Terminal RFLP analysis to determine the oral microbiota with hyposalivation.

Previous studies of oral microbiota by culture-dependent or targeted DNA approaches demonstrated that hyposalivation, a reduction in salivary secretions, might increase the amount of certain oral pathogens. However, the relationship between hyposalivation and the balance of oral microbiota, especially uncultivable bacteria, remains still unclear. The aim of this study was to elucidate the relationship between hyposalivation and oral microbiota by analyzing terminal restriction fragment length polymorphism (T-RFLP) of 16S rDNA. The 61 subjects were divided into two groups, hyposalivation group and normo-salivation group. The microbiota of tongue-coating samples was analyzed by T-RFLP. The amount of saliva, the number of Candida albicans, and also the dental status including plaque index, gingival index, bleeding on probing, probing pocket depth and decayed, missing, and filled teeth (DMFT) were assessed. Regarding the dental status, none of the evaluated factors were significantly different between the groups except the number of DMFT. According to the T-RFLP profiles, the patterns of microbiota in the tongue coating were classified into two groups, Clusters I and II. Cluster I is made up 76% of subjects with hyposalivation, while Cluster II is made up 61% of subjects with normo-salivation (p<0.001). Compared with the microbiota found in Cluster II, that in Cluster I had higher proportions of T-RFs corresponding to genera Veillonella, Dialister, Prevotella, Fusobacterium, and Streptococcus. T-RFLP analysis showed a significant role of salivary volume in determining the composition of the microbial community, regardless of the cultivability of the bacteria.

Communicating by electrolarynx with a blind tetraplegic spinal cord injury patient on mechanical ventilation in the ICU.

STUDY DESIGN: Single-subject case. OBJECTIVES: To describe the atypical presentation of communication with a blind tetraplegic spinal cord injury patient on a respirator using an electrolarynx. SETTING: Critical care center in Osaka, Japan. METHODS: A 53-year-old blind man with tetraplegic spinal cord injury was admitted to our center. It was difficult for him to express his desires and to communicate with others about his severe condition and other details of his care. We began to use an electrolarynx to communicate with this patient because he could move his mouth. RESULTS: With use of the electrolarynx, the patient gradually became better able to speak fluently by electrolarynx on the first day of use. The electrolarynx allowed us and his family to communicate with him. He was pleased with the improvement in communication. CONCLUSION: An electrolarynx is a useful method for communicating with blind tetraplegic spinal cord injury patients on mechanical ventilation.

Transfer of cholesterol between liposomal membranes.

The transfer of cholesterol between liposomal membranes was examined. On incubation of liposomes compsoed of egg yolk phosphatidylcholine, phosphatidic acid and cholesterol (molar percentage, 65.8 : 1.3 : 32.9 or 65.5 : 6.3 : 31.2), almost complete equilibration of the cholesterol pools was achieved within 6 to 8 h at 37 degrees C. The rate of transfer of cholesterol from the liposomes, in which cholesterol was introduced by 'the exchange reaction', was not significantly different from that from liposomes prepared in the presence of cholesterol, in which the cholesterol was distributed homogenously. These findings indicate that half life for 'flip-flop' of cholesterol molecules in egg yolk phosphatidylcholine liposomes is less than 6 h at 37 degrees C. The transfer of cholesterol between liposomes was strongly dependent on temperature and was affected by the fatty acid composition of the phospholipid, suggesting that the 'fluidity' of the membranes strongly influences the transfer rate. A preferential distribution of cholesterol molecules was observed in heterogeneous liposomes with different classes of phospholipids. The 'affinity order' of cholesterol for phospholipid deduced from the present experiments is as follows: beef brain sphingomyelin greater than dipalmitoylglycerophosphocholine = dimyristoylglycerophosphocholine greater than egg yolk phosphatidylcholine.

Gastrointestinal absorption of insulin-like growth factor in the mouse in the absence of salivary insulin-like growth factor binding protein.

