Tissue Overgrowth Research Articles

Effect of Aloe vera gel on the healing of cutaneous wounds in donkeys

The efficiency of fresh Aloe vera gel was tested on the healing of large cutaneous wounds of the forelimbs in donkeys. Twelve adult donkeys from both sexes were used in this experimental study. They were divided into equal groups. A square shape cutaneous wound about 8*8cm, was induced on the lateral aspect of the forelimb exactly between humeral and knee joint. In group one, the induced wound was left without treatment, while in second group the wound was treated by local application of fresh Aloe vera gel. The evaluation of healing process results was based on monitoring the gross signs of wound healing, in addition to the study the histopathological changes at 15th, 30th, 45th postoperative days. In group one, the wound healing process was characterized by infection, congestion, inflammatory exudate, excessive granulation tissue formation, and no decrease in wound size, while in group two, the healing of wound was characterized by absence of granulation tissue overgrowth with decrease in wound size and little occurrence of infection and congestion. The histopathological observations in first group was showed intensive granulation tissue formation with massive infiltration of mononuclear inflammatory cells and delay of reepithelization, while in second group, overgrowth of granulation tissue was lesser, little infiltration of mononuclear inflammatory cells, rapid reepithelization with more maturation and stretching of collagen fibers. It was concluded that the Aloe vera gel can be used successfully as topical treatment to improve and enhance large cutaneous wound healing in donkeys.

Keeping your dentist up to date

Your dentist needs to know about your past or current illnesses and medication use. Some general health conditions and medications can affect your oral health, and your oral health can affect some general health conditions. Dentists may ask you about your overall health, including conditions like these1Villa A da Costa J Duong M-L Frazier K Urquhart O for the Council on Scientific AffairsOral-systemic health considerations in dental settings: an American Dental Association Clinical Evaluators Panel Survey..JADA. 2022; 153: 388-389Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar:▪heart or blood conditions▪cancer▪eating disorders▪infectious diseases Dentists also ask about your overall health because some of these conditions can affect your mouth.2Lamster I.B. Lalla E. Borgnakke W.S. Taylor G.W. The relationship between oral health and diabetes mellitus.JADA. 2008; 139: 19S-24SPubMed Google Scholar For example, eating disorders can affect the gums and teeth, especially if the patient is vomiting often. The acid in vomit can wear down the hard outer layer of enamel on teeth. Some health conditions may be affected by oral health. Diabetes is a good example. Several oral diseases tend to be more common in people who have diabetes, like the following2Lamster I.B. Lalla E. Borgnakke W.S. Taylor G.W. The relationship between oral health and diabetes mellitus.JADA. 2008; 139: 19S-24SPubMed Google Scholar:▪gum disease▪dry mouth▪a fungal infection called thrush Furthermore, people with type 2 diabetes who have gum disease may have more difficulty controlling their blood sugar levels.3Graziani F. Gennai S. Solini A. Petrini M. A systematic review and meta-analysis of epidemiologic observational evidence on the effect of periodontitis on diabetes: an update of the EFP-AAP review.J Clin Periodontol. 2018; 45: 167-187Crossref PubMed Scopus (161) Google Scholar Then there are conditions that occur at the same time but do not really seem to affect one another. For some conditions, it is more likely that they share the same risk factor. For example, research suggests that some people who have the heart condition atherosclerosis also tend to have gum disease. The researchers cannot say whether one condition causes the other, but they know that both conditions share risk factors. For example, smoking increases the risk of both atherosclerosis and gum disease.4Cho H.J. Shin M.S. Song Y. Park S.K. Park S.M. Kim H.D. Severe periodontal disease increases acute myocardial infarction and stroke: a 10-year retrospective follow-up study.J Dent Res. 2021; 100: 706-713Crossref PubMed Scopus (10) Google Scholar This is another reason why dentists might ask about your behaviors and habits. Many dental offices might also check your pulse, temperature, breathing rate, and blood pressure at the start of a visit to see if these vital signs are okay before treatment begins.1Villa A da Costa J Duong M-L Frazier K Urquhart O for the Council on Scientific AffairsOral-systemic health considerations in dental settings: an American Dental Association Clinical Evaluators Panel Survey..JADA. 2022; 153: 388-389Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar Medications can also affect your oral health. Let your dentist know what you are taking and what you are allergic to. Be sure to include prescription medications, over-the-counter drugs that you buy without a prescription, vitamins, and herbal remedies.4Cho H.J. Shin M.S. Song Y. Park S.K. Park S.M. Kim H.D. Severe periodontal disease increases acute myocardial infarction and stroke: a 10-year retrospective follow-up study.J Dent Res. 2021; 100: 706-713Crossref PubMed Scopus (10) Google Scholar It is estimated that more than 400 medications cause dry mouth.5Ciancio S.G. Medications’ impact on oral health.JADA. 2004; 135: 1440-1448Abstract Full Text Full Text PDF PubMed Scopus (79) Google Scholar This not only can be uncomfortable, but a low saliva flow also can increase your risk of cavities. If you are taking a medication that causes dry mouth, your dentist may work with your physician to see if there is another medication you can take instead. If that is not possible, your dentist may suggest that you use an artificial saliva. Other oral effects of medications can include the following5Ciancio S.G. Medications’ impact on oral health.JADA. 2004; 135: 1440-1448Abstract Full Text Full Text PDF PubMed Scopus (79) Google Scholar:▪an overgrowth or swelling of the gum tissue▪problems with bone healing after surgery▪mouth sores It is important to fill your dentist in on your general health and any medications you are taking, including those that are prescribed by your physician and those you buy off the store shelf. Sometimes your general health or medications can affect your oral health and vice versa. Providing your dentist with an up-to-date and complete health and medication history can help your dentist care for you.

