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Medical Instructor, University of Connecticut School of Medicine

Alternatively, viral vectors can be used which selectively infect the desired tissue, in which case administration may be accomplished by another route. Non-limiting examples of such modifications include methylation, "caps", substitution of one or more of the naturally occurring nucleotides with an analog, and internucleotide modifications such as, for example, those with uncharged linkages. Polynucleotides may contain one or more additional covalently linked moieties, such as, for example, proteins. The polynucleotides may be derivatized by formation of a methyl or ethyl phosphotriester or an alkyl phosphoramidate linkage. Furthermore, the polynucleotides herein may also be modified with a label capable of providing a detectable signal, either directly or indirectly. Exemplary labels include radioisotopes, fluorescent molecules, biotin, and the like. By "recombinantly produced" is meant artificial combination often accomplished by either chemical synthesis means, or by the artificial manipulation of isolated segments of nucleic acids. Alternatively, it may be performed to join together nucleic acid segments of desired functions to generate a single genetic entity comprising a desired combination of functions not found in nature. Restriction enzyme recognition sites are often the target of such artificial manipulations, but other site specific targets. Plasmids are considered replicons, capable of replicating autonomously within a suitable host. The ability to hybridize will depend on both the degree of complementarity and the length of the antisense nucleic acid. One skilled in the art can ascertain a tolerable degree of mismatch by use of standard procedures to determine the melting point of the hybridized complex. Transcriptional gene silencing is the result of histone modifications, creating an environment of heterochromatin around a gene that makes it inaccessible to transcriptional machinery. Examples of particles include polymeric particles, single-emulsion particles, double-emulsion particles, coacervates, liposomes, microparticles, nanoparticles, macroscopic particles, pellets, crystals, aggregates, composites, pulverized, milled or otherwise disrupted matrices, and cross-linked protein or polysaccharide particles, each of which have an average characteristic dimension of about less than about 1 mm and at least 1 nm, where the characteristic dimension, or "critical dimension," of the particle is the smallest cross-sectional dimension of the particle. A "subject" to which administration is contemplated includes, but is not limited to , humans. A target tissue may be an abnormal or unhealthy tissue, which may need to be treated. A target tissue may also be a normal or healthy tissue that is under a higher than normal risk of becoming abnormal or unhealthy, which may need to be prevented. A "non-target tissue" is any biological tissue of a subject (including a group of cells, a body part, or an organ) or a part thereof, including blood and/or lymph vessels, which is not a target tissue. In some embodiments, treatment may be administered after one or more signs or symptoms of the disease have developed or have been observed. In other embodiments, treatment may be administered in the absence of signs or symptoms of the disease. For example, treatment may be administered to a susceptible subject prior to the onset of symptoms. Treatment may also be continued after symptoms have resolved, for example, to delay or prevent recurrence. As will be appreciated by those of ordinary skill in this art, the effective amount of a compound described herein may vary depending on such factors as the desired biological endpoint, the pharmacokinetics of the compound, the condition being treated, the mode of administration, and the age and health of the subject. The term "therapeutically effective amount" can encompass an amount that improves overall therapy, reduces or avoids symptoms, signs, or causes of the condition, and/or enhances the therapeutic efficacy of another therapeutic agent. The term "prophylactically effective amount" can encompass an amount that improves overall prophylaxis or enhances the prophylactic efficacy of another prophylactic agent. In such cases, the genetic disease will be heritable if it occurs in the germline. A proliferative disease may be associated with: 1) the pathological proliferation of normally quiescent cells; 2) the pathological migration of cells from their normal location. Angiogenesis is distinct from vasculogenesis, which is the de novo formation of endothelial cells from mesoderm cell precursors. The first vessels in a developing embryo form through vasculogenesis, after which angiogenesis is responsible for most blood vessel growth during normal or abnormal development. Angiogenesis is a vital process in growth and development, as well as in wound healing and in the formation of granulation tissue.

