James A. Olson

Proliferative verrucous leukoplakia: A long-term study of thirty patients

Up to 6% of oral leukoplakia, a relatively common mucosal disease, can be expected to become malignant. This report describes a long-term study of 30 patients in whom a particular form of leukoplakia was identified and labeled proliferative verrucous leukoplakia (PVL), a disease of unknown origin, which exhibits a strong tendency to develop areas of carcinoma. PVL begins as a simple hyperkeratosis but tends to spread and become multifocal. PVL is slow-growing, persistent, and irreversible, and in time areas become exophytic, wartlike, and apparently resistant to all forms of therapy as recurrence is the rule. The disease was most commonly seen in elderly women and had been present for many years. Patients were followed for 1 to 20 years. Thirteen died of or with their disease, 14 were alive with PVL, and 3 were alive without PVL at last contact. PVL rarely regressed despite therapy. All patients who died had persistent or recurrent disease. PVL appears to constitute a continuum of hyperkeratotic disease, ranging from a simple hyperkeratosis at one end to invasive squamous cell carcinoma at the other. Microscopic findings are dependent upon the stage of the diseases development and the location and adequacy of the biopsy.

Serum vitamin B12, folate, and iron levels in recurrent aphthous ulceration.

Hematologic deficiencies have previously been described in some cases of recurrent aphthous ulceration (RAU). Ninety patients with RAU and twenty-three healthy control subjects were evaluated by complete blood count, serum iron, and total iron-binding capacity, serum vitamin B12, and serum or red blood cell folate. Only three of ninety RAU patients proved to have abnormalities. There were no statistically significant differences between the patient and control populations, and no one in either group had abnormal serum vitamin B12 or serum or RBC folate assays. None of the patients or controls gave a history or symptoms suggestive of iron-deficiency or megaloblastic anemia, and all were without gastrointestinal complaints. These results suggest that hematologic tests other than a complete blood count are not routinely indicated for patients with RAU.

Levamisole: A new treatment for recurrent aphthous stomatitis☆

Abstract Fifty patients with recurrent aphthous stomatitis were treated with levamisole, an anthelmintic which has been found to increase immune responses. The subjects had previously been refractory to all modalities of treatment other than prednisone, and 92 per cent had experienced monthly or continuous attacks of aphthae. The responses were grouped into three categories: 6 per cent appeared to go into permanent remission, 56 per cent were improved, and 38 per cent showed no response. Levamisole appeared to have a definite enhancing effect on the immune system, as measured by skin test reactivity, but did not affect in vitro parameters of cellular immunity.

Humoral Responses and Cross-reactivity to Viridans Streptococci in Recurrent Aphthous Ulceration

It has been proposed that recurrent aphthous ulceration (RAU) is caused by hypersensitivity to oral streptococci. This hypothesis is based on reports that RAU patients have increased levels of circulating IgG antibodies against oral streptococci, and that rabbit antisera prepared against oral streptococci are cross-reactive with oral mucosa. Using indirect immunofluorescence, we have investigated both of these reported phenomena. End-point titers of serum antibodies against three different strains of oral streptococci were assayed from nine RAU subjects with active ulcers and compared with those of nine control subjects. Titers ranged from 1:2 to 1:64 in both groups and do not appear to have any clinical or immunopathogenic significance. Cross-reactivity was studied using hyperimmune rabbit antisera raised against five different strains of oral streptococci. Homologous bacterial titers ranged from 1:1024 to 1 :8192, but none of these anti-streptococcal sera produced heterologous titers greater than 1:32 with oral mucosa. This apparent low level of cross-reactivity with oral mucosal antigens appears to be non-specific and clinically insignificant. In previous reports, we have used both leucocyte migration and lymphocyte blast transformation to study cell-mediated immunity to viridans streptococci in RAU (Gadol et al., 1985; Greenspan et al., 1985). None of our results supports an immunopathogenic role for oral streptococci in RAU.

Idiopathic gingival ulcerations: Ten cases of a previously unreported entity

This report presents ten cases of a previously undescribed form of gingival ulceration. The lesions did not respond to the treatments given, but all were self-limiting. This condition may represent a reaction to an environmental toxin.