Cardiovascular complications are the major cause of mortality and morbidity in children with end-stage renal disease who are treated with chronic hemodialysis Arterial hypertension is a major cardiovascular risk factors in this population. The aim is that children who are on HD displays the prevalence of hypertension, to check arterial pressure before and after HD and displays the correlation with the left ventricle mass (LVM). Method: The study in 20 patients on chronic HD and 20 healthy control group children, blood pressure was measured by sphygmomanometer before and after HD. Also echocardiography were measured left ventricular mass before and after HD and track the correlation of these two parameters. Results: The prevalence of hypertension in children on HD is 62% for significant different compared to the control group (p <0.001) .. TA values of systolic and diastolic significantly lower after HD. (P <0.05). After HD TA values were significantly higher than the value of TA (p <0.05) in healthy children. The prevalence of LVH was 60% in children on HD and statistically be statistically highe then to the control group (p <0.001). The correlation between LVH and increased TA was linear but was not statistically significant in either group of patients. In conclusion: The fact that hypertension does not correlate significantly with left ventricular mass suggests that the increase in LVM except high blood pressure and affect other cardiovascular risk factors.

Twin to twin transfusion syndrome (TTTTS) accounts for approximately 10% of monochorionic twin pregnancies and, if left untreated, is associated with high morbidity and mortality rate. A net transfusion of blood flow from one fetus (donor twin) to the other (recipient twin) via placental vascular anastomoses has been supposed as the major etiology of TTTTS. The donor twin becomes hypovolemic and oliguria, oligohydramnios, and a variable degree of growth restriction develop, whereas the recipient twin manifests polyuria, polyhydramnios, and hydrops in response to hypervolemia. TTTTS can be treated by either serial amniocentesis or selective fetoscopic laser coagulation of the communicating vessels. The rationale for removal of large volumes of amniotic fluid is to prevent preterm delivery secondary to polyhydramnios and to improve fetal circulation by reducing pressure on the chorionic plate. On the other hand, the goal of laser therapy is to occlude vascular anastomoses, thereby interrupting intertwin blood exchange. Although laser treatment is associated with increased survival rate and reduced neurologic complications, compared with amnioreduction, it requires highly specialized centers, whereas serial amniocentesis has the advantage of being performed worldwide. Therefore, the optimal treatment for pregnancies complicated with TTTTS is still controversial.

Human preterm labor is a syndrome that may arise from different causes. Before 30 weeks of gestation, infection appears to predominate amongst these. In later gestation, premature activation of the fetal HPA axis in response to an adverse intrauterine environment, e.g. hypoxemia, undernutrition (UN) or even infection, may underlie the stimulus to prematurity. A third pathway clearly involves vascular thrombotic processes. Tests on sheep have been shown to there is a premature birth which is a significant change was associated with precocious increases in adrenocorticotrophic hormone (ACTH) and cortisol in the fetal circulation, and increased levels of mRNA encoding proopiomelanocortin (POMC) and prohormone convertase-1 (PC-1) in the pars intermedia of the fetal pituitary. It would seem that these different pathways may occur separately, or be activated to different degrees in the same patient.

Twin to twin transfusion sindrom (TTTTS) je patološko stanje gde blizanac donor „krvari“ u cirkulaciju fetusa recipijenta preko abnormalnih interblizanačkim placentnih anastomoza. Blizanac donor postaje anemičan, hipovolemičan, zaostaje u rastu i kao posledicu ima smanjenu urinarnu produkciju. Kako funkcija gutanja amnionske tečnosti nije oštećena, volumen plodove vode se progresivno smanjuje. Blizanac recipijent postaje hipervolemičan i policitemičan. Višak cirkulišuće krvi i nemogućnost adekvatne eliminacije nekada može da dovede do pojave hidropsa u težim slučajevima. Povećana urinarna produkcija recipijenta vodi pojavi polihidroamniona i prekomernoj distenziji amnionskog kavuma, kompresije i smanjnje perfuzije donora. Redukcija amnionske tečnosti kod donora rezultuje fiksacijom donora uz zid uterusa (najčešće prednji zid), (Slika 1.) (stanje nazvano stuck twin) 1,36.

Arrhythmogenic right ventricular dysplasia (ARVD) is a myocardial disease, often familial, that is characterised pathologically by fibrofatty replacement of the right ventricular myocardium, and clinically by ventricular arrhythmias of right ventricular origin which may lead to sudden death, mostly in young people and athletes. The term "dysplasia" was originally used to describe an entity that was considered to be the result of a developmental defect of the right ventricular myocardium.

Helical ventricula myocardial bend of Torrent-Guasp is the revolutionary new concept in understanding global, three-dimansional, functional architecture of the ventricular myocardium. Anatomy of the VMB, and recent proofs for its segmental electrical and mechanical activation, undoubtedly indicates that ventricular filling is the consequente of an active muscular contraction. Specific septal arrangment of the ascedent segments fibers, their interaction with adjacent descedent segment fibers, elastic elements and intracavitary blood volumen explein the physical principes involvel in this action. Understanding this mechanism cudld be of particular importance in our efforts to prevent and treat diastolic heart failure.

Rituximab is a human/mouse chimeric IgG1 monoclonal antibody that specifically targets the CD20 surface antigen expressed on the cell surface of all preplasma cell stages of B-cell differentiation. By binding to CD20, rituximab causes selective B-cell depletion through antibody-dependent and complement-dependent cell lysis and apoptosis. B-cell depletion is believed to disrupt the many B-cell functions that contribute to the pathogenesis of RA. The purpose of this study was to examine the efficacy and safety of RTX an anti-CD20 B cell depleting monoclonal antibody in combination with methotrexate (MTX),in patients with rheumatoid arthritis who experienced an inadequate response to one or more TNF antagonists and had active disease despite ongoing treatment with MTX and a TNF inhibitor. ACR responses in RTX treated patients were superior to placebo. The primary end point was the proportion of patients in each group that achieved an ACR20 response at Week 24. Secondary endpoints included ACR50 and ACR70 responses, changes in Disease Activity Score (DAS28), and EULAR response

Myocarditis is defined, clinically and pathologically, as inflammation of the heart muscle. The autoimmune phase is belived to play a major role and the use immunosuppressive agents may be useful in containing myocyte destruction. Aims was to systematically review the impact of Immunomodulative therapy on the outcame of severe and acute myocarditis in children. We retrospectively studied all the children admitted to University Children s Hospital with an acute viral myocarditis (AVM) from 2003-2008y. Patients were included if they had 1.severe and acute heart failure, 2 left ventricular dysfunction assessed by echocardiography, 3. a recent history of viralillness and 4. absens of personal or familial history of cardiomyopthy. Fourteen patient (37%) had severe and acute myocaditys. Seven patients were treated with immunomodulative therapy and anticongestive therapy (group I). Other seven patients were treated with anticongestive therapi only (group II). We comparred the use of antikongestiv therapy alone, with a combination of immunomodulative. Such studies have documented succeful outcome of AVM with immunomodulative trearment.