MANAGEMENT OF HYPER-MOBILE TISSUE WITH A MODIFIED COMBINE TECHNIQUE OF ZAFRULLA AND HOBKRIK

When in partially edentulous patient hyperplastic tissue replaces the alveolar bone, a flabby ridge develops which is often seen in long-term denture wearers. Flabby ridge provide poor retention for the denture fabrication if not recoded properly. A careful consideration and application of Zafrulla and Hobkrik technique of complete denture construction helps practitioner to over cone such conditions easily. This article describes procedure performed for flabby ridge patient and demonstrates Zafrulla and Hobkrik combination impression technique.

Preprosthetic Management of “Flabby Ridge” on Edentulous Patient

For edentulous patients, the integrity of the osteomucosal-bearing surface is a significant factor for the balance of the future removable prosthesis. The supporting tissues are influenced by several factors. Physiological bone resorption, senescence, and changes caused by systemic diseases and polypharmacy lead to modifications in these tissues. Similarly, trauma caused by an ill-fitted prosthesis influences the degree of bone resorption and the development of hyperplastic tissue. The etiology of bone resorption is multifactorial and complex, with continuous individual variations that are often unexplained. Although, no study has been able to establish the importance of the different factors in relation to each other, it is often reported that chronic excessive mechanical pressure in relation to occlusal constraints is responsible for the appearance of local resorption’s areas. The aim of this work is to present, through three clinical cases, the various factors involved in the alteration of the osteomucous-bearing surface and eventually, possible therapeutic attitude to deal with.

Management of Difficult Airway in a Cat with Tonsillitis

Background: Tracheal intubation is performed in an anesthetized patient in order to optimize oxygenation and to allow the administration of volatile anesthetics. Some patients have characteristics that make intubation a challenge. Therefore, an adequate pre-anesthetic evaluation enables the anesthesiologist to define the best management. There are reports of the impossibility of performing conventional intubation attributed to the lack of pre-anesthetic consultation in Medicine, which motivates and justifies the discussion of these aspects in Veterinary Medicine. Therefore, this study aims to report a case of difficult airway management in a feline with tonsillitis. Case: A 3-year-old male NDB cat weighing 3.5 kg was admitted to the Veterinary Hospital, Federal University of Pampa (UNIPAMPA) - Uruguaiana, for consultation. After physical examination, total tooth extraction and tonsillectomy was recommended. On the day of the procedure, a physical evaluation of the patient was performed, and he was classified as ASA II. Zolazepam and tiletamine [Zoletil®️ - 5 mg/kg, i.m] associated with morphine [Dimorf®️ - 0.3 mg/kg, i.m] was given as premedication. Given the difficulty of intubation in a previous procedure reported by the tutor, a thoughtful conduct was planned for the intubation of the patient, considering the possibility of tracheostomy. The patient was pre-oxygenated, and subsequently, propofol [Propovan®️ - 4 mg/kg, i.v] was administered to promote anesthetic induction. The first attempt at intubation was done by laryngoscopy, but despite the use of a 6 cm blade, it was too large in relation to the hyperplastic tissue; then swabs and a flashlight were subsequently used. With the help of two people, the experienced anesthesiologist was able to position the endotracheal tube correctly approximately 25 min after the first attempt, requiring supplemental doses of propofol [Propovan®️ to the effect, i.v] and oxygenation between the attempts. Anesthetic maintenance was achieved with isoflurane [Isoforine®️ vaporized in 100% oxygen] in a system without gas rebreathing. Locoregional block of the maxillary nerve and inferior branch of the mandibular nerve was performed with lidocaine 2% [0.1 mL/kg]. During the transoperative, the vital parameters remained stable and there was no need for analgesic rescue. After the end of the procedure and extubation, the patient received oxygen therapy via facemask until he regained consciousness and had no complications.Discussion: The mortality of dogs and cats related to anesthetic procedures is substantially higher when compared to humans. Studies have shown that most anesthetic-related complications in humans are predictable. The lack of adequate pre-anesthetic evaluation or anesthetic consultation are factors that can cause losses in the transoperative period. Therefore, sharing information that can mitigate these situations is critical. The scarcity of reports on pre-anesthetic evaluation in veterinary medicine allows the identification of a gap on the role of the anesthesiologist in this important stage of anesthesia, and how it is performed in the hospital routine or in veterinary clinics. The success in managing the difficult airway in the case reported here can be attributed to the procedures adopted in all stages of the procedure, especially the planning based on information obtained during the pre-anesthetic period. It is worth mentioning that the owner was a veterinarian and we believe this also contributed to the outcome, since he informed the anesthesiologist about the difficulties encountered during the previous procedure. This case motivated the implementation of a pre-anesthetic consultation service in the hospital in question. In addition to the physical examination, a complete anamnesis carried out with the owner may reveal relevant details for determining the most appropriate and safe anesthetic conduct for the patient.Keywords: preanesthetic evaluation, endotracheal intubation, veterinary anesthesia.Título: Manejo da via aérea difícil em um gato com tonsiliteDescritores: avaliação pré-anestésica, intubação endotraqueal, anestesiologia veterinária.

