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Tuesday, November 20, 2012

Ectodermal dysplasia

INTRODUCTION :

Ectodermal dysplasia syndrome is a large,heterogeneous group of inherited disorders , the manifestations of which could be seen in more than one ectodermal derivatives.


Common syndromes :
A. Hypohidrotic ED
B. Hidrotic ED

Etiology : 

 Ectodermal dysplasia syndrome results from aberant development of ectodermal derivatives in early embryonic life.


Symptoms

Teeth

In the development of tooth buds frequently result in congenitally absent teeth (in many cases a lack of a permanent set) and/or in the growth of teeth that are peg-shaped or pointed. The enamel may also be defective. Cosmetic dental treatment is almost always necessary and children may need dentures as early as two years of age. Multiple denture replacements are often needed as the child grows, and dental implants may be an option in adolescence, once the jaw is fully grown. Nowadays this option of extracting the teeth and substituting them with dental implants is quite common. In other cases, teeth can be crowned. Orthodontic treatment also may be necessary. Because dental treatment is complex, a multi-disciplinary approach is best.


People with ectodermal dysplasia may not sweat or may have decreased sweating because of a lack of sweat glands.

Children with the disease may have difficulty controlling fevers. Mild illness can produce extremely high fevers, because the skin cannot sweat and control temperature properly.
Affected adults are unable to tolerate a warm environment and need special measures to keep a normal body temperature.
Other symptoms include:
  • Abnormal nails
  • Abnormal or missing teeth
  • Absent or decreased tears
  • Decreased skin color (pigment)
  • Heat intolerance
  • Inability to sweat
  • Large forehead
  • Lower than normal number of teeth
  • Low nasal bridge
  • Poor hearing
  • Poor temperature regulation
  • Poor vision
  • Thin, sparse hair
  • Thin skin

    Treatment

    There is no specific treatment for this disorder.
    Some things you can do include:
    • Wear a wig and dentures to improve appearance.
    • Use artificial tears to replace normal tearing and prevent drying of the eyes.
    • Spray the nostrils with saline nose spray often to remove debris and prevent infection.
    • Live in a cooler climate and take cooling water baths or use water sprays to keep a normal body temperature (water evaporating from the skin replaces the cooling function of sweat evaporating from the skin).

      Reference :
      Wikipedia , Shafers text book of oral pathology


     


Thursday, November 8, 2012

Chronic Hyperplastic Pulpitis ( Pulp polyp )

A pulp polyp, also called as Chronic Hyperplastic Pulpitis, is found in an open carious lesion, fractured tooth or when a dental restoration is missing. Due to lack of intrapulpal pressure in an open lesion pulp necrosis does not take place as would have occurred in a closed caries case. Also a good vascular and immune supply is necessary, therefore found in adults. It is a productive pulpal inflammation where the development of granulation tissue is seen.



Causes

Causes of a pulp polyp include the following:
  • Carious tooth with significant loss of tooth structure
  • Loss of a dental restoration that results in pulpal exposure
  • Fractured tooth due to trauma with a pulpal exposure
  • Pulpal tissue with access to a good blood supply
  • Possible hormonal (estrogen and progesterone) influence


Clinical features :

1. Occurs mostly in children and young adults , who possess a high degree of resistance and reactivity.
2.It involves teeth with large,open carious lesions.
3.Pulp appears as a pinkish red globule of tissue protruding from the pulp chamber and not only fills the caries defect but also extends beyond.
4.The teeth most commonly involved by this phenomenon are the deciduous molars and the first permanent molars.


Note : On occasion the gingival tussue adjacent to a broken carious tooth may proliferate into the carious lesion and superficially resemble an example of hyperplastic pulpitis.In such cases , the distinction can be made to determine whether the connection is with pulp or gingiva.  

 Histological features :

1.It is basically a granulation tissue made of delicate connective tissue fibers interspersed with variable numbers of small capillaries.
2. It becomes epithelialized and the origin of these epithelial cells is a matter of controversy.
3.The epithelium is stratified squamous in type and closely resemles the oral muscosa,even to the extent of developing well formed rete ridges.


