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Biomedical subjects

P C Fox

Publications and source records attributed to P C Fox.

At least 109 records · Page 6Linked to original sources

Oral complications of cancer therapies. Pretherapy interventions to modify salivary dysfunction.

Salivary gland dysfunction is a common side effect of cancer therapies. Salivary secretions are reduced rapidly after starting head and neck radiotherapy. Salivary gland dysfunction has also been linked to bone marrow transplantation and to cytotoxic chemotherapy. Salivary gland stimulation during radiation has been suggested as a means of reducing radiation damage. Results of an ongoing study investigating the effects of pilocarpine on radiation-induced salivary gland dysfunction suggest that parotid function was preserved, but not submandibular/sublingual function. Also, patients receiving pilocarpine had less frequent oral complaints. Further research is necessary to develop means of preventing or alleviating the salivary side effects of cancer therapies.

Antineoplastic Agents↗

Elevation of salivary antimicrobial proteins following HIV-1 infection.

Thirty-seven HIV-1-positive patients contributed salivary samples from individual major salivary glands. Nineteen patients were unmedicated and asymptomatic, and 18 patients had developed signs of AIDS. Salivas from 15 healthy males served as controls. Levels of four salivary antimicrobial proteins (lactoferrin, lysozyme, secretory IgA, and histatins) were determined, as well as total fluid output of the major salivary glands. Concentrations of all four salivary antimicrobial proteins were found to be increased in the stimulated submandibular/sublingual saliva of all HIV-1-positive patients as well as the subset of unmediated HIV-1-positive patients. Those patients with evidence of oral candidiasis had the highest concentrations of lysozyme and histatins, potent antifungal proteins, in their saliva. Although the etiology of these protein increases is still unknown, these results further document salivary changes following HIV-1 infection.

Acquired Immunodeficiency Syndrome↗

Major salivary gland function in primary Sjögren's syndrome and its relationship to clinical features.

Unstimulated and stimulated salivary secretions of both the parotid and submandibular/sublingual glands were studied in 64 patients with primary Sjögren's syndrome to define further salivary changes in this disorder. The stimulated flows of the submandibular/sublingual glands were below normal in 56 of 64 patients, while stimulated parotid flows were decreased in only 35. Compositional changes of the submandibular saliva paralleled changes of parotid saliva, and these data suggest that ductal electrolyte resorption is altered in the glands of patients. Finally, stimulated parotid flow rates correlated inversely with focus scores of the minor salivary gland biopsies.

Adult↗

Objective measures of swallowing in patients with primary Sjogren's syndrome.

Primary Sjogren's syndrome (SS) is an autoimmune disorder primarily affecting salivary and lacrimal glands. Durational measures of the oral phase of swallowing were obtained on 34 patients with primary SS and 34 age-matched controls from analyses of ultrasound scans. Two conditions were examined: a basal (BA) swallow (only endogeneous secretions present in the subjects' mouths) and a 10 ml water bolus (WB) swallow. The patients with SS produced swallowing durations significantly longer (p less than 0.05) than those of the controls for each of the two conditions. Moreover, unlike normals, over 40% of the patients with SS produced WB swallows that were longer than their BA swallows. For further analyses, patients with SS were classified into two groups based on the difference in duration between their BA and WB swallows. These two groups differed from each other on clinical evaluations of oral motor function and presenting complaints. No significant differences were found between these two groups for salivary function or immunologic profile. These findings support the hypothesis that dysphagia can result from conditions leading to salivary gland dysfunction and document the need for the assessment of swallowing function in patients with Sjogren's syndrome.

Adult↗

Lack of acute effects of methotrexate on rat parotid salivary gland function.

Like other cytotoxic drugs, methotrexate (MTX) produces adverse reactions in oral tissues. Parotid gland function was examined, in vivo and in vitro, 18 h after MTX administration (15 mg/kg, i.p.). No salivary effects could be detected consistently. In addition, the integrity of the oral mucosa remained intact. Thus, at this dose, MTX does not exert an acute cytotoxic effect either on a rapidly replicating oral tissue like the mucosa, or on tissue with a slow turnover rate like the parotid.

