Biomedical subjects
Publications and source records attributed to I Tomić.
Primary gelatinous tumors of colon are very rare. There is a case of metastatic colon's tumor as a result of transcaelomic expansion of gelatinous cancer of stomach, there is a possibility of implantation tumor's cells during appendectomy.
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The aim of the study was to analyze the efficacy and toxicity of the therapy with pulse dose of cyclophosphamide in patients with Wegener's granulomatosis. The diagnosis was established in three patients (2 male, 1 female, average age 58.3 years) upon the clinical picture, laboratory-immunologic and histopathologic findings. The initial therapy was conducted by pulse doses of cyclophosphamide (0.6 and 0.8 g/kg), glucocorticoids (0.5 g), repeated plasmapheresis and pulse doses of immunoglobulin (0.4 g/kg). All patients achieved remission with complete recovery of renal function in one patient. The therapy with pulse doses of cyclophosphamide (time-period between pulses from 1 to 3 months), together with glucocorticoids taken orally for 24 months, was continued for the following 18 months. Stable remission (4-15 months) was maintained in all the patients after the immunosuppressive therapy was over. The treatment of Wegener's granulomatosis by cyclophosphamide and glucocorticoid pulse doses with the application of plasmaphereses and immunoglobulin pulse doses in the initial therapy lead to the remission of progressive types of long duration.
In 20 patients with pulmonary sarcoidosis bronchoalveolar lavage (BAL) was performed. The cellular content was analysed and lymphocyte subpopulation was determined using monoclonal antibodies. The patients with more than 28% of BAL T lymphocytes are classified as patients with high intensity alveolitis (n = 8) and those with less than 28% of T lymphocytes as low intensity alveolitis (n = 12). Of the total number of BAL T lymphocytes in high intensity alveolitis CD 3+ T cells were 88.8 +/- 8.4% and in low intensity alveolitis 68.2 +/- 13.8% (p < 0.001). In high intensity alveolitis the number of CD 4+ T cells was increased and the number of CD 8+ T cells was decreased which caused the increased index CD 4:CD 8; 9.8 +/- 8.7. In low intensity alveolitis this ratio was 2.2 +/- 1.2. Effects of smoking were also analysed. In smokers the total number of BAL cells was higher 184.0 +/- 47.2 x 10(4) ml of BAL, and in nonsmokers 101.3 +/- 65.1 x 10(4) ml of BAL (p < 0.001). Smoking has no effects on the characteristics of the cellular elements and subpopulation of BAL lymphocytes in patients with sarcoidosis. In 7 patients T lymphocyte subpopulation in the peripheral blood were determined too. Patients with high intensity alveolitis had the increased index CD 4:CD 8 in the peripheral blood compared with low intensity alveolitis.
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Bronchoalveolar lavage through fiberoptic bronchoscope was performed in the right middle lobe or lingula of 8 patients with clinically and radiologically active sarcoidosis and 5 healthy persons. Pellet cells were analysed. Lymphocyte subsets were detected with monoclonal antibodies by fluorescent microscopy or flow cytometry (EPICS-C, Coulter). In patients with sarcoidosis lymphocyte proportion is elevated (29.88 +/- 4.32) as compared to healthy persons (5.2 +/- 3.4). We detected an increase of CD 3 lymphocytes (86.38 +/- 6.71) and CD 4 helper-inducer T lymphocytes compared to the total number of lymphocytes and, likewise, of the CD 4/CD 8 ratio--5.62 +/- 0.94. CD 8 suppressor-cytotoxic T lymphocytes are decreased (13.0 +/- 1.3 as compared to the healthy persons 22.0 +/- 3.84), which is a relative decrease because due to an increase of the total lymphocyte number, an increase of CD 8 T lymphocytes (3.85 +/- 0.41 as compared to the healthy persons 1.09 +/- 0.59) still exists, compared to the total number of pellet cells.
The 188 patients with pulmonary embolism were treated at the Clinic for Pulmonary Diseases of the M.M.A. in the period 1979-1989. Clinical symptoms and signs, diagnostic procedures and therapy of pulmonary embolism are analysed. The diagnosis is difficult and is suggested by the predisposing factors, symptoms and signs of the disease as well as indirect diagnostic procedures. The contribution of perfusion lung scintigraphy is precious. Deep venous thrombosis of the lower extremities, the source of pulmonary embolism, is commonly clinically absent. The complete cure without complications was achieved in 156 (83%) patients. The most common complications were: early and late recurrences, hematuria and peptic bleeding. The lethal outcome occurred in two cases of basic disseminated malignant disease.