Hedgehog pathway modulation by glypican 3-conjugated heparan sulfate.

Glypicans are a family of cell surface heparan sulfate proteoglycans that play critical roles in multiple cell signaling pathways. Glypicans consist of a globular core, an unstructured stalk modified with sulfated glycosaminoglycan chains, and a glycosylphosphatidylinositol anchor. Though these structural features are conserved, their individual contribution to glypican function remains obscure. Here, we investigate how glypican 3 (GPC3), which is mutated in Simpson-Golabi-Behmel tissue overgrowth syndrome, regulates Hedgehog signaling. We find that GPC3 is necessary for the Hedgehog response, surprisingly controlling a downstream signal transduction step. Purified GPC3 ectodomain rescues signaling when artificially recruited to the surface of GPC3-deficient cells but has dominant-negative activity when unattached. Strikingly, the purified stalk, modified with heparan sulfate but not chondroitin sulfate, is necessary and sufficient for activity. Our results demonstrate a novel function for GPC3-associated heparan sulfate and provide a framework for the functional dissection of glycosaminoglycans by in vivo biochemical complementation. This article has an associated First Person interview with the first author of the paper.

Skin and soft tissue complications of bone-anchored hearing aids: Introducing a new classification system

ObjectivesThere have been significant surgical and technological advances in bone-anchored hearing aid (BAHA) design, function, and implantation technique, but peri-implant skin complications remain the most frequent complication. The most important aspect in dealing with cutaneous complications is to identify the type of cutaneous lesion.Although Holger's Classification has been an extremely useful clinical tool, this grading system has been shown to be unsuitable for some cases. We therefore propose a new consistent and easy assessment classification of cutaneous complications associated with BAHA. MethodsA retrospective clinical study was carried out at a tertiary centre, between January 2008 and December 2014. All patients under 18 years old with a unilateral BAHA were included in the study. ResultsA total of 53 children, with a BAHA, were included in the study. Post-operative skin complications were observed in 49.1% of the patients. Of the children, 28.3% presented with soft tissue hypertrophy, the most frequently reported skin complication, and grading according to the Holger's classification was not considered feasible.To overcome the difficulties we face in clinical practice, a new classification was developed and presented. ConclusionThe new proposed classification – Coutinho Classification – aims to fill the gaps in the one used currently by introducing new clinical features, most importantly the presence/absence of tissue overgrowth, and by providing a better description of what each category encompasses. This is an inclusive and objective new classification system, maintaining applicability, and useful in guiding the treatment.

Snail regulates Hippo signalling-mediated cell proliferation and tissue growth in Drosophila.

