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Biomedical subjects

L R Eversole

Publications and source records attributed to L R Eversole.

At least 19 recordsLinked to original sources

The distribution of the antimicrobial protein, calprotectin, in normal oral keratinocytes.

Calprotectin is a heterodimeric peptide isolated from neutrophil cytosol that exhibits profound antimicrobial effects. Using monoclonal antibody MAC 387, calprotectin was found to be expressed in oral keratinocytes from normal, non-inflamed oral mucosa. Orthokeratinized sites including the attached gingiva and hard palate expressed low levels of calprotectin with a restricted pattern; immunoreactants were identified only within subcorneal keratinocytes. Parakeratinized mucosa from the lips, soft palate, tongue and buccal mucosa expressed calprotectin in a more widespread, yet variable pattern, immunoreactants being detectable in only a portion of the spinous layer in some cases whereas in others the pattern of expression was more topographically diffuse. Antigen was not detected in basilar and lower strata cells. Both cytoplasmic and nuclear decoration could be identified. The results indicate that oral mucosa harbours an antimicrobial deterrent to micro-organisms that may enhance the physical epithelial barrier of host defence.

Antigens, Surface

Viral infections of the head and neck among HIV-seropositive patients.

Many viruses cause opportunistic infections in HIV-positive patients. Those that cause oral lesions include herpes simplex, varicella zoster, Epstein-Barr virus, cytomegalovirus, and papillomavirus. Importantly, many of the herpes-group viruses are able to augment immunosuppression and some actually transactivate HIV replication-inducing genetic sequences. This article reviews the role of viral agents in the activation of HIV replication and details the features of the reported oral lesions that represent viral opportunistic infections.

Acquired Immunodeficiency Syndrome

Polymerase chain reaction: relevance for oral pathology.

The polymerase chain reaction (PCR) is a recent innovation in biotechnology for amplifying specific nucleic acid sequences by use of repeated cycles of DNA synthesis. Application of PCR has been extended to a wide variety of biological and medical disciplines; fields of application include molecular genetics, pathology, microbiology, forensic medicine, and infectious diseases. Because of its speed and powerful sensitivity, PCR has become a highly valuable method for detecting small amounts of target nucleic acid sequence with the caveat that it has certain limitations. Importantly, false-positive reactions can result from the amplification of contaminating DNA whereas false-negative reactions can result from introduction of inadequate numbers of primer sequences. The application of PCR in the context of oral pathology is presented along with a discussion of the utility of this technique to aid in the elucidation of the etiology of oral disease.

DNA

Detection of human papillomavirus-genomic DNA in oral epithelial dysplasias, oral smokeless tobacco-associated leukoplakias, and epithelial malignancies.

Human papillomavirus (HPV) is an infectious agent that is increasingly associated with mucosal cancers, in particular cancer of the cervix. The present investigation was undertaken in an attempt to determine whether HPV could be easily detected in biopsies of oral tissues, specifically oral squamous cell carcinomas, oral epithelial dysplasias, smokeless tobacco keratoses, verrucous hyperplasia, and verrucous carcinoma. In situ DNA hybridization methods were used to isolate specific HPV genomes. Among 100 instances of benign leukoplakia, only 4% of non-tobacco-related and 10% of smokeless tobacco-related lesions harbored viral sequences. We were able to detect viral sequences in dysplastic lesions 3% of the time. Alternatively, 17% and 20% of the verrucous hyperplasias and verrucous carcinomas were positive for viral nucleic acids. Six percent of the squamous cell carcinomas harbored HPV. On the basis of these findings, it is concluded that HPV of known genotype can be identified in oral premalignant and malignant neoplasms.

Carcinoma in Situ

Comparison of clinical characteristics in myogenic, TMJ internal derangement and atypical facial pain patients.

