Diagnosis, treatment and follow-up control in 124 patients with basal cell carcinoma of the maxillofacial region treated from 1992 to 1997

AIM

The aim of this study was to analyze diagnostic and therapeutic procedures and the outcome of patients treated for the most common malignant tumor of the facial skin, basal cell carcinoma.

PATIENTS AND METHODS

The files of patients with basal cell carcinoma (BCC) treated over a period of 6 years were evaluated. Emphasis was placed on the frequency of second interventions, local recurrences and histological subtyping of tumors.

RESULTS

One-hundred and twenty-four patients were treated for 216 basal cell carcinomas (solitary: 67%, multiple: 33%). The tumors were predominantly located in the skin covering the middle third of the face. The tumors were 30 mm or less in diameter in 86%. Treatment was exclusively surgical. Histopathological subtyping revealed solid (83%), sclerodermiform (10%), metatypical (4%) and multicentric (3%) tumors. Resection of adjacent bone was mandatory in 12 patients and orbital exenteration in 2. Further local resections were necessary after thorough histological investigation in 71% of patients. Local recurrences occurred in 14 patients, predominantly within the first year after ablative surgery. Relative to the small number of sclerodermiform BCC, this subtype was the most frequent tumor that developed local recurrences.

CONCLUSION

Basal cell carcinoma is a malignant tumor, slowly growing and often showing wide extension to macroscopically non-affected sites. Resection of tumors is delicate in the maxillofacial region due to the predilection for sites of origin adjacent to structures of eminent importance for facial appearance. The sclerodermiform subtype is prone to local recurrence and these patients should be followed up carefully.

Stable and long-lasting immune response in horses after DNA vaccination against equine arteritis virus

Equine arteritis virus (EAV) is the causative agent of the equine viral arteritis. It is a small RNA virus with a linear, non-segmented plus RNA genome. EAV is a member of the Arteriviridae family that includes porcine reproductive and respiratory syndrome virus (PRSSV), simian haemorrhagic fever virus (SHFV) and lactate dehydrogenase virus (LDV). The viral transmission is via respiratory and reproductive routes. Clinical signs in horses vary, and severe infection can lead to abortions in pregnant mares or neonatal foal death. The aim of this study was to investigate the development of the immune response in horses after immunization with a DNA vaccine harbouring and expressing EAV Open Reading Frames (ORF) 2, 5, and 7, in combination with equine interleukin 2 (eqIL2). Three boosters followed the basic immunization in two-week intervals. Each immunization was a combination of gene gun and intramuscular injection. All horses developed a high titer of neutralizing antibodies after basic immunization within 2 weeks. Remarkably, this immune response was found to be independent of the age of animals. The youngest horse was six-years old, and the oldest twenty-two years old. A remarkable difference in the immune response between the young and old were not observed. The duration of immunity was investigated during a period of one year. After 12 months, neutralizing antibodies were still detectable in all the vaccinated horses.

[Abnormalities of the maxillary sinus in type 1 neurofibromatosis]

AIM

The aim of this study was to determine the malformations of the maxillary sinus in neurofibromatosis type 1 patients (NF1).

MATERIAL AND METHODS

Twenty-two patients with NF1 were investigated clinically and radiologically: 11 had an unilateral trigeminal plexiform neurofibroma and 11 had multiple cutaneous neurofibromas. The histological type of NF was ascertained in all cases following tumor resections. The malformation of the maxillary sinus was assessed on plain radiographs and computed or magnetic resonance tomograms. Intraindividual side comparison was used to judge the size of the sinus and its position in the midface.

RESULTS

In patients with cutaneous neurofibromas the maxillary sinus appeared symmetrical in size and position. The pneumatization of the sinus had no abnormalities on the radiographs. Malformations of the maxillary sinus were restricted to plexiform neurofibromas. On the side affected by a plexiform NF, the sinus appeared hypoplastic and caudally displaced due to an enlarged ipsilateral orbit. The expansion of the sinus to the lateral side was impaired, obviously due to tumor masses. Consecutively, the alveolar process of the affected side was also displaced leading to a complex malocclusion.

