Iatrogenic right coronary artery dissection distal to a total occlusion: a case report.

INTRODUCTION: Coronary artery dissections with or without rupture is a rare but well-recognized complication of coronary angiography with a high morbidity and mortality rate. CASE PRESENTATION: We present a rare case of right coronary artery dissection distal to a totally occluded vessel. The vessel dissected during the second injection of contrast agent without any direct mechanical manipulation (catheter or guide-wire induced). Hopefully the dissection had no clinical consequences and the patient was discharged after 48 hour intensive monitoring. CONCLUSIONS: We believe that the contrast agent that was forced in the proximal part of the RCA increased through the anastomotic branches the sheer stress on the diseased endothelium of the distal artery causing it to dissect. It is an instructive -not previously described- phenomenon that underscores that atherosclerotic tissue is unpredictable and should be treated with extreme caution.

Heat shock protein 70 membrane expression in oral cancer: a possible new target in antineoplastic therapy?

BACKGROUND: Heat shock proteins (HSPs) are a group of highly immunogenic proteins with an exceptional degree of conservation. Cells or tissues from a wide range of tumors have been shown to express atypical levels of 1 or more HSPs. Experimental evidence suggests that HSPs may promote tumorigenesis by suppressing apoptosis. AIM: The aim of this investigation was to study the expression and the localization of HSP70 in oral squamous cell carcinoma (OSCC) and to compare HSP70 expression between neoplastic, dysplastic lesions and normal oral tissues. METHODS: Immunohistochemistry staining was conducted to study HSP70 expression in 50 paraffinized tissue samples: 30 OSCCs, 10 leukoplakias with dysplasia and 10 samples from normal oral tissue. RESULTS: Our results showed that all slides with OSCC intensely expressed HSP70. Dysplastic lesions were positive to a lesser extent for HSP70. Samples from normal oral tissue were all negative for HSP70. CONCLUSIONS: It is concluded that increased HSP70 immunoexpression could be a marker for the presence of epithelial dysplasia or epithelial malignant transformation.

Black hairy tongue in a 2-month-old infant.

Black hairy tongue (BHT) is an unusual condition in adults, and is characterised by marked accumulation of keratin on the filiform papillae of the dorsum of the tongue resulting in a hairlike appearance. The colour of the papillae may vary from brown to black. We describe a case of BHT in a 2-month-old infant. An extended review of the literature suggests that our case is the youngest ever reported. In conclusion, although BHT is considered benign, clinical, haematological and histological, evaluation is recommended to exclude several entities which can present as pigmented lesions of the oral mucosa.

Increased anxiety level and high salivary and serum cortisol concentrations in patients with recurrent aphthous stomatitis.

Recurrent aphthous stomatitis (RAS) is one of the most common oral mucosal disorders. The aim of the study was to determine any association between anxiety levels and concentrations of salivary and serum cortisol in patients with RAS. It has been suggested that stress with its presumed effects on the immune system, constitutes one of the major causative agents of RAS. The concentrations of salivary and serum cortisol were measured in 38 patients with recurrent aphthous stomatitis, and 38 healthy controls. Salivary and serum cortisol levels were measured using a Luminenscent Immunoassay (LIA) method. Anxiety levels were evaluated using Spielberger's State-Trait Anxiety Inventory which measures both trait anxiety as a general aspect of personality (STAI-T) and state anxiety as a response to a specific situation (STAI-S). The salivary cortisol levels were 1.44 (+/- 0.58) microg dl(-1) in RAS patients and 0.91 (+/- 0.56) microg dl(-1) in controls (p = 0.001), while the serum cortisol levels were 3.13 (+/- 1.59) microg dl(-1) in RAS patients and 1.89 (+/- 1.11) microg dl(-1) in controls (p = 0.001). The state anxiety levels (STAI-S) were 48.85 (+/- 9.7) in RAS group and 39.45 (+/- 7.5) in control group (p = 0.001). The trait anxiety levels (STAI-T) were 49.78 (+/- 13.02) in RAS group and 38.49 (+/- 10.31) in control group (p = 0.001). Salivary and serum cortisol concentrations and state and trait anxiety levels in RAS were significantly higher than those in the control group. Our results suggest that stress may be involved in the pathogenesis of RAS.

