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Emilia Solomon,1,2 Dumitru Brănișteanu,1,3 Andrei Dumbravă,4 Radu Gheorghe Solomon,5 Lorànt Kiss,5 Mihai Glod,1 Cristina Preda1,3 1Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania; 2Department of Endocrinology, CF University Hospital, Iaşi, Romania; 3Department of Endocrinology, “Sf. Spiridon” Hospital, Iaşi, Romania; 4Faculty of Psychology, Alexandru Ioan Cuza University, Iaşi, Romania; 5ISUD, Faculty of Medicine, University Lucian Blaga, Sibiu, Romania Introduction: Active acromegaly is a rare chronic endocrine disorder caused by excessive growth hormone (GH). Clinical studies suggest that cognitive performance is impaired in acromegaly – particularly executive function as well as short- and long-term memory. This study compared the quality of life (QoL) and executive functioning in acromegaly patients vs healthy controls.Materials and methods: This was an observational case–control study on 38 subjects divided into 19 acromegaly patients and 19 matched controls. The groups were evaluated for QoL, attention, and executive function. All subjects completed Acromegaly Quality of Life Questionnaire (AcroQoL), Trail Making Test (parts A and B), Stroop, and phonemic fluency tests.Results: Acromegaly patients had an AcroQoL global score that was significantly lower than controls. There were significant differences between the acromegaly group and the control group in terms of the physical effects (P=0.001) and appearance (P

Tattoos have been practiced for thousands of years and remains a common practice in various cultures and countries. Tattooing has gained popularity in Western society where about 10% of the population has at least one decorative tattoo. Lately the same phenomenon can be also observed in Romania. Metal salts or organic compounds are the pigments used in tattooing to achieve a different color. The introduction of various substances into the skin can cause side effects such as: acute inflammatory reactions, contact dermatitis, photoinduced reactions, lichenoid reactions, granulomatous reactions, pseudolimfomatous reactions, discoid lupus erythematosus, and bacterial infections (pyoderma, leprosy, tuberculosis) or viral (warts, moluscum contagiosum, hepatitic virus, HIV). In parallel with the emergence of new ways of tattooing, new ways of removing them have also developed. Currently, Q-switched laser is most commonly used to remove tattoos, however, without guarantee their complete removal. [ABSTRACT FROM AUTHOR]

Sentinel lymph node biopsy (SLNB) is a surgical procedure that has been used in patients with cutaneous melanoma for nearly 30 years. It is used for both staging and regional disease control with minimum morbidity, as proven by numerous worldwide prospective studies. It has been incorporated in the recommendations of national and professional guidelines. In this article, we provide a summary of the general information on SLNB in the clinical guidelines for the management of cutaneous malignant melanoma (American Association of Dermatology, European Society of Medical Oncology, National Comprehensive Cancer Network, and Cancer Council Australia) and review the most relevant literature to provide an update on the existing recommendations for SLNB.

Purpose. The assessment of the incidence of ocular hypertension over a period of 1 year in patients treated with multiple intravitreal injections of anti-VEGF agents for neovascular AMD. Methods. The study comprised 58 eyes diagnosed with neovascular age-related macular degeneration and receiving PRN intravitreal treatment with anti-VEGF agents (bevacizumab or aflibercept). The follow-up period was 1 year. Intraocular pressure was measured by using the Goldmann applanation tonometry before the intravitreal injection, at 24 hours after the administration of the anti-VEGF agent and at 1 and 4 weeks. Patients diagnosed with glaucoma or who underwent ophthalmic surgery were excluded. Results. The patients received an average of 7.54 intravitreal injections. The mean baseline intraocular pressure was 15.3 mm Hg; 19.8 mm Hg at 24 hours; 17,4 mmHg at 1 week and 14.8 mmHg at 4 weeks after the administration of the anti-VEGF agent. 4 patients required long-term topical hypotensive treatment. Raised intraocular pressure was related to increased frequency of treatment. At 1 year follow up, an average difference of 2.1 mmHg compared to baseline was registered in the cases that have received more than 6 intravitreal injections. By comparison, in the cases treated with a reduced number of doses of intravitreal anti VEGF agent, the difference from baseline was 0,9 mmHg. There were no significant differences in mean IOP depending on the anti VEGF (bevacizumab or aflibercept) agent used. Conclusions. Intravitreal treatment with anti VEGF agents produces a transient increase in intraocular pressure, predominantly immediately following administration, without causing long-term increased values.

