Outcome following treatment for Helicobacter pylori in patients with recurrent aphthous stomatitis.

OBJECTIVE: The aim of the current study was to investigate any association of Helicobacter Pylori (HP) in recurrent aphthous stomatitis (RAS) and the effect of eradication of the microorganism in the clinical course of the disease. STUDY DESIGN: Forty-eight patients with RAS were included in the study. Twenty-six were women and 22 men, of average age 41.3 +/- 2.44. Thirty-four out of these 48 patients were HP positive and the rest 14 who were negative were used as a control group. The diagnosis of HP infection was based on the detection of specific immunoglobulin G (IgG), and immunoglubulin A (IgA) antibodies using the enzyme-linked immunoabsorbent assay technique in the serum and the saliva of the patients. In all HP carriers an eradication therapy was administered. After a 2-month period the patients were checked for HP status, using 13C-UBT. The follow up period was 6-12 months following the eradication therapy. RESULTS: At entry patients with HP infection suffered from more severe symptoms compared with HP negative patients (P < 0.05). After the administration of HP eradication therapy, patients who had become negative showed a remarkable improvement (62.5%) with reference to recurrence of RAS as well as to symptom intensity. In 29.2% of patients symptoms had disappeared and in 33.3% of patients there was a decrease in both the frequency of recurrence and the intensity of symptoms. After the eradication treatment, the periods between recurrence of RAS in patients who had become negative were statistically significantly longer compared with those before treatment (P < 0.001). Another important observation was that patients who became negative after eradication therapy were of comparable clinical status with those who were HP negative from the beginning of the study (P > 0.05). CONCLUSIONS: These findings support the concept of a potential association between RAS and HP.

Epidermal growth factor in saliva and serum of patients with cyclosporin-induced gingival overgrowth.

The purpose of this study was to investigate the presence of epidermal growth factor (EGF) in patients receiving cyclosporin therapy who had gingival overgrowth and to determine whether there were any differences between these patients and normal healthy controls. Seventeen patients with cyclosporin-induced gingival overgrowth and seventeen age- and sex-matched controls who were taking cyclosporin but had healthy gingiva were used for this study. Unstimulated whole saliva was collected from all individuals by expectoration. Gingival crevicular fluid (GCF) was also collected from all individuals. Blood was additionally collected from all subjects and serum was separated by keeping the samples overnight at 4 degrees C. EGF levels in all cases were measured by an ELISA assay. EGF concentrations were found to be significantly higher in the saliva of patients with cyclosporin-induced gingival overgrowth compared to the control group (401.2 +/- 31.1 pg/ml and 144.3 +/- 31.4 pg/ml, respectively), whereas the results were reversed in the serum (67.0 +/- 15.6 pg/ml and 141.6 +/- 17.7 pg/ml, respectively). EGF was not detected in the samples of GCF in either group. This study thus demonstrated an increase in EGF levels in the saliva and a decrease of EGF in the serum of patients with cyclosporin-induced gingival overgrowth.

Benign tumors of adipose tissue of the oral cavity: a clinicopathologic study of 13 cases.

PURPOSE: The purpose of this study was to determine the clinical and histologic features of 9 simple lipomas, 2 fibrolipomas, and 2 infiltrating lipomas of the oral cavity. In addition, 10 cases of infiltrating lipoma of the oral cavity previously reported in the literature were reviewed. MATERIALS AND METHODS: All cases were retrieved from the archives of the Department of Oral Medicine/Pathology of the University of Thessaloniki, Greece. Data on age, sex, location, clinical appearance, duration, recurrence, and histologic appearance were evaluated. RESULTS: This study showed that the sex distribution of the simple lipomas was approximately equal, and the mean age of patients was 60.2 years. The buccal mucosa was the most frequent location of the tumors. Their size ranged from 0.2 to 1.5 cm, with an average rate 0.8 cm. In 3 cases, the tumor was not encapsulated. The sex distribution of the infiltrating lipomas was equal, and the mean age of the patients was 36.8 years. The most frequent location was the tongue. CONCLUSIONS: Tumors of adipose tissue represent rare neoplasms of the oral cavity. The diagnosis is based on both the clinical and histologic characteristics. Caution is required during their surgical excision to avoid recurrence, especially with infiltrating lipomas.

