Submucosal Fibrotic Bands in Oral Lichen Planus: A Clinico-Pathological Investigation of a Newly Described Phenomenon.

Fibrosis is a recognized complication of chronic inflammatory conditions, which has not yet been described in oral lichen planus. To describe characteristics of submucosal fibrotic bands in oral lichen planus. Prospective study. Patients with biopsy confirmed lichen planus were included. Clinical examination recorded fibrotic bands, mouth opening, vestibular depth loss, gingival recessions adjacent to band, lichen subtypes, areas of affected mucosa, extra-oral manifestations. Patients completed the Chronic Oral Mucosal Disease Questionnaire, with additional questions regarding stiffness, restricted opening, symptom frequency, time from diagnosis of lichen, co-existing medical conditions. 73 patients were included, 14 M, 59 F, age 28-84 (mean 61) years. Buccal fibrous bands were palpated in 22 (30.1%), 13 (59%) were bilateral. Self-reported restricted opening/stiffness were significantly associated with fibrous bands (36% Vs. 11% in controls, p = 0.02). Mouth opening less than 40 mm was recorded in only 2 (9%) with bands, none in controls. Reduced vestibular depth was significantly associated with bands (11 (50%) Vs 3 (6%) in controls, p = 0.0001).Gingival recessions adjacent to bands were recorded in 3 (13.6%). No association was demonstrated between fibrous bands and erosive lesions, extra oral involvement, smoking, age, visual analogue scale, quality of life questionaire and disease duration. Histological evaluation of one case each with and without band and control showed increased mean width of connective tissue. Submucous fibrous band is first described in the present study. It is common in oral lichen planus, may lead to feeling restricted mouth opening, stiffness, loss of vestibular depth and adjacent gingival recession.

Clinical releveance of hemorrhagic component of endobronchial inflammation in severe chronic obstructive pulmonary disease exacerbation.

AIM: The study aimed at investigating the relationship between severe exacerbations of chronic obstructive pulmonary disease and hemorrhagic component of endobronchial inflammation. MATERIALS AND METHODS: Clinico-endoscopic characteristics of 118 patients presenting with severe infectious exacerbation of chronic obstructive pulmonary disease, bloody expectorations and endoscopically confirmed hemorrhagic component of endobronchial inflammation have been analyzed. All patients underwent a series (5-6) of bronchoscopic examinations accompanied by collection of bronchoalveolar lavage specimens to reveal the presence of acid-resistant mycobacteria and to determine the bacterial flora. The exclusion criteria were the concomitant pulmonary or extrapulmonary pathologic conditions which could lead to hemorrhagic endobronchial manifestations. The other direction of the study was to investigate a correlation between jugulation of the exacerbation and dynamics of such endobronchial symptoms as mucosal edema and hyperemia, quality of bronchial secretions and hemorrhagic component of endobronchial inflammation. RESULTS: All patients were found to have diffuse endobronchitis of severity grade II (39.83%) or III (60.17%) by Lemoine. The neoplastic and tuberculosis genesis of the hemorrhagic component of endobronchial inflammation and its clinical equivalent, the bloody expectorations, had been ruled out. In 50.85% of cases the hemorrhagic component of endobronchial inflammation could not be accounted for by hemolytic properties of cultured microorganisms. The mucosal edema and hyperemia remained stable during jugulation of the exacerbation. Unlike the improvement of quality of bronchial secretions, faster reversal of the hemorrhagic component of endobronchial inflammation showed statistical significance. CONCLUSION: The hemorrhagic component of endobronchial inflammation can represent a non-obligatory manifestation of severe exacerbation of chronic obstructive pulmonary disease, and its relief is the earliest endobronchial sign of incipient remission from severe COPD exacerbation.

[Analysis of the effectiveness and long-term results of formation of adaptive immunity in the use of various medications and vaccination schemes against pneumococcal infection in patients with chronic obstructive pulmonary disease]. / Analiz otdalennykh rezul'tatov éffektivnosti i formirovaniia adaptivnogo immuniteta pri primenenii raznykh preparatov i skhem vaktsinatsii protiv pnevmokokkovoi infektsii u bol'nykh s khronicheskoi obstruktivnoi bolezn'iu legkikh.

