Etiology Of Lesions Research Articles

A Case of Anterior Cingulotomy for Intractable Pain Caused Thalamic Glioma.

Stereotactic bilateral anterior cingulotomy, including lesions in the anterior and midcingulate cortex, is one of the methods used for treating thalamic pain syndrome. In cases of non-ischemic thalamic lesions, simultaneous stereotactic biopsy of the lesion can be performed in combination with cingulotomy. In this paper we present a case of a 45-year-old male with a lesion in the right thalamus, causing a severe contralateral hemi-pain syndrome. Bilateral radiofrequency anterior cingulotomy and stereotactic biopsy were performed during a single surgery. Pain completely subsided within a few days following the anterior cingulotomy. Histological examination identified a diffuse astrocytoma (WHO grade II, ICD-O 9400/3), and the patient was subsequently referred for LINAC-based radiosurgery. The pain syndrome was controlled for 4 years, after which the pain syndrome returned with an increase in tumor size. Simultaneous anterior cingulotomy and stereotactic biopsy of the thalamic lesion represent a safe intervention for thalamic pain syndrome, enabling the alleviation of pain, verification of the lesion's etiology, and the application of appropriate treatment.

Disruption of distal appendage protein CEP164 causes skeletal malformation in mice

The primary cilium is a cellular antenna to orchestrate cell growth and differentiation. Deficient or dysfunctional cilia are frequently linked to skeletal abnormalities. Previous research demonstrated that ciliary proteins regulating axoneme elongation are essential for skeletogenesis. However, the role of the ciliary proteins responsible for initiating cilium assembly in skeletal development remains unknown. Here, we investigate the function of centrosomal protein of 164 kDa (CEP164), a key ciliogenesis regulator that localizes at the distal appendages of the mother centriole, during skeletal development in mice. Interestingly, the mesodermal cell-specific Cep164 deletion resulted in severe bone defects and osteoblast-specific deletion of Cep164 affected bone development. In contrast, chondrocyte-specific Cep164 deletion did not cause overt skeletal abnormalities, indicating that CEP164 functions in a cell type-specific manner within skeletal tissues. Importantly, Cep164-mutant osteoblasts not only displayed a lack of cilia but also showed an increased number of γH2AX-positive cells, indicating the involvement of defective DNA damage response in the etiology of skeletal lesions of Cep164-mutant mice. These results demonstrate that CEP164 has both ciliary and non-ciliary functions to control osteoblast growth and survival. Our study therefore reveals a novel understanding of the pathogenesis of skeletal ciliopathies associated with CEP164 dysfunction.

Anatomical insights into medial-sided talar dome osteochondral lesions: a comparative analysis of unilateral and bilateral cases and healthy controls using MRI measurements

Background The etiology of medial-sided talar osteochondral lesions (OCLs) remains insufficiently understood. Purpose To identify anatomical risk factors contributing to the development of unilateral or bilateral OCL of the talus on the medial side, utilizing morphological parameters derived from magnetic resonance imaging (MRI). Material and Methods In this retrospective study, 24 ankle MRI scans from 12 patients exhibiting bilateral OCLs of the talar dome on the medial side, 24 ankle MRIs from 24 patients with unilateral medial-sided OCLs, and 24 healthy controls matched for age, sex, and side within each group were analyzed. Six distinct MRI parameters were measured: the anterior opening angle of the talus (AOT); tibial axis-medial malleolus angle (TMM); plafond-malleolar angle (PMA); anterior talofibular ligament-posterior talofibular ligament (ATFL-PTFL) angle; the ratio of the distal tibial articular surface to the length of the trochlea tali arc (TAS/TAL); and the depth of the incisura fibularis (IncDep). Results The AOT, ATFL-PTFL angle, and TMM of individuals in both the bilateral and unilateral groups were significantly higher when compared to the healthy controls. In addition, TMM measurements in the unilateral group were significantly higher than in the bilateral group. Conclusion AOT and TMM appeared to be the primary predisposing factors in the development of both unilateral and bilateral OCLs. Furthermore, TMM shows a greater increase in unilateral OCL cases compared to bilateral OCL cases. The fact that TMM is not significantly high in known unilateral OCL cases can be a stimulus for investigating the other ankle for OCL.