Comparative study of the cytotoxic effect of Resilon against two cell lines.

Resilon is a new material that is a candidate to replace gutta-percha as a root filling material. This study evaluated the antiproliferative effect of Resilon and two commercially available gutta-percha points (Roeko, Dentsply). Two established cell lines (L929 and RPC-C2A) were used for the experiment. Cell survival fraction was estimated by the sulforhodamine-B assay, in reference to controls after 48-h exposure. Non-parametric tests (Kruskal-Wallis followed by Dunn's multiple comparisons) were used to evaluate the statistical significance of the results (alpha=0.05). Cytotoxicity in a descending order was: Resilon > Roeko gutta-percha > Dentsply gutta-percha. At 24-h exposure, no statistically significant differences (p>0.05) were observed between tested materials in both cell lines. At 48-h exposure, statistically significant differences (p<0.05) were found between Resilon and the other materials in the L929 cell line. In the RPC-C2A cell line Resilon was significantly more cytotoxic than Dentsply gutta-percha (p<0.05), but no statistically significant differences (p>0.05) were found between Resilon and Roeko gutta-percha. The cytotoxicity of Resilon increased significantly from 24 h to 48 h in both cell lines. Resilon points were more cytotoxic than gutta-percha points. The cytotoxicity was time dependent and increased after 48 h.

Comparative study of the cytotoxic effect of resilon against two cell lines

Resilon is a new material that is a candidate to replace gutta-percha as a root filling material. This study evaluated the antiproliferative effect of Resilon and two commercially available gutta-percha points (Roeko, Dentsply). Two established cell lines (L929 and RPC-C2A) were used for the experiment. Cell survival fraction was estimated by the sulforhodamine-B assay, in reference to controls after 48-h exposure. Non-parametric tests (Kruskal-Wallis followed by Dunn's multiple comparisons) were used to evaluate the statistical significance of the results (α=0.05). Cytotoxicity in a descending order was: Resilon > Roeko gutta-percha > Dentsply gutta-percha. At 24-h exposure, no statistically significant differences (p>0.05) were observed between tested materials in both cell lines. At 48-h exposure, statistically significant differences (p<0.05) were found between Resilon and the other materials in the L929 cell line. In the RPC-C2A cell line Resilon was significantly more cytotoxic than Dentsply gutta-percha (p<0.05), but no statistically significant differences (p>0.05) were found between Resilon and Roeko gutta-percha. The cytotoxicity of Resilon increased significantly from 24 h to 48 h in both cell lines. Resilon points were more cytotoxic than gutta-percha points. The cytotoxicity was time dependent and increased after 48 h.

Resilon é um material novo com potencial para substituir a guta-percha como material obturador radicular. Este estudo avaliou o efeito anti-proliferativo do Resilon e de duas marcas comerciais de pontas de guta-percha (Roeko e Dentsply). Para os fins deste estudo foram utilizadas duas linhagens celulares conhecidas (L929 e RPC-C2A). A fração de sobrevivência celular foi estimada pelo método colorimétrico de sulforodamina B comparado aos controles após exposição por 48 h. A significância estatística dos resultados (α=0,05) foi avaliada pelos testes não-paramétricos de Kruskal-Wallis e Dunn para comparações múltiplas. A citotoxicidade dos materiais em ordem decrescente foi: Resilon > guta-percha Roeko > guta-percha Dentsply. Após 24 h de exposição, não foram encontradas diferenças estatisticamente significantes (p>0,05) entre os materiais testados em ambas as linhagens celulares. Após 48 h, o Resilon apresentou um efeito citotóxico significantemente maior (p<0,05) em comparação aos outros dois materiais na linhagem celular L929. Na linhagem RPC-C2A, a citotoxicidade do Resilon foi significantemente maior (p<0,05) que a da guta-percha Dentsply, mas não houve diferenças significantes (p<0,05) entre Resilon e guta-percha Roeko. A citotoxicidade do Resilon aumentou significativamente de 24 para 48 h para ambas as linhagens celulares. As pontas de Resilon foram mais citotóxicas do que as pontas de guta-percha. A citotoxicidade foi tempo-dependente e aumentou após 48 h de exposição.

