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Biomedical subjects

S Silverman

Publications and source records attributed to S Silverman.

At least 55 records · Page 3Linked to original sources
PubMed1998

Oral cancer education training methods: a comparison of self-study and didactic approaches.

BACKGROUND: Dentists' competence and comfort level in detecting oral cancer may be strongly influenced by their dental school training. The purpose of this study was to compare the demonstrated knowledge of oral cancer topics among students receiving lectures and those learning the material through self-instruction at two dental schools. METHODS: Students at School 1 received 17 hours of lectures on various topics in oral cancer, including epidemiology, etiologic factors, histopathology, clinical appearance, clinical management and treatment, and oral complications. Lecture topics reflected material in the assigned text. Students at School 2 received only an introductory lecture, followed by a ten-week self-paced course using the same text used in School 1. At the end of the courses, the students at the two schools received identical 50-item final examinations. RESULTS: The students who had received the lectures and assigned readings scored significantly higher than did those assigned self-instruction alone (mean score of 91.2% vs 81.3%; p < 0.0001). This difference remained after statistical adjustment for entering grade-point average and Dental Aptitude Test score. CONCLUSIONS: Self-study of assigned readings may result in lower levels of knowledge of oral cancer topics than more traditional lecture-based teaching. The impact of this difference on clinical performance has not yet been demonstrated.

Analysis of Variance↗
PubMed1998

Nd:YAG and CO2 laser therapy of oral mucosal lesions.

OBJECTIVE: Experiences gained in the management of oral mucosal lesions by CO2 and Nd:YAG laser therapy in an outpatient clinic treated over an 80-year period are described. SUMMARY BACKGROUND DATA: Lasers have indications for use in dentistry for incision, excision, and coagulation of intraoral soft tissue. Advances in laser technology have provided delivery systems for site-specific delivery of laser energy with short interaction items on tissue to be ablated. This study retrospectively evaluates a series of clinical case studies. METHODS: Sixty-four patients with a variety of benign oral soft tissue lesions were treated by laser excision. Thirty-five patients were treated by a pulsed fiberoptic delivered Nd:YAG contact laser, and 29 by a continuous free-beam CO2 non-contact laser. The largest group of lesions treated were leukoplakia (39 cases). Other lesions excised and biopsied were lichen planus, squamous papilloma, pyogenic granuloma, focal melanosis, nonhealing traumatic ulceration, hemangioma, and lymphangioma. All patients were followed postoperatively (mean 6.8 months, range 1-36 months). RESULTS: Laser excision was well tolerated by patients with no intraoperative or postoperative adverse effects. All patients healed postsurgically with no loss of function. CONCLUSIONS: CO2 and Nd:YAG lasers are successful surgical options when performing excision of benign intraoral lesions. Advantages of laser therapy include minimal postoperative pain, conservative site-specific minimally invasive surgeries, and elimination of need for sutures.

Adolescent↗
PubMed1998

Cell wall active antifungal compounds produced by the marine fungus Hypoxylon oceanicum LL-15G256. III. Biological properties of 15G256 gamma.

15G256 gamma is a cyclic lipopeptide antifungal agent discovered in a mechanism of action screen for cell wall acting antifungal agents. The compound shows moderate activity in both greenhouse tests against plant disease caused by pathogenic fungi and in in vitro tests against human fungal pathogens. Microscopic examination of treated fungi suggests that the compound acts by the inhibition of cell wall biosynthesis. However, in vitro inhibition of Neurospora crassa glucan and chitin synthase were only observed at high drug concentrations suggesting that 15G256 gamma may act on a novel cell wall target.

Antifungal Agents↗
PubMed1998

Over-the-counter products for oral ulcerations.

Over-the-counter products can be useful and effective in alleviating the pain from ulcerations of the oral mucosa. This article reviews over-the-counter medications that are available to treat ulcerative lesions. Among the categories included are covering agents, local anesthetics, and mouthrinses.

Anesthetics, Local↗
PubMed1997

Candidal colonization and oral candidiasis in patients undergoing oral and pharyngeal radiation therapy.