Based on previous observations of the presence of both insulin-like growth factors I and II (IGF-I and IGF-II) in murine saliva (kerr et al., Biochem Pharmacol 49: 1521-1531, 1995), the saliva from BALB/c and Non-obese diabetic (NOD) mice was examined for the presence of insulin-like growth factor binding proteins (IGFBPs). Using a western-blot type ligand binding assay with 125I-labeled IGF-I, a series of binding proteins with molecular masses (M), between 25 and 45 kDa were detected in the sera, but not saliva, from both BALB/c and diabetic NOD mice. In the diabetic NOD mice, there were detectable changes in the concentrations of several of the IGFBPs relative to BALB/c mice. Using specific antibody to the binding proteins, one of these was identified as IGFBP-2. Gavage administration of [125I]IGFI indicated substantial uptake from the gastrointestinal tract and significant tissue distribution. There was an increase in serum concentrations of radiolabeled IGF-I in diabetic NOD mice over that in BALB/c mice but less recovered from most of the tissues. Intact 125I-labeled IGF-I was extracted and purified from various tissues, following gavage, and shown to retain biological activity. Thus, the uptake of biologically active IGFs from saliva would appear to take place independently of specific binding proteins.

Transfer of steroids and alpha-tocopherol between liposomal membranes.

The transfer of various steroids and alpha-tocopherol between liposomes was examined. The transfer rate of cholest-4-en-3-one and epicholesterol between egg yolk phosphatidylcholine liposomes was much higher than that of cholesterol. Rapid transfer was also noted for coprostanol and 5-cholesten-3 beta-ol-7-one, while the transfer of cholestanol, which has a 3 beta-hydroxyl residue and a planar nucleus structure, was similar to that of cholesterol. These results suggest that the mode of interaction between steroid and phospholipid may be an important factor controlling the rate of transfer. It was found that alpha-tocopherol could also be transferred between liposomes. The transfer rate of alpha-tocopherol was dependent on the temperature and the phospholipid composition.

Immunoreactivities of alpha-amylase of humans and rats.

The immunoreactivities of amylase from human saliva and pancreatic juice and rat parotid and pancreas were investigated. Antisera were prepared in rabbits against each of the human and rat amylase. Human salivary and pancreatic amylases reacted similarly with the antibodies to both human salivary and pancreatic amylases. Rat parotid and pancreatic amylases reacted differently with the antibodies to both rat parotid and pancreatic amylases.

Endotoxin contamination in wound dressings made of natural biomaterials.

Contamination by endotoxin of nine kinds of wound dressings made of natural biomaterials (calcium alginate, collagen, chitin, and poly-L-leucine) was examined with the use of water extracts. By applying the Limulus amoebocyte lysate (LAL) test, high concentrations of endotoxin were detected in extracts from three kinds of products made of calcium alginate. These extracts evoked fever in rabbits and induced the release of a proinflammatory (pyrogenic) cytokine, interleukin-6 (IL-6), from human monocytic cells (MM6-CA8). The effects disappeared when the extracts were treated with endotoxin-removing gel column chromatography or with an endotoxin antagonist, B464, confirming that the contaminating pyrogen was endotoxin. A noteworthy finding was that one of the endotoxin-containing extracts showed very weak IL-6-inducibility in human monocytic cells in contrast to its high pyrogenicity to rabbits. The discrepancy could be explained based on differences between humans and rabbits in sensitivity to the endotoxin, because the extract showed higher proinflammatory-cytokine (TNF-alpha)-inducibility in rabbit whole-blood cells (WBCs) than human WBCs. The results suggest that the LAL test is a useful method of detecting endotoxin contamination in wound dressings and the MM6-CA8 assay is a good supplement to the LAL test for evaluating pyrogenicity in humans accurately.

Preoperative application of limited cone beam computerized tomography as an assessment tool before minor oral surgery.

We describe the preoperative application of limited cone beam computerized tomography (CT) using a Dental three-dimensional (3D)-CT as an assessment tool before minor oral surgery. The Dental 3D-CT provided 42.7 mm-high and 30 mm-wide rectangular solid images. This size covered the height of the mandible with standing teeth. Dental 3D-CT clearly demonstrated lesions in the maxillary and mandibular bone. Resorption of the bone due to disease expansion was depicted more clearly on the Dental 3D-CT than on conventional radiographs. Information about lesion location and the relationship between the lesions and their adjacent anatomical structures, such as the mandibular canal and maxillary antrum, was useful for minor oral surgery. Due to its high resolution and low radiation dose, Dental 3D-CT was useful for preoperative examination prior to minor oral surgery.

Ligneous conjunctivitis: a case report.

