Oral Manifestations in Acute Leukemia as the First Sign; The Interdisciplinary Approach of Diagnosis and Treatment

Systemic diseases often present associated oral signs and symptoms, which can occur either from the beginning of the disease or during its evolution. In some cases the oral manifestations reveal an undetected and severe disease, like leukemia. According to the encountered oral signs and symptoms and their response to topical/ dental treatment, the dentist and physician should take into account specific additional tests, which could highlight a possible associated systemic disease. The most frequent oral manifestations associated with leukemia are represented by paleness of oral mucosa/ local abnormal colour of the gum, gingival petechiae, ecchymosis, bleeding associating painless gingival hyperplasia, hemorrhages, ulcerative necrotic lesions and buccal infections. We presented in this paper the relevant literature data in respect to the oral manifestations encountered in leukemia, exemplified with two suggestive cases. As a conclusion, dentists should be advised not only to recognize and treat the encountered oral lesions but also to refer the patient to specialized professionals for additional investigations, especially in the situation when suspect a severe systemic disease that require a precocious diagnosis or in the case when the establishment of diagnosis exceed the possibilities of the usual tests. Chemotherapy administration in association with topical/ oral solutions often leads to total or partial remission of the oral signs and symptoms

Postpartum depression: Prevention and multimodal therapy

A woman goes through many biological (hormonal, physical), psychological (emotional), and socio-cultural changes during pregnancy. Furthermore, changes also occur in the mother\u27s familial and interpersonal world after childbirth. While some mothers have positive emotions at birth, such as joy and pleasure, others complain of negative experiences varying from sadness and depression to psychosis. Thus, the risk of depression is higher for women during the postpartum period, having a tendency to decrease in most cases over the first 2 weeks after delivery. Unfortunately, this favorable evolution does not happen in about 1 in 4-7 women, who develops postpartum depression. Postpartum depression has generally the same features as any common depressive episode encountered at any other time in life. However, assessment of depressive symptoms in the parental period implies not only general tools (such as the Depression Scale of the Center for Epidemiological Studies or the Beck Depression Inventory), but also a specific evaluation using the Edinburgh Postnatal Depression Scale. Taking into account all changes that occur during the peripartum period, a multimodal approach for postpartum depression would be recommended, including an appropriate lifestyle (walks, ambient environments), counseling, cognitive-behavioral therapy, and finally antidepressant medication when required. As a conclusion, postpartum depression may range from a mild and reversible episode to a severe and persistent form. Antepartum and postpartum screening, an early diagnosis, and a tailored approach to depression are essential for better results and prognosis related to both mother and child

Finasteride adverse effects and post-finasteride syndrome; implications for dentists

Finasteride is a 5α-reductase inhibitor widely used in present in the therapeutic approach of androgenic alopecia. Adverse effects consist in variable sign and symptoms, the most common being represented by mental troubles (reduced feeling of life pleasure or emotions, depression), physical impairments (loss of muscle tone and/or mass) and sexual complains (loss of libido and sexual potency). An increasing number of studies identify and describe even a post-finasteride syndrome (persistent adverse affects three months or more after finasteride cessation) or new adverse effects including but not limited at the skin level or oral cavity (marginal periodontium). We intend to present in this study several oral adverse effects encountered during finasteride administration, represented by mild and moderate signs which generally responded to topical procedures without to require the stop of the drug administration. New studies on large samples will further document the existing relation between the described oral adverse effects and the implied pathophysiological mechanisms. For this moment, we are taking into account as possible mechanisms- a direct action of finasteride administration, possible indirect consequences due to hormonal interferences, or coexisting factors with finasteride administration that were not detected

Laser therapy in superficial morphea lesions – indications, limitations and therapeutic alternatives

Morphea or localized scleroderma is an uncommon autoimmune and inflammatory disease which affects patients of any age. Even if morphea lesions present systemic symptoms as myalgias or arthritis, it is distinct from systemic sclerosis because it does not associate Raynaud’s phenomena or sclerodactyly, which are encountered in systemic scleroderma. The most common form of morphea in children is `en coup de sabre`, which can alter the local anatomy by deep tissue involvement. In contrast, the most frequent form that affects adults is represented by circumscribed morphea. The initial lesions present an inflammatory phase that manifests in the form of erythematous plaques, sometimes accompanied by edema. In later stages, the inflammation decreases and the lesions become sclerotic to atrophic. Therapy is most beneficial when initiated in the inflammatory stage. Topical application of high potency steroids along with phototherapy demonstrates the best results in the active phase of the disease. Localized superficial morphea can be treated with the excimer laser (using ultraviolet type B light, in range of 308nm) if topical steroid administration shows no significant clinical improvement. Phototherapy with ultraviolet light is capable of decreasing inflammation and may also have immunomodulatory effects

Treatment of lipomas and diffuse lipomatosis with NDYAG 1064 NM laser and their impact on the quality of life

Lipomas, the most common type of benign tumours, are generally developed from adipose tissue and present an incidence of 2.1 per 1000 inhabitants. In addition to lipomas, at least three other maladies of the adipose tissue lead patients to consult a doctor, especially for aesthetic purposes: multiple familial lipomatosis, diffuse congenital lipomatosis, and adiposa doloris. Unlike lipomas, these maladies are characterized by numerous lipomas, encapsulated or not, of different sizes, symmetrical or not, which may appear in the neck, limbs, or the trunk, sometimes being painful. The life quality of these patients is affected, not only from an aesthetic point of view but also from medical considerations, like pain. Chemical lipolysis has proven unsatisfactory for patients due to several reasons: the prolonged therapy, high cost, the partial dissolution of the lipomatosis, and high recurrence at one year. Surgical treatment remains the only viable option; sometimes when numerous lipomatous tumors required large and numerous incisions, treatment was refused by patients. The result after laser liposuction is excellent, the recovery time is short, without much pain for the patient, with minimal ecchymoses and edemas, without any recurrence in time, and with an excellent degree of patient satisfaction