Terson's Syndrome is represented by a vitreous, retrohyaloid, retinal, or subretinal hemorrhage occurring consequent to an acute intracranial hemorrhage or elevated intracranial pressure. The outcome may include a complete clearing of the blood and the restoration of VA or persistent hemorrhage. This report presents the case of a 43-year-old woman who underwent bilateral surgery for a persistent vitreous hemorrhage and a hematoma underneath the internal limiting membrane in the left eye. The event followed shortly after a subarachnoid hemorrhage due to the rupture of a posterior communicating artery aneurism. Vitrectomy was performed in both eyes, together with the peeling of the internal limiting membrane in the left eye, followed by a bilateral good outcome.

Lichen planus is a mucocutaneous inflammatory dermatosis characterized by a papular rash; the disease is self-limited, has several clinical subtypes and follows a chronic or subacute clinical course. This article presents some etiological hypotheses: stress, genetic predisposition, systemic diseases, viral infections, materials used in dentistry. Also, medicines or contact allergens can cause lichenoid reactions, which are the main differential diagnosis. Autoimmune hypothesis can be supported by the association with other autoimmune diseases, such as ulcerative colitis, alopecia areata, vitiligo, dermatomyositis, morphea, lichen sclerosus, myasthenia gravis. This disease seems to be mediated through an antigenic mechanism of cytotoxic T lymphocyte activation, and production of proinflammatory cytokines, cascade of events that causes apoptosis of basal keratinocytes. A good understanding of the pathogenesis, clinical presentation and early diagnosis of lichen planus is critical in determining the appropriate therapeutic management. This present article aims to present and discuss the various etiopathogenetic concepts of lichen planus.

Leptin is an adipose-tissue specific cytokine described 20 years ago and classically thought to be involved in regulation of food intake and energy homeostasis. More recently, leptin was proven to exert other multiple roles in carbohydrate and lipid metabolism, reproductive system, and inflammatory and immune reactions. Emerging data propose leptin to be a modulator of bone mass. In some particular circumstances leptin synthesis follow specific patterns in inflammation and sepsis, not being proportional with fat mass. Therefore, it may be used as diagnostic or prognostic marker for critical illness.

Vitamin D deficiency is nowadays very common in the general population and also in patients with primary hyperparathyroidism. Hypovitaminosis D may modify the clinical features and the severity of primary hyperparathyroidism. We present the case of a 75-year-old woman with a 10 year history of nephrolithiasis and severe osteoporosis, with multiple fragility fractures. Her bone and kidney status required a more thorough metabolic assessment. Despite minimal changes in serum calcium and phosphate levels, parathyroid hormone (PTH) level was markedly elevated. Ultrasound and specific Sesta-MIBI scintigraphy diagnosed and localized a left parathyroid adenoma. Vitamin D assessment showed levels in the range of hypovitaminosis. Vitamin D deficiency may mask hypercalcemia despite high serum PTH levels, and does not seem to diminish but on the contrary increases the risk of kidney lithiasis, as well as the deleterious effects of hyperparathyroidism on bone.

Aim: To present the epidemiological, etiopathogenic, clinical and therapeutic aspects in Erythema multiforme (EM)., Material and Methods: This is a 3-year retrospective study based on medical records of patients with EM admitted to the Dermatology Clinic. Forty patients were included in this study. The obtained data allowed the classification of patients according to their distribution by sex, age group, area of residence, etiology, clinical aspects, and type of administered treatment., Results: The prevalence of EM during the 3 study years was 0.4%. EM prevailed among the rural population, more frequently in women. The minimum age at which EM was diagnosed was 12 years and maximum age 78 years, with a peak incidence between 20-40 years old (37.5% cases). In 42.50% of the cases EM was drug-induced, and in 17.50% of cases it was caused by infection with herpes simplex virus (HSV). There were 18 cases of erythemotous-papular EM (45%), 14 cases of erythematous--vesiculobullous EM (35%) and 8 cases of recurrent EM (20%). All patients received treatment with antihistamines and nonspecific desensitizing agents. Systemic corticotherapy was used in 22 cases. Three patients received treatment with acyclovir., Conclusions: Erythema multiforme is a rare skin condition, easily diagnosed based on its characteristic clinical appearance, but remains a challenge for the physician in terms of establishing its causal agent.

