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Biomedical subjects

I van der Waal

Publications and source records attributed to I van der Waal.

At least 19 recordsLinked to original sources
PubMed2003

Oral metastases: report of 24 cases.

AIM: To study patients with oral metastatic tumours for the distribution of sex and age, the oral site and histopathological type of the metastasis, the primary tumour site and length of follow-up. PATIENTS AND METHODS: All patients who had an oral metastasis diagnosed during the period January 1970-January 2001 at the Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Centre, Amsterdam, The Netherlands, were included in this retrospective case study. RESULTS: Of 1537 patients with newly diagnosed oral cancers, 24 had metastatic tumours. There was an equal sex distribution and age at the time of diagnosis ranged from 8 to 90 years (median 60). The metastatic tumours most commonly involved the bone (18/24), the mandible being the most common (15/18). The predominant histological type was adenocarcinoma. In most patients (n = 16) the primary tumour was already known before the oral metastatic lesion appeared. The most common primary tumours were breast, lung, kidney, and prostate, in that order. Prognosis was poor (median survival 6 months, range 1-60). CONCLUSIONS: Oral metastases are rare and may present at any age in both sexes and predominantly involve bony structures, particularly the mandible. A third of oral metastases appeared to be the first indication of an occult malignant process elsewhere.

Adolescent↗
PubMed2003

Ano-genital granulomatosis: the counterpart of oro-facial granulomatosis.

Ano-genital granulomatosis encompasses the previously recognized clinical entities of vulvitis granulomatosa, posthitis granulomatosa, and ano-perineitis granulomatosa. We report three patients with ano-genital granulomatosis. The pathological features of the disease are lymphoedema and the presence of non-caseating giant cell granulomas. These granulomas are histologically indistinguishable from those found in both Crohn's disease and sarcoidosis, therefore, patients with ano-genital granulomatosis with accompanying gastro-intestinal or pulmonary symptoms should be investigated for the presence of Crohn's disease or sarcoidosis, respectively. The value of ano-genital granulomatosis as a unifying clinicopathologic concept is to provide a label for the affliction as well as to stimulate a careful search for possibly underlying systemic disorders, thus also permitting a more specific approach to therapy.

Adult↗
PubMed2003

Incidence and management of oral conditions in general practice.

Despite a high community prevalence, little is known about the occurrence of oral conditions in general practice. In an observational study, 354 new cases of oral complaints were recorded in 35 participating practices during a period of six months (cumulative incidence = 6.7 per 1000 per year). The incidence was highest in children under five years of age (21% of all cases). The conditions diagnosed most frequently were aphthous ulceration, oral candidiasis, and herpes simplex infection. Most oral conditions were minor ailments, and could be dealt with by the general practitioner alone.

Adolescent↗
PubMed2002

Oral leukoplakia: a proposal for uniform reporting.

Leukoplakia is the most common precancerous lesion of the oral mucosa. In order to promote uniform reporting of management results, including the event of malignant transformation, recommendations have been made for the various definitions and terminologies, including the application of a certainty factor with which the diagnosis of oral leukoplakia has been established. For reporting purposes there seems to be no rationale for distinguishing "tobacco-associated" leukoplakias from non-tobaccco-associated, so-called idiopathic leukoplakias. The recommendation has been made to use a classification and staging system in which the size and the histopathologic findings are reflected. At present, there seems to be no justification to give a weighting factor to the oral subsite of leukoplakias.

Diagnosis, Differential↗
PubMed2002

Cost-effectiveness of screening for the possible development of cancer in patients with oral lichen planus.

