Interventions for treating oral leukoplakia

BACKGROUND

Oral leukoplakia is a relatively common oral lesion that in a small but significant proportion of cases changes into cancer. Since most leukoplakias are asymptomatic, the primary objective of treatment should be to prevent such malignant transformation.

OBJECTIVES

To assess effectiveness, safety and acceptability of treatments for leukoplakia.

SEARCH STRATEGY

The following databases were searched for relevant trials: Cochrane Oral Health Group's Trials Register (to April 2006), CENTRAL (TheCochrane Library 2006, Issue 1), MEDLINE (from 1966 to December 2005), and EMBASE (from 1980 to December 2005). Handsearching was performed for the main oral medicine journals. References of included studies and reviews were checked. Oral medicine experts were contacted through an European mailing list (EURORALMED).

SELECTION CRITERIA

Randomised controlled trials (RCTs), enrolling patients with a diagnosis of oral leukoplakia, were included. Any surgical or medical (topical and systemic) treatment was included. The primary outcome considered was malignant transformation of leukoplakia. Other outcomes considered were clinical resolution, histological modification and frequency of adverse effects.

DATA COLLECTION AND ANALYSIS

Data were collected using a specific extraction form. Malignant transformation of leukoplakia, demonstrated by histopathological examination, was the main outcome considered. Secondary outcomes included clinical resolution of the lesion and variation in dysplasia severity. The validity of included studies was assessed by two review authors, on the basis of the method of allocation concealment, blindness of the study and loss of participants. Data were analysed by calculating risk ratio. When valid and relevant data were collected, a meta-analysis of the data was undertaken.

MAIN RESULTS

The possible effectiveness of surgical interventions, including laser therapy and cryotherapy, has never been studied by means of a RCT with a no treatment/placebo arm. Twenty-five eligible RCTs of non-surgical interventions were identified: 11 were excluded for different reasons, five were ongoing studies, leaving nine studies to be included in the review (501 patients). Two studies resulted at low risk of bias, six at moderate risk of bias and one at high risk of bias. Vitamin A and retinoids were tested by five RCTs, two studies investigated beta carotene or carotenoids, the other drugs tested were bleomycin (one study), mixed tea (one study) and ketorolac (one study). One study tested two treatments. Malignant transformation was recorded in just two studies: none of the treatments tested showed a benefit when compared with the placebo. Treatment with beta carotene, lycopene and vitamin A or retinoids, was associated with significant rates of clinical resolution, compared with placebo or absence of treatment. Whenever reported, a high rate of relapse was a common finding. Side effects of variable severity were often described; however, interventions were well accepted by patients, since drop-out rates were similar between treatment and control groups.

AUTHORS' CONCLUSIONS

To date there is no evidence of effective treatment in preventing malignant transformation of leukoplakia. Treatments may be effective in the resolution of lesion, however relapses and adverse effects are common.

Burning mouth syndrome: a retrospective study investigating spontaneous remission and response to treatments

OBJECTIVE

The aim of this investigation was to evaluate the spontaneous remission rate of burning mouth syndrome (BMS) in a group of subjects suffering from this syndrome.

SUBJECTS AND METHODS

The medical records of BMS patients attending the Unit of Oral Medicine (1995-2002) were reviewed. The patients with a follow-up period of at least 18 months were then contacted over phone and interviewed using a structured ad hoc questionnaire to record their current symptoms and data about their treatment responses to the therapies.

RESULTS

Forty-eight women and five men with a mean age of 67.7 years (range 33-82 years) were included in the study (mean duration of BMS 5.5 years, s.d. +/-1.9 years, mean follow-up period of 56 months). As a consequence of different treatments, 26 patients (49.0%) reported no change in oral symptoms, 15 (28.3%) moderate improvement and 10 (18.9%) a worsening of oral complaints. Only two patients (3.7%) reported a complete spontaneous remission of oral symptoms without any treatment.

CONCLUSIONS

In this study, a complete spontaneous remission was observed in 3% of the patients within 5 years after the onset of BMS. A moderate improvement was obtained in <30% of the subjects.

Osteonecrosis of the jaws in patients treated with bisphosphonates. Review of the literature and the Milan experience

AIM

A series of 5 patients with osteonecrosis of the jaws possibly related to the use of bisphosphonates is presented. A brief review of the literature is also proposed.

METHODS

A retrospective review of patients who received bisphosphonates and who developed osteonecrosis of the jaws following minor oral surgery was performed.

RESULTS

In all 5 patients, a tooth extraction preceded the onset of osteonecrosis of the mandible. Patients were on chronic use of intravenous bisphosphonates. The presenting lesions was a nonhealing extraction socket and an exposed jawbone. Biopsy of the bone lesions showed no evidence of metastatic involvement. Antibiotic therapy, conservative debridement and, in some cases, bone sequestrectomy were performed.

CONCLUSIONS

Osteonecrosis of the jaws appears to have a relationship with the use of bisphosphonates. It is important that medical oncologists and dentists become aware of this possible complication in order to perform minor oral surgery prior to starting bisphosphonates treatment.

Hepatitis C virus-associated oral lichen planus: is the geographical heterogeneity related to HLA-DR6?

BACKGROUND

The association between hepatitis C virus (HCV) and oral lichen planus (OLP) is more common in the Mediterranean area and Japan, possibly because of immunogenetic factors.

