Pyoderma vegetans developed on chronic leg ulcer.

Pyoderma vegetans is a rare disorder that more commonly affects middle-aged persons, with a male predilection. It is characterized by vegetating lesions that coalescence into a plaque with eroded surface, covered by purulent discharge and crusts. The etiology of this disease is not known with certainty, but it is often associated with bacterial infections in immunocompromised patients. We report the case of a 73-year-old men who presented to the Iasi Dermatology Clinic with a large, irregular, relatively well-defined dermohypodermic ulcer, with infiltrated sclerosing borders, accompanied by pain, with the floor covered in the Northern part by a proliferative, vegetative bleeding area, and the rest by a yellowish secretion and cellular debris, located on the left leg. Bacteriological examination of ulcer secretion identified Pseudomonas aeruginosa. Anatomopathological examination confirmed the development of Pyoderma vegetans on chronic leg ulcer. Under specific treatment for chronic leg ulcer and eradication of infectious focus the outcome was favorable both in terms of trophic ulcer scar- ring and Pyoderma vegetans healing.

Cutaneous manifestations associated with thyroid disease.

AIM: To present the clinical and laboratory features of patients with dermatologic disorders associated with thyroid diseases, diagnostic criteria, type of administered treatment and its effectiveness. MATERIAL AND METHODS: This study is a retrospective study based on the medical records of patients with thyroid diseases admitted to the Dermato venereology Clinic of the Iasi "Sf. Spiridon" University Emergency Hospital between January 1, 2012-December 31, 2013. Data on clinical manifestations, methods of investigation, therapeutic approach, and associated dermatologic and systemic diseases were reviewed. RESULTS: A total of 38 patients were enrolled in this study of which 36 females and two males. An high incidence of cases with autoimmune thyroiditis (63%), followed by polynodular goiter (26.3%) and hypothyroidism (10.7%) was found during the study. The identified dermatologic disorders associated with thyroid diseases were in order of frequency alopecia areata (22%), followed by lichen planus (18%). CONCLUSIONS: This study demonstrates that there is a significant association between certain dermatologic disorders and thyroid diseases, requiring periodic thyroid function tests.

Histopathologic features of Spitzoid lesions in different age groups.

Spitz nevus is one of the most difficult melanocytic lesions to diagnose in regard of malignancy, even for experienced dermatopathologists. We analyzed 28 tumors with Spitzoid morphology from 15 children (three little children 2-4-year-old, 12 peripubertary children 9-17-year-old) and 13 adults; there were 21 Spitz nevi, five atypical Spitz tumors and two Spitzoid melanomas in order to establish the diagnostic value of several morphologic parameters in different age groups. No significant differences in respect of age and/or tumor type occurred for gender, location, dimension, symmetry, sharp lateral demarcation, junctional nests orientation, adipose tissue extension, side-to-side cytologic symmetry, uniform melanin deposits, nuclear pleomorphism, presence of mitoses, inflammation and epidermal alterations. Pagetoid growth and/or melanin deposits in the keratin layer were significantly higher in little children. In adults, presence of isolated cells within the lateral margins allows differentiating Spitz nevus from atypical Spitz tumor and Spitzoid melanoma. Deep located mitoses were statistically associated with Spitzoid melanoma in adults. Ulceration was statistically more frequent in peripubertary patients than in adults, probably due to trauma. In conclusion, presence of worrisome morphologic features (pagetoid growth, isolated cells within the lateral margins or ulceration) is correlated to patient's age and less to tumor type; there is no unique morphologic feature to relay on when evaluating a Spitzoid tumor, the final diagnosis being the results of interpretation of multiple clinical, morphologic, immunohistochemical and molecular data and not least dermatopathologist's personal experience.

An analytic solution for the magnetization of two-dimensional ferrofluids based on the mean spherical approximation.

An analytic formula is derived for the magnetization of a two-dimensional dipolar hard disk fluid using a variational functional series expansion of the free energy as a function of the orientational distribution function. The excess term expressing the effect of the intermolecular forces is calculated on the basis of the mean spherical approximation. Comparison with our own Monte Carlo simulation data shows excellent agreement for large external fields and for the zero-field susceptibility. At intermediate field strengths, the agreement is satisfactory for moderate dipole moments and densities.

The role of confocal microscopy in the dermato-oncology practice.

