[The lipodystrophy syndrome and protease inhibitor therapy in HIV infection]. / Lipodistroficki sindrom i terapija inhibitorima proteaza kod HIV infekcije.

The accumulation of adipose tissue in the dorsocervical region is a typical finding in patients with intensive glycocorticoid function. This finding was described in numerous HIV infected patients. Combined antiretroviral therapy that included a protease inhibitor implied the suggestion that dorsocervical fat pad could be a consequence of protease inhibitor therapy. This is a case report of a patient who developed a similar changes a year after the beginning of protease inhibitor therapy.

[Successful treatment of echinococcal kidney disease with a combination of albendazole administration and percutaneous drainage]. / Uspesno lecenje ehinokokne bolesti bubrega kombinovanom primenom albendazola i perkutane drenaze.

Primary echinococcosis of the kidney, with no involvement of other organs is very rare manifestation of hydatid disease in humans. Until few years ago surgical treatment was the only therapeutical choice in patients suffering from this disease. This is a case report of a patient with large hydatid cyst of the left kidney. The patient was successfully treated with albendazole and percutaneous drainage of the cyst.

[Rhino-orbital zygomycosis]. / Rino-orbitalna zigomikoza.

Zygomycosis is rare but highly invasive fungal infection, with high mortality rate. A 67 years old diabetic man was presented with rhino-ocular form of the disease. Fungal elements invaded the skin and subutaneous facial tissue, with involvement of the nose, paranasal sinuses and orbit. The portal of entry of fungus was through paranasal sinuses, after the tooth extraction. Various clinical manifestations were presented: headache, facial swelling, tenderness over the involved sinuses, unilateral orbital cellulitis with proptosis, facial and orbital pain, black nasal discharge, decreased visual acuity, blindness. Patient was treated surgically and by liposomal amphotericin B. He underwent maxillectomy, ethmoidectomy and sphenoidectomy and orbital exenteration because of the dissemination of the disease into the orbit. The specific diagnosis of the infection was established upon the microscopic demonstration of casual agent in the debridement tissue. Early diagnosis was important in this highly fatal disease. Aggressive surgical debridement, therapy with amphotericin B and correction of underlying metabolic acidosis must be performed. The successful medical therapy in this patient suggests that lipid formulation of amphotericin B should be given, because this antifungal agent performed the best control of the infection with the minimal adverse effects.

[A severe form of falciparum malaria associated with staphylococcal endocarditis]. / Teska forma faliciparum malarije udruzene sa stafilokoknim endokarditisom.

A case is presented of a patient, aged 56 years, with severe form of imported malaria caused by Plasmodia falciparum. Hyperparasitemia of erythrocytes > 30% was registered, and during the course of the disease CNS dysfunction, severe anemia, acute renal failure, disseminated intravenous coagulation with manifest hemorrhagic syndrome, icterus, enterocolitis, pneumonia and staphylococcal endocarditis were developed Due to hyperparasitemia and numerous complications, antimalarial drugs such as quinidine (1,200 mg/day) and artemether (160 mg/day) were administered parenterally. Infected erythrocytes were exchanged with 2.5 litres of healthy erythrocytes suspension. Hemodialysis was also performed as well as nine-week antistaphylococcal therapy. During the treatment preparation of deplasmated blood, concentrated thrombocytes, fresh frozen plasma, cryoprecipitates, human albumins and immunoglobulins were applied, along with the correction of electrolytic dysbalance, administration of diuretic, cardiotonic, antiarrhythmic, anxiolytic, antipsychotic and antidepressive drugs. Two months after the admission the patient was released from the Clinic in good condition, with normal clinical-laboratory findings.

[Significance of determination of certain clinical and laboratory parameters in the evaluation of severity and outcome in sepsis]. / Znacaj odredjivanja pojedinih klinicko-laboratorijskih parametara u proceni tezine i ishoda sepse.

Sepsis and its complications are severe clinical syndrome that is caused by systemic inflammatory response of the host to infection. Despite the use of common and numerous new therapeutic protocols, mortality from this severe disease is still very high. In the study are presented 155 patients (111 males, 44 females) of average age 49.6 years with mean septic score 12.9 (2-40). Mortality in our patients was 20.6%, septic shock developed in 31.6%, ARF in 20.0%, DIC in 12.9%, and MODS in 25.8% of patients. Positive correlation existed between initial sepsis score and mortality. Older age and the presence of primary diseases (34.2% of patients) were associated with significantly higher septic score and were good prognostic factor for the poor outcome of sepsis. Between mean arterial pressure in the first 24 h after the admission and mortality existed negative correlation (p < 0.05). Positive hemocultures were found in 69.7%, and bacterial infection in 78.7% of patients. GP bacteremia was found in 55.6% of patients and GN in 45.4% of all positive hemocultures. Confirmed bacteremia and bacteremia caused by GPB were associated with the higher mortality rate compared to the patients with negative hemocultures and GN bacteremia (p < 0.05). Concentrations of fibrinogen and urea in the blood at the admission in the patients with sepsis were very good prognostic factors of the disease outcome, and leukopenia, leukocytosis and neutropenia were associated with the increased mortality. Negative correlation existed between fibrinogen concentration and mortality (p < 0.001), while positive correlation (p < 0.001) existed between urea concentration and mortality. In the absence of more efficacious therapeutic protocols, fast recognition of the sepsis, evaluation of its severity, knowledge of the risk factors for its poor outcome and aggressive use of antibiotic and existing supportive therapy can significantly decrease high mortality of this too severe clinical syndrome.

