[How does the Danish National Medical Research Council administer its funds?].
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Biomedical subjects
Publications and source records attributed to J J Pindborg.
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Some cancers, especially sarcomas, favor younger age groups, whereas others, particularly carcinomas, are most likely to develop in older age groups. The relative frequency, mortality and morbidity rates are defined using lip and tongue cancer as examples. The paper demonstrates how oral cancer rates increase with age. For tongue cancer there is a worsening of the prognosis with advancing age. The synergistic effect of tobacco and alcohol and its relation to age is also dealt with. For leukoplakia there is also a higher rate with increasing age, although there is a shift towards younger ages when compared with oral cancer. Tobacco, age and leukoplakia are also discussed. The increased cancer and precancer rate in older people may be due to age changes in the oral mucosa making it more vulnerable to the action of carcinogens.
A preleukoplakia, conceived as a precursor stage of leukoplakia, is grey or greyish-white area with indistinct borders. The paper describes 659 preleukoplakias detected among 20,358 individuals in two districts in India. In Bhavnagar district 99.5% of the preleukoplakias were among men. 23.5% of the hookli (clay pipe) smokers had preleukoplakias. In Ernakulam district 79.6% of the preleukoplakias were found among men and the mixed habit group of bidi smoking and tobacco chewing had the highest prevalence (6.1%). The preleukoplakias showed a marked tendency to regress; among the bidi smokers in Bhavnagar, 75% regressed. In two patients preleukoplakia turned into carcinoma.
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The FDI has shown considerable interest in the oral cancer and has in recent years arranged three symposia on the subject. The incidence of oral cancer shows marked geographic differences mostly depending upon environmental factors. In the present paper the epidemiology of oral cancer is illustrated by the relative frequency to total number of cancers and incidence rates from a number of countries. Canada has the highest rate of cancer of the vermilion border, which is extremely rare among dark-skinned people. Even within one country differences may be found, a fact which is illustrated by findings from Czechoslovakia and India. In most of the studies dealing with the etiology of oral cancer tobacco usage in its various forms is shown to be the outstanding factor.
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In a 7-year follow-up study of 107 cases of oral epithelial dysplastic precancerous lesions in Indian villagers, 6.6 per cent were found to develop into carcinomas. A clinical spontaneous regression occurred in 14.8 per cent. Follow-up biopsies showed histologic regression of dysplasia in six cases.
The smoking habits of 611 patients (68 per cent females and 32 per cent males) with oral lichen planus were studied. Forty-six per cent were daily smokers, 4 per cent smoked only at social events, and 50 per cent were nonsmokers. In comparison with the nonsmokers, the daily smokers showed significantly lower prevalences of reticular and atrophic types of oral lichen planus lesions and a significantly higher prevelance of the plaque type (P less than 0.001). It is suggested that these findings depend on a mechanism whereby original atrophic and reticular types of lesions are altered into the plaque type of lesions under the influence of smoking. The question arises whether such plaque type of lesion can be regarded as leukoplakias which have been superimposed on the oral mucosa affected by lichen planus.
In Srikakulam, India, 101 patients with palatal lesions due to reverse smoking were followed for 1 year at monthly intervals to analyze the behavior of the various components of their palatal lesions. Of these patients, 24% stopped the habit completely and 27% changed to the conventional type of smoking. Palatal keratosis was very stable, whereas red areas changed into nonpigmented areas. Epithelial dysplasia was found in 23% of the 101 biopsies, the highest being in the red areas. Mild inflammation was seen in about half of the biopsies.
The arterial blood pressure of 121 patients with oral lichen planus was determined using the auscultatory method. These values were then compared with those previously found in a general adult population. No significant difference was found betwween the values of the lichen planus patients and those of the general population. The present investigation does not support the hypothesis of a relationship between lichen planus and hypertension.
Of 123 patients with oral lichen planus two were known diabetics. The remainder were tested for fasting glucosuria, 113 for fasting blood glucose and 103 also with an oral glucose tolerance test. According to the criteria of WHO, 18 of the 123 patients were diabetics. In most of these patients the oral glucose tolerance test was only slightly abnormal. No decrease of the glucose tolerance with increasing duration of lichen planus was demonstrable. Comparison with two general population studies did not reveal any significant difference between the glucose tolerance of the lichen planus patients and that of the general population samples.
In the eastern part of Java and on the island of Bali betel chewing is a very common habit confined principally to females. The purpose of the present study was to examine the influence of betel chewing on the prevalence of dental caries. The study, which is based upon 982 villagers, indicates a strong inverse relationship between the prevalence of dental caries and the intensity of betel chewing. The possible mechanisms whereby betel chewing may have a caries-inhibiting effect are discussed.
Two male patients with oral leukoplakias exhibiting a peculiar type of apparent dysplastic changes have been followed for 4 and 6 years, and a series of biopsies have been examined by light and electron microscopy. The apparent lack of normal epithelial stratification below the keratinized cell layers was mainly caused by the frequent appearance of large ballooned cells and multinuclear giant cells. The centre of the large ballooned cells contained aggregations of chromatin and evenly-dispersed microtubulus surrounded by a thick rim of tonofibril bundles. In the peripheral cytoplasm large numbers of smooth-surfaced endoplasmic reticulum were found, but no Golgi apparatus was observed. In addition, several autophagocytic bodies were recorded. Along the cell membrane only a few desmosomes were present, whereas aggregations of digested desmosomes were found in the cytoplasm. On the basis of the ultrastructural findings, it is suggested that the large ballooned cells represented epithelial cells arrested in early stages of mitotic division. The epithelial cells in interphase exhibited a normal ultrastructure except for large nucleoli with varying degrees of condensation of nucleolonema and vacuolization. Further, atypical dense granular aggregations and strands of fine fibrillar material were recorded in the nuclei. It is suggested that this new type of oral leukoplakia has a viral etiology.
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A review of the world literature has revealed 113 cases of the calcifying epithelial odontogenic tumor. The clinical, radiographic, and histopathologic features are analyzed. Various treatments that have been carried out are related to the frequency of recurrence. The theories of histogenesis are discussed and an attempt is made to explain the nature and origin of the amyloid-like substance.
Biopsies of oral lesions from 21 patients with diagnostic skin lesions of discoid lupus erythematosus and from 21 patients with oral lichen planus and leukoplakia were examined blindly by light microscopy. The correct histologic diagnosis (DLE) was established in less than half of the cases. In one-third of the cases differentiation between DLE and lichen planus could not be made. In the rest of the cases histologic diagnoses other than DLE were stated. The study shows the need for better diagnostic methods for oral lesions.
A group of 20,358 villagers in two districts of India has been followed for 7 years to study the incidence of oral leucoplakia. The follow-up rate of the population in two districts ranged from 61% to 71%. In one of the districts (Bhavnagar) no new cases of leucoplakia were found among females in the 7-year period. Among males 105 cases developed (4-0/1000/year). The incidence was highest among hookli (clay pipe) smokers. In the Ernakulam district the incidence among males was 3-3/1000/year whereas among females it was 1-9/1000/year. The mixed habits group had the highest incidence of oral leucoplakias (7-2 and 9-9/1000/year among males and females respectively).