INTRODUCTION: Several authors have expressed the view that patients with oral lichen planus (OLP) are at increased risk of developing oral cancer. Since OLP cannot be effectively treated, regular screening for the possible development of oral cancer might be considered. OBJECTIVES: (i) To calculate costs and effectiveness of screening for oral cancer in OLP patients with a decision model; (ii) to compare the cost-effectiveness of different screening scenarios; and (iii) to perform a sensitivity analysis of several variables used in this model. METHODS: Costs and effectiveness of a population of 100,000 OLP patients, being either screened or not screened for oral cancer, were calculated for the period of 1 year. Health gain was expressed as quality adjusted live years (QALY's) and equivalent lives saved (ELS). Cost-effectiveness was expressed as extra costs (costs of screening minus costs of no screening) per ELS. Then, the outcome was compared with the cost-effectiveness of a different screening scenario. Finally, the effect of varying the variables: (i) costs of cancer treatment; (ii) annual malignant transformation rate (MTR); (iii) sensitivity and specificity of an oral examination; and (iv) proportion of cancers found in stage I on extra costs per ELS were assessed in a sensitivity analysis. RESULTS: The health gain from screening was 592 QALY's or the equivalent of 23.68 lives saved, costing 1,265,229 dollars, meaning that one ELS costed 53,430 dollars. Increase of cancer-treatment costs will significantly decrease the costs per ELS. When the MTR is lower than 0.4% per year, extra costs per ELS will increase exponentially. The effect of sensitivity and specificity of an oral examination in detecting oral cancer on cost-effectiveness seems to be substantial. When the proportion of cancers found in stage I can be increased from 40% (without screening) up to at least 60% after screening, extra costs per ELS will decrease exponentially. CONCLUSIONS: Screening for oral cancer in OLP patients, based on the presently used model, seems attractive. However, varying the several variables in the decision model has a significant impact on the final costs and effectiveness. Only, when additional information about these variables will become available, a more precise and realistic calculation can be performed.

Cell Transformation, Neoplastic↗
PubMed2002

The clinical relevance of epithelial dysplasia in the surgical margins of tongue and floor of mouth squamous cell carcinoma: an analysis of 37 patients.

BACKGROUND: The clinical relevance of the presence of epithelial dysplasia in the margins of surgically removed oral squamous cell carcinoma is still unclear. METHOD: In a retrospective study, the presence of mild or moderate epithelial dysplasia in the surgical margins of tongue and floor of mouth squamous cell carcinoma was examined histologically. Patients with tumor cells within 0.5 cm of the surgical margins were excluded. Also patients with severe dysplasia were excluded, as this is usually regarded as carcinoma in situ. Patients that received postoperative irradiation were also excluded. Only patients who completed a follow-up period of five years were included. All together, a total number of 37 patients fulfilled the inclusion criteria. RESULTS: Epithelial dysplasia was observed in 7 out of the 37 patients. Five of these patients, and two of the 30 patients with no dysplasia, had a local recurrence (P < 0.01). CONCLUSION: The presence of mild or moderate epithelial dysplasia in the margins of surgically removed oral squamous cell carcinoma carries a significant risk for the development of local recurrence. However, it should be noted that this study was of a retrospective nature and that the group of patients with epithelial dysplasia in the surgical margins was rather small. On the other hand, the inclusion criteria were somewhat strict, by limiting the oral subsite to tongue/floor of mouth, by excluding patients in whom tumors cell were found within 0.5 cm of the surgical margins and by excluding patients who received postoperative radiotherapy, amongst others.

Carcinoma, Squamous Cell↗
PubMed2002

Interobserver and intraobserver variability in the clinical assessment of oral lichen planus.

BACKGROUND: In 1978, a clinical definition of OLP was formulated by the WHO. To date, the validation results of this clinical definition have not been published. The aim of this study was to evaluate interobserver and intraobserver variability in the clinical assessment of oral lichen planus (OLP). METHODS: Four clinicians examined a set of 159 clinical pictures of a white lesion in a group of 60 patients. Each reviewing examiner was asked to apply the WHO definition of OLP from 1978, and to categorise each case as either: (i) diagnostic of OLP, (ii) other definable lesion, or (iii) leukoplakia. After three months, each of the four reviewing clinicians was given the clinical pictures of 45 randomly retrieved cases from the original 60. Interobserver and intraobserver variability were assessed by calculation of unweighted kappa statistics. RESULTS: Interobserver agreement varied from 0.43 (moderate) to 0.77 (substantial), while the intraobserver agreement varied from 0.62 (substantial) to 0.92 (good). CONCLUSIONS: Although the clinical WHO definition of OLP seems to be more reproducible than the histopathological one, there is still a significant amount of subjectivity in using this definition. A set of clinical and histopathological diagnostic criteria with good interobserver and intraobserver agreements (kappa values > 0.8) is very important in enabling reproducible and reliable studies on OLP to be performed.

Diagnosis, Differential↗
PubMed2002

Suprabasal p53 immunoexpression is strongly associated with high grade dysplasia and risk for malignant transformation in potentially malignant oral lesions from Northern Ireland.

