Oral malignancies in HIV disease: changes in disease presentation, increasing understanding of molecular pathogenesis, and current management.

Infection with human immunodeficiency virus (HIV) and progression to acquired immune deficiency syndrome (AIDS) are associated with a vide variety of morbidities. Local and systemic diseases can develop in association with HIV infection and may manifest themselves as malignancies of the oropharynx. Advances in HIV management, fueled by increasing understanding of molecular pathogenesis, have resulted in marked changes in the prevalence of oral malignant disease. This paper discusses recent trends in the presentation and treatment of malignancies related to HIV and AIDS with an emphasis on malignancies seen in the oral cavity.     

Segmental adenomyomatosis of the gallbladder. A radiologic, sonographic, and pathologic correlation

Adenomyomatosis is a hyperplastic condition that is occasionally symptomatic. The segmental form of adenomyomatosis can result in marked wall thickening in the waist of the gallbladder, giving a characteristic "hourglass" deformity in both the oral cholecystogram and the ultrasound examination.     

Effect of parenteral oestrogen on the coagulation system in patients with prostatic carcinoma

Patients with prostatic carcinoma on oral oestrogen therapy have an altered coagulation system and suffer cardiovascular side effects. Oestrogens--especially oral oestrogens--are potent inducers of liver synthesised proteins, including coagulation factors. We have assessed the effect of non-oral oestrogen on the coagulation system in patients with prostatic carcinoma. Twelve patients were given monthly intramuscular injections of 320 mg polyoestradiol phosphate (PEP). No additional oestrogens were given. No change was found in any of the coagulation factors, including factor VII, with the exception of a significant decrease in antithrombin III. No patient, including 38 patients treated with PEP, had any cardiovascular complications after a mean follow-up period of 12.9 +/- 0.7 months; 76% of the patients responded to treatment. Parenteral administration of oestrogen caused a less marked change in the coagulation system than oral administration and should be the treatment of choice for prostatic carcinoma.     

Oral bromazepam in premedication. A comparison with diazepam

Bromazepam, a relatively newly benzodiazepine with marked anxiolytic effects, was compared in a randomised, double-blind manner with diazepam for its effectiveness as an oral premedicant drug. A scoring system was used to assess sedation, relief of anxiety, nausea, and cardiovascular effects in two groups of women having gynaecological operations. No difference was demonstrated between the effectiveness of the two drugs.     

Randomised controlled trial comparing oral and intravenous paracetamol (acetaminophen) plasma levels when given as preoperative analgesia

Gastric absorption of oral paracetamol (acetaminophen) may be unreliable perioperatively in the starved and stressed patient. We compared plasma concentrations of parenteral paracetamol given preoperatively and oral paracetamol when given as premedication. Patients scheduled for elective ear; nose and throat surgery or orthopaedic surgery were randomised to receive either oral or intravenous paracetamol as preoperative medication. The oral dose was given 30 minutes before induction of anaesthesia and the intravenous dose given pre-induction. All patients were given a standardised anaesthetic by the same specialist anaesthetist who took blood for paracetamol concentrations 30 minutes after the first dose and then at 30 minute intervals for 240 minutes. Therapeutic concentrations of paracetamol were reached in 96% of patients who had received the drug parenterally, and 67% of patients who had received it orally. Maximum median plasma concentrations were 19 mg.l(-1) (interquartile range 15 to 23 mg.l(-1)) and 13 mg.l(-1) (interquartile range 0 to 18 mg.l(-1)) for the intravenous and oral group respectively. The difference between intravenous and oral groups was less marked after 150 minutes but the intravenous preparation gave higher plasma concentrations throughout the study period. It can be concluded that paracetamol gives more reliable therapeutic plasma concentrations when given intravenously.     

Dumping syndrome following Nissen's fundoplication: a cause for refusal to feed

Two cases of infantile dumping syndrome which developed following Nissen fundoplication for gastroesophageal reflux are described. Both infants were fed postoperatively via a gastrostomy and showed the typical clinical picture of dumping with failure to thrive, intermittent diarrhea, lethargy and pallor postprandially. Several glucose tolerance tests were highly pathological with marked hyperglycemia immediately after a gastrostomy meal followed by hypoglycemia two hours later. In one case HbA1c was significantly elevated which is thought to be an expression of recurrent hyperglycemia. In both infants the first and most impressive clinical sign was absolute refusal or oral feeds. Normal oral food intake was slowly re-established after normalization of blood glucose homeostasis.     

