Profile of renal diseases in Nepalese children

AIM AND OBJECTIVES

To find out the profile of renal diseases in children hospitalized in the pediatric department of the tertiary care university teaching hospital in Eastern Nepal.

MATERIALS AND METHODS

A retrospective chart review of all the patients admitted at the department of pediatric from April 2002 to March 2007 was carried out for the presence of any renal diseases on the basis of their clinical presentation, laboratory findings and final diagnosis.

RESULTS

A total number of 10,396 children were admitted during the study period out of which 651 (6.3%) children had renal disease. Among them, nephrotic syndrome seen in 222 patients (34.1%) was the commonest renal disease, followed by post streptococcal nephritis in 187(28.7%) and hemolytic uremic syndrome 66(10.1%), other renal diseases seen were acute renal failure in 25 (3.9%), lupus nephritis 24 (3.7%), urinary tract infection in 23 (3.5%) Henoch-Schönlein Purpura (HSP) nephritis 26 (4%), chronic renal failure in 27 (4.2%) and other miscellaneous causes 51 (7.8%).

CONCLUSION

A substantial number of children are hospitalised with renal diseases, and current trends indicate that majority of them are preventable. In near future, there is a need to develop a comprehensive service for the children with kidney diseases in Nepal.

Detection of individuals prone to develop hypertension in their future life

Hypertension is a global burning health problem. Early detection of proneness to hypertension may help an individual to lead a healthy life by altering the life style (by diet restriction, exercise etc.). Subjects at high risk of future hypertension e.g. the persons of hypertensive family and/or having high resting heart rate etc. show blood pressure hyper-responsiveness to stress. Elevated blood pressure due to sympathetic stimulation prevailed longer time in susceptible persons. In the present study sympathetic stimulation exerted through cold pressor test (hand immersion up to the wrist in 4 degrees C water) resulted in elevation of blood pressure and heart rate in all young male normotensive individuals (age 18-35 years, n=72). Nevertheless, blood pressure and heart rate returned to baseline, following 5 minutes of withdrawal of the stressor, in case of volunteers from normotensive families. On the other hand, the subjects whose parents, either or both were reported to be hypertensive showed elevated diastolic blood pressure even after 5 minutes of withdrawal of the said stressor- indicating that the autonomic nervous system in them was not competent enough for lowering the diastolic pressure quickly to baseline as observed in the volunteers from the normotensive families. The present study revealed that the young subjects who showed greater and prolonged responsiveness to diastolic blood pressure due to sympathetic stimulation through cold pressor test are prone to develop hypertension in future.

Centrosome amplification induced by survivin suppression enhances both chromosome instability and radiosensitivity in glioma cells

Glioblastoma is characterised by invasive growth and a high degree of radioresistance. Survivin, a regulator of chromosome segregation, is highly expressed and known to induce radioresistance in human gliomas. In this study, we examined the effect of survivin suppression on radiosensitivity in malignant glioma cells, while focusing on centrosome aberration and chromosome instability (CIN). We suppressed survivin by small interfering RNA transfection, and examined the radiosensitivity using a clonogenic assay and a trypan blue exclusion assay in U251MG (p53 mutant) and D54MG (p53 wild type) cells. To assess the CIN status, we determined the number of centrosomes using an immunofluorescence analysis, and the centromeric copy number by fluorescence in situ hybridisation. As a result, the radiosensitisation differed regarding the p53 status as U251MG cells quickly developed extreme centrosome amplification (=CIN) and enhanced the radiosensitivity, while centrosome amplification and radiosensitivity increased more gradually in D54MG cells. TUNEL assay showed that survivin inhibition did not lead to apoptosis after irradiation. This cell death was accompanied by an increased degree of aneuploidy, suggesting mitotic cell death. Therefore, survivin inhibition may be an attractive therapeutic target to overcome the radioresistance while, in addition, proper attention to CIN (centrosome number) is considered important for improving radiosensitivity in human glioma.

Study of clinical profile and antibiotic sensitivity pattern in culture positive typhoid fever cases

OBJECTIVES

The present study was designed to analyze the clinical profile and antibiotic sensitivity pattern in the cases of culture positive typhoid fever.

METHOD

The study was conducted over a period of 1 year. Total of 46 culture positive cases of Typhoid fever were included in the study. The sensitivity pattern of isolates from blood culture was recorded. The modes of presentation, clinical course, lab investigation reports were also recorded.

RESULTS

Out of 46 cases, 33 (71.7%) were males and 13 (28.3%) were females. Average age of presentation was 26.17 years. Fever was present in all patients. Resistance of S .typhi to amoxycillin, chloramphenicol and co-trimoxazole were significantly high. Ciprofloxacin showed resistance in 2 (4.3%) cases. Sensitivity to ceftriaxone was 100% in our study.

CONCLUSION

Typhoid fever is one of the most common health problem in Nepal. Various drugs are being used in the treatment of typhoid fever, in the mean time resistance to many of them are emerging. An appropriate antibiotic has to be initiated only after culture sensitivity in typhoid fever.

Typhoid fever in Dhulikhel hospital, Nepal

One hundred and twelve cases of typhoid fever presenting in outpatient and emergency department of Dhulikhel Hospital in Nepal were studied. In this study, it was found that 71% typhoid fever cases were less than 30 years of age group with male to female ratio of 3:1. Fever over 5 days followed by headache and chills were major presenting symptoms. Widal test and blood culture for Salmonella typhi were positive in 59% and 49% cases respectively. Two third of our study population had total leucocyte count of normal range. The fever clearance time was significantly better with ofloxacin compared to ciprofloxacin (p < 0.05) and ceftriaxone compared to chloramphenicol (p < 0.05). The release from treatment was significantly shorter with ceftriaxone compared to ofloxacin, ciprofloxacin and chloramphenicol (p < 0.01). Ceftriaxone was found to be 100% sensitive to salmonella typhi. Amoxicillin was only 52.1% sensitive to Salmonella typhi. Early diagnosis and institution of appropriate antibiotic therapy is of paramount importance in the management of typhoid patients.

THE DISTRICT HEALTH SYSTEM IN NEPAL-AN ASSESSMENT-I HEALTH SERVICES ANALYSIS

ABSTRACT

Oral mucosal lesions associated with betel quid, areca nut and tobacco chewing habits: consensus from a workshop held in Kuala Lumpur, Malaysia, November 25-27, 1996

A variety of betel/areca nut/tobacco habits have been reviewed and categorized because of their possible causal association with oral cancer and various oral precancerous lesions and conditions, and on account of their widespread occurrence in different parts of the world. At a recent workshop in Kuala Lumpur it was recommended that "quid" be defined as "a substance, or mixture of substances, placed in the mouth or chewed and remaining in contact with the mucosa, usually containing one or both of the two basic ingredients, tobacco and/or areca nut, in raw or any manufactured or processed form." Clear delineations on contents of the quid (areca nut quid, tobacco quid, and tobacco and areca nut quid) are recommended as absolute criteria with finer subdivisions to be added if necessary. The betel quid refers to any quid wrapped in betel leaf and is therefore a specific variety of quid. The workshop proposed that quid-related lesions should be categorized conceptually into two categories: first, those that are diffusely outlined and second, those localized at the site where a quid is regularly placed. Additional or expanded criteria and guidelines were proposed to define, describe or identify lesions such as chewer's mucosa, areca nut chewer's lesion, oral submucous fibrosis and other quid-related lesions. A new clinical entity, betel-quid lichenoid lesion, was also proposed to describe an oral lichen planus-like lesion associated with the betel quid habit.

