Differential Diagnosis Of Various Types Research Articles

Possibilities of ultrasound diagnostics of paragangliomas of the neck

The purpose of the study is to evaluate the results of ultrasound examination, generalize the criteria for differential diagnosis of various types of paragangliomas in neck area and the development of a standard ultrasound protocol that provides information about the resectability of formations.Material and methods. 91 patients (100 tumors) with a clinical diagnosis of neurogenic neck tumor were examined, of which 71 (71%) were carotid paragangliomas, 18 (18%) – vagal paragangliomas, 10 (10%) – neurinomas and 1 (1%) – neurofibroma. All patients underwent ultrasound examination, including examination of the tumor structure in B-mode, assessment of the size and prevalence formations relative to the base of the skull and color Doppler mapping to assess the degree of intra-tumor blood flow and the relationship of formations with carotid arteries.The study allowed us to systematize the main ultrasound signs characteristic of various neurogenic neck tumors, among which we identified: clear, even contours; the presence of a capsule; a heterogeneous, predominantly hypoechoic structure with hyperechoic inclusions resembling “salt–pepper”. The following parameters played a crucial role in differential diagnosis: localization of formation, features of intra-tumor blood flow and the relationship of paragangliomas with carotid arteries.Results. Evaluation of the structural features of the tumor in the B-mode did not show significant differences between various paragangliomas, neurinomas and neurofibromas, all formations had clear, even contours, their capsule was clearly visualized. For carotid paragangliomas in all 71 (100%) observations, the characteristic feature was the location in the bifurcation area of the common carotid artery, with the mouths of the internal and external carotid arteries moving apart, which was 100% the diagnostic criterion of this group of formations. Vagal paragangliomas or neurinomas in all cases were located outside the bifurcation of the carotid artery, although in close proximity to the carotid arteries. The nature and degree of intra–tumor vasularization is another argument in the differential diagnosis of paragangliomas, which, unlike other neurogenic tumors, are highly vascularized tumors. The study of the nature of the intracellular blood flow showed that arterial paragangliomas predominate vessels, unlike neurinomas and neurofibromas, have significantly poorer vascularization with a predominance of venous vessels in the structure of the tumor. In 8 (44%) cases, vagal paragangliomas sprouted into the adventitia of the carotid arteries, which was characterized by a local increase in blood flow in this area in combination with turbulence during ultrasound.Conclusion. The proposed algorithm of ultrasound examination of neurogenic formations in the neck area makes it possible already at the primary stage instrumental diagnostics to identify volumetric formations, differentiate them between themselves and with other neck formations and to assume the degree of traumatism of the proposed surgical intervention.

Disrupted Structural White Matter Network in Alzheimer's Disease Continuum, Vascular Dementia, and Mixed Dementia: A Diffusion Tensor Imaging Study.

Dementia presents a significant burden to patients and healthcare systems worldwide. Early and accurate diagnosis, as well as differential diagnosis of various types of dementia, are crucial for timely intervention and management. However, there is currently a lack of clinical tools for accurately distinguishing between these types. This study aimed to investigate the differences in the structural white matter (WM) network among different types of cognitive impairment/dementia using diffusion tensor imaging, and to explore the clinical relevance of the structural network. A total of 21 normal control, 13 subjective cognitive decline (SCD), 40 mild cognitive impairment (MCI), 22 Alzheimer's disease (AD), 13 mixed dementia (MixD), and 17 vascular dementia (VaD) participants were recruited. Graph theory was utilized to construct the brain network. Our findings revealed a monotonic trend of disruption in the brain WM network (VaD > MixD > AD > MCI > SCD) in terms of decreased global efficiency, local efficiency, and average clustering coefficient, as well as increased characteristic path length. These network measurements were significantly associated with the clinical cognition index in each disease group separately. These findings suggest that structural WM network measurements can be utilized to differentiate between different types of cognitive impairment/dementia, and these measurements can provide valuable cognition-related information.

