Biomedical subjects
Publications and source records attributed to C Scully.
Papillomaviruses are ubiquitous DNA viruses that are epitheliotropic and produce a range of epithelial neoplasms, both benign and malignant, in animals and man. Human papillomaviruses are associated with a variety of rare and uncommon oral lesions, and there has been increasing suspicion that they may be implicated also in some premalignant and malignant oral lesions.
Three fluorescein-labeled lectins were shown to bind differentially to cell surfaces in different epithelial layers of rat oral mucosa regardless of the age or the site of origin of the tissue. Griffonia simplicifolia (GS-1-B4), specific for alpha-D-galactosyl end groups, labeled basal cells only; Ulex europeus (Ulex 1) specific for alpha-L-fucosyl groups labeled spinous cells; and Bandeiraea simplicifolia (BSII), specific for N-acetyl-D-glucosamine, labeled cornified cells. Pretreatment of sections with alpha-galactosidase completely abolished the staining of basal cells by GS-1-B4, but had no effect on the staining of spinous cells by Ulex 1. In contrast, alpha-fucosidase abolished the staining of spinous cells by Ulex 1 and caused staining of both basal and spinous cells by GS-1-B4. Neuraminidase and chondroitinase ABC produced results similar to one another, with staining of basal cells by GS-1-B4 and labeling of both basal and spinous cells with Ulex 1. beta-galactosidase, beta-glucuronidase, and testicular hyaluronidase did not affect the staining pattern of GS-1-B4 or Ulex 1, whereas chymotrypsin completely abolished any staining with either lectin. The results demonstrate a complex arrangement of cell surface carbohydrates in the epithelium of rat oral mucosa. The findings indicate a possible simplification in the spatial arrangements of cell surface carbohydrates during the differentiation of basal to spinous cells.
One hundred and thirteen patients with histologically confirmed oral lichen planus, from three stomatology clinics, were examined for evidence of liver disease. No patient had clinical evidence of liver disease. Nine patients (7.9%) had a raised serum concentration of a single enzyme; 6 patients had raised gamma-glutamyl transpeptidase, 2 had raised alkaline phosphatase, and 1 had raised aspartate transaminase levels. No patient had serum auto-antibodies suggestive of primary biliary cirrhosis or chronic active hepatitis. Most patients presenting with oral lichen planus are unlikely to have liver disease.
Lichen planus (LP) is a common oral disorder which may represent the manifestation of a mucosal reaction to a variety of aetiological factors. Of the many immunological changes described in LP several may be epiphenomena although a cell-mediated immune response to unidentified antigens or antigenic changes clearly is involved. Associations with drugs or systemic disorders are well-defined in some patients but may, in others, be aleatoric. Finally, the prognosis of oral LP not only differs from that of cutaneous LP but there is little doubt that in a few instances LP is a premalignant condition.
The chemotactic, chemokinetic and phagocytic capacity of neutrophils from blood and from gingival crevicular washings of the same subjects were compared in visual assays, i.e. time-lapse cinematography and an orientation assay. A high proportion of the cells in both populations was motile, but the mean speed of locomotion of the crevicular cells was lower than that of the blood cells, indicating a relative impairment of chemokinesis. The differences between blood and crevicular cells in their capacity to migrate towards and phagocytose blastospores of Candida albicans in fresh serum were not significant, though crevicular cells were slightly less efficient in orienting towards sources of chemotactic gradients of various factors. Thus there is not a major defect of chemotaxis or phagocytosis of crevicular neutrophils.
A study of 60 patients with oro-facial granulomatosis has been conducted and the clinical presentation of this disorder defined. It encompasses the previously recognised clinical entities of Melkersson-Rosenthal syndrome and cheilitis granulomatosa. The pathological features of the disease are lymphoedema and the presence of multiple non-caseating giant cell granulomata. These granulomata are histologically indistinguishable from those found in both gastrointestinal Crohn's disease and systemic sarcoidosis. Within this series of patients, nine had evidence suggestive of gastrointestinal Crohn's disease, and in six this was confirmed. A diagnosis of sarcoidosis was made in a further two patients. The relationship of oro-facial granulomatosis to these systemic granulomatous diseases is not yet clear. Patients with oro-facial granulomatosis who have gastrointestinal symptoms should be investigated for the presence of gastrointestinal Crohn's disease. Those without symptoms should be investigated for evidence of malabsorption or serological evidence of Crohn's disease. Within the present study, the erythrocyte sedimentation rate, full blood count, corrected whole blood folate, serum albumin and calcium were the most sensitive markers of gastrointestinal involvement. Sarcoidosis should be considered in all patients with oro-facial granulomatosis. The absence of clinical signs suggestive of sarcoidosis, a normal chest radiograph and normal levels of serum angiotensin-converting enzyme makes sarcoidosis unlikely.
