Two unusual recurrences of intracranial germinoma

Two recurrent cases of intracranial suprasellar germinoma, with relapses at 55 and 16 months, respectively, after the end of primary therapy strongly effective against pure germinoma, are presented. Human chorionic gonadotropin beta subunit was elevated in the cerebrospinal fluid and in the serum in both patients at the time of recurrence but not before. This and resulting treatment failures suggest that there were also other, more resistant elements within the primary tumor, which have not been identified in biopsy specimens. The problem of adequate diagnosis and its impact on patients' survival are discussed.

Activity of nitrogen fixation and nitrogen assimilation enzymes in soybean plants inoculated with Bradyrhizobium japonicum strains

In studying the symbiotic associations of 8 Bradyrhizobium japonicum strains with two soybean varieties (NS-10 and NS-21), we determined the activity of nitrogen fixing (nitrogenase, NG) and nitrogen assimilation (glutamine synthetase, GS) and glutamate dehydrogenase (GDH) enzymes and the content of soluble proteins. The number of nodules was not in correlation with dry matter mass and nitrogen content. Dry matter mass and nitrogen content in the nodules of the soybean varieties in association with Bradyrhizobium strains 1, 1a, 2b, 2/1, 1003 and 8k turned out to be significantly higher than mass and nitrogen content of those in association with B. japonicum strains 17z and 2k. The results obtained indicate that the activity of the enzymes NG and GS in plants correlates with nitrogen fixation for both varieties on average, while the activity of GDH enzyme is conditioned by the specificity of variety and the Bradyrhizobium japonicum strains.

Effect of the aluminium ion on hepatic elimination of quinine and quinidine

A study of the influence of the aluminum ion on the blood and hepatic kinetics of two alkaloid stereoisomers--quinine and quinidine--after their p.o. and s.c. administration (80 mg/kg) to rats was carried out. It appeared that the mode of application of the stereoisomers had different effects on their resorbtion in control animals. In the case of s.c. application, blood concentrations of quinine in some time intervals reached significantly higher levels than those found for quinidine. Hepatic elimination of quinine appeared to be independent of the mode of its application, whereas the elimination of quinidine was significantly increased after its s.c. application. Pretreatment of rats with aluminium chloride (600 mg/kg, i.p.) 2 h before injecting one of the stereoisomers had a different effect on their concentrations in blood, and significantly higher effect on their bile elimination. The quinine concentrations in blood after its p.o. administration were not changed significantly, but after s.c. application these concentrations were increased in some time intervals. The presence of the aluminum ion caused a significant increase in the rate of hepatic elimination of quinine, whereas it had no significant effect on quinidine elimination.

[Pharmacotherapy childhood asthma]

The drugs which are used today in medical treatment of asthma can be divided into two groups. The first group contains corticosteroides, as antiinflammatory agents. The second group contains bronchodilatators, usually used as symptomatic medicaments, and the third group are asthma--profilactics. The mechanism of activity, doses for children and unwanted effects are briefly presented for eah of these three groups. The principles of the International consensus about medical treatment of childhood asthma are presented in the second part of this paper.

[Ectopic spleen--2 case reports]

Wandering spleen occurs consequently to the embryonal disturbances in the development of ligaments connecting the spleen with surrounding tissue. It is rarely the cause of abdominal discomfort, which is usually mild, but nevertheless it can be expressed within the signs of acute abdomen. In our study, two cases of wandering spleen are presented, the diagnosis was put according to the intermittent pain in lower abdomen, echotomography, radionuclide imaging and selective angiography. Splenectomy revealed subjective discomfort. In women, wandering pelvic spleen might be mis-diagnosed as a gynecological disease.

