Detailed Anamnesis Research Articles

Risks of medication-related osteonecrosis of the jaw in older patients with COVID-19

Coronavirus disease can cause respiratory complications and a systemic hyper inflammation. One of the most proposed treatments for COVID-19 still is the use of corticotherapy or antiresorptive drugs. However, these drugs have positive effects to COVID-19 patients, they also are associated with medication-related osteonecrosis of the jaw. Therefore, older adults requiring procedures involving bone need detailed anamnesis to avoid osteonecrosis of the jaw after infection with COVID-19.

Tétano em um canino: aspectos clínicos e terapêuticos

Abstract Tetanus is a serious and rare disease in small animals, of an acute nature and mediated by the action of the neurotoxin tetanospasmin, from the bacillus Clostridium tetani. This report describes a case of tetanus in a canine, with emphasis on its clinical and therapeutic aspects, in addition to its clinical recovery. A canine, female, Pitbull breed, five months old, in status epilepticus, was attended at the Veterinary Hospital of the University of Passo Fundo. After stabilizing the patient, the animal was found in a trestle position, with generalized spastic paralysis, risus sardonicus, trismus, erect tail and ears, and difficulty in expanding the thorax. The presumptive diagnosis of tetanus was established based on the anamnesis, clinical signs, and laboratory findings. The established supportive treatment included hydro electrolytic replacement, antitetanus serum, antibiotic therapy, analgesia, myorelaxant and anticonvulsant drugs. The patient's intensive management was carried out with urethral and gastroesophageal probing, changes of position every two hours, and reduction of environmental stimuli. Physiotherapy and acupuncture were also used to complement the treatment and accelerate recovery. The patient was discharged one month after the beginning of the treatment, presenting satisfactory evolution. In the present case, the clinical examination in association with the characteristic clinical signs of the disease, added to the detailed anamnesis, was essential for the presumptive diagnosis of tetanus. In addition, intensive management, drug treatment, physiotherapy, and acupuncture enabled the evolution of the clinical condition to cure.

Different methods for management of gaging reflex during prosthetic treatment

Introduction The reflex of gaging and vomiting is an unpleasant feeling. Its purpose is to protect the upper respiratory tract and to remove foreign particles from posterior part of the oropharynx and upper gastrointestinal tract. Gag reflex could also be provoked by psychogenic stimuli modulated by higher brain centers. A common problem in clinical dental practice are patients with hypersensitivity in the oral cavity. Dental care could be a challenge for the dentists. Detailed anamnesis, clinical examination and gaging reflex management contribute to the appropriate approach in oral rehabilitation. Aim The aim of this study is to present different techniques for gaging and vomiting reflex management during prosthetic treatment Materials and Methods Detailed research in electronic databases Google scholar, Scopus, Pubmed and Research gate was conducted from September 2022 until December 2022. The keywords were: gag reflex, management, dentistry, removable partial denture. The literature was in English. Results A total of 542 articles were found during the literature review. In this study 39 original scientific papers meeting the criteria were included. Data and evidence for the importance of gaging reflex management were found in the reviewed articles. Conclusion The gag reflex decreases the effectiveness of the prosthetic treatment. A number of methods for its management are described in the literature and in the practice. The application of some of them is limited by local or general contraindications. Others could be used after an additional training. Regardless of the methods that are chosen, the dentist must take into account the characteristics of each patient and apply an individual approach.

Spexin level in acute myocardial infarction in the emergency department.

We aimed to determine the serum spexin level in patients with acute myocardial infarction (AMI) admitted to the emergency department. A total of 100 patients with AMI (50 with ST-segment elevation myocardial infarction (STEMI) and 50 with non-ST-segment elevation myocardial infarction (NSTEMI)) and 50 control group patients with non-cardiac chest pain were included in the study. A detailed anamnesis was taken, a physical examination was performed, and 12-lead electrocardiograms and venous blood samples were taken at the time of admission. Spexin levels were measured via enzyme-linked immunosorbent assay. Serum spexin levels were significantly lower in the AMI group than in the non-cardiac chest pain group (p<0.001). There was no significant difference in serum spexin levels between STEMI and NSTEMI patients (p=0.83). In receiver operating curve analysis, we detected 58% sensitivity, 76% specificity, 82.9% positive predictive value, and 47.5% negative predictive value with an optimal cutoff value of 532 pg/mL for the diagnosis of AMI. In this study, serum spexin levels were significantly lower in AMI patients compared to patients with non-cardiac chest pain. The decrease in spexin levels suggests that it has the potential to be used as a diagnostic marker in AMI patients.

