bluuebunny/crossref_metadata_2025 huggingface dataset:
Positive patch test reactions to celecoxib may be due to irritation and do not correlate with the results of oral provocation
Authors: Kleinhans M. , Linzbach L. , Zedlitz S. , Kaufmann R. , Boehncke W. ‐H.
Published: March 2003

Nonsteroidal anti‐inflammatory drugs (NSAIDs) are among those therapeutics most frequently causing pseudoallergic and sometimes allergic cutaneous adverse reactions. Coxibs preferentially inhibiting cyclooxygenase‐2 are increasingly propagated as alternatives in NSAID‐sensitive patients. We evaluated the tolerability of celecoxib in NSAID‐sensitive patients. In 14 consecutive patients (6 males, 8 females, age 18–72 years), scratch and patch tests with homogenized Celebrex® were performed, followed by single‐blind, placebo‐controlled oral provocation (maximal single dose: 200 mg; cumulative dose: 350 mg). 8 of the first 10 patients showed erythematous reactions to celecoxib on patch testing after 2 days with decrescendo kinetics between then and day 3. 9 patients with no history of NSAID intolerance showed similar reactions. When the patch tests were repeated with homogenized Celebrex® at final concentrations of 5% and 10% in petrolatum, no reaction was observed in any patient. Subsequent oral provocation was tolerated without adverse effects by all individuals. We conclude that patch tests with high concentrations of celecoxib cause irritant reactions and do not correlate with the outcome of oral provocation tests. Therefore, these tests should be performed with lower concentrations of celecoxib (Celebrex®). Celecoxib itself seems to be a valuable alternative drug in NSAID‐sensitive patients.
Structure–activity relationships for selected fragrance allergens
Authors: Patlewicz G. Y. , Wright Z. M. , Basketter D. A. , Pease C. K. , Lepoittevin J.‐P. , Giménez arnau E.
Published: March 2003

Fragrance substances represent a very diverse group of chemicals, a proportion of them providing not only desirable aroma characteristics, but also being associated with adverse effects, notably the ability to cause allergic reactions in the skin. However, efforts to find substitute materials are hampered by the need to undertake animal testing to evaluate both the presence and the degree of skin sensitization hazard. One potential route to avoid such testing is to understand the relationships between chemical structure and skin sensitization. In the present work we have evaluated two groups of fragrance chemicals, saturated aldehydes (aryl substituted and aliphatic aldehydes) and α,β‐unsaturated aldehydes. Data on their skin sensitization potency defined using the local lymph node assay has been evaluated in relation to their physicochemical properties. The initial outcome has been consistent with the concept that α,β‐unsaturated aldehydes react largely via Michael addition, whilst the group of saturated aldehydes form Schiff bases with proteins. Simple models of chemical reactivity based on these mechanisms suggest that it may be possible to predict allergenic potency. Accordingly, the evaluation of an additional group of similar aldehydes is now underway to assess the robustness of these models, with some emphasis being based on ensuring a wider spread of chemical reactivity.
Gas chromatography: an investigative tool in multiple allergies to essential oils
Authors: Dharmagunawardena B. , Takwale A. , Sanders K. J. , Cannan S. , Rodger A. , Ilchyshyn A.
Published: March 2003

Essential or fragrant oils are volatile odourous mixtures of organic chemical compounds that are widely used in aromatherapy and in the perfume industry. Because of their frequent use, allergy to essential oils is being increasingly recognized. We report 2 cases of multiple allergies to essential oils in professional aromatherapists. Gas chromatography/mass spectrometry was used to analyse the oils in order to identify a common allergen responsible for the contact dermatitis. In both the cases, α‐ and β‐pinene were found to be the most common constituent in the oils and thus appeared to be key allergens. α‐pinene was confirmed as an allergen on repeat patch testing with pure α‐pinene in both cases. 12 controls tested were negative for the same. Gas chromatography‐mass spectrometry was found to be an extremely useful tool that could be utilized in investigating multiple allergies to essential oils.
Sensitizing capacity and cross‐reaction pattern of the isomers of diglycidyl ether of bisphenol F in the guinea pig
Authors: Pontén A. , Zimerson E. , Sörensen Ö. , Bruze M.
Published: March 2003

In this study, the sensitizing capacities of the 3 main low‐molecular‐weight isomers of epoxy resins based on diglycidyl ether of biphenol F (DGEBF) were investigated in a guinea pig maximization test (GPMT). The isomers are p,p′‐DGEBF, o,p′‐DGEBF, and o,o′‐DGEBF. The sensitization capacities were compared to diglycidyl ether of bisphenol A (DGEBA), which is the main constituent in the most common epoxy resin. The cross‐reaction pattern between all 4 compounds was also investigated. It was found that all 3 DGEBF isomers were potent sensitizers. It was also found that p,p′‐DGEBF, o,p′‐DGEBF, and DGEBA cross‐reacted with one another, and that animals induced with o,o′‐DGEBF reacted significantly only to o,p′‐DGEBF, but not to the other 2 DGEBF isomers or DGEBA.
Role of different valence states of chromium in the elicitation of allergic contact dermatitis
Authors: Iyer V. J. , Banerjee G. , Govindram C. B. , Kamath V. , Shinde S. , Gaikwad A. , Jerajani H. R. , Raman G. , Cherian K. M.
Published: March 2003