METHODS

Intermediate-resolution HLA-DRB typing by hybridization with oligonucleotide probes was performed in 31 Italian OLP patients with HCV infection, in 45 Italian OLP and in 48 British OLP patients without HCV infection. As healthy controls we included data from 145 unrelated Italian and 101 unrelated British bone marrow donors.

RESULTS

Italian HCV+ve OLP patients possessed the HLA-DR6 allele more frequently than Italian and British OLP patients without HCV infection (51.6% vs. 17.7% vs. 16.7%; P corrected = 0.028 and 0.017, respectively). There was no difference in the frequency of the HLA-DR6 allele between Italian and British control subjects.

CONCLUSIONS

The present data suggest that HLA-DR6 may be responsible for the peculiar geographic heterogeneity of the association between HCV and OLP.

Lichen planus and hepatitis C virus: a multicentre study of patients with oral lesions and a systematic review

BACKGROUND

An association between hepatitis C virus (HCV) infection and lichen planus (LP) has been investigated, but results have been inconsistent.

OBJECTIVES

To investigate the relationship between LP and HCV seropositivity. Methods In a cross-sectional study we tested the sera of 303 consecutive newly diagnosed patients with histologically proven LP referred to three Italian centres for the presence of anti-HCV IgG. A comparable control group was also tested. Next, in a systematic review, studies were identified by searching different databases in April 2004. Inclusion criteria were: (i) analytical study design; (ii) clinical and histological diagnosis of LP; and (iii) serological test for anti-HCV antibodies as main outcome. The risk of bias was assessed on the basis of characteristics of the study group, appropriateness of the control group and study design. Pooled data were analysed by calculating odds ratios (ORs), using a random effects model.

RESULTS

In the cross-sectional study, nearly one in five (19.1%) of the LP group was HCV positive, while a much lower prevalence of infection was found in the control group (3.2%) [OR 7.08; 95% confidence interval (CI) 3.43-14.58]. The systematic review yielded 25 relevant studies, six of which had a low risk of bias. There was a statistically significant difference in the proportion of HCV-seropositive subjects among patients with LP, compared with controls (OR 4.80; 95% CI 3.25-7.09). Following subgroup analyses, the variability of HCV prevalence in patients with LP seemed to depend on geographical area, but not on age.

CONCLUSIONS

Anti-HCV circulating antibodies are more common in patients with LP than in controls, although such an association may not be significant in some geographical areas.

Transdermal fentanyl in HSCT patients: an open trial using transdermal fentanyl for the treatment of oral mucositis pain

Fentanyl is a synthetic opioid that can be delivered through a transdermal therapeutic system (TTS). The aim of this study was to assess the efficacy of fentanyl TTS in treating oral mucositis pain in 75 adult hematopoietic stem cell transplant (HSCT) patients. The analysis was based on 62 patients who developed mucositis. Pain control was assessed by the patients using a visual analogue scale (VAS) from day 0 to day +33 after HSCT. Fentanyl TTS was administered at the patient's request. In all, 20 patients did not require fentanyl (group A). The first 22 patients asking for the patch received fentanyl 25 microg/h (group B) and the subsequent 20 patients received 50 microg/h (group C). There were no significant differences in pain relief between groups B and C. The expected effect of a decrease in mean pain score (mean of the VAS scores of all of the patients in the same group each day) following the application of fentanyl TTS was not noted. We can conclude that fentanyl TTS at the doses used in this study may not adequately relieve oral mucositis pain.

Interventions for treating oral leukoplakia

BACKGROUND

Oral leukoplakia is a relatively common oral lesion that in a small but significant proportion of cases changes into cancer. Since most leukoplakias are asymptomatic, the primary objective of treatment should be to prevent such malignant transformation.

OBJECTIVES

To assess effectiveness, safety and acceptability of treatments for leukoplakia.

SEARCH STRATEGY

The following databases were searched for relevant trials: Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE, EMBASE. Handsearching was performed for the main oral medicine journals. References of included studies and reviews were checked. Oral medicine experts were contacted through an European mailing list (EURORALMED).

SELECTION CRITERIA

Randomised controlled trials (RCTs), enrolling patients with a diagnosis of oral leukoplakia, were included. Any surgical or medical (topical and systemic) treatment was included. The primary outcome considered was malignant transformation of leukoplakia. Other outcomes considered were clinical resolution, histological modification and frequency of adverse effects.

DATA COLLECTION AND ANALYSIS

Data were collected using a specific extraction form. Malignant transformation of leukoplakia, demonstrated by histopathological examination, was the main outcome considered. Secondary outcomes included clinical resolution of the lesion and variation in dysplasia severity. The validity of included studies was assessed by two reviewers, on the basis of the method of allocation concealment, blindness of the study and loss of participants. Data were analysed by calculating relative risk. When valid and relevant data were collected, a meta-analysis of the data was undertaken.

MAIN RESULTS

The possible effectiveness of surgical interventions, including laser therapy and cryotherapy, has never been studied by means of a RCT. Nineteen potentially eligible RCTs of non-surgical interventions were identified: eight were excluded for different reasons, four were ongoing studies, leaving seven studies to be included in the review. Two studies resulted at low risk of bias, four at moderate risk of bias and one at high risk of bias. Vitamin A and retinoids were tested by five RCTs (245 patients), the other drugs tested were bleomycin (one study), mixed tea (one study) and beta carotene (one study). Malignant transformation was recorded in just two studies: none of the treatments tested showed a benefit when compared with the placebo. Treatment with beta carotene and vitamin A or retinoids, was associated with significant rates of clinical resolution, compared with placebo or absence of treatment. Whenever reported, a high rate of relapse was a common finding. Side effects of variable severity were often described; however, interventions were well accepted by patients, since drop-out rates were similar between treatment and control groups.

