[The cost of treating schizophrenia in Greece].

The objective of this study was to estimate the direct annual cost of treating patients with schizophrenia in Greece in 2005. Due to the lack of quantitative data, information on the treatment pathway and medical resource utilization of patients were collected from a consensus panel of 9 psychiatrists and 5 health economists. For estimating the costs a bottom up approach from the National Health System perspective was used. The panel of experts defined three patient categories based on the severity of the disease and the medical setting where treatment is received: (a) outpatient setting, (b) ambulatory care, (c) inpatient setting and long-term care. The annual direct cost of treatment per patient was found to be 3,187 € (2,659-4,166 €) in the first category, 10,135 € (7,429-13,972 €) in the second category and 20,782 € (17,482-25,462 €) in the third category. The total cost of treatment increased with the severity of the disease and the use of hospitalization. Systematic data collection on medical resource utilization must be established at the national level to facilitate further research, guide the efficient use of resources and improve the healthcare provision.

Primary breast lymphoma in a male patient.

Primary lymphoma of the male breast is extremely rare. We report a case of a diffuse large B-cell lymphoma in a male patient. A 67-year-old man presented with a palpable mass in the right breast and ipsilateral axillary lymphadenopathy. At operation a 6 x 5 x 4-cm mass was excised, and a frozen section demonstrated malignancy. A modified radical mastectomy was then performed, together with axillary lymph node clearance. Histological examination established the diagnosis of a primary non-Hodgkin's lymphoma of the breast. The patient was referred for chemotherapy and died a year later from systemic disease involving the adrenals. The importance of early diagnosis is emphasized; this should be based on an excisional biopsy or aspiration cytology. As patients with primary breast lymphoma (PBL) have a better prognosis than those with carcinoma of the breast or patients with extranodal lymphomas, a multidisciplinary approach including surgery, radiotherapy, and chemotherapy when needed would result in a more favorable outcome.

Understanding the burden of stress urinary incontinence in Europe: a qualitative review of the literature.

OBJECTIVE: This study was undertaken to better define the prevalence, risk factors, as well as the economic and human burden of stress urinary incontinence (SUI) in Europe that will help health care providers better understand the impact of this condition. METHODS: A literature search was performed using MEDLINE, EMBASE, BIDS, HealthStar, HSRProj, and HSTAT databases to review the European literature (France, Germany, Italy, Spain, UK) on SUI between 1990 and 2001. Clinical experts on UI provided advice on this review. RESULTS: In all European countries studied SUI was identified as a distinct and highly prevalent form of urinary incontinence, and in some countries, as many as 80% of all incontinent women were diagnosed with SUI. However, epidemiological figures varied widely between studies, due to different definitions of diagnostic criteria and disease states and study designs used. Parity and vaginal birth were identified as major risk factors for developing SUI. Only a few studies have examined the economic burden of SUI, but have found it to be significant on patients and society. SUI also significantly affects the quality of women's lives. CONCLUSION: There is a clear need for harmonisation in defining SUI, standardising survey methods and validation criteria, and outcome measures, if results are to be compared with any validity. A better understanding of the burden of SUI is essential for future research.

Expression and cellular localization of Na,K-ATPase isoforms in the rat ventral prostate.

OBJECTIVE: To determine the expression and plasma membrane domain location of isoforms of Na,K-ATPase in the rat ventral prostate. MATERIALS AND METHODS: Ventral prostate glands from adult male rats were dissected, cryosectioned (7 micro m) and attached to poly-l-lysine coated glass slides. The sections were then fixed in methanol and subjected to indirect immunofluorescence and immunoperoxidase procedures using a panel of well-characterized monoclonal and polyclonal antibodies raised against known Na,K-ATPase subunit isoforms. Immunofluorescence micrographs were digitally captured and analysed by image analysis software. RESULTS: There was expression of Na,K-ATPase alpha1, beta1, beta2 and beta3 subunit isoforms in the lateral and basolateral plasma membrane domains of prostatic epithelial cells. The alpha1 isoform was abundant but there was no evidence of alpha2, alpha3 or gamma isoform expression in epithelial cells. The alpha3 isoform was not detected, but there was a relatively low level of alpha2 isoform expression in the smooth muscle and stroma. CONCLUSION: Rat prostate Na,K-ATPase consists of alpha1/beta1, alpha1/beta2 and alpha1/beta3 isoenzymes. These isoform proteins were located in the lateral and basolateral plasma membrane domains of ventral prostatic epithelial cells. The distribution and subcellular localization of Na,K-ATPase is different in rodent and human prostate. Basolateral Na,K-ATPase probably contributes to the establishment of transepithelial ionic gradients that are a prerequisite for the uptake of metabolites by secondary active transport mechanisms and active citrate secretion.

