Enlargement of salivary glands. Review of the literature

A journey inside the elderly-onset primary Sjögren’s syndrome, looking for useful tips for the geriatrician

Primary Sjögren’s syndrome (pSS) is a systemic autoimmune rheumatic disease where xerophthalmia, xerostomia and presence of anti-SSA and anti-SSB antibodies are typical features. Its prevalence is higher in over-65 aged population than in other age groups. In the elderly, pSS diagnosis comes up against a whole series of critical points that may favor its misdiagnosis. The aim of our article is to discuss the most relevant of them: the frequent occurrence of a seronegative subset, the presence of systemic features not related to sicca syndrome, the sicca syndrome as iatrogenic manifestation and the possibility of a biopsy false negative of labial salivary glands.

Diabetes in the practice of otolaryngology

Diabetes mellitus is the most common endocrine disease, characterized by chronic hyperglycemia. The hyperglycemic milieu leads to endothelial injury in blood vessels of variant size, which results in microangiopathy and macroangiopathy (atherosclerosis). Consequential ischemia of nerves and hyperglycemia by itself lead to nerve degeneration and generalized neuropathy, affecting most often the sensory peripheral nerves and the autonomic nervous system. Auditory, vestibular and olfactory sensorium may be compromised by DM. People with DM have an increased susceptibility to infection, as a result of neutrophil dysfunction and impaired humoral immunity. Therefore DM predisposes to certain infectious diseases, such as fungal sinusitis or malignant otitis externa, which are rare in general population. Recovery from infections or from injuries may be compromised by coexisting DM. In this review we discuss complications of DM in the head and neck region. Otolaryngologists and general practitioners should be alert to specific conditions related to DM and be minded of the relevant complications and consequences.

Sialosis, Gout Induced or Idiopathic? Case Report

Sialosis is observed in relation to diabetes, alcoholism, and malnutrition. An assumed relation between gout and sialosis is probably based on confusion that originated from the therapeutic use of phenylbutazone for gout and the sialadenitis that the medication caused. This report describes a case of sialosis in a patient with a longstanding history of gout that was idiopathic in origin.

Early gene expression in salivary gland after isoproterenol treatment

Isoproterenol, a β-adrenergic agonist, has been shown to induce salivary gland hyperplasia. However, the mechanism involved in this pharmacological phenomenon is not well understood. To gain a better understanding of the underlying changes, including genes, networks and pathways altered by isoproterenol, microarray-based gene expression analysis was conducted on rat parotid glands at 10, 30, and 60 min after isoproterenol injection. After isoproterenol treatment, the number of differentially expressed genes was increased in a time-dependent manner. Pathway analysis showed that cell hyperplasia, p38(MAPK), and IGF-1 were the most altered function, network and pathway, respectively. The balanced regulation of up- and down-expression of genes related to cell proliferation/survival may provide a better understanding of the mechanism of isoproterenol-induced parotid gland enlargement without tumor transformation.

A 13-week subchronic toxicity study of sodium iron chlorophyllin in F344 rats

Sodium iron chlorophyllin (SIC), a water-soluble chlorophyll derivative, has been used as a food additive for green coloration. In the present study, a subchronic toxicity study of SIC was performed in male and female F344 rats with oral administration in diet at concentrations of 0%, 0.2%, 1.0%, and 5.0% for 13 weeks. No mortalities, abnormal clinical signs, and hematological changes were observed in any of the groups during the experiment. Significant reduction of body weight gain was noted in 5.0% males. In serum biochemistry, serum transferrin levels were significantly increased in 5.0% males and females. Relative spleen weights of both sexes were markedly reduced with 5.0% SIC as compared to the controls, and absolute weights of spleen were also significantly decreased in males. On histopathological assessment, diffuse hypertrophy of acinar cells in the parotid gland was observed in all examined 5.0% males and females, but not in the other groups. Based on the histopathology of the parotid glands, the no-observed-adverse-effect level (NOAEL) of SIC in the present study was estimated to be 1.0% (609 mg/kg bw/day for males and 678 mg/kg bw/day for females).

