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Background: Miniscrew-assisted rapid palatal expansion (MARPE) has gained attention as an effective alternative to traditional rapid palatal expansion, particularly in adult patients. This scoping review synthesizes recent evidence to assess the clinical efficacy and safety of MARPE, addressing a gap in comprehensive, up-to-date analyses in this area. Objective: To present the recent assessments concerning MARPE influencing factors, side effects, soft tissue alterations, and airway changes, focusing on comparisons with conventional devices. Methods: Using PRISMA guidelines, we conducted a search of the literature published in 2018–2023 using Medline, Scopus, and Embase databases. This review focused on randomized controlled trials, cohort studies, and other reviews that evaluated the outcomes of MARPE. Results: Our analysis included 75 studies and revealed that MARPE significantly improves suture expansion with fewer dental and skeletal side effects compared to traditional methods. The technique shows high efficacy in subjects up to 25 years of age, with reduced incidence of complications and improved stability of expansion. Conclusions: The results support MARPE as a viable and superior alternative for maxillary expansion in late adolescents and adults. Given its advantages over traditional methods, MARPE should be considered a standard procedure in orthodontic treatment plans. Future research should focus on long-term outcomes and optimization of patient-specific treatment protocols. [ABSTRACT FROM AUTHOR]

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Cardiovascular risk assessment in patients with rheumatoid arthritis (RA) is challenging. Not all risk calculators adjust for RA status, yielding discording results. A 56-year-old woman with RA presented for bilateral pain and swelling in the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints. She was diagnosed with RA 10 years ago, currently treated with methotrexate (MTX), sulfasalazine, and hydroxychloroquine. She has a history of type 2 diabetes mellitus, a total abdominal hysterectomy with bilateral salpingo-oophorectomy for an epidermoid carcinoma of the cervix, and surgical excision of a pulmonary rheumatoid nodule. Multiple subcutaneous nodules are seen bilaterally on the MCP and PIP joints. MTX may be associated with nodulosis in RA patients, which in turn is related to a further increase in cardiovascular risk compared to RA alone. MTX was discontinued. Abatacept was the biologic of choice, due to recent evidence suggesting superior efficacy in decreasing cardiovascular risk compared to anti-TNF therapies, especially in patients with diabetes and with positive rheumatoid factor. Initiating high-dose statin and abatacept may be a useful primary prevention strategy in complex RA patients that require biologic therapy.. [ABSTRACT FROM AUTHOR]

We present a rare case of breast neoplasm, synchronous (simultaneous) bilateral breast cancer, methods of diagnosis, multimodal treatment and the standard follow-up program. Bilateral breast cancer is a rare entity, with an incidence between 0.3 and 12%, representing 1 to 2.6% of all breast cancers. Bilateral breast cancer is defined as the presence of cancer cells in both breasts at the same time or at a distance of up to 3 months from the identification of the first tumor (synchronous), or metachronous if it occurs after more than 3 months from the identification of the primary tumor. There is not a general agreement regarding the optimal treatment. The prognosis is considered more severe than that of a unilateral neoplasm and the patients are treated more frequently by undergoing bilateral mastectomy rather than conservative surgery. We present the case of a 57-year-old patient diagnosed by clinical and imaging investigations (mammography, MRI) with bilateral breast tumor formations. The 57-year-old patient was referred to our clinic for a bilateral synchronous breast pathology. The pathological examination of the biopsy revealed bilateral invasive ductal breast cancer, with an intermediate histological grade G2, ER +, PR +, HER2 - (score 0 ASCO-CAP). Therefore, the diagnosis was simultaneous bilateral breast cancer, a rare entity which represents the real bilateral cancer of the breast. Neoadjuvant therapy was started and then Madden modified radical mastectomy was performed. The histopathological examination confirmed the invasive ductal carcinoma in the left breast - pT1cN1aG2 and in the right breastpT1cN0aG2. Considering that it is a rare variant of breast cancer, with a severe prognosis, the presented case reflects the current diagnostic and treatment approaches, and the gaining of better long-term results are ensured by a correct multidisciplinary approach. [ABSTRACT FROM AUTHOR]

