Bisphosphonate related osteonecrosis of the jaw: a study of 18 cases associated with fungal infection.

Osteonecrosis of the jaw (ONJ) is a serious complication associated with oral and intravenous bisphosphonate therapy. Its pathogenesis is not well understood and its management is difficult. Microbiological investigations have detected a variety of oral pathogens such as Actinomyces, Enterococcus, Candida albicans, Aspergillus, Haemophilus influenzae, alpha-hemolytic streptococci, Lactobacillus, Enterobacter, and Klebsiella pneumoniae. To better treat it, it is important to understand its causes and complications. Materials and Methods. Our present study addresses a microscopic observation of curetted jaw necrotic lesions related to bisphosphonates. Results. A mycotic infestation has been found in all of the 18 cases studied. Discussion. An identification of the fungal agent and its incrimination in the pathogenesis of bisphosphonates related osteonecrosis of the jaw could change radically the management of this condition.

Cytology and clinical spectrum of sexually transmitted infections in Lebanese women as revealed by Pap smear: a cross-sectional study from 2002-2006.

To study the cytology profile of cervical smears and the respective prevalence and incidence of certain cervico-vaginal infections detectable by routine Pap smear cytology in Lebanese women from 2002 to 2006. Pap smear cytology results were compiled from the archives of the Institut National de Pathologie for the period extending from 2002 until 2006. This study covered 118,230 cervical specimens obtained from Lebanese women attending clinics and hospitals in all the five districts of Lebanon; prevalence and incidence rates for infections detectable by routine Pap smear examination were determined. A rise in prevalence of these infections by 2.1 percent (2,555) from 2002 to 2006 was revealed. A doubling of Pap smears showing HPV-associated changes was detected (1.4 percent in 2002 to 2.9 percent in 2006), and a simultaneous almost 7-fold increase of Atypical Squamous Cells of Undetermined Significance (ASCUS) cytology was detected during this period; the rise in ASCUS cytology was age-dependent. Moreover, a 60 percent increase in prevalence of bacterial vaginosis (2.3 percent in 2002 to 3.7 percent in 2006) and a more than 3-fold decline in Trichomonas vaginalis infection (1 percent in 2002 to 0.3 percent in 2006) were also noted in this population during this period. An increase in the prevalence and incidence of cervico-vaginal infections detectable by Pap smear cytology in Lebanese women was revealed from 2002 to 2006. Such changes could point to recent modifications of sexual and health behaviours in the Lebanese community.

B-type natriuretic peptide receptors in hypertrophied adult rat cardiomyocytes.

Brain natriuretic peptide (BNP) binds to three types of natriuretic peptide receptors, NPR-A, -B and -C (NPRs). The expression shape of BNP and NPRs seems to be an important modulator factor in the pathogenesis of cardiac hypertrophy. The aim of this study was to evaluate the expression of NPRs in an animal model of pressure overload hypertrophy. Left ventricular hypertrophy was induced by chronic abdominal aortic banding in adult male Wistar rats. After six weeks, NPRs gene expression was evaluated with RT-PCR, BNP plasma concentration and BNP positive myocytes were measured with ELISA and immunohistochemistry techniques respectively. NPR-A and NPR-C mRNA expression was significantly increased in left ventricular hypertrophied cardiomyocytes by 1.6-fold and 2.1-fold respectively (P<0.01). Abdominal aortic banding increased significantly BNP plasma concentration (630+/-8pg/ml vs 106+/-4pg/ml; P<0.01). The percentage of BNP positive cells in normal myocardial tissue were 40% while in the hypertrophied one it raised to 80%. The data suggest that in our left ventricular hypertrophy model, the NPR-A and NPR-C receptors were increased in association to the increased BNP level. This relationship may amplify beneficial paracrine/autocrine effects of BNP on cardiac remodelling in response to hemodynamic overload.

Eosinophils and mastocytes in healing laser excision wounds.

