Brown tumor of the jaw as a rare manifestation of hyperparathyroidism: Two case reports and literature review.

INTRODUCTION AND IMPORTANCE: Brown tumor is a giant cell focal lesion of bone associated with hyperparathyroidism, even primary or secondary. Differential diagnosis of these lesions from others giant cell lesions of the jaw bone is mandatory for the correct treatment of the patient. CASE PRESENTATION: We present here two cases of brown tumor affecting the jaws by describing their clinical aspects and radiographic features, diagnostic criteria and treatment of this disease. CLINICAL DISCUSSION: Brown tumor is one of the lesions that develop in patients with hyperparathyroidism or renal failure. Skeletal bones including maxillo-facial ones can be the site of this lesion, also radiographic and histopathological exams of the jaw lesion are not sufficient to determine the diagnosis, which requires laboratory tests and radiographic examination. CONCLUSION: Dental surgeon should be aware of oral manifestations associated with systemic diseases, hence the importance of careful physical examination and thorough investigation for the diagnosis and treatment success. This article aims to illustrate the management strategy to aid clinicians in suspected cases of brown tumor.

Prenatal stress alters diazepam withdrawal syndrome and 5HT1A receptor expression in the raphe nuclei of adult rats.

Early-life events have long-term effects on brain structures and cause behavioral alterations that persist into adulthood. The present experiments were designed to investigate the effects of prenatal stress on diazepam-induced withdrawal syndrome and serotonin-1A (5HT1A) receptor expression in the raphe nuclei of adult offspring. The results of the present study reveal that maternal exposure to chronic footshock stress increased the anxiety-like behavior in the prenatally stressed (PS) animals withdrawn from chronic diazepam (2.5mg/kg/day i.p for 1week). Moreover, prenatal stress induced a down-regulation of 5HT1A mRNA in the raphe nuclei of adult offspring. To our knowledge, this study is the first to demonstrate that maternal exposure to chronic footshock stress enhances diazepam withdrawal symptoms and alters 5HT1A receptor gene expression in the raphe nuclei of adult offspring. Thus, more studies are needed to clarify the mechanisms underlying the decrease of 5HT1A receptors expression in the raphe nuclei of PS rats.

[Enlargement of mandibular canal and lower lip hypoesthesia revealing non-Hodgkin's lymphoma of the mandible]. / Elargissement du canal mandibulaire et hypo-esthésie labiale révélant in lymphoma non-hodgkinien mandibulaire de phenotype B.

Introduction: Primary lymphoma of the mandible are rare and most often revealed by painless swelling. They are often confused with odontogenic lesions. Hence, their diagnosis is delayed. The authors report the case of an isolated mandibular lymphoma revealed by hypoesthesia of the lower lip and enlargement of the left mandibular canal. Case Report: A 35-year-old woman patient consulted for hemi-mandibular pain with episodes of left labial hypoesthesia. Clinically, we noted the presence of a vestibular tumor in front of tooth 34. A panoramic radiograph revealed that the left mandibular canal was widely enlarged, extending from the mandibular foramen to the mental foramen. The biopsy revealed a B-cell lymphoma. No other localization was found. After treatment with seven courses of a chemotherapy based on R-CHOP followed by local radiotherapy, the patient was in remission eighteen months after treatment. Discussion: Primitive lymphoma of the mandible are rare; they represent about 0.6% of extra-nodal non-Hodgkin lymphoma. They occur at any age and mainly affect males. They most often come out as a painless swelling, sometimes ulcerated in the mouth. They are often misdiagnosed as a dental problem. Treatment combines variably radiotherapy and/or chemotherapy. The prognosis of bone lymphoma is more favorable than others malignancies bone, with a survival rate of 40-50% at five years.

Prenatal stress induces vulnerability to nicotine addiction and alters D2 receptors' expression in the nucleus accumbens in adult rats.

Prenatal stress (PS) can induce several long-lasting behavioral and molecular abnormalities in rats. It can also be considered as a risk factor for many psychiatric diseases like schizophrenia, depression or PTSD and predispose to addiction. In this study, we investigated the effect of prenatal stress on the reinforcing properties of nicotine in the CPP paradigm. Then, we examined the mRNA expression of the D2 dopaminergic receptors using the quantitative real-time PCR technique in the nucleus accumbens (NAcc). We found that prenatally stressed rats exhibited a greater place preference for the nicotine-paired compartment than the control rats. Moreover, we observed an overexpression of the DRD2 gene in adult offspring stressed in utero and a downregulation in the PS NIC group (PS rats treated with nicotine) compared with their control counterparts (C NIC). These data suggest that maternal stress can permanently alter the offspring's addictive behavior and D2 receptors' expression.