Detection, enumeration and characterization of T helper cells secreting type 1 and type 2 cytokines in patients with recurrent aphthous stomatitis.

One of the factors involved in the pathogenesis of recurrent aphthous stomatitis (RAS) is a cell-mediated immune response in which several cytokines seem to play a major role. The aim of this study was to detect, enumerate and characterize T helper cells which are secreting type 1 cytokines (interleukin [IL]-2, IL-12, interferon [IFN]-gamma, and tumor necrosis factor [TNF]-alpha) and type 2 cytokines (IL-4, IL-5, IL-6, and IL-10) in the peripheral blood of patients with RAS. Thirty-two patients in the active phase of RAS (14 men and 18 women) and 40 healthy individuals participated in the study. T helper (T) cells were detected and characterized using Elispot assay. T cells secreting IL-2, IL-12 or IFN-gamma were increased in patients with RAS compared with the controls (p < 0.05, p < 0.001 and p < 0.001, respectively). T cells secreting TNF-alpha in RAS patients and controls were not statistically different (p > 0.05). T cells secreting IL-10 were increased in patients with RAS compared with the controls (p < 0.05). T cells secreting IL-4 were decreased in patients with RAS compared with the controls (p < 0.001), No statistical difference was observed between T cells secreting IL-5 or IL-6 in patients with RAS and controls. Our findings suggest that the increased numbers of T cells secreting type 1 cytokines may influence the immune response against RAS. Whether this action is of etiological importance or epigenetic phenomenon is a question that needs to be answered.

Epidemiologic survey of pemphigus vulgaris with oral manifestations in northern Greece: retrospective study of 129 patients.

OBJECTIVE: To evaluate the epidemiology of pemphigus vulgaris (PV) in a Greek population and to compare it with other countries. MATERIALS AND METHODS: A retrospective study was conducted based on the records of 129 patients (41 males and 88 females) with PV who visited the Department of the Oral Medicine and Maxillofacial Pathology, Aristotle University of Thessaloniki, Greece and the State Hospital for Skin and Venereal Diseases of Thessaloniki, Greece, between 1985 and 2004. A group of 73 individuals was used as controls. RESULTS: The average annual incidence was found to be eight patients per year. The male to female ratio was 1 : 2.25. The difference in the age of onset between the two genders was statistically significant in marginal levels (P = 0.05). In addition, 86.1% of the patients showed oral lesions only, 13.3% oral and skin lesions and 1.3% manifested oral, skin, and ocular lesions. Twenty-eight of the 88 females were in the premenopausal period-of-life. Additionally, 19 males were farmers who had daily contact with organophosphoric pesticides. Co-existing pathologic conditions were present in 75 of the 129 patients, and of these 75 patients six (8%) were diabetics, 15 (20%) presented with hypertension, two (2.6%) faced problems from their thyroid gland, and 10 (13.3%) of the patients complained of allergic reactions. CONCLUSIONS: The results of this study demonstrated a relatively high incidence of PV in northern Greece compared with that in other countries. The disease most frequently occurred in the sixth decade-of-life and the majority of the patients manifested oral lesions. Further epidemiological studies are needed to elucidate whether this region is constituted from population groups with high susceptibility to PV.

Detection of pemphigus desmoglein 1 and desmoglein 3 autoantibodies and pemphigoid BP180 autoantibodies in saliva and comparison with serum values.

