Treatment options of periapical cysts of deciduous teeth: report of a case and systematic review of the literature.

AIM: Periapical cysts of primary teeth are pathologic entities which are seldom encountered in the clinical practice. Most frequently, these lesions arise in correspondence with primary teeth presenting previous pulp therapy, severe carious lesions, or a history of previous trauma. The aim of the present study is to systematically review the treatment modalities of periapical cysts of the deciduous, along with the reporting of a clinical case. MATERIALS: A case of periapical cyst treated with marsupialization occurring in an 11-year-old patient is described. A literature search was devised to retrieve studies reporting the treatment of periapical cysts, and involved papers published in the Cochrane Oral Health Group specialist trials, MEDLINE via PubMed, and EMBASE up to March 2023. A total of 39 articles were retrieved. Following title and abstract analysis, 27 articles were selected for full-text analysis, with the final inclusion of 24 articles. CONCLUSION: Periapical cysts of primary teeth present an overall good prognosis irrespective of the treatment option adopted. The performance of a prompt diagnosis appears of utmost importance, as the extraction of the primary teeth involved implies the management of the residual space for the correct positioning of the corresponding permanent teeth.

Contemporary Review of Multimodality Imaging of the Prostate Gland.

Tissue changes and the enlargement of the prostate, whether benign or malignant, are among the most common groups of diseases that affect men and can have significant impacts on length and quality of life. The prevalence of benign prostatic hyperplasia (BPH) increases significantly with age and affects nearly all men as they grow older. Other than skin cancers, prostate cancer is the most common cancer among men in the United States. Imaging is an essential component in the diagnosis and management of these conditions. Multiple modalities are available for prostate imaging, including several novel imaging modalities that have changed the landscape of prostate imaging in recent years. This review will cover the data relating to commonly used standard-of-care prostate imaging modalities, advances in newer technologies, and newer standards that impact prostate gland imaging.

Mechanics of facial growth in young patients.

AIM: The aim of this work is to focus on the impact of occlusion on facial development. METHODS: Literature was searched using Medline, Embase and Cochrane Library. The key words and mesh used were bone remodelling, facial growth, masticatory muscles, children. Only articles written in English were included in the study. CONCLUSION: Disturbances in the harmonious interplay of the masticatory muscles may result in facial alteration and asymmetries. If not treated, the dysplastic pattern of growth continues and worsens with time.

Predisposing factors involved in the aetiology of Molar Incisor Hypomineralization: a case-control study.

AIM: The aetiology of Molar Incisor Hypomineralisation (MIH) is currently unclear. Over time, several aetiological hypotheses have come forward, including pre- and perinatal medical problems and postnatal illness. The aim of this case-control study is the identification of possible predisposing factors involved in MIH aetiology. METHODS: Methods Study Design: By hypothesising the probability of at least one predisposing factor present 2.5 times more in MIH cases than in controls, with an estimated prevalence of MIH patients requiring therapy equal to 30%, at a unilateral alpha level of 5% and a power of 80%, 63 couples of subjects are needed with an allocation ratio of 1:1; individual matching for age and gender was carried out. After clinical examination, 78 children with MIH (EAPD criteria) were recruited (mean age 9.36 years). An anamnestic form filled-in by a parent was used to collect data on possible predisposing factors including demographic characteristics, pregnancy, birth, childhood medical illness and medications' intake. STATISTICS: One-tail McNemar chi square test was used to evaluate the significance of the association between predisposing factor and MIH; odds ratio and 95% confidence intervals were computed. CONCLUSION: A multifactorial aetiology may be advocated for MIH development; in particular, further investigations are required to confirm and clarify the role of genetic factors.

Mitogen-activated protein kinase phosphatase-1 controls PD-L1 expression by regulating type I interferon during systemic Escherichia coli infection.

Mitogen-activated protein kinase phosphatase 1 (Mkp-1) KO mice produce elevated cytokines and exhibit increased mortality and bacterial burden following systemic Escherichia coli infection. To understand how Mkp-1 affects immune defense, we analyzed the RNA-Seq datasets previously generated from control and E. coli-infected Mkp-1+/+ and Mkp-1-/- mice. We found that E. coli infection markedly induced programmed death-ligand 1 (PD-L1) expression and that Mkp-1 deficiency further amplified PD-L1 expression. Administration of a PD-L1-neutralizing monoclonal antibody (mAb) to Mkp-1-/- mice increased the mortality of the animals following E. coli infection, although bacterial burden was decreased. In addition, the PD-L1-neutralizing mAb increased serum interferon (IFN)-γ and tumor necrosis factor alpha, as well as lung- and liver-inducible nitric oxide synthase levels, suggesting an enhanced inflammatory response. Interestingly, neutralization of IFN-α/ß receptor 1 blocked PD-L1 induction in Mkp-1-/- mice following E. coli infection. PD-L1 was potently induced in macrophages by E. coli and lipopolysaccharide in vitro, and Mkp-1 deficiency exacerbated PD-L1 induction with little effect on the half-life of PD-L1 mRNA. In contrast, inhibitors of Janus kinase 1/2 and tyrosine kinase 2, as well as the IFN-α/ß receptor 1-neutralizing mAb, markedly attenuated PD-L1 induction. These results suggest that the beneficial effect of type I IFNs in E. coli-infected Mkp-1-/- mice is, at least in part, mediated by Janus kinase/signal transducer and activator of transcription-driven PD-L1 induction. Our studies also support the notion that enhanced PD-L1 expression contributes to the bactericidal defect of Mkp-1-/- mice.

