Sandra L. Myers

Prevalence, severity, and predictors of fatigue in subjects with primary Sjögren's syndrome

OBJECTIVE To investigate the relationship of fatigue severity to other clinical features in primary Sjögrens syndrome (SS) and to identify factors contributing to the physical and mental aspects of fatigue. METHODS We identified 94 subjects who met the American-European Consensus Group criteria for the classification of primary SS. Fatigue was assessed with a visual analog scale, the Fatigue Severity Scale (FSS), and the Profile of Fatigue (ProF). Associations with fatigue were compared using multivariate regression. RESULTS Abnormal fatigue, defined as an FSS score >or=4, was present in 67% of the subjects. Pain, helplessness, and depression were the strongest predictors of fatigue according to the FSS and the somatic fatigue domain of the ProF (ProF-S), both with and without adjustment for physiologic and serologic characteristics. Depression was associated with higher levels of fatigue; however, the majority of subjects with abnormal fatigue were not depressed. Anti-Ro/SSA-positive subjects were no more likely to report fatigue than seronegative subjects. The regression models explained 62% of the variance in FSS and 78% of the variance in ProF-S scores. Mental fatigue was correlated with depression and helplessness, but the model predicted only 54% of the variance in mental fatigue scores. CONCLUSION Psychosocial variables are determinants of fatigue, but only partially account for it. Although fatigue is associated with depression, depression is not the primary cause of fatigue in primary SS. Investigation of the pathophysiologic correlates of physical and mental aspects of fatigue is needed to guide the development of more effective interventions.

The feasibility of monitoring NF‐κB associated cytokines: TNF‐α, IL‐1α, IL‐6, and IL‐8 in whole saliva for the malignant transformation of oral lichen planus

Previous investigations have demonstrated that immune activation and chronic inflammation may be one of the causes of oncogenesis. A previous study from our lab has shown significant increases of NF‐κB dependent cytokines, TNF‐α, IL‐1α, IL‐6, and IL‐8 in different oral fluids from oral lichen planus (OLP) patients. The aim of this analysis was to explore the potential of detecting these cytokines in whole unstimulated saliva (WUS) in monitoring the malignant transformation of OLP. Thirteen patients with OLP (with epithelial dysplasia), 13 cases with oral squamous cell carcinoma (OSCC), and 13 age‐sex matched controls were enrolled in the study. The WUS samples were collected and the level of TNF‐α, IL‐1α, IL‐6, and IL‐8 in WUS was determined by ELISA. In moderate and severe dysplasia, the level of each cytokine was significantly higher than in control. In moderate dysplasia, TNF‐α and IL‐1α were significantly increased at a level without difference from OSCC, but IL‐6 and IL‐8 was detected at a concentration significantly lower than OSCC. In severe dysplasia, the level of TNF‐α was also not significantly different from that of OSCC, and the level of IL‐1α, IL‐6, and IL‐8 was still significantly lower than that of OSCC. The level of four cytokines between smokers and non‐smokers in each group did not show a significant difference. These results indicate that the change of NF‐κB dependent cytokines in WUS may in part reflect the malignant transformation of OLP and the analysis of these cytokines and may provide a useful, non‐invasive surrogate endpoint for monitoring malignant transformation as well as the therapeutic response of OLP. This is the first in vivo study utilizing saliva to confirm preclinical data that NF‐κB is upregulated in oral carcinogenesis.

Olfactory neuroblastoma invading the oral cavity in a patient with inappropriate antidiuretic hormone secretion

Olfactory neuroblastoma is an uncommon intranasal neoplasm that has not been previously documented to invade the oral cavity. The tumors variable clinical manifestations and microscopic features may create a diagnostic dilemma for the clinician. The neoplasm has been identified as a direct cause of ectopic arginine vasopressin production leading to inappropriate antidiuretic hormone secretion. An unusual case of olfactory neuroblastoma invading the oral cavity through the maxillary sinus in a patient with pathologic antidiuretic hormone secretion is reported.

