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The article presents a study of Ancient Roman city Sirmium's cattle and horse bone remains in a paleopathological perspective. Topics discussed include animal skeletal remains, taxonomic age, macroscopic and radiographic analysis, the benefits of paleopathology in studying animal diseases, and a brief history and geography of Sirmium. Also mentioned are species determination techniques and findings such as pathological lesions and locomotor disorders on the identified cattle and horses.

Introduction: The incidence rate of nasopharyngeal carcinoma in Serbia is less than one per 100,000 citizens, which classifies it as a region with low incidence for this disease., Objective: The aim of this study was to test some hypotheses of the risk factors for undifferentiated carcinoma of nasopharyngeal type (UCNT) in the low incidence population., Methods: A case-control study was used for the research. The study included 45 cases with histopathological diagnosis of UCNT and 90 controls. Cases and the controls were individually matched by sex, age (+/- 3 years), and place of residence (city-village). Data were gathered about sociodemographic characteristics, occupational exposure to harmful agents, habits, diet, personal history, and family history. In the analysis of the data, conditional univariate and multivariate logistic regression analyses were applied., Results: According to the results of multivariate logistic regression analysis UCNT was significantly positively associated with "passive smoking" of tobacco in the family during childhood, frequent consumption of industrially manufactured food additives for enhancing flavour and frequent consumption of white bread. UCNT was significantly negatively associated with frequent consumption of margarine, olive oil and cornbread., Conclusion: In our low incidence population, an independent risk factor for the occurrence of UCNT was "passive smoking" of tobacco in the family during childhood, use of industrially manufactured food with additives for enhancing flavour and consumption of white bread. Multicentric study enrolling a greater number of cases would be desirable.

Background/aims: Mycophenolate mofetil (MMF) has been increasingly used for the treatment of lupus nephritis (LN). The aim of this study was to examine the efficacy and safety of MMF used with low doses of corticosteroids as maintenance therapy in patients with LN., Methods: The study covered 35 patients, most of them with proliferative types of LN (5 WHO class III, 26 class IV), while 1 had class V and 3 class VI nephritis. MMF was administered in the dose of 1.5-2 g/24 h and prednisone at 10-20 mg/day. The treatment effects were followed over a 12-month period., Results: After 3 months of therapy significant reduction in proteinuria was achieved (2.1 +/- 2.4 g/24 h vs. 1.0 +/- 1.0 g/24 h, p < 0.01) and maintained to the end of the study. In parallel, a significant rise in serum albumin, a fall of cholesterol and a significant increase in mean glomerular filtration rate were noted. Complete remission was achieved in 16 patients (45.7%), including all patients in class III and V plus 10 patients in class IV. Not a single adverse effect was observed., Conclusion: MMF combined with low doses of steroids is an effective and safe treatment for the maintenance of stable remission of LN., (Copyright (c) 2010 S. Karger AG, Basel.)

Introduction: Tuberculous otitis is a diagnostic problem due to the difficulty to obtain microbiological, histomorphological and cytological confirmation of the disease., Objective: Our objective was to compare clinical and radiological characteristic and development of otogenic complications in patients with tuberculous otitis and otitis with cholesteatoma as the most destructive form of chronic nonspecific otitis in the purpose of establishing the diagnostic criteria for tuberculous otitis., Methods: Medical records of 12 patients with tuberculous otitis and 163 patients with cholesteatoma treated at the Institute of Otorhinolaryngology and Maxillofacial Surgery in Belgrade during the eight-year period were analyzed. All of the patients underwent otomicroscopic, audiological and radiological examination of the thorax and temporal bone, microbiological examination of the secretion and histomorphological examination of the tissue taken during middle ear surgery. Statistical analysis was done using chi2 test with Yates correction., Results: Otogenic complication as facial palsy and sensorineural hearing loss were more frequent in tuberculous otitis patients, than in cholesteatoma. Also, fistulas of the labyrinth and facial canal bone destruction were also more frequent in tuberculous otitis than in cholesteatoma. A larger extent of temporal bone destruction was noticed on CT scans of the temporal bone in half of the patents with tuberculous otitis. Coexistence with miliary pulmonary tuberculosis was detected in one third of the patients. There were no microbiological or histomorphological confirmations of the disease, except in one case with positive ZiehI-Neelsen staining., Conclusion: Tuberculous otitis media should be considered in patients with serious otogenic complications and with shorter duration of ear discharge, and in association with diagnosed miliary pulmonary tuberculosis and extensive temporal bone destruction. Polymerase chain reaction still is not reliable for diagnosis.

Background/aim: Nasopharyngeal carcinoma (NPC) is a relatively rare malignant disease, of which 80,000 individuals become ill around the world annually, which amounts to 0.7% of all carcinomas. The aim of this descriptive study was to analyze NPC incidence in Belgrade (the capital city of Serbia, with about 1.6 milion inhabitants) during the period 1991-2005., Methods: In data analysis, crude rates age and sex specific rates, and standardized incidence rates were used. Standardization was performed by a direct method, using world population as the standard., Results: In Belgrade, during the observed 15-year-period, the number of new NPC patients totaled 118, of which 86 (72.9%) were male and 32 (27.1%) were female. The average standardized incidence rate for men was 0.52 per 100,000 and for women 0.16 per 100,000. In both sexes the incidence was very low before 40 years of age. In men, the greatest incidence rate of NPC was in the 50-59 years age group, and in women in those 60 and more years old. Furthermore, undifferentiated carcinoma of nasopharyngeal type was 3.6 times more often in comparison to squamous cell carcinoma., Conclusion: Belgrade belongs to a region with a low incidence rate of NPC. Further investigations are needed to explain higher frequency of undifferentiated carcinoma of nasopharyngeal type than squamous cell carcinoma.

Introduction: Residual renal function (RRF) in the patients treated by haemodialysis (HD) is associated not only with better volume and blood pressure control but also with better metabolic control.The condition of the cardiovascular system significantly affects RRF., Objective: The aim of the study was to find if there was any association between blood pressure regulation and the achieved HD ultrafiltration in the first year of haemodialysis treatment and the maintenance of RRF., Methods: In this retrospective study, 53 patients were analyzed in the period 1994-2002. Residual clearance of urea (RCU) was measured for the first time at the beginning of HD treatment, and for the second time one year later. Laboratory data and values of blood pressure as well as the achieved HD ultrafiltration were taken from the electronic database of the Nephrology Hospital., Results: The value of RCU less than 1 ml/min was considered as the loss of RRF and, at the beginning of HD treatment, 14 patients (26.4%) had that result. The rise of mean arterial pressure (MAP) was associated in linear regression analysis with a drop of residual diuresis volume (beta = -0.28; p = 0.04), but there was no association with RCU. The patients with MAP > 105 mm Hg had RKU less than the patients with MAP < 105 mm Hg (t = 2.23; p = 0.03). The rise of the HD ultrafiiltration significantly affected the loss of RRF obtained by the linear regression analysis (beta = -0.44; p = 0.0001)., Conclusion: The greater HD ultrafiltration is related to a drop of RCU values. Only prospective randomised trials with the use of multiple regression analysis could define a more precise association between hypertension and RKU.

