Estrategia SEMERGEN, SEEDO y SEEN para la prevención y el tratamiento del sobrepeso y la obesidad en Atención Primaria / The strategy of the Spanish Society of Primary Care Physicians (SEMERGEN), the Spanish Society for the Study of Obesity (SEEDO) and the Spanish Society of Edocrinology and Nutrition (SEEN) for the prevention and treatment of excess weight and obesity in Primary Care

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Oral PUVA and topical steroids for treatment of oral manifestations of chronic graft-vs.-host disease.

BACKGROUND: Oral manifestations of chronic graft-vs.-host disease (cGVHD) can significantly affect the quality of life and severity often does not correlate with systemic manifestations. We evaluated the use of topical corticosteroids and the intraoral application of psoralen-UVA (PUVA) for treatment of oral manifestations of cGVHD. METHODS: Overall, 18 patients with oral manifestations of cGVHD were treated with either intraoral PUVA (n=7) or with topical corticosteroids (n=16). Four patients received intraoral PUVA after failure of topical steroids and one patient was treated with topical corticosteroids after failing treatment with intraoral PUVA. A glass fiber extension of an UVA source was used for manual intraoral application. Treatment with topical corticosteroids consisted of 0.1 mg/ml dexamethasone mouth wash four times a day in combination with antifungal prophylaxis. RESULTS: Four patients showed complete local response (CR) due to intraoral PUVA, two improved and one did not respond. Topical corticosteroids resulted in nine patients in CR, two improved and five did not respond. CONCLUSION: Intraoral PUVA as well as topical corticosteroids are effective in treatment of oral manifestations of oral GVHD with few side-effects and improve quality of life in patients with cGVHD.

Genetic progression and clonal relationship of recurrent premalignant head and neck lesions.

We constructed a preliminary genetic progression model for head and neck squamous cell carcinoma (HNSC) based on the frequency of genetic alterations in preneoplastic and neoplastic lesions from single biopsy specimens. To firmly establish the temporal order of established genetic events in HNSC, we sampled serial biopsies from five patients with recurrent premalignant lesions at a single anatomic site over a period of time (1 month to 144 months). These lesions were examined by microsatellite analysis of the minimal regions of loss on the 10 most frequently lost chromosomal arms in HNSC. Each set of serial biopsies from all five patients demonstrated LOH (loss of heterozygosity) of identical alleles at multiple loci with identical boundaries between areas of LOH and retention of heterozygosity, indicating a common clonal origin for each set. Three patients demonstrated genetic progression (new regions of LOH) over time correlating with histopathological progression, one patient demonstrated lack of genetic progression associated with unchanged histopathological morphology, and one patient demonstrated histopathological progression without detection of a corresponding genetic progression event. For one of these patients with a laryngeal tumor, at least four separate steps in progression to malignancy could be determined, accompanied by spatial expansion of an increasingly altered clonal population from the ipsilateral to the contralateral side, ultimately resulting in a malignancy. Microsatellite-based genetic analysis of recurrent premalignant lesions indicates that these lesions arise from a common clonal progenitor, followed by outgrowth of clonal populations associated with progressive genetic alterations and phenotypic progression to malignancy.

Squamous cell carcinoma of the tongue associated with cinnamon gum use: a case report.

BACKGROUND: Cinnamon aldehydes found in cinnamon-flavored gums can incite mucosal alterations at points of contact with the oral mucosa. These alterations may include inflammation and epithelial proliferation, but as a rule, the changes are reversible and promptly resolve when gum-chewing activity is discontinued. METHODS: The authors report a case of a 24-year-old woman who developed a squamous cell carcinoma of the tongue following persistent and prolonged exposure to cinnamon-flavored gum. RESULTS: Several social, clinical, and histopathologic features point to the cinnamon-flavored chewing gum as a possible causal factor in the development of the patient's oral carcinoma. CONCLUSIONS: Prompt withdrawal of cinnamon products is encouraged in heavy gum chewers who develop cinnamon-related oral lesions. For those lesions which do not promptly resolve upon cinnamon withdrawal, diagnostic biopsy should be considered to exclude the possibility of a squamous cell carcinoma.

Comparison of soft tissue response in rabbits following laryngeal implantation with hydroxylapatite, silicone rubber, and Teflon.

