Biomedical subjects
Publications and source records attributed to C Scully.
Adenomatoid hyperplasia is a rare idiopathic non-inflammatory, non-neoplastic and benign lesion of minor salivary glands, that typically presents with a tumour-like mass in the palate. A 77-year-old patient is described.
The regulation of cell growth is fundamental to the maintenance of health: disturbed regulation can result in neoplasia. Genes in normal cells (protooncogenes) code for proteins involved in the regulation of cell growth and differentiation; abnormalities in these genes (oncogenes) or their expression are often involved in the development of cancer. This paper summarises the essentials of the complex cell growth regulatory mechanisms, their genetic control, and their disturbances in neoplasia, emphasising the role of cancer-promoting (oncogenes) and suppressing genes (onco-suppressors or anti-oncogenes), especially in relation to oral carcinoma, and discusses the possible role of viruses as one cause of neoplasia.
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Dental hospital staff and students were observed during clinical work for their compliance with infection control procedures, as recommended by the British Dental Association. A total of 183 contacts between health care worker and patient were scrutinised during December 1990. Nearly all health care workers (96%) wore gloves to carry out dental treatment, but in some cases gloves were neither changed nor hands washed between patients. Only one half wore protective eyewear and about one third (38%) wore no mask. Some dental surgery assistants used heavy duty gloves and some even scrubbed dirty dental instruments without wearing any gloves. Strict audit is clearly needed in every clinical setting in order to ensure compliance with infection control.
The number of immunocompromised patients is increasing because of iatrogenic immunosuppression and HIV infection. Most have T lymphocyte defects and are prone to develop persistent and severe fungal and viral infections. Oral candidosis and peri-oral herpes simplex infections are particularly common. Other oral lesions may be seen: mouth ulceration is common and periodontal health is impaired.
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Radiation hazards in dental practice have long been recognized, and the dangers from ionising radiation during dental radiography are discussed elsewhere. Continuing legislation will undoubtedly help reduce the risk of over-exposure and accidents. Nevertheless, it is of some concern that radiation safety is still ignored by some: for example, one recent survey in the UK showed that not all radiography sets conformed to modern safety standards. However, the profession also has reason to be concerned about more public radiation hazards that may affect them, and their families and others, and may, without denying the importance of dental radiation protection, have far greater effects on health. Well-known examples of domestic radon exposure occurred in the UK, particularly in the Lake District and the South West, and the nuclear reactor accidents--notably at Chernobyl in 1986.
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Severe dental attrition has several causes but may be the result of bruxism in neurological or psychological disturbances. Rett's syndrome is an uncommon but increasingly recognised neurological disorder, characterised by acquired microcephaly, progressive dementia, bruxism, and loss of purposeful movements of the hands. A patient with Rett's syndrome who demonstrated masseteric hypertrophy, bruxism, and severe attrition is reported.
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This report describes a young male patient who had enamel hypoplasia, persistent oral candidiasis, skin hyperpigmentation, and vitiligo, and was thus suspected of having candidiasis endocrinopathy syndrome. The clinical and laboratory investigations employed to confirm the diagnosis are detailed.
Prevention and treatment of oral disease is required to maintain quality of life and to improve prognosis of patients infected with the human immunodeficiency virus (HIV). Management requires a team approach, and close collaboration with the appropriate responsible physicians and other health care workers is necessary. Oral infection is frequent and usually opportunistic, and management is based on certain principles. Infections may disseminate and can be persistent and severe; multiple concurrent or consecutive infections with different microorganisms are frequent; fungal, viral, and parasitic infections are rarely curable; and long-term antimicrobial therapy may be required. This article reviews the management of oral candidiasis, hairy leukoplakia, and infections with herpes simplex virus, varicella-zoster virus, and cytomegalovirus. The management of Kaposi's sarcoma, lymphomas, aphthous ulceration, gangrenous stomatitis, bleeding, xerostomia, and adverse drug reactions is also described. Treatment should avoid further immunosuppression and inducement of xerostomia or caries, and should be designed to avoid adverse drug reactions and possible drug interactions.
White sponge nevus (WSN) is a benign hereditary lesion of the mucous membranes. DNA extracted from a biopsy specimen of oral WSN was assayed for the presence of DNA sequences homologous to human papillomavirus (HPV) types 1, 2, 4, 6, 11, 13, 16, and 18 by Southern blot hybridization. Only HPV-16 homologous DNA sequences were detected at a copy number of approximately 200 to 250 genome copies per diploid cell. The viral DNA sequences did not appear to be integrated into the host cell chromosome. The finding of HPV-16 in an inherited lesion such as WSN indicates that caution must be exercised in ascribing a causal association in relation to the demonstration of HPV in other mucosal disorders.
This study investigated the levels of oxygen saturation and pulse rates of patients undergoing minor oral surgery under local analgesia, with (20 patients) or without (20 patients) intravenous sedation with midazolam. The results indicated that a statistically significant fall in arterial blood oxygenation of 1% to 2%, as measured by pulse oximetry, followed midazolam administration; however, this was physiologically insignificant. Both groups showed a similar postoperative small fall in oxygen saturation. Transient episodes (24 to 36 seconds) of physiologically significant mild hypoxia occurred during breath holding, but this condition was readily corrected by encouraging patients to breathe deeply. Midazolam had a small but significant calming effect on the higher preoperative pulse rates exhibited by anxious patients, but this effect was not sustained during the operating period. Both sedated and unsedated patients showed episodes of tachycardia that could have significance for patients with cardiac disease.
A patient with a rare combination of bilateral lingual necrosis and intestinal infarction, caused by giant cell arteritis, is described and the literature reviewed.
Oral myiasis (infestation by the larvae of Diptera flies) has only rarely been reported in the English-language literature. This article records a case of wound myiasis caused by flies of the family Sarcophagidae that affected a tooth-extraction site, and was a painful complication of the extraction.
The pigmented purpuric dermatoses are a group of disorders in which there is chronic capillaritis, with pigmented purpuric lesions predominantly on the lower limbs. We report a case with chronic oral lesions that had histologic features most in keeping with the purpuric lichenoid dermatitis of Gougerot and Blum syndrome.
The recent advances in the understanding of the non-neoplastic disorders of salivary glands are summarised in this paper. The common infections are discussed and newer aspects of juvenile recurrent parotitis outlined. The benign lympho-epithelial lesion is reviewed in relation to Sjogren's syndrome and the salivary gland pathology seen in relation to infection with human immunodeficiency virus. A range of unusual conditions that may affect the minor salivary glands in particular, and can cause diagnosis dilemmas, is summarised.