Age-related changes in ac-impedance spectroscopy studies of normal human dentine: further investigations.

One of the age-related changes occurring in dentine structure is the formation of peritubular dentine on the inner walls of dentinal tubules leading to complete closure of tubules. Ac-impedance is safe, fast and non-invasive technique. In the last decade, the popularity of the technique has increased in dental research. Several investigators have used the technique to detect tooth cracks and caries. The results of in vitro studies showed that ac-impedance technique was more advanced for caries detection than visual and radiographic methods. However, other studies demonstrated that the accuracy of impedance measurements can be affected by many factors such as remineralization after tooth eruption. A study has been published on effect of age on impedance measurements by the authors for two age groups by employing ac-impedance spectroscopy. Therefore, the aim of this study was to demonstrate the importance of this technique by conducting further investigations on dentine samples of wider age groups. Dentine samples were prepared from extracted sound third molars of known patient age. The ac-impedance measurements were carried out over a wide range of frequency. After performing all electrical measurements, dentine samples were examined under SEM to correlate the electrical measurements with their structure. Impedance measurements showed that there were differences in impedance between young and old dentine. One-way ANOVA of the means of resistance and capacitance for all age groups (20, 25, 30, 40 and 50 years old dentine) revealed a significant difference (ANOVA, P < 0.0001) as a function of age. Applying Tukey's post hoc test, to the same data showed that this difference was due to the 50 years old dentine for resistance and was due to the 40 and 50 years old dentine for capacitance which were statistically different to all other groups. SEM investigation of dentine samples showed that young dentine is characterized by open dentinal tubules distributed all over the sample while in old dentine most dentinal tubules were occluded by peritubular dentine. It is believed that this peritubular deposition is responsible for differences in impedance measurements. In spite of increasing use of electrical techniques to understand electrical properties of teeth, it is clear from this study that local structural variations have a marked influence.

Paediatric granular cell tumour of the larynx: case report of laser resection with frozen section.

Granular cell tumours of the larynx are a very rare cause of persistent hoarse or husky voice in children. We report the case of a 13-year-old girl who presented with a three-year history of progressively huskier voice. We discuss the presentation, location and diagnosis of the tumour. In addition, we present a method of surgical treatment of the tumour, involving the hitherto unreported technique of laser excision and frozen section of the lesion.

Vascularisation of Norian CRS bone cement and its replacement by autologous bone when used for orbital reconstruction.

Various bone cements based on calcium phosphate have been used as adjuncts for repairing both the craniofacial and axial skeleton. Ideally these materials should provide initial strength and contour for the reconstruction, and be replaced over time by physiological absorption and bony deposition. Although there is evidence from animal models to support this, opportunities for human studies are rare. Here we offer clinical and histological evidence of this process.

Significance of eosinophil counting in tumor associated tissue eosinophilia (TATE).

Eosinophils are present in large numbers in some squamous cell carcinomas of the oral cavity. Whilst it is proposed that they have an 'immuno-protective' effect, this remains unproven. The contradictory reports may be due to inconsistencies in eosinophil counting. Eighty-one cases of squamous cell carcinoma (SSC) of oral tongue were examined. Two methods of eosinophil counting were performed. In the first method (classical), the eosinophils were counted per 10 HPF. In the second method (our so-called density method), the highest eosinophil density per surface area was counted for each case. The two methods were correlated. Using the classical method a number of fields in cases ranked low, contained more than 10 eosinophils. Likewise, some moderate cases contained more than 100 eosinophils. There is poor correlation between the classical and density counts. Nevertheless, good correlation between the two methods could be achieved if the boundaries of the classical method are modified. Eosinophils invariably appear in clusters. We feel that an assessment of density may well be better than classical counting, and have more relationship with function.

Expression of the Sonic Hedgehog receptor "PATCHED" in basal cell carcinomas and odontogenic keratocysts.

Basal cell carcinoma (BCC) is a common invasive skin lesion in Caucasians. Odontogenic keratocysts (OKs) are developmental, non-inflammatory oral cysts. They can be sporadic and/or multiple and are locally destructive. Basal cell naevus syndrome (BCNS) comprises both multiple BCCs and multiple OKs, in addition to several other systemic manifestations. The genetic defect underlying this autosomal dominant syndrome is a germ line mutation in the Sonic Hedgehog receptor PATCHED (PTCH) gene. For this study, a rabbit anti-peptide PTCH antiserum was produced. Immunohistochemistry procedures were performed using PTCH antibody and commercially produced GLI-1 antibody (downstream member in the hedgehog pathway) to stain 11 BCNS-OKs, eight sporadic OKs, two BCNS-BCCs, and six sporadic BCCs. Most of these lesions had been previously screened for PTCH mutation. Most BCCs (n=7) demonstrated moderate staining, with the heaviest staining in the outer palisading cell layer, except a BCNS-BCC which had mutation proximal to the sequence used for production of immunogenic peptide; this demonstrated only weak staining. Although moderate to heavy staining with PTCH antibody was demonstrated in the epithelium of both types of OK (n=19), a quite different pattern of staining of the basal cell layer was observed in the two patient groups. In BCNS, OK staining was heaviest in basal epithelial layers. In contrast, staining in non-BCNS odontogenic keratocysts was exclusively located in the superficial epithelial layers. Up-regulation of PTCH and GLI-1 protein was demonstrated in both BCCs and OKs. The pattern of PTCH expression matched the PTCH transcript pattern previously reported in BCCs and appeared sufficiently characteristic in OKs to allow differentiation between syndromic and non-syndromic cysts.