Loss of basement membrane components laminin and type IV collagen parallels the progression of oral epithelial neoplasia.

AIMS: To determine the immunohistochemical localization of basement membrane components laminin and type IV collagen in premalignant and malignant lesions of the oral epithelium. METHODS AND RESULTS: Formalin-fixed tissue sections of 12 epithelial hyperplasias with no dysplasia and 30 dysplasias, clinically diagnosed as leukoplakia and/or erythroplakia, as well as 50 invasive squamous cell carcinomas, were stained with mouse monoclonal antibodies to human laminin and type IV collagen. Statistical analysis showed that there was a linear trend for discontinuous distribution of laminin from epithelial hyperplasia to epithelial dysplasia and invasive squamous cell carcinoma (P < 0.001). Laminin staining showed a linear trend for discontinuity with increasing grade of dysplasia (P < 0.05) and was more frequently discontinuous in areas of deep tumour invasion than in central or superficial areas (P < 0.05). Brush-shaped thickening and reduplication of the basement membrane were also identified. CONCLUSIONS: Alterations in the distribution of laminin and type IV collagen in oral premalignant and malignant lesions indicate that the loss of continuity of the subepithelial basement membrane parallels the progression of the neoplastic transformation process in oral epithelium.

Hyalinosis cutis et mucosae: gingival involvement.

Hyalinosis cutis et mucosae (lipoid proteinosis, Urbach-Wiethe disease) is a rare syndrome with autosomal recessive inheritance. The disease is characterized by diffuse deposition of a hyaline-like substance in the dermis, the submucosal connective tissue and various internal organs. The oral mucosa of affected people becomes nodular and thickened, with primary involvement of the labial, buccal and palatal mucosa, posterior tongue, and lingual frenulum. We report the case of a 66-year-old man with hyalinosis cutis et mucosae who presented with gingival hyperplasia due to diffuse deposition of hyaline-like material, and discuss the diagnostic significance of the microscopic findings of the gingival tissues. The present clinical features are also compared to those of the same patient at the age of 38 years.

Benign neural tumors of the oral cavity: a comparative immunohistochemical study.

To determine if immunohistochemistry can be used as adjunct to the diagnosis and classification of oral benign neural tumors, we stained 77 neurally differentiated tumors with a panel of neural-associated antibodies (S-100 protein, CD57, epithelial membrane antigen, factor XIIIa, CD34, CD68, collagen IV). Using standard histologic criteria, we identified 13 schwannomas, 16 neurofibromas, 23 traumatic neuromas, 16 palisaded and encapsulated neuromas, and 9 granular cell tumors from archived oral pathology specimens. Silver stains showed that neurofibromas, traumatic neuromas, and palisaded and encapsulated neuromas consistently contained axon filaments. Although all neural tumors contained S-100-positive cells, schwannomas and palisaded and encapsulated neuromas contained the most. All tumors expressed CD57; traumatic neuromas were stained intensely and the others stained weakly. The consistent epithelial membrane antigen capsular staining of schwannomas and the absence of factor XIIIa-positive dendritic/spindle cells helped distinguish these tumors from others. Many CD34-positive cells were found in schwannomas, and few were found in palisaded and encapsulated neuromas. Variable numbers CD68-positive cells were seen in all neural tumor types; some of these cells appeared to be macrophages and mast cells, but many were thought to be Schwann cells expressing this antigen. Collagen IV staining, apparently representing basement membrane, was generally a feature of all benign neural tumors. The immunophenotype of the granular cells of the GCTs was S-100+, CD57+, and collagen IV+ supporting the putative neural origin of these tumors. We conclude that neural origin/differentiation of a connective tissue tumor can be confirmed with stains for S-100 protein, epithelial membrane antigen, CD57, and collagen IV. Staining patterns and intensities associated with the panel of antibodies tested can be useful in tumor classification.

Apoptosis in oral erythema multiforme.

