[Changes in the oral mucosa in patients with bruxism]. / Izmeneniya slizistoi obolochki rta u patsientov s bruksizmom.

OBJECTIVE: The aim of the study was to determine changes in the oral mucosa in patients with bruxism using the method of autofluorescence stomatoscopy. MATERIAL AND METHODS: 50 patients with bruxism aged 35-65 years were examined at the Department of Prosthetic Dentistry, Faculty of Dental Medicine, Medical University - Sofia, Bulgaria. Using the digital diagnostic system OccluSense (Bausch, Germany), deviations in static and dynamic occlusion were determined. For the diagnosis of precancerous diseases and early stages of malignant neoplasms of the oral mucosa, we used the method of autofluorescent stomatoscopy using a LED stomatoscope «AFS¼ made in Russia with radiation in the spectral range of 400 nm. RESULTS: The normal mucous membrane of the mouth at this frequency of the spectrum has a green glow. Metabolic and/or structural changes occurring at the cellular and/or tissue level of the oral mucosa lead to a change in its optical properties.Analysis of occlusion in 50 patients with bruxism showed uneven distribution of the chewing load. In 60% of patients, the presence of supercontacts was revealed, and in 76% of cases, occlusion disorders were detected, in 88% of patients, hyperkeratosis of the buccal mucosa was noted, and in 77.3% they were localized along the line of closing of the teeth. CONCLUSION: Examination of the oral mucosa using the autofluorescent stomatoscopy method allows visualizing and, accordingly, objectifying the presence of hyperkeratotic changes in the buccal mucosa in patients with bruxism. The APS apparatus allows for a reliable and effective assessment of non-inflammatory and inflammatory changes, precancerous and cancerous lesions, which makes it indispensable for the manifestation of oncological alertness in the daily clinical practice of dentists.

[Protocol for clinical articulation of complete dentures in maximum intercuspation]. / Protokol dlia klinicheskogo artikulirovaniia polnykh s''emnykh protezov v maksimal'noi interkuspidatsii.

The aim of the study was to evaluate the application of clinical protocol for articulation of complete dentures (CDs) in maximum intercuspation (MIP) under the control of T-Scan 8 system and articulation paper. The study involved 32 edentulous patients, aged from to years (mean age 71±9.28 years), who had been treated with complete dentures in the Faculty of Dental Medicine, Medical University-Sofia. Two sets of Superacryl Plus plastic CDs with Flat Ac Acrylic resin teeth were made for each patient according to the classic methodology. The first set of CDs (group 1) was articulated in the MIP under the control of articulation paper only, while the second set of CDs (group 2) was articulated according to a clinical protocol, in which a digital T-Scan 8 analysis and an articulation paper registration were combined. In group 1, occlusion time (OT) higher than normal (56.2%); force outliers (81.25%); and reduced vertical dimension of occlusion (43.8%) were found, resulting in total occlusal force of 100% in the MIP in only 15.67% of the cases. In group 2, OT higher than normal was found in only one set of CDs (3.12%) and force outliers in four sets of CDs (12.5%). The strongest contacts were 2.03±1.57 per denture and most distally situated, and the total force in the MIP averaged 99.39±0.66%. Thus clinical protocol for articulation of CDs under digital control in combination with articulation paper allows the proper selection of contacts in articulation of dentures in the MIP by overcoming the subjective factor.

[Atypical respiratory tract infections in adult patients in the primary care]. / Les infections broncho-pulmonaires à germes atypiques chez l'adulte : Mythe ou réalité ?

Respiratory tract infections remain one of the most frequently encountered acute illnesses in the primary care. Atypical germs along with Streptococcus pneumoniae are an important cause of community-acquired pneumonia. Most infections caused by atypical germs are mild or moderate but some of them might cause a severe disease with important morbidity and mortality. Diagnosis of community-acquired pneumonia remains a challenge in the primary care. On the other hand some of them are reported to be associated with chronic cough which is a common problem in the general practice. The aim of this mini-review is to give a short overview of some data on local prevalence, presentation and scoring systems, with stress on feasibility of current diagnostic methods in the primary care practice and therapeutic considerations for the general practitioners.