The treatment of patients with supraglottic laryngeal cancer still remains a controversal issue. The study comprised 193 patients with a supraglottic laryngeal carcinoma treated in the period 1986-2003. All patients had primary surgery. They all had clinically and ultrasonografically negative findings in the neck (N0). Bilateral selective neck dissection at the level II-III was performed in all patients at the time of primar surgery. Postoperative radiotherapy was given to all patients with verified occult metastases (60 Gy). The occult cervical node metastases were found in 18% (35/193). Ipsilateral occult metastases were more common (77%, 27/35), but both bilateral and contralateral spread was also seen (14%, 5/35 and 9%, 3/35, respectively). Only in two (1%) did metastases develop subsequently. The 5-years survival rate was 86%.

Introduction: Two types of hereditary nephritis, nonprogressive and progressive, clinically present as asymptomatic haematuria, sometimes combined with proteinuria. At the onset, in both types, light microscopic changes are minimal, immunofluorescence findings are negative, and diagnosis can be made only upon electron microscopic findings that are considered to be specific., Objective: The aim of this study was to determine the significance of Goodpasture antigen detection in diagnosis of progressive and nonprogressive hereditary nephritis in its early phase., Method: Analysis of renal biopsy specimens was done in patients with hereditary nephritis that were followed from 1990 to 2005. Progression of renal disease was examined in 14 patients with Alport's syndrome, 10 patients with thin basement membrane disease, and 6 patients with unclassified hereditary nephritis diagnosed. For all these cases, indirect immunofluorescence study with serum from a patient with high titer of Goodpasture autoantibodies that recognize the antigenic determinants in human glomerular and tubular basement membrane was performed., Results: In 11 out of 14 cases diagnosed as Alport's syndrome, there was negative staining with Goodpasture serum, and in 3 additional cases with Alport's syndrome, expression of Goodpasture antigen in glomerular basement membrane and thin basement membrane was highly reduced. In all 10 patients with thin basement membrane disease, immunofluorescence showed intensive, bright linear staining with Goodpasture serum along glomerular and tubular basement membrane. In 2 out of 6 patients with unclassified hereditary nephritis, Goodpasture antigen expression was very strong, in one patient it was very reduced, and in 3 patients it was negative., Conclusion: The results of our study show that Goodpasture antigen detection plays a very important role in differential diagnosis of progressive and nonpregressive hereditary nephritis, particularly in early phases of the disease.

This is a retrospective analysis of 439 patients with supraglottic laryngeal cancer primary surgically treated in the period 1976-1999. The objectives of our study were to analyze the localizations as well as local and regional tumor spread, frequency of occult and palpable cervical metastases, the incidence of local and regional recurrences, five-year survival rate and functional results of supraglottic partial horizontal laryngectomies. A retrospective analysis of operated patients was carried out. T1 tumor was prevalent in 184 (42%) patients, T2 in 228 (52%) patients, and T3 tumor in 27 (6%) of cases. Clinically negative finding of the neck was found in 369 (84%) patients, and metastasis N1 was established in 70 (16%) patients. The patients with clinically negative cervical finding underwent selective neck dissection, while N1 metastasis patients were subjected to a selective or modified radical neck dissection. Five-year disease-free survival rate was 76% (334/439).

Introduction: It is well known that polyneuropathy has been an important cause of disability in patients maintained on hemodialysis as well as on peritoneal dialysis. The present study was aimed to analyze frequency and causes of polyneuropathy in patients on continuous ambulatory peritoneal dialysis (CAPD)., Material and Methods: Sixty three CAPD patients (37 men), aged between 30 and 85 who were on dialysis from 1 to 290 months, were analyzed. Biochemical parameters and dialysis adequacy (KT/V) were determined. Motor conduction velocity (MCV) of peroneal and tibial nerve, and sensitive conduction velocity (SCV) on sural nerve were measured., Results and Discussion: Biochemical parameters and dialysis adequacy were satisfactory in patients on CAPD. Polyneuropathy symptoms like paresthesias, pain, cramps and disability were found in more than 50% of patients. Over 80% of analyzed patients had pathological neurophysiological parameters: latency of F wave of n. peroneus and all analyzed parameters of n. tibialis, as the well as SCV on the sural nerve. A significant correlation was found between peroneal MCV and age, glycemia and serum creatinine; peroneal terminal latency (TL) and age; peroneal F wave and glycemia and serum urea; tibial MCV and glycemia; tibial F wave and glycemia, serum urea and KT/V., Conclusion: The most frequent signs of uremic polyneuropathy are reduced SCV on sural nerve and prolonged latency of F wave on peroneal and tibial nerves. Neurophysiological parameters on the lower extremities in patients on CAPD are in correlation with dialysis adequacy, glycemia and age.

Introduction: Urolithiasis, which affects 1-5% of western world population causing significant morbidity, is heterogeneous disorder with varying pathophysiologic milieu. Patients with recurrent stone formation are the particular problem because the understanding of the risk factors for active stone formation is deficient. The aim of the present study was to determine the most important metabolic and clinical parameters for active stone formation in order to recommend the best preventive therapies., Materials and Methods: In this study 134 consecutive outpatients (57 males, 46.9+/-14.4 years old) were referred and evaluated for urinary stone disease at our Institute. Clinical and metabolic parameters were determined by standardized procedures of questionnaire, serum biochemical profiles and urinalyses. An active stone former group was defined by an increase in the size or number of stones, or a recurrent stone event within 2 years., Results: In the evaluated cohort, 51 patients (38.1%) created the active stone former group. These patients were younger in the moment of the first stone elimination, had higher serum creatinine concentration, lower urine citrate concentration, as well as citrate/calcium ratio, higher urine pH and more frequently had clinical important urine sediment with eritrocituria and lenkocituria compared to the non-active stone group. Significant positive correlations were found between the active stone former and serum creatine concentration (r=0.227), urine pH (r=0.223), urine sediment (r=0.255) but negative with urine citrate (r=-0.275) and citrate/calcium ratio (r=-0.227). However, multivariate analysis indicated that clinical important urine sediment with eritrocituria and leuokocituria (p=0.033) and low urine citrate (p=0.04) were the only determinants of active urinary stone formation., Conclusion: Further study is required to investigate efficacy of alkaline citrate substitution and rigorous diagnosis and treatment of infections in order to prevent urinary stone recurrence.

