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Introduction. The renal artery and segmental renal artery pseudoaneurysm is a rare and usually asymptomatic vascular lesion which in most of the cases thrombose spontaneously, but at same time it can be a source of life-threatening hemorrhage and shock. Today, these pseudoaneurysms are discovered with increasing frequency due to unrelated abdominal imaging or on screening work-ups for hypertension, as well as widespread use of angiography. Typically, they are seen in patients after trauma, inflammation, or renal surgery or biopsy. Case outline. In our case, a 52-year-old male patient with no prior history of surgery, significant abdominal trauma and systemic disease, presented with left flank pain and signs of hypovolemic shock that manifested before the admission in the surgical emergency room. The CT scan promptly demonstrated rupture of large retroperitoneal hematoma with the massive intraperitoneal hemorrhage. The angiography confirmed the rupture of the renal artery pseudoaneurysm. The patient had the urgent operation. A life-saving nephrectomy was performed while intraperitoneal hemorrhage and retroperitoneal hematoma was evacuated. The fourteen days after surgery the patient was discharged fully recovered, with normal diuresis and serum levels of creatinine and urea within referential values. During the period of hospitalization, he was diagnosed and treated hypertension. Conclusion. Rupture of pseudoaneurysms with the following hemorrhage into the intraperitoneal cavity and retroperitoneum is a life-threatening condition, as proven with this case in which hypovolemic shock manifested before the admission. We would like to highlight the importance of high blood-pressure control and the importance of regular check-ups.

Introduction. Primary hyperparathyroidism is rare pathology in children (2?5:100,000). In more than 85% of patients, a single adenoma is present, and its extirpation is usually the only treatment a patient requires. In approximately 15?80% of cases, ectopic mediastinal parathyroid tissue can be found inside the thymus. Case outline. Our patient was a 13-year-old boy, who presented with multiple bone fractures in the previous period of time, and fatigue. Parathyroid hormone levels preoperatively were extremely high (1320 pg/ml ? more than 19 times higher than normal). Serum calcium was also elevated (total 3.55 mmol/l; ionized 1.41 mmol/l). He was examined and diagnosed as primary hyperparathyroidism by a pediatric endocrinologist. Imaging procedures for the preoperative localization of parathyroid adenomas were done (99mTc sestamibi scintigraphy and magnetic resonance imaging suggested ectopic mediastinal parathyroid adenoma). The patient underwent video-assisted thoracoscopic surgery procedure. After exploration of the mediastinum and chest, no ectopic parathyroid tissue was found, so total thoracoscopic thymectomy was performed. Final pathological section confirmed parathyroid adenoma inside the thymus. Conclusion. We believe that if no parathyroid tissue is found during surgical exploration of mediastinum, in a child with preoperatively detected parathyroid adenoma in anterior mediastinum, recommendation is to think about possible intrathymic localization and consider removing the thymus. Greater sample size is necessary for higher reliability of this statement.

Introduction/Objective. Fibroadenoma, often called ?breast mice tumors? due to their mobility, are the most common breast tumors in pediatric population. Considering that some tumors have a potential for rapid growth, breast tissue damage, and that an ideal diagnostic tool has yet to be found, complete mass extirpation might be the treatment of choice. The aim of the study was to present our clinical experience in treating children with breast masses. Methods. A retrospective review (2011?2018) of patients treated for breast tumors at the Institute for Child and Youth Health Care of Vojvodina in Novi Sad was conducted. Results. In this study 29 girls (mean age 15.8 ? 1.8) were included. The majority of masses were located in the upper outer (27.6%) or lower inner (24.1%) breast quadrant. The mean mass diameter was 39.7 mm. It has been observed that the mean mass diameter in the group of girls with positive family history for breast diseases was significantly lower (p < 0.05) than in those with negative family history (27.5 vs. 43.2 mm). There were no proven malignant tumors and all tumors have been completely extirpated. The mean postoperative stay was 1.5 ? 1.02 days. Conclusion. An appropriate radical operative technique dependent on mass size and localization is still the ?gold standard? for treating breast masses in pediatric patients. Cooperation with experts in the field of oncologic breast surgery enables implementing these operative techniques in clinical practice of pediatric surgeons.

