ABSTRACT
We retrospectively assessed the prevalence of positive results to cutaneous patch testing, and the relevance of exclusion of identified allergens in the disease process, in 1252 patients with oral mucosal diseases presenting to the Department of Oral Medicine in Glasgow Dental Hospital and School and referred to the Contact Dermatitis Investigation Unit in Glasgow Royal Infirmary. The prevalence of patch-test positivity in each disease cohort was compared with that in 100 control volunteers. Patients with oral mucosal diseases were significantly more likely to have demonstrable hypersensitivity to food additives, especially benzoic acid, and perfumes and flavourings, especially cinnamaldehyde, than controls, and avoidance therapy caused improvement in the majority. Patch testing and the resultant avoidance therapy are useful adjuncts in the management of oral mucosal diseases.
Subject(s)
Food Additives/adverse effects , Food Hypersensitivity/complications , Hypersensitivity, Delayed/complications , Stomatitis/etiology , Adolescent , Adult , Aged , Aged, 80 and over , Case-Control Studies , Child , Child, Preschool , Female , Food Hypersensitivity/diagnosis , Food Hypersensitivity/diet therapy , Humans , Hypersensitivity, Delayed/diagnosis , Male , Middle Aged , Patch Tests , Patient Compliance , Retrospective Studies , Stomatitis/diet therapy , Treatment OutcomeABSTRACT
OBJECTIVE: Patients may have various forms of angioedema and require dental treatment which can cause or contribute to the onset of an episode of angioedema. This paper seeks to highlight the causes and the management of this serious condition. DESIGN: An outline of the different types of angioedema is given here, along with three case reports which illustrate treatment and management. SUBJECTS AND METHODS: Three patients who presented to an Oral Medicine clinic with angioedema are presented to illustrate various types of angioedema and the different contributing factors that precipitated episodes of the condition. MAIN OUTCOME MEASURES: The three patients were all investigated for biochemical and allergic factors which may have caused their disease. RESULTS: Both drugs and dental materials were shown to be involved in the pathogenesis of angioedema in this short series of patients. CONCLUSIONS: Dental treatment or the use of some materials may promote or contribute to the disorder. Referral to hospital for specialist care is indicated for certain groups of patients who require invasive dental treatment. The multi-disciplinary team approach in the investigation and management of patients with angioedema is emphasised.
Subject(s)
Angioedema/complications , Dental Care for Chronically Ill , Laryngeal Edema/etiology , Macroglossia/etiology , Aged , Aged, 80 and over , Angioedema/etiology , Angioedema/therapy , Angiotensin-Converting Enzyme Inhibitors/adverse effects , Antigen-Antibody Complex , Complement C1 Inactivator Proteins/deficiency , Dental Materials/adverse effects , Environmental Illness/complications , Female , Food Hypersensitivity/complications , Humans , Laryngeal Edema/therapy , Macroglossia/therapy , Middle Aged , Pharyngeal Diseases/etiology , Pharyngeal Diseases/therapyABSTRACT
Regional compliance of the ascending aorta, aortic arch, and the descending aorta was measured in 70 normal subjects at varying ages, in 17 patients with coronary artery disease (10 coronary artery disease patients, 3 with syndrome X), and in 13 trained athletes using magnetic resonance imaging. Ascending aortic compliance was measured angiographically in 22 patients with documented coronary artery disease and in 11 patients with syndrome X. Magnetic resonance velocity mapping was used in six patients with documented coronary artery disease and in three patients with syndrome X to study two-dimensional velocity profiles in the proximal and mid-ascending aorta and to quantify both forward and reverse flow. The measurements were compared with earlier published measurements from 24 normal subjects. It was found that patients with ischemic heart disease or syndrome X had decreased or no measurable aortic compliance and that they had significantly reduced or abnormal ascending aortic reverse flow likely to cause reduced coronary artery flow. A new theory is advanced that decreased myocardial perfusion leading to ischemic heart disease has two sources: (1) insufficient blood flow into the coronary artery inlet due to abnormal aortic function and independent of coronary artery stenosis and (2) local coronary artery stenosis. Observations supporting the theory are presented.
