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Notizen: Background: Inactivation of the elastase inhibitor, α1 proteinase inhibitor (α1PI), may be of pathogenic significance in inflammatory diseases like periodontal disease. Two key mechanisms of inactivation appear to be (a) the formation of an α1PI–elastase complex and (b) proteolytic cleavage by elastase or other enzymes such as metalloproteinases of host origin or enzymes of bacterial origin. Based on the different heat stabilities of the intact, complexed and proteolytically cleaved forms of α1PI, an enzyme-linked immunosorbent assay (ELISA) that allowed the simultaneous measurement of native and inactive forms of α1PI was developed.Methods: The ELISA method described employs a commercially available antibody and represents a rapid, reproducible and sensitive method for studying α1PI inactivation in human inflammatory diseases. The assay was applied to normal human plasma and to human extracellular fluids obtained from patients with inflammatory diseases such as adult periodontitis and rheumatoid arthritis. Samples from patients with osteoarthritis, a “non-inflammatory” joint disease, were also studied.Results: The findings expressed as the mean percentage (±SD) of the total α1PI that was inactivated were as follows: gingival crevicular fluid from adult periodontitis patients: 73.5±16.6% (n=12); normal human plasma: 8.4±4.9% (n=13); knee-joint synovial fluid (SF) from rheumatoid arthritis patients: 12.5±4.5% (n=15); plasma from rheumatoid arthritis patients: 8.0±1.8% (n=15); knee-joint SF from osteoarthritis patients: 8.6±8.2% (n=14); plasma from osteoarthritis patients: 5.7±4.8% (n=14). The results obtained by ELISA were in good agreement with those obtained by the semi-quantitative method of SDS–PAGE and Western blotting.Conclusions: We have shown that the differential heat stability of α1PI may be utilised as the basis for a rapid, sensitive and reproducible ELISA assay of α1PI inactivation. In gingival crevicular fluid from periodontal disease patients, α1PI is mainly inactivated and the extent of this inactivation is much higher than in inflammatory fluids from other chronic diseases such as rheumatoid arthritis. This assay could be useful in monitoring the progression of periodontal disease.

Notizen: Objective: To compare the progression of periodontal destruction in people with and without HIV.Method: Relative attachment loss on 6 index teeth was compared between 19 people with HIV and 17 people without HIV infection over 12 and 18 month follow ups.Results: The proportions of sites with 1, 2 or 3 mm of relative attachment loss were similar in the study and control groups. Mean maximum relative attachment loss was similar in both groups after 12 months but greater in the study group after 18 months.Conclusions: The data are not compelling evidence of greater periodontal destruction associated with HIV infection. Large scale cohort studies or meta-analyses would be more conclusive.

Notizen: A case-control study on chewing and smoking habits and oral submucous fibrosis (OSF) was undertaken in Karachi in 1989/90. Cases were patients detected with fibrous bands and leathery mucosa and hospital-based controls were matched by age and sex. Information on habits was collected by personal interview of 157 cases and 157 controls. Despite overall female preponderance, a substantial number of young men were enlisted. The male/female risks were found to be similar. Immigrants from India to Pakistan (Mohajir) had a similar risk status to local Punjabis. No differences between risks were found when comparing the three age categories. 21.21-40, 41-60 yr. Among the cases, an increased risk was observed for areca nut chewing. This habit when practised alone appeared to have the highest risk (RR 154), followed by pan with or without tobacco (RR 64. 32 respectively). Logistic regression and discriminant analysis showed that daily consumption rates appeared to be more important with respect to risk than lifetime duration of habit. Tobacco habits were more prevalent amongst those 15 cases who presented with concurrent carcinoma and OSF: We conclude that areca nut chewing has a causal relationship with OSF: additional tobacco insult may be necessary for subsequent carcinoma development.

Notizen: Oncogene expression in human neoplasia has been examined extensively in the past decade. More recently the advent of the polymerase chain reaction (PCR) has facilitated studies of oncogenes and other DNA structures. Those few studies which have so far searched for oncogene changes in oral cancer have utilized frozen specimens. We report here an adaptation of the PCR technique applicable to DNA extracted from archival specimens. Our data complement recent findings that Ha-ras mutations are infrequent in oral squamous cell carcinomas among white caucasoid populations.

Notizen: Recent progress in understanding the biology of keratins together with the development of monoclonal antibodies to individual keratin proteins provide the foundation for studying keratin expression in normal and pathological oral epithelia. Areas of oral pathology in which the examination of epithelial keratin profiles may yield information of potential diagnostic value are discussed. Examples of altered keratin expression in epithelial dysplasia, oral cancer and odontogenic cysts and tumours are presented. Immunocytochemical demonstration of individual keratins can clarify the composition of complex epithelia and may help to establish epithelial lineage or indicate progression changes in tumours. Some problems in the application and interpretation of keratin immunocytochemistry are also considered.

