Ultrasound of Salivary Glands

Ultrazvuk je jednostavna i neinvazivna metoda, neškodljiva za bolesnika, razmjerno je jednostavna i pruža mogućnost da se pregled ponovi. Omogućuje brz uvid u morfologiju žlijezda slinovnica. Sama metoda se temelji na transmisiji energije u žlijezdano tkivo, primanju te energije pošto je ona bila reflektirana od tkiva, te njezina bilježenja, tako da se može interpretirati. Budući da se kod bolesti mijenja veličina, oblik i hitološka građa, mijenja se i ehostruktura same slinovnice. Na temelju te promjene zaključuje se da je riječ o patološkom procesu. Cilj je da ultrazvuk odmah nakon kliničkoga pregleda postane prva pretraga u dijagnostičkome postupku. Kod upalno promijenjenih žlijezda slinovnica, na temelju ehogenosti može se razlikovati akutna od kronične upale. Kod akutne upale parenhim je smanjene ehogenosti (hipoehogen), a kod kronične upale pokazuje pojačanu ehogenost (hiperehogen je). Benigni tumori su obično smanjene ehogenosti s pojačanim odjecima iza stražnje stijenke. Ultrazvučna slika pokazuje lokaciju, veličinu, ograničenost strukture i odnos tvorbe s okolnim tkivima i organima. Kod malignih tumora na slici je bitno uočiti je li tvorba ostala ograničena na tkivo žlijezde ili je infiltrirala u okolna tkiva, te jesu li povećani limfni čvorovi. Moguća je raščlamba drugih parenhimatoznih organa (jetre, slezene, limfnih čvorova abdomena). Vrijednost je ultrazvučne slike kod kamenaca žlijezda slinovnica u mogućnosti odgovarajućega slikovnog prikaza popratnih patomorfologijskih promjena u parenhimu žlijezda. Ultrazvučni aparat je uređaj koji daje slike presjeka unutrašnjosti ljudskoga tijela ravninom kojom se ultrazvučni snop širi. Ultrazvučni aparat emitira kratke impulse ultrazvuka visoke frekvencije (između 2 i 10 MHz) u unutrašnjost tijela uz pomoć odgovarajućeg pretraživača. Uspješnost ultrazvučne pretrage ovisi prvenstveno o kakvoći uređaja i pretraživača, a zatim o vještini liječnika i o vrsti patoloških promjena žlijezda slinovnica. Također je pod kontrolom ultrazvuka moguća ciljana punkcija pri kojoj se igla koso uvodi u željezdano tkivo ispred pretraživača u snop ultrazvučnih valova. Na taj način igla se vidi u cijeloj dužini, a vrh igle je usmjeren u područje iz kojeg se želi dobiti uzorak za citološku raščlambu. Iako ultrazvučna dijagnostika na spada u temeljne i uobičajene metode pretrage u stomatološkoj praksi, ona pomaže stomatologu da na osnovi ultrazvučne slike lakše spozna etiologiju procesa, odredi dijagnozu i po potrebi uputi pacijenta na daljnju spcijalističku pretragu.Ultrasound is a simple and non-invasive method with no negative effects on the patients health. It is also relatively cheap and enables patients to repeat the examination. It allows quick access into salivary gland morphology. This method is based on the transmission of energy into glandular tissue.The energy is then reflected from the tissue and subsequently received and recorded in order to be interpreted. Since the size, shape and histologic structure are altered by disease, the echostrukture of the salivary gland it self is altered as well, thus revealing a pathological process. The ultrasound should be used immediately after clinical examination as the first stage of diagnostic procedure. By echogenity of inflamed salivary glands acute inflammation can be differentiated from chronic. Unlike acute inflammation in which the parenchyma echogenity is decreased (hypoechogenic), chronic inflammation shows increased echogenity (hyperechogenic). Benign tumors usually show lower echogenity with intensified echoes behind the back wall. The ultrasound image reveals the location, margins, structure dimensions as well as its relation to the surrounding tissues and organs. In a malignant tumor image it is important to observe whether the tumor has spread into the surrounding tissues or it has remained within the glandular tissue. Also it is essential to check whether the lymph nodes are enlarged. An anlysis of other parenchymatous organs such as the liver, spleen and lymph nodes of the abdomen is also possible. Ultrasound of the sialolites of the alivary glands can indicate corresponding pathomorphological changes in glandular parenchyma. The ultrasound is a device which produces crosssection images of the inner parts of the human body spreading an ultrasound wave across the plane. The ultrasound device emits short ultrasound impulses of high frequency (2-10 MHz) into the human body by means of an adequate scanner. The effects of the ultrasound examination depend primarily on the quality of both the device and the scanner, in the physicians skill as well as on the pathologic changes of the salivary glands. When performing a needle biopsy, the ultrasound device also anables the needle to be inserted at a certain angle into the glandular tissue in front of the scanner and directly into the ultrasound waves. In this way, the needle can be seen across its whole lenght, its tip being directed into the area from which the sample for biopsy should be obtained. Although ulatrasound diagnostics is not included in the common methods of dental exmination, it allows the dentist to get better insights into etiology of the process. It also helps in making the diagnosis and, if necessary, referring the patient to further specialist examination

MHC class II deficiency: Report of a novel mutation and special review

The MHC II deficiency is a rare autosomal recessive primary immunodeficiency syndrome with increased susceptibility to respiratory and gastrointestinal infections, failure to thrive and early mortality. This syndrome is caused by mutations in transcription regulators of the MHC II gene and results in development of blind lymphocytes due to the lack of indicatory MHC II molecules. Despite homogeneity of clinical manifestations of patients with MHC II deficiency, the genetic defects underlying this disease are heterogeneous. Herein, we report an Iranian patient with MHC II deficiency harbouring a novel mutation in RFXANK and novel misleading clinical features. He had ataxic gait and dysarthria from 30 months of age. Epidemiology, clinical and immunological features, therapeutic options and prognosis of patients with MHC II are reviewed in this paper. © 2017 SEICAP. Published by Elsevier Espana, ˜ S.L.U. All rights reserved

Supplementary Material for: Solitary clear cell renal cell carcinoma metastasis to the eyelid: a case report

Introduction A case of solitary clear cell renal carcinoma (ccRCC) eyelid metastasis in a 66-year-old man as the first sign of a primary tumor. ccRCC usually spreads to the lungs, mediastinum, bones, liver and brain, while ocular metastases are rare. Case presentation Solitary metastasis presented as a solid mass in the central third of the upper eyelid, which has been growing for 3 weeks. Treatment included tumor removal and blepharoplasty. Histopathological examination showed metastasis of clear cell renal carcinoma. A thorough examination revealed a primary tumor on the lower pole of the right kidney. A right nephrectomy was performed, and histopathology showed ccRCC. Postoperative examinations showed no signs of local or systemic disease. Sunitinib malate was administered to the patient. Conclusion The eyelid metastasis in this case was still solitary and had been discovered before the existence of the primary tumor was known. Ocular metastasis of renal carcinoma is a rare initial manifestation of the disease and therefore require a multidisciplinary approach in the treatment of these patients