Masseter muscle flap for reconstruction of intra-oral defects in patients with early cancer of posterior-inferior parts of the oral cavity / Retalho do músculo masseter para reconstrução de defeitos intraorais em pacientes com câncer inicial de partes póstero‐inferiores da cavidade oral

Abstract Introduction Early carcinomas of the oral cavity in the posterior-inferior regions poses a challenge for reconstruction due to the lack of muscle support underneath and the limited space available to use some of the frequently-used flaps. Objective This study was done to evaluate the efficacy of the superiorly based masseter muscle flap in reconstruction of intra-oral post- ablation defects in patients with early oral carcinoma of the posterior-inferior part of the oral cavity. Methods A superiorly based masseter muscle flap were used to reconstruct the post-surgical intra- oral defect in 60 patients with early squamous cell carcinoma (T < 4 cm) of the posterior-inferior part of the oral cavity. The patients were followed up at 1-week and 1-month postoperatively to check for flap viability, complications, change in mouth opening and deviation of the mandible on mouth opening. To rule out any recurrence in the oral cavity masseter flaps, the patients were followed up for 1 year. Results The flap was viable in all patients and underwent mucosalization. 7/60 patients had postoperative infections, while 2/60 patients developed an oro-cutaneous fistula which required a secondary corrective procedure. The mean ± standard deviation of change in mouth opening at 1 week postoperatively was +1.917 ± 3.36 mm, which increased to +2.633 ± 2.95 mm at 1 month after surgery. The Friedman test revealed that there was a statistically significant change in mouth opening from preoperative period to the1 week and 1 month postoperative periods (p = 0.000). Female patients showed better improvement in mouth opening postoperatively. The ipsilateral deviation of the mandible on mouth opening was between 0-5 mm in 39 patients, 5-10 mm in 17 patients and more than 10 mm in 4 patients. There were no recurrences noted in the masseter flaps used. Conclusion The study infers that the superiorly based masseter muscle flap is a reliable method for reconstruction in early oral cancer patients yielding good functional results and acceptable cosmesis with nominal postoperative complications.

Resumo Introdução Os carcinomas iniciais da cavidade oral nas regiões póstero‐inferiores representam um desafio para a reconstrução devido à falta de suporte muscular abaixo da região e ao espaço limitado disponível para o uso de alguns dos retalhos mais empregados. Objetivo Avaliar a eficácia do retalho do músculo masseter de base superior na reconstrução de defeitos intraorais pós‐ablação em pacientes com carcinoma oral inicial da parte póstero‐inferior da cavidade oral. Método Um retalho do músculo masseter de base superior foi usado para reconstruir o defeito intraoral pós‐cirúrgico em 60 pacientes com carcinoma espinocelular inicial (T < 4 cm) localizado na parte póstero‐inferior da cavidade oral. Os pacientes foram acompanhados após uma semana e um mês de pós‐operatório para verificação da viabilidade do retalho, complicações, alteração na abertura bucal e desvio da mandíbula na abertura bucal. Para descartar recidiva nos retalhos do masseter, os pacientes foram acompanhados por um ano. Resultados O retalho foi viável em todos os pacientes e foi submetido à mucolização; 7/60 pacientes tiveram infecções pós‐operatórias, enquanto 2/60 pacientes desenvolveram uma fístula orocutânea que exigiu um procedimento corretivo secundário. A média ± desvio‐padrão da alteração na abertura da boca em uma semana de pós‐operatório foi + 1,917 ± 3,36 mm, que aumentou para + 2,633 ± 2,95 mm em um mês de pós‐operatório. O teste de Friedman revelou que houve uma alteração estatisticamente significante na abertura da boca do período pré‐operatório para os períodos de uma semana e um mês de pós‐operatório (p = 0,000). Pacientes do sexo feminino apresentaram maior melhoria na abertura da boca no pós‐operatório. O desvio ipsilateral da mandíbula na abertura da boca ficou entre 0 a 5 mm em 39 pacientes, 5 a 10 mm em 17 pacientes e mais de 10 mm em 4 pacientes. Não foram observadas recidivas nos retalhos de masseter usados. Conclusão O retalho do músculo masseter com base superior é um método confiável para reconstrução em casos de câncer oral inicial, produz bons resultados funcionais e resultados cosméticos aceitáveis com complicações pós‐operatórias insignificantes.