Chromium, a known contact sensitizer, is present at high levels in certain detergent bars (40–50 p.p.m.) sold in India. A concern was whether chromium present in such detergent bars could sensitize users or their use lead to the elicitation of allergic contact dermatitis. Chromium present in detergent bars was analyzed for its valence state. It was found to be trivalent [Cr (III)] and not hexavalent [Cr (VI)]. An elicitation test on normal volunteers, as well as on volunteers who were sensitive to chromium, was carried out to determine the elicitation potential of chromium (III) in the bars. Of the 48 volunteers who completed the study, 30 did not show any positive response to either potassium dichromate, the positive control, or the detergent bar containing chromium (III). 18 volunteers who were identified as chromium‐sensitive showed a positive response to potassium dichromate but not to the detergent bar containing trivalent chromium. This study clearly showed that the detergent bar with 40–50 p.p.m. of trivalent chromium did not elicit any allergic contact dermatitis even in individuals known to be chromium‐sensitive. Hexavalent chromium (potassium dichromate) did however, elicit allergic contact dermatitis in these subjects.
The reliability of crown–root ratio, linear and angular measurements on panoramic radiographs
Authors: Stramotas Steve , Geenty Joseph P , Darendeliler M Ali , Byloff Fritz , Berger Jeff , Petocz Peter
Published: March 2003

The aim of this study was to evaluate the reliability of crown and root length, crown–root ratio and angular measurements of teeth relative to constructed reference lines and to other teeth in the same region on consecutive (T1 and T2) panoramic radiographs (OPGs). This retrospective study employed 20 cases; ten with five implants in each jaw (age range between 20 and 60 years) and ten with a full permanent dentition (age range between 12 and 16 years). The consecutive pairs of OPGs ranged from 6 months to 3 years apart. Four variables were measured and compared: 1) the crown or coronal segment length and the root or apical segment length; 2) the crown–root ratio; 3) the angulations of teeth and implants relative to specific reference lines in each jaw; 4) the angle between teeth and implants in the same sextant. The results revealed that comparisons of measurements taken of the same structures at T1 and T2, there were no statistically significant differences (p>0.05) between vertical linear measurements. The crown–root ratios and coronal–apical segment ratios too, showed no significant differences (p>0.05). Whereas, angulations of teeth or implants relative to respective reference lines showed significant differences (p=0.001) for some of the teeth. These differences, however, were less than 5°; a clinically acceptable range. Angles measured between teeth or implants in the same sextant showed no significant differences (p>0.05). These results seem to support the hypothesis, therefore, that the linear vertical measurements, ratio calculations and angular measurements can be used to compare crown and root lengths, crown–root ratios and tooth angulations on OPGs taken of the same patient at different times with consistent accuracy.
Changes in the masticatory jaw movement following orthodontic traction of an impacted and transposed upper canine and occlusal adjustment
Authors: Miyawaki Shouichi , Shiai Yutaka , Takada Kenji
Published: March 2003

In a 10‐year‐old female with an impacted and completely transposed upper left canine, posterior temporal muscle activity and jaw movement during mastication were examined before and after orthodontic traction of the canine, alignment of teeth, and occlusal adjustment of the canine. After the orthodontic treatment, but before the occlusal adjustment, esthetic improvement in the static occlusion was achieved. The posterior temporal muscle on the non‐chewing side exhibited earlier bursts in the electromyography. Jaw movement trajectory of the jaw‐closing phase at a level close to the maximum intercuspation position was more to the medial side on the frontal view, and the jaw‐closing velocity in the lateral direction was slower during left‐sided chewing. Following occlusal adjustment of the transposed canine, however, the muscle activity and jaw movement patterns were improved to normal patterns. We suggest that it might be advisable to perform occlusal adjustment at an early stage during the retention period in such cases.
Agreement between normative and perceived orthodontic need amongst deprived multiethnic school children in London
Authors: Ahmed Bilal , Gilthorpe Mark S. , Bedi Raman
Published: March 2003

The Index of Orthodontic Treatment Need (IOTN) has been used in dental epidemiology and to prioritize orthodontic treatment. The aim of this paper was to use the aesthetic component (AC) of the IOTN to measure agreement between normative and perceived orthodontic need amongst school children. Three hundred and seventy‐eight children aged 11–14 years, enrolled in London UK state schools participated in this survey. The study focused on three ethnic groups: white, black and South Asian. Townsend deprivation scores suggested that the children were from areas of high socio‐economic deprivation. Logistic regression analysis was carried out for agreement between normative and perceived need at each threshold value. Perceived need for braces, ethnic background, social class and hours of television viewing were significant variables. Black pupils were significantly less likely to concur on normative and perceived need scores, tending to perceive less need for treatment than did the dentist. Subjects from lower social classes were significantly more likely to concur on normative and perceived need scores. In conclusion, the study showed that using the IOTN AC at various points along the scale, different influences play a significant role in agreement/disagreement between normative and perceived needs, indicating that patient–clinician agreement regards orthodontic treatment is sensitive to several cultural factors.
Mesial bodily movement of maxillary and mandibular molars with segmented mechanics
Authors: Cacciafesta Vittorio , Melsen Birte
Published: March 2003