Spezifische OCT-Veränderungen bei einer neuen Mutation im RS1-Gen bei X-chromosomal-rezessiver Retinoschisis

X-linked retinoschisis (XLRS) is a rare vitreoretinal dystrophy caused by molecular genetic changes in the RS1 gene. It usually manifests itself at a young age with symmetrical splitting within different layers of the retina and leads to a significant reduction in visual acuity. Correct diagnosis at older ages is difficult due to nonspecific changes in OCT scans. We report the morphological changes in OCT scans at different stages of life in a family with XLRS and a novel mutation in the RS1 gene. Our 78-year-old index patient presented with visual disturbances that he had experienced since his childhood. After a detailed anamnesis, complete clinical examination and measurement with SD-OCT, we performed germline genetic testing using whole blood DNA on the index patient, his clinically unaffected daughter and her clinically affected son. The OCT examination of the index patient showed nonspecific atrophic macular changes on both sides. A fundoscopy of the 8-year-old grandson showed the typical macular star pattern. The OCT scan showed the typical retinoschisis of the macula. The genetic analysis revealed thepreviously undescribed pathogenic variant c.487T>G; p.Trp163Gly in the RS1 gene in all 3patients. The typical fundus image and OCT pattern, which are absent in the 78-year-old patient, are also present in childhood with the novel RS1 mutation. Our case shows that even with nonspecific changes in the OCT scans, a detailed family history can provide important information on X-linked recessive inheritance and thus for an appropriate molecular genetic diagnosis, so that rare retinal diseases can be diagnosed even at an advanced age.

Osteomyelitis of the jaws and facial bones caused by drug use (perventin, α- pyrrolidinovalerophenone)

Introduction. An attempt was made to detect the pathogenetic factors involved in the occurrence of the disease by studying the clinical and laboratory data of 160 patients diagnosed with chronic osteomyelitis of the jaws treated in the clinic of oro-maxillo-facial surgery between 2005 and 2022. The patients studied were or are still drug users who use illicitly produced (amphetamine-type drugs) or other drugs (abbreviated α-PVP). We obtained positive results in the treatment of toxic osteomyelitis of the jaws following the implementation of a conservative and surgical treatment scheme. Materials and methods. Detailed anamnesis of disease development, clinical examination, pictures, an orthopantomogram, general blood analysis and biochemical profile, urine analysis, blood markers, and AIDS analysis. Results. The study of the composition of used substances is an important factor in the definition and development of the given disease’s cause and mechanism. According to the patient’s statement, this disease developed following the use of the amphetamine drug. This drug contained the main substance – ephedrine, and also red phosphorus and iodine, which accumulate and cause trophic changes. Almost all organisms’ systems are affected by amphetamine intoxication. Given that only surgical treatment has a small effect on any of the patients in this group, we devised a conservative presurgical treatment plan. We prescribe medication for these patients: detoxification of the body from drugs that cause spasm of small blood vessels and accumulate in bone tissue, causing necrosis. Lavages of the mouth cavity are performed daily, and necrectomy is eventually performed. Conclusions. Assistance to drug addicts with jaw necrosis is a demanding subject given that the majority of their population is unemployed and without insurance. According to unofficial data, there are only 5000 such patients in Chisinau.

A periapical lesion, not always an inflammation. Periapical radiopacities

A periapical radiolucency, radiopacity or mixed lesion identified on a radiograph is usually caused by an inflammation of endodontic origin. However, a periapical lesion is sometimes caused by primary bone pathology, predominantly manifesting at the apices of the teeth. Various intraosseous lesions can also be projected across the apices, creating the impression of a causal relation with these teeth. An incorrect diagnosis can lead to 1 or more endodontic treatments being carried out unjustifiably. A thorough and detailed anamnesis, a complete extra- and intraoral clinical examination and the careful study of the radiographic imaging leads to a correct diagnosis in most cases. In this regard, knowledge of the differential diagnosis of periapical lesions is essential. In this article, the focus is on apparent periapical radiopacities and how they can be differentiated from each other.