No evidence of association of xenotropic murine leukemia virus‑related virus with oral cancers: Experience from a tertiary care center in South India.

BACKGROUND: Development of oral cancer, a widely prevalent cancer in India, is multifactorial with increased risk in those habituated to smoking, consuming alcohol and chewing paan and tobacco. This does not preclude other etiological factors in the causation of this cancer. Exploratory studies on several oncogenic viruses have found varied associations with oral cancers. AIM: The aim of this study was to explore the association of xenotropic murine leukemia virus‑related virus, (XMRV) a retrovirus recently implicated in oncogenesis in humans, with oral cancers. SETTINGS AND DESIGN: The presence of XMRV proviral deoxyribonucleic acid (DNA) was evaluated by standard nucleic acid amplification from DNA extracted from representative bits of tumor tissues and adjacent normal tissues from surgically resected specimens sent post‑operatively for routine histopathological testing. MATERIALS AND METHODS: This prospective study comprised 109 patients with a provisional diagnosis of oral cancer who were operated at the Oral Oncology Department of Kidwai Memorial Institute of Oncology, over a period of 10 months. RESULTS: XMRV was not found in any of the tumor tissues (squamous cell carcinomas ‑ 98; verrucous carcinomas ‑ 4) nor in any of the normal tissues. It is thus important that the absence of this oncogenic virus in all the cases makes the association of XMRV with oral cancers very unlikely. CONCLUSIONS: There is a need to investigate potentially oncogenic viruses in other solid tumors and in larger sample sizes. Any such association could have implications in detecting, preventing and treating these cancers.

Mutation in mexR-gene leading to drug resistance in corneal keratitis in human.

The present study deals with the genetic polymorphism of the mexR gene which is involved in the resistance to drugs like ciprofloxacin. Mutations in mexR result in increased resistance to multiple antibiotics due to overexpression of this efflux system. The MexR product contains 147 amino acids with a molecular mass of 16,964 Da. We detected 28 point mutations in 14 samples from corneal scraping infected with Pseudomonas aeruginosa, which were screened for ciprofloxacin resistance. Twenty four were silent mutations and four missense mutations. Mapping these mutations was done by using in silico methods on the protein 3D- structure obtained from PDB database, localized at 3 specific sites. Single amino acid changes (mutations) may influence MexR stability or its ability to dimerise, and thus result in the conformation changes at the DNA-binding domain, of the structure. Hence it is concluded that the mutations in the DNA binding domain of mexR gene could be one of the factors contributing to the possible drug resistance in these patients.

Cardioprotective effect of mangiferin on isoproterenol induced myocardial infarction in rats.

Isoproterenol (ISPH) induced myocardial infarction was confirmed by disturbances in serum and heart tissue marker enzymes such as lactate dehydrogenase (LDH), creatine phospho kinase (CPK), aspartate transaminase (AST) and alanine transaminase (ALT), increased level of lipid peroxidation and histopathological changes in the heart of ISPH administered rats. Pretreatment with mangiferin (10 mg/100 g body weight) for 28 days was found to ameliorate the effect of ISPH-induced pathological changes, reduced the lipid peroxide formation and retained the myocardial marker enzyme activities at near normal level. The above results indicate the cardioprotective effect of mangiferin against ISPH-induced myocardial infarction in rats.

Protective effect of vilva juice on glycoconjugate levels in experimentally induced constipation in rats.

Efficacy of vilva, a polyherbal formulation was evaluated in morphine induced constipated rats. Vilva juice, at a dose of 1.5 ml/100 g body wt was given orally for a period of 7 days. Morphine sulfate was injected to induce constipation on 8th day, 45 min before the experiments. Protein bound glycoconjungates were estimated in intestinal tissue. Altered levels of glycoconjugates were maintained at near normalcy when pretreated with vilva juice in morphine induced rats. Histological changes were observed in the colon tissue. The damage to crypts of Liberkunn in constipated rats were found to be reduced in vilva pretreated rats. Vilva, thus, offered significant protection against morphine induced constipation by way of augmenting mucus secretion.

Effect of Solanum trilobatum against carbon tetrachloride induced hepatic damage in albino rats.