Scintigraphy in Thyroid Nodular Pathology

Thyroid scintigraphy is a method that formed more than 60 years ago and retains its importance for the diagnosis and assessment of the risk of nodular malignancy. The review examines the use of the scintigraphic method in functional and metabolic assessment of nodular goiter. Prerequisites for functional thyroid nodes screening with short-lived 99mTc-pertechnetate are outlined. Information is provided on the principles of its preparation and pharmacokinetics, as well as variants of the thyroid nodes functional activity, their possible malignant potential and indications for metabolic screening. The characteristic of metabolic activity allows to assess the risk of functionally “cold” thyroid nodes malignancy. The main stages of the use of nonspecific tumorotropic radiopharmaceuticals, the mechanism of their accumulation and metabolism in the thyroid tumors, the possibilities of the differential diagnosis of various types of nodular formations are presented. Modern views on the diagnostic capabilities of two-phase scintigraphy with 99mTс-methylisobutylisonitrile are reflected taking into account the relationship of radiopharmaceuticals accumulation with factors of proliferative activity and ultrastructural cell types, a variant of oncocytic pathology and multidrug-resistant protein expression.

Macroscopic findings of brain with dementia.

In this paper, we have described the points to be noted when examining the macroscopic findings of the brain of patients with dementia. The characteristics of the macroscopic findings of the brain of patients with dementia are shown in the figure of the outer surface and the cut surface. Gross findings in the brain of patients with Alzheimer's disease should consider, in addition to the degree of limbic changes, whether the atrophy is diffuse, the degree of ventricular enlargement, and the complications of vascular changes. The macroscopic findings of the brain of patients with dementia with Lewy bodies are characterized by the absence of notable abnormal findings other than the depigmentation of the substantia nigra and locus coeruleus. In dementia with Lewy bodies, other types of dementia complications should be considered if abnormal findings are present. It should be noted that accurate diagnosis of argyrophilic grain dementia and senile dementia of neurofibrillary tangle type by macroscopic findings alone is often difficult to distinguish from a mild case of Alzheimer's disease and change by physiological aging in particular. In frontotemporal lobar degeneration, changes in the basal ganglia, brain stem, cerebellum and motor neurons should be observed to make a differential diagnosis of various types of frontotemporal lobar degeneration. It is important to understand the areas that are often damaged in different types of dementia and the extent of lesions, and to distinguish each type of dementia. Care should be taken as macroscopic findings are more complex when several types of dementia are mixed. It was shown that accurate understanding of macroscopic findings is essential for understanding clinical symptoms, imaging findings, differential diagnosis of dementia and disease pathogenesis.

Differences between vascular and microcirculatory disorders of the brain in patients with dementia suffering from Alzheimer's disease and Binswanger's disease.

During differential diagnosis of various types of dementia, there are certain difficulties in determining disorders of cerebral angioarchitectonics and microcirculation. We present the features of cerebrovascular and microcirculatory disorders in Alzheimer's disease (AD) and Binswanger's disease (BD). The research included 120 patients, of whom: (1) 93 aged 34-80 (average age 67.5), 32 (34.40%) men and 61 (65.59%) women, suffering from AD. According to dementia severity, the patients were subdivided: (TDR-0) - 10, (TDR-1) - 29, (TDR-2) - 36, (TDR-3) - 18 people; (2) 27 aged 58-81 (average age 78), 17 (62.96%) men and 10 (27.04%) women, suffering from BD. The patients were subdivided according to dementia severity: (CDR-1) - 17, (CDR-2) - 10 people. The examination plan included cerebral MRI, CT, scitrigraphy (SG), rheoencephalography (REG), cerebral multi-gated angiography (MUGA). Patients with AD show the following changes in angioarchitectonics and microcirculation: (1) No calcium salts deposits in intracerebral vessels; (2) Increased tortuosity of distal intracranial arteries; (3) Capillary bed reduction in the temporal and fronto-parietal regions; (4) Development of multiple arteriovenous shunts in the same regions; (5) Development of abnormal venous trunks with early venous discharge of arterial blood in the same regions; (6) Development of intracerebral stasis of venous blood. These vascular changes are called dyscirculatory angiopathy of Alzheimer's type (DAAT). Patients with BD show the following changes in angioarchitectonics and microcirculation: (1) Multiple calcium salts deposition in intracerebral vessels; (2) Disseminated reduction of the capillary bed in the subcortical regions; (3) Development of multiple disseminated arteriovenous shunts in the subcortical regions; (4) No pronounced intracerebral venous stasis. Dyscirculatory angiopathy of Alzhemer's type, regardless of dementia severity, is a cerebrovascular and microcirculatory brain lesion specific for AD and not associated with atherosclerotic process. BD patients, irrespective of dementia severity, have vascular disorders of atherosclerotic nature. Anatomically, capillary bed reduction and arteriovenous shunts are located exclusively in the white matter of the brain. Due to the disseminated development of arteriovenous shunts, pronounced venous stasis does not occur. Timely identification of these changes is of an important diagnostic nature.

