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Cyclosporin: A mouthwash in the treatment of oral lichen planus
J Oral Maxillofac Surg 54:1475-1478, 1996
Abstracts Salivary Duct Carcinoma: Clinicopathalogic and Immunohistochemical Review. Lewis JE, McKinney BC, Weiland LH, et al. Cancer 77:223, 1996
A mouthwash is not an effective drug in the topical treatment of oral lichen planus.-R.E. ALEXANDER Reprint requests to Dr Jungell: Department of Oral and Maxillofacial Surgery, University of Helsinki, PB41, SF-00014 Helsinki, Finland.
In this study, authors evaluated 26 patients diagnosed with salivary duct carcinoma (SDC). All of those patients received treatment at Mayo Clinic over a 30 year period. SDC is a high grade adenocarcinoma arising from ductal epithelium of major salivary gland. The parotid gland was involved in 23 patients and submandibular gland in 3. Clinically, the tumors are characterized by aggressive behavior with early metastasis, local recurrence, gross facial nerve involvcmcnt, and significant mortality. The most frequent sites of distant metastasis were lungs, bone, and brain. Histologic findings include presence of the growth pattern typical of mammary ductal carcinoma in situ, ie, papillary, cribriform, or comedocarcinoma irregular cell nests, stromal desmoplasia. Neoplastic cells were large and polygonal with eosinophilic cytoplasm. Vesicular nuclei were seen. Other histologic features include perineural invasion and infiltration of adjacent structures. Results of immunochemical staining show that specimens from 25 patients were positive for epithelial membrane antigen (EMA) and 22 were positive for keratin (AEl/AE3). Treatment of the SDC includes surgical excision of the salivary gland with neck dissection followed by radiotherapy and chemotherapy for metastatic disease. Twenty patients died of the disease with mean survival of 36 months after diagnosis (range, 1 to 12 years). Authors believe, that prognosis of the SDC is dismal and clinically useful prognostic factors were not found. SDC often represents the malignant component of a pleomorphic adenoma. -Y. GERTSBERG
Pediatric Plastic Surgery. Plast Surg 23:139, 1996
Sadovc MA,
Epply BL. Clin
Congenital deformities and traumatic injuries of infants and children pose potential life long physical and psychological ramifications. Overlaid with the need for an increase in physical size and functional development, the issues of timing of intervention and their effects on subsequent tissue growth pose questions not faced in the adolescent or mature adult. Therefore, treatment approaches may differ from that in the adult depending on the anatomic site, stage of development, and biologic behavior of the underlying disease process. The development of an orally administered form of Midazolam and Eutectic Mixture of Local Anesthetics (EMLA) has made venipuncture, and sedation effective and efficient. Improvements in burn wound care have resulted in the development of specialized treatment ccntcrs, a better understanding of the pathophysiology of the bum wound, aggressive fluid resuscitation and nutrition, and early burn wound excision. Modifications in flap design have enabled “new’ ’ procedures to be used for cleft lip and palate repair. Research in suture patency, growth factors and genetics, along with three dimensional imaging, microplating systems, resorbable plating systems, and distraction osteogenesis have altered the treatment of craniofacial anomalies. Microplates and bioresorbable systems also offer new modalities for the treatment of pediatric fractures. Cross-facial nerve grafting and neuromuscular transplantation by fascicular territory has facilitated the creation of a spontaneous smile in the pediatric patient with facial paralysis. Laser instrumentation now cnables the treatment of hemangiomas, nevi, port wine stains, tattoos, and hypertrophic scars efficiently and effectively. The future directions in pediatric plastic surgery will include endoscopic surgery, gene manipulation, fetal surgery, pharmacologic immunoregulation, and clinical bioactive tissue agents to name a few.-R.H. HAIJCT
Reprint requests to Dr Lewis: Mayo Clinic, 200 First St SW, Rochester, MN 59505. Cyclosporin: A Mouthwash in the Treatment of Oral Lichen Planus. Jungell P, Malmstrom M. Int J Oral Maxillofat Surg 25:60, 1996 A wide range of drugs have been tried in the treatment of oral lichen planus, but no uniformly satisfactory medications has been found. Corticosteroids remain the cornerstone of trcatmcnt. Rcccntly, cyclosporin A (CsA) has been reported to be beneficial in the treatment of several mucocutaneous disorders, through suppression of T-cell cytokines. The results of previous studies involved high dosages of the expensive drug, with contradictory results. In this study, the investigators attempt to investigate the effect of low-dose, short-course treatment. Seven patients (mean age: 64 years) with a confirmed diagnosis of atrophic/erosive oral lichen planus (mean duration: 10 years) were treated three times daily for 4 weeks with cyclosporin A mouthwash (100 mg/ mL). Patients were evaluated before therapy, at 2 and 4 weeks, and monthly after treatment for 3 months. No patient showed total remission, two patients experienced an initial improvement (which later relapsed), and the other 5 patients remained unchanged. The authors conclude that cyclosporin
Reprint requests to Dr Sadove: Division of Plastic Surgery, Indiana University Medical Center, 702 Barnhill Dr, Room 2514, Indianapolis, IN 46202.5200.