Introduction. Females who have developed addiction to heroin also abuse it during pregnancy. Heroin can be detected in the fetal blood-flow already an hour after maternal i.v. injection. Heroin metabolites enter the fetal blood-flow through the placental barrier by passive transport. Case Outline. We present a 27-year-old female in the 5th month of pregnancy that had a miscarriage. Chemo-toxicological analysis (gas chromatography with mass spectrometry - GC/MS), showed the presence of morphine in the fetal liver (31.92 ng/g), placenta (27.94 ng/g) and meconium (136.33 ng/g). The analysis did not show the presence of 6-monoacetylmorphine. Conclusion. In all cases when the autopsy of fetus or newborn is performed, with mother suspected as i.v. heroin abuser, chemotoxicological placental analysis, placenta and meconium should be also done. [Projekat Ministarstva nauke Republike Srbije, br. 45005]

Balkan endemic nephropathy (BEN) presents an unsolved puzzle despite fifty years of its investigation. Academy of Medical Sciences of the Serbian Medical Society organized a round table discussion on current unsolved problems related to BEN. The present paper summarizes presentations, discussion and conclusions of this meeting. During the last fifty years, the course of BEN prolonged and it shifted towards the older age in all endemic foci. Data on the incidence of BEN have been controversial and frequently based on the data on the number of BEN patients starting haemodialysis treatment. In Serbia, BEN patients present 6.5% of haemodialysis population and this percentage differs among different centres ranging from 5% (Leskovac) to 46% (Lazarevac). Maintenance of high prevalence of BEN patients on regular haemodialysis indicates that BEN is not an expiring disease. In addition, recent data have shown more frequent microalbuminuria and low-molecular weight proteinuria in children from endemic than from nonendemic families. Aetiology of BEN is still unknown despite numerous investigations of environmental and genetic factors. Today, there is a very current hypothesis on the aetiological role of aristolochic acid but the role of viruses, geochemical factors and genetic factors must not be neglected. Morphological features of BEN are nonspecific and characterized by acellular interstitial fibrosis, tubular atrophy and changes on preand postglomerular vessels. New immunohistochemical and molecular biology methods offer a new approach to BEN investigation. Association of BEN with high incidence of upperurothelial tumours is well-known. Recent studies have shown significant changes of demographic characteristics of patients suffering upper-urothelial tumours, their prevalence in different endemic foci and characteristics of tumours. Further studies of BEN should be directed to determination of incidence and prevalence of disease in different endemic foci, investigations of different insufficiently examined aetiological factors as well as pathomorphological features of the disease by the use of modern methods.

The acute graft versus host disease (GVHD) is induced in sublethaly irradiated (AOxDA)F1 hybrid rats following transfer of parental AO spleen cells. However, when recipients were treated with anti-CD8 mAb on days -4, -2, 0, 4 and 8 in relation to parental cell transfer, acute GVHD converts to a chronic GVHD with an autoimmune phenomena. Diseased animals produce antinuclear antibodies and display glucose intolerance curves that are significantly abnormal. Histological examination of pancreata from diseased animals revealed milde insulitis with concomitant islet destruction. By using this model of anti-CD8 mAb treated animals we have investigated the role of interferon-gamma (IFN-gamma) and interleukin-1 (IL-1) in the complex pathology associated with GVHD. For this purpose, during the first 10 days of GVHD induction, we applied in vivo treatment with either anti-IFN-gamma mAb or with specific inhibitor of IL-1 activity (IL-1 INH). Treatment of F1 recipients with mAb to rat IFN-gamma resulted in an acceleration of glucose intolerance. In contrast to this, treatment of recipients with macrophage-derived IL-1 INH fully normalized their impaired glucose tolerance. Our data suggest that TH1 cells and their cytokine IFN-gamma down-regulate diabetes-like syndrom in chronic GVHD, while either IL-1 alone or IL-1 dependent TH2 cells support these processes. This further indicates the possibility to manipulate chronic GVHD-related immunopathological processes by blocking corresponding cytokines.

