Insuficiencia renal por enfermedad de depósito de cadenas ligeras / Renal failure due to light chain deposition disease

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Lifestyles, environmental and phenotypic factors associated with lip cancer: a case-control study in southern Spain.

The aim of this study was to identify factors related to lip cancer (LC) considering individual characteristics and sociodemographic factors. A case-control study was carried out in the province of Granada (Andalusia, southern Spain). The cases were 105 males with squamous-cell carcinoma of the lip, diagnosed between 1987 and 1989 (aged 20-70 years) and identified by means of a population-based Cancer Registry. As controls, a randomised populational sample of 239 males, stratified by age, was used. Multiple logistic regression analysis showed that risk factors are lifetime cumulative tobacco consumption and alcohol consumption. An interaction was found between alcohol consumption and the smoking habit (leaving the cigarette on the lip): OR=23.6; 95% CI: 3.9-142.0. Other risk factors identified are clear eyes (OR=3.5; CI: 95% 1.5-8.0), sun exposure early in life and cumulative sun exposure during outdoor work (OR=11.9; 95%: CI: 1.3-108.9), and skin reaction to sun exposure (Fitzpatrick levels). Another interaction was found between skin reaction and a previous history of common sporadic warts (OR=4.4; 95% CI: 1.01-19.1). We conclude that LC is related to phenotype, skin reaction to sun exposure, cumulative and early sunlight exposure, and tobacco and alcohol consumption, as well as a low educational level. Leaving the cigarette on the lip is predictive of LC risk irrespective of cumulative tobacco consumption.

Antibiotic treatment of incipient drug-induced gingival overgrowth in adult renal transplant patients.

BACKGROUND: Drug-induced gingival overgrowth (GO) remains a challenge in periodontics. Partial and total regressions of this GO have been reported after a short course of antibiotics. METHODS: We conducted a double-blinded controlled randomised study to determine the effect of metronidazole (MNZ) or azithromycin (AZM) on the regression of incipient cyclosporin A-induced GO in 40 adult renal transplanted patients. The quantitation of the GO was performed with Image Digital Analysis. RESULTS: None of the patients with GO showed complete remission after 30 days. The pretreatment GO index was 0.895 +/- 0.16 in the metronidazole treatment group (MNZ group, n = 13), 0.932 +/- 0.11 in the azithromycin treatment group (AZM group, n = 14), and 1.073 +/- 0.32 in the controls (placebo group, n = 13). At the end of the study (30 days), the GO index score was lower in 54.4% and 62.3% of the MNZ and AZM groups, respectively, and the mean score differences were statistically significant between the groups (0.897 +/- 0.28, MNZ group vs. 0.909 +/- 0.15, AZM group vs. 1.130 +/- 0.3, placebo group, P < 0.05 ANOVA). CONCLUSIONS: A 7-day course of MNZ or AZM does not induce remission of CsA-induced GO, although it acts on concomitant bacterial over-infection and gingival inflammation.

Lipomas en la cavidad oral. Presentación de seis casos clínicos / Lipomas of the oral cavity. Report of six cases

El lipoma es una de las neoplasias benignas más frecuentes, aunque rara en la cavidad oral. Se presentan como tumores asintomáticos, de lenta evolución, color amarillento y blandos a la palpación. Las localizaciones orales más frecuentes son la mucosa yugal, la lengua y el suelo de la boca. En la actualidad la etiología de los lipomas es desconocida aunque se jan propuesto diversas teorías que incluyen la hipertrofia y la metaplasia. Histológicamente es un tumor constituido por células adiposas maduras que se localiza en el tejido celular subcutáneo. Además del lipoma simple, se han descrito diversas variantes histológicas de lipoma entre las que se incluyen fibrolipomas, angliolipomas, lipomas mixoides y condrolipomas, siendo el fibrolipoma la más frecuente de todas. Se describe nuestra casuística de lipomas, analizando sus características clínicas, histológicas y terapeúticas (AU)

Antiproliferative effect of topic hyaluronic acid gel. Study in gingival biopsies of patients with periodontal disease.