Oral White Lesions with Special Reference to Precancerous and Tobacco-Related Lesions: Conclusions of an International Symposium Held in Uppsala, Sweden, May 18-21 1994. Axe11 T, Pindhorg T, Smith C, et al. Oral Path01 Med 25:49, 1996 The importance for clear definitions of oral white lesions, precancerous lesions, and precancerous conditions has long been recognized. Various international groups and publications have attempted to define and classify these lesions so that consistency in comparison, diagnosis, and prognosis can be made. Landmark publications by the World Health Organization in 1978 and 1984 defined oral leukoplakia and eryth1475
Abstracts Salivary Duct Carcinoma: Clinicopathalogic and Immunohistochemical Review. Lewis JE, McKinney BC, Weiland LH, et al. Cancer 77:223, 1996
A mouthwash is not an effective drug in the topical treatment of oral lichen planus.-R.E. ALEXANDER Reprint requests to Dr Jungell: Department of Oral and Maxillofacial Surgery, University of Helsinki, PB41, SF-00014 Helsinki, Finland.
In this study, authors evaluated 26 patients diagnosed with salivary duct carcinoma (SDC). All of those patients received treatment at Mayo Clinic over a 30 year period. SDC is a high grade adenocarcinoma arising from ductal epithelium of major salivary gland. The parotid gland was involved in 23 patients and submandibular gland in 3. Clinically, the tumors are characterized by aggressive behavior with early metastasis, local recurrence, gross facial nerve involvcmcnt, and significant mortality. The most frequent sites of distant metastasis were lungs, bone, and brain. Histologic findings include presence of the growth pattern typical of mammary ductal carcinoma in situ, ie, papillary, cribriform, or comedocarcinoma irregular cell nests, stromal desmoplasia. Neoplastic cells were large and polygonal with eosinophilic cytoplasm. Vesicular nuclei were seen. Other histologic features include perineural invasion and infiltration of adjacent structures. Results of immunochemical staining show that specimens from 25 patients were positive for epithelial membrane antigen (EMA) and 22 were positive for keratin (AEl/AE3). Treatment of the SDC includes surgical excision of the salivary gland with neck dissection followed by radiotherapy and chemotherapy for metastatic disease. Twenty patients died of the disease with mean survival of 36 months after diagnosis (range, 1 to 12 years). Authors believe, that prognosis of the SDC is dismal and clinically useful prognostic factors were not found. SDC often represents the malignant component of a pleomorphic adenoma. -Y. GERTSBERG
Pediatric Plastic Surgery. Plast Surg 23:139, 1996
Sadovc MA,
Epply BL. Clin
Congenital deformities and traumatic injuries of infants and children pose potential life long physical and psychological ramifications. Overlaid with the need for an increase in physical size and functional development, the issues of timing of intervention and their effects on subsequent tissue growth pose questions not faced in the adolescent or mature adult. Therefore, treatment approaches may differ from that in the adult depending on the anatomic site, stage of development, and biologic behavior of the underlying disease process. The development of an orally administered form of Midazolam and Eutectic Mixture of Local Anesthetics (EMLA) has made venipuncture, and sedation effective and efficient. Improvements in burn wound care have resulted in the development of specialized treatment ccntcrs, a better understanding of the pathophysiology of the bum wound, aggressive fluid resuscitation and nutrition, and early burn wound excision. Modifications in flap design have enabled “new’ ’ procedures to be used for cleft lip and palate repair. Research in suture patency, growth factors and genetics, along with three dimensional imaging, microplating systems, resorbable plating systems, and distraction osteogenesis have altered the treatment of craniofacial anomalies. Microplates and bioresorbable systems also offer new modalities for the treatment of pediatric fractures. Cross-facial nerve grafting and neuromuscular transplantation by fascicular territory has facilitated the creation of a spontaneous smile in the pediatric patient with facial paralysis. Laser instrumentation now cnables the treatment of hemangiomas, nevi, port wine stains, tattoos, and hypertrophic scars efficiently and effectively. The future directions in pediatric plastic surgery will include endoscopic surgery, gene manipulation, fetal surgery, pharmacologic immunoregulation, and clinical bioactive tissue agents to name a few.-R.H. HAIJCT
Reprint requests to Dr Lewis: Mayo Clinic, 200 First St SW, Rochester, MN 59505. Cyclosporin: A Mouthwash in the Treatment of Oral Lichen Planus. Jungell P, Malmstrom M. Int J Oral Maxillofat Surg 25:60, 1996 A wide range of drugs have been tried in the treatment of oral lichen planus, but no uniformly satisfactory medications has been found. Corticosteroids remain the cornerstone of trcatmcnt. Rcccntly, cyclosporin A (CsA) has been reported to be beneficial in the treatment of several mucocutaneous disorders, through suppression of T-cell cytokines. The results of previous studies involved high dosages of the expensive drug, with contradictory results. In this study, the investigators attempt to investigate the effect of low-dose, short-course treatment. Seven patients (mean age: 64 years) with a confirmed diagnosis of atrophic/erosive oral lichen planus (mean duration: 10 years) were treated three times daily for 4 weeks with cyclosporin A mouthwash (100 mg/ mL). Patients were evaluated before therapy, at 2 and 4 weeks, and monthly after treatment for 3 months. No patient showed total remission, two patients experienced an initial improvement (which later relapsed), and the other 5 patients remained unchanged. The authors conclude that cyclosporin
Reprint requests to Dr Sadove: Division of Plastic Surgery, Indiana University Medical Center, 702 Barnhill Dr, Room 2514, Indianapolis, IN 46202.5200.
Oral White Lesions with Special Reference to Precancerous and Tobacco-Related Lesions: Conclusions of an International Symposium Held in Uppsala, Sweden, May 18-21 1994. Axe11 T, Pindhorg T, Smith C, et al. Oral Path01 Med 25:49, 1996 The importance for clear definitions of oral white lesions, precancerous lesions, and precancerous conditions has long been recognized. Various international groups and publications have attempted to define and classify these lesions so that consistency in comparison, diagnosis, and prognosis can be made. Landmark publications by the World Health Organization in 1978 and 1984 defined oral leukoplakia and eryth1475