Tumor-associated glycoprotein 72 (TAG-72) expression in salivary gland neoplasia: an immunohistochemical study using the monoclonal antibody (MAb) CC49.

OBJECTIVES: The purpose of this study was to investigate immunohistochemically the expression of tumor-associated glycoprotein 72 (TAG-72) using the monoclonal antibody (MAb) CC49 in salivary gland neoplasia and normal salivary glands in an attempt to determine the potential usefulness of MAb CC49 in diagnostic and therapeutic applications. MATERIALS AND METHODS: Eighty-six specimens (21 benign tumors, 41 malignant, and 24 normal salivary glands), fixed in 10% formalin and embedded in paraffin, were retrieved from the files of the Department of Oral Medicine and Oral Pathology at the Dental School of Aristotle University, Thessaloniki, Greece, and were retrospectively studied with hematoxylin and eosin and with the streptavidin-biotin-complex method using the MAb CC49. RESULTS: Strong immunoreactivity for TAG-72 was observed in salivary duct carcinoma, adenocarcinoma, papillary cystadenocarcinoma, low-grade mucoepidermoid carcinoma, normal submandibular, sublingual, and minor salivary glands. Weak or no immunoreactivity was found in adenoid cystic carcinoma, basal cell adenocarcinoma, polymorphous low-grade adenocarcinoma, and normal parotid gland. CONCLUSIONS: Our results suggest the potential use of MAb CC49 in the differential diagnosis of some salivary gland neoplasms in which their histopathologic features overlap, and in the radiation immunolocalization and immunotherapy of malignant tumors that are localized in the parotid gland.

Immunohistochemical detection of insulin-like growth factor-I in the labial salivary glands of patients with Sjögren's syndrome.

OBJECTIVE: The purpose of the present study was to investigate the presence of insulin-like growth factor-I (IGF-I) in the labial salivary glands of patients with Sjögren's syndrome and healthy controls and to determine if there are any differences between these two groups. DESIGN: An immunohistochemical study. SUBJECTS AND METHODS: Twenty-five patients with Sjögren's syndrome, 20 healthy controls and 20 patients with mucoceles of the lip were used in this study. All individuals underwent a systemic evaluation and a lip biopsy. Sections from the lip biopsies were stained with haematoxylin and eosin (H&E). Immunohistochemical staining was also performed using a three-step indirect immunoperoxidase for IGF-I. RESULTS: The light microscopic examination revealed the presence of a mononuclear infiltration in the labial salivary glands of patients with Sjögren's syndrome. Most of the infiltrates were lymphocytes. Immunohistochemically an intense staining result was apparent in the same group. In contrast sections of labial salivary glands of healthy individuals and of patients with mucoceles revealed very weak staining. CONCLUSIONS: The above findings and the fact that both lymphocytic infiltration and IGF-I were predominantly seen in ductal regions, suggest that IGF-I may be a target of autoimmunity in Sjögren's syndrome.

Prevalence of oral lichen planus in diabetes mellitus according to the type of diabetes.

OBJECTIVE: The purpose of the present study was to determine the prevalence of oral lichen planus (OLP) in a population of patients with diabetes mellitus (DM) as compared with a control population. DESIGN: A clinicopathologic study. SUBJECTS AND METHODS: One hundred and thirty-nine patients with type I DM, 353 patients with type II DM and 274 controls were examined for clinical evidence of OLP. The clinical evidence of OLP in the diabetic and control patients was confirmed by histopathological examination. RESULTS: The prevalence of OLP in type I diabetic patients was 5.76%, in type II 2.83%, and 1.82% in the controls. The prevalence of OLP was significantly higher in patients with type I DM and slightly higher in patients with type II DM in comparison to the prevalence in the control sample. CONCLUSIONS: The above findings and the fact that type I diabetes and OLP are characterized by autoimmune phenomena and T cell immune responses respectively, suggest that the immune system may play a critical role in the appearance of OLP in patients with type I DM.