Factors affecting home delivery in the Kathmandu Valley, Nepal

This nested case-control study compares the characteristics of mothers having home or institutional deliveries in Kathmandu, Nepal, and explores the reasons given by mothers for a home delivery. The delivery patterns of mothers were identified in a cross-sectional survey of two communities: an urban area of central Kathmandu (Kalimati) and a peri-urban area (Kirtipur and Panga) five kilometres from the city centre. 357 pregnant women were identified from a survey of 6130 households: 183 from 3663 households in Kirtipur and Panga, 174 from 2467 households in Kalimati. Methods involved a structured baseline household questionnaire and detailed follow-up of identified pregnant women with structured and semi-structured interviews in hospital and the community. The main outcome measures were social and economic household details of pregnant women; pregnancy and obstetric details; place of delivery; delivery attendant; and reasons given for home delivery. The delivery place of 334/357 (94%) of the pregnant women identified at the survey was determined. 272 (81%) had an institutional delivery and 62 (19%) delivered at home. In univariate analysis comparing home and institutional deliverers, maternal education, parity, and poverty indicators (income, size of house, ownership of house) were associated with place of delivery. After multivariate analysis, low maternal educational level (no education, OR 5.04 [95% CI 1.61-15.8], class 1-10, OR 3.36 [1.04-10.8] compared to those with higher education) and multiparity (OR 3.1 [1.63-5.74] compared to primiparity) were significant risk factors for a home delivery. Of home deliverers, only 24% used a traditional birth attendant, and over half were unplanned due to precipitate labour or lack of transport. We conclude that poor education and multiparity rather than poverty per se increase the risk of a home delivery in Kathmandu. Training TBAs in this setting would probably not be cost-effective. Community-based midwife-run delivery units could reduce the incidence of unplanned home deliveries.

The effects of postnatal health education for mothers on infant care and family planning practices in Nepal: a randomised controlled trial

OBJECTIVES

To evaluate impact of postnatal health education for mothers on infant care and postnatal family planning practices in Nepal.

DESIGN

Randomised controlled trial with community follow up at 3 and 6 months post partum by interview. Initial household survey of study areas to identify all pregnant women to facilitate follow up.

SETTING

Main maternity hospital in Kathmandu, Nepal. Follow up in urban Kathmandu and a periurban area southwest of the city.

SUBJECTS

540 mothers randomly allocated to one of four groups: health education immediately after birth and three months later (group A), at birth only (group B), at three months only (group C), or none (group D).

INTERVENTIONS

Structured baseline household questionnaire; 20 minute, one to one health education at birth and three months later.

MAIN OUTCOME MEASURES

Duration of exclusive breast feeding, appropriate immunisation of infant, knowledge of oral rehydration solution and need to continue breast feeding in diarrhoea, knowledge of infant signs suggesting pneumonia, uptake of postnatal family planning.

RESULTS

Mothers in groups A and B (received health education at birth) were slightly more likely to use contraception at six months after birth compared with mothers in groups C and D (no health education at birth) (odds ratio 1.62, 95% confidence interval 1.06 to 2.5). There were no other significant differences between groups with regards to infant feeding, infant care, or immunisation.

CONCLUSIONS

Our findings suggest that the recommended practice of individual health education for postnatal mothers in poor communities has no impact on infant feeding, care, or immunisation, although uptake of family planning may be slightly enhanced.

Localization of Ca(2+)-binding S100 proteins in epithelial tumours of the skin

The Ca(2+)-binding proteins S100A1, S100A2, S100A4, S100A6 and S100B were evaluated immunohistochemically in normal skin and skin appendage tumours. Epidermal basal cells, epithelial cells of sebaceous glands, hair follicle sheet epithelia and eccrine duct reacted strongly with an antiserum against human S100A2 but were nonreactive or weakly reactive to S100A1, S100A4, S100A6 and S100B. Varying types of skin appendage tumours and most peripheral cells in tumour nests of basal cell carcinoma and squamous cell carcinoma showed positive S100A2 immunoreactivity in neoplastic cells corresponding to basal cells but were nonreactive or faintly reactive for other S100 proteins. Langerhan's cells and melanocytes were labelled by S100B. Basophilic cells of calcifying epithelioma were occasionally stained with S100A2 antiserum. Eccrine poroma did not react with any S100 antiserum. Mixed tumours of the skin containing neoplastic myoepithelial cells stained strongly for S100A2 and S100B but only faintly for S100A1, S100A4, S100A6. This is the first report on selective evaluation of different S100 proteins in normal skin. These antibodies are valuable tools for better characterization of skin appendage tumours.

Immunohistochemical evaluation of transglutaminase C in tumours of salivary glands

Transglutaminase C (TGase C), a family of Ca(2+)-dependent enzymes and an essential component in the cross-linking of peptide bonds, has been found to be a marker of epithelial differentiation with a possible role in cellular apoptosis, extracellular matrix stabilisation and Ca2+ binding, thereby having a potential role in tumour growth, differentiation and invasive behaviour. The expression of TGase C was evaluated in normal human salivary glands and their neoplastic lesions which included pleomorphic adenoma (n = 30), Warthin's tumour (n = 5), adenoid cystic carcinoma (n = 10), acinic cell carcinoma (n = 5), mucoepidermoid carcinoma (n = 5) and control tissue specimens of normal oral mucosa and squamous cell carcinoma, using polyclonal antibody, the specificity of which was determined by Western blotting, generated by immunising rabbits with purified transglutaminase. The TGase C was observed in the epithelial cells in the control tissue specimens examined. Pleiomorphic adenoma revealed reaction products in luminal tumour cells, the non-luminal or modified myoepithelial cells and their plasmacytoid variants, squamous metaplastic cells and chondroid cells. Adenoid cystic carcinomas had tumour cells in the luminal cells of tubular and cribriform structures and the acinic cell carcinoma had from low to moderate immunoreactivity in the tumour cell component and a diffuse immunoreactivity in the stroma for TGase C. Mucoepidermoid carcinoma showed no reaction products in the mucous-producing cells, while intermediate and epidermoid cells had immunoreactivity in the cell cytoplasm. As the presence of TGase C in salivary gland tumours was confined to those tumour cells which form the predominant histomorphology in each tumour subtype, it may be suggested that these enzymes may have a potential role in the regulation of cellular function in neoplastic salivary tissues affecting tumour growth, differentiation and neoplastic behaviour.