BACKGROUND: Ligneous conjunctivitis is a rare condition characterized by chronic, recurrent conjunctivitis associated with pseudomembrane, and it may involve other mucous membranes in the mouth, nasopharynx, trachea, and vagina. We examined and treated a case of presumed ligneous conjunctivitis. CASE: The patient was a 10-year-old boy. His chief complaints were visual impairment, discomfort, and discharge, but no itching in his eyes. His upper eyelids appeared thick without swelling. He had a past history of surgery for lid entropion. His two siblings had similar follicular conjunctivitis. OBSERVATIONS: This case exhibited several characteristics of ligneous conjunctivitis, such as large follicles, recurrent pseudomembrane and normal level IgE in the serum. Indispensable characteristics of vernal keratoconjunctivitis, strong itching, and extensive papillary formation, were not found. In spite of the lack of woody hardness of the conjunctiva, other clinical findings led to the diagnosis of ligneous conjunctivitis. Definite histological diagnosis was not obtained, because of the lack of common histological characteristics among previously reported cases with ligneous conjunctivitis. The boy had developed corticosteroid glaucoma after instillation of dexamethasone 0.1% for 7 months at a previous time. We successfully treated this case with combined instillation of fluorometholon and cyclosporin after trabeculotomy. CONCLUSIONS: Ligneous conjunctivitis must be considered as one type of differential diagnosis of vernal keratoconjunctivitis. Cyclosporin is an effective alternative for the treatment of ligneous conjunctivitis, especially in a case with a possible history of corticosteroid glaucoma.

Salivary gland changes in the NOD mouse model for Sjögren's syndrome: is there a non-immune genetic trigger?

Sjögren's syndrome is a systemic autoimmune disease characterized by patient complaints of oral and ocular dryness accompanied by clinical observations of a progressive loss of salivary and lacrimal function, related to the presence of a focal, periductal leukocyte infiltrate. Progress in understanding the mechanisms involved in the development of autoimmune diseases in general, and Sjögren's syndrome specifically, has been generated as a result of renewed interest in animal models, such as the NOD mouse, which mimics autoimmune sialoadenitis. Biochemical analyses have indicated that the salivary glands have reduced beta-adrenergic, muscarinic, and neuropeptide signal transduction responses that correlate to reduced receptor density and the appearance of autoantibodies directed against these and other cell surface proteins. Using the NOD-scid mouse (lacking functional B- and T-lymphocytes) it has been determined that salivary flow rates are normal; however, these animals show abnormal changes in protein biosynthesis with increasing age. Histological evaluation of the submandibular gland from older NOD-scid mice revealed a loss of acinar cells accompanied by a potential increase in the ductal cell component of the tissue. Consistent with this finding, we recently have observed increased levels of cell death-associated cysteine proteases in the submandibular glands of 20 week NOD and NOD-scid mice but not in BALB/c and young NOD controls. Other novel protease activity was detected in the parotid and submandibular glands from NOD mice, which were able to generate the aberrantly processed PSP from purified BALB/c protein. Taken together, these data paint a complex picture of the development of Sjögren's syndrome-like disease in the NOD mouse model. The presence of activated lymphocytes appears to be necessary for the ultimate loss of exocrine gland function, potentially through the loss of tolerance to glandular proteins. However, the findings of high levels of apoptosis and aberrant protein expression in the submandibular gland in the absence of an immune response (NOD-scid) suggests that genetic alterations in glandular homeostasis involving the death program contribute to disease progression or even the initial trigger of autoimmunity.

Prosthodontic treatment for a patient with advanced hydantoin-associated gingival hyperplasia: a case report.

A patient in whom gingival hyperplasia was caused by prolonged use of an anticonvulsant drug (hydantoin) is described. Advanced gingival hyperplasia and significant displacement of the remaining teeth caused severe damage, especially to the patient's appearance. It was not possible to cure the problems completely with routine periodontal treatment. It was decided to extract all the remaining teeth and restore function and esthetics early with complete dentures. Cephalometric analysis was used to determine the degree to which the teeth had drifted. During fabrication of the dentures, the analysis was very useful in deciding the position of the anterior teeth and checking the vertical dimension of occlusion.

[Efficacy of nidus embolization of large arterio-venous malformation prior to surgical excision].

Although it is undoubted that surgical excision is the ideal treatment for arterio-venous malformation, its large nidus and deep localization make it difficult in some instances. To make surgical procedure easier, efficacy of nidus embolization or of obstruction of feeding arteries by detachable balloon technique is reported. A case presented here is such a case with large arterio-venous malformation which was successfully removed surgically following artificial nidus embolization with silastic spheres. On May 12th, 1983, a 27-year-old housewife was admitted to our department with chief complaints of episodes of alexia, apraxia, and aphasia lasting for a few minutes during 4 years prior to admission. Neurological examination on admission showed no abnormalities. Left internal carotid angiogram taken on admission showed a large arterio-venous malformation in the left parieto-temporo-occipital region fed by three branches of the left middle cerebral artery and two branches of the left posterior cerebral artery (Fig. 2a, 3a). To enable successful excision without neurological deficits, nidus embolization with silastic spheres was performed on June 2, 1983. Forty silastic spheres of 1.5 mm in diameter were injected via a catheter introduced in the left internal carotid artery and a second injection of 48 silastic spheres of 2.0 mm in diameter was performed after confirmation of no stray of silastic spheres in the arteries unrelated to the nidus. Embolization procedure was interrupted after the second injection, because of stray of silastic sphere into the posterior internal frontal artery of the left anterior cerebral artery.(ABSTRACT TRUNCATED AT 250 WORDS)