A normocytic normochromic anemia is one of the first signs of renal failure. Since anemia increases morbidity and mortality, its elimination is one of the essential objectives of the treatment. Human recombinant erythropoietin (rHuEPO) has changed the therapeutical approach to anemia. The aim of the present study was to compare efficacy of anemia correction in peritoneal dialysis patients depending on treatment and dialysis modality. The study is the retrospective analysis of 64 patients who presented to our Clinic in 2003. Eighteen (28.13%) patients were treated with rHuEPO, 14 (28%) underwent continuous ambulatory peritoneal dialysis (CAPD), 2 (100%)--automated peritoneal dialysis (APD) and 2 (33.3%)--intermittent peritoneal dialysis (IPD). Mean hemoglobin level was 98.6 +/- 17.82 g/l in patients treated with rHuEPO versus 98.81 +/- 15.14 g/l in patients without rHuEPO treatment. Erythropoietin requirements were 3392.85 +/- 1211.77 IU/week All patients received iron supplementation during rHuEPO therapy. Mean serum ferritin levels were 463.41 +/- 360 ug/l. Transferrin saturation (TSAT) was 0.35 +/- 0.16%. No difference of serum iron and TSAT levels was found between CAPD and IPD patients. The degree of anemia significantly differed between CAPD and IPD patients. A total of 17.11% of PD patients were given blood transfusions, most frequently during the first three months after the onset of dialysis. Our conclusion is that the number of patients receiving rHuEPO should be increased, as 50% of our patients should be substituted, while only 28% are being treated. As 50% of patients receiving rHuEPO failed to reach target Hgb levels, higher EPO doses should be considered. Iron stores should be continuously monitored, particularly in patients receiving rHuEPO, since iron deficiency is an important problem for patients undergoing peritoneal dialysis, especially during erythropoietin therapy. Oral iron supplementation is satisfactory in the majority of patients, and iron-gluconate is absorbed better than iron-sulphate. If required, intra-venous iron bolus is safe and efficient. Continuous peritoneal dialysis treatment improves blood count more effectively compared to intermittent procedures, as hemoglobin levels are significantly higher in patients with comparable iron stores. Peritoneal dialysis is particularly efficient in improving the blood count in diabetics, since no significant difference of anemia between patients affected by diabetes mellitus and the others could be found in our study.

Introduction: In the last few years, an increasing number of patients suffering from terminal renal disease of various leading causes was treated with renal replacement therapy. Peritonaeal dialysis involves an exchange of water and solutes between blood in the peritonaeal capillaries and dialysate in the peritonaeal cavum throughout the peritonaeum. Effective dialysis treatment should provide good quality of life, decrease the number of physical complaints, and bring the incidence of morbidity and mortality closer to the incidence of morbidity and mortality in the healthy population., Aim: The aim of this study was the evaluation of peritonaeal transport characteristics and dialysis effectiveness in 58 patients affected by terminal renal disease who underwent peritonaeal dialysis treatment during August 2003 at the Clinic of Nephrology of the Clinical Centre of Serbia., Method: We examined 30 male and 28 female patients, with an average age of 52 years (range 26 to 78 years). The average duration of peritoneal dialysis treatment was 20 months (ranging from 2 to 66 months), and the end-stage renal failure was caused by different leading disease in our patients. We applied different dialysis modalities: continuous ambulatory peritonaeal dialysis (CAPD) with three to five 2- or 3-litre exchanges daily, cyclic peritonaeal dialysis (CCPD), intermittent peritonaeal dialysis (IPD), or automatic peritonaeal dialysis (APD), according to the transport characteristics of the peritonaeal membrane, the residual renal function (RRF), and the clinical status of the patients, in order to perform adequate depuration as suggested by the new international criteria. A peritonaeal equilibrium test (PET) was performed according to the new international advice; urea and creatinine clearances (Kt/V and Ccr) as well as RRF were calculated using the internationally suggested formulas., Results: Most of our patients received effective dialysis treatment, thanks to the modulation of number, volume, and timing of exchanges., Conclusion: Adequate dialysis improved blood count, nutritional status, and quality of life in our patients, while reducing the incidence of infection to a significant degree.

Background/aim: According to the data from immunological, biological and molecular researches, there is a close association between the undifferentiated carcinoma of nasopharyngeal type (UCNT) and Epstein-Barr virus (EBV). To use IgA EA antibody as a serological marker in our patients with nasopharyngeal carcinoma from a clinical viewpoint., Methods: 91 patients were followed in the period from 1989-1998. In 11 of the patients the antibody titre serum for the early antigen of EBV virus were determinated before the treatement, and in 24 of the patients 3 years after the treatement. There were three control groups of patients: 20 voluntary blood donors, 26 patients with squamocellular laryngeal carcinoma, and 10 patients with squamocellular nasopharyngeal carcinoma., Results: In the group of 11 patients with UCNT before the treatment, the value of anti-EA IgA titre was 31.09, and in the patients after the treatement anti-EA IgA antiody titre was 14.56. In the control groups of patients the results were: in the blood donors 5.00; in the group with the diagnosis of squamocellular laryngeal carcinoma, the titre was 5.00; in the patients with squamocellular nosopharyngeal carcinoma, the titre anti-EA IgA was 5.36., Conclusion: These results were statisticly highly significant (p < 0.01). Our research clearly showed that anti-EA IgA EBV marker could be useful in diagnosing, differential diagnosing and prognosing as well.

Introduction: The use of erythropoietin (EPO) in the treatment of renal anemia is justified by more than 15 years of experience. Clinical trials have shown that subcutaneous erythropoietin beta (Recormon - F. Hoffmann-La Roche) therapy once weekly, or even once every two weeks has proven successful. The aim of this study was to evaluate the efficacy of different regimes of Recormon therapy in maintaining stable levels of hemoglobin (Hb) and hematocrit (HCT) in hemodialysis patients., Material and Methods: An open, comparative, multicenter study was divided into three arms of patients and lasted for 24 weeks. 98 patients with stable Hb level (>100 g/l), were treated with a stable dose of Recormon, and had a ferritin level > 200 microg/l and transferrin saturation >20%. During the first 8 weeks all were on the usual 2-3 times weekly epo dosage. 8 weeks later, 70 patients received epo once weekly, while 28 patients (group 1) maintained the same regimen for the entire study period. After another 8 weeks, 21 of those 70 patients receiving epo once weekly, received it once every two weeks (group 3), while 49 patients continued once weekly regimen to the end of the trial (group 2). The primary efficacy parameter was the percentage of patients maintaining their target Hb and HCT levels (>100 g/l and >30% for HB and HCT respectively)., Results: 86 patients (87.75%) completed the study (25 from group 1, 42 from group 2 and 19 from group 3). One patient was excluded because he was transplated during the study, one due to uncontrolled hypertension, while 10 patients, all from the same center, were excluded due to protocol violation (4-week gap in epo therapy due to problems with epo supply). Efficacy analysis included per-protocol population (86 patients). Hb levels remained stable (>100 g/l) in all three groups. Although there were statistically significant differences in Hb levels between visits (p=0,026), there were no statistically significant differences between groups throughout the study (p=0,439). HCT levels remained stable (>30%) in all three groups throughout the study, without statistically significant differences between visits (p=0,053) and between groups (p=0,155). The average epo doses were not statistically significantly different between visits (p=0,676) or between groups (p=0,512). The main tolerability parameters: sitting systolic (SSBP) and diastolic (SDBP) blood pressures were monitored at all visits. Statistical analysis showed that there were no differences in SSBP or SDBP between visits or groups of patients throughout the study., Conclusion: All three dosing regimens of subcutaneous epo beta were statistically equivalent in maintaining target Hb and HCT levels. Once weekly or once every two weeks administration of epo beta does not lead to dose increase, and provides greater opportunities to individualize treatment for every single patient and may lead to better compliance.