This study evaluates the soft tissue response in rabbits following laryngeal implantation for medialization using hydroxylapatite prostheses, carved silicone rubber prostheses, and injectable Teflon. Sixteen rabbits underwent left recurrent laryngeal nerve section for denervation and laryngeal implantation with hydroxylapatite. At 1, 3, 6, and 12 months, 4 animals were painlessly sacrificed and processed for histology. Similarly, animals were implanted with carved silicone rubber prostheses or with Teflon injected through a flap in the thyroid lamina for comparison at 1, 3, and 6 months. In animals implanted with hydroxylapatite, histologic findings include limited acute inflammatory response, thin fibrous encapsulation, and osteogenesis in the region of the fenestra, with lamellar bone bridging the space between the implant and thyroid lamina. With silicone rubber prostheses, there is a limited inflammatory response and fibrous encapsulation of the implant without evidence of osteogenesis. Animals implanted with Teflon demonstrated a classic foreign body reaction with multinucleated giant cells, granuloma formation, and migration of Teflon into surrounding muscle. With respect to soft tissue response, both hydroxylapatite and silicone rubber are less reactive than Teflon. The osteogenesis observed in the presence of hydroxylapatite increases implant stability and minimizes the risk of migration. Conversely, the presence of bone growth may limit the reversibility of medialization procedures performed with hydroxylapatite.

Genetic progression model for head and neck cancer: implications for field cancerization.

A genetic progression model of head and neck squamous cell carcinoma has not yet been elucidated, and the genetic basis for "field cancerization" of the aerodigestive tract has also remained obscure. Eighty-seven lesions of the head and neck, including preinvasive lesions and benign lesions associated with carcinogen exposure, were tested using microsatellite analysis for allelic loss at 10 major chromosomal loci which have been defined previously. The spectrum of chromosomal loss progressively increased at each histopathological step from benign hyperplasia to dysplasia to carcinoma in situ to invasive cancer. Adjacent areas of tissue with different histopathological appearance shared common genetic changes, but the more histopathologically advanced areas exhibited additional genetic alterations. Abnormal mucosal cells surrounding preinvasive and microinvasive lesions shared common genetic alterations with those lesions and thus appear to arise from a single progenitor clone. Based on these findings, the local clinical phenomenon of field cancerization seems to involve the expansion and migration of clonally related preneoplastic cells.

Treatment of chronic graft-versus-host disease with ultraviolet irradiation and psoralen (PUVA).

Chronic graft-versus-host disease (GVHD) remains a difficult clinical problem to treat and manage. We have reviewed our treatment of 40 patients treated at a single institution with PUVA (ultraviolet irradiation and psoralen) over a 14 year period. Thirty-five patients were treated for refractory chronic GVHD and five patients were treated at presentation of high-risk chronic GVHD. Overall, 31 of 40 patients improved on PUVA treatment. Sixteen patients achieved a complete response to PUVA added to their GVHD regimen. Four of the 15 partial responders had complete resolution of cutaneous GVHD but persistence of other systemic manifestations. The remaining partial responders had at least a 50% improvement in GVHD. We have also used PUVA with a glass fiber extension to treat intra-oral GVHD. PUVA is well tolerated with a high rate of response in the skin and mild side effects except for three patients who had therapy discontinued after phototoxicity (burn).

Lymphoid infiltrates of the salivary glands: pathology, biology and clinical significance.

Lymphoid infiltrates of the salivary glands are common to a variety of pathologic conditions including autoimmune disorders, malignant lymphomas, and immunoregulatory responses to parenchymal neoplasms. Clearly, the correct identification of these salivary gland lymphoid infiltrates has important implications regarding patient prognosis and management. Immunophenotypic and molecular analyses have demonstrated that many lesions formerly regarded as myoepithelial sialadentis or benign lymphoepithelial lesion in fact represent neoplastic lymphoid proliferations with the potential for extrasalivary dissemination. In the most recent classification scheme of non-Hodgkin's lymphomas, these neoplasms fall within the spectrum of low-grade B-cell lymphoma of mucosa-associated lymphoid tissue. In the early stages of HIV infection, patients may develop salivary gland enlargement resulting from cystic lymphoepithelial lesions. These lesions are thought to reflect a localized manifestation of persistent generalized lymphadenopathy. Although HIV-associated salivary gland disease is regarded as a benign condition, malignant lymphoma has been described in association with some of these lesions, and further work is required to define more precisely the risk of salivary gland lymphoma in HIV-infected patients. Tumor-associated lymphoid proliferation refers to a prominent lymphoid reaction accompanying certain epithelial tumors of the salivary glands. Although tumor-associated lymphoid proliferation has not received as much attention as other types of salivary lymphoid infiltrates, it is a common phenomenon that is sometimes mistaken for an intraparotid lymph node harboring metastatic carcinoma.