Updates and Diagnostic Challenges in Surgical Pathology and Cytopathology.

Updates and Diagnostic Challenges in Surgical Pathology and Cytopathology.

Ulcer in the Disguise-A Rare Case Report

Tuberculosis (Tb) is an infectious disease which usually affects the pulmonary system and sometimes occursin other body organs including the oral cavity. The present article is on a case study of a 25-year femalediagnosed with TB osteomyelitis which presented a non-healing and non-painful ulcer both intra and extraorally. The diagnosis was confirmed based on histopathology. The patient underwent anti-TB therapy andher oral and systemic conditions improved rapidly. Although oral manifestations of tuberculosis are rare,clinicians should include them in the differential diagnosis of various types of oral ulcers. An early diagnosiswith prompt treatment can prevent complications and potential contaminations. Tuberculosis of the oralcavity is rare and have become a forgotten diagnosis of oral lesions. Dental practitioners need to be awarethat TB may occur in the oral cavity and should be considered in the differential diagnosis of any ulcerated,indurated non-healing lesion of the oral cavity, especially in lower socioeconomic groups. Besides, effortsshould be made to control oral TB by early detection and referral of the patient to a physician for propermanagement. Clinicians are to be careful about ulcers in disguise.

Dynamic11C-methionine PET/CT in differential diagnosis of brain gliomas

To evaluate the possibilities of dynamic preoperative 11C-methionine (MET) PET/CT in differential diagnosis of various types of brain gliomas in adults. The study included 74 patients aged 48±14 years with supratentorial gliomas: Grade IV - glioblastoma (GB, n=33), Grade III - anaplastic oligodendroglioma (AOD, n=10) and anaplastic astrocytoma (AA, n=12), Grade II - diffuse astrocytoma (DA, n=13) and oligodendroglioma (OD, n=6). All patients underwent standard MRI and dynamic MET PET/CT within 20 minutes after intravenous injection of radiopharmaceutical. Then, we compared MRI and PET/CT data and comprehensively analyzed the early stages of time-activity curve using 2 parameters: the first pass peak (FPP) and the first peak of maximum uptake (Pmax). We have significantly distinguished high-grade tumors (GB and AA+AOD) and certain benign gliomas (DA and OD) (p<0.05). AUC was over 0.7 and 0.8 for FPP and Pmax in differential diagnosis of various gliomas, respectively. We found that difficulties in differential diagnosis of gliomas arise mainly if oligodendrogliomas are included in the control group. Dynamic PET/CT with analysis of FPP and Pmax increases specificity of differential diagnosis of various gliomas compared to standard static imaging. These data are valuable for choice of optimal treatment strategy, as well as fundamental research of metabolic processes and vascularization of various tumors.

