Contact Sensitivity to Dental Prosthetic Materials - Alloys

Reakcije tipa IV, ili reakcije kasne preosjetljivosti, jedna su od manifestacija stanične imunosti. Te su reakcije uzrokovane specifično senzibiliziranim T-limfocitima. U stomatologiji posebice zanimljiva kontaktna preosjetljivost. Nadomjestci su u dugotrajnom izravnom doticaju s oralnim tkivima i slinom, a ujedno se u funkciji troše i savijaju. Ta zbivanja dovode do korozivnih procesa koji rezultiraju oslobađanjem iona, njihovom akumulacijom u tkivima i mogućom senzibilizacijom, to jest alergijskom reakcijom. Stomatolozi bi u svojemu radu trebali birati slitine s manjom tendencijom otpuštanja iona, odnosno dobre biosnošljivosti. Preporuča se izbjegavati uporabu slitina s visokim udjelom nikla. Epikutani (patch) test indiciran je u svakoga pacijenta koji u svojoj povijesti bolesti navodi preosjetljivost na kovine ili druge materijale koji će se upotrijebiti za izradbu protetskoga nadomjestka.Type IV reactions, reactions of delayed hypersensitivity, are manifestations of cellular immunity. Such reactions are caused by sensitised T-lymphocytes. In dental medicine contact sensitivity is of particular interest, as restorations are in long-term direct contact with oral tissues and saliva and during function they wear and bend, leading to corrosive processes which result in the release of ions, their accumulation in the tissues and possible sensitivity, i.e. allergic reaction. Dentists need to chose alloys with less tendency to the release of ions, in other words good biotolerance. It is recommended that the use of alloy with a high share of nickel should be avoided. Patch test is indicated for all patients with a history of hypersensitivity to metal or other materials used in the construction of a prosthetic restoration

Investigation of Contact Allergies to Component and Auxiliary Prosthetic Materials

Kontaktna alergija je odgođena reakcija preosjetljivosti u kojoj se lokalizirana lezija kože ili sluznice javlja zbog opetovanoga doticaja s alergenom. Od fiksnog ili mobilnoga protetskog rada u usnoj šupljini nastaju korozijski procesi na površini nadomjestka te otpuštanja iona koji, kao hapteni, mogu pokrenuti alergijsku reakciju. Svrha ovoga istraživanja bila je epikutanim alergološkim testom ispitati pojavnost alergije na gradivne i pomoćne protetske materijale u pacijenta s lihen ruber planusom, stomatitisom i stomatopirozom. U istraživanju su sudjelovala 32 pacijenta s fiksnim i/ili mobilnim nadomjestkom i 7 pacijenata s jednom od navedenih dijagnoza bez nadomjestaka. Ispitivanje je provedeno standardnom tehnikom (patch testom) na 13 alergena. Rezultati istraživanja pokazuju veću vjerojatnost na pozitivan patch test u osoba s navedenim bolestima i s nadomjestkom u usporedbi s ispitanicima bez nadomjestaka (P = 0,62). Pričvršćenjem fiksnog ili postavljanjem mobilnoga nadomjestka raste vjerojatnost da će se simptomi pogoršati (P = 0,019), a pogotovo ako se radi o nadomjescima od Co-Cr-Mo slitine. Povećanjem broja članova fiksnih nadomjestaka, ili pak postojanjem mobilnih nadomjestaka u objema čeljustima, raste i vjerojatnost pozitivnoga rezultata patch testa na kobaltni klorid (P = 0,05). Lichen ruber planus povećava vjerojatnost na pozitivan patch test u najvećem broju slučajeva (P = 0,05). Najviše pozitivnih rezultata bilo je na alergene nikla, kobalta i kroma (svaki 17,95%), a negativan nalaz dobiven je kod dibutilftalata i HH smjese. Stomatopiroza povećava vjerojatnost da ispitanik ima pozitivan rezultat testiranja na krom (P = 0,019). U žena je pojava pozitivnoga patch testa veća na sve alergene (P = 0,05) osim na epoksidne smole, kod kojih je manja nego u muških ispitanika (P = 0,036). Zbog sve češće kontaktne alergije u populaciji potrebno je provesti potanka ispitivanja protetskih materijala prije nego što ih se uvede u kliničku praksu, a u pacijenata s atopijskom anamnezom alergološka testiranja i imunološke testove prije protetske sanacije.Contact allergy is a delayed reaction to sensitivity in which a localised lesion of the skin or mucous membrane occurs as a result of contact with an allergen. The fitting of a fixed, or placement of a mobile, prosthetic appliance in the oral cavity causes corrosive processes to occur on the surface of the restoration and the release of ions which, as haptens, can induce allergic reaction. The aim of this investigation was to examine the occurrence of allergies to component and auxiliary prosthetic materials by patch test in patients with lichen ruber planus, stomatitis and stomatopyrosis. Thirtytwo patients with fixed and/or mobile restorations and seven patients with one of the above diagnoses without a restoration, participated in the investigation. Testing was carried out by standard technique (patch test) with 13 allergens. The results of the investigation indicate the greater probability of a positive patch test in subjects with the aforementioned diseases and with a restoration, in relation to subjects without a restoration (P = 0.62). The probability of symptoms worsening increased with the insertion/ fitting of a fixed or placement of a mobile restoration (P = 0.019). This was particularly so in the case of restorations made of Co-Cr-Mo alloy. With the increase in the number of units of fixed restorations, or the presence of mobile restorations in both jaws, the probability of a positive patch test to cobalt chloride also increased (P = 0.05). Lichen ruber planus increased the probability of a positive patch test in the majority of cases (P = 0.05). The greatest number of positive results were for the allergens nickel, cobalt and chrome (each 17.95%) and a negative finding was obtained for dibutylphthalate and HH mix. Stomatopyrosis increased the probability that the subject would have a positive result for chrome (P = 0.019). The occurrence of a positive patch test was greater in women for all allergens (P = 0.05), apart from epoxy resin, where it was less than in the male subjects (P=0.036). Because of the greater incidence of contact allergies in the population a more detailed investigation of prosthetic materials is needed prior to their introduction into clinical practice. In the case of patients with atopic history allergological testing and immunological tests should be performed prior to prosthetic treatment