SCIseg: Automatic Segmentation of Intramedullary Lesions in Spinal Cord Injury on T2-weighted MRI Scans.

"Just Accepted" papers have undergone full peer review and have been accepted for publication in Radiology: Artificial Intelligence. This article will undergo copyediting, layout, and proof review before it is published in its final version. Please note that during production of the final copyedited article, errors may be discovered which could affect the content. Purpose To develop a deep learning tool for the automatic segmentation of the spinal cord and intramedullary lesions in spinal cord injury (SCI) on T2-weighted MRI scans. Materials and Methods This retrospective study included MRI data acquired between July 2002 and February 2023 from 191 patients with SCI (mean age, 48.1 years ± 17.9 [SD]; 142 males). The data consisted of T2-weighted MRI acquired using different scanner manufacturers with various image resolutions (isotropic and anisotropic) and orientations (axial and sagittal). Patients had different lesion etiologies (traumatic, ischemic, and hemorrhagic) and lesion locations across the cervical, thoracic and lumbar spine. A deep learning model, SCIseg, was trained in a three-phase process involving active learning for the automatic segmentation of intramedullary SCI lesions and the spinal cord. The segmentations from the proposed model were visually and quantitatively compared with those from three other open-source methods (PropSeg, DeepSeg and contrast-agnostic, all part of the Spinal Cord Toolbox). Wilcoxon signed-rank test was used to compare quantitative MRI biomarkers of SCI (lesion volume, lesion length, and maximal axial damage ratio) derived from the manual reference standard lesion masks and biomarkers obtained automatically with SCIseg segmentations. Results SCIseg achieved a Dice score of 0.92 ± 0.07 (mean ± SD) and 0.61 ± 0.27 for spinal cord and SCI lesion segmentation, respectively. There was no evidence of a difference between lesion length (P = .42) and maximal axial damage ratio (P = .16) computed from manually annotated lesions and the lesion segmentations obtained using SCIseg. Conclusion SCIseg accurately segmented intramedullary lesions on a diverse dataset of T2-weighted MRI scans and extracted relevant lesion biomarkers (namely, lesion volume, lesion length, and maximal axial damage ratio). SCIseg is open-source and accessible through the Spinal Cord Toolbox (v6.2 and above). Published under a CC BY 4.0 license.

Etiology and Characteristics of Pseudotumoral Lesions and Tumefactive Demyelination in Multiple Sclerosis

IntroductionCerebral pseudotumoral lesions (CPTL) (>2cm) on magnetic resonance imaging (MRI) may pose a clinical challenge. A majority will occur in the context of multiple sclerosis (MS) – also referred to as tumefactive demyelinating lesions (TDL). The aim of this study was to define and analyze clinical, MRI, and paraclinical data for MS and non-MS patients. MethodsThis prospective study included adult patients with CPTL on brain MRI referred to the Neurology Clinic, Belgrade as a tertiary University Center (2019-2023) for clinical workup and treatment. Demographic, clinical, MRI, and paraclinical data were reviewed. ResultsThis study included 75 patients, of which 58.7% had MS. Fourteen patients had previously been diagnosed with MS, while 30 (68.2%) received the diagnosis of MS in the later course. The concordance of initial and final diagnoses was 52%. Relapsing disease (p<0.001) and brainstem presentation (p=0.039) were significantly more common in MS patients. Headache (p= 0.008) and lethal outcome (p=0.014) were significantly more common in the non-MS group. Lesions were ring-like more frequently in the MS group (p<0.001), while patients in the non-MS group frequently displayed infiltrative (p=0.001) and nonspecific lesions (p=0.002). The presence of headache and megacystic morphology was associated with the presence of pathology other than MS while the relapsing disease was in favor of MS. ConclusionMultiple sclerosis was the most common cause of CPTL. Headache, relapsing course of disease, and megacystic morphology may help discern MS from non-MS pathology. These findings should be challenged in future studies examining larger cohorts.

