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[Medical manuscript of Mihail Plamenac, a priest].

It is known that collections of popular medical prescriptions and instructions appeared in areas without educated physicians, and all previously published manuscripts of this kind are inevitably anonymous. The reported manuscript comprises 23 pages written in sepia ink, appendixed to a prayer book published in 1747, containing popular medical instructions and prescriptions collected and practiced by orthodox priest Mihailo Plamenac in Montenegro at the turn of the 18th century. Mihailo Plamenac took an important part in historical events, as documented by numerous domestic historical data and several letters discovered in The Archives of Vienna. Being the only literate persons at the time, priests were both politicians and military officers, but they also offered medical services to the population. The manuscript comprises advices for various common emergencies (snake bites, urinary retention, contusions, fever, burns, eye injuries, rabies, otitis, traumatic wryneck) and diseases(impetigo, scabies, infertility, gastric ulcer, low back pain) as well as for certain poorly defined conditions (chest pain, abdominal discomfort). Besides medically fully adequate treatment, for example, the remedy against scabies containing sulfur, there are numerous examples of magic and ritual pagan elements, including famous medieval SATOR formula against rabies. Most of the herbs used in prescriptions have been identified: fig, dog rose, hyssop, leek, laurel, absinthe, rosemary, mallow, cypress, elder, endive, mangel, orache, ivy. The manuscript is the first manuscript undoubtedly attributed to a well known historical personality, as indicated in the first page of the manuscript: "This is a medical prayer book by Mihailo Plamenac, left to him by his ancestors."

History, 18th Century↗

PubMed1998

[Microstructure of subcutaneous lesions in juvenile hyaline fibromatosis].

Juvenile hyaline fibromatosis is a rare autosomal recessive interstitial disease characterized by nodes and tumours of skin and soft tissues as well as by gingival hyperplasia. The authors described a case of 28-year-old male based on histopathological diagnosis. The patient was admitted to the hospital thrice in his life with the diagnosis of arthrogryphosis. Last time he presented with extensive secondary impetigo in extremities and pachydermia, polymalformation syndrome, multiple subcutaneous tumours, gingival hypertrophy, contractures, osteolytic lesions and positive family history. In histology, tumoriform lesions showed a structureless hyaline matrix often with chondroosseous metaplasia and calcium salts. More or less numerous cells in the matrix had a fibroblastoid appearance with eosinophilic cytoplasm, oval nuclei and frequently pericytoplasmic halo. Electron microscopy revealed dilated cisterns of rough endoplasmic reticulum and a hypertrophied Golgi apparatus. Particles representing calcium salts according to their density were rare. Immunohistochemistry of tumour cells showed vimentin, alpha-1-antichymotrypsin and alpha-1-antitrypsin. The findings concurred with the literature in which, nevertheless, the immunohistochemical picture were not mentioned.

Adult↗

PubMed1998

Bacterial skin infections at a tertiary dermatological centre.

BACKGROUND: Bacterial skin infections are common clinical problems encountered in most fields of clinical medicine. Staphylococcus aureus and group A streptococci are common invaders of eczematous, traumatised or immunocompromised skin. Advances in pharmacology have introduced a wide array of new antibiotics into the physician's armamentarium, but the rising incidence of bacterial resistance continues to be a problem. A retrospective study was carried out on 331 patients at the National Skin Centre, Singapore, to establish the causes of common primary and secondary pyodermas, as well as to determine the antibiotic sensitivities of the microorganisms responsible. METHODS: A retrospective study of the medical records of 331 patients seen at the Centre for skin infections between October 1995 and May 1996 was done. Skin cultures and antibiotic sensitivity testing was carried out and the data analysed. Both primary pyodermas (impetigo, folliculitis, furuncles/carbuncles and cellulitis) and secondary pyodermas (infected ulcers and infected eczemas) were included. The results of bacterial isolation cultures and sensitivity of the organisms isolated to the commonly used antibiotics such as cloxacillin, penicillin, erythromycin and the tetracyclines were analysed. RESULTS: Staphylococcus aureus was the commonest organism isolated from both primary and secondary pyodermas, accounting for 67% and 46.7% of the organisms isolated, respectively. There was no significant difference in the racial representation in each of the various skin infections, but there was a significantly greater female representation in the infected ulcers. The secondary pyodermas had a significantly higher incidence of gram negative organisms causing infections, as well as culture results showing multiple bacterial pathogens. The methicillin resistant strains of S. aureus were commoner in the secondary pyodermas, and accounted for 4.2% of the total organisms isolated and 7% of the total strains of S. aureus. The S. aureus had a high rate of resistance (89.5%) to penicillin and ampicillin, but was very sensitive (93%) to cloxacillin, cephalexin and cotrimoxazole. The incidence of erythromycin resistance was 18.7%. CONCLUSIONS: In patients with primary pyodermas, cloxacillin should be the first line antibiotic used, with erythromycin as a useful but less preferred alternative. The favoured combination of ampicillin and cloxacillin has little place in routine treatment of skin infections, except for cellulitis and infected eczemas. A cephalosporin can also be used in these conditions if single drug therapy is desired. The secondarily infected ulcers are difficult to treat and would probably require the use of combination therapy in view of frequent mixed infections.

Adolescent↗

PubMed1951