Biomedical subjects

J Dimitrijević

Publications and source records attributed to J Dimitrijević.

68 records · Page 4Linked to original sources

PubMedDate not supplied

[Acute renal insufficiency in poststreptococcal glomerulonephritis and its significance in evaluation of disease development in adults].

Importance of ARF occurring in the acute phase of PSGN in the disease evolution is still disputable because reported results are varying and even contradictory. Examination included 44 patients between 18 and 22 with the acute phase of PSGN. The serum creatinine levels over 124 mmol/l were found in 17 patients, while 27 of them were without ARF in the acute phase of the disease. The aim of the study was, after diagnosing APSGN, to form groups of patients according to the ARF presence and to examine its influence in the initial phase of PSGN on its evolution and prognosis. On the basis of clinical parameters, pH changes, renal rebiopsy and ARF associated with the type of evolution, severity of clinical presentation and pH changes it was shown that occurrence of ARF in the acute phase of PSGN was of no significant importance for clinical presentation of the disease, but it could have some influence on the degree of morphologic changes found by renal rebiopsy.

Acute Kidney Injury↗

PubMedDate not supplied

[The effect of gammaphos on the course and outcome of surgical treatment in combined radiation injuries in pigs].

The effect of gamaphos (0.6 mmol kg-1 im, 20 min before irradiation) was investigated upon the course and outcome of the surgical management of combined radiation-gunshot injury in pigs. The hypothesis was tested that the infliction of perforating gunshot injury (LD0/30 days) in pigs in the latent phase of the acute radiation injury (LD0/30 days) results in the increase of the lethal outcome. Gamaphos treatment prevented the lethal outcome. Besides, wound reepithelization and granular tissue vascularization in protected pigs was more intensive in comparison with the unprotected ones.

Acute Disease↗

PubMedDate not supplied

[Personal experience in the treatment of chronic viral hepatitis B with recombinant interferon B alfa-2].

Twelve patients were treated with alpha-2 recombinant interferon during 4 months. Patients were given daily dose of 3 million units three times a week. Therapeutic effect expressed as the percentage of HBeAG seroconversion or by the loss of antibodies for the core antigen in IgM fraction and by the core antigen loss from hepatic tissue, was achieved in 41.6% of patients. Corticosteroids, administered before interferon, could improve therapeutic effect. Better response to therapy was observed in patients with higher serum transaminase levels and with histopathologically confirmed chronic hepatitis. Predictive value of each immunological parameter of therapeutic effect requires further study.

Adult↗

PubMedDate not supplied

[Significance of renal biopsy in patients with isolated microhematuria].

Retrospective study included 30 patients with isolated microhematuria in which renal biopsy was performed. Renal biopsy provided diagnosis in 28 (98.3%) cases, and histological finding was normal in only 2 (6.7%) patients. The most frequent finding was IgA nephritis found in 15 (50%) patients, while the other forms of glomerulonephritis were less frequent. In our patients there were no indications for steroid therapy. It was concluded that renal biopsy had great diagnostic value and that it should be preferred to invasive urologic-radiologic diagnostic procedures particularly when it is to be performed transcutaneously.

Adolescent↗

PubMedDate not supplied

[Clinical and morphologic characteristics of adult IgA nephropathy].

Within the period 1987-1992 IgA nephropathy was diagnosed at the Nephrology Clinic of the Military Medical Academy in 61 patients aged from 17 to 41 years (mean +/- SD = 24.31 +/- 6.39). The aim of the study was to evaluate their importance as markers of progressive forms of IgA nephropathy by analysis of mutual relationship of clinical-laboratory and histopathological characteristics. Clinical form of the disease with recurrent macroscopic hematurias existed in 30 (49.2%) patients, and oligosymptomatic form in 31 (50.8%) patients. Acute renal failure of reversible oliguric character had 5 (8.2%) patients. Patients with recurrent macroscopic hematurias had more progressive course of IgA nephropathy which could be indirectly seen from the parameters of the global renal function. The most frequent histological form of IgA nephropathy was diffuse mesangioproliferative glomerulonephritis registered in 30 (49.2%) patients.

Adolescent↗

PubMedDate not supplied

[Personal experience with ex tempore diagnosis of neurosurgical biopsies using the smear method].

The results obtained by the use of the smear method were analyzed in ex tempore diagnostics of 240 neurosurgical biopsies, done in the period from 1991 to 1993. Thirty three different pathologic lesions were found that had their special morphology on smears, indicating the high specificity of this method. In 226 cases (94.17%) the diagnosis was established correctly, but in 14 cases (5.83%) it was not: in three cases the diagnosis was falsely negative and in 11 falsely positive. The main causes of the diagnostic errors were analysed and they included the subjective factors and uncommonness of the analyzed tissue samples. The accuracy of 94.17% enabled sufficiently reliable use of this method in ex tempore diagnostics of neurosurgical biopsies.

