Higher apoptotic cell rate in Balkan endemic nephropathy--stereologic analysis

The aim of this study was to correlate apoptotic cell rate from different nephron segments between control group and groups of patients with Balkan endemic nephropathy (BEN). Kidney specimens of20 patients with clinically and epidemiologically confirmed BEN were compared with biopsy material of 10 patients (group I, non BEN) without glomerular or tubulointerstitial disease. Out of 20 patients with BEN, 10 suffered and died from BEN (group II, BEN) and 10 patients (group III, BEN/CV) suffered from BEN but died from cardiovascular disease. Patient age ranged from 40 to 50 years. The apoptotic cell rate was measured in proximal and distal tubules and in collecting ducts using the 40X objective with a calibrated eyepiece multipurpose M 42 test system according to Weibel. Comparison of all three nephron segments yielded statistically significant differences in volume density of apoptotic cells in proximal tubules and in collecting ducts among all three patient groups (non BEN vs. BEN, non BEN vs. BEN/CV and BEN vs. BEN/CV, P<0.001 all). Statistically significant difference in apoptotic cell rate was also found in distal tubules between non BEN and BEN groups and non BEN and BEN/CV groups, but not between BEN and BEN/CV groups. Our results showed a statistically significant increase of apoptotic cells in all three nephron segments in patients with BEN (BEN and BEN/CV) compared to control group. The highest number of apoptotic cells was found in distal tubules in the groups of patients with BEN and BEN with coexisting cardiovascular disease, suggesting that these cells might be most frequently and most severely injured in patients with BEN.

Comparison of occurrence of upper urinary tract carcinomas in the region with endemic villages and non-endemic nephropathy region in Croatia

Balkan endemic nephropathy (BEN) is a chronic tubulointerstitial renal disease of a still unknown etiology, associated with an increased frequency of urothelial carcinoma, particularly of the upper urinary tract (UUT). The aim of the study was to compare the occurrence of UUT carcinomas between Brodsko-Posavska Region (BPR) which is the region with endemic villages and the non-endemic region of Zagreb (ZG) in two six-year periods with a 20 year period separating the two, pointing out a possible difference in occurrence regarding war in Croatia (1991-1995). Comparing BPR and ZG regions we found a more then 5 times higher frequency of UUT carcinomas in BPR in the first period and more than 4.5 times higher frequency in the second period. Women in BPR were more frequently affected with UUT carcinomas.

Aristolochic acid and the etiology of endemic (Balkan) nephropathy

Endemic (Balkan) nephropathy (EN), a devastating renal disease affecting men and women living in rural areas of Bosnia, Bulgaria, Croatia, Romania, and Serbia, is characterized by its insidious onset, invariable progression to chronic renal failure and a strong association with transitional cell (urothelial) carcinoma of the upper urinary tract. Significant epidemiologic features of EN include its focal occurrence in certain villages and a familial, but not inherited, pattern of disease. Our experiments test the hypothesis that chronic dietary poisoning by aristolochic acid is responsible for EN and its associated urothelial cancer. Using (32)P-postlabeling/PAGE and authentic standards, we identified dA-aristolactam (AL) and dG-AL DNA adducts in the renal cortex of patients with EN but not in patients with other chronic renal diseases. In addition, urothelial cancer tissue was obtained from residents of endemic villages with upper urinary tract malignancies. The AmpliChip p53 microarray was then used to sequence exons 2-11 of the p53 gene where we identified 19 base substitutions. Mutations at A:T pairs accounted for 89% of all p53 mutations, with 78% of these being A:T --> T:A transversions. Our experimental results, namely, that (i) DNA adducts derived from aristolochic acid (AA) are present in renal tissues of patients with documented EN, (ii) these adducts can be detected in transitional cell cancers, and (iii) A:T --> T:A transversions dominate the p53 mutational spectrum in the upper urinary tract malignancies found in this population lead to the conclusion that dietary exposure to AA is a significant risk factor for EN and its attendant transitional cell cancer.

