The influence of the tooth preparation finish line position on the expression of matrix metalloproteinase-9 and the presence of periodontopathogens in the gingival crevicular fluid

OBJECTIVE

The objective of the study was to determine the concentration of matrix metalloproteinase 9 (MMP-9) and changes in the presence of periodontopathogens in the gingival crevicular fluid before and after tooth preparation with the subgingival and equigingival finish line position.

PATIENTS AND METHODS

The clinical prospective study included 20 subjects with an indication for upper canine preparation, with the subgingival (group 1) and equigingival finish line (group 2). Samples were taken in four observation intervals: 5 minutes before (control samples), as well as 15 minutes, 24 and 72 hours after tooth preparation (experimental samples). Measurement of MMP-9 was done using Enzyme-linked Immunosorbent Assay (ELISA). The presence of bacteria in the gingival fluid was proven by the Polymerase chain reaction (PCR) analysis.

RESULTS

The MMP-9 values did not differ statistically significantly between the groups (p=0.524). The MMP-9 values showed a statistically significant difference in the given observation period (p<0.001) with a significant linear increase in values (p<0.001). A significant quadratic trend recorded a decrease in the MMP-9 values 15 minutes after preparation, and an increase 24 hours after preparation, without a significant difference in the interaction between groups (p=0.392). After preparation, a significant difference in the presence of periodontopathogens was confirmed, i.e., a decrease in the presence of Prevotella intermedia (p=0.025) and Tannerella forsythia (p=0.016) in group 1, and an increase in the presence of Aggregatibacter actinomycetemcomitans in both groups (p=0.029, p=0.026).

CONCLUSIONS

The study is a good basis for determining the influence of tooth preparation on gingival inflammation, with therapeutic (choice of preparation technique) and preventive significance regarding the protection of the periodontal tissue from possible iatrogenic damage.

Effectiveness of Tocilizumab after switching from intravenous to subcutaneous formulation in patients with rheumatoid arthritis: A single-centre experience

Nowadays, the appropriate control of rheumatoid arthritis (RA) involves the absence of clinical disease activity, delaying joint destruction as long as possible and adequate quality of life of the affected. With currently available therapeutic modalities, this therapeutic goal can be achieved in a large number of patients. The aim of this research was to determine the effectiveness of an IL-6 blocker (Tocilizumab) in patients with RA in everyday clinical practice. We also analyzed whether a change in the mode of drug administration (switching from intravenous to subcutaneous drug formulation) had an impact on drug effectiveness (using the DAS 28 SE and CDAI indexes) and quality of life of patients with RA (HAQ, Beck Depression Inventory, FACIT F score and SF 36 questionnaire). The study included 53 subjects diagnosed with RA, treated with Tocilizumab. After a six-month use of subcutaneous Tocilizumab, we concluded that the method of drug administration did not have an impact on its effectiveness and on all the examined parameters of quality of life assessment.

Systemic sclerosis and pulmonary arterial hypertension: A case report

Pulmonary arterial hypertension (PAH), which occurs in about 15% of patients with systemic sclerosis (SSc), is a progressive vasculopathy and despite modern therapeutic options is still one of the leading causes of death in these patients. We presented a patient diagnosed with the overlap syndrome (systemic sclerosis and rheumatoid arthritis) with a predominance of the clinical picture of systemic sclerosis (SSc), established in November 2018. She was initially treated by a rheumatologist with an antimalarial, which was soon discontinued by an ophthalmologist, followed by azathioprine which was excluded due to an allergic reaction. She has been continuously on corticosteroid therapy, and since January 2020, mycophenolate mofetil has been added to treatment. The patient was diagnosed with primary biliary cirrhosis by a gastroenterologist after clinical findings and additional examination methods; also, pulmonary fibrosis was diagnosed by a pulmonologist. In January 2020, deterioration of echocardiographic findings was registered (dilated right heart cavity, right ventricular systolic pressure (RVSP) 72 mmHg, tricuspid regurgitation 3+). Sildenafil was proposed by a responsible cardiologist for therapy that was not approved by gastroenterologist. Due to worsening of her symptoms in the form of pronounced fatigue, shortness of breath, in August 2020, a cardiologist of the Institute "Niška Banja" started bosentan therapy in a dose of 2 x 62.5 mg per day. After the applied therapy, the patient had a subjective improvement and reduction of symptoms. In November 2020, a control echocardiographic examination registered a decrease in RVSP to 55 mmHg. In addition to the therapy proposed by the responsible rheumatologist (mycophenolate mofetil 2 g daily, prednisolone 15 - 20 mg daily), the therapy prescribed by her cardiologist was also continued (bosentan 62.5 mg 2 x 1), with regular controls and monitoring of laboratory analyses. PAH in patients with SSc has a worse prognosis than idiopathic PAH, and additionally depends on RVSP and functional class. The process of treating PAH in patients with SSc requires a complex strategy that includes initial assessment of disease severity and subsequent responses to the therapy.

Association of vitamin D receptor genetic variants with bone mineral density and inflammatory markers in rheumatoid arthritis

BACKGROUND AND AIMS

Vitamin D receptor (VDR) genetic variants are considered to have a role in the pathogenesis of rheumatoid arthritis (RA). This study examines an association of FokI, BsmI, ApaI and TaqI with RA, as well as with bone mineral density (RA with normal bone mineral density, RA-NBMD; RA with associated osteopenia, RA-OSTP; and RA with associated osteoporosis, RA-OP) and inflammatory markers.

MATERIALS AND METHODS

VDR genetic variants were tested in 248 subjects using the PCR-RFLP method.

RESULTS

Significant differences were observed in the distribution of FokI genotypes between RA patients (p < 0.001), or subgroups (RA-NBMD, RA-OSTP, RA-OP) (p = 0.035, p = 0.02, p < 0.001, respectively) and controls. Prevalence of FokI f allele was significantly higher in RA group (p < 0.001) and subgroups (p = 0.003, p = 0.021, p < 0.001, respectively) compared to controls. An increased susceptibility to RA-OSTP was revealed in BsmI/ApaI Ba (AC) haplotype carriers (p = 0.012). A significantly higher erythrocyte sedimentation rate values were obtained in FokI FF compared to Ff + ff carriers (54.57 ± 23.73 vs. 22.83 ± 12.42; p < 0.001) within the RA-NBMD subgroup.

CONCLUSION

The results of the study indicate an association of RA with FokI genetic variant and increased susceptibility to RA in f allele carriers, as well as to RA-OSTP in BsmI/ApaI Ba (AC) haplotype carriers.

AB0455 HEMATOLOGICAL PARAMETERS AS THE MARKERS OF DISEASE ACTIVITY IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

Background:

As the standard markers of systemic inflammation in autoimmune diseases erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are usually used, but in recent years there have been conflicting results about the potential significance of neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR).

Objectives:

Our aim was to investigate the correlation of NLR and PLR with disease activity in patients with systemic lupus erythematosus (SLE).

Methods:

The study involved 160 patients with SLE (145 women and 15 men), hospitalized in the Clinic of Rheumatology, Institute „Niška Banja“, aged on the average 46.34 ± 10.82 years and with average disease duration of 9.76 ± 8.27 years, in whom the diagnosis was established based on the revised ACR criteria from 1997. In addition to clinical examination and supplementary tests, their disease activity was assessed using theSystemic Lupus Erythematosus Disease Activity Index(SLEDAI), together with determination of NLR and PLR.

Results:

In SLE patients, there was a positive correlation of NLR with ESR (r=0.212; p=0.010), anti-dsDNA antibodies (r=0.185; p=0.025), and PLR (r=0.601; p<0.001), as well as a negative correlation with complement component 3 (C3) (r=-0.264; p=0.003). Further, there was a positive correlation of PLR with ESR (r=0.329; p<0.001), CRP (r=0.249; p=0.003), anti-dsDNA antibodies (r=0.280; p=0.001), anti-nucleosome antibodies (r=0.263; p=0.026), and values of urinary chemoattractant protein-1 (MCP1) (r=0.263; p=0.043), as well as a negative correlation with C3 (r=-0.276; p=0.002). Our univariate analysis demonstrated that not only the values of ESR, CRP, C3, anti-dsDNA, anti-nucleosome, anti-C1q antibodies, serum and urinary MCP1 (p<0.001) were statistically significantly associated with SLEDAI, but also the NLR (p<0.001) and PLR (p<0.001). Using the method of standard multiple regression analysis, we examined the impact of the above parameters on SLEDAI. The examined model accounted for 21.7% of variance in activity index (corrected r2=0.217, F=2.525, p=0.017). As the statistically significant risk factors, ESR (Beta=0.394, p=0.020) and serum MCP1 (Beta=0.325, p=0.043) stood out.

Conclusion:

NLR and PLR, as hematological parameters available in everyday clinical work, can be significant for disease activity assessment in SLE patients.

References:

[1]Gasparyan AY, Ayvazyan L, Mukanova U, Yessirkepov M, Kitas GD. The Platelet-to-Lymphocyte Ratio as an Inflammatory Marker in Rheumatic Diseases. Ann Lab Med. 2019;39(4):345-57.

[2]Yu H, Jiang L, Yao L, Gan C, Han X, Liu R, Su N. Predictive value of the neutrophil-to-lymphocyte ratio and hemoglobin in systemic lupus erythematosus. Exp Ther Med. 2018;16(2):1547-53.

[3]Wu Y, Chen Y, Yang X, Chen L, Yang Y. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were associated with disease activity in patients with systemic lupus erythematosus. Int Immunopharmacol. 2016;36:94-9.

[4]Yolbas S, Yildirim A, Gozel N, Uz B, Koca SS. Hematological Indices May Be Useful in the Diagnosis of Systemic Lupus Erythematosus and in Determining Disease Activity in Behcet’s Disease. Med Princ Pract. 2016;25(6):510–6.

