Phl p 5 resorption in human oral mucosa leads to dose-dependent and time-dependent allergen binding by oral mucosal Langerhans cells, attenuates their maturation, and enhances their migratory and TGF-beta1 and IL-10-producing properties.

BACKGROUND: Sublingual immunotherapy (SLIT) is safe and effective as treatment of allergic rhinitis and mild asthma. Oral mucosal Langerhans cells (oLCs) play a central role. However, little is known about allergen binding by oLCs during mucosal allergen resorption and its impact on oLC functions. OBJECTIVE: Binding of Phl p 5 to oLCs was studied in a standardized ex vivo model to investigate mechanisms important for SLIT. METHODS: Human oral mucosal biopsies were incubated with the grass pollen allergen Phl p 5. Migration, binding of Phl p 5, phenotype and cytokine production, and T-cell priming of Phl p 5-binding oLCs were analyzed. RESULTS: Significant uptake required more than 5 minutes, and dose-dependent binding of Phl p 5 to oLCs was saturated at 100 microg/mL Phl p 5. Furthermore, Phl p 5 significantly increased the migratory capacity of oLCs but attenuated their maturation and strongly promoted the release of TGF-beta1 and IL-10 by oLCs themselves as well as by cocultured T cells. CONCLUSION: Oral mucosal Langerhans cells bind Phlp5 in a dose-dependent and time-dependent manner, leading to an increased production of tolerogenic cytokines and an enhanced migratory capacity but decelerated maturation of oLCs.

Distribution of insulin-like growth factors in condylar hyperplasia.

Condylar hyperplasia (CH) is a local overgrowth of the condylar process of the temporomandibular joint (TMJ) of unknown etiology. Probably, growth factors like the insulin-like growth factors (IGFs) are involved in its pathogenesis. Specimens from 12 patients were investigated histologically and immunohistochemically to obtain the distribution of the IGFs-I and -II and the IGF1 receptor. The results revealed juvenile and adult subtypes. While generally IGF-II could only be detected weakly, in the juvenile cases strong immunostaining for IGF-I in cartilage and bone supposes an influence on pathological growth processes.

Investigation of the expansion properties of osmotic expanders with and without silicone shell in animals.

BACKGROUND: Particularly in clinical studies, it has been found that rapid swelling of tissue expanders leads to high-pressure peaks that can cause hypoxia in the tissue and thus also skin damage. For this reason, the present study in animals investigated whether an osmotic expander with silicone shell is capable of expanding in tissue and bringing about useful tissue expansion without complications. It was also examined whether and what quantitative and qualitative differences there are between conventional osmotic expanders and the new expanders with silicone shell. METHODS: The expansion of osmotic expanders with silicone shell was compared with that of osmotic expanders without silicone shell in four mini pigs. The expander type used was an M1 rectangle with an initial volume of 6 ml. Five expanders were implanted in each pig, meaning that 20 expanders were measured. The volume of the expanders was measured directly after explantation. Indirect volume determination was performed by producing plaster casts for subsequent laser optical measurement. RESULTS: Comparison of the two curve profiles showed a much flatter profile for the expanders with silicone shell. The absolute values for the volumes of the expanders with silicone shell were likewise substantially lower. CONCLUSIONS: Controlled skin expansion is a technique of providing localized donor tissue for reconstructive surgery. The new expanders could be in a position to lower the rate of complications in tissue expansion.

Percutaneous endoscopic gastrostomy for long-term feeding of patients with oropharyngeal tumors.

Secondary malnutrition in patients with oropharyngeal tumors can be the cause of substantial morbidity. The present, prospective study examined 30 patients receiving treatment for an oropharyngeal tumor. Percutaneous endoscopic gastrostomy (PEG) was performed 1 wk prior to the start of therapy in 15 patients, and 15 patients were temporarily fed by nasogastric tube after surgery. Anthropometric and laboratory parameters were measured in both patient groups at five defined times. Based on these parameters, the nutritional status of the PEG patients was found to be substantially better. The present study was able to show that the prophylactic placement of a PEG tube greatly improves the nutritional status of the patients before and after surgery and minimizes the catabolism of the body's fat depots.

Comparative morphometric analysis of primary versus recurrent basal cell carcinoma and of histological subtypes. Significance of morphometry of the nuclei.

BACKGROUND: Basal cell carcinomas (BCCs) are the most common cutaneous tumors, accounting for approximately 70% of all malignant skin tumors. A morphometric analysis was performed to evaluate whether morphometric parameters of the nuclei of BCC tumor cells may serve as predictors for biological behavior like recurrence rate or are able to differentiate morphological subtypes (multifocal superficial, nodular, sclerosing and miscellaneous forms of BCC). MATERIALS AND METHODS: N = 130 histological sections from n = 126 patients with BCC of the head and neck were analyzed. Morphometry included: maximum and minimum diameter, perimeter, nuclear area (direct parameters). According to the direct parameters, so called form factors were evaluated: axis ratio, shape factor, nuclear contour index, nuclear roundness and circumference/contour ratio. RESULTS: Morphometric parameters were not able to differentiate significantly between primary and recurrent BCC. Concerning the histological subtypes, multifocal superficial BCC differed significantly (< 0.05) from all other subtypes by direct parameters. CONCLUSION: Morphometry can help to distinguish between histological subtypes of BCC. Morphometry alone is not able to predict recurrence rate.