Subchronic oral toxicity assessment of N-acetyl-L-aspartic acid in rats

We investigated the systemic effects of subchronic dietary exposure to NAA in Sprague Dawley® rats. NAA was added to the diet at different concentrations to deliver target doses of 100, 250 and 500 mg/kg of body weight/day and was administered for 90 consecutive days. All rats (10/sex/group) survived until scheduled sacrifice. No diet-related differences in body weights, feed consumption and efficiency, clinical signs, or ophthalmologic findings were observed. No biologically significant differences or adverse effects were observed in functional observation battery (FOB) and motor activity evaluations, hematology, coagulation, clinical chemistry, urinalysis, organ weights, or gross pathology evaluations that were attributable to dietary exposure to NAA. Treatment-related increased incidence and degree of acinar cell hypertrophy in salivary glands was observed in both male and female rats in the high dose group. Because there was no evidence of injury or cytotoxicity to the salivary glands, this finding was not considered to be an adverse effect. Based on these results and the actual average doses consumed, the no-observed-adverse-effect-levels (NOAEL) for systemic toxicity from subchronic dietary exposure to NAA were 451.6 and 490.8 mg/kg of body weight/day for male and female Sprague Dawley® rats, respectively.

Toxic effects of l-aspartic acid at high dose levels on kidneys and salivary glands in Fischer 344 rats detected in a 90-day feeding study

A subchronic oral toxicity study of l-aspartic acid (l-Asp) was conducted with groups of 10 male and 10 female Fischer 344 rats fed a powder diet containing 0%, 0.05%, 1.25%, 2.5% and 5.0% concentrations for 90 days. Serum biochemistry showed treatment-related decreases of blood urea nitrogen, creatinine and uric acid levels in both sexes. In addition, incidences of urinary ketone and protein were significantly increased in treated both sexes, while relative kidney weight was significantly increased in the 5.0% male rat, and regenerative renal tubules with tubular dilation were histopathologically observed in male rats of the 2.5% or greater groups. The observed renal injury was confirmed not to be due to accumulation of alpha2u-globulin. Acinar cell hypertrophy of salivary glands was histopathologically evident in male and female rats of the 2.5% or greater groups. The present results indicate that l-Asp causes toxic effects on kidneys and possibly salivary glands at high dose levels in male and female Fischer 344 rats. Such toxic effects were observed only in animals given 2.5% and/or higher doses of l-Asp. In conclusion, the no-observed-adverse-effect-level (NOAEL) for l-Asp is 1.25% (696.6 mg/kg body weight/day for males and 715.2 mg/kg body weight/day for females) under the present experimental conditions.

Idiopathic phenobarbital-responsive hypersialosis in the dog: an unusual form of limbic epilepsy?

Three unusual cases of salivary gland enlargement and hypersialosis in the dog that responded to anticonvulsant therapy are reported. Presenting complaints included weight loss, hypersalivation, retching and vomiting of several weeks' duration. Two dogs were presented with enlarged painful mandibular salivary glands. The third dog exhibited bizarre behaviour (including jaw chattering) and developed enlarged painful mandibular salivary glands during hospitalisation. Fine needle aspirate cytology and biopsies from the enlarged salivary glands revealed no significant pathological changes. In one dog, an electroencephalogram revealed changes consistent with epilepsy. Hypersialism and salivary gland enlargement resolved completely during phenobarbital administration in all cases. Two dogs were successfully weaned off treatment six months after diagnosis. The remaining dog relapsed after eight months, but normalised with the addition of oral potassium bromide. It is hypothesised that the syndrome idiopathic hypersialosis may in fact be an unusual form of limbic epilepsy.

Idiopathic salivary gland enlargement (sialadenosis) in dogs: a microscopic study

A histological, histochemical and morphometric study was performed on submandibular salivary glands from 13 dogs which had presented with a submandibular mass or swelling that proved to be a portion of non-inflammatory and non-neoplastic submandibular salivary gland. There were no consistent changes in lectin-binding histochemistry or immunohistochemical expression of various cell markers, and, in most cases, there was no measurable difference in acinar size in the affected gland. The possible explanation for the clinical salivary gland enlargement is therefore unclear.

Dermatologic findings in anorexia and bulimia nervosa of childhood and adolescence

The cutaneous signs of anorexia nervosa (AN) and bulimia nervosa (BN) have been described previously in adult patients. For the first time, we present here dermatologic findings in children and adolescents suffering from eating disorders. Thirty consecutive young anorexic and bulimic inpatients (8 to 17 years of age, mean 15.1 years) underwent a standardized dermatologic examination. Patients were checked for abnormalities of the skin including atopic stigmata, dermographism, hair, nails, and oral cavity. Serum was obtained for hemoglobin, iron, zinc, GPT, thyroid, and sex-hormone levels. In 13 patients, the total serum IgE was determined, and a prick test was carried out with defined type I allergens. Findings in order of frequency included xerosis of the skin, white dermographism, diffuse hypertrichosis, acrocyanosis, scars, diffuse effluvium, artifacts, brittle nails, and onychophagia. Significant co-relations were found between the presence of hypertrichosis and the existence of amenorrhea or a body mass index of less than 16. In 22 patients a low T3 level was found. In summary, children and adolescents suffering from AN or BN show dermatologic features similar to those reported in older patients. Special findings in this age group are extensive lanugo hair and signs of autoaggressive behavior.

