Orofacial pain evaluation in children.

AIM: Pain evaluation in children and its diagnosis are problems not always easy to solve. Children, because of their immaturity, are not always able to well communicate or to describe the clear characteristics of the disease by which they are affected. Moreover, they are often unable to report the real intensity of the pain they experience. These problems are related to their immature, not fully evolved psyche. Such problems can create difficulties to the physician who is called to examine and evaluate the origin of orofacial pain, as well as hesitation regarding when it could be necessary to start a drug therapy. Aim of this work is to propose the basic tools for the evaluation and measurement of pain that are better suitable for children, as these instruments can be used together with an accurate anamnesis and a meticulous examination, in order to formulate a precise differential diagnosis among the pathologies that affect the head and neck. A list of the most common painful diseases affecting this area is also presented. METHODS: A systematic literature review about the methods for evaluation and measurement of pain in children was conducted. The commonly used scales of measurement were examined: VAS, VSN, CAS, FPS and the Oucher SCALE. The different pathologies of head and neck and their characteristics are described and the possible causes of orofacial pain have been divided into extracranial and intracranial, in order to easily direct diagnosis. RESULTS: Orofacial pain in children is an issue of great interest in consideration of its high frequency in paediatric dentistry. Its measurement and evaluation is possible despite the small compliance of paediatric patients. Thanks to the modern technique and knowledge this evaluation can be realistic and reproducible. CONCLUSION: Evaluation scales of pain are suitable at any age and skill of the child and, together with a careful anamnesis and a proper clinical examination, allow the clinician to conduct a precise differential diagnosis of the pain so as to set the ideal therapy for the little patient.

Pedicled palatal flap for surgical repair of oro-nasal fistula.

Oronasal fistula can occur secondary to various pathologies, but cleft surgery is the most common. The authors propose a pedicled palatal flap technique for surgical repair of small oronasal fistula (0.5-0.8 cm), derived from their experience in the treatment of 7 patients between March 2003 and December 2007. In one case, the fistula was induced by prolonged snorting of cocaine. In the other cases, the fistulas developed after excision of a benign tumor of the palate. For the cocaine-induced fistula, failure of the repair attempt was apparent within 7 days of surgery. In all other cases, complete fistula closure was obtained, and no complications occurred.

Mechanism of action of trabectedin in desmoplastic small round cell tumor cells.

BACKGROUND: Desmoplastic small round cell tumor (DSRCT) is a rare and highly aggressive disease, that can be described as a member of the family of small round blue cell tumors. The molecular diagnostic marker is the t(11;22)(p13;q12) translocation, which creates an aberrant transcription factor, EWS-WT1, that underlies the oncogenesis of DSRCT. Current treatments are not very effective so new active drugs are needed. Trabectedin, now used as a single agent for the treatment of soft tissue sarcoma, was reported to be active in some pre-treated DSRCT patients. Using JN-DSRCT-1, a cell line derived from DSRCT expressing the EWS-WT1 fusion protein, we investigated the ability of trabectedin to modify the function of the chimeric protein, as in other sarcomas expressing fusion proteins. After detailed characterization of the EWS-WT1 transcripts structure, we investigated the mode of action of trabectedin, looking at the expression and function of the oncogenic chimera. METHODS: We characterized JN-DSRCT-1 cells using cellular approaches (FISH, Clonogenicity assay) and molecular approaches (Sanger sequencing, ChIP, GEP). RESULTS: JN-DSRCT-1 cells were sensitive to trabectedin at nanomolar concentrations. The cell line expresses different variants of EWS-WT1, some already identified in patients. EWS-WT1 mRNA expression was affected by trabectedin and chimeric protein binding on its target gene promoters was reduced. Expression profiling indicated that trabectedin affects the expression of genes involved in cell proliferation and apoptosis. CONCLUSIONS: The JN-DSRCT-1 cell line, in vitro, is sensitive to trabectedin: after drug exposure, EWS-WT1 chimera expression decreases as well as binding on its target promoters. Probably the heterogeneity of chimera transcripts is an obstacle to precisely defining the molecular mode of action of drugs, calling for further cellular models of DSRCT, possibly growing in vivo too, to mimic the biological complexity of this disease.

Time to onset of bisphosphonate-related osteonecrosis of the jaws: a multicentre retrospective cohort study.