Neki čimbenici rizika udruženi s astmom

The aim of the study was to determine whether the incidence of some risk factors was significantly higher in a group of asthma patients as compared with a control group of asthma-free subjects. The study included 100 asthmatics and 100 nonasthmatic subjects. Data were collected by the methods of interview and questionnaire. Study results indicated a positive association between asthmatics and lower educational level, poorer compliance with the treatment, and more frequent hospitalization for the disease. Atopy was significantly more common among asthmatics as well as in their family members; however, other chronic diseases were significantly less present in asthmatics as compared with the control group. In our opinion, the treatment of asthma should be strictly individualized and based on psychosocial characteristics of each patient in addition to the pulmonary clinical-functional parameters and international guidelines for the management of asthma. It is concluded that in addition to pharmacologic therapy, the management of asthma should also include patient education on the disease and methods of treatment, various psychotherapeutic measures, and self-care techniques.Cilj ovoga istraživanja bio je ispitati jesu li neki čimbenici rizika značajno više prisutni u promatranoj skupini astmatičara u usporedbi s kontrolnom skupinom ispitanika. Istraživanjem je obuhvaćeno 100 astmatičara i 100 ispitanika bez astme. Podaci su prikupljeni metodom razgovora i anketiranja. Rezultati su pokazali da astmatičari imaju nižu razinu obrazovanja, slabije surađuju u liječenju svoje bolesti, te da su češće na bolničkom liječenju zbog svoje bolesti. Među astmatičarima te u njihovim obiteljima je bilo značajno više atopičara negoli u kontrolnoj skupini. Međutim, astmatičari su imali značajno manje drugih kroničnih bolesti. Smatramo stoga kako liječenje astme treba biti strogo individualno za svakog bolesnika, temeljeno na kliničko-funkcijskim parametrima plućne funkcije i prema važećim svjetskim smjernicama za liječenje astme, kao i na psihosocijalnim značajkama svakog bolesnika. Zaključujemo kako liječenje astme uza suvremenu farmakološku terapiju treba uključivati i edukaciju bolesnika o njegovoj bolesti i metodama liječenja, razne psihoterapijske postupke, te postupke samopomoći

