Alberto Rodríguez-Archilla

Importance of tumour thickness measurement in prognosis of tongue cancer

Eighty-one patients who underwent surgery for cancer of the tongue were retrospectively studied to evaluate the influence on survival of some clinical and pathologic parameters. These parameters and data on the patients current status were gathered by the study of tissue sections, using haematoxylin-eosin staining, and from medical records. The 5-year survival rate was 68.5%. Univariate analysis showed that the parameters influencing survival were: T (P<0.01), pathologic T (P<0.01), N (P<0.05), pathologic N (P<0.05), extracapsular nodal spread (P<0.05), locoregional recurrence (P<0.01), and tumour thickness (P<0.05). Multivariate analysis showed that tumour thickness had the greatest influence on survival. Patients with tumour thickness of < or = 3 mm had a 5-year survival of 85.7%, significantly greater (P<0.05) than the rates of 58.3 and 57% for patients with tumour thickness of 4-7 mm and >7 mm, respectively. Wider studies are required to unify criteria for the measurement of this important prognostic parameter.

Epstein-Barr virus latent membrane protein-1 (LMP-1) expression in oral squamous cell carcinoma.

Objectives Epstein‐Barr virus (EBV) is frequently associated with malignant cell transformation through the action of the oncoprotein latent membrane protein‐1 (LMP‐1). The present study aimed to determine the presence of EBV in oral squamous cell carcinomas (OSCCs) and the expression of LMP‐1 in neoplastic cells of EBV‐positive OSCCs.

Antimicrobial substantivity over time of chlorhexidine and cetrimide.

INTRODUCTION To reach an adequate control of dentin infection and to promote success in endodontic therapy, antimicrobial irrigating solutions with confirmed substantivity are recommended. The aim of the present study was to evaluate the antimicrobial substantivity against Enterococcus faecalis of a dentin-volumetric unit exposed for 1 minute to chlorhexidine (CHX) and cetrimide (CTR). METHODS Standardized coronal dentin blocks of human molars, with and without collagen, were treated for 1 minute with 0.2% and 2% CHX and 0.2% CTR. Afterwards, they were exposed to E. faecalis suspension to determine the antimicrobial substantivity over a period of 60 days. Results were analyzed by means of Kaplan-Meier survival analysis (P < .05). RESULTS A direct relationship was seen between CHX concentration and survival time, and the most statistically significant results were obtained in specimens with collagen. CTR showed intermediate survival values close to those of 2% CHX. CONCLUSIONS The present study shows that 2% CHX used for 1 minute provides the longest substantivity followed by 0.2% CTR when applied to a dentin-volumetric model.

Antimicrobial activity of alexidine alone and associated with N-acetylcysteine against Enterococcus faecalis biofilm

The purpose of this study was to assess the efficacy of alexidine (ALX), alone and combined with N-acetylcysteine (NAC), in eradicating two Enterococcus faecalis strain biofilms. The biofilms of E. faecalis ATCC 29212 and the clinical isolate E. faecalis D1 were grown in the MBEC-high-throughput device for 24 h and were exposed to five twofold dilutions of ALX (2%–0.007 8%) alone and combined with 100 mg⋅mL−1 NAC, for 1 and 5 min. Eradication was defined as 100% kill of biofilm bacteria. The Student’s t-test was used to compare the efficacy of the associations of the two irrigants. After 1-min contact time, ALX eradicated the biofilms at all concentrations except for 0.007 8% and 0.015 6%–0.007 8% with E. faecalis ATCC 29212 and E. faecalis D1, respectively. Similar results for eradication and concentration were obtained when it was combined with 100 mg⋅mL−1 NAC. After 5 min of contact time, ALX alone and combined with NAC eradicated all enterococci biofilms. ALX showed antimicrobial properties against the two E. faecalis strain biofilms tested at very low concentrations, and its combined use with NAC was not seen to enhance its activity.

Denture stomatitis: Quantification of interleukin-2 production by mononuclear blood cells cultured with Candida albicans

Denture stomatitis is usually associated with the presence of yeast, particularly Candida albicans, and several bacteria. In this study mononuclear blood cells were grown in the presence of Candida albicans from a single colony, and interleukin-2 production induced in T lymphocytes was measured. Blood cells were from a population of patients with denture stomatitis and a control group of denture wearers without stomatitis. Induction of interleukin-2 production was correlated with factors that condition denture stomatitis, namely, isolation of Candida albicans in selective medium, age of the denture, and diabetes. Concentrations of interleukin-2 in supernatant and serum were also compared. Significant differences in interleukin-2 production were found between patients with denture stomatitis and controls. Statistical analysis demonstrated a significant association between isolation of Candida albicans and elevated interleukin-2 production in cultures from patients with and without denture stomatitis.