Immunohistochemical evaluation of the Ca(2+)-binding S-100 proteins S-100A1, S-100A2, S-100A4, S-100A6 and S-100B in salivary gland tumors

The Ca(2+)-binding S-100 proteins are involved in the regulation of a number of cellular processes and an altered expression has been reported in several neoplastic tissues. Tissue specimens of normal salivary glands (n = 23), pleomorphic adenomas (n = 60), basal cell adenomas (n = 6), canalicular ademomas (n = 2), myoepitheliomas (n = 2), adenoid cystic carcinomas (n = 26) and adenocarcinomas NOS (n = 11) were evaluated for the expression of S-100A1, S-100A2, A-100A4, S-100A6 and S-100B by using highly specific polyclonal and monoclonal antibodies generated against the recombinant human protein. In normal salivary glands, the ductal cells showed mild to intense immunoreactivity for S-100A1, S-100A2, S-100A4 and S-100A6, while S-100B was observed in nerve fibers in the connective tissue. The normal myoepithelial cells were unreactive. In pleomorphic adenoma, the luminal tumor cells of the duct-like structures showed moderate to intense immunoreactivity for S-100A2, while reactivity for S-100A1, S-100A4 and S-100A6 was relatively weak. The non-luminal cells, also termed neoplastic myoepithelial cells, showed immunoreactivity for S-100B, while tumor cells in the solid, myxoid and chondroid areas were immunoreactive for S-100A1, S-100A4, S-100A6 and S-100B. The non-luminally located tumor cells in basal cell adenomas and canalicular adenomas, and numerous tumor cells in clusters in myoepitheliomas were intensely reactive for S-100A2. In adenoid cystic carcinomas and in adenocarcinomas not otherwise specified, the luminal cells forming the tubular or cribriform structures were markedly positive for S-100A2 and/or S-100A6. Squamous metaplastic cells in salivary tumors showed intense immunoreactivity for S-100A2. The results of the present study suggest that the majority of the tumor cells in salivary neoplasms, despite the most heterogeneous tumor cell differentiation, express S-100 proteins more heterogeneously than the normal glandular ducts. The salivary ducts in normal glands, the luminal tumor cells and squamous metaplastic cells in the neoplastic lesions were intensely immunoreactive for S-100A2 as compared to S-100A1, S-100A4 or S-100A6. In contrast, the non-luminal tumor cells showed a rather heterogeneous expression of the S-100 proteins.

Proliferating patterns of salivary gland adenocarcinomas with the use of PCNA labeling

Cellular proliferation activity in a series of salivary gland malignant tumors was evaluated using the index of proliferation cellular nuclear antigen (PCNA) immunoreactivity. A streptavidin-biotin immunoperoxidase method (ABC) using a monoclonal antibody PC10 demonstrated nuclear staining with varying intensity and distribution in all tumor specimens. Acinic cell carcinoma (n = 5) and polymorphous low-grade adenocarcinoma (n = 1) showed relatively low proliferation fractions. In adenoid cystic carcinoma (n = 13), PCNA-positive nuclei were mainly distributed in neoplastic myoepithelial cells which were the predominant cells in tumor growth. No statistically significant difference was found between cribriformtubular and solid subtypes. In adenocarcinoma (n = 6), a well differentiated papillary-cystic pattern expressed a significantly higher PCNA index than poorly differentiated solid pattern, showing the loss of the relationship between PCNA expression and differentiation. Tumor cell differentiation appears to be more important than proliferation in determining biological behavior and prognosis.

Proliferating cell nuclear antigen (PCNA) and p53 in epithelial dysplasia and squamous cell carcinoma of oral mucosa--a marker for poor tumor differentiation, increasing nuclear atypia and invasiveness?

The immunohistochemical expression of proliferating cell nuclear antigen (PCNA) and p53 was investigated in 9 cases of epithelial dysplasia and 38 cases of squamous cell carcinoma of the oral cavity. The intensity of immunoreactivity for each marker was assessed using a semiquantitative grading system, and was correlated with tumor differentiation, nuclear atypia and the patterns of invasive margins in the underlying connective tissue. PCNA expression, in dysplastic epithelium, was observed in the suprabasal and lower spinous layers; and the labeling grade and intensity of staining increased along with the degree of cellular atypia. In 2 cases of dysplasia, weak positive immunoreactivity for p53 could be seen in a few isolated cells of the basal layer. In squamous cell carcinoma, PCNA expression was correlated with the degree of tumor differentiation and nuclear atypia in well and moderately differentiated carcinoma, but not with the invasive pattern of tumor growth. Immunoreactivity for p53 was positive in 30 cases and showed a distribution pattern very similar to PCNA but with fewer positive cells. Three distinct categories of expression for PCNA and p53 were observed, among them a combination of intense reactivity for both markers was indicative of poor differentiation, higher nuclear atypia and more invasive growth of tumor cells.

Intracellular localization of tenascin in squamous cell carcinoma of oral cavity: an immunohistochemical study

Tenascin is a multifunctional extracellular matrix glycoprotein generally expressed in epithelial tumors at sites of epithelial tumor-mesenchymal tissue interface. Studies so far have indicated that mesenchymal cells are a major source of tenascin in tumor tissues. The present study evaluated biopsies and surgically resected specimens of oral squamous cell carcinoma from 20 patients for the expression of tenascin using immunohistochemical methods. The normal mucosa included in all surgically resected specimens showed a delicate band in the submucosal connective tissue, with infrequent breaks in continuity in the immediate vicinity of the basement membrane. The hyperplastic/hyperkeratinized or dysplastic mucosa either showed a continuous band or enhanced expression of TN in the submucosal connective tissue. Evaluation of serial sections for immunoreactivity of tenascin in 7 cases of carcinoma showed intracellular localization of tenascin; particularly at the invading fronts of carcinomas of the buccal mucosa and tongue. The results of the present study may imply that despite the possible induction of tenascinllfrom mesenchymal cells by carcinoma cells, carcinoma cells, if they produce tenascin, do so at the invasive fronts.

Expression of cytokeratins in Warthin's tumour (adenolymphoma) of parotid glands: specific detection of individual cytokeratin types by monoclonal antibodies

This study evaluated the distribution of cytokeratins detected by monoclonal antibodies directed against individual keratin proteins in normal human salivary glands and epithelial tumour cells of Warthin's tumour arising in parotid glands to determine a more precise mapping of their cellular distribution. The normal salivary ducts showed the presence of cytokeratin 7, 8, 18 and 19 in the intercalated, striated and excretory ducts, the primary keratins of stratified and simple epithelia with a profile very similar to the non-cornified epithelium of the oral mucosa. The basally located cells of salivary gland ducts other than myoepithelial cells were reactive for keratins 7 and 19 suggesting a close similarity in profile of keratin in the basal cells of the oral epithelium. In Warthin's tumour, keratins 7, 8, 18 and 19 were consistently detected in the epithelial cells of the tumour, a profile with a tendency to mimic the same in normal ductal epithelium. The distribution, however, was diverse and a heterogeneity was observed in the basal and luminal cells of Warthin's tumour which differed even in different areas of the same tumour specimen.

