Isolation of a coronavirus from urinary tract tumours of endemic Balkan nephropathy patients.
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Biomedical subjects
Publications and source records attributed to N Bojanić.
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Endemic Balkan nephropathy (EBN) is a kidney disease of unknown etiology limited to Bulgaria, Rumania and former Yugoslavia. Primary kidney tissue cultures were established as explants from tissue obtained at operations from 5 EBN patients with urinary tract tumors. Four out of the five biopsy specimens on extended culture incubation at 33 degrees C yielded a coronavirus virus (EBNV) which was cytopathogenic for human fibroblast and Vero cells. In cells inoculated with EBNV, cytoplasmic immunofluorescence was found using antisera for human coronaviruses OC43 and 229E as well as the porcine transmissible gastroenteric virus and avian (chicken) bronchitis virus. In neutralization tests, EBNV failed to react with antisera to these viruses. Using hyperimmune serum raised with EBNV, positive cytoplasmic immunofluorescence was seen with cells infected with OC43, 229E, TGV and significantly with the kidney tissue of the biopsy specimens from the EBN patients. A screen for neutralizing antibody using the EBN virus revealed that 87.2% of EBN patients on dialysis were positive, also 74% of people from an endemic area were also positive, while only 13.5% from outside were positive. It is suggested that a coronavirus is involved in the etiology of the disease and that humans are an incidental host of a coronavirus zoonosis.
Removal of the urinary bladder-cystectomy--imposes the problem of urine derivation. The most sophisticated forms of urinary derivation imply those where the continent urinary reservoir is anastomosed to the urethra. One of these is Cameys enteroplasty. In our hospital this technique was applied on 52 patients. Postoperative complications and obtained results suggest that this form of urinary derivation is an important step nforward not only to incontinent forms of derivation, but to non-orthotopic continent urinary derivations, as well. All patients in our series were very successful in reintegration into the normal life, i.e. they were able to achieve a high a high quality of life after otherwise mutilating surgical procedure.
Ureterocutaneostomy, the anastomosis of the ureter to the skin, represents the most simple supravesical urinary derivation. It can be performed as unilateral, bilateral, bilateral with one orifice, or rarely as transuretero-ureterocutaneostomy. In period 1993-1998 on the Clinic of Urology, Clinical Center of Serbia, ureterocutaneostomy was performed in 155 patients as definitive type of urinary derivation. The most frequent indication for this type of derivation was the bladder tumor (130 out of 155 pts.). The rest of 25 pts. had carcinoma of vaginal portion of uterus, vesico-vaginal fistula (most frequently after irradiation), high ureteric lesions bladder neurogenic disfunction or rare bladder diseases. Having in mind short period of follow up two major complications were noticed: stenosis of uretero-cutaneostomy and retraction of anastomosis with consecutive formation of subcutaneous urinoma and abscesses formation. Although rarely used as definitive type of urinary anastomosis, ureterocutaneostomy has its place in wide spectrum of urinary derivations, since it is the only way to help those patients that have no other option of urinary derivation that might provide better way of social and professional rehabilitation.
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Based on the recent pathognomic accomplishment in the mechanisms of toxic actions, the favorable degree of protection was achieved by several drugs in acute poisoning of rats with sulfur and nitrogen mustards. It has been established that dexamethasone, promethazine, vitamin E, heparin, and sodium thiosulfate (a) prolonged the survival time in animals poisoned by 3 LD50s of toxic agents, (b) diminished the lethalty (with the protective indices ranging from 1.5 to 2.7), (c) antagonized the decrease of body weight, and (d) lessened the degree of pathological organ changes. The simultaneous administration of two or three of the drugs mentioned, of which sodium thiosulfate as chemical inactivator of the toxic agents was basic and consonant component, led to the further increase in effectiveness. It is concluded that satisfactory results obtained in this study speak in favor of the basic pathological effects of mustard gases, as well as possible causes and their possible ways of action as postulated by Dannenberg (1983).
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