Adjacent Connective Tissue Research Articles

Validation of Ultrasound for Quantification of Knee Meniscal Tissue: A Cadaveric Study

Background: While MRI is the gold standard for meniscal assessment, its cost and accessibility limitations have led to growing interest in ultrasound, though its validity for quantifying meniscal tissue remains unclear. To validate the use of ultrasound in quantifying meniscal tissue across the anterior, middle, and posterior regions of both menisci (medial and lateral) in longitudinal and transverse planes by comparison with cadaveric dissection. Methods: A cross-sectional study was conducted on ten cryopreserved anatomical donors, obtaining a total of 120 ultrasound scans from the different meniscal regions. Following ultrasound imaging, cadaveric dissection was performed to facilitate photometric measurements, thereby enabling validation of the ultrasound findings. The intra-examiner reliability of the ultrasound measurements was also assessed. Results: The intra-examiner reliability of ultrasound measurements ranged from moderate to excellent. A strong and statistically significant positive correlation was observed between ultrasound and photometric measurements across all meniscal regions (r > 0.821; p < 0.05). In the medial meniscus, ultrasound visualized 99.1% of the anterior region (8.71 mm with ultrasound; 8.64 mm with photometry), 96.3% of the middle region (9.09 mm with ultrasound; 9.39 mm with photometry), and 98.5% of the posterior region (10.54 mm with ultrasound; 10.61 mm with photometry). In the lateral meniscus, ultrasound visualized 107.1% of the anterior region, 105.1% of the middle region, and 97.8% of the posterior region. The observed excess in tissue visualization in some regions likely reflects the inclusion of adjacent connective tissue, indistinguishable from meniscal tissue on ultrasound. Conclusions: Ultrasound is a valid and reliable modality for visualizing most meniscal tissue across regions, with a measurement discrepancy under 0.7 mm compared to anatomical dissection. However, caution is advised as adjacent connective tissue may sometimes be misidentified as meniscal tissue during evaluations.

Surgical Treatment of Synovial Cyst in Scapholunate Joint

Ganglion cysts are the most common soft-tissue mass in the hand and wrist, making up 50% to 70% of all masses. They are most common in individuals in their twenties and forties, with women being affected three times more than males. The primary symptoms reported by people with wrist ganglion cysts are pain, weakness, and a visually unappealing look. Approximately 10% of patients report a prior traumatic experience being linked to the emergence of a ganglion cyst. Surgical treatment is often performed on an outpatient basis, using general anesthesia or axillary block anesthesia. A pneumatic tourniquet ensures a field without blood. Using a magnifying loupe is recommended to avoid detecting the pedicle and its connection to the ligaments below. Dorsal ganglion cysts involve making a transverse incision immediately above the cyst, dislodging the primary cyst from surrounding tissues using tenotomy scissors. Angelides' approach involves making a curved cut through the capsule next to the cyst, allowing for the removal of capsular attachments and mucin ducts. To alleviate severe pain caused by dorsal ganglion cysts, it is recommended to surgically remove the posterior interosseous nerve above the extensor retinaculum. Volar wrist ganglion cysts involve making an incision along the radial side of the cyst, enabling both proximal and distal extension to reach distant capsular attachments. The ganglion is released from all adjacent connective tissue, and the radial artery is moved both towards the body and away from it. Precise control of bleeding is achieved using bipolar electrocautery, and the wound is thoroughly flushed with fluid. Skin margins are infused with a prolonged-acting local anesthetic, and the wound is sealed with intermittent 4-0 or 5-0 nylon sutures. Prompt mobilization is recommended, but a splint is not used until significant dissection has occurred. Article Details

Basement Membranes, Brittlestar Tendons, and Their Mechanical Adaptability.