REVIEWERS' CONCLUSIONS

To date there is no evidence of effective treatment in preventing malignant transformation of leukoplakia. Treatments may be effective in the resolution of lesion, however relapses and adverse effects are common.

Dental experience and self-perceived dental care needs of patients with angioedema

The purpose of this study was to investigate the self-perceived dental care needs and dental experiences of patients with angioedema. At the 1998 annual meeting of the Voluntary Association for the Fight, Study and Treatment of Hereditary Angioedema ("Associazione volontaria per la lotta, lo studio e la terapia dell'angioedema ereditario"), a self-administered questionnaire was distributed to participants affected by hereditary or acquired angioedema. Fifty-seven persons completed the questionnaire (37 females, 20 males; mean age, 39 +/- 17 yrs; range, 5-76). The vast majority (91%) had the hereditary form of the disease. One-third of the respondents had some problems in obtaining oral treatment, with one person having been refused care. About half of the group had experienced an acute attack following dental treatment. Preventive measures needed improvement in about two-thirds of respondents. More than half (58%) of the group perceived a need for dental care. We conclude that persons with angioedema may experience difficulty in obtaining dental treatment, a common cause of acute attacks.

Lack of association between hepatotropic transfusion transmitted virus infection and oral lichen planus in British and Italian populations

BACKGROUND

A possible association between oral lichen planus (OLP) and chronic hepatic disease has been found in some populations, although this is probably geographically influenced. In 1997 a new hepatotropic virus, transfusion transmitted virus (TTV), was identified but has not been studied in relation to OLP.

OBJECTIVE

The present investigation evaluated the genoprevalence of TTV DNA in the sera of British and Italian patients suffering from OLP using two different sets of primers to identify TTV subgenomic DNA.

METHODS

Study groups comprised 40 adult subjects (21 British, 19 Italian) with OLP. For each country, two control groups, a disease-control group and a healthy-control group, were included. The presence of TTV DNA in the sera of patients and control subjects was assessed using two different polymerase chain reactions (PCR) and DNA sequence analysis.

RESULTS

Statistical analysis did not reveal evidence of any association between TTV infection and OLP or country of residence.

CONCLUSION

An association between TTV and OLP is unlikely.

[Prognostic systems in intensive care: TRISS, SAPS II, APACHE III]

BACKGROUND

To validate the accuracy of SAPS II, APACHE III and TRISS for the prediction of mortality in Intensive Care Unit (ICU) at polytrauma patients admission. The outcome of multiple trauma patients is often linked to the degree of physiologic dysfunction and to the extension of anatomic lesions, the age of the patient and the lesion mechanism.

METHODS

The study population consisted of 93 cases of multiple injured patients hospitalised at the ICU of the Padua hospital from October 1998 to October 1999; the term polytraumatized patient is referred to patients who have multiple lesions of which at least one potentially endangers, immediately or in a short term, their life. These cases were evaluated with the APACHE III, SAPS II, Revised Trauma Score and Injury Severity Score. The predictive power of each system was evaluated by using decision matrix analysis to compare observed and predicted outcome with a decision criterion of 0.50 and 0.40 for risk of hospital death.

RESULTS

All trauma score systems under study showed high accuracy rates, above all if they are used with a 40% positive test.

CONCLUSIONS

The prognostic scales used in this study showed a good correlation between expected and observed cases, particularly with TRISS and APACHE III systems. The APACHE III system seems to be the most reliable of the different methods analysed. These prognostic systems are seldom or occasionally used in the ICU, in Padua and in the whole of Italy, so Italian data are not suitable to be compared to international ones. Due to urgency, the importance of the evaluation scales is often underestimated, but even if they require time and attention, they surely can be useful in the evaluation of the treatment, and not only of a polytraumatized patient.

Interventions for treating oral leukoplakia

BACKGROUND

Oral leukoplakia is a relatively common oral lesion that in a varying proportion of cases undergoes malignant transformation. Since most leukoplakias are asymptomatic, the need for treatment is primarily based on the precancerous nature of the lesion.

OBJECTIVES

To assess effectiveness, safety and acceptability of treatments for leukoplakia.

SEARCH STRATEGY

The following data bases were searched for relevant trials: MEDLINE, EMBASE, CancerLit, Biological Abstracts, Cochrane library. Hand searching was performed for the main oral medicine journals. Oral medicine experts were contacted through an European mailing list (EURORALMED).

SELECTION CRITERIA

Randomised controlled trials (RCTs), enrolling patients with a diagnosis of oral leukoplakia, were included.

DATA COLLECTION AND ANALYSIS

Data were collected using a specific abstraction form. Malignant transformation of leukoplakia, demonstrated by histopathological examination, was the main outcome considered. Secondary outcomes included clinical resolution of the lesion and variation in dysplasia severity. The validity of included studies was assessed on the basis of the method of allocation concealment, blindness of the study and loss of participants. Data were analysed by calculating relative risk.