Antimicrobial residual effects of irrigation regimens with maleic acid in infected root canals

BackgroundThe success of endodontic treatment depends largely on the control of microorganisms present in infected root canals. The aim of this study was to determine the residual antimicrobial activity of several final irrigation protocols with 7% maleic acid (MA) alone and combined with chlorhexidine (CHX), cetrimide (CTR) or both, in root canals infected with Enterococcus faecalis. Biofilms of E. faecalis were grown in uniradicular roots for 4 weeks. A total of 72 specimens were divided into 5 experimental groups according to the final irrigation regime used: Group 1: 2.5% NaOCl; Group 2: 7% MA; Group 3: 7% MA + 0.2% CTR; Group 4: 7% MA + 2% CHX; Group 5: 7% MA + 0.2% CTR + 2% CHX; and Control group: 0.9% saline solution. Twelve roots (2/group) that were instrumented and not infected served as negative or sterility controls. The proportion of ungrown samples over 60 days was evaluated using non-parametric Kaplan-Meier survival analysis. Differences among groups were tested using the log-rank test (p< 0.05).ResultsThe association of MA with CHX and CHX + CTR as final irrigating solutions showed the best results, 5 and 4 samples out of 12, respectively, and without differences between them (p = 0.928), followed by 7% MA + 0.2% CTR with 7 out of 12. The 7% MA (11/12) group showed significant differences with respect to the groups in which MA was combined with CHX (p < 0.005) and CHX + CTR (p < 0.005).ConclusionFinal irrigating solutions of 7% MA combined with 2% CHX or 2% CHX + 0.2% CTR were found to effectively improve antimicrobial root canal disinfection.

Significance of p53 expression in non-tumoral epithelium adjacent to oral squamous cell carcinomas

Alterations of the p53 gene are the most frequently documented genetic abnormalities in human cancer. The aim of the present study was to analyse if this alteration is an early event in oral tumorigenesis and if the suprabasal expression of p53 is a marker of the presence and severity of epithelial dysplasia. Immunohistochemical p53 expression in 78 specimens of oral squamous cell carcinoma and non-tumoral adjacent epithelium was analysed. Non-tumoral epithelium was observed in 53 cases (67.9 per cent), being normal in six cases (7.6 per cent), hyperplastic in 24 cases (30.7 per cent) and dysplastic in 48 cases (61.5 per cent). Epithelial dysplasia was mild (23 cases, 47.9 per cent); moderate (23 cases, 47.9 per cent) and severe (two cases, 4.1 per cent). Twenty-one cases of the dysplasias (43.8 per cent) expressed p53. No p53 expression appeared in any normal epithelium. Basal p53 expression always appeared in mild dysplasias (two cases). Suprabasal p53 expression appeared in mild and moderate dysplasias in nine cases and in one severe dysplasia. No statistical correlation was observed between suprabasal expression of p53 and the presence or severity of the dysplasia. The expression of p53 is an early event in oral tumorigenesis but it does not behave as an objective marker of the presence or severity of epithelial dysplasia.

p16 Expression in Squamous Carcinomas of the Tongue

Background: 81 patients with tongue carcinomas were studied to determine: 1) the proportion of carcinomas with altered p16 expression; 2) whether loss of p16 is an early carcinogenic event; 3) whether p16 expression alterations influence the prognosis. Methods: 50/81 cases could be analysed by immunohistochemistry. Results: Tumours were p16– in 32% (16/50) and p16+ in 68% (34/50) of patients; 32.3% (11/34) of p16+ tumours presented 1–10% of tumour cells as positive, 14.7% (5/34) 11–40% as positive, and 59.2% (18/34) presented 41–100% of tumour cells as positive. Adjacent nontumoural epithelium (ANTE) was available in 33 of the 50 immunohistochemically analysed specimens. ANTE was normal in 25 cases and dysplastic in 8 cases. In normal ANTE, p16 expression was positive in 16% (4/25) and negative in 84% (21/25) of cases. p16 expression was negative in all dysplastic ANTE samples (8/8). Conclusions: Changes in p16 expression are frequent in tongue cancer and can be detected at very early stages of carcinogenesis. Nevertheless, in our study neither the absence nor the degree of p16 expression influenced the survival of patients.