Eosinophils can influence fibroblasts and the extracellular matrix in vitro and can participate in tissue remodelling in vivo. Therefore; we analysed the expression of eosinophils and mastocytes in healing laser excisions and control excisions made by scalpel. Carbon dioxide (CO(2)) laser (continuous wave, 5 W) or scalpel excision wounds were created in the dorsal tongue mucosa of 96 rats. Sixteen additional rats were kept as untreated controls. Specimens from the tongues were cut at 16 different healing time points and fixed in 10% formalin. Histological staining with slow Giemsa was done to determine microscopically the eosinophils and mastocytes. Mastocytes were always present, especially in large numbers around blood vessels, in scalpel and in laser wounds. The maximum number of eosinophils was almost two times higher in scalpel excisions than in laser excisions. The peak value was reached after 6 days in laser wounds and after 3 days in scalpel wounds. The increase reverted to normal levels after 10 days in laser wounds and after 6 days in scalpel wounds. The appearance and disappearance of eosinophils was slower in laser wounds. Mastocytes were always present in both groups. This identification as a potential source of transforming growth factor (TGF) alpha and TGF beta clearly permits a role for the eosinophils and influences epithelial cell proliferation, angiogenesis and organization of the wound.

[Mucoepidermoid carcinoma of salivary glands: the prognostic value of tumoral markers]. / Cancer mucoépidermoïde des glandes salivaires: signification pronostique des marqueurs tumoraux.

INTRODUCTION: Mucoepidermoid carcinoma is one of the most frequent malignant lesions of salivary glands. The treatment is based on clinical, paraclinical and histological data. Several studies on the prognostic value of molecular markers for these cancers were made with contradictory results. The aim of this retrospective study was to analyze the prognostic value of molecular markers of salivary gland mucoepidermoid carcinoma. MATERIAL AND METHODS: Sixteen patients were treated for mucoepidermoid carcinoma of principal and/or accessory salivary glands between 1994 and 2003. An immunohistochemical study of archive specimen was performed. Nine markers were specifically studied: 4 proteins/oncoproteins (p53, bcl2, c-erb-B2 and cd117), 2 markers of proliferation (PCNA and Ki67), 1 growing factor receptor (EGFR), 1 epithelial adhesion molecule (E-cadherin), and 1 angiogenic cytokine (PDGF). RESULTS: Nine men and 7 women were included, with a mean age of 43.7 years (14-80). The mean diameter of tumors was 3.1 mm (1-14), and the parotid gland was the most frequent location. The mean global survival rate was 57.3 months with a median of 55 months. The 2 to 5 years survival expectation rate were 82.5% and 46.4% respectively. The mean survival rate for women was superior to that of men (P=0.043). The expression of p53 and the high expression rate of EFGR were bad prognostic factors (respectively P=0.049 and P=0.012). The expression of PCNA was linked to the location (mainly the salivary gland) and to the diameter of the tumor (respectively P=0.037 and P=0.029). The degree of EFGR positivity and the histological grade were linked (P=0.027). DISCUSSION: The strong expression of EGFR was statistically linked to the histological tumor grade. The degree of PCNA positivity seemed to be associated to the preferential location in the main salivary glands and to the diameter of the tumor. The strong expression of p53 and EGFR were bad prognostic factors. These retrospective results need to be confirmed by prospective randomized and larger studies. EGFR and p53 were significant negative prognostic factors. EGFR was highly correlated to the histological grade, making it an interesting target for further investigation.

Protective effect of taurine against free radicals damage in the rat myocardium.

Free radicals are highly cytotoxic to the heart and are involved in ischemia/reperfusion injury. In this study, we tested the ability of taurine to neutralize the deleterious effects of free radicals generated ex vivo and in vitro. Taurine was added at a concentration of 0.1 mM to the drinking water of experimental rats during 6 months. The animal hearts were then isolated and submitted to regional ischemia and reperfusion; ventricular fibrillation was significantly reduced as compared to a control group of non-treated animals. Moreover, at a concentration of 1 mM, taurine provided significant cardio-protection against the deleterious effect of free radicals generated by the electrolysis of Krebs-Henseleit buffer. When isolated hearts were perfused with electrolysed buffer, extensive fiber necrosis occurred, as observed by staining with nitro blue tertrazolium, a soluble dye which yields a dark blue formazan stain in the presence of reducing agents This stain was barely detectable when taurine was added to the perfusing electrolysed buffer. To further understand the protecting mechanism of taurine, we used xanthine-xanthine-oxidase as a superoxide (O2-) generating system and monitored the O2- through yield O2--dependent cytochrome c reduction. We demonstrated that taurine did not affect this system, which indicated that it did not scavenge O2- directly. On the other hand, taurine inhibited the auto-oxidation of adrenaline to adrenochrome at pH 7.8 where this auto-oxidation is O2--independent and superoxide dismutase insensitive. We thus conclude that taurine acts as a potent, but non-specific, scavenger of free radicals that cause heart damage and protects against reperfusion-induced ventricular

Local application of IGF1 on dental pulp mechanically exposed; in vivo study on rabbit.

