Pieter J. Kostense

Effect of chemotherapy on survival of craniofacial osteosarcoma: a systematic review of 201 patients.

PURPOSEnTo evaluate the possible value of chemotherapy in the treatment of craniofacial osteosarcoma (CFOS).nnnDESIGNnIn a systematic review, data of 201 patients (age, 36.6 +/- 19.0 years [mean +/- SD]) from 20 uncontrolled series on CFOS indexed in Medline and Excerpta Medica between 1974 and 1994 were pooled; 180 patients had undergone surgery. Various chemotherapy regimens had been given to 71 patients. Radiotherapy was used in 69 patients. All patients had data for overall survival, and 182 had data for disease-free survival analysis. Cumulative survival distributions were estimated by the product-limit method, and a multiple regression analysis was performed.nnnRESULTSnPatients overall and disease-free survival rates were significantly improved by treatment with chemotherapy. This was confirmed for patients with complete surgical removal, as well as for those with incomplete removal of tumor. In a proportional hazards model, complete surgical removal and chemotherapy were independent significant factors for overall and disease-free survival. The effect of radiotherapy was insignificant. No prognostic factors could be identified among age groups, sex, and subsites.nnnCONCLUSIONnEvidence exists that chemotherapy improves survival in CFOS. We advocate the adoption of the chemotherapy protocols used for OS of the long bones for CFOS.

Fluocinonide in an adhesive base for treatment of oral lichen planus: A double-blind, placebo-controlled clinical study

Patients with symptomatic oral lichen planus frequently require therapy to reduce signs and symptoms. For this purpose, corticosteroids are often applied topically. In a randomized, double-blind, placebo-controlled study, the efficacy of the topical application of 0.025% fluocinonide was evaluated. Forty consecutive patients with oral lichen planus diagnosed on the basis of histopathologic and immunofluorescence findings participated in this study. All patients were followed for 3 to 17 months. No adverse effects were noted during follow-up period. In the group of 20 patients that received the drug, 4 patients (20%) showed a complete remission, and 12 patients (60%) had a good or partial response to topical treatment. In the placebo-group, these figures were 0 and 6 (30%), respectively. The majority of the placebo-group (70%) did not respond at all with regard to signs (Xt2 = 10.4; p = 0.0013) and symptoms (Xt2 = 6.97, p = 0.008). The results from this study suggest that topical application of fluocinonide in an adhesive base is a safe and effective drug to reduce signs and symptoms in oral lichen planus.

Second respiratory and upper digestive tract cancer following oral squamous cell carcinoma.

727 patients with squamous cell carcinoma (SCC) of the lip and oral cavity have been followed for the occurrence of second primary tumours (SPTs) in the respiratory and upper digestive tract (RUDT). 74 patients (10%) developed at least one SPT in the RUDT. The incidence of SPTs was expressed per 1000 person-years of follow-up. In our study about 28 SPTs per 1000 person-years of follow-up were seen in the RUDT. Patients were at risk for a second primary tumour, at a steady rate of approximately 2.8% per year during at least 10 years. Furthermore, patients with an index tumour in the lower part of the mouth (floor of mouth, retromolar area and lower alveolar process), which is more related to tobacco and/or alcohol, seem to be more at risk for SPTs than patients with an index tumour in the other (sub)sites of the mouth.

Preoperative antibiotic prophylaxis in orthognathic surgery: a randomized, double-blind, and placebo-controlled clinical study.

PURPOSEnThis study evaluated the need for antibiotic prophylaxis in orthognathic surgery.nnnPATIENTS AND METHODSnFifty-four patients (age range, 18 to 40 years) underwent bimaxillary orthognatic surgery. After randomization, a placebo (n = 19), 2,200 mg amoxicillin-clavulanic acid (n = 18), or 1,500 mg cefuroxime (n = 17) was administered in a double-blind fashion. During the first month, the postoperative course was observed according to the clinical parameters of infection, total leukocyte count and erythrocyte sedimentation rate (ESR).nnnRESULTSnFifteen of 54 patients developed a wound infection. Of these, 10 had received a placebo; 3, cefuroxime; and 2, amoxicillin-clavulanic acid.nnnCONCLUSIONSnThere was a statistically significant (P<.004) increased risk of having an infectious complication after bimaxillary orthognathic surgery without antibiotic prophylaxis. No significant difference in the incidence of infectious complications was found between the 2 medications.

