Infant Flow Driver or single prong nasal continuous positive airway pressure: short-term physiological effects

The effectiveness of single prong nasal continuous positive airway pressure (CPAP) was compared with the Infant Flow Driver (IFD) in a crossover study in 20 neonates treated with > or = 30% oxygen by nasal CPAP. They were randomized to the device used at the start of the study. Each infant was studied for four consecutive 2-h periods alternating between single prong nasal CPAP and the IFD. The FiO2 from the IFD read 0.02 higher than the same setting on the ventilators used for single prong nasal CPAP. The IFD improved the mean (95% CI) of the FiO2 by 0.05 (0.02-0.08), p = 0.008. Taking into account the systematic error in the FiO2 between the devices the real mean improvement in FiO2 produced by the IFD was 0.03 (-0.005 to 0.06), p=0.09. There were no significant differences in respiratory rate, heart rate, blood pressure or comfort score of infants during periods of single nasal prong CPAP compared with periods on the IFD.

Softness and potential to cause rebreathing: Differences in bedding used by infants at high and low risk for sudden infant death syndrome

OBJECTIVE

This study was carried out to determine whether bedding used by infants, who are at either high or low risk for sudden infant death syndrome (SIDS), differs in physical properties favoring rebreathing of exhaled gases.

STUDY DESIGN

We compared softness and limitation of carbon dioxide dispersal by bedding, using a mechanical model. A questionnaire was used to describe sociodemographic risk factors and sleep practices; bedding was studied in homes with a model positioned where each infant was found sleeping that morning.

RESULTS

The groups differed with respect to five sociodemographic risk factors (p values all < or = 0.0001). In addition, infants at higher risk were more likely to have been placed to sleep prone (46%, p = 0.02) by parents who were less likely to be aware of the risk associated with the prone position (62% aware, p = 0.005). Infants at higher risk had softer bedding (p < 0.0001, 54.1+/-17.2 cm2 vs 33.7+/-7.7 cm2 in contact with model), which caused more limitation of carbon dioxide dispersal (p = 0.008; CO2 retained, 0.60%+/-0.15% vs 0.34%+/-0.05%).

CONCLUSIONS

A series of infants who are at high risk for SIDS because of sociodemographic factors more often sleep on bedding that has physical properties favoring rebreathing, and their parents are less often aware of the risk associated with prone sleeping.

No health for all without better trained management

This article notes that existing health professionals and managers constitute the first 'generation' working in a world where Health for All is a practical possibility because, if founded on community-based public and primary health care with hospitals in support and good intersectoral help, we now have the appropriate technology, access to finance and adequate numbers of health workers. What we still lack are sufficient health professionals, at all levels, with the managerial skills and experience to apply the technology, generate the funding and motivate the staff; making full use of community involvement, the co-operation of other sectors and good relationships with local and central government. Management can be learned both at the workplace and in the training room, and from the managers a few of them will emerge as leaders, with the vision to secure the willing support of others in reaching worthwhile health goals. A very useful publication is the Training Manual on Management of Human Resources for Health, WHO/EDUC/93.201 from World Health Organisation, Geneva, Switzerland. The paper closes with examples illustrating four principles for health management development: finding key points of entry; reaching large numbers; accelerating national self-sufficiency; and international.

Ectomesenchymal chondromyxoid tumor of the anterior tongue: a report of three cases

Ectomesenchymal chondromyxoid tumor is a newly described benign neoplasm that presents clinically as a firm, painless, slow-growing mass that typically involves the anterior dorsal tongue. It has been reported to occur over a wide age range (9 to 78 years) and has no apparent sex predilection. Histologically, the tumor is composed of a well-circumscribed, unencapsulated lobular proliferation of fusiform and polygonal cells in a chondromyxoid matrix. Features such as multilobulated nuclei, foci of cellular atypia, and infiltration may be present. Though disturbing, these do not appear to indicate malignant behavior. We report three cases of ectomesenchymal chondromyxoid tumors that confirm the previously described clinical, histologic, and immunohistochemical features. In addition, we describe the ultrastructural features of one of the cases.