The safety and feasibility of laparoscopic partial splenectomy: analysis of perioperative indications from different vascular subtypes and improvement of surgical approach

IntroductionWhile laparoscopic splenectomy (LS) has been widely used in benign splenic tumor, more concerns have been raised for postoperatively short-term and long-term complications. Laparoscopic partial splenectomy (LPS) is a surgical option, to preserve splenic function, and reduce postoperative complications. The aim of our study was to retrospectively identify the safety and feasibility of LPS compared with LS in patients with splenic benign tumor.Materials and methodsFrom 2014 to 2024, a total of 165 patients diagnosed with occupational splenic lesions underwent splenectomy, of whom 87 underwent LPS and 78 underwent LS. We compare the perioperative parameters and long term follow up between these two groups.ResultsThe etiology of splenic space-occupying lesions was nonparasitic splenic cysts, followed by splenic lymphangioma and splenic hemangioma. Of the patients with LPS, 55 underwent conventional surgery with blockage of the splenic arterial branch and resection along the ischemic line (RAIL), and 32 underwent with our modified total splenic blood supply blockade followed by resection alone the tumor edge (RATE). The tumor size, the operative time and estimated blood loss were comparable between the LPS and LS groups. One patient developed abnormal signs during the LPS procedure and was promptly referred for LS. The LPS group had fewer pancreatic leakage, incision infection, and pulmonary infection. As for different vascular types, patients with LS under all branches of the splenic artery had a longer time to resume postoperative feeding. As for the comparison of RAIL and RATE, estimated blood and operative time were significantly reduced in patients receiving RATE. Postoperative complications were the same in patients underwent each surgical procedures.ConclusionLPS is a viable approach for patients with splenic benign tumor. We introduce the tumor artery supply types to indicate the resection region. Our RATE technique has proven to be clinically effective and safety.

Association of Extraosseous Arterial Diameter With Talar Dome Osteochondral Lesions.

Etiology of osteochondral lesions of the talus (OLT) is multifactorial and may develop from trauma, genetics, or hypovascularity. The talar dome is supplied by the posterior tibial artery (PTA) and, to a lesser degree, the sinus tarsi artery (STA). The role of talar dome hypovascularity on OLT remains poorly studied. We aimed to determine any relationship between the diameter of PTA (dPTA) and STA (dSTA) and the incidence and characteristics of talus OLT. This retrospective study included 77 patients with OLT and 77 subjects as a matched control group (age range: 30-40 years). Using magnetic resonance imaging, the dPTA was measured 1 cm above the tibial plafond, at the plafond, and at the level of medial malleolar tip. Likewise, dSTA was measured at the level of the talar neck. The area, volume, depth, localization, and surgical intervention for OLT were recorded as well. The study group had significantly smaller dPTA at all 3 levels (1.05 ± 0.22 mm, 0.99 ± 0.18 mm, 0.98 ± 0.31 mm, proximal to distal, respectively) compared with controls (1.25 ± 0.23 mm, 1.20 ± 0.22 mm, 1.14 ± 0.18 mm, respectively) (P < .001). The dSTA was also significantly smaller in the study group compared with the control group (0.5 ± 0.11 mm vs 0.57 ± 0.08 mm, respectively; P = .001). The mean dPTA (of all 3 levels) cutoff value for predicting the occurrence of OLT was 1.1 mm with 74% sensitivity and 75% specificity. A significant inverse correlation was observed between OLT area and arterial diameters (P < .001). Smaller luminal dPTA and dSTA appear to be associated with higher incidence of OLT, with defect size inversely correlated to arterial diameter.

Vermian multinodular and vacuolating lesion of unknown significance discovered following syncope: a case report

Introduction and importance: Multinodular and Vacuolating Posterior Fossa Lesions of Unknown Significance (MV PLUS) are benign cystic lesions that, though typically asymptomatic, can present with neurological symptoms such as seizures, headaches, and syncope. These lesions are predominantly found in sub-tentorial brain structures but can also appear in supratentorial areas. MRI is crucial in detecting these lesions, characterized by small nodules with high intensity on T2-FLAIR sequences. Despite increasing awareness, the pathophysiology and classification of MV PLUS lesions remain unclear, necessitating further research and careful monitoring. Case presentation: A 52-year-old female presented with subjective dizziness and a recent syncope episode. Neurological examination showed ataxia and a positive Romberg sign. MRI revealed a multicystic and nodular lesion in the vermian and paravermian regions, with altered signal intensity on T1-weighted and FLAIR sequences. The lesion showed no pathological enhancement post-gadolinium administration, and spectroscopy revealed no significant metabolite peaks. Clinical improvement was observed following corticosteroid and antivertiginous therapy, and the patient was discharged with a recommendation for neuroradiological follow-up. Clinical discussion: MV PLUS lesions are a subset of multinodular and vacuolating lesions that present significant diagnostic challenges due to their complex radiological features. First described in 2013, these lesions have distinct MRI characteristics, including a nodular appearance with high T2-FLAIR intensity and occasional cystic components. Despite being benign and typically stable, the differential diagnosis includes various other intracranial lesions, requiring careful evaluation. The pathogenesis and optimal management strategies for MV PLUS lesions are still under investigation, emphasizing the need for continued research. Conclusion: MV PLUS lesions, although rare and benign, present unique diagnostic challenges due to their varied radiological features and potential neurological symptoms. Regular MRI monitoring is essential to track their stability, given the current lack of understanding regarding their pathophysiology and long-term implications. Further research is needed to elucidate the etiology, natural history, and optimal management of these intriguing lesions.

