Prevalence study of oral mucosal lesions in a selected Cambodian population

Abstract The aim of this study was to investigate the epidemiology of oral mucosal lesions in a selected Cambodian population to obtain pilot data useful in planning an oral health data base for the country. Due to unstable conditions in Cambodia, the validity of population data related to present census information is highly questionable. Therefore, prior to this investigation a census registration was carried out using local health workers as registrars in nine villages of a commune. In the period July 4–31, 1991, a total of 1319 individuals (953 women, 366 men, 15–99 yr) were examined by one oral surgeon in the nine villages of Kok Trop Commune. Kandal Stung District, southwest of the capital Phnom Penh. Clinical diagnoses were based on WHO criteria. Information on smoking habits, betel nut chewing habits, and alcohol use was collected by 4 Khmer dental personnel. In total, 71 lesions were recorded in 64 (4.9%) individuals. Leukoplakia was found in 1.1%, lichen lesions in 1.8%, candidosis in 1.4%, submucous fibrosis in 0.2%, cancer in 0.1%) and other diagnoses in 0.8%. The prevalence of leukoplakia was 2.2% and 0.6% among men and women respectively, a statistically significant difference (P < 0.05). There were significantly more smokers (P < 0.01) among subjects with leukoplakia (64.3%) than among those without this lesion (28.6%). All subjects with lichen lesions were women. The age-adjusted relative risk for developing lichen among betel nut chewers as compared to non-chewers was 3.3. This study has provided information on epidemiological aspects of oral mucosal lesions, including the relationship to etiological factors such as tobacco smoking and betel nut chewing, which might prove valuable in planning future oral health studies and implementing preventive programmes in Cambodia.     

An improved technique for low anterior resection using a PDS endoloop

We describe herein the results of performing a new technique of low anterior resection of the rectum using a PDS endoloop, on ten patients with rectal cancer. This technique involves first preparing the rectosigmoid colon with an anvil as in the conventional low anterior resection; then, after the stapler is inserted transanally, two endoloops are slid over the colon and rectum. The rectum is ligated by pushing the knot of the endoloop and a second knot is applied 2 cm proximal to the first. Finally, the rectum is cut and the stapler is closed and fired to make a circular end-to-end anastomosis. The level of the anastomosis ranged from 2.5 to 6 cm with a mean of 4.7 cm in the ten patients, only one of whom developed a minor anastomotic leakage postoperatively. Moreover, no patient has developed local recurrence or distant metastasis to date. In summary, this technique offers certain advantages that allow the operation to be done with more skill and safety in a narrow pelvis.     

A 68-year-old woman with dementia and parkinsonism]

We report a 68-year-old woman who developed progressive dementia and parkinsonism. She was well until 1990 when she was 58 years of age. She started to show memory loss. Four years later, she developed difficulty in dressing and behavioral problems such as eating rice with her hands, going out of her house without purposes, and difficulty in finding the rest room in her house. She was admitted to the neurology service of Hatsuishi Hospital on January 19, 1996, when she was 64 years of the age. On admission, she was alert but markedly demented. The score of Hansegawa Dementia Scale was 0/30. She was unable to make any coherent conversation. She appeared to have dressing apraxia but did not appear to have aphasia. Cranial nerves were intact. She walked in small steps with stooped posture. She did not have motor weakness but she showed plastic rigidity in all four limbs. No tremor or ataxia was noted. Deep tendon reflexes were within normal limits but the plantar response was extensor bilaterally. She continued to deteriorate after admission. In May of 1998, she started to fall. In June of 1998, she had a generalized convulsion. In January of 1999, she became unable to take foods orally and a gastrostomy was placed. She expired on May 29, 1990. She was discussed in a neurological CPC and the chief discussant arrived at the conclusion that the patient had Alzheimer's disease. The question was whether her parkinsonism was a part of her Alzheimer's disease or she had an additional disease to explain her parkinsonism. Post-mortem examination revealed moderate to marked atrophy of the frontal and the temporal lobes as well as in the limbic areas with dilatation of the lateral ventricles. Marked neuronal loss was noted in the CA 1 to the subiculum region with gliosis. Neurofibrillary tangles were seen in the remaining neurons. Neuropil threads were seen by Gallyas-Braak staining. Similar changes were seen in the parahippocampal gyrus and in the entorhinal cortex. Senile plaques were seen in the insular cortex and in other cortical areas. Cortical type Lewy bodies were seen in the cingulate cortex. The Meynert nucleus showed marked neuronal loss and gliosis. The substantia nigra and the locus coeruleus showed moderate loss of pigmented neurons. Lewy bodies were seen in these regions. The dorsal motor nucleus of the vagal nerve was retained, however, one Lewy body was observed. Pathologic diagnosis was Alzheimer's disease plus Parkinson's disease. It is an interesting question whether or not her parkinsonism was due to nigral lesion or frontal lesions. It is known that parkinsonism may complicate in advanced Alzheimer's disease not necessarily due to nigral lesion. On the other hand, in incidental Lewy body disease, the substantia nigra shows mild Parkinson's disease-like change without clinical parkinsonism. This patient appeared to have been a true complication of Alzheimer's disease and Parkinson's disease.     

