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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.

This article introduces Representation readers to topics considered during ’Free and Fair Elections, Ten Years On: An International Roundtable on Election Standards’, held in November 2004 at the Inter‐Parliamentary Union's headquarters in Geneva. The organisers wish to express their sincere thanks to both the Inter‐Parliamentary Union and the Ford Foundation for their generous administrative and financial contributions.

This article considers international law as a criterion for judging electoral processes. An analytical framework is constructed by which an empirical connection might be forged between electoral obligations found in various mechanisms of international law and the electoral ‘markers’ contained within the constituent parts of electoral events. The paper demonstrates that much has changed with regard to this approach over the last decade, which points to the necessity of evaluating how newly established sources of international law have expanded our understanding of election standards during this period.

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.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.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%).This study demonstrates that there is a significant association between certain dermatologic disorders and thyroid diseases, requiring periodic thyroid function tests.

Background The topic pursued in our project was sexual and reproductive health in Roma communities. Although this subject is addressed superficially or not at all among Roma ethnic groups, through our program of health education we helped them apply correctly the techniques of personal hygiene and contraception. Method We enriched Roma’s level of knowledge regarding personal hygiene, sexually transmitted diseases and infections, right to promotion of …

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

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.

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.

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 CO 2 inside the probes and for comparison in a conventional ballooned intestinal tonometer were made in a closed container maintained at 37°C. In in vivo studies in anaesthetized dogs, the tonometric PCO 2 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 PCO 2 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.

In a recent publication we have introduced the induced charge computation (ICC) method for the calculation of polarization charges induced on dielectric boundaries. It is based on the minimization of an appropriate functional. The resulting solution produces an integral equation that is transformed into a linear matrix equation after discretization. In this work, we discuss the effect of careful calculation of the matrix element and the potential by treating the polarization charges as constant surface charges over the various surface elements. The cor- rect calculation of these quantities is especially important for curved surfaces where mutual polarization of neighboring surface elements is considerable. We report results for more complex geometries including dielectric spheres and an ion channel geometry with a surface of revolution.

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.

Measure of oxidative stress were studied in blood samples from 10 patients undergoing bloodless lower limb surgery. Ischaemia induced a significant increase in plasma hypoxanthine concentration and xanthine oxidase activity both in the operated leg and in the systemic circulation. Five minutes after reperfusion, ratio of xanthine oxidase/total xanthine oxidase and dehydrogenase activities rose moderately, whereas at 20 min xanthine oxidase accounted for all xanthine oxido-reductase activity in the systemic circulation. A significant increase in blood glutathione redox ratio, enhanced oxidation of haemoglobin to methaemoglobin and rise in plasma haemoglobin concentration were present only in the operated limb. Thus, although the level of the potential free radical generators rose significantly both locally and in the systemic circulation, oxidative stress, as indicated by blood glutathione and erythrocyte injuries, remained limited to the reperfused leg.

Due to the scientific progress and the rapid changes in social circumstances, medical ethics became a complicated and difficult science. On the basis of fundamental and simple principles of medical ethics (salus aegroti suprema lex) the author tries to take standpoint in questions arisen in his practice in which the medical aspect was not necessarily obvious. It can be ethically faulty when more then necessary is provided to the patients (in prescribing medicine, in welfare, in performing examinations). It is necessary that the steadily increasing medical specialization goes together with the better cooperation between the medical disciplines and with wider distribution of special experience. The system of the medical honorarium should be entirely open and publicly regulated. It is a medical ethical obligation to place the organs of brain death cases suitable for transplantation at the disposal of patients requiring it. In the field of reproduction not the suspicion alone but the undoubtebly proven injury of fetus only can be a sufficient medical indication for the termination of pregnancy. The medical person by his attitude in creating optimal conditions for the perinatal care has to do his best in avoiding any heartlessness, contralily, in promoting willingness in the parents to have children.

In two series of newborns needing intensive care the presence, the degree and the prognostic value of myoglobinaemia was examined. In series I. of hypoxic newborns the myoglobinaemia was present even in infants requiring less than 60% O2 therapy. The serum myoglobin value was significantly higher in cases needing oxygen therapy over 60% oxygen. This was most pronounced in the critically severe and progressive cases. In series II. of 34 consecutive cases of hypoxic newborns exceeding 7 nM/l proved to have a prognostic value indicating critically severe course or fatal outcome of the disease. The myoglobinaemia observed in the present study may explain the effectivity of the peritoneal dialysis therapy introduced previously by us in severe hypoxic newborns. This possibility was supported by further observations on the transperitoneal passage of myoglobin in 4 renal hilus ligated and peritoneally dialyzed newborn piglets. In conclusion, early detection of the elevated myoglobinaemia in severely hypoxic newborns has a definite prognostic value and its degree can be used in the indication of peritoneal dialysis.

