Association between polymorphism in p21[WAF1/CIP1] cyclin -dependent kinase inhibitor gene and human oral cancer

The cyclin-dependent kinase inhibitor gene p21[Waf/Cip1] plays a central role in inducing cellular growth arrest, terminal differentiation and apoptosis. Alterations in this gene may adversely affect regulation of these processes and increase susceptibility for cancer. A novel polymorphism in the p21[Waf/Cip1] gene in the Egyptian population and its association with esophageal cancer had been recently reported. An A->G transition at codon 149 resulted in amino acid substitution from aspartate to glycine in the proliferating cell nuclear antigen binding COOH-terminal domain of p21[Waf/Cip1] that may affect PCNA- p21[Waf/Cip1] interactions, thereby affecting regulation of cellular proliferation and may increase susceptibility for development of cancer. In a parallel study in our laboratory, we searched for putative p21[Waf/Cip1] mutations in oral premalignant and malignant lesions. No somatic mutation was detected in exon 2 of p21[Waf/Cip1]. Interestingly. a codon 149 polymorphism variant [A->G] was identified in 11 of 30 [37%] premalignant lesions [7 of 19 hyperplastic lesions and 4 of 11 dysplastic lesions] and 11 of 30 [37%] squamous cell carcinomas [SCCs]. This codon 149 variant was also identified in paired lymphocytes of all of the patients with premalignant lesions and SCCs harboring the variant allele, suggesting the occurrence of a polymorphism. Lymphocyte DNA isolated from 50 unrelated age- and gender-matched healthy subjects was screened for this polymorphism. Seven of 50 [14%] normal controls harbored the A->G codon 149 variant allele. Immunohistochemical analysis of p21[Waf/Cip1] protein expression showed immunoreactivity in 19 of these 30 [63%] oral premalignant lesions and 16 of 30 [53%] SCCs. The most intriguing features of the study were: [a] the significant increase in frequency of this polymorphism not only in patients with oral SCCs [p = 0.038], but also in patients with premalignant lesions [p = 0.038], compared with normal controls and [b] the significantly higher frequency of p21[Waf/Cip1] variants [codon 149] in oral premalignant lesions [10 of 11 cases] and SCCs [11 of 11 cases] with wild-type p53 [p = 0.045] than in lesions with p53 mutations, suggesting that this polymorphism affects the p53 pathway and may play a vital role in oral tumorigenesis. Furthermore, overexpression of p21 protein in oral lesions harboring missense mutations in the p53 gene suggest a p53-independent role for p21 in the pathogenesis of oral cancer

controlled study evaluating medical treatment versus surgical treatment in addition to medical treatment of nasal polyposis

Thirty-two patients with nasal polyposis and symmetrical nasal airways were randomized to unilateral endoscopic sinus surgery after pretreatment with oral prednisolone for ten days and local nasal budesonide bilaterally for one month. Postoperatively, the patients were given local nasal steroids [budesonide]. They were evaluated with nasal endoscopy, symptom scores and olfactory thresholds. They were followed up for 12 months. The sense of smell was improved by the combination of local and oral steroids. Surgery had no additional effect. The symptom scores were significantly increased with the medical treatment alone, but surgery had additional beneficial effects on nasal obstruction and secretion. After surgery, the polyp score decreased significantly on the operated side, but remained the same on the unoperated side. 25% of the patients were willing to undergo an operation also on the unoperated side at the end of the study. The medical treatment proved to be sufficient to treat most of symptoms of nasal polyposis

Fashioning a combined surgical technique for bilateral chronic nasal obstruction due to hypertrophied turbinates

In this study, three effective methods were compared to get the best results when applied on 40 patients. These methods were bipolar diathermy of whole antero-inferior length of the inferior turbinates, lateral outward fracture of inferior turbinates and an excision of the lower redundant part excluding the anterior end but including the posterior one

use of carbon dioxide laser to remoe small submandibular sialoliths

Six cases of small submandibular duct sialoliths were treated using carbon dioxide laser as a surgical dissector. When the laser beam encountered the small submandibular sialolith [3 mm or less], a light scattering effect [flash or burst] was observed thus enabling an almost immediate localization of the stone in the salivary duct or in the surrounding tissue. Stone extirpation is more rapid, with less surgical trauma, using this technique