Gingivomorphometry – esthetic evaluation of the crown–mucogingival complex: a new method for collection and measurement of standardized and reproducible data in oral photography

Objectives: A new method is introduced for the esthetic evaluation of the periimplant mucogingival complex through collection of standardized oral photographs and computer-assisted measurement of reproducible data. Using this method, different soft tissue and crown parameters in the dentogingival complex can be measured and the esthetic outcome monitored.
Material and methods: A photographic device for standardized oral photography and a standard protocol for the esthetic evaluation of the crown–mucogingival complex is presented, comprising six soft tissue parameters: (1) mesial and (2) distal papilla areas, (3) mesial and (4) distal papilla heights, (5) soft tissue–crown perimeter, and (6) gingival recession. In order to demonstrate the reproducibility of standardized oral photographs and the accuracy of the measurement of the six parameters, the data obtained in each of two such standardized clinical photographs, taken at 10–14 days intervals, of the anterior maxillary region from 10 patients with no apparent dental disease were compared. For the statistical analysis of the reproducibility of these dependent data the 95% confidence interval and the coefficients of variation were calculated from measurement means and ranges of each of the above parameters, pooled from all 10 patients.
Results: Statistical analysis revealed high reproducibility with no significant differences between the range of mean values of all six parameter measurements on the first and second standardized oral photograph of the same patient, respectively.
Conclusion: Gingivomorphometry on standardized oral photographs can be considered to be an accurate and reproducible method for the evaluation and measurement of different dentogingival and periimplant parameters.     

Molecular pathogenesis of pulmonary carcinosarcoma as determined by microdissection-based allelotyping

Pulmonary carcinosarcoma is a rare, biphasic tumor composed of malignant epithelial and mesenchymal elements. Its histogenesis is controversial in light of the presence of divergent cell lineages and the clonal nature of malignancy. To address these issues, we performed an extensive comparative genotypic analysis using microdissection to secure representative mesenchymal and epithelial components from each of six cases of pulmonary carcinosarcoma. Loss of heterozygosity was analyzed with a panel of 12 polymorphic microsatellite markers designed to indicate allelic loss and situated in proximity to known tumor suppressor genes located on 1p, 3p, 5q, 9p, 10q, and 17p. In accordance with the relatively greater biologic aggressiveness of this tumor type, both the epithelial and mesenchymal components showed extensive allelic loss, most notably for 3p, 5q, and 17p. More importantly, we found overall equivalent patterns of acquired allelic loss between the two components on an individual case basis, strongly supporting the monoclonal origin of these neoplasms. Minor differences in the allelic fingerprint between the two cell lineages could be explained by progressive accumulation of allelic loss alterations that appear to occur more frequently in the mesenchymal component of the tumor. The data support the efficacy of microdissection-based allelic fingerprinting to delineate the relationship between different morphologic components of a single neoplasm.     

A prospective study of ultrasound scan-guided thrombin injection of femoral pseudoaneurysm: a trend toward minimal medication

BACKGROUND: Catheterizations and endovascular procedures in which the femoral artery is cannulated are sometimes complicated by iatrogenic pseudoaneuryms. Surgical repair of pseudoaneurysms was the treatment of choice until 1991 when compression was used in those that were small. A less uncomfortable technique involving the ultrasound scan-guided injection of thrombin (UGTI) has been used more recently. The purpose of this study was to prospectively evaluate the effectiveness of ultrasound scan-guided thrombin injection (UGTI) as a treatment of iatrogenic femoral pseudoaneurysms. METHODS: From December 1998 to December 2000, 3734 femoral artery catheterizations were performed, and from those, 32 consecutive patients with 33 femoral pseudoaneurysms (0.88%) of less than 8 cm were prospectively enrolled for UGTI. With sterile technique, a 21-gauge or 22-gauge spinal needle was used to access the pseudoaneurysm and thrombin (100 to 6000 international units [IU]) was slowly injected until thrombosis occurred. RESULTS: The initial success rate was 100%. Thirty-one cases (93.9%) remained successfully thrombosed with a single injection at day 30. Recurrence of two pseudoaneurysms (6.1%) was seen at day 1 and day 8. One patient had groin cellulitis develop, and the other had a bleed into the thigh after discharge; both were treated with open surgical repair. Fifteen patients underwent UGTI on an outpatient basis with 100% successful ablation. More than half of the patients were on an inpatient basis (53.1%). Hospital stay was 1 to 9 days, with 88.2% of the patients released on day 1 or 2. However, two patients had a prolonged stay: one from open repair (day 9) and the other from a gastrointestinal bleed (day 8). Pseudoaneurysms ranged from 1.7 to 7.5 cm and lasted 1 to 17 days before UGTI. Twenty-one of the patients (65.7%) continued undergoing anticoagulant therapy at the time of injection. Ten of the last 11 cases needed less than 800 IU, and nearly half of the pseudoaneurysms (49%) successfully thrombosed with less than 600 IU. No procedural complications or mortality were noted. No statistical significance was found between occurrence of the pseudoaneurysm and sheath size (with chi(2) test, P value =.05) or between the size of the pseudoaneurysm and successful thrombosis (with chi(2) test: degrees of freedom, 6 - 1 = 5; P value =.227426). A mean follow-up period of 11.8 months was documented (range, 71 to 24 months). Seven patients were lost to follow-up at less than 30 days. CONCLUSION: Percutaneous thrombin injection of iatrogenic pseudoaneurysms is an effective treatment. Not only is it minimally painful, but it can be done as an outpatient procedure and anticoagulation therapy does not hinder the success. Minimal thrombin seems necessary to successfully treat pseudoaneurysms that may further limit procedure-related complications.     