Psoriasis is a chronic inflammatory disease that can affect up to 1% of children. Genetic (family history of psoriasis) and environmental factors (bacterial or viral infections, stress, and trauma) are frequently involved in its occurrence. Napkin psoriasis is a particular form of psoriasis affecting mainly children younger than 2 years of age and can be classified together with other diseases under diaper rash. We present the case of a 4-month-old infant, born at term, naturally, weight and height within the normal range, who was brought to the Dermatology Clinic for the occurrence of erythematosquamous lesions in the anogenital area, buttocks and upper third of the thighs, with subsequent dissemination of lesions. The onset of symptoms began a few days after a respiratory tract infection. Initially he received treatment with systemic antibiotic and topical corticosteroid and antibiotic with unfavorable outcome. Laboratory tests revealed iron-deficiency anemia, leukocytosis, thrombocytosis, accelerated ESR, marked hepatic cytolysis, hyperphosphatemia and nasal carriage of Staphylococcus aureus. A systemic antihistamine and nonspecific desensitization treatment was administered. Topical treatment consisted in the removal of predisposing factors and irritants (diaper, urine) by rigorous hygiene, application of topical non-fluorinated cortico-steroid and use of emollients, with favorable course of the lesions. The peculiarity of the case is that the diagnosis of psoriasis was based on history, physical examination and laboratory tests, in the absence of a pathology examination to confirm the diagnosis. Pathology examination could not be performed due to patient's age as biopsy required general anesthesia.

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.

Unlabelled: Herpes zoster (shingles) is a neurocutaneous viral disease, in recent years its incidence increasing throughout the world., Aim: To study the incidence of herpes zoster among Iasi county patients requiring hospital admission and to analyze the clinical and epidemiological features and socioeconomic status of the study group., Material and Methods: Retrospective study of 158 patients admitted to the largest clinical dermatology department in North-eastern Romania, the Clinical Dermatology Department of the Iasi "Sf. Spiridon" University Emergency Hospital. The study was conducted over a period of five years and included the analysis of epidemiological data, socioeconomic status, clinical forms of disease, associated diseases, pathology reports for skin biopsy fragments, administered treatment, and disease course., Results: This study confirms that shingles is not a sex-specific disease, the female/male ratio being 1.22: 1. Most patients belonged to the age group 70-80 years, accounting for about 35% of all patients, followed by the age group 60-70 years (24.6% of cases). A slight increase in the number of cases was recorded in autumn and summer in patients living in rural areas. 1.3% of the cases were diagnosed both with the disseminated form of disease, and complications (eczematization, bacterial superinfection, skin necrosis). 7.6% of patients presented additional skin disorders (pityriasis versicolor, impetigo, psoriasis vulgaris, mucocutaneous candidiasis), which raised the suspicion of an immune deficiency predisposing to shingles. The absence or late initiation of specific antiviral therapy correlated with prolonged hospital stay up to 4-6 days. We found an association between the erythematous form of shingles and young age, while the hemorrhagic or necrotic forms were present in the elderly and/or ill patients. The course was favorable and the length of illness was significantly shortened when the treatment adequate to the clinical form was administered. Associated comorbidities (essential hypertension 38.6%, dyslipidemia 24.6%, diabetes, mellitus 9.49%, chronic venous disease, other skin diseases) represent a factor complicating the development of herpes zoster by the cumulative stress the body is exposed to., Conclusions: The main statistically significant epidemiological data in the study group are: older age (over 60 years), associated diseases (which by the marked imbalances induced in the body increase the risk of varicella zoster virus reactivation) intense psychological stress. The following parameters did not change the risk of developing shingles: area of origin, sex, the season at disease onset, number of hospital days, and administered treatment. Early diagnosis and treatment of this disease is important for maintaining a good quality of life, to avoid complications, to limit the extent of the disease and its transmission to others.

Subacute lupus erythematosus (SLE) is a specific form of lupus erythematosus characterized by prevalently cutaneous manifestations usually with a good prognosis. It is more common in patients aged 15 to 70 years, and there is a female predilection. This form accounts for 10% of all lupus erythematosus cases. We present the case of a 57-year-old male patient diagnosed at age 35 with chronic psoriasiform subacute lupus erythematosus, pathologically confirmed at the Iaşi Dermatology Clinic. At the age of 54 years he had multiple ischemic strokes, followed by deterioration of general status, and at 56 years deep vein thrombosis in the right leg. The patient presented the erythematous-squamous lesions specific to psoriasiform SLE localized both on the upper third of the body and knees and associated with submucosal lesions of the lower lip, oral mucosa and appendages. The patient also presented hypo- and hyperpigmentated atrophic scar-like lesions. Laboratory tests performed during the last two admissions showed the presence of anti-ds DNA and antiphospholipid antibodies, inflammatory syndrome, and nitrogen retention syndrome. Treatment consisted of systemic and local dermatocorticoids and associated medication, emollient lotions and creams with SPF 50+, with slowly favorable progression. The peculiarity of the case lies in the chronic progression without significant systemic involvement for 19 years, and then in 2 years the antiphospholipid antibody syndrome and a shift to systemic lupus erythematosus to occur.

