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.

Radiological and optical coherence tomography aspects in external root resorption.

Pathological external root resorption is a process by which the hard tooth substance is lost because of action of different local irritative or systemic factors. Six forms of external root resorption are described: surface external root resorption, inflammatory external root resorption, replacement external root resorption, invasive external cervical root resorption, ankylosis and transient apical breakdown. The objective of the study was to establish the prevalence of the pathological root resorption in a retrospective radiological study, to highlight radiological aspects of external root resorption and to describe optical coherence tomography (OCT) aspects in pathological root resorption. External root resorption prevalence in our study was 17%. Radiological exam was very useful to detect the form of root resorption but also to establish possible etiological factors. The study presents the radiological aspects of some forms of pathological external root resorption highlighted on radiography accompanied by radiolucency of the adjacent bone to resorption lesion (as in inflammatory external root resorption and in invasive cervical root resorption) or as changes of the root form, in which the missing part of the root is replaced by the bone tissue, without radiolucency (as in replacement root resorption). The comparison of the OCT aspects of the physiological root resorption in primary teeth with the OCT aspects of pathological root resorption in permanent teeth showed an obvious difference between the images of the OCT signal of the two types of resorption. The OCT signal from the cement is stronger in pathological root resorption, and the OCT signal from the dentin in teeth with inflammatory external root resorption showed a demineralized dentin with multiple heterogeneities, anfractuosities corresponding to resorption craters, with craze lines in subjacent layers of dentin.

An evaluation of a collagen-based material osseointegration.

The aim of this study is to evaluate the osseointegration of a collagen-based material Alveoprotect, suitable for socket preservations, while preserving the vestibular bone lamella. This material is intended to be used in the field of implantology for smaller bone defects. Thus, 3-mm diameter experimental cavities were carried out on the calvaria and maxilla of 18 laboratory Wistar rats. The cavities were augmented with the collagen fleece Alveoprotect or left unaugmented as a control group and half of the laboratory animals were sacrificed after two months, and the other half after four months in order to evaluate in vivo the way in which the inserted material is osseointegrated. The obtained samples were submitted to a histological and immunohistochemical study. The bone defects healing followed the same pattern in all the three groups, but the bone wound healing evolution in the cases augmented with material Alveoprotect offered spectacular results especially in the cavities prepared in the calvaria. On the histological samples, we generally noticed the experimental defects filling with connective tissue with various bone ingrowths from the surrounding bone tissue. The collagen-based material Alveoprotect appeared as a biocompatible augmentation material that can be used successfully for the maintenance of bone volume in the case of small bone defects.

The Role Played by Growth Factors TGF-ß1, EGF and FGF7 in the Pathogeny of Oral Pseudoepitheliomatous Hyperplasia.

Pseudoepitheliomatous hyperplasia is an epithelial proliferation that develops in the dermis or lamina propria. It is a lesion associated to another pathology, which appears as a response to a great variety of infectious, neoplastic, inflammatory or traumatic stimuli. The etiopathogeny of this lesion is not clear yet. Therefore, we performed an immunohistochemical study on a group of 20 cases of pseudoepitheliomatous hyperplasia cases associated with inflammatory and neoplastic conditions, by investigating TGFß1 (Beta growth and transformation factor), EGF (Epidermal growth Factor), and FGF7 (Fibroblast growth factor) expressions during in its development. The TGF-ß1 expression was recorded in all the layers of the oral hyperplastic epithelium, going from the basal to the superficial layers, but with a different immunoreactive pattern, according to the region. Our study showed the absence of EGF immunoexpression in the carcinomatous proliferation areas associated to pseudoepitheliomatous hyperplasia and an almost exclusive presence in the hyperplasia lesions associated with inflammatory conditions (in about 30% of the investigated lesions) of a expression varying from poor to moderate for EGF. According to our investigations, we observed the presence of an immunolabeling for FGF7 in 80% of the investigated cases of pseudoepitheliomatous hyperplasia, a maximum of intensity being observed within the cases associated with inflammatory conditions.

