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At least 739 records · Page 41Linked to original sources
PubMed2000

MR imaging of the salivary glands in sicca syndrome: comparison of lipid profiles and imaging in patients with hyperlipidemia and patients with Sjögren's syndrome.

OBJECTIVE: We correlated abnormalities on MR imaging with the plasma lipid profiles of patients with hyperlipidemia and symptoms of sicca syndrome. SUBJECTS AND METHODS: MR imaging features of the salivary glands, salivary function, immunologic abnormalities, and plasma lipid profiles were analyzed in 24 patients with hyperlipidemia and symptoms of sicca syndrome and compared with those of 50 patients with Sjögren's syndrome. RESULTS: Swelling of the parotid gland, impaired salivary flow, or both were observed in 20 (83%) of 24 patients with hyperlipidemia and symptoms of sicca syndrome. MR imaging findings included an enlarged parotid gland replaced with extensive lipid infiltration, whereas sialography of the parotid gland revealed normal findings. Immunologic studies and analyses of the labial glands of the mouth revealed distinctive features in patients with Sjögren's syndrome. Importantly, elevated levels of plasma triglyceride correlated with parotid gland swelling, and increased cholesterol levels significantly affected salivary flow. CONCLUSION: Our findings suggest a distinct entity of sicca syndrome in patients with hyperlipidemia compared with patients with Sjögren's syndrome. Characteristic MR imaging findings of salivary glands in patients with hyperlipidemia included extensive lipid infiltration and gland enlargement.

Adolescent↗
PubMed1997

[Unilateral multiple tumorous lesions of the parotid gland].

Multifocal tumors within the same parotid gland are very rare. We treated 13 patients with multiple tumorous lesions within the unilateral parotid gland. We evaluated the multiple nodules by CT-sialography or magnetic resonance imaging (MRI). These imagings showed clearly two or more distinct nodular-appearing lesions. Recurrent pleomorphic adenoma (6 patients) was predominant, followed by Whartin's tumor (3 patients). The other lesions were two differential parenchymal tumors (polymorphous low grade adenoma/adenoma) within the same gland, a malignant lymphoma, a squamous cell carcinoma metastatic to the gland, and a tuberculous lesion. On palpitation, 9 of the patients had an unilateral tumor, one a palpable parotid mass in the gland, and the other four had two or more tumors in the unilateral gland. The patients with intra-parotid lymph node and metastatic lesions had extra-parotid cervical adenopathy. The clinical features and the differential diagnosis of the unilateral multiple tumorous lesions of the parotid gland are discussed.

Adenolymphoma↗
PubMed1999

[A case of primary Sjögren's syndrome presenting with aseptic meningoencephalitis associated with sarcoidosis].

A 64-year-old Japanese woman with sarcoidosis and primary Sjögren's syndrome was admitted to our hospital in January 1998 for consciousness loss. Physical examination revealed meningeal signs and hyperreflexia in the lower limbs. Laboratory investigations showed hypergammaglobulinemia and high titers of autoantibodies such as RF, ANA, anti SS-A and SS-B antibody. In addition, she had keratoconjunctivitis, and an apple-tree pattern was observed in sialography, but serum ACE was normal. In the cerebrospinal fluid (CSF), the cell count, total protein, and interleukin 6 (IL-6) were increased, but ACE in CSF was normal. We diagnosed the case as primary Sjögren's syndrome presenting with aseptic meningoencephalitis. After treatment with prednisolone, her manifestations and CSF findings including IL-6 resolved. Therefore, the level of IL-6 in CSF may be an indicator for the activity of primary Sjögren's syndrome associated with central nervous manifestations.

Agammaglobulinemia↗
PubMed1999

[Primary Sjögren's syndrome with lymphocytic interstitial pneumonia and pulmonary multiple cystic lesions].