AIMS: No good predictive marker for the malignant transformation of potentially malignant oral lesions (PMOLs) is currently available. This study re-evaluated the value of p53 immunoexpression to predict malignant transformation of PMOLs after discounting possible confounding factors. METHODS: PMOLs from 18 patients who showed progression to carcinoma, 16 of the respective carcinomas, and PMOLs from 18 matched controls were evaluated by immunohistochemistry (IHC) for p53 expression. A mouse monoclonal antibody that detects wild-type and mutant forms of human p53 was used. The p53 immunostaining pattern was also correlated with the degree of dysplasia. RESULTS: Suprabasal p53 staining was significantly associated with high grades of dysplasia (p < 0.01). The specificity and positive predictive value (PPV) for malignant transformation of suprabasal p53 staining were superior to the assessment of dysplasia, but sensitivity was inferior. All carcinomas derived from PMOLs with suprabasal p53 showed strong p53 immunostaining. However, the absence of suprabasal p53 staining and/or dysplastic changes did not preclude malignant transformation in a considerable proportion of PMOLs. CONCLUSIONS: This study confirms and extends previous findings that suprabasal p53 immunoexpression has a high PPV for malignant transformation of PMOLs and can be used as a specific marker for lesions that are at high risk for malignant transformation. The absence of suprabasal p53 staining (that is, absence of, or basal, p53 staining) is non-informative for prognostic purposes. Because of its limited sensitivity, p53 IHC is not a substitute for the assessment of dysplasia in the evaluation of PMOLs. Instead, p53 IHC emerges as a clinically useful supplement of histopathological assessment in the prognosis of PMOLs.

Adult↗
PubMed2002

[Lip carcinoma. A review].

Lip cancer develops in the vermilion border of the lip. The great majority of these malignancies are squamous cell carcinomas. Lip cancer predominantly affects the lower lip and particularly occurs in males. The main risk factors involved are cumulative lifetime exposure to sunlight and the use of tobacco. It usually presents at an early stage. In the Netherlands (16 million inhabitants), approximately 190 new cases are registered annually. Since lip cancers in most instances are easily recognized, they may be diagnosed at an early stage. Lip cancer is best cured when it is diagnosed early. Dental examination should routinely include clinical examination of the lips and, on indication, palpation. This article reviews the clinical presentation, diagnosis and management of lip cancer.

Carcinoma, Squamous Cell↗
PubMed2001

[Early diagnosis and prevention of malignant tumors in the head and neck region].

In the Netherlands more than 2000 new patients with head and neck cancer are diagnosed annually. Most of these cancers are squamous cell carcinomas. The use of tobacco and alcohol are well established aetiologic factors. Head and neck cancers usually affect patients above the age of 40 years and are somewhat more common in men than in women. The type of the initial symptoms of head and neck cancer depends largely on the exact location. Often, these symptoms are rather aspecific. However, laryngeal cancer is an exception. In this site cancer usually presents at an early stage with sudden hoarseness. Hoarseness of more than three weeks' duration requires laryngoscopic examination. Particularly the cancers of the floor of the mouth and the borders on the tongue can be detected early because of the accessibility of these sites, which allows proper inspection and palpation. The most common clinical manifestation of oral cancer is an indurated ulcer. An oral ulcer present for more than three weeks is an indication for biopsy. The prognosis of head and neck cancer in general depends largely on the stage at diagnosis. Small cancers carry a much better prognosis after surgical removal or radiotherapy than larger ones.

Alcohol Drinking↗
PubMed2001

Cheilitis granulomatosa.

Cheilitis granulomatosa is a rare inflammatory disorder with unclear aetiology. It is a disorder characterized by recurrent or persistent swelling of one or both lips that may be part of the Melkersson-Rosenthal syndrome or may be a manifestation of Crohn's disease. An overview of the clinical features, histopathology, differential diagnosis, management strategies and prognosis of cheilitis granulomatosa is presented and discussed with regard to the literature.

Anti-Inflammatory Agents↗
PubMed2001

Tobacco usage in relation to the anatomical site of oral leukoplakia.

OBJECTIVE: Tobacco usage is the most important known aetiological factor in the development of oral leukoplakia. The purpose of this study was to investigate the possible relation of tobacco usage to the anatomical site of the leukoplakia. SUBJECTS AND METHODS: Clinical data regarding tobacco usage and localisation of leukoplakia obtained from 166 patients with oral leukoplakia. RESULTS: Leukoplakias in the floor of mouth appeared to be statistically significantly more often present in smokers than in non-smokers, compared to all other oral sites (P < 0.001; OR = 8.47 and 18.13 for men and women, respectively). On the contrary, leukoplakias on the borders of the tongue were statistically significantly more common among non-smokers, than smokers, compared to all other oral sites (P < 0.001; OR = 0.22 and 0.12 for men and women, respectively). CONCLUSION: The present study suggests that the influence of tobacco on the development of leukoplakia varies by anatomical site.

