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Biomedical subjects

J B Epstein

Publications and source records attributed to J B Epstein.

At least 109 records · Page 6Linked to original sources
PubMed1993

Treatment of oral Kaposi sarcoma with intralesional vinblastine.

BACKGROUND: Kaposi sarcoma (KS) is an acquired immune deficiency syndrome-defining condition in human immunodeficiency virus infection. Oral KS may produce local symptoms and require treatment. Palliation of oral lesions may be achieved with radiation therapy and chemotherapy. This review was conducted to assess the effect of intralesional vinblastine in the management of oral KS. METHODS: Patients were referred because of oral KS. Intralesional injection of vinblastine (0.2 mg/ml) was conducted under local anesthesia, and patients were observed to determine the effect of treatment. RESULTS: Forty-two patients with oral KS were treated with intralesional vinblastine. A greater than 50% reduction in the lesions was seen in 74% of patients. The mean duration of response was 3.52 months for all patients. For patients not lost to follow-up and observed until recurrence of the oral lesions, palliation was achieved for a mean of 4.25 months. CONCLUSIONS: Effective local palliation of oral KS can be achieved with intralesional injection of vinblastine.

Adult↗
PubMed1993

Oral manifestations of cytomegalovirus infection.

Disease caused by cytomegalovirus is reported with increasing frequency. Cytomegalovirus is an important pathogen in immunocompromised and immunosuppressed patients. The most common manifestation of cytomegalovirus infection of the gastrointestinal tract including the oral mucosa is ulceration. The role of cytomegalovirus in xerostomia, Sjögren's syndrome, and Kaposi's sarcoma is continuing to be investigated. This article reviews the oral manifestations of cytomegalovirus, including recently reported oral manifestations.

AIDS-Related Opportunistic Infections↗
PubMed1993

Risk factors for oropharyngeal candidiasis in patients who receive radiation therapy for malignant conditions of the head and neck.

Twenty-seven consecutive patients receiving radiation to the head and neck were followed to assess risk factors for the development of candidiasis. One-third of the patients developed oral candidiasis during radiation therapy. Xerostomia was shown to correlate with risk of oropharyngeal infection (p = 0.033). The presence and use of oral prostheses were shown to correlate with oral colonization of Candida albicans before radiation therapy (p = 0.011). Alcohol use and smoking represent risk factors for oral colonization by Candida during radiation therapy (p = 0.023 and p = 0.045 respectively). These factors must be assessed in future studies of oropharyngeal candidiasis in radiation therapy.

Adult↗
PubMed1993

Presenting signs and symptoms of nasopharyngeal carcinoma.

Pain in the head and neck may be due to multiple causes and difficult to localize. A definitive diagnosis can be difficult to make. The literature reports several cases of nasopharyngeal carcinoma presenting as temporomandibular disorders (TMD). The records of 52 patients with a diagnosis of nasopharyngeal carcinoma were reviewed to determine the frequency of symptoms that may be similar to TMD. In 13.5% of the patients common TMD signs and symptoms were present, such as clicking in the joint, pain while chewing, and limited opening. Of the patients reviewed, 44.2% described the location of their pain as headache, earache, or as jaw, midface, or neck pain. The most common description of pain was aching, dull, or pressing. Symptoms identified that may assist in differentiation of nasopharyngeal carcinoma from TMD include nosebleed, nasal stuffiness, altered hearing, and cervical lymph node enlargement. A patient with carcinoma of the nasopharynx may have symptoms that must be differentiated from TMD.

Adult↗
PubMed1993

Hairy leukoplakia after bone marrow transplantation.

Hairy leukoplakia in 10 patients after bone marrow transplantation was identified clinically and assessed histologically. In situ hybridization for Epstein-Barr virus and human papilloma virus confirmed Epstein-Barr virus in hairy leukoplakia in two cases, and human papillomavirus in three cases. All cases with clinical follow-up resolved without treatment. These findings suggest that severe immunosuppression after a bone marrow transplantation may result in the development of hairy leukoplakia, and that as the immunosuppression resolves after the transplant the lesions also resolve.

Adolescent↗
PubMed1993

Radiation therapy and pain in patients with head and neck cancer.

Pain is commonly present at the time of diagnosis of head and neck cancer. Pain occurs in all patients treated for oropharyngeal cancer. This study examined the prevalence, severity and characteristics of pain in patients treated with radiation therapy for cancer involving the head and neck and oral cavity. Pain increases throughout the course of radiation and persists following treatment and in some patients continues for 6-12 months. Pain frequently requires systemic analgesics in addition to oral rinses.

