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Biomedical subjects

Larry L Cunningham

Publications and source records attributed to Larry L Cunningham.

17 recordsLinked to original sources
PubMed2006

Overexpression of p16INK4 is a reliable marker of human papillomavirus-induced oral high-grade squamous dysplasia.

OBJECTIVE: Human papillomavirus (HPV) infection has been implicated in the development of high-grade squamous dysplasia and carcinoma of the oral cavity in the absence of other known risk factors such as smoking. HPV-induced oral dysplasia or carcinoma may be a unique tumor entity in terms of biologic behavior and treatment decisions. In detecting such cases, most reported studies have used techniques that are less sensitive than DNA amplification. Recent reports have suggested that overexpression of the p16INK4 protein is a surrogate marker of HPV-induced high-grade dysplasia or carcinoma. However, the correlation between expression of p16INK4 and the presence of HPV DNA as determined by polymerase chain reaction (PCR) amplification has not been previously reported. The purpose of this research was to determine if immunohistochemistry for p16 would serve as a marker of HPV-associated high-grade oral squamous dysplasia. STUDY DESIGN: Archival formalin-fixed, paraffin-embedded tissue sections from 41 cases of high-grade oral squamous dysplasia were randomly selected. Expression of p16INK4 protein was assessed by immunohistochemical analysis (16P04 Neomarkers, Fremont, CA). Strong and diffuse nuclear staining restricted to the dysplastic region in the epithelium was scored as positive for protein expression, whereas focal or weak nuclear or cytoplasmic staining was scored as negative. The presence of HPV was determined by microdissection, DNA extraction, and PCR DNA amplification using elongated primers that align with corresponding sequences of the L1 region of 23 mucosotropic HPV genotypes. The HPV type was determined by direct sequencing of the PCR product. Normal squamous epithelium was used as an internal negative control, and cases of severe cervical high-grade squamous dysplasia were used as a positive control for immunohistochemical staining and PCR. RESULTS: The results of immunohistochemical analysis for overexpression of p16INK4 were positive in 6 of the 41 tissue sections. The results of PCR DNA amplification were also positive for these 6 sections. HPV-16 was identified in 5 of the positive cases; in the other case, the viral strain could not be determined. CONCLUSIONS: Immunohistochemical detection of p16INK4 is a technically simple and potentially reliable assay for diagnosing cases of HPV-induced oral high-grade squamous dysplasia. Detecting such lesions may influence future therapeutic decisions.

Adult↗
PubMed2006

Using prealbumin as an inflammatory marker for patients with deep space infections of odontogenic origin.

BACKGROUND: The general health of the host may contribute to the severity of odontogenic infections. An example is the link between protein malnutrition and host defense mechanisms, most notably cell-mediated and mucosal immune responses. The plasma concentration of prealbumin, a protein synthesized in the liver with a half-life of 1.8 days, is an indicator of malnutrition. MATERIALS AND METHODS: We retrospectively reviewed the medical records of all patients who were admitted to our hospital with a diagnosis of odontogenic infection in 2002 and 2003. We recorded prealbumin concentrations, number of infected spaces (ie, severity of infection), hematocrit, blood urea nitrogen (BUN) concentration, and the results of general blood studies. RESULTS: The median age of the 22 patients included in this study was 33 years (range, 17 to 57 years); 59% were men. The median prealbumin concentration was 12.85 (range, 5.7 to 27.5); the accepted normal level is 19 or higher (81.8% of concentrations were below normal). A Mann-Whitney rank sum test found a statistically significant relationship between prealbumin concentrations and length of hospital stay (P = .038). Logistic regression analysis showed that length of hospital stay was positively related to the number of infected spaces and the BUN concentration and negatively related to prealbumin concentrations. These factors could accurately predict the length of hospital stay for 77% of patients (Fisher exact test; P = .026). CONCLUSIONS: Prealbumin levels are significantly lower than normal among patients admitted for treatment of severe odontogenic infection. There appears to be a relationship between length of stay and lower prealbumin concentrations.

Adolescent↗
PubMed2006

The use of internal maxillary distraction for maxillary hypoplasia: a preliminary report.

PURPOSE: Distraction osteogenesis is a useful alternative to advance the maxilla in complicated cases of maxillary hypoplasia. The purpose of this article is to review the workup, experience, and preliminary results with the use of internal distraction osteogenesis for maxillary hypoplasia at one teaching institution. PATIENTS AND MATERIALS: Over a 5-year period, more than 300 patients with craniofacial and dentofacial defects have undergone oral and maxillofacial surgery at our center to correct their skeletal discrepancies. Of these, 10 have had maxillary distraction osteogenesis done with internal distractors. Follow-up of 6 months or more was available for 8 patients. Stereolithographic models were used to bend distractors prior to surgery in 6 patients. RESULTS: Latency prior to the start of distraction was 3 to 7 days and varied with the age of the patient. Distraction occurred at approximately 1 mm per day with an average distraction length of 8.5 mm (range, 6-10 mm). Excellent occlusal results were obtained in 5 patients. Major complications including nonunion and failure to achieve acceptable occlusal results were observed in 3 patients. Minor complications including pain and loosening of the distracter devices were observed in 2 patients, but did not appear to affect the esthetic and functional results. CONCLUSIONS: Distraction osteogenesis is a useful alternative to traditional orthognathic surgery to treat maxillary hypoplasia. Internal distractions are attractive to patients, but are more difficult to place and can cause discomfort to patients when trying to achieve an ideal primary vector of distraction. Stereolithographic models can help with placement of the device. Changes in design of distractors may help with patient discomfort.