AIM: To assess the long-term clinical results of vaccination with pneumococcal polysaccharide and conjugated polysaccharide vaccines in the separate and sequential use, by determining the optimal vaccination schedule in adult patients with chronic obstructive pulmonary disease (COPD) and to investigate adaptive immunity levels. SUBJECTS AND METHODS: The clinical effects of vaccination were evaluated in patients with COPD within 1 and 4 years after immunization against pneumococcal infection using various schemes, as well as the time course of changes in adaptive immunity indicators was examined. RESULTS: Four years after vaccination, the 13-valent pneumococcal conjugate vaccine (PCV13)/23-valent pneumococcal polysaccharide vaccine (PPV23) group showed a decline in the number of patients with COPD exacerbations by 50% (p<0.001) and reductions in the number of antimicrobial chemotherapy cycles by 47.8% (p<0.001) and in that of hospitalizations by 87.5% (p<0.001). At 1 year after vaccination versus at baseline, the COPD patients vaccinated against pneumococcal disease, regardless of the drug and schedule of vaccination, displayed elevated levels of IgG antibodies to the mixture of capsular polysaccharides included in PPV23 and PCV13. CONCLUSION: It has been indicated that a complex of basic therapy for patients with COPD should include initial vaccination with PCV13, followed by administration of a booster dose of PPV23.

[Choice of optimal vaccination tactics against pneumococcal infection from immunological and clinical standpoints in patients with chronic obstructive pulmonary disease].

AIM: To provide a rationale for choosing the optimal tactics of vaccination against pneumococcal infection in patients with chronic obstructive pulmonary disease (COPD) in the context of evidence-based medicine and on the basis of immunological and clinical data. SUBJECTS AND METHODS: Patients with COPD were examined during a year after vaccination with a 13-valent pneumococcal conjugate (Prevenar-13, PCV13) and a 23-valent pneumococcal polysaccharide (Pnemo-23, PPV23) vaccines. The following vaccination schemes were used: PCV13 monovaccination, PPV23 monovaccination, sequential vaccination with PPV23/PCV13, and sequential vaccination with PCV13/PPV23. RESULTS: Vaccination using all the analyzed schemes in the patients with COPD caused a statistically significant reduction in the frequency of exacerbations, the number of antibiotic cycles, and the number of hospital admissions, as shown by the results of analysis of short-term data. The use of PCV13 was followed by additional effects that were unobserved in the use of PPV23, namely: it promoted the formation of immunological memory to Streptococcus pneumoniae antigens, resulted in the enhanced activity of nonspecific resistance factors, and caused activation of antiviral defense factors. CONCLUSION: If patients with COPD need to be vaccinated against pneumococcal infection, preference should be given to PCV13 monovaccination. Short-term observations have shown that the sequential use of pneumococcal conjugate and polysaccharide vaccines is redundant and gives no additional benefit to patients with COPD. However, the sequential application of both vaccines may have additional advantages in the long term.

Screening for ovarian cancer in women with breast cancer with transvaginal sonography and color flow imaging.

The aim of the present study was to determine the efficacy of transvaginal color flow imaging as a screening tool for ovarian cancer. Six hundred patients with previous breast carcinoma were screened for ovarian cancer. Screening was performed using transvaginal sonography with color flow imaging. Serum CA 125 levels were measured in patients with abnormal sonographic findings. Eighty-three percent of the ovaries were detected in the premenopausal patients by ultrasonographic scanning and only 26% of the ovaries were detected in the postmenopausal patients. Intraovarian blood vessels were detected in 11% of the premenopausal women. The PI was less than 1 in 80% of these ovaries, but, on repeated examinations, the values of PI increased in all the blood vessels to greater than 1. Intraovarian blood vessels were detected in 1.8% of the normal ovaries observed in the postmenopausal women, but PI was always greater than 1. Eleven women with complex ovarian cysts (not simple) and one woman with enlarged ovaries underwent explorative laparotomy. In three women, primary malignant ovarian tumors were diagnosed and in one woman metastatic ovarian cancer was diagnosed. The specificity of sonography in detecting malignant ovarian tumors was 97.5% and the positive predictive value was 25%. The specificity of color flow imaging in detecting primary malignant ovarian tumors was 99.8% and the positive predictive value was 60%. In selected groups of women, screening for ovarian cancer with transvaginal color flow imaging may be justified.