Determination of Role of Type 16 Human Papillomavirus and Risk Factors in Assessing Oropharyngeal Cancer Survival.

BACKGROUND: It is ascertained that the survival rate of patients infected with type 16 human papillomavirus (HPV16) positive is better as compared to those infected with HPV16 negative. The present study was conducted to determine rgw role of HPV16 and risk factors in assessing oropharyngeal cancer (OPC) death. METHODOLOGY: A total of 102 clinically and histologically proven cases of oral pharyngeal cancer were included. Seropositivity for HPV16 E6 as a marker of HPV16-positive cancer was estimated. RESULTS: Out of 102 patients, there were 70 males and 32 females. Significant risk factors associated with OPC survival overall in the univariate analysis was female sex (hazard ratio [HR] 0.54, 95% confidence level [CL]: 0.36-80), alcohol use >2 drinks/day (HR 1.54, 95% CL: 1.12-2.08), smoking >10 pack-years (HR 2.20, 95% CL: 1.42-3.58), moderate dental (HR 1.54, 95% CL: 1.02-2.32), underweight (HR 2.24, 95% CL: 1.34-3.60), and Stage IV cancer (HR 2.82, 95% CL: 1.76-4.40). There was significant low risk for death among HPV16 positive (HR 0.48, 95% CL: 0.32-0.70). CONCLUSION: HPV16 status is an independent prognostic factor for OPC deaths. The common risk factors were female gender, moderate oral care, underweight body mass index, excessive alcohol, and smoking tobacco.

Role of Chemiluminescence examination as non-invasive diagnostic tool in early detection of Leukoplakia.

OBJECTIVES: To assess the efficacy of Chemiluminescent light (Vizilite plus) in enhancing visualization and its ability to highlight Leukoplakia lesion. MATERIAL AND METHODS: This was a cross-sectional study done on 40 study subjects. Subjects were inducted into the study irrespective of age and sex based on the specific inclusion and exclusion criteria. The lesion parameters like the location of the lesion, the shape of lesion, the size, the extent, borders and the presence or absence of any adjacent satellite lesions were assessed under Incandescent light followed by Toluidine blue and Vizilite plus examinations. Histopathological examination results were considered as the gold standard and TBLU and CHEM outcomes were compared to them. RESULTS: Vizilite plus examination method was most effective in assessing the size, borders and shape of the lesions followed by Toluidine blue and Incandescent light examinations. Toluidine blue and Vizilite plus examination methods demonstrated the sensitivity of 100% and specificity of 97.3%. They also demonstrated PPV of 100% and NPV of 75% with reliable accuracy of 97.5%. CONCLUSION: Chemiluminescent light is a stepping stone and has the potential to revolutionize the diagnostic protocol for patients with potentially premalignant lesions. The device can be used as a general oral mucosal examination system and may in particular improve the visualization of potentially premalignant lesions.

Comparison of Cytopathologist-Performed Ultrasound-Guided Fine-Needle Aspiration With Cytopathologist-Performed Palpation-Guided Fine-Needle Aspiration: A Single Institutional Experience.

CONTEXT.­: Although fine-needle aspiration (FNA) practice by pathologists is now well established, it has been primarily performed by manual palpation. In recent years, pathologists have begun to venture into ultrasound-guided FNAs (UGFNAs). Reports on experiences with this relatively new technique for pathologists have shown promising results. However to date, there have been few studies in the literature comparing pathologist-performed UGFNA with the more traditional pathologist-performed palpation-guided FNA (PGFNA). OBJECTIVE.­: To compare UGFNA to PGFNA by cytopathologists at an academic medical center. DESIGN.­: A retrospective study of FNAs performed by cytopathologists within the University of California, Los Angeles (UCLA) pathology departmental FNA clinic was performed. Data collected included performance technique (UGFNA versus PGFNA), lesion site and size, adequacy status (nondiagnostic rate), and number of passes per procedure. Corresponding surgical pathology/flow cytometric/cytogenetic result follow-up was compared to FNA results. Findings between UGFNA and PGFNA cases were compared. RESULTS.­: Of 1029 FNA cases during the study period, there were 449 UGFNA cases (43.6%) and 580 PGFNA cases (56.4%). Nondiagnostic rates with UGFNA and PGFNA were 6.7% (30 of 449 cases) and 20.7% (120 of 580 cases), respectively. Nondiagnostic rate was also significantly lower with UGFNA than with PGFNA for lesions within the thyroid (6.0% versus 33.3%), head and neck (6.6% versus 21.2%), and salivary gland (6.2% versus 17.1%), and across all nodule sizes. A total of 495 of 1029 FNA cases (48.1%) had follow-up. Discordance rate was significantly lower with UGFNA than with PGFNA (5.4% versus 12.8%). CONCLUSIONS.­: This study shows improved performance characteristics of cytopathologist-performed UGFNA versus PGFNA.

Assessment of Changes in Nickel and Chromium Levels in the Gingival Crevicular Fluid during Fixed Orthodontic Treatment.

