Abdominal ultrasound findings in adult patients with cystic fibrosis

INTRODUCTION AND AIMS

Cystic fibrosis (CF) is a genetic disease whose gastrointestinal compromise mainly involves the pancreas, bile ducts, and liver. Our aim was to analyze abdominal ultrasound findings.

METHODS

A retrospective, descriptive study was conducted on adults (patients ≥ 16 years of age) diagnosed with CF, within the time frame of 2006-2019. Clinical and genetic parameters, body mass index, forced expiratory volume in one second, pancreatic insufficiency, CF-related diabetes, cirrhosis secondary to CF, and abdominal ultrasound images were analyzed.

RESULTS

Seventy patients, 39 of whom were men (55.8%), had a mean age of 27 years and a mean body mass index of 21.3 ± 2.8 kg/m2 (r: 17-30.9). Forty-seven (67.1%) presented with pancreatic insufficiency, 6 (8.5%) with cirrhosis secondary to CF, and 21 (30%) had CF-related diabetes. Median forced expiratory volume in one second was 47% and the F508del mutation was found in 56.1%. Images of the pancreas: no pathologic findings in 49 (70%), increased echogenicity in 18 (25.7%), and cysts in 3 (4.3%). Gallbladder images: microgallbladder in 3 (4.2%), biliary sludge in 2 (2.8%), gallstones in 7 (10%), and a history of cholecystectomy in 4 (5.8%). Liver and spleen images: no pathologic findings in 47 (67.2%), homogeneous hepatomegaly with splenomegaly in 2 (2.8%), a heterogeneous pattern of the parenchyma in 11 (15.8%), increased echogenicity in 4 (5.7%), and heterogeneous echo patterns, lobulated liver contour, and splenomegaly in 6 (8.5%).

CONCLUSION

Abdominal ultrasound is a safe, low-cost technique that enables the identification of some degree of chronic liver and pancreatic diseases, improving the approach and follow-up decisions in adult patients with CF.

AB0308 FALL RISK EVALUATION WITH COMPUTERIZED DYNAMIC POSTUROGRAPHY IN RHEUMATOID ARTHRITIS PATIENTS

Background

Patients with rheumatoid arthritis (RA) have a higher risk of falling due to pain and physiological/biomechanical deformities (decreased muscle density, decreased functional stability, changes in gait, etc.) [1]. Although high incidences of falls have been reported in RA patients [1], there are not sufficient data regarding patient-specific fall risk.

Objectives

The aim of this study was to evaluate patient-specific fall risk, via computerized dynamic posturography, in RA patients, and to compare the results with those of age-matched healthy participants.

Methods

A total of 29 patients with RA (9 males, 20 females; mean age: 54.4±6.5 years) and 18 healthy participants (7 males, 11 females; mean age: 53.6±7.1) were included in the study. Detailed demographic, physical, and medical characteristics of the participants were recorded. Dynamic balance was tested with a computerized dynamic posturography, which assesses balance responses to induced postural disruption [2]. A translational ramp test (speed: 0.1 m/s), sinusoid tests (frequencies: 0.25 Hz - 0.50 Hz), and limits of stability evaluations were applied. Ramp and sinusoid tests were evaluated with the eyes open and closed, in the antero-posterior direction, and the participants were instructed to keep their balance during the tests. Limits of stability was evaluated on a static platform, with the eyes open. During the test, the participants were told to carry their pressure center as far as possible by performing the movement only from the ankle (in all directions), without lifting their feet, and trying not to fall.

Results

The groups were similar in terms of demographic and physical characteristics (p>0.05). Patients with RA showed statistically significant dynamic balance alterations compared to healthy participants (p<0.05) (Table 1). The fall test was positive in 31% of the RA patients and 5.6% of the control group (Figure 1).

Table 1.