MAIN RESULTS

The possible effectiveness of surgical interventions, including laser therapy and cryotherapy, has apparently never been studied by means of a RCT. Fourteen potentially eligible RCTs of nonsurgical intervention were identified: five were excluded for different reasons, three were ongoing studies, leaving six studies to be included in the review. Vitamin A and retinoids were tested by four RCTs (224 patients), the other drugs tested were bleomycin (one study), mixed tea (one study) and beta carotene (one study). Malignant transformation was recorded in just two studies: none of the treatments tested showed a benefit when compared with the placebo. Treatment with beta carotene and vitamin A or retinoids, was associated with better rates of clinical remission, compared with placebo or absence of treatment. Whenever reported, a high rate of relapse was a common finding. Side effects of variable severity were often described; however, interventions were well accepted by patients, since drop-out rates were similar between treatment and control groups.

REVIEWER'S CONCLUSIONS

To date there is no evidence of effective treatment in preventing malignant transformation of leukoplakia. Treatments may be effective in the resolution of lesion, however relapses and adverse effects are common.

Genoprevalence of TT virus among clinical and auxiliary UK dental healthcare workers: a pilot study

BACKGROUND

In 1997 a new human hepatotropic virus, TT virus (TTV), was identified. The clinical significance of TT virus infection remains unclear.

OBJECTIVE

To undertake an initial evaluation of the genoprevalence of TTV DNA among health care workers in the United Kingdom.

SETTING

A UK dental hospital.

STUDY DESIGN

The sera of 53 dental healthcare workers (9 dentists, 14 dental nurses and 30 office staff) were tested for the presence of TTV DNA using Polymerase Chain Reaction (PCR).

RESULTS

TT virus DNA was detected in 3 out of 53 (5.7%) samples. This frequency of TTV carriage is similar to that of blood donors and healthy persons in the UK.

CONCLUSION

The present data suggest that dental healthcare workers in the UK are not at increased risk of nosocomial acquisition of TT virus.

Skin morphology and function in Xenopus laevis exposed to a saline environment for up to one week

This study evaluated the skin adaptation response in Xenopus laevis to short- and medium-term stays (24 h, 48 h, 7 days) in brackish water. Morphological, histochemical, histoenzymological (alkaline phosphatase, carbonic anhydrase) and electrophysiological (short-circuit current, resistance) characteristics were examined. The results show that animals adapt to brackish water, implementing a variety of short and medium-term morphofunctional modifications of the epidermis and skin glands. These modifications form part of the defence mechanisms needed to protect the animal from an excess increase in the saline concentration of internal fluids.

A specific alkaline phosphatase of amphibia integument levamisole effect on short circuit current (SCC)

Using the Ussing chamber technique we have measured the short-circuit current (SCC), and so the ion transport, in the ventral skin of samples of Rana esculenta complex. The animals were not exposed to experimental treatment, and on SCC we have observed the effect of levamisole, administered either on external or internal side. Levamisole 0.0025 mM was ineffective; higher concentrations (0.025 mM, 2.5 mM), which inhibit alPase activity in tissue extracts and sections, induced an increase in SCC measurements and the effect was proportional to the concentration. Levamisole 25 mM produced a rapid and transitory increase of SCC, followed by a very quick decrement of it. Because of the action of Levamisole, "specific inhibitor of alPase activity", on ion transport in Rana skin, we propose that the alPase enzyme is probably involved in ion cutaneous transport and thus in the adaptative osmoregulation in the integument of amphibia.

Biochemical assessment and clinical evaluation of a non-ionic adsorbent resin in patients with intractable jaundice

We investigated in vitro and in vivo the ability of a non-ionic adsorbing resin (styrenedivinylbenzene copolymer) to remove bilirubin and bile acids from human plasma. In preliminary experiments, human plasma from healthy donors, enriched in conjugated bile acids and bilirubin, and pooled plasma from jaundiced patients were recirculated through the resin column. The removal of bilirubin and bile acids was evaluated at two different flow rates (200 ml/min and 40 ml/min), and compared to an activated charcoal column. Four patients with severe jaundice were subsequently treated by 4-hour plasmaperfusion through the resin. The in vitro studies showed that after 1 hour the removal of bile acids was almost complete and bilirubin level decreased significantly, reaching a plateau after 4 hours. In the in vivo study, all treatments were well tolerated. After plasmaperfusion, serum bile acid levels decreased by 64.9-94.6% and total bilirubin by 35.3-57.7%. No clinical or biochemical side effects were observed. Our data suggest that plasmaperfusion through this resin is safe and efficient for removal of bilirubin and bile acids in jaundiced patients. Thus, it may serve as a method of artificial liver support in the treatment of cholestatic syndromes.

Hepatitis C virus-associated oral lichen planus: no influence from hepatitis G virus co-infection

There is a variable geographic distribution in the prevalence of hepatitis C virus (HCV)-related oral lichen planus (OLP), which appears unrelated to either HCV genotype or HCV epidemiology. The present study investigated whether hepatitis G virus (HGV) co-infection may be a feature of patients with HCV-related OLP, which might explain these phenomena. HGV co-infection was detected in 6 of 39 Italian patients with HCV-related OLP, but the presence of HGV did not influence the clinical presentation of OLP. It is concluded that HGV co-infection is unlikely to influence the clinical detection of HCV-related OLP.