[5]Qin B, Ma N, Tang Q, Wei T, Yang M, Fu H, Hu Z, Liang Y, Yang Z, Zhong R. Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) were useful markers in assessment of inflammatory response and disease activity in SLE patients. Mod Rheumatol. 2016;26(3):372–6.

Disclosure of Interests:

None declared

AB1130 LOCALIZATION OF MRI INFLAMMATORY LESIONS OF THE HAND IN SCLERODERMA AND RHEUMATOID ARTHRITIS - COMPARATIVE STUDY

Background:

Inflammatory lesions of hand are frquent clinical feature in rheumatoid artritis (RA), with lower frequency in pts with systemic sclerosis (SSc), also. MR is useful method for detecting and quantification of inflammatory lesion of the hand (bone oedema, erosions, synovitis) in RA and SSc.

Objectives:

The aim of the study was to compare MR hand feature in SSc (experimental) and RA (control group) and to detect the localisation of the highest OMERACT RAMRISinflammatory score on the hand in pts with SSc and RA

Methods:

110 pts with SSc and 60 with RA were investigated (mean age 53y). All the pts underwenr clinical examination, X ray and MR on the dominant hand and wrist. Contrast enhanced low field MRI of the wrist and MCP2-5 joints was performend to all the pts. MRI inflammatory changes (bone oedema,erosions, synovitis)were assessed and scored by OMERACT RAMRIS scoring system.

Results:

Clinical examination confirmed synovitis in 17.1%, and 78% of patients with SSc using MR I (p <0.001). In the SSc group, erosions (by MR method) was confirmed in 52 (63.4%), by radiography in 22 pts (27.5%), which is a significantly lower percentage (p <0.001). In the control RA group, erosion was confirmed in 34 (97.1%) by MR method, and by radiography in 6 (17.1%), which is a statistically significant difference (p <0.001). Mean values of total MR score of synovitis (2.69 ± 2.29: 4.37 ± 1.31), oedema (6.58 ± 10.89: 20.57 ± 10.23) and erosion (6.84 ± 7, 43: 18.60 ± 5.01) on the wrist of the dominant hand were significantly higher in subjects with control RA than in those in the experimental SSc (p < 0.001). Mean values of total MR score of synovitis (3.15 ± 2.95: 5.26 ± 2.09), oedema (3.99 ± 9.82: 10, 51 ± 7.90) and erosion (4, 04 ± 4.76: 9.69 ± 4.27) on the MCP joints of the dominant hand were significantly higher in the control RA subjects (p <0.001).The highest OMERACR RAMRIS synovitis score was on distal radioulnar (DRU joint) of hand in SSc and also In RA pts. The highest erosion score was found on capitate bone in SSc, but in lunate bone in RA pts. The highest bone oedema score was also found on capitate bone in SSc, but in lunate bone in RA pts. According to the MCP joints, the highest synovitis score was found on the second finger in SSc and RA, highest erosion score also on the second finger in SSc, but on the third finger in RA; The highest bone oedema score was found on the third finger in SSc, and olso on the third and fifth finger in RA pts

Conclusion:

MR inflammatory lesions in SSc are less frequent compared to that in RA but still in significant percentage, confirming the need for early detection and aggressive treatment of both, RA and SSc patients with joint involvement

References:

[1]Avouac J, Walker UA, Hachulla E, Riemekasten G, Cuomo G, Carreira PE, et al. Joint and tendon involvement predict disease progression in systemic sclerosis: a EUSTAR prospective study. Annals of the rheumatic diseases. 2016;75(1):103–9.

[2]Abdel-Magied RA, Lotfi A, AbdelGawad EA. Magnetic resonance imaging versus musculoskeletal ultrasonography in detecting inflammatory arthropathy in systemic sclerosis patients with hand arthralgia. Rheumatology international. 2013;33(8):1961–6.doi:10.1007/s00296-013-2665-8.

Disclosure of Interests:

None declared

AB0227 BASELINE SYNOVIAL LEVELS OF MATRIX METALLOPROTEINASES-9 IN EARLY RHEUMATOID ARTHRITIS-THE ASSOCIATION WITH INITIAL RADIOGRAPHIC CHANGES

Background:

Matrics metalloproteinases (MMPs) are the key enzymes responsible for the joint destruction in rheumatoid arthritis (RA).

Objectives:

The aim of this study was to examine the association of baseline levels of metalloproteinases-9 (MMP-9) in serum and synovial fluid (SF) with structural damage of hand and feet joints in patients with early RA and also with imunoserological markers of the disease.

Methods:

The study enrolled 134 subjects with knee synovitis: 72 patients with early DMARD-naïve RA (symptom duration ≤12 months) and 62 patients with osteoarthritis (OA), as control group. Synovial fluid was obtained by an arthrocentesis of the knee joint. Joint damage was estimated by hands, knee and feet radiography. With regard to the presence of destructive joint changes on initial x-ray, RA patients were classified as erosive and nonerosive form of disease. ELISA assay was used for the detection of MMP–9 activity in serum and SF as well for the imunoserology tests: rheumatoid factor RF (IgG) and anti-CCP antibody (ACPA).

Results:

MMP–9 activity in serum and SF of RA patients was significantly higher compared to its activity in serum and SF of control group (p<0.01 and p <0.001 respectly) (table 1).

Table 1.

MMP–9 activity (ng/ml) in serum and SF of RA and control group patients

GroupMMP-9 activity in BP(ng/ml); mean±SDMMP-9 activity in SF(ng/ml)mean±SDRA(n=72)18.28±7.54**15.07±13.24***Controls -OA(n=62)13.58±3.070.65±0.41

RA – rheumatoid arthritis; SD – standard deviation; n – number of subjects; ** – p<0.01, *** p<0,001

We did not establish a significant correlation between the activity of MMP 9 in serum and SF in the RA and control groups (Spearman’s rank correlation coefficient in RA was 0,02 and 0,06 in control group).

Most of the subjects from RA group (52–72.22%) had verified radiographic erosive changes in joints. Nonerosive arthritis was present in remaning 20 (27.78%) of RA patients. No differences were obtained according to the sex, age or disease duration between erosive and nonerosive RA patients.

Table 2 represents MMP–9 activity in serum and SF of patients with erosive and nonerosive RA. The values of MMP–9 activity measured in serum were higher in nonerosive compared to erosive RA (20.35±10.30 vs. 17.46±6.25), but the difference was not statistically significant (p>0.05). However, MMP–9 activity in SF was significantly higher in erosive compared to nonerosive RA (17.53±12.87 vs. 8.76±7.72; p<0.05).

Table 2.

MMP–9 activity (ng/ml) in serum and SF of patients with erosive and nonerosive RA

MMP-9 activityErosive RA(n=52)[ng/ml]Nonerosive RA(n=20)[ng/ml]Serum17.46±6.2520.35±10.30Synovial fluid17.53±12.87*8.76±7.72

RA – rheumatoid arthritis; SD – standard deviation; n – number of subjects; * p<0.05;

We also examined the correlation of MMP 9 activity in serum and SF with standard imuno serological markers of disease (RF and ACPA). Our results indicate that there is a significant correlation of MMP 9 activity in SF with ACPA level in RA group (Spearman’s rank correlation coefficient is 0,48), but not with RF (Spearman’s rank correlation coefficient is 0.06).

Conclusion:

MMP–9 activity in serum and synovial fluid of patients with early RA is significantly higher compared to patients with osteoarthritis. High activity of MMP–9 in synovial fluid of patients with early RA correlated with ACPA level and may be a predictor of rapid radiographic progression of disease.

References:

[1]Prodanovic S, Radunovic G, Babic D. et al. Matrix Metalloproteinases-3 Baseline Serum Levels in Early Rheumatoid Arthritis Patients without Initial Radiographic Changes: A Two-Year Ultrasonographic Study Med Princ Pract 2018;27:378–386

[2]S. Fadda, E. Abolkheir, R. Afifi et al. Serum matrix metalloproteinase-3 in rheumatoid arthritis patients: correlation with disease activity and joint destruction, Egypt Rheumatol 2016, 38 (3) 153-159.

Disclosure of Interests:

None declared

Analysis on the risk factors for organ damage in patients with systemic lupus erythematosus: a cross-sectional single-center experience

BACKGROUND

Organ damage in patients with systemic lupus erythematosus (SLE) occurs as a consequence of the disease itself, the therapy applied and the accompanying conditions and complications. Organ damage predicts further organ damage and is associated with an increased risk of death.

OBJECTIVE

This study aimed to assess the degree of irreversible organ changes in SLE patients, using the Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) damage index (SDI); to establish correlations between organ damage and disease activity, quality of life, intensity of fatigue and serological factors; and to ascertain the risk factors for organ damage.

DESIGN AND SETTING

Cross-sectional single-center study conducted at the Institute for Treatment and Rehabilitation "Niška Banja", Niš, Serbia.

METHODS

83 patients with SLE were enrolled: 58 patients formed the group with organ damage (SDI ≥ 1), and 25 patients without organ damage served as controls (SDI = 0).

RESULTS

Organ damage correlated with age (P = 0.002), disease duration (P = 0.015), disease activity (grade 1, P = 0.014; and grade 2, P = 0.007), poor quality of life, severe fatigue (P = 0.047) and treatment with azathioprine (P = 0.037). The following factors were protective: use of hydroxychloroquine (P = 0.048) and higher scores obtained for the physical (P = 0.011), mental (P = 0.022) and general health (P = 0.008) domains.

CONCLUSION

It is very important to evaluate risk factors for organ damage in the body, including physicians' overall assessment, to try to positively influence better treatment outcomes.