Effect of prenatal stress on memory, nicotine withdrawal and 5HT1A expression in raphe nuclei of adult rats.

Maternal distress has often been associated with cognitive deficiencies and drug abuse in rats. This study examined these behavioral effects in offspring of mothers stressed during gestation. To this end, pregnant dams were subjected to daily electric foot shocks during the last 10 days of pregnancy. We measured litter parameters and body weights of the descendants after weaning (21 days) and at adulthood (80 days). Afterwards, prenatally stressed and control rats' performances in the novel object recognition test were compared in order to evaluate their memory while others underwent the Water consumption test to assess the nicotine withdrawal intensity after perinatal manipulations. Meanwhile, another set of rats were sacrificed and 5HT1A receptors' mRNA expression was measured in the raphe nuclei by quantitative Real Time PCR. We noticed no significant influence of maternal stress on litter size and body weight right after weaning. However, control rats were heavier than the stressed rats in adulthood. The results also showed a significant decrease in the recognition score in rats stressed in utero compared to the controls. Moreover, a heightened anxiety symptom was observed in the prenatally stressed offspring following nicotine withdrawal. Additionally, the Real Time PCR method revealed that prenatal stress induced a significant decrease in 5HT1A receptors' levels in the raphe nuclei. Nicotine had a similar effect on these receptors' expression in both nicotine-treated control and prenatally stressed groups. Taken together, these findings suggest that the cognitive functions and drug dependence can be triggered by early adverse events in rats.

Long-term effects of prenatal stress and diazepam on D2 receptor expression in the nucleus accumbens of adult rats.

Early life stress during the gestational period alters specific neuronal circuits leading to behavioral alterations later in life. In the present study, we assessed the effects of prenatal stress and repeated benzodiazepine administration on dopamine receptor 2 expression in the nucleus accumbens of adult offspring. Our results show elevated Drd2 expression levels in the nucleus accumbens (NAcc) of prenatally stressed rats compared to control subjects, while repeated diazepam administration in adulthood down-regulated Drd2 expression and prevented the effect of prenatal stress. These observations suggest that prenatal stress may induce permanent alterations in the corticolimbic pathway implicated in drug-seeking behavior.

Effects of prenatal stress on anxiety-like behavior and nociceptive response in rats.

We assess the anxiety-like behavior in the open field and elevated plus maze tests and measure the nociceptive response in the tail flick test following prenatal stress exposure in adult male and female Wistar rats. In both behavioral anxiety tests, prenatal stress increased the anxiety-like behavior in male PS rats, but not in females suggesting a strong sex-dependent anxiogenic effect. The tail flick results showed a hypersensitivity to pain in male and female PS rats with a subtle gender difference. These findings suggest that prenatal stress is an important risk factor for multiple mental disorders.

Prenatal stress alters sensitivity to benzodiazepines in adult rats.

In rats, prenatal stress (PS) induces persistent changes in the brain that eventually can be translated in altered behavior leading to a greater consumption of psychostimulants in the offspring during adulthood. Though many studies have been carried on the effects of PS on stimulant drug responsiveness, little is known about susceptibility to benzodiazepines dependence in this animal model. We hereby examined the long-lasting impact of PS exposure during the last 10 days of pregnancy on the vulnerability to benzodiazepine addiction in adult rats. In addition, we also investigated the link between PS and the sensitivity to anxiolytics. Our results reveal that PS offspring exhibited a significantly greater preference to the diazepam-paired side than control offspring in the conditioned place preference. Importantly, we found that PS enhanced the anxiolytic effects of diazepam in the elevated plus maze paradigm. This work demonstrates that PS increased the abuse potential of benzodiazepines and the sensitivity to anxiolytic drugs in offspring of stressed mothers. Thus, investigating the interactions among addiction and PS may contribute to a better understanding how early life events modify neural circuitry and thereby behavior.

[Oral Burkitt lymphoma in an immunocompetent patient]. / Lymphome de Burkitt buccal chez une enfant immunocompétente.

We report a case of Burkitt lymphoma of the jaws in an immunocompetent adolescent, revealed by intraoral swelling. An orthopantomogram showed multiple osteolytic lesions. Biopsy revealed Burkitt lymphoma. The disease was treated with chemotherapy. Complete remission was attained 15 months after the end of treatment. Burkitt lymphomas accounts for 30-40% of all non-Hodgkin lymphomas in children, with diagnosis confirmed by histology. Immunophenotyping completes the diagnosis by identifying the presence of B markers. Chemotherapy is currently the main treatment of BL, because of the high chemosensitivity of the tumor and its low radiosensitivity. Overall survival in localized stages is close to 100%.