Contrast enhanced ultrasound of liver lesions in patients treated for childhood malignancies

BackgroundPatients treated for cancer have a higher incidence of focal liver lesions than the general population and there is often concern for a malignant etiology. This can result in patient, caregiver and physician anxiety and is managed by a “wait and watch” approach, or immediate additional imaging, or biopsy, depending on the degree of clinical concern. Because it is a low-cost, easily accessible, radiation and sedation free modality, we investigated the value of contrast enhanced ultrasound (CEUS) to accurately distinguish benign from malignant liver lesions in patients treated for childhood malignancies.MethodsWe performed an IRB approved retrospective study of 68 subjects who were newly diagnosed, on treatment or off treatment for a pediatric malignancy and had liver lesions discovered on CT, MRI or non-contrast ultrasound and subsequently underwent CEUS between September 2013 and September 2021. Two experienced pediatric radiologists and a radiology trainee, blinded to the etiology of the liver lesions, independently reviewed the CEUS examinations and categorized lesions as benign, indeterminate, or malignant. The reference standard was biopsy for 19 lesions and clinical follow-up for 49. The sensitivity, specificity, positive and negative predictive value, and diagnostic accuracy of CEUS were calculated using only the benign and malignant CEUS classifications. Inter-reviewer agreement was assessed by Cohen’s kappa statistic.ResultsThere were 26 males and 42 females, mean age, 14.9 years (range, 1–52 years). Fifty subjects were off therapy, twelve receiving treatment, and six with newly diagnosed cancer. By the reference standard, 59 (87%) lesions were benign and 9 (13%) were malignant. Sensitivities of CEUS for the three reviewers ranged from 83 to 100% (95% CI, 35.9-100%), specificities from 93.1 to 96.0% (95% CI, 83.5-99.6%), PPV 60.0-71.4% (95% CI, 29.0-96.3%), NPV 98.0-100% (95% CI, 89.2-100%) and accuracy from 93.8 to 94.6% (95% CI, 85.1-99.7%). The kappa statistic for agreement between the two experienced radiologists was moderate at 0.58.ConclusionsCEUS is highly accurate in distinguishing benign from malignant etiologies of liver lesions in patients treated for pediatric malignancies.

Prophylactic pancreatic duct stenting to reduce the risk of post-ampullectomy pancreatitis: a comprehensive review and meta-analysis of 1858 patients.

