A Case of Chorioretinitis with Retinal Angiomatous Proliferation

A 48-year-old woman had an acute blurred vision in the right eye immediately after drainage of liver abscess. Her best corrected visual acuity (BCVA) was 8/400; fundus photography suggested the diagnosis of endogenous endophthalmitis with chorioretinitis and vitritis. Due to the bad systemic condition, a systemic antibiotic combined with periocular triamcinolone (TA) was carried out first. Inflammatory cells in the vitreous cavity were decreased after treatment; however, fundus fluorescein angiography (FFA) showed abnormal dilation and leakage of the capillaries and retinal-choroidal anastomose, supporting that there was retinal angiomatous proliferation (RAP). Vitreous interleukin-6 (IL-6) was only slightly elevated; the ratio of interleukin-10 (IL-10) and IL-6 was less than 1, and the etiological test was negative. After receiving intravitreal vancomycin injection combined with periocular TA injection, the patient’s BCVA was improved from 16/400 to 20/400 with a reduction in vitreous inflammatory cells. However, the patient’s RAP was progressed and her BCVA was dramatically decreased to count finger/30 cm. After intravitreal injection of ranibizumab, the patient’s BCVA was 5/400 with a significant shrink in lesions and absorption of hemorrhage, exudation, and fluid. Thus, we suggest that early anti-inflammatory treatment in conjunction with anti-VEGF may achieve a better prognosis in patients with inflammatory retinal angiomatous proliferation (RAP).

DIFFUSE IDIOPATHIC SKELETAL HYPEROSTOSIS OF THE CERVICAL SPINE - DIAGNOSIS, TREATMENT

Диффузный идиопатический скелетный гиперостоз - системное состояние, характеризующееся наличием по меньшей мере трех костных мостиков в переднебоковом отделе позвоночника. Распространенность заболевания составляет 2,9% - 42,0%. Важным компонентом для диагностики гиперостоза было наличие костного нароста в передней части смежных позвонков. Дебют диффузного идиопатического скелетного гиперостоза протекает бессимптомно, в результате чего заболевание обнаруживается как случайное открытие во время рентгенологического обследования других заболеваний. Клинически значимым симптомом гиперостоза в шейном отделе является дисфагия и обструкция дыхательных путей. В результате костного нароста, расположенного кпереди от тел позвонков в шейном отделе позвоночника, трахея и пищевод смещаются, что приводит к дисфагии и обструкции дыхательных путей, что является главным диагностическим критерием и показанием к оперативному лечению. Diffuse idiopathic skeletal hyperostosis is a systemic condition characterized by the presence of at least three bone bridges in the anterolateral spine. The prevalence of the disease is 2.9% - 42.0%. An important component for the diagnosis of hyperostosis was the presence of a bone growth in the anterior part of the adjacent vertebrae. The onset of diffuse idiopathic skeletal hyperostosis is asymptomatic, as a result of which the disease is detected as an accidental discovery during X-ray examination of other diseases. A clinically significant symptom of cervical hyperostosis is dysphagia and airway obstruction. As a result of the bone growth located anteriorly from the vertebral bodies in the cervical spine, the trachea and esophagus are displaced, which leads to dysphagia and airway obstruction, which is the main diagnostic criterion and indication for surgical treatment.

An unusual case of bone regeneration of a necrotic mandible with pathologic fracture in an elderly hemodialysis patient with medication-related osteonecrosis of the jaw: a case report and review of the literature

Background Bisphosphonates are frequently used for osteoporosis. Medication-related osteonecrosis of the jaw, a complication of bone-modifying agents, including bisphosphonates or angiogenic inhibitors, can be challenging to treat in elderly patients with numerous preexisting conditions. Achieving good treatment outcomes is especially difficult in patients with pathological fractures accompanied with extraoral fistulae. Case presentation We report an unusual case of prominent bone regeneration following palliative surgical treatment in a 72-year-old Japanese female patient undergoing hemodialysis. She previously had severe osteoporosis due to renal osteodystrophy and was receiving antiresorptive intravenous bisphosphonate. Computed tomography revealed a discontinuous left lower mandibular margin with a pathologic fracture and extensive, morphologically irregular sequestrum formation (80 × 35 × 20 mm). The patient was diagnosed with stage III medication-related osteonecrosis of the jaw and pathologic mandibular fracture. Immediately before the surgery, the anticoagulant used for dialysis was changed from heparin to nafamostat mesylate to reduce the risk of intraoperative bleeding. Sequestrectomy was performed under general anesthesia. Postoperative infection was not observed, the intraoral and submandibular fistula disappeared, and, surprisingly, prominent spontaneous bone regeneration was observed postoperatively at 6 months. Despite the severe systemic condition of the patient, the conservative surgical approach with sequestrectomy has yielded desirable results for more than 6 years since the surgery. Conclusions This rare report of spontaneous bone regeneration in a patient of advanced age and poor general condition is the oldest case of mandibular regeneration ever reported.

Role of Vascular Ultrasonography in Patients with Leg Swelling

There are many causes of leg swelling or edema. Leg edema due to systemic condition or disease demonstrates chronic, bilateral features, whereas leg edema caused by vascular disease shows more complex clinical features including secondary skin changes and ulcerative lesion, resulting in more complicated clinical outcomes with less frequent early diagnosis and appropriate management. Definite differential diagnosis might not be possible by medical history, clinical features, and physical findings. Vascular ultrasonography (Duplex ultrasound) can be used easily as a bedside diagnostic procedure and is a recommended diagnostic tool for differentiation of a non-vascular from vascular etiology in patients with leg swelling.