Benzydamine hydrochloride oral rinses in management of burning mouth syndrome. A clinical trial

OBJECTIVE

The purpose of this study was to evaluate the efficacy of the topical use of benzydamine hydrochloride 0.15% oral mouthwashes in the control of burning mouth syndrome symptoms.

STUDY DESIGN

In this double-blind, randomized, longitudinal investigation, each of 30 patients with burning mouth syndrome was assigned to one of 3 management modalities. Those in group A received an oral rinse solution of benzydamine hydrochloride 0.15% 3 times a day for 4 weeks, those in group B received a placebo 3 times a day for 4 weeks, and those in group C did not receive any kind of treatment. A visual analog scale was used for evaluation of the symptoms; a Kruskal-Wallis analysis of variance exact test was performed on the resulting data.

RESULTS

The findings of this investigation failed to reveal significant differences among the groups.

CONCLUSIONS

The clinical application of benzydamine hydrochloride oral rinses in the treatment of patients with burning mouth syndrome did not demonstrate significative efficacy in comparison with use of a placebo solution.

Hepatitis G virus: relevance to oral health care

OBJECTIVE

To review the current literature on the hepatitis G virus (HGV) infection, with particular attention to the aspects of interest for the dental staff.

MATERIAL AND METHODS

The authors searched for original research and review articles on specific aspects of the HGV infection including virology, epidemiology, transmission, natural history, and dental zaspects of HGV infection. The relevant articles were evaluated and reviewed.

RESULTS

HGV is a parenterally transmitted RNA virus that may cause acute, chronic, and fulminant liver disease; however, the real pathogenic potential of this virus and its possible effect on other hepatitic infections is still to be clarified. Preliminary studies have failed to demonstrate strong relationships between HGV infection and any oral disease. At present, data on the prevalence of HGV infection among health care workers are scarce. Nevertheless, in view of the potential transmission rates of HGV and the lack of effective immunization, HGV should be regarded as a potential occupational hazard for medical and dental staff.

CONCLUSION

Many virological, medical, and oral aspects of HGV infection need to be further investigated; nevertheless, until related data are available, HGV should be considered to be an infection that may be transmitted during dental care.

Assessment of distribution of CD34 epitope classes in fresh and cryopreserved peripheral blood progenitor cells and acute myeloid leukemic blasts

BACKGROUND AND OBJECTIVE

So far several reports have described changes in the expression of surface antigens in progenitor cells and blasts following cryopreservation. However, there are no data on the effects of cryopreservation on the expression of the three CD34 epitope classes, and on their relationship with the clonogenic capacity of PBPC collected by leukapheresis.

DESIGN AND METHODS

In order to analyze the effects of freezing/thawing procedures (Eth 80C storage for 3 months) and use of dimethylsulfoxide (DMSO) on the immunophenotype profile and colony production of peripheral blood progenitor cells (PBPC) in apheresis products derived from 20 patients with stage 0-III non-Hodgkin's lymphoma (nHL), a flow cytometry study was undertaken using different CD34 monoclonal antibodies (MoAbs) capable of recognizing the 3 epitope classes of CD34 molecule (class III: HPCA-2/FITC, HPCA-2/PE, 581/FITC, 581/PE; class II: Q-Bend 10/PE; class I: ICH3/PE, BI3C5-PE, Immu-133-PE). CD34 epitope expression was also analyzed in thawed CD34+ blasts obtained from 14 patients with acute myeloid leukemia (AML), who were analyzed using a larger number (#17) of CD34 epitope class I, II, and III reactive MoAbs.

RESULTS

Under our experimental conditions it was found that class III and class II CD34 epitopes (differentially resistant to enzymatic cleavage with neuraminidase, chymopapain and glycoprotease) are better preserved than class I epitope Eth sensitive to degradation Eth after cell exposure to cryoprotectant DMSO and the freezing- thawing procedures. Results further showed a concomitant decrease in class I CD34+ counts and in BFU-E colony production. A significant increase in CD34 antigen expression levels (i.e. antibody binding capacity, ABC) by cryopreserved cells stained with CD34 epitope class III, and class II reactive MoAbs was also documented, while no changes after cryopreservation were noted using class I-reactive MoAbs. The slight increase in the percentage of CD34+ cells detected after frozen storage was correlated to a concomitant decrease in the number of more mature myeloid cells (CD15+, CD13+, CD33+). Compared to pre-cryopreservation values, a slight reduction in class I CD34 epitope expression was also found in thawed CD34+ AML blasts.

INTERPRETATION AND CONCLUSIONS

As far as the reduction of class I CD34 epitope is concerned, it may be hypothesized that the freezing procedure, use of DMSO, and/or lysis methodology may either damage a CD34 subset, or induce distinct alterations of the CD34 glycoprotein, possibly determining a reduction in their immunoreactivity with some CD34 MoAbs. In conclusion, this study has shown that exposure to the cryoprotectant DMSO and the freezing/thawing procedures modifies the distribution of CD34 epitopes as well as the clonogenic capacity of PBPCs from nHL patients, and CD34+ blasts from AML. These findings need to considered when selecting CD34 MoAbs for enumeration and positive selection of stem/progenitor cells for research and clinical purposes.

GM-CSF mouthrinses in the treatment of severe oral mucositis: a pilot study

OBJECTIVE

The aim of this open trial was to test the efficacy of granulocyte-macrophage colony-stimulating factor (GM-CSF) mouthrinses as a potential treatment in reducing the duration of severe oral mucositis in patients undergoing bone marrow transplantation for hematologic malignancies.