Comparison of the groups in terms of the fall risk assessment criteria

Test ParametersRA Group (n=29)Control Group (n=18)p1.Ramp Eyes OpenEnergy in AP (J)2051 (1071-2258)1409 (1224-1644)0.005*1.Energy in ML (J)213 (122-414)208 (138-259)0.3691.Time in ML (s)3.9 (3.0-4.4)3.5 (2.6-3.9)0.0832.Ramp Eyes ClosedEnergy in AP (J)1939 (1856-2147)1718 (1334-1929)0.024*1.Energy in ML (J)224 (174-364)189 (155-381)0.5391.Time in ML (s)3.9 (3.5-4.9)3.4 (3.2-4.5)0.007*3.SinusoidGain in AP1.1 (1.0-1.3)1.1 (1.0-1.3)0.809 Eyes closedGain in ML0.3 (0.3-0.4)0.2 (0.2-0.3)<0.001* Eyes openGain in AP1.0 (0.8-1.3)0.7 (0.6-0.8)0.003*4.Limits of StabilitySurface (cm2)13.0 (10.0-15.0)21 (17.7-21.5)<0.001*

Data are presented as median and interquartile range. p value; Mann Whitney U Significance Test results between groups. (*): statistically significant difference (p<0.05). AP: Antero-posterior, ML: Medio-lateral

Figure 1.

Distribution of participants according to the number of positive criteria. The fallers met at least three criteria.

Conclusion

The results of this study showed that dynamic postural responses to destabilizing conditions are significantly altered in patients with RA compared to healthy controls. Determining the patient-specific fall risk is important in designing personalized rehabilitation programs and reducing the risk of injury.

References

[1]Armstrong C, Swarbrick CM, Pye SR, O’Neill TW. Occurrence and risk factors for falls in rheumatoid arthritis. Ann Rheum Dis. 2005;64(11):1602-4.

[2]Ghulyan V, Paolino M. Posturography for evaluating risk of falls in elderly unstable patients. Fr ORL. 2005;88:97-103.

Disclosure of Interests

None declared

Antifungal susceptibility, species distribution and risk factors associated with mortality of invasive candidiasis in children in Turkey: A six-year retrospective, single-centre study

Invasive candidiasis (IC) is a life-threatening fungal infection with high morbidity and mortality. In this study, we aimed to investigate the Candida species distribution and antifungal drug susceptibility and to identify the risk factors associated with IC mortality in children. We conducted a retrospective, single-centre study of paediatric IC in patients from a tertiary care hospital in Turkey between January 2013 and February 2019. A total of 56 Candida isolates underwent antifungal susceptibility testing performed by Sensititre YeastOne YO10 panel, and the demographic and clinical data of 65 patients were examined during the study period. The most commonly isolated species was Candida albicans in 30 patients (46%), followed by C. parapsilosis in 25 patients (38%) and C. tropicalis in three patients (5%). According to the antifungal drug susceptibility testing, C. albicans was fully susceptible to fluconazole and the other antifungal agents (100%). None of the isolates displayed resistance to anidulafungin, micafungin, flucytosine, posaconazole, voriconazole or itraconazole. There were low rates of resistance to fluconazole (1.8%), caspofungin (1.8%) and micafungin (1.8%). In addition, 5.3% of the Candida isolates were susceptible in a dose-dependent manner to itraconazole, 3.6% were susceptible to voriconazole and fluconazole and 1.8% were susceptible to anidulafungin. The mortality rate of IC was 15.4%. Thrombocytopenia after IC treatment was significantly associated with mortality in the multivariate analysis. These results, which help determine the species distribution, antifungal susceptibility patterns and risk factors for mortality, could make a significant contribution to the management of these challenging infections, including choosing appropriate empirical antifungal therapy.