The displacement of teeth into areas with substantial atrophy of the alveolar ridge or through the maxillary sinus has been considered a major limitation. Bone formation can, however, be generated if the orthodontic appliance can produce the necessary strain distribution along the entire periodontal ligament. The aim of this case report is to illustrate how bone formation can accompany mesial bodily movement of maxillary and mandibular molars. The necessary strain distribution was generated by the rational use of segmented mechanics. The use of superelastic Ni–Ti springs allows the application of low and constant forces over a wide range of deactivation, thus providing a uniform strain in the periodontium. The result of those appliances is highly predictable and side effects can be minimized effectively.
Co‐expression of CD56 and CD30 in lymphomas with primary presentation in the skin: clinicopathologic, immunohistochemical and molecular analyses of seven cases
Authors: Natkunam Yasodha , Warnke Roger A. , Haghighi Bijan , Su Lyndon D. , Le Boit Philip E. , Kim Youn H. , Kohler Sabine
Published: March 2003

Background: Natural killer and natural killer‐like T‐cell lymphomas presenting in the skin usually demonstrate aggressive behavior, an angiocentric distribution and a characteristic immunophenotype. In contrast, primary cutaneous CD30+ lymphoproliferative disorders form a heterogeneous spectrum including anaplastic large cell lymphomas, the majority of which display a good prognosis. Lymphomas with co‐expression of CD56 and CD30 are extremely rare and the significance of this co‐expression is unknown.

Methods: Seven retrospectively identified cases of lymphomas with co‐expression of CD56 and CD30 presenting in the skin comprise this study. Immunohistochemistry, in situ hybridization for Epstein‐Barr virus and T‐cell receptor gene rearrangement studies were performed on paraffin sections.

Results: This subset of cutaneous lymphomas showed a variable clinical course that ranged from resolution without treatment, treatment‐failure and recurrence, to death from disease. Histologic, immunophenotypic and molecular studies were of limited utility in predicting prognosis.

Conclusions: Cutaneous lymphomas co‐expressing CD56 and CD30 share many clinicopathologic features with natural killer and natural killer‐like T‐cell lymphomas or anaplastic large cell lymphomas, two entities with widely disparate clinical behavior. It is important to recognize that these lymphomas may behave more aggressively than primary cutaneous anaplastic large cell lymphomas do. Longer follow‐up and further investigations on larger numbers of cases are necessary to fully characterize this rare subset of cutaneous lymphomas.
“Tubular Spitz's nevus”– an artifact of fixation?
Authors: Ziemer Mirjana , Diaz‐Cascajo Carlos , Köhler Gabriele , Weyers Wolfgang
Published: March 2003

Background: Spitz's nevi may contain numerous tubule‐like structures. This phenomenon has been described as “tubular Spitz's nevus” and has been attributed to either apoptosis in the center of nests of melanocytes or tubular metaplasia of melanocytes.

Methods: In order to study this peculiar phenomenon, we reviewed 31 Spitz's nevi from our teaching collection.

Results: Empty spaces vaguely resembling tubules were found in 15 Spitz's nevi, all of which were examples of the epithelioid‐cell type of Spitz's nevus. Histopathologically and immunohistochemically, there was no evidence of apoptosis within or around tubule‐like structures. Empty spaces in the center of nests ranged from distinctive tubule‐like structures to only slight separation of melanocytes from one another. Furthermore, empty spaces were also seen around nests, often in combination with distinctive tubule‐like changes.

Conclusions: Our findings suggest that so‐called “tubular” structures in epithelioid Spitz's nevi result from retraction of tissue secondary to fixation in formalin. “Tubular Spitz's nevus” seems to represent an artifact rather than a distinctive variant of Spitz's nevus.
Assessment of clonality in melanocytic nevi
Authors: Hui Pei , Perkins Archibald S. , Glusac Earl J.
Published: March 2003

Background: Melanocytic nevi are among the most common lesions in man; however; their pathogenesis remains largely unknown. While often held to be neoplastic, this hypothesis has not been conclusively verified. Alternatively, some authorities have held that melanocytic nevi are hamartomas. More practically, difficulty may be encountered in the histologic discrimination of melanocytic nevi from melanoma. It was reported that nevi may be differentiated from melanoma in females by polymerase chain reaction (PCR) analysis of loci of human androgen receptor gene on the X‐chromosome. However, contradictory findings have also been reported, suggesting that both acquired nevi and melanoma are clonal.

Methods: Fifteen examples of melanocytic nevus were analyzed via PCR for pattern of X‐chromosome inactivation as indicated by the methylation status of the human androgen receptor gene.

Results: Among 15 nevi analyzed, 11 cases provided informative polymorphism at the androgen receptor loci. Nine of these 11 cases revealed a non‐random pattern of X‐chromosome inactivation.

Conclusions: These findings suggest that melanocytic nevi are clonal/neoplastic lesions. As such, they cannot be discriminated from melanoma on the basis of clonality.
Expression of the caveolins in dermal vascular tumors
Authors: Morgan Michael B. , Stevens G. Lex , Tannenbaum M. , Salup Raoul
Published: March 2003

Introduction: Histopathologic criteria are usually sufficient for the accurate distinction of benign from malignant dermal vascular tumors. A minority of cases, however, pose a vexing diagnostic dilemma. Recent studies suggest that caveolin, a scaffolding cell membrane protein, may prove helpful in predicting the biologic behavior of endothelial‐derived neoplasms.

