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With the aim of evaluating the effect of acetyl-l-carnitine (ALC) on the daily pattern of hypothalamic beta-endorphin (beta-EP), we studied the effect of chronic treatment with ALC on hypothalamic beta-EP contents after suppression of the dark-phase of the light-dark cycle in female rats. We evaluated the hypothalamic content of beta-EP immunoreactivity every 3 h for 24 h in: (1) female rats treated with ALC for 15 days; (2) female rats treated with ALC for 15 days and exposed to continuous light for 24 h. The concentration of beta-EP immunoreactivity in tissue extracts was measured by radioimmunoassay. The results demonstrate that concentrations of beta-EP immunoreactivity in the medial basal hypothalamus show a circadian rhythm, with beta-EP immunoreactivity levels being higher during the night than during the rest of the day. Exposure to continuous light for 24 h abolished the nocturnal increase in hypothalamic beta-EP immunoreactivity. Rats treated with ALC showed a daily pattern in the beta-EP content of the medial basal hypothalamus similar to that of control rats. These data emphasize the possible role of ALC in restoring or maintaining the endogenous rhythmicity of central beta-EP.

We have investigated the features and distribution of accessory cells (ACs) and the relationship of these cells to each other and to lymphocytes in the epithelium and lamina propria of oral hairy leukoplakia (HL), with the objective of better defining the differentiation and mutual interactions of immune-response cells within HL as a preliminary step to understanding the onset and significance of this lesion during human immunodeficiency virus (HIV) infection. Twenty-four HIV-infected patients with HL, two asymptomatic HIV-positive subjects, and three HIV-negative subjects were studied by immunohistochemistry; five HIV-positive patients with HL and three asymptomatic HIV-positive subjects were studied by electron microscopy. In both the epithelium and the lamina propria of HL, we found cells with the immunohistochemical and ultrastructural features of variably differentiated ACs; differences were found between the epithelium and lamina propria. In the lamina propria, ACs were characterized by dendritic shape, multiple contacts with lymphocytes, expression of CD1a antigen, and ultrastructural features of fully differentiated ACs. Conversely, in the epithelium ACs showed bluntly dendritic shape, low expression of CD1a, absent expression of HLA-DR, constant expression of CD11c and CD14 antigens, only occasional contacts with lymphocytes, and ultrastructural features of variably, but always incompletely, differentiated cells of monocyte-dendritic lineage. Seventy-nanometer wide intracisternal particles, closely resembling A particles described in retroviral infections, were found in the intraepithelial ACs in two patients with HL. The defective differentiation of ACs in the epithelium of HL--possibly influenced by the perturbation of the epithelial microenvironment induced by Epstein-Barr virus, and following the direct HIV infection of these cells--and the exceptional finding of close contacts with lymphocytes suggest that the lesional epithelium of HL may constitute a pathway for the entry of foreign antigens which circumvent monitoring by ACs and can induce immune tolerance. The impairment of the local immune response in HL may contribute to the development of full blown, systemic immunodeficiency.

The aim of the present study was to evaluate the changes in the diurnal rhythm of the hypothalamic beta-endorphin (beta-EP) contents in female rats as a function of circulating estrogens. With this purpose we evaluated the diurnal hypothalamic beta-EP changes (1) during the estrous cycle, and (2) in ovariectomized rats with and without acute and chronic estrogen replacement. Ovariectomized rats were treated either acutely with 10 micrograms of estradiol benzoate (EB) or chronically with 2 micrograms/day of EB for 15 days. beta-EP concentrations were measured in acid extracts of medial basal hypothalamus by a specific radioimmunoassay. During the estrous cycle, hypothalamic beta-EP concentrations showed a significant nocturnal increase, with no difference between the 4 days of the cycle. On the day of estrus, beta-EP concentrations between 12.00 and 18.00 h resulted significantly lower than in the other days of the cycle. After ovariectomy, the night-related changes in hypothalamic beta-EP disappeared. The acute administration of EB induced a significant increase in hypothalamic beta-EP after 21 h (18.00 h). On the other hand, the chronic replacement restored the nocturnal peak of hypothalamic beta-EP (18.00, 21.00, 24.00 h). The present data emphasize the role of central beta-EP in regulating the reproductive functions. Moreover, the effect of estrogen in modulating the circadian changes in hypothalamic beta-EP supports the important role of estrogens in brain function.