We report a case of primary Sjögren's syndrome with lymphocytic interstitial pneumonia and multiple cystic lesions. The patient was a 64-year-old woman. Abnormal chest shadows were detected by x-ray and computed tomographic (CT) examinations. The patient had no family history of disease and had never smoked. She had complained of dryness in the eyes and mouth for about 10 years. Laboratory tests were positive for anti-nuclear antigen, anti-SS-A antigen, and anti-SS-B antigen. Sialography revealed marked destruction of the salivary glands, yielding a diagnosis of Sjögren's syndrome. Chest X-ray films and CT scans showed multiple cystic lesions in both lungs, measuring from a few mm to 3 cm in diameter, as well as fine centrilobular nodules. Slight anemia and hyper gamma globlinemia were also detected. Pulmonary function tests showed mild obstructive disturbance. Bronchoalveolar lavage analysis disclosed an elevated lymphocytic fraction (28.6%), but transbronchial lung biopsy provided no adequate specimens for diagnosis. Thoracoscopic lung biopsy specimens demonstrated marked infiltration of lymphocytes and histiocytes through the interstitium of alveolar walls and peri-bronchovascular sheath, with some lymphoid follicles. The overall appearance was compatible with lymphocytic interstitial pneumonia. The cysts themselves were nonspecific, and no cellular infiltration was noted in the cyst walls. Because of the predominantly peribronchial distribution of the lesions, we suspected that the cysts were formed by the check valve mechanism. However, no definitive evidence was obtained.

Cysts↗
PubMed1999

[Sensory ataxic neuropathy presenting anti-a-fodrin antibody associated with rheumatoid arthritis].

We reported a 41-year-old woman with severe rheumatoid arthritis who developed chronic sensory ataxic neuropathy and anti-a-fodrin antibody. Neurological examinations, electrophysiological studies and sural nerve biopsy findings suggested dorsal root ganglioneuronopathy. T2*-weighted MRIs showed high signal intensities in the posterior column of the cervical and thoracic spinal cord, suggesting the degeneration of the posterior column of the spinal cord caused by ganglioneuronopathy. She showed xerophthalmia but no other manifestations indicating Sjögren's syndrome including sialography and salivary gland biopsy findings. In serological studies, although anti-SS-A/SS-B antibodies and anti-ganglioside antibodies were negative, her serum reacted to a-fodrin, a 120kD protein degraded from a chain of fodrin. As a-fodrin has been recently regarded as an autoantigen highly specific to Sjögren's syndrome and its antibody is likely to appear preclinically, she may develop Sjögren's syndrome in the future. It is essential to accumulate clinical and pathological findings of cases like ours in order to elucidate an etiological relationship between anti-a-fodrin antibody and dorsal root ganglioneuronopathy.

Adult↗
PubMed1999

[A case of Sjögren's syndrome with retrobulbar optic neuritis and cutaneous vasculitis].

A 52-year-old woman, diagnosed as having Sjögren's syndrome by parotid sialography and lip biopsy after a two years history of recurrent purpuric rashes on her lower extremities, was admitted to our hospital because of visual disturbance in March 1998. On presentation at the department of ophthalmology, her right visual acuity was light perception, and laboratory findings showed elevated levels of antinuclear antibody and anti-Ro/SS-A and anti-La/SS-B antibodies. Cerebrospinal fluid analysis showed mild pleocytosis and elevated levels of total protein and Q-albumin. The IgG-index was within normal level and no oligoclonal band was found. Magnetic resonance imaging showed increased signal intensity at the right optic nerve. After treatment with m-PSL pulse therapy, her visual acuity recovered to 0.08. When prednisolone was gradually tapered to the dose of 30 mg per day, she was transferred to our department because of high grade fever and pancytopenia. She also suffered from palpable purpura in her extremities extending the trunk, whose pathological diagnosis was leukocytoclastic vasculitis. The immunohistochemical examination showed depositions of IgG and C1q. After two additional cycles of mPSL pulse therapies, clinical improvement was achieved. The titers of von Willebrand factor and thrombomodulin correlated with her clinical improvement. Patients with Sjögren's syndrome can develop extra-grandular complications, including neurologic and cutaneus diseases, it is important to understand the role of SS-A-B antibodies in the immunopathogenesis of Sjögren's syndrome.

Female↗
PubMed2000

Salivary gland ultrasonography in the evaluation of primary Sjögren's syndrome. Comparison with minor salivary gland biopsy.

