Orofacial disease: update for the dental clinical team: 10. Halitosis and disturbances of taste, orofacial movement or sensation

This article discusses halitosis, and disorders of taste, orofacial movement or sensation.

Orofacial disease: update for the clinical team: 9. Orofacial pain

Orofacial pain, the main reason why many patients seek dental advice, usually has a local cause--primarily the sequelae of dental caries--but a wide range of diseases, particularly neurological, psychogenic and vascular disorders, can cause orofacial pain. This article will discuss disorders that can present with pain and the neurological, psychogenic and vascular causes of orofacial pain. The first article in this series made several general observations on diagnosis and treatment which should be borne in mind in relation to the material presented here.

The nature of real, implanted, and fabricated memories for emotional childhood events: implications for the recovered memory debate

A central issue in the recovered memory debate is whether it is possible to "remember" a highly emotional incident which never occurred. The present study provided an in-depth investigation of real, implanted, and fabricated (deceptive) memories for stressful childhood events. We examined whether false memories for emotional events could be implanted and, if so, whether real, implanted, and fabricated memories had distinctive features. A questionnaire was sent to participants' parents asking about six highly emotional, stressful events (e.g., serious animal attack) which the participant may have experienced in childhood. Next, across three sessions, interviewers encouraged participants (N = 77) to "recover" a memory for a false event using guided imagery and repeated retrieval attempts. In the first interview, they were asked about one real and one false event, both introduced as true according to their parents. In two subsequent interviews, they were reinterviewed about the false event. Finally, after the third inquiry about the false event, participants were asked to fabricate a memory report. Results indicated that 26% of participants "recovered" a complete memory for the false experience and another 30% recalled aspects of the false experience. Real, implanted, and fabricated memories differed on several dimensions (e.g., confidence, vividness, details, repeated details, coherence, stress). These findings have important implications for the debate over recovered and false memories.

Orofacial disease: update for the dental clinical team: 8. Salivary complaints

Certain lesions exclusively or typically affect the salivary glands; these are discussed in this article.

A case of discordant related abnormal karyotypes from chorionic villi and amniocytes

A case of three discordant cell lines in prenatal diagnosis is described, of which two were abnormal related structural abnormalities of chromosome 11. One of the abnormal cell lines was seen in all metaphases examined from direct preparations of chorionic villi, the cultured preparations showing an apparently normal male karyotype; the other abnormal cell line was seen in conjunction with a normal cell line in cultured amniocytes. Prenatal diagnosis offered solely on chorionic villus sampling would have yielded a mistakenly normal result on the basis of established criteria for distinguishing true mosaicism from confined placental mosaicism.

Orofacial disease: update for the dental clinical team: 7. Complaints affecting particularly the palate or gingivae

Certain lesions are exclusively or typically found in specific sites. This article discusses in detail conditions that occur mostly on the palate or gingivae.

Development, characterization, and use of monoclonal antibodies made to antigens expressed on the surface of fetal nucleated red blood cells

BACKGROUND

Current methods for obtaining fetal cells for prenatal diagnosis are invasive and carry a small (0.5-1.0%) but definite risk of miscarriage. An attractive alternative would be isolation of fetal cells from peripheral maternal blood using antibodies with high specificity and avidity.

METHODS

To generate antibodies, we purified nucleated red blood cells (NRBCs) from fetal livers and used them as the immunogen to generate monoclonal antibodies (mAbs) directed against surface antigens.

RESULTS

The four antibodies recognized at least two conformationally sensitive epitopes of the transferrin receptor. Isolation of NRBCs from 252 maternal blood samples using these antibodies in magnetic activated cell sorting after an initial density gradient centrifugation yielded 0-419 NRBCs per 25 mL of maternal blood. One antibody, 2B7.4, not only isolated the highest number of NRBCs (>10 in 90% of the samples) but also isolated these NRBCs in 78 consecutive maternal samples.

CONCLUSION

Antibody 2B7.4 shows promise for the isolation of NRBCs from maternal blood and should allow studies concerning the source of these cells, fetal vs maternal, and the factors controlling their prevalence.

