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Biomedical subjects

M Gorsky

Publications and source records attributed to M Gorsky.

At least 19 recordsLinked to original sources
PubMed2000

Craniofacial osseous and chondromatous sarcomas in British Columbia--a review of 34 cases.

Head and neck sarcomas are very rare diseases. The aim of this study was to assess the prevalence and presentation of hard tissue sarcomas in the head and neck and jaws. A search of the British Columbia Tumor Registry identified 34 craniofacial hard tissue sarcomas (11 chondrosarcomas, 23 osteosarcomas) over a period of 29 years. A male predominance (1.8:1) and a mean age of 40.4 years at diagnosis were seen. Of the 23 patients with osteosarcoma, one-third survived for 5 years and 12 (52%) died within a mean of 20 months. Of the 11 patients with chondrosarcoma, 45% survived for 5 years and two (18%) of the patients died within a mean of 6 months. In nine of the osteosarcoma patients (39%) the jaws were involved, and in six of those cases (67%) there was mandibular involvement. Swelling was the first sign in all jaw patients, with a mean age of 41.1 years at diagnosis and a male predominance with a ratio of 8:1. Three of the eight male patients with osteosarcoma of the jaw (38%) died within a mean of less than 1 year. Improved prognosis is related to early recognition and diagnosis to allow for adequate surgical resection. The benefit of a combination of surgery with irradiation or chemotherapy continues to be investigated.

Adolescent↗
PubMed1999

Topical application of vitamin A to oral leukoplakia: A clinical case series.

BACKGROUND: Due to the possibility of malignant transformation of oral leukoplakia, these lesions must be assessed and managed closely and, if not resolved, must be reassessed on a regular basis. METHODS: This study evaluated the use of topical 0.05% vitamin A (tretinoin) acid gel for the treatment of oral leukoplakia. Tretinoin was applied topically 4 times a day for the management of nonmalignant oral white lesions in 26 patients. The clinical response was evaluated in all patients and posttreatment biopsies were performed in ten patients. RESULTS: The mean age of the patients at the time of diagnosis was 62 years. Of the 26 patients, 50% were tobacco users. Patients were followed for a mean of 23 months. Approximately 27% of the patients had a complete clinical remission. Recurrence of leukoplakia was observed in approximately 40% of patients in whom complete clinical remission occurred if topical applications were discontinued. A 50% reduction in the clinical grade of leukoplakia from a mean of 2.8 to 1.4 on a scale ranging from 0 (no leukoplakia) to 4 (speckled leukoplakia) was observed. When the pretreatment and posttreatment biopsies from 10 patients were evaluated, no change in the mean histologic grade (between mild and moderate dysplasia) was noted; however, some reduction in the histologic grade was noted in 3 of these patients (30%). CONCLUSIONS: The use of topical vitamin A acid showed a limited effect in controlling oral leukoplakia. Further studies are needed to establish the appropriate indication, efficacy, and best choice for chemoprevention agents. Close follow-up of all patients with oral leukoplakia is required.

Administration, Topical↗
PubMed1998

Topical bleomycin for the treatment of dysplastic oral leukoplakia.

BACKGROUND: Because malignant transformation of dysplastic oral leukoplakia has been reported in up to 43% of cases, these lesions must be managed. METHODS: This study evaluated the use of topical 1% bleomycin in dimethylsulfoxide for the treatment of dysplastic oral lesions. Bleomycin was applied once daily for 14 consecutive days to lesions of the oral mucosa in 19 patients. Immediate posttreatment biopsies and the clinical response were evaluated and clinical follow-up was conducted for as long as possible. RESULTS: The mean age of the patients at diagnosis was 59.4 years and 74% were tobacco users. Seventy-five percent of patients had resolution of dysplasia at follow-up biopsy, with a mean improvement of two histologic grades of dysplasia after topical chemotherapy. Ninety-four percent of the patients attained at least partial responses. After a mean follow-up period of 3.4 years, 31.6% of patients had no clinically visible lesions and 47.4% of patients had clinically benign lesions of homogeneous leukoplakia or minimal visible leukoplakia. In 2 patients (11%) malignant transformation occurred a mean of 1.75 years after bleomycin treatment. CONCLUSIONS: Topical bleomycin may prevent the potential progression of leukoplakia through dysplasia to carcinoma. Close follow-up of all patients with dysplasia is required.