Lipid transfer protein allergy: characterization and comparison to birch-related food allergy.

Lipid transfer proteins (LTP) are a frequent elicitor of anaphylaxis to plant-derived food allergens in southern Europe. 15 German patients with LTP allergy were compared to 17 patients with birch-related food allergy (BRFA) using a detailed anamnesis, serology, skin tests, and the FAQLQ-AF quality of life questionnaire. While patients with BRFA mainly reacted to tree nuts, and pome and stone fruits, LTP allergic individuals reported vegetables, berry fruits, cereals, and seeds as common additional elicitors. Anaphylaxis was associated with cofactors in 73% of LTP allergic patients compared to only 6% in BRFA (P&lt;0.001). Symptoms occurred delayed by more than one hour in 40% and were triggered by raw and cooked foodstuffs in 86% of LTP allergic patients, compared to only 6% and 41% of BRFA patients, respectively. A peach prick test was positive in all LTP allergic patients, but only in 15% of BRFA patients (P&lt;0.001). Although patients with LTP allergy reported severe anaphylaxis more frequently, quality of life did not differ between groups. Anaphylaxis to plant-derived foodstuffs warrants assessment by IgE detection to Pru p 3 and skin tests with peach extract, particularly if cofactors and intolerance to heated foodstuffs are related.

Clinical case of leptospirosis in a woman against chronic alcohol intoxication

An interesting clinical case of leptospirosis infection in an elderly woman with a professional way of getting infection on the background of alcohol abuse has been described. The authors emphasized the clinical features of this bacterial zoonosis, considered aspects of differential diagnosis of leptospirosis with other common infectious diseases. It has been emphasized on the intricacies of a detailed epidemiological anamnesis taking in order to identify and evaluate biorisk factors for pathogenic leptospira con­tami­nation in a particular occupational environment. It has been pointed out the necessity of a complex laboratory-instrumental investigation in the infectious hospital, since the delay of hospitalization and adequate treatment can worsen the prognosis for a favorable outcome of the clinical case and recovery. Such specific laboratory methods for verifying leptospiras in the blood of patients as a reaction of microagglutination and lysis with a kit of leptospira and bacterioscopic examination of a smear in the dark field are of high sensitivity and specificity and therefore are widely used in clinical practice.

