Conservative treatment of oral ranula by excision with minimal excision of the sublingual gland: histological support for a traumatic etiology.

PURPOSE: This study investigates, clinically and histologically, a new conservative technique for the treatment of oral ranula based on the premise that a discrete unit of the sublingual gland feeds the ranula, which can therefore be treated by local removal with the attached part of the sublingual gland. PATIENTS AND METHODS: The study group consisted of 8 patients with ranula treated by decompression of the ranula followed by local surgical removal together with the attached part of the sublingual gland. Detailed histologic examination of the entire specimen was undertaken in every case. RESULTS: The treatment was successful in all the patients and there have been no recurrences after reviews of from 13 to 29 months (median, 26 months). Histologic examination of the entire specimen showed communication between the removed part of the sublingual gland and the ranula by way of a torn duct in every case. CONCLUSIONS: The premise that the ranula is fed by an attached, discrete unit of the sublingual gland has been vindicated and is the basis for the successful conservative treatment of ranula by decompression and local surgical removal together with the attached part of the sublingual gland. The finding of communication between the attached sublingual gland and ranula in every case indicates a traumatic etiology for these ranulas.

Evidence for Gag p24-specific CD4 T cells with reduced susceptibility to R5 HIV-1 infection in a UK cohort of HIV-exposed-seronegative subjects.

AIM: To characterize HIV-1 Gag p24-specific CD4 cell responses in HIV-exposed-seronegative (ES) individuals. METHODOLOGY: Twelve ES individuals, of diverse ethnicity and wild type for the CCR5 Delta-32 mutation, were identified. Controls were HIV-negative blood donors. Gag p24-specific and total Vbeta+ CD4 cells that expressed MIP-1beta, IFN-gamma and IL-2 were enumerated by intracytoplasmic cytokine staining. beta-Chemokine expression was correlated with susceptibility to R5 HIV-1 infection, as measured by polymerase chain reaction for integrated HIV-1 and by p24 enzyme-linked immunosorbent assay. RESULTS: Similar numbers of mitogen-stimulated and Vbeta+ MIP-1beta+, IFN-gamma+ and IL-2+ T cells were found in ES and HIV-negative control subjects. However, all ES subjects tested had an HIV Gag p24-specific MIP-1beta+, IFN-gamma+ and IL-2+ CD4 T-cell response that was rare in controls. p24-Specific cells of all ES but no control subjects could be expanded by in-vitro Ag/IL-2 stimulation, and when re-stimulated with an overlapping peptide series showed evidence of a broad CD4 cell memory response directed against multiple regions of Gag p24. Mitogen-stimulated ES CD4 cells were as susceptible to HIV infection as those from control subjects, but p24-specific IFN-gamma+ CD4 cells of six out of seven ES subjects tested were less susceptible to R5 HIV-1 infection than the counterpart fraction depleted of p24-specific IFN-gamma+ cells. The addition of blocking anti-beta-chemokine antibodies did not promote R5 HIV-1 infection of p24-specific IFN-gamma+ cells. CONCLUSION: Specific CD4 cell immunity, characterized by a broadly directed memory Gag-p24 CD4 cell response and reduced susceptibility of specific CD4 cells to R5 HIV-1 infection, is a likely correlate of non-transmission.

Incidence and patterns of mandibular fractures during a 5-year period in a London teaching hospital.

We retrospectively evaluated mandibular fractures in patients who presented to a London teaching hospital between June 2005 and May 2010. A total of 1261 patients sustained 1994 mandibular fractures (mean 1.6, range 1-5). The incidence of mandibular fracture was higher in male patients (87%) than in females (13%) (male:female ratio 6.6:1), and the peak incidence was during the third decade for both genders. The most common site of fracture was the angle (30%), followed by the parasymphysis (27%), and condyle (27%). Overall, interpersonal violence was the most common cause (72%) followed by falls (18%). In male patients, the most common cause was interpersonal violence (77%); in females it was a fall (46%). The anatomical sites of fracture reflected their cause. Interpersonal violence typically resulted in fractures of the angle (36%) while road traffic accidents and falls resulted in condylar fractures (28% and 53%, respectively). A total of 66 (5%) patients sustained other maxillofacial fractures and 37 (3%) presented with non-maxillofacial fractures. Our findings are consistent with trends reported in other urban centres.