Heterogeneity of cytokeratin expression as revealed using monoclonal antibodies in salivary adenocarcinomas

Numerous neoplastic lesions of the salivary glands often share a number of similar histopathological features and different areas of the same tumor specimen, not infrequently, may show a diverse histomorphology. The present study evaluates expression of single keratin proteins recognized by monoclonal anti-K7, K8, K18, K19 and keratins recognized by monoclonal KL1 and K8.12 in tubular-duct-like or cribriform structures, solid nests, clear cells, microcystic, basaloid cells and squamous metaplastic histomorphology present in tissue specimens of adenoid cystic carcinoma (n=11), acinic cell carcinoma (n=5), polymorphous low grade adenocarcinoma (n=1) and adenocarcinoma, not otherwise specified (NOS, n=5) of salivary glands. Expression of vimentin in the epithelial tumor cells was further evaluated using an anti-vimentin monoclonal antibody. A great heterogeneity of keratin expression was observed in the luminal and abluminal cells forming the tubular-duct-like and cribriform structures. The abluminal cells in more than half of the instances of adenoid cystic carcinoma had immunoreactive vimentin. In addition, heterogeneity was more pronounced in tumor cells forming the solid nests, comedo-necrosis, microcysts, clear cells or squamous metaplasia. A heterogeneity of keratin profile in different histomorphologies of different tumor types and even in different areas of the same tumor specimen, in the present study, and the available evidence so far limits the use of cytokeratin immunostaining in the differential diagnosis of neoplastic salivary lesions and characterization of a particular histomorphology which, in many instances, are ubiquitous in different tumor subtypes.

Immunohistochemical study on sebaceous adenoma and sebaceous carcinoma arising in parotid gland

The present study presents two cases of parotid mass diagnosed as sebaceous adenoma and sebaceous carcinoma in which immunohistochemical staining was performed for cytokeratins, vimentin, S-100 proteins, lactoferrin, lysozyme, alpha 1-antichymotrypsin, alpha 1-antitrypsin, and proliferating cell nuclear antigen to evaluate the characteristics of tumor cells and to distinguish these lesions from their counterparts in the skin. Sebaceous adenoma had circumscribed lobules containing sebaceous cell nests with well differentiated sebaceous cells surrounded by basaloid cells and a population of transitional cells. Sebaceous carcinoma had cellular pleomorphism and nuclear atypia and a population of cells resembling neoplastic myoepithelial cells of pleomorphic adenoma. The profile of markers used in the present study when compared with studies on sebaceous tumors of skin and the characteristics of other salivary neoplasms reasonably allowed us to conclude that the sebaceous differentiation and sebaceous tumors in salivary glands may differ from that of their counterparts in skin. The histogenesis of salivary sebaceous neoplasms may be attributable to the process of sebaceous metaplasia in the salivary tissues and based on our finding of similar immunohistochemical profile of sebaceous cells in sebaceous carcinoma with that of neoplastic myoepithelial cells in pleomorphic adenoma as reported earlier, sebaceous neoplasms may have a common histogenetic origin with other salivary neoplasms. However, their origin from the sebaceous glands normally present in the salivary tissues could not be excluded.

Tenascin in human neoplasia

Tenascin (TN), a recently characterized extracellular matrix protein, largely confined to the process with the development of embryo in areas of epithelial-mesenchymal interactions, developing neural tissues, bone and cartilage where there are morphogenetic movements and tissue patterning, has a highly restricted expression in adult tissues. The function(s) and molecular mechanisms of enhanced expression of TN in neoplastic lesions, however, remain unclear. Tissue specimens of human neoplasia obtained from 1050 cases of biopsy or surgery and their representative fetal and normal adult tissues were evaluated for immunoreactivity of TN using seven different clones of monoclonal antibodies in a three stage streptavidin biotin immunoperoxidase method. The normal epithelial lined structures such as the mucous membrane and skin had a thin delicate immunoreactive band just beneath the basement membrane at the epithelial mesenchymal interface. Hyperplastic or dysplastic lesions of the epithelium, such as leukoplakia of the oral mucosa, senile keratosis and intraepithelial carcinoma of skin showed an enhanced expression of TN extending down into the connective tissue where the degree of enhanced expression correlated with increasing hyperplasia or dysplasia. The squamous cell carcinoma and adenocarcinoma of different organs, both at the primary site and in lymph node metastasis, showed a widespread stromal immunoreactivity and the expression was affected by infiltration of inflammatory cells, fibrous tissue reaction and tumor cell differentiation. There was heterogeneity in the expression of TN in benign epithelial neoplasms, squamous cell carcinoma and adenocarcinoma which varied in different areas of the same tumor specimen ranging from no reaction to intensely reactive areas. The undifferentiated carcinomas often had low expression in the stroma. The non-epithelial or mesenchymal tumors such as chondrogenic, osteogenic, myogenic, neurogenic, vascular and other miscellaneous neoplasms also had an enhanced expression of TN. When the immunoreactivity of seven different monoclonal antibodies to detect TN were compared, the pattern of expression of TN with different monoclonal antibody in majority of the cases were identical and equivocal, but there were slight differences in the intensity of staining. Using a single monoclonal antibody nearly 94% of the cases of human neoplasia showed an enhanced immunoreaction for TN. In conclusion, the results of the present study when combined with our previous in vitro study (Shrestha et al, Eur J Cancer Oral Oncol, in press) suggest that the enhanced expression of TN in vivo in a wide variety of neoplastic lesions of both epithelial and non-epithelial in origin may affect tumor growth, differentiation, vascularity, cellular adhesion, invasion and metastasis.

Protein gene product 9.5 (PGP9.5) immunoreactivity in salivary gland tumors

PGP9.5 is a neuron specific protein with a molecular weight of 245 kDa and is expressed in neuronal cytoplasm and neuroendocrine cells, and is a marker of neuronal differentiation in normal and neoplastic tissues. The present study was designed to evaluate expression of PGP 9.5 in salivary gland tumors and its possible correlation with the expression of S-100, NSE and GFAP1 the other markers predominantly present in nerve tissues. Forty cases of pleomorphic adenoma and 10 cases of salivary adenocarcinoma were evaluated by three stage avidin-biotin-immunoperoxidase method using polyclonal antibody raised against PGP9.5. In normal salivary glands (n=6), PGP9.5 was confined to the peripheral nerve fibers. The non-luminal tumor cells in the tubuloductal structures of pleomorphic adenoma (n=40) showed spindle shaped modified myoepithelial cells expressing PGP9.5 with varying intensity of staining as well as S-100 protein, NSE and GFAP. A variant of modified myoepithelial cells, the plasmacytoid cells were intensely positive for PGP9.5, S-100 protein and NSE. One adenocarcinoma (1/10) showed a strong immunostaining for PGP9.5 in neoplastic cells. It is, therefore, suggested that the salivary gland tumors are composed of cells of heterogeneous differentiation: the luminal tumor cells are purely epithelial origin and characteristics, and modified myoepithelial cells express markers of neuronal differentiation and may arise from the cells of neural crest origin.