Although there is much literature on the detection of pemphigus and pemphigoid autoantibodies by enzyme-linked immunosorbent assay (ELISA) in serum, nothing is known about their presence in saliva. The aim of this study was to evaluate the salivary levels of these autoantibodies in pemphigus and pemphigoid patients. Autoantibodies against desmoglein3, desmoglein1, and BP180 were assayed, by ELISA, in serum and saliva samples of patients and healthy controls. The titres of autoantibodies against Dsg1/3 found in both serum and saliva of pemphigus patients showed a statistically significant correlation, suggesting that saliva may be a useful biological material for diagnostic purposes, in monitoring disease activity, as well as for the early detection of relapses. By contrast, the titres of autoantibodies against BP180 in the serum and saliva of bullous pemphigoid patients were not statistically related, and further study of the usefulness of the BP180 ELISA for saliva in this disease is needed. In addition, based on our results, the BP180 ELISA with a recombinant NC16a epitope failed to detect the autoantibodies against BP180 in the serum and saliva of mucous membrane pemphigoid patients.

Pemphigus vegetans of the oral cavity.

BACKGROUND: Pemphigus vegetans, a variant of pemphigus vulgaris, constitutes a rare form of all pemphigus cases, and oral involvement is common. Two clinical subtypes of pemphigus vegetans exist, characterized initially by flaccid bullae and erosions (Neumann) or pustules (Hallopeau). Both subtypes subsequently develop into hyperpigmented vegetative plaques with pustules and hypertrophic granulation tissue at the periphery. METHODS: We report three cases of pemphigus vegetans with oral manifestations exclusively. Two patients were male aged 30 and 45 years old, respectively, while one was a 51-year-old female. CONCLUSION: Oral lesions in all cases consisted of erosions and whitish, vegetating plaques. The histopathological characteristics were in all cases identical. The spinous cell layer was characterized by intense acanthosis and by the presence of vesicles between the spinous and basal cell layers. Inside the vesicles exudative elements were observed consisting mainly of eosinophils. In the upper lamina propria severe inflammatory reaction was observed. Streptavidin-biotin immunoperoxidase technique showed in all cases intercellular epithelial deposition of IgG and C3.

Ulcerative uremic stomatitis associated with untreated chronic renal failure: report of a case and review of the literature.

Uremic stomatitis represents a relatively uncommon intraoral complication seen, mostly, in cases of end-stage renal disease or undiagnosed/untreated chronic renal failure. Its incidence has decreased due to the advent of renal dialysis. Clinically uremic stomatitis is characterized by the presence of painful plaques and crusts that are usually distributed on the buccal mucosa, dorsal or ventral surface of the tongue, gingiva, lips, and floor of the mouth. Treatment consists of improvement of urea blood concentration and the underlying renal failure, supported by increased oral hygiene with antiseptic mouthwashes and antimicrobial/antifungal agents if necessary. Although uremic stomatitis occurs in patients with end-stage renal disease, we report a case of a patient who exhibited an ulcerative form of uremic stomatitis related to the sudden relapse of uremia, although not in an advanced stage of her renal disease. A description of the clinical and microscopic appearance is given along with our hypothesis for the pathogenesis of the disease.

Gingival involvement in a case series of patients with acquired immunodeficiency syndrome-related Kaposi sarcoma.

BACKGROUND: This case series presents the polymorphic clinical characteristics of gingival acquired immunodeficieny syndrome (AIDS)-related Kaposi sarcoma (KS), a malignancy that is gradually becoming uncommon in developed nations. An up-to-date overview of the related epidemiology, etiopathogenesis, histopathology, and treatment is provided, along with a pictorial guide to ease clinical diagnosis. METHODS: The oral/maxillofacial pathology records at Aristotle University and the University of Geneva were retrospectively reviewed. Thirty-two cases diagnosed with oral AIDS-related KS were retrieved between 1991 and 2004. KS diagnosis was established histologically by incisional biopsies from intraoral lesions. All charts contained clinical oral examination data, radiological images, and detailed photographic records. RESULTS: Thirteen patients (12 males and one female) presented with KS gingival involvement (40.6%). Eleven of the male patients were homosexual/bisexual men. The mean age of the patients at the time of intraoral KS diagnosis was 42.1 years, and the mean CD4 cell count was 103 (0 to 481). Gingival epidemic KS presented with various degrees of pigmentation and a wide range of clinical patterns, from relatively flat macules (early stage) to tumors with variable nodular morphology (advanced disease). Solitary or multiple gingival involvement may appear concomitantly with palatal and/or cutaneous lesions. CONCLUSIONS: Even though the incidence of intraoral KS had fallen precipitously in developed countries after the mid-1990s, gingival KS should be considered in the differential diagnosis of every pigmented gingival lesion. Periodontists are in a unique position to identify gingival involvement of intraoral KS and facilitate early diagnosis.

