Upper gastrointestinal involvement in systemic sclerosis: Findings in a real-life setting.

Gastrointestinal tract involvement is the most common visceral affectation in systemic sclerosis (SSc), but the manifestations may vary in extension and severity. Endoscopic and histopathological gastroesophageal findings were investigated in patients with SSc. A total of 79 consecutive patients with definite SSc were enrolled in a cross sectional study. Clinical data were collected, upper gastrointestinal endoscopy and biopsies from gastric mucosa were performed in all cases. Fifty-seven (72.1%) out of 79 SSc patients had gastroesophageal symptoms. The most frequent were dysphagia, present in 33 (41.7%) and gastroesophageal reflux symptoms in 23 (29.1%) patients. Out of the 79 patients, 22 were asymptomatic, but in 16 esophageal and gastric mucosa changes were endoscopically detected. Reflux esophagitis was found in 39 (49.3%) patients. The presence of esophageal manifestations was not related to the disease duration or with its other variables. Signs of gastritis were endoscopically described in 47 (59.4%) and confirmed on histopathologic examinations in 45 patients. In 31 patients without any endoscopic changes, 18 (22.7%) showed signs of gastritis on histopathologic examination. No significant statistical differences were found between symptomatic and asymptomatic patients or between those with limited cutaneous SSc and those with diffuse cutaneous SSc in terms of clinical, endoscopic or histopathological findings, except the higher proportion of hiatal hernia in symptomatic patients. The results of this study might suggest that upper gastrointestinal endoscopy should be performed during the early stage of the disease and then periodically in patients diagnosed with SSc, even in the absence of typical symptoms.

Relationship Between Ventricular Arrhythmias, Conduction Disorders, and Myocardial Fibrosis in Patients With Systemic Sclerosis.

BACKGROUND: Delayed-enhancement magnetic resonance imaging (DE-MRI) is a noninvasive diagnostic tool able to identify myocardial fibrosis. In patients with scleroderma, its relationship with arrhythmias and conduction disorders has not been fully explored. OBJECTIVES: The aim of this study was to evaluate the possible correlations between ventricular arrhythmias, conduction disorders, and myocardial fibrosis in patients with systemic sclerosis. METHODS: Thirty-six patients with diffuse or limited cutaneous scleroderma underwent 12-lead electrocardiogram (ECG), 24-hour Holter ECG monitoring, transthoracic echocardiography, and cardiac DE-MRI, with gadolinium administration in 33 patients. RESULTS: High-quality DE-MRI scans were obtained in 30 patients. Myocardial fibrosis was detected in 25 patients (83.3%). Eighteen patients (60%) had ventricular arrhythmias or conduction disorders. There was no significant difference in ventricular arrhythmia burden (the total number of premature ventricular contractions [PVCs]/24 hours) (48 ± 304 vs. 69 ± 236, P = 0.97), ventricular arrhythmia severity (couplets, triplets, runs) on Holter ECG, or in the presence of conduction disorders (36% vs. 40%, P = 0.86) between patients with and without myocardial fibrosis. In univariate analysis, diffuse fibrosis was weakly associated with the number of PVCs/24 hours (R = 0.157, P = 0.03). A number of at least 597 PVCs/24 hours had a sensitivity of 60% and a specificity of 92% in predicting the presence of diffuse fibrosis on DE-MRI (area under the curve = 0.640). CONCLUSIONS: Delayed-enhancement magnetic resonance imaging can identify myocardial fibrosis in a high percentage of scleroderma patients. Its presence does not seem to influence the ventricular arrhythmia burden and severity or the presence of conduction disorders, with the exception of diffuse myocardial fibrosis, which modestly influences the total number of PVCs/24 hours.

The Role of NT-proBNP in the Diagnosis of Ventricular Arrhythmias in Patients with Systemic Sclerosis.

BACKGROUND: In patients with systemic sclerosis, NT-proBNP is a useful diagnostic marker for pulmonary hypertension and ventricular dysfunction, with important prognostic significance. The aim of this study was to assess the relationship between the NT-proBNP levels and the presence and severity of ventricular arrhythmias in patients with scleroderma. METHODS: Forty consecutive patients with a diagnostic of systemic sclerosis according to the EULAR criteria admitted at the Rheumatology Clinic of Cluj-Napoca, Romania, from Jan 2014 to Apr 2014 were enrolled. Patients underwent a 12-lead ECG and a 24-hour Holter ECG monitoring for ventricular arrhythmias evaluation. Blood sample testing (including NT-proBNP level measurements), echocardiography, spirometry, chest X-ray and, when considered appropriate, high-resolution chest CT were performed. RESULTS: Sixty percent of patients (n=24) had abnormal NT-proBNP serum levels (>125 pg/ml) and 10 patients had >100 PVC/24 h. There was a statistically significant correlation between the NT-proBNP levels and the total number of premature ventricular contractions (PVC) (r=0.445, P=0.006), total number of isolated PVC (r=0,493, P=0.002), total number of ventricular couplets (r=0.379, P=0.021) and the number of PVC morphologies (r=0.501, P=0.002). The presence of an NT-proBNP serum level >287 pg/ml had a sensitivity of 55% and a specificity of 93% in predicting the presence of complex ventricular arrhythmias on 24-hour Holter ECG monitoring. CONCLUSION: NT-proBNP levels could become a useful ventricular arrhythmia marker for assessing the arrhythmic risk in patients with systemic sclerosis.

