Management and Treatment of Coxarthrosis in the Orthopedic Outpatient Clinic.

Coxarthrosis, or hip osteoarthritis (OA), is one of the main causes of hip pain, which can affect patients of all ages, being one of the most common reasons for patients presenting to the specialized outpatient clinic. The objective of our research was to determine the number of patients with coxarthrosis who presented to the Department of Orthopaedics and Traumatology within the Emergency County Hospital of Drobeta Turnu Severin, between 2017-2019, the sex, age, social environment of the patients. All patients underwent a thorough clinical examination to determine the risk factors, the favouring factors and their correlation with the paraclinical data obtained through imaging investigation (pelvis X-ray, computer tomography and nuclear magnetic resonance). The study included 462 patients, aged between 23 and 89 years old, who were diagnosed with varying degrees of coxarthrosis within the specialized outpatient clinic. The main risk factors were obesity, osteoporosis, chronic smoking, rural environment, female sex, the existence of a hip injury and intense physical exertion. The main purpose of the research was to analyse a series of data, which would bring information on the incidence, distribution by age groups, sex, living environment and professional activity of the population with coxarthrosis, in order to develop a therapeutic management as effective as possible.

Etiology Study of Acquired Developmental Defects of Enamel and Their Association with Dental Caries in Children between 3 and 19 Years Old from Dolj County, Romania.

Background: Developmental defects of enamel (DDE) are frequently encountered in primary and permanent teeth, yet their etiology is not completely known. Enamel hypoplasia is considered a predisposing factor for early caries. The objective of this study was the evaluation of several risk factors potentially causing DDE and the possible association between DDE and dental caries. Methods: This study was performed on a group of 213 rural children from Romania. It combined a thorough dental examination for all children, and a questionnaire filled in by their mothers, regarding the evolution of their pregnancy and the child's health status in the first years of life. Results: There was no statistically significant association between DDE presence and data regarding the evolution of pregnancy, mothers' health status or children's conditions during early childhood. There was a significant association between the use of amoxicillin, ibuprofen, and cephalosporin during the period of formation of permanent teeth, and one environmental factor (water source), and the presence of DDE (Chi Square, p < 0.05). Also, DDEs were associated with the presence of caries (Fisher, p = 0.001). Conclusions: Children who consumed water from private wells and children who received medication during early childhood developed more enamel defects, presenting a higher risk of caries development.

Clinical, histopathological and immunohistochemical behavior of peri-implant soft tissue.

The presence of foreign materials in the tissues, represented in the present study by the insertion of dental implants, creates artificial structures that can sometimes cause adverse consequences, which implies the obligation to perform a complex medical assessment before inserting dental implants. This assessment appreciates the quality of the tissue, depending on which the use of a certain type of biomaterial is indicated and focuses on a certain surgical technique. We assessed the clinical, histopathological (HP) and immunohistochemical (IHC) aspects of peri-implant soft tissue in patients who did not show mobility or imagistic signs of bone resorption, three months after implant insertion, some of them showing no inflammatory clinical signs. Immunohistochemically, on the sections of the peri-implant mucosa, we assessed the presence of mast cells, vascularization and the process of angiogenesis. Mast cells are key cells actively involved in the pathogenesis of peri-implant inflammation, having an immunomodulatory role. Vasodilation and angiogenesis, determined by the release of chemical mediators by degranulation of mast cells under the action of pathogens, induce tissue remodeling, ensuring the healing and formation of a tissue to form a barrier that effectively prevents the development of a bacterial biofilm. Thus, the control of the activity of these cells is important for the management of the local inflammatory process. The correlations between the clinical, HP and IHC behavior of the peri-implant soft tissue bring important information for the clinic, emphasizing the need to identify a therapeutic strategy to modulate mast cell activity, in order to prevent and treat peri-implant disease, to ensure osseointegration and longer survival of the dental implant.

The oral mucosa: Epithelial professional phagocytes, lymphatics, telocytes, and false telocytes.