Hyaline ring granuloma (HRG) is a distinct oral entity. In this study, 64 cases from the literature are analyzed and two new cases are reported. The lesions could be classified by location as central hyaline ring granuloma (42%) and peripheral hyaline ring granuloma (53%). Radiographically, a radiolucent area irregularly outlined by well-formed trabeculae of bone was found in central HRG, and a poorly defined erosion at the crest of the alveolar ridge was often found in peripheral HRG. Occasionally, the lesion occurred in the connective tissue wall of cysts (5%). The etiology of this condition is controversial, but most lesions were in edentulous areas and most patients had a history of tooth extraction or other trauma. The majority of cases (83%) occurred in the mandible, usually posterior to the premolar. The mean age of patients at diagnosis was 43 years, and the male/female ratio was 1.9:1. Pain was not a symptom, although local discomfort, such as recurrent swelling and tenderness, was noted in many cases. Hyaline rings with giant cell inclusions are the significant features for histopathologic diagnosis. HRG is treated by curettage or surgical excision, care being taken to remove the entire lesion. The removal of a peripheral HRG in an edentulous jaw should be followed by careful smoothing of the bone surface, since the lesion tends to infiltrate and is not well demarcated. Recurrence, probably due to incomplete excision, is uncommon.

The authors report a case of calcifying odontogenic cyst of the right mandible. The clinical and histopathological aspects of this rare entity are discussed.

Oral hairy leukoplakia is a new clinicopathological entity. Little is known about its etiology, pathogenesis and natural history. It is considered a specific marker of HIV infection, although it has been also reported in HIV-negative patients. The etiology appears related to Epstein-Barr virus. Hairy leukoplakia has a characteristic clinical and histopathological aspect, but it is not specific. Because hairy leukoplakia may be easily confused with other lesions of the tongue, the dentist should be very careful in making the final diagnosis. Hairy leukoplakia is usually asymptomatic and treatment is not necessary. In cases of extensive lesions or psychological intolerance of the patient, useful drugs are acyclovir and vitamin A derivatives.

To study the prevalence of oral manifestations, we examined 217 patients infected with the human immunodeficiency virus (HIV). Most of our patients were intravenous drug abusers (IVDAs) (65%). Other risk categories were represented by IVDAs who were also male homosexuals or bisexuals (11%), male homosexuals and bisexuals (16%), sexual partners of HIV-infected patients (5%), and hemophilic persons and recipients of blood transfusions (3%). Forty-six patients were women and 171 were men, with a median age of 27 years (range, 11 to 65 years). At the time of first examination, 38% of patients had asymptomatic HIV infection, 36% had lymphadenopathy syndrome, 17% had AIDS-related complex, and 9% had AIDS. Oral manifestations were observed in 89 (41%) patients. Of these, 15 had asymptomatic infection, 23 had lymphadenopathy syndrome, 27 had AIDS-related complex, and 24 had AIDS. Increasing severity of disease was significantly associated with higher prevalence of oral lesions (p less than or equal to 0.0001). Candidiasis was the most common oral lesion, followed by hairy leukoplakia. Kaposi's sarcoma, melanotic macules, herpes labialis, condyloma acuminatum, perioral molluscum contagiosum, and bacterial glossitis due to Escherichia coli infection were found in a small number of patients. Results of culture for fungi, available for 203 patients, revealed that 51% of patients with positive Candida cultures had clinical evidence of candidiasis. Our study demonstrates that oral lesions are also important signs of HIV infection among IVDAs. Early diagnosis of these manifestations is becoming increasingly significant in the practice of dentistry.

