[CHRONIC WOUND--A NEW ETIOPATHOGENETIC STATE AND MODERN THERAPEUTIC APPROACH]. / KRONICNI VRIJED--NOVE SPOZNAJE O ETIOPATOGENEZI I SUVREMENI TERAPIJSKI POSTUPAK.

Lower leg ulcer is the most common form of ulceration of lower extremities. The prevalence of leg ulcer varies among studies from 0.1% to 0.6%. During the last decade, new concepts on the inflammatory phase in chronic ulcer have been discovered, such as the importance of metalloproteinases, growth factor, irregular muscular function, vascular insufficiency and presence of biofilm in the ulcer that prevents healing. There are several hypotheses to explain the pathophysiological steps, referring to popliteal venous hypertension. Currently, the treatment of leg ulcer relies on due knowledge of ulcer pathophysiology and making an accurate diagnosis. Today, modern supportive dressings improve the patient's quality of life; however, their targeted application according to the protocol and indications is required. A new method of efficient wound biofim exclusion today is the application of hydrofiber dressings containing a combination of silver ions and two disinfectants because they influence the exclusion and prevention of new biofilm formation in the ulcer.

[ANTIMICROBIAL DRESSINGS FOR INFECTED ULCER AND CLINICAL COMPREHENSION OF BIOFILM]. / ANTIMIKROBNE OBLOGE ZA INFICIRANI VRIJED I KLINICKE SPOZNAJE O BIOFILMU.

Current knowledge and proofs of biofilm, interactions between various bacterial species and overall virulence of microbes play a role in delayed healing of wound and development of infection. High quality description of clinical symptoms and current knowledge of microbes provide an excellent guideline for creating the strategy of wound treatment. Owing to better understanding of the role of biofilm in prolongation of healing time and facts about biofilm system and structure, scientists have developed the Ag+ technology. This technology has strong synergistic effects of the general and antimicrobial activity of ionic silver and specific compounds, which have proved efficient in biofilm obstruction and removal.

[EFFECTS OF PLATELET-RICH PLASMA IN THE TREATMENT OF CHRONIC ULCER]. / UCINCI PRIMJENE PLAZME BOGATE TROMBOCITIMA (PRP) U LIJECENJU KRONICNOG VRIJEDA.

A venous ulcer is area of discontinuity of the skin, usually localised in distal parts of the lower legs. The aetiology is associated with chronic venous disease-venous hypertension. The size and shape of venous ulcer can be different and it may even cover all circumferential of extremity. Additionally, along with basic therapy possibilities, there are many different dressings. Therefore the knowledge of each characteristic of dressing on process of epithelisation is essential as well as treating the biofilm that is responsible for complications and persistence of ulcer. One of additional therapy possibility is platelet-rich plasma.

Radiotherapy of primary cutaneous follicle center lymphoma: case report and review of literature.

Primary cutaneous follicle center lymphoma is an indolent primary cutaneous B-cell lymphoma originating from the follicle center cells, composed of a combination of centrocytes (small and large cleaved cells) and centroblasts (large noncleaved cells) with a follicular, follicular/diffuse, or diffuse growth pattern. Lesions are mostly located on the head, neck and trunk. A case is presented of a 56-year-old male patient with primary cutaneous follicle center lymphoma, with lesions involving the skin of the back, shoulders, presternal area and right forearm. As the patient presented a disseminated cutaneous form of the disease that involved several anatomical regions, complete work-up was followed by superficial fractionated radiotherapy of eight fields in VI expositions, with total irradiation dose of 1400 cGy upon the following fields: right and left pectoral region, left and right shoulders, right suprascapular region, and proximal third of the right forearm. Total irradiation dose applied upon each field for the lesions located on the left and right side of the back was 1500 cGy. This therapy resulted in significant reduction of visible tumor. The patient was regularly followed up on outpatient basis for 12 months of radiotherapy, being free from local recurrence and systemic spread of the disease.

[Measurement ofthe ankle-brachial pressure index (ABPI)]. / Mjerenje glezanjskog indeksa (ABPI).