Administration, Topical↗
PubMed1998

Genetic influence on the prevalence of torus palatinus.

Torus palatinus (TP) represents a benign anatomic variation. It has been suggested that genetic factors play a leading role in its occurrence. The purpose of the present study was to determine, by segregation analysis, the inheritance of TP. Data were collected from members of 37 randomly selected Israel Jewish families and analyzed using the segregation analysis. Vertical transmission of TP was found in 19 families suggesting autosomal dominant transmission, which was supported by the results of the segregation analysis test. A significantly higher number of affected offspring (60.3%) was observed compared to the expected figure (50%) for an autosomal dominant trait with full penetrance. This is explained by the high gene frequency of TP and the relatively high proportion of homozygous parents.

Adult↗
PubMed1998

Beta-2-microglobulin-associated nodular amyloidosis of the tongue.

The tongue is an uncommon site for the deposition of beta-2-microglobulin amyloid. A case is presented of nodular amyloidosis of the tongue in a patient having prolonged hemodialysis. The lesions were small, firm, yellowish nodules on the lateral aspect of the tongue and were shown to be deposits of beta-2-microglobulin amyloid. The pathogenesis and differential diagnosis are discussed.

Amyloidosis↗
PubMed1998

Melanoma arising from the mucosal surfaces of the head and neck.

Oral mucosal malignant melanoma is a rare disease. We reviewed 30 years of data from a tumor registry and identified 65 patients who had head and neck melanomas. Two thirds (43) of the 65 patients were identified as male, with the mean age in the sixth decade. Of the 65 patients, only 6 had melanoma that arose from the oropharyngeal mucosa. Of the lesions involving the oral mucosa, each lesion manifested itself as a mass or was associated with symptoms of discomfort; only one third (2) of the lesions were pigmented. The clinician must carefully examine the head, neck, and oral cavity, and any pigmented lesion that is not recognized as a specific entity, such as amalgam tattoo, should be biopsied. The more common presentation of amelanotic malignant melanoma requires a high index of suspicion for masses identified in the mouth and requires biopsy for definitive diagnosis. The prognosis for oral mucosal malignant melanoma is poor.

Aged↗
PubMed1998

Head and neck and intra-oral soft tissue sarcomas.

Intra-oral soft tissue sarcoma is a rare disease. We reviewed a tumour registry over a 45 year period, between January 1951 and January 1997, and identified a total of 11,250 head and neck cancers in British Columbia. Of the head and neck cancers, there were 139 cases (1.24%) of sarcoma; and of these, there were only 16 cases (0.14%) of intra-oral soft tissue sarcoma. The initial presentation of intra-oral soft tissue sarcoma is most often as an asymptomatic mass and discomfort is reported by less than one half of the patients. The commonest lesion identified was rhabdomyosarcoma (RMS). In this review, we identified 2 unique cases, 1 case of intra-oral hemangiopericytoma and 1 case of oral carcinosarcoma. The prognosis remains poor. Treatment includes wide surgical excision which may be supplemented with radiotherapy and chemotherapy.

Adolescent↗
PubMed1997

Proliferative verrucous leukoplakia: a follow-up study of 54 cases.