Snail (Sna) plays a pivotal role in epithelia-mesenchymal transition and cancer metastasis, yet its functions in normal tissue development remain elusive. Here, using Drosophila as a model organism, we identified Sna as an essential regulator of Hippo signalling-mediated cell proliferation and tissue growth. First, Sna is necessary and sufficient for impaired Hippo signalling-induced cell proliferation and tissue overgrowth. Second, Sna is necessary and sufficient for the expression of Hippo pathway target genes. Third, genetic epistasis data indicate Sna acts downstream of Yki in the Hippo signalling. Finally, Sna is physiologically required for tissue growth in normal development. Mechanistically, Yki activates the transcription of sna, whose protein product binds to Scalloped (Sd) and promotes Sd-dependent cell proliferation. Thus, this study uncovered a previously unknown physiological function of Sna in normal tissue development and revealed the underlying mechanism by which Sna modulates Hippo signalling-mediated cell proliferation and tissue growth.

What is the Endometrial Polyps Malignancy Rate in Postmenopausal women?

Background: The endometrial polyps are overgrowths of localized endometrial tissue. These Polyps vary in size and can be pedunculated or sessile, single or multiple and they contain blood vessels and stroma in varying amounts covered by pseudo stratified epithelium. Depending on the pattern analyzed and the resection techniques used, occurrence rate of malignancy related to endometrial polyp levels from 0.8% to 8%1. Aim: To find out the rate of malignancy of endometrial polyps in postmenopausal women that are symptomatic. Method: In this systematic review data extracted by different search engines. The following search engines provided data for this systematic review, PubMed, Medline, Science direct, NCBI, Medscape, and Google scholars. Results: A literature review of more than 25 articles was included in this review, it is found that endometrial polyp is an asymptomatic disease so it can occur in both groups of reproduction and postmenopausal. The mean age of all subjects is about 76.5.The prevalence of this condition is about 24% to 30% in the general population and 40% to 45% in postmenopausal women. It is also concluded that the chance of endometrial polyps increases in postmenopausal women at about 45.23%. Conclusion: A literature review of more than 25 articles was included in this review. It is concluded that the incidence of malignancy in endometrial polyps is lower in the general population and higher in postmenopausal women at about 45.23%. The chance of developing endometrial polyp is more common at the mean age of 76.5. Keywords: Endometrialpolyps, postmenopausal women, malignancy in endometrial polyps

Acromegaly: Clinical Care in Central and Eastern Europe, Israel, and Kazakhstan.

Acromegaly is a rare condition typically caused by benign pituitary adenomas, resulting in excessive production of growth hormone. Clinical manifestations of acromegaly are diverse, varying from the overgrowth of body tissue to cardiovascular, metabolic, and osteoarticular disorders. Symptoms may emerge slowly, overlapping with other diseases and often involve many different healthcare specialists. In the last decade, efforts to provide an accurate and timely diagnosis of acromegaly have improved disease management and clinical experience. Despite this progress, marked differences in the diagnosis, treatment, and management of acromegaly exist from country-to-country. To address these inconsistencies in the region comprising Central and Eastern Europe, Israel, and Kazakhstan, a panel of acromegaly experts from 13 of these countries was convened. Acromegaly experts from each country provided available information on the approaches from their country, including regional treatment centers and multidisciplinary teams, treatment access, reimbursement and availability, and physician education, disease awareness, and patient advocacy. Across several areas of acromegaly management, divergent approaches were identified and discussed, including the provision of multidisciplinary care, approved and available treatments, and disease awareness programs. These were recognized as areas of potential improvement in the management of acromegaly, in addition to participation in national and regional acromegaly registries. Further experience exchange will facilitate the identification of specific strategies that can be adapted in each country, and widespread participation in acromegaly registries will enable their evaluation. It is anticipated that this approach will support the optimization of acromegaly patient care across this region.

Ramifications of Vorticity on Aggregation and Activation of Platelets in Bi-Leaflet Mechanical Heart Valve: Fluid-Structure-Interaction Study.

Bileaflet mechanical heart valves (BMHV) are widely implanted to replace diseased heart valves. Despite many improvements in design, these valves still suffer from various complications, such as valve dysfunction, tissue overgrowth, hemolysis, and thromboembolism. Thrombosis and thromboembolism are believed to be initiated by platelet activation due to contact with foreign surfaces and nonphysiological flow patterns. The implantation of the valve causes nonphysiological patterns of vortex shedding behind the leaflets. This study signifies the importance of vorticity in platelet activation and aggregation in BMHV implants. A two-phase model with the first Eulerian phase for blood and the second discrete phase for platelets is used here. The generalized cross model of viscosity has been used to simulate the non-Newtonian viscosity of blood. A fluid-structure-interaction model has been used to simulate the motion of leaflets. This study has also estimated the platelet activation state (PAS), which is the mathematical estimation of the degree of activation of platelets due to flow-induced shear stresses that cause thrombus formation. The regions in the fluid domain with a higher vorticity field have been found to contain platelets with relatively higher PAS than regions with relatively lower vorticity fields. Also, this study has quantitatively reported the effect of vorticity on platelet aggregation. Platelet densities in fluid areas with higher vorticity are higher than densities in fluid areas with lower vorticity, indicating that highly activated platelets aggregate in areas with stronger vorticity.