Measurement of the ankle-brachial pressure index, also known as ankle-brachial index or ankle-arm index is a ratio of the ankle blood pressure and brachial blood pressure. It is easy to perform and allows for diagnosis and further definition of the severity of peripheral arterial disease with sensitivity 90% and specificity 98%. The test is not appropriate for mild arterial changes as in case of comorbidity. Its further objectives are to identify patients at an higher risk of cardiovascular events.

Contact allergy caused by fragrance mix and Myroxylon pereirae (balsam of Peru)--a retrospective study.

Because of their widespread use, fragrances are among the most common causes of contact allergic dermatitis, second only to nickel. During a five-year period 3,065 patients with contact dermatitis were patch tested using a specific mix of fragrances. 509 (16.6%) patients were allergic to the fragrance mix, while 258 (8.4%) patients exhibited an allergic reaction to Myroxylon pereirae (balsam of Peru). Between those 509 patients, 157 were patch tested with eight individual substances contained in the fragrance mix: cinnamal, cinnamyl alcohol, eugenol, isoeugenol, geraniol, hydroxycitronellal, alpha-amyl cinnamal and Evernia prunastri (oak moss). The most frequent allergens were isoeugenol 57.9% (91/157), eugenol 55.4% (87/157), cinnamyl alcohol 34.4% (54/157) and Evernia prunastri (oak moss) 24.2% (38/157). There were 62 patients (39.5%) who exhibited an allergic reaction to both the fragrance mix and Myroxylon pereirae (balsam of Peru). The results prove the importance of avoiding allergens in daily life, especially in industrial and cosmetic products. In order to prevent ACD, better cooperation between industry and dermatologists is needed.

Immunologic aspects of atopic dermatitis.

Atopic dermatitis/eczema is a chronically relapsing, pruritic, and inflammatory skin disease. The term "atopic eczema/dermatitis syndrome" covers the "extrinsic" and "intrinsic" atopic dermatitis. The pathogenesis of atopic dermatitis includes complex interaction between the genetic background, skin barrier defects, abnormalities in innate and adaptive immunity, abnormalities of humoral and cellular immunity, and environmental influences. Understanding the immunopathogenesis of atopic dermatitis leads to new diagnostic and therapeutic approaches. The targets in atopic dermatitis are innate immunity including improvement of skin barrier defects by supplementing lipids or inhibiting proteases, and regulating antimicrobial peptides, adaptive immunity, and induction of regulatory T cells.

Development of epithelia in the ectopic transplant of the fetal rat epiglottis.

Embryonic in situ development is strictly regulated within the specific microenvironment of developing tissues. However, for regenerative medicine purposes (supplementation of damaged tissues/organs), transplantation to ectopic sites has been considered. To investigate developmental potential of fetal epiglottic epithelia at an ectopic site, fetal epiglottis was transplanted under the kidney capsule and its development compared to fetal and adult epiglottis. Seventeen-day-old Fischer rat epiglottides were microsurgically isolated under a dissecting microscope and transplanted under the kidney capsule of adult males. After 14 days, classic histology and immunohistochemical detection of the Proliferating Cell Nuclear Antigen (PCNA) were done in isolated and accordingly fixed transplants. The 17-day-old fetal epiglottis and adult epiglottis were processed in the same way. The 17-day-old fetal epiglottides were covered with immature epithelium expressing PCNA in almost all cells. Adult epiglottis was covered with two types of epithelia (stratified squamous epithelium and ciliated pseudostratified epithelium). In the stratified squamous epithelium PCNA was abundantly expressed in the basal cell layer and absent from more superficial and more differentiated cells. Transplants survived well during the experimental period. On their surface ciliated pseudostratified epithelium could be easily recognized, but squamous epithelium was almost absent. PCNA was expressed in basal cells of the ciliated pseudostratified epithelium and was absent from the more differentiated superficial cells. It seems that at this ectopic site further differentiation of the epiglottic epithelia can proceed but differentiation of squamous epithelium seems not to be favored. It seems that this ectopic site is optimal for further differentiation of the epiglottic epithelium towards ciliated pseudostratified epithelium.