Reflectance-mode confocal microscopy (RCM) is a new in vivo skin imaging technique. We present our one-year experience in RCM examinations in skin tumors and the retrospective analysis of patients enrolled in the Dermatological Department of 'N. Paulescu' Institute using the Fotofinder Dermoscope IIW for the dermatoscopy analysis and VivaScope 1500W for in vivo RCM. We established the rank of RCM in the complex algorithm of skin cancer diagnose, showing that the presented experience can open new possibilities to implement this automated image analyzing system in the routine practice. Our analyzed cases clearly showed that confocal microscopy, therefore, optical biopsy, could guide the clinician towards an accurate diagnosis before surgical removal. Moreover, we emphasized that the development of this technique increases the potential of future teledermatologic applications.

Evaluation of 5-alpha reductase activity on cultured fibroblast in patients with hyperandrogenemia.

The enzyme steroid 5-alpha reductase is responsible for the conversion of testosterone to dihydrotestosterone, the steroid that mediates the intracellular action of androgens in some target tissues. The goal of this study was to check the accuracy of three known biochemical methods of studying steroid 5-alpha reductase activity expressed by dermal fibroblasts, isolated from pubian skin. These methods were performed on cell lysates (spectrophotometric and spectrofluorimetric methods) and on cell culture media (Reversed Phase-HPLC) with the purpose of their use in diagnosis and monitoring of hyperandrogenic patients. We also optimized a molecular study of expression of 5-alpha reductase isoenzymes and used it in the analysis of patients diagnosed with polycystic ovary syndrome (PCOS) and hirsutism by comparison with normal women. There was noticed an increase of the isoenzyme expression level both in patients with PCOS and in the case of patients with hirsutism. In other experiments, dermal fibroblasts originating in 15 individuals were treated with androgen hormones (testosterone: 10(-7) - 10(-9) M) with the purpose of demonstrating the effect of hyperandrogenemia on the expression level of 5-alpha reductase isoenzymes. The study of 5-alpha reductase type 1 mRNA expression levels in fibroblasts resulted from 4 normal individuals, 3 patients with hirsutism and 6 patients with PCOS, demonstrated an increase with 108.3% at the patients with PCOS and 47.3% at the patients with hirsutism compared with normal women. We concluded that hyperandrogenemia is associated with high levels of expression of 5-alpha reductase type 1 and, to a less extent, of type 2 isoenzyme in pubian skin cultured fibroblasts.

A new simple tool for tonometric determination of the PCO2 in the gastrointestinal tract: in vitro and in vivo validation studies.

BACKGROUND AND OBJECTIVE: Following the discovery of the feasibility of assessing the adequacy of the splanchnic perfusion by means of gastrotonometry, this technique became extensively used in clinical practice and in research. At present, high-technology instruments are available for the purpose. However, there is still a need for a simple, cheap tool that is easily applicable for patients of all ages. The present article describes such a tool and presents the results of in vitro and in vivo validation measurements with it. METHODS: Balloon-free tonometric probes consisting of silicone rubber tubes were developed. In vitro measurements of the uptake of CO2 inside the probes and for comparison in a conventional ballooned intestinal tonometer were made in a closed container maintained at 37 degrees C. In in vivo studies in anaesthetized dogs, the tonometric PCO2 values were determined with a tonometric probe and catheter introduced simultaneously into the ileum of the animals and the results were analysed by the Bland-Altman method. RESULTS: The in vitro equilibration studies revealed that the filling media inside the probes equilibrated rapidly with the PCO2 content of the chamber. The data obtained from the in vivo investigations with the two different methods demonstrated a statistically significant linear association (correlation coefficient: 0.778, significance: P < 0.001). CONCLUSION: The new simple tonometric probe described appears to be a reliable tool with certain advantages for gastric tonometry. However, further studies are warranted before its general clinical use.

Temperature dependence of the double layer capacitance for the restricted primitive model of an electrolyte solution from a density functional approach.

We apply a different version of the density functional theory, given by Pizio, Patrykiejew, and Sokolowski [J. Chem. Phys. 121, 11957 (2004)], for a nonuniform restricted primitive model of an electrolyte solution to evaluate the temperature dependence of the capacitance of an electric double layer. We show that this theory is capable of reproducing the computer simulation data at a quantitative level. In particular, the reversal of the temperature dependence of the capacitance at low temperatures is predicted. This phenomenon has been difficult to predict from theory. Further, this theory also leads to an accurate description of the double layer structure.

Xanthine oxidase activity and blood glutathione redox ratio in infants and children with septic shock syndrome.