The clinical and histopathological features of two cases of botryoid odontogenic cyst are reported. The lesion is an uncommon variant of the lateral periodontal cyst and differs from this with regard to the histopathological features and the biological behaviour.

To identify the subgroups of patients with malignant non-Hodgkin's lymphomas who might benefit from prophylactic therapy to prevent CNS relapse, lumbar puncture was routinely performed among the other staging procedures from January 1976 to October 1979 in 76 patients with diffuse lymphomas. The study also takes into consideration 32 patients who came to out observation during the same period and who were studied with lumbar puncture performed in case of suspicious CNS involvement or along with other procedures during restaging the acquire further information on prognostic factors related to CNS involvement. Cerebrospinal fluid (CSF) cytology was positive in 3 of 76 patients studied with initial lumbar puncture; however, only 2 (2.6%) were asymptomatic. Within the group of 32 patients in whom lumbar puncture was performed during the course of the disease, all 17 patients with suspicious CNS involvement were found to have a positive CSF cytology with the exception of 1 patients with multiple focal involvement of brain parenchyma. Clinical signs of CNS involvement associated with CNS positivity were all found in patients with diffuse histology. In these patients bone marrow invasion or a leukemic picture was frequently associated with CNS relapse. In 47% of patients CNS disease developed while they were in clinical remission. In this series cranio-spinal irradiation associated with intrathecal chemotherapy provided the best results, even in survival was not primarily dependent upon the control of their CNS involvement but related to progressive systemic disease in other sites. On the basis of the clinico-prognostic parameters examined, some guidelines for early diagnosis and treatment of CNS lymphomatous involvement are provided.

AA. discussed the term "mucocele" from the standpoint of its clinical findings, incidence, pathogenesis and confusion in terminology. They thought that the removal, through sinuscopy, may be useful in order to break the cist and to draw a sample for pathological purpose. This simple procedure establishes the diagnosis and, in the same instance, may be curative.

The Authors report a case of mucoepidermoid tumor that began its growth inside the mandible. The central neoplasms of the jaws and of salivary origin are an unusual finding but the mucoepidermoid is the far more common with 45 cases already reported.

A case of granulocytic sarcoma, or chloroma, of the palatal mucosa, which developed 15 months before the onset of acute myelogenous leukemia (AML), is reported. The diagnosis was suspected on the basis of the light microscopic findings and confirmed by histochemical studies. Granulocytic sarcomas are rare, may be observed in a variety of body locations, and are considered specific lesions of AML or of the onset of blast crisis in chronic myelogenous leukemia. Primary granulocytic sarcomas of the oral cavity without systemic manifestations of AML are extremely rare. Clinical diagnosis of these lesions in patients with normal peripheral blood and bone marrow may be very difficult.

A case of cherubism, with a follow-up of ten years, is reported. The comparison between the radiographic examinations carried out now and ten years ago allows some considerations on the course of the disease.

Biopsy specimens removed from the oral cavity are often small, and there is high potential for causing artefacts at several stages: during removal, fixation, embedding, or staining. This report describes several of the most common artefacts created by erroneous handling of oral tissue and lists recommendations for preventing them.

Recently, an increasing incidence of oral Kaposi's sarcoma in association with acquired immunodeficiency syndrome (AIDS) has been observed. This article describes the clinical features and the histopathologic spectrum of oral epidemic Kaposi's sarcoma in six HIV-positive patients. Etiopathogenic, epidemiologic, therapeutic aspects of Kaposi's sarcoma of the oral cavity and its interrelationship with AIDS are discussed.

Since our first description and profile of patients with Kaposi's sarcoma (KS) in 1984, the relative rate of KS in patients with the acquired immunodeficiency syndrome has dropped from 34% to 20%. However, the absolute number is increasing. The pathogenesis of KS is still obscure, and its interaction with the human immunodeficiency virus infection remains unclear. Cause of death is usually opportunistic infections in both endemic and epidemic KS. The most common intraoral site is the palate, which is involved in 95% of our cases. The oral cavity may be the only or first site of KS, and therefore, becomes important in the diagnosis. More than 20% of our current patient population had the oral cavity as the initial site of manifestation. Because of functional impairment, bleeding, pain, or cosmetic reasons, treatment is frequently required. There are many modalities used, including chemotherapy, radiation, and laser resection. Radiation appears to be a most effective and practical control measure for oral KS.