Methods: We analyzed a series of 30 dermal vascular tumors including 12 lobular capillary hemangiomas (LCH), 4 cases of targetoid hemosiderotic hemangiomas (TH), 4 cases of tufted angioma (TA), 12 cases of Kaposi’s sarcoma (KS), 4 epithelioid (EH) and 1 spindle cell hemangioendothelioma (SH), and 4 cases of angiosarcoma (AS). The distribution of immunoreactivity was analyzed by quantifying cell membrane staining in each case.

Results: There was a statistically significant difference in the expression of caveolin between LCH (mean labeling index=91.6), TH (mean labeling index=89.7), and TA (mean labeling index=87.2) and the cases of KS (mean labeling index=21.6, EH mean labeling index=23.1), and the AS ( mean labeling index=6.3).

Conclusions: These results indicate that antibodies to caveolin may be useful in separating benign and malignant dermal vascular tumors and possibly implicates this peptide in their pathogenesis.
Sub‐populations of melanocytes in pigmented basal cell carcinoma: a quantitative, ultrastructural investigation
Authors: Lao Li‐Min , Kumakiri Masanobu , Kiyohara Takahiro , Kuwahara Hiroaki , Ueda Keiichi
Published: March 2003

Background:

Pigmentation is a characteristic clinical feature of basal cell carcinomas (BCCs) in Japanese patients. The pathogenesis of melanin pigment in pigmented BCCs is poorly understood.

Methods: We have combined the techniques of morphometric analysis and electron microscopy to assess accurately the morphologic aspects of melanocytes that occurred in pigmented and non‐pigmented areas of pigmented BCCs.

Results: In the pigmented areas melanocytes were not only located along the basal membrane but also interspersed between tumor cells in the central parts of the tumor nest, and had large and numerous dendrites. Those in a supra‐basal location displayed some degree of degeneration due to mitochondrion and melanosome swelling. In the non‐pigmented areas melanocytes were only basally located, showed fewer dendrites, and frequently showed abortive melanosomes. However, melanocytes in these two different portions were in the active state of melanogenesis and proliferation. Ultrastructural cytomorphometric analysis also showed significant differences in most of the nuclear and cell parameters including nuclear and cell area, the nuclear/cell area ratio, cell perimeter and cell form factor between these two types of melanocytes. Particularly melanocytes in the pigmented areas were twice the cell size of the latter. In addition, the melanosomes remained almost completely in the apoptotic tumor cells, and the phagocytosis of the melanosome‐containing apoptotic cells by the neighboring tumor cells appeared to be followed by the formation of the melanosome complexes.

Conclusions: These findings suggest that different populations of melanocytes are probably present in pigmented BCCs, and repeated cycles of phagocytosis of melanosome‐containing apoptotic cells may represent the predominant way of forming large melanosome complexes. The present morphological observation and quantitative analysis provide a morphological basis for further studies to interpret other pathologic changes in pigmented BCCs.
Dermatofibroma‐like granular cell tumor
Authors: Cheng Stephanie D. , Usmani Arif S. , DeYoung Barry R. , Ly Micki , Pellegrini Arthur E.
Published: March 2003

Background:

There have been several reports in the literature of dermatofibromas with granular cells. Here we report a granular cell tumor with the architecture of a dermatofibroma. This is the first report of this histological variant of granular cell tumor. The lesion was a 2.5‐cm oval, hyperpigmented plaque present for “years” on the back of a 60‐year‐old African‐American woman.

Methods: The specimen was processed using formalin fixation and paraffin embedding. Tissue sections were stained with hematoxylin and eosin. Immunohistochemical studies were performed with antibodies directed against S‐100 protein, neuron‐specific enolase, and factor XIIIa.

Results: Histopathologic examination revealed granular cells, some of which were spindle shaped, distributed singly and in small groups between collagen bundles resembling a dermatofibroma. Immunohistochemical studies showed the tumor cells to be positive for S‐100 and neuron‐specific enolase and negative for factor XIIIa.

Conclusion:

The immunohistochemical findings support the diagnosis of a granular cell tumor with a dermatofibroma‐like pattern.
Cutaneous mast cells are altered in normal healthy volunteers sitting in front of ordinary TVs/PCs – results from open‐field provocation experiments
Authors: Johansson Olle , Gangi Shabnam , Liang Yong , Yoshimura Ken , Jing Chen , Liu Peng‐Yue
Published: March 2003

Background: Considerable controversy has surrounded the question of possible biological responses to electromagnetic fields (EMFs) generated from visual display terminals (VDTs), such as personal computers (PCs) and ordinary television sets (TVs). The cellular and molecular mechanisms for such potential harmful health hazards have not yet been understood, although clues from the literature include mast cells and histamine. The aim of this study was therefore to investigate possible biological mast cell responses to TV/PC screens.

Methods: Using the indirect immunofluorescence technique, we studied the presence of histamine‐containing mast cells in the dermis of healthy volunteers. Cutaneous biopsies taken before and after exposure to ordinary TV/PC screens for 2 or 4 h were investigated in 13 healthy subjects.

Results: Our present in vivo study indicates that normal cutaneous mast cells could be altered by exposure from ordinary TV/PC screens. To our great surprise, we found the number of mast cells in the papillary and reticular dermis to increase, to varying degrees, in 5 out the 13 subjects after such an exposure. A migration of mast cells towards the uppermost dermis appeared as the most important event. Thus, the normally upper “empty zone” of the dermis disappeared, and instead, a higher density of mast cells were found in this zone. These cells also seemed to have a tendency to increase in number towards the epidermal‐dermal junctional zone and some of them lost their granular content and the cytoplasm shrunk (=degranulation). These findings could only be seen in the exposed skin. Two of the 13 cases instead showed a decrease in mast cell number, but the shift in mast cells towards the upper dermis was still visible. Twenty‐four h after the provocation, the cellular number and location were normalized in all subjects.