Infection by Moniliophthora perniciosa reprograms tomato Micro-Tom physiology, establishes a sink, and increases secondary cell wall synthesis.

Witches' broom disease of cacao is caused by the pathogenic fungus Moniliophthora perniciosa. By using tomato (Solanum lycopersicum) cultivar Micro-Tom (MT) as a model system, we investigated the physiological and metabolic consequences of M. perniciosa infection to determine whether symptoms result from sink establishment during infection. Infection of MT by M. perniciosa caused reductions in root biomass and fruit yield, a decrease in leaf gas exchange, and down-regulation of photosynthesis-related genes. The total leaf area and water potential decreased, while ABA levels, water conductance/conductivity, and ABA-related gene expression increased. Genes related to sugar metabolism and those involved in secondary cell wall deposition were up-regulated upon infection, and the concentrations of sugars, fumarate, and amino acids increased. 14C-glucose was mobilized towards infected MT stems, but not in inoculated stems of the MT line overexpressing CYTOKININ OXIDASE-2 (35S::AtCKX2), suggesting a role for cytokinin in establishing a sugar sink. The up-regulation of genes involved in cell wall deposition and phenylpropanoid metabolism in infected MT, but not in 35S::AtCKX2 plants, suggests establishment of a cytokinin-mediated sink that promotes tissue overgrowth with an increase in lignin. Possibly, M. perniciosa could benefit from the accumulation of secondary cell walls during its saprotrophic phase of infection.

Response to Alpelisib in Clinically Distinct Pediatric Patients With PIK3CA -related Disorders.

PIK3CA -related disorders include vascular malformations, potential overgrowth of various tissues, limb abnormalities, disordered soft tissue, and/or fatty hyperplasia that often leads to significant morbidity. Alpelisib, a targeted inhibitor of p110α, an enzyme encoded by the PIK3CA gene, has demonstrated success in a cohort of patients with PIK3CA -driven overgrowth syndromes. We describe the clinical course of 2 pediatric patients treated with alpelisib under the Novartis Managed Access Program. Both patients, though clinically distinct, demonstrate improvements in overgrowth volumes/extent, function of their affected limb, and quality of life, without significant adverse effects after prolonged treatment.

Toll-7 promotes tumour growth and invasion in Drosophila.

Objectives Drosophila melanogaster has become an excellent model organism to explore the genetic mechanisms underlying tumour progression. Here, by using well‐established Drosophila tumour models, we identified Toll‐7 as a novel regulator of tumour growth and invasion.Materials and methodsTransgenic flies and genetic epistasis analysis were used. All flies were raised on a standard cornmeal and agar medium at 25°C unless otherwise indicated. Immunostaining and RT‐qPCR were performed by standard procedures. Images were taken by OLYMPUS BX51 microscope and Zeiss LSM 880 confocal microscope. Adobe Photoshop 2020 and Zeiss Zen were used to analyse the images. All results were presented in Scatter plots or Column bar graphs created by GraphPad Prism 8.0.ResultsLoss of Toll‐7 suppresses RasV12/lgl −/−‐induced tumour growth and invasion, as well as cell polarity disruption‐induced invasive cell migration, whereas expression of a constitutively active allele of Toll‐7 is sufficient to promote tumorous growth and cell migration. In addition, the Egr‐JNK signalling is necessary and sufficient for Toll‐7‐induced invasive cell migration. Mechanistically, Toll‐7 facilitates the endocytosis of Egr, which is known to activate JNK in the early endosomes. Moreover, Toll‐7 activates the EGFR‐Ras signalling, which cooperates with the Egr‐JNK signalling to promote Yki‐mediated cell proliferation and tissue overgrowth. Finally, Toll‐7 is necessary and sufficient for the proper maintenance of EGFR protein level.ConclusionsOur findings characterized Toll‐7 as a proto‐oncogene that promotes tumour growth and invasion in Drosophila, which shed light on the pro‐tumour function of mammalian Toll‐like receptors (TLRs).