Upbeat nystagmus influenced by posture: report of two cases

Two cases of vertical gaze nystagmus, which were influenced by posture are reported. In both cases, upbeat nystagmus (UBN) on forward gaze in upright and supine positions changed to downbeat nystagmus (DBN) in prone position. Convergence had no influence on the vertical nystagmus. A CT scan revealed an atrophy of the anterior vermis of the cerebellum in the first case. The UBN of the second case was suspected to be associated with lesions in the brachium conjunctivum. The authors concluded that both UBN and DBN were not completely separate, but they could coexist in cases with certain lesions in the posterior cranial fossa.     

Possible involvement of ubiquitin function and ATP requirement in the development of thermotolerance in mammalian cells

Thermotolerance under chronic exposure to moderate hyperthermia at 41 degrees C was hardly induced in the mouse temperature-sensitive mutant ts85 cells, in contrast to the parental wild-type FM3A cells. Thermotolerance was induced at a reduced level in the mutant cells compared with the wild-type cells by incubation at 33 degrees C (permissive temperature), but not at 39 degrees C (non-permissive temperature), after a brief exposure at 44 degrees C. Under conditions where protein synthesis was inhibited by cycloheximide at 41 degrees C, significant amounts of thermotolerance developed in FM3A cells. FM3A cells depleted of cellular ATP by treatment with 2.4-dinitrophenol and 2-deoxyglucose were not sensitized to thermal cell killing at 44 degrees C, when drug-treated cells were washed and exposed to hyperthermia in drug-free growth medium, where cellular ATP rapidly recovered. However, the cells deprived of ATP under the treatment at 41 degrees C failed to develop thermotolerance, indicating a requirement of ATP for thermotolerance development. The decay of thermotolerance was not affected by ATP levels after it was developed. The degradation of abnormal cellular proteins which contained amino acid analogues was promoted at 33 degrees C relative to normal protein degradation in FM3A and ts85 cells. Both normal and abnormal proteins were degraded at a reduced rate at 43 degrees C. Pretreatment of cells at 41 degrees C decreased the rate of degradation of abnormal proteins at 33 degrees C by 20% in FM3A cells and by about 100% in ts85 cells. Pretreatment of cells at 41 degrees C increased significantly the conjugation of 125I-labeled ubiquitin to cellular endogenous proteins in extracts of FM3A cells, but decreased the conjugation in extracts of ts85 cells. The data presented here, in conjunction with the observations by others that the ts85 cell is a mutant defective in the ubiquitination of cellular proteins at nonpermissive temperatures, suggest that the ATP-dependent ubiquitination may be crucial for the development of thermotolerance.     

A case of familial breast cancer--identical twin sisters with a heterochronic bilateral breast cancer that developed at the same age

We have encountered very unique cases which involve identical twin sisters who underwent surgical treatment for a unilateral breast cancer at the same age of 28. Each, after 13 years, developed cancer in the opposite breast. In addition yet another sister, the youngest, had to undergo the same surgical procedure, at the same age that her identical twin sisters had had their first operations. These findings may indicate the existence of factors which decide the age of the malignancy onset, in addition to the existence of a predisposing factor for carcinoma in the genes of breast cancer patients.     

Direct projections from Ammon's horn to the rostral raphe regions in the brainstem of the cat

When WGA-HRP (wheat germ agglutinin-horseradish peroxidase conjugate) or HRP was injected into the regions around the superior central and/or the dorsal raphe nuclei in the cat, cell bodies of a number of non-pyramidal neurons were labeled in Ammon's horn. Thus the existence of direct projections from non-pyramidal neurons in Ammon's horn to the rostral raphe regions in the brainstem was suggested in the cat.     

Liquid chromatographic determination of uric acid and ascorbic acid in rat retinae after ophthalmic artery and optic nerve ligation

Change of urate and ascorbate levels in retinae of rat left eyes after ophthalmic artery and optic nerve ligation was studied by reversed-phase high-performance liquid chromatography with electrochemical detection. The right eyes were used for sham operation. We found that uric acid levels in the retinae of the left eyes increased as a function of time after the operation, whereas those of the right eyes remained unchanged. In addition, we found that ascorbic acid levels in the retinae of the rat eyes decreased after the operation.