Terminology of persistent diabetic macular edema has been initially reserved to cases unresponsive to conventional laser photocoagulation according to ETDRS criteria. While knowledge about pathophysiology of macular edema evolved and new drugs became available, the terminology of persistent diabetic macular edema expanded to include resistance to most current therapies. The purpose of this paper is to review medical and surgical options in the treatment of such difficult cases according to literature data and personal experience.

Purpose: To assess the anatomical and functional results after intravitreal bevacizumab administration in choroidal neovascularization (CNV) due to angioid streaks; To assess the safety and results stability;, Methods: Prospective, nonrandomized, interventional case study on choroidal neovascularization due to angioid streaks treated with intravitreal bevacizumab (AVASTIN). Intravitreal injection was repeated, if needed, at 4-6 weeks until leakage stopped. In all cases fluorescein angiograms and Spectral 3D OCTs were performed. Visual acuity was measured with ETDRS optotype. Cases were followed-up at least 6 months. Statistical analysis was performed using ANOVA and Wilcoxon tests., Results: 8 cases with CNV associated to angioid streaks were evaluated between January 2007 and January 2013. Mean age of patients in the study was 52,36 +/- 4,33 years (ranging 42-64 years). The mean number of intravitreal injections was 4.64 +/- 0,42 (ranging between 3-8 injections). Mean visual acuity improved significantly in all cases after 3 intravitreal injections with a gain of more than 15 letters in 6 out of 8 cases (75%). OCT confirmed reduced depth of lesion and also a reduced lesion volume after treatment. No major local or systemic side-effects were noted. At 6 months follow-up the CNV reoccurred in 5 out of 8 cases (62.5%) requiring additional treatment. 3 out of 8 cases finally lost more than 5 letters due to subretinal fibrosis., Conclusions: These results confirm the efficacy and safety of intravitreal bevacizumab in controlling the CNV due to angioid streaks. High recurrence rate and quick lesion progression to subretinal fibrosis might be responsible for long-term poor functional results in this type of CNVs. More cases are needed for validation.

Alopecia is a loss of hair in the areas where it normally grows. It has to be distinguished from atrichia, the congenital absence of hair due to the absence of hair follicles, and hipotrichosis, scarcity or absence of hair in some congenital diseases. Alopecia is either scarring, when the skin appears atrophic, scaling, and smooth and the hair follicles are absent, or nonscarring, when hair loss is not accompanied by the destruction of hair follicles. This paper is a review of all types of alopecia and their features in an attempt to make them easier to identify and differentiate.

Macular serpiginouschoroiditis is a rare variant of serpiginous choroiditis characterized by a severe recurrent inflammation of both central choroid and retinal pigment epithelium. Visual prognosis is severe due to subsequent distruction of retinal structures. Permanent central visual loss is the consequence of retinal pigment epithelium hyper or hypoplasia and/or subretinal neovascularization leading to fibrous scarring. This article reports the unusual case of rapid development of a macular hole soon after the onset of characteristic clinical features. Despite anti-inflammatory treatment and successful macular hole surgery the visual function remained significantly impaired by secondary central retinal pigment epithelium changes.

Ocular Toxocariasis is a parasitosis caused by Toxocara catis/canis larvae localized in the eye. The most frequent clinical manifestations are the central retinal granuloma, peripheral retinal granuloma and chronic endophthalmitis. Secondary complications due to the presence of parasite in the posterior segment of the eye may have significant consequences on visual function. We present the case of a 23 years old patient, admitted for progressive decrease of the right eye BCVA during the last 6 months. After performing clinical examination and serological tests we established the diagnosis of ocular Toxocariasis. The patient presented a particular form of the disease consisting in the presence of both a central retinal granuloma and a peripheral one. We performed 23G pars plana vitrectomy and membrane peeling. VA improved as soon as the first month after surgery.