A study was made of the effect of a 3-hour incubation with inosine-pyruvate-phosphate (IPP) on the P50 values and 2,3-DPG contents of fresh blood and blood which had stood for 96 h, from healthy adults, term neonates, 1–2-week-old symptom-free premature infants and RDS premature infants. It was found that the P50 value and the 2,3-DPG content could be increased considerably by IPP treatment in both the fresh and the stood blood in the various groups of neonates. The question remains open as to whether the effect of IPP, in significantly improving the O2 transport in neonates, is a consequence of the 2,3-DPG alone or of some other metabolite. In RDS the stimulating effect of the IPP mixture is appreciably lower.

Zur genauen Feststellung der unter klinischen Verhaltnissen vorkommenden Saure-Basengleichgewichtsstorungen wird die Bikarbonat- und CO2-Druck-Bestimmung im Blut empfohlen. Diese Angaben wurden nach der Astrupschen Standard-Bikarbonat- und nach der eigenen sog. gastrotonometrischen pCO2-Bestimmungsmethode ermittelt. Diese beiden Grunduntersuchungen sind verhaltnismasig einfach; der Standard-Bikarbonatwert wird im venosen Blut, der gastrotonometrische pCO2-Wert unblutig festgestellt. Aus den beiden Angaben gewinnt man die aktuellen Werte im Organismus durch Korrektion. Es wird ein “Saure-Basenkarte” genanntes Nomogramm beschrieben, mit dessen Hilfe aus den beiden Werten samtliche in der Praxis moglichen Saure-Basen-gleichgewichtsstorungen ermittelt werden konnen. Die Anwendbarkeit der Untersuchungen wird durch die Mitteilung der von gesunden Kindern und an verschiedenartigen Saure-Basen-gleichgewichtsstorungen leidenden Kindern stammenden Angaben nachgewiesen.

Wie 50 Bestimmungen ergaben, betrug der Astrupsche Standard-Bikarbonatwert in Ubereinstimmung mit den Normalwerten von Erwachsenen im Durchschnitt 21,6 mEq/l. Der Standard-Bikarbonatwert ist je nach dem Alter in fruher Kindheit niedriger, doch tritt im hoheren Alter nur eine geringe Abweichung zutage.

Dexamethasone (10 mg i.m.) administered to mothers 24 hours before delivery for the prevention of respiratory distress syndrome caused a considerable elevation of the serum level of unconjugated bilirubin in premature infants throughout the first week of life. On days 3 to 4 the incidence of infants with bilirubin levels exceeding 256.56 micrometer/l (15 mg/100 ml) was found to increase (7/15 vs 2/17). The urinary excretion of D-glucaric acid, which reflects the activity of the hepatic microsomal enzyme systems, proved to be low in pre-term infants over the first 7 days of life, and it was not enhanced significantly by antenatal dexamethasone therapy. In the light of the results presented, more detailed clinical and experimental analysis of the effects of glucocorticoids on bilirubin metabolism of pre-term infants and investigation into the drug prophylaxis of steroid-induced hyperbilirubinaemia are suggested.

Das Symposium wurde auf Veranlassung des Bundesministers fur Jugend, Familie und Gesundheit unter der Federfuhrung der hiesigen Abteilung Ernahrungsmedizin und Ernahrungsphysiologie mit dem Ziel durchgefuhrt Anforderungen fur diatetische Lebensmittel zur Behandlung von Aminosaurestoffwechselstorungen fur eine Anderung der Diat-Verordnung festzulegen.

Experiments were carried out on near term pregnant guinea pigs. Cesarean section was performed and by exteriorization of the foetuses the placental stage of labor was simulated. In one group of foetuses, chosen at random, we induced hypoxia, and in an another series of experiments asphyxia, each group with its own control. The results of acid-base values, experimental antipyrine transplacental transfer studies and the survival rate of foetuses, showed that it is advantageous for the newborn animal if we preserve the placental function in such conditions immediately post partum. Further study is necessary to determine to what degree and under what conditions our experimental observations are applicable to human perinatology.

Red blood cells are well equipped to handle intracellular oxidative stress, their membranes are permeable to O2- and H2O2, and in this way they are important regulators of oxygen reactions occurring in their surroundings. The protective effect against reduced oxygen species - generated during the endothelial cell injury of various tissues - is attributed mainly to the glutathione metabolism of red blood cells. The blood concentration of reduced (GSH) and oxidized glutathione (GSSG) was determined by a sensitive method using glutathione reductase in experimental shock syndromes induced by paraquat toxicity, tourniquet ligature and endotoxin in rats, by bleeding and reperfusion in dogs and by transient ligature of thoracic aorta in newborn piglets. Under these conditions the concentration of GSSG was elevated and GSH was lowered, resulting in an increase in the redox ratio: [GSSG/(GSH + GSSG)] x 100 (GSSG/GSH); particularly during reperfusion. Determination of the GSSG/GSH seems to be a reliable index to assess the degree of oxidative stress "in vivo".