[Mood and cognitive disorders, and androgen deprivation]. / Troubles de l'humeur et cognitifs et suppression androgénique.

Prostate cancer has become a chronic disease. In this context, it is important to take into account the quality of life of patients and their family in the therapeutic approach. Recent studies have demonstrated the importance of depression and the risk of suicide in patients with prostate cancer as well as the repercussions of the disease on the spouse and their relationship. The implication of hormonal treatment in the increase in risk of depression is difficult to affirm. Few studies have investigated this subject and they present methodological biases. Some authors report an increased risk of cognitive decline in patients on androgen deprivation. However, even if certain physiopathological hypotheses have been put forward, the imputability of the treatment on the alteration of cognitive functions has not been clearly established. Urologists are at the forefront of diagnosis and treatment of prostate cancer occurring most often in elderly subjects. Therefore, given the prevalence of depression syndromes and/or the alteration of cognitive functions in this population, the urologist must be aware of these different factors, which are potentially aggravated by the introduction of androgen deprivation. Based on a review of the recent literature, the authors suggest using a simple depression screening tool: confirmation of the diagnosis and management is within the competence of the general practitioner. As for the risk of cognitive decline, it seems difficult to imagine, and not necessarily relevant, to systematically propose a battery of neuropsychometric screening tests. On the other hand, giving the patient the G8 screening test can allow the urologist to assess whether the patient needs a geriatric consultation or not.

Soluble forms of Toll-like receptor 4 are present in human saliva and modulate tumour necrosis factor-alpha secretion by macrophage-like cells.

In health, mucosal inflammation is prevented by tightly regulated responses via Toll-like receptors (TLR) that interact with specific microbe associated molecular patterns. Currently, 13 TLRs have been identified. Based on the specificity of ligand recognition, TLR-2 and TLR-4 can recognize most oral commensal microorganisms. Recent identification of some soluble TLRs (sTLRs) suggests additional regulatory roles for these receptors. We report here the presence of sTLR-4 polypeptides in adult human saliva. Functionally, the salivary sTLR-4 suppressed cytokine secretion by activated macrophages. The sTLR-4 levels were elevated significantly in oral lichen planus (OLP), a chronic inflammatory condition of the oral mucosa characterized by clinical persistence. In contrast, the epithelial cells in the saliva of OLP subjects expressed significantly reduced TLR-2 and TLR-4 mRNA that correlated with fewer bacteria/salivary epithelial cells. Investigating the soluble and cellular components of saliva is useful in identifying potential biomarkers for oral mucosal lesions.

Profile of the oral healthcare team in countries with emerging economies.

Health is a critical dimension of human well-being and flourishing, and oral health is an integral component of health: one is not healthy without oral health. Significant barriers exist to ensuring the world's people receive basic healthcare, including oral healthcare. Amongst these are poverty, ignorance, inadequate financial resources and lack of adequate numbers of educated and trained (oral) healthcare workers. Emerging economies are encouraged to develop a national strategic plan for oral health. International organizations have developed goals for oral health that can be referenced and adapted by emerging economies as they seek to formulate specific objectives for their countries. Demographic data that assess the nature and extent of oral diseases in a country are essential to sound planning and the development of an oral healthcare system that is relevant, effective and economically viable. Prevention should be emphasized and priority consideration be given to oral healthcare for children. The types and numbers of members of the oral healthcare team (workforce) will vary from country to country depending on the system developed. Potential members of the workforce include: generalist dentists, specialist dentists, dental therapists, dental hygienists, denturists, expanded function dental assistants (dental nurses) and community oral health workers/aides. Competences for dentists, and other members of the team, should be developed to ensure quality care and developed economies should cooperate with emerging economies. The development, by more advanced economies, of digital, virtual curricula, which could be used by emerging economies for educating and training members of the oral healthcare team, should be an important initiative. The International Federation of Dental Educators and Associations (IFDEA) should lead in such an effort.

Extensive biopsy protocol improves the detection rate of prostate cancer.