Gastric and gingival localization of mucosa-associated lymphoid tissue (MALT) lymphoma. An immunohistochemical, virological and clinical case report

Non-Hodgkin's lymphomas (NHL) of the mucosa-associated lymphoid tissue (MALT) are characterized by their mucosal and glandular tissue localization. The case described here falls into the European-American classification of a low-grade B-cell lymphoma of the MALT type, with a gingival lesion 2 years after a gastric lesion. The pathogenetic mechanisms of NHL in oral MALT and the diagnosis and treatment are discussed.

Orofacial disease: update for the dental clinical team: 6. Complaints affecting particularly the lips or tongue

Certain lesions are exclusively or typically found in specific sites; these are discussed in this and the next two articles in this series.

Sexual harassment of psychiatric trainees: experiences and attitudes

A survey was carried out of psychiatric trainees' work-related experiences of unwanted sexual contact. A structured postal questionnaire was administered to 100 psychiatric trainees from senior house officer to specialist registrar level in a large psychiatric rotation. There was an 85% response rate; 86% (73) of the sample had experienced unwanted sexual contact, with 47% (40) experiencing deliberate touching, leaning over or cornering, and 18% (15) receiving letters, telephone calls or material of a sexual nature. Three-quarters (64) of respondents had experienced unwanted sexual contact from patients and 64% (54) from staff. Experiences and attitudes did not generally differ by gender, grade or training experience. Four out of 48 female respondents described stalking by patients. Of the 39 respondents who had reported harassment by patients, 31 felt supported by colleagues, while of the 13 who had reported harassment by colleagues, eight felt supported. Two-thirds of the respondents considered sexual harassment 'some-times' or 'frequently' a problem for the profession. Diagnoses of confusional states, mania or schizophrenia made subjects less likely to consider unwanted sexual behaviour to be 'sexual harassment' (86%, 80%, and 67%, respectively), but not for other diagnoses. Levels of threatening and intrusive sexual harassment are unacceptably high in this study group. Health trusts should adopt policies of 'zero tolerance' and all incidents should be reported. Psychological impact on victims should be acknowledged even when the behaviour of the perpetrator can be explained by diagnosis.

Orofacial disease: update for the dental clinical team: 5. Lumps and swellings

This article discusses the more common conditions presenting with orofacial lumps or swellings. The first article in this series presented several general observations on diagnosis and treatment which should be borne in mind in relation to this article.

This is my story: a descriptive analysis of a peer education HIV/STD risk reduction program for women living in housing developments

Descriptive, qualitative data was collected from 30 women who participated in the Centers for Disease Control and Prevention-funded Perinatal HIV Reduction and Education Demonstration Activities (PHREDA) Project. Women were primarily heterosexual, welfare-dependent, African-American mothers. Staff trained women to conduct HIV/STD education as peer volunteers. The theory-based educational components consisted of role model stories developed by women about their experiences with HIV/STDs and discussion groups to build behavioral and communication skills. Women were given role-model stories and safer sex supplies to initiate conversations about women's health and sexual safety in their communities. PHREDA groups allowed women to identify their risk reduction, sexual, and family issues. Role model stories provided a validating medium through which high-risk women explored reproductive health risk and planned steps toward behavioral change. Descriptive data from peer volunteers can provide an important perspective on small group, peer-based community HIV/STD reduction interventions.

Orofacial disease: update for the dental clinical team: 4. Red, brown, black and bluish lesions

This article discusses coloured lesions of the orofacial region.

DNA studies underestimate the major role of CDKN2A inactivation in oral and oropharyngeal squamous cell carcinomas

Loss of CDKN2A expression was demonstrated by immunohistochemistry in 87% of oral and oropharyngeal squamous cell carcinoma (OSCC) primary tumor samples. By contrast, DNA studies showed a much lower frequency of loss of the CDKN2A gene. Point mutations and promoter methylation of CDKN2A were seen in 7% and 23%, respectively, of primary tumors. Loss of heterozygosity analysis using a dense set of 9p markers showed allelic imbalance that included CDKN2A in only 31% of samples, but a further 47% showed loss at loci near CDKN2A with apparent retention of CDKN2A. No tumor with any allelic imbalance expressed CDKN2A, whether or not the imbalance appeared to involve the CDKN2A locus. We interpret these data as showing partially overlapping deletions on the two 9p homologues, with homozygous deletion of CDKN2A masked by amplification of contaminating stromal material. Our data show that inactivation of the CDKN2A gene products is a near-universal step in the development of oral and oropharyngeal squamous cell carcinomas, and we suggest that homozygous deletion is the most common mechanism of inactivation. The CDKN2A locus may be particularly prone to deletion because it encodes two unrelated tumor suppressor proteins, CDKN2A (p16INK4a) and p19ARF, and deletion, but not point mutation or methylation, would inactivate both gene products. However, our results also suggest that complex patterns of allelic imbalance in primary squamous carcinomas in general may not provide reliable evidence for the existence of multiple tumor suppressor genes within a single chromosomal region.

