[Clinical study of administration of abciximab--a monoclonal antibody to platelet glycoprotein IIb/IIIa in percutaneous intracoronary interventions]. / Klinicka studija o primeni monoklonskog antitela protiv IIb/IIIa glikoproteina trombocita--abciksimaba kod bolesnika sa perkutanom intrakoronarnom intervencijom.

During the last 10 years a new group of drugs was developed--platelet glycoprotein IIb/IIIa blockers that is nowadays largely and efficiently used as for the prevention of percutaneous coronary intervention complications as well as in the treatment of acute coronary syndromes. In the period February-June 2000--19 patients (18 males, 1 female, of average age 53.3 years) were administered Abciximab in the bolus dose of 10 mg immediately before the intervention and afterwards 10 mg by 12-hour infusion. All patients received aspirin and ticlopidine hydrochloride if the stent was introduced and heparin by the standard protocol. Elective intervention was done in 17 patients (non-Q infarction in 3 patients, unstable angina pectoris in 5 patients, postinfarction angina pectoris in 2 patients, acute myocardial infarction at least 1 month before the intervention in 6 patients and 1 patient with myocardiopathy) and in 2 patients the intervention was performed during the myocardial infarction. In 15 patients (79%) intracoronary stent was introduced and in 5 patients (21%) the intervention was performed on 2 arteries. Maximal immediate effect of the dilatation was achieved in 18 patients (94.7%). In the first 60 days of the follow-up 1 patient (5%) died of some other disease, and in no patients symptomatic myocardial ischemia was found. No adverse effects were observed.

[Amyloid tumor in a patient on a regular hemodialysis program]. / Amiloid tumor kod bolesnika na redovnom programu hemodijalize.

Amyloidosis is frequent complication in the patients subjected to hemodialysis, and is most frequently manifested in carpal tunnel syndrome, scapulohumeral periarthritis, osseous cysts and exceptionally as solitary tumor. A patient in presented, aged 72 years, who had undergone chronic dialysis for 10 years, in the last 4 years with symptoms and signs of amyloidosis, such as scapulohumeral periarthritis and erosive arthritis of the knee with recurrent effusions. A year ago he had noticed a tumor in the left popliteal cavity that had been progressively increasing and had limited the movements of the knee. After the extirpation, the diagnosis of amyloid tumor was confirmed by histopathologic analysis.

[Urticarial vasculitis--a syndrome with low complement levels and secondary glomerulopathy]. / Urtikarija vaskulitis--sindrom sa niskim vrednostima komplementa i sekundarnom glomerulopatijom.

In female patient, aged 41, 3 years ago appeared skin changes of urticarial type, and occasional pain in the joints of shoulders and hands, followed by complete weakness and exhaustion, as well as the occurrence of face and eyelid edema. Laboratory findings confirmed the presence of hypocomplentemia with proteinuria, microhematuria and cylindruria. Histopathologic (HP) finding of skin biopsy was leukocytoclastic vasculitis, and HP finding of the kidneys was mesangioproliferative glomerulonephritis. The regression of skin changes was observed during hospitalization after Dapsone was administered. The therapy started with corticosteroids (Prednisone 40 mg/day with weekly dose from 5 mg to 30 mg). In spite of the therapy, hypocomplementemia and proteinuria up to 335 mg/24 h have maintained for a year in the later controls in an outpatient department. The patient is without discomfort, and renal function is stable.

[Acquired renal cystic disease and renal carcinoma in patients on chronic hemodialysis]. / Stecena cisticna bolest bubrega i karcinom bubrega kod bolesnika na hronicnoj hemodijalizi.

The patient, aged 49 years, on chronic dialysis for 5 years, was admitted to Clinic of Nephrology of Military Medical Academy to establish the cause of the anemic syndrome. During the investigation, ultrasonographically, and by computed tomography of kidneys and Color-Doppler sonography it was discovered, and by renovasography confirmed, the carcinoma of the left kidney, together with the acquired polycystic renal disease. Left nefrectomy was performed. The tumor of 2 cm without regional invasion and with no evident distant metastases was histopathologically described as a well differentiated clear cell renal carcinoma. The increased frequency of renal carcinoma in uremic patients with acquired cystic renal disease compared to the common population, the absence of classic clinical picture, small tumor dimensions and asymptomatic course in the majority of patients necessitates the detailed search for suspected changes and routine screening once a year in all the patients on chronic dialysis program.

[Characteristics of membranous glomerulonephritis]. / Neke karakteristike membranskog glomerulonefritisa.

The diagnosis of primary glomerulonephritis was made in 20 patients from January 1990 to December 1995. They were followed-up up to 5 years. Various therapeutic modalities were applied: 12 patients were treated with pronison per os, in 5 patients (42%) the disease remission was achieved, the other 5 (42%) patients had frequent recurrences of nephrotic syndrome, while 2 patients (16%) were with renal failure. In 7 patients at the beginning of treatment "pulse" methil prednisolone of 500 mg/48 h and 200 mg/48 h of cyclophosphamide was administered per os. Remission was achieved in 5 (71%) patients, and renal failure developed in 1 patient. Four patients, refractery to previous therapy, were treated with cyclosporin A and remission was achieved in 1 patient with proteinuria less than 2 g/d. The other patient had relapses of nephrotic syndrome, and renal failure has developed in the other two patients. Corticosteroids are drugs of choice in the treatment of lighter forms of MGN. In case of resistence to corticosteroid therapy or the progression of renal failure, cyclophosphamide should be included in the therapy, but in the patient refracte to this treatment, therapy with cyclosporin A should be attempted.

[Acute renal insufficiency in hemorrhagic fever with renal syndrome]. / Akutna bubrezna insuficijencija kod hemoragijske groznice sa renalnim sindromom.

In the Clinic for Nephrology of Military Medical Academy, 116 patients with hemorrhagic fever with renal syndrome (HFRS) have been treated in the period from January 1989 to December 1995. The patients were hospitalized with advanced acute renal failure (ARF). The largest number of our patients got ill from HFRS from the middle of March till the end of May and during August when the other frequency elevation was noticed. Most frequently the disease has the course that is followed up by phases. Positive finding of antibodies to HFRS virus was noticed in all 116 patients (Hantaan 45%, Belgrade 35%, Puumala 20%). According to clinical symptoms, signs and syndromes that follow up HFRS, the most of our patients were with more severe disease type. The ARF treatment with dialysis was necessary in 45% our patients. The most severe clinical forms were caused by Belgrade strain. Very favorable effect of "an early dialysis" to the disease course and outcome was observed. By this approach in HFRS therapy, the patient's mortality was decreased to 0.86%. The development of chronic renal failure as HFRS sequela is possible, but not so frequent.