Insecticidal effects of extracts of Humulus lupulus (hops) L. cones and its principal component, xanthohumol

Insecticidal effects of the dichloromethane, ethyl acetate, acetone, ethanol and methanol extracts of Humulus lupulus (hops) L. cones and its principal components, xanthohumol was investigated on five stored pests, Sitophilus granarius (L.), Sitophilus oryzae (L.), Acanthoscelides obtectus (Say.), Tribolium castaneum (Herbst) and Lasioderma serricorne (F.). The mortality of adults of the insects treated with 2, 5, 5, 10 and 20 mg ml̠-1 concentrations of the extracts and xanthuhumol was counted after 24, 48, 72, 96 and 120 h. In order to determine the toxic effects of the substances tested against all tested insects, durations for 50% mortality of the adults, and LD50 values were also determined in the first 48 h by probit analysis. Our results also showed that xanthohumol was more toxic against the pests in comparison with the extracts applications. LD50 values for xanthohumol were found to be low dose as compared with the extracts. Xanthohumol was more toxic against S. granarius (L.) with 6.8 µg of LD50 value. Among the extracts, methanol extract was less effective than other extracts against all tested insects. The ethyl acetate extract of H. lupulus cones was the most effective extract against the tested pests. The quantitative amounts of xanthohumol in the extracts were determined using a high-performance liquid chromatography. The quantitative data indicated that amount of xanthohumol in the extracts increased with increase of polarity of the solvents used from methanol to dichloromethane. The methanol extract contained the high amount of xanthohumol with 5.74 g/100 g extract (0.46 g/100 g plant sample).

The role of selected neuropeptides in pathogenesis of atopic dermatitis

BACKGROUND

Atopic dermatitis (AD) is an inflammatory skin disease of a chronic course. The role of neuropeptides in pathogenesis of this disorder is probably not crucial; however, there is evidence that these substances influence the development and course of AD.

OBJECTIVE

The aim of this study was to evaluate the plasma level of substance P, neuropeptide Y (NPY) and calcitonin gene related peptide (CGRP) in AD patients during exacerbation and remission of the disease.

MATERIAL AND METHODS

Forty-nine patients with AD, aged 17 to 56 years, participated in the study. Among this group, there were 25 males (51%) and 24 females (49%). The disease lasted from 1 to 55 years. The severity of the disease was assessed with SCORAD index. The severity of pruritus was evaluated with Visual Analog Scale and a specially designed questionnaire. Neuropeptides plasma level was detected with radioimmunoassay.

RESULTS

Substance P plasma level in AD patients during exacerbation and remission was significantly higher than in the control group. There was a negative correlation between substance P plasma level and total IgE level. CGRP plasma level during exacerbation of AD was significantly lower than in healthy controls and increased in the remission. Significantly higher CGRP concentration was observed in patients suffering from severe pruritus; however, both in patients with more and less severe pruritus, CGRP plasma level was lower than in controls. Higher CGRP plasma level was also observed in patients with more severe disease. NPY plasma level in patients with AD was significantly increased both during exacerbation and remission. During remission of AD, NPY concentration was higher than during exacerbation.

Evaluation of quality of life in patients with toenail onychomycosis by Polish version of an international onychomycosis-specific questionnaire

BACKGROUND

Onychomycosis is the most frequent nail disease, which could impair the patient's quality of life.

OBJECTIVE

The present study was undertaken to evaluate the impact of toenail onychomycosis on quality of life among Polish population.

PATIENTS AND METHODS

Three thousand nine-hundred and four (3904: 2269 females and 1635 males) individuals fulfilled an international onychomycosis-specific quality-of-life questionnaire consisting of statements regarding social, emotional and symptoms problems. All patients had toenail onychomycosis confirmed by the positive direct microscopic examination and/or by the positive mycologic culture. Seven hundred and sixty-seven patients simultaneously had fingernail onychomycosis. All patients were divided into subgroups according to sex, age, education level, place of living, type of onychomycosis, number of involved toenails, fingernails involvement, duration of illness and previously used antimycotic therapy.

