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Background: Cicatricial pemphigoid is a subepidermal disease of the mucous membranes. In some patients blisters involving the oral cavity may be the only manifestation. The purpose of this work was to detail the clinical features and biological findings, highlighting the diagnostic and therapeutic difficulties., Material and Methods: Seventeen patients, nine women (mean age 59.6 years) and eight men (mean age 67.8 years) managed between 1990 and 2000 were reviewed retrospectively., Results: Mucous membranes of the mouth were the only localization in six of the seventeen patients. Other localizations (skin, eye, nose, anus) were associated, alone or in combination, in the other eleven patients. The gingivae were involved in 15/17 patients and constituted the only localization in six. Skin lesions (sometimes involving the lower limb) were variable and found in 6/17 patients. Ocular lesions were present at diagnosis in six patients, including two with severe lesions at onset. Nasal and/or laryngeal involvement was found in 6/17 patients. These lesions were often severe with major functional impact. ENT localizations were found in patients with at least three localizations and lesions extending to mucous membranes distant from the oral cavity. A biopsy was obtained from all patients and demonstrated subepidermal detachment in eleven. Direct immunofluorescence was positive in eleven. Indirect immunofluorescence, performed in twelve patients, was negative. In two patients, both histology and immunofluorescence were negative. Electron immunomicroscopy was performed in four patients and confirmed the diagnosis. Five out of six isolated oral manifestations were treated with topical steroids alone. Multiple lesions were treated case by case using daprosone and/or systemic corticosteroids associated with topical steroids in 16/17 patients. A bolus of cyclophosphamid was given for four patients with very severe lesions which did not respond to other treatments. At last follow-up (22 +/- 17 months), none of the patients was considered cured., Discussion: Cicatricial pemphigoid is a complex chronic disease. Oral manifestations may be isolated or associated with lesions of the skin or other mucous membranes. The painful aspect of oral lesions explains why the diagnosis is often made in stomatology. Careful evaluation at diagnosis is essential and requires a multidisciplinary approach. Certain diagnosis can be provided by immunohistology, particularly electron immunomicroscopy which enables distinguishing cicatricial pemphigoid from other autoimmune diseases of the dermo-epidermal junction. Treatment depends on disease severity. Isolated oral manifestations are generally well controlled by topical corticosteroids which ocular, nasal, and laryngeal localizations often require more extensive treatment.

Biopsy of the minor salivary glands has become a routine examination ordered by physicians working in a wide range of disciplines in order to search for or eliminate the diagnosis of Gougerot Sjögren's disease or another systemic disease. We emphasize the need to use this examinations as a part of a complete work-up of the buccal cavity and the salivary glands. We reviewed our experience with 1,500 biopsies. The glands biopsied were normal in 56% of the cases and led to the diagnosis of Gougerot Sjögren's disease in 24%, chronic sialadenitis in 10% and diverse trophic problems in 5%. The clinical stage of Gougerot Sjögren's disease is usually proposed according to the Chisholm classification which we propose to compare with the Chomette classification. Finally, we described the technique of minor salivary gland biopsy.

In a retrospective study, we used a series of 29 patients with Sjögren's Syndrome diagnosed according to the new European criteria (Cl. Vitali, S. Bombardieri, H. M. Moutsopoulos et al.) (8). (Arthritis Rheum 1993; 36:340-7). A labial biopsy technique allowed to classify these patients into the anatomical "scores" formerly related by Chisholm and Mason and Chomette et al. Referring to these criteria, only 45% of patients presented a characteristic histopathological pattern. If another complementary criterium, i.e. ductal tropism of lymphoid infiltrates, was added, that percentage remained low (50% only). Thus, these results would suggest the following considerations: the classical histopathological criteria do not seem sufficiently specific; other histological criteria such as ductal lesions previously noted by Leroy et al. must in addition be looked for; thus it would seem to be of considerable value to use in the future complementary quantitative studies by means of morphometric methods.