Elevated Serum Levels of Sclerostin are Associated with High Disease Activity and Functional Impairment in Patients with Axial Spondyloarthritis.

BACKGROUND: Recent research suggests that biomarkers may be useful in assessing disease activity, structural damage, and response to therapy in axial spondyloarthritis (axSpA). Our study aims at evaluating the relationship between inflammation and bone remodeling markers and variables assessing disease activity and functional disability in patients with axSpA. METHODS: Serum levels of sclerostin, matrix metalloproteinase-3 (MMP-3), interleukin-17 (IL-17), and IL-23 were measured in 60 patients with axSpA and 20 healthy controls. Disease activity was evaluated using Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score (ASDAS), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). Functional status was assessed by Bath Ankylosing Spondylitis Function Index (BASFI) and measures of spinal mobility. RESULTS: Sclerostin levels were more elevated in axSpA patients with high disease activity than in those with low disease activity and in controls. They were significantly correlated with BASFI values (r = 0.29, p = 0.03) and measures of spinal mobility, but not with the classical markers of disease activity (BASDAI, ASDAS, CRP, and ESR). Although both MMP-3 and IL-17 levels were elevated in patients with active disease, they were not correlated with markers of disease activity or with functional disability. The levels of sclerostin, MMP-3, IL-17, and IL-23 were similar in axSpA patients and healthy controls. CONCLUSIONS: Elevated levels of sclerostin, MMP-3, and IL-17 were observed in axSpA patients with active disease, suggesting their potential role in assessing disease activity. In axSpA patients, sclerostin levels might be equally influenced by inflammation and level of physical activity. Further studies are required to confirm our findings in order to understand their clinical value.

The Role of Chronic Exposure to Amoxicillin/Clavulanic Acid on the Developmental Enamel Defects in Mice.

Amoxicillin used in early childhood may be associated with enamel hypomineralization. Our aim was to assess disturbances of amelogenesis in mice lower incisors induced by chronic administration of amoxicillin/clavulanic acid (AMC). Twenty-eight C57BL/6 male mice, of similar age, randomly divided into a control and 3 treatment groups (n = 7) received subcutaneous injection, once per day, for 60 days: 50, 100, and 150 mg/kg BW of AMC. Scanning electron microscopy/energy dispersive X-ray spectroscopy analysis in AMC treatment groups showed higher content in F and a decrease in P and Ca. Morphology changes ranged from scratched patterns, and small isolated pits-like enamel loss, to generalized demineralized enamel surface, giving a rough, foamy, scaly, or even cracked eggshell appearance to the affected areas. Histological analysis showed disturbances of maturation ameloblasts, which were less organized, with increased amounts of clear vacuoles in the cytoplasm and slightly more elongated and less condensed nucleus. Additionally, they were often detached from the enamel matrix. Transitional ameloblasts formed underlying the cysts of varied sizes. In conclusion, AMC dose-dependently affect ameloblast functions especially in the maturation phase, causing hypomineralized enamel formation with quantitative and/or qualitative defects.

A PRELIMINARY EVALUATION OF RESIDENTS' PERCEPTION OF THEIR TRAINING AND KNOWLEDGE ON THREE-DIMENSIONAL IMAGING.

UNLABELLED: The aim of this preliminary study was to assess the residents' perception on their training program and on their knowledge regarding the use and interpretation of three-dimensional imaging techniques in their clinical practice. MATERIAL AND METHODS: A multi-item questionnaire was distributed among 104 residents training in four medical specialties at the University of Medicine and Pharmacy "Grigore T. Popa" in Iasi. RESULTS: Fifty-five residents agreed to fill in the questionnaire, achieving a participating rate of 52.88%. The majority of the respondents (74.5%) declared to indicate classic CT scans to their patients. A significantly lower fraction of the participating residents (32.7%) affirmed to indicate CBCT scans. Electronic literature was the most common information source on the use of three-dimensional imaging (52.7%). Most of the residents declared that they cannot interpret correctly CT and CBCT scans (78.2%, respectively 83.6%). A significant percentage of the respondents considered that the level of training provided on the interpretation of CT and CBCT results is very low (49.1%, respectively 60.0%). CONCLUSIONS: The residents' perception of the quality of their education regarding 3D imaging modalities, along with their perception of their knowledge in this area, indicates the necessity to improve their didactic and practical training. A further extended survey will be conducted to evaluate the educational experience of residents from all medical specialties that use 3D imaging techniques in neck and head imaging.