The clinical significance of antibody determination to cyclic citrullinated peptides in systemic sclerosis

INTRODUCTION

Anti-citrullinated peptides antibodies (ACPA) are present in 80% of sera of rheumatoid arthritis (RA) patients with high specificity for diagnosis and prediction for the development of early erosive arthritis. A few studies have reported a low frequency ACPA in systemic sclerosis (SSc) patients with the presence of arthritis.

OBJECTIVE

The aim of our study was to determine the frequency of ACPA in systemic sclerosis (SSc) patients, their correlation with clinical manifestations and radiographic features.

METHODS

The study included 82 patients with SSc, mean age 54.4 years, 59 with the limited (ISSc) and 23 with the diffuse (dSSc) form of the disease. The control group included 28 healthy age and sex matched subjects. ACPA and rheumatoid factor (RF) were determined in all SSc patients and healthy subjects in whom standard radiography of hands and wrists was also done.

RESULTS

The presence of ACPA was detected in 11 (13.4%) of SSc patients. Their level was not increased in any of the controls. Positive RF was found in 15.9% of SSc patients. Arthritis was present in 17.1%, as well as marginal bone erosions. There was a statistically significant association between positive ACPA and arthritis (p < 0.0001) and positive ACPA and marginal bone erosions (p = 0.0002).

CONCLUSION

The research confirmed the correlation between ACPA with clinical signs of arthritis and radiographic damage of hand joints. ACPA is a useful diagnostic marker in the identification of SSc patients with arthritis and anatomic bone damage enabling the use of adequate therapy in order to prevent joint damage and poor quality of life.

Maternal and paternal genealogy of Eurasian taurine cattle (Bos taurus)

Maternally inherited mitochondrial DNA (mtDNA) has been used extensively to determine origin and diversity of taurine cattle (Bos taurus) but global surveys of paternally inherited Y-chromosome diversity are lacking. Here, we provide mtDNA information on previously uncharacterised Eurasian breeds and present the most comprehensive Y-chromosomal microsatellite data on domestic cattle to date. The mitochondrial haplogroup T3 was the most frequent, whereas T4 was detected only in the Yakutian cattle from Siberia. The mtDNA data indicates that the Ukrainian and Central Asian regions are zones where hybrids between taurine and zebu (B. indicus) cattle have existed. This zebu influence appears to have subsequently spread into southern and southeastern European breeds. The most common Y-chromosomal microsatellite haplotype, termed here as H11, showed an elevated frequency in the Eurasian sample set compared with that detected in Near Eastern and Anatolian breeds. The taurine Y-chromosomal microsatellite haplotypes were found to be structured in a network according to the Y-haplogroups Y1 and Y2. These data do not support the recent hypothesis on the origin of Y1 from the local European hybridization of cattle with male aurochsen. Compared with mtDNA, the intensive culling of breeding males and male-mediated crossbreeding of locally raised native breeds has accelerated loss of Y-chromosomal variation in domestic cattle, and affected the contribution of genetic drift to diversity. In conclusion, to maintain diversity, breeds showing rare Y-haplotypes should be prioritised in the conservation of cattle genetic resources.

[Low dose CT protocol--capability for early detection of lung carcinoma]

Lung carcinoma is the most common cause of death among men who died from cancer; also, among women, the incidence of this disease is on the increase. Use of multislice computed tomography (MSCT) has enhanced detection capability for pulmonary nodules. Nowadays, low radiation dose CT technique (LDCT) increases interest in lung cancer screening. This study is a part of the project whose aim is early diagnosis and well-timed treatment of lung carcinoma. Participants in this screening were above the age of 40, both smokers and non-smokers, who have undergone MSCT examination of lungs following low-dose protocol (LDCT). In the first ten months of the study, 375 volunteers have been examined. Overall number of detected nodules was 361; and 303 of these nodules have been characterized as non-calcificated. 95 participants (24.27%) had at least one non-calcificated nodule. 17 patients were referred to pulmologist and for further clinical evaluation. LDCT significantly increases detection of small, non-calcificated pulmonary nodules, and, therefore, gives higher opportunity to detect early lung carcinoma.

Sesquiterpene lactone mix patch testing supplemented with dandelion extract in patients with allergic contact dermatitis, atopic dermatitis and non-allergic chronic inflammatory skin diseases

We investigated the value of patch testing with dandelion (Compositae) extract in addition to sesquiterpene lactone (SL) mix in selected patients. After we detected a case of contact erythema multiforme after patch testing with dandelion and common chickweed (Caryophyllaceae), additional testing with common chickweed extract was performed. A total of 235 adults with a mean age of 52.3 years were tested. There were 66 men and 169 women: 53 consecutive patients with allergic contact dermatitis (ACD); 43 with atopic dermatitis (AD); 90 non-atopics suffering from non-allergic chronic inflammatory skin diseases; 49 healthy volunteers. All were tested with SL mix 0.1% petrolatum (pet.) and diethyl ether extracts from Taraxacum officinale (dandelion) 0.1 and 3.0% pet. and from Stellaria media (common chickweed) 0.1 and 3% pet. A total of 14 individuals (5.9%) showed allergic reaction (AR) to at least 1 of the plant allergens, 4 (28.6%) to common chickweed extract, and 11 (78.6%) to Compositae allergens. These 11 persons made the overall prevalence of 4.7%: 8 (3.4%) were SL-positive and 3 (1.3%) reacted to dandelion extract. 5 persons (45.5%) had AD, 2 had ACD, 2 had psoriasis and 2 were healthy controls. The Compositae allergy was relevant in 8 cases (72.7%). The highest frequency of SL mix sensitivity (9.3%) was among those with AD. Half the SL mix-sensitive individuals had AD. ARs to dandelion extract were obtained only among patients with eczema. A total of 9 irritant reactions (IRs) in 9 individuals (3.8%) were recorded, 8 to SL mix and 1 to common chickweed extract 3.0% pet. No IR was recorded to dandelion extract (P = 0.007). Among those with relevant Compositae allergy, 50.0% had AR to fragrance mix and balsam of Peru (Myroxylon pereirae resin) and colophonium. SLs were detected in dandelion but not in common chickweed. Our study confirmed the importance of 1 positive reaction for emerging, not fully established, Compositae allergy. In conclusion, the overall prevalence of 4.7% in our study represents a basal SL mix detection rate of 3.4% reinforced and safely supplemented by testing with the dandelion extract.

Localization, clinical and pathological characteristics and survival in sporadic colon cancer patients younger than 40 and over 65 years of age

PURPOSE

Colorectal cancer is predominantly a disease of older population, but occasionally it affects younger patients, in whom very often diagnosis is overseen and treatment begins late. The aim of our study was to compare localization, clinical and pathological characteristics and survival of sporadic colorectal cancer patients aged up to 40 and over 65 years.

PATIENTS AND METHODS

The first group (group I) included 19 patients under 40 years and the second group (group II) 28 patients aged over 65 years, treated during 1997-2001. Patients with family history of colon cancer and inflammatory disease of the colon were not included. Arithmetic mean, standard deviation, Fisher's test, Student 's t test, x(2) test and the Kaplan-Meier method were used in the statistical analysis of the results.

RESULTS

There was no difference among the tested groups regarding tumor localization. The most frequent localization was in the rectum and left colon. At presentation, in group I patients, besides the metastases in the liver and lymph nodes, colorectal cancer infiltrated also the duodenum, stomach, right kidney capsule in one patient, and adnexa in two patients. In group II patients we registered only liver and lymph node metastases. Pathologically, tubular and mucinous forms were present in all of the patients up to 40 years of age, while only one patient over 65 had tumor with mucinous component. In group I, Astler-Coller stage B was found in 1.5% of the patients, stage C in 72.5% and stage D in 26%; in group II, stage B was found in 1.5%, stage C in 84.5% and stage D in 14%. Grade III was 36.8% in group I and 17.8% in group II. No statistical differences were found in stage distribution (p=0.36) and grade (p=0.06) between group I and II. Five-year overall survival was 57.8% and 28.5% in younger and older patients, respectively (p=0.053).

CONCLUSION

The results obtained showed no difference in clinical symptomatology and tumor localization in both groups. The incidence of more aggressive tumors was higher in younger persons. However, early detection combined with more aggressive therapeutic approach, could enable significant improvement of the 5-year survival of younger patients with colon cancer.

Radical radiotherapy in the treatment of carcinoma of the anal canal - single center experience

PURPOSE

Radiotherapy -/+ chemotherapy is the first-line treatment for carcinoma of the anal canal in most oncology institutions. The aim of our study was to evaluate the efficacy and toxicity of radical radiotherapy in the treatment of this carcinoma.

PATIENTS AND METHODS

Definitive radiotherapy was performed in 41 patients with squamous cell anal carcinoma. The majority (51.2%) of them were in T3 stage. Positive inguinal lymph nodes were found in 10 (24.4%) patients. Initially, all patients received external beam radiotherapy with pelvic fields, followed, after a 2-week gap in some patients or in continuity, by local external beam or brachytherapy boost. The total tumor dose ranged from 55-75 Gy.

RESULTS

Acute complications were noticed in 32 (78%) patients with moist skin perineal desquamation being the most frequent (63.5%). On the first follow-up examination (2 months after the end of radiotherapy) 65.9% of the patients were in complete remission (CR), 31.7% in partial remission (PR), while in one (2.4%) patient locoregional disease progression (PD) was registered. With a mean follow- up time of 38.4 months (range 12-90 months) 75.6% of the patients were disease-free, while local or distant disease progression was diagnosed in 24.4% of them. Local disease control was achieved in 82.9% of the patients. The 5-year overall survival was 76.59%. Late sequelae, which were of low grade (1 and 2), were registered in 22 (53.7%) patients.

