1,721,064 research outputs found
Raro caso di istiocitosi multifocaler a cellule di Langerhans. Case Report.
No full textINTRODUCTION: Langerhans cell histiocytosis (LCH) is a rare disorder characterized by high proliferation of Langerhans dendritic cells. LCH is a solitary or multifocal disease that primarily involves bone tissue. It often affects children and young men. Histological and immunohistochemistry analysis are essential to obtain the correct diagnosis.
CASE REPORT: A 29 years-old Caucasian man is referred to the Oral Surgery Unit of George Eastman Hospital of “Sapienza” – University of Rome with third degree mobility of teeth belonging to second, third and sixth sexstant. Panoramic radiograph showed multiple radiolucent areas with well demarcated borders on the right and left mandible and on the left maxilla. The presence of osteolytic lesions were confirmed by a subsequent CT scan. Incisional biopsy of the lesion with histological and immunohistochemistry analysis revealed Birbeck bodies, S100 protein and CD1a antigen positive markers. According to these findings the final diagnosis of multifocal Langerhans cell histiocytosis of the oral cavity was made. The patient was sent to the Hematology department of Umberto I Teaching Hospital of “Sapienza” – University of Rome for the appropriate treatment.
DISCUSSION: A brief literature review conducted by the authors reveals that Langerhans cell histiocytosis is common in children and that in about the 50% of cases it presents itself as a unifocal lesion involving the mandibular bone. Other findings in the most recent literature suggest that LCH can also have clinical appearance of hypertrophic gingivitis, premature tooth loss and oral ulcers; root resorption and tooth displacement are considered more uncommon clinical presentations. The present case of rare multifocal LCH only involving oral hard tissues shows the strong importance of better investigate, with appropriate additional exams, initial shifty symptoms that could lead to a misdiagnosis.
CONCLUSIONS: In this case the absence of oral manifestations except teeth mobility showed the importance to better investigate unusual findings such as third degree teeth mobility in a young patient with no history of periodontitis performing radiograph examinations and histological and immunohistochemistry analysis. The correct integration of the clinical and radiographic data allows the clinician to reach the final diagnosis. Early diagnosis of LCH is important to improve the patient's prognosis and quality of life
Multidisciplinary surgical management of Cowden syndrome: Report of a case
No full textCowden's Syndrome (CS) is a rare congenital autosomal dominant disorder that affects around 1/200000 patients with an incomplete penetrance and variable expressivity, characterized by alterations in a tumor suppressor gene. A 14-year-old Caucasian male patient came to the attention of the authors complaining of palm nodules, gingival bleeding and painful pedunculated lesions on the lips and on the labial side of anterior sextants. After genetic investigation the final diagnosis of a Cowden Syndrome was made. The lesions were surgically removed under general anesthesia and no clinical signs of recurrence were found three months after surgical excision. Considering the severe symptoms of the syndrome and the strong tendency to malignant development of the associated lesions all clinicians should focus their efforts to the early diagnosis and, when possible, multidisciplinary treatment
The central odontogenic fibroma: how difficult can be making a preliminary diagnosis
Full text linkCentral odontogenic fibroma (COF) is a rare benign odontogenic tumor derived from the dental ectomesenchymal
tissues. A 16-year-old Caucasian female patient was referred by her dentist for a radiolucent asymptomatic area
associated with the crown of the impacted lower right third molar. A preliminary diagnosis of a follicular cyst
was supposed. The lesion was surgically removed under general anesthesia together with the impacted tooth. The
microscopic diagnosis of the excised tissue revealed an odontogenic fibroma. No clinical or radiographic signs of
recurrence were found five years after surgical excision. Despite the various differential diagnoses of homogeneous
unilocular and well delimited radiolucencies of the jaws, enucleation with peripheral curettage, without any other
pre-operative imaging exams or biopsies, can be considered as the treatment of choice
Effect of Sinus Floor Augmentation with Platelet-Rich Fibrin Versus Allogeneic Bone Graft on Stability of One-Stage Dental Implants: A Split-Mouth Randomized Clinical Trial
