Submandibular salivary gland hypertrophy induced by phenytoin

A 16-year-old boy with epilepsy developed hypertrophy of the submandibular salivary glands, with high phenytoin (PHT) serum levels. The submandibular salivary glands became normal in 12 days after discontinuation of PHT. Other causes of salivary gland hypertrophy were excluded and we suggest that the hypertrophy was due to PHT.

Repetitive weekly cycles of 4-day continuous infusion of recombinant interleukin-2: a phase I study

A phase I trial was performed with a new interleukin-2 (IL-2) given as a continuous intravenous infusion in patients with solid tumors. The objectives of the study were to examine the feasibility of administering IL-2 in 4-day cycles for 4 consecutive weeks, and to investigate the response pattern of peripheral blood lymphocytes. Tumor necrosis factor (TNF) and IL-2 serum concentrations were also measured. Prior to this study, IL-2 had been tested at increasing dosages during one 4-day cycle, and it appeared that a dose of 1300 mcg/m2/day was tolerated. However, when this treatment schedule was maintained for 4 consecutive weeks, the maximum tolerated dose was 430 mcg/m2/day. In this schedule, a dose-dependent progressive increase in rebound lymphocyte count occurred after each weekly cycle, resulting in a 5-70-fold increase after the 4th cycle. Serum TNF peak concentrations also showed a tendency to increase during each subsequent cycle, while serum IL-2 peak concentrations showed a paradoxical decrease. Clinical toxicity comprised several events, which, possibly, could be ascribed to autoimmune phenomena. Myocardial infarction as a late toxicity of IL-2 is suggested. One complete response (renal carcinoma) and two partial responses (renal and breast carcinoma) were documented, one of these occurring in a patient who previously had shown a transient response on interferon therapy.

[Odontostomatological changes induced by drugs. I]

The purpose of the present review is to describe the unwanted effects of drugs or chemicals in the orofacial region. The authors take into consideration the alterations of salivation such as xerostomia and ptyalism, disturbances of sense of taste, halitosis and pain and swelling of the salivary glands. The dental surgeon who suspects that an oral alteration might be a drug reaction can play an important role in preventing the development of more severe toxic effects. All this points to the importance of the knowledge of pharmacology for dental practitioners.

Medication side effects of dental interest

Many dental patients require continuing medication. With some, the medications will have side effects that have an oral or perioral manifestation. Commonly prescribed medications and their dental side effects are listed. This information may aid patients who have oral symptoms unrelated to the needed dental care.

Estrogen induces the development of autoantibodies and promotes salivary gland lymphoid infiltrates in normal mice

There are important bidirectional interactions between the immune and the endocrine system. Sex hormones influence the immune system throughout life including postnatal and prenatal stages. For example, we find that administration of estrogen to normal mice markedly augments the ability of CD5+ B cells to express their autoimmune potential by producing increased numbers of plaque-forming cells (APFC) to bromelain-treated mouse erythrocytes (Br-ME). The effect of sex hormones on immune function at the most critical stage of development, the prenatal period, remains unstudied. We hypothesize that an imbalance of the in utero sex hormone microenvironment critically influences the fetal immune system. We have termed this influence immunological imprinting. After birth this imprinting could contribute to immune-mediated disorders. To test this hypothesis, we developed a mouse model in which normal mice were prenatally exposed to estrogens. In preliminary experiments, these mice produced higher numbers of APFC to Br-ME, particularly in the peritoneal cavity cell exudates. Furthermore, mice prenatally exposed to estrogens had accelerated development of autoimmune salivary gland lesions indistinguishable from Sjögren's syndrome (SS) in humans. Further experiments are warranted to confirm these findings. The prenatal effects of estrogen may have relevance for familial and neonatal autoimmune syndromes.

Radionuclide imaging of potassium iodide-induced sialadenitis

The authors report a rare complication of nuclear bone imaging, iodide mumps, and describe its appearance on the subsequent radionuclide salivary gland study.