IGF1 (Insulin Growth Factor, 1) was intentionally applied onto pulp tissues, aiming to provoque a dentine regeneration process through the stimulation of the dentinoblasts' potententials. 72 cavities were hence performed on rabbit molars, intentionally exposing the dental pulp. Different concentrations of IGF1 were then applied; The histo and anatomo-pathological observations showed persistent vitality of the pulp without any sign of necrosis, even 6 weeks after the IGF1 application. Dentinoblasts layers (as an indication of the regeneration activity) were counted, according to a pre-established protocol, at days 7, 14, 22, 28 and 42. The type of the applied IGF1, was carefully selected to be "Binding Protein Resistant" (IGF-BPR), so to avoid any inhibition of the IGF1 action by the endogenous binding proteins (Hochscheid and coll). The results were conclusive in indicating the IGF1 as an efficient dental pulp capping product.

Myofibroblasts in healing laser excision wounds.

BACKGROUND AND OBJECTIVE: The lack of myofibroblasts, cells responsible for wound contraction, has been suggested to be the underlying factor to the clinically observed minimal contraction in CO2 laser wounds. However, the histologic background to this phenomenon in laser excisions has not been thoroughly clarified. Therefore, we analyzed the expression of myofibroblasts in healing laser excisions and control excisions made by scalpel. STUDY DESIGN/MATERIALS AND METHODS: CO2 laser (continuous wave, 5 W) or scalpel excision wounds were created in the dorsal tongue mucosa of 144 rats. Sixteen additional rats were kept as untreated controls. Specimens from the tongues were cut at 16 different healing time points and fixed in 10% formalin. Immunohistochemical stainings with monoclonal antibodies to vimentin and to alpha-smooth muscle actin were done to determine microscopically the contractile type of myofibroblasts. RESULTS: The maximum amount of myofibroblasts was almost three times higher in scalpel than in laser excisions. The peak value was reached at 4 days in laser and at 3 days in scalpel wounds. The increase reverted to normal levels at 14 days in laser and at 6 days in scalpel wounds, respectively. CONCLUSION: Myofibroblasts appeared and disappeared slower in laser wounds. There were clearly fewer myofibroblasts in CO2 laser than in corresponding scalpel excisions known to heal by contraction. The lack of contractile myofibroblasts, therefore, is suggested as the reason for the minimal degree of contraction in CO2 laser excision wounds.

Value of duodenal endoscopic markers of villous atrophy.

UNLABELLED: Several endoscopic aspects of duodenal mucosa have been described in patients with villous atrophy (VA) and celiac disease. We assessed the accuracy of three endoscopic markers in patients referred for duodenal biopsy. METHODS: From January 1992 to June 2000 all patients undergoing upper gastrointestinal (UGI) endoscopy by a single operator (n = 4102), had the second part of the duodenum examined, without any magnification technique or addition of vital dye staining, for the presence of three markers of VA, (1) reduction or loss of Kerkring's folds, (2) scalloped configuration of the duodenal folds, and (3) mosaic appearance of the mucosa. Biopsy samples were taken from those in whom the mucosa was abnormal (n = 51), and from those in whom it was normal but where biopsy was indicated (n = 230). RESULTS: None of the 230 endoscopically normal controls had VA. Seven out of 51 patients (14%) with an abnormal mucosa had a normal histology, the remaining 44 (86%) had some degree of VA confirmed at histology, partial VA in 11 patients (25%) and subtotal or total VA in 33 patients (75%). 63% of the patients with only one endoscopic marker had VA confirmed at histology whereas the coexistence of more than one marker was always associated with histological villous atrophy. The overall sensitivity, specificity, positive and negative predictive values of the endoscopic markers were respectively, 100%, 97%, 86%, and 100%. CONCLUSION: The appearance of the second part of the duodenal mucosa as assessed during routine UGI endoscopy, is a sensitive and specific indicator of the presence of VA on biopsy, and should alert the endoscopist to the possibility of a celiac disease.