Estrogen receptors in human pulp tissue

OBJECTIVE: The aim of this study was to evaluate the expression of estrogen receptor (ER)-alpha in human pulp tissue. STUDY DESIGN: Tissue samples were collected from 51 teeth extracted for orthodontic reasons or from endodontically treated teeth. Immunohistochemical staining was performed with mouse antihuman ER-alpha 1D5 by using the alkaline phosphatase antialkaline phosphatase technique. Immunohistochemical reactivity was semiquantitatively assessed and graded on an intensity scale of 0 to 3. RESULTS: ERs were found in odontoblasts, endothelial cells, and Schwann cells. By means of statistical analysis, ERs were found to be common in odontoblasts (1.3-1.6) and in endothelial cells (1.0-1.4), whereas in Schwann cells they were somewhat rare (0.7-1.1). Difference in expression of ERs was not found among patients in different age groups. With respect to sex, a difference in reactivity was observed in Schwann cells, which showed higher reactivity in female pulps. CONCLUSION: The results of this study confirm the expression of ER-alpha in the human dental pulp.     

Diabetes impairs hypothalamo-pituitary-adrenal (HPA) responses to hypoglycemia,and insulin treatment normalizes HPA but not epinephrine responses

We recently established that in addition to plasma adrenocorticotrophic hormone (ACTH) and corticosterone, hypothalamic corticotrophin-releasing hormone (CRH) mRNA and hippocampal type 1 glucocorticoid receptor (GR1) mRNA were also upregulated in uncontrolled streptozotocin-induced diabetes. In the current study, control, diabetic, and insulin-treated diabetic rats underwent a hyperinsulinemic-hypoglycemic glucose clamp to evaluate central mechanisms of hypothalamo-pituitary-adrenal (HPA) and counterregulatory responses to insulin-induced hypoglycemia. Increases in plasma ACTH, corticosterone, and epinephrine were significantly lower in diabetic rats versus controls. Insulin treatment restored ACTH and corticosterone but not epinephrine responses to hypoglycemia in diabetic rats. Glucagon and norepinephrine responses to hypoglycemia were not affected by diabetes or insulin treatment. In response to hypoglycemia, hypothalamic CRH mRNA and pituitary proopiomelanocortin mRNA expression increased in control and insulin-treated but not in untreated diabetic rats. Arginine vasopressin mRNA was unaltered by hypoglycemia in all groups. Interestingly, hypoglycemia decreased hippocampal GR1 mRNA expression in control and insulin-treated diabetic rats but not in diabetic rats. In contrast, type 2 glucocortoid receptor (GR2) mRNA was not altered by hypoglycemia. In conclusion, despite increased basal HPA activity, HPA responses to hypoglycemia were markedly reduced in uncontrolled diabetes. We speculate that the defect in CRH response could be related to the defective GR1 response. It is intriguing that insulin treatment restored the HPA response to hypoglycemia but, surprisingly, not the deficient epinephrine response. This is important because during severe hypoglycemia, epinephrine is an important counterregulatory hormone.     

Commercial rodent feed as an occasional cause of morbidity and mortality in a rat breeding colony

In the last fifteen years there were several feed-related outbreaks of morbidity and mortality in the Institute's breeding colony of Wistar rats. The last event took place in April 1999, one month after the use of a new supply of the usual standard rodent feed. Animals did not thrive and manifested generalised oedema, hypoalbuminaemia, elevated liver enzymes, and high mortality. The effect of feed was assessed first by feeding a group of sick females during 14 days with either suspected feed (A-March) or with the earlier supply of feed (A-January) of the same producer. Then a group of healthy male rats Y59 from another breeding colony was fed either suspected feed (A-March) or feed from another producer (feed B). Although neither chemical nor microbiological deviation in feed analysis had been detected, decreased consumption and slower body weight gain in all animals fed with feed A-March suggested an association between this batch of feed and the increased morbidity in those animals. Eventually, the entire rat colony was put down and replaced with a new breed which was given a new brand of feed.     

Immunohistochemical profile of cystosarcoma phyllodes of the breast: a study of 23 cases

Cystosarcoma phyllodes (CP) of the breast is a rare biphasic tumor composed of benign epithelium and a spindle cell stroma. Biologic behavior of CP cannot be predicted with certainty on the basis of morphologic criteria only. We studied immunohistochemical expression of basic fibroblastic growth factor (bFGF), urokinase, Ki67, p53 protein, and microvessel density in stromal and epithelial components of 14 low-grade CP (LCP) and 9 high-grade CP (HCP). bFGF was more often positive in LCP than in HCP. The stroma was positive for bFGF in 86% of LCP and 67% of HCP, and the epithelium was positive in 64% of LCP and 14% of HCP. Urokinase was positive in stromal cells of 86% of LCP and 93% of HCP. The epithelial positivity for urokinase in both groups resembled closely that of the stroma. p53 protein was more often positive in stromal cells of HCP (67%) than in LCP (50%). Ki67 was positive in the stroma of 43% of LCP and 89% of HCP and in the epithelium of 14% of LCP and 33% of HCP. There was no significant difference in microvessel density (MVD) in low- and high-grade lesions. Our study demonstrates that stromal Ki67 and p53 immunohistochemical positivity are more often associated with high-grade tumors. The positive immunostaining for bFGF, urokinase, Ki67, and p53 in stroma and epithelium of the majority of CP supports the existence of epithelial-stromal interactions and recognizes epithelium as an integral part of this tumor.