Back cross animals were obtained by mating DA rats, which are highly susceptible to the induction of experimental low-dose streptozotocin induced diabetes, and AO rats, which are resistant to both diseases. Susceptibility to the induction of EAE in AO and DA rats correlates with IL-2 production. after 7 cycles of mating and selection for DA-susceptibility to EAE, the number of EAE susceptible animals decreased, and animals were uniformly resistant to diabetes induction. IL-2 testing revealed lower IL-2 activities in the supernatants of lymphocytes from these animals in comparison to DA rats. Our results reveal the dissociation of genes involved in the regulation of the susceptibility to EAE and autoimmune diabetes. In addition, IL-2 testing, even though argues against the critical role of IL-2, does not preclude the necessity of this lymphokine in the pathogenesis of EAE.

During the induction of diabetes with multiple low-dose of streptozotocin (40-45 mg/kg body weigh for 5 consecutive days) starting from day 3, CBA mice were injected repeatedly (10 daily injections) with either rat IL-1 inhibitor (IL-1 INH) derived from glucocorticoid-treated macrophages, or with recombinant DNA produced human IL-1 receptor antagonist (rIL-1ra). Althow not showing identity with each other, both agents by neutralisation of the activity of endogenous IL-1 interfered with the induction of diabetes. While control streptozotocin-treated mice developed sustained hyperglicemia with the late onset, histologically characterized with insulitis and islet cell destruction, mice injected with rat IL-1 INH, either in a form of dialyzed crude macrophage supernatant or partialy enriched 50-100 kDa fraction, remained normoglycemic. In agreement with diabetic status, insulitis and islet cell destruction were not observed in IL-1 INH treated mice. Human IL-1ra had milder, althow also significant protective effect. Our results, thus, suggest that IL-1 mediated immunopathogenic and/or inflammatory processes which lead to insulin-dependent diabetes, may be modulated by specific in vivo blockade of IL-1 receptors.

Interleukin-1 plays a key role in the regulation of hematopoiesis. One of the major controlling mechanisms of IL-1 activites is mediated through IL-1ra. In this report we investigated whether IL-1ra might function as a true negative growth regulator of hematopoietic cells. The effect of rIL-1ra on the proliferation of early- and late-appearing CFU-S was assessed in regenerating bone marrow during the recovery after sublethal damage by X-irradiation. To this, regenerating bone marrow cells of CBA/H mice, obtained 3 days after 2 Gy irradiation, were preincubated 90 min to 5 hr with increasing concentrations of rIL-1ra (5-100 ng/ml). To determine the proliferative activity of CFU-Sd12 and CFU-Sd8, cytosine-arabinoside was added for the last 1 hr of incubation. The results revealed significant dose-dependent inhibition of CFU-Sd12, but not of CFU-Sd8 cycling after IL-1 receptor blackade with rIL-1ra over 10 ng/ml. The data implicate IL-1 receptor involvement in the proliferative activity of hematipoietic stem cells, but suggest that prevention of cell cycling by IL-1ra depends on the position of target cells in the heterogenous stem cell compartment.

Sera of patients suffering from Balkan nephropathy, pyelonephritis and glomerulonephritis inhibit lectin-induced T-cell proliferation in vitro. Immunosuppressive factors were registered in the patients' sera during the early stage of the existing disease, and their activity was not in correlation with the degree of renal insufficiency. Serum inhibitors revealed their activity during the early phase of T-cell activation and had no effect on T-cell proliferation and DNK synthesis. Inhibitor activity was registered even if sera were not present in cell culture continuously but only 6 hours of preincubation; then their action was irretrievable.