Histopathological Study of Oral Pseudoepitheliomatous Hyperplasia.

Pseudoepitheliomatous hyperplasia, also called Heck's disease, is an epithelial, inconstant and conjunctive proliferation that develops as a response to a great variety of stimuli. It is a lesion associated to different diseases, being found in the following etiopathogenic conditions: infectious pathogenic conditions, tumoral pathogenic conditions, inflammatory pathogenic conditions. We studied oral pseudoepitheliomatous hyperplasia for which we performed a histopathological study, on a group of 47 cases of oral pseudoepitheliomatous hyperplasias, where we investigated the following: oral epithelium changes, changes in the underlying lamina propria and associated etiopathogenic conditions. The main changes of the oral epithelium were: elongation of the epithelial apexes (17.02%), acanthosis (100%), dyskeratosis (14.89%), and in the underlying lamina propria: fibrosis (29.78%), inflammatory infiltrate (70.21% and vascular proliferation (10.64%). The most frequent associated etiopathogenic conditions were the infectious ones (55.31%), followed by the tumoral ones (29.79%), on the last place being the inflammatory conditions (14.89%).

Experimental animal model in a histological study of drug-induced gingival overgrowth.

Gingival overgrowth (GO) is a pathology with important aesthetic and functional implications and with a multifactorial pathogenesis. Incriminated etiological factors include antihypertensive, antiepileptic and immunosuppressant medication. We aimed to evaluate the induction of gingival overgrowth on experimental rats, depending on the drug type, dose and duration. In the research conducted by us, the increase in gingival tissue production occurred gradually, depending on the administered medication and the time elapsed after its start. The study conducted shows that experimentally induced gingival overgrowth of the administered drugs is made possible by altering tissue homeostasis through altering the fibrocyte cell populations involved in the tissular turnover as well as those involved in the inflammatory process. A better understanding of the pathogenesis of this undesirable effect may lead to the development of improved management strategies for preventing it, or reducing it through non-surgical methods.

Clinical, imagistic and histopathological study of chronic apical periodontitis.

Periapical lesions are among the most frequent periodontal pathologies in human teeth, generally called apical periodontitis. Apical periodontitis is a continuation of the endodontic space infection and it is manifested as a response of the host defense against the microbial action. It may determine local inflammation, hard tissue resorption, destruction of other periapical tissues. The preliminary diagnosis of chronic periapical lesions is based on the clinical symptoms and imagistic investigation, which represent a reliable diagnosis instrument, but the histological investigation remains essential for a certain diagnosis. We performed a clinical and histological study of the periapical lesions, evaluating the various clinical and imagistic aspects and we compared them with the results of the histological examination, in order to establish the correspondence between the clinical-imagistic aspects and the morphological ones. The relation between the histological aspects, the clinical signs and imagistic aspects may provide valuable data both for establishing an accurate diagnosis and for adopting the most efficient treatment.

Study of some invasiveness markers as pathogenic factors in oral pseudoepitheliomatous hyperplasia.

Pseudoepitheliomatous hyperplasia is a benign reactivated epithelial lesion secondary to another pathology, whose incidence is difficult to establish. There still exist controversies regarding the origin and pathogenesis of these lesions. For this purpose, we performed an immuno-histochemical study upon 20 cases of oral pseudoepitheliomatous hyperplasia associated with inflammatory and neoplastic conditions, investigating a series of markers with a possible pathogenic potential in developing this type of lesions. Thus, the immunoreactivity study for ß-catenin showed the presence of a membrane reactivity in all the stratum spinosum and a predominantly cytoplasmatic reactivity, more rarely a nuclear one, in the cells of the basal stratum cells, especially in the epithelial apices that descend deeply in the chorion. Instead, in the case of vimentin, the reactivity was present only in the epithelial apices, especially in the peripheral cells, in comparison to the central ones, and especially in the cases where the epithelial apices descended deeply in the sublesional chorion. Moreover, we observed that the MMP9 reactivity in pseudoepitheliomatous hyperplasia lesions was present in the cells at the epithelium-chorion interface and especially in the epithelial apices that descend deeply into the chorion, and also in the epithelial chorion and networks. The study for CXCR4 immuno-reactivity showed a good reactivity in almost all layers of this hyperplastic lesion, with a maximum reactivity especially inside the epithelial apices that descend deeply in the sublesional chorion. Such an immunoprofile suggests the ability of the oral epithelial cells to undergo an epithelial mesenchymal transition process, thus acquiring mesenchymal characteristics through which it deeply migrates in the subadjacent chorion and contributes to the formation of epithelial apices in pseudoepitheliomatous hyperplasia. Moreover, the invasive ability of these lesions is also given by the average quantity of matrix metalloproteinases present in the epithelium-chorion interface determined by the activation of CXCR4 receptors at this level.