Tenascin: growth and adhesion modulation--extracellular matrix degrading function: an in vitro study

Tenascin (TN), a recently characterised extracellular matrix protein, largely confined to the process with the development of embryo in areas of epithelial-mesenchymal interactions and in areas where there are morphogenetic movements and tissue patterning, has a highly restricted expression in adult tissues. The expression of TN is enhanced in a variety of human neoplastic lesions. However, function(s) and molecular mechanisms of enhanced expression in neoplastic lesions remain unclear. We employed human tongue carcinoma cells (SCCKN), human salivary gland adenocarcinoma cells (SGT-1), normal mouse embryonic fibroblasts (NIH3T3-3) and K-ras-2 transformed fibroblasts (Cle-H3) in an in vitro study to elucidate the biological roles of TN. In in vitro studies, all the cell lines examined had enhanced secretion of TN in the presence of transforming growth factor-beta in a dose-dependent manner and TN itself was found to possess a growth-enhancing activity. Moreover, studies on adhesion of the cell lines on coated substrates of fibronectin (FN), laminin (LN), tenascin (TN), TN/FN and TN/LN showed that all the cells adhere and spread well on FN and LN. However, on TN they attach poorly and remain rounded. The relative concentrations of TN and FN affected the cellular adhesion and morphology. In SCCKN and SGT-1, but not in NIH3T3 and Cle-He3 fibroblasts, a higher concentration of TN inhibited cellular adhesion on fibronectin, suggesting that cells attach poorly on TN, it may interfere with the action of fibronectin, and the relative concentrations of TN, FN or LN may affect cellular adhesion and morphology which may differ in different cell types. When TN was added in the growth medium of exponentially growing cells, the cells lost their cell to cell contact and were seen to be separating. The presence of these extracellular matrix proteins were further tested to determine whether they could modulate the secretion of proteolytic enzymes responsible for extracellular matrix degradation by tumour cells, when the neoplastic cells but not the non-neoplastic cells grown on FN/TN substrate showed positive immunofluorescence for collagenase. FN, LN or TN alone did not induce collagenase in the tumour cells. If the same is true in vivo, although a number of factors and interactions may implicate the ultimate outcome, the enhanced expression of TN in neoplastic lesions may have potential implications for tumour growth, differentiation, cellular adhesion, invasion and metastasis.

Tenascin expression in adenoid basal cell carcinoma of the skin

The immunoreactivity of tenascin, an extra cellular matrix glycoprotein, spatially and temporarily expressed in a site restricted manner during embryogenesis, wound healing and various benign and malignant tumours, was evaluated in 24 cases of adenoid basal cell carcinoma of the skin. The expression of tenascin showed three distinct patterns: firstly, the expression was confined to the stroma surrounding the tumour cells, secondly, to the stromal tissues of epithelial tumour foci and lumens of cribriform or cyst-like epithelial structures, and finally, a mixed pattern of these two was seen. It is suggested that in addition to the stromal reactivity, epithelial tumour cells may produce tenascin to deposit into the cribriform cystic lumens in the adenoid basal cell carcinoma in the skin.

Expression of tenascin in odontogenic tumours

We investigated the expression of tenascin in a series of odontogenic tumours (n = 63) of epithelial and epithelial-ectomesenchymal origin by using immunohistochemical methods. A heterogeneity of expression of tenascin was observed in odontogenic tumours. The heterogeneity was most prominent in odontogenic tumours not forming calcified tissues. In these ameloblastomas and adenomatoid odontogenic tumours, tenascin was mainly localised at the epithelial tumour cell-mesenchymal tissue interface. In the calcifying epithelial odontogenic tumour, ameloblastic fibroma and odontoma, a widespread stromal immunoreactivity was observed which was, however, unreactive in the calcified masses. The stellate reticulum-like cells and granular cells of ameloblastoma also showed a positive immunoreactivity for tenascin. The results of the present study suggest that expression of tenascin in the stromal tissue of odontogenic tumours differs according to the potential of forming calcified masses by the tumour cells irrespective of tumour cell morphology.

Proliferating cell nuclear antigen (PCNA) expression in oral squamous cell carcinoma - an aid to conventional histological grading?

Proliferating cell nuclear antigen (PCNA) is a well known marker for cell proliferation. It tends to accumulate in the late G1 and S-phase of the cell cycle. A monoclonal antibody (MoAb) against PCNA is now available and it can react with paraffin-embedded specimens. In the present study, PCNA immunohistochemical staining of 36 cases of oral cancer specimens obtained from surgery were investigated. The results showed differing nuclear staining patterns for PCNA in normal, hyperplastic and dysplastic epithelium, early cancer and 3 levels of differentiation for squamous cell carcinoma of the oral cavity. It appears that PCNA can be a useful marker in delineating normal epithelium and hyperplastic epithelium from dysplasia in the oral cavity. The use of PCNA staining may further emphasize the conventional histopathological grading of well-differentiated, moderately-differentiated and poorly-differentiated oral squamous cell carcinoma but is still dependent on basic criteria as observed without immunostaining. PCNA expression for all grades of squamous cell carcinoma are present at the deep, infiltrative margins.

Expression of tenascin in hamster buccal pouch mucosa during experimental carcinogenesis

Experimental carcinogenesis by topical application of 7,12-dimethylbenz(a)anthracene (DMBA) in hamster buccal pouch mucosa was evaluated for expression of tenascin, an extracellular matrix glycoprotein expressed at the epithelial-mesenchymal interface during embryonic and fetal development, wound healing and in the stroma of various neoplastic lesions, by using immunohistochemical methods. The buccal pouch mucosa in normal hamsters showed immunoreactive tenascin either as a linear delicate band or without reactivity at the immediate vicinity of the basement membrane. During carcinogenesis, in the second to fourth week of application of DMBA, the hyalinous changes in the submucosal connective tissue had a weak but diffuse immunoreactivity for tenascin. The hyperkeratinised and hyperplastic mucosa following 5 weeks of application of DMBA showed focal areas of enhanced expression in the vicinity of the basement membrane. Subsequently, specimens showing hyperplasia, dysplasia, carcinoma in situ and invasive carcinomas had comparatively more widespread stromal immunoreactivity where the extent of enhanced reactivity positively correlated with the advancing lesion. These results compared with the results of expression in human normal mucosa, leukoplakia and squamous cell carcinoma of the oral cavity (Shrestha et al., Oral Oncol, Eur J Cancer 1994, 30, 132-137) suggest that the expression of tenascin in experimental carcinogenesis of hamster buccal pouch mucosa, as a model, faithfully mimics the same in human oral mucosa.