Although ameloblastoma is one of the benign odontogenic tumors, the maxillary localisations often grow more infiltratively and show higher recurrency than the mandibular localisations. The authors report a case of ameloblastoma in maxillary sinus and sketch out the operative methods with a literature review.

From 228 clinical files of cases with suspected sarcoidosis who had had a biopsy of the accessory salivary glands, 17 cases with both a final diagnosis of sarcoidosis and one or more tuberculoid granulomas. There were 12 women (mean age: 30 years) and 5 men (mean age: 28.5 years) including 3 of Caribbean or African descent. The histopathological examination was performed to determine: 1) the number of granulomas per biopsy, divided into 3 groups: group I, 1 granuloma (n = 1); group II, 2 to 5 granulomas, mean 3.5 (n = 6); group III more than 5 granulomas, mean 12.5 (n = 5); 2) the diffusion of the granulomas within the lobules: 17% of the lobules were involved in groups I and II vs 47% in group III; 3) the size of the granulomas "minimal" (barely identifiable in 3 of 6 patients in group I; rather easily identifiable in all the other patients; 4) the presence of "non-specific" lesions including lymphoid infiltration, epithelial changes. In addition correlations with other clinical parameters of severity and/or duration were evaluated including: involvement of the main salivary glands and/or non-secretory syndrome. The following conclusions were drawn: 1) lesions of the accessory salivary glands is a sign of sarcoid lesions outside the thorax since 16 of the 17 patients had extra-thoracic clinical, biological or anatomic manifestations; 2) there is not however any significant difference in clinical severity between the 3 anatomic "intensity" groups (number of follicules in the accessory salivary glands); 3) both cases of sarcoidosis of recent onset (< 3 months) with Loefgren's syndrome were in group I; 4) the intensity of the specific lesions in the accessory salivary glands was similar to that of the non-specific lesions and can be correlated with the intensity of the main salivary gland involvement, with or without a non-secretory syndrome.

Despite a thorough examination it is not always possible to detect the primary cancer responsible for malignant cervical adenopathy. In the vast majority of cases the metastases arise from an epidermoid carcinoma of the upper respiratory or digestive tract. A possible diagnostic, but also therapeutic procedure is exploratory cervicotomy with extemporaneous examination. The prognosis is poor, both locally (glandular involvement) and generally (metastatic spread).

The association of non-Hodgkin's lymphoma (N.H.L.) and AIDS is currently well recognized. Currently 113 cases have been identified by the French group studying AIDS-related Tumour Pathology. We report 4 cases of palatal involvement, including one associated with a contralateral Kaposi's sarcoma.

The rare case reported here was a mandibular metastasis of a malignant melanoma located in the nape of the neck and surgically removed. 4 years later, occurred a fibrosarcomatous mandibular tumour without local recurrence. The metastatic nature of this tumour was difficult to prove by means of immunohistochemical and ultrastructural methods. This case illustrated the eventuality of a desmoplastic change in metastasis of a common malignant melanoma. The histogenesis of this rare type of melanoma was discussed.

64 patients with extra-nodal maxillo-facial NHL were seen between 1969 and 1989. These rare tumours (1 to 4% of stomatological tumours) tended to occur more often in men (60% of cases) between the ages of 40 and 70. Bony involvement was common (maxillary and mandibular involvement), though more rarely the salivary glands or mucosa were involved, presenting as a swelling with lysis of underlying bone. Highly malignant varieties (85% of cases) were most commonly encountered. The treatment remains medical, involving chemotherapy (C.H.O.P. or high dose methotrexate) and gives an actuarial survival rate of 50% at 3 years.

A classification, according to the Lancefield's method, of the streptocoques isolated in the blood, after teeth extractions, as well as a determination of their sensibility to the antibiotics, are attempted in this study. It concerns to 23 adults, well supported, to whom multiple extractions, under general anesthesia have been done. We studied both biochemical and serological reactions, and a test for the antibiotic resistance is realised. We insiste in the contrindiction of streptomycine and sulfanilamides in the treatment or the prevention of bacteremia of dental origine.