Human papillomavirus expression in oral mucosa, premalignant conditions, and squamous cell carcinoma: a retrospective review of the literature

OBJECTIVES

The literature of human papillomavirus detection in normal oral mucosa and oral lesions associated with the dysplastic progression of epithelium was reviewed to help define the role of this virus in the development of oral squamous cell carcinoma.

STUDY DESIGN

All available data from published studies were analyzed by chi-square test for association between the human papillomavirus and age, gender, race, DNA type, location, lesional dysplastic progression, method of detection, tissue preservation, and use of tobacco and alcohol.

RESULTS

Human papillomavirus was identified with increasing frequency in normal oral mucosa (13.5%), benign leukoplakia (14.8%), intraepithelial neoplasia (18.5%), squamous carcinoma (26.2%), and verrucous carcinoma (27%). It was detected in oral squamous cell carcinoma significantly (p < 0.005) more often (37.1%; 122 of 329) in studies that used a high sensitivity assay (polymerase chain reaction) than studies that used moderate sensitivity assays (25.2%; 84 of 334) (e.g., Southern blot hybridization) and low sensitivity assays (16.9%; 61 of 362) (e.g., immunohistochemistry, in situ hybridization). Human papillomavirus DNA was detected significantly more often (p < 0.001) in frozen oral squamous cell carcinoma (51.6%; 115 of 223) than paraffin-embedded tissue (21.7%; 136 of 628). High-risk human papillomaviruses (2, 16, 18) were detected in 81.4% of OSCCs that contained the virus compared with low-risk human papillomavirus genotypes (6, 11) in 17.9% of oral squamous cell carcinoma that contained the human papillomavirus (p < 0.001). In studies that analyzed the use of chemical cofactors, the use of tobacco and alcohol (87.3%) was associated more often with oral squamous cell carcinoma than the presence of human papillomavirus (51.3%), however, the difference was not significant.

CONCLUSION

High-risk human papillomavirus genotypes have a significant association with oral squamous cell carcinoma. However, the presence of this virus in a high proportion of oral normal mucosa makes the virus alone a poor prognosticator of progression to malignancy.

A preliminary study of reconstruction of the monkey temporomandibular joint with autogenous tissues

PURPOSE

This study investigated the ability of autogenous pericranium-muscle and cranial bone to restore form and function of the temporomandibular joint (TMJ).

MATERIALS AND METHODS

A right TMJ discectomy, condylectomy, vertical ramus osteotomy with superior repositioning of the proximal fragment, and a cranial bone graft to the mandibular angle were performed in 12 cynomolgus monkeys. Clinical, histologic, and autoradiographic evaluation was done at intervals beginning at 3 days and continuing up to 78 weeks.

RESULTS

No significant postoperative sequela were identified in any of the monkeys. Jaw mobility and function were restored. Gross morphologic condylar changes were observed. The pericranium-muscle grafts did not differentiate into normal disc-like structures and a cartilage cap did not cover the condyle stump head.

CONCLUSIONS

The results of this study suggest that the previous TMJ function was restored. However, the histologic changes observed were consistent with advanced degenerative joint disease.

Estimation of total lung capacity from chest radiography and chest CT in children: comparison with body plethysmography

OBJECTIVE

The purpose of this study was to evaluate two methods of estimating lung volume using chest radiographs and one using chest CT in children. Estimates made with these techniques were compared with total lung capacity calculated with body plethysmography.

MATERIALS AND METHODS

CT scans and posteroanterior and lateral radiographs of the chest were obtained in 21 children (14 girls and seven boys) for follow-up evaluation after lung transplantation. Lung volume was measured by CT using a previously validated technique of tracing the margins of the lungs on each axial CT scan. Two methods were used to estimate lung volume on chest radiographs: a technique previously described in adults and children that requires 21 measurements on posteroanterior and lateral radiographs, and a modification of a simplified technique previously reported in adults that uses only two measurements on a posteroanterior radiograph alone. Estimated lung volumes from CT and from both methods using chest radiographs were compared with total lung capacity determined from body plethysmography using regression analysis, and 95% prediction intervals were generated.