Pulse dye laser therapy and superficial cryotherapy as a novel combination treatment for hypertrophic scars and keloids

Background: Hypertrophic scars are benign and fibrotic skin lesions caused by defects in the regulation of cellularity during the wound-healingprocess, in which there is higher collagen production and less degradation. Genetic predisposing factors and different skin injuries may play a role in developing these types of lesions. On the other hand, keloids are overgrowths of fibrous tissue outside the original boundaries of trauma, yet these may also occur spontaneously. There are numerous treatment options for both conditions, including silicone gel sheeting, pressure therapy, intralesional triamcinolone acetonide, radiation, laser therapy, cryosurgery, interferon, 5-fluorouracil, and surgical excision as well as a multitude of extracts and topical agents. Objective: The objective was to evaluate the effectiveness of pulse dye laser (PDL) therapy and superficial cryotherapy as a combination treatment for hypertrophic scars and keloids. Method: Four Arabic female patients were seen at the outpatient clinic of the Department of Dermatology at the King Fahd Hospital of the University in Khobar, Saudi Arabia. The patients had keloids and hypertrophic scars. Treatment with cryotherapy every week for three weeks followed by one session of pulsed dye laser was administered rotationally for three to six months until the lesions displayed remarkable physical improvement or complete resolution. Results: All patients experienced significant improvement, showing a reduction in the size, erythema, pliability, and pruritus. None of the hypertrophic scars or keloids deteriorated during the one year of treatment. No complications were noted during the treatment period. Conclusion: Sequential PDL therapy combined with superficial cryotherapy may be an option for treating hypertrophic scars and keloids.

MORPHOLOGICAL PECULIARITIES OF THE PANCREAS OF MALE RATS AFTER PROLONGED ADMINISTRATION OF MONOSODIUM GLUTAMATE DURING THE RECOVERY PERIOD.

The aim: To study changes in the exocrine and endocrine parts of the pancreas of rats after abolition of monosodium glutamate (MSG) administered in the diet. Materials and methods: White male laboratory rats with a baseline weight of 120 ± 5 g were randomized into 3 groups: 1 - control, 2 - animals with daily feeding of 70 mg/ kg MSG for 8 weeks, 3 - abolition of MSG with transfer of animals to a standard diet and pancreatic examination after 8 weeks. We used histological studies with morphometric analysis and statistical processing of acini and acinar cell areas, Langerhans islets, connective tissue (according to Stolte M.) and adipose tissue. Preparations of pancreas were stained with hematoxylin and eosin and azan. Results: The animals of groups 2 and 3 showed atrophic, degenerative and inflammatory disturbances in the exocrine and endocrine parts of the pancreas, which worsened after 8 weeks of MSG withdrawal (3 rd group). In the preparations, the Langerhans islets were of different shapes and sizes. Small islets predominated, as well as islets with low density of α- and β-cells, different capillary filling with blood and overgrowth of connective tissue in the capillary areas. The acinar cells and acini were reduced, and degenerative abnormalities were detected in the structures. Conclusions: After daily administration of 70 mg/kg MSG for 8 weeks, atrophic and degenerative changes in the exocrine and endocrine parts of the pancreas were revealed. No recovery of pancreatic structures was observed 8 weeks after MSG withdrawal.

The experience of interdisciplinary interaction in elimination of midface deformation (clinical observation)

Fibrous dysplasia is a hamartoma appearing as a benign pathologic process in which normal bone tissue formation is replaced by overgrowth of fibrous connective tissue. The problem of diagnosis and treatment of patients with fibrous dysplasia remains unsolved in the absence of a uniform understanding of its etiology and pathogenesis. Treatment and rehabilitation of patients with midface fibrous dysplasia is a complicated medico-social problem, which requires interaction of specialists of different fields to resolve it. The disease presents a practical interest for doctors of more than 20 specialties, as it can lead to disability. The present article describes a clinical case of interdisciplinary interaction of specialists in the fields of maxillofacial surgery, ophthalmology, otorhinolaryngology, plastic surgery and radiology involved in complex treatment of a patient with midface fibrous dysplasia accompanied by eyeball dislocation, decreased vision, as well as progressive impairment of nasal breathing function. The performed treatment resulted in favorable functional and aesthetic outcomes including elimination of exophthalmos, vertical strabismus, lacrimation disorders, nasal breathing disorders, increase of visual acuity and improvement of external appearance.