Prevention of diazepam withdrawal syndrome by nifedipine-behavioural and neurochemical studies.

Our studies aimed at investigating whether the dihydropyridine calcium antagonist, nifedipine, could prevent anxiogenic-like consequences of diazepam withdrawal in rats. Animals withdrawn from chronic diazepam (2 mg/kg/day i.p. for 2 weeks) drank significantly less water than did control rats in the unfamiliar arm of a Y maze. This anxiogenic-like effect could be prevented by acute administration of nifedipine (at 10 mg/kg i.p., but not at lower doses), which, on its own, did not change water intake in naive rats. Given chronically in combination with diazepam for the second half of a 2-week treatment with this drug, nifedipine (at the daily dose of 5 mg/kg i.p.) also suppressed the reduction of water intake normally observed on diazepam withdrawal. Biochemical measurements showed that acutely, as well as chronically, administered nifedipine increased 5-HT turnover in the hippocampus of diazepam-treated rats, thereby suggesting that the prevention of diazepam withdrawal-induced anxiogenic behaviour by the calcium antagonist might be underlain by serotoninergic mechanisms.

Sleep during Ramadan intermittent fasting.

During the month of Ramadan intermittent fasting, Muslims eat exclusively between sunset and sunrise, which may affect nocturnal sleep. The effects of Ramadan on sleep and rectal temperature (Tre) were examined in eight healthy young male subjects who reported at the laboratory on four occasions: (i) baseline 15 days before Ramadan (BL); (ii) on the eleventh day of Ramadan (beginning of Ramadan, BR); (iii) on the twenty-fifth day of Ramadan (end of Ramadan, ER); and (iv) 2 weeks after Ramadan (AR). Although each session was preceded by an adaptation night, data from the first night were discarded. Polysomnography was taken on ambulatory 8-channel Oxford Medilog MR-9000 II recorders. Standard electroencephalogram (EEG), electro-oculogram (EOG) and electromyogram (EMG) recordings were scored visually with the PhiTools ERA. The main finding of the study was that during Ramadan sleep latency is increased and sleep architecture modified. Sleep period time and total sleep time decreased in BR and ER. The proportion of non-rapid eye movement (NREM) sleep increased during Ramadan and its structure changed, with an increase in stage 2 proportion and a decrease in slow wave sleep (SWS) duration. Rapid eye movement (REM) sleep duration and proportion decreased during Ramadan. These changes in sleep parameters were associated with a delay in the occurrence of the acrophase of Tre and an increase in nocturnal Tre during Ramadan. However, the 24-h mean value (mesor) of Tre did not vary. The nocturnal elevation of Tre was related to a 2-3-h delay in the acrophase of the circadian rhythm. The amplitude of the circadian rhythm of Tre was decreased during Ramadan. The effects of Ramadan fasting on nocturnal sleep, with an increase in sleep latency and a decrease in SWS and REM sleep, and changes in Tre, were attributed to the inversion of drinking and meal schedule, rather than to an altered energy intake which was preserved in this study.

Daytime alertness, mood, psychomotor performances, and oral temperature during Ramadan intermittent fasting.

During the month of Ramadan, Moslems abstain from drinking and eating daily between sunrise and sunset. This change of meals schedule is accompanied with changes in sleep habit, which may affect diurnal alertness. This study examined the effect of Ramadan intermittent fasting on the diurnal alertness and oral temperature in 10 healthy young subjects. The cognitive task battery including movement reaction time (MRT), critical flicker fusion (CFF) and visual analogue scale, was administered at 6 different times of the day: 09.00, 11.00, 13.00, 16.00, 20.00 and 23.00 h on the 6th, 15th, and 28th days of Ramadan. The baseline day was scheduled one week before Ramadan, and the recovery day 18 days after this month. Oral temperature was measured prior to each test session and at 00.00 h. During Ramadan oral temperature decreased at 09.00, 11.00, 13.00, 16.00 and 20.00 h and increased at 23.00 and 00.00 h. Subjective alertness decreased at 09.00 and 16.00 h and increased at 23.00 h. Mood decreased at 16.00 h. MRT was increased at the beginning of Ramadan (R6) and CFF was not changed. These results showed that daytime oral temperature, subjective alertness and mood were decreased during Ramadan intermittent fasting.