Genetic and Clinical Evaluation of Retinitis Pigmentosa

Background: The aim of this study was to evaluate the most common underlying genetic and clinical etiologies of retinitis pigmentosa (RP) disease in our geographical area.&#x0D; Material and Method: In our archive, there are about 3000 patients who applied to our clinic between the years 2015-2021. The files of approximately 700 patients with a definitive genetic diagnosis were retrospectively scanned. A definitive genetic diagnosis was made in 22 of these patients. During our research, we collected some clinical parameters including the prenatal, natal, and postnatal history of the patients, history of surgery and seizures, and family history. In family history, we did a detailed pedigree with at least 3 generational analyses, questioned parental kinship, looked for similar members in families, and identified inheritance patterns of their disorder. We draw 3 generations pedigree and we collected peripheral venous blood samples from patients and sent them to a commercial lab for gene panels or WES. After obtaining the definitive genetic diagnosis of all patients, we compiled a table with the other parameters we questioned.&#x0D; Results: As a result of our WES analysis in patients 1 and 2, homozygous c.1331_1332 dupAG/p. Thr445ArgfsTer10 Class 2 variant was detected in the POC1B gene of patient #2.In the RP panel 1 reports of patients 3 and 4, the genomic alteration of c.2254dupA (p.Ser752Lysfs*14) was detected in exon 15 of the ABCA4 (NM_000350) gene. Patient 5, EYS c.4964T&gt;C heterozygous. Patient 6. SEMA4A C.1168A&gt;G (heterozygous). Patient 7, SEMA4A C.1168A&gt;G (heterozygous), RP1 c.5402C&gt;T (heterozygous), CGNB1 c.1382C&gt;T (heterozygous).Patient #8, . Heterozygous variation of p.Thr390Ala (c.1168A&gt;G) in the SEMA4A gene is present.As a result of our WES analysis, a homozygous c.2021C&gt;A/p.Pro674His Class 2 variant was detected in the RPGRIP1 gene of patient #9. Heterozygous c.119-2A&gt;C Class 1 mutation was detected in the NR2E3 gene of patient 10. Homozygous c.271C&gt;T/p.Gln91* Class 1 mutation was detected in the MFRP gene in patient 11. Patient #12 was diagnosed at the age of 7-8 years. When we look at the exome sequencing results, a homozygous mutation in the CNGB1 gene c.413-1G&gt; of patient 13 was detected. Heterozygous p.Ser361Tyr (c.1082C&gt;A) change detected in the ABCA4 gene of patient #14 was detected. The heterozygous p.Glu150Lys (c.448G&gt;A) change detected in the RHO gene of patient #15 was pathogenic according to ClinVar database and in silico analysis. rated as. Prediagnosis was Bardet-Biedle Syndrome in patient 16. P.Gly244Asp change was detected in RPE65 gene of patients 17 and 18. Automated DNA sequencing of patient #19 and patient #20 results in a homozygous sequence variation in the coding sequence of the NR2E3 genes, a homozygous CGG&gt;CAG nucleotide substitution, and an amino acid replacement of Arg311Gln. Heterozygous mutation was detected in the same gene region in patient 21 (fathers). Variation in NR2E3 is the most likely cause of these patients' eye condition, as it is a complete genotype and is strongly associated with RP in many published families. Genetic results on an allele of the BBS1 gene of patient 22 (chr11:66.278.121-66.291.364 (13.2kb)/ISCN: seq [GRCH37]11q13.2(66.278).121-66.291.364)x1). The other allele has a heterozygous point mutation (c.1424dupT p.Ser476fs-rs886039798).&#x0D; Conclusıons: As determined in our study, the disease can be encountered with many different genetic etiologies. In this regard, patients undergoing genetic testing should be carefully examined for both SNP (single nucleotide polymorphism) and CNV (copy number variation).In addition, before genetic tests are performed, it should be well determined whether there is an isolated RP or an accompanying RP. In this respect, patients should be evaluated by making a detailed anamnesis and physical examination and drawing a pedigree containing at least 3 generations. Therefore, it was concluded that accompanying abnormalities should also be examined in the evaluation of retinitis pigmentosa anomalies.

Management of Multiple Idiopathic Root Resorption in a Rheumatoid Arthritis Patient: A Case Report with 4-year Follow-up

Cervical root resorption is a rare destructive disease that originates from the external cervical root surface. It has a multifactorial etiology. Cervical root resorption may affect several teeth and its treatment can be complicated due to the size, location, and extension of the resorptive defect. Rheumatoid arthritis is a chronic inflammatory autoimmune disease that has systemic effects. The objective of this article was to report a rare case of multiple idiopathic cervical resorptions in a patient with rheumatoid arthritis. A 52-year-old male patient with a 20-year history of rheumatoid arthritis was diagnosed with multiple idiopathic cervical resorptions through cone-beam computed tomography (CBCT) and clinical examination. All known causes for cervical resorption were ruled out after a detailed anamnesis. This report details inflammation due to rheumatoid arthritis as a possible cause of idiopathic cervical resorption. The systemic alterations wrought by rheumatoid arthritis could be related to the etiopathogenesis of cervical root resorption. Non-surgical endodontic treatment was done for the maxillary left canine. The defect was surgically repaired using bioceramic putty. The 12-month recall revealed the good healing of the periodontal and periradicular conditions with no obvious clinical symptoms. At the 36-month recall visit, clinical and radiographic evidence of deterioration in the repair material was observed. At the 54-month follow-up, deterioration of repair material was observed with an increase in the extension of resorption in tooth 14 was detected. Reasons for this deterioration remain unclear. Ruling out all other factors for cervical root resorption, how rheumatoid arthritis contributes to cervical root resorption is still lacking/unclear. Dental care providers must be vigilant for signs of cervical root resorption in vulnerable patients with rheumatoid arthritis for early diagnosis and prompt treatment. Keywords: External root resorption, Inflammatory markers, Multiple root resorption, Rheumatoid arthritis, Resorption repair.