OBJECTIVES: Radiotherapy-induced hyposalivation encourages oral candidal colonization that often leads to oral/pharyngeal candidiasis. The purpose of this study was to quantitate oral candidal colonization, assess signs, symptoms, and response to antifungal management, speciate Candida, and evaluate the influence of smoking and dentures. STUDY DESIGN: Forty-six patients undergoing radiation therapy for oral/pharyngeal squamous cell carcinoma were evaluated clinically and by Candidal cultures before, during, and after irradiation. RESULTS: All patients complained of progressive xerostomia. There was a significant increase in the prevalence of positive candidal cultures (P = < 0.0001): baseline 43%, completion of radiotherapy 62%, and follow-up timepoint 75%. Smoking and denture wearing were not statistically significant risk factors for increased candidal colonization (p = 0.085 and p = 0.420, respectively). Eight patients developed clinical candidiasis. Although five responded clinically to systemic antifungal medication, all follow-up cultures remained positive. Candida albicans was the predominant species at baseline and completion of radiation (85% and 68%, respectively). CONCLUSIONS: When salivary glands are included in the field of radiation, xerostomia occurs, causing progressive increases in oral Candida colonization. Because 17.4% developed clinical candidiasis during radiotherapy and the question of fungal resistance remains speculative, a recommendation for the prophylactic use of antifungal medication is unresolved.

Adult↗
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↗
PubMed1997

Reactivity of monoclonal antibodies 17.13 and 63.12 with oral epithelial dysplasia and hyperkeratosis.

Monoclonal antibodies (MAbs) 17.13 and 63.12 exhibit characteristic reactivity patterns in normal stratified squamous epithelium, as well as highly sensitive and specific altered reactivity patterns in squamous cell carcinoma. The purpose of this study was to critically evaluate the patterns of reactivity of MAbs 17.13 and 63.12 in 43 biopsies of clinical oral leukoplakia or erythroleukoplakia with microscopic diagnoses of hyperkeratosis or epithelial dysplasia. Altered carcinoma-like reactivity patterns were seen in 72% of hyperkeratoses and in all cases of epithelial dysplasia, but varied in the level of epithelial strata exhibiting altered reactivity. Increased frequency of altered reactivity within the epithelial strata was associated with the presence, but not the grade of, epithelial dysplasia, as well as with the presence, intensity; and pattern of submucosal inflammation. The results of this study suggest that altered reactivity patterns of MAb 17.13 are associated with epithelial dysplasia and may be of assistance in detecting precancerous changes in hyperkeratoses before morphologically identifiable epithelial dysplasia. The association of submucosal inflammation with altered MAbs 17.13 and 63.12 reactivity may indicate either a decrease in specificity of these antibodies for precancerous change or an increased significance of inflammation in precancerous lesions.

Antibodies, Monoclonal↗
PubMed1997

Oral lichen planus update: clinical characteristics, treatment responses, and malignant transformation.

PURPOSE: To assess the current profile and the natural disease history of patients with oral lichen planus (OLP) and evaluate their responses to treatment. MATERIALS AND METHODS: Ninety-five community-referred patients with OLP, who were examined in our Oral Medicine Clinic between May 1995 and August 1996, comprised the study group. RESULTS: The OLP patients had been followed for 1-20 years (mean 6.1). The average age at first-recognized onset was 59 years, and there was a 2.3 to 1 female predominance. Only five of the patients knew of a family history of lichen planus. There were no evident associations with smoking, candida, systemic disease or medications. Of the 222 involved mucosal sites, the buccal mucosa was involved most often (79%) and the erosive form was most frequent. Of 70 patients who received systemic and/or topical corticosteroid treatment for pain (83%) or annoying irritation (17%), all but five obtained complete or satisfactory relief. A squamous cell carcinoma developed at a lesion site in three patients (3.2%) during the observation period.

Adult↗
PubMed1996

Heart failure in a macaw with atherosclerosis of the aorta and brachiocephalic arteries.

A female severe macaw (Ara severa) that was at least 11 years old was evaluated for sudden onset of exercise intolerance and dyspnea. Radiography revealed a large heart silhouette, an increase in prominence of the brachiocephalic arteries, and a diffuse increase in opacity of the lungs. Lateral nonselective angiography revealed dilatation of both chambers of the right side of the heart and incomplete emptying of the right atrium. Alterations in the shape and position of the left-side heart chambers and reduction in blood flow through the brachiocephalic arteries and aorta were identified. Despite treatment, the bird died suddenly 2.5 months after the first episode of dyspnea. At necropsy, severe atherosclerosis of the aorta and brachiocephalic arteries, dilatation of all heart chambers, pulmonary edema, and severe hepatic centrolobular atrophy and fibrosis were identified. Correlation between the angiography and necropsy findings suggested that angiography could be an important diagnostic tool for the detection of cardiovascular disease in birds.