Hyaluronic acid (HA) is the most abundant glycosaminoglycan of high molecular weight in the extracellular matrix of soft periodontal tissues. Our group recently demonstrated an HA-induced reduction in lymphoplasmocyte inflammatory infiltrate in periodontal disease. The objective of this study was to determine the effect of an HA gel of high molecular weight on cell proliferation, inflammation, and different periodontal lesion parameters. A double-blind clinical trial was conducted on the effect of an HA gel on cell proliferation in gingival biopsies from 28 patients with periodontal disease. A split-mouth design was used, randomly applying the gel to one quadrant and a placebo to the contralateral one. A gingival biopsy was taken for histopathological and immunohistochemical study, in order to determine the expression of cell proliferation antigen Ki-67 and to evaluate the inflammatory infiltrate. HA gel treatment induced a significant reduction in the proliferation index of the gingival epithelium, with 276 (range 234-317) Ki-67-positive cells per mm2 in treated samples versus 514 (range 158-876) per mm2 in controls (Mann-Whitney U test, p<0.003). In 13 patients, the number of Ki-67-positive fibroblastic cells was reduced by the treatment, whereas in 6 patients no differences were found (global difference, p=0.12). In 10 patients, Ki-67-positive cells were decreased in chronic inflammatory infiltrate present in the lamina propria, whereas in 6 patients no differences were found (global difference, p=0.054). We conclude that high molecular-weight HA gel reduces cell proliferation in epithelial cells such as fibroblasts and lymphocytes, abates the inflammatory process, and improves the periodontal lesion in patients with chronic periodontitis.

El Metronidazol en los agrandamientos gingivales secundarios a Ciclosporina A / Metronidazole in Cs-A-induced gingival overgrowth

Introducción: El agrandamiento gingival (AG) secundario a fármacos continúa siendo un problema importante para los periodoncistas. Han sido comunicadas remisiones parciales o totales del AG tras tratamientos cortos con diversos antibióticos. Metódos: del tratamiento con metronidazol durante siete días (250 mg/3 veces al día) sobre el AG incipiente secundario a ciclosporina A en pacientes adultos trasplantados renales. La valoración cuantitativa del AG se realizó semiautomáticamente con técnicas de Análisis Digital de Imagen. Resultados: En ninguno de los 26 pacientes incluidos en el estudio se obtuvo la remisión completa del AG al finalizar el estudio. El índice de AG obtenido a tiempo cero fue en los pacientes tratados con metronidazol (grupo MNZ) 0.90 ñ 0.16 y en los controles (grupo placebo) 1.11 + 0.33. Transcurridos 30 días de evolución el índice de AG en el grupo MNZ no se modificó (0.92 ñ 0.28) y en los pacientes que tomaron placebo se incrementó ligeramente (1.18 ñ 0.3), aunque sin llegar a ser estadísticamente significativo. El índice AG disminuyó en el 54.4 por ciento de los pacientes del grupo MNZ, mientras que sólo lo hizo en el 23.1 por ciento en el grupo placebo. A pesar de que no existieron diferencias en el índice de AG entre los dos grupo al principio del ensayo al finalizar el mismo el mayor incremento del IAG en el grupo placebo dio como resultado una diferencia estadísticamente significativa (MNZ 0.92 ñ 0.28 vs placebo 1.18 + 0.3, p<0 05 t de Student), diferencia que se acentuó cuando se compararon solo los pacientes de ambos grupos con AG clínico grado 1 ó 2 (MNZ 0.96 + 0.31 vs placebo 1.24 ñ 0.31, t de Student p<0.05). Conclusión: Los resultados del presente estudio indican que el tratamiento con metronidazol durante siete días no induce la regresión completa de los agrandamientos gingivales producidos por CsA, pero puede frenar parcialmente el curso clínico del AG, posiblemente al reducir la sobreinfección bacteriana y la inflamación gingival (AU)

Background: Drug-induced gingival overgrowth (GO) remains a significant problem for the periodontologist. Partial and total regressions of this GO have been reported after a short course of antibiotics. Methods: We conducted a double-blind controlled randomized study in order to determine the effect of 7 days of metronidazole treatment (250 mg /3 times day) on the regression of incipient cyclosporin Ainduced GO in adult renal transplanted patients. The quantitation of the GO was performed with lmage Digital Analysis. Results: At the end of the study, none of the 26 patients in the trial showed complete remission of the GO. Before treatment, the GO index was 0.90 ± 0.16 in the patients treated with metronidazole (MNZ group =13) and 1.11± 0.33 in the controls (placebo group =13). At the end of the study (30 days) the GO index score was lower in 54.4% of the MNZand the difference between groups was statistically significant (MNZ 0.92 ± 0.28vs. placebo 1.18± 0.3,p <0.05 Student's t test. Conclusions: The results of our present study indicate that a 7-day course of metronidazole does not induce the complete remission of CsA-induced gingival overgrowth but can partially abate the progression of the GO,probably through a decrease in the bacterial overinfection and gingival inflammation (AU)