Chlormadinone acetate pellet implantation plus short-term oral administration in dogs with benign prostatic hypertrophy

Eight beagles with benign prostatic hypertrophy (BPH) were treated by subcutaneous implantation of pellets containing 10 mg/kg chlormadinone acetate (CMA), a synthetic anti-androgen, plus daily oral administration of CMA at 2 mg/kg per day for 7 days as a therapy for BPH. Prostatic and testicular size were measured and prostatic and testicular biopsies were performed by laparotomy before and after CMA treatment. Plasma levels of luteininzing hormone (LH), testosterone and oestradiol were also measured. The clinical signs of BPH, for example haematuria and dysuria, resolved within 1 week of treatment. Mean prostatic volume decreased to 56% of the pretreatment value. At 40 weeks after treatment, prostatic volume had decreased by 36%. Histological examination of the prostate 1 week after treatment revealed reduction in diameter of the alveoli and in height of the glandular epithelium. Degeneration and atrophy of the glands were marked 4–12 weeks after treatment. In the testis, the diameter of seminiferous tubules and the number of germ cells in the seminiferous tubules had decreased markedly at 12 and 24 weeks after treatment. Although plasma LH concentrations did not undergo any marked fluctuations after CMA treatment, levels of testosterone and oestradiol were lower than before treatment. The results indicate that implantation of 10 mg/kg CMA, plus 7-day oral administration of 2 mg/kg CMA, bring about resolution of the clinical signs and marked reduction in prostatic volume within 1 week of treatment.     

Distinct array comparative genomic hybridization profiles in oral squamous cell carcinoma occurring in young patients

BACKGROUND: Oral cancer typically affects smokers older than 50 years of age. Recently, however, a marked increase in the number of patients 40 years old and younger, many with no history of tobacco smoking, has been noted. Studies in this age group have so far been restricted to genomic areas well recognized as abnormal in typical patients with oral cancer. The aim of this study was to assess genomic aberrations in oral cancer, using comparative genomic hybridization (CGH) microarray technology, and to compare the genomic aberration profile of patients older than 40 years old with those 40 years old and younger. METHODS: Tumor samples from 20 patients with oral cancer (age range, 21-78; 10 smokers and 10 nonsmokers) were laser microdissected, and array CGH was used to identify genomic imbalances in these two cohorts. RESULTS: The older cohort showed high numbers of gains and losses in contrast to very few copy number changes in the younger nonsmoker cohort. In concurrence with the literature, tumors from the older cohort manifested deletions involving 3p and 9p21 and gains involving 3q, 5q, 7p, 8q, 11q, and 20q. The younger group, particularly the nonsmokers, showed very few changes overall, and the aberrations were not in the sites classically associated with oral cancer. Deletion of CDKN2A (p16) was completely absent in the younger group but was present in 50% of the older cohort. CONCLUSIONS: We have demonstrated that there is far less genomic instability in young nonsmokers with oral cancer than found in typical patients with oral cancer. These observations indicate that oral cancer presenting at a younger age, particularly in nonsmokers, has a genomic profile different from the classically described oral cancer.     

乳痛症的治疗分析

目的 探讨乳痛症的临床诊治体会.方法 将门诊治疗的乳痛症女性病人随机分4组,用不同的方案治疗,作统计学分析.结果 3个月后A、B、C、D 4组按顺序,后面组都优于前一组(P＜0.05)有统计学意义.结论 在解除癌症恐惧,鼓励病人与周嗣人多交流,规律生活、运动,合理饮食,佩戴合理胸罩等基础上联合应用乳核散结片和三苯氧胺对...     

Naphthylamidase* in ameloblasts during enamel maturation

Naphthylamidase activity was studied in rat molar and incisor teeth at different stages of development. L-leucyl-4-methoxy-2-naphthylamide, L-alanyl-4-methoxy-2-naphthylamide, L-leucyl-2-naphthylamide and DL-alanyl-2-naphthylamide were used as substrates and Fast blue B and Fast Garnet GBC as diazonium salts. Naphthylamidase was not demonstrable in the teeth during enamel matrix formation. After the termination of this stage, naphthylamidase was present in the ameloblasts in their distal ends close to the enamel surface. The enzyme activity retained this localization until the dental epithelium fused with the oral epithelium at the time of tooth eruption into the oral cavity. Naphthylamidase was not found in other dental tissues, but marked activity was found in osteoclasts at the resorbing surfaces of alveolar bone surrounding the developing and erupting teeth and in certain areas of the connective tissue.     