Introduction: Most breast cancers require neoadjuvant chemotherapy and the response to primary systemic therapy (PST) is crucial for deciding on the surgical technique and predicting patient outcomes. However, chemotherapy also brings numerous side effects, with cardiovascular issues being some of the most significant, common and challenging to manage. Case presentation: We present the case of a 71-year-old woman diagnosed with stage T2N1M0 Luminal B breast cancer. It was decided to initiate chemotherapy consisting of four cycles of FEC (5-fluorouracil 600 mg/m² on days 1 and 8, epirubicin 60 mg-90 mg/m² and cyclophosphamide 600 mg/m²), followed by four cycles of docetaxel (75 mg/m² every three weeks). Near the end of the treatment cycles, she developed new-onset angina with complex critical coronary lesions. This required assembling a multidisciplinary team to determine the optimal management strategy from cardiological, surgical, and oncological standpoints. Just when we thought we had found the optimal approach for managing ischemic heart disease, the situation became more complicated with the development of deep vein thrombosis, requiring a reassessment of the entire treatment plan. Conclusions: Neoadjuvant chemotherapy is an important weapon against breast cancer but also a veritable enemy of cardiovascular diseases. The association of two major diseases requires a multidisciplinary team capable of making the best decisions to maximize benefits and minimize adverse effects. [ABSTRACT FROM AUTHOR]

Belimumab is a human immunoglobulin G1-lambda-1 (IgG1-λ) monoclonal antibody that targets the soluble BLyS human protein, also known as B-cell activating factor (BAFF) approved for the treatment of systemic lupus erythematosus (SLE). Serious and sometimes fatal infections have been reported in patients receiving novel immunosuppressive agents, including belimumab. Thus, physicians should exercise caution when considering belimumab in patients with SLE. A 50-year-old woman with SLE presented with a severe, diffuse rash two months after initiating treatment with belimumab. A skin biopsy revealed epidermal necrolysis with keratinocyte detachment and apoptosis in the basal layer of the epidermis, suggestive for toxic epidermal necrolysis (TEN). Belimumab was discontinued and 500 mg of pulse IV methylprednisolone therapy every day for 3 days were administered, with resolution of the skin lesions in the following days. To the best of our knowledge, this is the first case of belimumab-associated TEN. [ABSTRACT FROM AUTHOR]

Adult-onset polymyositis (PM) belongs to the idiopathic inflammatory myopathy (IIM) group and manifests with proximal muscle weakness, elevated muscle enzymes and positive myositis- specific antibodies. The subset of autoantibodies can indicate a higher risk for cancer association. An 82-year-old diabetic patient, with multiple cardio-vascular comorbidities, was hospitalized for muscle weakness of the upper girdle, dysphagia and dysphonia, accompanied by elevated serum muscle enzymes. Muscle biopsy showed an inflammatory infiltrate while immunological assays found positive ANA and anti-NXP2 antibodies. The diagnosis of PM was established, thus a screening for underlying neoplasia was required. Upper endoscopy visualized an area of ectopic mucosa in the esophagogastric junction and the biopsy confirmed a squamous cell carcinoma in situ. Patient had favorable muscle outcome under methylprednisolone pulse therapy. It is worth noting that polymyositis is more rarely associated with cancers as compared to dermatomyositis (DM). In conclusion, the type of antibodies identified in myositis can represent an alarm signal for oncologic screening, making possible an early diagnosis and efficient treatment of a hidden tumor. [ABSTRACT FROM AUTHOR]

