Oral cancer: A multicenter study

Background

To determine the prevalence and clinicopathologic features of the oral cancer patients.

Material and Methods

Biopsy records of the participating institutions were reviewed for oral cancer cases diagnosed from 2005 to 2014. Demographic data and site of the lesions were collected. Sites of the lesion were subdivided into lip, tongue, floor of the mouth, gingiva, alveolar mucosa, palate, buccal/labial mucosa, maxilla and mandible. Oral cancer was subdivided into 7 categories: epithelial tumors, salivary gland tumors, hematologic tumors, bone tumors, mesenchymal tumors, odontogenic tumors, and others. Data were analyzed by descriptive statistics using SPSS software version 17.0.

Results

Of the 474,851 accessioned cases, 6,151 cases (1.30%) were diagnosed in the category of oral cancer. The mean age of the patients was 58.37±15.77 years. A total of 4,238 cases (68.90%) were diagnosed in males, whereas 1911 cases (31.07%) were diagnosed in females. The male-to-female ratio was 2.22:1. The sites of predilection for oral cancer were tongue, labial/buccal mucosa, gingiva, palate, and alveolar mucosa, respectively. The three most common oral cancer in the descending order of frequency were squamous cell carcinoma, non-Hodgkin lymphoma and mucoepidermoid carcinoma.

Conclusions

Although the prevalence of oral cancer is not high compared to other entities, oral cancer pose significant mortality and morbidity in the patients, especially when discovered late in the course of the disease. This study highlights some anatomical locations where oral cancers are frequently encountered. As a result, clinicians should pay attention to not only teeth, but oral mucosa especially in the high prevalence area as well since early detection of precancerous lesions or cancers in the early stage increase the chance of patient being cured and greatly reduce the mortality and morbidity. This study also shows some differences between pediatric and elderly oral cancer patients as well as between Asian and non-Asian oral cancer patients.

Key words:Oral cancer, prevalence, clinic-pathologic features, retrospective study.

Pharmacological evaluation of a selective bradykinin B1 antagonist in a canine model of arthritis

The effects of a selective bradykinin 1 receptor antagonist, compound A, were evaluated in a canine model of acute inflammatory model of arthritis. Despite detection of the B₁ receptor in canine type B synoviocytes using a fluorescent ligand, oral administration of compound A (9 and 27 mg/kg) did not improve weight bearing of dogs injected intra-articularly with IL-1β in a force plate analysis. Analysis of the synovial fluid of IL-1β-treated dogs indicated high levels of bradykinin postchallenge. Excellent exposure, coupled with evidence of the presence of the B₁ receptor during an acute inflammatory model of pain, indicates an inability of the receptor to mediate inflammatory pain in canines.

Sarcoidosis exclusion criteria: the “simple truth” for a “complicated diagnosis”

The differentiation between sarcoidosis and sarcoid-type reactions remains a clinical and histopathologic diagnostic dilemma. A definitive distinction is yet to be determined according to the current literature data. Sarcoid-like tissue reactions with identifiable infectious or other immunogenic antigens, should be classified as non-specific clinical manifestations of a specific disease. The current assignment of this type of reaction under the generic umbrella of “sarcoidosis” is incorrect and may result in the subsequent misinterpretation of the definition of the disease in general. On the other hand, this may lead to clinical studies with incorrectly selected inclusion criteria and, therefore, contradictory statements regarding the epidemiology and pathogenesis of the disease. Thus we propose the introduction of new criteria for exclusion of sarcoidosis as an autonomous disease. Recent trials on patients with probable sarcoidosis have focused on ideal criteria, or have provided information about the genetic and immunological profile of patients with specific infections or other diseases, which manifest themself as sarcoidal granulomas. This could explain the heterogeneous clinical and/or genetic profiles of the reported patients, who in fact were not affected by the autonomous disease “sarcoidosis”. The simplification of the current available data regarding this issue will be of fundamental importance for the correct direction of future studies, whose aim is to unravel the pathogenesis of the immunological cascade in patients with sarcoidosis and sarcoid-like type of reaction. It is expected that the introduction of exclusion criteria will inevitably lead to a change in the approach to diagnosis as well as the fundamental understanding of this mysterious disease, known as sarcoidosis.

Early-life co-administration of cockroach allergen and endotoxin augments pulmonary and systemic responses

BACKGROUND

Environmental exposures to cockroach allergen and endotoxin are recognized epidemiological risk factors for the early development of allergies and asthma in children. Because of this, it is important to examine the role of early-life concurrent inhalation exposures to cockroach allergen and endotoxin in the pathogenesis of allergic airways disease.

OBJECTIVE

We examined the effects of repeated concomitant endotoxin and cockroach allergen inhalation on the pulmonary and systemic immune responses of newborn and juvenile mice.