Pili annulati (pelos anillados). Estudio con microanálisis de Rx / Pili annulati. A study with X-ray microanalysis

Presentamos el caso de una mujer de 37 años de edad que tenía un cabello muy característico, donde alternaban bandas oscuras, de cabello normal, con otras más claras y más gruesas con alteraciones cuticulares leves. No tenía antecedentes familiares conocidos. Realizamos microanálisis de rayos X, encontrando diferente composición a lo largo del cabello: disminución de los contenidos de azufre en las bandas claras, con respecto a las bandas oscuras. Creemos que debe tratarse de un caso con escasísima carga genética, que también podríamos considerar como un caso esporádico, donde las manifestaciones clínicas, morfológicas, estructurales y analíticas eran mínima (AU)

Isolation of ani-hepatotoxic principle form the juice of Ecballium elaterium.

The antihepatotoxic activity of elaterium (dried juice of the fruits of Ecballium elaterium, Cucurbitaceae) and cucurbitacin B (isolated from the juice) was studied against CCl4-induced hepatotoxicity. Pre- and posttreatment with elaterium and cucurbitacin B reduced CCl4-hepatotoxicity, as shown reduction in the anormally increased sGPT levels. Posttreatment caused a significant reduction in the degree of steatosis observed inthe control group, treated only with CCl4. In conclusion, elaterium and cucurbitacin B had preventive and curative effects against CCl4-induced hepatotoxicity.

Epstein-Barr virus and oral squamous cell carcinoma in patients without HIV infection: viral detection by polymerase chain reaction.

In order to test the hypothesis that Epstein-Barr virus (EBV) may be a cofactor for oral squamous cell carcinoma (OSCC) the authors evaluated tumour cells from OSCC of 108 patients without HIV infection, for the presence of EBV DNA by polymerase chain reaction. The sequences of oligonucleotides used in the amplification and hybridization included a set for the DNA polymerase region. The amplification was detected using an ELISA assay with peroxidase. EBV DNA was detected in 17.59% of the tumours. Inhibition studies showed that the ability to detect EBV DNA was not affected by the pathological material, suggesting that the negative PCR results in these samples were not caused by PCR inhibitors in the biopsy. Results revealed that 63.1% of the tumours (12 cases) were DNA positive affecting the lateral margin of the tongue, and were statistically significant (p < 0.001; chi 2). In the pool of tumours with EBV DNA only 26.3% (5 of 19 cases) were well differentiated OSCCs whereas the remaining 73.7% (14 of 19 cases) were moderately and poorly differentiated OSCCs, with a statistical significance of p = 0.08; chi 2. This study suggests a relationship between OSCC and EBV.

Gingival overgrowth induced by nifedipine and cyclosporin A. Clinical and morphometric study with image analysis.

In this study, we developed a quantitative method with digital image analysis to evaluate the degree of gingival overgrowth (GO), and compared GO in kidney transplant patients treated with cyclosporin A (CsA) (n = 21) or CsA+nifedipine (n = 8) and a group of healthy controls (n = 30). The method was reproducible and reliable. Our findings showed significant differences in papillary and gingival surface between controls and transplant patients treated with GO inducers. Gingival overgrowth index also differed significantly between controls and each patient group (p < 0.01, Kruskal-Wallis test). The administration of the calcium channel blocker nifedipine potentiated the adverse effect of CsA: comparison of the morphometric findings revealed significant differences between patients treated with CsA alone and CsA+nifedipine in papillary area, dental area, and GO index (p < 0.01, Mann-Whitney U-test). We conclude that the method of image analysis we developed is useful in assessing the degree of GO.

Differentiation of a human rhabdomyosarcoma cell line after antineoplastic drug treatment.

The feasibility of treating solid tumours with differentiation therapy using antineoplastic drugs is currently being investigated, but the emergence of multidrug resistance remains the major limitation to this therapeutic approach. A rhabdomyosarcoma cell line resistant to actinomycin D (RD-DAC) has been used as an in vitro model to investigate, with light and electron microscopy, the degree of differentiation in multidrug-resistant cells. The parental cell line (RD), derived from a human embryonic-type rhabdomyosarcoma, is undifferentiated, with no evidence of specific ultrastructural markers. Examination of resistant cells by transmission electron microscopy revealed myofilaments arranged parallel to the long axis of the cell, which was considered clear evidence of myogenic differentiation. These observations suggest that actinomycin D, the drug of choice in the treatment of rhabdomyosarcoma, induces differentiation in the cell line RD. It is postulated that multidrug resistance can interfere with cellular differentiation.

