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Biomedical subjects

J A Ship

Publications and source records attributed to J A Ship.

At least 37 records · Page 2Linked to original sources
PubMed1999

The influence of hypothyroidism and thyroid replacement therapy on stimulated parotid flow rates.

OBJECTIVE: The purpose of this study was to determine, through use of cross-sectional and longitudinal data, whether hypothyroidism and its treatment with thyroid hormones have a significant effect on the production of stimulated parotid flow rates. STUDY DESIGN: From the Baltimore Longitudinal Study of Aging (NIA, NIH), subjects with hypothyroidism taking and not taking thyroid replacement therapy were evaluated for the production of 2% citrate-stimulated parotid saliva in a cross-sectional and longitudinal investigation. Comparisons were made with nonmedicated healthy control subjects. RESULTS: Cross-sectional analyses revealed that stimulated parotid flow rates were not significantly different between healthy controls, subjects with hypothyroidism on thyroid replacement therapy, and subjects with hypothyroidism not on thyroid replacement therapy. In general, longitudinal analyses revealed no significant differences over time in stimulated parotid flow rates between healthy controls and subjects with hypothyroidism. CONCLUSIONS: Hypothyroidism and the concomitant use of thyroid replacement therapy do not cause significant changes in the production of stimulated parotid saliva.

Adult↗
PubMed1999

Two-year longitudinal study of parotid salivary flow rates in head and neck cancer patients receiving unilateral neck parotid-sparing radiotherapy treatment.

Radiotherapy (RT) is a common treatment for head and neck cancers, and frequently causes permanent salivary dysfunction and xerostomia. This 2-year longitudinal study evaluated unstimulated and stimulated parotid flow rates in 11 patients with head and neck cancers who received unilateral neck parotid-sparing RT. The results demonstrated that treated parotid glands had essentially no output up to 2 years post-RT. Alternatively, spared parotid flow rates were indistinguishable from pre-RT values at 1 and 2 years post-RT, and increased slightly over time. Total unstimulated and stimulated parotid flow rates 2 years after completion of RT were similar to pre-RT values, suggesting that spared parotid function may compensate for lost function from treated parotid glands. These results demonstrate that unilateral neck parotid-sparing techniques are effective in preserving contralateral parotid glands up to 2 years after the completion of RT.

Adult↗
PubMed1999

Treatment of primary Sjögren's syndrome with low-dose natural human interferon-alpha administered by the oral mucosal route: a phase II clinical trial. IFN Protocol Study Group.

The purpose of this investigation was to examine the safety and efficacy of four dosages of natural human interferon-alpha (nHuIFN-alpha) delivered over a 12-week period orally in lozenges (150 IU and 450 IU, once [QD] or three times [TID] daily) compared to placebo in subjects with primary Sjögren's syndrome. This randomized, double-blinded clinical trial demonstrated that nHuIFN-alpha at a dose of 150 IU administered TID by oral lozenge significantly improved stimulated whole saliva output compared to placebo after 12 weeks of treatment. The 150 IU TID dose also was suggestive of benefit for 5 of 7 subjective measures of oral and ocular comfort. IFN lozenges demonstrated a good safety profile, with no serious adverse events found in any treatment group. There were no significant differences between the placebo and the four doses of IFN for adverse events by total number, organ system, severity, dropouts, and number judged to be related to treatment. In conclusion, these results demonstrated that the use of 150 IU IFN lozenges TID for 12 weeks in subjects with primary Sjögren's syndrome improved salivary output and decreased complaints of xerostomia without causing significant adverse medical events.

Administration, Oral↗
PubMed1999

Effect of age on variability of parotid salivary gland flow rates over time.

