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Preoperative assessment of bone quality in the dental arches is important in implantology. Fan-beam computed tomography (CT) proved to be successful in this respect, although it involves high costs and excessive radiation exposure. Bone density estimated by CT correlates well with the mechanical bone density scale proposed by Misch [14]. Ranges of CT numbers, expressed in Hounsfield units (HU), were associated to various bone density classes. About an order of magnitude cheaper and less harmful than CT, cone-beam computed tomography (CBCT) has attracted much attention as an alternative technique for bone quality estimation. CBCT voxel values, however, are less informative than CT numbers because they depend on position, on instrument settings and type. This paper proposes a mathematical procedure for making corrections to CBCT voxel values in order to eliminate their position-dependence and to bring them closer to CT numbers. An anthropomorphic spine phantom, as well as granular CaCl2 and bone meal were scanned using both CT and CBCT. We found a mathematical relationship between CT numbers and CBCT voxel values, and used nonlinear least squares methods to find the model parameters that provided the best fit to experimental data. We validated our procedure for a few materials and one type of CBCT unit. Further research will be needed to test the feasibility of this procedure for other types of CBCT instruments. The approach proposed here might become clinically useful if model parameters will be identified for hard tissues from the oral environment. [ABSTRACT FROM AUTHOR]

Glanda hipofiză este situată la baza creierului, într-o formaţiune anatomică osoasă numită şaua turcească (sella turcica). Are un rol extrem de important în reglarea funcţiilor neuro-endocrine datorită hormonilor secretaţi. Prolactinomul reprezintă o tumoră benignă a glandei hipofize (adenom), ce produce în exces un hormon numit prolactina. Autorii prezintă cazul unui adolescent în vârstă de 16 ani, evaluat în ambulator pentru deficit staturo-ponderal, ocazie cu care s-au decelat valori crescute ale prolactinei serice. Ulterior, pacientul se internează în Clinica II Pediatrie pentru investigaţii suplimentare şi precizare de diagnostic. [ABSTRACT FROM AUTHOR]

Sindromul Kallmann se caracterizează prin deficit izolat de GnRH, asociat cu hipo/anosmie. La examenul clinic al pacienţilor cu sindrom Kallmann se decelează micropenis, criptorhidie, absenţa instalării pubertăţii, infertilitate. Se prezintă cazul unui adolescent în vârstă de 16 ani, afirmativ cu anosmie şi hipogonadism (sesizat de aparţinători) încă de la vârsta de 2-3 ani. A fost evaluat în repetate rânduri în diferite servicii medicale, fără a se stabili un diagnostic de certitudine. Ulterior, pacientul se internează în Clinica II Pediatrie pentru investigaţii suplimentare şi precizare de diagnostic. [ABSTRACT FROM AUTHOR]

CHARGE syndrome is an autosomal dominant condition caused by mutations in the chromodomain helicase DNA binding protein 7 (CHD7) gene. The present study reported on the case of a 16-month-old female with plurimalformative syndrome, whose etiology was identified by clinical whole-exome sequencing (WES) analysis. Clinical and follow-up assessments identified multiple craniofacial dysmorphisms, congenital defects and functional symptoms, including dysphagia and Marcus Gunn jaw winking synkinesis. Trio-WES analysis was performed for the patient and their parents and the presence of CHARGE syndrome was further indicated using single-molecule real-time sequencing. A de novo pathogenic variant, c.4379_4380del (p.Ile1460Argfs * 15), was identified in exon 19 of the CHD7 gene, which resulted in a premature translational stop signal. Trio-WES analysis was used for further investigation, indicating that neither of the patient's parents had the mutation and confirming its de novo nature. To the best of our knowledge, the case of the present study was the first reported case of CHARGE syndrome in Romania with congenital defects including an aberrant right subclavian artery and a horseshoe kidney. CHARGE syndrome was diagnosed in the patient based on the pathogenic mutation in the CHD7 gene. To the best of our knowledge, the present case report is the first to suggest that the CHD7 gene variant is associated with CHARGE syndrome., (Copyright: © Gug et al.)