RESULTS

Most of the patients demonstrated significantly reduced quality of life. The degree of life impairment varied between analysed subgroups. Patients with more advanced toenail onychomycosis and with fingernail involvement were more seriously affected. Both social and emotional impairments were more pronounced in female than in male patients, although there were no differences according to symptoms. Moreover, patients with better educational level and people living in towns or cities were more emotionally and socially affected by onychomycosis, although people living in the country or with poorer education level presented with significantly more severe symptoms.

CONCLUSIONS

Toenail onychomycosis is still a serious medical problem, which can significantly reduce the patient's quality of life.

Analysis of the incidence of fungal pathogens in air of the Department of Dermatology, Venereology and Allergology of Medical University in Wrocław

PURPOSE

Analysis of incidence of fungal pathogens in air of Department of Dermatology, Venereology and Allergology of Medical University in Wrocław.

MATERIAL AND METHODS

Materials for the tests were: the air samples in front of the building, corridors, library, lecture hall, and mycological laboratory. The air pollution was determined using SAS SUPER 100. Humidity and temperature were evaluated by a termohigrometr. Classification of the isolated fungi was made with an accordance to the current procedures.

RESULTS

From the air was isolated: in library 69 colonies (mean CFU 138 +/- 41.5), from the bookstands--25 colonies (mean CFU-125 +/- 63.6), lecture hall--119 colonies (mean CFU-380 +/- 98.8), mason room--52 colonies (mean CFU-104 +/- 21.9), mycological laboratory--154 colonies (mean CFU-513 +/- 155.3). Temperature in the tested rooms ranged from 24.5 degrees C (mason room) to 26.1 degrees C (library), humidity ranged from 40.1%-53.1%. Temperature outside of the building was 23.6 degrees C, and humidity 51.6%. Moulds Peniciullium citricum and Aspergillus niger and the yeasts Candida albicans were isolated more frequently.

CONCLUSIONS

The highest number of fungi colonies were isolated from the air sampled at the lecture hall and mycological laboratory. Moulds were the most common airborne fungi. Temperature and huimidity in the tested rooms are good conditions for the development of fungi.

CTLA-4 gene polymorphisms and natural soluble CTLA-4 protein in psoriasis vulgaris

CTLA-4 molecule is an important inhibitor of T-lymphocyte activation. Several single nucleotide polymorphisms (SNPs) in the CTLA-4 gene were found, and their associations with many human diseases were described. So far, however, such studies have not been performed in psoriasis vulgaris in Caucasoids. Therefore, we examined the distribution of three CTLA-4 SNPs: -1147C/T, -318C/T and +49 A/G in 116 patients with psoriasis vulgaris and 123 healthy blood donors using the polymerase chain reaction-restriction fragment length polymorphism method. For all three SNPs, the frequencies of alleles, genotypes and three-point haplotypes were very similar in patients and controls, suggesting no contribution of these genetic variants to psoriasis.

International multicenter phase II study of the HDAC inhibitor (HDACi) depsipeptide (FK228) in cutaneous T-cell lymphoma (CTCL): Interim report

3063

Background: Depsipeptide, a unique bicyclic peptide histone deacetylase inhibitor (HDACi), has shown activity in a range of in vitro and in vivo tumor models and clinical activity in T-cell lymphomas and prostate cancer. This study seeks to confirm the CTCL activity previously reported by the NCI (Piekarz, et al., ASCO, 2004). Methods: Single-arm, open label study, in 25 centers in the UK, Germany, Poland and the US. Patients aged ≥18 years with biopsy-confirmed CTCL (centrally reviewed) who have failed at least one prior systemic treatment receive up to 6 cycles of depsipeptide as a 4-hour IV infusion on Days 1, 8 and 15 q 28 days. Eligibility criteria include: mycosis fungoides and Sézary syndrome plus variants, Stages IB - IVA, adequate organ function, ECOG PS ≤ 1. Patients with significant cardiovascular abnormalities are excluded in addition to those taking QTc-prolonging or CYP3A4-inhibiting drugs. The primary endpoint is overall reponse rate measured by a combination of imaging, circulating cell counts and a weighted skin average instrument, confirmed by standardized photography. A subset undergoes pharmacokinetic assessments. Correlative studies include acetylation status, apoptotic markers and proteomic analyses where possible. Target accrual is 76 to yield 64 evaluable patients. Results: 30 patients have received treatment with 17 evaluable for efficacy. Responses seen are 1 cCR, 4 PRs (duration 2+ to 6 months) 9 SD and 3 PD. 3 patients withdrew early for PD and 2 for other reasons. The remaining patients on study are too early to assess. Most frequent toxicities are: nausea/vomiting, fatigue, myelosuppression and asymptomatic ECG changes. No patient has withdrawn for toxicity and there have been no treatment-related deaths. Conclusions: The previously reported efficacy of depsipeptide in CTCL has also been seen in the present study. Duration of response is encouraging. Toxicity is manageable and the study continues to accrue.