A periapical lesion, not always an inflammation. Overprojection of neoplastic pathology

A radiolucency, radiopacity or mixed lesion identified on a radiograph is usually the result of an inflammation of endodontic origin. However, a periapical lesion is sometimes caused by primary bone pathology, predominantly manifesting at the apices of the teeth. Various intraosseous lesions can be projected across the apices, creating the impression of a causal relation with these teeth. An incorrect diagnosis can lead to 1 or more endodontic treatments being carried out unjustifiably. A thorough and detailed anamnesis, a complete extra- and intraoral examination, and a careful examination of the radiological imaging will result in a correct diagnosis in most cases. Knowledge of the differential diagnosis of periapical lesions is essential. This article focuses on periapical radiolucencies due to overprojection of neoplastic pathology.

Ultrasound-guided cervical selective nerve block: A case series.

Cervical radiculopathy is characterized by pain, numbness, tingling, and weakness, mostly in an affected extremity, reflecting compression of a nerve in the neck is compressed or irritated where it emerges from the spinal cord. Diagnosis requires a detailed anamnesis, physical examination, and imaging. Physical therapy, exercise, medical therapy, and injections are the preferred treatments, but injections into the cervical region are only indicated if conservative treatment is ineffective. This study explored the utility of selective cervical nerve root blocks (SNRBs) performed at various levels under ultrasound guidance (USG). We evaluated patients diagnosed with cervical radiculopathy via physical examination and magnetic resonance imaging from November 2019 to March 2020. We included those who did not respond to conservative treatment and therefore received SNRBs at various levels. Sixty-three patients were evaluated over 6 months in terms of pain, functional status, and complications. We retrospectively evaluated patients with cervical herniated discs who received SNRBs at various levels between C4-7 under USG. Pain and functional status improved in month 1 and was maintained until at least month 6. SNRB injections performed under USG effectively treated pain and poor functional status in selected patients. The procedure is safe (especially) for patients who do not respond to conservative treatment.

A periapical lesion, not always an inflammation. Overprojection of neoplastic pathology

A radiolucency, radiopacity or mixed lesion identified on a radiograph is usually the result of an inflammation of endodontic origin. However, a periapical lesion is sometimes caused by primary bone pathology, predominantly manifesting at the apices of the teeth. Various intraosseous lesions can be projected across the apices, creating the impression of a causal relation with these teeth. An incorrect diagnosis can lead to 1 or more endodontic treatments being carried out unjustifiably. A thorough and detailed anamnesis, a complete extra- and intraoral examination, and a careful examination of the radiological imaging will result in a correct diagnosis in most cases. Knowledge of the differential diagnosis of periapical lesions is essential. This article focuses on periapical radiolucencies due to overprojection of neoplastic pathology.