Temporomandibular joint (TMJ) disorders have been collectively grouped as myofascial pain-dysfunction syndrome (MPDS) or temporomandibular joint dysfunction syndrome (TMJDS). In the past, these terms have been used synonomously to describe a set of clinical signs and symptoms that include pain in the TMJ and muscles of mastication, limited or deviant opening of the mandible, and/or joint sounds. The present study segregated two major subgroups subsumed within this diagnostic classification and assigned them to a myogenic facial pain (MFP) group and a TMJ internal derangement (TMJID) group. Previous studies may have included both of these disorders as MPDS/TMJDS. While some signs and symptoms are similar, the primary differentiation is based on meniscus displacement present with TMJID patients and pain distribution patterns between the two groups. While MFP/TMJID patients comprise the majority of the facial pain population, a third major group of patients is encountered, being classified under the diagnostic appellation of atypical facial pain (AFP). Patients with AFP usually complain of vague and wandering pain in the maxilla or mandible; however, no identifiable source of infection or organic disease can be uncovered. One hundred fifty patients seeking consultation and care for facial pain met the criteria for inclusion into one of three clinical groups. The groups were compared for age, sex, duration of symptoms, bruxism and/or clenching habits, and disturbed sleep patterns. Differences in surface electromyographic levels from the facial and cervical muscles were also examined. Minnesota Multiphasic Personality Inventory (MMPI) scores from 95 subjects were compared with self-report measures of depression and anxiety. It was concluded that subcategorization of myofascial pain dysfunction patients into a MFP and TMJID group is justified on the basis of psychometric differences, clenching habits, masseter EMG levels, and male:female ratio. Furthermore, psychopathological factors are more significant among MFP and AFP subjects than TMJID patients.

Facial Pain

Hairy leukoplakia: Epstein-Barr virus receptors on oral keratinocyte plasma membranes.

Hairy leukoplakia (HL) is an oral white lesion associated with, and probably caused by, the Epstein-Barr virus (EBV) among persons who are seropositive for infection with human immunodeficiency virus. A unique feature of HL is its localization to the lateral portion of the tongue. To determine site differences for EBV receptors according to epithelial phenotype, these receptors were mapped in oral mucosa with the use of monoclonal antibodies HB5 and B2(specific for the Complement Fraction 3d/EBV receptor on B lymphocytes). Immunoperoxidase and immunofluorescence techniques were employed with the use of both cytologic suspensions and frozen tissue sections of oral epithelium. Pericellular plasma membrane immunoreactants were localized to upper spinous layer cells of the parakeratin phenotype; basal and parabasilar layers as well as all strata of orthokeratinized epithelia were negative. Those cells harboring EBV DNA as detected by in situ hybridization corresponded to cells with C3d/EBV receptors.

Antibodies, Monoclonal

Oral lymphomas in HIV-infected patients: association with Epstein-Barr virus DNA.

Nine instances of oral non-Hodgkin's lymphoma occurring in homosexual male patients infected with the human immunodeficiency virus were evaluated for clinical features, histopathologic features, lymphocyte phenotypic markers, and Epstein-Barr virus (EBV) DNA. Histologically, the tumors represented immunoblastic sarcoma and small noncleaved cell lymphomas, some manifesting Burkitt-like features. Five cases exhibited positive staining with monoclonal antibody L26, a B-cell marker; none of the tumors showed evidence of a T-cell lineage with the use of monoclonal antibody UCHL 1. DNA in situ hybridization studies disclosed the presence of EBV DNA sequences in seven instances. These findings indicate that most oral lymphomas among patients with AIDS, similar to extraoral lymphomas in this population, are of B-cell lineage and harbor EBV DNA.

Acquired Immunodeficiency Syndrome

Mucosal pain disorders of the head and neck.

Painful disease processes that affect the mucous membranes of the upper aerodigestive tract include viral and bacterial infections, hypersensitivity reactions, and immunopathologic disorders. The diagnosis and treatment of the most common diseases that cause pain are described.

Bacterial Infections

Detection of EBV and HPV DNA sequences in oral "hairy" leukoplakia by in situ hybridization.

Oral "hairy" leukoplakia (OHL) is a white lesion of the oral mucosa, usually located on the lateral tongue among human immunodeficiency virus (HIV) positive acquired immunodeficiency syndrome (AIDS)-risk patients. The lesion has been reported to be associated with Epstein-Barr virus (EBV) and human papillomavirus (HPV). Twenty surgical biopsy specimens were evaluated for the presence of HPV genus-specific antigen, HPV 2/4, 6/11, and 16/18 DNA and EBV DNA by in situ hybridization employing formalin-fixed paraffin-embedded sections. Three cases exhibited immunoreactivity for HPV genus-specific antigen, with localization in cytopathically altered upper spinous layer keratinocytes. HPV 16, 18, or related DNA sequences were identifiable in a single case. Alternatively, employing an EBV long internal repeat subgenomic probe, 19 cases were found to harbor EBV DNA. In all positive cases, the hybrids were localized to upper spinous layer keratinocytes exhibiting nuclear/cytoplasmic vesiculation. It is concluded that OHL is consistently associated with EBV; furthermore, viral replication, as evidenced by DNA localization, corresponds to ultrastructural evidence of capsid and envelope assembly in the more differentiated layers of oral epithelium.

Acquired Immunodeficiency Syndrome

Oral squamous papillomas: detection of HPV DNA by in situ hybridization.

