The Experts below are selected from a list of 207 Experts worldwide ranked by ideXlab platform
M. S. Losowsky - One of the best experts on this subject based on the ideXlab platform.
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A history of coeliac disease
Digestive Diseases, 2008Co-Authors: M. S. LosowskyAbstract:Coeliac disease may have an ancient history dating back to the 1st and 2nd centuries AD. The first clear description was given by Samuel Gee in 1888. He suggested that dietary treatment might be of benefit. In the early 20th century various diets were tried, with some success, but without clear recognition of the toxic components. The doctOral thesis of Wim Dicke of 1950 established that exclusion of wheat, rye and oats from the diet led to dramatic improvement. The toxicity was shown to be a protein component, referred to as gluten. Dicke's colleagues, Weijers and Van de Kamer, showed that measurement of stool fat reflected the clinical condition. Early studies were in children but stool fat measurements documented that the condition could be recognised in adults. Histological abnormalities of the lining of the small intestine were demonstrated beyond doubt by Paulley in 1954 and techniques of per-Oral Biopsy described by Royer in 1955 and Shiner in 1956 afforded reliable diagnosis. Concurrence in monozygotic twins suggested a genetic component, confirmed by studies of HLA antigens. Additional, non-genetic factors seem likely. Circulating antibodies suggest an immunological mechanism of damage and provide non-invasive screening tests. Lymphoma, adenocarcinoma and ulceration of the small intestine and a range of immunological disorders are associated. A relationship with dermatitis herpetiformis was suggested by Samman in 1955 and established by Shuster and Marks in 1965 and 1968. The Coeliac Society (now Coeliac UK) was founded in 1968 and similar societies now exist across the world. They provide an extremely valuable service. Present problems include definition of the tolerated levels of gluten, whether oats are toxic for some or all coeliacs and the likelihood that the condition is relatively common and frequently without classical symptoms. Hope for the future is that more convenient methods of treatment will follow better understanding.
Umberto Romeo - One of the best experts on this subject based on the ideXlab platform.
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Biopsy of different Oral soft tissues lesions by ktp and diode laser histological evaluation
The Scientific World Journal, 2014Co-Authors: Umberto Romeo, C Russo, Gaspare Palaia, Rossella Lo Giudice, Alessandro Del Vecchio, Paolo Visca, Guido Migliau, Alberto De BiaseAbstract:Introduction. Oral Biopsy aims to obtain clear and safe diagnosis; it can be performed by scalpel or laser. The controversy in this latter application is the thermal alteration due to tissue heating. The aim of this study is the histological evaluation of margins of “in vivo” biopsies collected by diode and KTP lasers. Material and Methods. 17 Oral benign lesions biopsies were made by diode 808 nm (SOL, DenMatItalia, Italy) and KTP 532 nm (SmartLite, DEKA, Italy). Samples were observed at OM LEICA DM 2000; margin alterations were evaluated through Leica Application Suite 3.4. Results. Epithelial and connective damages were assessed for each pathology with an average of 0.245 mm and a standard deviation of ±0.162 mm in mucoceles, 0.382 mm ± 0.149 mm in fibromas, 0.336 mm ± 0.106 mm in hyperkeratosis, 0.473 mm ± 0.105 mm in squamous hyperplasia, 0.182 mm in giant cell granuloma, and 0.149 mm in melanotic macula. Discussion. The histologic aspect of lesions influenced the response to laser, whereas the greater inflammation and cellularity were linked with the higher thermal signs. Many artifacts were also associated to histologic procedures. Conclusion. Both tested lasers permitted sure histologic diagnosis. However, it is suggested to enlarge biopsies of about 0.5 mm, to avoid thermal alterations, especially in inflammatory lesions like Oral lichen planus.