Primary Pulmonary Botryomycosis: Case Report

A case is presented of pulmonary botryomycosis in a 61-year-old man with a massive right-side pulmonary infiltrate which looked like a tumor (on X-ray). Microscopic examination of a transbronchial biopsy specimen revealed chronic suppurative inflammation, which did not regress despite intensive antibiotic therapy for a period of two months. Histological analysis of specimens taken during surgery for hemoptysis revealed pulmonary botryomycosis. The disease was diagnosed on the basis of characteristic eosinophilic granules in which the bacteria are surrounded by protein material (Splendore-Hoeppli phenomenon). Pulmonary actinomycosis was excluded. The case demonstrates that pulmonary botryomycosis can have the appearance of a mass which resembles pulmonary carcinoma on X-ray, and may also be mistaken for pulmonary actinomycosis. For this reason, pulmonary botryomycosis, although rare, should be excluded during differential diagnosis of hemoptysis or pulmonary infiltrates

Changing Pattern of Sensitization in Croatia to Aeroallergens in Adult Population Referring to Allergy Clinic during a Period of 15 Years

Published data indicate that during the last decades there is a possible change in the pattern of sensitization to different aeroallergens in adult population with atopy. The aim of this investigation was based on the hypothesis that during last 15 years there has been a change in the structure of prevalence of sensitization to different aeroallergens in adult population of Zagreb and its surroundings with atopy. Medical records from outpatient allergy clinic were screened for the period 1991.–2004.We included 794 patients during years 1991–1994, 814 patients during years 1995–1999, and 969 patients during years 2000–2004. Following data were analyzed: age, gender, education level, residence, referral diagnosis, dominant symptoms, results of skin-prick test (SPT), total and specific serum immunoglobulin E. As risk factors for allergic sensitization we determined the decade of birth (p<0.0001), male gender (p<0.008), level of education (p<0.0001), and place of residence (p<0.05). Proportion of sensitized individuals to pollen significantly increased from the period 1991–1994 towards 2000–2004 (p<0.001 for the trend) with a significant increase in the proportion of sensitized individuals to weed pollen (p=0.002 for the trend) while the proportion of sensitized to other two groups of pollen (grasses and trees) was not significantly different. A significant increase in the proportion of sensitized individuals was determined for sensitization to ragweed pollen (p=0.004 for the trend), and to mugwort (p=0.005 for the trend). Despite all its limitations primarily based on the selection bias the results of this study are conclusive about the significant change in the proportion of sensitization to different aeroallergens and different pollen groups and individual pollen species during the investigated 15-year time interval

Kriptogena organizirajuća pneumonija - Idiopatska bronhiolitis obliterans organizirajuća pneumonija

Cryptogenic organizing pneumonia is a rare pulmonary disease with characteristic clinical, radiologic and histologic features. The radiologic presentation, and ventilatory and respiratory lung functions reflect the presence of intra-alveolar buds of granulation tissue occurring within the alveoli and alveolar ducts but rarely occupying the bronchiolar lumen. Therefore, it has been accepted that the diagnosis of these characteristic but not specific presentations of cryptogenic organizing pneumonia requires histologic confirmation. The terms cryptogenic organizing pneumonia and idiopathic bronchiolitis obliterans organizing pneumonia are synonyms. There is also secondary organizing pneumonia casually related to various conditions. Presentation is made of two patients with different clinical manifestations of cryptogenic organizing pneumonia: one with low-grade chronic clinical course and migratory inflammatory lung infiltrates, and the other with severe acute clinical manifestations of the disease. In both patients with cryptogenic organizing pneumonia, corticosteroids showed high efficacy for both primary disease and relapses.Kriptogena organizirajuća pneumonija je rijedak entitet u pulmologiji sa znakovitim kliničkim, radiografskim i histološkim manifestacijama. Radiografske manifestacije, kao i ventilacijsku i respiracijsku plućnu funkciju određuju pupoljci granulacijskog tkiva u alveolama i alveolarnim hodnicima, koji se mogu vidjeti i u bronhiolama. Zato je nužna histološka potvrda ovih promjena koje su znakovite, ali ne i specifične za kriptogenu organizirajuću pneumoniju. Kao sinonim za ovu bolest nepoznatog uzroka rabi se i izraz idiopatska (primarna) bronhiolitis obliterans organizirajuća pneumonija. Postoji i sekundarna organizirajuća pneumonija koja ima različite uzroke. Cilj ovoga prikaza je upozoriti na dvije različite manifestacije kriptogene organizirajuće pneumonije: jedna je polagana, kronična, s migrirajućim upalnim infiltratima i blagom kliničkom slikom, a druga akutna s teškom kliničkom slikom. U oba slučaja uslijedio je dobar odgovor na terapiju kortikosteroidima, ali se je javio recidiv koji je također dobro reagirao na ovo liječenje

