A 45-year-old woman with an anticholinergic toxidrome.

Intentional or accidental intoxications are common in the emergency department, but are not always sufficiently recognised. When intoxication is suspected, the causative agent or combination of agents often remain unclear, making these patients a diagnostic challenge. We present here a 45-year-old woman who was admitted due to altered consciousness. The clinical presentation fitted the anticholinergic toxidrome and an intoxication with venlafaxine (her known prescribed medication) was suspected. Plasma venlafaxine concentrations, however, were very low. After 24 hours the patient recovered completely. Further testing after discharge revealed high concentrations of promethazine, confirming the suspected diagnosis. This case illustrates the importance of knowledge of toxidromes and good collaboration with the hospital pharmacist. Because of the thorough testing the patient could receive proper treatment.

Regulatory T-cells in periapical lesions.

CD4(+)CD25(hi)Foxp3(+) regulatory T-cells (Tregs) are of crucial importance in regulating the immune response, including the control of any defense against infection. Their presence in periapical lesions has not been demonstrated, as yet. We hypothesized that Tregs infiltrate periapical lesions, where they inhibit T-cell proliferation. The aim of this study was to characterize Tregs in periapical lesions by confocal microscopy, flow cytometry, and functional assays. We showed that CD4(+)CD25(hi)Foxp3(+) cells in periapical lesions expressed IL-10 and TGF-beta. Their frequency was significantly higher than in peripheral blood and correlated with the levels of TGF-beta and IL-10 in culture supernatants of periapical lesion mononuclear cells. Tregs inhibited the proliferation of responder T-cells in vitro, at least in part, by stimulating the production of IL-10. These findings suggest that CD4(+)CD25(hi)Foxp3(+) cells in periapical lesions may play regulatory roles in controlling local immune/inflammatory processes.

[Etiologic factors which affect the development of infrabony periodontal defects]. / Ucestalost etioloskih faktora koji uticu na formiranje infrakostanih parodontalnih defekata.

The aim of the study was to examine frequency and distribution of etiologic factors which, associated with chronic inflammation, can influence the forming of intrabony periodontal defects. The following were studied: occlusal trauma, erosions and concrements on the roots, tooth malposition, the absence of contact point, inadequate interproximal distance of roots and iatrogenic factors. The results revealed that the most frequent etiologic factor in the forming of intrabony periodontal defects was occlusal trauma--55.8%, erosion of the roots--38% and concrements in the roots--34%, as tooth malposition, inadequate interproximal distances of the roots, the absence of contact point and iatrogenic factors. In the forming of 23.5% of intrabony periodontal defects two or more of the studied factors pariticipated. By the analysis of the distribution of etiologic factors by jaw segments, it was concluded that occlusal trauma was the most frequent in upper incisors--61.6%. In upper premolars the most frequent factor was the erosion on the roots--75%, and in the upper molars iatrogenic factors and erosion of the roots--44.4%. In the lower incisors, occlusal trauma was the most frequent--62.5%, in premolars also trauma--35.7%, and concrements of the molars--64.2%. Considering the high incidence the factors associated with chronic inflammation can be extremely significant in the forming of intrabony periodontal defects during parodontopahty.

[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.