HIV-infected patients may be faced with a variety of renal problem patterns. HIV-associated nephropathy is a unique pattern of sclerosing glomerulopathy and represents the most rapidly progressive form of focal segmental glomerulosclerosis. This study involved the examination of 32 renal biopsies: by light, immunofluorescence, and electron microscopy, in order to determine the most accurate and reliable diagnostic procedure. The findings show that the most sensitive and accurate procedure is electron microscopy, capable of detecting specific EM changes very early on, which is sufficient for the diagnosis of HIV-associated nephropathy.

Malignant tumors of nasopharyngeal epithelium differ clinically depending on the course of disease and applied therapy. They are presented in regard to the sex, age, smoking habits, alcohol usage and nutrition factors. Various studies already showed various etiological-causal links with Epstein-Barr virus (EBV). This leads to diversity of various morphological and histological types of diseases belonging to various classifications. In this work we presented 60 diagnosed and treated cases with malignant tumor of nasopharyngeal epithelium in the Institute for Otorynolaringology and maxillofacial surgery of Clinical Center of Serbia. All of them were pato-histologicaly examined and 24 of them received serological examination in regard to the concept of association between malignant epithelial tumour and EBV. An important correlation between histopathology and serology was found. Finally, the terminology used by WHO classification is not optimal for further histological determination of nasopharyngeal malignancy; therefore we recommend the French classification of C. Micheaua.

Introduction: Normocytic, normochromic anemia is one of the first signs of chronic renal failure and it is common in patients on chronic dialysis treatment. It causes decrease in oxygen supply to tissues, increases cardiac minute volume, causes left ventricular hyperthrophy, cardiac insufficiency, disorders related to cognitive functions and immune response, and increases morbidity and mortality rates. The leading cause of anemia in patients on chronic peritoneal dialysis (PD) is iron depletion and most patients on PD need oral or parenteral iron supplementation. The aim of this study was to evaluate our first experience with bolus intravenous ferrogluconate therapy in patients on chronic peritoneal dalysis at the Nephrology Clinic of the Clinical Center of Serbia (CCS)., Material and Methods: We examined 11 patients, 7 males and 4 females, mean-age 49 years (range 31 to 68 years) on chronic PD. All patients received blood transfusions, oral or intramuscular iron supplementation before 465 to 665 mg ferrogluconate therapy was given in 500 ml. saline intravenous infusion: 5 of them were on erythropoietin therapy and 2 of them started with EPO therapy after the ferrogluconate therapy., Results: The blood count improved during the first 3 months after application of bolus intravenous iron therapy (ferrogluconate); erytrhopoietin dose was not increased during the follow-up. Some patients suffered from side effects during infusion and 6 patients received the complete treatment., Discussion: Blood count improves in a number of patients affected by endstage renal desease during the first months on continuous ambulatory peritoneal dialysis (CAPD) treatment. But a large number of patients on chronic CAPD treatment are iron-depleted and they require oral or parenteral substitution. Side effects and complications of intravenous iron therapy were not severe and only one patient suffered from allergic manifestations. Ferremia and blood count improved in patients who did not receive erythropoietin during the follow-up, and patients on erythropoietin therapy required lower doses after receiving the intraveonous iron therapy., Conclusion: Blood count improvement and the lack of severe side effects speak in favor of further iron supplementation with bolus intravenous iron replacement.

Eustachian tube dysfunction is one of the well-known factors leading to development of chronic suppurative otitis media. Tube mucociliary transport is important for elimination of the inflammation products from the middle ear enabling recovery of the affected mucosa of the middle ear, local circulation and restoration of normal air pressure in the middle ear. The study was aimed at determining: 1. whether perforation site on the tympanic membrane influences tube mucociliary transport time in individuals with traumatic rupture of the eardrum; 2. possible time difference of tube mucociliary transport between group of patients with chronic suppurative otitis media and group of patients with traumatic rupture of the tympanic membrane; 3. possible time difference of tube mucociliary transport between chronic tubotympanic type of suppurative otitis media, so called tubotympanic otitis media and atticoantral type of chronic suppurative otitis media, the so called atticoantral otitis; 4. the association between the degree of defect of the tympanic membrane mucosa and time of tube mucociliary transport in each individual type of chronic suppurative inflammation of the middle ear. Eustachian tube mucociliary transport was studied in 16 patients with tubotympanic otitis, in 13 patients with atticoantral otitis and in 9 patients with traumatic rupture of the eardrum (control group of patients). All patients were treated at the Institute of Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre of Serbia in Belgrade during 2002. Tube mucociliary transport was studied upon instillation of 10 microl 5% sterile saccharine solution through the existing eardrum perforation in the course of preoperative preparation of the patient for surgical intervention. The time interval from the moment of sterile saccharine solution application till perception of the sweet taste in the mouth and pharynx was measured in studied patients. The obtained results were analyzed using the methods of descriptive and analytical statistics (t-test for small independent samples). The mean time of tube mucociliary transport in patients with traumatic rupture of the tympanic membrane was 7.6 minutes. The mean time of tube mucociliary transport in tubotympanic otitis with normal mucosa of the tympanic cavity promontorium was 15 minutes, while mean time of tube mucociliary transport in tubotympanic otitis with polypoid changes of the promontory mucosa was 24 minutes (t = 5.218; p < 0.01). Mean time of tube mucociliary transport in atticoantral otitis with normal promontory mucosa of the tympanic cavity was 35.5 minutes, while mean time of mucociliary tube transport in atticoantral otitis with polypold changes of promontory mucosa was 48 minutes (t = 6.99; p < 0.01). In the irreversibly changed tympanic cavity mucosa, tube clearance saccharine test was negative even after one hour. The results of our study indicate the possibility that prolonged mucociliary tube transport has greater influence to development of atticoantral otitis rather than to development of tubotympanic otitis. The association between the degree of mucosal defect and time of mucocillary transport was evidenced in both types of chronic suppurative inflammation of the middle ear.