Computer-assisted image analysis was used to measure four histopathologic parameters (number of giant cells, mean number of nuclei per giant cell, fractional surface area, and relative size index) in two groups of patients with central giant cell lesions in a search for possible histologic predictors of clinical behavior. The lesions of 22 patients were classified clinically into nonaggressive and the lesions of 10 patients were classified into aggressive categories in accordance with the method of Chuong and Kaban. The majority of patients with aggressive lesions had recurrent tumors within 2 years and/or experienced pain, root resorption, and cortical perforation. Giant cells were selected in 25 random high-power magnification (X400) fields and measured by means of the Leitz Texture Analysis System-Plus. Linear stepwise discriminant analysis was applied to each parameter studied. Clinically aggressive giant cell lesions were characterized by a higher number of giant cells and greater fractional surface area when compared with the nonaggressive tumors. With the use of the "jackknife" classification procedure, the accuracy of the two statistically significant parameters (number of giant cells and fractional surface area) in predicting the aggressiveness or the nonaggressiveness of our group of central giant cell granulomas was, respectively, 70% and 82%. This study provides further evidence that the use of cytometric analysis of giant cells may be helpful in predicting prognosis and in planning treatment for these often difficult-to-manage lesions.

Peripheral odontogenic fibroma (WHO type) is an uncommon lesion of the gingiva; 18 well-documented cases have been published. It is considered to be the extraosseous counterpart of the central odontogenic fibroma. Because of the paucity of reported cases, the full histomorphologic spectrum of this lesion has not yet been established. This article presents nine cases of peripheral odontogenic fibroma that illustrate the variety of its histopathologic findings. The connective tissue ranged from loose (almost myxomatous) to markedly cellular to relatively acellular and well-collagenized. Islands and/or strands of odontogenic epithelium were present in all lesions. Matrix of mineralized material was present in three cases, and juxtaepithelial hyalinization was seen in one case. To avoid the introduction of additional diagnostic terms, we suggest that all these lesions be considered a spectrum of the peripheral odontogenic fibroma (WHO type). We also suggest that the term WHO type be used to distinguish peripheral odontogenic fibromas from the peripheral ossifying fibroma with which they have often been confused.

During a prospective investigation of oral lesions of 120 consecutive patients positive for human immunodeficiency virus, belonging to the intravenous drug abuser risk group and other risk categories, we observed hairy leukoplakia (HL) in 23 cases (19%). The median age of the patients was 27 years (range, 20 to 50 years). Twenty patients were men and three were women. All but two of the twenty three patients used intravenous drugs for a median period of 6 years (range, 5 to 18 years) and were involved in several episodes of needle sharing. Eight men were also bisexual, one man was homosexual, and one man was hemophiliac and bisexual. Eleven patients had asymptomatic infection, five had lymphadenopathy syndrome, six had AIDS-related complex, and one had acquired immunodeficiency syndrome. In all patients, HL lesions were localized on the lateral borders of the tongue. In twelve patients, the lesion was unilateral, and in eleven patients, it was bilateral. Microscopically, hyperparakeratosis and the presence of koilocytes were observed in all cases. Surface candidiasis could be detected with staining with periodic acid-Schiff in two thirds of the cases. In four cases, electron microscopy showed the presence of intracellular and extracellular hyphae of Candida albicans in the parakeratin layer associated with coccobacilli in the spaces between surface epithelial cells. The spinous layer included koilocytes, which had a clear cytoplasmic matrix, sparse organelles and tonofilaments, and dispersed chromatin. These cells were found to be infected by a herpes-type virus in all cases examined. There was no ultrastructural evidence of human papillomavirus in the nuclei of the epithelial cells.(ABSTRACT TRUNCATED AT 250 WORDS)

A patient with Kaposi's sarcoma of the oral cavity is reported. The intralesional use of vinblastine may be an effective treatment for small Kaposi's sarcoma lesions of the mouth or the skin that are painful or create cosmetic problems.