STUDY DESIGN

The study group was composed of 10 consecutive patients suffering from severe oral mucositis during bone marrow transplantation procedures. The control group was similar to the study group in age and gender and comprised 29 historical patients with similar clinical characteristics. Freshly prepared GM-CSF mouthwash (0.5 microg/mL) was administered to the study population for 1 minute 3 times per day after oral hygiene procedures, starting from the first day of mucositis until clinical improvement of oral lesions. The study and control populations were compared with respect to duration of severe oral mucositis (1-9 days, 10-19 days, > or =20 days).

RESULTS

There was no statistically (chi2 exact test) significant difference in mean mucositis score between the study group (11.9+/-6.1) and the control group (16.6+/-8.9). However, the duration of severe mucositis appeared to be reduced; 60% of the GM-CSF mouthrinse patients had severe mucositis for less than 9 days, whereas only 28% of the controls had severe mucositis for less than 9 days. In addition, 10% of the GM-CSF mouthrinse patients experienced severe mucositis lasting 20 or more days, whereas 34% of the controls experienced severe mucositis for 20 or more days.

CONCLUSIONS

These findings suggest that GM-CSF may reduce the duration of severe mucositis, but controlled, double-blind clinical trials are now required.

Oral lichen planus in patients infected or noninfected with hepatitis C virus: the role of autoimmunity

Serum proteins, serum immunoglobulins, anti-nuclear antibodies (ANA), anti-smooth muscle antibodies (ASMA), anti-mitochondrial antibodies (AMA), anti-liver-kidney antibodies (LKM), anti-parietal-cell gastric antibodies (APCA), anti-epithelial antibodies and concomitant autoimmune disease were studied in 27 OLP-HCV+ve subjects and in a comparable group of 23 who were OLP-HCV-ve. In addition, all the patients with chronic liver disease who were sero-positive for ANA, AMA or LKM were scored using the new aggregate scoring system to detect those with the accepted criteria for the diagnosis of autoimmune hepatitis (AIH). Hypergammaglobulinemia was more frequent in OLP-HCV+ve than in OLP-HCV-ve (P = 0.008) subjects. Serum IgG and IgM levels were higher in HCV+ve than in HCV-ve (respectively, P = 0.017 and P = 0.018) individuals. However, there was no difference in the frequency of any autoantibody between OLP-HCV+ve and OLP-HCV-ve patients. Overall, immunologically-related abnormalities were found in 17(63%) OLP-HCV+ve and 11(48%) OLP-HCV-ve (P = 0.43) patients. Three OLP-HCV-ve and no OLP-HCV+ve patients had score criteria of probable AIH. The present and our previous data suggest that OLP patients with HCV infection neither had evidence of autoimmune liver damage nor had abnormal humoral immune-responses, with the exception of higher than control levels of serum immunoglobulins. Cryoglobulins may be responsible.

Prevalence and determinants of anti-lytic and anti-latent antibodies to human herpesvirus-8 among Italian individuals at risk of sexually and parenterally transmitted infections

Three hundred seventy-nine individuals [137 non-injecting drug using (non-IDU) heterosexuals, 130 homosexual men and 112 IDU] attending the human immunodeficiency virus (HIV) testing program of a sexually transmitted disease (STD) clinic in Rome were studied to estimate the prevalence and to identify the modalities of transmission of human herpesvirus-8 (HHV-8) infection. Serological analysis was performed by using an immunofluorescence assay able to detect anti-latent and anti-lytic HHV-8 antibodies. Twelve acquired immunodeficiency syndrome (AIDS)-Kaposi's sarcoma (KS) patients and 94 blood donors were tested as reference population groups. Anti-lytic antibodies were detected in 185 (48.8%) individuals; 52 of them (13.7%) also had anti-latent antibodies. Both anti-lytic and anti-latent antibody prevalence were higher among homosexual men (66.9% and 27.7%, respectively) than among IDU (49.1% and 8.0%, respectively) and non-IDU heterosexuals (31.4% and 5.1%, respectively), and tended to increase with age. Anti-lytic HHV-8 antibodies were associated with syphilis [odds ratio (OR)=3.81] but not with hepatitis C virus (HCV) seropositivity. HIV-infected homosexual men were more likely to have HHV-8 antibodies than those who were HIV-negative. When using anti-latent antibodies the direction of the OR remained the same, although the associations did not often reach statistical significance. Among AIDS-KS patients, 83.3% had anti-lytic and 66.6% had anti-latent antibodies. Among blood donors, 28% had anti-lytic antibodies and 2 of them (2.1%) also had anti-latent antibodies. Our data indicate that HHV-8 seroprevalence increases with age and is higher among homosexual men, particularly those infected with HIV. This is consistent with sexual transmission of HHV-8 infection. In addition, the presence of HHV-8 antibodies in HIV-negative non-IDU heterosexual contacts and in healthy blood donors is consistent with the high incidence of classic KS in Italy.

Hepatitis C virus infection: Review and implications for the dentist

OBJECTIVE

The purpose of this report was to review the current literature on hepatitis C virus infection, with particular attention to the aspects of interest for dental health care staff.

MATERIAL AND METHODS

The authors searched original research and review articles on specific aspects of hepatitis C virus infection, including articles on virology, epidemiology, transmission, diagnosis, natural history, extrahepatic manifestations, therapy and oral aspects of hepatitis C virus infection. The relevant material was evaluated and reviewed.