OBJECTIVE: To evaluate the diagnostic accuracy of ultrasonography (US) of the salivary glands versus histologic examination in detection of salivary gland involvement in primary Sjögren's syndrome (SS). METHODS: Thirty female patients with primary SS diagnosed according to the European criteria and 30 female subjects of similar age with dry mouth (symptomatic controls) due to other selected disorders were studied. Evaluation of salivary involvement was by 2 independent observers for both the parotid and submandibular glands using US score (range 0 to 4) that assigns points to the different degree of glandular inhomogeneity. Lip salivary gland (LSG) biopsies were graded according to the Chisholm and Mason classification system and by morphometric analysis. The area under receiver operating characteristic (ROC) curve was employed to evaluate the screening method's performance. RESULTS: Through ROC curves salivary gland US arose as the best performer, followed by the volume percentage of inflammatory cells and by the semiquantitative focus score. The difference between area under ROC curve of salivary gland US and lymphocytic focus score was significant (p = 0.044), reflecting the accuracy of the imaging diagnostic assessment. No differences arise between areas under the ROC curve of salivary gland US and volume percentage of inflammatory cells (p = 0.610) and between volume percentage of inflammatory cells and semiquantitative focus score (p = 0.081). Attempts to assess the independent contribution of the fractional composition of the LSG biopsy as the predictor of US score showed a significant contribution of both the fractional composition of inflammatory infiltrate (p = 0.01) and intralobular ducts (p = 0.02). These findings indirectly suggest that the US abnormalities we found were strongly related to SS. CONCLUSION: These results conclusively indicate that quantitative assessment of salivary gland ultrasonography is a very useful method fdr evaluating salivary gland involvement in SS and can replace other diagnostic techniques, such as sialography or salivary scintigraphy.

Adult↗
PubMed1975

Sjögren's syndrome.

The diagnosis of Sjögren's syndrome, a multi-systemic disease, is often difficult. Sialography is useful; however, biopsy of labial salivary glands is a simple procedure that aids significantly in arriving at a positive diagnosis. Treatment of the disease is usually on the basis of symptoms.

Adult↗
PubMed2001

[Effect of Bakumondo-to on increased sensitivity of the cough reflex in a Sjögren syndrome patient with interstitial lung disease].

A 63-year-old woman had complained of a persistent dry cough. Comparison of chest roentgenograms obtained 3 months earlier and at hospital admission, revealed progressive infiltrative shadows in bilateral middle and lower lung fields and mild volume loss. Hematologic study showed polyclonal hyper-gamma-globulinemia, positive anti-nuclear antibodies, and positive antibodies to Ro (SS-A) antigens. Ophthalmologic study demonstrated keratoconjunctivitis sicca. Parotid sialography showed an apple tree sign. Histopathologic features of labial salivary gland biopsy revealed agglomeration of at least 50 mononuclear cells. Chest CT showed non-segmental dense opacity in outer zones of middle and lower lung fields. Lung function test revealed a restrictive pattern with low diffusion capacity. Blood gas analysis showed hypoxemia (PaO2: 74 Torr, PaCO2: 32 Torr). Bronchoalveolar lavage fluid disclosed increased lymphocytes, and histologic features of a transbronchial lung biopsy included thickening of alveolar walls, infiltration of lymphocytes in the interstitium, and foamy cells in alveolar spaces. Therefore, the patient was diagnosed with primary Sjögren syndrome with interstitial lung disease. Bakumondo-to (Mai men dong tang) was started for the troublesome dry cough. The cough was subjectively relieved, cough scores were decreased, QOL scores improved, and sensitivity of the cough reflex measured by inhalation of capsaicin improved, but the chest roentgenogram was unchanged. Steroid hormone therapy was added, and radiographic abnormalities improved subsequently. Bakumondo-to, a traditional Chinese blended medicine, has notable antitussive activity in bronchitic guinea-pigs and in patients with postinfectious cough. It was concluded that Bakunondo-to may provide effective antitussive activity in some cases of interstitial lung disease with increased sensitivity of the cough reflex.

Adrenergic beta-Agonists↗
PubMed2001

[Submandibular lithiasis. Report of 48 cases].

This retrospective study concerned 48 patients treated surgically for sub mandibular lithiasis. Results of medical imaging (plain films, sialography, ultrasonography) are confronted with operative findings. The surgical indications are analysed according to lithiasis localisation.