Phosphodiesterase 2A and 3B variants are associated with primary aldosteronism

Familial primary aldosteronism (PA) is rare and mostly diagnosed in early-onset hypertension (HT). However, ‘sporadic’ bilateral adrenal hyperplasia (BAH) is the most frequent cause of PA and remains without genetic etiology in most cases. Our aim was to investigate new genetic defects associated with BAH and PA. We performed whole-exome sequencing (paired blood and adrenal tissue) in six patients with PA caused by BAH that underwent unilateral adrenalectomy. Additionally, we conducted functional studies in adrenal hyperplastic tissue and transfected cells to confirm the pathogenicity of the identified genetic variants. Rare germline variants in phosphodiesterase 2A (PDE2A) and 3B (PDE3B) genes were identified in three patients. The PDE2A heterozygous variant (p.Ile629Val) was identified in a patient with BAH and early-onset HT at 13 years of age. Two PDE3B heterozygous variants (p.Arg217Gln and p.Gly392Val) were identified in patients with BAH and HT diagnosed at 18 and 33 years of age, respectively. A strong PDE2A staining was found in all cases of BAH in zona glomerulosa and/or micronodules (that were also positive for CYP11B2). PKA activity in frozen tissue was significantly higher in BAH from patients harboring PDE2A and PDE3B variants. PDE2A and PDE3B variants significantly reduced protein expression in mutant transfected cells compared to WT. Interestingly, PDE2A and PDE3B variants increased SGK1 and SCNN1G/ENaCg at mRNA or protein levels. In conclusion, PDE2A and PDE3B variants were associated with PA caused by BAH. These novel genetic findings expand the spectrum of genetic etiologies of PA.

Morphological features of hyperplastic prostate tissue in patients with chronic prostatitis