Effects of extreme heat on teeth with implications for histologic processing.

This pilot study examined teeth subjected to extreme heat under laboratory conditions, and the subsequent effect of decalcification and histologic processing. Physical and microscopic findings were evaluated in relation to temperature and duration of thermal insult. Microscopic examination following decalcification and histologic processing revealed changes including severe tissue fragmentation, vapor bubbles within dentinal tubules, altered histologic staining, charring and tissue shrinkage. Dentin appeared to be the most reliable microscopic identifier of incinerated dental tissues. Temperatures above 600 degrees C strongly predicted tooth disintegration following decalcification. This finding has implications in incineration cases where histologic evidence must be maintained and examined intact.

A Quantitative Evaluation of Inflammatory Cells in Human Temporomandibular Joint Tissues From Patients With and Without Implants

PURPOSE Previous studies made only qualitative assessments of immune cell responses to temporomandibular joint (TMJ) implant wear debris. The aim of this study was to perform a quantitative comparison of inflammatory cell types in TMJ tissues with implant wear debris, TMJ tissues with a history of disc pathology without implant debris, and TMJ tissues from normal control subjects. MATERIALS AND METHODS TMJ tissues were collected from the following 3 groups of subjects: 1) individuals with failed TMJ implants (implant group, n = 10), 2) patients with TMJ disc pathology but no history of implant placement (nonimplant surgery group, n = 10), and normal cadaveric tissues with no history of surgery (control group, n = 10). Tissue sections (5 microm) from all subjects were stained with hematoxylin-eosin, after which cell counts were done for 2 types of inflammatory cells: multinucleated giant cells and lymphocytes. Mean inflammatory cell counts from the 3 groups were compared by use of a 1-way analysis of variance procedure and Bonferroni adjustment to maintain an overall type I error rate of .05. RESULTS Implant group tissues contained significantly more inflammatory cells than tissues from the nonimplant surgery and control groups (P < .0001). Multinucleated giant cells were only present in implant group tissues. Although the high number of multinucleated giant cells present in the implant group obscured a total count of lymphocytes for that group, lymphocyte cell counts were still significantly greater (P < .005) in implant group tissues than in tissues from the other 2 groups. CONCLUSIONS Our data provide quantitative confirmation that the presence of Proplast-Teflon implant (Vitek, Houston, TX) wear debris is associated with a significant increase in the number of local multinucleated giant cells and lymphocytes.

Gastrointestinal cyst of the tongue: A possible duplication cyst of foregut origin