The effectiveness of prophylactic pancreatic duct stenting (PPDS) in preventing post-ampullectomy pancreatitis (PAP) at the time of endoscopic ampullectomy (EA) has been reported, however, results are conflicting. We conducted a systematic review and meta-analysis looking at the use of PPDS in reducing PAP as well as overall post-ampullectomy complications. Multiple databases were searched through May 2023 for studies reporting on EA. Meta-analysis was performed to determine pooled proportions and relative risk (RR) with 95% confidence intervals (CI) of PAP, with and without PPDS. Pooled rates of adverse events including perforation, delayed bleeding, cholangitis, and procedure related mortality were assessed. Random effects model was used for our meta-analysis and heterogeneity was assessed using the I2 statistics. Thirty-four studies (14 case series, 18 cohort studies and 2 randomized controlled trials) with 1868 patients were included. The overall pooled rate of PAP was 12.3% (CI 10.3-14.5). We found no statistically significant difference in rates of PAP among patients with PPDS, 11.9% (CI 8.9-15.7) and without PPDS, 16.6% (CI 13.4-20.4), RR 0.8 (CI 0.51-1.28), p = 0.4. In terms of severe PAP, we found no difference between the two groups. The overall pooled rates of successful en-bloc and piecemeal resection were 74.8% (CI 67.3-81.1) and 25.1% (CI 19-32.4). Additionally, pooled rates of ampullary stenosis, post procedural bleeding, perforation, cholangitis, and procedure related mortality were 3.6%, 11.1%, 4.2%, 3.5%, and 1.3%, respectively. Our analysis shows that PPDS at the time of EA does not offer a significant protective effect against PAP. While the incidence of PAP was higher among the no PPDS group, it is plausible that this is more likely due to variation among studies in terms of lesion size, length/size of pancreatic stent used and etiology of ampullary lesions. Future well-designed randomized controlled trials are needed to validate our findings.

Vitelliform subretinal deposits: shared pathogenesis and clinical diversity

Since its initial description, Best vitelliform macular dystrophy has been strongly linked to characteristic retinal lesions—subretinal yellowish accumulations, with a hyperreflective structure on optical coherence tomography, situated above the retinal pigment epithelium layer. However, research on this topic remains scarce. It is now recognized that, within the common pathophysiological mechanism of vitelliform lesion formation, this process may contribute to the pathogenesis of a broad spectrum of both genetic and acquired conditions.The purpose of this review is to update our understanding of genetically determined and acquired retinal diseases associated with the formation of such lesions.Materials and methods. analysis of scientific publications from databases including PubMed, ScienceDirect, and Cyberleninka was conducted. The review encompasses 16 studies, predominantly from the past decade.Results. Advances in instrumental and genetic diagnostics have revealed that vitelliform subretinal changes are not exclusive to Best disease but serve as another biomarker, indicating disruption in the metabolism of outer retinal layers. It is hypothesized that, irrespective of etiology, the primary triggering factor for lesion formation is the disjunction of outer segments of photoreceptors and impairment of phagocytic function in retinal pigment epithelial cells. This article presents a contemporary perspective on the presumed etiology and pathophysiology of vitelliform lesions, alongside clinical characteristics, manifestations, and prognosis of diseases associated with this phenomenon. Diseases with identified genetic mutations in the BEST1 gene (Bestrophinopathies) and PRPH2, as well as common acquired conditions like age-related macular degeneration and vitreoretinal traction syndrome, are discussed.Conclusions. The provided clinical characteristics, supported by multimodal visualization, are expected to aid in differential diagnosis and prognostication of the disease course.

Nonendemic rhinoscleroma: An unusual manifestation of the trachea.

Rhinoscleroma is classically described as a chronic granulomatous disease caused by Klebsiella rhinoscleromatis which primarily affects the nose and nasopharynx. When present, tracheal manifestations will be seen late in the disease course rather than on initial presentation. We describe a rare case of nonendemic rhinoscleroma that presented with tracheal lesions as an initial manifestation of disease. Case report and literature review. An 88-year-old male presented with longstanding dysphonia. Flexible laryngoscopy demonstrated a septal perforation and diffuse glottic lesions. CT neck demonstrated a nonobstructive polypoid tracheal lesion and mucosal thickening of the paranasal sinuses. Biopsy confirmed an atypical lympho-histiocytic proliferation and microorganisms within macrophages on Grocott methenamine silver and Steiner stains consistent with rhinoscleroma. He was referred for rheumatology and pulmonology consultation. Systemic diseases rarely affect the trachea, and even less frequently is a tracheal lesion identified as the initial manifestation of disease. The most common systemic diseases that affect the trachea include relapsing polychondritis, granulomatosis with polyangiitis, amyloidosis, and inflammatory bowel disease. The literature surrounding nasolaryngotracheal rhinoscleroma is limited, especially in nonendemic areas. It is necessary to include unusual etiologies of airway lesions in the differential diagnosis, which warrants comprehensive airway evaluation including biopsy. 4.

Chronic Lead Exposure in Adult Mice: Associations with miR-671/CDR1as Regulation, NF-κB Signaling, and Alzheimer's Disease-like Pathology.