BACKGROUND: although several reports indicate that qualitative and quantitative assessments of parotid salivary function are age-stable in healthy adults, there have been no studies of the influence of age on the variability of repeated parotid flow rates. OBJECTIVE: to examine the influence of age on the variability of repeated parotid flow rates in unmedicated, healthy adults. MATERIALS AND METHODS: we assessed unilateral unstimulated and 2% citrate-stimulated parotid flow rates and collected responses to a five-item subjective xerostomia questionnaire in 14 subjects aged 20-40 years and 14 subjects aged 60-80 years. All subjects were healthy and unmedicated. We collected saliva and asked subjects to complete the questionnaire at baseline, 1 h and 2 h. RESULTS: unstimulated and stimulated parotid flow rates were similar at each time point in young and older subjects, and remained stable over the collection period. There were no differences in the standard deviations of the three collections of unstimulated and stimulated flow rates between young and older subjects. There were no differences between questionnaire responses between the two groups, and no change in response over time. CONCLUSIONS: there is no increased age-related variability in parotid salivary flow rates over repeated measures. Stimulated parotid flow rates are stable over 2 h in healthy people, and are similar in young and older individuals. These results suggest that parotid glands have a large secretory reserve.

Adult↗
PubMed1999

Conformal and intensity modulated irradiation of head and neck cancer: the potential for improved target irradiation, salivary gland function, and quality of life.

PURPOSE: To develop techniques which facilitate sparing of the major salivary glands while adequately treating the targets in patients requiring comprehensive bilateral neck irradiation (RT). PATIENTS AND METHODS: Conformal and static, multisegmental intensity modulated (IMRT) techniques have been developed. The salivary flow rates before and periodically after RT have been measured selectively from each major salivary gland and the residual flows correlated with glands' dose volume histograms. Subjective xerostomia questionnaires have been developed and validated. The pattern of local-regional recurrences has been examined using CT scans at the time of recurrence, transferring the recurrence volumes to the planning CT scans and regenerating the dose distributions at the recurrence sites. RESULTS: Target coverage and dose homogeneity in IMRT treatment plans were found to be significantly better than standard RT plans. Significant parotid gland sparing was achieved. The relationships among dose, irradiated volume and saliva flow rates from the parotid glands were characterized by dose and volume thresholds. A mean dose of 26 Gy was found to be the threshold for stimulated saliva. Subjective xerostomia was significantly reduced in patients irradiated with parotid sparing techniques, compared to patients with similar tumors treated with standard RT. The large majority of recurrences occurred inside high-risk targets. CONCLUSIONS: Tangible gains in salivary gland sparing and target coverage are being achieved and an improvement in some measures of quality of life is suggested by our findings. A mean parotid gland dose of < or = 26 Gy should be a planning objective if significant parotid function preservation is desired. The pattern of recurrence suggests that careful escalation of the dose to targets judged to be at highest risk may improve tumor control.

Dose-Response Relationship, Radiation↗
PubMed1998

Comprehensive irradiation of head and neck cancer using conformal multisegmental fields: assessment of target coverage and noninvolved tissue sparing.

PURPOSE: Conformal treatment using static multisegmental intensity modulation was developed for patients requiring comprehensive irradiation for head and neck cancer. The major aim is sparing major salivary gland function while adequately treating the targets. To assess the adequacy of the conformal plans regarding target coverage and dose homogeneity, they were compared with standard irradiation plans. METHODS AND MATERIALS: Fifteen patients with stage III/IV head and neck cancer requiring comprehensive, bilateral neck irradiation participated in this study. CT-based treatment plans included five to six nonopposed fields, each having two to four in-field segments. Fields and segments were devised using beam's eye views of the planning target volumes (PTVs), noninvolved organs, and isodose surfaces, to achieve homogeneous dose distribution that encompassed the targets and spared major salivary gland tissue. For comparison, standard three-field radiation plans were devised retrospectively for each patient, with the same CT-derived targets used for the clinical (conformal) plans. Saliva flow rates from each major salivary gland were measured before and periodically after treatment. RESULTS: On average, the minimal dose to the primary PTVs in the conformal plans [95.2% of the prescribed dose, standard deviation (SD) 4%] was higher than in the standard plans (91%, SD 7%; p = 0.02), and target volumes receiving <95% or <90% of the prescribed dose were smaller in the conformal plans (p = 0.004 and 0.02, respectively). Similar advantages of the conformal plans compared to standard plans were found in ipsilateral jugular nodes PTV coverage. The reason for underdosing in the standard treatment plans was primarily failure of electron beams to fully encompass targets. No significant differences were found in contralateral jugular or posterior neck nodes coverage. The minimal dose to the retropharyngeal nodes was higher in the standard plans. However, all conformal plans achieved the planning goal of delivering 50 Gy to these nodes. In the conformal plans, the magnitude and volumes of high doses in noninvolved tissue were significantly reduced. The main reasons for hot spots in the standard plans (whose dose calculations included missing tissue compensators) were photon/electron match line inhomogeneities, which were avoided in the conformal plans. The mean doses to all the major salivary glands, notably the contralateral parotid (receiving on average 32% of the prescribed dose, SD 7%) were significantly lower in the conformal plans compared with standard radiation plans. The mean dose to the noninvolved oral cavity tended to be lower in the conformal plans (p = 0.07). One to 3 months after radiation, on average 60% (SD 49%) of the preradiation saliva flow rate was retained in the contralateral parotid glands and 10% (SD 16%) was retained in the submandibular/sublingual glands. CONCLUSIONS: Planning and delivery of comprehensive irradiation for head and neck cancer using static, multisegmental intensity modulation are feasible. Target coverage has not been compromised and dose distributions in noninvolved tissue are favorable compared with standard radiation. Substantial major salivary gland function can be retained.

