Biomedical subjects
Publications and source records attributed to C Scully.
Non-Hodgkin lymphomas are a recognised complication of AIDS and may involve the oral cavity. However, no case of Hodgkin's disease affecting the oral cavity in AIDS appears to have been recorded. We report a male homosexual with AIDS and Hodgkin's lymphoma, who presented with gingival involvement.
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This study examines the demographic, aetiological and clinico-pathological features of 37 patients with oral squamous cell carcinoma (SCC) who were less than 35 years old and a comparable number of patients who were greater than 60 years old. The study was undertaken at the Regional Cancer Centre, Trivandrum, India, between 1988 and 1990. In patients younger than 35 years old, oral SCC occurred more commonly in females, was apparent in all social classes and was associated with fewer aetiological factors. The tumours manifested predominantly as invasive lesions affecting the tongue and there was early spread to lymph nodes. By contrast, in patients older than 60 years of age, oral SCC was more common in males, occurred more frequently in social classes III and IV and was always seen in association with smoking, alcohol or pan chewing. These latter tumours presented as exophytic lesions of the buccal mucosa or gingivae and spread late to lymph nodes. The results indicate that the biological behaviour of oral SCC in young patients may be distinct from that occurring in older patients.
Immunosuppression increases the risk of developing malignancies. In immunosuppression due to human immunodeficiency virus (HIV) disease the common head and neck tumors are Kaposi's sarcoma and non-Hodgkin's lymphoma. Squamous cell carcinoma has also been reported. Kaposi's sarcoma is the commonest neoplastic disease in AIDS. The incidence of lymphoma is rapidly increasing. This article reviews the incidence, clinical presentation and management of these diseases in the head and neck in AIDS patients.
Cancer of the oral cavity is an important contributor to the overall international cancer burden, especially in the developing countries. Smoking cessation, moderation of alcohol consumption, and increased consumption of fruits, and probably vegetables, have been identified by epidemiologic studies as three actions that could lead to the prevention of approximately three fourths of cases in Western countries. Similar effects could be brought about in developing countries through cessation of cigarette smoking and, where appropriate, betel quid chewing and increased consumption of fruits and vegetables. Since this disease is increasing in frequency in many countries, it is important to implement these health education messages. A similar situation holds true for larynx cancer. Clearly many head and neck cancers are preventable and it is worth repeating that prevention should become an epidemiologic priority. There are exciting prospects of effective chemoprevention opportunities in head and neck cancer, with a number of compounds having activity. Further developments in this important area are awaited.
This study examined the production of an immunosuppressive factor by the KB and H191 human oral squamous carcinoma cell lines. Conditioned media (CM) from both cell lines markedly inhibited mitogen- and alloantigen-induced proliferation of normal human and rat peripheral blood lymphocytes. By contrast, the proliferation of an exponentially-growing fibroblast cell line remained unchanged by CM. The immunosuppressive factor appeared to act after lymphocyte commitment as indicated by continued blast cell formation, the failure of CM to suppress resting lymphocytes and the fact that CM caused maximum inhibition of lymphocyte proliferation 72 h after the addition of PHA. The addition of exogenous IL-2 did not counteract lymphocyte suppression. Inclusion of indomethacin and isoniazid during cell culture did not significantly alter the degree of suppressive activity. Mycoplasma contamination was absent and CM did not act directly with the thymidine or mitogen. The factor was heat stable at 50 degrees C, acid labile and had a molecular weight in excess of 300 kDa. The results demonstrate that human oral squamous carcinoma cell lines produce an immunosuppressive factor that may have a role in tumour evasion of the host immune response.
The purpose of the study was to determine if toluidine blue application and counter staining with Logul's iodine would aid in diagnosis of oral dysplastic or malignant lesions. The sensitivity, specificity, and predictive values were studied. Routine use of these tissue stains was found to be sensitive and specific. The use of stains provided better demarcation of oral squamous cell carcinoma and dysplastic changes and assisted in site selection for diagnostic biopsy. The use of toluidine blue and Lugol's iodine can assist in assessment of patients at risk of developing malignant disease and those with lesions that are clinically suspect of dysplasia or malignancy.
Serum levels of immunoglobulin G (IgG) subclasses were examined in 71 adult patients with minor recurrent aphthous stomatitis (MiRAS). Seven patients (10%) had altered IgG subclasses: six had marginally raised IgG1 levels and one had a low level of IgG3. It is concluded that abnormalities of IgG subclass levels do not underlie MiRAS.
