Reconstructive surgeons often encounter complex soft tissue and skeletal defects following oncological surgery. Soft tissue defects after wide resection in upper extremities posses a difficult challenge to find adequate tissue for reconstructing these defects. Paucity of local tissues dictates the requirement of loco-regional or distant flaps for these complex soft tissue defects which often exposes tendons, bones, nerves and joints. The latissimus dorsi muscle is a near ideal flap for the reconstruction because of the long neurovascular pedicle, ease of mobilization and its expendability. It can be rotated, with or without overlying skin, to cover soft tissue defects of the shoulder arm and elbow. Due to the large size of the muscle, it can be used to resurface the soft tissue defects and cover all major structures. Eleven consecutive cases were reviewed in which latissimus dorsi myocutaneous flap was used to reconstruct soft tissue defects of the upper limb following radical tumor resection. Flap survival was 100% with nominal donor site morbidity.
Labial and buccal gingival recession is a common finding in the adult population, which can occur due to various factors. When present, it can lead to an unesthetic appearance and can cause hypersensitivity. However, very limited literature is available regarding the incidence of palatal gingival recession. Many times it goes unnoticed during routine clinical examinations. Although there are no esthetic concerns in these regions, recession can cause sensitivity and pose a technical challenge in surgical correction because of poor accessibility and visibility. This case reports the treatment of a single palatal recession defect using an epithelial embossed connective tissue graft. The 12-month follow-up of the case showed significant root coverage (93.6%) and decreased sensitivity. The advantage of the harvested graft was that the connective tissue was not exposed, as it was tucked into the underlying flap, and the mucosal contour was maintained.
The epithelial cystic linings and adjacent connective tissues of 61 cases of odontogenic cysts (radicular cysts[RC], dentigerous cysts[DC] and odontogenic keratocysts[OKC]) and unicystic ameloblastomas(UA) were described and compared histopathologically. The type of epithelium in relation to the presence of rete processes and the distribution of chronic inflammatory cells were analyzed statistically. Significant associations between the presence of rete processes in the non-keratinized epithelial linings and inflammation in the subjacent connective tissues of RC and DC were found in this study. There was also a statistically significant association between the presence of rete Processes and nonkeratinized epithelial linings in OKC. The results also showed that in inflamed OKC, the cystic lining epithelium exhibited hyperplasia indistinguishable from lining epithelium of RC and DC. This study further showed that ameloblastomatous-like epithelial cystic linings were present in inflammed odontogenic cysts. All except for one case of unicystic ameloblastomas in this study showed ameloblastomatous epithelial cystic linings. It is recommended that the lining epithelium of RC and DC be examined carefully in order to rule out OKC. Similarly, ameloblastomatous-like lining epithelium arising from chronic inflammation in RC and DC should be differentiated from true ameloblastomatous cystic lining. Such careful examinations are diagnostically important in view of the similarities of epithelial cystic linings of inflamed OKC with DC and RC aggressive behavior ofOKC and UA.
The calcareous rings of two species of local sea cucumbers, Stichopus hermanni Semper and Holothuria atra Jaeger, were located, dissected, exposed and recorded. The calcareous rings of both species each composed of ten plates knit together by connective tissues. The radial plate of H. atra was a square with a notch at the anterior part whereas in S. hermanni it was squarish consisting of 4 ridges in the anterior part with a notch at the posterior part. The interradial plates of both species were smaller than the radial plates. A ridge was present at the anterior part of the interradial plate in H. atra. In S. hermanii, the ridge at the anterior part of the interradial was thin and prominent. Under the scanning electron microscope the calcareous rings from the two species exhibited a mosaic of small, numerous spicules bound to each other.
Blood as connective tissue potentially contains evidence of all processes occurring within the organism, at least in trace amounts (Petricoin et al., 2006) [1]. Because of their small size, peptides penetrate cell membranes and epithelial barriers more freely than proteins. Among the peptides found in blood, there are both fragments of proteins secreted by various tissues and performing their function in plasma and receptor ligands: hormones, cytokines and mediators of cellular response (Anderson et al., 2002) [2]. In addition, in minor amounts, there are peptide disease markers (for example, oncomarkers) and even foreign peptides related to pathogenic organisms and infection agents. To propose an approach for detailed peptidome characterization, we carried out an LC-MS/MS analysis of blood serum and plasma samples taken from 20 healthy donors on a TripleTOF 5600+ mass-spectrometer. We prepared samples based on our previously developed method of peptide desorption from the surface of abundant blood plasma proteins followed by standard chromatographic steps (Ziganshin et al., 2011) [3]. The mass-spectrometry peptidomics data presented in this article have been deposited to the ProteomeXchange Consortium (Deutsch et al., 2017) [4] via the PRIDE partner repository with the dataset identifier PXD008141 and 10.6019/PXD008141.
