Subcutaneous dirofilariosis in South-East Serbia--case report.

Human dirofilariosis is a relatively rare infection caused by filarial worms of the genus Dirofilaria. We herein report the first case of human subcutaneous dirofilariosis in the southeastern part of Serbia. A complete alive nematode was removed from a nodule in the periorbital region of a 50-year-old woman. The nematode was morphologically identified as a D. repens-like immature female. The diagnosis was confirmed with molecular methods. The patient was probably infected in the South-East Serbia as she had not travelled abroad, nor in other parts of Serbia such as Vojvodina, recently identified as a hyperendemic area for D. repens infection of dogs.

Ethnobotanical study on traditional uses of wild medicinal plants in Prokletije Mountains (Montenegro).

AIM OF THE STUDY: The main objectives were to collect information on the use of wild growing medicinal plants by local people living in high mountain region of Montenegro and conduct local botanical and ecological surveys. Active ingredients of plant species officinal in European Pharmacopoeia 6.0 (Ph. Eur. 6.0) were studied and we assessed possibilities for commercial exploitation for local economic development. MATERIALS AND METHODS: The 75 people that were interviewed (40-82 years old) identified 94 species for treatment of various human ailments. For each named species, the following elements are provided: botanical name, family, part(s) used, medicinal use and perceived property, listing in published pharmacopoeias, the relative abundance of each species and locality where the plant was collected. Chemical analyses were done according to prescriptions of Ph. Eur. 6.0 in order to estimate potential commercial use of native plants. RESULTS AND CONCLUSION: The most common in traditional usage were Rosaceae (11 species) making 11.7%, Asteraceae (10 species) 10.6% and Lamiaceae (7 species) 7.4%. From 94 species reported, 35 (37.2%) are officinal in Ph. Eur. 6.0 and 12 in national pharmacopoeias (12.8%). Aerial parts were mostly used (43.6%). The most frequently reported medicinal uses were for treating gastrointestinal (57.4%) and respiratory diseases (41.5%).

Suicide in the elderly 60 years of age and over in the south-east part of Serbia.

Some previous investigations indicated that economic crisis (inflation in Serbia 1993/94) have great influence on increasing suicide rates in Serbia. After that suicide decreased, despite the war and bombing in 1999, specially among the elderly people. A total of 453 suicides were registered on the territory of south-eastern Serbia during 1995-2001 years. Of them 295 (65.1%) were aged over 60 years. Generally linear trends of suicide among both genders from 1995 to 2001 decreased, but the slope of decreasing was grater among males than among females. The highest rates among the both genders were registered in the years with the maximum number of suicides, but the linear trends of rates have statistically important correlation with time (r>0.5). Average annual suicide rate among males was 42.5, and among women it was 18.7. The highest average annual suicide rate among men was observed in the age group 75 years and over (93.3), and the lowest in the age group 65-69 (20.6). Among males, in the all age group linear trends of suicide rates decreased, with the highest slope among 75 years and over and the lowest among 65-69 years. The highest suicide rate among females was registered in age group 75 years and over (25.6), the lowest in the age group 65-69 (13.5). The linear trends are similar as among males: downward trend was observed among all aged groups, with the highest slope among women 75 years and over. The most common way of suicide among men was hanging up (63%), poisoning and by firearms. There were no statistical differences between way of suicide and age groups. The most frequent way of suicide among females was hanging up (55%), poisoning (25%) and drowning (12%). There were statistically significant differences in drowning between age groups, 70-74 and 75 and over (p<0.05), and between poisoning and age groups 60-64 years and 75 years and over. Poisoning and drowning are statistically more frequent among women than among men.

[Etiopathogenesis, clinical picture and diagnosis of onychomycoses]. / Etiopatogeneza, klinicka slika i dijagnostika onihomikoza.