Purpose: To assess the anatomical and visual outcome and also the retinal complications following vitreoretinal surgery for posterior segment intraocular foreign bodies (IOFBs)., Methods: Retrospective analysis of 59 IOFBs, with different locations within posterior segment,removed during pars plana vitrectomy (PPV) between January 1999 and January 2011, by the same surgeon, in Eye Clinic 1 Iasi. 47 out of 59 IOFBs (79.66%) were removed immediately after primary wound closure and 12 with a delay ranging from 48 hours to 5 years. All IOFBs were metallic. Total 20G pars plana vitrectomy with IOFB removal by forceps or intraocular magnet, careful membrane peeling and laser photocoagulation around the retinal injury (if present) was performed. Relaxing retinotomy was necessary in 3 cases of retinal incarceration. Endotamponade with SF6 (26 cases) or silicone oil (8 cases) were performed, if needed, at the end of surgery. The average follow-up period after surgery was 17.9 month (ranging 6 - 36 months)., Results: 18 out of 59 IOFBs (30.5%) were intraretinal. 39 out of 59 eyes (66.10%) showed signs of endophthalmitis at the time of surgery. Preoperative visual acuity ranged from light perception to 0.6. The mean visual acuity significantly increased after surgery from 0.16 preoperatively to 0.5 at the end of follow-up (range hand movements--1). 51 out of 59 cases (86.44%) had stable anatomical result. A final visual acuity equal or better than 0.1 was obtained in 45 cases (76.27%). Mild retinal folding could be noticed in some cases around the laser-treated retinal injury. In 8 out of 59 cases (13.56%) visual acuity remained low or decreased due to macular injury or PVR associated retinal detachment requiring additional surgery., Conclusions: IOFBs, and especially those intraretinal, require an early, complex and customized approach during PPV. Functional results do not match anatomical restoration if macula or optic nerve are impacted. Main postoperative complications were represented by retinal folds and PVR associated retinal detachment.

Purpose: To assess the anatomical result after primary macular hole surgery with or without internal limiting membrane (ILM) peeling. To assess the safety and stability results;, Methods: Prospective, comparative, interventional case study of 47 eyes with stage 3 or 4 macular hole treated by pars-plana vitrectomy between 2006 and 2011. In 19 cases (40.42%) only posterior hyaloid was removed (control group) while in the other 28 cases (59.57%) additional ILM peeling was performed. All cases had gas endotamponade. Postoperatively the cases were followed-up at least 6 months clinically and by OCT. Statistical analysis was performed using ANOVA and Wilcoxon tests., Results: The mean age of patients in the study was 54, 47 +/- 4, 83 years (ranging from 47 to 74 years). In 36 cases (76.59%) the macular hole was idiopathic. After surgery, the macular hole closed in 22 out of 28 cases with ILM peeling (78.57%) as compared to only 13 out of 19 cases from the control group (68.42%). No intraoperative complications were noted. Main postoperative complications were cataract augmentation and macular hole enlargement in 4 out of 12 failed cases (33.33%). No recurrence was noted if macular hole closed after surgery., Conclusions: These results confirm the stability, safety and efficacy of both techniques but with a significant higher success rate if ILM is peeled. The main postoperative complication was macular hole enlargement if surgery failed.

Unlabelled: Bone loss in postmenopausal women is mainly due to estrogen deficiency affecting the balance between osteoclast resorption and bone formation controlled by osteoblasts., Aim: To determine the relationship between bone mineral density (BMD) in pre and postmenopausal Caucasian women, and estrogen levels., Material and Methods: Cross-sectional study including six groups of 8 to 15 pre- and postmenopausal healthy volunteers with different weights, body mass index (BMI) (normal or underweight < 25 kg/m2, overweight 25-30 kg/m2, and obese > 30 kg/m2), not exposed to antiosteoporotic therapy. Lumbar bone mineral density (BMD) and body composition (BC) were evaluated by dual X ray absorptiometry (DXA, Hologic), while serum estradiol and estrone were measured by ELISA., Results: BMD in postmenopausal women is lower than in premenopausal women irrespective of body weight (p<0.05). Estradiol and estrone are positively correlate with bone mass in premenopausal women, but not in postmenopausal women (R2 0.3209, R2 0.2579, respectively)., Conclusions: It is very important to identify the risk factors for osteoporosis, especially in postmenopausal women, as we will show that aromatization of androgens into estrogens in adipose tissue appears not to have a significant role in postmenopausal women bone protection. Key-