Sapium baccatum is usually used as a timber in Malaysia. Its medicinal values are not well known and very little research has been conducted concerning the plant. Consequently, this study was conducted to observe toxicity effects of hexane extract of stem bark of S. baccatum. The toxicity effects were assessed through observation of physiological changes of the rats as well as through gross and histological examinations of its livers. The doses for the treated groups were given intraperitoneally for T2, T3 and T4 group which were given 100, 250 and 500 mg/kg, respectively. Meanwhile, control group (T1) was administered with 80% PEG 200 only. The observation period was 14 days. If the rat died, it was dissected and the liver was removed and examined. Some physiological effects observed include ataxia and hind-legs paralysis. The gross observations of the livers, growth of abnormal spots and connective tissues attachment to lobes of the livers were observed. The experiment was followed byhistopathological observation, which indicated the presence of abnormal hepatocytes with a distorted shape and undefined cell linings for T2 group. Results also indicated an increase in the distortion of hepatocytes, presence of massive cytoplasm and necrosis of hepatocytes for T3 and T4 groups. The results suggest that non polar extract of the stem bark of S. baccatum may promote toxic effects to the animals.
The present research has been designed to understand the histomorphological development of lymphatic tissues of Cobb 500 strains of postnatal broiler chickens, aged between day old and D14 of Kelantan, Malaysia by gross and histological study. In the present study, it was found that the gross weight, length and width of the thymus, bursa of Fabricius and spleen were increased with the advancement of ages of the broiler chickens and was found higher from D14 to D28. Fine septa of connective tissue divide the thymus into lobes and lobules. The cortex of lobule is densely populated with lymphocytes. The bursal follicles were composed of a peripheral cortex which was rich in bursal cells and centrally depopulated medulla. The mucosal folds of the bursa were lined by pseudostratified columnar epithelium. The spleen has two compartments, the red and white pulp. The red pulp consisted principally of red blood cells, while the majority of the populations of white pulp were the lymphocytes. The histological mean length and width of the thymic lobules, bursal follicles and white pulp of the spleen were grown faster with the advancement of ages at D14 and D28. In conclusion, the increment of gross and histological parameters of lymphoid organs of broilers in the present study was due to aging of broilers.
Alveolar ridge deficiency is considered a major esthetic limitation, especially in the maxillary anterior region. Several approaches have been developed to enhance and increase the soft-tissue volume. Among those approaches are connective tissue grafts, platelet-rich fibrin (PRF) membrane and implying the guided bone regeneration concept. The PRF grafting technique was employed in this clinical case to improve and enhance the anterior esthetic without the need for the bone graft and augmentation. This article describes the use of PRF as a sole grafting material for both socket and soft-tissue augmentation for a 23-year-old male, who had an accident 8 years ago while he was playing a basketball, which caused his upper front teeth to be intruded and discolored. The upper left central tooth suffered a major external root resorption; hence, it was extracted. PRF was prepared and packed in and extruded out of the socket. This was combined with ovate design provisional bridge. Ten days, 1 month, 3 months, and 6 months postoperative review showed a significantly well-progressed healing. According to the encouraging result obtained in this clinical case in regard to tissue healing and esthetic, the PRF can be a potential sole graft material for small anterior deficient areas. This may reduce the need of bone augmentation and graft in such selected cases.
Although rare, hard tissue deposits, namely dystrophic calcifications and cartilage, have been reported to occur in the connective tissue wall of the odontogenic keratocyst. However, dentinoid formation has not been previously documented. A case involving the left mandibular premolar-molar region in a 37-year-old Malay male is described here along with a brief review on the reported prevalence of hard tissue deposits in the odontogenic keratocyst. Differential diagnosis of this case from other dentinoid-forming odontogenic cysts and tumors-notably calcifying odontogenic cyst, odontoma, ameloblastic fibro-odontoma, central odontogenic fibroma and adenomatoid odontogenic tumor that may present with dentin/dentinoid formation-is discussed.