Carcinoma, Squamous Cell↗
PubMed1997

The relationship between dehydration and parotid salivary gland function in young and older healthy adults.

BACKGROUND: Saliva is essential for the maintenance of oral health. The primary constituent of saliva is water and, traditionally, decreased body water homeostasis has been linked with salivary dysfunction. This is consistent with the greater prevalence of dehydration and salivary gland dysfunction among the elderly. However, this association between dehydration and salivary dysfunction has never been tested using objective criteria. The purpose of this study was to determine the effect of body dehydration upon parotid salivary flow rates in young and older healthy adults. METHODS: Twelve young (20-40 years) and 12 older (60-80 years) healthy subjects abstained from food and beverage intake for 24 h (dehydration) and then underwent intravenous rehydration to replace all lost weight. Unstimulated and stimulated parotid salivary flow rates, weight, hematocrit, hemoglobin, serum sodium, plasma protein, creatinine, serum, and urine osmolality values were assessed at baseline, 24 h, and 1 h after the completion of rehydration. RESULTS: All subjects experienced a significant decrease in weight and increased levels of hematocrit, hemoglobin, plasma protein, and creatinine during dehydration with few age-related differences. Intravenous fluid replacement increased weight and decreased hematocrit, hemoglobin, plasma protein, and creatinine back to baseline values, demonstrating that subjects were metabolically rehydrated. Unstimulated (young and older, p = .0001) and stimulated (young, p > .05; older, p = .03) parotid flow rates decreased during the 24-h dehydration period, yet did not completely return (young and older unstimulated, p < .001; young and older stimulated, p > .05) to baseline values after rehydration. CONCLUSIONS: These findings suggest that body dehydration is associated with decreased parotid salivary gland flow rates, and that these changes are generally age-independent in healthy adults. Furthermore, although subjects were metabolically rehydrated, unstimulated salivary flow rates remained significantly lower than baseline levels.

Adult↗
PubMed1997

Parotid sparing study in head and neck cancer patients receiving bilateral radiation therapy: one-year results.

