Balkan endemic nephropathy: still a mysterious disease.

Balkan endemic nephropathy (BEN) is an acquired, environmental, polytopical disease of the entire urinary tract, with long latency. Tubulointerstitial chronic nephritis, urotheliomas of all localities, and renal cell carcinoma occur with a significantly higher frequency in the affected population. These represent only clinical manifestations of one unique nosological entity. BEN occurs in focuses. Within them, it agglomerates in households, without any evidence of hereditary background. Patients with various clinical manifestations of the disease can be simultaneously found within one single household. BEN appears equally among members of different ethnic groups. Its aetiology is not clear enough. There is no evidence of a causal relationship with silicon compounds, heavy metals and viruses. Much attention has been recently focused on research of the aetiological role of mycotoxins, mainly ochratoxin A. Toxic and carcinogenic agents of natural origin are commonly accepted as the major cause of BEN.

[Review of the present status of prevention, prophylaxis and therapy of pertussis and parapertussis]. / Osvrt na danasnje postavke prevencije, profilakse i terapije pertusisa i parapertusisa.

Whooping cough is endemic throughout the world. It becomes epidemic every 4-5 years (Yugoslavia 3-4 yrs). In Europe its incidence ranges from 0.4 (Hungary) to even 59/100.000 inhabitants (Rumania; Yugoslavia 28), with a general letality of 0.1% (infants: 1%; 75% children who die are younger than one yr). Only 5-10% cases are supposed to be registered. A low socioeconomic status is more and more emphasized as the principal risk factor. Its transmission rate is high (home contacts: 80-100%); infectivity lasts five weeks, disease from the beginning of incubation to the sanation lasts 50-60 days. Female children are more frequently affected. The term "Pertussis syndrome" is more end more used because a similar disease can be caused by various agents (B. pertussis; B. parapertussis: 5%-20%-30% cases; B. bronchiseptica rarely; adenoviruses, RS virus, parainfluenza virus, influenza A and B virus, HSV, CMV, EBV, entero-, adeno-, corona-, rota-viruses; chlamydiae and mycoplasmae). Prior to introducing vaccination, 95% of population have had a typical or atypical form of pertussis. Its differential diagnosis includes pneumonias of various etiology, bronchitis, bronchiolitis during an acute respiratory infection, bronchial asthma, cystic fibrosis, tuberculosis and lymphadenopathy. Morbidity in USA was reduced by vaccination from 157 to 0,5-1,5/100,000 inhabitants; in SR Croatia it was six times reduced in period 1959-1970. According to the official sources 81% of children in Croatia and Yugoslavia get primovaccinated; the 80% level is generally accepted as a rational goal. Immunization schedules differ from country to country. Local and general reactions after combined vaccines are mostly caused by pertussis component.(ABSTRACT TRUNCATED AT 250 WORDS)