An analysis of delayed action cell immunology tests involved 300 patients suffering from stomatological cancers. The tests used, tuberculine, candidine, varidase and DNCB have no particular value as far as discovering the size of the tumour, the quality of eradicating treatment or its progress. On the other hand, bias in the same direction and, even more, variations in the direction of immunity in the course of evolution seem to be a reflection of the patient's immune defence potential. This immune defence potential which can be roughly assessed in this way dose not seem to be reduced by chemotherapy or increased by immunotherapy, at least judging by the criteria used.

A study of the distribution of these cancers demonstrated that they were mainly epidermoid carcinomas (144 cases), cylindromas (38 cases), and sarcomas. The series included 58% of male patients, but the percentage of women is high because of the predominance of muco-epidermoid epitheliomas and hematosarcomas in female patients. Age distribution was identical for both sexes. The period between the first sign and the diagnosis varied according to the histological type (5 months for epidermoid carcinoma, 10 months for the cylindromas, and 28 months for muco-epidermoid epitheliomas). The initial examination revealed the presence of palpable glands in 40% of the cases with epidermoid cancer of the gums, as against 25% of those with facial epidermoid carcinomas. Survival rate after 5 years was 33% for epidermoid cancer, 72% for cylindromas, and 15% for muco-epidermoid epitheliomas. For epidermoid carcinomas, survival was related to their size (56% for T1, 52% for T2, 30% for T3, and 16% for T4). No significant differences in relation to the site of the lesion were found. The incidence of glandular invasion is of the greatest importance. All N3 cases died within 30 months. In fact, two categories of patients can be conveniently distinguished; those with T1, T2, T3, NO who have an overall mean survival rate of 68% after two years, and all the other cases with a mean survival rate of 28%.

Various types of erythrocyte lesions are observed: hemoglobin anomalies, enzyme disorders, membrane anomalies. This leads to a reduction in the duration of life of the erythrocytes or to abnormal erythropoiesis with, in both cases, reactive development of hematopoietic tissue. This extension of the medullary field in bones results in alterations that are initially visible on radiography, and then, in the severe forms, in the development of mainly craniofacial and dental dysmorphia with, in some cases, additional secondary enamel and dentine anomalies of the hemolytic origin. These anomalies were present to varying degrees in a series of patients in whom cranial radiographies were performed. In two cases there was a fortuitous association of dental anomalies of the melanodontia and opalescent dentine types. These patients may raise particular problems during dental care and treatment: risk of infection, respect of drug contraindications, latent cardiac insufficiency.

Two new drugs have been proved to be effective for isolated or recurrent stomatological tumors : detorubicine (limited because of cardiotoxicity), and CDDP (limited because of renal and neurological toxicity). Drugs used mainly as adjuvant treatment concurrently with BCG, as immunotherapy, are bestatine (without clinical or biological toxicity) and levamisole (rare cases of agranulocytosis). Randomized trials of chemo- and immunotherapy now underway are the only means of assessing long-term efficacy of adjuvant treatments.

139 salivary gland biopsies have been studied in patients with Sjögren's syndrome. Histologically, we classified labial salivary gland injuries (127 cases) in 3 groups based on striated duct distension: first, some tubular ectasia with few interstitial lymphoid cells; second, much ectasia associated with many lymphoid cells and early pericanalar sclerosis; third, intensive ectasia, scarce lymphocytes, severe peri and intralobular sclerosis and extensive destruction of acini. This grading is positively correlated with that of parotid biopsies and also with abnormalies on 60 parotid sialographic radiogramms performed simultaneously. Histoenzymological and ultrastructural studies demonstrate, at an early stage of the disease, epithelial and myoepithelial alterations in striated ducts, with tubular ectasia. Simultaneously, an intensive regeneration from intercalated ducts takes place. Nevertheless that regeneration fails to repair myoepithelial cells. Furthermore, young myoid cells, leaving tubular walls, migrate in interstitial tissue and are responsible for accumulation of membranoid material and later of collagen sclerosis.

