Sjogren's syndrome and keratoconjunctivitis sicca.

Keratoconjunctivitis sicca patients diagnosed on the basis of a history, dry-eye symptoms, and definite clinical signs of keratoconjunctivitis sicca, with the associated symptoms of dry mouth and/or arthritis, had measurements of tear osmolarity, Schirmer tear test without anesthetic, stimulated parotid salivary flow, and serum analysis for the presence of autoantibodies associated with Sjogren's Syndrome. In contrast to previous studies, a lower incidence of SS-A or SS-B (1-3%), ANA (41-47%), DNA (11-16%), and RF (9-12%) serum antibodies was detected. Salivary-stimulated parotid flow was abnormally decreased in 59% of the patients. Sjogren's syndrome, as indicated by the presence of serum antibodies, appears to have a lower incidence in keratoconjunctivitis sicca than considered previously.

Content and solubility of sodium in denture adhesives.

The objectives of this study were to determine the content and solubility of sodium in denture adhesives, and to ascertain relationships between these values. Nine powder and 10 cream denture adhesives were assayed for sodium by spectrophotometry. The range of dry weight sodium content was 2.4 gm/100 gm to 6 gm/100 gm. The range of solubility of sodium in the denture adhesives, as determined by in vitro methods, was 0.51 gm/100 gm to 1.70 gm/100 gm. The percent of solubility of sodium was 12% to 42%. Application of the Mann-Whitney test determined that the observed differences in sodium content and percent of solubility between the groups of powder and cream adhesives were not significant (alpha 0.001). However, sodium solubility of the powder adhesives was significantly greater (alpha 0.001) than that of the cream adhesives. It has been shown that dietary sodium restriction reduces blood pressure in hypertensive patients and that a diet high in sodium chloride produces hypertension in the population predisposed to the disease. This study raises questions as to the possible effect of the sodium in denture adhesives on the hypertensive patient. We suggest the use of adhesives with a low percent of sodium solubility.

Salivary gland dysfunction and swallowing disorders.

We have reviewed the functions of salivary secretions and the major role that saliva plays in maintaining oral homeostasis by protection, repair, and lubrication as well as in the initial phase of digestion. Diseases affecting the salivary glands per se as well as systemic diseases that may alter salivary function were discussed, as were treatments of diseases that may disrupt normal salivary function. Simple yet reliable methods of evaluating salivary function to validate subjective complaints were presented.

A study of factors contributing to the development of osteoradionecrosis of the jaws.

The histories of 14 patients in whom osteoradionecrosis developed were compared with those of 28 patients who had similar tumors and/or treatment and were not afflicted with osteoradionecrosis. 1. Fourteen of 15 episodes of bone complications occurred in the mandible, and 70% occurred within 1 year after the completion of radiation therapy. 2. A high dose of radiation, with conventional fractionation, did not specifically predispose patients to osteoradionecrosis. Fifty percent of the ORN patients actually received a total dose of 6000 rad or less. Combined radiation therapy and surgery did not seem to significantly increase the risk inasmuch as both groups of patients had similar combinations. In two of four patients who received methotrexate, however, osteoradionecrosis developed during the time of administration. 3. One of the most prevalent negative factors associated with the ORN patients was the continued heavy use of alcohol and tobacco by 86% of them. These strong tissue irritants could have significantly contributed to the breakdown of mucosa and exposure of bone. Alcohol and tobacco could also have potentiated the combined effects of the other negative factors, such as contributing to poor oral hygiene. 4. The ORN patients had poorer oral hygiene than the control group. Seventy-five percent of the patients with teeth who had osteoradionecrosis continued to have poor oral hygiene. In contrast, none of the control patients had poor oral hygiene. 5. A combination of factors relating to stage of tumor and treatment was found in the ORN patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Nicotine gum and self-help manuals in smoking cessation: an evaluation in a medical context.

This study evaluated the effectiveness of nicotine chewing gum in smoking cessation, when incorporated into a behaviorally oriented self-help program. One hundred ninety-seven patients were randomly assigned to nicotine gum with a self-help manual, a self-help manual without gum, or a control condition, but received no further treatment from the prescribing physician. At six weeks, the nicotine gum group was superior to both the self-help and control conditions. By one year, many gum patients had relapsed, and the treatment effect was no longer significant. Patients who were able to quit initially were most likely to remain ex-smokers in the self-help condition. The clinical importance of these findings is discussed.

Medical management of non-neoplastic salivary gland disease.

Non-neoplastic salivary gland disorders are increasing as a result of many factors. The role of salivary secretion in providing protection to the oral and pharyngeal tissues is discussed along with the diagnosis and treatment of some of the more common non-neoplastic salivary gland diseases.

Clinical utilization of sialochemistry in Sjögren's syndrome.