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This paper describes a complication of herpes zoster infection of the orofacial region involving a 15-year-old girl who, following herpes zoster of the right mandibular division of the trigeminal nerve at the age of 7 years, suffered abnormal development of the permanent teeth in this quadrant.
Since early this century, when Rous (1911) first demonstrated the association of a tumour (chicken sarcoma) with a transmissible agent, evidence has accumulated on possible associations between viruses and various neoplasms. There is now conclusive evidence linking some RNA viruses (Temin, 1972) and DNA viruses (Rapp, 1973) with tumours in animals--including sub-human primates (Leading article, 1982). Indeed, a serious complication of hepatitis B infection in man is now recognised to be hepatocellular carcinoma. (Editorial, 1982). The evidence association other viruses with human neoplasms is not unequivocal but there are strong associations between, for example, herpesviruses and some human malignant neoplasms (Klein, 1972; Rapp, 1973; zur Hausen, 1975).
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Biopsy specimens from patients with oral squamous cell carcinoma were examined by in situ hybridisation for evidence of RNA complementary to herpes simplex virus (HSV) type 1, HSV type 2, and adenovirus type 2. RNA complementary to HSV was found in 66% of carcinomas and 33% of non-malignant lesions from other patients. In a further study with internally paired controls, RNA complementary to HSV was found in 53% of carcinoma biopsy specimens but in no biopsy specimens of normal oral mucosa from the same patients. RNA complementary to HSV was found in over 50% of oral squamous cell carcinomas.
This paper summarises the evidence for the involvement of the immune response in the development of neoplasia, discusses the immunological abnormalities found in patients with head and neck carcinoma, and outlines recent attempts at treatment of patients with head and neck carcinoma by modulation of the immune response (immunotherapy).
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The importance of a medical history to identify potential problems in dental management is self-evident but the means of collecting medical data vary widely. This study has assessed the reliability of a self-administered questionnaire (SAQ) used by 292 randomly selected adult dental out-patients (mean age 41.7 years) attending the oral medicine clinic of a dental teaching hospital. Results of the SAQ were compared with the history taken by receiving surgeons. Significant discrepancies were revealed not only in the SAQ but also in the history taken by the receiving surgeon, although the latter produced a more comprehensive record. Maximum yield of information regarding known medical problems was only produced by using the self-administered questionnaire with a check of this by the receiving surgeon.
A sensitive radio-assay for ferritin was developed and used to examine serum ferritin levels in 105 patients with recurrent oral ulceration (ROU), 41 patients with Behçet's syndrome (BS), 42 with other ulcerative oral lesions, 35 patients with non-ulcerative oral lesions and in 78 controls. Ferritin levels increased with age and were significantly higher in males than females. The mean ferritin concentrations in male patients with ROU, BS or with other oral ulcers were significantly reduced in comparison with controls, and in female patients were significantly reduced in those with major aphthous ulcers. The prevalence of low serum ferritin levels was about 8% in patients with ROU, 15% in BS and 9.5% in patients with other ulcerative oral lesions, compared with less than 3% in patients with non-ulcerative oral disorders and in controls. Most of the iron-deficient patients were female. Serum ferritin levels did not directly correlate with serum iron levels and may be a more accurate indicator of iron deficiency. Furthermore, serum ferritin can distinguish between patients with true iron deficiency and those with secondary sideropenia. It is suggested that in a small number of patients, oral ulceration may be a presenting sign of iron deficiency, and that in a further small proportion of patients, ROU already present will be exacerbated by concurrent iron deficiency. Both groups will show a therapeutic response to correction of the iron deficiency. The results suggest that serum ferritin levels are a useful part of the haematological investigations in patients with ROU.