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Histological in vitro evaluation of the effects of Er:YAG laser on Oral soft tissues
Lasers in Medical Science, 2012Co-Authors: Umberto Romeo, Gaspare Palaia, Alessandro Del Vecchio, Paolo Visca, Fabrizio Libotte, Gianluca Tenore, Samir Nammour, Antonella PolimeniAbstract:In Oral pathology, laser devices can provide important advantages, especially in the treatment of certain lesions. However, there is controversy about the use of some wavelengths in the analysis of suspected dysplastic or neoplastic lesions, raising doubt about the laser’s suitability for use in Biopsy procedures. In recent studies, the KTP and diode lasers have been used in Biopsy procedures without histological artefacts. The aim of this in vitro study was to evaluate the exact extent of peripheral thermal damage to Oral soft tissues caused by an Er:YAG laser (λ 2,940 nm) without water cooling. The study was performed on five swine cadaver tongues. Nine samples from each tongue were taken by the same operator using the Er:YAG laser with increasing energies (from 60 to 150 mJ) and fluencies (from 21 to 53 J/cm^2). In addition to the laser samples, a specimen obtained using a scalpel was used as control. The samples were placed in 10% formalin solution and were examined by optical microscopy by two blinded pathologists who assigned a thermal damage score (from 0 to 3) to each sample. The Er:YAG laser produced less damage at 80 and 100 mJ and 28 and 35 J/cm^2 (intermediate parameters). Although in some samples thermal damage was minimally visible, in all samples histological evaluation was clearly possible. The study demonstrated that the Er:YAG laser can be safely used in Oral Biopsy investigations while ensuring a successful histological evaluation, which is fundamental to correct clinical management.
Jane Setterfield - One of the best experts on this subject based on the ideXlab platform.
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the optimal Oral Biopsy site for diagnosis of mucous membrane pemphigoid and pemphigus vulgaris
British Journal of Dermatology, 2020Co-Authors: Barbara Carey, Sandeep Joshi, Abedalla Abdelghani, Manoharan Andiappan, Jane SetterfieldAbstract:BACKGROUND: Accepted 'standard practice' for the diagnosis of immunobullous disease is a perilesional sample for direct immunofluorescence (DIF). OBJECTIVES: To compare diagnostic outcomes of a normal buccal punch Biopsy (NBPB) with a perilesional Biopsy (PLB) for mucous membrane pemphigoid (MMP) and pemphigus vulgaris (PV). METHODS: A retrospective analysis of 251 DIF-positive patients with MMP and 77 DIF-positive patients with PV was undertaken. Parameters analysed included the intraOral sites of involvement and histopathological, DIF and indirect immunofluorescence (IIF) findings. RESULTS: For MMP, PLB was positive in 134 of 143 (93.7%) samples, compared with 129 of 144 (89.6%) by NBPB. The diagnostic sensitivities for PLB (81%, 39 of 48) and NBPB (77%, 37 of 48) among 48 patients who underwent both techniques were not significantly different (P = 0.62). In gingival-only MMP, PLB was positive in 63 of 69 (91%) and NBPB was positive in 63 of 75 (84%). For multisite MMP, PLB was positive in 71 of 74 (96%) and NBPB was positive in 66 of 69 (96%). In gingival-only MMP, biopsies from reflected alveolar mucosa in 17 consecutive patients were positive in 17 of 17 cases (100%). For PV, PLB was positive in 42 of 43 (98%), compared with 42 of 42 (100%) by NBPB. Histopathology was diagnostic in 93 of 134 (69.4%) cases of MMP and 38 of 41 (93%) cases of PV. IIF was positive in 126 of 197 (64.0%) MMP and 68 of 74 (92%) PV patient sera. CONCLUSIONS: In the largest series of combined Oral DIF results in patients with MMP and PV, we have shown that NBPB is equivalent to PLB for the diagnosis of PV and multisite MMP, and is more sensitive than both histology and IIF. What's already known about this topic? The variation in sensitivity of Oral Biopsy sites for direct immunofluorescence (DIF) in the diagnosis of Oral MMP and PV has not been studied in detail in large series of patients. Biopsy can be challenging due to difficult access and fragility of the Oral mucosa. The diagnostic Biopsy technique is therefore critical. What does this study add? We have shown that a normal buccal punch Biopsy (NBPB) from uninvolved Oral mucosa is as sensitive as a perilesional Biopsy (PLB) for diagnosis of Oral PV, and superior to serology and histology. For multisite MMP, NBPB is equivalent to PLB and is more sensitive than serology and histology. The Oral punch Biopsy technique on uninvolved buccal mucosa tissue is a simple and safe practical method for diagnosing Oral PV and MMP.
Antonella Polimeni - One of the best experts on this subject based on the ideXlab platform.