Cytological diagnostics of subcutaneous dirofilariasis imitating proliferative lesions in dogs

Subcutaneous dirofilariasis is a disease in animals caused by invasions of nematodes, most often of the following species: Dirofilaria repens, D. tenuis, and D. striata transmitted by mosquitoes. Until recently, D. repens was endemic to the Mediterranean countries in Europe, but, in recent years, it has also been increasingly reported in Central and Eastern Europe. Cytological preparations collected by a fine-needle aspiration biopsy from nodular lesions located in the subcutis and skin of dogs were used to diagnose suspected proliferative lesions of a cancerous or inflammatory nature. The microscopic examination of the delivered cytological preparations revealed erythrocytes (very numerous), neutrophils and eosinophils (quite numerous), macrophages (single), and whole and/or damaged fragments of microfilariae of Dirofilaria sp. in various numbers. It should be noted that the described infection of Dirofilaria repens in Poland and other countries of this latitude will be an increasingly common pathology in dogs. Due to the mosquitoes transmitting the microfilariae, it is a zoonosis that is an increasingly frequent and a more serious threat to humans. In the differential diagnosis of various types of skin and subcutis lesions of unknown aetiology, dirofilariasis should be considered.

Differential diagnosis of various types of fluids on the eye fundus in patients with age-related macular degeneration

Age-related macular degeneration (AMD) is a leading cause of vision loss both worldwide and in Russia. A distinctive feature of the exudative form of AMD is the presence of choroidal neovascularization (CNV) as a result of pathological angiogenesis of the choroid. With the introduction of optical coherence tomography (OCT) - a non-invasive imaging technique - it has become possible to monitor CNV activity. In the development of CNV, OCT can reveal three types of fluid localization: intraretinal fluid (IRF), subretinal fluid, fluid under retinal pigment epithelium (RPE). Exudative IRF is characterized by the presence of round and/or oval space. This type of fluid is characterized by good response to anti-VEGF therapy. Degenerative IRF («cystoid degeneration») is characterized as a small, clearly defined hyporeflective spaces above the area with altered RPE not responding to anti-VEGF therapy. Thus, early diagnosis of AMD and detection of «new activity» after therapy with antivascular endothelial growth factor (anti-VEGF) by comparing distribution of the fluid in SD-OCT are critical to maintaining or restoring the best possible visual acuity in patients with this disease.

Parycalcitol + J131 - A New Route to Treatment Secondary Hyperparathyroidism in Patients with Chronic Kidney Disease on Long-term Dialysis?

Two cases with the dramatic course of secondary hyperparathyroidism in patients with chronic kidney disease on long-term dialysis. Has anything possible been done in management of these patients? Complications associated with impaired bone mineralization among patients with chronic kidney disease on long-term dialysis are observed frequently with an array of pathologic processes being found. Kidney osteodystrophy may be associated with either increased or decreased (adynamic bone disease, osteomalacia, aluminum-induced osteopenia) bone metabolism, as well as mixed forms related to the B2 microglobulin amyloidosis. Differential diagnosis of various types of osteopathy is difficult and is usually based on the histologic assessment of the bone biopsy. The most typical bone complication in patients with impaired kidney function is osetodistophy with increased bone metabolism, caused by secondary hyperparathyroidism clinically manifesting as osteitis fibrosa. High serum levels of PTH induce osteoclast and osteoblast activity. Early changes, with characteristic increase in the woven osteoid suggesting early, increased osteoplastic bone resorption may be found in a significant percentage of patients with GFR&gt;60ml/min/1,73m2 of the body surface. Lower values of the GFR are associated with both faster bone synthesis and more active resorption with progressive increase in the intraosseous fibrosis and decreased bone mineralization. As the abnormalities progress, which is especially marked in patients on long-term dialysis, a rage of clinical symptoms, such as: severe bone and joint pain, bone deformation, pathological fractures, especially in the spinal region, calcifications of the soft tissues and vessels, including heart valves and lungs. In children, the most common abnormality is growth impairment. In some patient’s skin calcifications, with subsequent necrosis, due to increased calcium deposition in small and medium arteries. The diagnosis is based on the typical clinical picture, biochemical parameters (calcium and phosphate ratio, parathormone levels, characteristic radiologic charges and sometimes, bone histology. Prevention and treatment of these complications includes effective dialysis, appropriate low-phosphate diet with limitation of the protein supply to the 0.8g/kg of the body mass, adequate calcium and active Vitamin D3 supply, introduction of the phosphate binding medications (sevelamer or lantan) as well as calcimimetic use (substances activating parathyroid gland calcium receptors inhibiting both its up-regulation and PTH secretion). In the severe cases, with insufficient effect of the treatment described above, parathyroidectomy is required after close ultrasound and scintigraphy-based assessment of these glands. However, even such treatment may be insufficient in some cases, as presented below.