[Nidus embolization of cerebral arteriovenous malformation fed mainly by a pericallosal artery prior to surgical excision. Case report].

Nidus embolization of large arteriovenous malformation (AVM) by silastic spheres is not rarely performed prior to surgical excision of AVM. This technique is highly indicated for the large AVM supplied by the middle and the posterior cerebral arteries since silastic spheres injected into either the internal carotid or the vertebral arteries usually enter the middle or the posterior cerebral arteries due to less sharp angle from the main arteries. The authors report a case whose AVM, fed mainly by the anterior cerebral artery, was successfully embolized with silastic spheres using balloon catheter technique. On December 1, 1983, a 27-year-old man was admitted to our department with chief complaint of headache and clonic convulsion of the left upper and lower limbs. Convulsion began in 1973 and severe headache suddenly appeared two months prior to admission. He was neurologically asymptomatic on admission. Right internal carotid angiogram taken on admission showed a presence of large arteriovenous malformation in the medial portion of the right fronto-parietal lobe and corpus callosum fed mainly by the right pericallosal artery. Nidus embolization with silastic spheres was planned to make surgical removal easier. To prevent stray of silastic spheres into the right middle cerebral artery, balloon, introduced into the M1, was inflated for a few minutes, during which time, injection of 40 silastic spheres of 1.5 and 2.0 mm in diameter was performed via the right internal carotid artery. The nidus was significantly reduced and total removal of the nidus was successfully done 28 days following the embolization.(ABSTRACT TRUNCATED AT 250 WORDS)

Angiosarcoma of the oral cavity: a clinicopathological study and a review of the literature.

Soft tissue sarcomas are uncommon in the head and neck. Primary angiosarcomas of the oral cavity area are extremely rare, and have mostly been presented as case reports. This paper presents the clinical and histological features of three such cases. All patients were diagnosed based on the presence of rapidly extending masses involving the tongue, maxillary gingiva, or mandibular gingiva; bone destruction was present in two cases. The resected specimens revealed clustered large, pleomorphic, and spindle-shaped cells with a markedly haemorrhagic background. Tumour cells showed expression of vascular endothelial markers, such a CD31, CD34, and factor VIII-related antigen. Despite undergoing radical surgery, distant metastases developed in all three cases. We also studied the clinicopathological features of a series of oral angiosarcomas. This article therefore reports the clinicopathological features of the three new cases and provides a review of the cases of primary oral angiosarcoma reported during the past 20 years.

A survey of the appropriate use of antiseptic agents in the operating room of several key health care facilities. A comparison between surveys in 2000 and 2004.

Since 2000, new hand and environmental hygiene guidelines have been published by the Center for Disease Control and Prevention (CDC) based on scientific evidence. Accordingly, we expected that the use of disinfectants in clinical settings had been changed. To compare the use and amount of disinfectants before and after the publication of these guidelines, we conducted a questionnaire-based survey on the use of antiseptic agents in operating rooms (ORs) in 6 key hospitals over a period of a month in 2000 and 2004. As a result, the amount of disinfectants used in ORs was reduced in all hospitals in 2004. Especially, amphoteric detergents and glutaral products showed significant reductions in the total amount used in the 6 hospitals, by 94.8 and 96.8%, respectively. The use of povidone-iodine (PVP-I) was decreased by 23.4% overall, although it was increased in 3 hospitals by 11.0-58.6%. The number of applications of PVP-I on the surgical site did not change; however, the site was left to dry without wiping after PVP-I application more frequently in 2004 than in 2000. The time for surgical scrubbing was shortened in 2004, but brush scrubbing was still used as often as in 2000. Many of the hospitals used brush scrubbing in conjunction with alcohol-based rubs. These results indicated changes in infection control measures in hospital settings after publication of the new CDC guidelines; environmental disinfection had been limited and excessive use of disinfectants reevaluated.