[Plasmapheresis in clinical practice]. / Plazmafereza u klinickoj praksi.

Plasmapheresis is an immunomodulatory procedure with immunosuppressive effect. Plasmapheresis involves taking blood, separating off the plasma and returning the red cell-enriched fraction to the patient. In plasmapheresis improvement is due to the removal of mediators of tissue damage. Therapeutic plasmapheresis has been used in many diseases in which immunological mechanisms are proved. It has been noted that there may be a "rebound" in the level of antibodies and immune complexes after plasmapheresis, perhaps due to elimination of feedback suppressor mechanisms. For that reason, plasmapheresis is only effective when used as part of an immunosuppressive regimen which also includes steroids and/or cytotoxic agents.

[Therapeutic use of human immunoglobulin]. / Terapijska primena humanih imunoglobulina.

Human immune globulin administered intramuscularly has been used for more than 40 years. In the last decade intravenous preparations were developed. They do not aggregate and contain IgG molecules with intact recognition and effector functions. These compounds are safe and only minor side effects were reported even when high doses were given. The mechanism by which intravenous gammaglobulin exacts its function is a combination of the Fc receptor blockade in the reticuloendothelial system, a marked increase in the suppressor cell function with down regulation of the antibody production and an intervention in the idiotype-antiidiotype network. Human immune globulin is an important therapeutic tool not only in the antibody deficiency, but also as an immunomodulatory agent in autoimmune disorders.

[Simultaneous recording of nonspecific bronchial response using continuous measurement of total respiratory resistance and oxygen saturation of arterial blood]. / Uporedno pracenje nespecificnog bronhijalnog odgovora pomocu kontinuisanog merenja ukupnih disajnih otpora i saturacije arterijske krvi kiseonikom.

In 78 patients with bronchial asthma symptoms undergoing nonspecific bronchial response test with bronchoprovocation inhalation of progressively increased methacholine concentrations, total respiratory resistance (Rrs) and oxygen saturation (SaO2) of arterial blood were continually measured. An average Rrs increase was 153% when compared to the initial values and it correlated with SaO2 decrease (5.5% of the initial values). In 45 patients along with continual Rrs and SaO2 measurements, bronchoprovocation test and spirogram flow-volume curve were periodically done. Ten of these patients had no significant Rrs or FEV1 changes, but there was a considerable drop in FEF50, FEF25 and SaO2. These results, associated with dyspnea and physical pulmonary findings in the course of BPT, as well as history of patients with similar difficulties in every-day life and in work environment, point to the need of expanding diagnostic criteria for positive BPT and for patients who did not have Rrs increased double the initial values nor sufficient FEV1 20% drop. Spirometry and oximetry as complementary methods, increase Astograph sensitivity to methacholine test. Oximetry has an advantage of enabling continual SaO2 monitoring and increased patient's safety during the BPT.

[Simultaneous recording of spirometric parameters and total respiratory resistance on the Astograph in nonspecific bronchial provocation tests using methacholine]. / Uporedno pracenje spirometrijskih parametara i celokupnih disajnih otpora merenih Astografom kod nespecificnih bronhoprovokacionih testova sa metaholinom.

Parallel study results of spirometric parameters (S.P.) FEV1, FEF50, FEF25 and total respiratory resistance (Rrs) measured by Astograph in nonspecific metacholine bronchoprovocation test were analyzed in 378 patients suspected of bronchial asthma. The patients were divided into 7 groups based on Astograph and S.P. instances criteria. Of 92 patients with positive test results, 91% met the set Astograph criterium; 72% met all three S.P. criteria, 1% one criterium and 12% failed to meet any of the S.P. criteria. It was noted that the patients met more the FEF50 and FEF25 criteria (87%) than FEV1 (73%). Also, there was no significant increase in respiratory resistance for those with a predominant reaction in small airways (9%). This fact points to the need of introducing appropriate complementary Astograph methods.

[Etiopathogenic mechanisms of increased airway responsiveness]. / Etiopatogenetski mehanizmi povecanog odgovora disajnih puteva.

Views on mechanisms of increased airway responsiveness in patients with bronchial asthma and other respiratory tract are presented. The data have been divided into three parts: mucosal and submucosal changes, changes in airway regulations and effector cells. In the first part the etiopathological mechanisms of inflammatory processes in airways are explained. The second part views the neurogenic and other airway disorders (vagus reflex arc, local axon reflex, epithelial relaxing factor) while the third focuses on the receptor activity changes and cellular mechanisms known to cause airway hypersensitivity and hyperreactivity.