OBJECTIVE: Cell death was evaluated in oral erythema multiforme to test the hypothesis that apoptosis may be a mechanism by which keratinocytes die in this condition. STUDY DESIGN: Ten erythema multiforme and five control oral mucosa biopsy specimens were evaluated in immunohistochemically stained sections for apoptosis-regulating proteins Bcl-2, Bcl-x, Bax, p53, Fas, and Fas-ligand. Apoptotic keratinocytes, determined by a detection method for DNA fragmentation (TUNEL) and by conventional morphologic criteria were counted per high power field. RESULTS: Keratinocyte staining for Bcl-2 protein was comparable in erythema multiforme and controls. Bcl-x expression was reduced in five erythema multiforme cases. Staining for Bax protein differed in six erythema multiforme cases and showed variable intensity in layers under the parakeratin. Only slight differences in staining patterns of Fas and Fas-ligand proteins were noted between erythema multiforme and controls. The number of apoptotic keratinocytes evaluated by morphologic examination was significantly higher in erythema multiforme (mean per high power field, 0.90 +/- 0.2; controls, 0.06 +/- 0.04; p < 0.05, Mann-Whitney test) and was limited in significance by the TUNEL method (erythema multiforme, 0.43 +/- 0.1; controls, 0.02 +/- 0.02). Overexpression of p53 protein was seen in basal keratinocytes in five erythema multiforme specimens (mean, 17.5 +/- 4.03 per high power field; controls 1.2 +/- 0.3). CONCLUSIONS: There is evidence that cell death in erythema multiforme is at least in part due to apoptosis. The apoptotic mechanism may be related to an altered expression of apoptosis-regulating proteins. Although measurable alterations in the phenotypic expression of Fas and Fas-ligand proteins were not apparent, activation of Fas/Fas-ligand system could still be involved in the induction of apoptosis in erythema multiforme.

Spindle-cell hemangioendothelioma of the oral cavity. A case report.

We describe a vascular tumor classified as SCH by histological criteria that was found in the mandibular-buccal fold of a 12-year-old girl. Microscopically, the lesion consisted of thin-walled cavernous spaces containing thrombi and phleboliths, and cellular areas composed of spindle-shaped, epithelioid and vacuolated cells. Immunohistochemically, the endothelial vascular lining was highly reactive with HAM56 antibody, while variable reactivity was observed for factor VIII-associated antigen. All cell types were positive for vimentin and anti-PCNA stained less than 3% of the tumor cells. This is the first report of SCH in the oral cavity.

Intravascular papillary endothelial hyperplasia of the oral soft tissues: report of 18 cases and review of the literature.

PURPOSE: Intravascular papillary endothelial hyperplasia (IPEH) is a benign, nonneoplastic, vascular lesion, that is characterized histologically by papillary fronds lined by proliferating endothelium: it is thought to represent an unusual form of organizing thrombus. It may develop in a distended vessel or in association with other vascular lesions. The main significance of IPEH is its microscopic resemblance to angiosarcoma and possible misinterpretation as such. METHODS: We report the clinicopathologic features of 18 examples of IPEH of the oral soft tissues and lips, and review such features of 55 previously reported oral cases. RESULTS: The lips and tongue were most frequently involved and a female predilection was evident. Histologically, the pure form of IPEH was more commonly encountered. CONCLUSION: The differential diagnosis and possible histogenesis of the lesion are discussed.

Histocompatibility antigens and geographic tongue.

The HLA-A, B and HLA-DR antigens were investigated in 50 unrelated Greek persons with geographic tongue and in 380 healthy control persons. An increased incidence of DR5 and DRW6 antigens was observed in the blood of persons with geographic tongue. Ten (20%) of them had the DRW6 antigen, and it was significantly increased compared with 29 (7.6%) of the controls (p < 0.01, RR = 3.32). Twenty-seven (54%) of the experimental group showed DR5 antigen compared with 136 (35.7%) of the controls (p < 0.025, RR = 2.18). On the contrary, only 12% (5) of the experimental group had the B51 antigen in comparison with the controls (26.3%) (p < 0.05, RR = 0.37). A decrease of the DR2 antigen was also found in the persons with geographic tongue (24%) in comparison with the controls (39.2%) (p < 0.05, RR = 0.58).

Laband syndrome: a case report.

A case of Laband syndrome in an 8-yr-old girl is presented. The case is sporadic. The patient manifests enlargement of the soft tissue of the hard palate and the gingiva, which partly or completely covers the crowns of the teeth and macroglossia. The cartilagenous part of the nose and the ears is large and soft. She has synophrys and thick, straight hair. The nails of the fingers and toes are dysplastic. The girl exhibits no other abnormality, except an IQ of 61.

Juvenile fibromatosis.

Fibromatosis is an aggressive, non-metastasizing disease characterized by a neoplastic proliferation of fibroblasts, that rarely involves bone and lies on the borderline between benign and malignant tumours. We report three new cases of this rare entity.

Plasma cell myeloma of the jaws.

Solitary myeloma may be the first manifestation of the disseminated form, known as multiple myeloma, and characterized by multiple skeletal lesions, general metabolic alterations, impairment of renal function and eventually death. Involvement of the jaws is not unusual, although infrequently reported. We present 2 cases, where oral involvement was the first indication of the disease.