Orofacial disease: update for the dental clinical team: 3. White lesions

White lesions usually contain an increased amount of keratin. Some are rare congenital conditions, such as white sponge naevus and dyskeratosis congenita, unlikely to be seen in general dental practice. Inflammatory causes include candidosis and hairy leukoplakia, both now common in HIV disease. Non-infective causes include the common lesion of lichen planus, and the less common condition lupus erythematosus. Neoplastic and possibly preneoplastic causes include carcinoma, keratoses and leukoplakia. This article discusses the more common causes of oral white lesions. The first article in this series presented several general observations on diagnosis and treatment which should be borne in mind in relation to this article.

Pulmonary epithelial expression of human alpha1-antitrypsin in transgenic mice results in delivery of alpha1-antitrypsin protein to the interstitium

Alpha1-antitrypsin (alpha1AT) therapy is used as a treatment for alpha1AT deficiency. It has also been proposed as a therapy for cigarette smoke-induced emphysema, although the efficacy of such therapy is as yet unproven. Moreover, the optimal route of delivery of alpha1AT to the lung interstitium, the crucial locus of action, is unknown. We created transgenic mice with expression of the human alpha1AT gene directed by a human surfactant protein C (SpC) promoter fragment or a rat Clara cell 10-kDa protein (CC10) promoter fragment in order to examine the ability of pulmonary epithelial cell expression of alpha1AT to deliver protein to the interstitium, and to produce a model that would allow studies on the efficacy of alpha1AT in preventing lung damage after cigarette smoke exposure. Four transgenic lines were studied. In situ hybridization and light microscopic immunohistochemistry showed that two CC10 driven lines expressed human alpha1AT in type 11 alveolar cells and airway epithelial cells; alpha1AT expression was seen in the alveolar parenchyma in two SpC driven lines, and in small airway epithelium in one of the SpC lines. Electron microscopic immunochemistry showed the presence of the human alpha1AT protein in the interstitium in all lines. Mean levels of human protein varied from 0.37 to 2.9 microg/g lung protein and serum levels from 0.72 to 1.3 microg/ml, compared to normal human serum alpha1AT levels of 2-5 mg/ml. We conclude that transgene-mediated expression of alpha1AT in pulmonary epithelial cells results in diffuse expression of the transgene in the alveolar parenchyma and reproducibly leads to transfer of protein to the interstitium. The present model is, however, limited by low levels of protein production; limited protein production may be a problem in other forms of gene therapy in which relatively large amounts of extracellular protein are needed in the lung for a therapeutic effect.

Orofacial disease: update for the dental clinical team: 2. Ulcers, erosions and other causes of sore mouth. Part III

This article discusses the various infective causes of mouth ulcers.

Optimizing the balance between false positive and false negative error probabilities of confirmatory methods for the detection of veterinary drug residues

GC-MS data on veterinary drug residues in bovine urine are used for controlling the illegal practice of fattening cattle. According to current detection criteria, peak patterns of preferably four ions should agree within 10 or 20% from a corresponding standard pattern. These criteria are rigid, rather arbitrary and do not match daily practice. A new model, based on multivariate modeling of log peak abundance ratios, provides a theoretical basis for the identification of analytes and optimizes the balance between the avoidance of false positives and false negatives. The performance of the model is demonstrated on data provided by five laboratories, each supplying GC-MS measurements on the detection of clenbuterol, dienestrol and 19 beta-nortestosterone in urine. The proposed model shows a better performance than confirmation by using the current criteria and provides a statistical basis for inspection criteria in terms of error probabilities.