Long-term exposure to lead (Pb) can result in chronic damage to the body through accumulation in the central nervous system (CNS) leading to neurodegenerative diseases, such as Alzheimer's disease (AD). This study delves into the intricate role of miR-671/CDR1as regulation in the etiology of AD-like lesions triggered by chronic Pb exposure in adult mice. To emulate the chronic effects of Pb, we established a rodent model spanning 10 months of controlled Pb administration, dividing 52 C57BL/6J mice into groups receiving varying concentrations of Pb (1, 2, or 4 g/L) alongside an unexposed control. Blood Pb levels were monitored using serum samples to ensure accurate dosing and to correlate with observed toxicological outcomes. Utilizing the Morris water maze, a robust behavioral assay for assessing cognitive functions, we documented a dose-dependent decline in learning and memory capabilities among the Pb-exposed mice. Histopathological examination of the hippocampal tissue revealed tell-tale signs of AD-like neurodegeneration, characterized by the accumulation of amyloid plaques and neurofibrillary tangles. At the molecular level, a significant upregulation of AD-associated genes, namely amyloid precursor protein (APP), β-secretase 1 (BACE1), and tau, was observed in the hippocampal tissue of Pb-exposed mice. This was accompanied by a corresponding surge in the protein levels of APP, BACE1, amyloid-β (Aβ), and phosphorylated tau (p-tau), further implicating Pb in the dysregulation of these key AD markers. The expression of CDR1as, a long non-coding RNA implicated in AD pathogenesis, was found to be suppressed in Pb-exposed mice. This observation suggests a potential mechanistic link between Pb-induced neurotoxicity and the dysregulation of the CDR1as/miR-671 axis, which warrants further investigation. Moreover, our study identified a dose-dependent alteration in the intracellular and extracellular levels of the transcription factor nuclear factor-kappa B (NF-κB). This finding implicates Pb in the modulation of NF-κB signaling, a pathway that plays a pivotal role in neuroinflammation and neurodegeneration. In conclusion, our findings underscored the deleterious effects of Pb exposure on the CNS, leading to the development of AD-like pathology. The observed modulation of NF-κB signaling and miR-671/CDR1as regulation provides a plausible mechanistic framework for understanding the neurotoxic effects of Pb and its potential contribution to AD pathogenesis.

Bony Bankart Lesion: Diagnosis, Management, and Outcomes.

» Bony Bankart lesions are fractures of the anteroinferior glenoid rim, commonly associated with a traumatic anterior shoulder dislocation, and are diagnosed through radiological imaging and physical examination. Young male athletes playing contact sports are at highest risk of these injuries. Early diagnosis and treatment are crucial because, if left untreated, recurrent anterior shoulder instability and glenoid bone loss can occur. Both nonsurgical and surgical treatment options are available depending on the size of the lesion, with arthroscopic repair being the most common treatment method. After repair, patients typically have favorable outcomes with low rates of recurrent instability. This review aims to discuss the etiology, diagnosis, and treatment of bony Bankart lesions.» Bony Bankart lesions are fractures of the anteroinferior glenoid rim and occur in up to 22% of first-time anterior shoulder dislocations.» Young men involved in contact sports or combat training are at the highest risk of sustaining bony Bankart lesions.» Diagnosis and treatment of bony Bankart lesions are essential to prevent long-term shoulder instability.» Bony Bankart lesions can be treated either nonoperatively or operatively (arthroscopic vs open repair), with the size of the glenoid defect being the primary determinant of treatment.

Osteochondritis Dissecans of the Elbow in Overhead Athletes: A Comprehensive Narrative Review.

Osteochondritis dissecans (OCD) of the elbow mainly occurs in overhead athletes (OHAs). This narrative review aimed to comprehensively analyze the epidemiological data, etiological factors, clinical and imaging features, treatment options, and outcomes of OHAs with the diagnosis of elbow OCD. A literature search was performed in PubMed/MEDLINE, Scopus, and Web of Science. Individuals with elbow OCD were usually 10-17 years of age with incidence and prevalence varying between studies, depending on the sport activity of the patients. The etiology of OCD lesions is multifactorial, and the main causes are believed to be repetitive trauma, the biomechanical disproportion of the articular surfaces, poor capitellar vascular supply, and inflammatory and genetic factors. Athletes usually presented with elbow pain and mechanical symptoms. The mainstay for the diagnosis of elbow OCD is MRI. The treatment of elbow OCD lesions should be conservative in cases of stable lesions, while various types of surgical treatment are suggested in unstable lesions, depending mainly on the size and localization of the lesion. The awareness of medical practitioners and the timely diagnosis of OCD lesions in OHAs are key to favorable outcomes.

