Early clinical diagnosis of solitary plasmacytoma of the jaws: a case report with a six year follow-up

The authors reported a case of a solitary mandibular plasmacytoma in a 53-year-old male Caucasian patient. The histological examination of the specimen was positive for a plasmacytoma with anaplastic appearance. Since the patient refused a demolitive surgical treatment, he was treated with a local radiation therapy of 4000 rads over a 20-day period and polychemotherapy with cyclophosphamide, prednisone and melphalan. Six years after starting radiation treatment the patient is free of recurrent primary disease and not affected by multiple localization. In conclusion, the solitary bone plasmacytoma represents an initial stage of the multiple myeloma rather than a distinct clinical pathology. Unfortunately, the diagnosis of the plasmacytoma is only rarely carried out in the early phases of the disease. The importance of the identification of the initial stage without a clear M component, as in the reported case, is self-evident, since the prognosis is related to the mass of plasmacytoma cells that are present at the time of the diagnosis. The purpose of this study is to report an extremely rare case of solitary bone plasmacytoma with a mandibular localization treated with radio- and polychemotherapy.

The treatment of oral aphthous ulceration or erosive lichen planus with topical clobetasol propionate in three preparations: a clinical and pilot study on 54 patients

BACKGROUND

This study evaluated the clinical use of a corticosteroid in three preparations (topical clobetasol propionate ointment, clobetasol propionate in an oral analgesic base, and clobetasol propionate in an adhesive denture paste).

METHODS

Fifty-four patients (34 males and 20 females) with a history of vesiculo-ulcero-erosive oral lesions were selected: 24 with oral erosive lichen planus and 30 with aphthae. The subjects enrolled were randomly divided into three groups, each of 18 patients (10 with aphthae and 8 with lichen planus): the first was treated with topical clobetasol propionate ointment (0.05%) directly on the lesion(s) three times a day; the second with clobetasol propionate in an adhesive denture paste in equal amounts (1:1) two times a day; the third with clobetasol propionate in an oral analgesic base (Orabase-B) in equal amounts (1:1) two times a day. Each subject scored his or her symptoms daily from most severe (7) to none (0) by verbal assessments using a categorical scale.

RESULTS

In all cases, the administration of the corticosteroid was effective in producing remission of symptoms in each group of patients. Significant differences (P<0.05) between groups were determined by the Kruskal-Wallis test. The Dunn test was used in order to detect which group differs from the others; clobetasol and adhesive denture paste correlated with an early remission of pain in lichen and apthous lesions.

CONCLUSION

The results suggest that topical application of clobetasol in an adhesive denture paste is an effective drug for symptomatic oral vesiculo-erosive and/or ulcerative lesions.

Brain electrical microstates in subjects with panic disorder

Brain electrical microstates represent spatial configurations of scalp recorded brain electrical activity and are considered to be the basic elements of stepwise processing of information in the brain. In the present study, the hypothesis of a temporo-limbic dysfunction in panic disorder (PD) was tested by investigating the topographic descriptors of brain microstates, in particular the one corresponding to the Late Positive Complex (LPC), an event-related potential (ERP) component with generators in these regions. ERPs were recorded in PD patients and matched healthy subjects during a target detection task, in a central (CC) and a lateral condition (LC). In the CC, a leftward shift of the LPC microstate positive centroid was observed in the patients with PD versus the healthy control subjects. In the LC, the topographic descriptor of the first microstate showed a rightward shift, while those of both the second and the fourth microstate, corresponding to the LPC, revealed a leftward shift in the PD patients versus the healthy control subjects. These findings indicate an overactivation of the right hemisphere networks involved in early visual processing and a hypoactivation of the right hemisphere circuits involved in LPC generators in PD. In line with this interpretation, the abnormal topography of the LPC microstate, observed in the CC, was associated with a worse performance on a test exploring right temporo-hippocampal functioning. Topographical abnormalities found for the LPC microstate in the LC were associated with a higher number of panic attacks, suggesting a pathogenetic role of the right temporo-hippocampal dysfunction in PD.

Reliability and validity of the DSM-IV diagnostic category of schizoaffective disorder: preliminary data

BACKGROUND

Concerns have been expressed about the reliability and validity of the DSM-IV criteria for schizoaffective disorder, but no systematic study has been published up to now.