OBJECTIVES: Proliferative verrucous leukoplakia is a unique form of oral leukoplakia that has a high risk for becoming dysplastic and transforming into squamous cell carcinoma. The purpose of this review is to update patient profiles, pathogenesis, and survival. STUDY DESIGN: Fifty-four patients with proliferative verrucous leukoplakia (17 from a previous report) were followed prospectively in our clinic for a mean of 11.6 years after initial biopsy. RESULTS: In the patient population studied, the mean age was 62 years, and women outnumbered men 4 to 1. Multiple intraoral sites were involved (mean, 2.6 per patient); the most common sites were buccal mucosa in women and tongue in men. In a mean time of 7.7 years, 70.3% of the patients developed a squamous cell carcinoma at a proliferative verrucous leukoplakia site, most frequently the gingiva and tongue. Twenty-one of the patients with proliferative verrucous leukoplakia died of proliferative verrucous leukoplakia-associated carcinoma. Only 31% of the 54 patients used tobacco in any form. Radiation did not appear to enhance surgical control. CONCLUSIONS: Proliferative verrucous leukoplakia is a high risk precancerous lesion with a high mortality rate. Because of both the propensity for progression to dysplasia and malignancy, as well as a high recurrence rate, these patients must be treated aggressively and followed carefully.

Adult↗
PubMed1996

Prevalence of torus palatinus in a population of young and adult Israelis.

The prevalence of torus palatinus, a common exostosis with a debatable pathogenesis, was epidemiologically investigated in a group of 1002 Israeli Jews. This protuberance was observed in 21% of the entire sample, with non-significant differences among different age groups. The smooth type of torus was noted in 72.9%, 68.1% were smaller than 2 cm, and 53.8% were located in the molar area only. The prevalence of torus palatinus in the combined molar-premolar area increased with age, whereas in the molar area it decreased, expressing a significant relation between location and age (p < 0.01). The prevalence of tori larger than 2 cm was much higher in the 21-year and older age groups than in the younger groups. The diverse prevalence of torus palatinus in some of the ethnic groups was also statistically significant (p < 0.05). The aetiology of this common osseous outgrowth is probably multifactorial, including environmental factors acting in a complicated and unclear interplay with genetic factors.

Adolescent↗
PubMed1996

Clinical characteristics and treatment of patients with oral lichen planus in Israel.

Oral lichen planus (OLP) has a multiple-site involvement, with the buccal mucosa being the most prevalent. A possible relationship between OLP and the risk of malignancies in the involved site is documented. The characteristics of OLP have been studied in different populations; however, no similar studies have been conducted in any Jewish population. The purpose of this study was to evaluate the natural history of OLP in Israeli Jewish patients. Data were collected from 157 charts of patients with histologically confirmed OLP. No evidence suggesting a connection between OLP and diabetes, cardiovascular disease, smoking, alcohol use, or positive Candida culture was found. Skin involvement of lichen planus was found in one fifth of the patients. Symptomatic OLP was noted in half of the patients, mainly in those with the erosive form. In 65% of the patients with symptoms, improvement by more than 50% was shown within 2 weeks of steroid use. The transformation rate of 1.3% of OLP into malignancy was observed in the entire group. A constant follow-up for contributing symptoms and for early diagnosis of suspected transformed lesions is of utmost importance.

Adrenal Cortex Hormones↗
PubMed1995

Referral delay in diagnosis of oro/oropharyngeal cancer in Israel.

The delay, stage at diagnosis and referral pattern of 543 oro/oropharyngeal cancer patients in Israel were investigated. About two-thirds of the malignancies were diagnosed at early stages. In more than two-thirds there was a delay of at least 2 months from the onset of signs and symptoms up to diagnosis, with a non-significant relationship between stage and delay. A significant correlation (P = 0.002) was found between delay and malignancy site. A delay of more than 4 months was observed in 71% of the patients with lip cancer. Cancers of the lip, palate and buccal mucosa were more frequently diagnosed at early stages. A significant correlation (P = 0.001) was found between stage at diagnosis and referral source. Although 86% of the cancers were diagnosed by physicians, nearly half were already at an advanced stage; when the cancers were diagnosed by dentists, 81% of the remainder were at early stages. No significant relationship was found between the referral medical profession and site of diagnosis. No nasopharyngeal, oropharyngeal or laryngeal cancers were diagnosed by dentists.

Adolescent↗
PubMed1994

The prevalence of oral cancer in relation to the ethnic origin of Israeli Jews.