ETIOLOGY OF ONYCHOMYCOSES: Onychomycoses can be caused by dermatophytes, molds and yeasts. However, dermatophytes appear to be the chief organisms capable of a primary attack on the nail. By far the most frequent dermatophytes isolated from nails are Trichophyton rubrum, T. mentagrophytes var. interdigitale and Epidermophyton floccosum. Molds virtually only invade toenails, but their role as a primary pathogen is still debated. Yeasts have been isolated from diseased nails at highly different rates. Nails may be infected by two different dermatophytes, two dermatophytes and a yeast, a dermatophyte, a yeast and a mold, etc. PATHOGENESIS OF ONYCHOMYCOSES: The mode of infection is still under debate. In many cases palmar and/or plantar tinea, exists but can often remain asymptomatic for years. After spreading to the nail, the fungus invades the hyponychium or lateral nail sulcus to finally reach the nail bed where it moves proximally to the matrix. Proximal subungual onychomycosis probably starts with a fungal skin infection, whereas white superficial onychomycosis seems to be a culture of T. mentagrophytes on a softened nail surface. Total dystrophic onychomycosis may result from both distal and proximal subungual onychomycosis or from C. albicans in chronic mucocutaneous candidiasis. Candida infections occur most often due to previous Candida paronychia, but it appears that a number of cases of so called idiopathic onycholysis are also caused by C. albicans with damage to the hyponychium being the portal-of entry. CLINICAL PICTURE OF ONYCHOMYCOSES: Onychomycoses can be divided into four different types. Distal subungual onychomycosis is the most common. The most frequent presenting clinical features are thickening and opaci-fication of the nail plate along the distal and lateral borders. The discoloration ranges from white to brown. The edge of the affected nail is usually uneven and often one or more streaks of dystrophic discoloured nail extend towards the distal border. Proximal subungual onychomycosis is uncommon. A white spot appears beneath the proximal nail fold and may extend distally to involve the deeper layers of the whole nail. Superficial white onychomycosis is also uncommon. The surface is the initial site of invasion. The causative organisms produce small superficial white and powdery patches over the nail. The surface becomes rough and the texture softer than normal. Total dystrophic onychomycosis represents the most advanced from all the previous three types, especially the distal subungual onychomycosis. The nail matrix has become permanently scarred by chronic infection. The nail is thick, elevated, denser and opaque. Candidomycotic onychomycosis shows erythematous and swollen proximal and lateral nail folds. Consequently, the nail plate becomes detached from the eponychium. Mycotic onycholysis is characterized by detachment of the nail plate from the bed, distal nail erosions, and grayish-yellow paste-like material under the nail. DIAGNOSIS OF ONYCHOMYCOSES: The diagnosis of onychomycoses cannot be made on the basis of clinical observation alone. Direct microscopy plays an important role in diagnosing nail fungal infections. However, fungal cultures are the only definitive test that can be used to identify the genus and the species of the infectious organism. Histological examination is a routine technique useful for defining the nature and localization of fungi in the nail plate. Immunohistochemistry applied to onychomycosis is an experimental approach bringing prominent information about identification of fungi. In vivo confocal microscopy represents a technique of the future.

[Darier's disease--a familial case report]. / Darierova bolest--familijarni slucaj.

INTRODUCTION: Darier's disease is a slowly progressive autosomal dominant disorder characterized by a gene with variable penetrance. However, many cases of this disease are considered to be a new mutation in the genealogic tree. The prevalence of the disease was estimated as 1/55,000 to 1/100,000. CASE REPORT: The authors report a case of a female patient, 66 years of age, with Darier's disease, hospitalized at the Clinic of Dermatovenereology of the Clinical Center Novi Sad. The first changes of the skin occurred at the age of 16 originally on the shins and face, as miniature hard papules confluent in larger areas. Skin changes always exacerbated in the summer. At hospital admission the patient's head and hair were whole covered with white, thick, keratotics layer, resembling a helmet. The skin of the trunk was covered with white-gray, hyperkeratotic, fused papules like verrucous plaques, more expressed on the back. The skin of forearms presented with hyperkeratotic papules, and dorsum of the hands presented with plaques. Lower legs were covered with fused papilokeratotic, rough cauliflower-like layers with macerates and foetor. Buccal mucous was covered with whitish papules on erythematous lesions of cobblestone-like appearance. The nails were thickened with longitudinal furrowing, whereas the left third finger presented with V-shaped onychorrhexis. 4 generations were investigated, and the disease occurred only in the patient's younger daughter. DISCUSSION: Beside the classic "seborrheic" forms of Darier's disease there are a few clinical types: hypertrophied (intertriginous), vesiculo-bullous and linear (zosteriform) type. CONCLUSION: This case is a very severe classic form of Darier's disease, with variable penetrance and severity in the family.