[Stereotaxic excisional biopsy of non-palpable breast lesions by the ABBI(Advanced Breast Biopsy Instrumentation) technique. Advantages. Disadvantages. Indications. Apropos of 67 cases]. / Biopsie excisionnelle stereotaxique de lesions mammaires non palpables par la technique ABBI. Avantages. Inconvénients. Indications. A propos de 67 cas.

OBJECTIVES: Introduce briefly: the classification of the American College of Radiology for non palpable breast lesions; and the different techniques used for stereotactic breast biopsies. Evaluate the efficiency of the ABBI technique for non palpable breast lesions and its role in breast biopsies, on the base of 67 cases. SUBJECTS AND METHOD: Sixty-seven stereotactic excisional biopsies on dedicated prone tables were performed using the ABBI technique for 21 probably benign and 46 indeterminate non palpable breast lesions seen on mammograms. Twenty-five cases were densities, architectural distortions or radial scars, and 42 were microcalcifications. RESULTS: In our hands, the technique is 100% specific and sensitive. This high percentage of success is related to a team work between radiologists, surgeons or gynecologists. The specimen represent the whole lesion. Ductal carcinoma in situ (DCIS) and atypic ductal hyperplasia (ADH) are diagnosed with accuracy. Twelve carcinomas are found, three of them DCIS. ADH was encountered in two cases. Complications are minor, hematomas of small and moderate volume were encountered in eight cases (12%). CONCLUSION: ABBI technique replaces surgical biopsies after wire hook localisation for solitary lesion smaller than two cm in diameter; and stereotactic Tru-cut biopsies, even with vacuum aspiration, for small cluster of microcalcifications, architectural distortion and radial scar, where the percentage of failure is higher. For malignant lesions, surgery must follow, even when the margins are free.

[Breast cancer: prognostic value of flow cytometry and hormone receptors. Apropos of a Lebanese series of patients]. / Cancer du sein: valeur pronostique de la cytometrie de flux et des recepteurs hormonaux. A propos d'une série libanaise.

OBJECTIVES: This study has three objectives. 1) First to establish the influence of flow cytometry and hormone receptors on overall survival and disease free survival of stage I to IIIA breast cancer patients. 2) Second to search for associations between the classical prognostic factors: age, menopausal status, histological and nuclear grading, tumor diameter, node metastases, stage, estrogen and progesterone receptors (ER, PR), as well as ploidy and S phase fraction. 3) And third to evaluate the effect of flow cytometry and hormone receptors on the response to neoadjuvant chemotherapy in stage IIIB and IV patients. MATERIAL AND METHODS: The series is composed of 150 patients with primary invasive breast cancer (149 females and one male), diagnosed at the St George Hospital Pathology Department and in whom an evaluation of the hormone receptors and a measuring, by flow cytometry, of ploidy and S phase fraction (SPF) were performed. Among them, 68 were followed for a mean period of 45 months. The disease free survival and the overall survival were recorded as well as the response to neoadjuvant chemotherapy. RESULTS: The authors did not find any statistically significant difference in survival between diploid and aneuploid tumors, tumors with SPF above and below 8%, those who are ER+ and ER- and those who are PR+ and PR-. But it seemed that diploid, low SPF and positive hormone receptors tumors had a tendency toward a better disease free survival. The multivariate analysis using the Cox proportional hazards identified the tumor diameter as being the only independent prognostic factor (p = 0.046). The nuclear grade reached a limit of significance (p = 0.08). Diploidy, low SPF and positivity of ER and PR were associated one to the other and to low histologic and nuclear grades. Finally, neither flow cytometry parameters nor hormone receptors were predictive of a susceptibility to neoadjuvant chemotherapy.

Transfusion associated graft versus host disease in immunocompetent patients. Report of two cases.

Transfusion graft versus host disease (TGVHD) in immunocompetent patients is a recently recognized disease, reported mainly after open heart surgery, and almost always fatal. We report two cases of TGVHD in immunocompetent patients after open-heart surgery. The disease is characterized by the occurrence of fever, skin rash, liver failure and pancytopenia. Preventive measures include exclusion of first- and second-degree relatives as blood donors, and/or irradiation of blood to be transfused.

