Intralesional vinblastine vs. 3% sodium tetradecyl sulfate for the treatment of oral Kaposi's sarcoma. A double blind, randomized clinical trial

In this double-blind, randomized trial, we compared the clinical efficacy of intralesional vinblastine (VNB) and 3% sodium tetradecyl sulfate (STS) in the treatment of oral Kaposi's sarcoma (OKS). Subjects with OKS were randomly assigned to receive a single intralesional injection of either VNB or STS, at a standard dose (0.2 mg/cm(2)). Differences were evaluated by the Mann-Whitney U and Fisher's exact tests. Sixteen HIV-infected patients were included, eight received VNB and eight received STS; clinical response was evaluated at days 7, 14, and 28 following treatment. Tumor size reduction was 0.68 and 0.61 cm in the VNB and STS groups, respectively (P=0.80). Two VNB patients had complete or partial response whereas four STS subjects had partial responses (P=0.61). Patients in both groups experienced minimal toxicity. We conclude that intralesional vinblastine or STS are adequate for the management of OKS. The benefits of STS are its low cost and ease of use.

Frequency of oral conditions in a dermatology clinic

BACKGROUND

Oral mucosal manifestations may be the initial feature, the most florid clinical feature, or the only sign of mucocutaneous diseases.

METHODS

Sixty adult patients (48 women, 12 men) with oral mucous complaints were referred to and evaluated at a dermatology clinic in a tertiary care hospital in Mexico City between November 1996 and September 1998.

RESULTS

The most frequent oral conditions observed were pemphigus vulgaris (18.3%), lichen planus (8.3%), candidiasis (8.3%), recurrent aphthous ulcers (6.7%), herpetic lesions (6.7%), xerostomia (6.7%), and traumatic lesions (6.7%). Oral affection in mucocutaneous conditions was observed in 21 (35%) patients; the diagnosis was based on oral signs in 10 (48%) of these patients. A large number of oral conditions had previously been misdiagnosed.

CONCLUSIONS

The importance of the diagnosis of oral conditions in dermatology has been underlined in this study due to the frequency and diversity of oral lesions. The benefits of an interdisciplinary approach in the management of patients has been highlighted.

[Experience in the management of the HIV patient among the physicians of the Secretaría de Salud]

OBJECTIVE

To determine the experience of the National Health Ministry physicians in the management of HIV-infected patients and in the use of antiretrovirals.

MATERIAL AND METHOD

A descriptive, observational and transversal study was performed, with support from the National AIDS Council from March to May 1998. Self-applicable questionnaires were filled by National Health Ministry physicians with experience in HIV patient clinical care, at the beginning of 5 different meetings on HIV/AIDS in several cities of the country. Statistical analysis included the chi-square test.

RESULTS

One hundred and eighty-one questionnaires were applied. The median of HIV patients attended by physicians was 4 (interval 1-97); 36.5% of the physicians had used antiretrovirals (35.4% prescribed nucleoside analogs and 9.9% protease inhibitors). The most frequently used drugs were AZT and/or ddl (40.3%); 17.7% had administered CD4+ lymphocyte count and 8.8% viral load.

CONCLUSIONS

The proportion of National Health Ministry physicians with experience in VIH patient care was low, as was the use of antiretrovirals. Efforts should be focus on improving care of HIV patients through physician training.

Oral manifestations as a hallmark of malignant acanthosis nigricans

We present a case of malignant acanthosis nigricans (AN) that initially manifested in the oral cavity. In the present report, the patient had typical clinical and histological findings of oral and esophageal AN, with subtle skin changes, associated with a gallbladder adenocarcinoma. The importance of the clinical oral examination is emphasized because the recognition of oral lesions led to the diagnosis of AN and to the following detection of the internal malignancy. Since the tumours associated with AN are highly malignant, it is of the utmost importance to recognize the skin and mucous membrane changes in adults.

Thalidomide as therapy for human immunodeficiency virus-related oral ulcers: a double-blind placebo-controlled clinical trial

A double-blind, randomized, placebo-controlled clinical trial was performed in Mexico City to evaluate the efficacy of thalidomide in treating oral recurrent aphthae in human immunodeficiency virus (HIV)-infected subjects. Sixteen HIV-infected patients with clinical and histological diagnosis of oral recurrent aphthous ulcerations received randomly an 8-week course of either thalidomide or placebo, with an initial oral dosage of 400 mg/d for 1 week, followed by 200 mg/d for 7 weeks. Ten subjects received thalidomide and six received placebo. At 8 weeks, nine subjects (90%) in the thalidomide group had complete healing of their ulcers, compared with two (33.3%) of the six patients in the placebo group (P = .03). There was a significant reduction in largest ulcer diameter in the thalidomide group. Rash was observed in 80% of the thalidomide patients. Although thalidomide demonstrated an unquestionable benefit in treatment of oral ulcers in HIV patients, caution must be taken given the frequent occurrence of side effects.