Introduction. Benign prostatic hyperplasia (BPH) is a common disease wich is characterized by the proliferation of periurethral prostate glandular tissue. Infectious and inflammatory processes in the prostate play an important role in proliferation and hyperplasia, causing a significant deterioration in prostate metabolism and proliferation acceleration. This leads to progressive growth of the hyperplastic tissue in the prostate gland (PG). Тhe aim of study was to perform a comparative analysis of morphological changes in prostate hyperplastic tissue in patients with chronic prostatitis, who underwent various types of surgical treatment for BPH. Materials and methods. A comparative analysis of morphological changes in prostate tissue was performed, using a material from 276 patients with chronic prostatitis and BPH, who underwent various types of surgical treatment. The patients were divided into three groups: group I (n = 50) - patients who underwent surgical transvesical adenomectomy, group II (n = 76) - patients who underwent transurethral resection of the prostate (TURP) and group III (n = 150) - men who underwent holmium laser enucleation of the prostate. Fragments of the removed prostate tissue were fixed with neutral 10% formalin. The tissue samples were numerated automatically, using DIAPATH Donatello processor. Microscopic examination was carried out using a light microscope ZEISS «Axioskop 40» (eyepiece x 10, objectives x 5, x 10, x 20, x 40, 100). Results. Morphological features of resected prostate from patients with BPH and from patients with its combination with chronic bacterial inflammation were analyzed. The morphological picture varies from acute purulent inflammation to pronounced chronic lymphoplasmacytic inflammation around the acini. The features of morphological changes in the prostate after transvesical adenomectomy, TURP and laser enucleation were also studied. It was shown, that against the background of a chronic infectious and inflammatory process as well as a gross cicatricial process in the prostate, the organ anatomy, as well as the architectonics of vessels are disrupted, which can lead to a decrease in surgical treatment effectiveness. Discussion. In the majority of patients with BPH histological examination reveals a lymphoplasmacytic reaction of varying severity, which causes anatomical abnormalities and microcirculation deterioration. This condition significantly increases the risk of postoperative complications, requiring long-term conservative therapy and sometimes another surgical intervention. Conclusions. Against the background of a chronic infectious and inflammatory process, a gross cicatricial process in the prostate, its anatomy as well as vessel architectonics become disrupted, leading to a decrease in the effectiveness of surgical treatment. In the comparative study of morphological characteristics after various types of surgical procedures, it was revealed that the least significant changes were detected after laser enucleation of prostatic hyperplasia.

A Rare Case of non Syndromic Congenital Idiopathic Gingival Fibromatosis: Electrosurgical Management

Idiopathic gingival fibromatosis (IGF) is a rare, genetically heterogeneous condition that is usually a part of syndrome or, rarely, an isolated disorder. It is characterized by a slowly progressive, non hemorrhagic, fibrous enlargement of keratinized gingiva which usually begins at the time of eruption of permanent dentition, however very few cases involving the primary teeth have been described in literature. Congenital gingival fibromatosis is very rare condition in which the gingival tissues become thickened and erupting teeth remain submerged beneath hyperplastic tissue masses. This case report discusses the rare case of congenital non syndromic idiopathic gingival fibromatosis in a two year old boy who reported with absence of teeth and incompetent lips. Gingivectomy was done using modified microdissection electrocautery needle to remove the excess gingival tissues. Excised tissue has been examined histologically. The patient was followed up for a period of one year and no recurrence was observed.

Laser and its Implications in Dentistry : A Review Article

The term LASER is an acronym for ‘Light Amplification by the Stimulated Emission of Radiation’. Miaman was the first who introduced laser application in dentistry in 1960 and its hard and soft tissue application. There is lot of advancement in lasers in past two decades. Various hard tissue applications includes caries prevention, bleaching, restorative removal and curing, cavity preparation, dentinal hypersensitivity, growth modulation and for diagnostic purposes, whereas soft tissue application includes wound healing, removal of hyperplastic tissue to uncovering of impacted or partially erupted tooth, photodynamic therapy for malignancies, photostimulation of herpetic lesion. Although lasers proves to be slightly costlier than traditional treatment but its an effective tool to increase efficiency, specificity, ease and comfort of the dental treatment.

SAT-386 Inconsistent Bilateral Arm Serum PTH Testing in Recurrent Hyperparathyroidism in a Patient Status-Post Parathyroid Auto-Transplantation