Adult↗
PubMed1998

Surgery of the salivary ducts.

Successful surgery of the salivary ducts relies on an understanding of the surrounding anatomy and the delicate dissection of tissues in order to reduce morbidity. Trauma to the ducts should be assessed when lacerations or wounds encroach on their paths. Early diagnosis and treatment will reduce the complications of stricture and fistula formation from these injuries. Sialoliths can be located in several places along the length of the salivary ducts. The correct diagnosis and positioning of the stone in the duct is important in establishing the appropriate surgical approach. Imaging using plain films, ultrasonography, and endoscopy can be very valuable, with sialography and CT scans helpful in cases of radiolucent stones, glandular atrophy, or suspected tumor. As the condition becomes more chronic, resulting in glandular atrophy, excision of the diseased gland is often indicated. Treatment of excessive salivary flow in patients with cerebral palsy can be managed by a combination of ductal repositioning and glandular excision. Redirection of both the parotid and submandibular glands can be accomplished, either to reroute excess salivary flow or salvage the duct in cases of lesion excision.

Humans↗
PubMed2002

Oral and ocular manifestations in Sjögren's syndrome.

OBJECTIVE: Little is known about the relationship between lachrymal and salivary gland involvement in Sjögren's syndrome (SS). It is also of interest to know which eye test contributes most to the diagnosis of SS. We investigated the performance of different tear tests and how these tests relate to common serologic and salivary tests in SS. METHODS: In patients suspected of SS, the tear breakup time and the tear mucus score were evaluated in addition to the routine tests. Eighty consecutive patients were included, categorized into primary SS (pSS), secondary SS (sSS), and negative for SS. RESULTS: The tear breakup time and mucus score both performed insufficiently in diagnosing SS, in contrast to the Rose Bengal score. In pSS and sSS patients, a clear correlation was noted between tear and saliva quality and secretion rate, and between the Rose Bengal score and parotid sialography. Increased Rose Bengal scores also correlated significantly with hyperglobulinemia and presence of SSB antibodies in serum, with duration of subjective eye dryness, and with decreased tear gland function. CONCLUSION: The Rose Bengal score remains the eye test of choice having the highest specificity for SS. Hyperglobulinemia and especially positive SSB serology may warrant close monitoring of the eyes, since these serum findings appear to relate to the severity of ocular surface damage. Theoretically, a positive evaluation of either the ocular or oral component, in addition to positive serology or histopathology, could be sufficient to diagnose the syndrome for clinical purposes.

Adult↗
PubMed2002

[A case of sarcoidosis complicated by primary Sjögren's syndrome].

A 35-year-old woman had been suffering for 10 years from a dry mouth and dry eyes without being medically examined. When she finally saw a doctor in September 1996, a chest radiograph revealed bilateral hilar lymphadenopathy. Histopathological examination of the lung and scalene lymph nodes revealed non-specific lymphadenitis. She was followed thereafter without any therapy. In 1997, she was referred to our hospital because of a high titer of antinuclear antibody. A diagnosis of Sjögren's syndrome was made on the basis of the results of sialography, lip biopsy, Schirmer's test, and the present of anti-SS-A antibody. Re-evaluation of the mediastinal lymph nodes and the lung by thoracoscopic biopsy revealed non-caseating epithelioid cell granulomas, which led to a diagnosis of sarcoidosis. Although the coexistence of Sjögren's syndrome and sarcoidosis has been reported occasionally, cases with histological proof of sarcoidosis have been rare. In a survey of 27 reported cases, the majority of the patients were female and in roentgenological stage I. In most cases, Sjögren's syndrome preceded sarcoidosis. The predominance of the Th 1 immune response at the site of each disease may be involved in the pathogenic mechanism by which these diseases coincide.

Adult↗
PubMed2002

[Primary Sjögren's syndrome presenting with choreo-athetosis].

A 69-year-old man presenting with choreo-athetosis was proved to have primary Sjögren's syndrome. Choreo-athetosis suddenly appeared in the bilateral legs and the right arm; it was predominant in the right limbs. On the neurological examinations, there was no abnormal finding except for this involuntary movement. Brain MRI showed no abnormal finding. 18F-Fluorodeoxyglucose PET revealed that glucose metabolism was relatively increased in the bilateral striatum and thalamus (left side dominant). Dry eye and thirst were present for 4 years, and a diagnosis of primary Sjögren syndrome was confirmed by ophthalmological examinations, lip biopsy and sialography. Choreo-athetosis disappeared after thioridazine hydrochloride was started, while steroid was not effective.