OBJECTIVES: The possible role of xanthine oxidase (XO) activation in the signal transduction process during the septic shock syndrome was examined. The XO activity index after caffeine intake was assessed simultaneously with the blood glutathione redox ratio, a known parameter of oxidative stress. DESIGN AND SETTING: An investigational clinical study in a nine-bed pediatric intensive care unit. PATIENTS: Critically ill infants and children (n = 34) with systemic inflammatory response syndrome following infection, trauma or major surgery. Biochemical investigations (n = 54) were performed at various stages of the shock syndrome, characterized by pediatric risk of mortality and organ dysmetabolic scores. Controls consisted of 30 healthy children. MEASUREMENTS AND RESULTS: The in vivo XO activity index was measured as the urinary ratio of two metabolites of caffeine: 1-methyluric acid and 1-methylxanthine. The blood concentrations of oxidized (GSSG) and reduced glutathione (GSH) were determined. The XO activity index and redox ratio GSSG/GSH were highly increased in patients in shock dominated by the clinical symptoms of a proinflammatory response. A significantly lower XO activity index was found with an increased GSSG/ GSH in patients whose stage of shock was characteristic of an excessive anti-inflammatory response. The XO activity index and GSSG/ GSH were correlated closely with each other (r = 0.624, n = 54; p < 0.001), and were also related to the daily severity scores. CONCLUSION: Potent and simultaneous activation of the two redox systems strongly indicates a definite role of free radicals from XO in the overspill of the acute proinflammatory reaction of the shock syndrome, followed by a significant downregulation.

Blood glutathione redox status in gestational hypertension.

Gestational hypertension during the third trimester reflects an exaggerated maternal inflammatory response to pregnancy. We hypothesized that oxidative stress present even in normal pregnancy becomes uncompensated in hypertensive patients. A glucose-6-phosphate dehydrogenase (G6PD) activity sufficient to meet the increased reductive equivalent need of the cells is indispensable for defense against oxidative stress. The erythrocyte glutathione redox system was studied, where G6PD is the only NADPH source. The glutathione (GSH) redox status was measured both in vivo and after an in vitro oxidative challenge in pregnant women with gestational hypertension (n = 19) vs. normotensive pregnant subjects (n = 18) and controls (n = 20). An erythrocyte GSH depletion with an increase in the oxidized form (GSSG) resulted in an elevated ratio GSSG/GSH (0.305 +/- 0.057; mean +/- SD) in hypertensive pregnant women vs. normotensive pregnant or control subjects (0.154 +/- 0.025; 0.168 +/- 0.073; p <.001). In hypertensive pregnant patients, a "GSH stability" decrease after an in vitro oxidative challenge suggested a reduced GSH recycling capacity resulting from an insufficient NADPH supply. The erythrocyte GSSG/GSH ratio may serve as an early and sensitive parameter of the oxidative imbalance and a relevant target for future clinical trials to control the effects of antioxidant treatment in women at increased risk of the pre-eclampsia syndrome.

Structure of charged colloids under a wedge confinement

Monte Carlo simulations have been performed to study the influence of a wedge confinement by hard walls on the ordering of charged colloidal particles interacting through screened Coulomb repulsive potential in an aqueous medium. The density distribution of particles for a fixed wedge angle straight theta(0) is studied for different suspension parameters, viz., bulk volume fraction straight phi, salt concentration C(s), and charge Ze on the particles. The density distribution rho(straight theta) along the angular direction and that along the radial direction, rho(r), have been analyzed in different regions of the wedge. Simulations show the formation of layered structure along the angular direction and a large gathering of particles along the wall. The number of layers as well as the density of particles within the layer are found to change as the strength and range of the interaction are varied, whereas the density profiles calculated close to the vertex region showed no significant variation in the density. The radial density profiles rho(r) corresponding to the vertex region show one-dimensional (1D) ordering of particles parallel to the vertex at a distance that is close to a wedge height, h equal to diameter of the particle. This 1D ordering is found to be destroyed upon the addition of salt or lowering the straight phi. The reported experimental observations on the "vacuum phase" are discussed in the light of the present results.

Density Functional Theory and the Capillary Evaporation of a Liquid in a Slit.

Density functional theory is applied to a Lennard-Jones fluid near a single hard wall and in a slit formed by two walls. We use some simplified versions of the Weeks-Chandler-Andersen (WCA) and the Barker-Henderson (BH) theories. Only the most crude mean field version of the WCA theory, in which the hard-sphere correlation function is set equal to unity for all distances, seems useful. Use of the full WCA approximation is impractical because the effective hard-sphere diameter is density dependent. Generally, the best results are obtained using the BH macroscopic compressibility approximation. Our earlier study of "evaporation" of Lennard-Jones molecules in a slit is extended to other densities using the mean field theory. Copyright 2000 Academic Press.

The caffeine metabolic ratio as an index of xanthine oxidase activity in clinically active and silent celiac patients.