CONCLUSION

Our study confirmed good treatment results and acceptable toxicity of definitive radiotherapy in the treatment of anal canal carcinoma.

[Carcinoma of the anal canal--results of radical radiotherapy]

From February 1995 to August 2001, 34 pts with squamous cell carcinoma of the anal canal (stage T2-35.3%, stage T3-44.1%, stage T4-20.6%, stage N1-29.4%) were treated prospectively by definitive radiotherapy only, delivered with megavoltage linear accelerator, combined with intracavitary brachytherapy in some patients, at the Institute for Oncology and Radiology of Serbia. Total tumor dose was range 55-75 Gy. Median follow-up time was 24.7 mounts (range 6-66 mounts). Overall survival and disease free survival at 5 years were 65.44% and 68.44%. Local control was 82.3% (28/34 pts). Eight pts had local or distant failure. Early and late complication rates were acceptable. In majority of patients the anal sphincter function was preserved.

[New surgical approaches in splenic diseases]

To improve the success of postoperative results, in the surgeries of the spleen diseases new procedures had been developed from hematological pretreatment to further operative and postoperative treatment of the patient. Elective splenectomy is quite a big anesthetic challenge. In the period from 1996 to 1998 in the Institute for digestive diseases 147 splenestomies had been done as a consequence of the spleen diseases. Before the operation there is no reason for compensate the platelets if their number is equal or bigger than 50 x 10(9)/l unless the patient is bleeding. If the patient has less than 50 x 10(9)/l the operation shouldn't postponed if we have previously prepared enough doses of platelets from the separator the pool, or the ordinary platelets. Now days at our clinic we operate the patients with extremly plateleptema. The operations have been very successful. The team work of surgeons, anestehsiologists and hemathologist is the most important thing.

[Darier's disease--a familial case report]

INTRODUCTION

Darier's disease is a slowly progressive autosomal dominant disorder characterized by a gene with variable penetrance. However, many cases of this disease are considered to be a new mutation in the genealogic tree. The prevalence of the disease was estimated as 1/55,000 to 1/100,000.

CASE REPORT

The authors report a case of a female patient, 66 years of age, with Darier's disease, hospitalized at the Clinic of Dermatovenereology of the Clinical Center Novi Sad. The first changes of the skin occurred at the age of 16 originally on the shins and face, as miniature hard papules confluent in larger areas. Skin changes always exacerbated in the summer. At hospital admission the patient's head and hair were whole covered with white, thick, keratotics layer, resembling a helmet. The skin of the trunk was covered with white-gray, hyperkeratotic, fused papules like verrucous plaques, more expressed on the back. The skin of forearms presented with hyperkeratotic papules, and dorsum of the hands presented with plaques. Lower legs were covered with fused papilokeratotic, rough cauliflower-like layers with macerates and foetor. Buccal mucous was covered with whitish papules on erythematous lesions of cobblestone-like appearance. The nails were thickened with longitudinal furrowing, whereas the left third finger presented with V-shaped onychorrhexis. 4 generations were investigated, and the disease occurred only in the patient's younger daughter.

DISCUSSION

Beside the classic "seborrheic" forms of Darier's disease there are a few clinical types: hypertrophied (intertriginous), vesiculo-bullous and linear (zosteriform) type.

CONCLUSION

This case is a very severe classic form of Darier's disease, with variable penetrance and severity in the family.

Efficiency and mechanism of the antioxidant action of trans-resveratrol and its analogues in the radical liposome oxidation

trans-Resveratrol (trans-3,5,4'-trihydroxystilbene) is a nonflavonoid polyphenol reported to exert different biological activities, among them inhibition of the lipid peroxidation, scavenging of the free radicals, inhibition of the platelet aggregation, and anticancer activity as the most important. In order to enlighten the radical-scavenging mechanism of trans-resveratrol, stationary gamma-radiolytic experiments in liposomes and pulse radiolytic experiments in aqueous solutions were performed. Applying the stationary gamma-radiolysis together with the subsequent product analysis, reactions of lipid peroxyl radicals, LOO*, with trans-resveratrol and other natural antioxidants were investigated. It was found that trans-resveratrol was a better radical scavenger than vitamins E and C but similar to the flavonoids epicatechin and quercetin. The comparison of the radical-scavenging effects of trans-resveratrol and its analogues trans-4-hydroxystilbene and trans-3,5-dihydroxystilbene revealed that trans-resveratrol and trans-4-hydroxystilbene showed almost the same effect and were more efficient than trans-3,5-dihydroxystilbene. These findings indicate greater radical-scavenging activity of trans-resveratrols para-hydroxyl group than its meta-hydroxyl groups. Using the pulse radiolysis, reactions of trans-resveratrol and its analogues with trichloromethylperoxyl radicals, CCl(3)OO*, were studied. Spectral and kinetic properties of the observed transients showed great similarity between trans-resveratrol and trans-4-hydroxystilbene which seems to confirm that para-hydroxyl group of trans-resveratrol scavenges free radicals more effectively than its meta-hydroxyl groups.

[Small-plaque parapsoriasis: case report]

INTRODUCTION

Small plaque parapsoriasis is a relatively rare, chronic, idiopathic dermatosis, most often seen in middle age people. This disease shows a definite male predominance of approximately 3-4: 1. It is characterized by presence of round or oval erythematous, slightly scaly plaques on the limbs and trunk, which histologically reveal mild eczematous changes.

CASE REPORT

A male patient, 61 years of age, was admitted to the Clinic of Dermatovenereology in Novi Sad due to long persisting erythematous patches on his upper and lower limbs. Plaques were of oval and round shape, pretty well marginated. They were of light red colour, covered with fine scales with a slightly wrinkled surface. He complained of itching. Laboratory findings showed no abnormalities. Histopathologic examination of the skin specimen revealed epidermal atrophy, focal parakeratosis, perivascular dermal infiltrate of mononuclear cells with exocytosis in the epidermis. This finding was compatible with the clinical diagnosis. After treatment with topical corticosteroid cream combined with whole body exposure to sunlight irradiation, vast majority of skin lesions regressed.

DISCUSSION

The clinical course of small plaque parapsoriasis is very long. The plaques are remarkably stubborn, responding to treatment with steroid creams or to natural or artificial sunlight, but usually reappearing promptly when treatment is discontinued. The patches increase in number for a time, and then remain relatively constant for a long time. A small minority of cases clears entirely. Recent studies provided evidence of monoclonality and immunophenotypic abnormalities. Rearrangement of T-cell receptor genes was demonstrated by using PCR method. Detection of monoclonal T-cell populations in skin lesions, as a characteristic of lymphoproliferative diseases, forced some authors to include this dermatosis into a group of abortive cutaneous T-cell lymphomas.

CONCLUSION

This case deserves a long and probably life-long clinical and histological assessment, especially due to new knowledge about the possible nature of this disease.

[Epidemiologic characteristics of onychomycosis--results of a retrospective study]

INTRODUCTION

The term onychomycosis is used for fungal infections of the nail unit. Tinea unguium is defined as a dermatophyte nail infection. The aim of this study was to determine the epidemiological characteristics of onychomycoses.

MATERIAL AND METHODS

Ambulatory patients of the policlinic department of the Clinic of Dermatovenereology in Novi Sad were included in this study. Every patient with clinically suspected nail changes was examined. Direct microscopy of nail clippings and isolation of fungi on Sabouraud agar were performed. The results were evaluated using standard statistic methods.

RESULTS

During a one-year-period (1995-1996) 70 cases of onychomycoses were registered that is 1.07% of the total number of patients examined in this period (N = 6535). The vast majority of observed patients were females (N = 47-67.14%), and male patients were significantly less frequent (N = 23-32.86%, p < 0.01). The most frequent type was dermatophyte onychomycosis (N = 39-55.71%), and the most often isolated agent was Trichophyton mentagrophytes (N = 38-54.29%). Manual workers were most often affected (N = 18-25.71%). Most patients were in the 41-50 year age group (N = 23-32.86%). The mean age of patients was X = 47.64 years (SD = 15.39). Table 4 shows the clinical duration of different types of onychomycoses. The longest clinical course was in the group of dermatophyte onychomycosis (20 years, one case). The mean clinical duration of the whole group was 26.81 months (SD = 40.04). Table 5 shows presence of other dermatomycoses associated with onychomycoses. Tinea pedis was the most frequently observed dermatomycosis (N = 9-60.00%).

DISCUSSION

The incidence (1.07%) is something less than usual, and other findings are compatible with standard results. A lower incidence could be the result of the fact that children under 17 years are managed at the Institute of Mother and Child Health Care in Novi Sad.

CONCLUSION

This study is a contribution to epidemiological investigations of onychomycoses. This disorder, with its social and medical importance and dubious treatment results, puts onychomycoses on high level of interest in modern dermatovenereology.