Animals↗

Kaposi's sarcoma of the parotid gland in acquired immunodeficiency syndrome.

A patient with acquired immunodeficiency syndrome complained of a dry mouth and bilateral swelling of the parotid glands. Kaposi's sarcoma (KS) was found within the tissue of the parotid gland. Although KS is a common manifestation of acquired immunodeficiency syndrome, the presence of KS in the salivary glands is very rare. The human immunodeficiency virus I (HIV-I) genome was not identified in parotid glandular cells or in KS cells in this case, although the virus was detected in infiltrating lymphocytes and in tissue macrophages.

Acquired Immunodeficiency Syndrome↗

Glandular secretion of lactoferrin in a patient with neutrophil lactoferrin deficiency.

Patients with specific granule deficiency (SGD) develop recurrent severe bacterial skin infections. Neutrophils from patients with SGD are deficient in lactoferrin (Lf), an antimicrobial protein commonly found in many mucosal secretions. Unstimulated and stimulated nasal secretions, saliva, and tears were collected from a patient with SGD and from normal control subjects and were analyzed for Lf. The secretions from the patient contained normal values of Lf, suggesting that the glands secrete Lf from a source other than neutrophils. Immunohistochemical staining of normal nasal mucosa demonstrated that Lf is localized within serous submucosal gland cells and that neutrophils are not normally observed in the nasal mucosa. These findings suggest that glandular tissues produce and locally secrete Lf by processes that are independent of neutrophil degranulation.

Child↗

Longitudinal evaluation of major salivary gland function in HIV-1 infected patients.

Parotid and submandibular gland function were evaluated in 12 HIV-1 antibody-positive men at two visits separated by a median interval of 14.5 months (range 6-22 months). Unstimulated and stimulated flow rates, and the concentrations of total protein, lysozyme, albumin and lactoferrin in these secretions, were determined. Parotid and submandibular gland secretions changed in a specific fashion with time. Lysozyme levels in both glandular stimulated secretions showed significant changes (approximately 40% and 70% elevated, between visits, in parotid and submandibular saliva, respectively). In addition, the frequency with which albumin was detected in unstimulated parotid secretions increased with time. These findings support earlier results suggesting the presence of alterations in major salivary gland function following HIV-1 infection. Submandibular gland function appears to manifest these alterations earlier, but with time the parotid secretions show similar changes.

Albumins↗

High levels of oral yeasts in early HIV-1 infection.

Ten human immunodeficiency virus-1 (HIV-1) infected homosexual or bisexual individuals (ages 24-45) with no history of opportunistic infection were examined, by culture, for the presence of yeasts in whole saliva and on oral mucosa. All were HIV-1 antibody-positive men, non-smokers, non-denture wearers, and taking no medication. The mean salivary level of yeast was four logs higher in the HIV-1 infected group compared to a control group of normal, unmedicated, non-smoking men (ages 20-41) who denied any risk behavior for HIV-1 infection. Identification of the yeast in these HIV-1 positive individuals established that Candida albicans was the predominant species found in whole saliva and on buccal mucosa and tongue. Distinct hyphae were observed with only one mucosal sample. No significant correlation was found between whole saliva yeast concentration and the T4/T8 lymphocyte ratios or absolute number of T4 cells. No correlation was observed between oral yeast concentration and anti-C. albicans IgA titers. The high level of oral yeast in these individuals prior to the development of opportunistic infections is consistent with the suggestion that oral defense mechanisms are compromised in individuals following HIV-1 infection.

Adult↗

Effects of furosemide on the oral cavity.