Background: Gastrointestinal stromal tumors are the most common primary mesenchymal tumors of gastrointestinal, more frequently located in the stomach (60-70%), followed by small intestine (20-25%), colon and rectum (5%), and esophagus (< 5%). They typically express CD117, CD34, S100 and SMA. This study is aiming to characterize GISTs immunoprofile and to establish correlations between morpho-patological and immunohistochemical parameters. Material and methods: Tissue samples of 141 GISTs, from "Victor Babes" Institute files, were evaluated using H&E stain and immunohistochemistry for CD117, CD34, SMA and S100. Statistical analysis was made by Student t-test, "paired two samples for mean" variant. Results: The patients (M : F = 77 : 64), aged from 32 to 84 (mean = 56, SD = 1.6), had spindle cells GISTs in 53.18 %, epithelioid in 29.8% and mixed pattern in 17.02% of tumors. Immunohistochemically, CD117 was positive in 72.34% of GISTs, CD34 in 79.4%, SMA in 56.02% and S-100 in 69.5% of cases. A female predominance was encountered in all antibodies immunohistochemical expressions, except S100. The fusiform pattern was the most frequent for all tested antibodies and the small intestine was the favorite site for all studied markers. Statistical analysis revealed no significant correlation between antibodies. Conclusions: Our results confirm CD117 and CD34 as sensitive markers for GISTs diagnosis. Immunohistochemical expressions of all tested markers, except S100, were more frequently encountered in women and in the spindle cell type GISTs; the small intestine was the most frequent localization. [ABSTRACT FROM AUTHOR]

Psoriatic arthritis (PsA) is an inflammatory joint disorder associated with psoriasis, which belongs to the group of seronegative spondylarthropaties. We present a case of a young patient with erosive arthritis and invalidant bilateral coxitis nonresponsive to disease modifying antirheumaic drugs (DMARDs) successfully treated etanercept. The patient presented almost all negative prognostic known factors (young age, HLA-B27, polyarticular involvement etc.). Over expression of tumor necrosis factor a (TNFa) in synovial biopsy removed in the course of the surgical treatment is a reliable indicator for a good response to biological treatment anti-TNFα. The strict monitoring of the side effects during etanercept treatment is mandatory in daily clinical practice. [ABSTRACT FROM AUTHOR]

Granulomatosis with polyangiitis (GPA) is a rare disorder characterized by inflammation of small and medium- sized blood vessels (vasculitis) that results in damage to various organ systems of the body, most often the respiratory tract and kidneys. The relapse rate rises from about 20% at 12 months to about 60% at 5 years. The combination of glucocorticoids and cyclophosphamide remains the standard therapy for patients with generalised GPA. Nevertheless, some patients do not respond satisfactorily to this treatment. Here we present a 32 year-old female with relapsing GPA successfully treated with methotrexate for ear, nose and throat (ENT) manifestation. [ABSTRACT FROM AUTHOR]

Introduction: Lung cancer is the leading cause of death among neoplasias, worldwide. Non-small cell lung carcinomas (NSCLC) represent the majority of lung epithelial malignancies (>75%). Compared to other malignant tumors, lung cancer pathology is very heterogeneous; currently, there are no generally accepted proteic and molecular markers for prediction and prognosis related to these tumors. The aim of this study is to characterize the proteic and molecular aspects of some factors with major role in solid tumors carcinogenesis in our geographical area, to look for possible correlations between the proteic expressions of EGFR, Cerb-B2 and EGFR gene amplification in lung cancer, and to analise their potential prognostic implications. Material and method: We studied 72 tissular samples of NSCLC stages I-IV. After the histopathological diagnosis, these cases were analized by immunohistochemistry (IHC) for EGFR and Cerb-B2 proteins, and by fluorescence in situ hybridization (FISH) for EGFR gene amplification. The IHC and FISH results were statistically analized for possible correlations with histological type, stage and clinical evolution. Results: EGFR overexpression was more frequently encountered in adenocarcinomas (34.02%). The Cerb-B2 protein had an approximativelly uniform distribution between the different studied histological types: adenocarcinomas (39.02%), squamous carcinomas (34.78%), and adenosquamous carcinomas (33.33%). Only eight cases presented both Cerb-B2 and EGFR positive IHC reactions (11.11%). EGFR gene overexpression (FISH) was detected in 11 cases (15.27%). FISH positive cases associated short survival intervals or early metastases. Conclusion: EGFR gene amplification detected by FISH may be considered a prognostic marker in lung carcinomas. [ABSTRACT FROM AUTHOR]

