A denture complication: sarcoid-like foreign body granulomas of the tongue

Sarcoidosis in the oral cavity occurs extremely rare (there have been described only 47 cases in the literature) and is almost always doubtful. We describe a protruding painful nodule (1 cm) on the apex of the tongue of a 65-year-old female, adjacent to the site of irritation of a new denture. Histologically it was confluent mass of non-caseous granulomas, rich in Langhans' cells. Silver impregnation showed them stamped out as in sarcoidosis. Corticosteroids proved to be ineffective and the therapy was discontinued because of the concomitant diabetes. Six months later, similar nodules reappeared on the same place. When examined in polarized light these giant cells were found to be of the foreign body type, each of them containing phagotized particles displaying bright yellow and dark green colour. We assume a sarcoid-like reaction of traumatic origin. There was no recurrence of the condition after removal of the denture.     

Sectio ceasarea isthmicolongitudinalis--a forgotten beginning and/or groundless fear?

A retrospective analysis of the frequency, indications, intra- and postoperative complications in isthmicotansverse (ITS) and isthmicolongitudinal (ILS) cesarean section has been conducted with a view to justifying the wider application of ISL in modern obstetrics. For a five-year period (1996-2000) at the Obstetrics and Gynecology Clinic of St. Ann Hospital-Sofia a total of 522 cesarean section were performed of which 348 (66.7%) with isthmicotansverse incision and 174 (33.3%) with isthmicolongitudinal incision. The data show that ILS were ith less blood loss and with less intra- and postoperative complications and it was applied in all types of obstetric indications and urgent cases. Having in mind the good results and the fact that ILS is a technique which could be performed by every obstetrician familiar with ITS, The authors are convinced that isthmicolongitudinal cesarean section can find a wider application in everyday obstetric practice.     

Amplification of protooncogenes in human ovarian carcinomas

Amplification of the proto-oncogenes c-myc, c-erbB2, c-K-ras2, c-H-ras1, c-erbA1, c-int2 and c-fms was studied by Southern-blot analysis of DNA extracted from 27 primary ovarian carcinomas. In addition, karyotype analysis and interphase cytogenetics using fluorescence in situ hybridization (FISH) were applied to control the chromosomal variability of the tumors. By these additional analyses the possibility of a false estimation of the grades of amplification should be diminished. In nearly 50% of the studied tumors a low to moderate (2- to 10-fold) amplification of one or more oncogenes was detected. The proto-oncogene amplified most frequently was c-myc (11 tumors), followed by c-erbB2 and c-Kras2 (3 tumors each), c-fms (2 tumors), and c-int2 (1 tumor). Neither an amplification of c-erbA1 nor of c-H-ras1 could be detected in any of the tumors. Some of the tumors showed a simultaneous amplification of two or three oncogenes. The pattern of proto-oncogene amplification clearly differentiates the studied ovarian cancers from breast tumors, but also differs from some previous results obtained from ovarian carcinomas.     

Mandibular fracture complications associated with the third molar lying in the fracture line

A retrospective study of 622 patients (551 men and 71 women, age range 14-63 years) with 650 mandibular fractures crossing the third molar was conducted. In 183 patients (193 fracture lines) the wisdom tooth was retained or partially erupted and in 439 patients (457 fractures) the wisdom tooth in the fracture line was normally situated in the dentition. The analysis showed no statistically significant difference in the complication frequency associated with the extraction of retained or erupted wisdom teeth (12.50% and 8.37%, respectively). In treatment of fractures with retention of the wisdom tooth in the fracture line the complications with the totally erupted and normally situated third molars were more frequent than those with the unerupted third molars (20.70% vs 7.69%). The analysis of the complications according to the applied method of treatment shows that the complications in open (operative) reposition and fixation of the fragments were more frequent with unerupted (20.00%), as well as with erupted wisdom teeth (24.13%). With closed (non-operative) fracture treatment the complications were respectively 7.30% with the unerupted and 11.33% with the erupted wisdom teeth. On the basis of the obtained results conclusions are made for the practice.     

Alveolar echinococcosis-spreading disease challenging clinicians: A case report and literature review

Human alveolar echinococcosis (AE) is a potentially deadly disease; recent studies have shown that the endemic area of Echinococcus multilocularis , its causative agent, is larger than previously known. This disease has low prevalence and remains underreported in Europe. Emerging clinical data show that diagnostic difficulties are still common. We report on a 76-year old patient suffering from AE lesions restricted to the left lobe of the liver who underwent a curative extended left hemihepatectomy. Prior to the resection a liver biopsy under the suspicion of an atypical malignancy was performed. After the intervention he developed a pseudoaneurysm of the hepatic artery that was successfully coiled. Surprisingly, during surgery, the macroscopic appearance of the tumour revealed a growth pattern that was rather typical for cystic echinococcosis (CE), i.e. , a gross tumour composed of multiple large vesicles with several centimeters in diameter. In addition, there were neither extensive adhesions nor infiltrations of the neighboring pancreas and diaphragm as was expected from previous imaging results. The unexpected diagnosis of AE was confirmed by definite histopathology, specific polymerase chain reaction and serology results. This is a rare case of unusual macroscopic presentation of AE that posed immense diagnostic challenges and had an eventful course. To our knowledge this is the first case of an autochthonous infection in this particular geographic area of Germany, the federal state of Saxony. This report may provide new hints for an expanding area of risk for AE and emphasizes the risk of complications in the scope of diagnostic procedures and the limitations of modern radiological imaging.     