We have employed the polymerase chain reaction (PCR) to detect Human Papillomavirus (HPV) type 16 in oral squames and mononuclear cells from 62 healthy young adult volunteers. Two groups were screened for the presence of this virus, but in not all cases was DNA obtained from the scrapes. In the first (n = 30), the results show that 43% of normal individuals harbour HPV 16 (a genital type) in their buccal mucosa, epithelium of dorsum of tongue and hard palate. In the second group (n = 18), 44% of individuals were positive for HPV 16 in their oral epithelial scrapes, while only 6% were positive for the same virus in mononuclear cells. Interestingly, in 2 cases, peripheral blood lymphocyte DNA gave a positive reaction with the HPV 16 primers. To investigate possible HPV infection of lymphocytes, a further 42 lymphocyte samples, taken from the same age group as the epithelial study group, were analysed. None of these lymphocytes were positive for the presence of HPV 16 DNA.
Aspergillosis, cryptococcosis and zygomycosis (mucormycosis) are overall the most common systemic mycoses but histoplasmosis is particularly endemic in parts of central USA and other areas worldwide. Orofacial lesions caused by systemic mycoses have rarely been reported in the past though they have been recorded particularly in outdoor workers from geographic areas with a high prevalence of infection and occasionally in immunocompromised individuals. Increasing world-wide travel, and the dramatic increase in numbers of immunocompromised persons, especially those with human immunodeficiency virus (HIV) disease, have been responsible for an increase in reports and other studies of orofacial disease in systemic mycoses and new opportunists are now being recognized. Those in Oral Medicine and Pathology must now be aware of the possibility of a systemic mycosis as the cause of chronic oral ulceration, chronic maxillary sinus infection, or bizarre mouth lesions, especially in patients with HIV disease, lymphoproliferative disorders, or diabetes mellitus, or in those who have been in endemic areas. Diagnosis and management should be undertaken in consultation with a physician with appropriate expertise, as pulmonary and other systemic infection may well be present. This paper reviews the eight main systemic mycoses.
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The aim of this study was to determine the opinions of on-call senior house officers in British oral and maxillo-facial surgery, or related units, about aspects of their working conditions. Despite concern about the conditions of service of junior hospital staff in other clinical specialties, the results suggest that most senior house officers in this discipline are satisfied with their present posts. However, regular review of their conditions of service is still indicated.
A retrospective analysis of 1,000 consecutive patients was undertaken to determine the frequency and types of common dental problems presenting to the Emergency and Oral Medicine Clinic at Bristol Dental Hospital. The results show that most attenders presented with problems readily manageable by dental practitioners, but providers of emergency dental services should be aware that rare, but serious, conditions can occur. Information presented in this paper should be incorporated into the design of undergraduate curricula and emergency dental services.
After a decade of study of the acquired immunodeficiency syndrome (AIDS) there is evidence to address the concerns of dental staff about possible transmission of human immunodeficiency virus (HIV). This paper reviews that evidence which demonstrates an extremely low risk of transmission of HIV to staff and patients. Only a few isolated cases have implicated transmission during dental practice, however, there are no proven cases where seroconversion has been demonstrated in relation to an exposure during dental treatment.
The recent identification of one of the causes of non-A, non-B hepatitis (NANBH) has led to an improved understanding of the epidemiology and possible clinical manifestations of this infectious disorder. NANBH is of some concern to dental personnel since the causative agents may be transmitted to health care workers and there is no effective immunization against NANBH. Current recommendations for cross infection control in the dental workplace must apply to NANBH.
Viral diseases of relevance to dentistry have recently been reviewed with respect to human immunodeficiency virus disease, other immunocompromised persons, oral malignancies, infection control, and antiviral therapy. This review discusses the most recent advances in the understanding of aspects of human immunodeficiency virus relevant to dentistry and relevant aspects of the herpesviruses, human papillomaviruses, hepatitis viruses, and other viruses. Further detail is available in other recent reviews.
Three siblings with familial gingival hyperplasia and abnormal feet are reported. Despite the resemblance to the Laband syndrome, where there are anomalies of the terminal phalanges, the abnormalities of the feet in these children were caused by the persistent wearing of "flip-flop" sandals. Care is required in the conduct of history and examination.