Unlabelled: Body weight positively correlates with bone mass, gravity being a stimulating bone stress. Adipose tissues could influence bone metabolism especially in postmenopause. Also, muscle mass positively correlates with bone mass and is dependent on physical activity, but also on some hormones with direct effect on bone, such as insulin growth factor-1 (IGF-1)., Aim: Our study investigated the relative influence on lumbar bone mass of pre and postmenopausal women of body weight, leptin, adiponectin and IGF-1., Material and Methods: Cross-sectional study including six groups of 8 to 15 pre and postmenopausal healthy volunteers with different weight: body mass index (BMI): normal and underweight (BMI<25 kg/m2), overweigh: (BMI 25-30 kg/m2), and obese (BMI>30 kg/m2). Lumbar bone mineral density (BMD) and body composition (BC) were evaluated by dual X ray absorptiometry (DXA, Hologic), while serum leptin, adiponectin and IGF-1 were measured by ELISA., Results: Body weight, fat and lean mass positively correlated with BMD, irrespective of age (p<0.05, ANOVA). Leptin was an independent predictor for bone mass only in postmenopausal women (p<0.05). Adiponectin negatively correlated (R2=0.1975) and IGF-1 positively correlated with body mass (p<0.05)., Conclusions: Increased body weight prevents bone loss after menopause. Leptin and IGF-1 have adjacent positive roles in preserving bone mass during postmenopause.

Dissecting cellulitis of the scalp or dissecting folliculitis also known as "perifoliculitis capitis abscedens et suffodiens" (PCAS), is a rare, severe and distinct dermatological disease. It most probably occurs because of follicular occlusion via hyperkeratosis, having the same mechanism of acnea conglobata and hidradenitis suppurativa. These dermatoses may be associated or may have an isolated evolution. PCAS is one of the primitive cicatricial alopecia of neutrophilic type (with pustules). What is characteristic for the histopathologic picture of the disease is the deep inflammatory infiltrate, placed at the reticular derm or hypoderm level. The initial perifolliculitis evolves towards forming profound abscesses and the destruction of polysebaceous follicles because of granuloma, usually lymphoplasmocitary and with gigantic cells. Here is the case of a 24-year-old male with records of acne conglobata and cicatricial alopecia of the scalp, with relapsed inflammatory nodular lesions on the surface of the alopecic plaques and follicular pustules on their margin. The patient had followed before hospitalizing a systemic treatment with antibiotics (azithromycin, tetracycline, ciprofloxacin, in therapeutic schemes that the patient cannot mention, but anyway of short time) and after that a treatment with retinoids (isotretinoin, 20-30 mg/day, in two successive therapies of one month each). The evolution of the disease under these treatments was with outbreaks and short times of remission of the acne lesions and nodular lesions of the scalp. The clinical diagnosis of PCAS is difficult, especially in the initial stage of the disease, as it was the case of the patient presented here. We underline the importance of a correct history of the disease, of the complete clinical exams and the need of paraclinical investigations (histopathologic exam from the lesional biopsy - microscopy and immunohistochemistry) in order to come with a positive diagnosis of PCAS and a differential one.

Chilblain lupus or lupus pernio is a particular clinical type of cutaneous chronic lupus erythematosus, more frequently met in adults and difficult do diagnose without specific lesions at the level of the face and/or the scalp. The patient B.A., female, aged 16 is hospitalized in the Dermatological Clinic Iasi for some red-to-violaceous plaques, infiltrated, slightly scaling located around the nails and on the hands and legs finger sides. The lesions come up at the age of 13 become even more serious and painful in cold weather, getting better in the warm season when they become slightly pruriginous and are accompanied by a discrete facial erythema in "vespertilio", completely neglected by the patient. The general status was very good during this time, without general manifestations or visceral touches. The clinical diagnosis that was initially suggested, pernio, was afterwards denied by a detailed anamnesis, by laboratory testes (positive antinuclear antibodies, positive anti-double-stranded DNA antibodies) and by the histopathological examination of the biopsy from cutaneous lesions. The introduction of the antimalarial drugs (Plaquenil 200 mg/ day) associated with photoprotective creams, led to cure of cutaneous lesions.

Purpose: To compare the benefit of pars plana vitrectomy versus conventional laser therapy in eyes with persistent diabetic macular edema., Methods: In this interventional, comparative study we prospectively evaluate 22 eyes from 11 patients with bilateral, persistent diabetic macular edema. In one eye (study eye), at random, pars plana vitrectomy with internal limiting membrane (ILM) peeling was performed and in fellow eye (control eye) laser photocoagulation was continued. Cases with taut posterior hyaloid and epiretinal membranes were excluded. No dye was used for ILM staining. Cases were followed-up at least 12 months., Results: Resolution of macular edema was noted in 72.70% of vitrectomized eyes as compared to 18,20% of laser treated eyes. Visual acuity increased in 45.45% of study eyes as compared to only 9.09% of control eyes. Significantly increase of vision (from 0.087 to 0.2) was noted only in vitrectomized eyes previously laser-treated less than 3 times., Conclusions: Pars plana vitrectomy with ILM peeling was effective in reducing persistent diabetic macular edema in most of the cases. Significant functional result was limited by numerous previous laser sessions.