A review of the expanding field of exotic animal oral health care--veterinary dentistry

This article reviews the clinical literature of the field of Veterinary Dentistry from its conception in the late 1960's to its rapidly expanding role today as an emerging clinical specialty practice in veterinary medicine. It defines eight dental sub-disciplines in contemporary veterinary oral health care from a practical point of view and provides information concerning standardization of key words searches, definition of terms, and use of the expanded Medical Subject Headings (MeSH) necessary for a comprehensive review of the rapidly expanding literature stored in electronic databases.

Pilocarpine alters caries development in partially-desalivated rats

This study examined the effect of pilocarpine on caries and saliva composition in rats with compromised salivary gland function. Eight litters of specific-pathogen-free female Sprague-Dawley rats were divided into five groups for surgery. Partial desalivation was performed in either of three ways: (1) Both parotid ducts were ligated; (2) both submandibular/sublingual (SM/SL) glands were excised, or (3) one parotid duct was ligated, and submandibular/sublingual glands were removed unilaterally. Completely desalivated animals and unoperated animals served as positive and negative controls, respectively. One week following surgery, groups were subdivided so that half of each group had osmotic pumps implanted which delivered pilocarpine HCl (24 mg/kg/day). All animals were infected with Streptococcus sobrinus 6715 and fed cariogenic diet ad libitum for 28 days. Caries scores, microbiological data, and saliva flow rate and composition were determined for all animals. Animals which had both SM/SL glands removed and received pilocarpine developed significantly lower sulcal caries (p < or = 0.05) compared with the animals that had both SM/SL removed but did not receive pilocarpine. The concentration of protein in parotid saliva in these pilocarpine-treated animals was unaffected, and no differences were observed in the electrophoretic profiles on SDS-PAGE. Pilocarpine appears to exert its greatest caries-protective effect when the parotid glands remain intact.

Adenomatoid hyperplasia of minor salivary glands

Adenomatoid hyperplasia of minor salivary glands is an uncommon clinicopathologic entity. It comprises clinical swelling resembling a neoplasm with a histologic picture of aggregates of normal-appearing salivary gland tissue in excess of that anticipated for the anatomic site. The significance of this lesion is derived from its clinical resemblance to a neoplasm of salivary gland origin. This study adds 40 new cases to the literature and analyzes their clinical and histologic features. Most of the lesions were located on the hard and soft palates. The exact nature of the minor salivary gland hyperplasia is not clear. Some of the cases may represent a hamartoma or a reactive hyperplasia, but in most cases the nature of the hyperplasia is idiopathic.

Changes in glucose metabolism in submandibular salivary glands of rats after isoproterenol or incisor-tooth amputation

Rats were injected daily with isoproterenol (2 mg/kg of body wt) for up to five days, or their incisor teeth were amputated on every other day for up to five amputations. The animals were subdivided in two subgroups killed 12 or 24 h after the first or last intervention. At 12 h all enzymes except hexokinase (HK) and pyruvate kinase (PFK) showed decreased activities after isoproterenol. After incisor amputation, only increased HK and PFK activities were observed. With both procedures, there is activation of beta-adrenergic receptors but results show that different biochemical events take place, suggesting different mechanisms.

Compensatory proliferative response of the rat submandibular salivary gland to unilateral extirpation