Pelvic Lipomatosis in a Young Male: A Case Report

Pelvic Lipomatosis (PL) is a rare benign disease of unknown aetiology characterised by intrapelvic overgrowth of mature fatty tissue. Although non malignant, the adipose tissue is infiltrative and causes compression of the pelvic structures-the genito urinary tract, lower gastrointestinal tract or the vascular system leading to a broad range of symptoms. With limited cases of PL reported in the literature there are no clear-cut guidelines for its management and both conservative and surgical modalities have been described with varying results. This report describes a case of PL in a young 34-year-old male which was associated with bilateral hydroureteronephrosis and was well managed conservatively. PL is also known to be associated with complications like hypertension, severe upper tract obstruction, renal failure and rarely pulmonary thromboembolism, portal vein thrombosis and adenocarcinoma bladder, thus commanding early diagnosis of the disease and long-term follow-up in all the patients.

Development of severe aplastic anemia during steroid therapy for autoimmune hemolytic anemia

A 50-year-old male patient was admitted for close monitoring of anemia (hemoglobin level, 5.0 g/dl). Autoimmune hemolytic anemia (AIHA) of warm type was diagnosed based on the elevated reticulocyte and bone marrow erythroblast counts, elevated indirect bilirubin level, serum haptoglobin level below the detection limit, and positive direct Coombs test result. The patient responded to prednisolone 60 mg/day (1.0 mg/kg); however, pancytopenia was observed during gradual dose tapering and maintenance therapy. The bone marrow showed remarkable hypoplastic findings, and magnetic resonance imaging scans of the thoracolumbar spinal cord showed an overgrowth of the adipose tissue. Thus, the patient was diagnosed with aplastic anemia (AA) stage 4. He was successfully treated with a combination of immunosuppressive therapy (anti-thymocyte globulin +cyclosporine), which allowed him to reduce his dependence on transfusions. However, the direct Coombs test result remained positive even after hematopoietic recovery. Aplastic anemia following AIHA treatment is extremely rare and has not been reported previously.

PI3K and AKT at the Interface of Signaling and Metabolism.

The PI3K/AKT signaling module is recruited by several receptors implicated in maintaining tissue and metabolic homeostasis and signaling pathways controlling immune responses. Constitutive activation of PI3K/AKT signaling leads to tissue overgrowth and is frequently observed in cancer cells, whereas reduced PI3K/AKT signaling is associated with diabetes and growth defects. Thus, a critical roadblock to effective PI3K-targeted therapy comes from the crucial role of PI3K/AKT signaling in systemic metabolic homeostasis. This chapter describes the role of PI3K/AKT in insulin signaling and metabolic homeostasis and the interplay between insulin action and metabolic feedback loops that cause resistance to PI3K-targeted therapies. Furthermore, we provide examples of insulin-independent roles for PI3K/AKT in metabolic homeostasis, and some generalizations on the action of PI3K/AKT signaling at the interface of signaling and metabolism are derived. Finally, the specific roles for different class I PI3K isoforms in controlling systemic metabolic homeostasis and energy balance are discussed. We conclude that defining the functional specificities and redundancies of different class I PI3K isoforms in pathways driving disease and controlling metabolic homeostasis is fundamental to develop novel PI3K-targeted therapies.

Oral cholangioscopy for biliary system diseases

To improve the results of treatment of obstructive jaundice by using of oral cholangioscopy. There were 321 patients with obstructive jaundice between October 2020 and November 2021. Of these, cholangioscopy (SpyGlass video system) was used in 18 patients. Patients were divided into two groups: group 1 (n=9) - malignant biliary strictures; group 2 (n=9) - choledocholithiasis with large calculi (≥1.2 cm). At admission, all patients underwent laboratory and instrumental examination. In the first group, bilioduodenal stenting with plastic stents 7 and 10 Fr in diameter, 7 to 12 cm long or self-expanding nitinol stents 0.8-1.0 cm in diameter, 6 to 10 cm long was carried out. Patients with large calculi underwent targeted laser lithotripsy under endoscopic control until formation of 1-cm fragments. These fragments were removed using a lithoextraction balloon and Dormia basket. Cholangioscopy (SpyGlass system) was performed within 2 days after admission. In group 1, tumor tissue overgrowths were found during cholangioscopy. Five out of 9 (55.6%) patients underwent bilioduodenal stenting for adequate biliary drainage. Of these, 4 (44.5%) patients developed acute edematous pancreatitis on the first postoperative day. This complication regressed after 3-4 days under therapy. Four (44.5%) patients died from cancer-related multiple organ failure. In group 2, cholangioscopy effectively visualized the calculus and ensured its destruction by laser contact lithotripsy. Intraoperative and postoperative complications were not revealed in both groups. SpyGlass system is effective and safe for diagnosis and treatment in 100% of patients with extrahepatic biliary strictures and/or large calculi.