35 cases of non-Hodgkin malignant lymphomas of head and neck, stages I and II. All were treated in Pitié-Salpêtrière Hospital in Paris, by radiotherapy alone or combination chemotherapy and radiotherapy, with or without surgery. The authors discuss the prognostic and therapeutic aspects.

Operative difficulties when attempting to treat oral cavity angiomas suggested the use, of cryotherapy for limited lesions. The technique is simple in use non-aggressive and has few after effects. The principle of cryotherapy has been known for a long time, but it was only in the 60's that it was applied in ophthalmology, neurology, dermatology, gynecology and the treatment of hemorrhoids, as a result of the availability of new products: Freon, liquid nitrogen. Conclusions as to the value of cryotherapy are drawn from results obtained in buccal mucosa affections treated by this method over the last four years.

The authors report a case of malignant melanoma of the parotid occurring in a 22-year-old man, followed by two local recurrences after surgical excision, radiotherapy and chemotherapy. The primary parotid nature of the tumour was confirmed by the absence of tumour in other sites and by the histological characteristics.

Clinical and radiologic findings and differential diagnosis of the rare Robinow's syndrome are discussed in relation to one case. Features included nanism associated with multiple malformations such as mesomelic brachymelia, buccofacial anomalies, genital hypoplasia and hemivertebra. Transmission mechanisms are unknown and the karyotype is always normal.

A diffuse papulo-erosive histiocytosis of the oral mucosa occurred during the fourth year of progression of a case of multiple maxillary eosinophilic granuloma whilst the bone lesions were progressing favourably. This mucosal form appeared to have completed its course in approximately one year, i.e. much more quickly than each of the bony lesions.

An immunohistochemical study was performed on 9 gingival biopsy specimens from patients suffering of a periodontal disease comparatively to 7 control specimens from patients with inflammatory gingival hyperplasia of various causes and from healthy gums. We used mono or polyclonal antibodies as markers of the different types of inflammatory cells (T-1 lymphocytes and their subsets, B-lymphocytes, macrophages, plasma cells). In patients with periodontal disease, the high percentage of transformed T-lymphocytes with a majority of helpers was obvious. In controls, the inflammatory cells were principally B-lymphocytes, macrophages and plasma cells. The characterization of different types of collagen produced by periodontal fibroblasts was performed by specific antibodies (anti I, III, V collagen sera). The respective ratio and the topographic distribution of those collagen substances were different in patients with periodontal disease and controls. In the first eventuality, one could find quite exclusively type I collagen. In the other group, type I collagen was associated with type III sub epithelial and type IV perivasor ar collagen. By means of these findings, the pathogenesis of the periodontal disease was discussed and its immune mechanism was suggested.

Rapid regression of all symptoms was obtained after moderate chemotherapy in two women aged 69 and 77 years respectively with malignant non-Hodgkin's lymphomas. Cervico-facial locations of these tumors are discussed in relation to definition, etiology, geographic factors, genetic markers, and associated immunologic disorders. Diagnosis requires a series of explorations including, obviously as a last resort, exploratory cervicotomy. Other regions may be involved and must be investigated, but lesions not affecting lymph nodes occur in only approximately 2 p. cent of patients with cervico-facial malignant non-Hodgkin's lymphoma (approximately 10 p. cent of all malignant non-Hodgkin's lymphomas). Other localizations include the hard palate, gums, sinuses, and salivary glands. Burkitt's lymphoma represents, on the contrary, 30 p. cent of malignant non-Hodgkin's lymphoma seen in European children. The different therapeutic modalities available are discussed.

Aneurysmal cysts of the mandible and maxilla are rare conditions, though not exceptional, which are seen in particular in the child and adolescent. A part from facial asymmetry and tumefaction, it is rare to find other clinical manifestations. No neurological signs were seen in the present study. An aneurysmal cyst gives a radiological appearance of non-characteristic lysis compatible with a large range of diagnoses. Histological study permits early diagnosis but must always involve the whole specimen with careful examination to detect any other associated lesion. The pathogenesis of the condition remains obscure and, at the extreme, it may be questioned whether the aneurysmal cyst is a separate entity or a particular form of chronic osteopathy.

