Multifocal necrotizing fasciitis - case report.

PURPOSE: Necrotizing fasciitis (NF) is a rare, life-threatening soft-tissue infection, characterized by rapidly spreading inflammation, with secondary necrosis of the fascia and surrounding tissues. It is mostly caused by group A beta-haemolytic streptococci or multibacterial. A case of the 25-year-old man admitted on September 2006 to the Department of Dermatology and Venereology with suspicion of erysipelas of the left upper limb and left foot is presented. On admission the pain, erythema, diffuse oedema of the left upper limb and erythema of the left foot were observed. Laboratory results revealed elevated: ESR, acute phase parameters (C-reactive protein, D-dimer), CPK and fibrinogen. Within 72-hours, despite treatment with antibiotics and anticoagulants, the oedema and pain increased, initial necrosis of the skin and extreme local tenderness appeared. Suspecting NF the patient had been transported to the Department of Surgery from where, after surgical debridement of devitalized tissue, was moved to the Intensive Care Unit and then transferred to the National Centre of Hyperbaric Medicine of the Medical University of Gdansk. Despite of repeated debridement, aggressive antibiotic therapy and hyperbaric oxygen therapy, necrosis was spreading. The patient developed sepsis and acute respiratory distress syndrome. Amputation of the left upper limb was performed. Five months later patient was admitted to ICU in Bialystok after a suicide attempt. After next four months he died. The dramatic course of the disease is the evidence, that having an adequate knowledge about early symptoms of NF can save patient's life.

Plasma and scales levels of interleukin 18 in comparison with other possible clinical and laboratory biomarkers of psoriasis activity.

The aim of the study was to assess plasma and scales levels of interleukin (IL) 18 collected from psoriatic patients with different disease activity. IL-18 concentrations were measured using an enzyme immunoassay in the plasma and scales of 34 patients with chronic plaque type psoriasis. IL-18 levels were analysed with respect to plasma-transforming growth factor beta1 (TGF-beta1), the disease duration and the duration of the present relapse, and psoriasis area and severity index (PASI). Plasma IL-18 concentration varied from 90 to 1300 pg ml-1 and means (368.2 +/- 42.4 pg ml-1) were significantly elevated in comparison with healthy controls (205.9 +/- 31.8 pg ml-1). The presence of IL-18 was also demonstrated in scales from skin lesions. Treatment caused a significant decrease of plasma IL-18 concentration to 250.2 +/- 13.8 pg ml-1. There was a significant correlation between plasma IL-18 levels and PASI values (r = 0.554). There was no correlation between IL-18 concentration in scales and PASI, between IL-18 concentrations in plasma and scales, and between plasma IL-18 and the disease duration or duration of present relapse. Plasma TGF-beta1 concentration demonstrated a significant correlation with PASI (r = 0.353), but not with IL-18 levels in plasma (r = 0.063) and scales (0.141). The sum of plasma levels of IL-18 and TGF-beta1 divided by the optimal coefficient demonstrated a statistically significant correlation with the highest r-value. The findings confirm an association between plasma IL-18 concentration and psoriasis severity. Moreover, it was shown that combined measurement of IL-18 and TGF-beta1 in plasma can be considered as a possible biomarker of psoriasis activity.

Evaluation of CA 15-3 serum levels in breast cancer patients.

The usefulness of post operative serum CA 15-3 determination was evaluated in a group of 57 breast cancer patients. CA 15-3 was assayed at baseline and every 3 months for a median follow-up of 34 months. Recurrence-free survival probability for patients with elevated serum CA 15-3 levels before surgery was 53.5% versus 88% for patients with normal serum CA 15-3 levels (p < 0.201). In 12 of the 15 patients with increased trend for CA 15-3 during follow-up, elevated CA 15-3 levels preceded (10 patients) coincided (2 patients) with the clinical detection of tumour recurrence, providing a predictive value of an increased trend of 80%. In the group of 10 patients who showed elevated serum CA 15-3 levels prior to the detection of recurrence, the median load-time was 5 months/(range 3-11 months). We concluded that CA 15-3 had prognostic value in breast cancer. Serial determinations of CA 15-3 was consistent with the treatment results.

Fibrin stabilizing factor activity of the skin carcinoma.

Activity of fibrin stabilizing factor and contents of sulphydryl group in the homogenate of malignant skin carcinomas (melanoma, spinocellular carcinoma, basal cell carcinoma, fibromyoma, liposarcoma) is higher than in the homogenate of benign neoplasm (lipoma, papilloma) and in the homogenate of the normal skin. Fibrin stabilizing factor activity and contents of sulphydryl group in the blood serum of subjects with malignant skin carcinomas is slightly lower than in the blood serum of subjects benign neoplasm and in healthy subjects.

Studies on the exocrine function of healthy human pancreas: pancreatic juice and its certain components.

The exocrine function of healthy pancreas was studied continuously during 9 days in a 28-year-old man. Pancreatic juice was collected by means of a drain passed into Wirsung's duct. The 24-hour volume of the juice was 1118 +/- 117 ml. In daytime the mean rate of juice secretion was 56 ml/hour and in the night it decreased to 20 ml/hour. Amylase and lipase activity in the pancreatic juice was very high and significantly higher in nocturnal secretion. Administration of 2% HCL or secretin (1.5 mu/kg) increased the volume of juice by 30 ml in the following hour without changes in the activities of amylase and lipase. Atropine ephedrine and pancreatin reduced the juice volume by 20-40 ml but the enzymatic acitivity decreased only after atropine. The rise in the juice volume was associated with an increase in its HCO3 concentration and a fall in CL- concentration. The levels of Ca++, K+ and Na+ as well as protein were also determined and it was found that protein concentration in the juice ranges from 0.1 to 4.1 g/100 ml.