Postoperative Outcomes of Pterygium Excision Surgery with Autograft Using Autologous Blood Versus Conventional Sutures

Introduction: Pterygium is an extremely common ocular condition believed to be occurring due to proliferation and overgrowth of abnormal epithelial and fibrovascular tissue onto the cornea. They are characterized by cellular proliferation, neovascularization, and inflammation. Ultraviolet rays (UVR) induced elastoid degeneration of subepithelial connective tissue, genetic alteration associated altered cytokine expression plays an important role in the pathogenesis of pterygium. The recent treatment entities include conjunctival autograft with good results. The most commonly used means of fixating conjunctival autografts is by sutures or fibrin glue.
 Aim: This study aimed at comparative assessment of postoperative outcomes of pterygium excision surgery with autograft using autologous blood versus conventional sutures.
 Methods: Forty post-operative cases of pterygium excision surgery with conjunctival autograft were enrolled in the study and serially followed up. The study included two groups of 20 patients each. Group-A included cases of pterygium excision with autograft using autologous blood, and Group-B included cases of pterygium excision with autograft and sutures. Post-operatively, patients were examined on the 1st, 7th and 30th day to document the graft loss. Graft stability was also assessed on day 1 in both groups. Final comparisons were documented in terms of graft edema, stability and recurrence. Also suture related complications like foreign body sensation, watering, discomfort, granuloma formation and suture abscess were assessed in follow-up.
 Results: Group-B (suture group) revealed better graft stability whereas displacement of graft was documented in six cases of Group-A. Graft edema was reported in 10 cases from Group A and 7 cases from Group B. On the 30th day, all patients of both groups presented with similar findings. However, subjective discomfort was reported to be more in group-B as compared to group-A during each follow-up.
 Conclusion: Issue of graft displacement was a critical challenge with autologous blood group (Group A) patients compared to suture-related complications in group B. Looking towards the evidence of less remarkable complications and almost similar outcomes, the surgeons dilemma on pterygium management still persists.

Perbandingan Pemasangan Implan Dental Single-Tooth Loss: Faktor Risiko dan Penyulit

Background: Edentulous cases or missing teeth is one of the problems complained about by patients in daily dental practice. Missing teeth are mostly discovered in adult patients, especially in posterior teeth such as premolar and molar. Nowadays, dental implant restoration in posterior single-tooth loss cases has been stated as the best treatment option. Nevertheless, hypertension is one of the risk factors that might cause difficulties in the dental implant procedure. Purpose: to compare the insertion of a dental implant in single-tooth loss between a patient without any systemic disease and a patient with a history of hypertension, using the same dental implant system and in the same timeframe. Case and Procedure: Case # 1, female patient age 43 years old came to RSGM-P FKG Usakti to have a dental implant insertion in the lower right posterior region. There was an absence of system disease in this patient. There were no difficulties during the dental implant insertion in tooth 46, therefore the osseointegration occurred nicely and the restorative crown insertion was precisely inserted. Case # 2, male patient age 49 years old with a chief complaint of missing tooth in the lower left posterior region, wanted to have a dental implant insertion. The patient had a history of hypertension with a regular daily intake of Amlodipine 5 mg once a day. Osseointegration occurred well after the dental implant insertion in tooth 35. However, during the screw uncovering stage, there was bone growth covering the surface of the cover screw. Therefore, removal of the bone growth should be done by using a round bur. In the impression-taking stage, there was slight gingival enlargement or overgrowth that almost covered the path of crown insertion. Gingivectomy had to be done before taking the impression in order to achieve precise crown insertion. The risk factor in the second case is that the patient consumed Amlodipine 5 mg daily, which causes overgrowth of bone and soft tissue surrounding the cover screw and implant fixture. Conclusion: There are differences in the outcome of the dental implant insertion in a patient without systemic disease and a patient with a history of hypertension with a daily intake of Amlodipine 5 mg medication; the factor that caused difficulties in the prosthetic stage is the presence of the alveolar bone and soft-tissue overgrowth.