[Etiopathogenesis, clinical picture and diagnosis of onychomycoses]

ETIOLOGY OF ONYCHOMYCOSES: Onychomycoses can be caused by dermatophytes, molds and yeasts. However, dermatophytes appear to be the chief organisms capable of a primary attack on the nail. By far the most frequent dermatophytes isolated from nails are Trichophyton rubrum, T. mentagrophytes var. interdigitale and Epidermophyton floccosum. Molds virtually only invade toenails, but their role as a primary pathogen is still debated. Yeasts have been isolated from diseased nails at highly different rates. Nails may be infected by two different dermatophytes, two dermatophytes and a yeast, a dermatophyte, a yeast and a mold, etc. PATHOGENESIS OF ONYCHOMYCOSES: The mode of infection is still under debate. In many cases palmar and/or plantar tinea, exists but can often remain asymptomatic for years. After spreading to the nail, the fungus invades the hyponychium or lateral nail sulcus to finally reach the nail bed where it moves proximally to the matrix. Proximal subungual onychomycosis probably starts with a fungal skin infection, whereas white superficial onychomycosis seems to be a culture of T. mentagrophytes on a softened nail surface. Total dystrophic onychomycosis may result from both distal and proximal subungual onychomycosis or from C. albicans in chronic mucocutaneous candidiasis. Candida infections occur most often due to previous Candida paronychia, but it appears that a number of cases of so called idiopathic onycholysis are also caused by C. albicans with damage to the hyponychium being the portal-of entry. CLINICAL PICTURE OF ONYCHOMYCOSES: Onychomycoses can be divided into four different types. Distal subungual onychomycosis is the most common. The most frequent presenting clinical features are thickening and opaci-fication of the nail plate along the distal and lateral borders. The discoloration ranges from white to brown. The edge of the affected nail is usually uneven and often one or more streaks of dystrophic discoloured nail extend towards the distal border. Proximal subungual onychomycosis is uncommon. A white spot appears beneath the proximal nail fold and may extend distally to involve the deeper layers of the whole nail. Superficial white onychomycosis is also uncommon. The surface is the initial site of invasion. The causative organisms produce small superficial white and powdery patches over the nail. The surface becomes rough and the texture softer than normal. Total dystrophic onychomycosis represents the most advanced from all the previous three types, especially the distal subungual onychomycosis. The nail matrix has become permanently scarred by chronic infection. The nail is thick, elevated, denser and opaque. Candidomycotic onychomycosis shows erythematous and swollen proximal and lateral nail folds. Consequently, the nail plate becomes detached from the eponychium. Mycotic onycholysis is characterized by detachment of the nail plate from the bed, distal nail erosions, and grayish-yellow paste-like material under the nail. DIAGNOSIS OF ONYCHOMYCOSES: The diagnosis of onychomycoses cannot be made on the basis of clinical observation alone. Direct microscopy plays an important role in diagnosing nail fungal infections. However, fungal cultures are the only definitive test that can be used to identify the genus and the species of the infectious organism. Histological examination is a routine technique useful for defining the nature and localization of fungi in the nail plate. Immunohistochemistry applied to onychomycosis is an experimental approach bringing prominent information about identification of fungi. In vivo confocal microscopy represents a technique of the future.

[Von Recklinghausen's neurofibromatosis (neurofibromatosis type I)--a familial case report]

INTRODUCTION

Neurofibromatosis is a term used for two disorders: NF-1 and NF-2. NF-1 is Von Recklinghasusen's neurofibromatosis and comprises characteristic skin lesions (cafe au lait spots, intertriginous freckles, neurofibromatous skin tumors) and other congenital and hamartomatous bone, endocrine glands and central nervous system lesions. Its incidence is one in every 2500 to 3300 births.

CASE REPORT

Two female patients, a 20 years old daughter and her mother 46 years of age were admitted to the Clinic of Dermatovenereology in Novi Sad due to appearance of many sessile and pedunculated neurofibromas, cafe au lait spots and freckles on their trunks, axillary and inguinal regions. Laboratory findings showed no abnormalities. Both of them were examined by many specialists. No systemic disturbances were established. The daughter was sent to plastic surgery for operative treatment.

DISCUSSION

The clinical presentation of NF-1 is very variegated. Beside characteristic skin lesions, other clinical features include skeletal bony abnormalities, mental deficiency, seizures, neurofibromas of the spinal and cranial nerve roots, iris hamartomas, optic nerve gliomas, endocrine disorders, endocrine tissue tumors, other visceral tumors, etc. Some of these disorders can be life-threatening. Malignant transformations of the NF-1 lesions occur approximately in 5% of patients, most often as neurofibrosarcomas, Wilms' tumors, rhabdomyosarcomas or various forms of leukemias.

CONCLUSION

We present familial cases of Von Recklingausen's neurofibromatosis without systemic abnormalities so far. The clinical course of this disease is unpredictable and a multidiscipline clinical assessment is necessary during whole life.

[What do we know today about diaminodiphenylsulfone?]

INTRODUCTION

Diaminodiphenylsulfone or dapsone is a chemical analogue of sulfapyridine, synthesized in 1908. Dapsone is a bacteriostatic agent that proved to be efficient in treating leprosy and malaria, but today it is used in treating dermatologic noninfectious inflammatory diseases.

PHARMACOLOGY

Dapsone is orally used in a dose of 50-400 mg per day in treatment of dermatologic diseases, and also in a dose of 50-100 mg per day in leprosy treatment. Dapsone is mainly eliminated from the body by urine and smaller part by faeces. Pharmacological interaction was reported when it is used with rifampicin and probenecid.

MECHANISM OF ACTION

The bacteriostatic effect of dapsone is well known. It involves inhibition of folic acid synthesis in susceptible organisms. The anti-inflammatory effect of dapsone, which proves to be efficient in treating noninfectious inflammatory diseases, has not been explained completely yet. There are some pieces of evidence that anti-inflammatory action is not connected with its antibacteriological action.

CLINICAL USE

Based on previous studies about therapy efficiency of dapsone in treating some diseases, there are two groups of diseases: the group responding well to dapsone (leprosy, malaria, DH, linear IgA-dermatosis, erythema elevatum diutinum, bullous systemic lupus erythematosus) and a group responding with average good response to dapsone (pyoderma gangrenosum, bullous and cicatricial pemphigoid, acne conglobata, discoid cutaneous lupus erythematosus, subcorneal pustulosis dermatosis, granuloma faciale, rheumatoid arthritis, polychondritis, leucocytoclastic vasculitis).

ADVERSE EFFECTS

Adverse effects depend on the dose and they rarely occur at doses less than 100 mg per day. They are mainly shown on skin, nervous system, digestive system, hepatobiliary system, and kidney and hematologic system. The most important adverse effects are hemolytic anaemia and methemoglobinemia. Hemolysis usually occurs at doses of 200 mg and more per day. In patients with glucose-6-phosphate dehydrogenase deficiency, hemolysis may be provoked by a dose less than 50 mg per day. For prevention, before using dapsone in therapy, clinical examination with history, blood parameters, liver and renal parameters and determination of glucose-6-phosphate dehydrogenase level are recommended.

CONCLUSION

The use of dapsone is absolutely indicated in DH treatment and erythema elevatum diutinum. Because of anti-inflammatory effects, dapsone can also be used in treating other inflammatory noninfectious dermatoses when one should take care about "therapy efficiency/adverse effect" balance using the correct dose, monitoring relevant clinical and laboratory parameters and educating patients.

[Characteristics of the Koebner phenomenon in patients with psoriasis vulgaris]

INTRODUCTION

Koebner phenomenon in psoriasis presents development of psoriatic lesions, after injury of uninvolved skin, which are identical in morphology with the previous trauma. The aim of this study was to establish the correlation of Koebner phenomenon with sex and age distribution, clinical variants of psoriasis vulgaris, age of onset and incidence in psoriasis among relatives of affected patients.

MATERIAL AND METHODS

Sixty patients, with severe clinical picture, participated in this study: 38 patients in acute flare of a chronic form; 10 with acute exanthematic form; 8 with a chronic stable form; 3 with psoriatic changes on palms and soles and one patient with psoriatic erythroderma. According to the presence of Koebner phenomenon they were divided in two groups, one with positive and the other with negative Koebner phenomenon which presented the control group at the same time.

RESULTS AND DISCUSSION

The Koebner reaction is often thought to be more frequent in actively spreading, severe psoriasis. Although this may be true, it has to be established by prospective studies. According to our investigation, Koebner phenomenon did not depend on clinical picture of psoriasis vulgaris. This reaction also appears to be a marker for a subgroup of patients with a tendency to early onset, but that was not confirmed by our study. In available literature we did not find any data about relations of Koebner phenomenon to sex and age or familiar incidence of psoriasis vulgaris. Our results demonstrated no connection of Koebner phenomenon with sex and age structure. At the same time its presence did not depend on familiar incidence of psoriasis vulgaris.

CONCLUSIONS

There is no relationship between Koebner phenomenon and sex and age distribution. It does not depend on clinical picture and also does not predict the age of onset and familiar incidence of psoriasis vulgaris.

[Congenital giant pigmented hairy nevus--case report]

INTRODUCTION

Authors present the characteristics of a giant congenital pigmented hairy nevus (GCPN) of the skin.

CASE DESCRIPTION

A case of a female patient, 21 years of age, with many changes of the skin, namely: giant congenital pigmented hairy nevi involving the skin of the trunk, the upper and lower extremities and the face is reported. There have not been any changes in regard to the color, size or distribution of the nevi. The family anamnesis is negative. The involvement of the skin is 20% of the total body surface, according to Wallace. Since there was a suspicion of neurocutaneous melanosis, the patient underwent electroencephalography (EEG) and nuclear magnetic resonance (NMR). These examinations could not ratify the pathologic changes of the brain structures, which could affirm the neurocutaneous melanosis.

DISCUSSION

The frequency of occurrence of GCPN larger than 20 cm in diameter in pediatric patients is estimated as 1:4,150 of children with female predominance. Data on possible malignant alteration of GCPN into a malignant melanoma vary from 6-12%. Authors have decided to follow-up the patient and to perform a clinical observation of the nevi, mostly due to extent of the skin changes and signs of malignant alterations.

CONCLUSION

Authors have presented this case because of the risk of malignant melanoma development in a patient with GCPN and in the aim of pointing to the problem of melanocytic tumor progression.