RESULTS

All three methods of estimating lung volumes from radiographs correlated well with total lung capacity from plethysmography (r = .89-.92). However, we found no statistically significant or clinically meaningful difference among the methods of estimating lung volume.

CONCLUSIONS

Lung volumes in children can be accurately estimated from specific measurements made on chest radiographs and on CT scans. Of the two methods tested with chest radiographs, the technique that required only two measurements from a posteroanterior chest radiograph was as accurate as the more complicated technique that required 21 measurements.

Detection of HPV DNA in oral carcinoma using polymerase chain reaction together with in situ hybridization

This study determined the prevalence of human papillomavirus 16/18 DNA in deparaffinized oral carcinoma specimens on slides with the use of the different sensitivities of in situ hybridization and a technique that combines polymerase chain reaction and in situ hybridization. Human papillomavirus DNA was not detected in the 30 biopsy specimens analyzed by in situ hybridization alone using biotinylated DNA probes specific for human papillomavirus 16/18. Twenty of 30 specimens (66.7%) were found to have human papillomavirus DNA (p < 0.001) with the use of the polymerase chain reaction-in situ hybridization technique. Human papillomavirus 16 was detected in 18 of 26 specimens (69.2%), and 7 of 25 carcinomas (28%) were found to contain human papillomavirus 18. Dual infections were present in 5 of 21 (23.8%) specimens. Human papillomavirus DNA was more prevalent in men (75%) than women (57.1%). However, there was no difference in the mean age of patients with oral carcinoma (men, 67.8 years; women, 67.5 years) who had human papillomavirus and those who did not (67.2 years). Carcinomas associated with dual infections occurred at a lower mean age (59.4 years) than those associated with a single human papillomavirus type (p < 0.005). We conclude that the polymerase chain reaction-in situ hybridization technique enhances our ability to demonstrate human papillomavirus types highly associated with oral squamous cell carcinoma.

In situ hybridization analysis of human papillomavirus in orofacial lesions using a consensus biotinylated probe

The effectiveness of the Viratype Omniprobe in situ human papillomavirus tissue hybridization kit (Digene Diagnostics) was evaluated for the detection of HPV DNA in common orofacial lesions. Seventy mucocutaneous lesions were hybridized with a biotinylated Omniprobe that was specific for HPV types 6, 11, 16, 18, 31, 33, 35, 42, 43, 44, 45, 51, 52, and 56. Eighteen (25.7%) of the specimens analyzed had intranuclear positive signals for HPV. Probing with HPV 6/11, 16/18, and 31/33/35 to delimit the HPV genotype yielded HPV DNA 6/11 in 16 (88.9%) of the Omniprobe-positive specimens. Only squamous papilloma and condyloma acuminatum were found to harbor HPV DNA. Sites most frequently infected were the labial and buccal mucosa (21.7%) and the floor of the mouth (17.4%). These results suggest that hybridization with the Omniprobe provides appropriate sensitivity and specificity for detecting HPV in some benign proliferations of the oral cavity. However, the detection of HPV in oral squamous cell carcinoma, lichen planus, and keratoacanthoma remains problematic until more sensitive and specific molecular techniques are used.