The 4 cases of malignant xanthogranuloma reported here are peculiar because of their unusual localization in the cervico-facial area and of their good outcome (3 patients are alive without recurrence more than 6 years after chemotherapy and radiotherapy). Besides the histological study, the 4 cases were examined by immunohistochemical methods : vimentin was positive in 20 to 40% of cells and lysozyme in 5 to 15% of cells. In addition, one case was studied by electron microscope which showed the polymorphism of tumoral cells.

Three surgical methods are proposed by the authors for the treatment of an oralantral bistula (1. Wassmund-Rehrmann-Schüchardt--2. Kazanjian-Schüchardt--3. J. M .Vaillant). This is an experience drawn by 450 cases treated in the Ceinic of Oral Surgery of the University of Salonica (Greece), during the last three years. Fistulas, immediately appeared after extraction of an upper caspid of premolare, surgical removal of teeth, or apex, intrasinusaly located, long persistance of a fistula because of a kyste or tumor in the upper jaw have been the subjects of the present paper.

Possible relationships between Moschcowitz's disease and acute systemic lupus erythematosus are analyzed based on findings in one case. Initial exclusively buccal symptoms suggested a diagnosis of lupus, and then of Moschcowitz's disease leading to a fatal outcome. The main points discussed relate to diagnostic difficulties to enable distinction between the two diseases. A thrombotic thrombopenic purpura during the second phase of the disease showed a characteristic microangiopathy associated with a non-autoimmune hemolytic anemia and a schizocytosis: two forms of the affection are recognized, one with a chronic and one with an acute course. The latter, which has a fulminating progression leading to death, was that described in the case reported.

In Midline malignant granuloma, a clinical entity characterized by necrotic ulcerations of the upper respiratory tract, two different histological features can be observed. The first one, called "idiopathic" granuloma, looks like simple granulation tissue and remains a strictly localized disease. In the second type (midline malignant reticulosis or histiocytosis), the granulation tissue contains atypical histiocytic cells. The 3 cases reported here belong to this last group. The early lesions were located in the nose (2 cases) or in the maxillary sinus (1 case). The histological analysis showed in all cases 20 to 40% of atypical histiocytes associated with other "inflammatory" cells. Radiotherapy was used in association with chemotherapy or surgery in the treatment. One patient is still alive at 3 years. We have no follow-up data for another patient. The third patient died after 18 months. An autopsy demonstrated multifocal visceral involvement by atypical histiocytes (malignant histiocytic lymphoma). The histogenesis of this disease, in light of histoenzymological and ultrastructural findings, and its possible relationship to lymphomatoid granulomatosis are discussed.

The authors review the studies describing dental changes after radiotherapy or curietherapy of the cervicofacial region published over the last 50 years. They discuss more particularly: --direct and indirect effects on the teeth,--lesions of the salivary glands,--dental lesions,--fluoride prophylaxis for dental lesions after irradiation.

Before antitumoral facial irradiation, those teeth that cannot be conserved for a sufficiently long post-irradiation period of at least two years should be extracted. Teeth that are less affected, in patients given palliative treatment and in whom the prognosis is better, can be conserved. The conserved teeth are protected from destruction by the application of a fluoride gel. Dental reconstruction is ensured by the conventional methods, including the fixed prosthesis. The arches can be restored with atraumatic fixed prostheses but prudence is required. If extraction is necessary, a strict procedure must be employed and sufficient antibiotic treatment prescribed.

11 specimens were carried out in patients with idiopathic gingival hyperplasia (3 cases), gravidic hyperplasia (1 case), iatrogenic hyperplasia (5 cases after cyclosporin A administrated in patients with cardiac grafts, 2 cases after treatment by Adalat). By optic microscopy, the deep collagen base is thickened, associated sometimes to an inflammatory process. By histoenzymology, the fibroblasts have high activities of their oxidative enzymes and also of the enzymes of protein synthesis. The electron microscopy corroborates the numerous globular fibroblasts with well-developed rough endoplasmic reticulum. These results prove the main role of fibroblasts in these lesions and the etiopathogenesis of this hyperplasia is discussed.