METHODS

The Cohen's kappa for the individual items of the DSM-IV definition of schizoaffective disorder, manic episode and major depressive episode was evaluated in 150 patients independently interviewed by two psychiatrists using the Composite International Diagnostic Interview. The two-year outcome of patients with a consensus DSM-IV diagnosis of schizoaffective disorder was compared to that of patients with DSM-IV schizophrenia and schizophreniform disorder, using the Strauss-Carpenter Outcome Scale.

RESULTS

The Cohen's kappa was 0.22 for the diagnosis of schizoaffective disorder, 0.71 for that of manic episode, and 0.82 for that of major depressive episode. Schizoaffective patients had a significantly better outcome than those with schizophrenia but a worse outcome than those with schizophreniform disorder.

CONCLUSIONS

The inter-rater reliability of the DSM-IV criteria for schizoaffective disorder is not satisfactory. The better outcome of DSM-IV schizoaffective disorder compared with schizophrenia seems to depend more on the inclusion, in the definition of schizophrenia but not in that of schizoaffective disorder, of the six-month duration and functional impairment criteria than on the different symptomatological patterns of the two conditions.

LIMITATION

The size of the sample of patients fulfilling DSM-IV criteria for schizoaffective disorder was small.

CLINICAL RELEVANCE

The study suggests that the clinical implications of the currently problematic diagnosis of schizoaffective disorder may be modest.

Hemispheric asymmetry and psychopathological dimensions in drug-free patients with schizophrenia

Several neuropsychological models of schizophrenia have regarded the syndrome as a disorder of the left hemisphere. However, discrepant experimental findings have been reported. It has been proposed that the different psychopathological dimensions of the syndrome are associated with distinct patterns of hemispheric imbalance. The present study was aimed at exploring relationships of psychopathological dimensions of schizophrenia with fronto- and temporo-hippocampal functioning of either hemisphere in 42 drug-free patients with a DSM-III-R diagnosis of schizophrenia. For the negative dimension, an inverse correlation with the performance on a verbal conditional associative task was found, consistent with the presence of a left fronto-hippocampal impairment in this dimension. As to the positive dimension, our results showed a direct correlation with perseveration on a verbal self-ordered pointing task, suggesting a hyperactivation of the left-hemisphere in this dimension. The disorganisation was found to be associated with a faster execution of a spatial memory task, probably reflecting increased perceptual priming and a right temporo-hippocampal disinhibition.

'Simple schizophrenia': a controlled MRI and clinical/neuropsychological study

The present study explored the frequency of neuromorphological, neurological and neuropsychological abnormalities in 13 patients with an ICD-8/9 diagnosis of simple schizophrenia, also fulfilling DSM-IV criteria for 'simple deteriorative disorder', and in 13 matched patients with an ICD-8/9 diagnosis of a subtype of schizophrenia other than simple schizophrenia, fulfilling DSM-IV criteria for schizophrenia. The frequency of neuromorphological abnormalities in the two patient groups was also compared with that observed in 13 neurological control subjects. Both patients with simple schizophrenia and those with other schizophrenia subtypes showed a higher frequency of brain developmental abnormalities and greater ventricular and subarachnoid space volumes than controls. There was no significant difference between the two groups of patients with respect to neuromorphological variables. Two patients with simple schizophrenia (vs. none of those with other schizophrenia subtypes) had gross brain abnormalities; they were the most deteriorated subjects in the whole sample. Patients with simple schizophrenia, as compared to those with other schizophrenia subtypes, presented a higher frequency of soft neurological signs and a greater impairment of social relationships.

Expression of cell cycle and apoptosis-related proteins in sporadic odontogenic keratocysts and odontogenic keratocysts associated with the nevoid basal cell carcinoma syndrome