Tumor-associated glycoprotein (TAG-72) in chronic submandibular sialadenitis and normal minor salivary glands defined by monoclonal antibody B72.3.

Formalin-fixed, paraffin-embedded samples of three normal minor salivary glands, 10 chronic submandibular sialadenitis, and three normal submandibular glands were studied immunohistochemically using the monoclonal antibody (Mab) B72.3 in order to have a better understanding of the distribution of tumor-associated glycoprotein (TAG-72). Diffuse expression of TAG-72 was observed in the mucous cells of normal minor salivary glands, and in the ducts with goblet cell metaplasia and/or hyperplasia of chronic submandibular sialadenitis (eight of 10). Focal expression of TAG-72 was seen in the acinar mucous cells of normal submandibular gland (three of three), and in the mucous cells of normal or atrophic acini of chronic submandibular sialadenitis (eight of 10). These results should be considered in the cytologic diagnosis of the mucoepidermoid carcinoma using the Mab B72.3 as a diagnostic aid, as well as in future studies for the radiation immunolocalization and immunotherapy of submandibular gland tumors.

Malignant potential of oral lichen planus; a follow-up study of 326 patients.

326 patients with oral lichen planus were followed for periods ranging from 6 months to 10 years (mean 4.8 years), in an attempt to clarify the malignant potential of this disease which is still controversial. Malignant transformation occurred in 4 patients (1.3%) in a mean time of 6.5 years after the onset of lichen planus. Before cancer development, 3 of these patients manifested the erosive form of oral lichen planus, while the others, a combination of the papular/atrophic form. Malignant transformation in our patients could not be associated with any evident factors, such as family history, local irritation, alcohol consumption, nutritional disturbances or other systemic diseases.

Desquamative gingivitis: a clinical, histopathologic, and immunologic study.

Desquamative gingivitis is believed to be a clinical sign of certain mucocutaneous diseases rather than a distinct pathologic entity. The prevalence of desquamative gingivitis was studied in a group of patients with the most common mucocutaneous diseases. Of 414 patients with pemphigus vulgaris, mucous membrane pemphigoid, or oral lichen planus, 49 (11.8%) exhibited gingival lesions in the form of desquamative gingivitis. Desquamative gingivitis was most prevalent in the patients with mucous membrane pemphigoid (41.6%) followed by those with pemphigus vulgaris (9.1%). Other clinical characteristics, as well as histopathologic and immunohistochemical findings, that aid in early diagnosis are presented.

Immunohistochemical evaluation of TGF-beta and extracellular matrix proteins expression in rat squamous cell carcinomas.

OBJECTIVE: The aim of this study was to establish a possible association between the degree of differentiation of squamous cell carcinomas (SCC) derived from rat oral tissues treated in vivo with carcinogen 4NQO, and the expression of TGF-beta on epithelial cells and the distribution of extracellular matrix proteins (laminin-collagen type IV). MATERIALS AND METHODS: A parent tumor showing a spectrum of differentiation was used to establish clonal subpopulations that formed differentiated SCC and undifferentiated (spindle cell phenotype) tumours following transplantation to athymic mice. RESULTS: Immunohistological findings revealed the absence of TGF-beta staining on epithelial cells and extracellular matrix proteins in spindle cell tumours. In contrast, staining of SCC revealed a significant number of TGF-beta positive cells and the presence of extracellular matrix proteins. CONCLUSIONS: The findings suggested that there is a positive correlation between histological differentiation, TGF-beta expression and the elaboration of extracellular matrix proteins.

Squamous cell carcinoma of the lips in a northern Greek population. Evaluation of prognostic factors on 5-year survival rate--I.

