Recurrence of Quadruple Extramammary Paget's Disease after 12 Years: A Case Report and Literature Review.

Introduction: Extramammary Paget's disease (EMPD) is a rare skin cancer that tends to be multicentric, with quadruple EMPD cases being scarcely reported. Case Presentation: We report the case of an 81-year-old man with heterochronous quadruple EMPD. Twelve years after total resection of vulvar EMPD, the patient developed erythematous lesions on the resection margin in the lower abdomen, umbilical region, and both axillae. Histological examination revealed that all lesions were in situ EMPD. Discussion: We reviewed six reported cases of quadruple EMPD with respect to race, sex, site, recurrence, time to recurrence, serum carcinoembryonic antigen, and depth. All patients were elderly Japanese males. In all but one case, the lesions were located in the apocrine region, which is a common site in such as the genital and axillary areas. Our case was the only heterochronous quadruple EMPD. The lesions were limited to the epidermis; therefore, they were unlikely to cause metastasis. It has been reported that the therapeutic effects of imiquimod can be expected in in situ EMPD. Therefore, quadruple EMPD may be a good indication of treatment option. Conclusion: EMPD is a disease whose pathogenesis is not yet clear; however, it is hoped that the origin and aetiology of EMPD will be elucidated from the clinical features of multiple EMPD in the future.

The influence of patient characteristics on acrylic-based resilient denture liners embedded in maxillary complete dentures.

PURPOSE: A major complication associated with the use of resilient denture liners (RDLs) is a change in hardness over time. In vivo studies on the deterioration of RDLs over time are needed. We aimed to investigate the influence of patient characteristics on the hardness of acrylic-based RDLs (ARDLs) embedded in complete maxillary dentures. We hypothesized that 1 month after application of the ARDLs, the hardness would be influenced by age, saliva condition, occlusal force, smoking, drinking, denture wearing during sleeping, denture cleanser usage, and denture type. METHODS: Thirty complete maxillary denture wearers were recruited after obtaining informed consent. One investigator measured the Shore D hardness of the commercially available ARDLs, Soften (SFT), FD Soft (FDS), and Bio Liner (BIO) using a Vesmeter(®). The salivary flow rates and pH values and the occlusal force were measured for all patients before initiation of the study. T-tests and Pearson's correlation coefficients were used for the statistical analyses. A p-value of <0.05 was considered statistically significant. RESULTS: Smoking, wearing dentures while sleeping, use of denture cleansers, and denture type were associated with an increase in the hardness of the RDLs. The resting saliva pH only influenced the hardness of the SFT ARDLs. CONCLUSIONS: Smoking, denture wearing while sleeping, denture cleanser usage, denture type, and resting saliva pH are important predictors of the deterioration of ARDLs over time.

Effect of an acrylic resin-based resilient liner applied to mandibular complete dentures on satisfaction ratings among edentulous patients.

PURPOSE: The aim of this study was to investigate whether an acrylic resin-based resilient liner (ARL) could improve the satisfaction ratings of complete denture wearers. The null hypothesis was that no difference exists between the satisfaction ratings of conventional acrylic resin denture (CARD) wearers and those of ARL denture (ARLD) wearers. MATERIALS AND METHODS: From April 2004 to July 2006, a randomized controlled trial was conducted at two centers, including 74 edentulous patients. Of these, 37 patients were each randomly allocated to the ARLD and CARD groups. All of the patients rated their satisfaction with dentures, including general satisfaction and satisfaction with chewing ability, speaking, cleaning, stability, retention, comfort, and esthetics. These satisfaction ratings were measured by a 100-mm visual analog scale. Perceived chewing ability of different foods, divided into five grades, was measured using a questionnaire. The mastication index (MI) was calculated for each grade. RESULTS: General satisfaction, satisfaction with chewing, and satisfaction with speaking were significantly higher in the ARLD than in the CARD group (P = .049, .025, and .049, respectively). The chewing satisfaction with maxillary dentures in the ARLD group was significantly higher than that of the CARD group (P = .02). No significant difference existed between the MI of the ARLD (69.2 ± 17.0) and CARD groups (66.7 ± 18.7). CONCLUSIONS: Within its limitations, this study showed that the ARL improves a complete denture wearer's satisfaction ratings.

Evaluation of the antihistamine effects of olopatadine and levocetirizine during a 24-h period: a double-blind, randomized, cross-over, placebo-controlled comparison in skin responses induced by histamine iontophoresis.

The antihistamine effects of olopatadine and levocetirizine, in standard-dose application described in their information (5 mg twice a day for olopatadine; 5 mg once daily for levocetirizine), were examined from 11.5 to 24 h after application. The test was designed in a double-blind, randomized, cross-over, placebo-controlled study of 12 healthy volunteers on histamine-induced flare and wheal response using an iontophoresis technique. The suppressive effect of olopatadine on the wheals induced by a 0.1-mA histamine iontophoresis lasted for 24 h after dosing. Both drugs inhibited flare induced by histamine iontophoresis almost completely until 24 h after the first administration. Suppression of the 0.2-mA-induced wheal response by levocetirizine, taken once daily, decreased with time, although 0.1-mA-induced flare was almost completely suppressed by the drug. Olopatadine completely suppressed even the wheal response induced by a 0.2-mA histamine iontophoresis. Compared with the placebo, the two drugs significantly suppressed the subjective itching assessed by visual analog scale at all intervals. There were no significant differences in subjective drowsiness and objective cognitive function between drug- and placebo-treated subjects. These results demonstrate that olopatadine seems to be more potent than levocetirizine when administrated in a standard dose. In conclusion, mild to moderate urticaria could be controlled by standard application as described in their information. On the other hand, severe urticaria could be managed by a standard application of olopatadine, but levocetirizine may need an additional dose to control severe urticaria.