Biomedical subjects
Crispian Scully
Publications and source records attributed to Crispian Scully.
Human herpesvirus 8 (HHV-8) and the etiopathogenesis of Kaposi's sarcoma.
OBJECTIVE: To review the current literature on human herpesvirus 8 with particular attention to the aspects related to the etiopathogenesis of Kaposi's sarcoma. MATERIALS AND METHODS: The authors searched original research and review articles on specific aspects of human herpesvirus 8 infection, including virology, epidemiology, transmission, diagnosis, natural history, therapy, and Kaposi's sarcoma etiopathogenesis. The relevant material was evaluated and reviewed. RESULTS: Human herpesvirus 8 is a recently discovered DNA virus that is present throughout the world but with major geographic variation. In the Western world, the virus, transmitted mainly by means of sexual contact, is strongly associated with Kaposi's sarcoma and body cavity-based lymphoma and more controversially with multiple myeloma and other non-proliferative disorders. There is no specific effective treatment, but HIV protease inhibitors may play an indirect role in the clearance of human herpesvirus 8 DNA from peripheral blood mononuclear cells of HIV-infected patients. Human herpesvirus 8 DNA is present in saliva, but there are as yet no documented cases of nosocomial transmission to health care workers. The prevalence of human herpesvirus 8 among health care workers is probably similar to that in the general population. CONCLUSION: Human herpesvirus 8 appears to be, at least in Western Europe and United States, restricted to a population at risk of developing Kaposi's sarcoma. Human herpesvirus 8 certainly has the means to overcome cellular control and immune responses and thus predispose carriers to malignancy, particularly Kaposi's sarcoma. The wide diffusion of Human herpesvirus 8 in classic Kaposi's sarcoma areas appears to represent an important factor in the high incidence of the disease. However, additional co-factors are likely to play a role in the development of Kaposi's sarcoma.
Burning Mouth Syndrome: open trial of psychotherapy alone, medication with alpha-lipoic acid (thioctic acid), and combination therapy.
OBJECTIVE AND STUDY DESIGN: This open study of 192 otherwise healthy persons with burning mouth syndrome, examined the efficacy on control of symptoms of psychotherapy alone with two hour sessions weekly for two months; alpha lipoic acid (ALA, tioctic acid; Tiobec) 600 mg/day alone for two months; or combination therapy of psychoanalysis and 600 mg/day ALA for two months. Controls received placebo alone. RESULTS: Most benefit was obtained with combination therapy. Combination therapy of psychoanalysis and alpha lipoic acid (ALA, tioctic acid; Tiobec. 600 mg/day) for two months gave most benefit and significantly more than psychoanalysis alone for two 1 hour sessions weekly for two months (p<0.0005), or ALA 600 mg/day alone for two months (p<0.0005). CONCLUSION: The present results suggest that alpha lipoic acid may complement psychotherapy and can be an acceptable alternative to psychoactive agents, but trials to compare the two approaches are now warranted.
Spectrum of oral manifestations of HIV/AIDS in the Perm region (Russia) and identification of self-induced ulceronecrotic lingual lesions.
OBJECTIVE: To study the frequency and spectrum of oral manifestations of HIV-infected drug-users in the Perm region. SUBJECTS: 104 seropositive HIV-infected drug-users (69 male, 35 female; ages 15 to 32 years; 13 co-infected with hepatitis viruses) and 13 AIDS-infected drug-users (7 male, 6 female; ages 16 to 37 years; 12 co-infected with hepatitis viruses). RESULTS: The most frequent forms of oral mucosal lesions in the HIV-infected group -- candidiasis (32.7%), herpetic lesions (15.4%), cheilitis glandularis (3.9%), recurrent aphthous stomatitis (2%). Regional lymphadenopathy was observed in 31% cases. The ulceronecrotic oral mucosal lesions were seen in the sublingual region and tongue in 11.5% patients and manifested with pain, dysarthria, dysphagia, and dysgeusia. These lesions were found in drug-users who injected the opioids sublingually. AIDS patients had oral candidiasis (84.6%), herpetic lesions (53.8%), recurrent aphthous stomatitis (15.4%) and cheilitis glandularis (7%). All AIDS-patients had severe xerostomia, and 15.4% had unilateral or bilateral swelling of the parotid glands. Generalized ulceronecrotic gingivostomatitis was found in 50% of the patients but the sublingual ulceronecrotic lesions were not identified. CONCLUSIONS: 1. The spectrum of oral cavity lesions of HIV/AIDS patients in Perm region is widespread enough. 2. Dissemination of oral cavity lesions is increasing in proportion of disease progression. 3. Dental care of HIV/AIDS patients should include periodic oral examinations to monitor their disease progression and to alleviate symptoms of oral opportunic and neoplastic diseases, to improve the life-style of the patients infected with HIV.
Candida-related denture stomatitis: a pilot study of the efficacy of an amorolfine antifungal varnish.
PURPOSE: Candida albicans is a component of the normal oral microflora, but local and systemic factors can transform this commensal C albicans to a pathogen. The most frequent cause of Candida opportunistic infections (candidiasis) is dentures, especially if poorly fitting or poorly cleaned. Management of oral candidiasis depends on an accurate diagnosis, identification and elimination of predisposing factors, and, often, use of antifungal agents. The aim of this study was to examine fingernail varnish, currently used for onychomycosis therapy, to reduce the fungal colonization in prosthetic biofilms. MATERIALS AND METHODS: A varnish containing 5% amorolfine was applied once or twice a week for 6 months in six patients affected by nystatin-resistant denture-related stomatitis. In all six patients, the prostheses had previously been removed at night, and daily antimycotic topical therapy with nystatin had failed to resolve the stomatitis; after 30 days, these patients all showed persistence of candidal stomatitis. RESULTS: After 1 month, five of the six patients were negative for Candida; this situation was unchanged in the following monthly controls. Only in the patient with suspected Sjögren syndrome was oral Candida found 15 days after the last varnish application. None of the patients had any complaints about the medication. CONCLUSION: This varnish containing 5% amorolfine, applied once or twice a week for 6 months, was able to suppress the nystatin-resistant denture-related stomatitis.