Adult↗
PubMed1993

Hyperbaric oxygen and postradiation osteonecrosis of the mandible.

The clinical and dental records of 26 patients with the clinical diagnosis of postradiation osteonecrosis (PRON) managed with hyperbaric oxygen (HBO) were reviewed to determine the efficacy of HBO. 19 patients were male and 7 were female; age at the first HBO session ranged from 28 to 80 years (median 57.5 years). All but 8 patients reviewed had some form of surgical management; 7 had mandibulectomy for PRON. As part of management, a total of 9-84 HBO sessions (median 35 sessions) was administered. 18 of the 26 patients ultimately achieved persistent mucosal and cutaneous coverage 1-84 months (median 24 months) after the first HBO session. 13 of the 26 patients met strict criteria for resolution of their disease; fully 21 of 26 patients had improved PRON status following HBO therapy. HBO treatment as part of a comprehensive management plan is safe and effective in the management of PRON.

Adult↗
PubMed1993

Management of orofacial pain in cancer patients.

Pain in patients with cancer may arise due to the primary disease, or due to therapy of the malignant disease. Pain may be caused by oral infection, oral mucositis, and by alteration in musculoskeletal and neurological function. The management of orofacial and oropharyngeal pain in patients with cancer is reviewed in this paper.

Analgesics↗
PubMed1993

Oral infections due to cytomegalovirus in immunocompromised patients.

Herpes group virus infections in the immunocompromised host are associated with significant morbidity and mortality. Herpes simplex virus (HSV) and to a lesser extent varicella zoster virus (VZV) have long been recognized as causes of oral and peri-oral lesions in subjects undergoing bone marrow transplantation and in individuals infected with the Human Immunodeficiency Virus (HIV). A role for Cytomegalovirus (CMV) in such lesions is less clear and not well documented. This report describes two bone marrow transplant recipients and one individual infected with HIV in whom CMV was implicated as the cause of oral lesions. Diagnostic and management issues as well as clinical implications are discussed.

AIDS-Related Opportunistic Infections↗
PubMed1992

Efficacy of chlorhexidine and nystatin rinses in prevention of oral complications in leukemia and bone marrow transplantation.

The goal of reducing oral complications during chemotherapy and bone marrow transplantation has received attention at several centers. The current randomized study of 86 adults with leukemia treated with chemotherapy or bone marrow transplantation assessed the potential role of chlorhexidine, nystatin, and saline solution rinses to reduce the findings of oral mucositis, gingivitis, and oral infection. The results of this study did not show a reduction in mucositis with the use of these rinses. However, potential bacterial and fungal pathogens were identified less frequently in the patients using chlorhexidine rinse.

Adolescent↗
PubMed1992

Head and neck malignancies associated with HIV infection.

Immunosuppressed persons are at greater risk of developing malignancies. In human immunodeficiency virus (HIV) immunosuppression the most common oral cancers are Kaposi's sarcoma and non-Hodgkin's lymphoma. Squamous cell carcinoma has also been reported to be associated with HIV disease. Kaposi's sarcoma is the most frequent neoplastic disease in acquired immunodeficiency syndrome and is by far the most common in the head and neck area. This article reviews the prevalence, clinical features, and management of these diseases in HIV infection.

Acquired Immunodeficiency Syndrome↗
PubMed1992

The value of panoramic radiographic examination in patients with leukemia before medical management.

Panoramic radiographs were completed for patients with leukemia before the start of medical management. The radiographs were taken as part of the patient admission evaluation. Patients were examined and followed throughout the course of their medical management. Panoramic radiographs did not identify pathologic conditions that were not identified clinically or that required management during medical therapy. The radiograph evaluation was of value in correlation with clinical findings and was required before dental treatment. It is concluded that panoramic radiograph evaluation of patients with leukemia is not indicated as part of their routine evaluation and should not be used to screen patients for occult pathosis. The use of these radiographs should be based on history and examination findings.

Adolescent↗
PubMed1992

Neoplastic disease in the head and neck of patients with AIDS.

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.

AIDS-Related Opportunistic Infections↗
PubMed1992

Toluidine blue and Lugol's iodine application in the assessment of oral malignant disease and lesions at risk of malignancy.

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.

Adult↗