We present the case of a 29 year old patient, mono-ophthalmic, diagnosed with Acute Retinal Necrosis Syndrome. The disease rapidly progressed despite the medical treatment, and the patient developed complex retinal detachment. After repeated surgical procedures, due to the recurrence of intraocular inflammatory process and the development of a complicated cataract, we finally obtained a good and stable functional result.

Diabetic retinopathy is a major cause of blindness worldwide with an expected increasing incidence. Tight blood sugar and blood pressure control have proven essential in preventing both appearance and evolution of retinopathy. Surgical treatments as laser therapy and vitrectomy have also been proved highly effective in preventing major visual loss in advanced stages of retinopathy. Continuous scientific research is leading to a better understanding of pathogenesis of the disease and thus an effective medical treatment is expected in both preventing and treating different stages of diabetic retinopathy. In this update we review ongoing clinical trials and also the knowledge from finalized clinical trials that were testing the clinical impact of experimental treatments or known therapies.

The etiology and pathogenesis of acne vulgaris are not yet completely understood. Therefore we have investigated 5 patients with different clinical forms of disease, including the rare form of acne fulminans. Taking into consideration the four factors that are currently incriminated in the development of acne, sebaceous hypersecretion, hyperkeratosis of the pilosebaceous infundibulum, bacterial colonisation and perifollicular inflammation, we have focused our study on a set of cells involved in the chronic inflammatory process. We have evidenced by immunohistochemistry methods, using appropriate monoclonal antibodies, the presence of T lymphocytes and macrophages, while the B cells could be evidenced only in the severe forms. We were also interested to investigate the occurrence of new capillary formation, as an accompanying phenomenon of the inflammatory process. The presence and histological distribution of these cells highly supports the hypothesis that the mechanisms underlying the development of acne vulgaris belong to the Delayed Type Hypersensitivity.

The etiology and the pathogenesis of acne vulgaris are not complete cleared up yet. This work presents the results of the electronomicroscopic examinations effected on lesions of acne vulgaris biopsied from 5 patients with different clinical forms of disease (including acne fulminans). In this study we had in view the investigation and description of the ultrastructural modifications that followed the intervention of the 4 factors incriminated in the etiology and pathogenesis of acne: sebaceous hypersecretion, hyperkeratosis pilosebaceous infundibulum, bacterial colonisation, perifollicular inflammation. The ultrastructural aspects that we had in view underline the role of the 4 etiology and pathogenesis factors of acne vulgaris, confirming the data related by the specialised literature.

The microscopic morphology of the respiratory territory was investigated on sections of pulmonary tissue and bronchioalveolar lavage liquid (BAL) that were stained with Giemsa, PAS and trichrome solutions. As a result of the induced pathological conditions, the following histological images were encountered: normal histological aspect of the bronchoalveolar territory was seen in the groups nebulized with 0.9% NaCl or sensitized after i.p. administration of ovalbumin (OA); macrophage cells influx in both tissue samples and BAL in animals nebulized with OA; after sensitization with OA followed by nebulization with OA, the same sequence of events as in atopical asthma was reproduced, including loss of epithelial structure and the appearance of mast cells and basophils in the alveolar territory. Hydrocortisone hemisuccinate, used to treat asthma attacks, causes a similar histological aspect as in the untreated group. Cells with intact basophilic granules were seen in the hypersensitized group under ketotiphen protection.

Levothyroxine (LT4) treatment in benign thyroid nodules is a controversial management. The favorable response varies between 10-60%, being, in some studies, comparable between treated and untreated groups. The aim of this study was to evaluate the response of uninodular goiter at the LT4 treatment, in comparison with untreated patients. The study group (S) included 53 patients diagnosed with nodular goiter, treated with LT4 for 1 year. 26 patients with nodular goiter, age and sex-matched, untreated, constituted the control group (C). All patients were from a minor iodine deficient area. The including criteria were euthyroidism, single nodule, solid (ultrasonography), cold (Scintigraphy), and benign (FNAB). After 1 year mean nodular volume had a significant decrement in both groups, higher in group S (35%: from 7.8 to 5.2 mL, p = 0.0098) than in group C (25%: from 8.4 to 5.9 mL, p = 0.026). Linear regression showed a slight correlation between the nodular decrement and the initial volume (r = 0.23): the responders percentage was higher in nodules with a volume < 5 ml than in those with volume > 5 ml (51.5% vs o 19.6%, p < 0.0001). The evolution of treated nodules seamed to be better than of the untreated ones, but the differences were only slightly significant. We believe that the evolution of thyroid nodules under LT4 treatment can be influenced by the iodine supply, since in most of the studies from minor iodine deficiency regions (Europe, South America) the response is better than in regions with sufficient iodine supply (North America). Knowing the potential side effects of LT4 therapy, this kind of management of benign thyroid nodules should be reserved to selected cases.