Introduction: Innate immunity is the first protection against microorganisms. Nowadays, there is a growing interest in innate immune molecule known as palate, lung, nasal epithelial clone (PLUNC). PLUNC is a specific product of the airways, of approximately 25 kDa, encoded by adjacent genes found within a 300 kb region of chromosome 20; these proteins must be detected predominantly in the upper respiratory tract., Materials and Methods: We performed a case-control study to investigate the presence of this protein in nasal tissue of patients affected by chronic rhinosinusitis. 59 patients were enrolled (44 cases, 15 controls). We have examined the correlation between the presence of pathology and the PLUNC proteins positivity., Results: 100% of controls have a +++ rated PLUNC proteins positivity, while cases have a lower percentage of positivity. We used χ (2) statistical test to analyze the results of the study and there is a difference statistically significant between cases and controls in PLUNC proteins positivity., Conclusions: These observations suggest that, in response to agents or chemical factors, nasal mucosal epithelium will react and produce PLUNC proteins. So PLUNC proteins have a protective function on upper airways mucosa, as we can see by evaluating the high positivity in control group.

Somatostatinoma is a rare neuroendocrine tumor which especially develops in the pancreas. There are few communicated cases about extra-pancreatic localization, having as a particularity the absence of somatostatin hypersecretion syndrome and frequent association with von Recklinghausen neurofibromatosis. We present the case of a 42-year old patient with Von Recklinghausen neurofibromatosis admitted in our clinic with a chronic upper digestive obstruction syndrome. The presence of a first jejunal loop somatostatinoma was an intraoperative surprising diagnosis that imposed jejunal resection and association of complementary specific treatment. Despite the therapeutic correct management, the status of the patient deteriorated very fast, confirming the aggressiveness of this neoplasia.

Introduction: Malignant fibrous histiocytoma (MFH) is a tumor which has a mesenchymal origin, and an uncertain histogenesis. MFH with giant cell accounts for 3-15% of all malignant fibrous histiocytomas., Objective: To explore the histopathology, the diagnosis and the treatment of MFH with giant cell of larynx., Patient and Methods: We report a case of a glottic MFH at a 59-year-old male, who has been smoking for 30 years, and was hospitalized in June 2008 at Emergency County Hospital of Craiova., Results: The largely-sized tumor was originated in glottic area, upper a left vocal cord, with no paresis. The tumor determined respiratory failure and dysphonia. Patient underwent surgical excision of the tumor after an emergency tracheotomy. The immunohistochemical techniques proved positive for vimentin, smooth muscle actin, CD68, CD34, bcl2, EGFR, S100, Ki67, and negative for CD117, NFT, chromogranin, c-erbB2, CK34betaE12, MNF116, and p53., Conclusions: Malignant fibrous histiocytomas (MFH) with giant cell of larynx are very rare mesenchymal neoplasm (this case seems the first reported). The diagnosis of MFH of larynx was difficult and the immunohistochemistry could have been helpful.

Detection of the esophagogastric junction adenocarcinoma in symptomatic stage determine a low survival. The aim of the study was to identify the prognostic factors after eso-gastrectomy for esophagogastric junction adenocarcinoma. There was done a prospective study of a 43 patients with esophago-gastric resections and abdomino-mediastinal lymph nodes dissection between 2001 and 2006 at the General and Esophageal Surgery "St. Mary" Clinical Hospital: 25 patients with transhiatal total gastrectomy, 6 patients with total gastrectomy and distal esophagectomy by separated incisions, abdominal and thoracic, 3 patients with total gastrectomy and subtotal esophagectomy by abdomino-cervical approach, 9 patients with subtotal esophagectomy by abdomino-cervical approach with cu small gastric curvature resection, radical resections in 22 patients. The patients were followed by clinic, endoscopic, TC exam and tumoral markers. There were done complex statistic analysis using SPSS 16.0. The mean interval of the surveillance was 24 months (6 - 60 months). 1 year survival was 77,74%. Long-term survival was influenced by age (p&#95;value = 0.0129), tumoral grading (p&#95;value = 0.0297), the number of lymph nodes metastasis (p&#95;value = 0.0029) and pT stage (p&#95;value = 0.0139), and was not dependent on Siewert type, ASA class, surgical approach, resection type, the number of the dissected lymph nodes, abdominal or mediastinal. In locally advanced esophagogastric junction adenocarcinoma, the frequency of lymph nodes metastasis (81%) especially in patients with tumoral type III and unfavorable results of surgical treatment as unique therapeutically method show the necessity of a multimodal approach pre and post-operatory by using selection methods with a good prediction of neoadjuvant treatment.