Regenerating axons enhance differentiation of perineurial-like cells involved in minifascicle formation in the injured peripheral nerve

The role of regenerating axons in the restructuring of the endoneurium into minifascicles after peripheral nerve injury was investigated. Endoneurial changes were studied in the control distal stumps of crushed rat sciatic nerves and in the distal nerve stumps in which, in addition to other cellular elements, the original perineurium had also been destroyed by freezing and thawing. Injured nerves in which axonal regeneration had been prevented were examined for comparison. The changes were observed at light microscopic and ultrastructural levels. Two weeks after nerve injury, incipient endoneurial restructuring by proliferating endoneurial fibroblast-like cells was observed in the distal nerve stumps in all groups of animals. By 4 weeks, the endoneurial changes in control regenerating nerves (crush only) displayed no progress. On the contrary, extensive minifascicular reorganization of the endoneurium was observed in the distal nerve stumps in which the original perineurial barrier had been eliminated. The cells that encircled the minifascicles in the nerves with regenerating axons looked like differentiated perineurial cells, whereas in the absence of regenerating axons, the endoneurial cells that encircled the neurilemmal tubes mostly lacked typical features of the perineurial cells. Therefore, persistent perineurial damage is necessary to induce complete endoneurial compartmentalization. In this case, the regenerating axons enhance differentiation of the endoneurial fibroblast-like cells into the perineurial cells.

[Our experience in the treatment of painful shoulder syndrome by Streptofil]

Streptofil is a biological product obtained from streptococcus beta haemoliticus, with molecular weight of 700 D and antigenic properties. It has anti-inflammatory, antibacterial and reparative effects. The objective of our study was to test the Streptofil therapy effect on painful shoulder syndrome. Testing included 73 patients. One ml of Streptofil was used locally in the projection of m. supraspinatus insertion five days a week; treatment lasted 3 weeks in average. Therapy effect estimate was made according to Constant and Murley method. As full clinical effect we considered pain loss and complete function restitution (score 90-100) and incomplete reduction or loss of pain and incomplete function recovery (score less than 90). Control radiography was performed only in patients with calcification tendinitis. In 46% of patients tendon calcification had disappeared. Full clinical effect was achieved in 80% of the patients in whom tendon calcification disappeared after therapy, and in 58% of those in whom it remained. This finding coincided with results obtained in the group of patients without tendon calcification.

The mechanism of recurrence of mouse myeloid leukaemia after total body irradiation and bone marrow transplantation

RFM mice were X-irradiated (9.5 Gy) 3, 4, 5, 6 or 7 days after inoculation of a transplantable strain-specific myeloid leukaemia (ML) and were reconstituted or not with syngeneic or allogeneic bone marrow cells. Recurrent leukaemia was observed in mice with either type of the bone marrow transplant, indicating that ML cells survived the dose of 9.5 Gy of X-rays. ML cells exposed in vitro to high doses of X-rays (20, 30, 40, 50, 60 Gy) and injected into lethally irradiated syngeneic recipients were still capable of forming leukaemic colonies on the spleens. Higher doses (70, 80, 90 and 100 Gy) abolished the colony formation completely. Irradiated ML cells were also capable of causing leukaemia (hepatosplenomegaly) if inoculated into lethally irradiated CBA mice reconstituted with bone marrow cells of CBA or RFM mice. That was attributed to the release of a leukaemogenic factor from the ML cells, capable of transforming transplanted normal cells.

[Causes of dehiscence in the anastomosis between the stomach and small intestine in our clinical data 1970-1990]

Gastrojejunal anastomotic leakage occurred in our clinical material of 4284 gastric resections Billroth II type with an incidence of 0.93 percent. 62 cases with anastomotic dehiscence were analyzed, with 22 from other clinics. The most critical part of the anastomosis was the upper angle of Billroth II Hoffmeister Finsterer anastomosis. The causes were mostly local; reoperations and resuture with necrotic and devitalized tissue, impaired vascularization of the stomach and small intestine due to rough manipulation, too narrow anastomosis and too tight securing of ligatures, as well as too massive tissue aglomeration in more layers. Stomach obstruction is a significant cause, as it is dista obstruction to anastomosis, duodenal dehiscence, peritonitis or pancreatitis. Some of the local causes are likely to be solved with using of one layer of resorptive suture material or using of a stapling device. General conditions are also important, but only as factors that stress the local conditions of risk. The mortality rate in this serial is high as 70.9%, in spite of the reoperations and complex conservative treatment.