Seventeen cases are reported of desmoplastic variant of ameloblastoma of the jaws observed during the years 1967-1991. There were 12 females and 5 males, and these consisted of 7 Chinese, 6 Malays, 2 Indians, 1 Sikh and 1 Kadazan. Their ages at diagnosis ranged from 21-60 years with a mean of 36.6 years. There were 10 mandibular and 7 maxillary tumours. Of these, 14 cases involved the anterior segment with extension to the premolar region in 5 cases. 60% of cases were radiologically suggestive of fibro-osseous lesions. The main mode of treatment was resection and 1 case presented with recurrence. The findings of this study were compared with those of previous reports.
This report details a case of mandibular peripheral ameloblastoma having a clear cell component. The latter consisted of ovoid cells with vacuolated or clear cytoplasm and vesicular or pyknotic nuclei that may be disposed as discrete clusters or show direct transition from typical acanthomatous areas. Comparison of this lesion with other odontogenic and nonodontogenic tumors that contain clear cells is discussed in the context of the differential diagnosis.
Sixty-two "leukoplakias" from the cheeks of betel-nut chewers in West Malaysia were studied histologically. Ten biopsies were from non-tobacco betel-nut chewers. An amorphous von Kossa positive layer was seen on the keratin surface in 42 specimens. Tobacco did not appear essential for its formation, and it appeared to be significantly associated with parakeratosis. Its possible significance as a cuticle-like layer prolonging contact between carcinogens and the mucosa is discussed.Parakeratosis appeared to be the most common form of cornification seen, and the mitotic activity in parakeratinized leukoplakias appeared to be significantly greater than orthokeratinized leukoplakias.Comparison with studies on other population samples using different quids suggested that severe histological changes were more likely to be seen when tobacoo-containing quids were chewed as compared to non-tobacco-containing quids.An attempt to correlate the histological changes seen with the clinical habit in leukoplakias from chewers using tobacco-containing quids suggested that epithelial atrophy appeared to be significantly related to the duration of the habit but not to the "intensity" of the habit.
Twelve pleomorphic adenomas of minor salivary gland origin were examined for the distribution of S-100 protein, detected using the peroxidase-antiperoxidase (PAP) method. Strong S-100 protein immunoreactivity was noted in areas containing plasmacytoid cells, stellate and spindle cells against a myxochondroid or hyalinous stroma, and solid epithelial areas. Tubular and duct-like structures showed variable stainability. Stromal tissue and normal salivary glands were generally negative for S-100 protein. These findings were compared with those reported elsewhere.
Ideal alveolar ridge width and height allows placement of a natural appearing pontic, which provides maintenance of a plaque-free environment. The contour of a partially edentulous ridge should be thoroughly evaluated before a fixed partial denture is undertaken. Localized alveolar ridge defect refers to a volumetric deficit of the limited extent of bone and soft-tissue within the alveolar process. These ridge defects can be corrected by hard tissue and/or soft-tissue augmentation. A 30-year-old male patient was referred to the Department of Periodontology for correction of Seibert's Class III ridge defect in the lower anterior region. Granulation tissue/connective tissue present at the base of the defect was removed after elevation of full thickness flap. MucoMatrixX, an animal derived, collagen based soft-tissue graft was sutured to the labial flap and bone graft was placed into the defect. If a soft-tissue graft material could be used to replace the palatal grafts, then all the possible complications associated with donor site would be eliminated and above all periodontal plastic surgery and ridge augmentation would be better accepted by patients.
Chondroblastomas are a primary benign cartilaginous tumor that accounts for approximately 1% of all benign bone tumors. Primarily they are treated by curettage. The patient presented 4 years after a successfully treated chondroblastoma (curettage and Bone cement). Wide resection of the proximal tibia with endoprosthesis replacement was done. Lung CT showed multiple lung metastasis and despite starting chemotherapy, he succumbed to the disease. We discuss regarding the possibilities of "aggressive" chondroblastoma and more recently termed chondroblastoma-like osteosarcoma which is a separate entity from chondroblastoma. Aggressiveness in chondroblastoma can be 1 of 3 types as follows: 1. benign chondroblastoma with lung metastasis. 2. malignant chondroblastoma. 3. subsequent malignant transformation of benign chondroblastoma. We have attempted to review the literature and describe the "aggressive" chondroblastoma and chondroblastoma-like osteosarcoma in this report.