[Table: see text]

Distribution of Ca.LSU intron and acid protease production by Candida albicans strains isolated from gastrointestinal tract of diabetes children

The association between the presence of self-splicing intron Ca.LSU and proteolytic activity of Candida albicans isolates was tested. Study included 95 C. albicans strains isolated from gastrointestinal tract of diabetes children. The strains with the intron (genotype B) displayed a significantly higher proteolytic activity (385.2+/-192U/L) than did strains without intron (genotype A) (119+/-115U/L) (p = 0.0000048).

Characterization of new oxovanadium(IV) complexes of saccharides

Oxovanadium(IV) complexes of the monosaccharides D- and L-arabinose, D-galactose, D-mannose, D-lyxose, D-xylose and the disaccharide maltose were obtained in aqueous solutions at pH 13. Their sodium salts were precipitated with absolute ethanol and characterized by UV-vis spectroscopy (absorption and reflectance), thermo-analytical (TG and DTA) data, magnetic susceptibility measurements and IR-spectroscopy. All the complexes were found to be mononuclear, possessing the VO2+ moiety. The IR spectra were analyzed and discussed in detail allowing one to determine the characteristics of the metal-to-ligand interactions.

Short-term itraconazole versus terbinafine in the treatment of tinea pedis or manus

A total of 304 patients with a clinical diagnosis of palmar-type tinea pedis or manus and a positive mycologic examination were recruited into this double-blind, randomized, multicenter, phase III study. Patients were randomized to receive either oral itraconazole 200 mg twice daily (in the morning and evening) for 7 days, followed by placebo for 7 days (n = 153), or placebo in the morning and oral terbinafine 250 mg in the evening for 14 days (n = 151). At the first visit and 1, 2, and 6 weeks after the start of the study, signs and symptoms were assessed clinically, and scales were taken for mycologic assessments (microscopy and culture). At weeks 1, 2, and 6, the effectiveness of therapy was evaluated globally and given a rating of healed (absence of signs and symptoms), marked improvement (> or = 50% clinical improvement), considerable residual lesions (< 50% clinical improvement), no change, or worsened. The primary efficacy parameter was the mycologic cure rate at the follow-up end-point (week 6). The tolerability of the study medications was assessed at weeks 1 and 2. Adverse events were recorded at weeks 1, 2, and 6. Routine hematologic and biochemical tests were performed at the start of the study and after 1 week of treatment. No significant differences were seen in the baseline patient characteristics between the two groups. The rate of mycologic cure (negative microscopy and culture test result) was 79% in the itraconazole group and 80% in the terbinafine group at the follow-up end-point. The analysis of the 90% confidence interval for the difference between the treatment groups (-7.1, 5.4) and the outcome of the Blackwelder test (for two one-sided tests, P = 0.013 and P = 0.029) showed the two treatments to be equivalent. The results of the global evaluations of the efficacy in the two treatment groups are shown in Table 1. The rate of clinical response (healed or markedly improved) was 93% in the itraconazole group and 91% in the terbinafine group at the follow-up end-point. The analysis of the 90% confidence interval for the difference between the two groups (-2.5, 5.7) and the outcome of the Blackwelder test (for two one-sided tests, P = 0.004 and P < 0.001) showed the two treatments to be equivalent. The severity of the clinical signs and symptoms decreased from the baseline to the treatment end-point and from the treatment end-point to the follow-up end-point in both groups. At the double-blind treatment period end-point (week 2), the tolerability of the study medication was rated as very good or good in more than 97% of patients. During treatment, 21 of 153 patients (14%) in the itraconazole group and 28 of 151 patients (19%) in the terbinafine group reported adverse events. During follow-up, one patient in the itraconazole group and two in the terbinafine group reported adverse events. The most frequent events were headache, abdominal pain, nausea, vomiting, and hypertriglyceridemia. Two patients in the itraconazole group and four in the terbinafine group withdrew because of adverse events. Severe adverse events were reported by one patient in the itraconazole group and five in the terbinafine group. Serious adverse events were reported by two patients in the terbinafine group, although these were probably not drug related. No clinically relevant changes in laboratory variables were observed.