DISCUSSION

Malformations of the face are frequently presented as case reports in the literature. Emphasis is given to the elephantiasis-like tumor growth of the face in certain patients with NF1. The underlying pathology has not yet been fully understood. This report provides evidence that in the midfacial region the overgrowth is predominantly caused by the plexiform neurofibroma itself and that the bones can even be hypoplastic and show scoliosis-like malformation compared to the nonaffected side. These findings are relevant when debulking procedures of the face are planned for NF1 patients.

Limitations of B-scan ultrasound for diagnosing fractures of the mandibular condyle and ramus

The aim of this study was to analyse the applications and limitations of B-scan ultrasonography for diagnosing fractures of the mandibular condyle and ramus. Thirty-two patients with 39 radiologically proven fractures of the mandibular condyle and ramus were included in the study. The patients were examined with a 7.5 MHz small-part applicator. Five patients without fractures of the facial skeleton acted as controls. Normal sonoanatomical findings had been obtained for patients without mandibular fractures. B-scan ultrasonography enabled the experienced examiner to identify dislocated fractures of the mandibular ramus and the articular process in 67% of the fractures. The main disadvantage of ultrasonography was the inability of this technique to identify non-dislocated fractures. Because of its low sensitivity and specificity, B-scan ultrasonography does not provide an alternative to X-ray diagnosis of mandibular condyle and ramus fractures.

Large envelope glycoprotein and nucleocapsid protein of equine arteritis virus (EAV) induce an immune response in Balb/c mice by DNA vaccination; strategy for developing a DNA-vaccine against EAV-infection

Equine arteritis virus (EAV) is a member of the Arteriviridae family, that includes lactate dehydrogenase-elevating virus (LDV), porcine reproductive and respiratory syndrome virus (PRRSV), and simian haemorrhagic fever virus (SHFV). Equine arteritis is a contagious disease of horses and is spread via respiratory or reproductive tract. The objective of the present study is to evaluate the possibility for developing a model system for prevention horses against an EAV infection by DNAvaccination. A cDNA bank from the RNA of EAV was established. This gene library contains the translation unit of the EAV open reading frames (ORF) 1 to 7. The identity of the cDNA was confirmed by nucleotide sequence analysis. Using this defined EAV cDNA gene library the cDNA sequence of the viral ORFs were molecularly cloned into the corresponding sites of well characterized and powerful expression vectors (pCR3.1, pDisplay, and/or pcDNA3.1/HisC). The capability of these recombinant plasmids expressing the gene products of the individual viral ORFs 3 to 5, and 7 in induction of an immune response in mouse system was investigated. The Balb/c mice (ten mice per assay) were inoculated with the DNA of the constructed expression vectors harboring and expressing the EAV cDNA of the viral ORFs. The Balb/c mice were injected with about 100 microg DNA diluted in 100 microl PBS. The DNA was injected subcutaneously and into the tibialis cranialis muscle (Musculus gastrocnemius). The mice were boosted 3 to 5 times with the same quantities of DNA and under the same conditions at about two week intervals. Control mice received the same amount of parental expression vectors via an identical route and frequency. The pre- and post-vaccinated sera of the individual animals were screened by neutralization tests (NT). Neutralizing antibodies against EAV were detected when the animals were inoculated with the DNA of the expression vectors harboring cDNA of the EAV ORFs 5 and 7. Highest NT-titers were observed when the animals were administered with the cDNA of ORF 5 and/or with the cDNA of the neutralization determinants of EAV that is located on the N-terminal ectodomain of the gene product of ORF 5 between the amino acid positions 1-121. These results obtained from these studies justified proofing the capability of the EAV cDNA sequences of the viral genes including ORFs 5 and 7 in the autologous animal system horse.