BACKGROUND & OBJECTIVES: Many hepatoprotective herbal preparations have been recommended in alternative systems of medicine for the treatment of hepatic disorders. No systematic study has been done on protective efficacy of Solanum trilobatum to treat hepatic diseases. Protective action of Solanum trilobatum extract (STE) was evaluated by us in an animal model of hepatotoxicity induced by carbon tetrachloride (CCl4). METHODS: Wistar albino rats were divided into five groups. Group I was normal control group; Group II, the hepatotoxic group was given CCl4; Groups III-V received different doses of plant extract with CCl(4). Liver marker enzymes were assayed in serum and antioxidant status was assessed in liver tissue. RESULTS: Levels of marker enzymes such as alanine transminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), and lactate dehydrogenase (LDH) were increased significantly in CCl4 treated rats (group II). STE brought about a significant decrease in the activities of all these enzymes. Lipid peroxidation (LP) was increased significant in liver tissue in the CCl4 treated rats (group II) while the activities of glutathione peroxidase (GPx), catalase (CAT) and superoxide dismutase (SOD) were decreased. STE treatment led to the recovery of these levels to near normal. INTERPRETATION & CONCLUSION: The present observations suggested that the treatment with S. trilobatum extract enhance the recovery from CCl4 induced hepatic damage due to its antioxidant and hepatoprotective property.

Bacopa monniera Linn. extract modulates antioxidant and marker enzyme status in fibrosarcoma bearing rats.

Antioxidative property and tumor inhibitive property of B. monniera (20mg/kg body wt, sc) was examined in 3-methylcholanthrene induced fibrosarcoma rats. Antioxidant enzymes such as catalase (CAT), superoxide dismutase (SOD), glutathione peroxidase (GPx) and the levels of glutathione (GSH) and the rate of lipid peroxidation (LPO) in the liver and kidney tissues were assessed. A significant increase was noted for the rate of LPO with a corresponding decrease in the antioxidant enzyme status in fibrosarcoma bearing rats. In fibrosarcoma bearing rats, the tumor markers like lactate dehydrogenase (LDH), creatine kinase (CK), alanine transaminase (ALT), aspartate transaminase (AST) and sialic acid (SA) were increased in the serum. Treatment with B. monniera extract significantly increased the antioxidant enzyme status, inhibited lipid peroxidation and reduced the tumor markers. It can be concluded that B.monniera extract promotes the antioxidant status, reduces the rate of lipid peroxidation and the markers of tumor progression in the fibrosarcoma bearing rats.

Effect of a polyherbal formulation, Ambrex, on butylated hydroxy toluene (BHT) induced toxicity in rats.

Effect of polyherbal formulation Ambrex was evaluated in butylated hydroxytoluene (BHT) induced toxicity of lungs and liver in rats. Toxicity was produced by administering BHT (500 mg/kg/day) for 3 days. Lung damage was evidenced by elevated levels of broncho alveolar lavage fluid (BAL) parameters such as protein, lactate, lactate dehydrogenase (LDH), alkaline phosphatase (ALP), acid phosphatase (ACP) and glucose-6-phosphate dehydrogenase (G6PDH). Liver damage was proved by elevated levels of serum protein and markers such as LDH, ALP, aspartate amino transferase (AST), alanine amino transferase (ALT), decreased level of lipid peroxides (LPO) in serum and glutathione (GSH) in liver. Administration of aqueous suspension of Ambrex (50 mg/kg orally) retained these elevated levels of BAL-protein, lactate, LDH, ALP, ACP, G6PDH and serum-protein, LDH, ALP, AST and ALT at near normal values. Decreased level of liver GSH was retained at near normalcy in Ambrex pretreated BHT-administered animals. There was no change in liver LPO in all the four groups.

Prevention of HCl-ethanol induced gastric mucosal injury in rats by Garcinia cambogia extract and its possible mechanism of action.

Oral pretreatment of rats with G. cambogia fruit extract (1 g/kg body weight/day at interval of 7 and 15 days) protected gastric mucosa against HCl-ethanol induced damage by decreasing the volume and acidity of gastric juice. Increased lipid peroxidation, decreased activity of antioxidant enzymes, altered levels of protein and glycoproteins in the ulcerated mucosa, and gastric juice were maintained at near normal levels in G. cambogia pretreated rats. The results suggest the anti-ulcer activity of G. cambogia by virtue of its ability to decrease acidity and increase mucosal defense.

Seizures in hyperglycemic patients.