BACKGROUND: The oral mucosa protects the underlying tissue from mechanical damage as well as from the entry of exogenous particles and microorganisms. Telocytes (TCs) are disputed stromal cells featuring peculiarly long and thin processes with uneven calibre known as telopodes, which play a number of roles within the interstitia. The present study aimed to test the key markers recommended for discriminating between TCs and false TCs in samples of normal oral mucosa. METHODS: Archived paraffin-embedded oral mucosa samples were tested by means of immunohistochemistry with the following markers: CD34, D2-40, CD31 and CD68. RESULTS: The epithelial expression of CD68, D2-40 and CD34 was detected. Two subsets of CD34-expressing stromal cells were identified, large cells with telopodial processes, presumably of the hematopoietic lineage, and spindle-shaped TC-like cells. Macrophages and TC-like cells within the lamina propria expressed CD68. The lymphatic endothelia were found to express CD31 and D2-40, but not CD34. Sprouting lymphangiogenesis was demonstrated by the lymphatic endothelial tip cells, which were projecting thin processes within the connective stroma. CONCLUSIONS: The epithelial expression of CD68 suggests the professional phagocytic potential of the oral epithelium. Regarding the TCs and TC-like cells in the oral mucosa they could not be accurately distinguished from other possible cell types, neither on morphological basis (evidence of telopodes) nor by use of panels of markers which include CD34.

Giant abdominal tumor - would you think adrenal?

Adrenal cavernomas are rare benign tumors, and those of giant dimensions are exceptional. Usually, they are symptomless or they induce symptoms and signs due to compression over nearby organs. We present the case of a 68-year-old woman, who complained of abdominal enlargement and abdominal pain in the left part of the abdomen. Imagistic investigations (native and contrast abdominal computed tomography) revealed an inhomogeneous retroperitoneal mass of 210∕182∕200 mm, containing calcifications. Laboratory findings were not relevant, just a slight and non-significant elevation of carcinoembryonic antigen and a slight elevation of C-reactive protein. Diagnosis of cancer of undetermined origin was considered, and surgery was performed. During surgery, a giant encapsulated inhomogeneous tumor of 330 mm, with cystic areas, was removed, without assessing the origin. Primary or secondary tumors (metastasis from breast, intestinal, lung, renal or skin cancer) were taken into account. Only histopathology and immunohistochemistry revealed the diagnosis of adrenal cavernoma. Until this moment, we found only one published article in the medical literature with similar dimensions of an adrenal cavernoma as in our case. Even if rare, hemangioma of the adrenal gland must be considered during the differential diagnosis of an adrenal tumor.

Immunohistochemical study of experimentally drug-induced gingival overgrowth.

The increasing frequency of using in the medical practice drugs that have the potential to induce gingival overgrowth (GO) and the existence of many unknown aspects in GO etiopathogenesis have prompted us to carry out this immunohistochemical experimental animal study. We conducted a cell proliferation study by Ki67 immunostaining and a cytokeratin (CK) study using anti-pan-CK AE1∕AE3 and anti-MNF116 antibodies, investigating the differences induced by different classes of drugs that are more frequently involved in the induction of GO. The results of our study indicate that CK AE1∕AE3 plays an important role not only in normal cellular proliferation, but also in hypertrophic tissues, and can be considered a marker of the proliferative process occurring in GO. Immunostaining for the anti-MNF116 antibody was weaker and inconsistent in intensity compared to anti-CK AE1∕AE3 antibody, its staining pattern appearing as diffuse or zonal.

A microscopic insight of the morphological changes induced by dental zirconia prosthetic structures.

As zirconia is today probably the dental material with the largest increase in the frequency of use in dental prosthetics, the reason for this study was based on a series of clinical observations made following its use in clinical prosthetics. Thus, we were interested in two aspects: the histological evaluation of the response of the oral soft tissues to the presence of the prosthetic structures in zirconia, and the microscopic evaluation of the abrasion lesions that appeared in the hard dental tissues of the zirconia prostheses antagonists. For the first part, samples from three zirconia-based dental prosthetics commercial products were implanted submucosal in the oral cavity of male Wistar rats. After six weeks, the oral soft tissue reaction was clinically and then histologically investigated. For the second part, we made two study groups to investigate the influence of the zirconia-glazed surface vs. polished surface to the wear pattern of the antagonist enamel, using a tribological equipment and a dedicated software. Our study showed a good clinical response of the oral soft tissues surrounding the inserted zirconia samples, with subclinical, only histological revealed, signs of inflammation, of a foreign body reaction, while polished zirconia samples determined abrasion surfaces, with a different pattern and significantly smaller dimensions, compared to zirconia glazed samples, at the level of the hard dental tissues of the antagonist teeth. Despite the generally good response of the biological structures to the presence of zirconia prosthetic structures in the oral environment, more scientifically proved information is needed to obtain the desired biological responses in all clinical situations.