Surgical diseases of thyroid gland

Medical reports of 8,768 patients with various diseases of thyroid gland were analyzed. There were 1,563 (17.8) male and 7,201 (82.2%) female patients aged 6 to 86 years. One-nodular goiter was diagnosed at 13.85% patients, multinodular goiter - at 67.2%, diffuse toxic goiter - at 5.85%, thyreotoxic adenoma - at 4.91%, Hashimoto's thyroiditis - at 8.16% patients. Thyroid cancer was revealed at 1.56 patients with nodular goiter, at 8.45% - with multinodular goiter, at 2.72% - with diffuse toxic goiter, at 3.71% - with thyreotoxic adenoma, and at 27.09% patients with Hashimoto's thyroiditis. Totally thyroid cancer was diagnosed at 741 (8.45%) patients including 71.12% papillary cancer, 26.47% follicular cancer and 2.42% medullar (anablastic) cancer. Some patients had metastases. It is concluded that all the patients with goiter should be operated. At diffuse toxic goiter the surgical treatment is indicated at the patients with recurrences or after 6 - 12 months of conservative treatment without clinical improvement.     

Therapy of ovarian inactivity in postpartum Bulgarian Murrah buffaloes by PRID and Ovsynch estrus synchronization protocols

ObjectiveThe aim of the present study was to assess therapeutical effect of modified Ovsynch and PRID estrus synchronization protocols in Bulgarian Murrah buffalo with inactive ovaries during the low-breeding season.MethodsThe study was carried out in 46 Bulgarian Murrah buffaloes with small inactive ovaries established by two consecutive transrectal ultrasonographies on Day 40 and 50 postpartum. At the start of the therapy the buffaloes were randomly divided into three groups. Group I (n=18) was treated by PRID-based protocol; Group II (n=18) was treated by Ovsynch based protocol and Group III (control; n=10) was injected intramuscular with saline at the same days as in the first two groups and fertile bull was introduced after that. The animals in the different groups were submitted to ultrasound examination at day of artificial insemination or bull introduction. Ovulation was determined 7 days post insemination by ultrasound. The pregnancy diagnosis was done 30 days after insemination. Mean diameter of the largest follicles at the start of therapy and the day of AI was registered. In the hormonal treated buffaloes estrus clinical sings, ovulation rate and pregnancy rate after AI were determined. In the control group pregnancy rate after spontaneous estrus was established. The mean diameter of the largest follicles determined on Days 40 and 50 after calving was not over 9 mm for all buffaloes.ResultsAt day of AI the average diameters of the preo-vulatory follicles in PRID and Ovsynch treated buffaloes were significantly (P<0.01) greater than these on Day 0. The cases of a clear uterine mucus discharge during the induced estrus were significant more (P<0.05) for Group I (94.4%) than Group II (66.7%). The pregnancy rate after AI (56.6% and 38.8%) in PRID and Ovsynch program was significant higher (P<0.05) than pregnancy rate after spontaneous estrus (10%) in the control group.Conclusionsthe treatment of buffalo ovarian inactivity could start on Day 50 postpartum. The PRID and Ovsynch estrus synchronization protocols by substitution of the second GnRH with hCG, could be successfully used for therapy of Bulgarian Murrah buffaloes with inactive ovaries during the low-breeding season.     

Nitric oxide and free stable nitroxyl radicals in the mechanism of biological action of the spin-labeled compounds

A comparison of more important physical, chemical and biological properties of the nitric oxide (NO) and free stable nitroxyl radicals (nitroxides) on the base of their structural similarity is made in the article. The active moiety in the nitroxide molecule represents a sterically hindered nitric oxide. The mechanisms of biological action of the nitroxides and especially of their derivatives with antitumor agents from the groups of nitrogen mustards, nitrosoureas, aziridines and triazenes (spin-labeled compounds) is explained through the biological activities of sterically hindered NO. Similarly to NO, nitroxides also can react with superoxide anion radical (O(2)(-)), they possess superoxide dismutase (SOD) mimetic action. While the interaction of NO with O(2)(-)yields very toxic peroxynitrite (ONOO(-)), its formation is strongly limited in the presence of a nitroxide. It is known that the nitrosourea antitumor drugs, like lomustine (CCNU) and carmustine (BCNU), showed high general toxicity, one of the reasons for that probability is the formation of NO, and subsequently of ONOO(-), during their metabolism. The biological investigations of the nitroxides showed their considerably lower general toxicity that could be explained with the SOD-mimetic action of the nitroxide present in their molecule.