Biopsy↗

PubMedDate not supplied

[Ultrasound guided percutaneous biopsy of the kidney].

In the course of 5 years, 582 ultrasound guided percutaneous renal biopsies were performed in 558 patients. Kidney tissue was obtained in 507 patients (90.9%), and in 485 (86.9%) the obtained sample was sufficient to establish the diagnosis. Complications following renal biopsies were observed in 221 patients, or 38% of total biopsies. There were 212 (36.4%) clinically moderate complications. The most frequent ones were asymptomatic hematomae (32.6%), and infrequently lumbar pain (2.4%) and hematuriae lasting less than 12 hours (1.4%). In 9 patients 10 (1.7%) serious clinical complications in the form of hematuria lasting more than 12 h (1%), large perirenal hematomae (0.5%) and urinary infections (0.2%). In the older age group and in patients with pronounced renal failure no significant difference in the incidence of complications was observed. Ultrasound guided percutaneous renal biopsy is a safe diagnostic method, and the associated complications do not seriously curb its use. The therapy of complications is primarily conservative, and only rarely surgical.

Adolescent↗

PubMedDate not supplied

[IgA nephropathy--IgA1 disease].

The aim of this study was to prove the increased IgA1 production in patients with IgA nephropathy compared to the control group of healthy subjects, by determination of serum subclasses IgA, IgA1 and IgA2 levels. That with the exclusive presence of IgA1 in kidney tissue, justified the assertion that IgAN was IgA1 disease. Eighteen patients with IgA nephropathy, 15 male and 3 female, average age 17-54 (mean +/- SD = 34.1 +/- 5.18) were included in the prospective study. The diagnosis was proved by immunofluorescent assay of bioptic kidney material obtained by ultrasonically guided biopsy. The total serum IgA and IgA1 and IgA2 subclasses levels were determined in the patients and healthy conscripts from the control group. The methods of immunonephelometry and radial immunodiffusion were used. Increased IgA values were found in 22.75% and of IgA1 subclass in 38.85% patients. Patients with IgA nephropathy had significantly higher IgA1 values (p < 0.01), compared to the control group. There was no significant difference in IgA2 subclass levels. Renal function did not significantly affect IgA1 and IgA2 subclasses values.

Adolescent↗

PubMedDate not supplied

Therapy of rapidly progressive glomerulonephritis with immunosuppressive agents.

Rapidly progressive glomerulonephritis is a kidney disease leading to sudden and definitive damages of the renal parenchyma and progressive impairment of its function until the complete failure. Histological findings of the changes are characterized with dominant glomerular lesions with crescentic formations. Early and intensive immunosuppressive therapy with pulse doses of steroids (Solumedrol 1.5 to 2.5 g), followed by Prednisolone 1 mg/kg every other day and cytostatic drugs (cyclophosphamide 1-2 mg-kg/every other day) discontinues the processes of specific and non-specific inflammation in the kidney and could enable regeneration of the kidney tissues with favorable outcome of the disease. Immunosuppressive therapy should be gradually lowered after two months, and applied for at least three to six months.

Acute Kidney Injury↗

PubMedDate not supplied

[Correlation of cytologic and pathohistologic findings in ultrasonically-guided thin-needle biopsy of abdominal and retroperitoneal organs].

The ultrasonically guided fine needle biopsy is cheap, very sensitive and specific method for the diagnosis of nonpalpable deep-seated lesions. During 1992 in the institute of Radiology of Military Medical Academy in Belgrade 87 biopsies of abdominal and 81 biopsies of retroperitoneal organs were performed for the cytological and histopathologic analysis. Deficient material was obtained in 15.4% of the cases. A good correlation between cytologic and histopathologic findings was observed, with diagnostic concordance in 90.8%. In 9 cases with falsely positive cytological diagnosis at the first examination, the diagnosis of malignancy was later confirmed by other diagnosis procedures. Diagnostic difficulties and the significance of adequate biopsy were particularly stressed.

Abdominal Neoplasms↗

PubMedDate not supplied

[Treatment of nephrotic syndrome in IgA nephropathy with IgG pulsed doses].