Local cause of gingival overgrowth. Clinical and histological study.

The overgrowth, depending on its extension, has multiple effects on the stomatognathic apparatus: functional disorders (impaired speech), difficulty in chewing and aesthetic problems but can cause significant psychological problems. We proposed this study, motivated by the relative increased frequency of the gum outgrowth, its multifactorial etiopathogeny, but especially from the point of view of the specialist practitioner, by the problems that this pathology raises not only for the functionality of the stomatognathic apparatus but also for the facial esthetics, and especially for future therapeutic attitudes needed to solve the existing pathology at this level. We conducted a clinical study and a histological one. For the clinical study, we selected 74 patients who experienced different degrees of gingival outgrowing associated with fillings, dental caries, fixed prostheses, mobile prostheses, orthodontic apparatus. Thirty gingival fragments from patients with gingival outgrowing were processed by paraffin-embedding histological technique and stained with Hematoxylin-Eosin. The morphological results obtained provide the necessary support for understanding the possibility of developing a therapeutic strategy to prevent or minimize the gum outgrowth by administering antibiotic and anti-inflammatory medications associated with medications, which shall cause the apoptosis of the fibroblasts.

Study of CK18 and GDF5 immunoexpression in oral squamous cell carcinoma and their prognostic value.

Oral cavity cancer remains one of the most common cancers worldwide, with an increased incidence in young adults, although there has been lately a decrease tendency in the incidence of this form of cancer. Lingual localization has a very high mortality and tends to be more aggressive becoming frequently metastatic at the regional lymph nodes. The purpose of this study is to investigate the immunohistochemical expression of cytokeratin 18 (CK18) and the reactivity to GDF5 (CDMP-1), called the morphogenetic protein-1, cartilage-derived, in lingual squamous cell carcinoma and the correlation between the immunoreactivity of this panel of antibodies, and the clinical stage, the degree of differentiation and the invasion pattern. In this regard, we studied the immunohistochemical behavior of these markers in 15 cases of lingual squamous cell carcinoma. In our study, we observed the correlation of CK18 and GDF5 expression with the clinical stage, differentiation degree and invasion pattern, the highest levels of immunoreactivity being recorded in poorly differentiated forms, in high-level invasion patterns and in the most advanced stages. The markers used can become therapeutic targets, which could help increase the quality of life and life expectancy for these patients.

The histopathological study of radicular dentinal changes in patients with chronic marginal periodontopathies.

Periodontal disease is one of the most frequent conditions in individuals, having major health and social implications. Progressing as a chronic inflammation at the level of tooth support tissues, untreated chronic periodontitis may lead to a premature loss of the dental organ. Even though the main lesions caused by the periodontal disease affect the alveolo-dental ligaments, we tried to highlight the presence of certain lesions of radicular dentine in patients with chronic marginal periodontopathy. In our study, in the patients with chronic marginal periodontopathy, at periodontium level, there was highlighted the presence of a chronic inflammatory process with numerous lymphocytes and macrophages, microhemorrhages, and also areas with tissular necrosis. At radicular dentine level, in the cases of old, untreated periodontal disease, there were observed areas of more or less extended demineralization, erosion and necrosis. Our study showed that chronic periodontal disease may affect the tooth, as well, not only its support tissues.