[Principles of the current therapy in autoimmune diseases]

Presented are principles of systemic connective tissue diseases therapy (SCTD) based on data from literature, our experience and reported at international meetings held in Europe during last years special attention has been paid to the advances and perspectives in the treatment of rheumatoid arthitis (RA) and systemic lupus erythematosus (SEL).

[The antiphospholipid syndrome in systemic connective tissue diseases]

The aim of the study was to prove the incidence of antiphospholipid syndrome (APS) in systemic connective tissue disease (SCTD), especially in systemic lupus erythematosus (SLE) and to find out serologic markers of APS. Of 94 patients with SCTD followed up in the last three years 80 had SLE, 7 Sjogren's syndrome, 3 systemic vasculitis, 2 combined systemic connective tissue disease, 1 rheumatoid arthritis, 1 Sjogren's syndrome with vasculitis. Antiphospholipid antibodies (ApSt) were determined by ELISA method. In 31 of 80 patients with SLE (38.07%) antiphospholipid antibodies were proved. In lo of 31 (32.26%) signs of systemic lupus or the presence of APS markers have not been found, while 21 of 31 (67.74%) had some of clinical manifestations of APS (most commonly thrombocytopenia or vascular thrombosis) with evolution of the basic disease. Among our patients with SLE the most common finding was IgG antibody isotype-in 14 or 66.66% of cases. In 5 of 7 patients with Sjogren's syndrome ApAt were proved without clinical evolution of the basic disease and APS. Only 2 of 7 patients of this group showed, together with more increased ApAt, mild evolution of the basic disease and manifestation of APS (livado reticularis and recurrent venous thrombosis).

[Chlamydia trachomatis and Reiter's syndrome]

Results of the study of incidence of chlamydia trachomatis infection in patients with Reiters syndrome are presented. Chlamydia trachomatic was isolated from the uretral smear in 12 (34.28%) of 35 patients with Reiter's syndrome. In the group of patients with other rheumatologic diseases Chlamydia trachomatis was isolated in 2 (5.13%) of 39 patients. In all patients with negative isolation, infection was confirmed serologically also and in some patients with negative isolation it was also proved.

Reduction of 1-nitroso-2-naphthol by NADPH in the presence of liver microsomes

1. The endogenous, NADPH-supported production of H2O2 and of O2-.-radicals in liver microsomes, was very strongly enhanced in the presence of 1-nitroso-2-naphthol. 2. A 30-fold induction by NON was the consequence of its direct reduction to NON-radicals, catalyzed by microsomal NADPH:cytochrome P450 reductase. 3. Nitroso radicals reduce molecular oxygen to superoxide anion radicals, which were readily dismutated by superoxide dismutase to hydrogen peroxide. 4. O2-.-radicals were the sole precursors of all NON-induced production of H2O2 in liver microsomes.

[Evaluation of the effect of therapy with Turganil in 1,240 patients]

The paper deals with results of investigation on therapy efficiency of tiaprophenic acid (Turganil, Jugoremedia) in the group of 1240 outpatients and hospitalized patients. It was an open clinical experiment, the drug has been applied for six months approximately, and the group consisted of patients with inflammatory, degenerative and outjoint rheumatism and other systemic diseases of the connective tissue. Favorable therapy effects occurred in all investigated groups, being in harmony with other authors' data, while drug tolerance was relatively good.