AIM OF STUDY: To study the pattern of seizures in hyperglycemic patients and its correlation with serum osmolality, blood sugar and serum sodium. MATERIALS AND METHODS: (Study period June 1999-June 2000) Forty patients who presented with first time seizures and who were detected to be diabetic were included in the study. All patients had detailed history, clinical examination blood sugar, BUN, serum electrolytes, serum osmolality, serum calcium estimation. EEG and CT head scan was also done. The seizures were classified as per ILAE classification (1981). The study group was further divided into Group A--those with normal CT (n 24) and Group B-- those showing infarcts in CT scan (n 16). The control group (n 40) were matched for age and had first occurrence of seizures and CT showed infarct and were euglycemic. All the investigations were done for the control group as well. Statistical analysis was done using ANOVA. RESULTS: None of the patient had diabetic ketoacidosis. Patients in study group had statistically significant incidence of (1) Focal seizures with or without generalisation (100%); (2) Visual hallucination (25%); (3) Epilepsia partialis continua (20%). Comparing the subgroups (A and B) complex partial seizures and visual hallucination was significant at 5% level in the group A (NKH with normal CT). Ninety percent in the study group had increased serum osmolality (Vs 22.5% in the control group). Duration (eight days Vs 1) and frequency (15 per day vs 1.45) were positively correlated with RBS > S.osmolality > S.sodium. CONCLUSION: 1. Long duration and frequent focal motor seizures with or without secondary generalisation occurs in NKH which at times may be the first manifestation of DM. 2. Complex partial seizures, visual hallucination and epilepsia partialis continua are more common in NKH patients than in euglycemic patients. 3. There is positive correlation of blood sugar, S.osmolality and S.sodium with frequency and duration of seizures. RBS > S.osmolality > S.Na. 4. Correction of hyperglycemia is the main stay of management of seizures. 5. Movement induced seizures which is specific for NKH is a rarity.

Histopathological and lipid changes in experimental colon cancer: effect of coconut kernal (Cocos nucifera Linn.) and (Capsicum annum Linn.) red chilli powder.

Influence of coconut kernal and red chilli on the metabolism of lipids was studied in animals given 1,2-dimethylhydrazine (DMH). The average weight gain by the animals in the coconut kernal group was more than DMH and chilli treated groups. The concentration of cholesterol showed a decrease and phospholipids an increase in most of the tissues studied, of the kernal groups. The cholesterol-phospholipid ratio was found to be increased in most of the tissues of all experimental groups, when compared to control animals. HMG CoA reductase activity decreased in the high fat and most of the tissues of the kernal + DMH, kernal + chilli and kernal + chilli + DMH groups, while it increased in the DMH, chilli and chilli + DMH groups. Histopathological studies showed that coconut kernal supplemented animals had fewer papillae, lesser infiltration into the submucosa and lesser changes in the cytoplasm with decreased mitotic figures. Coconut kernal, thus reduced the mutagenic and carcinogenic effect of chilli and DMH respectively.

Role of redchilli (Capsaicin) in the formation of colonic carcinoma.

The effect of feeding redchilli (Capsaicin) powder on the histopathological changes occurring in the colonic mucosa was studied in rats. These animals were compared with those treated with a colonic carcinogen 1,2-dimethylhydrazine (DMH). Animals fed with redchilli, dimethylhydrazine, dimethylhydrazine plus redchilli powder showed polyp and dysplasia, malignant tumour and malignant tumour with transitional area of dysplasia.

Influence of red chilli on lipids and bile acids in different tissues in experimental colon cancer.

Effect of feeding red chilli on the levels of lipids, fecal bile acids and fecal sterols was studied in animals given 1,2-dimethylhydrazine (DMH). When the three experimental groups were compared with control, the levels of cholesterol increased while phospholipids and free fatty acids decreased or showed no alteration in most of the tissues studied. Cholesterol-phospholipid ratio was high in both DMH as well as in the chilli + DMH treated groups. Weekly assessment of bile acids and neutral sterols showed a significant increase in all the three experimental groups, when compared to the control rats. Morphological and histopathological studies show that there were a number of visible malignant tumors in the colon and intestine of all the three experimental animals.

Carcinoma of the urinary bladder metastatic to the oral cavity.

Oral Metastasis from a carcinoma of the urinary Bladder is extremely uncommon. Two cases of transitional cell carcinoma of the Bladder, presenting eighteen and ten months after initial diagnosis, one with soft tissue metastasis in the upper alveolus and the other with bony metastasis to the mandible are discussed.