Adolescent↗
PubMed2005

The relationship between enophthalmos, linear displacement, and volume change in experimentally recreated orbital fractures.

PURPOSE: The purpose of this investigation was to establish the relationship between enophthalmos, linear displacement, and volume change for various patterns of experimentally recreated orbital fractures. MATERIALS AND METHODS: We fabricated an experimental apparatus that permitted uniform displacement of simulated orbital wall fractures. Measurements of linear displacement, volume change, and degree of simulated enophthalmos were taken for 1- and 2-walled displacements. Means and standard deviations were derived, and analysis of variance was used to compare means for statistically significant differences ( P < .05) between groups and among major categories. RESULTS: No statistically significant differences were found for any uniform displacement caused by 1-walled defects or for any given displacement caused by 2-walled defects The linear coefficient for displacement and enophthalmos or for displacement and volume change approached 1.0 for all groups (range, 0.9802 to 0.9999). However, statistically significant differences in mean enophthalmos and mean volume change at uniform displacements were found between 1- and 2-walled defects. CONCLUSIONS: Displacement of 1- and 2-walled orbital defects results in a direct and linear change in both orbital volume and enophthalmos, regardless of the location of the defect.

Enophthalmos↗
PubMed2005

The use of calcium phosphate cements in the maxillofacial region.

Defects in the maxillofacial region may result from many causes, including injury and tumor excision. Such defects must be repaired as completely as possible so that the best possible restoration of function and cosmesis can be achieved. Calcium phosphate cements (CPCs) are a blend of amorphous and crystalline compounds that are used in paste form and become solid HA when they set. This article will review literature regarding various types if CPCs, their application to maxillofacial surgery, and the contraindications and complications associated with their use.

Animals↗
PubMed2004

The efficacy of valacyclovir in preventing recurrent herpes simplex virus infections associated with dental procedures.

BACKGROUND: Oral herpes simplex virus, or HSV, infections recur after trauma and stress. The prevalence of these infections after dental procedures is not known. Also, it is unclear whether antiviral agents are effective in preventing dental procedure-induced HSV recurrences. This study determined the efficacy and safety of oral valacyclovir in suppressing dentally related cold sore outbreak and HSV shedding. METHODS: The authors enrolled 125 otherwise healthy HSV-seropositive adults who reported having recurrent herpes labialis (more than one episode per year and at least one episode in the previous year) in a randomized, double-blind, placebo-controlled study and gave them valacyclovir prophylactically (2 grams taken twice on the day of dental treatment and 1 g taken twice the next day) or a matching placebo. To detect the presence of the virus, the authors used clinical examinations, viral cultures and real-time polymerase chain reaction analysis of saliva. RESULTS: During the one-week observation period after treatment, there were more clinical lesions (20.6 percent versus 11.3 percent), more HSV-1-positive culture specimens (7.9 percent versus 1.6 percent) and more HSV-1-positive saliva specimens (7.9 percent versus 4.0 percent) in placebo than in valacyclovir-treated patients, respectively. The percentage of patients who developed recurrences and shed HSV-1 in saliva 72 hours after dental procedures was significantly smaller in the valacyclovir group than in the placebo group (11.3 percent versus 27 percent; P = .026). The mean time to pain cessation was significantly less in the valacyclovir group (3.2 days) than in the placebo group (6.2 days) (P = .006). CONCLUSION: HSV recrudescence after routine dental treatment is suppressed by valacyclovir prophylaxis. CLINICAL IMPLICATIONS: HSV recrudescence is common after routine dental treatment. Clinicians should consider antiviral therapy for patients at risk of experiencing a recurrence, as well as to minimize transmission of the disease.

Acyclovir↗
PubMed2003

The endoscopic brow and midface lift.

Improvements in technology have increased the level of patient care in all aspects of medicine and surgery. This is no less true in the area of cosmetic surgery. The use of endoscopy has led to improved aesthetics with respect to postoperative scarring, decreased healing time for patients, and an increase in overall patient satisfaction. Because the endoscopic brow and midface lift accomplishes the three primary goals of facial cosmetic surgery (restoration, rejuvenation, and enhancement) while adhering to the concepts of working from inside out and repositioning rather than excising, it could be concluded that there is no longer any indication for either the coronal or trichophillic brow lifts. An argument could be made that a direct brow lift may be indicated in cases of extreme brow ptosis with deep frontal rhytids to allow concealment of the scar; however, even moderate-to-severe brow ptosis can be corrected endoscopically when deep forehead rhytids are not present.

Bone Screws↗
PubMed2003

Plates, screws, and children: their relationship in craniomaxillofacial trauma.

The ideal modality for fixation of pediatric craniomaxillofacial fractures remains elusive for a number of reasons. Surgeons who manage these injuries have replaced wiring techniques with the introduction of some form of reconstructive implant. The most commonly used implants are either resorbable or semi-rigid titanium. This presentation is a synopsis of the past 30 years of the English-speaking scientific literature including plastic and reconstructive surgery, otolaryngology, head and neck surgery, oral and maxillofacial surgery, pediatric, trauma, craniofacial, materials, and biomaterials publications. While no consensus on ideal management was observed, various implant treatment options are discussed, including their indications, contraindications, considerations, and consequences after implant placement.

Absorbable Implants↗