METHODS

C3H/HeBFeJ mice were exposed to inhaled endotoxin and cockroach allergen via intranasal instillation from day 2 to 21 after birth, and systemic and pulmonary responses were examined in serum, bronchoalveolar lavage fluid, and lung tissue.

RESULTS

Cockroach allergen exposures induced pulmonary eosinophilic inflammation, total and allergen-specific IgE, IgG(1), and IgG(2a) production, and alveolar remodelling. Co-exposures with endotoxin and cockroach allergen significantly increased serum IgE and IgG(1), lung inflammation, and alveolar wall thickness, and decreased airspace volume density. Importantly, compared with exposures with individual substances, the responses to co-exposures were more than additive.

CONCLUSIONS

Repeated inhalation exposures of neonatal and juvenile mice to endotoxin and cockroach allergen increased the pulmonary inflammatory and systemic immune responses in a synergistic manner and enhanced alveolar remodelling in the developing lung. These data underscore the importance of evaluating the effect of multiple, concurrent environmental exposures, and of using an experimental model that incorporates clinically relevant timing and route of exposures.

Sun awareness and behaviour in healthcare professionals and the general public

The knowledge, attitudes and behaviour of healthcare professionals and the general public towards issues of sun awareness were assessed in this questionnaire-based study. The findings indicated that junior doctors and nurses were no different from the general public when it came to seeking a tan or experiencing sunburn. The increased level of knowledge in doctors was not sufficient to have changed their behaviour and the medical profession should be targeted in education campaigns at an early stage in career development.

The prevalence of chemical substance and alcohol abuse in an obstetric population in Dublin

OBJECTIVE

To determine the prevalence of illicit drug abuse and alcohol use in an obstetric population based in an urban maternity hospital.

SETTING

A collaborative study between the Rotunda Hospital, Dublin and the Irish National Drug Advisory & Treatment Centre.

DESIGN

A prospective study consisting of anonymous, unlinked urine testing of 504 'first visit' antenatal patients and a separate group of 515 patients six weeks after delivery.

METHODS & OUTCOME MEASURES

Toxicological screening using enzyme-linked immunoassay techniques, with all positive samples being reanalysed. Drug histories were taken and samples were tested for alcohol and six of the most commonly abused drugs. The pre- and postnatal prevalence of abuse was matched with demographic data.

RESULTS

The prevalence of chemical substance misuse in the antenatal population was 2.8% and 5.6% in the postnatal population. Substances identified included benzodiazepines, cannabis, amphetamines, opiates and cocaine. Less than 2% of samples tested positive for alcohol. None of the women yielding positive samples had been pre-identified on the basis of history. A significant proportion of the women were in the high risk categories with regard to age and socio-economic status.

CONCLUSION

The prevalence of drug misuse antenatally was nearly 3% and postnatally almost 6%. Substance abusers in pregnancy are more likely to be single, unemployed, and to have had a previous pregnancy.

Maternal and neonatal hyponatraemia: a comparison of Hartmanns solution with 5% dextrose for the delivery of oxytocin in labour

We performed a randomised controlled trial to compare the effect on neonatal and maternal serum sodium of using oxytocin in Hartmanns solution compared to the standard 5% Dextrose regimen for induction or augmentation in labour. We found significantly decreased maternal and neonatal serum sodium concentrations in the 5% Dextrose group compared to the Hartmanns group.

Haemostatic, fibrinolytic and endothelial variables in normal pregnancies and pre-eclampsia

OBJECTIVE

To determine the behaviour of the coagulation variables antithrombin III (ATIII), protein C, thrombin/antithrombin III (TATIII); fibrinolytic activity, tissue plasminogen activator antigen (t-PA), plasminogen activator inhibitors (PAI) 1 and 2, and endothelial involvement by fibronectin assay in normal and pre-eclamptic pregnancies.

DESIGN

Longitudinal and cross-sectional observational study.

SETTING

Antenatal clinic and maternity hospital.

SUBJECTS

Thirty-six primigravid normotensive caucasian patients, four of whom subsequently developed pre-eclampsia, and 12 patients with established pre-eclampsia.

MAIN OUTCOME MEASURES

Plasma levels of PAI-1, PAI-2 and t-PA antigen were determined using an ELISA technique as were TATIII complex levels of fibronectin. ATIII and protein C plasma levels were assayed using chromogenic substrate techniques.

RESULTS

PAI-1 and PAI-2 antigen levels rose progressively throughout normal pregnancy. Among the established pre-eclamptic group compared with matched normal pregnancies, the PAI-2 antigen level was significantly lower (48.5 +/- 22.8 versus 183.5 +/- 37.4; P < 0.001), the PAI-1 antigen level was significantly higher (122 +/- 34.4 versus 79.2 +/- 19.7; P < 0.001), ATIII activity was significantly lower (87.8 +/- 27.1 versus 110.9 +/- 19.3; P < 0.001) and TATIII complex levels were significantly higher (16.9 +/- 6.4 versus 10.2 +/- 5.9; P < 0.001). Among the four initially normotensive patients who subsequently developed pre-eclampsia, fibronectin levels were significantly elevated from as early as nine weeks of gestation.