Oral tuberculosis associated with a treatment with anti-rheumatic drugs.

BACKGROUND: The use of immunosuppressive medication is a dominant risk factor for infection in patients with rheumatoid arthritis (RA). Methotrexate (MTX) is one of the traditional disease-modifying antirheumatic drugs. Adalimumab [a human anti-tumor necrosis factor-alpha (anti-TNF-alpha) monoclonal antibody] represent an important advance in the treatment of RA and has been recently come in use. TNF-alpha plays a role in the host defense against Mycobacterium tuberculosis and notably in granuloma formation. Infections occur at a high rate among those who use one or the combination of the two medications. METHOD: We examined a female patient that was referred to our department for evaluation and treatment of a granular lesion on the soft palate and uvula, complaining of mild dysphagia. The patient was treated for 4 months with MTX and adalimumab for RA before the oral lesion appeared. RESULTS: The histopathological examination of a specimen of the oral lesion, taken by biopsy, showed a chronic inflammation characterized by tuberculous granulomas. Polymerase chain reaction test and culture of a new specimen was positive for M. tuberculosis. CONCLUSIONS: The therapeutic use of MTX or/and adalimumab for the treatment of RA or few others diseases, can cause oral tuberculosis.

Detection of C-KIT (CD117) molecule in benign and malignant salivary gland tumours.

C-KIT (CD117), a tyrosine kinase receptor, is involved in the growth and development of normal tissues and some types of neoplasms. In the present study we analysed the expression of this molecule in salivary gland tumours. Archival formalin-fixed, paraffin-embedded sections of 40 benign and 57 malignant salivary gland tumours were retrieved and retrospectively studied immunohistochemically using a polyclonal C-KIT antibody in an Envision/HRP technique. In addition five samples of chronic submandibular sialadenitis, five normal minor salivary glands and parotid or submandibular gland tissue adjacent to benign tumour were also studied. C-KIT expression was observed in cases of adenoid cystic, acinic cell polymorphous low grade, epithelial-myoepithelial, carcinosarcoma and basal cell adenocarcinomas, as in luminal cells of pleomorphic adenomas, in serous acinar and only in intercalated and a small number of striated ductal cells of inflammatory salivary gland tissue, whereas normal salivary lobules were generally negative except a weak positivity of intercalated cells. Contrary to other reports, this study suggests that, C-KIT protein does not appear to be an exclusively specific marker for benign or malignant salivary gland neoplasms, but may be useful in differential diagnosis of adenoid cystic carcinoma from polymorphous low grade adenocarcinoma. Furthermore its expression in serous acinar cells in sialadenitis and intercalated ductal cells in normal and inflammatory lesions may indicate a possible participation in pathogenesis of both neoplastic and non-neoplastic salivary gland diseases.

Facial and perioral primary impetigo: a clinical study.

Impetigo is the most common skin infection in children. The face, especially the perioral region, is one of the most frequently involved areas. Impetigo is a disease that interests the pediatric dentist, as it poses significant problems in its differential diagnosis from other conditions. Sixteen otherwise healthy children were examined suffering from facial and perioral impetigo. The typical clinical appearance was scattered, painless, slightly pruritic erosions covered by "honey-colored" crusts. In 4 children impetigo was localized in the facial and perioral area, whereas in all other cases lesions were diffused in perioral area and several regions throughout the body. Four children exhibited neck lymphadenopathy and one had mild fever. The treatment of impetigo included the application of topical measures with the systemic antibiotic chemotherapy.

Immunohistochemical detection of the expression of the cell adhesion molecules E-cadherin, desmoglein-2, beta4-integrin, ICAM-1 and HCAM (CD44s) in Warthin's tumour of the parotid gland.

