentne glomeruloskleroze.

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.

[Lupus nephritis--clinical and morfological correlation]. / Lupus-nefritis (klinicko-morfoloska korelacija).

During the last five years at our Department renal biopsy was carried out in 41 patients with systemic lupus erythematosus. On the basis of the pathologic findings glomerular changes were classified as follows: minimal in 5 patients; mesangial proliferative glomerulonephritis in 11; focal and segmental proliferative glomerulonephritis in 5; diffuse proliferative glomerulonephritis in 15; membranous glomerulonephritis in 3, and diffuse sclerosing glomerulo-nephritis in 2 cases. Morphological changes of renal biopsy did not correlate with the degree of deterioration of glomerular function. Twenty seven patients were regularly followed-up. Most of them had diffuse proliferative glomerulonephritis (11) and mesangial proliferative glomerulonephritis (7). This is a larger number than in other authors' series. The clinical manifestation of lupus nephritis was: nephrotic syndrome (19 patients); minimal urinary abnormalities (6); rapidly progressive renal failure (1), and acute nephrotic syndrome (1). The majority of patients had high blood pressure (23). Their immunosuppressive therapy was ordered according to renal histologic lesions and severity of extrarenal manifestations. Clinical remission was achieved in 22 patients, but 2 died due to extrarenal complications.

[Acute renal failure after kidney transplantation]. / Akutna bubrezna insuficijencija posle transplantacije bubrega.

The aim of the study was to establish causes of acute renal failure after renal transplantation and to investigate its influence on subsequent kidney function. Hundred sixty seven renal transplantations were performed at the Institute of Urology and Nephrology, Belgrade, from January 1988 to November 1991. Acute renal failure occurred in 29 patients. Monitoring of serum creatinine levels in acute renal failure patients in the first posttransplant year revealed significantly higher levels than in patients without acute renal failure in the immediate postoperative course. This indicates that acute renal failure significantly influences subsequent function of the transplanted kidney.

[Duplex-Doppler sonography in the diagnosis of acute rejection in kidney transplantation]. / Primena sonografske analize dupleks-dopler u dijagnostici akutnog odbacivanja presadjenog bubrega.

Duplex Doppler sonography can be used in evaluation of renal allografts. Arterial Doppler signals were quantified with a pulsatility index. In this study 114 Duplex Doppler examinations were performed in 75 patients after renal transplantation. The mean PI in patients with acute rejection was statistically compared with the mean PI in normal allografts, and the mean PI in patients with CsA nephrotoxic effects and chronic rejection. The data shaw that there is statistically significant difference between the patients with acute rejection and other examined groups. The results of this study show that the use of quantitative Doppler US scanning may be valuable in differential diagnosis among the various forms of graft disfunction.

[Kidney transplantation in high-risk patients]. / Transplantacija bubrega u bolesnika sa visokim rizikom.

Immunosuppression with Cyclosporine A in kidney transplantation, triple therapy (CyA + Imuran + corticosteroids) and plasmapheresis before and after kidney transplantation in high risk recipients (positive cytotoxic antibody, MLC at the level of non related persons), also in high risk patients (juvenile diabetes, patients over 50 years old). In 1988 we had done in our Centre, kidney transplantation in 52.8% (28: 53) in high and increased risk patients. Triple therapy with plasmapheresis before and after kidney transplantation (if the level of cytotoxic antibodies is over 15%) allows successful kidney transplantation in high risk kidney recipients. Patients with juvenile diabetes are also available kidney recipients with therapy and permanent regulation of blood sugar. The patients of the age group between 50-60 years should be considered as suitable for kidney transplantation.

[Characteristics of renal failure in chronic liver disease]. / Karakteristike bubrezne insuficijencije u hronicnih oboljenjima jetra.

The aim of this study was to establish the characteristics of renal failure in patients with cirrhosis and compare their laboratory data on blood and urine with those of patients with chronic renal failure without liver disease; and then to correlate the data of patients with cirrhosis and renal failure with that of patients with cirrhosis without renal failure in relation to liver function There were three groups of patients: group A - patients with cirrhosis and renal failure; group K1-patients with cirrhosis without renal failure; and group K2-patients with chronic renal failure. The parameters of renal and liver function were also compared. The laboratory data on blood and urine in patients with cirrhosis and renal failure revealed characteristics of prerenal failure in a higher degree (functional renal failure). When liver failure was concerned there was no difference between patients with cirrhosis and renal failure and subjects with cirrhosis and no renal failure. The degree of renal failure was not always the same regarding the degree of liver failure although they can sometimes paralell.