Mileta Golubovic

Immunohistochemical analysis of blood vessels in peri-implant mucosa: a comparison between mini-incision flapless and flap surgeries in domestic pigs

AIM The aim of this experimental study is to compare the effect of mini-incision flapless versus flap technique of implant placement on the amount of vascular structures and blood vessel elements in peri-implant soft tissue, using immunohistochemical analysis. METHOD The experiment was conducted on five domestic pigs. Each animal received six implants in mandible according to the split-mouth design. On one randomly chosen jaw side, mini-incision flapless surgery was performed, whereas on the opposite jaw side, flap was raised. After 3 months of implant healing through submerged approach, the experimental animals were sacrificed and samples for immunohistochemical analyses were taken from the buccal side of peri-implant mucosa next to the neck of implants, from three levels. The study outcome was the presence of vascular structures and elements of the blood vessels in the peri-implant mucosa per microscopic field, estimated through ordinal scores from 0 to 2. Effects of surgical approach, site of implantation, and their interaction on vascular scores of peri-implant mucosa were assessed by Brunner and Langer nonparametric analysis of longitudinal data. RESULTS Statistically significant effect of surgical approach on vascularity of peri-implant mucosa has been revealed in the second mucosal layer, where flapless approach provided higher vascularity compared with flap approach (P = 0.002). In the remaining two layers, surgical approach did not affect mucosal vascularity significantly (layer 1: P = 0.071; layer 3: P = 0.433). CONCLUSION The flapless surgical implant placement approach using mini-incision provides better vascularization of peri-implant mucosa after 3 months of healing compared with flap surgery.

Histopathological comparative analysis of peri‐implant soft tissue response after dental implant placement with flap and flapless surgical technique. Experimental study in pigs

AIM The aim of this study was comparing the effect of flapless vs. flap technique of implant placement on inflammation degree of peri-implant soft tissue, through histopathological analysis. METHOD The experiment was conducted on five domestic pigs. Nine weeks after tooth extraction, implants were installed. Each animal received six implants in mandible. According to split-mouth design, randomly one side was used for flapless technique using mini-incision, while on the other side, flap was raised. After 7, 14, 21, 28, and 90 days, the experimental animals were sacrificed. Samples for histopathological analyzes were taken from the buccal side of peri-implant mucosa next to the neck of implants, from three levels. The degree of inflammatory response in the peri-implant soft tissue was estimated through ordinal scores from 0 to 3. RESULTS In the flap group Score 3 indicating high degree of inflammation was present from day 7 to day 21, in contrast to flapless group where Score 3 was not recorded during the entire follow-up. Three months after implantation, there were no signs of inflammation neither around flap nor around flapless implants. CONCLUSION Flapless surgical implantation technique using mini-incision decreases peri-implant soft tissue inflammatory reaction compared with flap surgery.

Correlation between disease progression and histopathologic criterions of the lip squamous cell carcinoma

BACKGROUND/AIM The most common malignancy of the lip is squamous cell carcinoma (SCC). In our population, according to epidemiological data, almost a half of all (45%) SCC of oral mucous tissue spreads over the lower and upper lip. The aim of this study was to estimate prognostic importance of histopathologic characteristics--histologic grade, nuclear grade and tumor size in relation to the appearance of lymph node metastases and relapse in SCC of the lip. METHODS In the retrospective-prospective study 70 cases of lower and upper lip SCC were analyzed. They were diagnosed from 2002 to 2006 in the Clinic of Maxillofacial Surgery, Clinical Center of Montenegro. The data about localization of the carcinomas, histopathologic characteristics and lymph node status were taken from medical files of the patients. The patients were followed up in a 3-year period and the disease relapse or/and metastatic disease appearance were registereds. RESULTS There was statistically significant difference in tumor size among the patients with and without disease relapse (p = 0.027). Logistic regression analysis showed that the tumor size is a statistically significant factor (R = 0.186; p = 0.011) for the appearance of regional lymph node metastases. Relative risk [exp (B)] for the appearance of regional lymph node metastases in relation to tumor size was 2.807. CONCLUSION Histologic and nuclear grade of lip SCC are not prognostic factors for the appearance of the disease relapse and regional lymph node metastases. Tumor size is a predictive factor of the relapse appearance, as well as for lymph node metastases appearance. In clinical practice, tumor size is a factor that classifies patients with lip SCC into the groups of higher and smaller risk of relapse appearance and for lymph node metastases appearance. Our results suggest that, risk for lymph node metastases appearance increases 2.8 times with increasing of the tumor size over 2 cm in diameter.

Fatal laryngeal oedema in an adult from an air rifle injury, and related ballistics.

Air guns (air pistols and rifles) are already recognized as being potentially lethal. The diabolo pellet has a calibre of .177 (4.5 mm), a 1250 fps velocity, is high energetic, and is most commonly used in such weapons. In the presented case, the victim sustained an air rifle injury to the neck. The pellet passed through the thyroid cartilage, subsequently causing the extensive laryngeal swelling with haematoma around the pellet channel which fatally obstructed the airway. It is estimated microscopically that at least a number of hours must have passed from the injury to the time of death. For this case, a shooting distance was estimated by using experimental shooting values compared to physics formulas for accelerated motion. The case under question has confirmed an applicable legal approach that can be utilized by countries to classify air rifles as being as harmful as other firearms, especially those with high muzzle velocities.