Immunohistochemical evaluation of tenascin in benign eccrine gland tumors: comparison with laminin and fibronectin

Surgically resected specimens of skin appendage tumors, spiradenoma, poroma of eccrine glands, syringoadenoma, syringoadenoma papilliferum and mixec tumor of skin were evaluated for tenascin, as well as the basement membrane-associated protein laminin, and the extracellular matrix protein fibronectin, using immunohistochemical methods. In normal sweat glands, tenascin was localized as a delicate, thin band in the immediate vicinity of the basement membrane and laminin was limited to the basement membrane. Tenascin in syringoadenoma was also expressed linearly adjacent to the basement membrane. Mixed tumors of skin showed a characteristic distribution of tenascin in the modified myoepithelial cell area adjacent to the tumor epithelia with a heterogeneous pattern, and particularly strong expression in the hyalinous and chondroid areas. In addition, the localization of laminin in the basement membranes of tumors, intracellular immunoreactivity was observed in syringoadenoma, syringocystadenoma papilliferum, and mixed tumor of skin. Fibronectin reactivity was visualized as a diffuse staining in the tumor stroma of eccrine poroma but its expression was restricted in eccrine spiradenoma. The present study suggests a heterogeneity in the distribution of basement membrane and extracellular matrix proteins in skin appendage tumors and elucidation of their functional roles would assist in understanding the changes in the supporting tumor stroma following neoplastic changes.

Stimulation of in vivo calcification using collagen membranes cultured with osteoblastic cells in vitro: a preliminary report

Guided tissue regeneration (GTR) is a useful modality in the management of periodontal disease and for bone augmentation around osseointegrated implants. This study evaluated the in vivo use of atelocollagen membrane (AC) on which osteoblastic cells (OBCs) were cultured in vitro, for application as a GTR membranous material. Osteoblastic cells isolated in our laboratory from mouse calvaria formed a thin film on the AC in vitro which was easily manipulated after 21 days in culture. The AC and OBCs complex material (ACOB) was subjected to freezing and thawing and implanted in mouse subcutaneous tissue for the study of histologic events surrounding the implanted ACOB. Histologic findings in the subcutaneous tissue showed calcification on the ACOB at 28 days postimplantation, while no such finding was evident at the control site, where only AC without OBCs were grafted. The present study suggests the possibility of membrane calcification for GTR through ACOB produced by OBCs on an AC in vitro.

Immunoreactive tenascin in tumours of salivary glands: evidence for enhanced expression in tumour stroma and production by tumour cells

Tenascin, a large molecular weight extracellular glycoprotein expressed at the epithelial-mesenchymal interface during morphogenesis in embryo, wound healing and in the stroma of various benign and malignant tumours was evaluated in a series of primary epithelial tumours of salivary glands using a monoclonal antibody. Normal salivary glands (n = 5) had linear delicate band-like immunoreactive tenascin in relatively large excretory or intralobular ducts. Pleomorphic adenomas (n = 40) had heterogeneity of expression in modified myoepithelial cell-associated myxoid, hyaline and chondroid areas. Warthin's tumours (n = 10) had a linear immunoreactivity profile of tenascin just adjacent to the basal cells of the epithelial tumour component. A heterogeneity of expression with intense to low or negative stromal immunoreactivity was observed in adenoid cystic carcinomas (n = 8), mucoepidermoid carcinomas (n = 8), epithelial-myoepithelial carcinomas (n = 4), polymorphous low-grade carcinomas (n = 3), papillary cystadenocarcinomas (n = 15) and undifferentiated carcinomas (n = 3). In addition, small cystic spaces or lumens of epithelial-lined tubulo-ductal structures in numerous salivary tumours had positive immunoreactivity for tenascin, suggesting its production by the epithelial tumour component. An enhanced expression of tenascin in salivary tumours suggests a role of this protein in the stromal remodelling and tumour growth.

Neuroblastoma of parotid gland: report of a case and immunohistochemical characteristics

A case of a parotid mass in a 2-year-old boy, postoperatively diagnosed as neuroblastoma, a rare tumour not previously reported in the parotid gland is presented. The neoplasm developed within the parotid gland as a painless mass without regional lymphadenopathy. Histopathologically, the tumour showed primitive nerve cells-neuroblasts-with round or oval dark basophilic nuclei and scanty cytoplasm. The cells were arranged in circular rosettes around an eosinophilic mass consisting of very fine filaments originating in the tumour cells or papillary configuration and sometimes scattered in the poorly developed stroma. Immunohistochemical evaluation of the tumour showed a positive immunoreactivity for vimentin, alpha and beta subunits of S-100 protein, neurone-specific enolase (NSE), substance P, met-enkephalin and chromogranin but cytokeratins, desmin, actin, myosin, glial fibrillary acidic protein (GFAP) and calcitonin gene related peptide (CGRP) were negative. The histopathological and immunohistochemical findings conclude a diagnosis of neuroblastoma of the parotid gland.

Histogenesis and possible mechanism of chondroid changes in mixed tumour of the skin: immunohistochemical evaluation of bone morphogenetic protein, glycosaminoglycans, keratin, vimentin and neuronal markers

The distribution of immunoreactivity of bone morphogenetic protein (BMP), the glycosaminoglycans chondroitin 4-sulphate (C4SPG), chondroitin 6-sulphate (C6SPG), dermatan sulphate (DSPG) and keratan sulphate proteoglycans (KSPG), cytokeratin (K8.12), vimentin, glial fibrillary acidic protein (GFAP), actin, desmin, S-100 protein and neuron-specific enolase (NSE) in mixed tumour of the skin was investigated using immunohistochemical methods using monoclonal (MoAb) and polyclonal antibodies (PoAb). A strong BMP immunoreactivity was found characteristically in outer tumour cells of tubuloductal structures and modified myoepithelial cells. Modified myoepithelial cells and chondroidally changed cells showed positive immunoreactivity for C4SPG, C6SPG and DSPG; and KSPG was more pronounced in the modified myoepithelial cells. Vimentin, S-100 protein, GFAP and NSE, but not actin and desmin, were distribute in the outer tumour cells and modified myoepithelial cells in chondroidally changed tissue. Two factors show that chondrogenesis in mixed tumour of the skin is associated with the modified myoepithelial cells through the activity of BMP and biosynthesis of glycosaminoglycans as matrix substance. First, outer or basal tumour cells in mixed tumour of the skin is characterized by the presence of positive immunoreactivity for BMP, KSPG, vimentin, cytokeratin K8.12, S-100 protein, GFAP and NSE, and second, there is a matrix of chondroidally changed tissue containing the reaction products of C4SPG, C6SPG, DSPF and KSPG.