Epidemiology

Frequency

United States

Pulp polyps are reportedly uncommon in the United States, and no epidemiologic studies specifically document the frequency of this entity. Although this lesion is reported to be uncommon with only isolated references in the literature, the true prevalence of this reactive pulpal disease is likely to be underestimated because it is a well-recognized sequela of extensive dental caries in children.

International

Pulp polyps are uncommon in countries with routine access to dental care, but they are encountered more frequently in developing countries. In a study of Vietnamese refugees who sought dental care, the prevalence of pulp polyps was 6%. This high number of cases is an indication of the severity of dental disease in this impoverished population.

Mortality/Morbidity

Pulp polyps tend to be asymptomatic and are not associated with any significant morbidity or mortality except for gross caries destruction with premature tooth loss in many cases.

Race

No racial predilection is recognized for this sequela of dental caries; however, it is more common in individuals of lower socioeconomic background who have limited access to dental care than in other people.

Sex

No sexual predilection has been documented for this oral lesion.

Age

This pulpal disease occurs almost exclusively in children and young adults, and it can occur in both the primary dentition and the permanent dentition.


Treatment :

Extraction of the tooth or by Pulp extirpation.



Sunday, November 4, 2012

Macroglosia

Macroglossia, meaning large tongue, has been a documented anatomical anomaly for several centuries but remains an entity defined more by presentation than by strict cephalometric analysis. The earliest known written description of tongue lesions comes from the Egyptian Papyrus Ebers, originally thought to be from around 1550 BC.
Obviously, tongue lesions have since been categorized by their etiologies. Macroglossia has an extensive list of possible causes. Its treatment has been largely surgical in the modern era.



Problem

Multiple studies have attempted to define macroglossia by objective measurements based on a variety of clinical and radiographic tests. However, because of the difficulty in performing these tests and because intervention is not based on measurements but on clinical presentation, macroglossia is most often diagnosed subjectively.
Ueyama and others defined macroglossia as occurring when  of the following  criteria is met:extravasation of the lingual apex or lingual border onto or outside the dentition;  the impression of one or more teeth on the lingual border visualized when the mouth is open; or  following surgery for correction, a relapse of increased interdental space, open bite deformity, and/or jaw deformation with malocclusion occurs.
As with many lesions, medicine has identified a triad for those with macroglossia. It includes open bite deformity, mandibular prognathism, and malalignment.



Epidemiology

Frequency

Although the exact incidence of macroglossia is unknown (because the etiologies are too numerous to quantify), some congenital syndromes often express macroglossia in their phenotypes, most commonly Down syndrome (1 per 700 live births) and Beckwith-Wiedemann syndrome (0.07 pre 1000 live births). In Beckwith-Wiedemann syndrome, 97.5% of patients have macroglossia.The literature documents 2 families with autosomal dominant inheritance of isolated macrogloss


Pathophysiology

Because the pathophysiology of the enlarged tongue is related to the specific etiology, defining the pathophysiology of each is beyond the scope of this discussion. However, in all cases, the locoregional complications of macroglossia are generally the same relative to the magnitude of the enlargement. Mechanical obstruction in the oral cavity can directly occlude the airway. This occlusion is usually worsened by lying supine when an enlarged tongue base is more directly acted upon by gravity to block the oropharynx and hypopharynx. Depending on muscle mass and tone, speech and swallowing may be affected as well.
Several studies document the role of the tongue in shaping the oral cavity. Just as reduced pressure of the tongue on the palate and mandible may lead to an adenoid facies, increased pressure on the surrounding anatomy can have opposite effects. Upper incisors can be pushed horizontally, inducing forward maxillary growth. Other morphologic changes include open bite deformities, prognathism, class III malocclusion, anterior and/or posterior crossbites, buccal tipping of posterior teeth, accentuated curve of Spee in the maxillary arch, reverse curve of Spee in the mandibular arch, increased transverse width of mandibular and/or maxillary arches. Furthermore, difficulty with mastication may lead to temporomandibular joint pain.
If the tongue protrudes beyond the lips and is exposed to the air, drying of the tongue with resultant glossitis and bleeding is common. Prior to the 1900s, this was not an uncommon occurrence for patients.