Constant features of the adult maxillary bone in the site of the premaxillary suture: the sutura notha, Macalister's foramina, Parinaud's canal, and the second angle of the canalis sinuosus of Wood Jones.

Developmental theories regarding the premaxillary (incisive) suture commonly overlook it separates the premaxillary and maxillary parts of the frontal process of maxilla. Thus, one would expect that neurovascular structures within this transitory mesenchymal zone to appear embedded within the adult frontal process of maxilla. The sutura notha (false suture, Weber's sutura longitudinalis imperfecta) is a poorly described, although constantly present, shallow groove in front of the anterior lacrimal crest, being perforated by a row of holes first described, to our knowledge, by Macalister, in 1884. Macalister's foramina should be discriminated anatomically from the accessory infraorbital foramina. Macalister's foramina lead into canals, usually described as vascular, within the frontal process. We demonstrate in cone-beam computed tomography that these canals, which correspond topographically to Parinaud's vascular canal, are connected, usually through a delicate intraosseous network, with Wood Jones' canalis sinuosus (i.e., the ampullar angle of this canal located above the upper canine tooth). As this later carries the anterior superior alveolar nerve and artery, it is reasonable to consider that the canalar network within the frontal process of maxilla could serve for an accessory distribution of that nerve to the nasolacrimal duct, the atrium of the middle nasal meatus, the agger nasi cell, as well as to the infraorbital (prelacrimal) recess of the maxillary sinus.

Clinical, statistical, histological and immunohistochemical aspects of periodontal changes in patients with diabetes mellitus.

BACKGROUND: Both diabetes mellitus (DM) and periodontal disease are the most widespread chronic inflammatory diseases that affect a very large number of the population worldwide. AIM: This study's aim was to compare the status of dental hygiene in a group of patients with DM, with patients in the control group, and to histologically analyzing the gum from the subjects with DM. PATIENTS, MATERIALS AND METHODS: The study sample was made up of 53 control subjects and 107 diabetics aged 19-80 years old. We evaluated the following parameters: the plaque index (PI) and the calculus index (CI), according to Simplified Oral Hygiene Index, and the gingival index (GI), according to the Löe & Silness criterion, correlated with glycosylated hemoglobin and the blood sugar levels. RESULTS: For all hygiene indices, the mean values recorded for the control group were significantly lower than the mean values recorded for any sub-category in the diabetic groups. CONCLUSIONS: DM contributes unfavorably to the evolution of periodontal disease. The poor glycemic control and the improper oral hygiene have a negative impact on the health of the periodontium, highlighted by increased scores on PI, CI and GI scales.

The evaluation of the morphological evolution of the tissue integration of dental implants through conventional histology and immunohistochemistry techniques.

Soft peri-implant tissues are important to ensure the integration of a dental implant, and information on their morphophysiology may explain some clinical failures. Through this study, we aim to contribute to a better understanding of the behavior of peri-implant soft tissue, the morphological support being the one that can explain the different clinical situations. Thus, we sought to reconcile clinical, histopathological and immunohistochemical (IHC) aspects of soft peri-implant tissue, in patients who did not show clinical mobility or radiological signs of bone resorption four months after insertion of implants, some of them showing no clinical signs of inflammation. Immunohistochemically, we highlighted the cellular populations participating in the inflammatory process present in the peri-implant mucosa, in the two groups of patients. The IHC identification of these types of cells and the degree to which each of them was represented by the use of monoclonal antibodies can provide additional insight into the local response of peri-implant soft tissue in healing and osseointegration. This helps the clinician to improve the clinical success of dental implant treatment because the soft tissue surrounding the dental implant separates the implant from the oral cavity and makes a biological seal that prevents the development of the peri-implant pathology. Thus, the soft tissue surrounding the dental implants ensures the conditions of osseointegration and hence the long-term survival of an implant.