中西医结合治疗伪膜性肠炎

目的：观察中西医结合治疗伪膜性肠炎的疗效。方法：用生脉散口服、白头翁汤保留灌肠加万古霉素口服治疗腹部大手术后及化疗后２８例伪膜性肠炎患者作为治疗组,用万古霉素口服治疗２６例伪膜性肠炎患者作对照组。观察两组患者止泻退热、失水纠正时间疗程,停药后复发例数。结果：治疗组用药后５项指标均较对照组缩短,无１例死亡,停药后仅１例复发,差异显著。结论：中西医结合治疗慕生肠炎具有疗效好、疗程短、停药后复发率低的优     

Reversal of abnormal glucose metabolism in chronic pancreatitis by administration of pancreatic polypeptide

Chronic pancreatitis, induced in dogs by pancreatic duct ligation, is associated with glucose intolerance due to insulin deficiency, reduced hepatic sensitivity to insulin, and a marked deficiency of pancreatic polypeptide. Treatment with a 14 day continuous subcutaneous infusion of pancreatic polypeptide resulted in improved oral glucose tolerance and improved hepatic glucose responses to insulin in dogs with chronic pancreatitis. No effect of continuous subcutaneous infusion of pancreatic polypeptide was seen in the control dogs. The time course of the effect of continuous subcutaneous infusion on the hepatic response to insulin was relatively immediate, whereas the effects on improvement in oral glucose tolerance were prolonged. We conclude that pancreatic polypeptide may function physiologically to enhance the hepatic glucose response to insulin and that alterations in glucose metabolism seen in chronic pancreatitis may be due, in part, to a deficiency in pancreatic polypeptide. Since treatment with continuous subcutaneous infusion of pancreatic polypeptide restored the hepatic response to insulin and oral glucose tolerance to more normal levels in our animal model, administration of pancreatic polypeptide may play a therapeutic role in the treatment of certain forms of pancreatogenic diabetes.     

COMPARISON OF THE SUBECTIVE EFFECTS AND PLASMA CONCENTRATIONS FOLLOWING ORAL AND I.M. ADMINISTRATION OF FLUNITRAZEPAM IN VOLUNTEERS

Flunitrazepam 0.5, 1.0 or 2.0 mg was given by the oral or i.m.routes to groups of volunteers and its effccts compared. Plasmaconcentrations of the drug were estimated by gas-liquid chromatography,in a smaller number of the subjects. The most striking effectwas sedation which incraned with the dose, 2 mg producing deepsleep although the subjects could still be aroused. The cffectsof i.m. administration were apparent earlier and sometimes lastedlonger than those following oral adminiatration. Dizziness waslees marked than sedation, but increased with the dose. Therewas pain on i.m. injection of flunicrazepam significantly moreoften than with isotonic saline. Plasma conccntrations variedwith dose and mute and corresponded qualitatively with the subjectiveeffects. The drug was still present in measurable quantitiesaftar 24 h even with the smalleat dose.     

The inexhaustible beta cell.

Repeated intensive pancreatic beta-cell stimulation was carried out in 42 subjects, comprising 22 normal controls, 10 mild to "severe" maturity-onset diabetics, and 10 chronic pancreatitis patients. Each subject received 75 gm. oral glucose twice and 1 mg. glucagon plus 0.5 gm. tolbutamide intravenously three times at short intervals. Each of the three combined stimuli caused almost equivalent marked spikes of insulin release in all experimental groups. The total calculated output of insulin was equivalent to the total daily insulin output in normal subjects. Pancreatitics and those with severe diabetes (fasting blood sugar greater than 120 mg./100 ml.) had qualitatively similar but a quantitatively smaller response. Those with mild diabetes were similar to the normal subjects but had an exaggerated response to the second oral glucose dose, suggesting overactivity of the enteroinsular axis. Despite the inordinate insulin levels, hypoglycemia did not occur.     