Oral manifestations of HIV infection by gender and transmission category in Mexico City

A cross-sectional analysis was conducted in Mexico City from September 1989 to March 1996, to determine the prevalence of HIV-related oral manifestations by gender and route of HIV transmission. The diagnosis of HIV-associated oral lesions was based on preestablished criteria. For the statistical analysis chi-squared and Fisher's exact tests were used where appropriate. Odds ratios were calculated as estimates of the relative risks. Control of confounding factors was performed by logistic regression models. Oral lesions were present in 75% of 436 HIV+ patients. Hairy leukoplakia, erythematous and pseudomembranous candidosis, angular cheilitis and oral ulcers were frequently found. Patients who contracted HIV through blood transfusion were more likely to present erythematous candidosis (P=0.005) than subjects who acquired HIV through sexual transmission. Oral ulcers were seen only in men (P=0.02) and in individuals who contracted HIV through sexual transmission (P=0.02). This study brings valuable data in regard to differences in the type and prevalence of HIV-related oral lesions by gender and the risk categories analysed, particularly blood transfusion.

Chemotherapy-associated oral mucosal lesions in patients with leukaemia or lymphoma

In order to determine the incidence rate of oral lesions associated with chemotherapy, as well as well as its association with clinical and laboratory parameters and potential risk factors, 50 in-patients with non-Hodgkin's lymphoma or leukaemia under chemotherapy were followed from January 1993 to May 1994. Basal and weekly oral examinations were performed. Clinical and laboratory data were registered. Wilcoxon's rank sum test, chi square test, univariate and multivariate logistic regression analyses were used, 36 individuals with leukaemia and 14 with non-Hodgkin's lymphoma were followed for 158 weeks; mean age was 33 years (range 15-85). Oral lesion incidence rate was 45/100 patients-week. Exfoliative cheilitis and infections (herpes and candidosis) were the most common oral complications, followed by haemorrhagic lesions and mucositis. Haemorrhagic lesions correlated with thrombocytopenia (RR = 30.5). Etoposide administration (RR = 8.6), alkylating agents (RR = 15.6), a prior course of chemotherapy (RR = 23.2) and neutropenia (RR = 4.16) were predictors of mucositis. Oral lesions were a common complication in this study, and a possible association of mucositis with several factors is suggested.

Prognostic value of oral candidosis and hairy leukoplakia in 111 Mexican HIV-infected patients

A follow-up study was carried out to evaluate the prognostic value of hairy leukoplakia (HL) and oral candidosis (OC) in a cohort of 111 asymptomatic Mexican HIV infected patients. Oral exams were performed at baseline and every 6 months, from September 1989 to March 1994. Chi-square contingency table test, the Kruskall-Wallis one-way analysis of variance, the Kaplan-Meier product-limit method and the log rank test were used for the analysis. Univariate and multivariate Cox's proportional hazards analysis were also performed. Fifty-four patients (51%) progressed to AIDS (initially 36 CDC-II and 18 CDC-III). Individuals with HL and/or OC, showed faster development to AIDS than subjects without lesions or other HIV-related manifestations (P = 0.008). The presence of OC, HL or both always remained significant despite adjustment for total lymphocytes, CDC stage, zidovudine therapy or its combinations. Oral lesions in HIV infection may be regarded with other clinical and laboratory studies as markers of HIV disease progression and as indicators to begin antiretroviral treatment.

Cancer of the mobile tongue in Mexico. A retrospective study of 170 patients

Histological reports of 170 patients with cancer of the mobile tongue between 1977 and 1989 were identified at the Instituto Nacional de Cancerología (INCan), in Mexico City. Demographic, clinical and histological information was retrospectively reviewed. Chi-square, Student's t-test and Wilcoxon rank-sum test were applied for comparisons, and Kaplan-Meier curves, log-rank test and Cox proportional hazards for survival analysis. Of the 161 patients with mobile tongue squamous cell carcinoma (MTSCC), 104 (65%) were males and 57 (35%) were females. The mean age was 60 years old (range 19-91). T1 and T2 lesions comprised 35%, T3 and T4 lesions 65%. There was a statistically significant association between size of the tumour and lymph node involvement (P < 0.0001). The proportion of cases with advanced disease was 80% for males and 57% for females (P = 0.008). The 5-year survival rate was 16% (CI 10.2-22.8%). Cancer of the mobile tongue in Mexico still has a poor prognosis. Efforts should be made to reduce the delay in diagnosis of MTSCC, in order to increase the cure rates and improve the quality of life of the patients.