Basement membranes (BMs) are thin layers of extracellular matrix that separate epithelia, endothelia, muscle cells, and nerve cells from adjacent interstitial connective tissue. BMs are ubiquitous in almost all multicellular animals, and their composition is highly conserved across the Metazoa. There is increasing interest in the mechanical functioning of BMs, including the involvement of altered BM stiffness in development and pathology, particularly cancer metastasis, which can be facilitated by BM destabilization. Such BM weakening has been assumed to occur primarily through enzymatic degradation by matrix metalloproteinases. However, emerging evidence indicates that non-enzymatic mechanisms may also contribute. In brittlestars (Echinodermata, Ophiuroidea), the tendons linking the musculature to the endoskeleton consist of extensions of muscle cell BMs. During the process of brittlestar autotomy, in which arms are detached for the purpose of self-defense, muscles break away from the endoskeleton as a consequence of the rapid destabilization and rupture of their BM-derived tendons. This contribution provides a broad overview of current knowledge of the structural organization and biomechanics of non-echinoderm BMs, compares this with the equivalent information on brittlestar tendons, and discusses the possible relationship between the weakening phenomena exhibited by BMs and brittlestar tendons, and the potential translational value of the latter as a model system of BM destabilization.

Beyond the Norm: Exploring Mucocele on the Attached Gingiva - A Case Report

Introduction Mucocele is a commonly encountered lesion in the oral mucosa, resulting from alterations in minor salivary glands. There are two histological types - extravasation and retention, with distinct causative factors such as trauma leading to duct severance and mucin spillage into adjacent connective tissue, and obstruction, respectively. Clinically, mucoceles manifest as soft, bluish, and transparent cystic swellings, often resolving spontaneously. Painless yet troublesome, mucoceles can disrupt eating or speaking and, when untreated, may lead to a persistent bump on the inner lip. Treatment options include surgical removal, micro marsupialization, cryosurgery, steroid injections, and CO2 laser. Materials and Methods In this case study, we present the case of a 10-year-old female patient with a painless, gradually progressing swelling in the anterior mandibular labial gingiva. Conclusions Treatment involved conservative surgical intervention, confirming the suspected clinical diagnosis of mucocele through radiographic assessments, substantiated by histological examination. Key Words Labial gingiva, Minor salivary glands, Mucocele, Oral Mucosa

The challenge of pharmacotherapy for musculoskeletal pain: an overview of unmet needs.

Musculoskeletal disorders are characterized by several impairments, including pain, affecting muscles, bones, joints and adjacent connective tissue, resulting in temporary or permanent functional limitations and disability. Musculoskeletal pain is particularly prevalent worldwide and greatly impacts the quality of life, social participation and economic burden. To date, several issues persist about the classification of musculoskeletal pain and its management strategies and resources. The treatment of musculoskeletal pain conditions is complex and often requires a multimodal approach, including pharmacological and non-pharmacological therapy that might be ineffective in many cases, resulting in poor patient satisfaction and controversial expectations about the potential benefits of available interventions. This manuscript provides an overview of unmet needs in managing musculoskeletal pain, particularly focusing on pharmacotherapeutic pitfalls in this context.

Imaging Findings in Pediatric Musculoskeletal Infection and Inflammation

Infections and inflammatory conditions of immature musculoskeletal systems in pediatric patients also affect the adjacent muscles, connective tissues, and joints. Rapid diagnosis leading to appropriate treatment can significantly impact the occurrence of complications and mortality rates due to these conditions. When a radiologist becomes familiar with the imaging findings of pediatric musculoskeletal infections and inflammatory diseases, rapid differential diagnoses and more timely and appropirate treatment could be possible. In this paper, we introduce the imaging findings of infectious and inflammatory diseases affecting the immature musculoskeletal system, such as osteomyelitis, pyogenic arthritis, juvenile idiopathic arthritis, and hemophilic arthritis, based on the anatomical and pathophysiological characteristics of the immature musculoskeletal system in children.

SAT563 Follicular Thyroid Cancer Masquerading as Chest Wall Mass With an Aggressive Course