First diagnostic cases of human babesiosis in Montenegro

Babesiosis is a parasitic infection similar to malaria. It belongs to the group of vector-borne transmissible zoonoses.1 The primary vectors are various types of ticks.2 Dispersion of the infection is enabled by a wide range of reservoirs for parasites (domestic and wild mammals).2–4 Examinations in Europe proved that the Babesia parasite is the most frequent agent in coinfections with Borrelia burgdorferi.5 The first diagnosed cases of human babesiosis in Montenegro were registered in 2011, at the Infectious Disease Clinic in Podgorica.6 In our ten examined patients, clinical characteristics and laboratory findings were not specific. Manifest Erythema migrans (EM) was observed in six patients. In seven cases, Lyme borreliosis was diagnosed by Elisa method. The diagnosis of babesiosis was confirmed in all ten patients by analysis of the bone marrow biopsy, stained according to Romanowski, and in four patients by analysis of thick drop and peripheral blood smear, stained by Giemsa-I. Seven cases had coinfection with Borrelia burgdorferi and Babesia agents. In the clinical picture, non-specific symptoms of common infectious syndromes predominated. Changes in blood and differential blood pictures were registered for every patient. Intraerythrocytic annular forms of the parasite Babesia spp. were found in histological cultures (Fig. 1). In comparison with Plasmodium, Babesia does not cause pigment in erythrocytes, nor does it produce schizonts or gametocytes. After the diagnosis was made in all ten cases, treatment was administered: clindamycin + quinine sulphate in a course

Histopathology of urinary bladder carcinoma: Less common variants

Bladder cancer is a common form of neoplasia which most often presents histologically as urothelial (transitional cell) carcinoma. In this article we review recent publications dealing with the less common variants of urothelial carcinoma such as tumours that show unusual forms of differentiation or the well know squamous, glandular, or sarcomatoid differentiation. Urothelial tumours may also show several distinct growth variants characterized by a nested, micropapillary, lymphoepithelioma-like, or plasmacytoid and giant cell growth pattern.The clinical course of bladder cancer varies depending on the histological type of neoplasia, grade and stage of the tumour. High-grade muscle-invasive urothelial cancers and tumours showing variant microscopic morphology have in general high mortality and poor prognosis.

Clinical significance of understanding lateral and medial circumflex femoral artery origin variability

The common femoral artery (CFA) divides into the superficial femoral artery (SFA) and deep femoral artery (DFA). The lateral circumflex femoral artery (LCFA) and medial circumflex femoral artery (MCFA) are most often branches of the DFA, although a large number of different variations in their origin has been described. We performed microdissection on both lower limbs of 30 fetuses, gestational age from 7 to 10 lunar months. Our results show that the LCFA and MCFA usually arise from the DFA. In 78.3% of cases, the MCFA originated from the DFA. In 11.7% of cases, the MCFA originated from the CFA, and in 5% of cases from the SFA. One case showed a common trunk with the DFA. Also, the MCFA was missing in one case, and it had a common trunk with the LCFA in one case. In 83.3% of cases, the LCFA arose from the DFA and in 6.7% of cases from the CFA. In one case, it had a common trunk with the DFA, and in one case with the MCFA. In 3.3% of cases, the LCFA was missing. In 66.7% of cases, both arteries originated from the DFA, in 15% of cases one originated from the DFA and the other from the CFA or SFA. Our results are in accordance with some published studies but also differ from the outcomes of other studies. Comprehensive knowledge of different variation types is imperative in order to prevent complications during surgical and orthopedic interventions.

Human Vector-Borne Transmissible Parasitic Diseases in Montenegro

Montenegro is an endemic country for a significant number of vector-borne diseases (VBD). Natural conditions and geographical position (Mediterranean area) are favorable for the existence of the disease, and its expansion (1). Current vector-borne transmissible parasitic infections that haves been registered in Montenegro includes: leishmaniasis, babesiosis, malaria, and filariasis (dirofilariasis). The causers of leishmaniasis are the members of protozoa leishmania species (spp). The phlebotomies are the primary vectors in transmission of parasites. Documented cases of visceral leishmaniasis (VL) from 1992 to 2014 in Montenegro present 84 cases with of Kala-azar, and the 1 case of skin leishmaniasis. In 2014 the coinfection of leishmaniasis and HIV/AIDS for the first time was registered in one case. Babesiosis is a parasitic infection similar to malaria. In transmission of parasites, the primary vectors have different tick species, possibly the other blood meal vectors (sand flies, mosquitoes, and bugs). Dispersion of the infection in the worldwide is enabled by a wide range of reservoirs of parasites. Examinations in Europe proved that babesia is the most frequent agent of co-infection together with Borrelia burgdorferi. The first diagnosed cases of human babesiosis in Montenegro were registered in 2011. By the end of 2013, 12 cases were diagnosed. The coinfection of babesia and B.burgdorferi were registered in 73% cases. Malaria is the most known parasitic transmissible disease in the world. The causative agent is Plasmodium, a genus of Apicomplexa, which is transmitted by mosquitoes of the genus Anopheles. In Montenegro, the disease was officially eradicated after World War II, but we continuously register 04 cases of imported malaria per year (sailors, travelers to endemic areas). These facts are significant because of the existence of the