[Epidemiologic characteristics of onychomycosis--results of a retrospective study]. / Neke epidemioloske odlike onihomikoza--rezultati retrospektivnog ispitivanja.

INTRODUCTION: The term onychomycosis is used for fungal infections of the nail unit. Tinea unguium is defined as a dermatophyte nail infection. The aim of this study was to determine the epidemiological characteristics of onychomycoses. MATERIAL AND METHODS: Ambulatory patients of the policlinic department of the Clinic of Dermatovenereology in Novi Sad were included in this study. Every patient with clinically suspected nail changes was examined. Direct microscopy of nail clippings and isolation of fungi on Sabouraud agar were performed. The results were evaluated using standard statistic methods. RESULTS: During a one-year-period (1995-1996) 70 cases of onychomycoses were registered that is 1.07% of the total number of patients examined in this period (N = 6535). The vast majority of observed patients were females (N = 47-67.14%), and male patients were significantly less frequent (N = 23-32.86%, p < 0.01). The most frequent type was dermatophyte onychomycosis (N = 39-55.71%), and the most often isolated agent was Trichophyton mentagrophytes (N = 38-54.29%). Manual workers were most often affected (N = 18-25.71%). Most patients were in the 41-50 year age group (N = 23-32.86%). The mean age of patients was X = 47.64 years (SD = 15.39). Table 4 shows the clinical duration of different types of onychomycoses. The longest clinical course was in the group of dermatophyte onychomycosis (20 years, one case). The mean clinical duration of the whole group was 26.81 months (SD = 40.04). Table 5 shows presence of other dermatomycoses associated with onychomycoses. Tinea pedis was the most frequently observed dermatomycosis (N = 9-60.00%). DISCUSSION: The incidence (1.07%) is something less than usual, and other findings are compatible with standard results. A lower incidence could be the result of the fact that children under 17 years are managed at the Institute of Mother and Child Health Care in Novi Sad. CONCLUSION: This study is a contribution to epidemiological investigations of onychomycoses. This disorder, with its social and medical importance and dubious treatment results, puts onychomycoses on high level of interest in modern dermatovenereology.

[Small-plaque parapsoriasis: case report]. / Parapsorijaza malih plakova: prikaz slucaja.

INTRODUCTION: Small plaque parapsoriasis is a relatively rare, chronic, idiopathic dermatosis, most often seen in middle age people. This disease shows a definite male predominance of approximately 3-4: 1. It is characterized by presence of round or oval erythematous, slightly scaly plaques on the limbs and trunk, which histologically reveal mild eczematous changes. CASE REPORT: A male patient, 61 years of age, was admitted to the Clinic of Dermatovenereology in Novi Sad due to long persisting erythematous patches on his upper and lower limbs. Plaques were of oval and round shape, pretty well marginated. They were of light red colour, covered with fine scales with a slightly wrinkled surface. He complained of itching. Laboratory findings showed no abnormalities. Histopathologic examination of the skin specimen revealed epidermal atrophy, focal parakeratosis, perivascular dermal infiltrate of mononuclear cells with exocytosis in the epidermis. This finding was compatible with the clinical diagnosis. After treatment with topical corticosteroid cream combined with whole body exposure to sunlight irradiation, vast majority of skin lesions regressed. DISCUSSION: The clinical course of small plaque parapsoriasis is very long. The plaques are remarkably stubborn, responding to treatment with steroid creams or to natural or artificial sunlight, but usually reappearing promptly when treatment is discontinued. The patches increase in number for a time, and then remain relatively constant for a long time. A small minority of cases clears entirely. Recent studies provided evidence of monoclonality and immunophenotypic abnormalities. Rearrangement of T-cell receptor genes was demonstrated by using PCR method. Detection of monoclonal T-cell populations in skin lesions, as a characteristic of lymphoproliferative diseases, forced some authors to include this dermatosis into a group of abortive cutaneous T-cell lymphomas. CONCLUSION: This case deserves a long and probably life-long clinical and histological assessment, especially due to new knowledge about the possible nature of this disease.