RESULTS

Hepatitis C virus is an RNA virus that is present throughout the world and has major geographic variations. The virus, transmitted mainly by means of blood contact, causes chronic hepatitis in up to 80% of cases and may give rise to hepatic cirrhosis and hepatocellular carcinoma in a significant proportion of patients. Although it is of limited efficacy, interferon alpha is currently the drug of choice in the treatment of the infection. Hepatitis C virus infection is associated with a number of extrahepatic manifestations that may include oral diseases such as lichen planus or sialadenitis. Although there are documented cases of nosocomial transmission to health care workers after percutaneous exposure, the prevalence of hepatitis C virus among dental staff members is probably similar to that in the general population.

CONCLUSION

Hepatitis C virus infection is a relatively common infection worldwide (1.4% in the US general population) that causes significant chronic hepatic disease. The dentist is thus likely to face a growing number of patients with a diagnosis of hepatitis C virus infection. For this reason it is essential for dental health care workers to be aware of the principal features of the disease and of its oral and dental implications.

Kappa light chain deposition disease of the liver

We report the case of a middle-aged woman presenting epigastric discomfort, hepatomegaly, biochemical signs of cholestasis, bone marrow plasmocytosis and Bence Jones proteinuria. Percutaneous liver biopsy disclosed kappa light chain deposition disease of the liver and fine needle aspiration of abdominal fat showed amyloid substance. Renal blood chemistries and urinalysis were repeatedly normal. To our knowledge, this is the first reported case of kappa light chain deposition disease of the liver and concomitant amyloidosis without renal involvement as the first manifestation of plasma cell dyscrasia. This condition should be considered in the differential diagnosis of intrahepatic cholestatic liver disease.

Prevalence of HCV infection in health care workers of a UK dental hospital

OBJECTIVE

To determine the prevalence of hepatitis C virus (HCV) antibodies in a group of dental health care workers (DHCW).

DESIGN

Retrospective cross sectional study.

SETTING

A UK dental hospital.

SUBJECTS AND METHODS

The sera of 167 unselected DHCW were tested for the presence of IgG antibodies to HCV using two, third-generation enzyme-linked immunosorbent assays (ELISA). HCV viremia was determined by reverse transcription polymerase chain reaction (RT-PCR) analysis.

RESULTS

Two (1.2%) of the serum samples were found to be anti-HCV positive; one was also viremic. The two antibody-positive subjects were a qualified dental nurse and a student dental nurse, both females, without any known risk factor for HCV acquisition. No dentist was HCV seropositive.

CONCLUSIONS

Since the prevalence of HCV infection in the UK general population varies between 0.08% and 0.55%, these results suggest that DHCW, and auxiliary staff in particularly, may have a slightly increased risk of HCV infection.

Preparation and characterization of oxide film electrodes

In this paper are presented data on the preparation and characterization of different oxide electrodes. RuO2–TiO2, IrO2–TiO2, and SnO2–Sb2O5 mixed-oxide films have been taken as model systems. For the first, the traditional preparation method based on the pyrolysis of precursor salt deposits was adopted. For the SnO2-based films, the spray pyrolysis preparation has been used. The characterization of RuO2–TiO2 films confirms the existence of a solid solution between the two component oxides over a wide composition range. Rutherford backscattering spectrometry confirms the occurrence of segregation of titanium oxide species in the outermost part of the films. Nuclear reaction analysis indicates that large amounts of carbon and hydrogen impurities are trapped in the oxide films. SnO2-based films were found to be less porous and chemically more simple. The differences between the two systems have been discussed in terms of the preparation method and the differences in chemical properties of the precursors. Keywords: oxide film electrodes, mixed-oxide films, Rutherford backscattering spectrometry, nuclear reaction analysis.

HCV genotypes in Italian patients with HCV-related oral lichen planus

Hepatitis C virus (HCV) has high genomic variability and since its discovery, six different "types" and an increasing number of "subtypes" have been reported. HCV genotype may influence viral replication, natural history of disease and response to therapy. Recently, an association between lichen planus (LP) and HCV infection has been suggested, as there is an increased frequency of HCV infection among some groups of patients with LP, in particular from Italy and Japan. These results have not been confirmed by other reports from different geographical areas. Since HCV genotypes have a heterogeneous geographical distribution, we have determined by restriction fragment length polymorphism the genotypes of 39 HCV-seropositive Italian patients with oral LP in order to establish whether the association between LP and HCV infection is influenced by HCV subtype. Of the 33 (84.6%) viraemic patients, 17 (51%) were infected by HCV subtype 1b, 9 (27%) were infected by HCV subtype 2a, 2 by subtype 1a and 1 by subtype 2b. In four cases the gel patterns were uninterpretable. This distribution of HCV genotypes is similar to that reported in recent studies of Italian HCV-seropositive patients of unknown LP status. It is concluded from this small sample that the association of lichen planus with HCV infection and its differential geographic distribution is unlikely to be due to infection by a particular HCV genotype.

Local antimicrobial therapy of oral mucositis in paediatric patients undergoing bone marrow transplantation

The present investigation has examined the clinical benefits of tobramycin, polymyxin E and amphotericin therapy in the management of oral mucositis in children undergoing chemotherapy prior to bone marrow transplantation. Tobramycin, polymyxin E, and amphotericin reduced the degree of oral mucositis more than conventional therapy of diphenhydramine, Maalox, and local analgesic. While there was a statistically significant fall in the severity of the mucositis with tobramycin, polymyxin E and amphotericin, this was unlikely to be of practical benefit.