Influence of Ramadan on the pharmacokinetics of a single oral dose of valproic acid administered at two different times.

This study was carried out in healthy volunteers in order to examine the influence of changes in eating and rest/activity rhythms during Ramadan on the pharmacokinetics of valproic acid (VPA; Depakine). A single oral dose of 800 mg was administered to the first group of subjects (n = 7) at 8:00 PM and to the second group (n = 5) at 5:00 AM. Each group was submitted to three treatment phases: the first was carried out 3 weeks prior to Ramadan (PR), the second one at the end of the first week of Ramadan (R1) and the last at the end of the third week of Ramadan (R3). The plasma kinetics of VPA were determined for each treatment schedule throughout the 50 h following drug intake. During Ramadan, a significant decrease was observed in the Cmax (56.22 +/- 5.32 mg/l in PR vs. 48.35 +/- 5.07 mg/l in R3; p < 0.05) and in the AUC(0.50 h) (1429.92 +/- 284.23 in PR vs. 1090.26 +/- 277.73 mg.h/l in R3; p < 0.05) for the 8:00 PM intake. For the 5:00 AM intake, a significant decrease was observed in the t1/2 (12.15 +/- 1.45 h in PR vs. 9.55 +/- 1.97 h in R3; p < 0.05) and AUC(0.50 h) values (1241.29 +/- 239.01 mg.h/l in PR vs. 1019.21 +/- 256.86 mg.h/l in R3; p < 0.05). These parameters showed a significant decrease at the end of the third week of Ramadan (R3), compared to the control period (PR).

Epidemiological study: chronotype and daytime sleepiness before and during Ramadan.

Few epidemiological data have been reported on the relation between Ramadan fasting, life habits (meal frequency, sleep habits) and daytime sleepiness during Ramadan. This paper presents the results of a detailed study of the chronotype and daytime sleepiness before and during Ramadan. It was conducted on a sample of 264 subjects aged between 20 and 30 years. Results have revealed a significant decrease in the meal frequency during Ramadan compared with the control period. Before Ramadan, the majority of subjects woke up between 6 and 7 a.m. and went to sleep between 10 and 11 p.m. however, during Ramadan fasting, they woke up after 8 a.m. and preferred to go to sleep later (after midnight). Chronotype as evaluated by the Horne and Ostberg scale was changed significantly during Ramadan: an increase of the evening type and a decrease in the morning type of subjects was observed. Daytime sleepiness as evaluated by the Epworth Sleepiness Scale was significantly increased.

[Drug prescription and utilization in Morocco]. / Prescription et utilisation des médicaments au Maroc.

The aim of this study was to assess drug prescription and utilization in Morocco 8 years after the statement of the Action Program for Essential Drugs. To evaluate the role of essential drugs in these prescriptions, a study of about 600 prescriptions and questionnaires sent to a random sample of 111 prescribers and a series of visits with the investigator as a neutral observer was undertaken. The average number of drugs prescribed was 3.27, which reflected the feelings of most of the clinicians, for whom 3 drugs per patient is the required number. The number of drugs prescribed is lower in the public health structure (2.0 +/- 0.14 depending on the type of institution: hospital or primary health care centre). Specialties from the national list of essential drugs accounted for 15.48 per cent of all drugs which is to be compared with 16.2 per cent of the clinicians stating knowledge of the action programme for essential drugs. In public structures, these prescriptions ranged between 29.8 per cent and 82.4 per cent of the essential drugs (WHO general list). The length of the visit ranged between 3.27 +/- 0.96 min and 4.87 +/- 1.04 min according to the health centres and prescriptions included at least one antibiotic in 47.5 per cent of cases (25 per cent to 64 per cent). At least one antibiotic was prescribed in 43.3 per cent of cases in the study of prescriptions and 17.3 per cent of prescriptions included at least one injectable drug. The average cost of one prescription was 146.25 dirhams (ranging between 4 and 1200 dirhams = US $17). According to 68.6 per cent of the prescribers, the patients felt there to be a strong relation between efficacy and cost. Among the prescription motivations, cost ranked above availability of the drug and after efficacy.

Potential serotonergic interactions with the anxiolytic-like effects of calcium channel antagonists.