Differential diagnosis of various types of intrahepatic cholestasis in children with chronic liver diseases

Differential diagnosis of various types of intrahepatic cholestasis in children with chronic liver diseases

Возможности стабилометрической диагностики нарушений функции равновесия

The aim of this study was to develop an automated system for differential diagnosis of various types of ataxias method of computer stabilography using the principle of vector analysis statokinesigram and create predictive mathematical models on the basis of the mathematical method of analysis of tree classifications. In this study, 217 people were included, including 196 patients and 21 healthy subjects. Patients with labyrinth, cerebellar and sensitive ataxia were studied. Additional parameters of vector analysis of stabilographic information allow fully and comprehensively characterize the dynamic process of maintaining a person's vertical posture. The analysis of stabilograms was reduced, basically, to the study of their amplitude-frequency characteristics by means of various methods of statistical processing, including spectral analysis. Analysis of the frequency of oscillations made it possible to identify slow (respiratory, cardiac) and fast waves, which characterize the contractile activity of skeletal muscles. In the course of the study it was revealed that the artificial division of the movement of the human body into oscillations in the frontal and sagittal planes led the researcher away from understanding the essence of the process of movement of the human body while maintaining a static equilibrium. An adequate method of predicting the type of ataxia based on the data of stabilographic information for performing automated computer differential diagnosis of various ataxia types, as well as screening the normal equilibrium function, is the compilation of mathematical models of „classification trees“.

ULTRASOUND STUDY OF PATIENTS WITH KELOID SCARS OF THE MAXILLOFACIAL AREA

Despite the possibility of modern surgery and dermatological cosmetology, the problem of differential diagnosis of patients with keloid scars remains relevant and significant at present. As clinical practice shows, not just the presents and the size of functional or aesthetic defect in scar tissue changes are important, but also the degree of their negative influence on the process of physical, psychological and social adaptation of the patient. The aim of our study was to optimize and improve the effectiveness of treatment of facial keloid scarring by identifying the type of scarred skin of the head and neck, and using ultrasound examination. The ultrasound method of investigation was performed on 50 patients with keloid scars of the head and neck. Clinical study of the general characteristics of the scar was supplemented by an additional analysis of the structural features of the cicatricial tissues by ultrasound examination. For the purpose of comparison, intact skin was used. Analysis of ultrasonography allowed to determine the color echogenic pattern of keloid scars, which differed substantially from the dermis of intact skin. Among the echogenic signs of postoperative keloid scarring, one should point out an increase in the depth of cicatrix of the tissue in comparison with the thickness of the intact derma, an average of 8-11%, an average thickness of the epidermis is 18-26%, a clear boundary between intact skin and keloid scar is traced, which is a clear differential sign of this type of scar. Only in 7% of cases, we have visualized the border with the hypodermis in the peripheral edges of the scar, which indicates the infiltration character of the growth of the keloid and again proves its similarity with the tumor. Today, there is no universal method for differential diagnosis of various types of scars of the head and neck. Therefore, it is necessary to develop an informative and economically expedient method of diagnostics. Ultrasonography of scarring is a non-invasive survey method that can objectively, informatively and safely evaluate numerous anatomical structures, determine the type and depth of scar formation.