Temporal patterns in a fish assemblage of a semiarid mangrove zone in Madagascar

Gillnet sampling was conducted for a year in a tropical mangrove creek (SW Madagascar), characterized by a limited freshwater influence, a high turbidity and a tidal range up to 3 m. Sixty species of juvenile fishes were caught, 44 species being of commercial interest. Catches were dominated by Gerreidae (27% of total abundance), Teraponidae (16%), Carangidae (13%) and Sparidae (12%). The temporary resident fishes in the mangrove zone represented 50% of the species and 97% of the total abundance, the other species being rare (less than five individuals). The species richness, abundance and biomass per netting were low in the middle of the cool season (July-August). Monthly changes in the fish assemblage were particularly complex, with three species groups displaying a clear seasonal pattern, some species succeeding one another in a rather unstructured way, and three species abundant throughout the year. There was no clear structuring effect of temperature, salinity and turbidity on the fish assemblage. However, tidal, lunar and diel effects on the composition of the fish assemblage were evident. The species overlap between the Sarodrano mangrove fauna and the adjacent coral reef fauna is particularly weak with six species in common and shows that the mangrove plays only a very limited nursery role for coral reef species.

The monitoring of cadmium, zinc and copper in the kidneys and liver of humans deceased in the region of Cracow (Poland)

Cadmium, zinc and copper levels were determined in the renal cortex and liver of 60 inhabitants of Cracow, Poland. Cadmium levels in the renal cortex were contained in broad limits of 5-176 μg/g, mean 50.6 μg/g (wet weight). Maximum levels were found in the age group of about 50-60 years. The levels were slightly higher in men (53 μg/g) than in women (45 μg/g), with no effect of location within the region. The levels in smokers (62 μg/g) were much higher than in non-smokers (32 μg/g). The above relations were less pronounced for cadmium levels in the liver. Whole body retention of cadmium followed the pattern of cadmium in renal cortex. The level of zinc in renal cortex reflected those of cadmium. A significant proportion of the population (54% in smokers, 9% in non-smokers) showed cadmium levels in renal cortex exceeding the reference level of 50 μg/g recently accepted for general population. In the view of the authors the exposure to cadmium of the population of Cracow is excessive and calls for attention.

[Level of beta 2-microglobulin in serum of patients with acute viral hepatitis types A, B and C]

Serum beta 2-microglobulin concentrations were assayed in 14 patients with acute hepatitis A, 16 with acute hepatitis B and 10 with hepatitis C. Serum samples were taken from each patient in the first and the second week of hospitalization and in the period of aminotransferase normalization. There was a significant increase of beta 2-microglobulin level in every type of hepatitis compared to the control group. A raised serum beta 2-microglobulin concentration persisted during convalescent period. It decreased gradually in type A and B of hepatitis. Serum beta 2-microglobulin level during convalescence in hepatitis C was similar to that of first weeks of hospitalization.