Frequency estimation of the gene alleles for genodermatoses in the population of Vojvodina

Genodermatoses are hereditary skin disorders or anomalies. The authors had investigated the frequency of genes, species and clinical forms of hereditary dermatoses in Vojvodina including age and sex distribution. The experimental group was selected by random sampling of the diseased of genodermatosis and/or genetic diseases at the Clinic of Dermatology and Venereology and Institute for Children and Adolescents in Novi Sad. The experimental group included 152 cases, and that made simultaneously the experimental and positive control group in relation to the diseased population with genodermatoses and/or genetic diseases in Vojvodina. In the investigation we applied the following methods: family history taking including genealogy; dermatoglyphic examination; screening tests in medical genetics; cytogenetic analysis of patient's karyotype; histopathological analysis of the material obtained by skin biopsy; dermatovenereological, genetic and dysmorphologic examination of skin diseases by analysis of dysmorphologic signs on the skin using a special computer program--POSSUM (Pictures of Standard Syndromes and Undiagnosed Malformations). Application of non-parametric statistics and Log-linear analysis, revealed that there is no statistically significant difference between the experimental group and the group with genetic diseases in population of Vojvodina. The obtained incidence of genodermatoses and/or genetic diseases was computed by "Hardy-Weinberg's principle". These methods of genetic population investigations give possibilities for valid incidence estimation of the diseases and frequency of the gen allele's for genodermatoses and/or genetic disorders and syndromes in defined population. Our results of investigation of the incidence genodermatoses in our's population showed significantly increased values in relation to literature data for the same hereditary disorders.

[The Koebner phenomenon, a prognostic sign of PUVA therapy effectiveness in patients with psoriasis vulgaris--yes or no?]

INTRODUCTION

Former investigations of Koebner phenomenon had demonstrated its higher incidence in patients with severe generalized and/or unstable forms of psoriasis which expressed increased resistance to various treatment modalities. The aim of this study was to establish the correlation between the presence of Koebner phenomenon and the PUVA therapy effects, total number of PUVA treatments, total dose of UVA radiation and the duration of remission after PUVA therapy discontinuation.

MATERIAL AND METHODS

Sixty patients with severe clinical picture of psoriasis vulgaris, treated with PUVA therapy, were included in this research. According to the presence of Koebner phenomenon they were divided into two groups, 20 patients with positive and 40 patients with negative Koebner reaction, who were the control group at the same time.

RESULTS AND DISCUSSION

95% of patients treated with PUVA, were cleared of psoriatic changes in the Koebner positive, as well as in the Koebner negative group. There were also no differences between the Koebner positive and Koebner negative group in the mean number of PUVA treatments, mean total dose and the last dose of UVA radiation, which led up to the clinical remission of psoriasis. Our results of investigation have demonstrated increased relapse of psoriasis, during the first 6 months after cessation of PUVA therapy, in the Koebner positive group, with a high statistical significance (p < 0.001), comparing with Koebner negative group in the same period. Furthermore, the tendency of relapse of Koebner positive and Koebner negative psoriatic patients was higher in Koebner positive group even in the first 3 months after PUVA therapy.

CONCLUSIONS

PUVA therapy effects, total number of PUVA treatments, total dose of UVA radiation didn't depend on presence of Koebner phenomenon. However, Koebner phenomenon was a mark of high relapsing tendency of psoriasis in the first 6 months after PUVA therapy cessation.

Exposure of Mn and FeSODs, but not Cu/ZnSOD, to NO leads to nitrosonium and nitroxyl ions generation which cause enzyme modification and inactivation: an in vitro study

The effect of NO treatment in vitro on structural and functional alterations of Cu/Zn, Mn, and Fe type of SODs was studied. Significant difference in response to NO of Cu/ZnSOD compared to the Mn and Fe types was demonstrated. Cu/ZnSOD was shown to be stable with respect to NO: even on prolonged exposure, NO produced negligible effect on its structure and activity. In contrast, both Mn and Fe types were found to be NO-sensitive: exposure to NO led to their fast and extensive inactivation, which was accompanied by extensive structural alterations, including (in some of the samples tested) the cleavage of enzyme polypeptide chains, presumably at His residues of the enzyme metal binding sites. The generation of nitrosonium (NO+) and nitroxyl (NO-) ions in NO treated Mn and FeSODs, which produce enzyme modifications and inactivation, was demonstrated. The physiological and biomedical significance of described findings is briefly discussed.

[Characteristics of laser light]

Laser is one of the greatest technical discoveries of the 20th century. It is important in basic sciences, but particularly in diagnosis and therapy of various pathologic conditions of human organism. It is electromagnetic radiation, not X-irradiation and, as such, it is not expected to produce new generation of iatrogenic malignancies. Laser falls between infrared and ultraviolet on the spectrum mainly in the visible light spectrum. Properties of laser light are: monochromacity (the same color), coherence (all of the light waves are in phase both spatially and temporally), collimation (all rays are parallel to each other and do not diverge significantly even over long distances). Lasers were first conceived by Einstein in 1917 when he wrote his "Zur Quantum Theorie der Strahlung" (the quantum theory of radiation) which enumerated concepts of stimulated and spontaneous emission and absorption. Drs. Arthur Schawlow and Charles Townes, in 1956, extended lasers into the optical frequency range and Maiman, in 1960, operated the first laser using ruby as the active medium (ruby laser). Laser is an acronym for Light Amplification by Stimulated Emission of Radiation. To understand the acronym, it is necessary to understand the basic physics of the atom. However, if the atom that is in the excited state is struck by another photon of energy before it returns to the ground state, two photons of equal frequency and energy, travelling in the same direction and in perfect spatial and temporal harmony, are produced. This phenomenon is termed stimulated emission of radiation. An external power source hyperexcites the atoms in the laser medium so that the number of atoms possessing upper energy levels exceeds the number of atoms in a power energy level, a condition termed a population inversion. This "pumping system" which imparts additional energy to the atoms may be optical, mechanical, or chemical. These atoms in a hyperexcited state spontaneously emit photons of light. The laser chamber or optical cavity contains an active lasing medium which usually determines the name of each laser. There are four types of lasing material commonly employed. Solid state lasers use a solid matrix material such as a ruby crystal. Gas lasers use a gas or mixture of gases such as helium, argon, and CO2. Dye lasers employ a complex organic dye in liquid solution or suspension such as rhodamine. Semiconductor lasers use two layers of semiconductor substances such as gallium arsenide.

[Clinico-epidemiologic characteristics of superficial multiple basal cell carcinoma at the Dermatovenereology Clinic in Novi Sad 1986-1996]

INTRODUCTION

Multiple superficial basal cell carcinomas of the skin (MSBCC) appear as a rare clinical form of basal cell carcinoma (BCC) on the trunk. The aim of this paper was to display the clinical characteristics and frequency of superficial basal cell carcinomas on the trunk.

MATERIAL AND METHODS

The examination was done on a 10-years material of the Department of Dermatological Oncology of the Dermatovenererology Clinic in Novi Sad (in the period 1986-1996). The examination included only MSBCC.

RESULTS

In the 10-year period the total number of nonmelanotic malignant epithelial tumors of the skin (NMETS) was 2218 with 22 of MSBCC with total incidence of 0.99%. The average annual number of NMETS was 221.8. The average annual number of MSBCC was 2.2. In regard to the incidence of BCC of the skin in the same period, the total number of BCC of the skin was 1220, with the incidence of MSBCC 1.80%. The total number of changes of the superficial types BCC in the examined group was 110, and the average number of changes 5. The localization of MSBCC in the examined group shows the greatest number of tumors on the skin of the back (42--38.18%), hence thorax (29--26.36%), abdomen (25--22.73%) and the least on the presternum (14--12.73%). The average period from discovery of MSBCC in the examined group until the moment of inspection was about 2.5 years. In one case nevocellular syndrome was established, MSBCC was established in 35 patients, while in 80 cases these were different types of BCC of the face, capillitium, neck, trunk and extremitites. In the examined group 22.73% patients with positive familial anamnesis in regard to malignancy. Most were pensioners (11 cases--50.00%) mainly living in towns, while agriculturers are on the second place (7 cases--31.82%) mostly living in the village. In regard to the age, it appears that increasing number of patients are in the seventh decade of life.

DISCUSSION

The recent literature data point to the genetic dispositions for MSBCC on the skin of the trunk, probably due to poorphotoexposition of the skin.

CONCLUSION

Authors principally point to the genetic pre-disposition as the main etiological factor for MSBCC of the skin of the trunk. Professional or accidental photoexposition to ultraviolet radiation, also have a secondary role. The disease mostly affects the elderly and mostly males.