Carcinoma of the external meatus is a rare disease and a challenge to treat. Demographic and clinical characteristics of this disease are discussed for 14 patients treated in the Institute of Otorhinolaryngonlogy and Maxillofacial Surgery during the period 1993-2003. using four different clasification of the disease. All patients were treated surgically with postoperative radiotherapy. Five years survival is 100% for the II and II stage of the disease for all clasifications, and 75% for the III stage according to Pitsburg clasiffication. Reccurence of the disease in the first year after treatment is 66.6% and, 84% in the second year. The diagnostic protocol is clinical examination, computed tomography of the temporal bone, nuclear magnetic resonance of the temporal bone and endocranium, ultrasound examination of the neck and parotid region and tumor biopsy. The surgical approach could be less radical, through mastoid, with postoperative

IgA nephropathy is glomerular disease characterized by the presence of IgA dominant or codominant immunoglobuline deposits in glomerular mesangium which can be demonstrated by immunofluorescence. Clinical manifestations of IgA nephropathy in the majority of cases is hematuria which can be macro or microscopic, isolated or combined with proteinuria, which can be of nephrotic range. The prognosis of the disease is better if presented with haematuria. Intensity of morphologic changes as well as the prognosis is in correlation with the amount of proteinuria. The prognosis is better in children.

Development of the eardrum retraction pocket, as pathologic finding, depends on Eustachian tube dysfunction, onset of the middle ear infection and site of development of retraction on the eardrum. The study is aimed at: 1. Determining the incidence of eardrum retraction pocket and cholesteatoma within it, as well as at the degree of eardrum retraction; 2. Determining of association between eardrum retraction pocket and changes of the eardrum mucosa and pars tensa of the tympanic membrane; 3. Determining of onset and intensity of the bone destruction in eardrum retraction pocket; 4. Examining of Eustachian tube function based on time of mucocilliary transport according to the type of the eardrum retraction pocket. The study is based on the retrospective analysis of the results obtained from the patients treated at the Institute of Oto-Rhino-Laryngology and Maxillofacial Surgery, Clinical Centre of Serbia in Belgrade for the diagnosis of the chronic suppurative otitis who underwent otosurgical procedures during the six-year period, from 1996-2001. In our series of 540 patients subjected to otosurgical treatment, the incidence of the retraction pocket of the eardrum was 11.23%. Onset of more severe degree of eardrum retraction was most frequent in the attic. Cholesteatoma was detected in 82.2% of patients of the group with the attic-retraction pocket of the eardrum, as well as in 25% of patients of the group of tensa-sinus retraction pocket of the eardrum. Atrophic changes of the tympanic membrane pars tensa were detected in almost all tensa-sinus retraction pockets of the eardrum. Approximately one half of the attic-retraction pockets of the eardrum were accompanied by eardrum atrophy. Bone destruction of the auditory ossicles was limited to the long process of incus and superior structures of stapes. Time of the mucocilliary transport was significantly longer (p < 0.01) in attic-retraction pocket of the eardrum than in tensa-sinus retraction pocket of the eardrum, indicating significance of tube in development of attic-retraction pocket of the tympanic membrane. Reversible changes of the middle ear mucosa were evidenced in three quarters of the tensa-sinus retraction pockets of the eardrum indicating that inflammation is the major factor influencing onset of tensa-sinus retraction pocket of the eardrum.

The influence of intensive acute hypoxia on the frequency-amplitude formant vocal O characteristics was investigated in this study. Examinees were exposed to the simulated altitudes of 5,500 m and 6,700 m in climabaro chamber and resolved Lotig's test in the conditions of normoxia, i.e. pronounced the three-digit numbers beginning from 900, but in reversed order. Frequency and intensity values of vocal O (F1, F2, F3 and F4), extracted from the context of the pronunciation of the word eight (osam in Serbian), were measured by spectral speech signal analysis. Changes in frequency values and the intensity of the formants were examined. The obtained results showed that there were no significant changes of the formant frequencies in hypoxia condition compared to normoxia. Though, significant changes of formant's intensities were found compared to normoxia on the cited altitudes. The rise of formants intensities was found at the altitude of 5,500 m. Hypoxia at the altitude of 6,700 m caused the significant fall of the intensities in the initial period, compared to normoxia. The prolonged hypoxia exposure caused the rise of the formant intensities compared to the altitude of 5,500 m. In may be concluded that, due to different altitudes, hypoxia causes different effects on the formants structure changes, compared to normoxia.

Beta-catenin is a glicoprotein which has an important role in cell-cell adhesion, as well as in cell signal transmission, in u regulation of gen expression and in interaction with axin and APC (adenomatous poliposis coli). Its oncogenic role in several types of carcinomas in human population is well known. It is very likely that beta-catenin as an protooncogen plays an important role in genesis of Wilms tumor. It is well known that in 15% Wilms tumors there are beta-catenin mutations, which indicates that there is a disorder in Wnt signal path that plays an important role in Wilms tumor genesis. The aim of our study was to investigate b-catenin expression in Wilms tumor, to compare it with the expression in normal renal tissue as well as to see if there is a positive correlation between b-catenin expression in Wilms tumor with tumor stage, histologic type and/or prognostic group.

Juvenile nasopharyngeal angiofibroma is an infrequent epipharyngeal tumour necessitating particular diagnostic and therapeutic procedures in comparison to other benign epipharyngeal tumours due to its expansive growth tendency. Our retrospective study is aimed at presenting clinical casuistry of the tumour in order to evaluate modern diagnostic and therapeutic possibilities. The study included 13 male patients, aged 13-24 years, who were hospitalized, diagnostically assessed and surgically treated at the Institute of Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre of Serbia over the period 1990-June 2001. The following parameters were analyzed: sex, age groups, preoperative symptoms of the disease, diagnostic methods, embolization, local tumour spreading, number and time of tumour relapses and surgical approach.

Chronic inflammation of the middle ear is the most frequent cause of otogenic complications. Meningitis is the most frequent otogenic intracranial complication, followed by otogenic brain abscesses, while other complications are significantly less frequent. The study is aimed at presenting clinical causitry of otogenic brain abscesses consequential to chronic suppurative otitis in order to evaluate modern diagnostic and therapeutic possibilities. The study was retrospective and included the patients treated at the Institute of Otorhinolaryngology and Maxillofacial Surgery of the Clinical Centre of Serbia diagnosed with otogenic brain abscess during a five-year period (1996-2000). A total of 9 patients (male to female ratio 8:1), aged 16-68 years, were assessed. The following parameters were analyzed: sex, age groups, place of living, occupation, number of hospitalizations, diagnostic procedures, symptoms and clinical signs of otogenic complications, other otogenic complications associated with brain abscess, endocranial localization of otogenic abscess, therapeutic procedures (oto-surgical treatment) and intraoperative otological findings. In our group of patients, otogenic brain abscesses were significantly more frequent in male patients in their forties, with median age of 33.5 years. As for the place of living, the patients from the provinces were more frequent, while with respect to their level of education, those with elementary or high school degrees were predominant. The inflammatory process most frequently spread into the endocranium through direct destruction of the bone walls of the middle ear. Diagnostic procedures included history, clinical otorhinolaryngological examination, audiological and vestibulological assessment, neurological ophthalmologic and radiographic examinations (CT, MRI). CT is the most reliable diagnostic tool enabling localization of the change, timing of surgical treatment and monitoring of surgical success. Presence of other otogenic complications associated with brain abscess was evidenced in six of our patients. Cerebral localization of abscess was more frequent (7). Four patients underwent previous oto-surgical treatment. The treatment included primary neurosurgical approach (radical extirpation or abscess drainage), followed by radical oto-surgical treatment after improvement of the patient's general condition.

