Alice Markitziu

Salivary and lacrimal gland involvement in a patient who had undergone a thyroidectomy and was treated with radioiodine for thyroid cancer

A patient with bilateral, insidiously developing enlargement of the parotid glands that started 1 year after a total thyroidectomy and ablative radioiodine therapy (200 mCi I131) for papillary carcinoma is presented. The patient displayed prolonged periods of hypothyroidism accompanied by hypercholesterolinemia, notwithstanding hormone replacement therapy. Three years after surgery, parotid and lacrimal gland functions were reduced and fatty degeneration of the parotid parenchyma was demonstrated histologically. The submandibular and sublingual glands were preserved. It is suggested that the hormonal and metabolic derangements are responsible for the glandular dysfunction, rather than a direct effect of iodine on the glands.

Thyroid papillary carcinoma presenting as jaw and parotid gland metastases

A slowly progressing colloidal goiter of 20 years standing was excised in a 67-year old woman. Two years later, a metastatic tumor inducing facial swelling was diagnosed radiologically in the left parotid gland and left ascending mandibular ramus. The incisional biopsy confirmed papillary carcinoma of thyroid origin. The patient refused treatment. Six months later, she returned to the clinic and presented with advanced destructive changes of the involved structures. This rare case of unrestricted malignant growth may shed light upon the sequence and mode of metastatic invasion.

Salivary gland function in patients on chronic lithium treatment

Salivary gland function was studied in 14 manic-depressive patients treated with lithium carbonate (Li) for 4 to 120 months. Function level was evaluated by means of sialometry, dynamic salivary scintigraphy, and sialography. Daily Li dose, serum Li concentration, duration of Li therapy, and caries activity index were correlated with the salivary function parameters studied. Hyposalivation was noted in 71% of the patients, showing good correlation with the scintigraphic (r = 0.94) and sialographic (r = 0.87) results. Duration of Li therapy was poorly correlated with the degree of salivary gland dysfunction and with the caries activity index, whereas the correlation between duration of therapy and each of the three salivary function parameters was erratic. Because four of the patients exhibited normal salivation, we suggest that there are some additional factors (e.g., genetic or thyroid function level) that might be involved in salivary dysfunction connected with Li therapy.

PEMPHIGUS VULGARIS AFTER INFECTION BY EPSTEIN-BARR VIRUS

The Correspondence Section serves as a forum for opinion exchange about subjects of general interest such as dermarologic training, relations between dermatologists and pharmaceutical houses, governmental control ol dermatology and medical practice in general, peculiarities of dermatology related to geographic, climatic, or racial factors, the flow of information and publications, as well as other concerns the readership might have. Contributions are welcome and should conform to the usual format for correspondence. Manuscripts will undergo standard editorial procedures. Submit all correspondence to Mauricio Goihman-Yabr, M.D., Ph.D., Editor, Jet International M-154, P.O. Box 020010, Miami, FL 33102.

Salivary gland involvement in Wegener's granulomatosis: A case report and review of the literature

Late involvement of the parotid gland in a patient with a limited form of Wegeners granulomatosis is presented. We report the full course of the disease and the difficulties encountered in determining the nature of the parotid enlargement. We discuss the contribution of computerized tomography and ultrasonography to elucidate parenchymal morphologic findings and radioisotope studies to determine the functional capacity of the gland. In cases of Wegeners granulomatosis with salivary symptoms, measurement of salivary gland functional capacity, in addition to the c-ANCA test, may help to monitor disease activity. Despite the rarity of the disease, in cases when granulomatous diseases are considered, it should be recognized that Wegeners granulomatosis may result in salivary gland involvement.

Necrotizing Sialometaplasia after Silastic Ring Vertical Gastroplasty: Case Report and Review of Literature

Necrotizing sialometaplasia (NS) is a self-limiting benign condition of unknown origin that affects mainly the minor salivary glands on the hard palate. In its clinical and histological appearance, it mimics malignancy. This report presents a patient with NS who suffered from frequent bouts of vomiting subsequent to silastic ring vertical gastroplasty which resulted in remarkably low pH of the oral cavity. The literature pertaining to NS appearing in conjunction with gastrointestinal disorders was reviewed, and the possible contribution of recurrent emesis to the pathogenesis of NS is discussed.

Lichenoid Lesions of Oral Mucosa Associated with Ketoconazole/Lichenoide Herde der Mundschleimhaut bei Ketoconazol-Therapie

Summary: In eight consecutive patients successfully treated with ketoconazole for oral candidiasis and onychomycosis, a lichenoid dysplasia of the oral mucosa and skin occurred during the course of therapy. Some of the histological features mimicked lichen planus, whilst the immunof‐luorescent tests were negative for IgG, IgA, IgM, C3 and fibrinogen. The dermatosis persisted for more than three months after withdrawal of the drug. Various possibilities for the pathogenesis of the reactive disorder are discussed.

Endodontic treatment of patients who have undergone irradiation of the head and neck: A longitudinal follow-up of eleven endodontically treated teeth

Abstract Eleven root canal fillings were performed in two patients subjected previously to tumoricidal doses of irradiation for head and neck cancer. A 2-year longitudinal evaluation showed an altered healing process in the area directly irradiated; this may explain the low rate of success (two out of eleven teeth) in these cases.

Gingival pemphigus vulgaris: Report of a case

Abstract A case of pemphigus vulgaris in which the lesions were confined to the gingival mucosa is reported. Diagnosis was based on the clinical presentation and confirmed by histologic study and direct immunofluorescence. Indirect immunofluorescence was negative. The patient responded to steroid therapy. The significance of the negative indirect immunofluorescence test in early pemphigus vulgaris is discussed.

Major salivary glands in branchial arch syndromes

In five patients with branchial arch syndromes the presence of the salivary glands was demonstrated. Clinical, sialographic, and scintigraphic examinations revealed morphologic defects and diminished function of the parotid glands. Hyperfunction of the submandibular glands was assumed in the three patients in whom scintigraphic studies were performed. The findings may be of diagnostic value in patients in whom the clinical signs of the syndrome have remained occult.