The significance of immunoglobulins in the treatment of patients with sepsis and septic shock.

Inappropriate body response is, besides the infectious agent, responsible for the genesis of sepsis and septic shock. It is non-specific and in cascade of events it can hardly be controlled. The results of immunoglobulins administration compared to the disease course and outcome have been compared and analyzed in 135 patients with sepsis and septic shock. A hundred and four patients were treated for sepsis. Immunoglobulins were administered to 18, of whom 17 patients (94.55%) were cured, while one (5.55%) developed septic shock with lethal outcome. Out of the other 86 patients who did not receive immunoglobulins, 82 (95.35%) were cured, while in 4 (4.65%) patients the outcome was lethal. No difference was observed between studied groups. Among 31 patients with septic shock, 13 received immunoglobulins. Seven (53.85%) patients were cured, and 6 (46.15%) died. In relation to the favorable disease outcome the difference was observed (statistically non-significant) in the group that received immunoglobulins, compared to the group that did not (53.85% vs. 44.45%). The importance of immunoglobulins administration, in sepsis and septic shock should be emphasized.

[Personal experience in the diagnosis and treatment of hepatic echinococcosis]. / Nasa iskustva u dijagnostici i lecenju ehinokokoze jetre.

Human echinococcosis is endemic disease that occurs in some regions of Yugoslavia. It is caused by tapeworm Echinococcus granulosus, whose larva can develop cysts in liver and other organs. In the study were presented 119 patients with hepatic echinococcosis, 57 (47.9%) females of average age 41.4 years (9-80) and 62 (52.1%) males of average age 35.5 years (6.72). Primary echinococcosis was present in 75 (63%), and recurrent in 44 (37%) patients. Right lobe of liver was affected in 83 (69.7%), left in 17 (14.3%) and both lobes in 19 (16%) of cases. The complications of hepatic echinococcosis such as cyst infection, cholestasis, cyst rupture in biliary tract and liver fibrosis were observed in 20 (16.8%) patients. Indirect immunofluorescence antibody test was positive in 91 out of 119 (68.1%) patients, and hemagglutination inhibition test was positive in 56 out of 77 (72.7%) patients. Surgically were treated 57 (47.9%) patients, and 41 of them received antihelminithic drugs pre and/or postoperatively. Disease recurrence was observed in 4 (7%) patients. Percutaneous puncture and drainage of echinococcus cyst with simultaneous albendazole administration was performed in 12 (10%) patients. In three of them liver abscess was developed during drainage, and for that reason, two patients had to be surgically treated. Ten (83.3%) patients were completely cured. Medicamentous therapy as the only treatment was used in 31 (26.1%) patients, 9 patients received mebendazole, 19 received albendazole and 3 patients received praziquantel. The success was achieved in 10 (32.3%) patients. Out of the total number, 19 (16%) patients were not treated at all. Surgical removal of the cyst takes a leading place in the treatment of hepatic echinococcosis. However, in well-selected cases and in the patients with high surgical risk, antihelminithic therapy and percutaneous drainage of echinococcus cyst are of more significance.

[Tonsillo-pharyngeal form of tularemia]. / Tonzilofaringealni oblik tularemije.

Clinical, laboratory and serologic features of tonsillopharyngeal form of tularemia in 14 patients were analyzed in the study. The disease was ignored under the diagnosis of typical tonsillopharyngitis followed by cervical lymphadenopathy. Routine laboratory analyses results were non-specific and didn't reveal the disease etiology, while microagglutination test (MAT) of F. tularensis in the second week of disease was positive in 86% of patients. Skin tularin test was positive in all the tested patients during the first week of the disease. The best results in the treatment were achieved by administration of streptomycin and doxycycline. Well timed therapy prevented the lymph nodes colliquation, disease recurrence and infection generalization. The authors point out the significance of this clinical form of tularemia in the differential diagnosis of tonsillopharyngitis and cervical lymphodenopathy.

[Clinical characteristics and perplexities in the treatment of chronic Lyme borreliosis]. / Neke klinicke karakteristike i nedoumice u lecenju hronicne lajmske borelioze.

The frequency of symptoms and signs in 52 patients with chronic Lyme borreliosis was analyzed in the study. The significantly higher frequency of: headache, myalgias, cranial neuritis, chronic dermatitis, ataxia and arrhythmia (p < 0.05) was found in the group of untreated (n = 31) in the early phase compared to the frequency of the same symptoms in the group that was treated (n = 21). The neuropathy of sensitive type was more frequently noticed in that group (p < 0.01). The treatment of patients with Lyme borreliosis in the early stage should be started as soon as possible and should be performed until the probable elimination of significant decrease of causative agents number in the tissues.

[Autoimmune hepatitis and autoimmune manifestations in patients with chronic viral hepatitis]. / Autoimunski hepatitis i autoimunske manifestacije u obolelih od hronicnih hepatitisa izazvanih virusima.

The study reviews pathogenesis of autoimmune hepatitis and role of hepatotropic viruses in this disease. For a long time it was not known for certain which antigen was autoantigen on the hepatocyte. The discovery of human asialo glycoprotein receptor as an autoantigen enabled distinguishing autoimmune hepatitis from other chronic active hepatitis of unknown etiology. Autoantibodies and other tissue antigens ensured differentiation of autoimmune hepatitis in regard to severity of clinical manifestations in patients of different age and sex. The paper deals with autoantibodies and their occurrence in virally induced chronic hepatitis and some other autoimmune manifestations.