Influence of intrarenal deposits of ciclosporin A on acute renal transplant rejection.

Immunohistochemical techniques were used to study the presence of ciclosporin A (CsA) and leukocyte subsets in 36 posttransplant renal biopsy specimens histologically diagnosed as acute graft rejection. Glomeruli from patients with CsA deposits contained more leukocytes (p < 0.05) than glomeruli from tissues without deposits. In contrast, the interstitium from patients without deposits contained significantly more B lymphocytes than interstitia from kidneys with CsA deposits. In both glomeruli and interstitia, the CD4/CD8 ratios were higher in tissues without deposits, although the difference was not significant. The plasma levels of creatinine increased with the intensity of renal CsA deposits, and significantly more patients on hemodialysis had deposits as compared with patients not on hemodialysis. Our findings suggest two types of acute nonvascular rejection: (1) predominantly interstitial, with a good prognosis, characterized by low numbers of intrarenal CsA deposits and a predominance of B lymphocytes and (2) predominantly glomerular, with a poor prognosis, characterized by high levels of intrarenal CsA and a predominance of CD8-positive cells and macrophages.

Presence of cytomegalovirus genome and leucocyte subsets in renal transplant biopsies. Relationship with prognosis.

The influence of immunosuppressant therapy and of the presence of CMV genome on the distribution of lymphoid subpopulations of the inflammatory infiltrate in renal graft rejection was analyzed, as was the role of both factors in the evolution and survival of the graft. The study included 22 patients treated with Cyclosporin A (CsA) and 22 patients treated with Azathioprine (AZA). Inflammatory infiltrate was studied by immunostaining with a panel of monoclonal antibodies, and CMV DNA was detected by in situ hybridization on tissue sections. In patients treated with CsA, increased cellularity was found at both glomerular and interstitial levels, consisting mainly of macrophages and T-cells, which was consistent with the higher rate of glomerulointerstitial rejection found in this group. In contrast, the vascular type of rejection predominated in AZA treated patients. However, the presence of CMV DNA did not influence the phenotype of the inflammatory infiltrate, and was not associated with any specific lesion. Furthermore, the final outcome of the renal graft was independent of the detection of CMV. Therefore, this study provides no evidence of any active role of the CMV genome in renal graft rejection, and suggests that therapy should be adapted to the type of rejection as defined on morphologic and immunophenotypic grounds.

Mononuclear cell subsets in IgM mesangial proliferative glomerulonephritis. A comparative study with minimal change nephrotic syndrome and immunonegative mesangial proliferative glomerulonephritis.

Glomerular and interstitial leukocyte subpopulations were analyzed in renal biopsies from 18 patients with IgM mesangial proliferative glomerulonephritis (IgM MPGN), 19 patients with minimal change nephrotic syndrome (MC) and 10 patients with immune-negative mesangial proliferative glomerulonephritis (IN MPGN), by immunoperoxidase techniques with monoclonal antibodies. Mesangial cell proliferation was strongly correlated with absolute numbers of intraglomerular T lymphocytes (r = 0.71; p < 0.01) in IgM MPGN, but not in MC or IN MPGN. Significant differences were found in the numbers of macrophages, CD4- and CD8-positive glomerular cells (Student's t test p < 0.01, 0.05 and 0.01, respectively) in IgM MPGN, but not in MC or IN MPGN. The numbers of CD45-, CD3- and CD8-positive cells also differed in each patient group (ANOVA p < 0.01, 0.05 and 0.05, respectively), the greatest and smallest values appearing in IgM MPGN and MC, respectively. Multiple regression test showed initial proteinuria values in IgM MPGN to be closely dependent on the density of neutrophils, macrophages, T and B lymphocytes and CD4 cell inflammatory infiltrates (r2 = 0.92; p < 0.01). At the end of the follow-up, proteinuria in IgM MPGN, but not in MC or IN MPGN, was dependent on T cell infiltrate (r2 = 0.97; p < 0.01). Our findings suggest that proteinuria in IgM MPGN results from local mesangial damage rather than from the effects of a soluble circulating factor, as has been proposed for MC. The clinical and immunohistochemical differences observed between these two processes support the notion that they should be considered as separate entities.