Notizen: Opportunistic fungal infections account for a significant amount of morbidity associated with HIV disease. We report here a case of localised oral histoplasmosis without evidence of disseminated disease in a patient who lacked stigmata of HIV disease at the time of initial presentation. The diagnosis is based on histology with special stains, complement fixing antibodies in serum, and culture of the organism from fresh tissues. Activation of subclinical disease following an infection in Uganda may explain the development of these exophytic oral lesions in this British resident.

Notizen: Histological and ultrastructural features of 25 oral snuff dipper's lesions with distinctive subepithelial hyaline deposits were investigated. Periodic acid-Schiff reaction with and without diastase digestion demonstrated the presence of glycogen and other carbohydrates, but histochemical stains for normal collagen, elastin and fibrin showed a weak variable reactivity of the deposit. Although in 7/25 cases the deposit was in close proximity to labial salivary glands and on occasions ducts were found within the deposit, the presence of mucin was not a consistent feature. Congo red staining and immunohistochemical investigation with an anti-amyloid antibody did not support the previous contention that such de-posits were amyloid in nature. Immunohistochemically, collagen antibodies also provided negative results, but ultrastructural features of three biopsies studied suggest that the bulk of this deposit made up of collagen, as typical cross-striated fibrils were found. The pathogenesis of this deposit could therefore be interpreted as over-production and/or reduced turnover of collagen by resident fibroblasts, which is further altered by the ingredients of toombak. The deposit does not appear to be a secretory product.

Notizen: This study describes the results of a survey undertaken to assess the management of potentially malignant oral mucosal lesions by oral medicine practitioners and compares their approach with that of oral & maxillofacial surgeons that we have previously described. Significant differences were noted between the two groups in the use of photography to document the lesions and in the use of certain special investigations, which included measurement of serum iron, serum ferritin, serum Vit B12, red cell folate and candidal isolation. The groups also varied in the perceived importance of the age of the patient and anatomical site of the lesion when deciding on the need for further biopsy. There was also significant variation in the use of certain treatment modalities, including excising non-dysplastic and severely dysplastic/carcinoma in-situ lesions and eliminating trauma when treating mild/moderately dysplastic and severely dysplastic/carcinoma in-situ lesions. Significant differences in the frequency and duration of follow-up were noted for non-dysplastic lesions. Finally, the two groups differed significantly when asked to rank the perceived importance of certain factors (the histopathology of the most recent biopsy and the anatomical site of the lesion) when deciding the need to follow-up. Possible reasons for the variation are discussed.

Notizen: Clinical (n=281) and histopathological (n=141) characteristics of toombak-associated oral mucosal lesions detected in an epidemiological study in northern Sudan in 1992/93 are described. The lesional site in the majority of toombak users was the anterior lower labial groove and the lower labial mucosa. 4 degrees (1–4) of clinical severity of lesions, similar to those used to characterise Swedish snuff-dipper's lesion, were applied. An association between the severity of mucosal lesions and a longer lifetime duration (〉10 years) of toombak use was found, but the severity was not related to the daily frequency of the habit. Parakeratosis, pale surface staining of the epithelium and basal cell hyperplasia were commonly observed, but epithelial dysplasia was infrequent (10/141). The most significant observation was a PAS-positive amorphous deposit between the lamina propria and the submucosa, found in 25/141 biopsies. The clinical and histopathological features of toombak lesions are closely similar to Swedish moist snuff-dipper's lesions and this may reflect the high alkalinity of these products, resulting in an alkaline burn on the oral mucosa following chronic exposure. The low prevalence of epithelial dysplasia implies a low risk of malignant transformation. Nevertheless, the high concentrations of tobacco-specific nitrosamines present in toombak, and the high prevalence of oral cancer in Sudan, mandate biopsy and careful histopathological analysis of any such lesions detected in habitues.

Notizen: In Part A, the techniques most commonly used to study epithelial cell kinetics and their suitability for use in man are reviewed. In Part B, the application of such methods to comparative studies of normal and abnormal oral epithelia of both man and experimental animals is examined. Claims regarding the possible prognostic value of LI's or MI's of biopsies of potentially or overtly malignant human oral lesions are also considered. Normal and abnormal kinetic data for other lining epithelia, e.g., skin, uterine cervix and gastrointestinal mucosa arc assessed where they provide a better illustration of some of the problems arising in such comparative investigations. Finally, the present and likely future areas in which cell kinetic studies may provide a guide to expected tumour prognosis and optimum treatment are summarized.