The nasoparanasal region rhabdomyosarcoma belongs to the group of the rare malignant diseases, however it nevertheless represents major diagnostic and therapeutic problem. The study is aimed at presenting clinical casuistry of the nasoparanasal region rhabdomyosarcoma in adults and children, for the purpose of assessment of modern diagnostic and therapeutic possibilities. The study was retrospective and included the patients with evidenced and pathohistologically verified rhabdomyosarcoma of the nasoparanasal region diagnosed and treated at the Institute of Otorhinolaryngology and Maxillofacial Surgery of the Clinical Centre of Serbia, during the period 1988-2001, and subsequently at the Institute of Oncology in Belgrade. The total of 9 patients aged 3-50 years (median 15) were assessed, with the female to male ratio being 4:5. Seven patients were previously hospitalized in other health institutions. The following parameters were analyzed: sex, age group, number of hospitalizations, diagnostic procedures, histological tumour types, mode of treatment and disease outcome. In 7 patients, the tumour spread beyond the nasoparanasal region--in 6 into the orbit, in 5 into the epipharynx, in 3 intracranially, in 1 into the pterygopalatine pit and in another 1 into the parapharyngeal space. Regional lymph nodes were affected only in one patient, while distant bone metastases were evidenced on another one. Embryonal type of the rhabdomyosarcoma was verified in 7 patients, while two had the alveolar type. In the affected children mean survival was significantly longer (76.3 months) in comparison to the one observed in adults (11.5 months). Therapeutic procedure included combined application of the chemotherapeutic protocols (adjusted with respect to the age group and stage of the disease) and radiotherapy. Radical surgical procedures were applied on in case of stage I tumours, and they may also be used in rest-relapse cases subsequent to the applied chemo-, i.e., radiotherapy.

Introduction: Some thirty years ago peritoneal dialysis (PD) became a respectable modality of renal replacement therapy. That is why peritoneal membrane attracted interest of investigators. Certain changes, known as uremic serositis, appear in morphology of serous membranes in end stage kidney disease (ESKD). The aim of our investigation was to examine the morphology of peritoneal lining cells in control group of healthy persons and morphology of peritoneal lining cells in patients on PD., Material and Methods: Peritoneal biopsies were taken in 10 healthy volunteers during the kidney donation and in 15 patients on PD during clinically indicated extirpation. Biopsy samples were prepared for standard routine HE staining and for plastic embedded fine sections studying. Sections were mounted in an ultramicrotome, stained with Toluidine blue (TB) and studied by light microscope (SM), while fine sections were mounted in an ultramicrotome and studied by transmission electron microscope (TEM)., Results: One layer mesothelium of the cuboidal or flattened lining cells were present over the lamina propria connective tissue. Mesothelial cells were overlapped like tiles on the roof. These cells were interconnected with different types of cell junctions (unpermeable, adhesion and communication junctions) positioned on lateral parts of the interdigitated cell membranes. A great number of microvilli were often present on the appical surface, as well as a kinocilia and lamellar bodies. Nuclei were euchromatic with well developed nucleoli. Many ribosomes, mitochondria, cisternae of rough endoplasmic reticulum (RER) and Golgi apparatus, lamellar bodies and lipid inclusions were present in the cytoplasm. Using TEM in analyzing fine sections of biopsies of patients on PD, characteristic ultrastructural changes including epithelial defects with only remaining parts of destroyed cells were established, as well as significantly greater number of rough endoplasmic reticulum (RER) cisternae and immature mesothelial cells in lamina propria indicating intensive regeneration of this epithelium. The cytoplasm of new mesothelial cells were of less electron density on TEM photomicrographs, whereas the nuclei of mesothelial cells in these patients were euchromatic with prominent nucleoli and numerous perichromatic granules and fibrogranular nuclear bodies, indicating cells of great activity. Cytoplasmic protrusions of different shape and content were often recognized on the apical surface of cells. Lamellar bodies were also present in this group of patients within the mesothelial cells, as well as between two mesothelial cells or on their apical surface. Mitochondria were picnotic in many of the mesothelial cells of peritoneum in this patient group. In these mesothelial cells intracytoplasmic paracrystaline inclusions were established. TEM photomicrographs showed basal lamina multiplication in this epithelium., Conclusion: Our findings comply with reports of other authors. It should be stressed that TEM examination detects characteristic ultrastructural changes in mesothelial lining cells of peritoneum in patients on PD, which could compromise the function of peritoneum as a membrane for dialysis.

Introduction: Patients older than 65 years represent the group of patients affected by end-stage renal failure characterized by the most rapid growth. The prevalent causes of end-stage renal disease (ESRD) in the elderly are diabetes mellitus and nephrosclerosis due to long-term arterial hypertension. There are a number of physiologic changes which occur with aging that might have an impact on the choice of renal replacement modality for an elderly patient: clinical or subclinical diminished cardiovascular reserve due to atherosclerosis or impaired baroreceptor function, slow deterioration of pulmonary function, impaired immunity, increased susceptibility to infection, metabolic disturbances, bone loss from osteoporosis, altered metabolism of protein and a variety of drugs, high rate of malnutrition, tendency to carbohydrate intolerance., Material and Methods: When choosing a dialysis regimen for an elderly patient, physiologic changes that occur with aging, specific medical conditions that are common in this period of life, medical and psychosocial advantages and disadvantages of the single mode need to be taken into consideration., Discussion: Continuous ambulatory peritoneal dialysis (CAPD) is the predominant mode of therapy for elderly patients. Medical advantages of CAPD in elderly patients are easier control of hypertension and anemia, slower and sustained ultrafiltration, avoidance of cardiac arrhythmias, improvement of nutritional status, better correction of cognitive functions. Psychosocial benefits are home dialysis program, improvement of quality of life and avoidance of co-morbid diseases. There are contraindications to peritoneal dialysis which apply to elderly as well as to younger patients: inadequate peritoneal membrane function, hernias that cannot be repaired, inability to insert a chronic peritoneal access. Relative contraindications include recurrent pancreatitis, chronic back pain, recent aortic prosthesis placement, severe periferal vascular disease and recurrent diverticulitis. Further potential disadvantages of peritoneal dialysis in the elderly are depression and physical and intellectual incapability of self-performing dialysis in the absence of an adequate assistant. Besides, pain, malnutrition and in-hospitalization time associated with peritonitis may be less well tolerated in the elderly than in younger patients. Finally, anorexia, nausea and protein losses in dialysate may aggravate malnutrition. Food intake in the elderly is lower than in younger patients because of the financial situation, loneliness, habits, inertia, depression, bad teeth, impairment of sense of smell and taste, nausea, impeded moving, use of a variety of drugs and many other reasons. Renal failure aggravates malnutrition in the elderly, while peritoneal dialysis is characterized by significant protein losses in the dialysate. It is advisable to make an individual plan of nutrition for elderly patients on peritoneal dialysis in order to provide adequate intake of proteins, energy, vitamins and minerals. Survival rates are the same in patients on peritoneal dialysis and on hemodialysis, but the number of co-morbid conditions is higher in the first group. Age of course is a major death risk factor. Many complications of peritoneal dialysis occur no more frequently in the elderly than in younger patients. The rate of hospitalization is higher and its duration is longer in elderly patients, due to higher incidence of Staphyloccocus epidermidis peritonitis and vascular disease. Urea removal normalized to urea volume of distribution (Kt/Vurea) and weekly creatinine clearance are used as methods of assessing adequacy of peritoneal dialysis in the elderly. Creatinine production declines significantly in older patients and serum creatinine is a poor measure of level of renal function or dialysis adequacy. Assessment of quality of life is quite subjective. Only 15-30% of elderly patients on peritoneal dialysis relate their health worse t