[Classification of laser irradiation and safety measures]

The use of lasers in medicine and especially surgery is rapidly expanding in many disciplines from clinical laboratory to the office practice and operating room. It is essential that users of this powerful tool have knowledge of their potential hazards and the measures to protect patients and personnel against injuries or undesired effects. Below, we have included information about the way lasers are classified; the development of protective standards; the current status of protection standards that apply to lasers, especially those used in medicine/surgery; the specific kinds of hazards associated with medical/surgical applications; and the measures by which hazards have been controlled. Since laser technology is still a young field, it is likely that problems unknown at present will occur and methodologies for controlling hazards will evolve. The American National Standards Committee produced the first consensus standard Z136.1 in 1973. The Standard was revised in 1976 to accommodate differences in biological effects for different wavelengths in the visible spectrum. The ANSI Standard has been revised again in 1980, and currently (1984) there are two additional standards in preparation, Z136.2 and 136.3, which treat the safe use of light-emitting diodes and the safe use of lasers in the health care environment, respectively. Most surgical and medical lasers are Class III or IV. Some lasers have a Class IV therapy level beam plus a Class I or II alignment beam. When using lasers, it is possible to generate incandescence or fluorescence in an irradiated object. This can occur even with protective eyewear, because the correlated radiations are usually of a different wavelength. Generally, this should not be a problem when beams are directed at biological material. However, hazard could be caused by lasers designed to produce fluorescence. Control of correlative radiation in a laser system is required in the federal regulations. Hazards of lasers may be grouped as those to the eye, skin and associated hazards, fire, x-rays, electrical, fumes, toxic materials, etc. Effects on tissue are governed by the following factors:--the energy or power density of the beam;--the absorption in tissue at the laser wavelength;--the time the beam is held at a given area.;--the protective effects of heat removal by thermal conduction and by circulation. Eye hazards include thermal burns or acoustical disruption (shock waves) from high-powered or high-energy beams in the visible and near infrared wavelengths. Direct beam exposure or specular or diffuse reflaction from these very high-power lasers can also cause injuries to other parts of the retina. For example, beams can directly penetrate through the sclera and cause retinal injury. Near ultraviolet (less than 400 hm) and far infrared (.3000 hm including CO2 lasers) can cause moderate to severe corneal burns. Far ultraviolet (200-315 nm), mid infrared (1400-3000 nanometers) can cause welders' flash or snow blindness and chronic exposure could cause cataract, and exposure to ultraviolet rays may be carcinogenic. For CO2 lasers, the far infrared radiation is attenuated by plastic goggles, or by glasses, or quartz. Other eyewear with special filters is used for different lasers. The whole personnel who may be exposed to direct beams, specular reflections, and many times diffuse reflections must wear protective eyewear. In all cases the surgeon and others viewing the procedure through the endoscope need glasses or suitable protective lenses installed in the endoscope. Persons who are not viewing the beam may not need to wear protective glasses with the same level of optical density. Glasses may be selected to provide protection for lasers operating in the visible wavelength to the point where the normal aversion response could protect the individual.

[Fournier's gangrene associated with carcinoma of the colon]

BACKGROUND

A case of Fournier's gangrene associated with colon carcinoma was reported. Fournier's gangrene is a progressive soft tissue infection of the perineal and scrotal region.

CASE REPORT

A 50-year-old man was transferred to our hospital with clinical signs of septic shock and necrotizing soft tissue infection, of the scrotal and perianal regions. Local examination revealed a communication between rectum and left ishioanal fossa, many openings in the skin with purulent discharge and crepitus. After resuscitation the patient underwent emergent operation. Surgical debridements were performed. The wounds healed well with good granulation tissue.

DISCUSSION

The majority of patients with Fournier's gangrene are immunocompromised. Malignant disease, obesity, diabetes mellitus and peripheral vascular disease have been cited as the main predisposing factors. The origin of this synergic infection is in alimentary and urinary tract. As a rule, penis, testes, bladder and rectum are spared. Conventional treatment includes repeated surgical debridement, special antibiotic regimen to cover both, aerobes and anaerobes, and intensive care treatment. Despite optimal medical and surgical management the mortality rate in Fournier's gangrene still remains high.

[Diagnostic and biostimulating lasers]

In this brief report authors present data regarding the application of diagnostic and biostimulating laser instruments in medicine. For diagnostic purposes there are several types of laser instruments and procedures available: Laser Microscopic Masonic Analyzer (LAMMA), Flow cytometry. Doppler effects of laser rays (Laser Doppler velocytometry, Laser Doppler spermokhinezymetry, Laser Doppler spectrometry), Laser fluorescent microscopy, Laser nephelometry, Transilumination by lasers (diaphanography), Laser spectroscopy, Laser holography, Laser rethinoscopy, Microirradiation by lasers. Literary data concerning favorable effects of low power laser radiation on series of diseases covering different medical specialties are cited, pointing to possibility of significant enrichment of already available arsenal of physical methods, thera-pies and rehabilitation procedures. Mechanisms of biostimulation of human tissues and organs under low power laser radiation are also presented. All these stimulatory and regulatory mechanisms of the cell metabolism are involved in the wound epitelization, reduction of edema and inflammation and reestablishement of arterial, venous and lymph microcirculation and consequently inducing better tissue nutrition. The use of laser spectroscopy for quantitative analysis of cations from a single drop of dried blood on a piece of filter paper was not realized, although individual analyses of frozen skin biopsies for calcium, arsenic and gold were accomplished. In Europe, this technique has also found its application in forensic medicine. Furthermore, laser-based methods have been used to study air pollution with carcinogens in occupational exposures and also for the detection of narcotic drugs. Laser cytofluorometry utilizes the argon laser for scanning of single stained cells and has achieved utilization in mass examination programs for Pap-smear determinations. The same technique is used in cell sorting system that is now important in monoclonal antibody determination in hybridoma technology. Other possible diagnostic applications include laser particle size measurement techniques, and laser nephelometry for determination of immunoglobulins classes and autoantibodies such as rheumatoid factors. Laser Doppler velocimetry is used to measure blood flow by means of a simple probe that rests on the lip. Biostumulating laser instruments The world famous Hungarian scientist Mester Endre, from Budapest, is one of the pioneers with the greatest experimental and clinical experience in the use of biostimulating effects of lasers. His former student, O. Ribari first used biostimulating effects of He-Na laser (390 mJ power) for the epitelization of perforated tympanic membrane and treatment of postoperative fistulas of the neck and of the mastoid. Generally speaking, biostimulating effect of low level laser treatment (LLLT) is in its anti-inflammatory, analgesic and anti-edematous effect on tissues. There is absolute increase in microcirculation, higher rates of ATP, RNA and DNA synthesis, and thus better tissue oxygenation and nutrition. There is also increase in the absorption of interstitial fluid, better tissue regeneration and stimulation of the analgesic effect. The past three decades of laser medicine and surgery have shown great progress and promise for the future.

[Types of medical lasers]

The knowledge about different types of lasers and their potential use in medicine is presented. A very rapid development of laser technology in the world imposes a need for up-to-date information about the characteristics of different laser instruments. Without this kind of information it would be difficult to keep in touch with the latest developments in the world's technology. Different types of lasers have different indication range in the medical practice. An inquiry into the fundamental principles of lasers physics is an important prerequisite for successful application of this technology in medicine. Laser as a surgical knife has shown certain advantages over scalpel, electrocautery and cryosurgery, as the laser surgery is a noncontact method, bloodless, precise, with better visualization, minimal postoperative edema, painless healing, without complications. Although laser cannot entirely replace conventional surgical instruments, it is still the instrument of choice for treatment of numerous pathological conditions. The carbon dioxide laser is a highly precise, bloodless light scalpel used for incising and excising tissues and sealing small blood vessels. The infrared beam at 10,600 nm wavelength is absorbed by water and tissue destruction is due to the instantaneous vaporization at relatively low temperature of 100 degrees C. The beam seals blood vessels of up to 0.5 mm in diameter and if the beam is defocused, larger vessels may be controlled. The beam also seals lymphatics, possibly reducing the spread of tumour cells by this route, and seals nerve endings: there is no incidence of neuroma formation. Carbon dioxide laser has shown a great efficiency in otorhinolaryngology, in maxillo-facial surgery and plastic surgery, in urology and gynecology. Provides true "no touch" surgery, and is used increasingly in neurosurgery for the precise atraumatic removal of tissue and for creation of precise lesions for the control of pain. The carbon dioxide laser beam cannot, at present, be transmitted via a flexible fibre, although a number of fibres are being investigated. Delivery of laser energy to microscope, colposcope or handpiece is via an articulated arm which is a hollow tube with mirrors at the articulations. The argon laser produces blue-green coherent light at a number of wavelengts but 80% of the energy is at wavelengths of 488 and 514 nm. This laser was first used in ophtalmology to treat diabetic retinopathy through, and without damage to, the clear anterior parts of the eye. The argon laser is used for blood vessel coagulation but can be used to perform slow, thermal tissue destruction at higher power levels. Argon laser is most commonly used in ophthalmology for otological micro-surgery, particularly in the treatment of otosclerosis and tympanosclerosis. Very good results have been achieved in the argon laser treatment of gastrointestinal bleeding ulcers, vascular lesions and polyps. Dermatology is another field where argon laser has shown great efficiency: hemangyomas, telangiectasias, tattoos, small benign and malignant tumours are amenable to argon laser treatment. In neurosurgery it is used to control both normal and abnormal blood vessels but at present much work on treatment of arteriovenous malformations and aneurysms is experimental. Both the argon laser energy can be transmitted via flexible fibre optic delivery system which can then be attached to an operating microscope, slit lamp, endoscope delivery fibre or handpiece. The Neodymium-YAG laser is used both for tissue destruction with good haemostasis and for the control of normal and abnormal blood vessels. This laser produces infrared coherent light at 1060 nm wavelength, which is deeply absorbed in the tissues without colour or tissue specificity. Neodymium-YAG laser is mostly used in tracheobronchial, gastrointestinal and urologic pathology in the treatment of stenoses, granulomas, benign tumours, and for reduction of malignant tumours. (ABSTRACT TRUN

[Epidemiologic characteristics of viral dermatoses--results of a retrospective study]

INTRODUCTION

A great number of skin diseases are caused by viruses (1, 2, 3). Virus infections can cause skin diseases due to three mechanisms: direct inoculation, systemic infection and local spreading of the internal focus. The aim of this study was to determine the characteristics of virus-associated dermatoses (VD).

MATERIAL AND METHODS

Ambulant patients of policlinical department of the Clinic of Infectious and Dermatovenereological Diseases Novi Sad were included in this study. Epidemiologic characteristics were analyzed by retrospective studying of medical documentation.

RESULTS

During a five-year-period (1991-1995), 1,461 cases of VD were registered or 7.09% of the total number of patients examinated in this period (N = 20.596). Majority of the observed patients were males (N = 788-53.25%) and female patients were less frequent (N = 683-46.75%, table 1). Table 2 shows the age distribution of our patients. Most of the patients were in the 20-29 year age group (N = 443 or 30.32%). The mean age of patients was X = 36.14 years (SD = 19.02). Table 3 shows the occupational structure of our patients. The most frequent was the group of employed (N = 773 or 50.17%). Table 4 shows the structure of the patients according to pathogenic agents. The most frequent was the group of warts and condylomata (N = 900 or 61.60%). It is apparent that the number of VD is increasing.