Indications

Indications for surgical intervention are varied. The most important is airway compromise. A tracheostomy may be required as a first step in surgical care (in some cases an elective tracheostomy is performed prior to surgical correction). Other indications include dysarthria, dysphagia, and cosmesis.
The goal of nearly all surgery is to return the patient to an anatomically and physiologically normal condition; the same is also true in surgery for macroglossia. The goal is to reduce tongue size and thereby improve function. Those main functions include articulation, mastication, deglutition, protection of the airway, and gustation. Of these, only gustation is not often improved with surgical intervention.


Contraindications

As with all intervention, whether medical or surgical, the benefits of the operation must outweigh the risks. Relative contraindications are those associated with most surgeries and include coagulopathies and other comorbidities that make general anesthesia more dangerous. In the pediatric population, many cases of macroglossia are associated with syndromes that may have lesions that increase the risk of general anesthesia.


Friday, October 19, 2012

Horrifically injured gun accident victim shows off results of the most extensive face transplant ever performed

Pictured: Horrifically injured gun accident victim shows off results of the most extensive face transplant ever performed

  • Richard Lee Norris, 37, injured in 1997 in gun accident, was treated by 100-strong team of doctors at University of Maryland in March
  • Mr Norris said: 'I am now able to walk past people and no one even gives me a second look'

These are the incredible before-and-after pictures of 37-year-old Richard Lee Norris who was given the most extensive face transplant ever performed.
Mr Norris, who was injured in a 1997 gun accident, was pictured seven months after being given a new face, teeth, tongue and jaw in a 36-hour surgery at the University of Maryland Medical Center.
For 15 years, Mr Norris lived as a recluse in Hillsville, Virginia, hiding behind a mask and only coming out at night time. He can now feel his face and is able to brush his teeth and shave. He's also regained his sense of smell, which he had lost after the accident.
Scroll down to see the transplant taking place
Incredible: Richard Lee Norris, 37, who had the most extensive face transplant to date, is seen before and in a photo made 114 days after the transplant was performed in March
Incredible: Richard Lee Norris, 37, who had the most extensive face transplant to date, is seen before and in a photo made 114 days after the transplant was performed in March

When he shot himself in the face in 1997, Mr Norris lost his nose, lips and most movement in his mouth. He has had multiple life-saving, reconstructive surgeries which also replaced underlying nerve and muscle tissue from scalp to neck. Motor function is now 80 per cent on the right side of the face and 40 per cent on the left.
'I am now able to walk past people and no one even gives me a second look. My friends have moved on with their lives, starting families and careers. I can now start working on the new life given back to me,' he said in a release to NBC.
He received the new face from an anonymous donor in March whose organs saved five other patients' lives on the same day.
The transplant was led by Dr Eduardo D. Rodriguez, professor of surgery at the University of Maryland School of Medicine and chief of plastic, reconstructive and maxillofacial surgery at Shock Trauma.

Before: Richard Lee Norris before the tragic shooting accident (left) and with his new face, teeth, tongue and jaw after extensive surgery in March (right) Before: Richard Lee Norris before the tragic shooting accident (left) and with his new face, teeth, tongue and jaw after extensive surgery in March (right)
Dramatic: Mr Norris suffered gun injuries in 1997 and has underwent years of surgeries before his final life-changing face transplant in March (right)

'Before, people used to stare at Richard because he wore a mask and they wanted to see the deformity,' Rodriguez said in March. 'Now, they have another reason to stare at him, and it's really amazing.'
Mr Norris opened his eyes on the third day after the surgery with his family around him. 'He put the mirror down and thanked me and hugged me,' said Dr Rodriguez.  'We concealed all the lines so it would give him the most immediate best appearance with minimal touch-ups down the road.'
To ensure Mr Norris would retain maximum function of his facial expressions and movements, doctors gave him a new tongue for proper speech, eating, and chewing, normally aligned teeth, and connected his nerves to allow for smiling.
 