EXPERIENCE OF USING DIGITAL SYSTEMS FOR DIAGNOSTICS OF HYPERTROPHIC SKIN SCARS OF FACE

The relevance of the problem. Head and neck scars resulting from the effects of various endogenous and exogenous factors are an actual problem of modern surgical stomatology. A large number of scientific researches devoted to the study of different methods of diagnosis of head and neck scars indicates that the verification of the diagnosis is a highly complicated issue. Currently, conventional algorithms for selecting methods of treating patients with scars are available. The development of such algorithm is difficult due to the uncertainty of criteria for the differential diagnosis of various types of scars. Despite significant pathogenetic and morphological differences of scarring, some of their types often have clinically similar features, resulting in a significant number of diagnostic errors. In its turn, carrying out the treatment without taking into account the clinical and morphological structure of scars usually leads to the lack of tangible therapeutic effect, recurrence and increased growth of scar tissue. That is why the development of a clear algorithm of comprehensive examination of this category of patients is of particular importance for determining the tactics of their treatment.&#x0D; The aim of the research is to increase the effectiveness of face scars treatment due to identification of type of scar-modified tissue by means of method of digital visualization of graphic digital images.&#x0D; Objects and methods of the research. Fifty patients with hypertrophic scars of face were examined. Further analysis of the structure of hypertrophic scars was performed using RGB-method of visualisation. At present, computer digital image research is widely used in histological, cytological, pathologic and immunological studies, which led us to consider the use of digital analysis of images as the initial stage of primary diagnosis in various types of postoperative scarred facial tissues. Computer imaging is still the only source for obtaining visualized qualitative and quantitative information and preserving it in digital form.&#x0D; Results of the research. We have studied the distribution of color constants of red, green and blue colors in 4 points: T1 – the area of intact skin, T2 – the medial and T3 – the lateral edge of the scar, and T4 – the area of the middle zone of scar. Due to the proposed method, the features of architectonic layers of the skin in the area of hypertrophic scar have been studied in detail. The obtained results allow improving the differential diagnosis of scars and expanding the possibilities to develop the pathogenetically grounded treatment of patients with head and neck scars. The analysis of the results of digital visualization of graphic digital images showed that statistically reliable differences in digital indices, being observed during visualization of hypertrophic scars, could be an important criterion of their differential diagnostics.&#x0D; Conclusion. Thus, examination of patients with scars of the maxillofacial region, providing the RGB-method, is an effective method of non-invasive diagnosis of hypertrophic scars allowing to evaluate the changes in scar-modified tissues in dynamics. The authors substantiated the feasibility of the use of RGB-system for the improvement of differential diagnosis of hypertrophic scars of the head and neck. Due to the proposed method, features of architectonic layers of the skin in the area of hypertrophic scar have been studied in detail. The obtained results allow to improve the differential diagnosis of scars and expand the possibilities of developing pathogenetically grounded treatment of patients with scarring of the head and neck.

Ultrasonоgraphic analysis of the fetal heart rhythm: clinical significance and differential diagnosis of bradyarrhythmias

The aim – 1) to evaluate the possibilities of ultrasound fetal heart examination in the detection and differential diagnosis of bradyarrhythmias; 2) to study the influence of arrhythmias on fetal hemodynamics; 3) to examine the role of fetal echocardiography in the management of prenatally diagnosed bradyarrhythmias for determining the optimal pregnancy and delivery tactics.Material and methods. The analysis of echocardiographic examinations of the fetal heart from April 1996 to July 2016 has been performed. During this period 2073 pregnant women were examined and 213 cases of fetal heart arrhythmias were detected. Ultrasound examination of the fetal heart was conducted according to the general protocol. The anatomy of the fetal heart was assessed based on segmental analysis. Rhythm of the fetal heart was determined by simultaneous recording of mechanical events (contractions of the atria and ventricles), which are the consequence of electrical activity, with estimation of the ratio between them, as well as the measured time intervals of the cardiac cycle with calculation of their ratio. For this purpose, various ultrasound techniques (M-method, color, pulse-wave and tissue Doppler) have been used.Results. During the study period 45 cases of fetal bradyarrhythmias were detected, (2.2 % of the number of all patients examined and 21.1 % of all arrhythmias). They included 20 cases (44.5 %) of periodic bradycardia of different duration, 9 cases (20 %) of sustained sinus bradycardia, 9 cases (20 %) of complete atrioventricular block, 5 cases (11 %) of blocked atrial bigeminy and 2 cases (4.5 %) of 2nd degree atrioventricular block. Persistent fetal bradycardia requires a complete echocardiographic examination to exclude structural pathology and assess possible hemodynamic complications. Bradyarrhythmias with a frequency of ventricular contractions of more than 60 bpm are well tolerated by the fetuses due to various adaptive mechanisms. Permanent forms of arrhythmia with a frequency less than 55 bpm, as usual, lead to serious hemodynamic comromise even in the absence of fetal congenital heart defects.Conclusions. Ultrasound fetal heart examination provides not only the identification and reliable differential diagnosis of various types of fetal bradyarrhythmia, but also an assessment of its hemodynamic consequences and prenatal period monitoring of the fetal condition. This makes possible to choose the tactics of pregnancy management, determine the frequency of follow-up examinations, plan the time, place and route of delivery. The majority of fetal brady­­arrhythmias are non-threatening rhythm disorders.