Odontogenic keratocysts are occasionally (4-5%) associated with the nevoid basal cell carcinoma syndrome, a pleiotropic, autosomal disorder presenting a spectrum of developmental abnormalities and a predisposition for the development of different neoplasms. The aim of this study was to establish whether keratocysts showing clinically aggressive behavior associated with nevoid basal cell carcinoma syndrome reflect differences in cellular proliferation rate and/or in the expression of oncoproteins and tumor suppressor genes. For this reason, formalin-fixed paraffin-embedded sections of odontogenic keratocysts associated with the nevoid basal cell carcinoma syndrome (16 cases) and sporadic odontogenic keratocysts (16 cases) were compared for expression of proliferating cell nuclear antigen (PCNA) and p53, bcl-2, and bcl-1 (cyclin D1) onco-proteins. Most of the epithelial lining of odontogenic keratocysts associated with the nevoid basal cell carcinoma syndrome showed nuclear immunopositivity for p53 protein and overexpression of cyclin D1 with various degrees of staining intensity. All sporadic odontogenic keratocysts were negative for p53 and cyclin D1. The expressions of bcl-2 oncoprotein were found to be substantially similar between the two groups of lesions, with a cytoplasmic immunopositivity localized only in the resting reserve basal layer of the epithelium. PCNA expression showed no statistically significant difference between the two groups of lesions. In conclusion, the finding of cyclin D1 and p53 overexpression in odontogenic keratocysts associated with the nevoid basal cell carcinoma syndrome could be considered a hallmark of a mutated cellular phenotype, thus leading to the hypothesis that their aggressive clinical behavior could be due to a dysregulation of the expression of cyclin D1 and p53 proteins, involved in a check-point control of cellular proliferation.

Early diagnosis of nevoid basal cell carcinoma syndrome

BACKGROUND

Nevoid basal cell carcinoma syndrome, or NBCCS, is a hereditary condition characterized by basal cell carcinomas, or BCCs; odontogenic keratocysts, or OKCs; and skeletal abnormalities. The authors conducted this study to determine the early signs of NBCCS.

METHODS

The authors reviewed files from two Italian dental schools from January 1980 to January 1995 to determine the early signs of NBCCS and the age at which patients were first examined. They re-examined all of the patients, using the diagnostic criteria for NBCCS.

RESULTS

The authors found 14 patients who fulfilled the criteria for diagnosis of NBCCS in five families. All of the patients were 16 years of age or younger. In 11 cases (78 percent), the first sign of NBCCS in the patients was an OKC. The OKCs diagnosed in patients older than 13 years of age were large and characterized by widespread bone resorption. One 11-year-old patient had six large OKCs. The authors also found a case of multiple OKCs in an 8-year-old patient. Only one patient showed BCCs.

CONCLUSIONS

OKCs are often the first signs of NBCCS and can be detected in patients younger than 10 years of age. Our data suggest that OKCs arise earlier in patients who have NBCCS than in patients who do not have NBCCS. The patients' young ages explain the low incidence of BCCs in this study.

CLINICAL IMPLICATIONS

The presence of multiple OKCs in a child or onset of BCC in a patient younger than 20 years of age should alert dentists to the possibility of the patient's having NBCCS.

Nevoid basal cell carcinoma syndrome. Clinical findings in 37 Italian affected individuals

Nevoid basal cell carcinoma syndrome (NBCCS) is a hereditary condition transmitted as an autosomal dominant trait with complete penetrance and variable expressivity. The syndrome is characterised by numerous basal cell carcinomas (BCCs), odontogenic keratocysts of the jaws, palmar and/or plantar pits, skeletal abnormalities and intracranial calcifications. In this paper, the clinical features of 37 Italian patients are reviewed. Jaw cysts and calcification of falx cerebri were the most frequently observed anomalies, followed by BCCs and palmar/plantar pits. Similar to the case of African Americans, the relatively low frequency of BCCs in the Italian population is probably due to protective skin pigmentation. A future search based on mutation screening might establish a possible genotype phenotype correlation in Italian patients.

[Physiopathology of beta and gamma catenin expression in the oral epithelium]

BACKGROUND

Catenins belong to a family of proteins that mediate the binding between intracytoplasmic domain of cadherins and cytoskeleton. Few data on distribution of beta and gamma catenins in non-neoplastic tissues are available from current literature. This study aims to evaluate distribution of beta and gamma catenins in oral epithelium.

METHODS

Nine formalin-fixed and paraffin-embedded samples of oral epithelium were retrieved from files of Department of Oral Pathology of the University of Naples "Federico II". These samples were tested with anti-beta and anti-gamma monoclonal antibodies revealed by standard streptavidin-biotin-peroxidase technique. Sections have been evaluated by two observers by optical microscope using a 40X objective. The number of positive cells has been evaluated using a semi-quantitative method.

RESULTS

The results of this study show that beta and gamma catenins were mostly distributed in the upper two-thirds of oral epithelial thickness, except for keratinized areas which appear negative. Basal layer is positive except for the basal side of basal cells. Keratinized layers are negative for beta and gamma catenins.