Conclusions: By definition, normal healthy volunteers are assumed not to react to a TV/PC screen provocation. To our great surprise, this proved not to be true. The present results might lay a foundation to understand the underlying cause of so‐called “screen dermatitis” with special reference to mast cells. However, blind or double‐blind experiments using patients ought to be further investigated in order to find out the exact cause for the observed changes. Such causes include the effects of surrounding airborne chemicals, stress factors, etc.
Bax expression and growth behavior of basal cell carcinomas
Authors: Tilli Claudia M. L. J. , Stavast‐Kooy Angela J. W. , Ramaekers Frans C. S. , Neumann H. A. Martino
Published: March 2003

Background:  To understand the typical growth behavior of basal cell carcinoma (BCC) we searched for the correlation between proliferation and apoptosis and progression of BCC.

Methods: Expression of Bcl‐2, Bax, and Ki‐67 was immunohistochemically investigated in both normal skin and BCC cells, as well as in the epidermis overlying BCC.

Results:  The results showed that in normal epidermis, Bcl‐2 was homogeneously expressed in the basal cell compartment, whereas Ki‐67 expression was largely restricted to the parabasal layer, the layer just above the basal cell layer, and exhibited a more scattered staining pattern. Bax was occasionally expressed in the basal layer and widely in the suprabasal compartment. Strikingly, the apparently normal epidermis overlying BCC showed an increased Bcl‐2 staining. In BCC, cells stained homogeneously for Bcl‐2, whereas Bax and Ki‐67 showed scattered staining patterns. Simultaneous expression was seen for Bcl‐2 and Bax in 80 ± 7% of the tumor cells, and co‐expression of Bcl‐2 and Ki‐67 in 20 ± 7% of the tumor cells. The cells expressing Bcl‐2 and Ki‐67, but lacking expression of Bax, the progressive fraction, comprised on average 7 ± 3% of the tumor cell population.

Conclusion:  These results suggest that this small progressive fraction of tumor cells, in combination with the relatively high percentage of cells still prone to apoptosis, can explain the indolent growth behavior of BCC.
Large atypical cells of lymphomatoid papulosis are CD56‐negative: a study of 18 cases
Authors: Harvell Jeff D. , Vaseghi Marmar , Natkunam Yasodha , Kohler Sabine , Kim Youn
Published: March 2003

Background: Histologically, diffuse dermal infiltrates of large atypical lymphocytes can be seen in lesions as indolent as type C lymphomatoid papulosis (LyP) to ones as aggressive as NK/T‐cell lymphoma. While lesions of lymphomatoid papulosis are definitionally positive for CD30, their ability to express CD56 has not been formally studied. The objective of the current study was to determine whether or not the large atypical cells of LyP express the natural killer cell marker, CD56.

Methods:  Biopsies from 18 patients with LyP were studied with monoclonal antibodies to CD30, CD56, CD8, and TIA‐1. These included four type C LyP lesions. Clinical information was obtained by chart review and included extent of LyP lesions, presence/absence of disease at follow‐up, and any associated hematologic malignancies.

Results:  None of the biopsies exhibited CD56 positivity within the large atypical cells of LyP. While some biopsies demonstrated CD56‐positive, small, presumably reactive, lymphocytes within the infiltrate, their presence did not correlate with extent of disease, persistence of disease, or propensity for an associated non‐LyP hematologic malignancy.

Conclusions:  The large atypical cells of types A and C LyP do not exhibit positivity for CD56, and thus a panel of antibodies that includes CD30 and CD56 can readily distinguish between the benign end of the spectrum of CD30‐positive lymphoproliferations and aggressive NK/T‐cell lymphoma.
Heavy multinodular cutaneous lymphoid infiltrates: clinicopathologic features and B‐cell clonality
Authors: Ceballos K. M. , Gascoyne R. D. , Martinka M. , Trotter M. J.
Published: March 2003

Background:  Criteria for distinguishing between cutaneous lymphoid hyperplasia (CLH) and low‐grade B‐cell lymphoma are not well defined. We examined the hypothesis that the presence of a clonal B‐cell population in heavy multinodular lymphoid infiltrates correlates with clinical presentation and outcome.

Methods:  We identified 29 patients with skin lesions characterized histologically by a heavy dermal lymphocytic infiltrate with a multinodular architecture and extension into deep dermis and subcutaneous fat. Clonality was assessed immunophenotypically by light‐chain restriction and also by analysis for IgH‐gene rearrangement using PCR on DNA extracted from paraffin blocks.

Results:  Follow‐up (mean 80 months; median 45 months) was obtained in all patients. Twenty‐four patients (83%) presented with a solitary lesion: only four had solitary recurrences, and none developed multiple synchronous lesions or systemic B‐cell lymphoma. However, 9/24 of these solitary lesions (38%) were clonal by light‐chain restriction or IgH PCR; 5/29 patients (17%) presented with multiple recurrent lesions and continued to develop lesions during the period of follow‐up; 3/5 patients (60%) with multiple lesions demonstrated a B‐cell clone. No patient developed systemic B‐cell lymphoma.