NON-HODGKIN'S LYMPHOMA VERSUS TOOTH ABSCESS: IMPORTANCE AND CHALLENGES OF A CORRECT DIAGNOSIS

A 41-year-old male patient reported pain and discomfort in the jaw for 2 months. A private dentist established the diagnosis of a tooth abscess and prescribed antibiotics for 2 weeks. On extraoral exam, slight facial asymmetry and an enlarged and firm right submandibular lymph node were noted. On intraoral exam, a lobulated, reddish, partially ulcerated, soft, and asymptomatic nodule in the maxillary ridge referring to tooth 16, measuring 2.5 cm, was observed. A differential diagnosis of lymphoma and fibrosarcoma was established, and an incisional biopsy was performed. Histopathologic examination revealed a proliferation of round and blue cells, compatible with lymphoma. The complementary immunohistochemical examination was positive for CD20 and BCL6. Dentists should consider lymphoma as a diagnostic hypothesis among lesions that grow rapidly and cause diffuse bone resorption. To avoid iatrogenesis and improper drug prescriptions, dentists should always make detailed anamnesis and complete physical examinations of patients. A 41-year-old male patient reported pain and discomfort in the jaw for 2 months. A private dentist established the diagnosis of a tooth abscess and prescribed antibiotics for 2 weeks. On extraoral exam, slight facial asymmetry and an enlarged and firm right submandibular lymph node were noted. On intraoral exam, a lobulated, reddish, partially ulcerated, soft, and asymptomatic nodule in the maxillary ridge referring to tooth 16, measuring 2.5 cm, was observed. A differential diagnosis of lymphoma and fibrosarcoma was established, and an incisional biopsy was performed. Histopathologic examination revealed a proliferation of round and blue cells, compatible with lymphoma. The complementary immunohistochemical examination was positive for CD20 and BCL6. Dentists should consider lymphoma as a diagnostic hypothesis among lesions that grow rapidly and cause diffuse bone resorption. To avoid iatrogenesis and improper drug prescriptions, dentists should always make detailed anamnesis and complete physical examinations of patients.

Airborne anaphylaxis: highlighting an invisible enemy.

Airborne anaphylaxis is a rare disorder defined by the occurrence of anaphylactic reactions to inhaled allergens, which may arise not only in occupational exposure but also in common settings. Foods are the most common cause of airborne anaphylaxis, even organic mixtures scents. The other important cause is represented by drugs, while in the wide range of other causes, there are often reports on unique cases. This review aims to make an overview about the potential causes of airborne anaphylaxis, by analysing what is described in literature on this topic. Concerning epidemiology, no data on specific prevalence of airborne allergy in adults are available. To date, only one study evaluated the specific prevalence of airborne allergy with anaphylaxis to foods in children, resulting in 5.9% of reactions due to exposure to aerosolized foods, compared with 78% of reactions caused by food ingestion. In addition to anaphylaxis, airborne-related reactions may also present with symptoms such as rhino-conjunctivitis, wheezing, dyspnoea and asthma. A detailed anamnesis facilitates a correct diagnosis, which allows appropriate therapeutic and preventive interventions, but, similarly to rare diseases in general, only specialized doctors are able to implement it. The assumption of the approach used in emergency medicine for other causes of anaphylaxis, that is referring the patient at discharge to an allergist who will teach the basic notions to recognize symptoms and access the appropriate therapy, would allow the patient to avoid situations of serious danger.

Follow up Management after Transcatheter Aortic Valve Implantation

Transcatheter aortic valve implantation (TAVI) has emerged as the gold standard therapy for patients with severe aortic stenosis with a high operative risk or older than 75 years. As these patients usually exhibit several comorbidities, not only the preinterventional and periinterventional management are of interest, but also the postinterventional care plays an incremental role in order to prevent short and long term complications having an enormous influence on morbidity and mortality. Therefore, a close clinical observation by the primary care physician and primary cardiologist is essential for the patient's outcome. After discharge the first follow up examination should be carried out 1 to 3months after TAVI, the second one 6 months after TAVI, afterwards once a year. A detailed anamnesis especially regarding symptoms such as dyspnoea, anginal complaints and vertigo should be performed. Additionally, an electrocardiogram is recommended to detect conduction disturbances. An echocardiography with the focus on prosthetic valve function, paravalvular leckage, left ventricular function and possible indications for endocarditis is essential. Next to the endocarditis prophylaxis before specific dental procedures, the antithrombotic regimen plays a key role in the follow up management after TAVI. On the one hand, antithrombotic therapy reduces thromboembolic complications, on the other hand they might increase the bleeding risk. An optimal antithrombotic treatment strategy challenges clinicians as patient-specific risk factors and comorbidities (e. g., age, atrial fibrillation, coronary artery disease) must be considered and current data still leave some uncertainties.