A novel polymorphism in the PTC gene allows easy identification of allelic loss in basal cell nevus syndrome lesions.

Basal cell nevus syndrome (BCNS; also nevoid basal cell carcinoma syndrome [NBCCS]; Gorlin's syndrome) is an autosomal dominant syndrome characterized by multiple basal cell carcinomas, keratocysts, and developmental skeletal defects. Mutation of the human homologue of Drosophila patched (PTC) gene is considered to be the molecular defect in BCNS. PTC mutations have been observed in sporadic tumors including basal cell and ovarian carcinomas and medulloblastoma. The authors report a novel C/T polymorphism in the PTC gene. Forty-eight normal blood samples were screened for the presence of the polymorphism using direct radioactive and automated sequencing of polymerase chain reaction (PCR) products and restriction enzyme digestion. Results demonstrated 20 homozygous T (43%), 11 homozygous C (23%), and 17 heterozygous C/T (35%). The presence of this polymorphism has permitted us to directly detect allelic loss in BCNS, sporadic keratocysts, and basal cell carcinoma (BCC). Further, four BCNS keratocysts and two BCNS-BCC and three non-BCNS keratocysts showed allelic loss of complementary DNA from lesions when compared with their corresponding blood genomic DNA.

Trefoil factor expression in normal and diseased human salivary glands.

Trefoil factors are wound-healing peptides important in protection and healing of the human gastrointestinal tract. Their potential for therapy of gastrointestinal ulcers has been established. This study investigated the hypothesis that trefoil factors are also present in human salivary gland. Tissues from surgical biopsy specimens were collected fresh into ice and stored in liquid nitrogen. Breast, stomach, and colon constituted positive controls. Trefoil factor mRNAs were detected by reverse transcription polymerase chain reaction (RT-PCR) or by in situ hybridization (ISH) with formalin-fixed, paraffin-embedded sections. Amplified DNA fragments were ligated into pGEM-T Easy vector and used to transform competent Escherichia coli JM109, allowing sequencing to confirm identity of cloned fragments. Generation of amplifiable cDNA was confirmed using primers specific to the ubiquitously expressed abl gene. By RT-PCR, TFF1 (pS2) mRNA was detected in 14 of 15 glands, TFF3 (hITF) mRNA in 13, and TFF2 (hSP) in only 1 gland. ISH of 15 glands (7 of which had been studied by RT-PCR) showed the same pattern of expression and indicated that TFF1 mRNA was usually expressed at low levels by a few mucous cells, whereas TFF3 was produced abundantly by most mucous cells. There was no difference in patterns of expression comparing parotid, submandibular, and minor mucous glands. Nor was there an obvious relationship between trefoil factor expression and pathology, but those glands not expressing TFF1 or TFF3 had evidence of chronic inflammation or atrophy. Trefoil factors are likely to be important in healing, predisposition to, and therapy of, oral diseases.

Role of the 25 kDa major outer membrane protein of Legionella pneumophila in attachment to U-937 cells and its potential as a virulence factor for chick embryos.

The gene encoding the 25 kDa major outer membrane protein (MOMP) of Legionella pneumophila was transformed into Escherichia coli JM 83 and the resultant E. coli LP 116 clone expressed the Legionella-MOMP. Compared with the parent E. coli strain, the clone showed a fivefold increase in opsonin-independent binding to U-937 cells. Furthermore, this gene was incorporated by electroporation into a low virulence derivative of Leg. pneumophila which showed reduced expression of the MOMP but enhanced expression of a 31 kDa protein in the OMP profile. After electroporation, the attenuated strain showed an increased expression of the MOMP while the 31 kDa protein was eliminated and virulence for the chick embryo was re-established. The use of a monoclonal antibody specific for the MOMP abolished virulence and adherence. These studies suggest that the 25 kDa MOMP of Leg. pneumophila serves as an adhesive molecule for host cells and that this protein plays a major role in the virulence of the organism for the chick embryo.