BACKGROUND: Various components of appliances used in fixed orthodontic treatment are fabricated from materials that are highly resistant in nature and have high strength and biocompatibility. Corrosion of materials occurs inside the oral cavity due to numerous environmental or oral factors that act on them. These factors include temperature, pH variation, salivary conditions, mechanical loads, microbiological and enzymatic activity, and various food components. Gingival crevicular fluid (GCF) is the material obtained from the gingival sulcus and might act as a potential source for various biomarkers in the orthodontic setup because inflammatory-induced response is directly related to orthodontic forces in GCF. In the light of above-mentioned data, we planned this study to assess and evaluate the changes occurring in nickel and chromium levels in the GCF during fixed orthodontic treatment. MATERIALS AND METHODS: This study included assessment of 30 patients who underwent fixed orthodontic treatment. Three samples were taken from the GCF of the patients giving a total of 90 samples. The samples were collected at the following time intervals: At baseline (pretreatment time), 1 month after the start of orthodontic treatment, and at 6 months after the commencement of orthodontic treatment. Cellulose strips were used for isolation of the tooth region. For GCF collection, a standardized cellulose acetate absorbent strip was used. Placement of the strips was done in the sulcus for 60 seconds for the collection of the samples. Refrigeration of the specimen bottles was done for a minimum of 7 days and was then sent to a laboratory where specimens were transferred for atomic absorption spectrophotometry. All the results were analyzed by Statistical Package for the Social Sciences software. RESULTS: At 1 month, the mean value of nickel and chromium in GCF was found to be 4.5 and 4.9 ug/gm of GCF respectively. While comparing the mean nickel levels between 1 and 6 months and between baseline and 6 months, significant results were obtained. Significant results were also obtained while comparing the mean values of chromium in GCF between baseline and 6 months and between 1 and 6 months. Gingival health index of the patients was found to be associated with increased inflammation with the progression of time of orthodontic treatment. CONCLUSION: Levels of nickel and chromium might show considerable elevation in the GCF with time along with an increase in the severity of inflammation in the gingival health in patients undergoing fixed orthodontic treatment. CLINICAL SIGNIFICANCE: Regular oral prophylaxis of the patients undergoing orthodontic treatment should be done to avoid tox-icities caused by the release of nickel and chromium and for maintenance of good oral hygiene and oral health.

Peripheral ossifying fibroma.

Intraoral ossifying fibromas have been described in the literature since the late 1940s. Peripheral ossifying fibroma (POF) is usually a fibroma of the gingival which shows areas of calcification or ossification. It is a nonneoplastic enlargement of gingiva. Due to its clinical and histopathological similarities, some POFs are believed to develop initially as a pyogenic granuloma that undergoes fibrous maturation and subsequent calcification. It has been suggested that POF represents a separate clinical entity rather than a transitional form of pyogenic granuloma or irritation fibroma. This paper describes a case report of a 60-year-old female patient reported with growth on gingiva in the upper left front region of mouth three years ago.

A metatarsal equivalent to the metacarpal index in Marfan syndrome.

BACKGROUND: Foot problems are common in patients with Marfan syndrome because of the ligamentous laxity that affects the weightbearing joints most. Such patients frequently are seen by their general practitioners or podiatrists. Educating primary health care providers about a metatarsal index, if it is sufficiently sensitive and specific, may help patients get early and appropriate workup for connective tissue disorders. METHODS: A metatarsal equivalent to the metacarpal index (MCI) in the hand was evaluated as a diagnostic tool for Marfan syndrome (and possibly other connective tissue disorders). Fifty-six patients were studied. Sixteen had a genetic diagnosis of Marfan syndrome. There were 20 controls each for the MCI and the metatarsal index (MTI). Hand and foot radiographs were reviewed. RESULTS: The average MCI in patients with Marfan syndrome was 9.8 compared to 7.6 in the control group (p < 0.0005). The average MTI was 12.7 and 9.8, respectively (p < 0.0005). An MCI value of 8.5 and an MTI value of 10.5 had the best statistical profiles (combination of sensitivity and specificity) in diagnosing Marfan syndrome in our study population. CONCLUSION: The MTI as a screening tool for Marfan syndrome is as effective as, if not more than, the well-recognized MCI.

Dose-dependent effects of testosterone on regional adipose tissue distribution in healthy young men.

Testosterone supplementation reduces total body adipose tissue (AT), but we do not know whether the effects are uniformly distributed throughout the body or are region specific, or whether they are dose related. We determined the effects of graded doses of testosterone on regional AT distribution in 54 healthy men (18-35 yr) in a 20-wk, randomized, double-blind study of combined treatment with GnRH agonist plus one of five doses (25, 50, 125, 300, or 600 mg/wk) of testosterone enanthate (TE). Total body, appendicular, and trunk AT and lean body mass were measured by dual-energy x-ray absorptiometry, and sc, intermuscular, and intraabdominal AT of the thigh and abdomen were measured by magnetic resonance imaging. Treatment regimens resulted in serum nadir testosterone concentrations ranging from subphysiological to supraphysiological levels. Dose-dependent changes in AT mass were negatively correlated with TE dose at all sites and were equally distributed between the trunk and appendices. The lowest dose was associated with gains in sc, intermuscular, and intraabdominal AT, with the greatest percent increase occurring in the sc stores. At the three highest TE doses, thigh intermuscular AT volume was significantly reduced, with a greater percent loss in intermuscular than sc depots, whereas intraabdominal AT stores remained unchanged. In conclusion, changes in testosterone concentrations in young men are associated with dose-dependent and region-specific changes in AT and lean body mass in the appendices and trunk. Lowering testosterone concentrations below baseline increases sc and deep AT stores in the appendices and abdomen, with a greater percent increase in sc depots. Conversely, elevating testosterone concentrations above baseline induces a greater loss of AT from the smaller, deeper intermuscular stores of the thigh.