Pseudo-achalasia is a rare pathologic entity that mimics idiopathic achalasia, usually secondary to malignant infiltration of the cardia. Its significance is related to the fact that it may be difficult to distinguish from primary achalasia; the outcome and therapeutic course are different. In fact, a large variety of processes may be responsible for the development of a secondary achalasia syndrome; we present a case with pseudo-achalasia due to a middle thoracic esophageal squamous cell carcinoma.

Krukenberg-type tumors (KT) are rare among ovarian metastases, but responsible for the most frequent diagnostic confusions with ovarian cancer. They are peculiar: uncertain pathogenesis, challenging etiological diagnosis, poorer prognosis for the primary. We studied 9 cases, with a mean age of 52 years, operated since 2001; no case was discovered as a result of prophylactic oophorectomy. Timing of TK diagnosis: 3--metachronous, 4--synchronous, as incidental discovery and 2--retrospective pathological diagnosis. Site of primary: 3--gastric, 5--colonic or appendiceal, 1--breast. Imaging appearance was useful only if interpreted in clinical conditions. Morphology: 7/9 bilateral, solid or mixed gross appearance, oval, mean diameters 9.4/7.8 cm. Microscopy: in 8 KT of digestive origin, 3--signet-ring cell carcinoma, 3--mucinous adenocarcinoma, 2--mixed pattern; 1 KT or breast origin was diagnosed by immunohistochemistry; 6/9 presented microscopic peritoneal despite a lack of strong correlation with the appearance of carcinomatosis or cytology of ascites. Survival: 3--no evidence, 5--disease-free after 4-13 months, 1--survived 2 years after debulking (4 years after colectomy). Clinical, evolutive and prognostic features of KT are determined by the biologically behavior of the primary (rapid lymphatic and hematogenous spread to the ovary), so the benefit of surgery is limited. Bilateral ovarian tumors, particularly in premenopausal women, must raise a high index of suspicion for KT, before or during surgery; diagnosis is a team challenge.

A small percentage of ovarian neoplasms are transitional cell tumors, which proves to be a distinct group with various histological and immunohistochemical patterns. In this study, 13 archived formalin-fixed paraffin-embedded samples of transitional cell tumors of the ovary have been assessed using standard HE stain and the indirect tristadial ABC peroxidase IHC method for 11 antibodies (CA125, CK7, CEA, EMA, MNF116, CK20, Vim, ER, PgR, PCNA, Ki-67). More than 50% were malignant Brenner tumors. CA125 was positive in all malignant tumors (of Brenner type and transitional cell carcinomas), but not in benign and borderline tumors, while CK7 was positive in approximately 70% of all cases. These two antibodies have shown a high sensitivity and low specificity, but do not correlate to each other. PCNA was positive in the study batch with a mean value of 40% and Ki-67 with a mean value under 25%. A direct correlation statistically significant has been noted between the aforementioned proliferation factors and the tumor grade (r = 0.4, p = 0.05). The other markers were unspecific, with low sensitivity and independently of the histopathological type.

The aim of the work paper is to present the diagnosis methods of the esophago-gastric junction adenocarcinoma, based on our experience and literature data. The later reveal many novelties about diagnosis means in Barrett's esophagus (BE), the definition and classification of BE, as well as the progress of the endoscopical, immunohistochemical and molecular methods in surveillance of the dysplasia arising in BE and in detection of intraepithelial neoplasia. Early esophago-gastric junction (EGJ) adenocarcinoma (AC) is asymptomatic and its detection may be possible only through endoscopical surveillance. Although endoscopical surveillance is widely practiced, early AC represents only 20% from AC arising in BE. For this reason is necessary to use some more precise methods for identifying intestinal metaplasia on distal esophagus, in patients with gastro-esophageal reflux disease, as well as for risk stratification in patients with dysplasia and for detection of intraepithelial neoplasia. Applying modern methods of immunohistochemical and molecular diagnosis on endoscopical biopsy or esophageal brushing samples, the diagnosis rate for BE, dysplasia and early AC is improved and using the imaging means permits to obtain preoperative TNM staging and tumoral type (Siewert), with implications in therapeutical management.