Furosemide, a potent loop diuretic, has been reported to cause xerostomia, a sensation of oral dryness. We obtained urine and salivary secretions from five normal males after oral intake of either 0.5 mg/kg body weight of furosemide or placebo. The experimental treatment resulted in a five-fold increase in urinary output. In contrast, analysis of salivary secretions indicated there were no significant differences in flow rates, total output, total protein, or Na+, K+, or Cl- concentrations following drug or placebo. Subjectively, xerostomia was experienced 10 times more frequently after ingestion of furosemide. These data suggest that, in vivo, furosemide had a greater effect on the kidney than on the salivary gland and that the sensation of oral dryness is not solely a function of the quantitative salivary output.

Adult↗

Salivary inhibition of HIV-1 infectivity: functional properties and distribution in men, women, and children.

Human salivary gland secretions inhibit infection of human lymphocytes by the human immunodeficiency virus 1 (HIV-1), the causative agent of the acquired immune deficiency syndrome (AIDS). This activity was found in saliva collected directly from the orifice of the major salivary gland ducts and the whole saliva of healthy male volunteers. In the current report, the observations on salivary secretions are expanded to a greater number of individuals, including healthy women and children, and men infected with HIV-1.

Acquired Immunodeficiency Syndrome↗

IgA rheumatoid factor and IgA containing immune complexes in primary Sjögren's syndrome.

IgA rheumatoid factor (RF) and immune complexes containing IgA-IgG, C3-IgA, and C3-IgG from sera of patients with primary Sjögren's syndrome and controls were quantified by ELISA. Salivary tissue obtained from patients at the same time as serum was scored to simultaneously reflect lymphoplasmocytic infiltrate and fibrosis. Patients had significantly increased amounts of IgA RF and all complexes when compared to controls (p less than 0.0005). IgA-IgG complexes, thought to be IgG-IgA RF complexes, were inversely correlated to tissue pathology (p less than 0.001) and peripheral white blood cell counts. Additionally, IgA RF was inversely correlated to stimulated parotid flow. This suggests immune complex formation precedes tissue destruction or is associated with less destructive pathology in primary Sjögren's syndrome.

Adult↗

Evaluation of submandibular salivary flow rate in different age groups.

The production of unstimulated and citrate-stimulated submandibular saliva was examined in 90 male and female adults, aged 26-93 years. None was taking prescription medications for treatment of systemic disease. There was no diminution in submandibular gland fluid output, at rest or during stimulation, with increasing age. Similar findings, previously reported for the parotid glands, were also confirmed. These results demonstrate that major gland fluid secretion capacity is maintained in healthy older individuals.

Adult↗

Oral defense mechanisms are impaired early in HIV-1 infected patients.

We have examined the hypothesis that individuals infected with human immune deficiency virus type 1 (HIV-1) experience significant, specific alterations in mechanisms protecting the oral cavity prior to the appearance of AIDS-related systemic opportunistic infections. In a study of 13 early-stage, stable anti-HIV antibody positive patients, parotid salivary function was found to be generally intact. In contrast, several indicators of submandibular gland dysfunction were detected. In particular, stimulated fluid output was decreased and salivary lysozyme levels were increased relative to controls by 50-60% for both resting (p less than 0.05) and stimulated (p less than 0.001) conditions. Also, the frequency of albumin detection in submandibular saliva samples was approximately 65% in HIV-1 infected patients vs. 0% in controls (p less than 0.05). In addition, cytologic evaluation of oral mucosa revealed a fivefold increase in the prevalence of candidal hyphae in HIV-1 infected patients compared to controls (41% vs. 8%, p less than 0.05). We conclude that normal oral defense mechanisms show signs of compromise in HIV-1 infected individuals. We suggest that (a) effects of HIV-1 infection are seen early in the oral cavity, (b) impairment of oral defense mechanisms may facilitate entry of microorganisms with an attendant increased risk of morbidity and mortality, and (c) intensive oral surveillance and prophylactic care should be part of the routine management afforded to AIDS patients soon after HIV-1 infection is recognized.

Acquired Immunodeficiency Syndrome↗