Norris's transplant comes on the heels of successful face transplants in Forth Worth, Texas, and Boston, Massachusetts, last year. He is the first full face transplant recipient in the United States to retain his eyesight.

A virtual army of 100 doctors, scientists and other university medical staff ranging from plastic surgeons to craniofacial specialists teamed up for the operation.
The surgery involved ten years of research funded by the Department of Defense's Office of Naval Research, and will serve as a model for helping war veterans injured by improvised explosive devices in Afghanistan, the university said.



Transformation : Scans show the original injuries to Norris's face (left), with the damaged areas removed and after the transplant (right)


'Surreal experience': Lead surgeon Eduardo Rodriguez explains how the procedure successfully replaced the 37-year-old's face, teeth, tongue and jaw
'Surreal experience': Lead surgeon Eduardo Rodriguez explains how the procedure successfully replaced the 37-year-old's face, teeth, tongue and jaw
'Amazing': The operation by Dr Rodriguez and his team took 36 hours and is believed to be the most extensive procedure of its kind ever performed
'Amazing': The operation by Dr Rodriguez and his team took 36 hours and is believed to be the most extensive procedure of its kind ever performed

Rodriguez saluted the work of the teams around the world that had conducted the 22 face transplants to date, without which, he said, this operation would not have been possible.
The first full face transplant was performed in France in 2005 on a woman who was mauled by her dog. The Cleveland Clinic performed the first face transplant in the U.S. in 2008.
The Department of Defense has been funding some face and hand surgeries with the goal of helping wounded soldiers. More than 1,000 troops have lost an arm or leg in Afghanistan or Iraq, and the government estimates that 200 troops might be eligible for face transplants.
The University of Maryland's research on transplants was funded by a grant from the Office of Naval Research, and doctors said they hope to begin operating soon on military patients. Officials provided little detail on Norris or the circumstances of the accident.
'This accidental injury just destroyed everything. The rest of his friends and colleagues went on to start getting married, having children, owning homes,' Dr Rodriguez said.
'He wants to make up for all of that.'

MAKING MEDICAL HISTORY: THE WORLD'S FIRST FACE TRANSPLANTS


image004.jpg
2005: The first ever face transplant was performed in 2005 on a 38-year-old French patient, Isabelle Dinoire, who had to have the surgery after a large part of her face was ripped off in a horrific dog attack.
She was unable to speak or eat properly because of her injuries. Her new face was transplanted from a woman of 46 who died from a severe loss of blood to the brain.
connie culp
2008: The first person to receive a face transplant in the U.S. was Connie Culp, from Ohio. The now 48-year-old was operated on in 2008 after her top lip, nose, roof of her mouth, one eye and both cheeks were destroyed by then husband Tom, who brutally shot her in the face after flying into a rage.
Surgeons spent months trying to fix the damage by trying numerous plastic surgery procedures but it took a donor's face mixed with part of her own for it to work.
image001.jpg
2010: A Spanish farmer, known only as Oscar, was horribly injured in 2005 a shooting accident, which prevented him from breathing normally and made it difficult to swallow or speak. After two years of planning, a team of 30 doctors started work on him in March 2010, in an operation which was to last 24 hours.
The transplant included complete facial skin and muscles, eyelids, nose, lips, upper jaw, all his teeth, the palate, cheekbones and lower jaw.
ch
2010: Charla Nash, from Stamford, Connecticut, was so severely mauled by a 200-pound chimpanzee called Travis that belonged to her friend, that she lost her eyesight, hands and face.
Nash received a face and hand transplant in 2010 over 72 hours of operations in total. Her hands later had to be removed after infection set in. She is now suing the state of Connecticut.
image001.png
2011: Dallas Wiens became the first man in the U.S. to receive a face transplant after suffering life-threatening burns when he fell off a lift platform and slammed into a live power cable that seared off his face.
A team of 30 doctors, nurses, anaesthesiologists and residents performed the transplant at Brigham and Women's Hospital in Boston, replacing Wiens' nose, lips, facial skin, muscles of facial animation and nerves.
image007.png
2012: Ugur Acar, 19, from Turkey, suffered serious burns to his face during a house fire when he was just 40 days old. He underwent several procedures through his life until he received the cosmetic procedure to repair his face in January at Akdeniz University's School of Medicine in the country.
Doctors successfully transplanted tissue from the face of a 45-year-old donor to Mr Acar.
VIDEO: 'Richard put the mirror down and hugged me' says surgeon. Watch the most extensive full face transplant to date... 