Basal cell carcinoma arising in professional radiodermatitis of the nail

SIR, The ichthyoses are a heterogeneous group of skin disorders of epidermal differentiation, with both inherited and acquired forms. This cornification disorder may be found isolated or in association with other genetic defects. In 1998, five siblings with congenital ichthyosis, follicular atrophoderma, hypotrichosis and hypohidrosis were described as a new genodermatosis by Lestringant et al. We report a 17-year-old Turkish patient with ichthyosis vulgaris, follicular atrophoderma, woolly hair and hypotrichosis as a second report on this syndrome. A 17-year-old-girl was admitted to our hospital because of woolly hair, sparse eyelashes and eyebrows, and a very dry skin. She was born at term after an uncomplicated pregnancy. Ichthyosis and baldness were present at birth, but there was no history of a collodion baby. She had almost no scalp hair until she was 4 months old. In the early childhood period, funnel-shaped round follicular depressions had appeared on the dorsal aspects of the hands. She stated that her scalp hair had improved and straightened with age. The patient was otherwise healthy and detailed ophthalmological, neurological and audiometric examinations were normal. There was no history of atopy. There was no family history of similar skin problems. Both her parents and paternal grandparents were first cousins. There was no maternal history of drug intake during pregnancy. On examination, there was diffuse ichthyosiform scaling sparing the major flexures and face as in ichthyosis vulgaris (Fig. 1). The ichthyotic skin was hypohydrotic but the axilla, palms and soles sweated normally. Follicular atrophoderma was observed on the backs of her hands (Fig. 2). She had diffuse and patchy non-scarring hypotrichosis with a receding frontal hairline. Her hair was normal in length, but was light brown in colour, coarse, curly and unruly, in contrast to the straight black hair of the rest of her family. Eyelashes and particularly eyebrows were sparse (Figs 3–4). Routine haematological, biochemical, immunological, thyroid and radiological investigations were normal. Osteopoikilosis was not present on the X-rays. Echocardiography and ECG were normal. Hair microscopy was normal apart from curling. Biopsy from ichthyotic skin showed orthokeratosis with focal hypogranulosis (Fig. 5). Electron microcopy showed normal tonofilaments. Based on clinical and laboratory findings a diagnosis of ichthyosis vulgaris associated with follicular atrophoderma, hypotrichosis and woolly hair was made. The patient was prescribed 10% urea cream and salicylic acid ointments. The ichthyotic lesions resolved within a few weeks. Ichthyosis is a feature of several genetic disorders. These are rare disorders and the associated ichthyosis may be mild. The following syndromes with ichthyosis may be considered

Dental extraction in patients receiving dual antiplatelet therapy.

Background Dual anti platelet therapy consists of administering antiplatelet (antiaggregant) drugs (clopidogrel and aspirin) to prevent thrombotic processes, as a preventative measure in patients with acute coronary disease, or in patients subjected to percutaneous coronary intervention. Objectives The purpose of this study was to evaluate the efficacy of a protocol for performing dental extraction in patients receiving dual anti platelet therapy. Material and Methods Thirty-two patients undergoing dental extractions were included in the study. The variables evaluated were: collagen-epinephrine fraction, collagen- adenosine diphosphate fraction, surgical surface, post-surgical measures, and adverse effects. Alveolar sutures and gauzes impregnated with an antifibrinolytic agent (tranexamic acid), which the patient pressed in place for 30 minutes, were applied to all patients as post-surgical measures. Descriptive statistics were calculated and analyzed with Student’s t-test to compare pairs of quantitative variables; simple regression analysis was performed using Pearson’s correlation coefficient. Statistical significance was set at p<0.05. Results Collagen/epinephrine fraction was 264.53±55.624 seconds with a range of 135 to 300 seconds, and collagen/ADP fraction was 119.41±44.216 seconds, both values being higher than normal. As a result of the post-surgical measures taken, no patients presented postoperative bleeding, hematoma or infection. Conclusions Dental extraction was safe for patients receiving dual anti-platelet therapy when using sutures and gauze impregnated with tranexamic acid, which the patient pressed in place for 30 minutes. Key words: Aspirin, clopidogrel, tranexamic acid, dental extraction, platelet function.