Adult↗
PubMed2001

Granular cells in oral lichen planus.

OBJECTIVE AND DESIGN: Three cases of granular cells associated with oral lichen planus (OLP) have been reported to date, which prompted us to look for the presence of granular cells in a consecutive series of 250 cases of OLP in the period 1996-1998. RESULTS: Only one case with granular cell changes was encountered in that series. H&E stained slides as well as direct immunofluorescence examination showed characteristics compatible with OLP. Part of the subepithelial connective tissue was replaced by a granular cell proliferation; S-100 protein was diffusely expressed in all granular cells, whereas no expression of smooth muscle actin was observed. CONCLUSION: Based on these findings it seems unlikely that the granular cells in the present case represent a so-called 'oral ceroid granuloma'. The presence of granular cells might rather have been a reactive phenomenon triggered by the inflammatory infiltrate or a granular cell tumour (GCT). Whether the simultaneous presence of a GCT and OLP in this particular case was based on a causal relationship or on coincidence still remains unknown.

Actins↗
PubMed2001

[Oral medicine].

Oral medicine is the discipline in dentistry which deals with diagnosis and non-surgical treatment of lesions and diseases of the oral tissues, particularly those of a systemic, multiorgan or drug-induced nature. In the Netherlands, the oral and maxillofacial surgeon is usually the one who takes care of oral medicine. In the dental curriculum in the Netherlands oral medicine is not taught as a separate discipline, but is included in the courses of oral and maxillofacial surgery, oral pathology, periodontology and also, amongst others, in the course of biochemistry. In the Netherlands it is not a recognised speciality and it is questionable whether there really is a need for it. In the medical curriculum and in the training program for family doctors only a very few hours on oral diseases is included. Since many patients with oral diseases see their family doctor first, an extension of the numbers of hours on oral diseases in general and, more specific, in oral medicine, in the medical curriculum is recommended.

Curriculum↗
PubMed2001

[Vesiculobullous lesions of the oral mucosa].

In general practice, the dentist can be confronted with a vesiculobullous lesion of the oral mucosa. In many cases the lesion can be classified as recurrent herpes labialis, but many other causes can induce a vesiculobullous lesion of the oral mucosa and perioral skin as well. This article gives an overview of the various vesiculous and bullous lesions of the oral mucous membranes. Special attention is given to the possible causes and their treatment.

Blister↗
PubMed2001

[Burning mouth syndrome].

Symptoms of a burning sensation of the oral mucosa mainly occur in the elderly, more often in women than in men. Often accompanying symptoms are complaints of a dry mouth and taste disturbances, all together referred to as the burning mouth syndrome. In the majority of cases there is no detectable cause. Although a psychogenic aetiology has often been put forward, no scientific evidence has ever been provided on this matter. In the majority of patients the burning mouth syndrome will disappear spontaneously, although this may take many years.

Age Factors↗
PubMed2000

Squamous cell carcinoma of maxillary sinus.

BACKGROUND: Medical records of 43 patients with histologically proved diagnosis of squamous cell carcinoma who were treated between the years 1975 and 1994 at the department of Otolaryngology Head Neck Surgery, VU Amsterdam were examined. METHODS: Tumors were restaged according to UICC classification 1997. Thirty-eight patients were treated for cure, nine were treated with chemotherapy followed by external beam radiotherapy, and 28 patients were treated with surgery followed by postoperative radiotherapy. No patient was lost to follow-up. Data with respect to survival were analyzed. RESULTS: Eighty-three percent of the tumours were in stage III or stage IV at the time of first presentation. Five-year survival after surgery and postoperative radiotherapy for all patients was 64%. For stages II, III, and IV it was 83%, 49%, and 37%, respectively. Cervical nodal metastases were present in 4.1% at the time of presentation. Thirty-seven percent of the patients survived 2 years after chemotherapy followed by radiotherapy. CONCLUSIONS: Squamous cell carcinoma continues to be diagnosed late. Surgery followed by radiotherapy remains the treatment of choice. Mandibulotomy should be considered for better clearance of retromaxillary space in T3 -T4 tumors. The eye should be preserved whenever it is oncologically safe to do so.

Adult↗