Applications of PET/MRI in Abdominopelvic Oncology.

With PET/MRI, the strengths of PET and MRI are combined to allow simultaneous image acquisition and near-perfect image coregistration. MRI is increasingly being used for staging and restaging of abdominopelvic oncologic lesions, including prostate, hepatobiliary, pancreatic, neuroendocrine, cervical, and rectal cancers. Fluorine 18-fluorodeoxyglucose PET/CT has long been considered a cornerstone of oncologic imaging, and the development of multiple targeted radiotracers has led to increased research on and use of these agents in clinical practice. Thus, simultaneously performed PET/MRI enables the acquisition of complementary imaging information, with distinct advantages over PET/CT and MR image acquisitions. The authors provide an overview of PET/MRI, including descriptions of the major differences between PET/MRI and PET/CT, as well as case examples and treatment protocols for patients with commonly encountered malignancies in the abdomen and pelvis. Online supplemental material is available for this article. ©RSNA, 2021.

Histologic findings associated with false-positive multiparametric magnetic resonance imaging performed for prostate cancer detection.

Magnetic resonance imaging (MRI)/ultrasound fusion-targeted biopsy (TB) has been shown to more accurately identify higher-grade prostate cancers compared with standard-of-care systematic sextant prostate biopsy (SB). However, occasional false-positive imaging findings occur. We investigated the histologic findings associated with false-positive prostate MRI findings. A retrospective review was performed on our surgical pathology database from 2014 to 2017 selecting patients with no cancer detected on TB with concurrent SB after at least 1 prior benign SB session. Histologic features evaluated included percentage of core involvement by chronic inflammation, percentage of core composed of stroma, percentage of glands involved by atrophy, and presence of the following features: acute or granulomatous inflammation, stromal nodular hyperplasia, adenosis, squamous metaplasia, basal cell hyperplasia, and presence of skeletal muscle. Histologic findings were compared between TB and concurrent SB. We identified 544 patients who underwent TB. Of these, 41 patients, including 62 targeted lesions, met criteria. Compared with SB tissue, the mean percentage of stroma was increased in TB (P = .02). Basal cell hyperplasia was also found to be more common on TB (P = .02). Both high percentage of stroma (P = .046) and presence of basal cell hyperplasia (P = .038) were independent predictors on multivariate analysis. The combination of high chronic inflammation, high stroma, acute inflammation, and basal cell hyperplasia was associated with TB (P = .001). Atrophic glands and chronic inflammation showed a positive correlation (r = 0.67, P = .003), which was especially seen in high prostate imaging reporting and data system lesions. Specific benign histologic entities are associated with false-positive findings on prostate MRI.

The role of transesophageal echocardiography in the management of renal cell carcinoma with venous tumor thrombus.

We reviewed the role of transesophageal echocardiography (TEE) in the management of renal cell carcinoma (RCC) with associated tumor thrombus. Many consider intraoperative TEE as imperative in cases of Level 4 thrombi with atrial involvement, as well as in cases that require the use of cardiopulmonary bypass (CPB). However, the role of TEE in the surgical management of RCC with associated inferior vena cava (IVC) thrombus may expand beyond this subset. When performed after induction, TEE provides updated information regarding tumor thrombus staging, which is essential for optimal surgical planning. Furthermore, TEE provides feedback regarding properties of the thrombus, such as fragility and adherence, which may alter surgical technique. TEE can also be used intraoperatively for central venous line placement, to monitor cardiovascular and fluid status, to guide vascular clamp placement, and to ensure complete removal of the tumor thrombus. In some cases, the use of TEE allows for less morbid procedures and safe avoidance of CPB. We therefore recommend the use of preoperative TEE in all cases with a known tumor thrombus with discretion as to what extent TEE is used throughout the remainder of the case. Further investigation is necessary to elucidate the effect of TEE on patient outcomes, including surgical complication rates, morbidity and mortality of procedures, and cancer control.