Askinov tumor - rijedak tumor prsišta i pluća

Askin\u27s tumor is a malignant small round cell tumor affecting the thoracopulmonary region. Because of its neuroectodermal origin it is also known as primitive neuroectodermal tumor. This rarely seen and aggressive malignant tumor most frequently occurs in children and young adults. The symptoms and clinical presentation as well as radiomorphologic abnormalities are nonspecific. Therefore, establishing an accurate diagnosis of Askin\u27s tumor is difficult, thus histologic and immunohistologic findings are important. Immunohistologic stain of the specific marker neuron-specific enolase is essential. In addition, Askin\u27s tumor shows histologic features similar to Ewing\u27s tumor located in the bones, which suggests it to belong to the group of Ewing\u27s tumors. Therapeutic approach is multimodal, e.g., surgical resection, chemotherapy, and radiation. Overall prognosis is poor. The objective of this report is to point to this unusual tumor of the thoracopulmonary region. A 23-year-old female with a giant right chest tumor mass and immunohistologic findings of the surgical specimen characteristic of Askin\u27s tumor is described.Askinov tumor je maligni tumor malih okruglih stanica koji zahvaća područje prsnoga koša i pluća. Zbog njegovog neuroektodermalnog podrijetla poznat je i kao primitivni neuroektodermalni tumor. Ovaj rijetko viđeni i agresivni maligni tumor najčešće se javlja u djece i mlađih odraslih osoba. Simptomi i klinički izgled, kao i radiomorfološke nenormalnosti su nespecifične. Stoga je teško postaviti točnu dijagnozu Askinova tumora, pa su histološki i imunohistološki nalazi vrlo važni. Od ključnog je značenja imunohistološko bojenje na specifičan biljeg za neuron specifičnu enolazu. Uz to, Askinov tumor ima histološka obilježja slična Ewingovu tumoru smještenom u kostima, što ukazuje na to da pripada skupini Ewingovih tumora. Terapijski pristup je višestruk, npr. kirurško odstranjenje, kemoterapija i zračenje. Sveukupna je prognoza loša. Namjera ovoga prikaza je ukazati na ovaj neuobičajen tumor prsnoga koša i pluća. Opisana je 23-godišnja bolesnica s golemom tumorskom masom u desnom dijelu prsnoga koša i imunohistološkim nalazima kirurškog uzorka znakovitima za Askinov tumor

Neki čimbenici rizika udruženi s astmom

The aim of the study was to determine whether the incidence of some risk factors was significantly higher in a group of asthma patients as compared with a control group of asthma-free subjects. The study included 100 asthmatics and 100 nonasthmatic subjects. Data were collected by the methods of interview and questionnaire. Study results indicated a positive association between asthmatics and lower educational level, poorer compliance with the treatment, and more frequent hospitalization for the disease. Atopy was significantly more common among asthmatics as well as in their family members; however, other chronic diseases were significantly less present in asthmatics as compared with the control group. In our opinion, the treatment of asthma should be strictly individualized and based on psychosocial characteristics of each patient in addition to the pulmonary clinical-functional parameters and international guidelines for the management of asthma. It is concluded that in addition to pharmacologic therapy, the management of asthma should also include patient education on the disease and methods of treatment, various psychotherapeutic measures, and self-care techniques.Cilj ovoga istraživanja bio je ispitati jesu li neki čimbenici rizika značajno više prisutni u promatranoj skupini astmatičara u usporedbi s kontrolnom skupinom ispitanika. Istraživanjem je obuhvaćeno 100 astmatičara i 100 ispitanika bez astme. Podaci su prikupljeni metodom razgovora i anketiranja. Rezultati su pokazali da astmatičari imaju nižu razinu obrazovanja, slabije surađuju u liječenju svoje bolesti, te da su češće na bolničkom liječenju zbog svoje bolesti. Među astmatičarima te u njihovim obiteljima je bilo značajno više atopičara negoli u kontrolnoj skupini. Međutim, astmatičari su imali značajno manje drugih kroničnih bolesti. Smatramo stoga kako liječenje astme treba biti strogo individualno za svakog bolesnika, temeljeno na kliničko-funkcijskim parametrima plućne funkcije i prema važećim svjetskim smjernicama za liječenje astme, kao i na psihosocijalnim značajkama svakog bolesnika. Zaključujemo kako liječenje astme uza suvremenu farmakološku terapiju treba uključivati i edukaciju bolesnika o njegovoj bolesti i metodama liječenja, razne psihoterapijske postupke, te postupke samopomoći