OBJECTIVES: Osteonecrosis of the jaw (ONJ) is a potentially severe adverse effect of bisphosphonates (BP). Although the risk of ONJ increases with increasing duration of BP treatment, there are currently no reliable estimates of the ONJ time to onset (TTO). The objective of this study was to estimate the TTO and associated risk factors in BP-treated patients. SUBJECTS AND METHODS: Retrospective analysis of data from 22 secondary care centres in seven countries relevant to 349 patients who developed BP-related ONJ between 2004 and 2012. RESULTS: The median (95%CI) TTO was 6.0 years in patients treated with alendronate (n = 88) and 2.2 years in those treated with zoledronate (n = 218). Multivariable Cox regression showed that dentoalveolar surgery was inversely associated, and the use of antiangiogenics directly associated, with the TTO in patients with cancer treated with zoledronate. CONCLUSIONS: The incidence of ONJ increases with the duration of BP therapy, with notable differences observed with respect to BP type and potency, route of administration and underlying disease. When data are stratified by BP type, a time of 6.0 and 2.2 years of oral alendronate and intravenous zoledronate therapy, respectively, is required for 50% of patients to develop ONJ. After stratification by disease, a time of 5.3 and 2.2 years of BP therapy is required for 50% of patients with osteoporosis and cancer, respectively, to develop ONJ. These findings have significant implications for the design of future clinical studies and the development of risk-reduction strategies aimed at either assessing or modulating the risk of ONJ associated with BP.

Cáncer oral y dentistas: conocimientos, actitudes y prácticas en Chile / Oral cancer and dentists: knowledge, attitudes and practices in Chile

El objetivo de este estudio fue describir los conocimientos, actitudes y prácticas en relación al cáncer oral de Cirujano ­ Dentistas de la comuna Las Condes, Santiago de Chile. Se realizó un estudio descriptivo, transversal. Se aplicó una encuesta de autollenado a 264 Cirujano ­ Dentistas de la comuna Las Condes, Santiago de Chile en el período junio ­ julio 2014. Se informó previamente a los participantes el carácter voluntario, anónimo y confidencial de la encuesta. La muestra final fue de 205 (Tasa de pérdida: 22,3 %).Se realizó estadística descriptiva con tabulación y distribución de frecuencias. La mayoría de los participantes identificó los principales factores de riesgo decáncer oral: tabaquismo (99,5 %) y consumo de alcohol (83,4 %). Menos de dos tercios identificó las dos lesiones cancerizables más frecuentes (leucoplasia y eritroplasia) y al carcinoma espinocelular como la forma más común de cáncer oral. El 25,4 % reportó presentar conocimientos actualizados sobre el cáncer oral y el 35,6 % reportó practicar habitualmente un examen clínico para detectar cáncer oral. Se observaron carencias en los conocimientos, actitudes y prácticas en relación al cáncer oral de Cirujano ­ Dentistas de la comuna Las Condes, Santiago de Chile. Estas carencias son susceptibles a ser mejoradas mediante intervenciones educacionales dirigidas a Cirujano ­ Dentistas que permitan mejorar sus conocimientos, actitudes preventivas y competencias procedimentales en la prevención y diagnóstico precoz del cáncer oral.

The aim of this survey was to describe the knowledge, attitudes and practices regarding oral cancer in a sample of dentists from Las Condes, Santiago de Chile. A descriptive, cross-sectional study was conducted. A self-filling survey was applied to 264 dentists of Las Condes, Santiago de Chile during june ­ july 2014. Participants were previously informed that the survey was voluntary, anonymous and confidential. The final sample included 205 dentists (Loss Rate: 22.3 %). Descriptive statistic was applied using tabulation and frequency distribution. Most participants identified the main risk factors for oral cancer: tobacco (99.5 %) and alcohol usage (83.4 %). Less than two thirds of the participants identified the two most common precancerous lesions (leukoplakia and erythroplakia) and squamous cell carcinoma as the most common type of oral cancer. 25.4 % of the participants reported to have updated knowledge regarding oral cancer and 35.6 % reported to routinely perform clinical examination to detect oral cancer. Deficiencies in knowledge, attitudes and practices regarding oral cancer of dentists from Las Condes, Santiago de Chile were observed. These deficiencies are likely to be enhanced through educational interventions which would improve their knowledge, attitudes and strengthen their role in the prevention and early diagnosis of oral cancer.

Expression of salivary biomarkers in patients with oral mucositis: evaluation by SELDI-TOF/MS.