Introduction: The problem of an adequate peritoneal dialysis has attracted attention in the recent years. The monitoring and adjustment of intraperitoneal dialysis liquid volume and dialysis duration between the filling and emptying, contributed to individualization of dialysis, improvement of its quality and prolongation of its application. Causes of decline of peritoneal dialyses adequacy have been recently the subject of many clinical studies. The aim of this study was to determine whether the number of peritonitis episodes and duration of treatment with continuous ambulatory peritoneal dialysis (CAPD) influence dysfunction of the peritoneal membrane., Patients and Methods: We analysed 10 patients (4 females and 6 males), aged 27 to 77 years (60.1 +/- 13.9 years), who had been on CAPD for more than two years. All patients were tested at the beginning of CAPD, after one year and after two years of CAPD treatment (using 8 L exchanges per day): dialytic solute urea and creatinine clearance, daily and weekly; KT/V, daily and weekly; residual urea and creatinine clearance; and sum urea and creatinine clearance. The results are expressed as mean +/- SD and the differences between groups were studied by T-test and linear correlation coefficient., Results: Daily and weekly KT/V declined during time, but was not statistically significant (Table 1). Decline of diuresis influenced the residual and sum creatinine and urea clearance, with no statistical significance (Table 1). Positive correlation was established between decline of diuresis and sum creatinine and urea clearance after one year of CAPD treatment (rcr = 0.7705; rur = 0.7782), as well as after two years (rcr = 0.6332; rur = 0.6852), with statistical significance (p < 0.05). During the first year of the study our patients had 20 episodes of peritonitis (2.00 +/- 1.65) and after two years this number increased to 51 (4.42 +/- 1.72). Negative correlation was evidenced between the number of peritonitis episodes and daily and weekly KT/V, with no statistical significance after one year (rd = -0.2462; rw = -0.2371), but with statistical significance after two years (rd = -0.6332; rw = -0.6852) of CAPD treatment (p < 0.05) (Graph 1)., Discussion: In order to achieve a better prognosis and longer CAPD therapy, we must take into account the patients age, nutrition, catabolism of proteins, residual renal function, and adequacy of dialysis. The consequences of an inadequate therapy can be reflected on morbidity and mortality in these patients. In spite of many discussions, the problem of an adequate peritoneal dialysis, and the value of daily and weekly KT/V are still controversial. Burkat recommends a daily KT/V above 0.24 as adequate and we found this KT/V value as appropriate in one half of our patients. The other authors found that adequate dialysis was achieved with KT/V above 0.29, what we found in two of our patients. The mean daily KT/V was 0.27 at the beginning of the study, and 0.26 after one year of treatment (Table 1); this finding is the the same as in the study of Gotch, and better than reported by Teehan et al. After two years of CAPD the mean daily KT/V was 0.23, what was better than in the study of Teehan et al. Many authors agree that weekly KT/V has to be at least 1.7 for an adequate dialysis; we found the same in one half of our patients in each time interval. Recently, many authors found that the optimal weekly KT/V was over 2, what we found in two of our patients. The mean weekly KT/V at the beginning of the study and after one year of CAPD was above the minimum of adequacy (Table 1). However, after two years of dialysis the mean weekly KT/V was 1.62; this was below the minimum of adequacy. At the beginning of dialysis the residual renal function declines, what we observed in our patients, but without statistical significance (Table 1). The decline of diuresis reflects on the residual and sum creatinine and urea clearance. (ABSTRACT TRUNCATED)

Diabetes mellitus has become one of the most prevalent causes of renal disease, and approximately 30% of all insulin-dependent diabetic patients die of renal failure. Renal transplantation is generally the preferred treatment for diabetic patients with end-stage renal disease because it leads to a better quality of life than any other form of dialysis. Because fluid retention, electrolyte and acid-base disturbances are present in diabetics at a higher glomerular filtration rate than in non-diabetics, dialysis is initiated when the creatinine clearance is 10-20 ml/min, levels slightly higher than the recommended 5 ml/min for non-diabetics. Since 1978 continuous ambulatory peritoneal dialysis (CAPD) has become the preferred mode of therapy for diabetics. This method of dialysis offers several medical advantages: slow and sustained ultrafiltration, stable cardiovascular status, easier control of hypertension, preservation of residual renal function for a period longer than haemodialysis, steady state biochemical parameters. An additional advantage is a good, tight control of blood sugar achieved by intraperitoneal administration of insulin, which eliminates the need for multiple subcutaneous insulin injections. Intraperitoneally administered insulin closely mimics physiological events, though this route usually requires higher daily insulin doses. Heparinisation and access-related complications, which are the major cause of morbidity while on haemodialysis, are avoided. The social advantages include the possibility of home dialysis, long distance travel, uninterrupted job-related activity. Peritonitis remains the main complication of CAPD in diabetics. The pathogenesis, spectrum of organisms and treatment of peritonitis in diabetics do not differ from those seen in non-diabetics. The technique of catheter insertion, postoperative catheter care and common catheter complications are similar in diabetics to that in nondiabetic patients. Nutritional problems during CAPD may be aggravated by the loss of proteins, amino-acids, polypeptides and vitamins in the dialysate. They are especially important in those diabetics who are wasted and malnourished because of poor food intake, vomiting, and intercurrent illnesses. Foot problems are very important in diabetics on CAPD, and a multidisciplinary approach is absolutely crucial. The major contributory factors in the development of foot ulceration are neuropathy, peripheral vascular disease and abnormal stress. With proper selection of patients, diabetics can survive for a long period of time on CAPD. The morbidity and mortality observed during this therapy are primarily related to associated risk factors such as cardiovascular disease, atherosclerotic complications and infections. Certain features of CAPD make it a suitable therapy for diabetics.