Clear cell carcinoma of salivary glands: immunohistochemical evaluation of clear tumor cells

A total of 14 cases of clear cell carcinoma of salivary glands were evaluated by immunohistochemical methods using monoclonal antibodies to cytokeratin (K1.1 and K8.12), vimentin, S-100 alpha and beta subunits, neuron-specific enolase (NSE), glial fibrillary acidic protein (GFAP), MAM-3 and MAM-6 antigens and proliferating cell nuclear antigen (PCNA), as well as polyclonal antibodies to lysozyme (Ly), lactoferrin (la) and Alpha-1-antichymotrypsin (alpha 1-Ach). Histopathologically, the carcinoma was characterized by round or polygonal tumor cells with cytoplasm that does not stain with hematoxylin and eosin, nuclei with little pleomorphism and few or no mitotic figures, and growing in solid sheets, small nests or cords with collagenous stroma. Cytokeratin KL1 and K8.12 was present in few tumor cells with almost negligible to strong reaction in all cases, vimentin in 6, GFAP in 5 cases with multiple-expression of cytokeratin K8.12, vimentin and GFAP in 5 cases. S-100 protein immunoreactivity was the most prominent feature with more intense reaction of S-100 beta than S-100 alpha subunit. NSE reactivity was seen in 6 cases. Ly, La, a1-ch, MAM-3 and MAM-6 antigens were localized in clear cells with various reaction intensities. The authors conclude that the clear tumor cells in clear cell carcinoma of salivary glands are not myoepithelial in origin but epithelial or neuroectodermal/neural crest in origin, showing ductal differentiation at the immunohistochemical level.

Papillary cystadenocarcinoma of salivary-glands - an immunohistochemical study

The immunohistochemical features of 16 cases of papillary cystadenocarcinoma of salivary glands using a panel of monoclonal and polyclonal antibodies were evaluated. The specimens were from patients postoperatively diagnosed as papillary cystadenocarcinoma of salivary glands where the age of the patients ranged from 20-70 years, males were more commonly affected than the females and parotid gland was the most commonly affected site. The cytokeratins detected by MoAb KL1 and K8.12 were positive in all cases showing a heterogeneity in intensity of reaction. A coexpression of vimentin with cytokeratin was found in 10 cases. The tumor cells had a coexpression of S-100 protein and neuron specific enolase (NSE). Glial fibrillary acidic protein (GFAP) was positive in one case with multiple expression of cytokeratins, vimentin NSE, S-100 protein. The polymorphic mucin MAM-6 was positive in all cases and MAM-3 in 8 cases showing different intensity of reaction. The tumor cells were positive for lysozyme (8 cases), lactoferrin (10 cases) and alpha-1-antichymotrypsin (10 cases). The immunoreactive c-erbB-2 oncoprotein on the cell surface membrane was detected in 2 cases. The labeling index of proliferating cell nuclear antigen in the tumor cells ranged from 3.8 to 43.2% (mean 14.2 +/- standard deviation 9.8). Histopathological feature and a heterogeneity of multiple expression of tissue markers may suggest that a population of cells in papillary cystadenocarcinoma may be counterparts of modified myoepithelial cells of pleomorphic adenoma that express epithelial, mesenchymal and neuronal differentiation although the role of myoepithelial cells in the genesis of this tumor is not clear. However, disorganized stratification and malignant transformation of ductal cells may be the most likely possibility in the histogenesis of this tumor.

Enhanced tenascin immunoreactivity in leukoplakia and squamous cell carcinoma of the oral cavity: an immunohistochemical study

Tenascin is an extracellular matrix glycoprotein that shows a site restricted expression especially in areas of cell proliferation, cell motility, and tissue modeling at the epithelial-mesenchymal junction during embryogenesis. Tissue specimens obtained from surgery and/or biopsy for oral leukoplakia (n = 22) and squamous cells carcinoma (n = 36) were examined for the presence of tenascin by using monoclonal antibody. In normal tissue specimens (n = 5), tenascin immunoreaction appeared as a linear continuous lining at the immediate vicinity of basement membrane (n = 3). Hyperplastic epithelia in leuoplakia showed a distinct increase in tenascin immunoreactivity in the submucosa correlating with the degree of hyperplasis and/or dysplasia. In squamous cell carcinoma (SCC), the reactivity was most intense extending deeply into the underlying stroma with marked reaction around large tumour cell nests and the infiltrating tumour margin. The connective tissue stroma, however, in undifferentiated carcinoma showed traces of immunoreactivity. Positive immunoreactivity was seen around metastatic squamous cell carcinoma masses in regional lymph nodes. The stromal tissues infiltrated by inflammatory cells were usually unreactive while those with desmoplastic changes were positive for tenascin. The authors conclude that an enhanced expression of tenascin may play an important role during active phases of tumour cell proliferation and stromal changes in the premalignant and malignant lesions of the oral mucosa.

Chronotoxicological effect of methyl mercury in rat submandibular gland. Immunohistochemical changes of r-EGF, S-100 protein and keratin

The effect of toxicity of methyl mercury was investigated in the submandibular gland (SMG) of adult male rats subjected to 12 h light dark cycle (6 a.m. to 6 p.m. light/resting phase; 6 a.m. to 6 p.m. dark/active phase). Two groups of rats received a defined dose of methyl mercury hydroxide at seven different time points during the active (dark) and resting (light) phase over a 24 h period. After 10 d, the rats were killed at 9 a.m. and 9 p.m. in the resting and active phase, respectively. The immunohistochemical distribution pattern of epidermal growth factor (r-EGF), S-100 protein and K8.12 keratin were studied in granular convoluted tubules (GCT). Those rats which received injections during the active phase (6 p.m. to 6 a.m.), showed stronger reactivity for r-EGF; however, the reactivity for S-100 protein was unchanged. On the contrary, in both groups, GCT cells showed intense staining for K8.12 keratin. It is concluded that the detoxification mechanism of mercury appears to be dependent on the chronobiological oscillation pattern of the GCT and their substructures.

Immunoreactivity of proliferating cell nuclear antigen in salivary gland tumours: an assessment of growth potential

Immunoreactivity of proliferating cell nuclear antigen (PCNA) was assessed to evaluate growth potential in surgically resected tissue specimens from 70 cases of benign and malignant salivary gland tumours. Three stage streptavidin-biotin immunoperoxidase immunostaining using monoclonal antibody to PCNA showed a heterogeneity of PCNA index and distribution. In normal salivary gland specimens, PCNA was demonstrated in the nuclei of few ductal and acinar cells. In pleomorphic adenoma a multiple nodular growth pattern was observed with positive immunoreactivity restricted to the nuclei of tubulo-ductal structures. Warthin's tumour had positive nuclei in the outer cuboidal cells of epithelial component and germinal centres of lymphoid tissue. Myoepithelioma and acinic cell carcinoma showed slightly differing values and a statistically significant difference in the value of the index was observed in tumour cell aggregates of the cribiform type of adenoid cystic carcinoma and the solid undifferentiated type and between low/intermediate and high-grade mucoepidermoid tumours. PCNA is a useful marker of tumour cell proliferation; the index correlates with the grade of malignancy in salivary gland tumours.

Rare expression of the c-erbB-2 oncoprotein in salivary gland tumors: an immunohistochemical study

An immunohistochemical study of c-erbB-2 oncoprotein expression was carried out on 201 cases of primary salivary gland tumors, using a polyclonal antibody, raised to the intracytoplasmic domain of the c-erbB-2 oncogene product. An intense membrane reactivity was observed in one case of sialocarcinoma transformed from pleomorphic adenoma (n = 8) and one case of mucoepidermoid carcinoma (n = 22). A comparative histopathologic evaluation of c-erbB-2 positive tumors showed marked variation in cell size, nuclear pleomorphism, multinucleation, a high mitotic rate and increased lymphoid cell infiltration and an aggressive clinical course with poor survival. The results indicate that c-erbB-2 oncoprotein is rarely expressed in malignant salivary gland tumors. However, the overexpression appears to have a distinct histopathologic feature, but a larger study incorporating histopathology and clinical data would be necessary to correlate the significance of c-erbB-2 oncogene product in salivary malignant tumors.