PREVALENCE OF EXTERNAL AND/OR INTERNAL NASAL VALVE INSUFFICIENCY IN PATIENTS WITH PRIMARY SNORING AND OBSTRUCTIVE SLEEP APNEA

Introduction: Nasal valve insufficiency is a distinct cause of symptomatic nasal obstruction. The nasal valve has been described as the cross-sectional area with greater resistance to the respiratory-inspiratory flow of the entire respiratory system. This subject is of scientific and academic importance, because it is an original contribution to the aid in the treatment of snoring, considering that nasal valve insufficiency is one of the causes of symptomatic nasal obstruction. This nasal alteration has gained special attention from specialists in the evaluation of the symptomatology of patients with snoring and Obstructive Sleep Apnea Syndrome. Objective: This was a prospective, quantitative, observational, and interventionist study, with the objectives of evaluating the frequency of this alteration and confirming the momentary improvement of this signal with the use of an external nasal dilator device. Methods: Thirty-one patients who sought care at the IPO Hospital (Curitiba/PR, Brazil) participated in this study to evaluate the symptoms of snoring. Patients with snoring symptoms, with no predilection for ethnicity and sex, age 18 years or older, were included. The study was conducted from October to November 2019, by means of detailed anamnesis. Results: A high prevalence of nasal valve insufficiency was identified in the analyzed patients.

Serie: Een periapicale afwijking, niet altijd een ontsteking. Overprojectie van niet-neoplastische pathologie

A radiolucency, radiopacity or mixed lesion, identified on a radiograph is usually the result of an inflammation of endodontic origin. However, a periapical lesion is sometimes caused by primary bone pathology, predominantly manifesting at the apices of the teeth. Various intraosseous lesions can be projected across the apices, creating the impression of a causal relation with these teeth. An incorrect diagnosis can lead to 1 or more endodontic treatments being carried out unjustifiably. A thorough and detailed anamnesis, a complete extra- and intraoral examination, and a careful examination of the radiological imaging will result in a correct diagnosis in most cases. Knowledge of the differential diagnosis of periapical lesions is essential. This article focuses on apparent periapical radiolucencies caused by overprojection of non-neoplastic pathology.

Chest wall deformities and their possible associations with different genetic syndromes.

Our primary objective was to identify discrete and syndromic cases of Pectus excavatum (PE) and Pectus carinatum (PC). We also intended to highlight the significance of further genetic exploration in clinically suspected syndromic cases of PC and PE. Pectus excavatum (PE) and Pectus carinatum (PC) are the most common morphological chest wall deformities. Although various hypotheses have been put forth, the pathogenesis of both entities is largely unknown. Clinicians often refer such cases for further genetic evaluation to exclude an associated underlying connective tissue disorder or a syndrome. Additionally, a detailed anamnesis with focused family history and thorough dysmorphological physical examination was done. PE and PC are considered isolated abnormalities if there is the absence of features of other syndromes, eliminating the need for further genetic evaluations. It is believed that the pattern of inheritance of these non-syndromic isolated PE and PC cases with positive family history could be multifactorial in nature. The recurrence risk of such isolated cases is thought to be low. Further diagnostic studies are indicated as PE and PC could be a part of a syndrome. Among the many syndromes, the most common monogenic syndromes associated with PE and PC are Marfan's and Noonan's. After obtaining the consent, we compiled a database of the patients who presented with chest wall deformities during the period 2017-2019. We selected 70 cases with PC and PE deformities to identify the discrete and syndromic PC and PE cases. During the study, we perused the cytogenetic and/or molecular analyses, that had been conducted to confirm the clinically suspected syndromic cases. We also scrutinized for the presence of PC and PE cases that are associated with the rare syndrome (s). Various genetic abnormalities were identified in 28 (40%) of the 70 cases that had been diagnosed with chest wall abnormalities. Along with PE and PC, other thoracic wall abnormalities were also identified, such as the broad chest, bell-shaped thorax, and elongated or enlarged thorax. One case of a rare genetic disorder of Morquio syndrome associated with PC was also identified. Novel (previously unpublished) genomic variants are reported here. It is important to delve deeper when encountering cases of PE and PC by conducting a further genetic exploration of such cases to identify syndromic associations that cause other structural and functional disorders, diagnosis of which might be missed during the early developmental period. Early identification of such disorders may help us correcting the defects, slowing the progression of disease processes, and preparing better to deal with the potential outcome.