Some anthropometric characteristics, reactions on physical stress, and blood pressure in males aged 18 in "Primorsko-Goranska" County, Croatia

The paper presents the distribution and average values of some anthropometric characteristics in 1,210 males aged 18 in "Primorsko-Goranska" County, as well as some manifestations of physical fitness parameters and some correlations between these two groups of characteristics. The prevalence of hypertensive and limit values for systolic blood pressure (SBP) was 8.6% and for diastolic blood pressure (DBP) 2.1%. Body weight and body mass index were in a significantly positive correlation with SBP and DBP Body mass index showed a significantly positive correlation with heart rate after step-test. Therefore, it can be concluded that overweight reduces tolerance on workload.

Work conditions as risk factors for varicose veins of the lower extremities in certain professions of the working population of Rijeka

This research aims to establish the effect of working conditions on the appearance of varicose veins. The epidemiological study was carried out on 1,324 examinees, 530 males and 794 females, employed in 5 highly represented groups of professional activities in Rijeka (catering, trade, light industry, heavy industry and finances). The data were collected by survey and clinical examination. Varicose veins were more prevalent in the trade than in the office workers (odds ratio (OR) = 2.08; 95% confidence interval (CI) = 1.31-3.31), and more prevalent in catering industries than in the office workers (OR = 1.56; 95% CI = 1.001-2.43). chi 2-testing suggested that standing in the workplace (OR = 1.35; 95% CI = 0.95-1.92), weight handling while working (OR = 1.29; 95% CI = 1.01-1.64) and working indoors (OR = 1.61; 95% CI = 1.02-2.53) were risk factors for varicose veins. By multiple logistic regression, the following risk factors were isolated in the total population: female sex (OR = 1.92; 95% CI = 1.37-2.67), workplace (OR = 0.89; 95% CI = 0.78-0.99), age (OR = 1.05; 95% CI = 1.03-1.07), body mass index (OR = 1.04; 95% CI = 1.01-1.07) and family history of the disease (OR = 1.99; 95% CI = 1.55-2.57).

[Use of angioscopy in vascular surgery bypass with an in situ approach--first year experience]

Femoropopliteal and femorocrural bypass, managed by "in situ" procedure with the use of angioscope, became a standard surgical method in the treatment of occlusive process in the arteries of lower extremities in the Department of Vascular Surgery, Clinical Hospital "Sestre milosrdnice" in Zagreb. The capabilities of angioscopy in diagnosis and in surgery are presented, with special emphasis on bypass "in situ" procedure. Technical difficulties encountered in bypass formation and our solutions are described. From December 1993 to December 1994, eleven patients were operated. Common femoral artery was used for proximal anastomosis in four patients. Superficial femoral artery was used in five patients, and profound femoral artery was used in two patients. The third segment of popliteal artery was used for distal anastomosis in five cases. In six cases crural bypass was done. Three of them were on posterior tibial artery, two were on fibular artery and one was on anterior tibial artery. Two out of four or 50% of femoropopliteal bypasses are patent after the first year. One patient died of cardiorespiratory complications in the early postoperative period. Femorocrural bypasses are patent in five out of six patients or 83.3%. Bypass with great saphenous vein "in situ" is the procedure of choice, especially in femorocrural position.

[Aneurysms of the extracranial part of the carotid artery]

The purpose of this article is to take firm position on the surgical treatment of the carotid artery aneurysm on the basis of ten years of experience, considering their rare occurrence and significant pathology. From January 1984 to December 1994, ten patients with aneurysms or pseudoaneurysms of extracranial carotid arteries were diagnosed and operated in the Department of Vascular Surgery, Clinical Hospital "Sestre milosrdnice" in Zagreb. In the same period, eight hundred operations of extracranial carotid arteries were performed. Special emphasis is put on the etiology of the disease where atherosclerosis is prevalent, but cases of traumatic, mycotic and postoperative aneurysms are also shown. In symptomatology, signs of palpable local tumor dominated in six patients, while in three patients central nervous system symptoms were found. All patients with neurologic symptoms were in the group with atherosclerotic aneurysms. In nine patients resection of the aneurysm and reconstruction with the interposition of a part of vena saphena magna or with allograft was performed. In one patient, neoanastomosis of the internal carotid artery in the common carotid artery was performed following the resection of a small aneurysm. In the early postoperative period there was no morbidity nor mortality. In view of frequent preoperative neurologic complications and good postoperative results, surgical treatment is indicated in all cases. Reconstruction is always indicated, and the procedure of choice is reconstruction with the interposition of a part of great saphenous vein.