Endodontic-periodontal continuum of tooth: Systematic literature review

INTRODUCTION. The pathogenetic relationship between periodontal and pulp diseases was first described by Simring and Goldberg in 1964. Since then, the term “endodontic-periodontal” lesion (or “endo-perio”) has been used to describe lesions caused by inflammatory products found to varying degrees in both the periodontal and dental pulp tissues. The pulp and periodontium have embryonic, anatomical and functional relationships. The simultaneous presence of changes in pulp tissue and inflammatory periodontal diseases can complicate diagnosis and treatment planning. The etiology, pathogenesis and treatment methods of endodontic-periodontal lesions can vary from quite simple to relatively complex aspects. Knowledge of the basis of concomitant inflammatory processes in the pulp and periodontium is important for making the correct diagnosis.AIM. Carry out a systematic analysis of the literature and summarize the available data on etiopatogenetic relations, diagnostic features and clinical history of endodontic periodontal dental lesions. MATERIAL AND METHODS. A systematic literature analysis was carried out, as well as a manual search in the databases PubMed, Google Search, eLibrary, disserCat, Cyberleninka. Among national and foreign publications corresponding to the topic of this review, 28 publications were selected for systematic analysis, the results of literature review are presented in this article.CONCLUSION. This systematic review found that dental anatomy and the etiology of endodontic periodontal lesions are the basis for difficulties in the diagnosis and treatment of patients with endo-periodontal lesions. Determining the prevalence of infection and the individual characteristics of EPP pathogenesis in patients in this group remains a challenge. In the future, it is necessary to develop new methods of diagnosis, prophylaxis and complex treatment of combined periodontal tissue and tooth pulp, which will improve the prognosis of treatment of injured teeth in the long term.

Granulomatous Epulis in Maxillary Anterior Interdental Teeth

Introduction: Epulis is a tumor-like enlargement of the gingiva originating from periodontal connective tissue, which is caused by chronic irritation. Epulis that occurs on the upper anterior teeth will disrupt the aesthetics and function of the lips and reduce self-confidence, so treatment is needed. Case report: The patient came to RSGM complaining that there was a lump on the upper front tooth and it felt painful. The patient had gone to the dentist regarding this case and was given topical medication, but the patient forgot the name of the medication. The patient's pain is aggravated when brushing his teeth and eating hard food or meat, for the taste is relieved when left alone. At the first meeting, patients are given information and education regarding the disease they are suffering from. Case management: The surgical phase by excision of the epulis with gingivectomy and subsequent curettage after surgical treatment of the gingiva. Discussion: Granulomatous epulis is a tissue mass that only exists in the gingiva which is richly vascularized, this lesion can grow to a certain size and stop growing. The etiology of granulomatous epulis lesions is usually caused by chronic irritation. Conclusion: Excision treatment and gingival formation performed with a scalpel can be considered for the treatment of maxillary anterior granulomatous epulis

A Detailed Comparison regarding the of Knowledge Level of Final Year Dental Students of Isfahan Azad University with Other Statistical Communities in Other Studies, in Relation to Squamous Cell Cancer of the Oral Cavity