No full textRehabilitation of an edentulous posterior maxilla with dental implants is challenging, and sinus floor augmentation could be considered as an important surgical procedure for bone augmentation in this region before implant placement. Platelet-rich fibrin (PRF) is a new-generation platelet concentrate with simplified processing: its application in sinus floor augmentation has been widely investigated in literature. However, the biological properties and actual efficacy of this product remain controversial. This study assessed the effect of sinus floor augmentation with PRF versus freeze-dried bone allograft (FDBA) on stability of one-stage dental implants. This split-mouth randomized clinical trial evaluated 10 patients who required bilateral sinus floor augmentation. PRF and L-PRF membrane were used in one quadrant while FDBA and collagen membrane were used in the other quadrant. Implant stability was assessed by resonance frequency analysis (RFA) immediately, and 2, 4, and 6 months after implant placement. The implant stability quotient (ISQ) was compared over time and between the two groups using repeated measures ANOVA and independent sample t-test. The mean ISQ significantly increased over time in both groups (p < 0.001). The increase was greater in the PRF group (p < 0.05). Within the limitations of this study, PRF yielded superior results compared with FDBA regarding the stability of one-stage dental implants
Towards an emerging role for anticoagulants in cancer therapy: a systematic review and meta-analysis
No full textBackground: Anticoagulants, renowned for their role in preventing blood clot formation, have captivated researchers’ attention for the exploitation of their potential to inhibit cancer in pre-clinical models. Objectives: To undertake a systematic review and meta-analysis of the effects of anticoagulants in murine cancer research models. Further, to present a reference tool for anticoagulant therapeutic modalities relating to future animal pre-clinical models of cancer and their translation into the clinic. Methods: Four databases were utilized including Medline (Ovid), Embase (Ovid), Web of science, and Scopus databases. We included studies relating to any cancer conducted in murine models that assessed the effect of traditional anticoagulants (heparin and its derivatives and warfarin) and newer oral anticoagulants on cancer. Results: A total of 6,158 articles were identified in an initial multi-database search. A total of 157 records were finally included for data extraction. Studies on heparin species and warfarin demonstrated statistically significant results in favour of tumour growth and metastasis inhibition. Conclusion: Our findings constitute a valuable reference guide for the application of anticoagulants in cancer research and explore the promising utilization of non-anticoagulants heparin in preclinical cancer research. Systematic Review Registration: PROSPERO [CRD42024555603]
Timing of surgery following SARS-CoV-2 infection: an international prospective cohort study
No full textPeri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4–1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0–2 weeks, 3–4 weeks and 5–6 weeks of the diagnosis (odds ratio (95%CI) 4.1% (3.3–4.8), 3.9% (2.6–5.1) and 3.6% (2.0–5.2), respectively). Surgery performed ≥ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5% (0.9–2.1%)). After a ≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2–8.7) vs. 2.4% (95%CI 1.4–3.4) vs. 1.3% (95%CI 0.6–2.0%), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay
Influence of modified titanium abutment surface on peri-implant soft tissue behaviour: A systematic review of histological findings
No full textPURPOSE: The purpose of the present systematic review was to investigate at the histological level if a modified titanium surface abutment could affect the behaviour of soft peri-implant tissue (connective tissue adhesion and soft tissue inflammation). MATERIALS AND METHODS: An electronic databases research (MEDLINE/PubMed, Scopus, Web of Science, Cochrane Library) until 24 June 2019 for randomised controlled trials (RCTs), controlled clinical trials and non-randomised studies of interventions (NRSI) was performed. The focused question was: "In healthy patients with at least one titanium healing abutment connected to a dental implant, is the effect of a healing abutment surface modification different from machined titanium at the histological level?" The Cochrane Handbook for Systematic Reviews of Interventions to assess the risk of bias in individual studies was used for RCTs. The Newcastle-Ottawa quality assessment scale was used to evaluate NRSI. RESULTS: In total, 192 records were evaluated for titles and abstracts. Seven studies were included in the review. Five of them reported an enhanced soft tissue adhesion in the modified abutment group without increasing the soft tissue inflammation. One study reported no significant differences among titanium-modified (double acid-etched) and titanium-machined groups. One author demonstrated at the 6-month follow-up period a higher level of inflammation around acid-etched surfaces, with a higher number of T and B lymphocytes and expression of vascular endothelial growth factor. CONCLUSIONS: Short-term data (< 6 months) suggested an enhanced connective fibre attachment next to titanium abutments with a modified surface and a similar inflammatory response, in comparison with machined surface titanium abutments. However, modified surfaces may lead to a long-term increased risk of a higher degree of inflammation in the peri-implant tissues. Due to limited available evidence, further long-term studies are needed to confirm these results
Treatment of oral hamartomas in a pediatric patient with Cowden’s Syndrome: a case report
No full textAim. Cowden’s Syndrome (CS) is an autosomal dominant disorder associated with mutations in PTEN (Phosphatase and TENsin homolog), a tumor suppressor gene, that cause the PTEN protein not to work properly.