Abstract Disclosure: I. Goyal: None. E. Punni: None. L. Adhikari: None. Introduction:Follicular thyroid cancers (FTC) are more aggressive than papillary thyroid cancer and usually have more advanced tumor stage at the time of presentation. Musculoskeletal metastases are rare though, but when present can cause various complications like pathological fractures and nerve compression. Clinical case:A 75-year-old female was seen in orthopedics clinic for a left infraclavicular chest wall mass. MRI chest showed a large destructive mass invading the manubrium. Biopsy showed follicular cells consistent with ectopic thyroid tissue. CT neck/chest showed 2x1.8 cm right thyroid lobe nodule and left sternoclavicular joint metastasis. She underwent total thyroidectomy and resection of portions of manubrium, left clavicle and left 1st and 2nd rib. Pathology showed FTC in right thyroid lobe, measuring 2.6 cm in greatest dimension with angioinvasion, and FTC of manubrium, adjacent connective tissue and sternoclavicular joint and ribs, measuring 6.3 cm in greatest dimension. Pathological TNM staging was pT2N0M1. Her 6-week post-op thyroglobulin (Tg) level was 28.7 ng/mL (Beckman Coulter Immunometric Assay, reference value <0.1 athyrotic). She was started on levothyroxine supplementation to achieve a TSH <0.01 uIu/mL. She was subsequently treated with 200 mCi of radio-active iodine (RAI) as adjuvant therapy. Post-therapy whole body scan showed increased activity in the right strap muscle and iodine-avid osseous metastasis in right hemisacrum. She further received radiation therapy to neck and sternal regions, and the right sacroiliac joint. Following this, patient was monitored with serial Tg panel and neck ultrasound (US). Her initial post-op US neck showed a soft tissue fullness in right thyroidectomy bed, concerning for residual disease but this was no longer seen after 3 months. Her Tg level downtrended from 28.7 ng/mL to 12.6 ng/mL and further to 1.8 ng/mL at 1-year follow-up. However, her course was complicated by development of several oral ulcers resulting from high-dose RAI therapy which were treated symptomatically with hydration, topical analgesics and Listerine mouth washes. The patient reported ongoing bowel incontinence since her initial cancer diagnosis. MRI pelvis showed rim-enhancing 4.5cm lesion centered at right sacral ala and extending into adjacent S1/S2 neural foramina. She was re-referred for palliative radiation therapy.Conclusion:This case of FTC is unique due to its uncommon initial presentation. Skeletal metastases to sacrum resulted in bowel incontinence in our patient. When present, skeletal metastases need treatment with high-dose (200 mCi) RAI. RAI therapy can cause xerostomia, hypogeusia and sialadenitis due to reductions in salivary flow. Clinicians should be aware of the early and late-onset complications of RAI therapy, discuss these with the patient before therapy and manage the complications adequately if these occur. Presentation Date: Saturday, June 17, 2023

Disseminated neoplasia in cultured hard clams (Mercenaria mercenaria).

Marine bivalves are commonly affected by disseminated neoplasia of presumed hemocytic origin (i.e., hemic neoplasia and hemocytic neoplasia). Histopathology of 520 cultured hard clams (Mercenaria mercenaria) from Florida was performed for health surveillance over a consecutive 13-month period. Disseminated neoplasia was identified in 9 of 520 animals (1.7%). The neoplasia was characterized by the presence of large, round to oval, anaplastic cells within hemolymphatic vessels and sinusoids with variable infiltration into adjacent connective tissues of the visceral mass, mantle, foot, and/or adductor muscles. Frequent involvement and/or infiltration of the gill was also identified (5/9). Disseminated neoplasia in other species of clams, mussels, and cockles is considered a transmissible disease. At this time, it is unknown if these hard clams represent de novo development of the disease or potential transmission; however, this report expands both the geographic and host range for this condition.

Pathogenetic aspects of the development of psoriatic arthritis in people with generalized chronic periodontitis

The pathogenetic mechanisms of progression of chronic periodontitis and psoriatic arthritis have common components in immune and inflammatory responses.The pathogenesis of chronic periodontitis involves interaction of microbial and immunological components. As a chronic immune-mediated inflammatory disease and a consequence of an infectious trigger that originally affects gingival soft tissue, periodontitis is typically characterized by periodontal destruction and damage to adjacent connective tissues. Neutrophils contribute to the development of periodontitis and participate in its progression by recruiting T helper 17 cells and stimulating synthesis of the receptor activator of the nuclear factor kappa-β ligand (RANKL), contributing to bone resorption.Macrophages as producers of proinflammatory cytokines (interleukin (IL)-1β, IL-6, IL-22, IL-23, tumor necrosis factor (TNF)), free radicals, and matrix metalloproteinases contribute to the chronic course of the disease. Tissue destruction results in generation of reactive oxygen species by neutrophils, which, against the background of a decrease in the antioxidant potential, leads to development of oxidative stress. These processes together lead to tooth mobility, formation of periodontal pockets, and bone resorption.The key factors in the formation of psoriatic arthritis against the background of periodontitis are overproduction of proinflammatory cytokines in target tissues (skin, joints, gingival microflora) and development of an excessive systemic immune response to the microbiota inhabiting the epithelial and periodontal tissues. A statistically confirmed correlation of the progression of periodontal destruction with the presence of psoriatic arthritis proves the significance of the effects of inflammation as a background for the progression of a comorbidity. Increased IL-17 synthesis plays a crucial role in the development of immune responses of pathological bone remodeling and bone resorption in periodontitis and psoriatic arthritis.