Oral squamous papillomas were segregated from other papillary lesions on the basis of histopathologic features. Twenty representative papillomas were evaluated for the presence of papillomavirus genus-specific antigen with the use of an immunoperoxidase technique. These same tumors were analyzed for human papillomavirus (HPV) types 2, 4, 6, and 11 with biotinylated full-length double-stranded DNA probes by in situ hybridization. Only one case exhibited papillomavirus antigen reactivity. Alternatively, seven of twenty cases (35%) yielded positive results for HPV 6 or 11 DNA; one papilloma exhibited a dual infection with both HPV 2 and 6 when assayed under conditions of high-stringency hybridization. It is concluded that some oral squamous papillomas harbor HPV genotypes akin to those encountered in genital tract condylomas. Viral DNA can be detected in the absence of capsid antigen immunoreactivity, thereby obviating the use of antigen detection assays for determining the presence or absence of virus.

Antigens, Viral

Oral granular cell tumors: a clinicopathologic and immunocytochemical study.

To investigate the histogenesis of the granular cell, a large series of granular cell tumors was studied for clinical and histopathologic features with emphasis on immunocytochemical markers. The nongingival granular cell tumors (NGGCT) were found to be more prevalent among females than males by a ratio of 2:1 and arose on the tongue (67%), the buccal mucosa (13%), the lips (8%), the soft palate (6%), and other sites (6%). With the use of the avidin-biotin-peroxidase method, polyclonal rabbit antisera were employed. The antisera were directed to the following antigens: S-100 protein, myoglobin, myosin, actin, desmin, alpha-1-antitrypsin, and muramidase. Results indicated that granular cell tumors are not homogenous for immunocytochemical markers. Nongingival granular cell tumors were universally positive for S-100 protein and failed to exhibit immunoreactivity for myogenous or histiocytic markers. Alternatively, the gingival granular cell tumor of infancy was negative for all markers, whereas rhabdomyoma was reactive with myogenous markers and a subpopulation of tumor cells displayed S-100 protein immunoreactivity. The granular cell ameloblastoma was reactive only with antiserum to alpha-1-antitrypsin. Ultrastructurally, granular cells from one of two NGGCT showed a direct evolution from skeletal muscle fibers. It is concluded that the oral NGGCT is a tumor positive for S-100 protein that may arise from muscle or nerve sheath.

Adolescent

Oral sialocysts.

Epithelial-lined sialocysts of the minor oral salivary glands are rare when compared with the common mucous retention phenomenon or mucocele. One hundred twenty cases are reported and segregated into three distinct subtypes on the basis of clinicopathologic features. The true mucous retention cyst was most prevalent, occurring in patients older than 20 years, with no sex predilection. The floor of the mouth was the most common site. Reactive oncocytoid cysts arose in elderly patients and were more common among women. The buccal mucosa-mandibular vestibule was the favored site. Mucopapillary cysts are rare and may be confused histologically with low-grade mucoepidermoid tumors.

Adult

Juvenile fibromatosis of the infratemporal fossa.

A case of extensive juvenile fibromatosis of the infratemporal fossa in a 2-year-old child, which was evident only as progressive mandibular hypomobility, is reported. The current literature is reviewed with regard to the etiology of the fibroproliferative lesions, the histopathologic diagnosis, and treatment modalities. Although complete surgical resection is the treatment of choice, radiation therapy and chemotherapy have been recommended in extensive cases. Because of the immense size and location of the lesion in the case presented herein, the tumor was deemed inoperable and was treated with multimodality chemotherapy.

Child, Preschool

Vasogenic facial pain (cluster headache).

8 cases of vasogenic facial pain are presented with delineation of differentiating clinical features. These vasogenic syndromes include classic episodic cluster headache, chronic cluster headache, and indomethacin responsive chronic cluster headache. Open clinical trials employing inhalation O2 therapy as an abortive treatment strategy utilized in combination with prophylactic nifedipine therapy proved highly efficacious in controlling pain among most classic and chronic cluster headaches. A single case of chronic paroxysmal hemicrania responded favorably to indomethacin.

Adult

Human papillomavirus type 2 DNA in oral and labial verruca vulgaris.

Twenty instances of verruca vulgaris, equally divided between oral mucosa and lip vermillion, were assayed for the presence of human papillomavirus (HPV) capsid antigen and type-specific DNA employing in situ hybridization methods. All 10 cases arising on lip vermillon expressed capsid antigen and harbored HPV Type 2 genomes as assessed under conditions of high stringency DNA hybridization. Oral verrucae rarely expressed capsid antigen; HPV Type 2 genomes were encountered in 20% of the cases.

Antigens, Viral