Aged↗
PubMed2003

Sialolithiasis or complex odontoma?

We present a case of a 53-year old woman admitted for treatment in the clinic after detection of radiopacity in the left half of the mandible. The patient was operated on with a tentative diagnosis of complex odontoma. No pathological lesion was found intraoperatively after trepanation of the mandibular bone. Additional clinical examination and contrast media sialography of the left submandibular salivary gland in PA and lateral oblique view were instrumental in making the correct diagnosis and administering the proper treatment. This case demonstrates that difficulties may arise in differentiating between a sialolith and a complex odontoma.

Diagnosis, Differential↗
PubMed1992

[A case of sarcoidosis associated with Sjögren's syndrome].

A 49-year-old woman, who has had a past history of Raynaud's phenomenon since 1981, dry mouth since 1987 and dry eyes since 1990, was admitted to our hospital complaining of general fatigue, bilateral gonalgia, and shortness of breath in April 1991. Physical examinations revealed bilateral parotid gland enlargement and bilateral uveitis. Her family history included mixed connective tissue disease in her eldest daughter. Laboratory findings indicated an elevated erythrocyte sedimentation rate, hypergammaglobulinemia, and elevation of serum lysozyme and angiotensin converting enzyme levels. Antinuclear antibodies, anti-SSA antibodies, anti-SSB antibodies were positive, while tuberculin test was negative. Chest X-rays showed bilateral hilar lymphadenopathy and small nodular shadows in both lung fields. Increases in lymphocytes and the CD4/CD8 ratio of T cells were noted in alveolar lavage fluid. Renal biopsy revealed non-caseous granulomas. Other remarkable findings included positive Schirmer's test, apple tree lesions by sialography and chronic sialoadenitis by biopsy of the labial minor salivary gland. On the basis of all these findings, we diagnosed her as suffering from sarcoidosis with Sjögren's syndrome. After oral administration of prednisolone, her shortness of breath, hilar lymphadenopathy and small nodular shadows in the lung field disappeared, but the patient was transferred to the department of urology due to the onset of hydronephrosis. This case is noteworthy because sarcoidosis associated with Sjögren's syndrome has been reported in only 11 cases in the literature.

CD4-CD8 Ratio↗
PubMed1999

[The manufacture and clinical use of the auto-sialographic instrument by remote controlling]

OBJECTIVE:The purpose of this article is to realize the auto-control of the injection of radiographic drugs in terms of the principle in remote controlling.METHODS:30 cases of sialaden diseases was studied using the auto sialographic instrument by remote controlling,compared to 67 cases studied using sialography by hand-controlling.RESULTS:The auto-sialographic instrument by remote controlling realize the telecontrol of the injection of the sialographic drugs and auto-injection,simplify the working procedure,and prevent medical staffs from X-ray radiation at work.CONCLUSION:The auto sialographic instrument by remote controlling can not only bring much convenience to medical staffs,but also improve the conformation to clinical diagnosis.

Journal Article↗
PubMed2001

Clinical and statistical study of salivary gland adenoma.

The authors studied 100 patients with salivary gland adenomas for a period of ten years (from 1989 to 1999). Different types of adenomas regarding their glandular localization, clinical presentation, the age and the sex of the patients were studied. Different diagnostic methods were applied: medical history, clinical examination, sonography, scintigraphy, tomodensitometry, sialography, express morphological diagnosis and permanent histological preparation. All patients were treated surgically: in 61% lateral parotidectomy was performed, in 1.4% - conservative parotidectomy and in 24% - enucleation. The authors report about 7.75% recurrence of pleomorphic adenoma and 6% malignization, mainly in the recurrences of the pleomorphic adenoma. In 22 of the patients a postoperative paresis was observed, in 18 of them it was transitory and gradually disappeared after 8 to 9 months. Auriculotemporal syndrome was observed in 4 of the patients.

Adenoma↗