Characterization of dendritic cells from human oral mucosa: a new Langerhans' cell type with high constitutive FcepsilonRI expression.

BACKGROUND: The oral mucosa represents a unique immunologic unit with a high frequency of native allergen contact within the gastrointestinal tract in which immune tolerance is the natural outcome of allergen contact. Although Langerhans' cells (LC), known to play a crucial role in initiating allergen-dependent immune responses in the skin, have also been detected in the oral mucosa, little is known about their phenotype and exact physiologic role. OBJECTIVE: To elucidate whether LC from oral mucosa (oLC) differ from skin LC (sLC), these cells were subjected to detailed comparative analysis. METHODS: Crude epidermal and oral mucosa cell suspensions were prepared by trypsinization. oLC and sLC were compared phenotypically by flow cytometry techniques and functionally in T-cell proliferation assays. RESULTS: In contrast to sLC, freshly isolated oLC expressed significantly higher amounts of MHC class I and II, as well as costimulatory molecules CD40, CD80/B7.1, and CD86/B7.2. oLC displayed FcgammaRIII/CD16 and FcgammaRI/CD64. Most surprisingly, oLC constitutively expressed the high affinity receptor for IgE (FcepsilonRI) even in nonatopic donors. FcepsilonRI expression on oLC was further increased and correlated with the serum IgE levels in atopic individuals. oLC showed a higher allogeneic stimulatory activity than sLC, whereas the activation of autologous T cells correlated to the FcepsilonRI expression. CONCLUSION: Taken together, our results strongly indicate that oLC profoundly differ from their skin counterparts. The constitutive high expression of FcepsilonRI on oLC could point to particular skills of these cells within the regional immune system of the oral mucosa.

Type A botulinum toxin in the treatment of chronic facial pain associated with masticatory hyperactivity.

PURPOSE: Chronic hyperactivity of the masticatory muscles is a common functional disorder associated with chronic facial pain and headache. The positive therapeutic effect of botulinum toxin type A on functional disorders and pain symptoms has been known in connection with the treatment of cervical dystonia. The purpose of this report is to assess whether the targeted reduction of masticatory muscular hyperactivity by local injection treatment with botulinum toxin type A can improve facial pain headache symptoms in the event that other treatment methods prove ineffective. MATERIALS AND METHODS: In an randomized blinded placebo-controlled study, 90 patients (60 verum and 30 placebo) with chronic facial pain were treated with botulinum toxin type A (Botox; Allergan, Ettlingen, Germany) injections into masticatory muscles. RESULTS: Ninety-one percent of patients who received botulinum toxin improved by a significant mean reduction of approximately 3.2 on a visual analog pain scale. By comparison with t test and chi(2) test, there was a significant difference compared with the placebo group (P <.01). CONCLUSIONS: The local injection of botulinum toxin type A constitutes an innovative and adequately efficient treatment method for chronic facial pain associated with hyperactivity of the masticatory muscles. An improvement in the painful symptoms can be expected in up to 90% of patients who do not respond to conservative treatment methods.

Location and sanitation of dental foci in liver transplantation.

The literature describes various treatment concepts for the pre-operative sanitation of septic foci in the oromaxillofacial area prior to liver transplantation. There are no uniform guidelines, and so far, a connection between dental foci and postoperative infection after transplantation has not yet been proven. Taking into account the complications occurring during focus sanitation, the appropriate extent of, and the most suitable point of time for, focus sanitation have to be ascertained. The clinical and radiological findings from 80 patients were analyzed, with particular attention being paid to dental foci prior to liver transplantation. The complications performed in 39 sanitations and the oral hygiene status of 37 patients were included in the analysis. All the obtained findings were correlated to the etiology of the liver disease and the Child-Pugh stage. Former alcoholics had significantly poorer oral hygiene and more foci than non-alcoholics. After sanitation, complications occurred more frequently in alcoholics (43.8%) and patients in Child-Pugh stage C (41.2%) than in the other groups. Secondary bleeding, severe in some cases, occurred in a total of 15.4% of all patients, despite coagulatory preparations. We can conclude that, given the high rate of complications found in this study after sanitation prior to transplantation, the demand for radical prophylactic dental sanitation should be reconsidered. Rather, it would appear more appropriate for only absolutely necessary sanitation to be carried out prior to transplantation and for the definitive measures to be postponed until after transplantation when liver function has stabilized.

Comparison of three different preparations of platelet concentrates for growth factor enrichment.