Background: The presence of metastatic cervical adenopathy is essential for treatment planning and prognosis assessment. Treatment of patients with head and neck cancer with clinically negative cervical lymphadenopathy (N0) remains controversial. Neck palpation, as the method used in tumor, node, metastasis (TNM) staging, has limitations and can provide false negative results in some cases. Lymph node metastases are associated with a reduced survival rate but at the same time, neck dissection for the patient with N0 neck is not without risks or complications., Objectives: In prospective study, we compared palpation, ultrasonography (US) examination of the neck and histopathological examination in patients with cancers of the pharynx and larynx., Patients, Materials and Methods: Forty-six patients with cancers of the pharynx and larynx that presented with a N0 neck were prospectively analyzed. They were divided in two groups: 23 patients operated with an external approach including the control of the lymph node areas, and a second group of 23 patients operated using endoscopy and carbon dioxide (CO2) laser, no neck dissection - "watchful waiting policy". All patients have had a flexible endoscopy of the pharynx and larynx, US of the neck and all received surgical treatment for their primary tumor. Imaging was performed in selected cases. All the removed lymph nodes were sent for histopathology. US was also used as a follow-up method. The US features of the examined lymph nodes were: diameters [longitudinal (L) and transverse (T)]; the ratio of the two diameters (L∕T); shape; lymph node area; central hypodensity; regular∕irregular margins; aspect (homogeneous or not)., Results: US has detected 25 lymph nodes in the open surgery group and intraoperatively, we excised 31 (sensitivity of 80.6%). Ten lymph nodes showed metastases, with 100% accuracy of US, which have been confirmed both pathologically and immunohistochemically. US in the second group - patients treated with CO2 laser - detected at four patients 10 cervical lymph nodes that did not presented any malignant features. At recurrence alone, the US confirmed 100% presence of nodes metastases., Conclusions: US was superior to palpation and this method can be recommended as a diagnostic tool in preoperative assessment of patients without palpable metastasis (N0).

Soft-tissue vascular anomalies have a worldwide estimated prevalence of 4.5% in the pediatric population. From January 1, 2014 until December 31, 2018, imagistic and histological evaluations were performed in 214 patients aged between one day and 18 years old, who were diagnosed with different soft-tissue vascular anomalies in our Center. From the 214 patients included in the study, 36.45% (n=78) were males, 63.55% (n=136) were females and 37.38% (n=80) of the patients were less than one year of age at time of admission. Infantile hemangioma was the most frequent type of soft-tissue vascular anomaly (35.51%) and the face was the most frequent affected region (25.7%). Ultrasound (US) examination is the most used imaging technique due to its wide accessibility and for providing valuable information about the anatomical localization of the lesions, the type of vessels involved, distribution and density of vascularization. Magnetic resonance imaging (MRI) can be used for assessing the extent of deep or large lesions, but it usually requires anesthesia. Computed tomography (CT) is useful when patients present contraindications to anesthesia and it has the advantage of a shorter image acquisition time. Histological studies have an important role in establishing the diagnosis even for the atypical cases of soft-tissue vascular anomalies. Furthermore, the prognosis depends on the histological type. In conclusion, there is a need for collaboration between the clinician, radiologist, pathologist and surgeon in order to establish a precise diagnosis and therapeutic strategy for each patient.

The acute limb ischemia (ALI) in neonates is a rare phenomenon, but with serious consequences if undiagnosed or untreated. The purpose of this review is to briefly present the etiology of ALI and morphological findings in correlation with specific causes. Etiology can be classified into two main groups: prenatal (in utero compression, thrombosis and embolism) and postnatal (iatrogenic, thromboembolism and vascular malformations). The most common cause of ALI is catheter-related thrombosis (almost 90% of thrombosis cases are associated with catheter use), but other rare causes like vascular malformations should not be overlooked. Ultrasound represents a non-invasive, inexpensive and widely available imaging technique, which provides sufficient information to evaluate the situation and establish proper therapeutic strategies. Morphological tests do not represent the standard diagnostic procedure in ALI, but they can provide useful information. The findings depend on the etiology: intraluminal thrombi, vascular changes, placental pathological modifications. Every morphological result must be correlated with the clinical picture and imagistic findings. In conclusion, ALI in neonates is a rare condition, usually associated with catheter use in intensive care unit setting, with multiple risk factors and conditions that increase the risk of occurrence.