Interferon gamma and prostaglandin in BSE-infected cattle

Suspect field cases of BSE infection (displaying clinical signs) were examined for possible alterations of cytokine/autacoid plasma levels and were compared to control cases (not displaying clinical signs of BSE infection). Interferon gamma (IFN-gamma) plasma levels were demonstrated as being elevated in all suspected field cases of BSE infection (irrespective of BSE status; determined via postmortem histopathological examination). We demonstrated that plasma IFN-gamma levels were significantly (P<0.005) higher in suspect cases of BSE infection than in control cases. BSE-positive prostaglandin-E(2), (PGE(2)) plasma levels were demonstrated as being elevated 1.25-fold above BSE-negative cases and 2.22-fold above control cases. No significant (P>0.5) increase in PGE(2)plasma levels was recorded between BSE-positive and -negative. IFN-gamma and PGE(2)plasma levels were examined using commercially available ELISA assay. The results presented in this publication are the first demonstration of alteration in immune state in animals with BSE.

[Detection of p53 mutation in mouth mucosa smears of patients with oral squamous epithelial carcinoma]

Tumour-suppressor gene p53 encodes for an important cell-cycle regulatory protein and is therefore probably important for the development of many malignant diseases, e.g. squamous cell carcinoma of the mouth. This gene has mutated most frequently in connection with the development of cancer, so it has been well explored. Hence we chose it to find out whether swabs of the oral mucosa are suitable for supplying material for the detection of mutations in a gene that is connected with the development of oral squamous cell carcinomas, because swabs are easier to obtain than biopsies. We examined biopsies, swabs from the tumour, and swabs from mucosa that appeared healthy from 32 patients with oral squamous cell carcinoma and mucosal swabs from 35 healthy persons with polymerase chain reaction (PCR) and temperature gradient gel electrophoresis (TGGE). Fourteen of the 32 patients with a tumour showed mutations of p53, and in all cases the mutation could be demonstrated both in the biopsy and in the tumour swab. In four cases the mutation was also found in the swab of normal mucosa. Our investigations revealed that swabs are a suitable method for obtaining material for the detection of gene mutations in oral squamous cell carcinomas.

P53-mutation in smears of oral squamous cell carcinoma

The tumor suppressor gene p53 encodes for an important cell cycle regulatory protein. Loss of the protein's function is probably important for the development of a variety of malignant diseases, including oral cancer. Up to present knowledge, the mutations of the p53 gene are one of the most frequent genetic alterations detectable in human cancer. The aim of this study was to explore the capability of molecular diagnostics to identify p53 mutations (exon 5-8) in smears of the oral mucosa (polymerase chain reaction, temperature gradient gel electrophoresis). Thirty two patients with oral squamous cell carcinoma comprised the study. Biopsies of the tumor, smears of the ulcer, and smears of apparently healthy mucosa were collected from these cancer patients. Smears of 35 healthy volunteers served as controls. P53-mutations were detected in 14 of the 32 cancer patients (44%). The same mutations was also detected in the biopsy in all cases. In addition, swabs of apparently normal mucosa harboured p53-mutated cells in 4 of these 14 patients. No mutation was found in healthy volunteers. Our investigation showed the suitability of swabs for gaining sufficient material to detect p53 gene mutations in oral squamous cell carcinoma.

Uptake, toxicity, and effects on detoxication enzymes of atrazine and trifluoroacetate in embryos of zebrafish