Malignant non-Hodgkin type lymphomas (MNHL) are relatively frequent tumors but their localisation in the salivary glands is rarely reported in the published literature. The authors describe 11 such cases, seen in the stomatology Department of the Salpêtrière Hospital in Paris over a period of 4 years, in which the MNHL was located in the salivary tissues (2 purely glandular, 1 of the mixed type, and 8 extranodal tumors). Treatment by multiple chemotherapy and radiotherapy demonstrated that survival, whatever the anatomical type or even the histological form, was improved in relation to that observed with tumors in other locations.

During the ten last years, 13 neural tumors of the tongue have been observed in the department of stomatology and maxillo-facial surgery of Salpêtrière Hospital Paris (Prof. J.M. Vaillant): 4 amputation neuromas, 5 benign schwannomas, 1 malignant schwannoma, 2 neurofibromas and 1 multiple endocrine syndrome type III. The authors analyze the clinical and histological data from these case-reports; they point out difficulties encountered in the diagnosis, and the prognostic problems brought up by such infrequent lesions.

Long-term use of corticoids had proved beneficial in the treatment of advanced stomatological cancers, the effective dose being 40 mg of prednisone per day. In so far as it is possible to distinguish any specific action on individual symptoms, its action on pain was obvious in 40% of cases, on inflammation and infection in 52% of cases on fever (independent of infection) in 14% of cases, on oedema in 34% of cases. It was almost invariably favourable on the general condition. The method of using it emphasize how easy it is to use corticoids by injection which is of particular value in our speciality in view of: dysphagia, administration of large doses, deficiencies in the general condition, sometimes a matter of urgency. The counter-indications usually recognized for corticoids need to be modified in the case of cancer patients. Incidents occur surprisingly rarely and are minor relative to the advantages of the therapy, provided the patient is kept under strict supervision.

In 6 cases of horizontal impacted second molars seen between 1951 and 1961, the authors were able to remove or ensure removal of the gum overlying the crowns of these teeth, to make a small transverse horizontal hole below the mesial neck, and straighten them in an average period of 5 months with the use of an auxiliary spring on a plate or better on a vestibular arch (figs 5 and 6). The constant success of this method led them to use if for impacted lower wisdom teeth, even when almost horizontal (figs 1, 2, 3, 4) in patients aged between 17 and 20 years, avoiding their removal.

73 minor salivary gland biopsies (lip biopsy) were performed in patients with primary and secundary Sjögren's syndrome and other collagen diseases without sicca syndrome were studied by means of immunohistochemistry. The results were compared to those obtained in sarcoidosis, sialadenitis and normal glands. In all cases of Sjögren's syndrome and of other sialadenites, we could note predominance of T-lymphocytes with an increase of T-Helpers and a T-suppressor ratio superior to 1. Besides, HLA-DR antigen was present in all the activated cells of lymphocytic infiltrates, in endothelial cells and in some epithelial ductal and acinous cells around the infiltrates. This method cannot permit to differentiate Sjögren's syndrome from the other sialadenites. But, it is very useful to appreciate the evolutivity of the disease (increase in B-lymphocytes in the initial period and in evolutive phases) and to detect its change into pseudolymphoma (polyclonal cells with increase in B-cells) and into malignant lymphoma (usually monoclonal B-lymphocytes proliferation).

The relatively poor results of therapy for epidermoid oropharyngeal carcinoma stages T3 and T4 suggested the need for new treatment regimens. A study involving 24 patients included bifractionated radiation on a daily basis, as used by J. C. Horiot and A. Nabib and then by the E.O.R.T.C. group. The more encouraging results reported by A. Nabib were not obtained. The 5-year survival rate will possibly be no better than after conventional external radiation. Post-radiotherapy complications were observed.