The prevalence of noise-induced hearing loss in seamen

Hearing was analysed in 231 seamen with the length of sea service longer than five years. Among 107 seamen in deck service, 86 seamen in engine service, and 38 seamen in radio and general services statistically significant differences in relation to age, total length of service and the length of sea service were not established. There were no differences in the degree of hearing loss among those groups of seamen either. Based upon calculated simple regression coefficients, a statistically significant correlation was established between age, total length of service or length of sea service with the average hearing loss at the frequencies of 500, 1000, 2000 and 4000 Hz in the left ear in seamen from all ship services. Correlation was best pronounced at 2000 and 4000 Hz. In seamen from deck, radio or general services, a significant multiple correlation was established between age, total length of service and length of sea service, and the degree of hearing loss at 4000 Hz in the left ear. The same correlation, likewise, was true of seamen from deck service at 2000 Hz in the left ear and at 4000 Hz in the right ear.

Knowledge of seafarers about AIDS problems and their vulnerability to HIV infection

The results of a questionnaire survey conducted among 243 seafarers in Rijeka in 1989-1990 indicated that the knowledge of ratings among them on AIDS and HIV virus transmission was inadequate. The majority of them had not used condoms for protection against HIV virus infection. More education on AIDS should be given to seafarers, particularly those employed on ships flying flags of developing countries.

Estimation of physical work load by statistical analysis of the heart rate in a conveyor-belt worker

Physical work load was estimated in a female conveyor-belt worker in a bottling plant. Estimation was based on continuous measurement and on calculation of average heart rate values in three-minute and one-hour periods and during the total measuring period. The thermal component of the heart rate was calculated by means of the corrected effective temperature, for the one-hour periods. The average heart rate at rest was also determined. The work component of the heart rate was calculated by subtraction of the resting heart rate and the heart rate measured at 50 W, using a regression equation. The average estimated gross energy expenditure during the work was 9.6 +/- 1.3 kJ/min corresponding to the category of light industrial work. The average estimated oxygen uptake was 0.42 +/- 0.06 L/min. The average performed mechanical work was 12.2 +/- 4.2 W, i.e. the energy expenditure was 8.3 +/- 1.5%.

Pathomorphology of Balkan endemic nephropathy

Within the county of Slavonski Brod, Yugoslavia hyperendemic areas of Balkan endemic nephropathy (BEN) have been recognized for a long time. As the Department of Pathology and Forensic Medicine of the Medical Centre in Slavonski Brod is responsible for all diagnostic post-mortem examinations in the county, and at the same time is engaged in surgical pathological diagnosis, a considerable amount of material relating to BEN and concomitant urinary-tract tumours has been collected during a 16-year period. This material has been classified and used for pathological, anatomical and histological investigations. In this paper the most relevant findings are described and briefly discussed, without the intention to speculate on possible aetiology of BEN. As the origin of BEN and of the high frequency of urinary tumours among the people from the endemic areas are still unexplained, and uniform criteria for the pathomorphological diagnosis of BEN are badly needed, the proposal to set up an archive encompassing cases from all the centres investigating BEN is supported.

[Alcoholism, risk factors and prevalence of arterial hypertension in naval personnel]

In this paper, the authors tried to establish the association of alcoholism with arterial hypertension as well as with risk factors for atherosclerosis, which are invariably accompanying arterial hypertension, in engine-room personnel (N = 80), in other seamen of the "Jugolinija" (N = 119), and in the control group which was made up of employees of the Technical Department, Shipyard, "3. maj", Rijeka (N = 108). The chi 2-test showed a statistically significant difference in the prevalence of alcoholism, and the t-test a statistically significant difference in the daily consumption of alcohol between the two groups of seamen and the control group. The prevalence of alcoholism and the daily consumption of alcohol were higher in seamen. There were no such differences between the two groups of seamen. Similarly, arterial hypertension was more prevalent and systolic (SBP) and diastolic blood pressure (DBP) were higher in the two groups of seamen compared with the control group. Since, there were no significant linear correlations between the alcohol consumption and SBP and DBP, it could not be said that higher values of SBP and DBP were positively related to the greater consumption of alcohol in seamen as compared to the control group. No significant linear correlation was found between alcohol consumption and studied risk factors too. However, higher prevalence of arterial hypertension in alcoholics among the engine-room personnel suggested some association of the alcohol consumption with arterial hypertension.