BACKGROUND: The xanthine oxidoreductase system has been identified as one of the main sources of free radicals responsible for various forms of tissue injury. Because the intestinal villi are an important location of this enzyme, it was of interest to study the role of xanthine oxidase in gluten-sensitive celiac enteropathy, associated with characteristic villous atrophy. Measured by a noninvasive method, the ratio of caffeine metabolites excreted in the urine after a caffeine challenge had previously been shown to be indicative of the total xanthine oxidase activity of the patient. METHODS: The study involved 22 children with gluten-challenged celiac disease, exhibiting subtotal villous atrophy in specimens from the third intestinal biopsy in accordance with ESPGHAN criteria. Ten of the patients displayed overt clinical symptoms (active form), whereas 12 had no symptoms (silent form). Urinary caffeine metabolites were determined by high-pressure liquid chromatography. The total in vivo xanthine oxidase activity was expressed as the caffeine metabolite index. RESULTS: In patients with active celiac disease the xanthine oxidase activity index was considerably higher, whereas in those with silent disease it was significantly lower than the control value. A significant negative correlation was shown between the index indicative of xanthine oxidase activity and the serum iron level of the patients. CONCLUSIONS: Activation of xanthine oxidase may play a role in the pathogenesis of active celiac disease with definite malabsorption, gastrointestinal symptoms, and anemia. The caffeine test reflects the difference in the pathogenetic mechanism leading to the mucosal lesion and clinical symptoms of active and silent forms of celiac disease.

Surface tension, glutathione content and redox ratio of the tracheal aspirate fluid of premature infants with IRDS.

OBJECTIVE: Determination of the surface tension (ST), the total glutathione (GL) content and the ratio of oxidized glutathione (GSSG) to reduced glutathione (GSH) in the tracheal aspirate (TA) of newborn infants with IRDS. METHODS: The ST of the TA was determined by monitoring the fluid level pulsated in a capillary glass tube by means of a digitalized videocomputerized picture analysis program, a technique developed in our laboratory. The concentrations of GSSG and total GL in the TA were determined enzymatically with glutathione reductase. All results of laboratory tests were referred to the total phospholipid (PL) concentration. Patients, Experimental Material: TA samples were collected from 32 intubated premature and newborn infants admitted to the NICU with IRDS during the first 2 weeks of their lives. Control samples were obtained from 11 children prior to elective surgery. RESULTS: The ST relative to the PL content (surface tension index, STI) was significantly lower in the newborns with IRDS than in the control group, and the concentration of GSH in the TA was also markedly decreased in all IRDS infants studied. The concentration of GSSG and the ratio of GSSG to GSH were significantly higher in the severe cases and in those with an unfavourable prognosis. Surfactant treatment had a protective effect against oxidative stress, it induced a decrease in both the GSSG concentration and in the GL redox ratio (GSSG/GSH) in the TA. There was a close correlation between the GSH content and the STI value of the samples studied. CONCLUSION: Oxidation and consequent depletion of GSH in the TA may be an aggravating factor in the development of the insufficient surface activity in intubated newborns with IRDS.

[Possible pitfalls in giving expert opinion in legal actions against medical services]. / Szakmai tévedések lehetösége orvosi perek szakértöi véleményezésében.

The authors report their experience in cases under legal action against medical service needing expert opinion. By the rapid development and differentiation of medical science in the recent years the possibility of making mistake in every day practice increased, on the other hand this circumstance includes also occurrence of the pitfalls in giving expert opinion in legal actions against medical service.

Measurement of surface tension in biological fluids by a pulsating capillary technique.

Ever since the discovery of the antiatelectatic function of the pulmonary surfactant, the measurement of surface tension (ST) has been of increasing importance in respiration physiology and clinical research. For the determination of ST, the elevation of the level of a fluid artificially pulsated in a capillary glass tube was monitored, and ST was calculated with the digitalized video-computerized picture analysis program Surftens. The biological relevance of the method is given by the Gibbs-Thomson principle, according to which surface-active lipids stream towards the surface by an adsorptive process; on pulsation of the fluid in a capillary glass tube, therefore, ST is gradually decreased to a minimal value. ST values of 60 amniotic fluid samples collected from pregnancies with different gestation times were determined. A multiple regression analysis of the results, including other parameters (total protein content, total lipid content, phospholipid content and microviscosity), indicated that this method may enhance the precision of the determination of gestation time. Precision analysis of various samples proved that this technique gives well-reproducible results under the given standardized conditions. The main field of application of the method may be in clinical practice and in studies on as yet inadequately known factors affecting the ST of biological fluids.