[Occurrence of sexually transmitted diseases in Vojvodina during the last 20 years]. / Prisustvo polno prenosivih bolesti u Vojvodini u poslednjih dvadeset godina.

INTRODUCTION: Sexually transmitted diseases are the most often registered communicable diseases in a great number of countries. The aim of this study was to analyze dynamics and distribution of gonorrhea, syphilis and scabies in Vojvodina region during the last twenty years. MATERIAL AND METHODS: Epidemiological characteristics of gonorrhea, syphilis and scabies were analyzed on the basis of data obtained from the Section of Epidemiology of the Institute of Public Health in Novi Sad. The research included the period between 1980 and 1999, with sex and age distribution of patients. Morbidity rates were given per number of inhabitants of Vojvodina. RESULTS: In the period between 1980-1999 there were 454 registered patients with the diagnosis of syphilis in Vojvodina. The morbidity ratio was highest in 1980 (3.41/100.000), and lowest in 1991 (0.24/100.000). In the twenty-year period there were more patients with gonorrhea, than patients with syphilis. There were 44.621 registered patients with gonorrhea. The maximum morbidity ratio was in 1980 (25.09/100.000), but the minimum was in 1998 (1.68/100.000). Within the examined period scabies was recorded in 56.490 patients. The highest morbidity ratio was in 1984 (232.37/100.000) and the lowest was in 1992 (73.56/100.000). DISCUSSION: The average morbidity ratio of syphilis in USA, between 1992-1994, was 11.8/100.000 and at the same time in Vojvodina it was only 0.42/100.000. In Vojvodina most patients with this disease were 20-39 years old. In the same period in USA the ratio of gonorrhea patients was 309/100.000 and in Vojvodina it was 2/100.000. In this group also, most patients were 20-39 years old. However, scabies mostly appeared at the age of 7-14. CONCLUSION: According to the obtained results, the number of registered patients with these three diseases in Vojvodina stagnates or it decreases. In order to deal with real data, it is necessary to report these diseases regularly.

[Congenital giant pigmented hairy nevus--case report]. / Kongenitalni gigantski pigmentni dlacni nevus--prikaz slucaja.

INTRODUCTION: Authors present the characteristics of a giant congenital pigmented hairy nevus (GCPN) of the skin. CASE DESCRIPTION: A case of a female patient, 21 years of age, with many changes of the skin, namely: giant congenital pigmented hairy nevi involving the skin of the trunk, the upper and lower extremities and the face is reported. There have not been any changes in regard to the color, size or distribution of the nevi. The family anamnesis is negative. The involvement of the skin is 20% of the total body surface, according to Wallace. Since there was a suspicion of neurocutaneous melanosis, the patient underwent electroencephalography (EEG) and nuclear magnetic resonance (NMR). These examinations could not ratify the pathologic changes of the brain structures, which could affirm the neurocutaneous melanosis. DISCUSSION: The frequency of occurrence of GCPN larger than 20 cm in diameter in pediatric patients is estimated as 1:4,150 of children with female predominance. Data on possible malignant alteration of GCPN into a malignant melanoma vary from 6-12%. Authors have decided to follow-up the patient and to perform a clinical observation of the nevi, mostly due to extent of the skin changes and signs of malignant alterations. CONCLUSION: Authors have presented this case because of the risk of malignant melanoma development in a patient with GCPN and in the aim of pointing to the problem of melanocytic tumor progression.

[Von Recklinghausen's neurofibromatosis (neurofibromatosis type I)--a familial case report]. / Von Recklinghausenova neurofibromatoza (neurofibromatoza tip I)--familijarni slucaj.