Many patients with head and neck cancers receive radiation therapy as part of their treatment which frequently causes considerable morbidity, including various degrees of permanent salivary gland dysfunction. Three-dimensional treatment planning [3-DTP] and conformational dose delivery constitute a new therapeutic modality that conforms the high-dose radiation volume to the shape of the tumor volume while minimizing the dose to tissue that is not at risk of containing cancer. The treatment volumes for head and neck tumors as well as parotid glands can be well-defined on cross-sectional CT imaging techniques. The purpose of this investigation is to determine if 3-DTP and conformational dose-delivery could minimize radiation dose and salivary gland dysfunction to contralateral parotid glands in patients with head and neck cancers. Eleven patients with head and neck cancers who required bilateral radiation therapy were treated with 3-DTP. Unstimulated and stimulated bilateral parotid saliva was collected prior to radiotherapy, weekly during treatment, and 1, 3, 6, and 12 months after the completion of radiotherapy. Treated parotid glands received an average dose of 5745 cGy, while spared glands received only 1986 cGy (p < 0.0001). Unstimulated and stimulated parotid flow rates decreased dramatically in treated glands after the initiation of radiotherapy, remained at extremely low rates without any improvements, and were significantly lower at 1 year after radiotherapy compared with baseline. Conversely, parotid flow rates in spared glands underwent mild changes during radiotherapy and were approximately 50% of baseline values. The results of this study suggest that with the use of 3-DTP, contralateral parotid gland function can be partially preserved for at least 1 year in patients with head and neck cancers requiring bilateral radiation.

Aged↗
PubMed1997

Diagnosing depression in patients with chronic facial pain.

Depression is a common serious disorder that has a high comorbidity with chronic facial pain. This article provides an overview of the clinical presentation, pathophysiology and diagnosis of depression. In particular, it addresses some of the problems associated with identifying depressive symptoms in dental patients who have chronic facial pain.

Chronic Disease↗
PubMed1996

Parotid gland sparing in patients undergoing bilateral head and neck irradiation: techniques and early results.

PURPOSE: To minimize xerostomia in patients receiving bilateral head and neck irradiation (RT) by using conformal RT planning to spare a significant volume of one parotid gland from radiation. METHODS AND MATERIALS: The study involved 15 patients with head and neck tumors in whom bilateral neck radiation was indicated. The major salivary glands and the targets (tumor, surgical bed, metastases to lymph nodes, and the locations of lymph nodes at risk for metastases) were outlined on axial computed tomography images. Beam's-eye view (BEV) displays were used to construct conformal beams that delivered the prescribed doses to the targets while sparing from direct radiation most of one parotid gland. The gland that was planned to be spared resided in the neck side that was judged in each patient to be at a lesser risk of metastatic disease. Major salivary gland flow rates and the responses to a subjective xerostomia questionnaire were assessed before, during, and after radiation. RESULTS: Radiation planning for patients with central oropharyngeal tumors required the generation of multiple axial nonopposed beams. The resulting isodoses encompassed the targets, including the retropharyngeal nodes and the jugular nodes up to the base of skull bilaterally, while limiting the dose to the oral cavity, spinal cord, and one parotid gland. For patients with lateralized tumors, the ipsilateral neck side was treated up to the base of the skull; in the contralateral neck side, the treatment included the subdigastric nodes but excluded the jugular nodes at the base of the skull and most of the parotid gland. This was accomplished by a moderate gantry angle that was chosen using the BEV displays. Three months following the completion of radiation, the spared parotid glands retained on average 50% of their unstimulated and stimulated flows. In contrast, no saliva flow was measured from the unspared glands in any of the patients. Subjective xerostomia was absent, mild, or not different from that reported before radiation in 10 of 15 patients (67%). CONCLUSION: Partial parotid gland sparing is feasible by using three-dimensional planning in patients undergoing bilateral head and neck radiation. Approximately 50% of the saliva flow from the spared glands may be retained, and most patients thus treated have no or mild xerostomia in the early period after the completion of radiation. Whether tumor control and late complications are comparable to standard radiation will be assessed as more experience is gained.

Aged↗
PubMed1996

Ipsilateral parotid sparing study in head and neck cancer patients who receive radiation therapy: results after 1 year.