The incidence of CS is around 1/200 000 subjects. Since many of the clinical features of CS are common in the general population (e.g. fibrocystic breast disease, uterine fibroids), this condition is probably under-diagnosed and it could have a higher incidence.
Methods. A 14-year-old child came to the attention of the Operative and Paediatric Dentistry unit of the Department of surgical sciences for head and neck diseases – Polyclinic “Agostino Gemelli”, “University of Sacred Heart” of Rome complaining of several pedunculated lesions of the lips, which had been recently traumatized and sensitive to palpation. Considering the notable features
of his previous medical history (medulloblastoma, multiple intestinal hamartomas, multiple thyroid nodules and mucogengival lesions) besides his uncooperative attitude towards medical staff (odontophobia and anxiety disorder) the clinicians decided to treat him under general anesthesia. Intraoral mucosal examination revealed geographic and fissured tongue and multiple,
confluent, asymptomatic oral papillomatous papules, ranging from 1 to 3 mm in diameter, localized on the tongue, lips, angles of the mouth, buccal mucosa and attached gingiva. Dental examination revealed poor oral hygiene (generalized chronic periodontal disease and multiple carious lesions) and dental malposition with premature loss of teeth. Basing on the clinical features, particularly the presence of multiple muco-cutaneous nodules, a working diagnosis of Cowden’s syndrome was made.
The clinical management of the patient included the surgical excision of the multiple papules affecting the upper and lower lip. The excised lesion were fixed with 10% buffered formalin and sent for microscopical examination.
Histological examination of the polyps revealed these to be hyperplastic and adenomatous confirming the working Cowden’s syndrome diagnosis.
No recurrence has been seen at the 3 months clinical follow-up.
Discussion. Cowden’s syndrome, or multiple hamartoma syndrome, was first described in 1940 by Costello in a 27-years old Mexican female. In 1963, Lloyd and Dennis defined and named this pathology by their patient, Rachel Cowden, a 20-year-old female with adenoid facies, high-arched palate, hypoplasia of the soft palate and uvula, papillomatosis of the lips and oropharynx,
scrotal tongue, thyroid lesions, hypertrophy and fibrocystic disease of the breast, scoliosis, and lesions of the bones and liver.
Although CS is mainly associated with benign tumors, the prevalence of malignancies, especially breast and thyroid carcinomas, in affected patients is greater than in general population.
In view of this, it is essential to request a histological examination of the excised lesions in patients for whom a preliminary diagnosis of CS is made.
Conclusion. The dentist thus should be aware of the clinical features and possible developments of the CS because he can be the first health care professional who identifies it in its early stages; in such a case the clinician must alert the patient to do medical checks for preventing the formation of a neoplasia or its metastatic development
Fibrolipoma of the oral cavity: treatment choice in a case with an unusual location
Full text linkFibro-lipoma has been infrequently found in the oral cavity. Clinical and histological features of an unusual case located alongside the lingual cortical of the
mandible are reported. A particular surgical approach was used with an intrasulcular incision, since it allowed best access to the pathological tissue, optimal flap repositioning and a lower risk of post-surgical wound dehiscence
L'impatto del trattamento ortopedico pre-chirurgico sulle abitudini nutrizionali di pazienti affetti da labiopalatoschisi
No full textCleft Lip and Palat
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