Using anesthetic localization to diagnose oral and dental pain.

The anesthetic localization procedure is an aid in ruling out or confirming suspected primary sources of oral or dental pain. The authors present two cases to demonstrate the effectiveness of the procedure.

Analysis of Epstein-Barr virus-encoded small RNA 1 expression in benign lymphoepithelial salivary gland lesions.

Salivary gland enlargement resulting from benign lymphoepithelial lesions may be seen in patients with Sjögren's syndrome (SS) and in the early stages of human immunodeficiency virus (HIV) infection. Although the pathogenesis of these lesions is thought to differ in SS and HIV infection, Epstein-Barr virus (EBV) has been suggested as a pathogenetic agent in both cases. We have assessed the presence of latent EBV infection in a series of 15 lymphoepithelial salivary gland lesions using RNA-RNA in situ hybridization with digoxigenin-labeled riboprobes complementary to the abundantly-expressed EBV-encoded small RNA 1 (EBER1). Two of four benign lymphoepithelial lesions (BLEL) from patients seropositive for HIV expressed EBER1 in lymphocyte nuclei in a fashion similar to that described previously in HIV-associated persistent generalized lymphadenopathy (PGL). By contrast, EBER1 was not expressed in any of four BLEL from patients with SS, or seven lymphoepithelial cysts (LEC) and BLEL from patients with neither HIV infection nor SS. These data suggest that latent EBV infection does not play a major pathogenetic role in the lymphoepithelial salivary gland lesions associated with SS or those seen in patients without systemic disease. In the case of HIV-associated salivary gland lesions, the data are consistent with earlier proposals that these BLEL result from the involvement of intraparotid lymph nodes by PGL.

Frequent loss of chromosome 9p21-22 early in head and neck cancer progression.

In order to define more clearly the role of chromosome 9 loss in head and neck squamous cell carcinoma (HNSCC), 29 invasive carcinomas and 17 preinvasive lesions were analyzed for loss of heterozygosity (LOH) on chromosome 9. We found LOH in 21 of 29 (72%) HNSCC tumors using highly polymorphic microsatellite markers. In 17 of 21, LOH was found at all informative sites on the p arm with no LOH of the q arm. Further mapping in tumors, with partial LOH of the 9p arm, localized a common region of loss between markers D9S165 and D9S156. Deletion of this region on chromosome 9 has been found in several other tumor types implying the presence of a tumor suppressor gene at this locus. The inactivation of a tumor suppressor gene on chromosome 9p may represent the most commonly described genetic alteration in HNSCC. A similar incidence of allelic loss on chromosome 9p was identified in 12 of 17 (71%) preinvasive lesions. The identical frequency of loss in preinvasive and invasive lesions suggests that loss of 9p is an early event in HNSCC progression.

Lichenoid chronic graft-vs-host disease occurring in a dermatomal distribution.

BACKGROUND: Chronic graft-vs-host disease (GVHD) is a late complication of allogeneic bone marrow transplantation and is associated with high morbidity and mortality. While the pathogenesis of chronic GVHD is not fully understood, several observations and studies suggest that viral infections may play a role. We describe two patients who developed linear lichenoid chronic GVHD. The dermatomal distribution of their lesions suggests an association with herpes zoster virus infection. OBSERVATIONS: Two allogeneic bone marrow transplantation patients developed violaceous papules in a dermatomal distribution. Histologic examination of these lesions revealed dyskeratosis, vacuolar changes in the basal layer, and a mild perivascular and interstitial infiltrate, diagnostic of lichenoid chronic GVHD. CONCLUSIONS: The linear distribution of our patients' lichenoid chronic GVHD is unique and may represent an association with herpes zoster virus infection, providing further support for a role for viral infections in the pathogenesis of chronic GVHD.

Atypical oral presentation of herpes simplex virus infection in a patient after orthotopic liver transplantation.