OBJECTIVE: To determine if three-dimensional treatment planning and conformational dose delivery could minimize radiation dose and salivary gland dysfunction to contralateral parotid glands in patients with unilateral head and neck cancers. STUDY DESIGN: Fifteen patients with unilateral head and neck cancers were treated with three-dimensional treatment planning. Unstimulated and stimulated bilateral parotid saliva was collected before radiotherapy, weekly during treatment, and 1, 3, 6, and 12 months after the completion of radiotherapy. RESULTS: Treated parotid glands received an average dose of 4949 cGy, whereas spared glands received only 355 cGy. Unstimulated and stimulated parotid flow rates decreased dramatically in treated glands after the initiation of radiotherapy and were significantly lower at 1 year after radiotherapy compared with baseline. Conversely, parotid flow rates in spared glands underwent mild changes during radiotherapy and were similar at 1 year after radiotherapy compared with baseline. CONCLUSION: Parotid gland function can be preserved for at least 1 year in patients with unilateral head and neck cancers with three-dimensional treatment planning.

Adult↗
PubMed1996

Ten-year longitudinal study of periodontal attachment loss in healthy adults.

Despite much research, it is still difficult to make generalizations concerning aging and periodontal diseases. This study examined 95 healthy men and women (aged 29 to 76 years at initial visit) from the oral physiology component of the Baltimore Longitudinal Study of Aging over a 10-year period. Periodontal measurements were taken at two visits, and recession, pocket depth, and level of attachment determined. The change of level of attachment and attachment loss was assessed as a longitudinal measure of disease progression. Overall there were only slight changes in periodontal measurements over the 10-year period. Attachment loss was age-dependent and was due primarily to increased recession not to changes in pocket depth. Periodontal disease destruction (as measured by attachment loss) occurred over time but was not related to the age or gender of a person. These results from healthy persons suggest that periodontal diseases are not a natural consequence of the aging process, and that advanced age is not an accurate predictor of attachment loss.

Adult↗
PubMed1996

Recurrent aphthous stomatitis. An update.

Recurrent aphthous ulceration or recurrent aphthous stomatitis is the most common oral mucosal disease known to human beings. Despite much clinical and research attention, the causes remain poorly understood, the ulcers are not preventable, and treatment is symptomatic. The most common presentation is minor recurrent aphthous stomatitis: recurrent, round, clearly defined, small, painful ulcers that heal in 10 to 14 days without scarring. Major recurrent aphthous stomatitis lesions are larger (greater than 5 mm), can last for 6 weeks or longer, and frequently scar. The third variety of recurrent aphthous stomatitis is herpetiform ulcers, which present as multiple small clusters of pinpoint lesions that can coalesce to form large irregular ulcers and last 7 to 10 days. Diagnosis of all varieties is usually made after clinical examination. Many local and systemic factors have been associated with these conditions, and there is evidence that there may be a genetic and immunopathogenic basis for recurrent aphthous ulceration. Management of this condition depends on the clinical presentation and symptoms and includes analgesic, antimicrobial, and immunomodulatory drugs. As dental clinicians and researchers become better trained in oral medicine and stomatology, it is anticipated that the pathophysiology, prevention, and treatment of recurrent aphthous ulceration will improve in the future.

Adjuvants, Immunologic↗
PubMed1996

Longitudinal changes in smell identification.

BACKGROUND: Cross-sectional studies have demonstrated that olfactory function diminishes with increasing age, which may impact on the safety and quality of life of older persons. To date, however, there have been no published longitudinal studies on olfaction. The purpose of this study was to examine the influence of age and gender on smell identification over a 3-year period in a group of generally healthy men and women. METHODS: Males (n = 85) and females (n = 76) between the ages of 19 and 95 years were administered the University of Pennsylvania Smell Identification Test (SIT) over a 3-year span as part of the oral physiology component of the Baltimore Longitudinal Study of Aging. A linear mixed-effects regression model was used to determine how longitudinal changes in SIT scores differ with respect to gender, history of medical problems, and use of prescription medications. RESULTS: Over the 3-year period, SIT scores diminished progressively with increased age. Women and men in the eighth decade of life experienced a decline of greater than one SIT point per year. Females consistently performed better than males in smell identification. Similar results were obtained regardless of medical problems or medication usage. CONCLUSIONS: These results extend the conclusions of previous cross-sectional olfactory studies and indicate that smell identification deteriorates progressively with greater age. Furthermore, age-related declines in olfaction occur even in the absence of overt medical problems.

Adult↗
PubMed1996

Tongue strength and endurance in different aged individuals.