[Attitudes of spouses toward examinations for the early detection of cervical and breast carcinoma]

Our research program included 3474 women from Novi Sad (1957) and villages (1517) in the territory of Vojvodina. The poll investigated especially the attitudes of husbands toward the participation of their wives in check-ups for the detection of cervical and breast neoplasms. Positive attitudes toward cervical check-ups were found in 750 males from the city (54.6%) and 697 (45.9%) from the villages which represents the majority compared to those who either don't care or have no opinion of their own. More authentic relations were obtained when "negative attitudes" included also males who didn't give any answer, in that case 1206 males from the city (61.6%) and 843 from the villages (55.6%) don't encourage their wives for the detection check-ups. Similar answers were obtained to the question about breast check-ups. Positive attitude was found in 747 (54.3%) males from the city and 602 (54.1) from the villages while the number of those who either don't care or have no attitudes is smaller (628--45.7% from the city and 510--45.9% from the villages). If "negative attitudes" include those who didn't answer the question (1217--62.2% from the city and 936--61.7% from the villages) husbands who don't encourage the check-ups represent the majority. We are sure that wives' attitudes toward detection check-ups are influenced by their husbands' attitudes. Our data show that the majority of husbands' do not encourage detection check-ups negatively influencing their wives' attitudes.(ABSTRACT TRUNCATED AT 250 WORDS)

[Xenobiotic and biochemical parameters of isolated rat hepatocytes]

The authors investigated the effects of the inductors (griseofulvin and fenitoin) and the inhibitors of the cytochrome P-450 (metronidazole, chloramphenicol and phenylbutazone), the effects of the drugs with the purine structure (aminophylline, xanthinol-nicotinate, pentoxiphylline, azathioprine, thioguanine, 6-mercaptopurine), and the effects of several pesticides (lindane, binapicrile, parathion) on some biochemical parameters of the rat liver. The following parameters were determined: viability of hepatocytes, the content of glutathione and cytochrome P-450, and the activity of xanthinoxidase and lipoperoxidase. The experiments were performed in vivo and in vitro. The results showed that the cell viability as well as the other parameters studied, were most drastically affected by chloramphenicol, azathioprine and parathion, whereas the other substances elicited less intensive changes.

[Perforated ulcer in Meckel's diverticulum]

Three cases, two women and one man, aged 27, 47 and 79 years with perforated peptic ulcer of Meckel's diverticulum are reported. All patients had diffuse peritonitis. The exact diagnosis of the cause of peritonitis has not been preoperatively established in any of them. In two patients cuneiform excision (diverticulectomy) was performed, and resection and anastomosis of the small intestine in the third. The female patients, aged 79, after an uneventful recovery suddenly died due to an acute heart failure on the eight day after surgery. In other patient suppuration of the wound occurred and convalescence was prolonged. In all cases microscopic examination revealed ectopic gastric mucosa on the top of the diverticulum with peptic ulcer.

[Megacolon congenitum (Hirschsprung's disease) in adults]

Hirschsprung's disease is rare in adults and represents a unique problem in the diagnosis and therapy. The permanent symptoms of the disease are persistent chronic constipation and meteorism. The degree of constipation depends on the length and narrowing of the aganglionary segment, diet and compensatory capacities of the bowel. Already known characteristics of agangliosis (absence of ganglions cells in intramuscular and submucous plexus, changes in nerve fibers and increased cholinesterase activity of the parasympathetic nerve fibers) cause impairment in peristalsis of the aganglionary segment and insufficient relaxation of the internal anal sphincter. The result is a functional refractory constipation. The disease can be diagnosed on the basis of the history, RTG examination, electromanometry and histopathology. In the majority of cases RTG examination is very reliable if performed according to generally accepted criteria. It is important to reveal the narrowed aganglionary area by oblique and profile images during irrigoscopy and irrigography. The treatment is surgical. The preferred operations are those with a combined transabdominal-transanal approach. Such operations are the most successful in management of constipation and maintenance of contingency. The authors present three cases. Three patients were old between 21 and 23 years. Their stools ranged from 10 days to two months (a stool per 10 days to two months). The diagnosis was established for all three patients by RTG examinations and histopathological findings. All bore the operation very successfully. Three various operation techniques were used according to surgeon's choice.