The purpose of this study was to determine the clinical features of squamous cell carcinoma (SCC) of the lips, along with its prognostic factors, in order to extend and update the information related to lip cancer in northern Greece and to provide a basis for international comparison. Records of 1510 patients with SCC of the oral cavity presented at the Theagenion Anticancer Institute of Thessaloniki, Greece from 1979 and 1989 were reviewed. The most common site for oral squamous cell carcinoma (OSCC) was found to be the lips (59.4%) as compared to 40.5% of intra-oral SCC. Males were affected more frequently, presenting a ratio of 9.2:1. The peak age of incidence was found to be the 6th decade for men and the 8th for women. Rural residents and outdoor workers were affected more than urban residents (79.9% versus 28.1%). Most of the patients were diagnosed in early categories and early clinical stages of the disease. Almost all (98.5%) were classified into T1 and T2 categories, and 92.9% into stages I and II. A total of 7.59% of patients presented with clinically-positive lymph-node involvement. Most of them were classified as an advanced stage of the disease. Primary surgical excision was performed on 60.14%, radiotherapy on 35.14%, a combination of these on 2.47%, and chemotherapy alone or in combination with the above regimens in 2.22% of the cases. The outcome was adequate for surgery, radiotherapy, and the combination of the two, since 91.3, 74, and 90%, respectively, survived for more than 5 years. An overall 5-year survival rate of 83.3% was found. Our findings showed that the survival rate was significantly influenced by the main prognostic factors, such as the size of the tumour, the lymph-node involvement, the clinical stage of the disease and the histologic differentiation. SCC of the lips continues to be the most common site of oral cancer development amongst the Greek population. The aetiologic significance of actinic radiation for SCC of the lips is confirmed by our findings. The main prognostic factors proved to significantly influence the survival of our patients. Our results support the fundamental principal of head and neck cancer, i.e. that early detection of the primary tumour is the best prognostic factor for increasing survival rates. Therefore, public awareness concerning the disease, and better education for health care workers which will provide a thorough knowledge for the prognosis of oral cancer and the factors influencing it, is necessary.

Median rhomboid glossitis. An oral manifestation in patients infected with HIV.

A follow-up study included the oral examination of 39 persons known to be infected with the human immunodeficiency virus. In addition to the other human immunodeficiency virus-associated oral lesions, lesions clinically similar to the smooth form of median rhomboid glossitis, which is now believed to be erythematous candidiasis located in the dorsum of the tongue, were found in seven patients (18%). Patients with median rhomboid glossitis were classified in different stages of the Centers for Disease Control 1986 classification system and showed an average of CD+4 cell counts 397.5/mm3. Also the presence or the absence of anti-p24 antibodies in the serum and stimulated whole saliva of the patients with median rhomboid glossitis did not correlate with the stage of the disease or with low levels of CD+4 cell counts as in other forms of oral candidiasis. Therefore our results suggest that median rhomboid glossitis should be included as a distinct form of oral candidiasis in the classification of the oral manifestations of infection with the human immunodeficiency virus.

Immunologic status in patients infected with HIV with oral candidiasis and hairy leukoplakia.

Although numerous studies of oral manifestations associated with HIV have been reported, only a few refer to the correlation of these lesions with laboratory parameters. In this study we investigated the relationships between the two most common HIV-associated oral lesions, oral candidiasis and hairy leukoplakia, with the stage of the disease, circulating CD4+ cell counts, and the presence of anti-p24 antibodies in serum and stimulated whole saliva in 43 known HIV-1-infected persons. Although oral candidiasis and hairy leukoplakia were exclusively observed in subjects who were classified as Centers for Disease Control and Prevention group IV, only the prevalence of oral candidiasis is strongly associated with circulating CD4+ counts less than 200/mm3 (p < 0.02). The prevalence of oral candidiasis and hairy leukoplakia was significantly related to the absence of anti-p24 antibodies in serum (p < 0.01 and p < 0.01, respectively), but was only statistically significant for hairy leukoplakia in stimulated whole saliva (p < 0.02). The results suggest that oral candidiasis and hairy leukoplakia in correlation with immunologic status as indicated by low circulating CD4+ cell counts and the absence of anti-p24 antibodies in serum and the loss of secretory anti-p24 antibodies in subjects with hairy leukoplakia, may constitute prognostic markers for the progression of HIV-infection to AIDS. Our results also indicate that the absence of anti-p24 antibodies is not only influenced by the low levels of circulating CD4+ cells but probably by the presence of oral candidiasis or hairy leukoplakia as well.