The preliminary results of nephrotic syndrome treatment in IgA nephropathy (IgAN) with pulse IgG doses have been presented. The diagnosis of IgAN has been made exclusively by percutaneous ultrasonically guided biopsy of kidneys, on the basis of characteristic finding of immunofluorescent and light microscopy. Histopathological changes were classified upon the Classification of World Health Organization for IgAN with the calculation of average glomerular, vascular and indices of interstitial fibrosis and tubular athrophy. The therapy with IgG was applied in 3 patients with nephrotic syndrome in complex of IgAN with minimal histologic changes, i.e. diffuse mesangioproliferative glomerulonephritis. Initial pulse dose of IgG was 0.4 g/kg and it was administered in slow intravenous infusion for three days running during three months. The therapy of maintenance consisted of intramuscular administration of IgG in the dose of 2.5 g, twice a month, for the next three months. After the six-month treatment, clinical and biochemical remission was achieved in the patient with minimal histologic changes, and in the other two patients with diffuse mesangioproliferative glomerulonephritis the effect of therapy was revealed in proteinuria decrease for over 50% and the preserved renal function on the level before the therapy has started. Temporary increase of creatinine serum concentration was registered in two our patients. Preliminary results of pulse therapy with immunoglobulin G, although obtained on the small patient number, imply its powerful immunomodulatory features, which complexity and action levels should be more investigated.

Adult↗

PubMedDate not supplied

[Significance of inflammatory cytokines in the pathogenesis of IgA nephropathy].

Prospective study was performed on the concentrations of inflammatory cytokines IL-1, TNF and IL-6 in serum and urine (ELISA tests) were determined in the scope of total clinical-laboratory and histologic treatment in 59 patients with primary IgA nephropathy. Control group consisted of 20 healthy subjects. IL-6 was not detected either in serum of patients with IgAN, or in control examinees. TNF alpha and IL-1 beta were detected in control patients' sera and in patients with IgAN, but detected concentrations were not significantly different. IL-1 beta in urine was detected in 82.8%, TNF alpha in 90.0%, and IL-6 in 40% of our patients with IgAN. The concentrations of IL-1 beta were significantly higher compared to IL-1 beta concentrations in urine of healthy subjects and significantly correlated with the severity of glomerular and tubulointerstitial changes, as well as with the degree of proteinuria. Direct and indirect toxicity of TNF alpha on renal structures was confirmed in significantly higher concentrations of that cytokine in urine of patients with mesangial sclerosis of different percentage compared to the patients with isolated mesangial hypercellularity. Also in the patients with index of chronic lesion over 7 significantly higher TNF alpha concentrations in urine were found compared to the patients with lesion index 0-3 and 4-7. Creatinine clearance was in negative correlation with TNF alpha concentrations in urine of our patients with IgAN. Concentrations of IL-6 in urine were in correlation neither with laboratory parameters of renal function, nor with the degree of histologic changes.

Adult↗

PubMedDate not supplied

Treatment of IgA nephropathy with nephrotic syndrome using pulse doses of IgG.

This paper presents the preliminary results of the treatment of nephrotic syndrome in IgA nephropathy (IgAN) using pulse doses of IgG. Diagnosis was established only by percutaneous ultrasonically-guided renal biopsy, as well as on the basis of typical immunofluorescence and light microscopy findings. Histopathologic changes were classified according to the World Health Organization classification for IgAN, by determination of average glomerular, vascular and interstitial fibrosis indices and the degree of tubular atrophy. IgG therapy was administered in three patients with nephrotic syndrome associated with IgAN characterized by minimal histological changes, i.e., by diffuse mesangioproliferative glomerulonephritis. Initial IgG pulse dose was 0.4 g/kg, given as slow intravenous infusion during three consecutive days in the course of the three-month period. Maintenance therapy consisted of intramuscular IgG in the doses of 2.5 g twice a month, for the next three months. After a six-month treatment, clinical and biochemical remission was achieved in patients with minimal histologic changes, but in other two patients with diffuse mesangioproliferative glomerulonephritis, the effect of the therapy consisted of reduced proteinuria by more than 50%, with the renal function restored to the level before therapy. Transient increase in the serum creatinine level was found in two patients. These preliminary results with IgG pulse therapy, although obtained on a small number of patients, suggest the drug's potent immunomodulatory properties, but its complexity and levels of actions should be further investigated.

Adult↗

PubMedDate not supplied

[Histopathologic changes in the kidneys in patients with asymtomatic pathologic findings in urine].

The authors had analyzed histopathologic changes in the kidneys of patients with asymptomatic abnormalities of urine analyzing if they were correlated with the type of pathologic finding in urine. Retrospective study comprised a total of 76 patients with asymptomatic urine abnormalities. In all three groups of patients, formed upon the type of pathologic finding in urine, were determined heterogeneous histopathologic changes, and different types of glomerulonephritis, respectively. The most frequent histopathologic finding was IgA nephropathy, observed in 16.7% patients with isolated proteinuria, in 50% patients with isolated microscopic hematuria and in 55.9% patients with associated urine abnormalities. In distinction from the other two groups of patients, in the group of patients with isolated proteinuria normal histologic finding was very frequently found (25% patients), and in group of patients with associated urine abnormalities were observed more severe histopathologic forms of glomerulonephritis, such as membranoproliferative glomerulonephritis. It was concluded that different types of glomerulonephritis most frequently caused asymptomatic abnormalities of urine in younger patients.

Adult↗