Diagnostic approaches in unsuspected oral lesions of syphilis.

Awareness of the increased prevalence of syphilis is essential for early diagnosis and treatment, and to prevent the spread of the disease. Although serological studies are the primary tool used to confirm the diagnosis of secondary syphilis, biopsy of unsuspected oral lesions is not uncommon in the routine oral pathology laboratory. In these cases, histopathological characteristics are likely to indicate the possibility of syphilis, and an immunohistochemical reaction can confirm it. The aim of the present study was to highlight the histological features and test the efficacy of immunohistochemistry in the detection of Treponema pallidum in oral lesions biopsied with the assumption of a non-syphilitic disease. Thirty-nine tissue samples from patients for whom the possibility of syphilis was suggested on the basis of histopathological findings, were retrieved from the surgical oral pathology service files and submitted to immunohistochemical staining for T. pallidum. The study was approved by the institutional ethics committee. Eighteen of the tissue samples were positive for T. pallidum. Following this, the contributing clinicians were contacted to check whether they had asked for serological examinations when the diagnostic report was received; for all 18 positive cases, the clinicians confirmed that the patients had tested positive at that time. This study shows the importance of clinical-pathological correlation and the value of immunohistochemistry in the diagnosis of unsuspected syphilis.

Determinants of variable response to simvastatin treatment: the role of common variants of SCAP, SREBF-1a and SREBF-2 genes.

We investigated the effect of single-nucleotide polymorphisms in sterol regulatory element-binding factors-1a and -2 (SREBF-1a and SREBF-2) and SREBF cleavage-activating protein (SCAP) genes on lipid-lowering response to simvastatin. In all, 146 hypercholesterolemic patients of European descent were prospectively treated with simvastatin 20 mg/day for over 6 months. Of these 99 subjects completed the 6-month follow-up. Plasma lipids and lipoproteins were measured before and throughout the study. The mean percentage decrease in plasma total cholesterol (TC) was greater in subject carriers of SCAP 2386G allele compared with those homozygous for 2386A allele (-29.6+/-13.4 vs -22.1+/-13.8%, P=0.007). About 61% of the 2386G carriers were above-average responders for TC levels (DeltaTC -27.8%), whereas only 29% of 2386A homozygous reached this reduction (P=0.009). Our data suggest that the SCAP 2386A>G gene polymorphism was a significant predictor of TC and triglyceride responses to simvastatin treatment.

Association between -250G/A polymorphism of the hepatic lipase gene promoter and coronary artery disease and HDL-C levels in a Southern Brazilian population.

Hepatic lipase (HL) is a glycoprotein that plays a major role in remodeling high-density lipoprotein (HDL). The effect of the -250G/A promoter polymorphism on coronary artery disease (CAD) and lipid levels was studied in 231 male CAD patients and in a population-based sample of men and women (n = 514). A sample of 140 men was chosen among those included in the population-based sample as controls for the CAD sample. In the total group of CAD patients, the frequency of the -250A allele was somewhat lower (25% in CAD patients and 32% in controls; p = 0.06), but when the control samples were compared only with the CAD(+) sample (more than 60% of luminal stenosis in at least one coronary artery or major branch segment) the -250A allele was significantly less frequent (23% in the patients vs 32% in controls; p = 0.02). A multiple logistic regression analysis showed that this association was independent of classical CAD risk factors [odds ratio (OR) = 1.79, p = 0.025]. Using multiple linear regression analyses, it has been shown that this polymorphism was a significant factor affecting HDL-C levels in men from the population-based sample (p = 0.001), an interaction between -250G/A variant and wine consumption was also detected (p = 0.001). Thus, our results show that the -250G/A polymorphism in the HL gene is associated with significant variations in HDL-C levels and CAD risk in males.

Candida albicans: Frequency and characterization in oral cancer (Stage I) from smokers and drinkers.

The frequency and the biotype of Candida albicans, from patients with epidermoid carcinoma of the oral mucosa (stage I) were evaluated. The patients chosen were habitual drinkers and smokers, aged 34 to 81 years who had not submitted previously to any treatment. They exhibited ulcero-vegetative lesions, mainly on the floor of the mouth, palate and tongue and were classified as stage TNM 100 - TNM 200. Samples from the buccal mucosa were collected for mycological study including: identification of yeasts, serotyping, determination of exo-enzymes as proteinase and phospholipase as well as "killer" assay for biotype characterization. Positive cultives for yeasts were observed in 51.5% of the patients(17/33), being 21.2% represented by C. albicans, all serotype A. The "killer" test demonstrated two different biotypes of C. albicans, namely 211(71.4%) and 611(28.6%), with high levels of proteinase (Prz < 0.30), while phospholipase presented intermediary levels (Pz > 0.29 and =/< 0.69). These data suggested a potentiality to virulence of C. albicans, although did not show an association of a particular biotype with the carcinogenic factors present or with the development of oral epidermoid carcinoma in this initial stage.

Human papilloma virus--its association with epithelial proliferative lesions.

The Papillomaviruses are DNA viruses which belong to the Papova family, having a great affinity for epithelial tissue. They can produce proliferative lesions either in the skin or mucosa, in man and other animals. Various kinds of lesions, mainly benign, are caused by numerous types of HPV involving the well-known verruca vulgaris, oral papilloma, condiloma acuminatum and the focal epithelial hyperplasia, as well as a possible association with other alterations and lesions.