Tolerance, withdrawal, and supersensitivity to dopamine mediated cues in a drug-drug discrimination

Rats were trained to discriminate between 0.25 mg/kg amphetamine (AMPH) and 0.03 mg/kg haloperidol (HAL) in a two-lever drug discrimination task. In order to test for a drug-induced withdrawal state, animals were assigned to one of three chronic treatment groups and given injections of AMPH, HAL, or distilled water (DW) for 10 consecutive days. Subjects from each treatment condition were then tested at 24, 48, or 72 h after the final injection. At the 24 h retest interval, subjects injected with AMPH responded as though administered an acute dose of HAL (0.028 mg/kg) and subjects injected with chronic HAL responded as though administered an acute dose of AMPH (0.15 mg/kg). By 72 h choice behavior had returned to pretreatment values. To determine whether the rebound observed after 10 days of drug treatment was present after a single injection, independent groups of subjects were injected with single doses of either 10 mg/kg AMPH or 1.0 mg/kg HAL and then retested from 4 h to 48 h later. Single doses of both AMPH and HAL produced significant rebounds that peaked between 20 h (AMPH) and 24 h (HAL) following administration. In a third experiment, animals were tested with or without acute doses of drug following pretreatment with either HAL or AMPH. Receptor supersensitivity accounts for the tolerance observed to HAL 24 h after treatment with 1.0 mg/kg HAL, whereas receptor subsensitivity accounts for the tolerance observed 20 h after treatment with 10 mg/kg AMPH.

Intraoral sebaceous carcinoma

An instance of sebaceous carcinoma that presented as a mass in the left buccal mucosa is described. This is the first known report in the English-language literature of a sebaceous carcinoma presenting as an intraoral tumor. The light and electron microscopic findings are described. The histologic differential diagnosis, clinical behavior, and appropriate therapy are discussed. Previously reported intraoral sebaceous neoplasms and sebaceous carcinomas of the parotid are reviewed.

In situ detection of HPV DNA in oral mucosal lesions. A comparison of two hybridization kits

The purpose of this study was to compare the sensitivity of ViraType in situ hybridization kit (Life Technologies, Inc. [LT] and PathoGene (Enzo Diagnostics, Inc. [ED]) in situ hybridization kit for human papillomavirus (HPV) DNA detection in oral tissue. Forty benign oral lesions histologically suspicious for HPV infection were analyzed. Specimens were hybridized with DNA probes specific for HPV types 6/11, 16/18, and 31/33/35 [LT] and HPV types 6/11, 16/18, and 31/33/51 [ED]. Positive hybridization reactions were seen for HPV DNA type 6/11 only. Hybridization occurred significantly more often (p less than 0.01, McNemar Exact Test) in LT probed specimens (20/40) than ED assayed sections (12/40). HPV DNA sequences were found in 100% condyloma acuminata (13/13), 100% verruca vulgaris (4/4), and 13% squamous papilloma (3/23) using the LT system. The ED probes yielded positive signals in 77% condyloma acuminata (10/13), 25% verruca vulgaris (1/4), and 4.4% squamous papilloma (1/23). A more intense hybridization signal was exhibited using the LT system. The results indicate that the LT probes and detection reagents are more sensitive for detecting HPV DNA in oral mucosal specimens.

In situ hybridization analysis of human papillomavirus DNA in oral mucosal lesions

Commercial biotinylated DNA probes specific for human papillomavirus (HPV) types 6 and 11; 16 and 18; and 31, 33, and 35 were used for in situ hybridization analysis of 105 oral mucosal specimens from 5 cases of verruca vulgaris, 15 cases of condyloma acuminatum, 30 cases of squamous papilloma, 20 cases of hyperkeratosis/acanthosis, 15 cases of epithelial dysplasia, 5 cases of carcinoma in situ, and 15 cases of squamous cell carcinoma. Positive hybridization signals were found in 26 specimens (24.8%). Only HPV-6/11 was detected. HPV DNA occurred significantly more often (p less than 0.005, chi-square analysis) in condyloma acuminatum (100%) and verruca vulgaris (100%) than squamous papilloma (13.3%), hyperkeratotic/acanthotic lesions (10%), and malignant and premalignant lesions (0%). The tongue (19.1%) and labial epithelium (17.1%) were infected most frequently. Nuclear reaction products indicating HPV infection were associated primarily with koilocytes. These results demonstrate the usefulness of commercial biotinylated probes for HPV DNA analysis in routine paraffin-embedded lesion specimens. They confirm HPV involvement in benign lesions of the oral mucosa but fail to associate HPV infection with oral cancer and precancer.