Gorlin and Sedano,’ in their 1993 extensive review of hamartomatous and choristomatous lesions of the tongue, pointed out that aberrant gastric mucosa may be seen in an inordinate number of gastrointestinal locations: epiglottis, esophagus, deep within the stomach wall, the small intestine, Meckel’s diverticulum, the biliary tract and gallbladder, pancreas, umbilicus, appendix. rectum, vitelline duct, thoracic duct, and even the spinal canal (neuroenteric cyst). Incorporation of gastric mucosa in the esophageal wall is found at autopsy in almost 8% of infants and children. Approximately 50% of these patients have the heterotopic gastric mucosa in the upper third of the esophagus. Barrett’s esophagus is an acquired condition, characterized by replacement of the squamous epithelium with columnar-lined mucosa and associated with chronic gastroesophageal reflux. Involvement ranges from the lower one third to the entire esophagus, and the condition has a malignant potential. In addition, there are at least 65 descriptions of cysts lined by gastric, esophageal, or intestinal mucosa in the tongue or oral area. These were first reviewed by Gorlin and Jirasek’ in 1970. The reader may find the earlier cases summarized in that article, because they are not cited in the following review. There is at least a 3M:lF sex predilection for such cysts. The choristomatic cyst may be entirely enclosed within the body of the tongue,2-31 oral floor.3,29.32-39 hypopharynx,‘4*40-43 anterior neck.44 larynx,3” or submandibular gland,‘4,45-48 or it may communicate with the surface. A similar lesion has been reported in the lip.49 The cystic wall may be composed partly of stratified squamous and partly (or rarely totally) of gastric mucosa of the type seen in the body and fundus of the stomach or the intestinal mucosa. In one patient, the cyst was stated to contain pigmented ciliated epithelium, although this was not illustrated.50 However, respiratory epithelium has been shown.z1.51 52 Glands usually are present. Schultz” described these as Brunner’s glands, although marked resemblance to gastric glands can be noted in the photomicrographs in his article. Both parietal and chief cells may be found. Associated pancreatic tissue was noted by Douniau et a1.45 A few examples of both oral dermoid cyst and choristomatous cyst occurring together have been noted.53.54 A muscularis mucosa was noted around the cyst in several cases. In a case reported by Gorlin and Jirasek,’ a tube surrounded by muscle connected the cyst to the oral mucosa. Sebaceous glands emptied into the tube. Several authors13,55-57 have reported a lingual tube surrounded by sebaceous glands without gastric or intestinal epithelium being present. We suspect that the sebaceous glands associated with papillary atrophy on the dorsum of the tongue of a 28-year-old-man was a minimal expression of this disorder.58 The origin of the heterotopic gastric or intestinal epithelium is not known. The tongue arises from the floor of the pharynx in the region of the first three branchial arches. In the 3to 4-mm embryo, the undifferentiated primitive stomach lies adjacent to the anlage of the tongue. The cyst is probably derived from misplacement of embryonal rests and represents their pleuripotentiality. We do not believe that the cyst differs, in essence, from the few examples of lingual cyst lined entirely by respiratory epithelium described by Gorlin and Sedano.’

Estrogen receptor-alpha polymorphism in patients with and without degenerative disease of the temporomandibular joint

Abstract Aims: The genetic aspect of degenerative joint disease (DJD) of the temporomandibular joint is poorly understood. The prevalence of the estrogen receptor alpha (ER-alpha) gene polymorphism in patients with and without DJD using xbal and pvull restriction fragment length polymorphisms (RFLPs) was studied. Methodology: DNA samples from 42 DJD+ and 36 DJD− subjects were amplified. A 346-base pair long ER-alpha gene fragment containing the two sites of polymorphism in intron 1 was analyzed for xbal and pvull RFLP. Statistical analysis was carried out using Fisher’s exact test and two-group t-test. Results: Five different ER-alpha genotypes were found in both groups. These were PXPX, pxpx, pxPX, PxPX, and pxPx. Discussion: There was a higher number of pxpx and pxPX genotypes in the DJD+ samples compared to the DJD− group, which suggests the presence of polymorphism possibly modulates the ER-alpha activity in bone and contributes to the degenerative process in the joint.

Differences in Initial Symptom Scores Between Myogenous TMD Patients with High and Low Temporomandibular Opening Index

Abstract The temporomandibular opening index (TOI) is a more useful measure of mandibular movement than linear mouth opening, since it is independent of age, gender, ramus length, and gonial angle. It is also useful when categorizing temporomandibular disorder (TMD) patients into diagnostic groups. Two subgroups of myogenous patients have been identified, one with a high and one with a low temporomandibular opening index. This study examined initial symptom severity in these two subgroups. Thirty-three (33) patients with a myogenous temporomandibular disorder were recruited. Twenty-six (26) were female and seven male. Eleven were found to be in the high temporomandibular opening index group and the remaining 22 in the low group. Symptom severity scores were determined prior to the start of treatment. Pain, joint sounds, headache, and neck pain were all rated by patients on a four-point verbal response scale. These symptom scores were compared between the two subgroups using the Wilcoxon two sample test. There appeared to be a significant difference between the two groups (p=0.0025). TMD patients with high temporomandibular opening index appeared to have more severe signs and symptoms of TMD than patients with a low index.