Diffuse intrinsic pontine gliomas (DIPG) at recurrence: is there a window to test new therapies in some patients?

Children with diffuse intrinsic pontine glioma (DIPG) need new and more efficient treatments. They can be developed at relapse or at diagnosis, but therefore they must be combined with radiotherapy. Survival of children after recurrence and its predictors were studied to inform the possibility to design early phase clinical trials for DIPG at this stage. Among 142 DIPG patients treated between 1998 and 2014, 114 had biopsy-proven DIPG with histone H3 status available for 83. We defined as long survivors' patients who survived more than 3 months after relapse which corresponds to the minimal life expectancy requested for phase I/II trials. Factors influencing post-relapse survival were accordingly compared between short and long-term survivors after relapse. Fifty-seven percent of patients were considered long survivors and 70% of them had a Lansky Play Scale (LPS) above 50% at relapse. Patients who became steroids-independent after initial treatment for at least 2 months had better survival after relapse (3.7 versus 2.6 months, p = 0.001). LPS above 50% at relapse was correlated with better survival after relapse (3.8 versus 1.8 months, p < 0.001). Patients with H3.1 mutation survived longer after relapse (4.9 versus 2.7 months, p = 0.007). Patients who received a second radiotherapy at the time of relapse had an improved survival (7.5 versus 4 months, p = 0.001). In the two-way ANOVA analysis, steroid-independence and LPS predicted survival best and the type of histone H3 (H3.1 or H3.3) mutated did not improve prediction. Survival of many DIPG patients after relapse over 3 months would make possible to propose specific trials for this condition. Steroid-independence, H3 mutation status and LPS should be considered to predict eligibility.

The case for salvage cystectomy after pelvic radiation.

Radical cystectomy is considered the standard of care for muscle invasive bladder cancer (MIBC), as well as some high-grade or recurrent non-muscle invasive bladder cancers. There are a number of reasons that urologic surgeons may find themselves considering a salvage cystectomy (SC) for a patient. Understanding the risks associated with performing SC is important for patient counseling when considering primary management of MIBC. Awareness of the unique complications that can occur can alter surgical technique and approach and can equip clinical staff with knowledge to properly monitor the patient during post-operative surveillance to identify and treat these situations. In this review, we characterize the outcomes of patients who underwent SC, elucidate the special considerations that must be made when performing this surgery, and discuss these outcomes in comparison to primary surgery in the absence of radiation.

Correlation between viral load, plasma levels of CD4 - CD8 T lymphocytes and AIDS-related oral diseases: a multicentre study on 30 HIV+ children in the HAART era.

This experimental retrospective multicenter study carried out on 30 seropositive children treated with Highly Active Antiretroviral Therapy (HAART), between the ages of 18 months and 14 years, in the clinical categories Centers for Disease Control (CDC) classification 1993 A (mildly symptomatic), B (moderately symptomatic) and C (severely symptomatic) aims to: 1) clinically and immunologically demonstrate the therapeutic benefits of HAART; 2) monitor the frequency of AIDS-related oral diseases in seropositive children with HAART therapy; 3) monitor the plasma levels of total CD4, CD4 percent, CD8 percent, CD4-CD8 lymphocytes and viral load from 1997 to 30 April, 2011. The statistic methods used are the analysis of covariance and the Bonferroni Test. More than 100 AIDS-related oral diseases were found in the study samples, the most frequent being: oral candidiasis, oropharyngeal candidiasis, HSV-1 herpetic esophagyitis, herpetic gingivolstomatitis (RHOG), recurrent aphthous stomatitis (RAS), parotid swelling, oral hairy leukoplakia (OHL), Herpes simplex 1 (HSV-1), linear gingival erythema (LGE), necrotizing gingivitis (NUG), facial lipodistrophy, facial-cervical lymphadenopathy (FCL), xerostomia, dysgeusia, hyposmia, oral mucosa hyperpigmentation (OMP). The Bonferroni test showed a significant difference between the mean plasma values (mpVTL) of total CD4, CD4 percentage, CD4-CD8 T lymphocytes and Viral Load (VL) of the various oral diseases found in the study samples. The therapeutic benefits of HAART are: immune reconstitution; reduction of the HIV/AIDS-related stomatology diseases; prevention and cure of the AIDS correlated neoplasias; reduction in maternal-fetal transmission of the HIV virus. The negative effects of HAART in relation to odontostomatolgy are: increase in oral lesions from HPV; xerostomia; dysgeusia/ageusia, hyposmia, perioral paresthesia; hyperpigmentation of oral mucosa; facial lipodystrophy, recurrent aphthous stomatitis (RAS). No case of immune reconstitution inflammatory syndrome or human papillomavirus (HPV)-related oral diseases were found in this study.