Mechanical suture (stapler) was applied 164 times in digestive surgery in the period from October 1985 to December 1988. There have been performed 82 anastomoses (30 low collateral, 20 esophagointestinal, 20 ileocolic, 10 enteroenteral and 2 colocolic) and 76 closure of intestines. Anastomoses were performed with EEA stapler in 50, GIA stapler in 30 and TA stapler in 2 cases. Intraoperative complications related to the use of stapler were observed in 4.8% cases. Clinically manifested dehiscence of the stapler anastomoses was evident in 4.8% (82) and immediate cause of death in 1.2% (1) case. The incidence of secondary wound infection after four years was 2.4%. No clinically manifested stenosis of anastomoses were observed within the follow up period from one to four years.
There have been examined 145 patients with hemoptyses and normal x-ray findings. The majority of patients were males, smokers, more than 45 years old. Bronchoscopically the most common findings have been signs of inflammation and blood traces. The most common cause of hemoptyses has been chronic bronchitis in patients older than 45 years, and bronchoectasis in younger patients. Bronchogenous carcinoma was discovered in 8 patients: in 5 by bronchoscopic examination at hemoptysis occurence and in 3 by subsequent follow up after 8, 15 and 20 months. Pulmonary vessel malformations have been discovered in 9 patients, and cardiac diseases have been the cause of hemoptysis in 7 patients. The cause of hemoptysis remained undetected in 33 (22.8%) patients.
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In the period 1985-1990, 760 patients with bronchogenic carcinoma have been examined and treated at the Clinic of Lung Diseases of the Military Medical Academy. Obstruction syndrome was found in 64% of patients of whom 21% with severe obstruction. Pulmonary insufficiency, most commonly of milder, partial type, was found in 19% of patients. Due to the limited lung function as a consequence of chronic obstructive lung disease (COLD) 45 patients with locally demarcated tumours were not operated, surgical resection was not possible. In the operated patients with obstruction syndrome the risk of postoperative complications was increased. COLD and limited lung function most commonly had not been the obstacle for application of radiotherapy of bronchogenic carcinoma.
In the four-year period (1991-1995), 96 tuberculosis patients from the war areas of former Yugoslavia were treated in the Clinic for Lung Diseases of Military Medical Academy, that makes 31% of total number of sick and treated for tuberculosis-309 (100%). In group I (patients from war areas) there were 45 cases of cavernous pulmonary tuberculosis (47%), 28 bilateral (29%), 16 pleurisy (16.7%) and 6 cases of extensive pulmonary tuberculosis (5.1%). Among 213 patients (100%) from group II (patients from FR Yugoslavia), 81 patients had cavernous pulmonary tuberculosis (38%), 49 patients had bilateral (23%), 33 patients had pleurisy (15.5%) and 6 patients had extensive pulmonary tuberculosis (2.8%). In group I the diagnosis was bacteriologically and/or histopathologically proved in 94.8% cases: by finding of acid-resistant bacilli in sputum and other biological materials in 69 patients (72%), by positive Löwenstein's cultures in 73 patients (76%) and by histopathological result of tuberculosis inflammation in 34 patients (35.4%). In group II tuberculosis was bacteriologically and/or histopathologically proved in 134 patients (63%) by acid-resistant bacilli in sputum and other biological materials, in 141 patient (66%) by positive Löwenstein's culture and in 71 patient by positive histopathological results. Pulmonary tuberculosis in war areas is characterized by greater frequency of severe clinical forms (cavernous, bilateral and extensive) and by high direct bacillarity.
Endobronchial metastases of extrapulmonary malignant tumors are very rare and they appear in 1-2% of all the pulmonary metastases cases. By their endoscopic presentation, they are similar to primary bronchogenic carcinoma. Eleven patients with endobronchial metastases were presented, 8 male and 3 female. The average age was 58.27 years (from 37 to 72 years). Primary renal carcinoma existed in 2 patients. The one was operated 5 years before the metastases appeared in bronchus, and the metastases in bronchial wall contributed to the discovery of primary tumor in the other patient. Endobronchial metastases appeared in 3 patients, 2 years after the surgery of malignant colonic or rectal tumor, and in fourth patient it appeared 5 years after the surgery. One female patient sustained mastectomy and the radiation therapy was performed 11 years before the bronchial metastases occurred and the other female patient had the disease revealed a year ago and the polytherapy was performed. In the female patient with non Hodgkin Lymphoma, the change in bronchus was revealed simultaneously as the primary disease. Endobronchial metastases appeared in 2 patients two years after the surgery of malignant melanoma. The disease diagnosis was set by clinical-radiological examination, by endoscopy and by the comparison of histopathologic finding of primary carcinoma and metastases.