In a series of experiments, we investigated the interaction between the calcium channel antagonist, nifedipine, and the 5-HT1A agonist, ipsapirone. In the first experiment, we demonstrated that nifedipine (20 mg/kg), and to a lesser extent nimodipine (20 mg/kg), exerted an anxiolytic-like effect as did diazepam (5 mg/kg) in an experimental paradigm based on water consumption in a novel environment. In the second experiment, nifedipine (1.25, 2.5, and 5 mg/kg), and in the third experiment, ipsapirone (1.5. 3.0, and 6.0 mg/kg), have been found to exert a dose-dependent effect in the same test. Finally, a small and ineffective dose of ipsapirone (1.5 mg/kg) potentiated the anxiolytic-like effect of various doses of nifedipine. The data obtained are discussed in terms of the potential anxiolytic-like action of calcium channel antagonists and in relation to their electrophysiological effects. Moreover, the interaction between ipsapirone and nifedipine is discussed in terms of the possible involvement of central serotonergic systems in the behavioral effects of the calcium channel antagonists.

Ramadan diet restrictions modify the circadian time structure in humans. A study on plasma gastrin, insulin, glucose, and calcium and on gastric pH.

The rule of Ramadan (1 month of food and water intakes restricted to night hours) is followed by the majority of the Moslem fraction of the human population, but the possible consequences of this long-lasting modification of food intake schedule on public health have not yet been extensively documented. Therefore, a group of healthy control subjects and a group of healed duodenal ulcer patients were studied before (controls), during (both groups), and after (both groups) the month of Ramadan. The time-restricted food and water intakes were associated with variations of gastric pH, plasma gastrin, insulin, glucose, and calcium documented on a circadian basis. All of the studied biological variables, except insulin, underwent changes in their 24-h mean concentration (e.g. decrease in gastric pH, increase in plasma gastrin), some of which were still present 1 month after the end of Ramadan. The circadian patterns of all the studied variables were altered during the month of Ramadan. Some differences between the group of healthy control subjects and the group of healed duodenal ulcer patients may suggest a greater susceptibility of the latter to the modifications of feeding and sleeping schedule, which could possibly be a risk factor for the disease.

[Effect of Ramadan fasting on intragastric pH recorded during 24 hours in healthy subjects]. / Effet du jeûne du ramadan sur le pH intragastrique enregistré sur 24 heures chez le sujet sain.

OBJECTIVES: Lifestyle changes during Ramadan as the meals are taken exclusively in the evening, and nightly sleep is often delayed and shortened. The wake/sleep cycle is also modified. The aim of this study was to evaluate the influence of Ramadan on gastric acidity in healthy volunteers. METHODS: Nine healthy volunteers had 24-hour measurement of the gastric pH; 4 periods were compared: one week prior to Ramadan, day 10 and day 24 during Ramadan, and one month after Ramadan. The pH profiles and the [H+] activity (area under the curve) were measured during 24 hours, the night phase (5PM-8AM) and diurnal phase (8AM-5PM). RESULTS: The diurnal variations of the pH profile were more significant; the median pH was 2.3 prior to Ramadan, 1 at day 10 and day 24 and 1.6 one month after Ramadan. The 24-hours [H+] activity increased by 45% at day 10 of Ramadan compared with its level prior to Ramadan. This increase was mostly diurnal (+122%) and also nightly (+25%). The activity [H+] was steady during Ramadan. One month after Ramadan, the 24-hours [H+] activity was 23% higher than the one noted before Ramadan. CONCLUSIONS: This study shows that the conditions of feeding imposed by Ramadan are associated with an increase of the gastric acidity mainly in diurnal phase. These results do not explain the origin of the healthy volunteer digestive symptoms encountered during Ramadan.

[The observance of Ramadan and its repercussion on gastric secretion]. / L'observance du Ramadan et son retentissement sur la sécrétion gastrique.

The influence of the Ramadan on the gastric secretion has been assessed in 13 volunteers. Their basal and pentagastrin-stimulated secretion has been collected before, during and one month after the Ramadan. Gastric activity, pepsin activity, sialic acid bound to glycoprotein, choline and gastrinaemia have been measured. During Ramadan, acid secretion was increased (+ 159%; P = 0.02) and it recovered the pre-Ramadan level, one month later. Pepsin secretion was also increased during the Ramadan (+ 133%; P = 0.05) and it was significantly reduced after Ramadan. The secretion before the Ramadan was related to vagal hypertony, decreased during Ramadan and was substituted by a gastrinic stimulation after the Ramadan. Mucolysis and gastrinaemia were not modified and no duodenogastric reflux was observed during and after the Ramadan. The Ramadan induces an increase of acid and pepsin secretion. This increase was reversed when Ramadan stopped. These gastric secretion modifications are likely involved in the increase of dyspeptic symptoms observed during the Ramadan.