Background: More than 95% of patients with primary hyperparathyroidism will be cured with the initial operation by an experienced surgeon. However, localization of hyperparathyroid recurrences, especially after extensive surgery becomes challenging. For patients with transplanted parathyroid glands into the forearm, there may be utility in bilateral arm serum PTH testing to help with localization. Clinical Case: A 65-year-old woman presented to the clinic with primary hyperparathyroidism in 2008. After a localization study, she had a partial parathyroidectomy but continued to have persistent biochemical hyperparathyroidism despite negative localization studies. She was then referred to another institution for further studies. Follow up Sestamibi scans were negative but 4D-CT scans assisted in localizing the presence of a superior parathyroid gland adenoma which was later removed in 2011. During this time, the left inferior parathyroid gland was auto-transplanted into the left forearm. Again, her calcium and PTH levels rose despite negative Sestamibi scans showing no abnormalities in post-operative beds or in the forearm. Review of previous labs revealed elevated PTH levels in the ranges of 80-110 pg/mL since 2012-2019. The patient’s most recent PTH was 2408 pg/mL. At that point, the decision was made to repeat the labs on the left and right forearms simultaneously and labs showed PTH levels of 1283 pg/mL and 118 pg/mL, respectively. Repeat Sestamibi scan following these labs demonstrated evidence of increased radiotracer uptake in the region of the prior transplanted parathyroid tissue with no neck uptake concerning for hyperparathyroidism due to auto-transplanted hyperplastic tissue. Conclusion: This case demonstrates the utility of bilateral arm serum PTH testing in the evaluation of recurrent hyperparathyroidism in patient’s status-post parathyroid auto-transplantation.

Primary hyperaldosteronism: difficulties in diagnosis

Primary hyperaldosteronism (PA) - is the clinical syndrome, results from autonomous of the major regulators of secretion, aldosterone overproduction by a tumorous or hyperplastic tissue in adrenal cortex. Being the most frequent cause of secondary hypertension, PA may be represented by disorders with unilateral or bilateral aldosterone overproduction and differential diagnosis between them is crucial for choosing a right therapeutic approache: lifelong medical therapy with mineralocorticoid receptor antagonists or unilateral adrenalectomy. Adrenal venous sampling (AVS) is currently the «gold standard» test for identifying laterality of excess hormone production, unlike imaging tests, sensitivity and specificity of which is not enough, due to inability to evaluate functional activity with confidence, and also to limitations in detecting tiny abnormalities of adrenals, such as microadenoma or hyperplasia. Excluding certain cases, AVS is recommended to patients with confirmed PA, planning surgical treatment, to determine the lateralization of aldosterone hypersecretion. Described clinical case of patient with confirmed lateralization from adrenal without any detected lesions on CT-imaging and nonfunctioning tumour on contralateral side, highlights the importance of using AVS for decision to refer patients for surgery.

Awareness of Laser Dentistry Among Dentists in Tanjore- A survey

Diode laser are used for soft tissue surgeries in the oral cavity.The use of laser is limited due to the lack of knowledge, effectiveness and the high cost of laser unit. The use of lasers can decrease morbidity after surgery and reduces the need for anaesthetics.the laser is used for caries prevention, bleaching, restorative removal and curing, cavity preparation, dentinal hypersensitivity, growth modulation and for diagnostic purposes, whereas soft tissue application includes incision, excision, ablation, wound healing, removal of hyperplastic tissue to uncovering of impacted or partially erupted tooth, photodynamic therapy for malignancies, photo stimulation of herpetic lesion. Although dental lasers was introduced in 1964, its knowledge and implementation has increased only in past 15-20 years especially in developing countries like India. In order to evaluate the knowledge on laser and its implementationin the field of dentistry among dentists in Tanjore, this survey was conducted among dentists in Tanjore. This cross-sectional, descriptive study was carried out among dentists in Tanjore. A questionnaire consisting of 3 main parts was designed and administered to dentists in Tanjore and knowledge was assessed. The data were entered and analysed statistically. 14% of dentists have adequate knowledge,46% of dentists have moderate knowledge, 39% of dentists have inadequate knowledge.35% of dentists had practiced laser dentistry before.The wellknown information among dentists about the dental laser is the lasers application in gingivectomy and crown lengthening. 50% of dentists felt that cost of laser unit is the biggest deterrant in practicing laser dentistry. Most of the dentists have only moderate knowledge on laser.Education should be given on laser to increase its implementation in field of dentistry.