&#x0D; &#x0D; &#x0D; Introduction: Oral squamous cell cancer (OSCC) constitutes 90% of oral cancers, the most important factors of which are smoking tobacco and drinking alcohol. Early detection of cancerous and precancerous lesions and subsequent referrals are the most important factors in reducing OSCC mortality. The purpose of this study is to compare the knowledge level of senior dental students of Isfahan Azad University regarding etiology, prognosis and treatment of OSCC lesions with three other statistical communities in other statistical populations( dental students in different years of studying, the graduates , and the doctors).&#x0D; Methods: The present study was conducted in the academic year 2021-2022 on 82 senior students of the Faculty of Dentistry in Islamic Azad University, Isfahan Branch (Khorasgan) using census sampling method. The type of study was cross-sectional and descriptive-analytical. A researcher-made questionnaire, whose validity and reliability was calculated was distributed to the students by the researcher in person. Data analyses were done and statistical tests were examined at a significance level of 0.05. Finally, other studies with the same statistical communities were also examined through Google scholar, Scopus, Sid, Proquest and PubMed databases and the results (general and detailed) were compared with the present study.&#x0D; Results: Of 82 students participating in the study, 47/9% were females, 80/5% were unmarried, and 74/4% were native people. The average score of awareness regarding the etiology dimension was 2/5 out of 3, while in the prognosis and treatment level, it was estimated as 3/44 out of 7. In addition, a significant difference was not observed between the average knowledge of students in both etiology and treatment dimensions, and the variables of gender, marital status, and residence status .&#x0D; Conclusion: The results of the present study showed that the knowledge level of senior students in the Faculty of Dentistry in Islamic Azad University, Isfahan (Khorasgan) Branch, as in many statistical communities in other studies, is far from the ideal level. In order to improve these conditions, it is suggested that students have more contact with patients and oral lesions during the course of their studies. Moreover, more retraining courses (virtual or face-to-face) are recommended in the field of malignant and premalignant oral lesions.&#x0D; &#x0D; &#x0D;

Sutton-Kadir Syndrome can be treated safely with endovascular embolisation alone.

Sutton-Kadir Syndrome (SKS) describes true inferior pancreaticoduodenal artery (IPDA) aneurysms in the setting of coeliac artery (CA) stenosis or occlusion. Although rare, SKS aneurysms can rupture and cause morbidity. Due to its rarity and lack of controlled treatment data, correct treatment for the CA lesion is currently unknown. Our aim was to assess if endovascular embolisation alone was safe and effective in treatment of SKS aneurysms, in emergent and elective settings. Secondary objectives were to describe presentation and imaging findings. A retrospective cohort study of patients treated at Sir Charles Gairdner Hospital between January 2014 and December 2021 was done. Data on presentation, diagnostics, aneurysm characteristics, CA lesion aetiology, treatment and outcomes were extracted from chart review. Twenty-four aneurysms in 14 patients were identified. Rupture was seen in 7/15 patients. Most aneurysms (22/24) were in the IPDA or one of its anterior or posterior branches. Median arcuate ligament (MAL) compression was identified in all. There was no difference in median (IQR) maximal transverse diameter between ruptured and non-ruptured aneurysms (6 mm (9), 12 mm (6), P = 0.18). Of ruptures, 6/7 had successful endovascular embolisation and 1/7 open surgical ligation. Of non-ruptures, 6/7 had successful endovascular embolisation, 1/7 open MAL division then endovascular CA stenting and aneurysm embolisation. No recurrences or new aneurysms were detected with computed tomography or magnetic resonance angiography over a median (IQR) follow-up period of 30 (10) months in 12 patients. Endovascular embolisation of SKS aneurysms without treatment of MAL compression is safe and effective in both the emergent and elective settings.

Characterisation, prevalence and severity of skin lesions caused by ophidiomycosis in a population of wild snakes

Ophidiomycosis is an emerging infectious disease affecting wild snakes in the Northern Hemisphere. Recently confirmed in Great Britain, the prevalence, severity and significance of ophidiomycosis has yet to be characterised in free-living snakes at a population level in Europe. Therefore, a population of barred grass snakes (Natrix helvetica) in eastern England was monitored for three seasons (May 2019 to October 2021), to investigate the prevalence (25.5%; 191/750 snakes) and severity of skin lesions and their aetiology. The most frequently observed skin lesion characteristics were changes in scale colour, crusting, and scale margin erosion. The majority of such lesions (96.9%; 185/191 snakes) was observed on the ventral surface along the length of the body. The severity of skin lesions was considered mild in more than half of the cases (53.1%; 98/191 snakes). Predominantly, skin lesions were observed in adult snakes (72.8%; 139/191 snakes). Combined histological examinations and qPCR tests of skin lesions from N. helvetica sloughs and/or carcasses confirmed a diagnosis of ophidiomycosis. Further targeted surveillance, supported by molecular and histological examinations to confirm skin lesion aetiology, is required to determine the extent to which our findings reflect the occurrence of ophidiomycosis in populations within wider landscapes.