Reliability and accuracy of three different computerized cephalometric analysis software.

The aim of this investigation was to determine, compare and evaluate three different computerized tracing programs, where the lateral cephalograms were digitized on the screen. 39 randomly selected cephalometric radiographs were used in the present study. Three programs Planmeca Romexis® (Romexis 3.2.0., Helsinki, Finland), Orthalis (France) and AxCeph (A.C 2.3.0.74, Ljubljana, Slovenia) were evaluated. 12 skeletal, 9 dental and 3 soft tissue parameters were measured that consisted of 11 linear and 13 angular measurements. Statistical analysis was carried out using multivariate analysis of variance (MANOVA), Levene test, Tukey Honestly Significant Difference (HSD) test and Kruskal-Wallis test. The measurements obtained with the cephalometric analyses programs used in the study were reliable.

Assessment of the consequences in premature loss of the temporary lower molars.

The consequences of premature loss of temporary teeth are complex, both of functional and morphological order and the clinical presentation depends on multiple factors: the temporary tooth loss rate as compared with permanent tooth eruption sequence and the number and topography of teeth extracted, so the clinical form of edentulous, which can be frontal or lateral, symmetric or asymmetric, isolated or continuous.

A software tool used in 3D evaluation of the alveolar bone defect in bilateral cleft lip and palate patients.

UNLABELLED: Evaluation of the cleft size and the assessment of an estimative volume required for bone grafting provide useful information to the surgeon performing secondary alveolar bone grafting. AIM: To use a software tool to evaluate the estimative volume of the bone defect in the alveolar cleft area, based on cone beam computed tomography (CBCT) data. MATERIAL AND METHODS: Three patients with bilateral cleft lip and palate (BCLP) were randomly selected in the order of referral to treatment at "Saint Mary" Emergency Hospital for Children. CBCT examinations were performed prior to secondary alveolar bone grafting procedure. The preoperative estimative volume (PEV) of the alveolar bone defect was evaluated by three observers with different areas of expertise (a dentomaxillofacial radiologist, a maxillofacial surgeon, and a Ph.D. radiology student), using Romexis 3.0.1 software program. The inter-observer fidelity was assessed using the Interclass Correlation Coefficient (ICC), with an optimal value of 0.837 for all observers. RESULTS: The mean PEV for all BCLP patients was 1.84 +/- 0.16 cm3. CONCLUSIONS: The results suggest that measuring the preoperative estimative volume of the alveolar bone defect in CLP patients using Romexis 3.0.1 software program, with CBCT scan data is beneficial. A proper protocol should be established, in order to provide useful information for the surgeon performing the secondary alveolar bone grafting.

Clinical--imaging aspects of young permanent teeth traumas and the ethiopatogenic mechanisms involved.

UNLABELLED: Dental trauma occurring to children and teenagers all over the world represents a serious issue in Public Health. AIM: This present study wants to investigate the etiology and the environment in which the dental trauma occurs and also wants to establish a connection between dental trauma and social-economic status. MATERIAL AND METHODS: The study was made to collect information about dental trauma on human subjects involving 372 children and teenagers, both female and male, between 8 and 20 years of age. The data obtained from the clinical and radiological exams for each patient have been registered in a special conceived register, which represented a stage of the study. RESULTS: The frequency of dental trauma varied from 62.1% for males to 37.9% for women. Most of them have suffered from dental trauma between the age of 14 and 16 (30.1%), and a few between 18 and 20 years (2.2%). Dental trauma has occurred most frequently in school, during sports lessons, followed by those in public places like the street (23.1%), from which 17.1% have been associated with bicycle accidents, 3.5% with scooter accidents and 2.5% with car accidents. Children and teenagers who live in areas with a low social economic level have been the fewest to seek medical attention due to difficult access to medical services. CONCLUSIONS: Overall, this study wanted to present the importance of knowing the frequency of dental trauma in children and teenagers and to point out the need of promoting medical education to parents regarding the means they can use to reduce the risk factors associated with dental trauma.