The uptake, toxicity, and elimination of atrazine and trifluoroacetate (TFA) were studied in early life stages of the zebrafish (Danio rerio). Furthermore, the effects of these xenobiotics on soluble (s) and microsomal (m) glutathione S-transferases (GST) of zebrafish embryos were investigated using 1-chloro-2,4-dinitrobenzene (CDNB), 1,2-dichloro-4-nitrobenzene (DCNB), and [(14)C]atrazine. [(14)C]Atrazine was taken up by the embryos within seconds, unhindered by the chorions. It accumulated in the embryos by a factor of 19 after 24 h of exposure time. LC(50) (48 h) was determined at 36.8 mg/L. At a level of 5 mg/L atrazine, activities of s and m GSTs were elevated in most stages, especially in prim 6 and long pec stage (24, 48 h after fertilization, respectively). GST activity toward atrazine was detectable only in untreated D. rerio eggs, increasing with developmental time. [(14)C]Atrazine was eliminated from the embryos between 24 and 48 h, indicating a possible metabolism to a more hydrophilic GSH conjugate. [(14)C]TFA was taken up by embryos, reaching at maximum fivefold the concentration of the incubation medium after 10 h. The chorions served no physiological protection. TFA (1 g/L) caused low elevation of the GST activity. No acute toxic effects (48 h) were observed up to 4 g/L TFA.

Effects of the Iron Baron oil spill on little penguins (Eudyptula minor). I. Estimates of mortality

The bulk ore carrier Iron Baron ran aground on Hebe Reef at the mouth of the Tamar River in northern Tasmania, Australia, on 10 July 1995. It released an estimated 325 tonnes of bunker fuel oil. Of the wildlife species affected, the most readily detected was the little penguin (Eudyptula minor); 1894 were collected and treated for oiling. This study estimates the impact of the oil spill on populations of little penguins. At Ninth Island (approximately 40 km from Hebe Reef), one of the most affected little penguin colonies, pre-oil-spill population estimates were available. Extensive regular trapping and mark–recapture of birds at this site during the course of the oil spill provided longitudinal data on oiling rates from a known population size. Using these data, we estimate that 19.6% of birds from Ninth Island were oiled and survived to come ashore. This represents about 526 (1932–3108, 95% CL) adult birds, or up to 5566 (4197–6917) birds in total (adults and juveniles). For estimates of the impact on little penguin populations in the region, we provide three scenarios of the possible numbers of penguins oiled. After considering the biases of each risk assessment, we believe that between 10 000 and 20 000 penguins were killed as a result of the oil spill. The study indicates that, despite the relatively small amount of oil spilt by the Iron Baron, the impact on penguin populations was extensive. This study also highlights the difficulties and requirements in assessing the impact of oil spills on wildlife populations.

Effects of the Iron Baron oil spill on little penguins (Eudyptula minor). II. Post-release survival of rehabilitated oiled birds

The post-release survival of rehabilitated oiled little penguins (Eudyptula minor) was monitored over 20 months following the Iron Baron oil spill (10 July 1995) in northern Tasmania, Australia. During rehabilitation, over 1800 little penguins were individually banded and detailed records kept of factors including their degree of oiling, sex, capture and release mass and capture and release condition. Post-release survival of rehabilitated oiled little penguins was assessed through regular trapping of birds over two breeding sites (Ninth Island and Low Head). The minimum estimate of post-release survival was 59% for penguins from Ninth Island and 44% for penguins from Low Head. Rehabilitated oiled little penguins had significantly lower survival than non-oiled birds at both sites. The main factor affecting post-release survival was the extent of oiling, which itself had a significant influence on the capture mass and condition of birds. Combined, these factors had the greatest power to predict post-release survival. Other factors that significantly affected post-release survival included release mass and condition, and the sex of the bird. The duration of rehabilitation and whether birds were translocated (200–410 km) from their capture site prior to release did not significantly affect survival. The results of this study indicate how aspects of oiling, the condition of birds and rehabilitation affect post-release survival. As such, they will help improve the success of wildlife rehabilitation in future spills, and highlight the importance of individually marking rehabilitated oiled wildlife and post-release monitoring in assessing the success of rehabilitation programs.