An unusual case of Brugia sp. infection in a dog from Alberta, Canada

Brugia is a vector-transmitted nematode that is commonly known for its zoonotic significance of causing lymphatic filariasis in Asia and Oceanic regions of the world. In addition to public health concerns, Brugia species have been known to infect domestic animals, including dogs and cats. However, information is scarce regarding genus Brugia in North America, and rare infections have been noted in domestic cats, humans, and other wild mammals. Herein, we document the first reported case of a Brugia species infection in a dog from North America and the first molecular characterization of the species in question. A three-year-old German Shepard from Alberta, Canada presented to a local veterinary clinic with a facial subcutaneous nodule that was surgically excised. Histopathology identified an enlarged buccal lymph node containing small foci of eosinophilic and granulomatous inflammation within the cortex and capsule. This inflammation was associated with adult filarioid nematodes localized within lymphatic vessels or adjacent connective tissue. Genomic DNA was extracted from formalin-fixed paraffin-embedded tissue, and PCR targeting the Hha1 repeat and the partial cytochrome oxidase c subunit 1 (cox1) of the mitochondrial DNA confirmed parasite identity as Brugia sp. While we can rule out B. beaveri being the causative agent, we cannot exclude B. lepori infection or a third uncharacterized Brugia species. Veterinarians and physicians should be made aware of North American Brugia infections and their possible health concerns.

An anatomical and radiological study of the tectorial membrane and its clinical implications

The radiological image of an intact tectorial membrane (TM) became an important favorable prognostic factor for craniovertebral instability. This study visualized the fascial layers of the TM and adjacent connective tissues with clinical significance by micro-CT and histological analysis. The TM firmly attached to the bony surface of the clivus, traversed the atlantoaxial joint posteriorly, and was inserted to the body of the axis showing wide distribution on the craniovertebral junction. The supradental space between the clivus, dens of the axis, anterior atlantooccipital membrane, and the TM contained profound venous networks within the adipose tissues. At the body of the axis, the compact TM layer is gradually divided into multiple layers and the deeper TM layers reached the axis while the superficial layer continued to the posterior longitudinal ligament of the lower vertebrae. The consistent presence of the fat pad and venous plexus in the supradental space and firm stabilization of the TM on the craniovertebral junction was demonstrated by high-resolution radiologic images and histological analysis. The evaluation of the TM integrity is a promising diagnostic factor for traumatic craniovertebral dislocation.

ORAL MANIFESTATION OF BENIGN MEMBRANE PEMPHIGOID: A CASE REPORT

Mucous membrane pemphigoid is a rare autoimmune bullous disease characterized by involvement of oral mucous membranes in 90% of cases. A 49-year-old female patient presented with erosive gingival lesions with positive Nikolsky's sign, as well as vesicular lesions on the abdomen, forearms, and palmar regions, with 3 years of evolution. An incisional biopsy was performed and histopathologic examination of the oral mucous membranes revealed a lesion characterized by detachment of the lining epithelium, forming a subepithelial cleft. The lining epithelium presented areas of acanthosis, exocytosis, and spongiosis. In addition, a chronic inflammatory infiltrate was present in the adjacent connective tissue. The diagnosis was benign membrane pemphigoid. The patient was referred to an ophthalmologist for investigation of ocular involvement and treatment was carried out with oral corticosteroid of triamcinolone acetonide. Recognition of the oral lesions of pemphigus by the clinician, its early diagnosis, and prompt therapy are essential for a favorable prognosis.

Angiogenesis in patient-derived xenografts of odontogenic myxoma.

