Differentiating a contact lens-induced peripheral ulcer (CLPU) from early stage microbial keratitis (MK) is primarily based on clinical judgment rather than on microbiologic or histopathologic investigations. For this reason, tests do not provide valuable information at the early stages in the clinical course of MK. Whereas in gross terms, the clinical picture of MK is more acute and severe than CLPU, clinical features of the two can overlap, sometimes resulting in errors of judgment and mismanagement. This article provides clinical clues that help distinguish the two conditions. In addition, a scoring system has been devised for MK and CLPU. Microbial keratitis (MK) is a dreaded complication for contact lens wearers. Although the risk is small, the large population of contact lens (CL) users have made CL wear a major predisposing factor for corneal infection. The reported incidence of MK among CL wearers may be inaccurate because it can be easily confused with its sterile counter part, contact lens-induced peripheral ulcer (CLPU). An accurate initial clinical impression is critical in avoiding mismanagement of these conditions. Clinical differentiation between infected and sterile corneal infiltrates in CL wearers has been addressed in the literature. We suggest a scheme for distinguishing early stage MK from CLPU.

Background: Excision of all visible neoplastic tissue is the goal of endoscopic mucosal resection (EMR) of colorectal laterally spreading tumors (LSTs). Flat and fibrotic tissue can resist snaring. Ablation of visible polyps is associated with high recurrence rates. Avulsion is a technique to continue resection when snaring fails. Methods: We retrospectively analyzed colonic EMRs of 564 consecutive referred polyps between 2015 and 2017. Hot avulsion was used when snaring was unsuccessful. Polyps treated with and without avulsion were compared. Results: Hot avulsion was used in 20.9% (n=112) of all resected lesions. The recurrence rates on follow up colonoscopy were 17.52% in avulsion group versus 16.02% in the non-avulsion group (p= 0.76). Hot avulsion was associated with a trend toward higher rates of delayed hemorrhage (5.35% vs 2.58%; p=0.15) and post-coagulation syndrome (1.8% vs 0.47%; p=0.15), but polyps treated with any avulsion were larger than those in which no avulsion was used (p=<0.001). There were an insufficient number of adverse events to perform a multivariable analysis testing the effects of avulsion, size, and location on the risk of overall adverse events. Conclusion: Unlike previous reports of using argon plasma coagulation to treat visible polyp during EMR, hot avulsion of visible/fibrotic neoplasia was associated with similar EMR efficacy compared with cases that did not require hot avulsion. The safety profile of hot avulsion appears acceptable.

Background:The Bcl-2 (B-cell lymphoma) gene product also known as apoptotic inhibitor is expressed in many normal and tumor tissues. This Bcl-2 gene protects the cell by blocking postmitotic differentiation from apoptosis, thus maintaining the stem cell pool.Objective:To study the expression of Bcl-2 protein in ameloblastoma and keratocystic odontogenic tumor (KCOT) to determine their apoptotic behaviors and to analyze biological nature of KCOT, which has higher proliferative potential and aggressive clinical behavior like odontogenic tumors.Materials and Methods:Formalin-fixed paraffin sections of ameloblastoma (n = 20) and KCOT (n = 20) are considered for immunohistochemical analysis using monoclonal antibody against antihuman Bcl-2 oncoprotein. Lymphomas (n = 3) were used as controls.Statistical Analysis:The statistical analysis was performed using software package of social science version 16. The data were analyzed using Chi-square test and Student's t test. In all the above tests, P < 0.05 was accepted as statistically significant.Results:The positive ratio of Bcl-2 was 85% (17/20) in ameloblastoma, 85% (17/20) in KCOT and 100% (3/3) in lymphomas. Bcl-2 was expressed in peripheral cells and few scattered cells of stellate reticulum in ameloblastoma. KCOT showed strong positivity for Bcl-2 mainly in the basal layer.Interpretation and Conclusion:The present study demonstrates the aggressive nature of KCOT and intrinsic growth potential of its lining epithelium. This study clearly demonstrates that KCOT like ameloblastoma demonstrates aggressive clinical and noticeable invasive behavior. Therefore, it is now considered as no longer a developmental cyst but as odontogenic tumor.