Clinical significance of pepsinogen A isozymogens, serum pepsinogen A and C levels, and serum gastrin levels

Gastric mucosal pepsinogen A phenotype, serum pepsinogen A level, serum pepsinogen C level, serum pepsinogen A/pepsinogen C ratio, and serum gastrin level were evaluated as potential markers for gastric cancer or its precursors in 19 healthy volunteers and 341 patients from the gastroscopy program. Gastric cancer, atrophic gastritis, and intestinal metaplasia of the stomach were associated with pepsinogen A phenotypes, characterized by an intense fraction 5, and with a low serum pepsinogen A level (<25 μg/l), a low serum pepsinogen A/pepsinogen C ration (<1.5), and a high serum gastrin level (> 79 ng/l). The specificity of pepsinogen A phenotypes with an intense fraction 5 for gastric cancer or its precursors was 95.1% with a sensitivity of 20.4%. The sensitivity and specificity of the noninvasive tests were evaluated with the receiver operating characteristic. For clinical purposes, a serum pepsinogen A/pepsinogen C ration less than 1.8 is the most suitable test, with a sensitivity of 74% and a specificity of 76% for gastric cancer or its precursors, with a reference population of patients with benign gastric disorders. However, the sensitivity and specificity of the single or combined tests are too low for population screening purposes. Cancer 59:952‐958, 1987.

Delay in diagnosis of oral squamous cell carcinoma; A report from The Netherlands

The referral pattern, patients and doctors delay of a limited number of 50 patients suffering from oral squamous cell carcinoma have been investigated. The majority of the patients consulted the family doctor as the first source of help. The mean patients and doctors delay was 103 and 22 days, respectively the median being 35 and 11 days, respectively. The gender, dental status, site and tumour size did not show a significant correlation with the delay. Measures directed to the early detection of oral cancer should place special emphasis on the patients delay.

Erythrocyte superoxide dismutase deficiency in Fanconi's anaemia established by two independent methods of assay.

Erythrocyte superoxide dismutase (SOD; E.C.1.15.1.1) levels were quantitated in human haemolysates, both by an immunological technique and by an activity assay. The erythrocyte SOD activity level in a group of seven Fanconis anaemia patients was significantly decreased (27%, on the average) compared to a control group of nineteen healthy individuals. The fact that both the activity per antigenic unit and the electrophoretic mobility of the erythrocyte SOD was normal indicates that the deficiency in these Fanconis anaemia patients is most probably not due to a mutation in the structural gene for the enzyme but more likely due to a disturbed mechanism regulating the SOD level in the erythrocyte.

Squamous cell carcinoma of the lip and oral cavity in the netherlands; an epidemiological study of 740 patients

The epidemiological data of 740 patients with primary squamous cell carcinoma (SCC) of the lips or oral cavity is reported. The mean age was 63 years. The mean onset of oral cancer in women was 7 years later than in men. Patients under the age of 40 years were mainly males. The male-to-female ratio ranged from 8.3 for the lower lip to 0.9 for the upper alveolar ridge with an overall ratio of 1.8. In the case of multiple oral SCCs the tongue was the most frequently affected site. No significant association was found between the age or gender of patients and the size of the tumour. However, a significant association was observed between the site and size of the tumour. Lesions of the lower lip had a significantly smaller size than tumours of other sites. Furthermore, a linear trend could be observed between the size of the tumour and the clinical stage of the neck.

A comparative in vitro study on fixation of sagittal split osteotomies with Würzburg screws, Champy miniplates, and Biofix (biodegradable) rods.

A bilateral sagittal split osteotomy was performed on seven fresh cadaver mandibles. Three different systems of fixation were mechanically tested on 14 sites. Tensile diagrams were obtained in which the (offset-) yield point was measured. This resulted in mean yield stresses of 199 N for bi-cortical self-tapping screws (n = 6), 49 N for miniplates with monocortical screws (n = 5), and 113 N for bi-cortical biodegradable rods (n = 3).

Enzyme-linked immunosorbent assay and radioimmunoassay of serum pepsinogen A.

The determination of serum pepsinogen A (= pepsinogen I) levels is of clinical importance in the study of duodenal ulcer, atrophic gastritis and gastric cancer. In the present study two different quantitative immunological techniques for serum pepsinogen A were compared: a radioimmunoassay (RIA) (Helsinki) and an enzyme-linked immunosorbent assay (ELISA) (Amsterdam). Serum samples of 177 subjects with various gastric diseases were tested in a double blind study. The correlation was excellent (r = 0.954 in the range 0-760 micrograms/l and r = 0.971 in the range 0-100 micrograms/l). The functional relationship between ELISA (x) and RIA (y), determined by weighted model II regression, was y = 1.12x-0.54. Initially the use of goat anti-PGA in the ELISA resulted in falsely high values in about 10% of the individuals. This was caused by circulating antibodies cross-reacting with goat IgG. This artefact was eliminated by pre-incubation of all samples with non-immune goat serum.