The epithelium is sup ported by hyperplastic central cores of wellvascularized stromal tissue. The epithelium is hyperplastic and often demonstrates pseudoepitheliomatous features, occasionally severe enough to mimic squamous cell carcinoma. No evi dence of dysplasia is found in association with this lesion and risk of malignant transformation is not increased. Differential Diagnosis Histopathology the range of possibilities in the differential diagnosis of papillary hyperplasia of the palate is limited because it is seldom confused with other forms of pathology. The chief lesion to be separated from papillary hyperplasia is nicotine stomatitis involving the hard palate; however, nicotine sto matitis does not occur on the hard palate of those who wear complete maxillary removable appliances. Also, nicotine stomatitis tends to be more keratinized and usually demon strates the presence of a small red dot or punctum in the center of each nodular excrescence, which represents the orifice of the subjacent minor salivary gland duct. Numerous squamous papillomas may occur on the palate; however, these lesions tend to be more keratinized with more delicate projections. In the socalled malignant form or neoplasiaassociated type of acanthosis nigricans, oral lesions are papillary in nature and may re gress relative to the treatment response of the underlying distant malignancy. These nodules, composed of benign fibroepithelial proliferations, may im part a cobblestone appearance, usually to the tongue, buccal mucosa, and gingiva. Affected patients usually have other stigmata of the syndrome, including hamartomatous pap ules of the skin, benign and malignant breast lesions, and malignancies of the thyroid and kidney. The actual surgical method is often a matter of individual preference and may include curettage, cryosurgery, electrosurgery, microabrasion, or laser ablation. Removal of appliances at bedtime and soaking in a weak disinfecting or antifungal medium, as well as maintenance of good oral hygiene coupled with topical antifungal therapy, may significantly reduce the intensity of lesions. In mild cases, the use of soft tissue conditioning agents and liners, with frequent changes of the lining material, can produce sufficient resolution to preclude surgery. Topical antifungal ointment, alone or mixed with a corticosteroid ointment, Treatment and Prognosis · Figure 6-8 Papillary hyperplasia. Condyloma Latum Condyloma lata is one of the many and varied expressions of secondary syphilis. As with all forms of syphilis, cutane ous, mucosal, and systemic lesions that mimic other condi tions or diseases can be seen. Characteristic of condyloma latum is the presence of exophytic, sometimes friable, papil lary to polypoid lesions within the oral cavity. Condyloma latum contains abundant microorganisms (Treponema pallidum), making it potentially infectious. Condyloma latum usually appears on the skin, especially in the perianal and genital areas. Lesions may also be noted within the oral cavity and the lips where they form a soft, red, often mushroomlike mass with a generally smooth, lobulated surface. Microscopically, the overlying epithelium demonstrates significant acanthosis, intracellular and intercellular edema, and transmigration of neutrophils. A dense perivascular plasma cell infiltrate is common within the lamina propria in the absence of a true vasculitis. Patients require systemic administration of antibiotics to eliminate the underlying bacteremia. The oral lesions gener ally regress as the systemic disease is brought under control. The epithelial layer itself is hyperplastic without evidence of dysplastic change. The underlying stroma is well vascularized and may contain a trace of chronic inflammatory cells. Al though condyloma acuminata tend to show more parakera tosis and acanthosis than verruca vulgaris, no universally accepted microscopic features can be used to reliably sepa rate the two. Treatment for these lesions is generally surgical excision that may consist of cryosurgery, scalpel excision, electrodesicca tion, or laser ablation. Recurrences are common and perhaps are related to surrounding normalappearing tissue that may be harbor ing the infectious agent. Early studies described lesions in Native Americans in both the United States and Brazil, and in the Inuits of Greenland.

Syndromes

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• Sometimes the surgeon uses a laparoscope to do this procedure. A laparoscope is a tiny camera that the surgeon inserts into the area through a small surgical cut. The camera is attached to a video monitor. The surgeon makes the repair with small instruments that are inserted through other small surgical cuts.
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• CT scan of the head