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Histological in vitro evaluation of the effects of Er:YAG laser on Oral soft tissues
Lasers in Medical Science, 2012Co-Authors: Umberto Romeo, Gaspare Palaia, Alessandro Del Vecchio, Paolo Visca, Fabrizio Libotte, Gianluca Tenore, Samir Nammour, Antonella PolimeniAbstract:In Oral pathology, laser devices can provide important advantages, especially in the treatment of certain lesions. However, there is controversy about the use of some wavelengths in the analysis of suspected dysplastic or neoplastic lesions, raising doubt about the laser’s suitability for use in Biopsy procedures. In recent studies, the KTP and diode lasers have been used in Biopsy procedures without histological artefacts. The aim of this in vitro study was to evaluate the exact extent of peripheral thermal damage to Oral soft tissues caused by an Er:YAG laser (λ 2,940 nm) without water cooling. The study was performed on five swine cadaver tongues. Nine samples from each tongue were taken by the same operator using the Er:YAG laser with increasing energies (from 60 to 150 mJ) and fluencies (from 21 to 53 J/cm^2). In addition to the laser samples, a specimen obtained using a scalpel was used as control. The samples were placed in 10% formalin solution and were examined by optical microscopy by two blinded pathologists who assigned a thermal damage score (from 0 to 3) to each sample. The Er:YAG laser produced less damage at 80 and 100 mJ and 28 and 35 J/cm^2 (intermediate parameters). Although in some samples thermal damage was minimally visible, in all samples histological evaluation was clearly possible. The study demonstrated that the Er:YAG laser can be safely used in Oral Biopsy investigations while ensuring a successful histological evaluation, which is fundamental to correct clinical management.
Paolo Visca - One of the best experts on this subject based on the ideXlab platform.
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Biopsy of different Oral soft tissues lesions by ktp and diode laser histological evaluation
The Scientific World Journal, 2014Co-Authors: Umberto Romeo, C Russo, Gaspare Palaia, Rossella Lo Giudice, Alessandro Del Vecchio, Paolo Visca, Guido Migliau, Alberto De BiaseAbstract:Introduction. Oral Biopsy aims to obtain clear and safe diagnosis; it can be performed by scalpel or laser. The controversy in this latter application is the thermal alteration due to tissue heating. The aim of this study is the histological evaluation of margins of “in vivo” biopsies collected by diode and KTP lasers. Material and Methods. 17 Oral benign lesions biopsies were made by diode 808 nm (SOL, DenMatItalia, Italy) and KTP 532 nm (SmartLite, DEKA, Italy). Samples were observed at OM LEICA DM 2000; margin alterations were evaluated through Leica Application Suite 3.4. Results. Epithelial and connective damages were assessed for each pathology with an average of 0.245 mm and a standard deviation of ±0.162 mm in mucoceles, 0.382 mm ± 0.149 mm in fibromas, 0.336 mm ± 0.106 mm in hyperkeratosis, 0.473 mm ± 0.105 mm in squamous hyperplasia, 0.182 mm in giant cell granuloma, and 0.149 mm in melanotic macula. Discussion. The histologic aspect of lesions influenced the response to laser, whereas the greater inflammation and cellularity were linked with the higher thermal signs. Many artifacts were also associated to histologic procedures. Conclusion. Both tested lasers permitted sure histologic diagnosis. However, it is suggested to enlarge biopsies of about 0.5 mm, to avoid thermal alterations, especially in inflammatory lesions like Oral lichen planus.
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Histological in vitro evaluation of the effects of Er:YAG laser on Oral soft tissues
Lasers in Medical Science, 2012Co-Authors: Umberto Romeo, Gaspare Palaia, Alessandro Del Vecchio, Paolo Visca, Fabrizio Libotte, Gianluca Tenore, Samir Nammour, Antonella PolimeniAbstract:In Oral pathology, laser devices can provide important advantages, especially in the treatment of certain lesions. However, there is controversy about the use of some wavelengths in the analysis of suspected dysplastic or neoplastic lesions, raising doubt about the laser’s suitability for use in Biopsy procedures. In recent studies, the KTP and diode lasers have been used in Biopsy procedures without histological artefacts. The aim of this in vitro study was to evaluate the exact extent of peripheral thermal damage to Oral soft tissues caused by an Er:YAG laser (λ 2,940 nm) without water cooling. The study was performed on five swine cadaver tongues. Nine samples from each tongue were taken by the same operator using the Er:YAG laser with increasing energies (from 60 to 150 mJ) and fluencies (from 21 to 53 J/cm^2). In addition to the laser samples, a specimen obtained using a scalpel was used as control. The samples were placed in 10% formalin solution and were examined by optical microscopy by two blinded pathologists who assigned a thermal damage score (from 0 to 3) to each sample. The Er:YAG laser produced less damage at 80 and 100 mJ and 28 and 35 J/cm^2 (intermediate parameters). Although in some samples thermal damage was minimally visible, in all samples histological evaluation was clearly possible. The study demonstrated that the Er:YAG laser can be safely used in Oral Biopsy investigations while ensuring a successful histological evaluation, which is fundamental to correct clinical management.