Les infections respiratoires sont la première cause de consultation en médecine générale. Le Streptococcus pneumoniae suivi par les germes atypiques sont une cause importante de pneumonies bactériennes en médecine extrahospitalière. La cause d'une pneumonie communautaire chez les patients hospitalisés est par ordre de fréquence décroissante, un organisme encore inconnu ou non détecté, des virus et enf in des bactéries1. Les germes atypiques sont généralement la cause d'infections peu sévères, mais peuvent malgré tout générer occasionnellement des infections plus sévères, parfois mortelles. Elles peuvent parfois simplement se manifester par de la toux chronique, un problème courant en première ligne. Diagnostiquer une pneumonie communautaire peut s'avérer difficile en médecine générale. Le but de cette mini-revue de littérature est de revoir la prévalence, la présentation clinique et les méthodes diagnostiques accessibles en première ligne, ainsi que les traitements à appliquer.

[Rational approach and management of the dyspnoeic patient in general medical practice]. / Approche rationnelle et prise en charge du patient dyspnéique en médecine génerale.

Dyspnea represents 3-4 % of consultations at primary care medicine (general medicine, emergency medicine) and is found in 14 % of the interviewed general population. It is defined as an abnormal and uncomfortable breathing and can be classified according to the mode of appearance, the breathing pattern or the rhythm. Different classifications are used to specify the severity of the situation: visual analog scale, functional classification of the New York Heart Association, dyspnea modified scale from the Medical Research Council, ... Rare among young people, dyspnea often hides asthma; more prevalent among seniors, it is often secondary to chronic lung or heart disease. The rational approach is the same in general medicine and in the emergency room. The management starts with an assessment of the severity of the patient's clinical situation, via the early warning score. The critical patient requires to be managed according to the progressive and cyclical ABCDE approach. For non-critical patients, a traditional approach and a reasoned method are needed. In patients suffering from chronic obstructive pulmonary disease (COPD), the use of the Anthonissen criteria allows to orient toward a pulmonary superinfection or another cause of worsening dyspnea (cardiac, ...). In case of suspected pulmonary embolism, the Geneva score and the modified Wells score help to separate low, intermediate or high probability cases of pulmonary embolism. D-dimers have a very good negative predictive value in the low and middle risk group and pulmonary CT angiography applies only to a smaller group of dyspnoeic patients with a high probability of pulmonary embolism. Echocardiography has a prominent role to assess the LV systolic function, the search for pulmonary artery hypertension, the vascular filling state, etc. We speak of psychogenic dyspnea after having excluded the potentially serious pathologies.

Weekly cisplatin may reverse liver dysfunction and jaundice caused by diffuse liver metastases of solid tumors.

Few data are available on patient management in jaundice caused by liver metastases of solid tumors (nonbreast and noncolon origin). We report the first patient series consecutively treated with cisplatin weekly in patients with severe jaundice and liver failure due to underlying metastatic neoplasms. In 4 out of 8 cases, liver function tests were reversed and jaundice disappeared, permitting subsequent standard chemotherapy. The other 4 patients died 3 to 5 weeks after admission, illustrating the extent and severity of the underlying neoplasm.

[Tubular structural pattern of filaments of elastic fibers]. / Zum tubulären Baumuster der Filamente der elastischen Fasern.

Substructural organization and morphogenesis of elastic fiber filaments (EFF) from different organs (blood vessels, auricular cartilage, skin) are described. EFF reveal a tubular pattern of organization. In cross section, the filament's "wall" is build up of 4 dense particles (subunits), which surround an electron-lucent interior; in longitudinal section, subunits seems to be arranged in a chain-like manner. The EFF's tubular organization is somehow similar to that of intermediate filaments and cytoplasmic microtubules. An universal structural pattern for both, intra- and extracellular filamentous structures, with skeletal function is suggested.

Secretory features of chondrocytes related to morphogenesis of the elastic elements in the auricular cartilage.