Steroid is commonly used for various connective tissue diseases and immunological related disorders. Psychiatric side effects are common in patient with systematic treatment of steroid. The reported prevalence ranges from 6% to 28%. Antidepressant-induced mania occurs when the mood of a patient switches to manic or hypomanic from depression after the use of antidepressant. We reported a case of a 55 year old lady, who presented with agitation and grandiosity after the treatment with antidepressant. She was initially diagnosed as having Bell’s palsy with unilateral facial muscle weakness. Oral prednisolone was prescribed for seven days where she became depressed, having auditory hallucination and delusion of guilt. She was then started on antidepressant where she became irritable, agitated and developed grandiose delusion. The antidepressant was withheld and she was started on atypical antipsychotic. Her condition improved and discharged well after three days of stay in the ward.
Pulmonary epithelioid hemangioendothelioma is an uncommon lung malignancy of endothelial origin. Besides demonstrating unpredictable presentation features and prognosis, the paucity of established treatment guidelines remains a challenge in managing these patients. We present two patients. The first patient presented with chronic productive cough over 1-year duration. He was initially diagnosed and showed partial response to treatment for cardiac failure. A persistent right upper zone consolidation on chest radiograph prompted further investigations which revealed the diagnosis of pulmonary epithelioid hemangioendothelioma. The second patient presented with right-sided hemiparesis for 1-month duration. Initial computer tomography scan of the brain showed findings of distant metastatic foci. Subsequent investigations revealed pulmonary epithelioid hemangioendothelioma as the primary lesion. Both patients succumbed without any treatment due to rapid progression of the disease. We believe that pulmonary epithelioid hemangioendothelioma is undoubtedly rarely reported in south-east Asia region. In these two case reports, the patients were diagnosed in west and east Malaysia, respectively, in the same year (2015). Both cases highlight the increasing prevalence of pulmonary epithelioid hemangioendothelioma. We postulate that this could possibly be secondary to the advancement in diagnostic capabilities and improved healthcare facilities available in this region. Late presentation of pulmonary epithelioid hemangioendothelioma generally results in grave prognosis. Further investigations are required to elucidate the nature of progression and therapeutic options for patients with pulmonary epithelioid hemangioendothelioma.
Tumour-induced or oncogenic osteomalacia (OOM) is a rare paraneoplastic syndrome characterized by bone pain and muscle weakness. A biochemical profile consisting of normocalcaemia, hypophosphataemia, phosphaturia, increased serum alkaline phosphatase and inappropriately low serum levels of 1, 25-dihydroxyvitamin-D is diagnostic. OOM is usually caused by an osseous or soft-tissue tumour of mesenchymal origin that secretes phosphaturic substances leading to increased urinary phosphate wasting. These tumours are small and slow growing. The diagnosis continues to be easily missed and when eventually made, localization of the tumour can be difficult. We describe the case of a young man who presented with severe generalized pain associated with muscle weakness. He was extensively investigated and eventually diagnosed to have OOM 3 years after initial presentation. Specialized investigations were necessary to localize the offending tumour.
Amino acids are known as anabolic factors that are essential for formation of muscle by stimulating protein synthesis while inhibiting proteolysis, and they are significant component for the synthesis of various nitrogenous compounds. There are 20 amino acids are essential to require in cell for formation of body protein of which about 10 amino acids, which cannot be synthesized by the birds are termed essential. Among the essential amino acid arginine one of the essential amino acids for chickens because, like other birds, they are unable to obtain Arginine from endogenous sources due to the absence of most of the enzymes involved in the urea cycle. This amino acid involved in synthesis of proline, hydroxyl proline and polyamines which are essential for connective tissue synthesis as well as increased growth of chicken. Moreover, L-arginine (L-Arg) is effective for reducing fat deposition in broiler. Moreover, it decrease heat stress increase meat quality and increase immune response of broiler. This re-view presents the recent advances in the relevance of the inclusion of excess L-Arginine in broiler ration to growth, fat deposition and immune response in broiler.
Gelatine is used as an excipient for various pharmaceutical dosage forms, such as capsule shells (both hard and soft),
tablets, suspensions, emulsions and injections (e.g. plasma expanders). It is also broadly used in various industries
such as food and cosmetics. Gelatine is a biopolymer obtained from discarded or unused materials of bovine, porcine,
ovine, poultry and marine industrial farms. The discarded materials can be the skin, tendons, cartilages, bones and
connective tissues. Gelatine sourced from animals is relatively easy and inexpensive to produce. The potential needs of
gelatine cannot be overemphasised. Rising demands, health concerns and religious issues have heightened the need for
alternative sources of gelatine. This review presents the various industrial uses of gelatine and the latest developments
in producing gelatine from various sources.