The aim of the present study was to compare three different systems for preparing platelet concentrates: two commercially available bed-side techniques (Curasan system and PCCS) and a procedure used routinely in transfusion medicine. Platelet concentrates were prepared from venous blood of 12 healthy male volunteers using the three different systems. Platelet and leucocyte counts were performed and platelet derived growth factor and transforming growth factor beta were assayed by enzyme linked immunoassay. Handling was also considered. The three systems were able to collect 19.0 +/- 16.6% (laboratory system), 41.9 +/- 9.7% (Curasan system) and 49.6 +/- 21.0% (PCCS) of the absolute number of platelets which were originally in the venous blood volume within the platelet concentrate. Due to the amount of plasma which is left in the platelet concentrate portion, the platelet concentration could be increased between 1.4 +/- 1.3 times (laboratory system), 5.0 +/- 2.3 times (PCCS) and 11.7 +/- 2.4 times (Curasan system) compared to the venous blood. The amount of growth factors correlated with the number of platelets within the platelet concentrates. The two systems for intraoperative use are similar in their effects on the platelets. The absolute gain of platelets seems to be the highest with the PCCS; the highest concentration of platelets per micro L is gained with the Curasan system. The laboratory system may offer an alternative if an intraoperative system is not available.

Treatment of soft tissue defects with exposed bone in the head and face region with alginates and hydrocolloid dressings.

PURPOSE: In cases of soft tissue defects with exposed bone surfaces in the head and face region, there is the option of treating the defect with free split-thickness skin grafts following appropriate wound granulation. Secondary granulation on free bone surfaces is often a lengthy process, as granulation primarily occurs from the edges of the wound. Hydrocolloid dressings are gaining increasing attention in this context. The question arises as to whether the positive properties of hydrocolloid dressings can bring about rapid and positive conditioning of the base of the wound in soft tissue defects with exposed bone in the head and face region, with a view to subsequent split-thickness skin graft transplantation. MATERIALS AND METHODS: In the period from 1997 to 2000, a total of 25 patients with soft tissue defects with exposed bone surfaces in the head and face region were treated with hydrocolloid dressings in the framework of a prospective clinical study. RESULTS: The average time taken for complete granulation of the bone surface was 39.44 days (minimum, 10 days; maximum, 72 days). As a rule, this necessitated 12.8 changes of dressing (minimum, 3; maximum, 26). The granulation tissue was of good quality, generously vascularized, and occasionally exuberant at the edges of the wound CONCLUSION: On the whole, the combination of hydrocolloid dressing and alginate compress was found to have significant advantages as regards conditioning the exposed bone surface.

Solid-state nuclear magnetic resonance microscopy demonstrating human dental anatomy.

OBJECTIVE: Magnetic resonance imaging has become a common diagnostic tool in medical practice. It is a common view that solid-state material lacking a sufficient amount of unpaired nuclear spins, in particular proton spins, is impossible to depict with clinically used magnetic resonance devices. Characteristically rapid dephasing, caused by relatively short spin-spin relaxation (T(2) time) also leads to broad resonance lines. A newly introduced technique, constant-time imaging, uses 3 phase-encoding gradients for the acquisition of only one complex data point per phase-encoding step, resulting in detection times of only a few microseconds and extremely sharp resonance lines. STUDY DESIGN: Using a Bruker spectrometer AMX 300 WB (300 MHz, 7.1 T) with a microimaging attachment, we performed solid-state magnetic resonance imaging of whole teeth. Data processing was carried out by means of 3-dimensional Fourier analysis, and reconstructions were performed by the ParaVision (Bruker) software system. RESULTS: Dental hard tissues (enamel, dentin, and root cementum) and pulpal soft tissue could be depicted in 2-dimensional and 3-dimensional images. The voxel resolution isotropically reached 195 microm. CONCLUSION: The constant-time imaging technique enabled a naturalistic and nondestructive visualization of the teeth without application of ionizing radiation. This technique bears the potential to help us overcome the limitations of clinically used standard magnetic resonance tomography devices and offers new perspectives for dental imaging.

Natural history of 70 fetuses with a prenatally diagnosed orofacial cleft.

OBJECTIVE: This study is an analysis of neonatal outcome in 70 fetuses diagnosed over a 10-year period as having cleft lip with or without cleft palate (CL-P) by ultrasonographic examination. METHODS: We describe the natural history of these 70 fetuses with orofacial clefts and select those who may be candidates for fetal surgery. The sonograms of 70 fetuses with orofacial clefts were evaluated for the nature of the CL-P and for the nature of the associated anomalies. Additionally, karyotyping was performed in 63 of 70 patients (90%). RESULTS: The frequency of additional anomalies and the mortality rate varied with the type of cleft. Also, the frequency and type of chromosomal abnormalities varied with the type of cleft. The overall mortality rate was 63% (n = 44). 3 of the surviving 26 fetuses had severe associated anomalies. In 13 of the remaining 23 cases, the fetal age at diagnosis (> or =22 weeks) excluded the fetuses from the potential benefits of fetal intervention. CONCLUSION: Of 70 fetuses with prenatally diagnosed orofacial clefts, only 10 (14%) were candidates for fetal CL-P surgery.