Concurrence of torus palatinus with palatal and buccal exostoses: case report and review of the literature.

Exostoses, also known as hyperostoses, are localized bony protuberances that arise from the cortical plate. These developmental anomalies, or hamartomas, frequently affect the skeletal jaw. Different types of exostoses have been described. Torus palatinus and torus mandibularis are two of the most common intraoral exostoses. Other types of exostoses, affecting the palatal aspect of the maxilla (palatal exostoses) or the buccal aspects of the jaws (buccal exostoses), are less commonly encountered. Concurrence of different forms of exostoses in the same individual is very rare. A 48-year-old woman manifesting excessive palatal exostoses, torus palatinus, and buccal exostoses is described. We present the clinical and histopathologic features and applied therapy and provide a comprehensive review of the current features of exostoses.

Salivary alterations in insulin-dependent diabetes mellitus.

OBJECTIVES: To examine the flow rate and composition of unstimulated whole saliva and of serum in children with newly diagnosed insulin-dependent diabetes mellitus (IDDM) and to compare these with values for a group of healthy controls. DESIGN: Cross-sectional. SETTING: Diabetic Department of a University Hospital in Thessaloniki, Greece. SUBJECTS AND METHODS: The test group was made up of 10 recently diagnosed child patients with IDDM, aged 4-15 years and free of other systemic disease. Ten healthy children aged 5-17 years served as controls. Children were clinically examined before unstimulated saliva was collected over a 5 minute period and blood samples taken. Saliva and serum measurements included glucose, total proteins, albumin and immunoglobulins (IgA, IgG). RESULTS: No significant difference was seen in salivary flow rate between the two groups. Significantly greater concentrations of glucose were seen in saliva and serum in children with IDDM. Neither total protein nor albumin differed significantly between the two groups. Salivary IgA concentration was higher in the test group as was serum IgG. CONCLUSIONS: Findings in this sample suggest that changes in salivary composition may, together with estimated glucose levels, play a helpful diagnostic role in the early stages of IDDM in some children.

[Serum immunoglobulins IgA, IgG and IgM, and oral lichen planus]. / Prosdiorismos ton apososphairinon tou orou IgA, IgG kai IgM se astheneis me omalo leichena tou stomatos.

Oral lichen planus is a common dermatosis with oral manifestations. It is widely accepted that its unknown pathogenetic mechanism has an immunological background although the exact immune mechanism involved is not clear. In our research we attempted to estimate the participation of humoral immunity in the pathogenesis of the disease, comparing the levels of serum immunoglobulins IgG, IgA and IgM between a group of 24 patients with oral lichen planus and a group of 19 healthy individuals. Our results revealed no differences for immunoglobulins IgG and IgM (p greater than 0.05) but increased values of IgA were found (p less than 0.05). It is therefore concluded that humoral immunity is involved in lichen planus but it is difficult to explain its exact participation.

Turnover of bacteriuria in old age.

Among 352 residents of a home for the elderly, who were fully mobile and devoid of most predisposing factors for bacteriuria, 19% of men and 27% of women had two positive cultures within two months. Positive conversion at one year among men and women negative at entry was 11% and 23% respectively, negative conversion of bacteriurics 22% and 27%. Subjects bacteriuric at entry but sterile at six months had a 77% (men) and 44% (women) reinfection rate at 12 months. The data indicate firstly that a significant proneness to infection does exist in old age, coupled with a lesser trend toward spontaneous cure; the latter is equal to that of younger ages. Thus, prevalence rises steadily in old age. Secondly a previous history of bacteriuria in a subject with currently sterile urine increases his chances of reinfection or recurrence two to seven times compared to those of subjects without past infection.

Bacteriuria and survival in old age.

We studied the effect of asymptomatic bacteriuria on survival in 342 healthy residents of a home for the aged. At entry into the study 76 subjects (22 per cent) had bacteriuria on two consecutive urine cultures. There were no differences in age distribution, blood pressure, hematocrit, smoking habits, cholesterol, or myocardial changes between bacteriuric and nonbacteriuric subjects. Median survival was 53 and 75 months in nonbacteriuric men and women 70 to 79 years old, and 45 months in all nonbacteriuric subjects over 79; median survival of bacteriuric men and women aged 70 to 79 was 33 and 34 months, and that of those older was 31 and 29.5 months; the shorter survival of bacteriuric subjects was significant (P less than 0.003). These differences in mortality among subjects living under identical conditions and with equal prevalence of risk factors indicate that bacteriuria in old age is associated with a reduction in survival of 30 to 50 per cent.

Urate excretion in old age.

Serum urate levels were marginally higher in 11 nonbacteriuric elderly men (5.1 +/- 1.8 mg%) than in 24 nonbacteriuric women (3.9 +/- 1.6 mg%) of the same age. Bacteriuric elderly subjects (6 men, 7 women) had lower levels, these being closely similar in the two sexes (3.4 and 3.6 mg%, respectively). Significant reductions of CIn, Ccreat, and TMPAH were observed for bacteriuric men, but not for bacteriuric women. Further, the CUrate:CIn ratio was higher in bacteriuric men and in women, bacteriuric or not, and was not depressed during the TMPAH periods. Increased daily intake of protein from 60 to 75 g was associated with higher serum urate levels in a larger group of subjects. We conclude that: (1) women, even at the age of 80 have a lower serum urate, related to a higher CUrate; (2) bacteriuria increases the ratio CUrate:CIn, particularly in men; (3) secretory mechanisms for urate differ from those of p-aminohippurate in the human, and (4) dietary protein overrides the effect of bacteriuria on serum urate without affecting the male:female ratio.

Mechanisms of renal tubular defects in old age.

The mechanisms of renal tubular dysfunction in old age have been examined in twenty-eight clinically healthy elderly subjects without infection, and in fourteen subjects of similar age with laboratory evidence of intrarenal infection. The data were compared with those from thirteen clinically healthy young subjects. Studied were: proximal tubular (Tm(PAH)) and distal tubular (CH2O) activity, minimal and maximal osmolal U/P ratios, maximal osmolal excretion in hydropenia, and GFR levels under standard hydration and under water-loading. The reduction of GFR in old age is evident particularly in men under conditions of standard hydration: it is accentuated in the presence of renal infection. Proximal tubular activity is also significantly lower in elderly men, especially if they have chronic bacteriuria. The reduction is closely related to GFR levels, with identical Tm(PAH):C(in) ratios in all groups. This supports the intact nephron hypothesis for this part of the nephron. Distal tubular activity is depressed in old age in both sexes proportionately more than proximal tubular activity or the GFR. The lower CH2O: GFR ratios imply a selective distal tubular damage. Maximal osmolal U/P ratios in hydropenia are significantly higher in the young (mean 367) than in either the elderly non-infected (mean 279) or the elderly infected subjects (mean 212). Conversely, minimal U/P ratios in water-loading are lower in the young (mean 0.247) than in either elderly group (means 0.418 and 0.668). Osmolal excretion in hydropenia is not different between the groups, but urine flows in water-loading clearly separate them. The data indicate that simple functions of the distal-collecting tubule (e.g. the CH2O), are less affected in old age than are functions involving several medullary structures (as is the maximal U(osm) or U/P ratio). They suggest that the main impairment of the distal tubular cell involves the failure to achieve a proper osmotic gradient between tubular fluid and blood, rather than an inability to excrete or re-absorb an adequate amount of solute. Finally, it appears that renal infection aggravates the larger glomerular and proximal tubular deficits observed in non-infected men: it depresses distal tubular function equally in both sexes.