[Simultaneous bilateral spontaneous rupture of the quadriceps tendon. Apropos of a case of a hemodialysis patient with hyperparathyroidism and review of the literature]. / La rupture spontanée bilatérale simultanée du tendon quadricipital. A propos d'un cas chez une patiente hémodialysée avec hyperparathyroïdie et revue de la littérature.

The bilateral simultaneous spontaneous rupture of the quadriceps tendons is a rare condition. Of the pathologies associated with this condition, in the literature, chronic renal failure with hyperparathyroidism is of special interest. In this context, the frequency of this lesion is related to the chronicity of the renal disease. We report a case treated surgically with a good functional result in a patient under dialysis with hyperparathyroidism.

[Allergic granulomatous angiitis in the Churg-Strauss syndrome. Two case reports]. / L'angeite granulomateuse allergique de Churg-Strauss. A propos de deux cas.

The Churg-Strauss Syndrome (CSS) or allergic granulomatosis and angiitis is a relatively unusual disease. It is a subset of the group of systemic necrotizing vasculitis and the clinical manifestations involve multiple organ system. The CSS is characterized typically by three phases, asthma or atopic disease, peripheral eosinophilia and ultimately, vasculitis. The authors report two cases of CSS. The first patient presented allergic rhinitis and asthma for 19 years when she developed acute abdominal pain, mononeuritis of her right leg, pulmonary infiltrates and hypereosinophilia. The lung biopsy showed extravascular granulomas and eosinophilic infiltration. The second patient presented asthma for two years when she developed a mononeuritis of the left leg and then a hypereosinophilia with cutaneous eruption of hands and feet, and a myo-pericarditis. In both cases, treatment with prednisolone produced a dramatic improvement in symptoms and eosinophilia.

[Juvenile hyaline fibromatosis]. / Fibromatose hyaline juvénile.

BACKGROUND: Juvenile hyaline fibromatosis (JHF) is rare disease of autosomal recessive inheritance. CASE REPORT: A 14-year old boy, born to consanguineous parents was admitted because he suffered from multiple tumors since the age of 5 years. These tumors were mobile, painful varying in size, located mainly on the head, the back, and extremities; they were associated with gingival overgrowth. Bone X-rays showed osteolytic lesions. The cognitive development was normal. Biopsy of tumors showed cords of spindle-shaped cells embedded in homogeneous eosinophilic matrix. The child was progressively disabled due to articular changes. Two of his brothers presented the same features. CONCLUSION: This new case of JHF confirms the severity of prognosis of such a fibromatosis presently considered as a hereditary disorder of collagen metabolism.

[Generalized amyloidosis associated with Hashimoto's thyroiditis and hypothyroidism]. / Amylose généralisée associée a une thyroïdite de Hashimoto avec hypothyroïdie.

Involvement of the thyroid gland in systemic amyloidosis is known since 1855, most frequently histologic than clinical. We report here a case of systemic amyloidosis associated with myxedema and Hashimoto's thyroiditis which has been rarely reported in the literature, and may represent a new example of auto-immune diseases associated with systemic amyloidosis.

[Papillary carcinoma developed in the wall of a thyroglossal duct cyst]. / Carcinome papillaire développé dans la paroi d'un kyste du tractus thyréoglosse.

A case of papillary carcinoma arising in the wall of a thyroglossal duct cyst is described. This is a rare occurrence (1% of cases). Controversies exist concerning its nature (cancer of the thyroid or primary cancer of the thyroglossal cyst) and its treatment (Sistrunk's operation alone or combined with thyroidectomy).

Conservative surgical treatment of 27 cases of umbilical pilonidal sinus.

A retrospective study of 27 cases of umbilical pilonidal sinus (UPNS) was conducted at the Central Military Hospital of Beirut between 1987 and 1991. In this study a simple conservative surgical technique is described by removing the dead hair and the cotton like dirt as an outpatient procedure without need for anaesthesia or hospitalization. There were 26 male and one female, a mean age of 26 years, patients were followed for a period of 2 years (1987-1991). The cure rate was 98% with only four cases which needed more than one session of treatment.