Introduction: “The fatty liver” is over collection of fat (triglycerides) inside of the liver cells leads to middle increased liver. Non-alcoholic steatohepatitis appears at the patients with pathological level of the lipids in their blood, at the diabetic patients, and at the obese patients. The safest method for diagnosis of the fatty liver is biopsy of the liver, but the ultrasound of the liver is also very objective method for diagnosis. The goal of the research was to find connection between pathological ultrasound of liver (fatty liver) and pathological levels cholesterol, triglycerides, sugar in the blood of all of the patients. The patients and Methods: There were 170 of the patients in the trans-section study (57 of the men (33.50%) and 113 of the women (66.50%). The patients were divided in two groups: a) experimental group with the patients with pathological level of lipids in their blood (32 of the men, and 59 of the women), and b) control group with the patients with normal values of the lipids in their blood (25 of the men, and 54 of the women). Criteria for excluding from research are: the patients under age of 30 years. Cholesterol, triglycerides, sugar, ultrasound of liver was determined in all patients. Results and Discussion: There were 40 of the patients with pathological ultrasound in experimental group, and 11 of the patients with pathological ultrasound in control group (P<0.0001). Conclusion: The patients with pathological levels of lipids in their serum have fatty liver, as a pathological ultrasound finding.

Sir, Idiopathic retroperitoneal fibrosis (IRF) is a collagen vascular disease of unknown aetiology. It is characterized by chronic, non-specific retroperitoneal inflammation, which may cause ureteric obstruction. Many authors believe that it is a type of immune disorder [1]. Bosnia and Herzegovina is known as a region where Hanta virus infection has been endemic for >50 years [2]. A case of IRF associated with haemorrhagic fever with renal syndrome (HFRS) has not been reported up to now. A 44-year-old, previously healthy man was hospitalized with acute renal failure. He was febrile 2 days before admission, had dull abdominal pain, decreased urine output, shortness of breath, diarrhoea and arterial hypertension (190/120mmHg). Blood tests showed metabolic acidosis (HCO3: 15.9mmol/l) and increased C-reactive protein (11.26mg/l), potassium (7.9mmol/l), serum creatinine (884 mmol/l), blood urea nitrogen (17.6mmol/l) and globulins (49.1 g/l) and decreased haemoglobin (7.4mmol/l). Urinanalysis showed proteinuria and leukocyturia. Urine culture was negative. Indirect immunofluorescene tests for Hanta viruses were positive for Pummala virus. Ultrasound showed acute renal parenchymal lesions with bilateral hydronephrosis, grades I–II, and widening of the wall of the abdominal aorta. The presence of a great number of rodents in the forest where the patient was working has been reported by the epidemiology service. After supportive, antihypertensive and diuretic therapy, the patient’s renal function stabilized, with serum creatinine at 187 mmol/l and potassium at 4.5mmol/l. Intravenous urography showed a functioning left kidney, with a suspected retrocaval ureter on the right side and dilation of the channels of the right kidney. A computed tomography contrast scan showed a solid retroperitoneal mass, in the form of thick plate of high density, extending from the level of the renal hilum down caudally to the bifurcation of the aorta (compatible with retroperitoneal fibrosis). A double-J stent was applied and steroids and androgens were administered (pronison 60mg plus tamoxifen 20mg 2). After 3 months, the stents were removed and medications were continued. After 6 months, the patient’s total DTPA clearance was 61.1ml/min (11.8ml/min in the left kidney and 49.3ml/min in the right kidney), measured by technetium marked by diethylaminoacid. Steroids and androgens were withdrawn after 12 months. The patient has normal blood pressure and stable renal function, with serum creatinine at 125mmol/l. It remains a mystery whether HFRS triggered an immune abnormality and acceleration of the symptoms of a latent IRF or whether the two diseases merely coincided. Adequate treatment of HFRS was certainly the reason that renal function recovered and the progression of the disorder caused by the chronic disease, IRF, was hampered.

Objectives  Bosnia and Herzegovina is a known endemic region for Hantavirus infection. In this region at least two different Hantaviruses, the Dobrava viruses (DOBV) and Puumala viruses (PUUV) have been found. The aim of the study was to determine glomerular filtration rate (GFR) in patients with a history of hemorrhagic fever with renal syndrome (HFRS) 9 to 10 years after the acute phase of the disease. Design and Methods  We prospectively reviewed clearance of technetium marked diethyl three amino pentacetic acid (Tc99m DTPA) in 42 male convalescents with serologically confirmed HFRS, 13 patients with PUUV infection and 29 patients with DOBV infection. Results  The tubulosecretory phase of the GFR was prolonged in six patients (46%) with PUUV infection and 23 patients (79%) with DOBV infection (P < 0.05). Total and separate clearance EDTA were significantly statistically lower (P < 0.001) in patients with serologically confirmed DOBV infection. In patients with DOBV infection elimination of radio pharmac was prolonged. Conclusions  Hemorrhagic fever with renal syndrome can cause sustained renal damage that very rarely progresses into renal failure. The tubulosecretory DTPA phase was prolonged in 46% of examinees with PUUV and in 79% of examinees with DOBV infection. Elimination of radio pharmac from the kidney was prolonged in both groups of patients. The DTPA clearance rate was lower in patients with serologically confirmed HFRS than in normal populations, especially in patients with DOBV infection.