Previously, by employing 3D organotypic tissue culture and patient-derived xenograft (PDX) model, oral myxoma response to a MAPK/MEK inhibitor was observed. Gross examination of the tumour fragments obtained after 55days of PDX grafting revealed increased capsule vascularization. Microscopic analyses showed blood capillaries intermixed with myxoma cells, but the origin of these capillaries, from mice or humans, was not established. This study aimed to investigate whether the endothelial cells observed in the myxoma PDX model are derived from the mouse or from the primary human tumour. Immunohistochemistry was performed on five tumour fragments from the PDX of myxoma after 55days of implantation in mice. Immunopositivity for antibodies against human (HLA-ABC) and mouse (H2 Db/H2-D1) major histocompatibility complex class I (MHCI) was assessed in the endothelial cells. The endothelial cells in the PDX fragments revealed a membrane staining for the human MHCI protein in the PDX tumour and adjacent connective tissue capsule, indicating that capillaries were derived from the human tumour fragment. Considering the probable human origin of the endothelial cells from capillary blood vessels in the myxoma PDX, we conclude that this PDX model is an interesting model to study myxoma angiogenesis.

A fast and efficient method for isolating Schwann cells from sciatic nerves of neonatal mice

BackgroundSchwann cells (SCs) isolation is one of the basic techniques for study of peripheral nervous system and peripheral neuropathy. A combined and effective method of isolating SCs from sciatic nerves of newborn mice with high yield and purity is still lacking. New methodsSciatic nerves from neonatal mice aged 3–5 days serve as the source of SCs. Removal of adjacent connective tissue and epineurium, treatment with arabinoside hydrochloride and differential cell detachment technique were applied to eliminate fibroblast contamination and increase the purity of SCs. Combined use of collagenase/dispase and trypsin was chosen to increase the yield of SCs. Culture dishes precoated with poly-l-lysine and laminin, culture medium supplemented with heregulin β-1 and forskolin, and reasonable cell seeding density were implemented to increase the growth and proliferation of cultured SCs. Immunostaining of S100β and p75 neurotrophin receptor was used to identify the purity of SCs. ResultsOur method is able to obtain high-yield SCs with a purity of 90% within five days and a purity more than 99% within seven days from sciatic nerves of neonatal mice. Comparison with existing methodsPrevious SCs isolation mostly focused on rats or adult mice and have a few limitations due to fibroblasts contamination, low yield and time-consuming. Our method permits SCs isolation from neonatal mice with a high yield and purity of primary SCs within 7 days. ConclusionWe described a fast, efficient and step-by-step method of isolating SCs from sciatic nerves of neonatal mice with high yield and purity.

Juvenile hyaline fibromatosis: A clinicopathological study of five cases

Juvenile hyaline fibromatosis (JHF) is an extremely rare autosomal recessive disease that typically presents in infancy or early childhood. Largely due to the rarity, JHF is still not widely recognized by clinicians and pathologists in China. It is not uncommonly to misdiagnose the disease as other types of disorders. In this study, we present our experience with five cases of JHF to enhance the recognition of this rare but distinctive entity. There were 4 males and 1 female, with age at presentation ranging from 5 to 44 years. All patients presented with multiple subcutaneous nodular lesions of varying size in various parts of the body since birth or early childhood. Three patients also had joint involvement. Pathologically, the lesions were poorly circumscribed, located mainly in the dermis and subcutis. All five cases were characterized by abundant homogeneous hyaline-like matrix that differs sharply from the adjacent connective tissue, which stained strongly with periodic acid-Schiff (PAS) and was diastase resistant. Embedded within the eosinophilic glassy matrix were cords or small clusters of plump spindled to epithelioid cells, frequently with clear cytoplasm. Familiarity with the characteristic features of JHF is not only important in avoiding misdiagnosis but also essential for clinical management and prognostic evaluation.

