Reexamination of delays in diagnosis of oral cancer following an intervention program in Cordoba, Argentina.

OBJECTIVE: We compare the results of delay in oral cancer diagnosis before and after a campaign directed toward dentists and raising awareness of the population to achieve early diagnosis of oral cancer in Córdoba, Argentina. The campaign included training dentists in diagnostic skills and a public awareness program through media and networks. STUDY DESIGN: Clinical records (period 1: before intervention program, n = 70; period 2: after intervention program, n = 60) of patients presenting with oral squamous cell carcinoma treated in 2 referral centers were analyzed. Records included first symptoms, first consultation with a health professional, and the time when treatment was formulated. RESULTS: Oral cancer diagnosis at early stages increased from 27% (period 1) to 40% (period 2). Biopsy at first consultation was indicated in 6% of patients in period 1 and in 23.3% in period 2 (odds ratio = 4.68; 95% confidence interval, 1.87-11.73; P < .05). Professional delay at early stage decreased from 72% in period 1 to 36.8% in period 2. During period 1, for initial stage cancer, the average patient and professional delays were 2.7 and 2.9 months, respectively (P = .06); in period 2, patient delay was 2.67 months and professional delay was 1.34 months (P = .005). CONCLUSION: The intervention program helped to improve early-stage diagnosis from 27% to 40% by reducing professional delays.

Linfoma de Burkitt esporádico en cavidad bucal: caso clínico / Sporadic Burkitt´s lymphoma in the oral cavity: a clinical case report

Objetivo: Presentar un caso clínico de Linfoma de Burkitt esporádico en cavidad bucal como manifestación inicial en un paciente adulto joven, tratado en el Hospital Interzonal General de Agudos "General José de San Martín" de La Plata. Caso clínico: Un paciente masculino de 20 años de edad se presenta con una lesión tumoral localizada en sector posterior de reborde mandibular, pérdida espontánea de piezas dentarias y parestesia del nervio dentario inferior. Acompañado de un aumento de volumen testicular, compromiso intestinal y poliadenopatías. El cuadro morfológico y de inmuno-marcación confirma un Linfoma de Células B "agresivo". El paciente fue tratado con esquema intensivo de 6 bloques de quimioterapia y terapia intratecal. No se observaron señales de recurrencia durante el período de seguimiento de 12 meses. Las manifestaciones bucales iniciales del Linfoma de Burkitt deben considerarse en el diagnóstico diferencial de las enfermedades bucales benignas. Debido a su naturaleza agresiva, el reconocimiento temprano y rápido de este linfoma es esencial para la administración oportuna de la terapia adecuada y mejora el pronóstico del paciente (AU)

Aim: To present a case of sporadic Burkitt's lymphoma with oral initial manifestatios in a young adult patient, who received treatment at the Hospital Interzonal General de Agudos "General José de San Martín", La Plata. Clinical case: A 20-year-old male patient presents with a tumor lesion located in the posterior area of the mandibular ridge, spontaneous loss of teeth and paresthesia of the inferior dental nerve, increase in testicular volume, intestinal compromise and polyadenopathy. The morphological and immunostaining conditions confirm an "aggressive" B-Cell Lymphoma. The patient received an intensive scheme of 6 blocks of chemotherapy and intrathecal therapy. No signs of recurrence were observed during the 12-month follow-up period. Oral manifestations of Burkitt´s lymphoma in the initial stages should be considered in the differential diagnosis of benign oral diseases. Due to its aggressive nature, early and rapid recognition of these this lymphoma is essential for the timely administration of adequate therapy and for a patient's better prognosis (AU)

Long-term outcomes after cosmetic customized prostheses and dermis fat graft in congenital anophthalmia: a retrospective multicentre study.

PURPOSE: To evaluate long-term outcomes of progressively enlarging cosmetic customized prostheses (CCP) early after birth followed by dermis fat graft (DFG), as a strategy of socket rehabilitation in children with clinical congenital anophthalmia (CCA). METHODS: Twenty patients with unilateral and two patients with bilateral CCA were enrolled. All patients were treated by inserting a CCP at the time of their first assessment which was then enlarged. Subsequently they underwent DFG. Differences in vertical palpebral aperture (VPA) and horizontal palpebral length (HPL), between affected and unaffected sides, were recorded at the first CCP fitting as well as before and after DFG. Satisfaction with cosmetic results, prosthetic retention, and complications rate were assessed. Magnetic resonance imaging of the orbit was performed in all patients before and after surgery. RESULTS: A significant decrease in the difference between the normal and the anophthalmic side of both PA and HPL was found over follow-up. Both VPA and HPL differences decreased by 47.6% (10.5 mm, range 1-28 mm) and by 7.1% (5.8 mm, range 0-18 mm), respectively. Satisfaction in terms of cosmetic outcomes proved to be very positive, being "very satisfied" for families and "satisfied" for physicians. Excellent retention of prostheses was observed in all cases. CONCLUSIONS: A rehabilitating strategy combining early CCP and further DFG proved to be a valuable approach in children with CCA, offering significant benefits in terms of socket expansion, prosthetic retention, psychological impact, and cosmetic outcomes.