Expression of beta-defensin genes by human salivary glands.

This study investigated expression of genes encoding human beta-defensins 1 and 2 by human salivary glands. Tissues from surgical biopsies were collected fresh onto ice and stored in liquid nitrogen. Total RNA was extracted using Trizol reagent and human beta-defensin messenger RNA detected by reverse transcriptase polymerase chain reaction amplification. DNA sequencing of amplified fragments, after ligation into pGEM-T Easy vector and transformation of competent Escherichia coli, confirmed identities of cloned fragments. Human beta-defensin 1 messenger RNA was detected in all 25 samples that generated amplifiable cDNA, as assessed using abl-specific primers. Three of 13 submandibular gland samples (two normal, one chronically inflamed), and 2 of 2 minor salivary gland samples (one normal, one chronically inflamed) expressed human beta-defensin 2 messenger RNA. All six parotid gland samples studied were negative for human beta-defensin 2 messenger RNA. Thus, human beta-defensin 1 gene expression occurred in all human major and minor salivary glands studied, whereas human beta-defensin 2 expression occurred only in a small number of gland samples.

Histological identification of carcinoma in 21 gauge needle tracks after fine needle aspiration biopsy of head and neck carcinoma.

Six cancer resection specimens were thoroughly sectioned and microscopically examined at areas known to have been around 21 gauge fine needle aspiration (FNA) biopsy sites, in an attempt to identify needle tracks. All cases had an interval of not less than 10 days between FNA biopsy and surgery. Foci of tumour were identified histologically in needle tracks from two patients with carcinoma. This is the first instance, outside of experimental animal models, of histologically confirmed, viable tumour spread in FNA biopsy tracks. Although this complication is not common and is of unknown clinical significance, it is one that all clinicians who undertake FNA of malignant neoplasms should be aware of.

Characterisation of human patched germ line mutations in naevoid basal cell carcinoma syndrome.

Mutations in the human patched gene have recently been detected in patients with naevoid basal cell carcinoma syndrome. We have characterised a further 5 novel germ line mutations in patients presenting with multiple odontogenic keratocysts. Four mutations cause premature stop codons and one mutation results in an amino-acid substitution towards the carboxyl terminus of the predicted patched protein. No obvious genotype-phenotype correlations could be interpreted, consistent with previous studies.

Rapid determination of the complexity of cDNA bands extracted from DDRT-PCR polyacrylamide gels.

A band extracted from a differential display polyacrylamide gel often represents a composite of heterogeneous products. We have developed a non- radioactive method to simply and rapidly analyse its complexity. A fluorescent restriction enzyme fingerprint of the composite mixture is generated. The number of individual bands observed in this fingerprint indicates the complexity of the re-amplified cDNA mixture. Restriction fingerprints of the inserts of cDNA subclones derived from the re-amplified cDNA mixture are compared to the composite fingerprint to select those representing the most intense bands in the composite. This dramatically reduces the number of clones required for further characterisation.

Automated differential display using a fluorescently labeled universal primer.

We have modified the automated differential display reverse transcription polymerase chain reaction technique (DDRT-PCR) such that a single fluorescently labeled universal primer (d(F)CTCACG-GATCCGTCGATTTT) is used in all PCRs together with a selection of arbitrary primers. We term this fluorescent detection procedure FDDRT-PCR. Anchoring primers of general structure dTGGTCTCACGGATCCTCGA-(T)12 VN (where N can be any deoxynucleoside and V can be any deoxynucleoside other than thymidine) are used for the RT step, and the universal primer together with selected arbitrary primers are then used for the PCR amplification. Advantages of this approach are: (i) the fluorescently labeled universal primer is a constant feature in every PCR, so that changes in banding profile are highly likely to reflect the incorporation of different arbitrary 10-mer primers; (ii) artifacts that result from arbitrary 10-mer to arbitrary 10-mer primer amplifications are not observed by fluoresence detection on an automated gene scanner because such products are not fluorescently labeled; (iii) sample throughput and ease of data handling are increased when compared with the conventional radioactive/manual approach and (iv) using a single fluorescently labeled primer in all PCRs is highly cost-effective.

Decreasing p53 overexpression in sequential, recurrent, oral squamous cell carcinomas.

Expression of abnormal p53 protein is a widely recognised marker of malignancy including oral squamous cell carcinoma. This is a longitudinal study of p53 expression in fixed, paraffin-embedded tissue from 3 patients with multiple, recurrent, squamous cell carcinomas of floor of mouth (n = 4, 4, 3). All carcinomas demonstrated increased expression of p53 compared to normal tissues. However, there was reduction in expression from primaries to subsequent recurrent tumours in all 3 patients. The significance of reduction of expression of p53 in sequential recurrences is unclear, but as each of these patients has now survived for at least 5 years this may be a phenomenon indicating a favourable prognosis. As this study relates to only 3 patients, a larger study is needed to confirm this initial observation.