Sunday, September 30, 2012

Concept of pulp tests !

Dental pulp testing is a useful and essential diagnostic aid in endodontics.Pulp sensibility tests include thermal and electric tests, which extrapolate pulp health from sensory response.
Traditional electronic pulp testers work by passing a current into the tooth and measuring how much current is required to cause a sensation. Unfortunately, the diagnosis is often made on a tooth that has or is near a metal tooth filling, which can change the path of the current in unpredictable ways. Clinically, this has led to false-positive readings. University of Oxford researchers have designed a magnetic analog of this device that aims to alleviate this issue.
                                        Dental pulp tests are investigations that provide valuable diagnostic and treatment planning information to the dental clinician.The most accurate way of evaluating the pulp status is by examination of histological sections of the tissue specimen involved to assess the extent of inflammation or the presence of necrosis as a means of gauging pulp health. Unfortunately in the clinical scenario, these are both impractical and not feasible; hence clinicians must use investigations such as pulp tests to provide additional diagnostic information.

 Pulp Testing Techniques and Effectiveness

A.Thermal Tests






A common misconception is that thermal tests cannot be performed on teeth with crowns or temporary restorations. These teeth can be cold-tested but it may be necessary to leave the cold in place for up to 10 seconds before the patient responds.4 A CO2 ice stick may be used but doing so requires an extensive armamentarium (that is, a gas cylinder and plastic plunger). 

Various cold tests include : 
a.Ice
b.Refrigerant spray
c. Carbon dioxide snow (CO2)


Electric Pulp Test

 Electric pulp testing (EPT) works on the premise that electrical stimuli cause an ionic change across the neural membrane, thereby inducing an action potential with a rapid hopping action at the nodes of Ranvier in myelinated nerves .




In dentistry, an electric pulp test ascertains the vitality of a tooth.
An electric pulp test consists of the following: An electric pulp tester is placed on the tooth to be tested along with a drop of conducting paste. The electric current is gradually increased until the patient signals a sensation, which consists of clicking or buzzing in the tooth. The test is repeated on neighboring teeth and often on the corresponding contralateral tooth. The lowest perceptible current is recorded for each tooth.
No response from a tooth generally indicates pulpal necrosis or dental abscess, which suggests root canal therapy or dental extraction. A very quick response compared to the adjacent teeth generally indicates pulpitis and presages pulp death. Similar response to neighboring teeth suggests a healthy tooth.
 Safety Concerns of EPT
In EPT operation manuals, warnings have been made that the current produced by the testing device may cause danger to patients who have cardiac pacemakers, with the risk of precipitating cardiac arrhythmia via pacemaker interference. This concern is based on a sole animal study , where EPT interfered with a pacemaker fitted in a dog. At the time of that study (the early 1970s), cardiac pacemakers were primitive but as pacemakers have become equipped with better shielding, more recent studies have shown no interference from EPT or similar electrical dental devices .

Summary
It is remarkable that dentistry still relies upon placing cold and tapping on a tooth to diagnose the need for nonsurgical root canal treatment. Although several technological tools can be used to aid in diagnosis, including laser Doppler flowmetry and conebeam tomography, it remains the dentist’s job to use tried-and-true diagnostic methodology and put the pieces of the puzzle together to form a clear diagnostic picture.3,9 Only then can endodontic treatment be undertaken with the knowledge that no harm has been done. 