Management of porous orbital implants requiring explantation: a clinical and histopathological study.

PURPOSE: To perform a histopathological review of exposed porous orbital implants requiring explantation and to study the clinical outcome of replacement of the exposed implant with an autologous dermis-fat graft. METHODS: Case series. Analysis of the clinical charts of 25 patients (age 5 to 62 years) who were submitted to explantation of exposed hydroxyapatite orbital implants, followed by simultaneous replacement with a dermis-fat graft by 1 oculoplastic surgeon between 2000 and 2011. A histopathological and microbiological evaluation of implant sections was performed. This study adheres to the principles outlined in the Declaration of Helsinki. RESULTS: Microbiological examination showed the presence of Gram-positive cocci infection in 59% of the patients. Histopathological examination showed the presence of a chronic inflammatory infiltrate in 22 of the implants (88%) and significantly reduced fibrovascular colonization of the implant in all patients. CONCLUSIONS: The reduction of fibrovascular ingrowth resulted in poor integration of the implant in the eye socket. The exposure allowed bacterial colonization of the implant, causing a chronic inflammatory infiltrate. A dermis-fat graft at the same time of explantation can be considered a suitable surgical option in both adults and children: only minor complications may occur, and cosmetic results are satisfactory.

T-helper 17 lymphocytes in ocular cicatricial pemphigoid.

PURPOSE: T-helper 17 lymphocytes (Th17) were identified in the healthy conjunctiva and in patients with ocular cicatricial pemphigoid (OCP), a disease characterized by chronic ocular surface inflammation. METHODS: Conjunctival biopsies and blood samples were obtained from 10 patients with OCP (4 males, 6 females; 57-90 years of age) and 6 age/sex matched healthy subjects. Conjunctival samples were immunostained with anti-human IL17/CD4 antibodies and stained cells were then counted by confocal microscopy in three 60X field images per each sample. Mononuclear cells were isolated from both OCP and healthy blood samples and evaluated for IL17 and CD4 by FACS. IL17, TGF-beta, IL4, and IFN-gamma levels were determined in plasma of OCP and healthy patients by ELISA. RESULTS: The presence of Th17 lymphocytes in conjunctival biopsies was significantly (p<0.05) increased in patients with OCP (14.9+/-12.8 cells per microscopic field) compared to healthy subjects (0.5+/-0.8 cells per microscopic field). Th17 lymphocytes comprised 72% of CD4(+) cells in four stage-III OCP conjunctival samples. No significant difference was observed for IL17 in peripheral blood of OCP versus healthy subjects. CONCLUSIONS: In this study, we report an increased localization of Th17 lymphocytes in OCP conjunctiva, not accompanied by similar findings in peripheral blood. This finding suggests an increased recruitment of Th17 lymphocytes in conjunctiva and/or a dysfunctional local immune response in the chronically inflamed conjunctiva of OCP. Our findings are in line with previously reported evidence demonstrating that Th17 cells play a critical pathogenic role in mucosal autoimmunity.

Therapeutic effect of topical 5-fluorouracil in conjunctival squamous carcinoma is associated with changes in matrix metalloproteinases and tissue inhibitor of metalloproteinases expression.

PURPOSE: To evaluate matrix metalloproteinases (MMP)-2, MMP-9, and tissue inhibitor of metalloproteinase (TIMP)-1 expression in a case of conjunctival intraepithelial squamous cell carcinoma (SCC) treated with topical 5-fluorouracil (5-FU) chemotherapy. METHODS: Clinicopathologic case report. RESULTS: A 71-year-old male patient presented with an intraepithelial conjunctival SCC. Because of a recurrence, he was placed on topical 5-FU for 4 weeks that ultimately led to a complete resolution of the disease. Conjunctival biopsies, impression cytologies, and tear samples were taken from the mass and the contralateral healthy eye. An overexpression of MMP-2, MMP-9, and TIMP-1 was observed in the tumor by immunohistochemistry. Clinical resolution of the neoplasm obtained using topical 5-FU was accompanied by a reduction in the expression of MMP-2, MMP-9, and TIMP-1 in tears and dysplastic conjunctival epithelium. CONCLUSIONS: In our case report, we have shown that gelatinase and TIMP-1 are unregulated in conjunctival SCC and can be monitored as a marker of response to topical chemotherapy. Further studies are required to define the role of MMPs in growth and resolution of ocular tumors.