BACKGROUND: It is generally accepted that age-related changes occur in voluntary muscle. Studies of hand grip strength and aging demonstrate a decrease in strength with age; however, there are little data regarding tongue function. The purpose of this study was to determine the relationship of increased age to tongue strength and endurance. METHODS: A pressure transducer, the Iowa Oral Performance Instrument, was used to measure maximal strength and endurance of both the hand and tongue. Ninety-nine healthy volunteers from the oral physiology component of the Baltimore Longitudinal Study of Aging were divided into four age groups, ranging from 21 to 96 years of age. A multivariate analysis of variance was used to determine differences in strength and endurance between age groups and genders. Regression analysis was done to determine the relationship of strength and endurance with age. RESULTS: Gender analysis indicated that both tongue and hand strength were greater in males; however, tongue and hand endurance demonstrated no gender differences. The strength in both the tongue and hand decreased with age. Individuals over the age of 79 years showed statistically decreased tongue strength, and individuals over the age of 59 years showed statistically decreased hand strength. There was no significant change in the tongue and hand endurance with age. CONCLUSIONS: The results of this study suggest that tongue function is gender- and age-dependent and follows the same trends as hand function. Tongue strength is decreased in older individuals and females, while tongue endurance is gender- and age-independent.

Adult↗
PubMed1996

Geriatric oral health and its impact on eating.

OBJECTIVE: Adequate food and fluid intake and nutritional health are requisites for sustaining life. The oral-pharyngeal region has evolved multiple, highly regulated processes to ensure that the intake, chewing, and swallowing of foods and beverages is maintained. The objective of this paper is to identify the independent and collective roles of oral health on eating in older people. DESIGN: Research reports from peer-reviewed scientific journals. Hypothesis-driven research that objectively examined taste, smell, dental and oral mucosal health, dental prostheses, chewing, and swallowing in the context of aging. DATA EXTRACTION AND SYNTHESIS: Data results were extracted independently by multiple observers. A qualitative synthesis of data results from independent studies was made in order to form conclusions regarding the role of oral health on eating in older people. CONCLUSIONS: Many oral functions remain intact in healthy older adults. However, significant alterations arise from oral and systemic diseases and their treatments, and these may have a profound effect on eating, drinking, and the nutritional status of older individuals. The care of older persons with smell, taste, dental/alveolar, oral mucosal, chewing, and swallowing problems requires a multidisciplinary team of health care providers. Recognition of the interrelationship between oral, pharyngeal, and systemic physiological processes will help practitioners identify the etiology of these disorders and implement appropriate therapy.

Aged↗
PubMed1995

Extended stimulated parotid and submandibular secretion in a healthy young and old population.

BACKGROUND: Previous morphological studies have shown that both the human parotid and submandibular glands display age-related reductions in the proportion of fluid secreting acinar cells. In contrast, short-term functional studies of fluid secretion do not show such a consistent disparity among different-aged persons. This study compared the ability of a population of healthy young and old individuals to secret saliva from the parotid and submandibular glands for an extended period of time under conditions of intense gustatory stimulation. METHODS: Saliva was collected over 30 minutes from 30 healthy, unmedicated individuals using 10% citric acid as a gustatory stimulus. Of the 30 subjects, 15 were young (age range 27-40 years) and 15 were old (age range 60-97 years). Parotid salivary flow rates were determined every minute, and submandibular flow rates were determined at 2, 10, 20, and 30 minutes. A comparison was made between the slopes of the two groups. The slopes were derived from the average salivary flow rate at each time point. RESULTS: There was no difference in the ability of the parotid glands of young and old individuals to secrete saliva. In contrast, the submandibular glands of the elderly individuals did not show the same pattern of secretion when compared to their younger counterparts, who demonstrated increasing flow rates over the test period. CONCLUSIONS: The parotid glands of young and old persons are able to maintain high secretory ability under the stress of intense stimulation for an extended period of time. Conversely, the submandibular gland demonstrates an age-related, statistically significant difference in the pattern of fluid secretion with an intense gustatory stimulus.

Adult↗