DISCUSSION

According to collected data, patients with VD make up a great group being treated at dermatological clinics. Our findings (7.09%) are compatible to the standard results. A relative high mean age of our patients is determinated by the fact that the children are managed at the Institute of Health Care of Mother and Child Novi Sad (the warts are most frequent in this population) or in other dermatological ambulants. There is no evidence that actual socio-political events affect the spreading of VD. Most patients belong to the urban population making up dominant groups (employed, scholars, pensioners).

CONCLUSION

The number of patients with VD is increasing. Although from year to year the number of diseased increases or decreases, generally speaking there is an increasing trend of VD.

[Clinico-histologic characteristics of spinocellular carcinoma of the skin]

INTRODUCTION

Authors present clinical-histological characteristics of squamous cell carcinomas of the skin in patients treated at the Clinic of Infectious and Dermato-Venereology Diseases in Novi Sad in the period from 1989 to 1995.

MATERIAL AND METHODS

The examined group comprised 26 cases (2.32%) with histologically verified squamous cell carcinomas of the skin out of 1119 nonmelanomatous epithelial skin tumors, clinically examined by dermatologists and treated by x-ray surface therapy. All patients with SCC were clinically examined by dermatologists at the Clinic of Dermatology and Venereology in Novi Sad, while histological examinations were performed by pathologists of the department of Pathology and Histology of the Faculty of Medicine in Novi Sad. Tumor biopsy specimens were obtained by shave biopsy, saucer biopsy and punch biopsy. All the biopsy specimens wee histologically examined and verified with standard methods with haematoxyllineosin-staining.

RESULTS

In the group of examined patients most were with SCC--that is exophytic tumor of the skin in 16 cases (61.54%). Histological examination revealed: squamous cell carcinoma of the skin in 9 cases (56.25%), keratotic squamous cell carcinoma in 5 cases (31.25%) and invasive squamous cell carcinoma in 2 cases (12.50%). In the examined group there were also 9 cases of SCC (36.41%) with clinical forms of endophytic tumor of the skin. By histological examination the following tumors were diagnosed: Morbus Bowen in 3 cases (incipient squamous cell carcinoma of the skin) (33.33%); squamous cell carcinoma of the skin in 5 cases (55.56%) and keratotic squa- mous cell carcinoma in 1 case (11.11%). In one case SCC with clinical features like keratoacanthoma was found (3.85%), while by histological examination keratotic squamous cell carcinoma of the skin was diagnosed.

DISCUSSION

In regard to the biopsy technique, SCC of the skin was diagnosed mostly as spinocellular carcinoma of the skin in 14 cases (53.85%) without a more precise description of the degree of tumor cells degeneration as well as tumor edge characteristics and type of histological type of tumor. Keratotic squamous cell carcinoma was found in 7 cases (26.92%); it is a tumor of mature structure (1-2 Broders' grade of clinical stage of tumors), but also without a detailed description of the tumor edge and type of histological type of tumor. Invasive squamous cell carcinoma was found in 2 cases (7.96%) and it reveals a SCC of the skin with deep infiltration into the dermis and hypodermis, sometimes involving the neighboring tissue (cartilage tissue, bone, muscle tissue and so on). This histological form of SCC had 3-4 Broders' grade of clinical stage of tumors.

CONCLUSION

Authors of the paper conclude that histological examinations of SCC of the skin are necessary meaning detailed analysis: degree of differentiation of tumor cells by Broders' examination, examination of tumor edges and histological types of tumor. The incisional biopsy of tumor lesions had only been used to confirm clinical diagnosis in order to perform x-ray therapy, but it could not meet necessary criteria the excisional biopsy could in regard to evaluate tumor edges and histological type of the tumor.

[Case report of Klippel-Trenaunay-Weber syndrome]

This is a case report on a very rare and interesting clinical form of a generalized nevus flammeus as a part of Klippel-Trenaunay-Weber syndrome. Authors point to necessity of cooperation among dermatologists and other specialists in treatment and follow-up of such diseases.

[Lasers in dermatologic surgery]

The authors review their experiences with the use of carbon-dioxide (CO2) lasers in dermatological surgery in a group of 3000 patients, with a total number of 3920 tumorous skin lesions, during a three-year period. The word LASER is an acronym for L-ight A-mplification by S-timulated E-mission of R-adiation. It must be pointed out that it is electromagnetic radiation, not X-irradiation. In regard to the spectrum laser light is between infrared and ultraviolet light, mainly in the visible spectrum, so its application does not produce new generations of iatrogenic malignancies as in the case of ionizing radiation. The laser is a new scalpel which differs from the metal surgical scalpel (also called "optical knife" and "light scalpel"). In the conclusion authors state that using (CO2) complete success was achieved in treatment of the following skin lesions: common viral warts, senile keratosis, seborrhoeic keratosis, plantar viral warts, papillomas, capillary telangiectasias of the face, hemangiomas, juvenile viral warts of the face, ingrown nails, condyloma acuminata, pendular fibromas, xanthelasmas, atheromas, pyogenic granulomas, keratoacanthomas, tattooed skin and basocellular epitheliomas.

[Modern radiologic diagnosis of prostatic diseases]

Prostatic pathology presents one of the key elements of morbidity in adult and older males. In developed countries malignant prostatic tumors are the third most common cause of death in males older than 55 years of age. New diagnostic procedures such as transabdominal and transrectal ultrasound, computerized tomography and magnetic resonance enable direct prostatic visualization thus better and more efficient diagnostics. This study offers a review and schedule of diagnostic procedures which enable early detection and classification of prostatic diseases.

[Ultrasonographic verification of hypertrophic pyloric stenosis]

In a two-year study on 24 newborn infants, diagnosis of hypertrophic pyloric stenosis (HPS) was intraoperatively confirmed, following preoperative ultrasonography. By means of real time sonography three parameters of the pyloric muscle were measured; the mean length was 19.6 mm, diameter 13.4 mm and the muscle thickness was 5.1 mm.

Evidence that recombination between reiterated sequences in the Bacillus subtilis chromosome does not occur via unequal crossing over

An experimental system was designed to permit the detection of recombination events occurring via unequal crossing over between sister bacterial chromosomes in Bacillus subtilis. It exploits the fact that during spore development, genetic and metabolic cooperation occurs between two different cell types, only one of which survives. During the early stages of sporulation, the two chromosomes of the developing sporangiole lie in the same cell and recombination between them is possible, in principle. Internal duplications flanking a selectable antibiotic-resistance gene have been introduced into the spoIIIC, spoIVA and spoVJ genes, whose correct expression in the mother cell (non-surviving compartment) is necessary for completion of spore development. After incubation in a sporulation-inducing medium in the absence of selective pressure, these strains sporulate at a low frequency and up to 30% of the progeny are Spo-. They result from mosaic sporangioles, in which only the chromosome segregated into the mother cell compartment of the developing sporangiole contains a reconstituted spo gene. In mosaic sporangioles generated by unequal crossing over between sister bacterial chromosomes, the insertionally inactivated spo gene, segregated into the pre-spore compartment, would carry an extra copy of the duplication initially present. Analysis of the products of 124 independent recombination events giving rise to mosaic sporangioles provided no evidence for the occurrence of unequal crossing over.

[Epidemiological characteristic of basocellular skin epitheliomas treated at the Department of Dermatovenereal Diseases in Novi Sad]

The authors review some of the epidemiological characteristics of epithelioma basocellulare (EB) of the skin, showing the incidence of 2.39% of the cases treated for EB of the skin from 1984 to 1990, derived from the total of 61,384 initial examinations carried out in this period at the Department of Dermatovenereal Diseases in Novi Sad. The mean age of the patients was 64.42, the male-female ratio was slightly in favor of the females, 1:1.25. As for localization, EB of the skin were most frequently found on the face, head and neck (87.16%). Regarding occupation of the patients on the top were retired people (47.17%) and agricultural workers (33.02%) and regarding the place of living, most were found in the rural population (68.07). The mean time the treated patients came for a check-up was 1.26 year after the onset of the tumor. Relapses were found in 18 cases (1.23%). The mean time of their occurrence after the rtg therapy was 1.9 year. Familial predisposition for skin tumors was detected in 232 cases (15.79%).

[Favre-Racouchot syndrome: case report]

The authors present a case of Favre-Racouchot syndrome (elastoidosis nodularis cystica et comedonica) in a male mason aged 65, associated with nodular-ulcerative type of basocellular skin neoplasm and seboroic keratosis of the irritative type. A special reference is given to nodular cystic elastoidosis (NCE) with concurrent numerous skin changes characteristic for chronic actinic skin lesions which were clinically evidenced. An objective examination of the patient revealed the presence of multiple follicular comedones, black in colour, the size of a pinhead, and of yellowish follicular papulas, 2-5 mm in size, of solid consistency, on the top of which is a formation similar to comedone. These eflorescences are densely disseminated in periorbital, zygomatic and temporal regions of the face, sparsely on the nose, forehead and preauricularly. In other regions of the face and neck other manifestations of chronic actinic skin lesions with characteristics of "citrine skin", cutis rhomboidalis nuchae and elastoma Dubreuilh are present as wall. In the right nasolabial furrow a clearly edged tumefaction, 1.2 x 0.8 cm, which belongs to the nodular-ulcerative type of basocellular skin neoplasm is seen. Seboroic keratosis of the irritative type was observed on the skin in the middle of the upper lip was histologically verified.