The essential role of cone beam computed tomography to diagnose the localization of impacted maxillary canine and to detect the austerity of the adjacent root resorption in the Romanian population.

UNLABELLED: The impaction phenomenon is a pathological condition which is defined as the lack of eruption of a permanent tooth in the oral cavity. After third molar, the first permanent tooth impacted in the alveolar bone is the permanent maxillary canine, with varies from 1% to 3%. The aim of this study was to use the most recently imaging technique--CBCT, to evaluate the position of the impacted maxillary canine and to determinate the severity of root resorption of the adjacent teeth. MATERIAL AND METHODS: The all 230 patients of this study were referred to a CBCT scanning with Scanora machine and only the region of clinical interest was irradiated. RESULTS: The age of the subjects was distributed between the ages of 11 and 42 years. From a total of 364 impacted canine teeth, 92 were side impacted canines, 97 right impacted canines and 87 were left impacted canines. DISCUSSION: We report a lateral incisors root resorption present in 54.37% and 24.29% the resorption of central incisors. CONCLUSIONS: The use of CBCT in patients with impacted canines has potential diagnostic and may influence the planning of treatment. Also the CBCT can be a genuine method used to rectify, to diagnose and to make a suggestive treatment for the resorption of the root of incisors.

[Correlation between the lower first permanent molar axis and the premature loss of temporary molars]. / Relatia dintre axul molarului prim permanent mandibular si pierderea prematura a molarilor temporari.

UNLABELLED: The aim of our study was to determine the impact of premature loss of temporary molars upon the longitudinal axis of the first permanent molar. MATERIAL AND METHOD: The study sample was formed by 94 orthopanthomografies of child patients with premature loss of lower temporary molars (first or second) after clinical eruption of the first permanent molar. All panoramic radiographs have been realized with the same panoramic unit with 1.4% magnification coefficient and were analyzed using a standardized technique of tracing the images of teeth and bone on matte acetate paper. It was evaluated the angle between longitudinal axis of first permanent lower molar and occlusal plane. RESULTS: It was observed that premature loss of lower second deciduous molar modifies greater the vertical axis of first permanent molar (between 61 degrees and 79 degrees) then premature loss of first lower primary molar. This is perhaps because the loss of space in the case of premature exfoliation of first primary molar is due more to distal drift of canine then mesial drift of molars. CONCLUSION: The drift to mesial of first permanent molar is more accentuated proportional with the age at which appeared premature loss and so it is loss of leeway space.

[Clinical, computerized tomography and pathological findings of lesions in the parapharyngeal space]. / Aspecte clinice, computertomografice si anatomopatologice intâlnite in leziunile spatiului parafaringian.

UNLABELLED: We present the clinical, computer tomografic and patological findings of current lesion of the parapharyngial space. MATERIAL AND METHOD: We retrospectivly analised the clinical, cross-sectional imaging files and the patological results for 33 patients explored during January 2006-March 2008 by a medical team at the "Prof. Dr. N. Oblu" Clinical Hospital. RESULTS: In our study we didn't find primitive lesions in the parapharyngial space but, we explored 33 lesions extended in the parapharyngial space with origins around the parapharyngial space. The most frequent hystological types of tumor were represented by squamous cell carcinoma of nasopharyngs (n = 22), followed by primitive lesions in to the infratemporal phosa (n = 5). We had also 2 tumoral cases of the parotyd gland, one of the skull base and 3 facial fractures with involvement in to the parapharyngial space. CONCLUSION: The infiltrations of parapharyngial space by different lesions require Computer tomographic exams for a precise evaluation of the extension of the lesions, evenetual lymph node metastasis, the presence of tumoral recidive and the orientation to a imagistic diagnosis which will be confirmated by a patological exam. The multidisciplinary approach of these lesions will permit a proper terapeutical management to each case.

[CT exam and 2D and 3D reconstructions in facial tumors diagnosis]. / Aportul examenului CT si al reconstructiilor 2D si 3D in diagnosticul tumorilor masivului facial.

UNLABELLED: This study presents the CT imaging of a group of maxillofacial tumors that include benign tumors and primary and secondary malignant processes. MATERIAL AND METHOD: All patients were CT explored with and without intravenous contrast, using specific head and neck protocols. RESULTS: We studied the topography of the tumors, their impact on neighborhood regions and post-treatment results. The diagnostic of all patients had histological confirmation. In maxillofacial tumors and tumor-like diseases, 3D imaging was significantly superior to 2D axial imaging in showing the tumor shape and spatial relationships between tumors and surrounding structures. Two dimensional imaging and MPR imaging were excellent to reveal internal structure and pathological changes of tumors. 2D imaging and MPR imaging also achieved better results in showing tumors extended to soft tissues.