Kaposi's sarcoma of the oral cavity: case reports.

Classic Kaposi's sarcoma is a rare malignant neoplasm of endothelial cell origin. Oral manifestation of Kaposi's sarcoma is even more uncommon. The purpose of this article is to describe two cases of classic Kaposi's sarcoma and to discuss the current knowledge regarding its pathogenesis, epidemiology, clinical characteristics, and therapy.

The role of the time of application of the promoter in two-stage chemically induced carcinogenesis in the oral mucosa: experimental study in the rat.

The purpose of this study is to determine the role of the time of application of the promoter (in this case, mechanical irritation) in two-stage chemically induced oral carcinogenesis. One hundred fifty-five male rats were divided into seven groups. Group 1, 2 and 3 each received two intraperitoneal injections of the carcinogen N-nitroso-N-methylurea (NMU): 50 mg/Kg BW. Mechanical irritation was applied on the left buccal mucosa, 7 days before the first injection of NMU (group 1), 16 days (group 2), and 80 days (group 3) after the carcinogenic administration. Animals of groups 4, 5, 6 and 7 served as controls. Only group 1 and 2 animals developed tumors in the irritated buccal mucosa. From the results of this study we conclude that the delay of the application of the promoter does not lead to tumor formation. This could be explained by the repair of the carcinogenic lesion at the cellular level.

Cyclosporin-induced gingival hyperplasia: an ultrastructural study of the oral epithelial prickle cells.

In this study the ultrastructural characteristics of the prickle cells of the human gingival epithelium after cyclosporin-A treatment are described. The prickle cell layer shows hyperplasia, along with the well known hyperplasia of the connective tissue components. The prickle cells show large numbers of free ribosomes, rough endoplasmic reticulum profiles and well developed Golgi complexes. The intercellular space is usually large and the neighboring cells are joined by desmosomes. In many cases the intercellular space is almost diminished and the cells are joined by a lot of desmosomes. Occasionally, a single cilium was observed to project into the intercellular space but the functional significance of this observation is unknown. The tonofilaments exhibit a specific arrangement in the cytoplasm of the prickle cells and it is believed that they contribute to the formation of a 'tonofilament network' which, along with the desmosomes, provide strength to the epithelium. Possible mechanisms regarding the gingiva overgrowth are discussed.

Reticulohistiocytic granuloma of the tongue: a case report.

Reticulohistiocytic granuloma is a type of reticulohistiocytosis that is manifested without systemic disturbances. A rare case of reticulohistiocytic granuloma presenting as a solitary nodule on the tongue is reported and discussed.

[Treatment of sialolithiasis and its complications with intraglandular injection of biotherapeutic solution]. / Therapeutike antimetopise tes sialolithiases kai ton epiplokon tes me endoadenike egchyse biotherapeutikou dialymatos.

The creation of sialoliths in the ductal system of major salivary glands causes characteristic symptoms due to the obstruction of the flow of produced saliva. If sialolithiasis is not treated early obstructive sialadenitis will develop and its repeated relapses may lead to fibrosis and degeneration of glandular parenchyma. In this study we present the method of intraglandular injection of biotherapeutic solution (1.000.000 I.U. penicillin G in 5 cc normal saline) to achieve treatment of obstructive sialadenitis and rejection of the sialolith. Our results as shown in tables I and II and in figures 1-9 are very encouraging. From the conclusions drawn it looks like this method can be recommended as an optional solution to surgery (lithectomy-adenectomy) under the conditions mentioned in the discussion.

[Lateral periodontal cyst with keratinization (odontogenic keratocyst). Case report]. / Plagia periodontike kyste me keratinopoiese (odontogenes keratokyste). Anaphora periptoses.

The purpose of this study was to present the clinical and histological features of one case of lateral periodontal cyst with keratinization. The incidence, the histological features and the aetiopathogenesis of this type of cyst that is recurred were discussed.