PURPOSE: We evaluated improvement in the rate of prostate cancer detection when using an extensive biopsy protocol involving peripheral cores. MATERIALS AND METHODS: We prospectively evaluated 303 consecutive men who underwent transrectal ultrasound guided biopsy due to elevated prostate specific antigen (PSA) and/or abnormal digital rectal examination. Ten biopsies were performed, including at least 5 at the base and middle of each lobe. In addition to standard biopsy at a 45-degree angle, a more peripheral 30-degree angle biopsy was obtained. At the apex only 1 standard biopsy was done. However, when prostate volume was greater than 50 cm.3, an additional peripheral biopsy was obtained at the apex. RESULTS: The complication rate in this biopsy protocol was 1% (3 patients). Prostate cancer was detected in 118 of the 303 men (38. 9%). Overall this extensive protocol resulted in 6.6% improvement in the detection rate. Improvement was 6.5% in men with PSA 10 ng./ml. or less and 7% in those with PSA greater than 10 (not significant). CONCLUSIONS: Increasing the number of biopsy cores and improving prostate peripheral zone sampling resulted in a significant improvement in the detection of prostate cancer.

Ameloblastic carcinoma: a clinicopathologic study and assessment of eight cases.

The term ameloblastic carcinoma is differentiated from the term malignant ameloblastoma and is defined as an ameloblastoma in which there is histologic evidence of malignancy in the primary tumor or the recurrent tumor (or metastasis), regardless of whether it has metastasized. Eight cases of ameloblastic carcinoma from the Armed Forces Institute of Pathology (AFIP) are reported. The mean age of patients was 30.1 years, with no sex predilection noted. Seven cases involved the mandible and one involved the maxilla, with the posterior regions favored. The most common sign was swelling, although pain, rapid growth, trismus, and dysphonia also occurred. Lesions characteristically were evident as ill-defined destructive radiolucencies, with occasional radiopacities noted. Histologic features generally resembled those of conventional ameloblastoma but with cytologic features of epithelial malignant disease. The clinical course was uniformly aggressive with extensive local destruction and spread, frequent recurrences, and one case of neck node metastasis. The nomenclature and classification of odontogenic carcinomas are discussed, as well as entities that should be included in the differential diagnosis. Further reporting of ameloblastic carcinoma is encouraged.

Salivary gland tumors of the tongue. Analysis of 55 new cases and review of the literature.

Fifty-five cases of primary salivary gland tumors of the tongue from the files of the Armed Forces Institute of Pathology are reported and analyzed and the results compared with the information in the literature. Five tumors were benign and 50 were malignant. The average age at presentation was 47 years for the benign tumors and 54.3 years for the malignant ones. Although the overall benign/malignant ratio was 1:10, women were more likely to have a malignant tumor than were men. The site of 80% of the benign tumors was the middle to anterior portion of the tongue, whereas over 85% of malignant tumors involved the base. Clinical signs and/or symptoms related to the site aroused suspicion in some cases but often were of short duration and in over 60% of cases did not occur. The most common benign tumor type was the myoepithelial variant of the benign mixed tumor. The most common malignant tumor type was the low-grade mucoepidermoid carcinoma (38%) followed by adenocarcinoma (20%), high-grade mucoepidermoid carcinoma (14%), adenoid cystic carcinoma (10%), and clear cell carcinoma (8%), with occasional basaloid, papillary cystadenocarcinoma, acinic cell and mucus-producing adenocarcinoma. Treatment was similar to that of other accessory salivary gland neoplasms of similar histologic type and clinical stage. Prognosis worsened with high histologic grade, old age, and advanced clinical disease at presentation.

Psoriasis. Palatal manifestations and physiologic considerations.

The histologic and clinical criteria for psoriasis involving the palate are discussed. A review of the literature shows the present case to be the fifth well-documented one in the literature. A possible explanation for the rarity of clinical manifestations in the oral cavity is presented.

Clouston syndrome: an ultrastructural study.

A previously undescribed French-Canadian family affected with Clouston Syndrome (Hypohidrotic Ectodermal Dysplasia) is described. Ultrastructural study of the hair shows disorganization of the hair fibrils with loss of the cuticular cortex. The SEM findings are consistent with the model, suggesting a biochemical defect in the keratin of the integumentary system.