Yeast artificial chromosome cloning and chromosomal localization of the abundant odontogenic keratocyst protein elafin.

An imbalance in human leucocyte elastase (HLE) activity is widely recognized to play an important pathological role in a number of human diseases. An earlier report has described greater transcription of elafin, an endogenous inhibitor of HLE, in epithelia of odontogenic keratocysts of the jaw than in normal oral mucosa. The elafin gene was now localized to chromosome 20q11.2-13.1 using a combination of somatic cell-hybrid panel screening and fluorescence in situ hybridization using a biotinylated DNA probe prepared from isolated yeast artificial chromosomes. No other positive fluorescent signals were observed. This eliminates the elafin gene as a candidate gene for naevoid basal-cell carcinoma syndrome, as the gene for this syndrome localizes to chromosome 9q23.1-31. The elafin yeast artificial chromosome DNA is to be subcloned to identify polymorphic microsatellite markers that will establish whether this gene is frequently amplified in oral neoplastic tissue.

Investigation of chromosome 9q22.3-q31 DNA marker loss in odontogenic keratocysts.

Multiple basal cell carcinomas and odontogenic keratocysts of the jaws are a feature of the inherited naevoid basal cell carcinoma syndrome (NBCCS), although both occur more commonly as single, sporadic cases. The NBCCS gene has been mapped to chromosome 9q22.3-q31 and loss of heterozygosity for DNA markers from this region has been observed in familial and sporadic basal cell carcinomas. Based on these observations, we undertook a pilot study to determine if a similar pattern of chromosome loss occurs in odontogenic keratocysts. DNA extracted from microdissected odontogenic keratocyst epithelium was examined for loss of heterozygosity for six polymorphic DNA markers mapping to human chromosome 9q22.3-q31. Allelotype loss was detected in epithelium from three, single, sporadic odontogenic keratocysts. These results implicate homozygous inactivation of the NBCCS gene in the initiation and progression of the odontogenic keratocyst.

Increased elafin expression in cystic, dysplastic and neoplastic oral tissues.

Expression of human leukocyte elastase inhibitor, elafin, otherwise known as skin-derived antileukoproteinase inhibitor (SKALP), was investigated in normal and abnormal oral tissues using a specific anti-SKALP rabbit antiserum. Weak staining was observed in keratinizing epithelia of normal oral mucosa but not in non-keratinizing mucosa. Increased expression was also observed in the suprabasal layers of dysplastic oral epithelia and in well-differentiated squamous cell carcinoma, but not in basal cell carcinoma. A uniform strong expression was observed in all supra-basal layers of odontogenic keratocyst epithelia, except in regions where inflammatory infiltrate was adjacent to keratocyst epithelia. In contrast, elafin expression in a small number of dentigerous cysts and ameloblastomas was more patchy. The increased levels of elafin in keratocyst epithelia and dysplastic tissue may be a cellular homoeostatic response to generate a protective barrier preventing proteolytic degradation of underlying elastic tissue.

Increased expression of a 38kd cell-surface glycoprotein MH99 (KS 1/4) in oral mucosal dysplasias.

A "window of expression" of a 38-kD cell-surface glycoprotein MH99 (KS 1/4 antigen) has been observed in dysplastic oral tissues using an MH99-specific monoclonal antibody. It appeared that expression of this epitope increases from baseline levels in normal oral epithelium to that of high levels in mild, moderate and severe dysplasia. In invasive squamous cell carcinoma, relatively low levels of expression were observed. In contrast, high levels of expression were demonstrated in basal cell carcinomas. Antibody reactivity could clearly distinguish between the margins of histologically normal and dysplastic tissues. It is envisaged that the expression of this cell-surface glycoprotein, which is possibly related to nidogen, a matrix-adhesion molecule with receptor-like function, could be used in monitoring progression or regression of these lesions and assessment of surgical excision margins. It could also be useful in in vivo and in vitro investigations into molecular changes underlying the formation of dysplastic lesions.

The polymorphous odontogenic cyst.

Over the years there have been sporadic reports of unusual cystic lesions of the jaws, not readily classified under conventional headings but which have been variously diagnosed as median-mandibular, glandular, sialo-odontogenic or botryoid odontogenic cyst. We present five cases which do not fit into other categories of odontogenic cyst, two of which have recurred within a few years of conservative treatment. This paper aims to alert clinicians to the propensity for regrowth of these cysts, proposes the term polymorphous odontogenic cyst for these lesions, to encompass their varied histological appearances and discusses their distinction from other cyst types with mucous and papillary formations in epithelium.