Angiography↗
PubMed1996

Evaluation of serum and tissue levels of alpha-tocopherol.

This study was designed to test the effect of supplementation of several antioxidants, including alpha-tocopherol, on the clinical reduction of premalignant oral lesions. Samples of oral mucosa and serum were taken from baseline to 9 months of supplementation from patients with premalignant oral lesions and analyzed for alpha-tocopherol by HPLC. Statistical increases in both serum and tissue alpha-tocopherol were found after supplementation. There was no statistical relationship between alpha-tocopherol and beta-carotene levels.

Female↗
PubMed1996

Malignant acanthosis nigricans with florid papillary oral lesions.

Acanthosis nigricans is a distinctive skin disease of importance, because it has served as an external marker for a variety of systemic disorders including endocrinopathies, and malignant tumors of internal organs. It typically appears as hyperpigmented, roughened plaques of velvety consistency and infrequently as verruca-like papillations. The oral cavity and lips can be affected by florid papillary growths. Because of its rarity and nonspecific microscopic appearance, clinical recognition of acanthosis nigricans continues to be a challenge. A case of mucocutaneous "malignant" acanthosis nigricans is presented in which pigmented skin lesions led to the discovery of a gastric adenocarcinoma, which in turn was followed by the appearance of massive oral papillomatosis. No effective treatment was found.

Acanthosis Nigricans↗
PubMed1996

Use of antioxidant supplements in the treatment of human oral leukoplakia.

An increasing public awareness of antioxidants may prompt a patient's request to be treated without surgery if a leukoplakic lesion is discovered. However, surgical excision remains the treatment of choice for oral leukoplakia. The use of antioxidant supplements has shown some promise, but the predictability of success remains uncertain and long-term results are unavailable. Before the decision to use any antioxidant is made, it is critical to obtain a histopathologic diagnosis of the lesion. When dealing with a lesion diagnosed as hyperkeratosis, it may be appropriate to choose an antioxidant that may take some time for clinical improvement to occur. However, as the grade of epithelial dysplasia becomes more severe, consideration must be given to the possibility of malignant transformation during antioxidant treatment. We do not recommend the use of antioxidant supplements in the treatment of any carcinoma. The therapeutic use of antioxidant supplements outside of clinical trials conducted at academic medical centers should be done with considerable caution by practitioners in private practice. It should be emphasized that in these clinical trial patients were seen at frequent intervals to monitor their progress and to intervene if there was a noticeable deterioration in the clinical appearance of the lesion. In spite of the uncertainty with respect to antioxidant treatment, there are circumstances in which it should be considered. Recurrence after surgical excision when there is little reason to believe that a second surgical excision would be any more successful is an ideal candidate. Also, patients with widespread leukoplakia that involves a large area of the oral mucosa might be suitable for treatment with antioxidants, as well as patients who have extensive medical problems that make them surgical risks. The choice of which antioxidant(s) to use is complex because thus far there is no combination that is superior to the others. Beta-carotene with ascorbic acid or alpha-tocopherol is attractive because of a lack of side effects, but the range in reported values for lesion improvement has been broad and the clinical improvement typically takes several months. Clinical response with 13-cRA is faster but requires baseline and periodic serologic testing, as well as close monitoring for side effects. In those circumstances in which time is an important consideration, 13-cRA might be useful because clinical improvement can be evaluated within a matter of weeks as compared with beta-carotene. The group from M.D. Anderson Hospital has shown the value of an induction dose of 13-cRA that is followed by a lower maintenance dose. Unfortunately, the problem of recurrence after discontinuation of 13-cRA is quite common. One aspect that has not been evaluated is the combination of conventional surgical excision and the administration of postoperative antioxidants. This would have the obvious advantage of conventional treatment of surgery together with the possible protective effect of the antioxidants. Although this is an attractive hypothesis, we do not know of any studies that have proven this to be beneficial.

Animals↗