A case of Hodgkin's disease beginning in the skin of the face with local lymph node involvement is reported. This was a lymphogranulomatous form without characteristic Reed-Sternberg cells in skin biopsy specimens, rendering the diagnosis difficult. There was a combination of granulomatous inflammation, plaques of necrosis and lesions of fibrinoid necrosis in the vessel walls. This form entered the classification of clinical Stage IV, with its associated serious prognosis.

Prognosis in 11 cases of hemangiopericytoma of the orofacial region (9 buccal and 2 parotid tumors) was, as with these lesions in other zones, an uncertain entity: 4 local recurrences within 8 months to 7 years; one fatal outcome after 3 years from pulmonary micrometastases. Histologic classification of these tumors into 3 cytologic groups of increasing malignancy (I to III) is a function of the number of their cytologic anomalies. They are also divided according to their overall morphology into poorly differentiated, differentiated and sclerous types. Positive correlations between structure and cytologic criteria of malignancy and structure and clinical course have been demonstrated. Ultrastructural examination in 2 cases showed polymorphic endothelial, fibroblastic and smooth muscle cells in contact with adult tumoral pericytes. This suggests the origin of the tumor from young cells of multiple potency rather than from adult pericytes.

Vindesine, a vinblastine derivative, was evaluated in 36 patients with malignant tumours of the buccal cavity previously untreated. Vindesine was used (1) pre-operatively, in short, weekly intravenous courses for 1 to 3 weeks and (2) prior to radiotherapy of inoperable tumours, in prolonged treatments, either by bolus i.v. injections with vein washing weekly or, in case of failure, by continuous i.v. infusion over 5 days. In the first group major responses were obtained in 22.2% of the cases. In the second group only 1 of 18 patients responded to weekly injections, whereas 3 out of 10 patients responded to continuous infusion (including one complete remission), showing that this mode of administration was more effective than bolus injections. Toxic reactions to the drug are discussed. Venous damage was the predominant complication of continuous infusion.

The terminology used for white lesions of the oral cavity requires careful definition: the term keratosis is general, covering all lesions which by histological examination show evidence of keratin on the surface, regardless of other detectable lesions; the term leukoplasia is more restrictive, indicating (according to the WHO) white lesions not falling within the context of a known disease = lichen, lupus erythematosus, florid oral papillomatosis, chronic candidiasis, etc. This review chose the diagnostic difficulties of different varieties (planus, warty, erosive) of leukoplasia. In our experience the ambiguity of keratosis may be due to inadequate data from clinical examination and/or histological examination, to the combined existence in a given patient and at the same time of two white lesions of different nature, or to the successive existence at the same place of two lesions with a different clinical and/or histological diagnosis (raising the problem of transformation).

This report presents our observations in 81 cases; and we have used indirect lymphography only, we injected the contrast medium, lipiodole ultra fluide, intramuscularly to both sides of the tongue. The injection sites are first anaesthetized. The amount of contrast medium should not exceed 5 cc. It is injected in about 10 mn. The first radiological examination is performed 4, 8 and 12 hours after the injection. X-rays are taken using the occipitomental and also lower intraoral occlusal views. The following radiological studies are made after 24 and 48 hours. If necessary further x-rays can be taken as well.

Cystic lymphoid hyperplasia of the parotid, a rare disease, was recently described in patients with acquired immunodeficiency syndrome. We reported here 2 new cases of this illness. The 2 HIV+ patients showed an enlargement of parotid gland. A superficial parotidectomy was performed. The histological and immunohistochemical studies were completed in one case by a histoenzymological and ultrastructural study. We could see numerous cystic cavities lined with a cylindrical or metaplastic malpighian epithelium and surrounded by a lymphoid tissue, similar to a true lymph node with germinal centers. In these lymphoid structures, we could find some epithelial remnants and numerous epimyoepithelial islands. Besides, anomalies similar to those described in persistent generalized lymphadenopathies were obvious: hyperplastic germinal centers with multiplication of B lymphocytes and thin mantle zone, perifollicular hypervascularization, numerous macrophages, plasmocytes and T lymphocytes with increase of T8 cytotoxic subset in interfollicular and paracortical areas. An early opportunist infection is suggested in the histogenesis of this disease.