Conclusions:  Heavy, multinodular cutaneous lymphoid infiltrates have an excellent prognosis. Multiple lesions at presentation are the best predictor of recurrent multiple lesions confined to the skin. The presence of a clonal B‐cell population does not correlate with clinical presentation or histology, nor does it predict development of further lesions or systemic lymphoma.
Chloracne: histopathologic findings in one case
Authors: Pastor Maria Antonia , Carrasco Loreto , Izquierdo Maria José , Fariña Maria Carmen , Martín Lucia , Renedo Guadalupe , Requena Luis
Published: March 2003

Background: Chloracne is an acneiform eruption due to poisoning by halogenated aromatic compounds having a specific molecular shape. This condition is always a symptom of systemic poisoning by chemical chloracnegens and not just a cutaneous disorder.

Methods: We have studied a patient with severe chloracne who showed cutaneous lesions involving mostly the face and the axillae.

Results:  Histopathologic study of the facial lesions demonstrated that almost every vellus hair follicle was involved, showing a dilated infundibulum filled by a keratotic plug. This keratotic material was mostly composed of orthokeratotic basket‐weave basophilic corneocytes, namely infundibular keratin, although there were also some dilated infundibula containing eosinophilic laminated or granular sebum at their center. Small infundibular cysts were more numerous than comedones. Mature and well‐developed sebaceous glands were seen at the base of many of the dilated infundibula and no squamous metaplasia of the sebaceous glands or ducts could be demonstrated. Hyperpigmentation of the lesions resulted from hyperproduction of melanin by a normal number of melanocytes along the basal layer of the epidermis and infundibular epithelium. Abundant melanin granules also impregnated the corneocytes of the infundibular plugs.

Conclusions:  Our findings support the notion that tiny infundibular cysts rather than comedones represent the basic lesions of chloracne.
Development of histologic features of scleroderma in congenital lesions*
Authors: Harford Robert , Smith Kathleen J. , Skelton Henry
Published: March 2003

Background:  Localized scleroderma has been reported after radiation therapy, but has never been reported to occur at the site of a congenital lesion.

Case report: We present two patients, both with family histories of autoimmune disease, who reported unilateral hypopigmented areas on the trunk since birth. The areas remained asymptomatic and grew with the patients until adulthood when the areas became indurated then firm and showed hyperpigmentation.

Histology: Histologically, both lesions showed features of localized scleroderma with diffuse sclerosis of collagen and loss of periadnexal fat. There was a perivascular lymphoplasmocytic infiltrate with occasional eosinophils extending into the subcutaneous fat predominantly along fat septae, and diffuse loss of CD34+ stromal cell populations within the lesions.

Conclusion: We propose that somatic mutations affecting vessels may predispose to increased endothelial cell apoptosis. This could lead to the development of an autoimmune response in some individuals, and the areas of localized scleroderma may be markers of susceptibility to autoimmune disease.
Study of HHV‐8 DNA sequences in archival biopsies from lesional skin of Kaposi's sarcoma, various mesenchymal tumors and related reactive conditions
Authors: Kazakov Dmitry V. , Prinz Bettina M. , Michaelis Sonja , Schmid Mirka , Müller Beatrix , Adams Volker , Burg Günter , Kempf Werner
Published: March 2003

Background: HHV‐8 has been identified as the causative agent of Kaposi's sarcoma (KS) and some lymphoproliferative disorders. In addition, there are anecdotal reports on the presence of HHV‐8 in other tumors, especially cutaneous epithelial and mesenchymal neoplasms. The aim of the study was to ascertain the value of identification of HHV‐8 viral DNA sequences in routinely processed, formalin‐fixed, paraffin‐embedded tissues for the diagnosis of Kaposi's sarcoma and other mesenchymal tumors.

Methods: The presence of HHV‐8 sequences in archival material was studied by nested PCR using specific primers for amplification of a 233‐bp long fragment of HHV‐8 (ORF 26).

Results: Thirty‐three patients with KS (18 classic/sporadic, six post‐transplant and nine AIDS‐related) and various mesenchymal tumors and related conditions (n = 76) were studied. HHV‐8 DNA sequences were detected in 29 of the 33 cases of KS and in one case of multiple eruptive dermatofibroma (MEDF).

Conclusions: Identification of HHV‐8 DNA sequences in routinely processed tissue is a useful diagnostic marker for KS. Although other mesenchymal tumors are usually not associated with HHV‐8, its presence is not fully specific for KS since HHV‐8 sequences were also found in one case of MEDF. Therefore, PCR analysis for the detection of HHV‐8 should only be used as an additional diagnostic marker for KS and in the context of other tools such as routine histology.
Alteration of mast cell proliferation/apoptosis and expression of stem cell factor in the regression of mastocytoma – report of a case and a serial immunohistochemical study
Authors: Inoue Tae , Yoneda Kozo , Kakurai Maki , Fujita Sachiko , Manabe Motomu , Demitsu Toshio
Published: March 2003

Background: Spontaneous regression of solitary mastocytoma is a well‐described phenomenon, but its mechanism is unknown.

Methods: Serial‐section immunohistochemical analyses were performed on biopsies of a mastocytoma from a Japanese child during the proliferation stage (PS, 7 months of age) and the regression stage (RS, 5 years old).