Effects of the Iron Baron oil spill on little penguins (Eudyptula minor). III. Breeding success of rehabilitated oiled birds

The long-term effects of oiling on the breeding success of rehabilitated oiled little penguins (Eudyptula minor) were examined over two consecutive breeding seasons following the Iron Baron oil spill in 1995. The commencement of egg laying was delayed among rehabilitated oiled penguins compared with non-oiled birds during the 1995/96 breeding season. During that season, hatching success (number of eggs hatched from those laid) was no different in nests containing rehabilitated oiled penguins than in those containing non-oiled birds, but overall egg success (number of pre-fledging chicks from the number of eggs laid) was significantly lower among rehabilitated oiled birds. This effect was predominant in nests containing a rehabilitated oiled female, where the probability of successfully fledging any chicks was 22% lower than in nests containing a non-oiled female. During the 1996/97 breeding season, there was no significant difference between either the hatching or egg success of rehabilitated oiled penguins and non-oiled birds. In both seasons, the pre-fledging masses of chicks from rehabilitated oiled penguins were significantly lower than those from non-oiled birds. The chicks of rehabilitated oiled penguins were therefore expected to have lower survival than chicks raised by non-oiled parents. Results indicate that oiling not only reduced the number of chicks raised by rehabilitated oiled penguins in the short term, but also decreased the quality of young produced for at least two seasons following the spill.

Parametric population representation of retinal location: neuronal interaction dynamics in cat primary visual cortex

Neuronal interactions are an intricate part of cortical information processing generating internal representations of the environment beyond simple one-to-one mappings of the input parameter space. Here we examined functional ranges of interaction processes within ensembles of neurons in cat primary visual cortex. Seven "elementary" stimuli consisting of small squares of light were presented at contiguous horizontal positions. The population representation of these stimuli was compared to the representation of "composite" stimuli, consisting of two squares of light at varied separations. Based on receptive field measurements and by application of an Optimal Linear Estimator, the representation of retinal location was constructed as a distribution of population activation (DPA) in visual space. The spatiotemporal pattern of the DPA was investigated by obtaining the activity of each neuron for a sequence of time intervals. We found that the DPA of composite stimuli deviates from the superposition of its components because of distance-dependent (1) early excitation and (2) late inhibition. (3) The shape of the DPA of composite stimuli revealed a distance-dependent repulsion effect. We simulated these findings within the framework of dynamic neural fields. In the model, the feedforward response of neurons is modulated by spatial ranges of excitatory and inhibitory interactions within the population. A single set of model parameters was sufficient to describe the main experimental effects. Combined, our results indicate that the spatiotemporal processing of visual stimuli is characterized by a delicate, mutual interplay between stimulus-dependent and interaction-based strategies contributing to the formation of widespread cortical activation patterns.

DNA-antiviral vaccines: new developments and approaches--a review

Current vaccines can be divided into "live," "recombinant" and "killed" vaccines. Live vaccines are traditionally composed of attenuated viruses or bacteria, selected for their reduced pathogenicity. Recombinant vaccines, driven by a viral or bacterial vector express foreign antigens, or only recombinant proteins injected as antigen. Killed vaccines consist of inactivated whole pathogens. But all these traditional vaccines have some disadvantages: Attenuated live vaccine are able to undergo mutation and as mutated viruses or bacteria can now provoke the diseases against which the vaccine should protect the organism. A further disadvantage of live vaccines is the possibility of shedding which is a real problem especially in veterinary medicine. Clearly, there is a need for better vaccines to protect against diseases without the disadvantages associated with vaccines presently in use. Modern vaccines might be characterized as safe, no risk of reversion to pathogenicity, and they should be stable without the necessity of a "cold chain." Production should be simple, standardized and inexpensive. Vaccine development has now been improved by the ability to use direct inoculations of plasmid DNA encoding viral or bacterial proteins. One of the major benefits of DNA-vaccines, variously termed "DNA-, genetic- or nucleic acid-immunization," is the endogenous synthesis of the encoded protein. Therefore DNA vaccines mimic natural infection and provoke both strong humoral and cellular immune response. This review summarizes new developments and approaches of DNA vaccination and explains the construction of expression plasmids as well as possible mechanisms of immune responses.