Oral tuberculosis diagnosed from exfoliative cytology - two case reports

Oral lesions of tuberculosis though uncommon, are seen in both the primary and secondary stages of the disease. Primary oral tuberculosis is very rare and may present a diagnostic challenge for the clinician. This article presents two rare cases of oral tuberculosis manifesting as non-healing oral ulcers which were suspected to be squamous cell carcinoma on clinical examination. The cases were detected initially by exfoliative cytology of oral ulcer and subsequently confirmed by histopathological examination and Ziehl Neelsen (ZN) stain of the cytosmears. The patients underwent anti-tuberculosis therapy and the oral conditions improved rapidly. Although oral manifestations of tuberculosis are rare, it should be considered in the differential diagnosis of various types of oral ulcers with the non-healing tendency.

New endoscopic ultrasonography techniques for pancreaticobiliary diseases.

Endoscopic ultrasonography (EUS) is widely used to evaluate pancreaticobiliary diseases, especially pancreatic masses. EUS has a good ability to detect pancreatic masses, but it is not sufficient for the differential diagnosis of various types of lesions. In order to address the limitations of EUS, new techniques have been developed to improve the characterization of the lesions detected by EUS. EUS-guided fine needle aspiration (EUS-FNA) has been used for diagnosing pancreatic tumors. In order to improve the histological diagnostic yield, a EUS-FNA needle with a core trap has recently been developed. Contrast-enhanced harmonic EUS is a new imaging modality that uses an ultrasonographic contrast agent to visualize blood flow in fine vessels. This technique is useful in the diagnosis of pancreatic solid lesions and in confirming the presence of vascularity in mural nodules for cystic lesions. EUS elastography analyzes several different variables to measure tissue elasticity, color patterns, and strain ratio, using analytical techniques such as hue-histogram analysis, and artificial neural networks, which are useful for the diagnosis of chronic pancreatitis and pancreatic cancer.

Extensive Inflammatory Gingival Tumor in a Young Nonsmoking Woman: Back to Basics.

Tuberculous lesions of the oral cavity are rare and can be a diagnostic challenge, particularly in young immunocompetent patients. Most of the cases in the literature are secondary to pulmonary disease, whereas primary form is uncommon. This paper presents a case of gingival tuberculosis in a 26-year-old Indian female patient, manifesting as a rapidly extensive ulcer. The diagnosis was confirmed by histopathology and immunological investigations. Although oral manifestations of tuberculosis are rare, clinicians should include them in the differential diagnosis of various types of oral ulcers. An early diagnosis with a prompt treatment can prevent complications and potential contaminations.

Oral ulcer: an uncommon site in primary tuberculosis

Tuberculosis is a chronic infectious disease and a major cause of morbidity and mortality worldwide. It can affect any part of the body, including the oral cavity. Oral lesions of tuberculosis, though uncommon, have been observed in both primary and secondary stages of the disease. This article presents a case of primary tuberculosis manifested as a non-healing, tender ulcer on the lingual mucosa of the edentulous right mandibular arch molar zone, an uncommon site. The diagnosis was confirmed after histopathology examination, polymerase chain reaction and purified protein derivative tests and chest radiograph. A recommended treatment plan of six months with four anti-tuberculotic antibiotics was commenced. Clinically, the oral ulcer disappeared three months after the commencement of treatment. The resurgence of tuberculosis should compel clinicians to include the disease in the differential diagnosis of various types of non-healing oral ulcers.