Clinicopathological findings, molecular detection and characterization of Babesia gibsoni infection in a sick dog from Italy.

A 4-year-old intact female American Pit Bull Terrier from Italy descendant of an American-born bitch was evaluated for anorexia, lethargy, weakness, and intermittent vomiting. On physical examination, the dog was dehydrated, had pale mucous membranes, hunched posture and abdominal pain. A moderate anemia was observed. Splenomegaly and hyperechoic regions suspected as infarcts in the spleen were seen on abdominal ultrasound. Based on the suspicion of splenic torsion, splenectomy was performed. After surgery, the clinical condition deteriorated. A follow-up complete blood count demonstrated severe macrocytic normochromic anemia with evidence of marked regeneration, left shift neutrophilia, monocytosis and marked thrombocytopenia. Blood smear evaluation revealed single to multiple, variable sized (1-3 microm in diameter), and round to oval to band-like piroplasms within many red blood cells consistent with small form Babesia spp. or Theileria spp. A partial segment of the 18S rRNA gene was amplified and the PCR product was analyzed by direct sequencing. The nucleotide sequence was completely identical to that of Babesia gibsoni present in GenBank. This is the first molecular detection and characterization of B. gibsoni infection in a sick dog from Italy.

Evaluation of efficacy of estrogen and phytotherapy in oral cavity alterations of women in menopause.

AIM: Hypo-estrogenism during menopause is the cause of numerous disturbances affecting various structures such as the oral cavity which can present with the following symptoms: changes in salivary secretion, gingivitis, bleeding and altered taste sensation. The object is to study whether hormone replacement therapy prescribed for female patients in menopause have any beneficial effect on the oral discomfort which affects the quality of life of these patients. METHODS: The study enrolled 95 female patients; 14 were the control group and received no hormone replacement therapy while 81 patients underwent two types of therapy: 38 were prescribed estrogen therapy and 43 phytotherapy. The main outcome measures were alterations of the oral cavity: salivary change, gingivitis, bleeding and taste changes. RESULTS: It was observed that the patients receiving treatment had an improvement or disappearance of symptoms in the oral cavity and that estrogen was more effective than phytotherapy regarding the salivary change while the gingivitis, bleeding and taste changes was the same for both therapies. CONCLUSIONS: Estrogen and phytotherapy have beneficial effect on oral discomfort in women in menopause. The proposed treatment can have a beneficial effect on osteopenia and osteoporosis and therefore also on possible increase of future tooth loss during menopause.

[Childhood cerebral tumors: morbidity and follow-up into adulthood]. / Tumeurs cérébrales de l'enfant: morbidité et suivi à l'âge adulte.

This chapter presents guidelines for the follow-up of children with brain tumors, whether benign or malignant, in their transition to adulthood. The consequences of their disease and its treatment overlap greatly. The complications and long-term follow-up are detailed based on the specialists involved.

[Possible consequences of urban pollution caused by radio frequency]. / Indagini sulle possibili conseguenze dell'inquinamento urbano da radiofrequenze.

The AA. report the results of an inquest on the health effects of radio wave pollution in an area of Trieste, where television transmitters and broadcasting are installed. The following results were obtained: the measure of electromagnetic fields showed in the mentioned area a power density 10-100 times higher than that + in other zones of Trieste. According to present knowledge, the observed values of EM fields may have some psychological, behavioural and neurovegetative effects on exposed subjects. Clinical examination, integrated by the analysis of some seventy biochemical and functional parameters, showed nothing but minor changes of hypophyseal-suprarenal hormones and a relevant incidence of neurovegetative troubles. Some difficulties were found in the interpretation of psychological troubles, which may be reactive to broadcasting installation or secondary to radio wave exposure.

Tratamiento de la psoriasis con antralina. / Psoriasis treated with anthralin

En el presente trabajo se estudiaron 132 pacientes de ambos sexos, portadores de psoriasis, a los que se realizo tratamiento con antralina unguento al 0,03% en las lesiones del cuerpo y antralina aerosol a la misma concentracion en cuero cabelludo.Se busco establecer la eficacia de la droga en ambas formas farmaceuticas mediante la medicion del tiempo requerido para obtener la mejoria clinica. Los pacientes fueron controlados periodicamente durante cinco meses, observandose al termino de ese tiempo la desaparicion de las lesiones en la mayoria de ellos.Se destaca el hecho de que para su aplicacion no fue necesario el uso de metodos y aparatos especiales,ni de personal idoneo. En base a estos resultados, hemos considerado a la antralina como droga de eleccion para el tratamiento local de la psoriasis, como terapeutica unica o asociada al tratamiento sistemico en aquellos casos que, por su gravedad o extension, asi lo requirieron