[Comparison of prolactin levels in first, second and multiple physiological pregnancy]

Serum prolactin level was estimated by radioimmunological method (RIA) in women during the first, the second and the multiple normal pregnancy. The value of prolactin was compared in the successive pregnancies and in the successive weeks of pregnancy. The dependence between concentration of prolactin and successive pregnancy was observed. A significant increase of prolactin was noted in the 4 week of multiple pregnancy. The increased level of prolactin was observed in the 10th, 12th, 14th, 40th and 42nd weeks of the first normal pregnancy.

Simultaneous operation for hydatid cyst of right lung and liver

Hydatid disease is endemic in many regions of Turkey. We observed 23 cases of simultaneous liver hydatid cyst in 344 patients having pulmonary hydatid cyst referred to our center. The simultaneous hydatid cysts were diagnosed by ultrasonography. In all cases complete resection was possible in a single operation. We performed thoracophrenotomy in 21 cases and thoracolaparotomy in two cases. Empyema was observed in three patients postoperatively. No mortality has occurred. Recurrence of a pulmonary cyst was observed in one patient 20 months postoperatively.

[Assessment of the phagocytosis and intracellular killing of Candida albicans by granulocytes of patients with atopic dermatitis]

Using morphological and radionuclide methods the ability of engulfing and intracellular killing of Candida albicans cells by granulocytes of patients with atopic dermatitis was tested. The patients had moderately intense lesions without secondary infections. The results obtained by the morphological method, that is the percent of phagocytizing granulocytes, the percent of C. albicans cells engulfed by the granulocytes and the percent of killed C. albicans cells in the group of 25 patients and in the group of 25 controls were not statistically significantly different. The radionuclide method with 51Cr labelling of Candida albicans failed to demonstrate differences between 15 patients and 25 controls in the intracellular killing of these cells. No significant effect of the serum of healthy subjects on the functions of the granulocytes and no effect of the serum of the patients on granulocyte functions of controls were noted.

["Tooth mortality" in a Marseille S.C.T.D. The effect of periodontal disease: comparison with some results of a national epidemiological study]

1,247 avulsions have been noted for a year in the S.C.T.D. (tooth, age and sex of the patient). 44.6% were caused by tooth decay. However periodontal disease was responsible for 39.5% of tooth avulsions. The tooth lost because of periodontal disease were in most part extracted after 40 years. A weakness of some type of teeth regarding tooth mortality may be quoted. A sexual dimorphism of tooth mortality was present in the studied population.

[Error in expert assessment]

On the basis of the statutory code of physicians' duties in Poland, the authors discuss a new category of professional error, namely "error in expert assessment." Expert assessment comprises: Issue of certificates stating temporary inability to work (L-4 forms); Issue of certificates allocating patients to appropriate disability categories; Issue of certificates entitling patients to special services; Issue of certificates for legal purposes According to regulation any physician can be required to provide an expert assessment, because institutions requesting such an opinion refer to persons or institutions so as to obtain special information. In certain cases physicians may request to be released from this obligation. Nevertheless, if they accept it and then pass an erroneous opinion they may be liable to a charge of malpractice. The authors have pointed out that errors in expert assessment usually result from: Inadequate professional knowledge; Examination of the records with no clinical examination; Failure to take account of information included in the patient's file; Illogical or unjustified conclusions about the cause and result relationship. The most common errors in the formulation of expert assessments are: "Overdiagnosis" of the results of an accident; Unjustified statements that death has resulted from an accident or from bad working conditions in cases of death from natural causes; Incorrect reconstruction of the events leading up to an accident or of the mechanism of injuries.(ABSTRACT TRUNCATED AT 250 WORDS)

[Zinc content of leukocytes and serum in psoriasis patients]

The mean zinc level in leucocytes from psoriasis patients was found to be decreased by a statistically significant amount, which was not the case in serum. On the basis of data from the literature and our own observations, the role of zinc is discussed in the development of immunologic events.