CONCLUSION

Significantly elevated levels of PAI-1 and fibronectin occurring early in pregnancies that subsequently develop pre-eclampsia suggest that these variables may have predictive values. PAI-2 would seem to be a marker of placental function in pre-eclampsia while increased t-PA and TATIII complex levels reflect the severity of the condition.

Novel polyalkenoate (glass-ionomer) dental cements based on zinc silicate glasses

Powdered zinc silicate glasses were investigated for cement formation with aqueous poly(acrylic acid). Alkali metal zinc silicate glasses and calcium zinc silicate glasses gave polyalkenoate cements which were hydrolytically unstable, whilst alumino-zinc-silicate glasses gave hydrolytically stable cements with short setting times (under 10 min) and high compressive strengths (above 90 MPa). The aluminium to silicon ratio was not important in determining the cement forming ability of the glass. The ability to form a cement was, instead, determined largely by the network connectivity of the glass.

Twenty-four-hour ambulatory blood pressure measurement in a primigravid population

OBJECTIVE

To establish the profiles of 24-h non-invasive ambulatory blood pressure measurement (ABPM) during the trimesters of pregnancy and the puerperium in normotensive healthy primigravidae.

DESIGN

A prospective study in which 24-h ABPM was performed on five occasions in each subject: in the first trimester between 9 and 16 weeks' gestation; in the second trimester between 18 and 24 weeks; in the third trimester between 26 and 32 weeks and between 33 and 40 weeks; and finally at 6 weeks post partum.

METHOD

One hundred and six Caucasian primigravid women who were normotensive at their first booking visit were recruited consecutively from the antenatal clinic and had 24-h ABPM performed with the SpaceLabs 90207 ambulatory system.

RESULTS

Of the 106 women recruited, 98 completed 24-h ABPM on four of the five measurement occasions. Four women delivered prematurely before 33 weeks' gestation, thereby missing one ABPM measurement. Changes during pregnancy and the puerperium were assessed against the ABPM performed in the first trimester. There was no difference for daytime or night-time systolic blood pressure between 9 and 33 weeks, but it rose significantly from 33 to 40 weeks. At 6 weeks post partum, systolic blood pressure was not significantly different from the daytime pressure in the first-trimester ABPM but was raised significantly at night. Diastolic blood pressure decreased significantly between 18 and 24 weeks for both daytime and night-time. From 33 to 40 weeks it increased in parallel with systolic blood pressure, and at 6 weeks post partum it was raised significantly compared with first-trimester values for daytime and night-time. The nocturnal fall in blood pressure was preserved throughout pregnancy with a significant difference between daytime and night-time measurements present on all measurement occasions for systolic, diastolic and mean blood pressures and heart rate. There were significant differences between daytime ABPM and clinic blood pressure for both systolic and diastolic blood pressure up to 33 weeks. From 33 weeks until 6 weeks post partum there was no significant difference between daytime ambulatory and clinic blood pressures.

CONCLUSION

This study provides reference values for ABPM in healthy primigravidae with generally uncomplicated pregnancies.

Accelerated folate breakdown in pregnancy

During pregnancy there is an increased requirement for folate. We studied pregnant women to determine whether the increased requirement might be due to enhanced catabolism of the vitamin. Six normal pregnant women provided 24 h urine samples during each trimester and postpartum while taking a defined diet. The urines were assayed for the folate breakdown products p-amino-benzoylglutamate (pABGlu) and its acetylated derivative p-acetamidobenzoylglutamate (apBGlu) by high-pressure liquid chromatography. Mean concentration of excreted apABGlu rose significantly in the second trimester but returned to baseline postpartum. This increased rate of folate catabolism produces an extra demand for dietary folate of about 200-300 micrograms per day in pregnant women, a considerably greater value than recent recommendations.

Oral care of HIV-infected patients: the knowledge and attitudes of South African dentists

As the numbers of people with HIV infection and AIDS increase, so will the contribution required from the dental practitioners. A postal questionnaire survey was therefore conducted among dental practitioners in South Africa to determine their knowledge and attitudes towards HIV infection and the issues it raises for them. Although a majority of dentists were aware of the facts related to AIDS, and the spread and oral manifestations of HIV infection, there were considerable gaps in their knowledge with regard to the dental management of infected patients. Only 45 per cent were prepared to be engaged in the continued care of HIV-infected patients while contradicting opinions were expressed on the risk of HIV transmission in dentistry and attitudes towards HIV seropositive patients and staff. Further educational efforts on HIV infection and its implications in dentistry should be directed towards dentists in South Africa.