Results: Mast cell (MC) density in RS was markedly decreased (406 cells/mm2) compared to that in PS (3554 cells/mm2). MCs in RS were larger than those in PS. With proliferative cell nuclear antigen (PCNA) staining, 1.7% MCs were positive in PS, whereas no positive MCs were seen in RS. TUNEL‐labeling index (LI) in RS (2.8%) increased 1.5‐fold in PS (1.9%). With stem cell factor (SCF) staining, 57% of lesional MCs in RS revealed strong cytoplasmic immunoreactivity, whereas only 9% of MCs were positive in PS. Epidermal SCF reactivity was found as intracellular and intercellular patterns in both PS and RS.

Conclusions: Loss of MC proliferating activity, an increase in apoptotic MCs, and increased expression of SCF in remaining MCs in RS may play a role in the involution of mastocytomas.
Clonal analysis of cutaneous fibrous histiocytoma (dermatofibroma)
Authors: Hui Pei , J. Glusac Earl , Sinard John H. , Perkins Archibald S.
Published: March 2003

Background:  Dermatofibroma (DF) or cutaneous fibrous histiocytoma is a common benign fibrohistiocytic lesion involving the dermis and subcutis. Histologically, it is subclassified into fibroblastic and histiocytoid forms. Its histogenesis is controversial. While often referred to as a neoplastic process, definite evidence of neoplasia in DF has been lacking. Alternatively, some authorities have suggested that DF is a fibrosing inflammatory process. Diagnostically, the most important question faced is the distinction from dermatofibrosarcoma protuberans (DFSP). Misdiagnosis can occur, as the early phase of DFSP can simulate DF, particularly the deep and cellular forms of DF.

Methods:  To address this issue, and to investigate whether DF is in fact a neoplasm, we evaluated 31 examples of DF of various histological types in female patients and assessed clonality by analyzing X‐chromosome inactivation as indicated by the methylation status of the androgen receptor gene (HUMARA). Representative cases of DFSP were analyzed for comparison.

Results:  Among the selected 31 cases of DF, 24 cases provided intact DNA and informative polymorphism at the AR alleles, including one case of recurrent deep fibrous histiocytoma. Among these 24 cases, randomly inactivated AR alleles were observed in 17 cases including a deep, recurrent fibroblastic DF. A non‐random inactivation at AR alleles was observed in seven cases, of which six cases showed either typical histiocytoid form of DF (four cases) or mixed cell types with predominant histiocytoid cell type (two cases). One fibroblastic DF also showed a monoclonal pattern. HUMARA analysis of DFSP revealed non‐random inactivation of polymorphic AR alleles.

Conclusions:  These findings suggest that DF is a heterogeneous process. Monoclonal genotype was found in DFs with histiocytoid or mixed type with predominant histiocytoid features, suggesting that histiocytoid cells probably represent the neoplastic component. The fibroblastic form of DF may represent a reactive fibroblastic proliferation. Alternatively, it may represent a true neoplasm whose neoplastic cell type has been obscured by prominent reactive fibroblastic component.
The value of a questionnaire in assessing the acquisition and retention of basic science knowledge by dental students
Authors: Last K. S. , Appleton J. , Ferguson D. B. , Stevenson H.
Published: March 2003

This cross‐sectional study aimed to assess and compare, by performances in a questionnaire, the level of knowledge of basic medical sciences in 6th‐form school pupils studying science subjects as entrance requirements to University and in 2nd, 3rd and 4th‐year undergraduate dental students. A 40‐part multiple response, true/false questionnaire, testing recall of factual knowledge in anatomy, biochemistry, physiology and oral biology, was used as the method of assessment. The results suggested that this simple format was an acceptable and useful method of assessment of the knowledge level of the study groups. The difference in scores of knowledge, expected to be higher in 2nd‐year students compared to 6th form groups, was greatest in anatomy and oral biology, less in biochemistry and, unexpectedly, was not apparent in physiology. A difference in performance on the knowledge questionnaire was observed between 4th and 2nd year dental students, attributable primarily to decreased scores for 4th year dental students in biochemistry and, to a lesser extent, anatomy. The results obtained with this standardised test of factual knowledge recall may be of value to teachers compiling medical sciences courses for dental undergraduates and to those planning and evaluating new curricula with a less didactic approach.
Do better qualified dentists make fewer hospital referrals?
Authors: Lamb David J. , Fairclough Angela L. , Ellis Bryan
Published: March 2003

Objective: To assess the influence of further qualifications and length of clinical experience on the number of referrals of complete denture problems made by GDPs to secondary care.

Design: An audit was made of complete denture referrals to Sheffield Dental Hospital between January 1997 and June 1999.

Method: All complete denture referrals (n=257), either single complete denture or 2 complete dentures, made by locally practising NHS registered dentists (n=211) to Sheffield Dental Hospital, were recorded, along with the year of qualification and any additional clinical qualifications of referring practitioner.

Results: Fewer referrals were made by better qualified dentists (p=0.003). Better qualified dentists also appeared willing to treat more difficult cases. In the absence of a further clinical qualification, length of clinical experience had no effect on the number of referrals made.