AA. report 5 cases of mucoceles that they have seen during a 5 years period; all the etiological factors that have been reported are present. Flogosis, trauma and neoplasm may create a mechanical obstacle to mucoid fluid flow; the intrasinusal pressure increases and erode the osseus wall and thus the mucoceles con herniate into adjacent structures.

The glomus tumor, or glomangioma, is a benign neoplasm arising from the normal glomus. Glomus tumors of the oral cavity are rare, with only ten cases reported in the literature. We report the light and electron microscopic features of an additional case of glomus tumor of the lip which occurred as a solitary, painless, submucosal mass in a 51-year-old woman. Clinical, diagnostic, and histogenetic aspects are discussed.

The human papillomavirus (HPV) causes a variety of cutaneous warts and proliferative squamous lesions of oral mucosa. This article reviews, on the basis of the literature and personal observations, the biology of HPV and its etiopathogenetic role in some uncommon oral diseases.

The ameloblastic fibroma, ameloblastic fibrodentinoma, and ameloblastic fibro-odontoma are mixed odontogenic tumors that are considered to arise from both epithelial and mesenchymal elements of the tooth germ. This article presents the clinical and histopathologic characteristics of 23 new cases. The patients' ages ranged from 3 to 19 years (median 9). Most tumors were asymptomatic and were associated with an unerupted tooth or teeth. All patients were treated with simple enucleation of the tumor. We found that histologically these lesions comprise a spectrum. Some were probably benign odontogenic tumors (neoplasms) and others were odontomas undergoing maturation (hamartomas); however, in any given case we were, on histologic grounds, unable to differentiate the two. The majority, if not all, of our cases were nonaggressive with little or no tendency to recur, whereas some reported cases have exhibited local aggressiveness and recurrence, suggestive of neoplasia. In our opinion, it is clinically important to distinguish the mixed odontogenic tumors from ameloblastoma since the mixed tumors, found mostly in children, are relatively benign when compared to ameloblastoma, which is found in all age groups (usually adults). The usually innocuous behavior of these lesions does not justify aggressive treatment initially, and simple enucleation should be appropriate in most cases.

This case report concerns a case of multiple osteomas of the maxillary sinus which probably arise from flogosis and discusses the clinical features. The review of the literature on the histogenesis of these rare lesions remains controversial and it is still difficult to formulate a precise definition.

The peripheral or extraosseous ameloblastoma is a rare tumour of the oral cavity. Only a few well-documented cases have been reported. One additional case of this infrequent tumour in a 70-year-old edentulous man is described. The tumour arose on the mucosa of the lower alveolar crest. It was asymptomatic tender, with a raised and red appearance. The tumour was excised and no evidence of recurrence was seen five years later. Peripheral ameloblastoma probably arises from oral mucosa or from cell rests. It is less invasive than its intraosseous counterpart, and surgical excision with adequate margins is the treatment of choice.

The Author discusses the most recent data on incidence, etiopathogenesis, clinical aspects and treatment of recurrent aphthous stomatitis.

Pigmented nevi are uncommon oral lesions. We report the clinical and microscopic features of three cases of combined nevus, characterized by the association of an intramucosal nevus and a common blue nevus. Two cases were clinically suspected to be melanoma. The lesions were located on the maxillary gingiva, the mandibular gingiva, and the mucosa of the left posterior portion of the hard palate. Combined nevi of the skin vary considerably in histologic appearance. The microscopic findings demonstrated by oral combined nevi also appear to exhibit substantial histologic variation. The oral combined nevus should be differentiated from malignant melanoma by histopathologic means for, as in the skin, it appears to be clinically benign.