Iatrogenic causes of salivary gland dysfunction

Saliva is important for maintaining oral health and function. There are instances when medical therapy is intended to decrease salivary flow, such as during general anesthesia, but most instances of iatrogenic salivary gland dysfunction represent untoward or unavoidable side-effects. The clinical expression of the salivary dysfunction can range from very minor transient alteration in saliva flow to a total loss of salivary function. The most common forms of therapy that interfere with salivation are drug therapies, cancer therapies (radiation or chemotherapy), and surgical therapy. These therapies can affect salivation by a number of different mechanisms that include: disruption of autonomic nerve function related to salivation, interference with acinar or ductal cell functions related to salivation, cytotoxicity, indirect effects (vasoconstriction/dilation, fluid and electrolyte balance, etc.), and physical trauma to salivary glands and nerves. A wide variety of drugs is capable of increasing or decreasing salivary flow by mimicking autonomic nervous system actions or by directly acting on cellular processes necessary for salivation: drugs can also indirectly affect salivation by altering fluid and electrolyte balance or by affecting blood flow to the glands. Ionizing radiation can cause permanent damage to salivary glands, damage that is manifest as acinar cell destruction with subsequent atrophy and fibrosis of the glands. Cancer chemotherapy can cause changes in salivation, but the changes are usually much less severe and only transient. Finally, surgical and traumatic injuries interfere with salivation because of either disruption of gland innervation or gross physical damage (or removal) of glandular tissue (including ducts).

Acute transient sialadenopathy associated with anesthesia

Five cases of acute transient sialadenopathy associated with the administration of anesthesia are described in this article. In each case, the patient's straining on the endotracheal tube was followed immediately by firm swelling of one or more of the salivary glands. The facial swelling was resolved within 24-four hours without treatment.

[Acute iodine poisoning associated with sialadenitis, allergic vasculitis and conjunctivitis following administration of iodine-containing contrast media]

Sialadenitis ("iodide mumps") and allergic vasculitis are rare sequelae to administration of iodinated contrast media. The condition is characterized by rapid, painless, bilateral enlargement of salivary glands following administration of iodinated contrast media. An 81-year-old female patient with moderate renal failure is described in whom marked sialadenitis, allergic vasculitis with (in part) bloody blisters developed following excretory urography and digital subtraction angiography of the renal arteries. Additional but mild symptoms included fever and conjunctivitis. All lesions subsided completely within four weeks. A relation between blood iodine concentration and extent of the lesions could be demonstrated. The highest iodine level in serum determined was 70 600 micrograms/100 ml.

[Parotid duct occlusion with prolamine--sequelae of long-term administration in the animal model]

The effects of occlusion of the parotid excretory duct, after injection of a basic aminoacid solution (prolamine), were studied in 12 rabbit parotid glands one year after prolamine application. 40% of the experimental animals present the picture of an extensive abscess-forming sialadenitis both macroscopically and microscopically. The secretory parenchyma of the gland is almost completely eliminated. Remnants of the injected prolamine solution found in the duct system could possibly be responsible for the abscess formation. At the present experimental stage therapeutic application of prolamine in the human parotid gland cannot be recommended.

Toxic and drug-induced disorders in otolaryngology

Toxic and drug-induced disorders can be identified with alarming frequency. Otolaryngologists in the past were acutely aware of the ototoxic properties of certain medications but, with today's increasing armamentarium, new problems arise that may have an iatrogenic cause.

Contrast induced sialadenitis--a case report

The authors report a rare complication of intravenous pyelography: namely "iodide mumps". A review of the literature is undertaken.

Oral manifestations of drug reactions

The clinical manifestations of oral reactions to the more commonly prescribed drugs have been presented. These reactions include the following conditions: stomatitis, ulceration and necrosis, opportunistic infections, hemorrhage, gingival hyperplasia, pigmentation, altered salivary function, and altered taste sensation. A patient who complains of any of these signs and symptoms should be thoroughly questioned regarding medication. If an offending drug can be identified, its alteration or elimination, in consultation with the prescribing clinician, will often result in resolution of the clinical problem.

Sialadenitis and systemic reaction associated with phenylbutazone

Sialadenitis is an uncommon side effect of phenylbutazone, and we report seven patients with this reaction who were admitted to Fairfield Infectious Diseases Hospital over a seven year period. In addition to salivary gland swellings, all patients had evidence of a systemic disturbance that included fever in all cases, and, in varying combinations, pericarditis, pleurisy, rash, conjunctivitis, and disturbed hepatic function. Resolution of these features occurred following cessation of phenylbutazone, but this took several weeks in some cases. Pericarditis was the most severe manifestation, and in one patient, this required corticosteroid therapy.

[Effects of contraceptive pills in the field of otolaryngology? (author's transl)]

Besides the wellknown alterations of the Eustachian tube and membrana mucosa nasi there will be discussed the effects of the contraceptive pills on salivarian glands and on inner ear. The influence of gestagen and estrogen on the regulation mechanism of the above mentioned organes is demonstrated. Especially the erectile tissue of the submandibular and parotic glands and recidiving sudden deafness and discussed. To solve the about mentioned problems the interaction of medical statistics with clinical experiences is desirable.