Squamous odontogenic tumor. Report of five cases and review of the literature.

Five previously unreported cases of squamous odontogenic tumor are reported and the literature is reviewed. This lesion appears to be a benign odontogenic neoplasm arising from rests of Malassez; it occurs over a wide range and has a predilection for the anterior maxilla and the posterior mandible. Maxillary lesions are more aggressive than mandibular ones. The most common sign is mobility of teeth in the area. Radiographically, the most characteristic picture is that of a well-circumscribed semicircular radiolucency bounded by a sclerotic border and emanating from the area of the alveolus adjacent to the roots of teeth. The histologic features are sufficiently characteristic to differentiate it from ameloblastoma and epidermoid carcinoma; however, evaluation of the entire clinicopathologic picture is necessary to exclude the diagnosis of squamous odontogenic tumorlike proliferations in an odontogenic cyst.

A clinical, genetic, and ultrastructural study of snow-capped teeth: amelogenesis imperfecta, hypomaturation type.

Snow-capped teeth (SCT) is a rare form of amelogenesis imperfecta, hypomaturation type. It has been alluded to on numerous occasions but, to our knowledge, no pedigree or clinical-histopathologic data have been published. In this report, two families are described. Scanning electron microscopic (SEM) studies of unetched teeth from affected persons revealed numerous defects of the enamel surface. After etching with 10 percent hydrochloric acid for 21/2 minutes to remove the outer prismless layer of enamel, SEM features of the enamel prism were essentially identical to those of normal teeth. These findings suggest that the structural defect in SCT is confined to the outer prismless enamel layer and that the bulk of the enamel is normal. The genetic analysis supports the concept that SCT is inherited in an X-linked recessive fashion and not as an autosomal dominant trait, as previously reported.

Paraoral cartilage analogue of fibromatosis.

A case of cartilage analogue of fibromatosis (CAF) adjacent and inferior to the mandible of a 48-year-old man is reported. CAF is a term currently used by some authors to replace the term juvenile aponeurotic fibroma. Histologically, this apparent variant of fibromatosis is made up of a richly cellular fibroblastic stroma with foci of fibrocartilage or benign chondroid differentiation. Although the CAF may be locally aggressive, malignant behavior has not been reported, and these neoplasms may be adequately managed by conservative surgery. This case appears to be the first case of CAF from paraoral region; however, care examination of previous reports and cases of fibromatosis may indicate that this entity may be more common that the literature suggests.

The art of history taking.

The art of history taking involves the ability to recognize the interrelationship between the details of the medical history and the patient's personal history. For the oral surgeon, this provides important insights into how the patient has reacted to illness in the past as well as how he is most likely to react to current treatment. Specific problems have been reviewed as well as suggested interview techniques to guide the oral surgeon in his management of his patient's reactions. No one expects the doctor to be an iconoclast. He cannot be all things to all patients. He should recognize a problem, acknowledge it as a problem, and be flexible enough to deal with it or refer the patient to someone who can. This kind of understanding will enable the oral surgeon to fulfill his role with appreciation from his patients and an inner sense of professional and personal achievement.

Focal odontoblastic dysplasia: dentin dysplasia type III?

A new, nonsyndromic dentin defect, focal odontoblastic dysplasia, is described on the basis of clinical, radiographic, histologic, and scanning electron microscopic criteria. A provisional classification is proposed for this disease entity according to the nosology of Shields and associates. Four additional cases in the literature which possibly represent this new entity are presented, and a possible genetic etiology is discussed.

Dentin dysplasia, type II: a rare autosomal dominant disorder.

Dentin dysplasia, Type II, is a rare autosomal dominant disorder. The primary teeth are amber and translucent and the pulp chambers are obliterated. The permanent teeth have a normal to brown-gray coloration and a thistle-tube pulp configuration with multiple true denticles. To date, only five families with this disorder have been reported. This article presents two additional families. Light and scanning electron microscopy of an affected primary incisor showed the dentin, including the mantle layer, to be highly disorganized throughout. Possible pathogenic events associated with the phenotype are discussed.