Conclusions: Better qualified dentists make fewer complete denture referrals, emphasising the importance of continuing education in reducing referral rates and improving patient service.
Application of behavioural sciences teaching by UK dental undergraduates
Authors: Pine Cynthia M. , McGoldrick Pauline M.
Published: March 2003

From 1990, Behavioural Sciences have become a requisite subject of dental undergraduate curricula across the UK (2). However, subject matter taught varies from school to school (4). The aim of this study was to determine the views and experiences of senior dental undergraduates in applying their behavioural sciences teaching across a range of clinical situations. A questionnaire survey was designed in which 5 UK Dental Schools were included to provide a countrywide geographic distribution and where >75% of senior students in each Dental School participated. The questions required the students to evaluate their psychosocial skills in 4 main areas: dentist/patient interactions; enhancing preventive behaviour; anxiety management; coping with personal stress. 252 students participated, 43% were male. In general, students valued their behavioural sciences teaching and 84% rated its inclusion in the curriculum as important. Some patient management situations had been infrequently encountered in their clinical experience and their confidence in dealing with these situations was low. The data was entered into a stepwise logistic regression to determine which factors explained the variation in reported confidence. In relation to dentist‐patient interactions and preventive aspects (9 aspects), significant variables were how well students felt they were taught and how often they encountered the situations. Gender contributed to explaining variation in 4 of these aspects. In dealing with patient aggression, men were over 7× more confident than women (Odd’s ratio 7.32), but in changing patients’ attitudes to oral health, women were more than 2× as confident as men (Odd’s ratio 2.08). In anxiety management and dealing with personal stress, additional variables entered the model and these were age, gender and Dental School. For most aspects of confidence in anxiety management, the quality of teaching to manage these situations was the key variable. In conclusion, this survey has provided an evaluation of UK students’ perceived psychosocial skills in a range of clinical settings. This should encourage educators to improve curricular content to support the development of clinical competency in this area.
Personality types of dental school applicants
Authors: Morris David O.
Published: March 2003

A questionnaire‐based prospective study was carried out to measure the personality styles of students being interviewed for a place on the 1997/98 dental undergraduate course in Leeds, England. A total of 334 applicants attended for interview between November 1997 and March 1998, of which 311 anonymously and voluntarily completed a personality questionnaire. The Keirsey Temperament Sorter was used to measure the strength and nature of preferences along four dimensions: extroversion‐introversion (E‐I), sensing‐intuition (S‐N), thinking‐feeling (T‐F) and judging‐perceiving (J‐P). 4 personality types accounted for 79% of the students, 21% were divided among nine personality types with no type comprising more than 6.7% of the students. The remaining 3 possible personality types were not represented in this student population. Further comparisons revealed significant differences between this student sample and the general population in the judging‐perceiving preference and also an intra‐group gender difference with regard to the thinking‐feeling (T‐F) preference. A predominance of the S‐J (sensing with judging) temperament type was also confirmed. Personality questionnaires may be a useful adjunct in the selection process of dental school applicants. The identification of a student’s working and learning style preference has implications for both the dental undergraduate curriculum and the teaching methods employed by dental school staff.
Socio‐economic characteristics and personal attitudes of patients attending a French prosthodontic teaching clinic
Authors: Fromentin Olivier , Boy‐Lefèvre Marie Laure
Published: March 2003

The aims of the study were to define the socio‐economic characteristics of patients attending a Teaching Hospital Prosthetics Department and to determine the attitudes and aspirations of such patients. The study was performed on 162 patients who requested prosthetic treatment in a French university dental hospital department. They were asked to complete a questionnaire at the beginning of their treatment. The questionnaire was composed of 2 parts, covering respectively: firstly, social, economic, and demographic data concerning the patients, the source of referral and the primary motivation for their decision to request treatment, and secondly comments concerning their prosthetic treatment. The results show the socio‐professional and socio‐economic diversity of this population. In most cases, the patients were recommended to the university hospital service by their relatives or friends. Among the criteria proposed, they indicate that cost and quality of treatment were their major motivation. Analysis of the patients’ comments identifies some factors responsible for the lack of efficiency associated with care and dental education.
Report on the development of a new dental curriculum at Helsinki
Authors: Kerosuo Eero , Ruotoistenmäki Juha , Murtomaa Heikki
Published: March 2003

A review of the dental curriculum was undertaken in Helsinki in the mid 90s. The objectives of the new curriculum were to reinforce the links between basic biomedical and dental sciences in order to give more emphasis to oral medicine and comprehensive dental care. Furthermore, the curriculum needed to promote an interdisciplinary approach and encourage students to understand dental diseases in relation to the community at large. A two‐year, topic‐based, preclinical curriculum, fully integrated with medical students, was started. For didactic teaching in the clinical phase, new learning entities were established to promote an inter‐disciplinary approach. For the first time in Finland, objectives were formulated for attitudes and interpersonal skills. Clinical training was conducted in a comprehensive clinic, based on the team concept, where emphasis was given to proven competency instead of to the number of procedures performed. The time spent in the clinic was kept the same as previously (1440 h). Students' learning process was assessed with a portfolio. The majority of students welcomed the comprehensive care clinic, especially its team concept and treatment planning seminars. However, feedback seminars after treatment of the patient were not in favour. As part of the evaluation process, a DENTED visitation took place in Helsinki in March 1999. The results obtained in the student questionnaire were consistent with the aims of the undergraduate training and with the present patient treatment range. In conclusion, the curriculum change enabled the school to broaden the biomedical aspects by increasing the period of preclinical studies. Although the extent of these studies was greater than in the past, and meant postponement of clinical skills courses by one semester, it did not jeopardise the competency in clinical dentistry, owing to the effective integration of the clinical phase teaching.