[Tumor reduction of plexiform neurofibroma in the craniofacial and neck area]

Neurofibromatosis type 1 (NF1) is an autosomal dominant hereditary disease of high penetrance and variable expression. Epidemiologic data on craniofacial manifestations are still lacking. Up until now 74 patients with NF1 have been treated at the Department of Oral and Maxillofacial Surgery of the University of Hamburg. Forty-two patients presented periorbital and orbital neurofibromas varying in extension and in the severity of findings of the affected site. Surgical therapy is mainly based on tumour reduction, frequently combined with face-lifting. In our experience neurofibromas of the neck tend to be pseudo-encapsulated, facilitating the preparation of the tumour. On the other hand, identification and preparation of diffuse infiltrating neurofibromas in the trigeminal nerve region are difficult and local recurrence must be expected.

Detoxification of Formaldehyde by the Spider Plant (Chlorophytum comosum L.) and by Soybean (Glycine max L.) Cell-Suspension Cultures

The phytotoxicity of formaldehyde for spider plants (Chlorophytum comosum L.), tobacco plants (Nicotiana tabacum L. cv Bel B and Bel W3), and soybean (Glycine max L.) cell-suspension cultures was found to be low enough to allow metabolic studies. Spider plant shoots were exposed to 7.1 [mu]L L-1 (8.5 mg m-3) gaseous [14C]-formaldehyde over 24 h. Approximately 88% of the recovered radioactivity was plant associated and was found to be incorporated into organic acids, amino acids, free sugars, and lipids as well as cell-wall components. Similar results were obtained upon feeding [14C]formaldehyde from aqueous solution to aseptic soybean cell-suspension cultures. Serine and phosphatidylcholine were identified as major metabolic products. Spider plant enzyme extracts contained two NAS+-dependent formaldehyde dehydrogenase activities with molecular mass values of about 129 and 79 kD. Only the latter enzyme activity required glutathione as an obligatory second cofactor. It had an apparent Km value of 30 [mu]M for formaldehyde and an isoelectric point at pH 5.4. Total cell-free dehydrogenase activity corresponded to 13 [mu]g formaldehyde oxidized h-1 g-1 leaf fresh weight. Glutathione-dependent formaldehyde dehydrogenases were also isolated from shoots and leaves of Equisetum telmateia and from cell-suspension cultures of wheat (Triticum aestivum L.) and maize (Zea mays L.). The results obtained are consistent with the concept of indoor air decontamination with common room plants such as the spider plant. Formaldehyde appears to be efficiently detoxified by oxidation and subsequent C1 metabolism.

Role of interleukin 1 in mycoplasma mitogen-induced proliferation of human T cells

Recently, a mitogenic effect of the supernatant of cultured mycoplasma arthritidis (MAS) on human and murine lymphocytes has been described. Here, we studied the role of accessory cells (AC) in MAS-induced T cell proliferation in a system of human leukocytes. Nylon-wool purified T cells were non-responsive to MAS with regard to both proliferation and IFN-gamma production. The capacity of T lymphocytes to respond to MAS could be restored when viable AC were added. Treatment of AC with UV light resulted in a cell population which was incapable of reconstituting T cells. Addition of human recombinant interleukin 1 alpha (IL 1 alpha) or IL 1 beta again showed a reconstituting effect. However, only a partial reconstitution of the T cell response could be achieved by addition of recombinant IL 1 alpha or IL 1 beta. The optimal restoration was achieved by adding IL 1 at a concentration of 100 U/ml IL 1 alpha or 100 U/ml IL 1 beta. The results indicate that metabolically active AC were required for MAS-induced T cell proliferation to occur and that IL 1 was able to substitute for the role of AC. Since this restoration was only partial, it remains to be determined whether factors others than IL 1 are required to fully substitute the role of accessory cells.