INTRODUCTION: Neurofibromatosis is a term used for two disorders: NF-1 and NF-2. NF-1 is Von Recklinghasusen's neurofibromatosis and comprises characteristic skin lesions (cafe au lait spots, intertriginous freckles, neurofibromatous skin tumors) and other congenital and hamartomatous bone, endocrine glands and central nervous system lesions. Its incidence is one in every 2500 to 3300 births. CASE REPORT: Two female patients, a 20 years old daughter and her mother 46 years of age were admitted to the Clinic of Dermatovenereology in Novi Sad due to appearance of many sessile and pedunculated neurofibromas, cafe au lait spots and freckles on their trunks, axillary and inguinal regions. Laboratory findings showed no abnormalities. Both of them were examined by many specialists. No systemic disturbances were established. The daughter was sent to plastic surgery for operative treatment. DISCUSSION: The clinical presentation of NF-1 is very variegated. Beside characteristic skin lesions, other clinical features include skeletal bony abnormalities, mental deficiency, seizures, neurofibromas of the spinal and cranial nerve roots, iris hamartomas, optic nerve gliomas, endocrine disorders, endocrine tissue tumors, other visceral tumors, etc. Some of these disorders can be life-threatening. Malignant transformations of the NF-1 lesions occur approximately in 5% of patients, most often as neurofibrosarcomas, Wilms' tumors, rhabdomyosarcomas or various forms of leukemias. CONCLUSION: We present familial cases of Von Recklingausen's neurofibromatosis without systemic abnormalities so far. The clinical course of this disease is unpredictable and a multidiscipline clinical assessment is necessary during whole life.

[Epidemiologic characteristics of viral dermatoses--results of a retrospective study]. / Neke epidemioloske odlike virusnih dermatoza--rezultati retrospektivnog ispitivanja.

INTRODUCTION: A great number of skin diseases are caused by viruses (1, 2, 3). Virus infections can cause skin diseases due to three mechanisms: direct inoculation, systemic infection and local spreading of the internal focus. The aim of this study was to determine the characteristics of virus-associated dermatoses (VD). MATERIAL AND METHODS: Ambulant patients of policlinical department of the Clinic of Infectious and Dermatovenereological Diseases Novi Sad were included in this study. Epidemiologic characteristics were analyzed by retrospective studying of medical documentation. RESULTS: During a five-year-period (1991-1995), 1,461 cases of VD were registered or 7.09% of the total number of patients examinated in this period (N = 20.596). Majority of the observed patients were males (N = 788-53.25%) and female patients were less frequent (N = 683-46.75%, table 1). Table 2 shows the age distribution of our patients. Most of the patients were in the 20-29 year age group (N = 443 or 30.32%). The mean age of patients was X = 36.14 years (SD = 19.02). Table 3 shows the occupational structure of our patients. The most frequent was the group of employed (N = 773 or 50.17%). Table 4 shows the structure of the patients according to pathogenic agents. The most frequent was the group of warts and condylomata (N = 900 or 61.60%). It is apparent that the number of VD is increasing. DISCUSSION: According to collected data, patients with VD make up a great group being treated at dermatological clinics. Our findings (7.09%) are compatible to the standard results. A relative high mean age of our patients is determinated by the fact that the children are managed at the Institute of Health Care of Mother and Child Novi Sad (the warts are most frequent in this population) or in other dermatological ambulants. There is no evidence that actual socio-political events affect the spreading of VD. Most patients belong to the urban population making up dominant groups (employed, scholars, pensioners). CONCLUSION: The number of patients with VD is increasing. Although from year to year the number of diseased increases or decreases, generally speaking there is an increasing trend of VD.

[Clinico-histologic characteristics of spinocellular carcinoma of the skin]. / Klinicko-histoloske odlike spinocelularnih karcinoma koze.