Type 1 diabetes mellitus and its oral tolerance therapy

As a T cell-mediated autoimmune disease,type 1 diabetes mellitus(T1 DM) is marked by insulin defect resulting from the destruction of pancreatic β-cells.The understanding of various aspects of T1 DM,such as its epidemiology,pathobiology,pathogenesis,clinical manifestations,and complications,has been greatly promoted by valuable research performed during the past decades.However,these findings have not been translated into an effective treatment.The ideal treatment should safely repair the destroyed immune balance in a longlasting manner,preventing or stopping the destruction of β-cells.As a type of immune hypo-responsiveness to the orally administrated antigen,oral tolerance may be induced by enhancement of regulatory T cells(Tregs) or by anergy/deletion of T cells,depending on the dosage of orally administrated antigen.Acting as an antigen-specific immunotherapy,oral tolerance therapy for T1 DM has been mainly performed using animal models and some clinical trials have been completed or are still ongoing.Based on the review of the proposed mechanism of the development of T1 DM and oral tolerance,we give a current overview of oral tolerance therapy for T1 DM conducted in both animal models and clinical trials.     

Transdermal oxybutynin: sticking to the facts

OBJECTIVES: This article critically reviews all the available published and presented data about transdermal oxybutynin to provide a summary of its efficacy, tolerability, and acceptability. RESULTS: For patients with urge incontinence or mixed incontinence, transdermal oxybutynin offers equivalent efficacy to variable dose oral oxybutynin IR and tolterodine LA 4 mg/d. At present no data are available for patients with frequency and urgency but without incontinence (overactive bladder [OAB] dry). Transdermal oxybutynin offers marked improvements compared with placebo in incontinence episodes, daily urinary frequency, and nocturia. These objective improvements are matched by improvements in quality of life. The rate of anticholinergic side-effects is lower than that for oral anticholinergic preparations. This benefit is offset by a rate of local skin reactions. CONCLUSIONS: The balance of efficacy and tolerability suggests that transdermal oxybutynin should be considered as a potential first-line therapy in OAB or mixed incontinence.     

Intestinal motility and its variations in replacement bladder and intestine

Urinary reservoirs replacing the bladder are made of intestine. The digestive tract motor activity is regulated by hormonal and neurologic mechanisms. The purpose of this work is the comparison of the motor activity in intact bowel with that of the new urinary reservoir during and after an oral intake. The modifications of pre- and post-prandial motor activities are recorded simultaneously in duodenum and neobladder by 4 patients with a tubular entero-cystoplasty (Camey I); standard meal (570 Kcal) triggers a similar activity in both segments. The modifications induced by an oral intake are then recorded by 14 patients with various reservoirs (ileum, ileum-cecum, cecum) and with different shapes (tubular or non-tubular). The compliance of non-tubular colic or ileocolic reservoirs appears greater than that of ileal reservoirs, even after detubularization. After oral intake, basal pressure and motor activity increase clearly in ileal bladders and much less in colic or ileocolic bladders. Nocturnal leak observed in many urinary reservoirs may be linked to the persistence of an intense motor activity in the neobladder with a marked increasing during the second part of the night.     

Giant hepatic adenoma with atypical features in a patient on oxcarbazepine therapy

An association between oxcarbazepine therapy and hepatic adenoma (HA) has been documented in animal models but not observed in humans. The authors report a case of a 16-year-old girl on oxcarbazepine therapy for seizure disorder who presented with a giant HA. Pathology of the HA was notable for marked periductal fibrosis and glycoprotein inclusions in the nontumor liver. The patient was not on oral contraceptives and has no other known risk factors for HA.     

Marked improvement of calcinosis in adult dermatomyositis with etidronate therapy

We report a 26-year-old woman with severe calcinosis associated with dermatomyositis. Although calcinosis of the skin or muscles is unusual in adults with dermatomyositis, this patient developed subcutaneous calcinosis with tenderness on the arms, axillary areas, shoulder areas, chest, abdomen, pelvis, and limbs. The calcinosis steadily increased and spread until joint motions were severely limited. Radiographic examination showed extensive soft-tissue calcification with a reticular pattern and severe osteoporosis. The patient was treated with oral etidronate (800 mg/day for 3 months every 6 months) to prevent calcification of the lesions. Three months later, the patient showed a dramatic improvement in symptoms with softening of the calcinosis, reduced pain, and marked increase in joint mobility. Radiographic examination showed marked decreases in the size of the calcified lesions compared to pre-treatment findings, and this effect persisted with a constant progressive efficacy for 3 years. The 3-year course of etidronate therapy also resulted in marked improvement of the severe osteoporosis and the patient was able to return to work and enjoy a normal life. We propose etidronate as a beneficial and effective therapy for calcinosis with osteoporosis.