Among lipodystrophies, the Barraquer-Simons syndrome or "parital lipodystrophy of the cephalothoracic type" is a rare condition of unknown origin characterized by a progressive atrophy of the subcutaneous fat of the upper part of the body. We report a 34-year-old woman with progressive loss of subcutaneous fat during 20 years, first affecting the face and spreading to the upper part of the body, equally presenting hypertrophy of the lower body fatty tissue. An overview of this rare syndrome is made.

This study aims at assessing the ability of asthma patients to defend themselves against the noxious effects of oxidative stress, known being the inflammatory nature of this disorder. As the anti-radical defence ability of the body is reflected by the antioxidative potential of blood and tissues, our study was based on the determination of the activity of superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx) and CAT/SOD and GPx/SOD ratios in the blood. Except for SOD, the activity of which was lower in asthma patients by -34.08%, CAT and GPx had values increased by +32.18%, respectively, with a resulting increase of CAT/SOD and GPx/SOD ratios. Our data, demonstrating a change in per-oxidants/antioxidants balance in favour of the first ones, seem to suggest that in the treatment of bronchial asthma the association of some compounds with antioxidants effects would be beneficial.

Objective: Analysis of the safety and efficiency of various modalities of 5-FU administration in the surgery of refractory glaucoma., Materials and Method: A prospective, randomized study including 36 patients with refractory glaucoma who received 5-FU in the following protocols: group A (10 patients)--intraoperative application of 50 mg 5-FU, group B (12 patients)--postoperative subconjunctival injections of 5 mg 5-FU, group C (14 patients)--intra and postoperative administration of 5-FU. Mean follow-up interval is 6 months., Results: Last controlled intraocular pressure is lower in C group patients (13.92 mmHg) versus group A and group B patients (< or = 15.7 mmHg). The real therapeutic success rate (intraocular pressure < or = 15 mmHg) and the qualified success rate (intraocular pressure < or = 21 mmHg) are higher in group C (85.7% and 92.8% respectively) as compared with group A and group B (50% and 82% respectively). The rate of side-effects in highest in group B and lowest in group C., Conclusions: Association of intra and postoperative use of 5-FU in refractory glaucoma increases the rate of therapeutic success and a lower incidence of side-effects.

Oxidative stress occurs when the antioxidative defence mechanism of the body are surpassed by the intra- and/or extracellular presence of reactive oxygen species (ROS). ROS were involved in the etiopathogenesis of many disorders, but it is difficult to discern whether their role is decisive--as in the production of atherosclerosis--or only aggravating, as an intermediate link, this being the case in neoplasms. Today, the participation of ROS in the progression of some respiratory diseases, such as bronchial asthma, is considered essential. Thus, since the first description of asthma by Aretaeus of Cappadocia, a huge leap in the understanding of this disease was recorded, this condition being nowadays considered a chronic inflammatory disorders with the participation of oxidative stress. For ascertaining the share of oxidative stress in the determinism of this disease and the efficacy of antioxidants on its course further investigations are needed.

Purpose: Comparing the efficiency and incidence of postoperative complications of classical limited trabeculectomy (30-35 degrees trabecular excision) and large and adapted trabeculectomy (60-120 degrees)., Method: A prospective study of 40 patients with symmetric bilateral glaucoma in whom limited trabeculectomy was performed in one eye and large and adapted trabeculectomy in the opposite eye. All operations were performed by the same surgeon, and the follow up interval was 4.2 years., Results: Postoperative and long-term pressure drop are similar for both types of trabeculectomy. Following limited trabeculectomy the incidence of postoperative complications is 30% lower, the incidence of severe complications is very low and patient's functional rehabilitation is faster., Conclusions: Except for the clinical conditions where IOP has to be decreased to very low levels (below an intraocular pressure tolerance level of 11-12 mmHg) when a large trabeculectomy is required, limited trabeculectomy is to be preferred as it is safer and obviously beneficial.