OBJECTIVE: This study aims to evaluate changes in proteomic salivary profile of patients with oral mucositis after adjuvant cancer treatments. MATERIALS AND METHODS: Samples were collected from patients after adjuvant cancer therapies, and were analyzed by means of SELDI/TOF. Patients were separated in two groups: patients affected by mucositis (MUCOSITIS) and patient without mucositis (NO MUCOSITIS). All patients were divided in function of the anticancer treatment: patients who had radiotherapy (MUCOSITIS RADIO), had not radiotherapy (MUCOSITIS NO RADIO), had chemotherapy (MUCOSITIS CHEMO), and those who had not chemotherapy (MUCOSITIS NO CHEMO). Statistical evaluation PCA (Principal Component Analysis) was conducted with the software BIO-RAD Data Manager(™) (Version 3.5). RESULTS: We found the increased peaks of 3443, 3487, and 4135 m/z in MUCOSITIS group, while 6237 m/z was reduced. These same peaks would the same modifications in MUCOSITIS RADIO, while in MUCOSITIS CHEMIO are increased 3443 and 6237 m/z but 3487, 4135 m/z are reduced. These data were confirmed by the PCA. CONCLUSION: Anticancer therapy influenced the level expression of many salivary biomarkers in mucositis with a good significance. Therefore, 3443, 3487, 4135, and 6237 m/z are good biomarker candidates of oral mucositis.

Surgical treatment of sacral chordoma: survival and prognostic factors.

INTRODUCTION: Sacral chordoma is a rare low-to-intermediate grade malignant tumour. The mainstay of treatment is still surgery with en bloc and wide resection margins, which can grant the best chances of a long-term control or cure of this disease. The first aim of this paper is to collect data about survival, time to local recurrence and metastasis among patients affected by sacral chordoma and primarily treated with surgery. The second aim is to analyze the influence of level resection, tumor volume and surgical margins on local recurrence. MATERIALS AND METHODS: The study population was composed of 14 patients treated with sacral chordoma resection at the National Tumour Institute of Naples-Pascale (Italy) from January 2000 to June 2013. The median follow-up was 84 months (range 24-132 months). The follow-up was characterized by: standard radiographs, MRI, and a CT scan of the chest annually. Time to recurrence or metastasis was calculated from the date of resection to the date of diagnosis of first recurrence or metastasis. RESULTS: Out of all the patients, six died (42.86 %) during the follow-up; 6 (42.86 %) had local recurrence; 4 (28.57 %) had metastasis. At univariate analysis wide surgical margins (R0) were associated with increased survival up to a local recurrence (OR = 0.0286; 95 % CI = 0.0014-0.5739; P = 0.026); the level of resection (OR = 3.33; 95 % CI = 0.3619-30.7025; P = 0.592) and tumour volume (P = 1) did not show a statistically significant correlation. DISCUSSION: Based on our experience, we hope all patients to be treated by surgery, the only good standard treatment of this disease. The resection should result in margins as wide as possible. For these reasons, it is essential for this disease to be treated in highly specialized centres because only a complete surgery can offer a chance to care for these patients. CONCLUSIONS: Solid survival at long-term follow-up can be achieved by a surgical resection performed with wide margins.

Calibre Persistent Labial Artery: Clinical Features and Immunohistochemistry Diagnosis.

Calibre persistent labial artery (CPLA) usually presents as an asymptomatic papule on the lower lip and can be easily misdiagnosed as a mucocele, haemangioma, venous lake, varix or fibroma. When it is ulcerated, squamous cell carcinoma is the most usual differential diagnosis. Here, we report a case of a 25-year-old woman with no previous relevant medical history who presented with a complaint of an asymptomatic, non-ulcerated, progressively growing nodule (over the last 5 months) on the upper lip. In this case, the diagnosis was made clinically and confirmed by immunohistochemical analysis. We conclude that clinicians should be aware of CPLA and it should be included in the differential diagnosis of labial mucosal papules. Sometimes, the immunohistochemical analysis is necessary to make a correct diagnosis.

Expression of p16 in squamous cell carcinoma of the mobile tongue is independent of HPV infection despite presence of the HPV-receptor syndecan-1.

