[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.

[Crimean-Congo hemorrhagic fever]. / Krimska-kongo hemoragijska grozinica.

Crimean-Congo hemorrhagic fever was for the first time recognized in Yugoslavia in 1971. In this paper were presented clinical and laboratory findings of a patient infected with Crimean-Congo hemorrhagic fever in Kosovo in 1999. The disease was manifested with fever, headache, vomiting, myalgia, abdominal pain, pharyngitis, conjuctival injection, diarrhoea, hypotension, gingival bleeding, skin hemorrhages, hematuria, hepatomegaly, splenomegaly, jaundice, thrombocytopenia, prolonged prothrombin and partial thromboplastin time, high serum fibrinogen degradation product, leukocytosis, mild anemia, elevated levels of bilirubin and serum aminotransferases. Diagnosis was set clinically, epidemiologically and supported by serological tests. Supportive management of hypotension, multi-organ failure, coagulation disturbances the patient was of the utmost in the treatment together with the isolation and prophylactic measures.

[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.

[Clinico-laboratory characteristics and treatment of patients with trichinosis]. / Klinicko-laboratorijske karakteristike i lecenje bolesnika sa trihinelozom.

The severity of clinical features of trichinosis and cardiac involvement incidence were examined in the study. The values of eosinophiles, serum enzymes and serologic response to T. spiralis were determined in relation to the disease severity. Twenty-nine patients, of mean age from 24 to 29 years treated in the Clinic in the period from January to April 1995 were presented-7 with severe form of trichinosis, 10 with moderately severe and 12 with light. The fever was noticed in 93.1% of patients, gastrointestinal disorders in 65.5%, myalgias in 96.6%, facial edema in 79.3%, cardiac disorders in 31% and rash in 20.7%. Positive IIF test result was found in 100% of patients with severe clinical features, and only in 58.3% of patients with light clinical features. The patients were treated with mebendazole in the dose of 25 mg/kg BM a day during 14 days. It was concluded that severe trichinosis forms were frequently followed by myocardial damage, that severe forms responded faster and better serologically to trichinella and those patients should be treated with high mebendazole doses.

[Treatment of patients with subfulminant forms of viral hepatitis B using prostaglandin E1]. / Lecenje bolesnika sa subfulminantnom formom B-virusnog hepatitisa prostaglandinom E1.

The efficacy of prostaglandin E1 was demonstrated in the treatment of 4 patients with subfulminant hepatitis caused by a virus B. Three patients suffered from hepatic enchepalopathy of the first degree, and the remaining one of the second degree. In three patients the clinical and biochemical improvement came relatively quickly, followed by recovery. In one patient, due to drug intolerance, the treatment was discontinued on the third day. The recurrence of illness was noted with the moderate increase of serum aminotransferases activities without clinical deterioration, necessitating no further use of prostaglandin E1. Prostaglandin E1, applied in the treatment of patients with subfulminant form of hepatitis, has favorable effect on the course of illness.

[Viral hepatitis C. Personal experience with diagnostic, monitoring and epidemiologic studies]. / Virusni hepatitis C. Nasa iskustva u dijagnostici, pracenju i epidemioloskim ispitivanjima.

In the period from 1991 to 1993, 18 patients with the acute viral hepatitis type C were treated and followed up--13 men and 5 women, the average age of 42 years. The group of 6 patients (4 men and two women) with the "old" proven liver cirrhosis, whose etiology was unknown for 20 years, was analyzed. The investigations showed that the acute viral hepatitis type C usually began with the mild subjective disorders. The half of the patients did not have either jaundice or hepatomegaly, only half of them recover, and the first cases of cirrhosis could have been expected almost as early as a year after the beginning of illness. The developed liver cirrhoses remained compensated for years. About 58% of patients got infected parenterally, and the rest of them could have gotten infected in other manner. ELISA test showed great reliability in proving the antibodies against the viral hepatitis type C in the confirming the diagnosis of illness.

[Changes in thyroid hormone levels in patients with acute viral hepatitis]. / Promene nivoa hormona stitaste zlezde u bolesnika sa akutnim virusnim hepatitisom.

In 10 patients with acute viral hepatitis A or B the dynamics of the concentrations of the thyroid hormones thyroxine (T4), triiodothyroxine (T3) and their coefficient T3/T4, and thyroid stimulating hormone (TSH) in all phases of hepatitis have been studied. In acute phase and in the fully developed clinical picture of the diseases, the increased T4 values and decreased values of T3, T3/T4 coefficient and TSH were found. These changes are explained by the slowed down deiodinization of T3 and T4 in hepatocytes as well as by the disturbed secretion of the thyroid hormone in hepatitis and they could be of some value in diagnosis and prognosis.