[Causes of permanent disability in professional drivers]

In the period from 1984 to 1989 a total of 8139 professional drivers were examined in the Centre for Prevention, Diagnosis and Assessment of Work Ability in Rijeka. Of this number 347 were assessed as permanently disabled. On the basis of the Regulations on Health Requirements, with which motor vehicle drivers must comply, 130 of these 347 drivers were completely disabled for all driving categories (A, B, C, D and E categories). More than half the disabled professional drivers were aged from 18 to 47 years. The most frequent cause of disability of professional drivers was disease of the eyes and defective sight (34.3% of disabled). The second cause was alcoholism (19%) and the third cause was disease and conditions of the skeletal system and locomotor apparatus (11.5% of the total number of disabled drivers).

[Noise as a risk factor for arterial hypertension in sailors]

Analysis of the prevalence of arterial hypertension among seamen using the chi-square test did not show a difference between the engine-room personnel (n = 80) exposed to elevated total ship noise levels (103 +/- 4.6 dB) and the rest of the crew (n = 119) exposed to lower noise levels (63 +/- 4.6 dB), or between the engine-room personnel and the control group (n = 108) exposed to lower levels of occupational noise (64-72 dB). The number of persons with hypertension was higher among the rest of the crew than among the controls. According to Student's t-test there was no difference in systolic or diastolic blood pressure levels between the two groups of seamen. In both these groups blood pressures were higher than in the control group. Among the seamen not working in the engine-rooms and in the subpopulations of both groups of seamen the number of hypertensive persons was greater among those with a noise-induced hearing loss than among those without it. Of the features which could be connected with arterial hypertension and are known to be risk factors of atherosclerosis (age, length of service, body mass index, body fat percentage, plasma cholesterol, triglycerides and glucose, cigarette and alcohol consumption, psychic tension index and recovery time in Lorenz test), only the body mass index could have caused the marked differences in blood pressures between seamen and the controls. The degree of hearing loss correlated with systolic blood pressure in both groups of seamen as well as with diastolic blood pressure in the engine-room personnel. The results of the study do not allow to draw a clear conclusion regarding correlation between ship noise and arterial hypertension, although some indicators point to a certain effect of noise on blood pressure.

[Changes in the anterior segment of the eye in workers in the coke manufacturing industry]

An investigation carried out of eye disorders in workers employed in the manufacture of coke demonstrated a high percentage of changes in the anterior segment of the eye. Registered symptoms such as conjunctival hyperemia, pinguecula, pigmentation and conjunctivitis were most probably connected with specific work and exposure to coal dust and irritants. In workers exposed for less than two years there were no changes in lacrimal secretion. In those working for 2-7 years excessive hypersecretion dominated, and after a longer period of exposure the majority of workers had hyposecretion.

[Manifestations of glue sniffing in secondary school students]

The habit of glue sniffing among pupils has been noted recently. Most sniffers are experimental consumers who seek pleasure and conditional paradise through glue sniffing. An epidemiological investigation carried out in three secondary schools in Rijeka, by means of a questionnaire, showed that among 2254 pupils, aged 14-18 years, 15.2 per cent of the boys and 11 per cent of the girls were sniffers. According to the results of the investigation the pupils who sniffed were more inclined to take up smoking or drugs than those who did not sniff (p less than 0.005). Among the boys who sniffed only 14.7 per cent were non-smokers. The percentage of non-smokers among the girls was 15.2.

[Lacrimal hyposecretion in women working with video terminals]

Tests of vision and lacrimal secretion were performed as part of a general medical check-up among women employed at video-terminals in a bank. The tests were taken by three groups of 100 employees each. The first group consisted of full-time (eight hours) employees, the second of those working part-time (the time spent at a video-terminal daily was never less than two hours of continuous work) and a third group of control subjects having different clerical jobs but working in the premises with video-terminals. Diminished lacrimal secretion was most often present among full-time workers (20 per cent). A statistically significant difference in lacrimal secretion was observed between the first and the second group of examinees. There was no significant difference between the second group and the controls.