The present experiment was conducted in order to identify the progenitor compartment of the submandibular salivary gland (SSG) and to explore the proliferative activity of this gland in response to unilateral extirpation. Left submandibular and retrolingual glands were extirpated in 30 rats (B.W. 200 +/- 12 g). The rats were killed 0, 1, 2, 3, 5 and 7 days after surgery. Five intact rats served as controls. The animals were given intraperitoneal injections of 3HTdR (0.5 microCi/grB. W) 1 h before they were killed. The contralateral SSG's were subjected to routine histological procedures and embedded in glycol methacrylate. Selected sections (2 micron thickness) were processed for autoradiography. In each gland, labelled and unlabelled nuclei were counted in 50 random microscopic fields and sorted according to their parenchymal histomorphological features and "nuclear class" (number of nuclei/cross section/feature). In the control glands the total labelling index (LI) was 0.18%; during acute compensatory stimulation, however, the total LI reached a maximum of 0.86% on day 3 after surgery. suggesting that the SSG, which normally undergoes a slow turnover, is capable of elevated proliferation in response to a stimulus. In both normal and stimulated glands, the LI was higher in the intercalated ducts (1.1%-5.85%) than in the granular ducts (0.17%-0.93%) and acini (0.05%-0.36%). This consistency of LI ratio between the various histomorphological features in the normal and experimental glands indicates that the glandular progenitor compartment is located in the intercalated ducts, which supply cells to both the ductal system and acini.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect on peroxidase activity and specific binding of the hormone 17 beta-oestradiol and rat salivary glands

The effect was studied on immature and adult female rats. Oestradiol, given either once (10 micrograms) or three times (3 X 10 micrograms) subcutaneously significantly retarded the total weight gain of immature rats whereas, at the same time, the weight of the uteri increased several fold. The weights of neither salivary nor lacrimal glands were dependent on oestradiol. The activity of the peroxidase enzyme, a marker of oestrogen-responsive tissues, increased significantly in the rat uteri but had no effect on lacrimal peroxidase. The levels of rat salivary peroxidase increased during oestradiol administration with considerable differences between various glands. The increase in peroxidase activities could not be explained by changes in the total protein content but seemed to be specific for this enzyme. Experiments using [3H]-oestradiol indicated specific binding to uterus, parotid and submandibular glands. It is concluded that rat salivary glands are oestrogen-responsive.

Parotid enlargement: a presenting sign in anorexia nervosa

The purpose of this article is to present the pertinent medical and dental features of anorexia nervosa and to add an additional oral-facial finding, parotid gland enlargement, which has been described infrequently in a few scattered reports. Pertinent differential diagnoses for the systemic and oral-facial findings are discussed, including a review of the factors producing salivary gland enlargement. Early recognition of the psychiatric and pathophysiologic components of this disorder are essential to diagnosis and successful treatment. The dentist should consider the diagnosis of anorexia nervosa in the presence of such abnormal dental findings as perimylolysis and chronic salivary gland enlargement, especially in underweight and amenorrheic young women.

[Morphology of salivary gland diseases]

The human salivary glands represent a functional system with manifold responsibilities and interactions to the organism. The major and minor salivary glands show a common construction schedule consisting of an acinar functional system for the production of an enzyme- and mucin-containing primary saliva and a ductal functional system with manifold secretory, resorptive and regulatory responsibilities for the transport and the definitive composition of the saliva. The cyclic AMP and calcium iones localized in the glandular acini have an exceptional importance for the course of the secretory process. The neurohormonal control of the salivary secretion results by adrenergic and cholinergic transmitter substances. Moreover the secretory process shows a daily cycle combined with morphological alterations of the glandular cells (so called circadian structures). The fluid secretion of the salivary duct system (the output of sodium-, potassium- and chlorine-iones) represents an active energy-consumed transport process which will be regulated by several factors (autonomic nervous system, quantity of perfusion, hydrostatic pressure in the blood capillaries, transepithelial active transport by ATP-consumed pump systems). The striated ducts are the functional most important sector of the duct system for a rapid fluid- and electrolyte excretion. The terminal axons of the postganglionic sympathic and parasympathic neurits are characterized by spindle-shaped enlargements (varicosities) which contain neurosecretory granules. In the region of the acinar and intercalated duct cells a direct synaptic contact exists for the stimulation transmission, in the course of which the terminal axon contacts immediately with the effector cell by penetration of the basement membrane. The salivary glands form a part of the stabil tissues with reversible postmitotic cells in regard of the tissue regeneration. Under pathological conditions (inflammations, impediment of secretion fluid, radiation effects etc.) metaplasias and proliferations of the duct system arise with development of indifferent duct formations analogous to the type of an embryonal salivary gland. The terminal zone between intercalated and striated ducts represents an indifferent zone with large regeneratory potency. A special behaviour shows the myoepithelial cells which are developed as well to the outside of primitive embryonic duct buds as differentiated intercalated and striated ducts. Morphologically three types of diseases can be classified in the salivary glands: sialadenosis, sialadenitis and tumours.(ABSTRACT TRUNCATED AT 400 WORDS)