CONCLUSIONS

In physiologic conditions staining pattern for beta and gamma catenins is almost exclusively membranous, sometimes cytoplasmic but never nuclear. This staining is well-represented even in conditions of chronic inflammation and leucoplakia.

[The distribution of intermediate filaments, histiocytic antigens and neural crest-related antigens in the adult dental pulp. An immunocytochemical approach]

MATERIALS AND METHODS

Ten human healthy teeth were extracted for orthodontic or surgical purposes and processed for histological and immunocytochemical examination with the streptavidin-biotin-peroxidase method. Highly purified antibodies were used to reveal the distribution of intermediate filaments (vimentin, desmin, alpha-smooth muscle actin), histiocytic antigens (alpha-1-antitrypsin, lysozyme), neural and neural-crest-associated antigens (neuron-specific enolase, chromogranin-A, S-100, synaptophysin, glial fibrillary acidic protein, neurofilaments) in the adult pulp tissue.

RESULTS

Vimentin immunostaining was strongly positive in the network of pulpal fibroblasts. Desmin and alpha-smooth muscle actin were present only in the vessel walls. Staining for alpha-1-antitrypsin and lysozyme reveals a number of macrophage-like cells in the central portion of the pulp. Macrophages were the most dominating immunocompetent cells. Negative immunostaining for chromogranin-A demonstrated the absence of neuroendocrine antigens in the adult dental pulp. Immunostaining for neuron-specific enolase, S-100 protein, synaptophysin, glial fibrillary acidic protein and neurofilaments were positive, with different intensity, in nerve fibres, but no pulp cell was found to be immunoreactive.

CONCLUSIONS

The conclusion is drawn that the lack of labelling of pulp cells by the neural associated antibodies could be due to differentiation processes during tissue development.

Iron overload alters innate and T helper cell responses to Candida albicans in mice

The effect of iron overload on susceptibility of mice to Candida albicans infection and on the type of T helper (Th) immunity elicited was investigated. Iron overload greatly increased susceptibility to disseminated infection with low-virulence C. albicans cells of exogenous origin. The candidacidal activity and the ability to release nitric oxide and bioactive interleukin (IL)-12 were greatly impaired in neutrophils and macrophages from infected mice. CD4 T cells from spleens of iron-overloaded mice were found to produce high levels of IL-4 and IL-10 and low levels of interferon-gamma. Treatment of iron-overloaded mice with the iron chelator, deferoxamine, resulted in the cure of mice from infection, restored the antifungal effector and immunomodulatory functions of the phagocytic cells, and allowed the occurrence of CD4 Th1 protective antifungal responses. These data indicate that iron overload may negatively affect CD4 Th1 development in mice with candidiasis, a function efficiently restored by therapy with deferoxamine.

Chemical analysis and biological activity of airborne particulate matter

We examined the chemical composition of the suspended particulate matter in a typical, middle-sized, nonindustrial Italian town in terms of total carcinogenic PAH, heavy metal, and polynuclear azo-aromatic compounds. The chemical data relate to the biological activity of the organic extract of the particulate matter (mutagenicity and mice alveolar macrophage phagocytosis inhibition). The concentration values of benz(a)pyrene, the concentration ratios of selected PAH's, and the GC-MS profile of some typical samples indicate that motor vehicle traffic is the main pollution source. PAH concentration is significantly correlated with mutagenicity and a phagocytosis inhibition of up to 75% was observed at the highest PAH concentration. As far as the effect of meteorological variables on PAH concentration and mutagen-icity is concerned, a statistically significant inverse correlation with temperature was found.

Multilead quantitative EEG profile of clozapine in resting and vigilance-controlled conditions

Clozapine is the prototype of a new class of drugs, referred to as 'atypical antipsychotics'. As a matter of fact, the antipsychotic activity of the drug was not predicted by the first studies with quantitative electroencephalography (QEEG), which actually reported an antidepressant pattern. All previous QEEG studies carried out in healthy subjects used a maximum of four leads, exploring only the posterior quadrants of the scalp. The present article reports findings of a multilead QEEG study carried out in 16 healthy men under resting and vigilance-controlled conditions. Increases in slow (delta, theta, and alpha1) and decreases in fast (alpha2 and beta) activities were found, corresponding to changes described for chlorpromazine-type antipsychotics. These results are compared with those of earlier studies. It is suggested that changes in the beta frequency range vary across subjects, whereas changes in slow and alpha activity are more consistent and critical for defining the QEEG profile of the drug.