BACKGROUND: Tongue squamous cell carcinoma (TSCC) is increasing in incidence, especially among young patients and preferably females. Infection with human papilloma virus (HPV) has been suggested as a cause of SCC in the head and neck, and the proportion of oropharyngeal cancers caused by HPV has steadily increased. METHODS: Samples from 109 patients with primary TSCC were analysed for the presence of HPV16 by in situ hybridisation and for expression of its surrogate marker p16 and the HPV receptor syndecan-1 by immunhistochemistry. RESULTS: No evidence of HPV16 DNA was observed in the tumours, although one-third showed p16 staining. There was no difference in the expression of the primary HPV receptor, syndecan-1, between TSCC and a group of tonsil SCC. CONCLUSION: Whereas p16 is expressed in some TSCCs, HPV16 is undetectable, therefore, p16 cannot be used as a surrogate marker for high-risk HPV-infection in this tumour. Despite presence of the HPV-receptor syndecan-1 in TSCC, HPV prefers the tonsillar environment. Lack of p16 associates with worse prognosis primarily in patients aged ⩽40 years with tongue SCC. The improved prognosis seen in p16-positive TSCC can be due to induction of a senescent phenotype or an inherent radiosensitivity due to the ability of p16 to inhibit homologous recombination repair.

Sialoendoscopy: a viable treatment for I(131) induced sialoadenitis.

To evaluate the viability, efficacy, and safety of sialoendoscopy for the diagnosis and management of radioiodine I(131-) related sialoadenitis, we retrospectively reviewed 30 patients referred between September 2007 and July 2013 from the Thyroid Surgery Unit to the Maxillofacial Unit of the Second University of Naples Hospital with persistent sialoadenitis after treatment with I(131). After the affected gland had been isolated, the endoscope was introduced into the duct under local anaesthesia with 2% lignocaine and continuous lavage with isotonic saline, and was advanced until it reached the ductal system. We studied 24 women and 6 men, mean (SD) age 52 (??) years. In 25 patients I(131) was given for papillary (83%), in 3 for medullary (10%), and in 2 for follicular thyroid carcinoma (7%). Stenosis alone was found in 30 glands (40%), mucous plugs alone in 35 (47%), and mucous plugs, stenosis, and kinks in 10 (13%). Of the 75 glands, dilatation of the ducts was successful in 70, and we completely removed all mucous plugs and kinks. We achieved symptomatic improvement in 23 patients (77%) during a follow-up ranging from 2 weeks to 84 months. Sialoendoscopy is a viable technique for the diagnosis of obstructive salivary disease, and is a safe and effective way to treat sialoadenitis, the most common complication of treatment with I(131).

Importance of spinal deformity index in risk evaluation of VCF (vertebral compression fractures) in obese subjects: prospective study.

INTRODUCTION: Obesity and osteoporosis share many features and recent studies have identified many similarities suggesting common pathophysiological mechanisms. Obesity is associated with a higher risk of non-traumatic fractures despite bone mineral density (BMD) being normal or even increased. MATERIALS AND METHODS: 54 obese subjects were analyzed (51 ± 16 years, 10 males, 44 females). Spinal deformity index (SDI) is a semi-quantitative method that may be a surrogate index of bone microarchitecture. SDI index was higher in patients than in controls. In 87.5 % of patients and 10 % of controls we found morphometric vertebral fractures, despite a DEXA Tscore not diagnostic of osteoporosis. CONCLUSION: The objective of this study was to assess in obese patients levels of 25OH vitamin D, parathyroid hormone, serum and urinary calcium (Ca) and phosphorus (P), BMD, and SDI. 87.5 % of the obese subjects present nontraumatic vertebral fractures and reduced bone quality as measured by SDI.

Dynamic evaluation of benign neoplasm of parotid glands with multidetector row CT.

AIM: The aim of this paper was to evaluate the role of net-enhancement (NE) of benign salivary glands with multiphase multidetector row CT (MDCT). METHODS: Forty-eight patients (M=27, F=21), aged 35-76 years old (mean =57) with benign parotid neoplasms were examinated with 4 MDCT, at 20'', 40'', 70'' e 9' after intravenous administration of contrast medium. NE was calculated after subtracting precontrast phase to postcontrast phases. Final data were compared to the histopathology. RESULTS: Thirty-six cases were pleomorphic adenomas (PA), 24 Warthin (WT). PA had a medium NE values of 23 HU, 74 HU, 53 HU e 34 HU at 20'', 40'', 70'' e 9' respectively. WT had a medium NE of 52 HU, 54 HU, 40 HU e 39 HU respectively at the same times. After subtracting precontrast phase to the delayed phase, with NE at 9' and cut-off of 34 HU, we have differenziate PA from WT and normal gland with specifity (SP) 87%, sensibility (SE) 60%, positive predictive value (PPV) and negative predictive value (NPV) of 75% and 59%; with NE at 20'' and cut-off of 54HU we have distingueshed WT from AP with SP 83%, SE 50%, PPV 75% and NPV 63%. CONCLUSION: The study of NE can allow the characterization of benign parotid gland tumors.