The study of the expression of cell adhesion molecules (CAMs), E-cadherin, desmoglein-2, beta4-integrin, HCAM (CD44s) and ICAM-1 in Warthin's tumours. Twenty formalin--fixed, paraffin--embedded parotid Warthin's tumours were studied using an Envision/HRP immunohistochemical technique. Beta4-integrin was strongly expressed in all cell-basement membrane and intercellular contacts of the epithelium, E-cadherin and desmoglein-2 in cell-cell contacts, but not in basal cell-basement membrane connections and on columnar cells' luminal surfaces, HCAM (CD44s) in intercellular contacts of both luminal (mainly), basal cells and also in the periphery of monocytic-lymphocytic stroma, and ICAM-1 was weak to moderate expressed in both luminal and basal epithelial cells and strongly in the germinal lymphocytic centres. CAM expression suggests a bilayered excretory ductal structure of the neoplastic epithelium in Warthin's tumour, as a result of hyperplastic process of the glandular epithelium that interacts with the excessive lymphoid tissue of the stroma.

Pyogenic granuloma of the oral cavity: comparative study of its clinicopathological and immunohistochemical features.

There are two histological types of pyogenic granuloma (PG) of the oral cavity: the lobular capillary hemangioma (LCH) and non-LCH type. The aim of the present study was to examine and compare the clinical features, etiological factors, diameter of vascular elements and immunohistochemical features of LCH and non-LCH histological types of PG to determine whether they are two distinct entities. Thirty cases of LCH and 26 cases of non-LCH PG were retrieved and retrospectively studied. Clinically, LCH PG occurred more frequently (66.4%) as sessile lesion whereas non-LCH PG occurred as pedunculated (77%). Non-LCH PG was associated more frequently (86.4%) with etiological factors. The lobular area of the LCH PG contained a greater number of blood vessels with small luminal diameter than did the central area of non-LCH PG. In the central area of non-LCH PG a significantly greater number of vessels with perivascular mesenchymal cells non-reactive for alpha-smooth muscle actin and muscle-specific actin was present than in the lobular area of LCH PG. The differences found in the present study suggest that the two histological types of PG represent distinct entities.

Localized B-cell non-Hodgkin's lymphoma of oral cavity and maxillofacial region: a clinical study.

OBJECTIVE: Non-Hodgkin's lymphomas (NHL) are the third most common group of malignant lesions in the oral cavity and maxillofacial region. Most such lymphomas have been shown to be predominantly of B-lineage. The purpose of the present study is to analyze the clinical signs and symptoms and the clinical staging of B-cell NHL of this region. STUDY DESIGN: Eighteen adults, with B-cell NHL manifestations of the oral cavity and maxillofacial region, were available for this study. The clinical stage according to the Ann Arbor system was assessed by history, physical, and laboratory examination. Hematoxylin and eosin--stained slides and paraffin blocks were available for all cases. Histologic diagnosis was based on the WHO classification of tumors. RESULTS: The mean age of patients at the time of biopsy was 64 years. At the time of the disease presentation, according to the Ann Arbor system, 11 patients were in stage IE, 2 patients in stage IIE, 2 patients in stage IIIE, 1 patient in stage IVE, and 2 patients in stage IV. The typical clinical appearance was a painless local mass lateral or bilateral. Often there is a superficial ulceration of the tumor mass. Tonsillar NHL was the most frequent site occurring in 8 patients followed by NHL of the oral cavity, of the salivary glands, and of the mandible. Grading revealed that most cases were high grade (11 cases), followed by the cases of low grade (5 cases) and intermediate grade (2 cases). All the different histologic types may be observed, but the most frequently encountered is the diffuse large type. CONCLUSIONS: The B-cell NHL may involve both osseous and soft tissues of the oral cavity and maxillofacial region. The favored sites are tonsils, palatal mucosa and parotid glands. The typical clinical appearance is a painless local mass lateral or bilateral. Often there is a superficial ulceration of the tumor mass. According to the Ann Arbor system, the majority of the cases at the time of diagnosis are in stage I or II. Most patients have high grade disease. All the different histologic types may be observed, but the most frequently encountered is the diffuse large type.