Friday, September 21, 2012

Japan tooth patch could be end of decay; microscopically thin film that can coat individual teeth

The "tooth patch" is a hard-wearing and ultra-flexible material made from hydroxyapatite, the main mineral in tooth enamel, that could also mean an end to sensitive teeth.

 

A tooth patch, an ultra thin biocompatible film made from hydroxyapatitte, is pictured on September 6, 2012.

Scientists in Japan have created a microscopically thin film that can coat individual teeth to prevent decay or to make them appear whiter, the chief researcher said.
The "tooth patch" is a hard-wearing and ultra-flexible material made from hydroxyapatite, the main mineral in tooth enamel, that could also mean an end to sensitive teeth.
"This is the world's first flexible apatite sheet, which we hope to use to protect teeth or repair damaged enamel," said Shigeki Hontsu, professor at Kinki University's Faculty of Biology-Oriented Science and Technology in western Japan.
"Dentists used to think an all-apatite sheet was just a dream, but we are aiming to create artificial enamel," the outermost layer of a tooth, he said earlier this month.
Researchers can create film just 0.004 millimetres (0.00016 inches) thick by firing lasers at compressed blocks of hydroxyapatite in a vacuum to make individual particles pop out.
These particles fall onto a block of salt which is heated to crystallise them, before the salt stand is dissolved in water.
The film is scooped up onto filter paper and dried, after which it is robust enough to be picked up by a pair of tweezers.
"The moment you put it on a tooth surface, it becomes invisible. You can barely see it if you examine it under a light," Hontsu told AFP by telephone.
The sheet has a number of minute holes that allow liquid and air to escape from underneath to prevent their forming bubbles when it is applied onto a tooth.
One problem is that it takes almost one day for the film to adhere firmly to the tooth's surface, said Hontsu.
The film is currently transparent but it is possible to make it white for use in cosmetic dentistry.
Researchers are experimenting on disused human teeth at the moment but the team will soon move to tests with animals, Hontsu said, adding he was also trying it on his own teeth.
Five years or more would be needed before the film could be used in practical dental treatment such as covering exposed dentin -- the sensitive layer underneath enamel -- but it could be used cosmetically within three years, Hontsu said.
The technology, which has been jointly developed with Kazushi Yoshikawa, associate professor at Osaka Dental University, is patented in Japan and South Korea and applications are under way in the United States, Europe and China.


Banking Baby, Wisdom Teeth For Stem Cells Banking..




New York
June 8, 2005—Baby and wisdom teeth, along with jawbone and periodontal ligament, are non-controversial sources of stem cells that could be "banked" for future health needs, according to a National Institutes of Health researcher who spoke today at the American Dental Association's national media conference. Harvested from the pulp layer inside the teeth, jawbone and periodontal ligament, these stem cells may one day correct periodontal defects and cleft palate, and may help restore nerve cells lost in diseases such as Parkinson's, according to Pamela Gehron Robey, Ph.D., Chief, Craniofacial and Skeletal Diseases Branch, National Institute of Dental and Craniofacial Research of the National Institutes of Health, Department of Health and Human Services. Stem cells have the potential to save injured teeth and grow jawbone.
Regenerating an entire tooth is on the horizon, and years from now, Dr. Robey said stem cells from teeth and jawbo- ne might be used to correct cleft palate, one of the most common birth defects, sparing children multiple surgeries. "As long as a cell has a nucleus, anything is possible," Dr. Robey states. In time, individuals may be able to bank their own stem cells from baby and wisdom teeth, similar to the way umbilical cord blood is stored. At present, commercial facilities to store stem cells from teeth are not available. According to Dr. Robey, the viability of stem cells derived from baby teeth is determined by when the tooth comes out. The longer a loose tooth is left in the mouth to fall out on its own, the less viable it is as a source of stem cells. As research in the field progresses, Dr. Robey hopes that stem cells from baby and wisdom teeth may one day restore nerve cells damaged by diseases such as Parkinson's Disease, one of the most common neurological disorders affecting the elderly.
"The stem cells from jawbone and teeth share a common origin with nerve tissue," Dr. Robey points out. "With the proper cues, researchers may be able to encourage them to form nerve-like tissue which may restore cells that make dopamine, but much more work is needed." Dopamine is a brain chemical that nerve cells need to properly function. To extract the stem cells from teeth, researchers can remove the periodontal ligament, drill into the tooth to remove the crown and then extract the pulp which is placed in an enzyme solution to release the stem cells. From jawbone, cells can be isolated by collecting marrow following a tooth extraction, for example, or by biopsy.
Therapeutic Application
Dental Stem Cells can Differentiate into...