[The role of syndecan and tenascine during tooth development. Review o the literature]

Morphogenesis and cell differentiation in the developing tooth are controlled by a series of reciprocal interactions between the epithelial and mesenchymal tissues. The exact molecular mechanisms operating in these interactions are unknown at present, but both structural components of the extracellular matrix and cellular receptors have been suggested to be involved. In this review we resume our knowledge about tenascin and syndecan distribution and activity.

Influence of moclobemide on cognitive functions of nine depressed patients: pilot trial with neurophysiological and neuropsychological indices

Quantitative electroencephalogram (QEEG) changes induced by the acute administration of moclobemide (200 mg) in patients with major depression include a transient increase in theta-activity, a slight augmentation of alpha-activity and a sustained increase in beta-activity. This QEEG profile distinguishes moclobemide from sedative antidepressants. A 42-day treatment with 400 mg/day of the drug produces a significant decrease in the late positive-complex peak latency of the event-related potentials, suggesting a positive effect on attention and cognitive functions.

QEEG alpha 1 changes after a single dose of high-potency neuroleptics as a predictor of short-term response to treatment in schizophrenic patients

Baseline quantitative electroencephalographic (QEEG) characteristics and their changes after a single test dose of either haloperidol or clopenthixol were investigated in a group of 29 schizophrenics as possible predictors of short-term response to those drugs. On baseline QEEG assessment, responders (R) to subsequent treatment showed fewer slow and more fast activities than nonresponders (NR). A large overlap between R and NR with respect to these measures was observed, however, revealing their practical inadequacy to predict short-term response in individual patients. On the contrary, changes in alpha 1, observed 6 hr after the administration of a single test dose of either haloperidol or clopenthixol, discriminated to a very large extent between R and NR, correctly identifying 17 out of 18 R and 8 out of 10 NR. The QEEG test dose procedure might be used in the selection of the most appropriate antipsychotic drug for individual schizophrenic patients.

Computerized EEG topography findings in schizophrenic patients before and after haloperidol treatment

An increase of delta and fast beta activity in schizophrenic patients when compared with normal controls has been consistently reported. Topography of these abnormalities, in particular a possible frontal localization of delta, and their relationship to drug treatment and clinical status are still debated. In order to assess these issues, a multilead CEEG investigation was carried out in a group of 20 DSM-III-R schizophrenics, both before and after haloperidol treatment. All findings are described in terms of amplitude and relative power. Drug-free schizophrenics, when compared with a group of normal controls, showed a generalized increase of delta and fast beta, and a decrease of alpha 2 relative power. After acute treatment, patients showed a significant decrease of delta, and an increase of theta 2, beta 1, and beta 2. After 28 days of haloperidol treatment, similar changes were observed for delta, together with an increase of alpha 1, and a decrease of fast beta.

C-EEG brain mapping in DSM-III schizophrenics after acute and chronic haloperidol treatment

A multi-lead C-EEG investigation was carried out, in order to evaluate changes induced by acute and chronic treatment with haloperidol in DSM-III-R schizophrenics. After the acute treatment the main C-EEG changes were (1) a significant decrease of delta relative power (RP) over all the explored leads and of theta 1 over the occipital leads; (2) an increase in alpha 2 and beta 2 RP, as well as a decrease of beta 3 RP confined to the anterior temporal leads (T3, T4). During chronic treatment, C-EEG changes observed were (1) a significant decrease of delta RP and an increase of theta 1 RP; (2) an increase of alpha 1 and alpha 2 RP; (3) a significant decrease of beta 1, beta 2 and beta 3.

[A clinical study of the therapeutic activity and tolerance of nimesulide in a suppository formulation in oral medicine]

A double-blind versus placebo clinical study has been carried out in order to assess the antiinflammatory and analgesic activity of nimesulide suppositories in pain-inflammatory pathologies of odontostomatological nature. Forty-four patients aged between 18 and 62 were recruited for the purpose and assigned at random to treatment with nimesulide or placebo for a minimum period of 3 days. Treatment with nimesulide reduced both the pain and the tumefaction due to the inflammatory pathology more rapidly and, by the 3rd day of treatment led to complete remission of the symptomatology. Tolerability of nimesulide was excellent.