The well-developed secreting vacuolar system is a characteristic feature of all chondrocytes (CH) during prenatal and early postnatal ontogenesis as well as of the CH near the perichondrium in the adult rat's auricular cartilage. Two kinds of secretion vacuoles exist, dense vacuole (DV) and electron lucent vacuoles (LV). The DV are heterogeneous in size, matrix appearance and origin. The factors (organ necessities and chemical maturation) responsible for the DV matrix heterogeneity are discussed. The presence of dilated rough endoplasmic cisternae with local parts of their cisternal surfaces without bound ribosomes suggest the existence of a direct secretory pathway which bypasses the Golgi complex. During prenatal ontogenesis the extracellular matrix of the auricular cartilage consists of bundles of elastic microfibrils and primary elastic fibres. The elastic microfibrils are tubular structures with a wall composed of 3-5 subunits. After birth the primary elastic fibres are joined to form intercellular septae. The presence of matrix vesicles is discussed with regard to the fine differentiation of the auricular elastic system by their lysosomal activity.

[Ultrastructural similarities of secretory processes in arterial smooth muscle cells and elastic cartilage chondrocytes. vacuolar apparatus and microtubules (author's transl)]. / Ultrastrukturelle Parallelen der Sekretion in glatten Muskelzellen von Arterien und Chondrozyten des elastischen Knorpels. Vakuolärer Apparat und Mikrotubuli.

A highly developed vacuolar apparatus is found in aorta and pulmonary trunk smooth muscle cells and elastic cartilage chondrocytes, and its relationship with cytoplasmic microtubules is described. The Golgi complex as well as the rough endoplasmic reticulum (RER) may be the intracellular sources of the components of the vacuolar apparatus. Some vacuoles, Golgi-related only, showed an association with microtubules. Smooth muscle cells which contained vacuoles derived from RER did not possess Golgi vacuoles and microtubules. In chondrocytes, both Golgi-related and RER vacuoles coexisted in a single cell. 2 main secretory pathways are suggested to operate in smooth muscle cells and chondrocytes: Golgi and RER pathway. The former requires an intact cell tubulin system (cytoplasmic microtubules and membrane-bound tubulin), while the latter is probably microtubule-independent.

[Matrix vesicles in various "elastic" organs]. / Matrixvesikel in einigen "elastischen" Organen.

Matrix vesicles (MV) have been found during normal development in the rabbit and rat aorta and pulmonary trunk as well as in the elastic cartilage of the rat external ear. In spite of the morphological variability of MV, two basic types can be ruled out: MV with dense osmiophilic content, and light or electron-translucent MV. MV of the first type are considered to be extracellular lysosomes. MV in the vessel wall are predominantly localized in the subendothelium, and the border-zones between media and endothelium or media and adventitia; in elastic cartilage they are localized near the perichondrium. Especially often they can be seen at the place of contact between elastic and other fibers of the intercellular space. They can even penetrate the elastic membranes and plates. The parts of the organs mentioned encounter higher functional demands and are more active during development and growth. The MV appear almost exclusively a short time before birth, and predominantly during the first 20-60 days of postnatal life. Their origin may be due to exocytosis and the detachment of parts (Mikroapokrinie) of endothelial cells, smooth muscle cells, fibrocytes and chondrocytes. The MV are considered to be a substrate for subsidiary extracellular mechanisms of adaptation during the normal ontogenesis of the elastic tissue of these organs.

[Ultrastructural manifestations of the secretory function of the chondrocytes in elastic cartilage]. / Ultrastrukturni proiavi na sekretornata funktsiia na khondrotsitite v elastichniia khrushtial.

The authors examined ultrastructural manifestations of the secretory function of chondrocyetes in the auricular tendon of rats. They found that chondrocyetes were active secretorily in the prenatal and early postnatal ontogenesis; in later age such activity possessed mainly those chondrocytes located subperichondricaly. The existance of direct communications of cysternas of the granulated endoplasmic reticulum with extracellular area was interpreted as a possibility for direct release of the secretory products. Small coated vesicules with dense content were followed-up from the Goldi's organs till their openings on the cellular surface. Two types of vacuoles were differentiated-some with optically dense content, localized in the Goldi's organs, and others-optically empty, which were encountered in their boundaries as well. A concept was given that the first type originates from the granulated endoplasmic reticulum and transported protein product, but the second type-from the Goldgi's complex and transported probably polysaccharides.