Limb amputations; etiopathogenesis, diagnosis and the multidisciplinary therapeutic approach

Despite remarkable advances in medicine, limb amputations remain a therapeutic measure that saves the lives of many patients. Given the varied etiopathogenesis, such operations are performed both as an emergency and as an elective procedure. Such interventions address either only the distal segments of a limb, or even the entire limb, having a great psychological, functional and social impact on the patient. Due to these multiple implications, limb amputations must be performed by specialized teams, in order to achieve the best possible functional and aesthetic results to be compatible with the correction of the remaining deficit with a prosthesis. The main causes leading to amputations and the corresponding preventive measures are presented, as well as the general principles of amputations as a therapeutic solution of last resort. In conclusion, reducing the number of traffic/workplace accidents and effective treatment of chronic diseases affecting the vascular system can contribute to decreasing the need for amputations, a life-saving therapeutic solution, but with a devastating impact on the patient and society

Barrett\u27s esophagus as a premalignant condition; medical and surgical therapeutic management

Barrett\u27s esophagus (BE) represents a special clinical entity, which may have reduced symptoms, but an increased potential for malignant degeneration. The factors that lead to the appearance of Barrett\u27s esophagus are multiple, the most important being gastro-esophageal reflux, as well as smoking and obesity. BE occurs as a result of damage of the esophageal mucosa, caused by acid/basic gastroesophageal reflux and resulting in the transformation of the epithelium from squamous to intestinal type. The diagnosis of BE is primarily based on endoscopic examination. This method has not only a diagnostic role, but also a therapeutic one through the minimally invasive resection of the mucosa with suspicious dysplastic lesions, thus reducing the risk of esophageal adenocarcinoma. Conservative therapeutic methods by administering chemoprotective agents (proton pump inhibitors, statins, etc.) are also useful. Surgical treatment of Barrett\u27s esophagus aims to both resect areas of high-grade esophageal dysplasia/adenocarcinoma and reduce the degree of gastroesophageal reflux through various surgical procedures. As a conclusion, the potential for malignant degeneration of BE should not be neglected, the form of treatment largely depending on the patient\u27s age and comorbidities

Therapeutic Considerations Related to Finasteride Administration in Male Androgenic Alopecia and Benign Prostatic Hyperplasia

Finasteride has been used extensively until now as a relative efficient therapeutic option for male androgenic alopecia and benign prostatic hyperplasia. Unfortunately, over time several concerns appeared regarding the frequency and magnitude of adverse effects, which in some cases have been even irreversible. Herein we review the recent literature on this topic, trying to clarify the current safety profile of Finasteride for these two therapeutic indications. We concluded that Finasteride could be retained as a therapeutic approach for male androgenic alopecia, based on two important reasons. First, a synergistic action between a partial inhibitor of 5α-reductase (Finasteride) and another compound (like Minoxidil) are preferable to a complete suppression of 5α-reductase (see Dutasteride), in order to preserve the important physiological roles of dihydrotestosterone. Second, Finasteride side effects can currently be addressed in part prior to the onset of the therapy, by using information about the patient such as hand preference and sexual orientation to predict the risk of adverse effects

Laser therapy in superficial morphea lesions – indications, limitations and therapeutic alternatives

Morphea or localized scleroderma is an uncommon autoimmune and inflammatory disease which affects patients of any age. Even if morphea lesions present systemic symptoms as myalgias or arthritis, it is distinct from systemic sclerosis because it does not associate Raynaud’s phenomena or sclerodactyly, which are encountered in systemic scleroderma. The most common form of morphea in children is `en coup de sabre`, which can alter the local anatomy by deep tissue involvement. In contrast, the most frequent form that affects adults is represented by circumscribed morphea. The initial lesions present an inflammatory phase that manifests in the form of erythematous plaques, sometimes accompanied by edema. In later stages, the inflammation decreases and the lesions become sclerotic to atrophic. Therapy is most beneficial when initiated in the inflammatory stage. Topical application of high potency steroids along with phototherapy demonstrates the best results in the active phase of the disease. Localized superficial morphea can be treated with the excimer laser (using ultraviolet type B light, in range of 308nm) if topical steroid administration shows no significant clinical improvement. Phototherapy with ultraviolet light is capable of decreasing inflammation and may also have immunomodulatory effects

Modern concepts in non-surgical esthetics; a review

New non-surgical esthetics is the most dynamic field in contemporary medicine. At the same time, it is greatly influenced by our contemporary society. This paper reviews modern methods used in non-surgical esthetics, especially in Romania. From injectology and non-surgical face lifting to non-surgical body contouring, we analyzed all procedures performed by Romanian physicians, and we show the advantages and disadvantages of the advanced esthetic procedures. Injectology typically implies hyaluronic acid, botox and mesotherapy (for wrinkles and rejuvenation). Laser and radiofrequency treatment are used for wrinkles as well, with fewer unwanted adverse reactions and results exceeding those of injectables. Non-surgical lifting has gained more ground because it requires little recovery time and the results are very positive. Elective treatment for facial discoloration is the laser approach. For non-surgical body contouring, cryolipolisis, vacuum, radio frequency, and infrared systems have all revolutionized this part of esthetics, but each has limitations, and only after establishing the correct course of action, might we think of achieving favorable results and thus raising to the expectations of patients