Smoking, alcohol, and familial background are considered major cofactors in the cause of oral cancer. The purpose of the present study was to determine the relationship between ethnic origin and oral cancer in the Israeli Jewish Population. Data were collected during the years 1970 to 1980 from 342 dental records of patients in Israeli hospitals. Results showed a male/female ratio of 2:1. Of 264 patients with clearly determined ethnic origin, 72% were Ashkenazi, 15% Sephardi, and 13% Eastern ethnic origin. The relative prevalence showed that the risk of the Ashkenazi group to develop oral cancer was at least twice as high as the other two ethnic groups. The increase in occurrence of oral cancer with age in each ethnic group was highly significant (p < 0.001). The most common type of malignancy was squamous cell carcinoma (95%) with 99% of this malignancy occurring in patients in their sixth and seventh decade. A significant (p < 0.02) relationship between site of involvement and ethnic origin was also noted. The tongue was the leading site in the Ashkenazi and Sephardi groups, whereas the lip and alveolar ridges were the most affected sites in the Eastern ethnic group.

Adult↗
PubMed1994

Pemphigus vulgaris in adolescence. A case presentation and review of the literature.

Pemphigus vulgaris, a chronic autoimmune vesiculobullous disease, affects people in their fifth or sixth decade of life. Involvement in adolescence is rare with only about 30 cases reported in the last 35 years. This article presents a case of adolescent pemphigus vulgaris in a 15-year-old girl with oral and skin lesions. The patient has been free of lesions with a maintenance dosage of 10 mg of prednisone every other day. The mean age of the 31 patients, including our patient, was 14 years. Skin involvement was reported in 87% of patients, oral involvement in 87%, and skin and oral lesions in 81% with oral lesions preceding skin lesions. Early diagnosis of adolescent pemphigus vulgaris is important to eliminate or reduce the severity of further intraoral or extraoral involvement. The term adolescent pemphigus vulgaris is suggested when the onset is between 12 and 18 years of age.

Adolescent↗
PubMed1994

Sucralfate suspension as a treatment of recurrent aphthous stomatitis.

DESIGN: A prospective randomized, double-blind, placebo-controlled, cross-over clinical trial. SETTING: A university hospital. SUBJECTS: Twenty-one patients with symptomatic recurrent aphthous stomatitis (RAS), unresponsive to conventional treatment were enrolled. They were divided into three groups. INTERVENTION: In a cross-over trial, the patients received an oral suspension of sucralfate, an antacid solution or a placebo for 2 years. RESULTS: After 2 years of follow-up, sucralfate was found to be superior to both placebo and antacid (P < 0.001) with regard to duration of pain, reduction of the healing period, response time to first treatment and duration of remission. CONCLUSION: Sucralfate suspension should be added to the armament of treatment modalities of RAS.

Administration, Buccal↗
PubMed1992

Clinical response to levamisole in thirty-nine patients with erythema multiforme. An open prospective study.

Patients with erythema multiforme (EM) often have chronic or recurring oral lesions that cause intense pain and interfere with a variety of functions including eating and speech. Previous studies suggest that levamisole restores to normal the function of phagocytes and T lymphocytes, and activates the inflammatory response. In our previous double-blind study 8 of 13 patients with EM had a decrease in severity and frequency of attacks. The purpose of this open prospective study was to evaluate short-term and long-term clinical efficacy of levamisole in patients with mucocutaneous EM. Thirty-nine patients with mucocutaneous EM seen in the Oral Medicine Clinic, School of Dentistry, University of California-San Francisco, comprised our study group. Levamisole was used alone in 17 patients or in combination with prednisone in 22 patients and was given as a single dose of 150 mg/day for 3 consecutive days. Thirty-one patients showed a complete response from levamisole (alone in 13 and in combination with prednisone in 18). Four showed a partial response of signs and symptoms, and four others had no benefits from levamisole whether alone or in combination. The most common side effects from levamisole were skin rash, tiredness, weakness, myalgia, taste change, and insomnia.

Adolescent↗