Oral lichen planus is not associated with IgG circulating antibodies to epithelial antigens

Autoantibodies to a number of epithelial components have previously been described in small groups of patients with lichen planus. Recently a group of antibodies to monkey esophagus have been detected in lichen planus related to hepatitis C virus infection. This study has examined the frequency of serum antiepithelial antibodies in a group of patients with idiopathic oral lichen planus and lichenoid drug reactions. Five of 34 patients with idiopathic lichen planus and two of six patients with lichenoid eruptions had circulating antibodies that gave rise to an antinuclear pattern when examined using epithelial tissue. However, these antibodies were present in only low titer and were not specific to a particular clinical presentation of lichen planus or lichenoid drug reaction. It seems likely therefore that such antibodies do not play an important part in the etiopathogenesis of lichen planus, and their detection is unlikely to be beneficial in the diagnosis of this disease.

Hepatitis C virus infection and lichen planus: a short review

OBJECTIVE

To review the current literature regarding the association of lichen planus (LP) and liver disease, with particular attention to the association of the oral variant of the disease with hepatitis C virus (HCV) infection.

MATERIALS AND METHODS

Available literature of the possible association of LP with systemic disorders, in particular chronic hepatic disease, has been reviewed.

RESULTS

LP is sometimes associated with infectious or autoimmune disease and/or neoplasia, however an aetiological association between LP and these disorders seems unlikely. A more consistent association exists between LP and chronic hepatic disease. The precise cause of this association is not known. However, in the last 6 years a notable association between HCV infection and LP has been observed, particularly in patients in Spain, Italy and Japan. The pathogenesis of this possible HCV-associated LP is not known, but it may involve a cell mediated response to an altered epithelial antigen.

CONCLUSION

There is now evidence to suggest a significant association between HCV infection and LP in some groups of patients.

Attitude towards smoking and oral cancer prevention among northern Italian dentists

The aim of the study was to evaluate the smoking habits of Northern Italian dental practitioners and their basic skills in the prevention of oral cancer. 217 of the 250 dental practitioners (86.8%) contacted by telephone from September to December 1994, answered a simple questionnaire. One third of the sample interviewed was formed by current smokers; nevertheless 60.8% of them always advise their patients to give up smoking. Only a relatively small percentage of the questioned dental practitioners (10.6%) do not examine the oral mucosa of the patients on a regular basis and 40% of responders had made a clinical diagnosis of oral cancer in the past. The lack of a specific dental education was associated with less scrupulous examination of the oral soft tissues and minor experience of cancer diagnosis. Despite their smoking habit, Northern Italian dental practitioners self-reported encouraging behaviour towards primary and secondary oral cancer prevention.

Antibodies to epithelial components in oral lichen planus (OLP) associated with hepatitis C virus (HCV) infection

Oral lichen planus (OLP) is a common chronic inflammatory disorder sometimes associated with hepatitis C virus (HCV) infection. An increased prevalence of autoimmune markers has been reported in patients with HCV infection. The aim of the present study was to determine, by conventional indirect immunofluorescence, the nature and frequency of circulating antibodies to epithelial antigens in the sera of HCV-positive patients who also have OLP. The study comprised four groups: 14 patients with OLP and HCV infection. 14 HCV-seronegative patients with OLP, 21 HCV-seropositive patients without OLP and 18 healthy controls. We found a significant association between the concomitance of OLP and HCV infection and the presence of such antibodies. It is concluded that some patients with HCV-associated OLP may have circulating antibodies to epithelial antigens, although their precise aetiological role in the development of this disease in HCV infection remains unknown.

Development of squamous cell carcinoma in hepatitis C virus-associated lichen planus

The hepatitis C virus may occasionally be associated with oral lichen planus. The present report details the features of a patient with hepatitis C virus infection and oral lichen planus who developed a squamous cell carcinoma of the tongue.

Occupational risk of hepatitis C virus infection to dental health care staff: an update

This article highlights current knowledge of the epidemiology and transmission of hepatitis C virus and reviews current information on the risk of transmission of the virus during dental health care.

Hepatitis C virus (HCV)--an occupational risk to dentists?

Hepatitis B virus has long been regarded as an occupational hazard in dentistry. However, as the availability of effective vaccination has reduced the risk of HBV infection, so dental staff have become aware of the potential risk of transmission of hepatitis C virus during dental treatment. This article outlines current relevant data suggesting that nosocomial transmission of HCV in dentistry is unlikely.

[Findings in relation to serum and urinary iron in heterozygotic beta-thalassemia]

Iron status (expressed as serum ferritin and iron levels) has been compared in normal and in heterozygous beta-thalassemic subjects. A higher serum ferritin concentration has been found in beta-thalassemic males, showing, therefore, a shift towards super-normal values of the balance between tissue iron and serum ferritin levels. In beta-thalassemic subjects the serum ferritin levels have been found in the normal range and this seems to be correlated with an adequate and ready iron supply by protein transferrin to hyperplastic bone marrow. The higher urinary iron values in normal male subjects can be explained in this way: a large iron supply from the transferrin to the thalassemic erythroid cells limits the contribution from this protein to the urinary iron.