Kriptogena organizirajuća pneumonija - Idiopatska bronhiolitis obliterans organizirajuća pneumonija

Cryptogenic organizing pneumonia is a rare pulmonary disease with characteristic clinical, radiologic and histologic features. The radiologic presentation, and ventilatory and respiratory lung functions reflect the presence of intra-alveolar buds of granulation tissue occurring within the alveoli and alveolar ducts but rarely occupying the bronchiolar lumen. Therefore, it has been accepted that the diagnosis of these characteristic but not specific presentations of cryptogenic organizing pneumonia requires histologic confirmation. The terms cryptogenic organizing pneumonia and idiopathic bronchiolitis obliterans organizing pneumonia are synonyms. There is also secondary organizing pneumonia casually related to various conditions. Presentation is made of two patients with different clinical manifestations of cryptogenic organizing pneumonia: one with low-grade chronic clinical course and migratory inflammatory lung infiltrates, and the other with severe acute clinical manifestations of the disease. In both patients with cryptogenic organizing pneumonia, corticosteroids showed high efficacy for both primary disease and relapses.Kriptogena organizirajuća pneumonija je rijedak entitet u pulmologiji sa znakovitim kliničkim, radiografskim i histološkim manifestacijama. Radiografske manifestacije, kao i ventilacijsku i respiracijsku plućnu funkciju određuju pupoljci granulacijskog tkiva u alveolama i alveolarnim hodnicima, koji se mogu vidjeti i u bronhiolama. Zato je nužna histološka potvrda ovih promjena koje su znakovite, ali ne i specifične za kriptogenu organizirajuću pneumoniju. Kao sinonim za ovu bolest nepoznatog uzroka rabi se i izraz idiopatska (primarna) bronhiolitis obliterans organizirajuća pneumonija. Postoji i sekundarna organizirajuća pneumonija koja ima različite uzroke. Cilj ovoga prikaza je upozoriti na dvije različite manifestacije kriptogene organizirajuće pneumonije: jedna je polagana, kronična, s migrirajućim upalnim infiltratima i blagom kliničkom slikom, a druga akutna s teškom kliničkom slikom. U oba slučaja uslijedio je dobar odgovor na terapiju kortikosteroidima, ali se je javio recidiv koji je također dobro reagirao na ovo liječenje

Učestalost senzibilizacije na pelude u odrasle populacije s atopijom u Zagrebu i okolici

Allergic disorders have during the last 40 years noticeably gained importance as disorders associated to modern lifestyle with increasing prevalence. For their dramatic increase in prevalence during the second half of twentieth century we still have no distinctive explanation. The questions regarding the cause of that increasement in prevalence are raised. Is that a consequence of global changes in civilized living, economic, political, cultural, meteorological, and ecological or other unknown factors? The aim of this research is based on the hypothesis that during last 15 years there had been a change in the structure of prevalence of sensitization to different aeroallergens in adult population of Zagreb and its surroundings with atopy. Specific goals were to determine the structure of prevalence of sensitization to different pollens in adult population with respiratory symptoms, as well as to determine whether there are changes in sensitization in adult population with respiratory symptoms to different aeroallergens, and to determine the changes in prevalence of sensitization to ragweed during the investigated time period. Retrospective analysis of medical records from Allergy Clinic in the period between 1991 and 2004 have identified 5591 patients. We included 794 patients during years 1991-1994, 814 patients during 1995-1999, and 969 patients during 2000-2004 as 3 time dependent subgroups. These patients were included based on having all relevant data in their medical charts: age, gender, education level, residence, referral diagnosis, dominant symptoms, result of skin-prick test (SPT), total and specific IgE. Statistical analysis was done using Statistica, Kernel release 5.5 A (StatSoft, Inc. Tulsa, OK). As statistically significant P106; sensitivity, 99.25%; specificity, 100%; P<0.001). Despite all its limitations primarily based on the election bias the results of this study are conclusive about the significant change in the proportion of sensitization to different aeroallergens and different pollen groups and individual pollen species during the investigated 15-year time interval. These results have to be verified by the well planned epidemiological survey