This has Potential Benefit in..
arrow

arrow
Cardiac cells (heart cells)
arrow
Repair damage caused by Myocardial Infarction (Heart Attack)
Neurones (nerve cells)
arrow
Repair due to stroke or other degenerative diseases
Myocytes (muscle cells)
arrow
Repair loss due to crush-injuries or other degenerative diseases
Osteocytes (bone cells)
arrow
Repair fractures and other joint/bone diseases
Adipocytes (fat cells)
arrow
Restore fat loss
Chondrocytes (cartilage cells)
arrow
Repair of cartilage after injuries or other degenerative diseases such as Osteoarthritis
Dermal tissue (skin cells)
arrow
Assistance in Plastic Surgery applications

  • Mesenchymal stem cells help repair hearts damaged by heart attack -- in part by becoming heart cells themselves.
  • Autologous Mesenchymal Stem Cell Therapy Delays the Progression of Neurological Deficits in Patients With Multiple System Atrophy -May 2008
  • Mesenchymal Stem Cell Transplantation Accelerates Hearing Recovery through the Repair of Injured Cochlear Fibrocytes
  • Mesenchymal stem cells have shown to have a Therapeutic potential of in prostate cancer bone metastasis –
  • Clinical applications of human Mesenchymal Stem Cells are evolving rapidly with the aim to improve hematopoietic engraftment, expanding HSC, preventing graft-versus-host disease (GVHD), correcting inborn metabolic errors and delivering a variety of therapeutic genes into the cells.

Applications of mesenchymal stem cells in tissue engineering and regenerative medicine
Mesenchymal stem cells have been used to regenerate marrow microenvironment after myeloablative therapy.
The use of natural and synthetic biomaterials as carriers for mesenchymal stem cells delivery has shown increasing promise for orthopedic therapeutic applications, especially bone formation. Mesenchymal stem cells are ideal for treating arthritis and connective tissue ailments. When introduced into the infarcted heart, mesenchymal stem cells prevent deleterious remodeling and improve recovery. Number of reports have also indicated that these cells possess the capacity to trans-differentiate into epithelial cells and lineages derived from the neuro-ectoderm, and in addition, mesenchymal stem cells can migrate to the sites of injury, inflammation and to tumors. These properties of mesenchymal stem cells make them promising candidates for use in regenerative medicine and may also serve as efficient delivery vehicles in site-specific therapy.
Future Research on Mesenchymal Stem Cells
According to American Diabetes Association, mesenchymal stem cells can be the key to healing diabetic foot ulcers: Diabetic foot ulcers are the primary cause of hospital admissions for diabetics. Foot ulcers that heal improperly are at risk for infection, which can lead to amputation