INTRODUCTION: Authors present clinical-histological characteristics of squamous cell carcinomas of the skin in patients treated at the Clinic of Infectious and Dermato-Venereology Diseases in Novi Sad in the period from 1989 to 1995. MATERIAL AND METHODS: The examined group comprised 26 cases (2.32%) with histologically verified squamous cell carcinomas of the skin out of 1119 nonmelanomatous epithelial skin tumors, clinically examined by dermatologists and treated by x-ray surface therapy. All patients with SCC were clinically examined by dermatologists at the Clinic of Dermatology and Venereology in Novi Sad, while histological examinations were performed by pathologists of the department of Pathology and Histology of the Faculty of Medicine in Novi Sad. Tumor biopsy specimens were obtained by shave biopsy, saucer biopsy and punch biopsy. All the biopsy specimens wee histologically examined and verified with standard methods with haematoxyllineosin-staining. RESULTS: In the group of examined patients most were with SCC--that is exophytic tumor of the skin in 16 cases (61.54%). Histological examination revealed: squamous cell carcinoma of the skin in 9 cases (56.25%), keratotic squamous cell carcinoma in 5 cases (31.25%) and invasive squamous cell carcinoma in 2 cases (12.50%). In the examined group there were also 9 cases of SCC (36.41%) with clinical forms of endophytic tumor of the skin. By histological examination the following tumors were diagnosed: Morbus Bowen in 3 cases (incipient squamous cell carcinoma of the skin) (33.33%); squamous cell carcinoma of the skin in 5 cases (55.56%) and keratotic squa- mous cell carcinoma in 1 case (11.11%). In one case SCC with clinical features like keratoacanthoma was found (3.85%), while by histological examination keratotic squamous cell carcinoma of the skin was diagnosed. DISCUSSION: In regard to the biopsy technique, SCC of the skin was diagnosed mostly as spinocellular carcinoma of the skin in 14 cases (53.85%) without a more precise description of the degree of tumor cells degeneration as well as tumor edge characteristics and type of histological type of tumor. Keratotic squamous cell carcinoma was found in 7 cases (26.92%); it is a tumor of mature structure (1-2 Broders' grade of clinical stage of tumors), but also without a detailed description of the tumor edge and type of histological type of tumor. Invasive squamous cell carcinoma was found in 2 cases (7.96%) and it reveals a SCC of the skin with deep infiltration into the dermis and hypodermis, sometimes involving the neighboring tissue (cartilage tissue, bone, muscle tissue and so on). This histological form of SCC had 3-4 Broders' grade of clinical stage of tumors. CONCLUSION: Authors of the paper conclude that histological examinations of SCC of the skin are necessary meaning detailed analysis: degree of differentiation of tumor cells by Broders' examination, examination of tumor edges and histological types of tumor. The incisional biopsy of tumor lesions had only been used to confirm clinical diagnosis in order to perform x-ray therapy, but it could not meet necessary criteria the excisional biopsy could in regard to evaluate tumor edges and histological type of the tumor.

[Case report of Klippel-Trenaunay-Weber syndrome]. / Prikaz slucaja Klippel-Trenaunay-Weberovog sindroma.

This is a case report on a very rare and interesting clinical form of a generalized nevus flammeus as a part of Klippel-Trenaunay-Weber syndrome. Authors point to necessity of cooperation among dermatologists and other specialists in treatment and follow-up of such diseases.

[Clinical and epidemiologic aspects of paraneoplastic dermatoses in hospitalized patients treated at the Clinic for Dermatologic and Venereal Diseases in Novi Sad over a 10-year period (1980-1990)]. / Neke klinicko-epidemioloske odlike paraneoplastickih dermatoza kod hospitalno lecenih bolesnika na Klinici za dermatoveneroloske bolesti u Novom Sadu u desetogodisnjem periodu (1980-1990. godine).

Authors report results of a retrospective investigation on frequency of paraneoplastic dermatoses, their clinical characteristics, time of onset and course regarding 10 - year material on hospitalized patients at the Clinic for Infectious and Dermatovenerous Diseases in Novi Sad. Out of 9086 hospitalized patients in 14 patients (0.16%) paraneoplastic dermatisis was diagnosed. Out of 14 patients in 5 patients (35.71%) Herpes zoster was diagnosed; in 4 patients (28.57%) bullous dermatosis; in 2 patients (14.29%) paraneoplastic acrokeratosis; in 1 patient (7.14%) exudative multiform erythema in 1 patient (7.14%) erythema figuratum and in one more patient necrotic Herpes labialis was diagnosed. Concerning malignant neoplasms of internal organs together with paraneoplastic dermatosis in most cases (4 - 28.57%) chronic lymphocyte leucosis was found, and in remaining 10 (71.43%) carcinomas were diagnosed at different internal organs. In 7 cases (50%) malignancy proceeded paraneoplastic dermatosis, in 4 cases (28.57%) the malignancy was diagnosed at the same time as paraneoplastic dermatosis and in 3 cases (28.43%) malignancy was established after the onset of paraneoplastic dermatosis. Authors point to the fact that usual skin changes, characteristic for the dermatologic diseases mentioned, in cases when they are associated with visceral malignomas, are characterized by a more serious clinical picture, a longer course of the disease and resistance concerning usual therapy.