An atypical oral presentation of herpes simplex virus infection in a 49-year-old woman after orthotopic liver transplantation is reported. Clinically, the differential diagnosis included chronic hyperplastic candidiasis, nodular leukoplakia of undetermined etiology, and malignant neoplasm. An excisional biopsy revealed herpesvirus infection, and immunoperoxidase staining confirmed herpes simplex virus infection. This report describes the clinical and histologic appearance of these lesions and the course and treatment of the patient.

[An epidemic outbreak of measles in a rural area]. / Brote epidémico de sarampión en una área rural.

OBJECTIVE: Analysis of an outbreak of measles among a partially vaccinated school population: the epidemiology, the effectiveness of the control measures and the efficacy of the vaccine (EV). DESIGN: A descriptive study and cohorts study. SETTING: Primary Care in the borough of Sant Andreu de la Barca. PATIENTS AND OTHERS PARTICIPANTS: The school population of Sant Andreu de la Barca. MEASUREMENTS AND MAIN RESULTS: The outbreak lasted three months and twenty days, with 95 cases overall. The most affected age group was form 4 to 10. 8.4% presented complications. Children were infected at school in 87% of the cases. The overall infection rate of the population between 0 and 15 was 2.4%. 36% of the cases had been correctly immunized and 43% were preventable cases. Vaccine coverage contacts was 67%. 84% of the susceptible contacts were vaccinated. Immunization status and immunization age of 323 out of 500 pupils was studied for the EX analysis. Global EV was 66% (42-80), 58% (13-80) for those immunized, between 12-14 month of age and 71% (43-85) for those immunized after the 15 month of age. CONCLUSIONS: In order to eradicate the autoctonous measles an increase in immunization coverage, an improvement in the epidemiologic surveillance, and in the outbreak control measures are needed.

Cutaneous giant cell hyalin angiopathy.

Giant cell hyalin angiopathy (GCHA) is an unusual histologic finding associated with inflammation. The lesion has previously only been reported intraorally and is usually preceded by trauma. We report the first case of cutaneous GCHA. The eosinophilic, amorphous material (so-called "hyalin") stained for light chain products, suggesting that their deposition resulted from a reactive process associated with inflammation.

Desmoplastic ameloblastoma. A case report and literature review.

The desmoplastic ameloblastoma is a rare histologic variant of ameloblastoma. This article presents a case of desmoplastic ameloblastoma with unique and complex histologic findings. The tumor, which was located in the anterior mandible, was treated by an anterior marginal resection with preservation of the inferior border of the mandible. The clinical, radiographic, surgical, and pathologic aspects of this unusual lesion are presented, and the relevant literature is reviewed.

Ameloblastoma of the mandible with intracranial metastasis. A case study.

Ameloblastoma is an aggressive locally recurring neoplasm of odontogenic epithelium. We describe a case of a mandibular ameloblastoma with a 17-year history of local recurrences followed by two metachronous intracranial metastases. Central nervous system metastasis without pulmonary involvement is previously unreported in a living patient with ameloblastoma. The behavior of this tumor qualifies it as a malignant ameloblastoma.

Thalidomide for the treatment of chronic graft-versus-host disease.

BACKGROUND: Allogeneic bone marrow transplantation is an accepted therapy for hematologic cancer, aplastic anemia, and inherited immunodeficiencies. Chronic graft-versus-host disease (GVHD) is the principal complication in patients surviving more than 100 days. Thalidomide has been shown experimentally to be effective in treating GVHD. METHODS: We treated 23 patients with chronic GVHD refractory to conventional treatment and 21 patients with "high-risk" chronic GVHD (identified as having at least two of the following three risk factors: chronic GVHD that has evolved from acute GVHD, lichenoid skin or mucous-membrane changes, and hepatic dysfunction. Such patients have a high mortality rate.) with thalidomide in a dose that produced a plasma level of 5 micrograms per milliliter two hours after administration. Therapy was continued for three months after a complete response or for six months after a partial response. RESULTS: The overall actuarial survival of all enrolled patients was 64 percent. Survival was 76 percent among the patients receiving salvage therapy for refractory GVHD and 48 percent among those with high-risk GVHD. A complete response was observed in 14 patients, a partial response in 12 patients, and no response in 18. Side effects were minor, most notably sedation in almost all patients. CONCLUSIONS: In this preliminary trial, thalidomide appeared to be safe and effective for the treatment of chronic GVHD. A trial comparing thalidomide with prednisone in patients with newly diagnosed chronic GVHD will be required to demonstrate its relative efficacy.