Verruciform xanthoma within carcinoma in situ

This report describes an unusual case of verruciform xanthoma of the posterior floor of the mouth that occurred within carcinoma in situ. The significance of this case is described in light of current theories on the etiology and management of verruciform xanthoma.

Benign solid oncocytoma of intraoral minor salivary glands

We present an example of an intraoral benign solid oncocytoma of minor salivary gland origin. A review of intraoral benign solid oncocytomas reported in the English-language literature and discussion of the clinical behavior of these tumors are included.

Healing following condylar shave in the monkey temporomandibular joint

Condylar shaves were performed in monkeys, and the reparative process was studied by histologic and autoradiographic techniques. The condylar surface was found to repair mainly with fibrous connective tissue produced by cells derived from the underlying marrow spaces. The residual condylar cartilage did not play a significant role in this process.

Dentinal candidiasis in cancer patients

Two examples of an unusual presentation of oropharyngeal candidiasis in cancer patients are offered. The light and scanning electron microscopic appearances of candidiasis involving the dentin of teeth are described. The potential significance of recognition of this form of candidiasis in cancer patients is discussed.

Healing following conventional and cryosurgical discoplasty in the monkey temporomandibular joint

The techniques of conventional discoplasty and the scar producing potential of cryosurgical treatment of the bilaminar region were examined in a study of 17 adult female cynomologous monkeys. Temporomandibular joint (TMJ) tissues were obtained at four and 10 days, four, 20, 52, and 78 weeks after surgery, and compared to TMJ tissues in unoperated control animals. No clinically observable changes in weight, occlusion, or jaw function were identified. All the surgical sites healed normally. At necropsy, lesions of the articular surface of the condyle were apparent in areas that had been surgically "shaved." The anterior, intermediate, and posterior zones of the surgically-treated discs were generally free of change. Two cryosurgically-treated discs showed lesions and perforations. Histologic and autoradiographic observations suggested that the bilaminar area heals quickly with minimal scarring, following both conventional surgical manipulation and cryosurgery. Under the conditions of this experiment the cryosurgical technique was judged not to be superior to the conventional surgical approach.

Freeze treatment of the monkey mandibular condyle

Monkey mandibular condyles were frozen in situ and subsequently examined clinically and histologically. The frozen bone served as a structural matrix for the formation of new, vital bone. No ankylosis, open-bite deformity or loss of function was observed.

Chondromyxoid fibroma of the maxilla. Electron microscopic findings and review of the literature

A case of chondromyxoid fibroma of the anterior maxilla is presented. The light and electron microscopic appearances of this tumor are described. A review of chondromyxoid fibromas of the jaws is performed, with a discussion of the appropriate therapy.

Megaloblastic anemia with oral lesions: a consequence of gastric bypass surgery

This report describes the clinical and histologic features of a case of megaloblastic anemia, resulting from a gastric bypass operation, in which oral symptoms were the first significant finding. Although this case appears to be the first of its type reported in the literature, the potential for future cases is increasing with the increased use of the gastric bypass operation in the treatment of morbid obesity.

Mycosis fungoides: initial diagnosis via palatal biopsy with discussion of diagnostic advantages of plastic embedding

The authors present an example of mycosis fungoides which was initially diagnosed from a palatal biopsy. The distinctive nuclear morphology of the tumor cells, with a discussion of their diagnostic importance, is presented. The advantages of plastic-embedded formalin-fixed tissue are delineated.

The lateral periodontal cyst. A report of 37 cases

The lateral periodontal cyst is a developmental cyst of odontogenic origin which is located along the lateral aspect of a tooth root. Thirty-seven previously unreported lateral periodontal cysts ( LPCs ) are presented. Clinical, roentgenographic and histologic features of the LPC are reviewed. Further, the importance of distinguishing the developmental LPC from laterally positioned inflammatory cysts of pulpal or periodontal disease origin and laterally occurring odontogenic keratocysts is stressed.