We analysed 27 patients (15 women and 12 men) on CAPD treatment longer than 6 months at the Clinic of Nephrology, CCS, in Belgrade. Pts were between 22 and 72 years old (57.77 +/- 12.21 years). These pts had 47 episodes of peritonitis: 6 pts (22.22%) were without peritonitis, but 21 pts (78.22%) had between 1 and 5 episodes of peritonitis. We found 1 peritonitis /pts/year. Causes of peritonitis were mostly unknown (27/47) because treatment had began before taking culture of the peritoneal dyalisate. The most common causes of peritonitis were coagulase negative staphylococci: Staphylococcus aureus (8) and Staphylococci epidermidis (8). Laboratory showed: leucocytosis, hyperfibrinogenaemia, hypoproteinaemia and accelerated ESR. There was no connection between causes of chronic renal failure and frequency or peritonitis. During treatment of peritonitis in 2 pts we had to replace the peritoneal catheter and 5 pts went on haemodialyses. The other were recovered and continued CAPD treatment.

In hundred patients with different stages of renal functional damage, including the controls of healthy persons we examined the disturbances of phosphate, calcium and magnesium ion metabolism during chronic renal failure (CRF) progression. We also determined the serum levels of regulatory substances, parathormone and 1.25 dihydroxyvitamin D3 in 43 pts. grouped according to their group, sex, age average and season (autumn-winter) distribution. We established actual renal compensatory mechanisms for all of substances we determined, which were involved in homeostasis preservation of those substances. Some characteristic changes in plasma substance concentration and renal mechanisms of their regulation during CRF progression, suggest the following conclusions. No substances have preserved body homeostasis, although renal compensatory mechanism were expressed by different size for any of them. Those disturbances very tightly correlate with the stage of renal functional deterioration, as well as the serum parathormone rising and serum 1.25 DHHC decreasing.

Secondary hyperparathyroidism is a complex pathophysiologic event which we examined in hundred patients Sixteen of them belonged to the control with normal renal function, and the rest of them were categorised into four subgroups according to the actual level of chronic renal failure, determined by GFR a.i. by endogenous creatinine clearance. We determined the serum level of parathormone (C-PTH) and plasma concentration of phosphate and calcium in all of patients. In 43 of them we measured serum level of 1.25 dihydroxycholecalcipherol and ionised calcium. Our results suggested an important parallelism between parathormone hypersecretion (GFR +/- 58.3 ml/min), 1.25 dihydroxycholecalcipherol hypovitaminosis (GFR +/- 50.7 ml/min) and hypocalcemia (GFR +/- 47.7 ml/min) which connect them in very strong relationship. Even if secondary hyperparathyroidism in chronic renal failure is caused by numerous factors, it appears that the hypovitaminosis of 1.25 dihydroxycholecalcipherol with consequent hypocalcemia and phosphate retention acts as a main movement of this complex pathophysiology mechanism.

We analysed 27 patients (15 women and 12 men) on CAPD treatment, between 6 months and 7 years at the Clinic of Nephrology, Clinical Center of Serbia, in Belgrade. Patients were between 22 and 72 years old. The main causes of pulmonary abnormalities were infections (5), hypervolaemia, hypoproteinaemia and heart failure (13). We had 11 patients (40.74%) with 18 pulmonary abnormalities: bronchopneumonia (2 pts), pleuritis sicca (1 pt), pleural effusion (10 pts): unilateral (4) and bilateral (7). Three patients had recurrent pulmonary infections and pulmonary abnormalities. All patients recovered and continued treatment with CAPD.

In patients with terminal renal failure treated by peritoneal dialysis diffusion and ultrafiltration are used for removal of substances from the blood. Neofiltration is realized via the osmolar gradient, determined by different concentration of glucose and dialysis solutions. Osmotic water transport during peritoneal dialysis is limited. In the course of one exchange of two liters of the dialysate, exponential reduction of glucose levels in the peritoneal fluid ensues against time. Substance of low molecular weight, such as glucose, are resorbed from dialysate reducing the osmotic gradient between blood and dialysis fluid. Two successive phases in the course of exchange lasting for several hours are the main features of ultrafiltration during peritoneal dialysis. The first phase includes positive ultrafiltration, transport of water and soluble substances from the blood into the dialysate. Peritoneal volume increases gradually up to a certain maximum. Time needed to achieve that depends on the glucose concentration in the dialysate and time. The second phase starts when osmotic concentration of peritoneal solution becomes lower than osmotic concentration of the blood due to glucose resorption. It results in negative ultrafiltration, i.e. return of water and soluble substances from dialysis solution back into the blood: The paper reviews the production of concentration haemodialysis solutions at the Department of Pharmacy. Military Medical Academy, Belgrade. The first series of 3400 liters was produced during 1971. It is only 3% of the current production. Ever since, the extent of production and number of new products have increased annually. Today, 2500 lit of five types of solutions for hemodialysis are manufactured weekly at the Institute of Pharmacy. The quality of these solutions is secured by good manufacturing practise, quality control of substances and physico-chemical control of the produced solutions. The Institute of Pharmacy collaborates with the Clinic of Nephrology permanently improving and adjusting the production program.

Functional disturbances among different tissues and organic systems are associated with chronic renal failure. The most common problems following the disturbances in complex hemostatic changes in uremic patients are prolonged bleeding time ant the increased thrombosis tendency. As the patients vascular access is critical to the treatment of the chronic haemodialysis patient, we performed an investigation of causes of repeated vascular access thrombosis with purpose of detecting any consistent abnormality of the haemostatic system. Research has been conducted on a group of 29 patients (14 males and 15 females), age 21 to 61 (x = 45), on regular haemodialysis from 1 to 6 years (x = 2.2); 23 of them having one episode of thrombosis of vascular access, and 6 having two episodes. Partial thromboplastin time was among the normal ranges in all investigated subjects, three of them had low prothrombine time and thrombine time was prolonged in two cases. The high fibrinogen value was found in 19 patients. Mean value of platelet count was normal, though seven patients had thrombocytopenia. Absence of coagulum retraction was found in three patients. Assessment of blood coagulation in this study could not explain the development of repeated thrombotic events affecting arterio-vein fistula in chronic renal failure patients receiving haemodialysis. That points out the necessity to analyze functional status of natural coagulation inhibitors, fibrinolytic system and platelet function.

The bone disease in chronic renal failure patients with secondary hyperparathyroidism is usually termed renal osteodystrophy. Radiographic methods have been applied in renal bone disease mainly to discover lesions on long bones, hands and fee. During the evaluation of hormonal disturbances of hemodialysed chronic renal failure female patients, roentgenograms of sella turcica were taken. Findings that were detected were most probably the consequences of renal osteodystrophy. Osteoporosis of clinoid processes posteriores and dorsum sellae and intrasellar calcifications were confirmed in 25 percent of investigated patients. Lateral view of the sellae turcica demonstrated a "double floor".These pathological findings in sella turcica region could be of practical importance because of well known anatomophysiological position of this sceletal structure.