Proliferating cell nuclear antigen in malignant and pre-malignant lesions of epithelial origin in the oral cavity and the skin: an immunohistochemical study

Proliferating cell nuclear antigen (PCNA) is a nuclear protein synthesized in the late G1 and S phase of the cell cycle and immunohistochemical detection of the protein represents a useful marker for the proliferating fraction of cells in tissue specimens. A series of malignant and pre-malignant lesions of the oral cavity and skin were evaluated by the streptavidin biotin immunoperoxidase method for detection of this protein. Monoclonal anti-PCNA antibody (PC 10) labelled proliferating cells in all cases with varying intensity of nuclear staining. In squamous cell carcinoma (n = 48), PCNA positivity correlated with the differentiation and atypia of the tumour cells; however, in poorly differentiated tumours, the relationship between PCNA expression and proliferation was lost. Basal cell carcinoma showed an increased growth fraction in tiny epithelial nests (mean 43.8, SD 6.0, n = 20) than in neoplastic basal cells (mean 30.1, SD 6.9, n = 8). The growth fractions were significantly higher in the pre-malignant lesions (leukoplakia, mean 22.3, SD 7.7, n = 14; Bowen's disease, mean 45.2, SD 11.7, n = 12; senile keratosis, mean 41.2, SD 7.0, n = 12) than in the normal mucosa (mean 9.8, SD 4.9, n = 10), suggesting that cellular growth fractions correlate with the degree of dysplasia in pre-malignant lesions.

Epidermal growth factor receptor in odontogenic cysts and tumors

The expression of epidermal growth factor receptor (EGFR) was investigated in 67 cases of odontogenic cysts and 35 cases of odontogenic tumors using monoclonal antibody to EGFR (Biomarker, Israel) to determine the presence and significance of this transmembrane growth factor receptor. The cystic epithelial cells of odontogenic cystic lesions (keratocyst 60%; primordial cyst 75%; radicular cyst 35%; and follicular cyst 47.4%) were positive to EGFR staining. Cytochemical characterization of EGFR in those cystic epithelium was cell membrane positive type as in the normal epithelium. No expression of EGFR was found in the odontogenic tumors. This diversity of EGFR represents no binding activity of EGF, or loss of EGFR in the tumor cell upon EGFR mediated growth in odontogenic tumors was suggested a different tumor cell growth factor status or microenvironment in cell proliferation mechanism at the cellular level in cysts and tumors of odontogenic origin.

Proliferating cell nuclear antigen in breast lesions: Correlation of c-erbB-2 oncoprotein and EGF receptor and its clinicopathological significance in breast cancer

Monoclonal anti-proliferating cell nuclear antigen (PCNA PC10), which is directed against a 36 kDa auxiliary protein for DNA polymerase delta specific for the S-phase of cell cycle, was used to measure tumour cell proliferation in 4 lactating breasts and 98 benign and malignant breast tumours. The percentage of PCNA-positive cells determined by point counting was significantly lower in the lactating breast [mean 3.6%, standard deviation (SD) 0.67, n = 5] than in fibroadenoma and mastopathy (mean 23.7, SD 5.0, n = 2). Primary breast carcinoma showed a PCNA index ranging from 2% to 36% (mean 12.3, SD 9.3, n = 50), whereas in recurrent carcinoma the index was mean 28.5, SD 4.0. A high index was correlated with c-erbB-2 and epidermal growth factor (EGF) receptor membrane reactivity, worsening histological grade, poor survival and disease-free survival. The expression of c-erbB-2 and EGF receptor was associated with poor survival and disease-free survival in primary breast cancer patients.

Ameloblastoma--a clinical study of 13 cases

Ameloblastoma is commonly encountered odontogenic tumour in Bangladesh. A clinical assessment of this tumour is presented in this paper with the particular attention to its age, and sex incidence, clinical presentation, and its management. Complete removal of the neoplasm is the treatment of choice regardless the method of accomplishment to obtain complete cure. Small lesion, particularly in young patients may by given chance to be managed by enucleation and curettage exposing the healthy surrounding tissue. However radical resection of the tumour is the most efficient treatment particularly in large tumours to avoid recurrence.

Congenital granular cell epulis: A rare diagnosis

Congenital granular cell tumor is very rare and it arises from the gum pad of neonates. Surgery is required immediatly after birth as the tumor interfares with feeding and respiration. Although a benign tumor, it can create immense anxiety amongst the attending physician and family members. Its recognition is important so as to avoid over diagnosis leading to radical surgery. We report a case of congenital epulis arising from the maxillary alveolar ridge in a newborn female child, which was successfully excised and the diagnosis confirmed histologically. No tumor recurrence has been reported in the patient postoperatively. Keywords: Congenital; Epulis; Granular cell DOI: 10.3126/jpn.v1i1.4458 Journal of Pathology of Nepal (2011) Vol.1, 69-72

Clinical and Bacteriological Profiles of Blood Culture Positive Sepsis in Newborns

Neonatal infections currently cause about 1.6 million deaths annually in developing countries. Sepsis and meningitis is responsible for most of these deaths. This study was undertaken to determine the clinical presentations, bacteriological profiles and antibiotic sensitivity patterns of isolates from blood cultures of neonates admitted in a tertiary care hospital in Eastern Nepal. All blood culture reports (n=103) during January 2006 - February 2007 from newborns admitted in neonatal division at BP Koirala Institute of Health Sciences, Nepal were analyzed and antibiotic sensitivity patterns were studied. The positive blood culture was 20% (103/513). Most (97.1%) of the sepsis was caused by single organism, while polymicrobial aetiology was observed in 2.9% cases. Meningitis was documented in 9(8.7%) cases. Staphylococcus aureus (38.8%) and coagulase negative staphylococcus (CONS) (21.3%) are the commonest isolates in blood culture. Among gram-negative organisms, Klebsiella species (11.6%) and Enterobacter species (9.7%) were the leading cause of neonatal sepsis. Majority of newborns with neonatal sepsis presented with refusal to feeds (42.7%), fever (41.7%) and jaundice (41.7%). Most of the organisms showed sensitivity with amino glycosides (gentamicin and amikacin) and third generation cephalosporins. It is concluded that Staphylococcus aureus, CONS, and Klebsiella species remain the principal organisms causing neonatal sepsis and first line antibiotics like amino glycosides should be first choice of drugs. Key words: Blood culture, neonatal sepsis, antibiotic sensitivity. doi:10.3126/jnps.v27i2.1411   J. Nepal Paediatr. Soc. Vol.27(2) p.64-67