Wednesday, September 12, 2012

Congenital Epulis ( Gingival granular cell tumour ) of the Newborn

CONGENITAL EPULIS OF THE NEWBORN

Epulis is a rare tumor of the newborn, also known as granular cell tumor of the newborn or Neumann's tumor. This tumor arises from the mucosa of the gingiva, most commonly from the anterior part of the maxillary alveolar ridge, and is typically seen as a mass protruding out of the newborn child's mouth, which may interfere with respiration or feeding. Epulis is seen only in the newborn and is a different entity from other granular cell tumors. The tumor has a marked female preponderance of 8:1. The recommended treatment is prompt surgical resection. Recurrences of the tumor and damage to future dentition have not been reported, suggesting that radical excision is not warranted.
A newborn female with such a mass is described. The tumor was resected using a carbon dioxide laser; the postoperative course was uneventful. On histologic examination, it was composed of diffuse sheets and clusters of polygonal cells containing small round to oval nuclei and abundant coarsely granular cytoplasm. The tumor cells stained positive for vimentin, and negative for S100-protein, actin, desmin, laminin, keratin, estrogen, and progesterone receptors. Electron microscopic examination showed granular cells containing heterogeneous electron-dense granules, lysosomes, and cytoplasmic lipid droplets. The clinical and microscopic features of such tumors are reviewed. 
                                    Epulis, or congenital granular cell tumor (GCT), is a rare tumor of the newborn. It is seen as a mass arising in the mouth from the alveolar ridge; this mass may interfere with respiration or feeding. A case of congenital epulis is reported; the tumor was resected using a carbon dioxide laser. The clinical aspects as well as the morphologic, histologic, and electron microscopic features of this lesion and its treatment are reviewed. 
Although the clinical presence of the congenital epulis may frigten parents,it ceases to grow following birth and is entirely benign,with some cases undergoing spontaneous involution.The usual treatement is simple surgical excision,with care taken not to interfere with the developing dentition.There is no propensity for recurrence , even in those in which the lesion is incompletely removed.


Ref: Dentistry for child and adolescent .

Wednesday, September 5, 2012

Desmoplastic ameloblastoma of Maxilla

Ameloblastoma, a relatively common epithelial odontogenic tumor includes several histopathologic subtypes like follicular, plexiform, acanthomatous and desmoplastic variants. Hybrid desmoplastic ameloblastoma (DA) composed of typical desmoplastic ameloblastoma along with areas of follicular/plexiform ameloblastoma is an extremely rare variant of ameloblastoma.

       Desmoplastic ameloblastoma (DA) was first
described in detail by Eversole et al in 1984 and
is defined as “a variant of ameloblastoma with
specific clinical, imaging and histological                   
features” in the recent WHO classification of
odontogenic tumors. Thus, it often occurs in the
anterior region of jaws, presents with unique
radiographic appearance resembling fibrosseous
lesions and show distinct histopathology
characterized by extensive stromal
collagenisation or desmoplasia surrounding
compressed islands of odontogenic epithelium
making it a distinct entity.



Ameloblastoma is a rare odontogenic tumor accounting for around 1% of all the cysts and tumors in the jaws.It encompasses several histological variants like follicular, plexiform,basaloid,acanthomatous and desmoplastic variants.The striking difference in the anatomic location i.e. occurrence in the anterior-premolar region ofmaxilla/mandible, unusual radiologic presentation of mixed radiolucency-radiopacities with illdefined borders and distinctive histopathology of extensive stromal desmoplasia with scattered odontogenic epithelium makes it a distinct clinicopathologic entity. Additional findings
reported for DA are almost equal sex predilection and relative higher frequency of occurrence in
Asians.







A: Intraoral clinical photograph of the tumor in the
left maxilla. B, PNS view demonstrating a mixed
radiolucent and radiopaque appearance with opacification of
the sinus. Computed tomography scan demonstrating a mixed
radiolucent –radiopaque lesion (C). Cut surface of the gross
specimen demonstrating a solid, granular, creamish white
lesion (D). E: Radiograph of the gross specimen depicting a
mottled appearance with focal radiolucencies.

For further reference :
Source : http://www.easternjmed.org/PDF/2011_1/9.pdf

Indian doctor becomes WHO’s Deputy Director General

The World Health Organization has an Indian doctor for its new Deputy Director General for Programmes. Dr. Soumya Swaminathan, the directo...