Characteristics of bacteriuria in a homogeneous maternity hospital population

Bacteriuria and urinary tract infection are a common cause of morbidity in pregnancy. Recent evidence has, however, questioned the magnitude of this risk and the effectiveness of therapy in reducing it. To clarify matters, a prospective study on 3123 ante-natal women was carried out. Screening for bacteriuria was carried out by culturing a mid-stream specimen of urine. Treatment was given to all patients with a positive culture and was based on antibiotic sensitivity testing. Repeat culture was performed 1 week after completion of therapy. The prevalence of bacteriuria in our population was 4.74%. Over half of these patients were asymptomatic. 67% of those with bacteriuria at screening were symptomatic or had a past history of urinary tract infection. Escherichia coli was the predominant organism cultured. The most effective antibiotic was Nitrofurantoin, which was sensitive in over 90% of isolates. Late urinary tract infection occurred in 3.52% of patients. There was no increase in maternal or foetal complications amongst those with bacteriuria. We concluded that it might be more cost-effective to confine screening to those patients who are symptomatic or have a past history of urinary tract infection.

Clinical application of ambulatory blood pressure measurement in pregnancy

Eclampsia and pre-eclampsia are the most important obstetric causes of maternal mortality in the Western world. The current definitions of hypertensive disorders in pregnancy rely on arbitrary blood pressure limits based on intermittent clinic readings which are subject to bias and error. Twenty-four-hour ambulatory blood pressure monitoring can overcome many of these deficiencies but has only recently been introduced into antenatal care. Five pregnancy studies using ambulatory blood pressure monitoring are currently underway in Birmingham, Glasgow, Grenoble, Oxford and Dublin. The results so far indicate that ambulatory blood pressure monitoring is an acceptable method of measuring blood pressure in pregnancy. It is also concluded that ambulatory blood pressure monitoring may have several roles in the future antenatal management of hypertension, including modification of existing classification systems, a clinical confirmatory role and a possible predictive role for pre-eclampsia.

The use of exercise as a method of aborting migraine

Exercise, as a method of migraine management has been discussed theoretically and tested empirically. The consensus is that exercise can help to reduce the frequency, intensity and/or duration of migraine attacks. Conversely, there are case studies which, with few exceptions, suggest that periods of exercise can precipitate a migraine headache. The literature concurs, however, that one should not attempt exercise when in the midst of an attack. The present article presents a case study of a woman who found prompt relief from her migraines with strenuous exercise.

Exercise and migraine. A critical review

Exercise has been frequently discussed as a method of migraine management, but the pathways by which exercise may alter migraines are unclear at present. The purpose of this paper is to provide a theoretical discussion of variables potentially involved in the prophylactic effects of a program of regular exercise. Exercise medicated changes to neurochemical secretory patterns, as well as symptoms commonly associated with, and thought to precipitate migraines will be discussed. Due to the paucity of experimental investigations of exercise and migraine, the bulk of supportive evidence for exercise as a treatment for migraines is gathered from related areas of research.

Neonatal seizures: the Dublin Collaborative Study

Asphyxial seizures occurred in 89 of 101,829 infants born alive at term (0.87/1000) in three large maternity hospitals from January 1980 to December 1984. These seizures were significantly associated with antenatal complications, primiparity, and prolonged pregnancy. Meconium staining of the amniotic fluid was also associated with asphyxial seizures, but there were high false positive (11%) and false negative (50%) rates. Fifteen of the infants who had seizures died (18%) and 21 (25%) were handicapped at 1 year. Outcome was most successfully predicted by the way the infant was feeding at 1-2 weeks. All infants taking more than half their estimated requirements by mouth at 1 week were normal, and those still being fed by tube at 2 weeks were handicapped.

Maternal and neonatal elimination of amobarbital after treatment of the mother with barbiturates during late pregnancy

Plasma half-lives of amobarbital were determined in newborn children of 10 mothers who had been treated with barbiturates for hypertension in pregnancy for 6 to 42 days prior to delivery. Five mothers had received amobarbital, 200 mg daily, and 5, phenobarbital, 60 to 180 mg daily. Half-lives in 7 of the babies ranged from 16.6 to 49.4 hr, comparable to those previously reported in babies of mothers who had received only a single dose of amobarbital. Thus there was no evidence of induction of amobarbital hydroxylation in these children. Two babies who had a greater than normal rise in serum bilirubin had longer half-lives (86.1 and 117.7 hr). In 1 baby whose mother had membranous glomerulonephritis, plasma amobarbital concentration did not significantly change over the period of the study.

Autoregulation in external carotid artery branches in the baboon

The effects of changes in systemic blood pressure upon external carotid branches of the baboon have been measured by cerebral angiography. They have been shown to have an autoregulatory type of response down to a blood pressure of about 60 mmHg, below which they constrict.