Ulcerative Lesions of the Oral Cavity

Apart from dental and periodontal diseases, oral mucosal lesions are also frequently encountered by both general dentists and dental specialists in outpatient clinics. Although these soft tissue lesions may only reveal a localized issue, sometimes they may be the only sign of a more serious underlying systemic condition. Thus, oral ulcerations pose a unique diagnostic challenge for healthcare providers and should be cautiously handled when they last for more than two weeks, even after any possible traumatic etiologies are eliminated. There are many different classifications regarding oral ulcerations based on their etiologic or clinical features. In order to provide a logical and simple stepwise guidance to accurate diagnosis, this chapter will categorize and explain these lesions based on their clinical properties.

Periodontal Inflammation and Systemic Diseases: An Overview

Periodontitis is a common inflammatory disease of infectious origins that often evolves into a chronic condition. Aside from its importance as a stomatologic ailment, chronic periodontitis has gained relevance since it has been shown that it can develop into a systemic condition characterized by unresolved hyper-inflammation, disruption of the innate and adaptive immune system, dysbiosis of the oral, gut and other location's microbiota and other system-wide alterations that may cause, coexist or aggravate other health issues associated to elevated morbi-mortality. The relationships between the infectious, immune, inflammatory, and systemic features of periodontitis and its many related diseases are far from being fully understood and are indeed still debated. However, to date, a large body of evidence on the different biological, clinical, and policy-enabling sources of information, is available. The aim of the present work is to summarize many of these sources of information and contextualize them under a systemic inflammation framework that may set the basis to an integral vision, useful for basic, clinical, and therapeutic goals.

Ayurvedic Successful Management of Nodular Episcleritis with Prolonged Period Follow Up-A Case Report

Episcleritis, an acute unilateral or bilateral inflammation, usually idiopathic or autoimmune condition with or without underlying systemic condition is a troublesome manifestation of red eye reported. It manifests as red or pinkeye, varied mild pain to foreign body sensation, tender discomfort on touch, commonly recurs. As an acute condition patient seeks medical assistance. Ayurveda recognised this either as Sirajala, Siraharsha, Sirajapidika and a Shuklabhagaroga. Here a young lady with painful repeated manifestation of episcleritis is reported seeking Ayurveda for holistic management of the condition after repeatedly trying other systems in vain. Patient was treated with suitable Shodhana, Kriyakalpa followed by necessary Dinacharya and Rasayana ensuring non recurrence; Deepan pachana, Anulomana, Kriyakalpa, Rasyana chosen were all Chakshushyadravyas. To add up to synchronize the effect of yoga therapies advised, to achieve non recurrence of symptoms. Trikatu, Trivrt, Triphala, Yashtimadhu, Madhu, Ghrta known Chakshushyadravya having vitamins and trace elements known to be highly beneficial to the eye and all sense organs was advocated, Kriyakalpa play a major role in immediate mitigation of symptoms and also prevents recurrence. Seka is most accepted Kriyakapla for enhancing quick relief, non recurrence, cost effective Ayurveda management reported after a prolonged period of follow up for a year. Yoga therapy included Suryanamaskar, Anulomaviloma pranayama and Trataka, Ayurveda and yoga when added to management ensured non recurrence.

Clinical performance of a new prediction rule of systemic loxoscellism. case report

Systemic or cutaneous-visceral loxoscelism is the most severe clinical presentation of loxoscelism. Currently there is no validated laboratory diagnostic method that allows us to confirm the presence of this disease in the face of arachneism. However, there is a clinical prediction rule (CPR), which allows us to predict the evolution of a bite towards a systemic condition and which would be useful in emergency rooms. We present the case of a woman who developed the systemic picture of loxoscelism to whom a new CPR was applied for the early detection of systemic loxoscelism, presenting adequate performance for early evaluation in emergency services.

Extra-Articular Manifestations and Comorbidities in Psoriatic Disease: A Journey Into the Immunologic Crosstalk

Psoriatic arthritis (PsA) is a chronic inflammatory disease primarily affecting peripheral and axial joints, with the possible presence of extra-articular manifestations (EAMs), such as psoriasis, uveitis, and inflammatory bowel disease. Recently, the concept of psoriatic disease (PsD) has been proposed to define a systemic condition encompassing, in addition to joints and EAMs, some comorbidities (e.g., metabolic syndrome, type II diabetes, hypertension) that can affect the disease outcome and the achievement of remission. EAMs and comorbidities in PsA share common immunopathogenic pathways linked to the systemic inflammation of this disease; these involve a broad variety of immune cells and cytokines. Currently, various therapeutics are available targeting different cytokines and molecules implicated in the inflammatory response of this condition; however, despite an improvement in the management of PsA, comprehensive disease control is often not achievable. There is, therefore, a big gap to fill especially in terms of comorbidities and EAMs management. In this review, we summarize the clinical aspects of the main comorbidities and EAMs in PsA, and we focus on the immunopathologic features they share with the articular manifestations. Moreover, we discuss the effect of a diverse immunomodulation and the current unmet needs in PsD.