Polymyalgia rheumatica--an underdiagnosed disease.

Characteristic features of polymyalgia rheumatica, a widely underdiagnosed disease, are described. The features of the disease are illustrated by the authors' own experience in the treated patients, and compared with literature data. According to the authors' experience, patients with polymyalgia rheumatica are mostly treated for inaccurate diagnoses such as cervicobrachial or lumbosacral syndrome, seronegative rheumatoid arthritis, unexplained febrile state, or precipitated erythrocyte sedimentation rate of unknown etiology. This results is delayed diagnosis or the accurate diagnosis is never reached at all.

[Cardiac sarcoidosis verified histologically by endovenous myocardial biopsy]. / Sarkoidoza srca histoloski verificirana endovenskom biopsijom miokarda.

The female patient with sarcoidosis simultaneously involving the lungs, heart, liver, eyes, skin and lacrimal glands is presented. The diagnosis of this disorder was established by biopsy of the liver and skin as well as by at our institution newly introduced method of endovenous blind-myocardial biopsy. Generalized active sarcoidosis had brought the patient into a very profound cachectic state (body weight 48 kg), but her life was directly endangered by granulomatous inflammation of the myocardium with the development of cardiac decompensation, grade I and II atrioventricular conduction disturbances as well as by transitory and total AV block with frequent arrhythmias. A significant resolution of the disease occurred after the introduction of corticosteroid therapy. However, grade I AV block persisted even after one year of treatment, suggesting that the syndrome has probably proceeded from granulomatous inflammation to fibrosis. Therefore, the patient is still a potential candidate for an electrostimulator.

[Initial experience with ventilation-perfusion scintigraphy in patients with a suspected pulmonary embolism]. / Nasa prva iskustva s ventilacijsko-perfuzijskim scintigramom u bolesnika sa sumnjom na plucnu emboliju.

Ventilation-perfusion (V/P) scintigraphy was performed 62 times in 57 patients suspected of having pulmonary embolism (PE). The aim of this study was to present the results and our first experiences in V/P scintigraphy, as well as to point out some specificities of the study. Perfusion scintigraphy was performed following i.v. administration of 99mTc MAA. If the finding was positive, ventilation scan was performed directly after the inhalation of 99mTc DTPA aerosol. Based on the comparison of both findings the patients were divided into four groups: normal finding (8.1% of patients), low (54.8%), medium (22.6%), and high level of PE probability (14.5%). As V/P scintigraphy is a very sensitive and non-aggressive method, it is our opinion that it should be included in PE diagnosing as a "screening" method, because the scanning results greatly influence further therapeutical and diagnostic treatment of the patient.

[Is there a rheumatic fever?]. / Ima li reumatske vrucice?

In 1988, 11 patients with a suspicion to rheumatic fever (RF) or acute polyarthritis were admitted to the Department of Internal Medicine, University Hospital, "Dr. M. Stojanovic". Eight patients have been extensively treated together with a physiatrist, while one of them on an outpatient basis. Follow-up has been from 3 to 9 months. Rheumatic fever was diagnosed with a certainty in only one patient. Three have had the diagnoses of Reiter's syndrome and individually, of infectional, ankylosing and rheumatoid arthritis. One patient is still followed up because of the symptomatic diagnosis of partially cured oligoarthritis or recurrent RF. The numerical relation of established diagnoses for the followed up patients has been in accordance with the decrease in incidence of RF both in our country and the world some decades ago. The possible causes of frequent diagnoses of RF in adults and the necessity of careful evaluation of clinical and laboratory parameters and the need to follow-up unclear polyarthritis even when the patients are not hospitalized, until the definite diagnosis has not been made is stressed in this paper. Therefore, the administration of corticosteroids has to be avoided in these patients, except in special cases.

[Systemic allergic vasculitis: case report of a female patient with the Churg-Strauss syndrome]. / Sistemni alergijski vaskulitis: prikaz bolesnice sa Churg-Strauss sindromom.

A female patient with asthmatic attacks developed signs of peripheral and central nervous system involvement, cutaneous and joint manifestations, pulmonary and gastrointestinal involvement, with significant body weight loss. A blood eosinophilia was found and muscle biopsy revealed tissue infiltration by eosinophils and vasculitis. Very short interval from onset of first symptoms to appearance of vasculitis is a bad prognostic sign and probably cause of unsuccessful therapy.

[Henoch-Schoenlein purpura with pulmonary infiltration]. / Purpura Henoch-Schönlein s plucnim infiltracijama.

Purpura Henoch-Schönlein (PHS) was described in 55-year old man. The damages of skin, joints, gastrointestinal tract, kidneys and lung were found. The spreading of the PHS into the lungs with the development of transitory respiratory failure was found out on X-ray finding (bilateral pleural effusions and interstitial infiltrations), functional testing (differential diffusing capacity of alveolar membrane reduced to 31% of normal) and with measurement of blood gases (hypoxemia with PaO2 43.8 mmHg respectively 5.7 kPa). The impairment of lung function is rarely described since according to the data from the literature the lungs are damaged only in 6.5% of patients with PHS. Due to the corticosteroid therapy all clinical and laboratory findings were significantly improved.

Acute respiratory distress syndrome after aprotinin infusion.

OBJECTIVE: To report a case of acute respiratory distress syndrome (ARDS) following first exposure to aprotinin. CASE SUMMARY: A 24-year-old previously healthy white man was treated with aprotinin infusion because of bleeding following tonsillectomy. The patient had never been treated with aprotinin before, including local application of different hemostatics containing the aprotinin component. Two hours later, hypotension and severe ARDS developed. A full recovery was noted after discontinuation of the drug and prolonged ventilatory support. DISCUSSION: To our knowledge, this is the first reported case of ARDS following first administration of aprotinin, although serious adverse effects at first exposure have been reported. We propose two possible mechanisms for this adverse reaction: a nonallergic or anaphylactoid reaction with direct degranulation of mast cells and basophils by aprotinin, and microthrombosis of the small pulmonary arterioles precipitated by aprotinin. CONCLUSIONS: Most clinicians consider aprotinin to be a safe drug, especially if it has not been administered before. Reexposure carries a high risk of allergic reactions because of possible sensitization. Nonimmunologic, toxic, or idiosyncratic adverse reactions can be expected at first exposure to any drug, as well as to aprotinin.