[Chronic urticaria caused by penicillin. Results of monitoring cases of acute penicillin urticaria which developed into chronic urticaria]. / Hronicna urtikarija izazvana penicilinom. Rezultati pracenja slucajeva akutne urtikarije na penicilin koji su se razvili u hronicnu urtikariju.

Penicillin is known to cause allergic reactions with different clinical manifestations and possible immunologic mechanisms. The purpose of this study was to follow cases of established hypersensitivity to penicillin and its possible development into chronic urticaria. 35 patients with a clinical picture of acute urticaria and with or without angioedema were examined. Three kinds of tests to penicillin were performed: patch test, scarification test and PPL test. Hypersensitivity to penicillin was confirmed in 12 (34.27%) patients with positive PPL test. Seven (58.33%) out of these 12 developed the clinical picture of chronic urticaria. As food was assumed to be the hidden source of penicillin, eliminatory diet was included. In 4 (57.14%) patients there was a complete remission of the disease during the course of diet without milk and milk products (intradermal test to milk and specific IgE antibodies were negative). The gathered results show that acute urticaria caused by penicillin can get a chronic character. It is the consequence of prolonged penicillin's activity in some so called "hidden sources of penicillin".

[Diagnostic value of electroencephalography and evoked potentials in monitoring brain maturation in children with febrile convulsions]. / Dijagnosticki znacaj elektroencefalografije i evociranih potencijala u pracenju cerebralne maturacije kod dece sa febrilnim konvulzijama.

A group of 31 children aged 4-14 was presented with clinical manifestations of febrile convulsions, which after clinical examination, were followed--up in outpatient clinics during 1-12 year period. Together with continuous electroencephalographic monitoring, visual and somatosensory potentials were measured with the aim to stress a diagnostic significance of these neurophysiological methods for cerebral maturation assessment in children with febrile convulsions. Results reveal that electroencephalography (EEG) and somatosensory potentials (SEP) have higher diagnostic sensitivity compared to the visual ones (VEP). In 25 children (80.64%) SEP changes were registered in the form of prolonged central conductivity time (CCT) and EEG revealed changes in the form of slower cerebral activity and posterior theta activities fr. 4-7 Hz (P-O bilaterally) in 10 children (32.26%). Registered SEP changes, particularly prolonged CVP, as well as changes in the form of slower basic cerebral activity or posterior theta rhythm could be explained by slower maturation of some CNS regions. EEG and SEP findings show positive correlation with clinical findings and different diagnostic sensitivity, therefore their use in clinical follow-up of children with febrile convulsions is important.

CEA and CA 15-3 in pleural effusion of advanced breast cancer patients: clinical relevance and diagnostic value.

Serum and pleural effusion fluid were tested for CEA concentration in 83 advanced breast cancer patients, in 43 of whom CA 15-3 was also determined. All pleural effusions were clinically malignant. The sensitivity of the CEA test for the presence of pleural metastases was closer to that of the CA 15-3 test in effusion (0.59 and 0.79, respectively) than the sensitivity of CEA compared to CA 15-3 in serum (0.43 vs. 0.79). The use of two markers combined with cytology increased the diagnostic rate from 48% (cytologically positive) to 88% (cytologically positive and/or with one or both markers increased in effusion). A high diagnostic rate in cytologically negative effusions (65%), and in effusions presented as the sole metastatic involvement (100%), points to the clinical value of these two markers. Our results show that markers produced by pleural metastases may be secreted either into the effusion fluid or into serum, or both. This finding, as well as some other observations, are discussed in the present paper.