Preparation and Characterization of in-Situ Gelling Systems Containing Curcumin Loaded Solid Lipid Nanoparticles for Periodontitis

Local delivery of curcumin (Cmn) in the form of site-specific periodontal formulations can open up newer option for the management of periodontal diseases. Efficacy of such delivery systems is dependent on the sustained release of Cmn from the device in a soluble form and its penetration into the base of the periodontal pocket and adjacent connective tissue. However, Cmn finds limited clinical applications in oral environment due to its poor aqueous solubility, poor permeability, high metabolism, and instability (hydrolytic, enzymatic and photodegradation). Nanotechnology could address these shortfalls of Cmn by allowing its delivery in a solubilized, bioavailable and photostable formulation amenable for periodontal application. Encapsulation of Cmn within solid lipid nanoparticles; SLNs (C-SLNs) in our previous work has shown an increase in its water dispersibility, chemical stability and bioactivity. In the current study, we have prepared in-situ gelling system incorporating C-SLNs using poloxamer 407 as in-situ gelling agent and Carbopol 934 as mucoadhesive agent. The in-situ gelling systems showed a prolonged and sustained release up to 8 days (192h). We also tested antioxidant potential of C-SLNs and compared it with ascorbic acid and raw Cmn using DPPH in-vitro antioxidant assay kinetics. C-SLNs showed higher IC50 with respect to free Cmn solution and also ascorbic acid. At the end of 5 days, IC50 of C-SLNS was 152.12 ± 0.20 mM which was lesser than that of ascorbic acid and Cmn. Kinetic analysis of ascorbic acid, Cmn and C-SLNS also established the superior antioxidant potential of C-SLNS in comparison to ascorbic acid and Cmn. Thus, the present investigation reports the development of a sustained release Cmn loaded solid lipid nanoparticles containing formulation with good antioxidant potential which can be employed as an effective treatment option for periodontitis.

Evaluation of Guided Bone Regeneration in Critical Defects Using Bovine and Porcine Collagen Membranes: Histomorphometric and Immunohistochemical Analyses

Guided bone regeneration (GBR) is a technique used to facilitate bone regeneration, which uses a biocompatible membrane acting as a physical barrier to prevent the adjacent connective tissue from invading the bone defect. The aim of this study was to evaluate and compare the effectiveness of bovine and porcine collagenous membranes as barriers to connective tissue invasion during the repair of critical bone defects in rat calvaria, using histological, histometric, and immunohistochemical analyses. For this study, 72 rats were divided into three groups: clot group (CG), bovine collagen group (BCG), and porcine collagen group (PCG). Analyses were performed on days 7, 15, 30, and 60. The histological results showed that the PCG exhibited bone neoformation starting from day 7, and after 30 days of repair, the surgical defect was completely filled in some animals. For the BCG, there was little bone neoformation activity in the initial periods, and from day 30 onwards, there was an increase in bone neoformation, with a greater increase on day 60. The data obtained in the histometric analysis reveal that, on day 30, the neoformed bone area did not vary greatly between the PCG and the BCG, though both varied from the CG. By day 60, the PCG presented a greater area of neoformation than the BCG. These results were corroborated by the immunohistochemistry results. In view of the results obtained, it can be concluded that all membranes studied in this research promoted GBR.

Recurrent painless lump on lower lip in a girl; mucocele

A 10-year-old girl was admitted to pediatric rheumatology department due to recurrent painless lump on her lower lip. Her past medical history revealed that she had the lesions began within the last 4 months. The mother stated that these lesions started after her younger brother was born 4 months ago. She presented with the same complaint at another medical center 2 months prior, and she was diagnosed with stomatitis related to deficiencies of vitamins and zinc. Despite oral multi-vitamin and zinc supplementation, local steroid and anti-mycotic treatments, the lesions did not improve. Oral examination revealed there was a transparent liquid-filled lump around slightly hyperemic with the size 6x3 mm on the lower lip mucosa. On the right side there was a shrunken lump (Figure). The lower lip was dry. The other organ systems, growth and development parameters were normal. Regarding this typical image, the lesion on the lip of the patient was diagnosed mucocele which is cystic lesion of minor salivary glands on oral mucosa. Mucoceles are typically transparent or bluish, recurrent submucosal painless masses, and more frequent on lower lip. The most important cause of mucocele is habit of lip or cheek biting due to stress that can lead trauma and the saliva leaks from the damaged duct into the adjacent connective tissue (1). Herpes simplex labialis, exposure to an allergen should be considered in differential diagnosis. Herpes simplex labialis lesions which are caused by human herpes simplex virus are small blisters. The lesions are typically vesicular and recurrent. They usually occur around the mouth, lips, or nose. Before the appearance of herpes labialis; focal pain, burning, itching, or tingling may be observed in the affected area. The vesicles tend to merge, rupture, and then crust quickly in a few days. Herpes labialis improves completely within two weeks (2). Exposure to an allergen can cause lip inflammation followed by a lump. Allergens that can trigger a reaction on the lips include lipstick products (especially in preadolescents and adolescents), foods such as chocolate and strawberry (in younger children), and pet dandruff. Children with this type of reaction may often experience recurrent lip swelling and itchy lumps after exposure to the allergen. The clinical findings and medical history of the patient were not compatible with any of the above. When the anamnesis was detailed, it was understood that she showed beginning jealous behavior associated with birth of his brother 4 months ago. After birth of his brother, she has showed low academic performance in school compared to last year and a habit of lip biting has begun. Her mucocele excised surgically, and a child psychiatrist has been consulted. It is widely accepted that surgical excision and cryosurgery are effective treatments for childhood mucoceles (1).

Ultrasound examination predicts 6-month progression in carpal tunnel syndrome patients.

Carpal tunnel syndrome (CTS) is a peripheral neuropathy resulting from chronic median nerve compression. Chronic compression leads to neurological changes that are quantified through nerve conduction studies (NCS). Although NCS represents the gold standard in CTS assessment, they provide limited prognostic value. Several studies have identified ultrasound as a tool in diagnosing and potentially predicting the progression of CTS in patients. The purpose of this study was to evaluate the predictive value of ultrasound examination in CTS patients. Twenty patients recruited at their first visit with the neurologist completed two NCS and ultrasound examinations approximately 6 months apart. Ultrasound examination consisted of B-mode, pulse-wave Doppler and colour Doppler ultrasound videos and images to quantify median nerve cross-sectional area, intraneural blood flow velocity in three wrist postures (15° flexion, neutral, and 30° extension), and displacement of the flexor digitorum superficialis (FDS) tendon and the adjacent subsynovial connective tissue (SSCT) of the middle finger during repetitive finger flexion-extension cycles. A questionnaire was administered to assess the work-relatedness of CTS. Linear regression analyses revealed that intraneural blood flow velocity (R2 = 0.36, p = .03), assessed in wrist flexion, and relative FDS-SSCT displacement (R2 = 0.27, p = .04) and shear strain index (R2 = 0.28, p = .04) were significant predictors of nerve sensory and motor changes at 6 months. Results suggest the possibility of using a battery of ultrasound measures as viable markers to predict median nerve functional changes within 6 months.

Inward collapse of the nasal cavity: Perinatal consolidation of the midface and cranial base in primates.

Living primates show a complex trend in reduction of nasal cavity spaces and structures due to moderate to severe constraint on interorbital breadth. Here we describe the ontogeny of the posterior end of the primate cartilaginous nasal capsule, the thimble shaped posterior nasal cupula (PNC), which surrounds the hind end of the olfactory region. We used a histologically sectioned sample of strepsirrhine primates and two non-primates (Tupaia belangeri, Rousettus leschenaulti), and histochemical and immunohistochemical methods to study the PNC in a perinatal sample. At birth, most strepsirrhines possess only fragments of PNC, and these lack a perichondrium. Fetal specimens of several species reveal a more complete PNC, but the cartilage exhibits uneven or weak reactivity to type II collagen antibodies. Moreover, there is relatively less matrix than in the septal cartilage, resulting in clustering of chondrocytes, some of which are in direct contact with adjacent connective tissues. In one primate (Varecia spp.) and both non-primates, the PNC has a perichondrium at birth. In older, infant Varecia and Rousettus, the perichondrium of the PNC is absent, and PNC fragmentation at its posterior pole has occurred in the former. Loss of the perichondrium for the PNC appears to precede resorption of the posterior end of the nasal capsule. These results suggest that the consolidation of the basicranial and facial skeletons happens ontogenetically earlier in primates than other mammals. We hypothesize that early loss of cartilage at the sphenoethmoidal articulation limits chondral mechanisms for nasal complexity, such as interstitial expansion or endochondral ossification.