Sialochemistry was performed on the stimulated parotid secretion of a group of patients with Sjögren's syndrome (SS) having a Grade 4 lymphocytic infiltrate of their minor labial salivary glands and a normal control group. Parameters examined included flow rate, and concentration of sodium, potassium, chloride, urea, calcium, phosphate, total protein, IgA, IgG. albumin, amylase and lactoferrin. Although all SS patients had virtually no parotid secretion in the absence of stimulation, with a gustatory stimulation, 40% of the patients with SS had a relatively normal parotid flow rate, when compared with the control group. The SS patients, regardless of flow rate, exhibited a highly significant (p less than 0.01) elevation in the concentration of sodium, chloride, IgA, IgG, and lactoferrin and a significant (p less than 0.05) increase in albumin concentration, when compared with the control group. The phosphate level was significantly lower (p less than 0.01) in SS patients than in the control group. The elevated IgA in SS was almost all 11S, in contrast to parotitis where 7S was a major contributor. In view of the variation in flow rate in SS patients chemical quantitation of selected salivary components can be a valuable aid in the differential diagnosis of this disease and in monitoring patients over time.

The effect of collection technique on tear composition.

Selected proteins were quantitated after collecting samples of the tears by using two sampling techniques. Tears from the same individual were collected via absorption by Schirmer filter paper strip from the unanesthetized, inferior, conjunctival sac and were compared with tears collected by a capillary tube (taking care not to touch the conjunctiva), after stimulation of tearing by irritation of the nasal mucosa with ammonia vapor. Tear samples were quantitated immunochemically for two typical lacrimal proteins, lysozyme and lactoferrin, and three typical serum proteins, albumin, transferrin, and IgG. Tear analysis of all constituents were performed on a single sample of tears collected by each method from the same individual. Normal subjects without ocular pain or discomfort comprised a sample of 12 subjects ranging in age from 19 to 57 years and consisting of 9 men and 3 women. Concentrations of lysozyme and lactoferrin in samples collected by either method were not significantly different. In contrast, the concentration of albumin, IgG and transferrin collected by Schirmer filter paper technique was significantly higher (P less than 0.01) than the concentration in tears collected by the capillary tube technique. A highly significant increase in serum proteins was seen when the Schirmer filter paper strip was used to collect tears compared to tears collected without mechanical stimulation of the conjunctiva.

A comparative study of salivary lysozyme in caries-resistant and caries-susceptible adults.

Lysozyme concentration was quantitated immunochemically in parotid and submandibular-sublingual saliva of 46 caries-resistant and 17 caries-susceptible adults. There was essentially no difference between the two groups. The concentration of lysozyme was three times higher in the submandibular-sublingual than in the parotid secretion, and was significantly higher in unstimulated submandibular saliva than in secretions stimulated with 1, 2, or 4% citric acid. There were no significant differences in flow rate between caries-resistant and -susceptible subjects. Salivary lysozyme concentration is not a critical determinant of resistance or susceptibility to caries.

Basal and reflex human tear analysis. I. Physical measurements: osmolarity, basal volumes, and reflex flow rate.

Minimally stimulated, retained "basal' tears and stimulated reflex tears were collected from normal controls, keratoconjunctivitis sicca (KCS) patients, and contact lens (CL) wearers. Basal tear samples were collected on small filter paper strips (Periopaper) over a five-second period, and volume was measured by means of an electronic device (Periotron). Collected basal tear volumes for KCS patients (0.84 +/- 0.42 mul) were significantly lower (P less than 0.01) than normal controls (1.18 +/- 0.36) and CL wearers (1.24 +/- 0.27). Reflex tear flow rates were measured over a five-minute period on Schirmer strips. Volume was calculated by comparison of wet length with known volumes of 1% egg white lysozyme solution. The reflex tear flow rates in KCS patients (3.29 +/- 3.57 mul/minute) were significantly lower than normal controls (5.71 +/- 5.86) and CL wearers (6.96 +/- 6.07). The elevation in CL wearers was not statistically significant when compared to normals. KCS patients are deficient in both basal and reflex tears compared to normals but have a more significant deficiency of basal tears. Female normals and CL wearers over 40 years of age have a higher tear osmolarity than those under 41 years of age. Female KCS patients over 40 years of age have a tear osmolarity that is not significantly different from female KCS patients under 41 years of age.

Basal and reflex human tear analysis. II. Chemical analysis: lactoferrin and lysozyme.

Unstimulated basal tears and stimulated tears were collected from normal controls, keratoconjunctivitis sicca (KCS) patients, and contact lens (CL) wearers. Basal tear volume (Periopaper) and reflex tear volume (Schirmer Strip) were measured and tears eluted from their respective strip with a TMED-acetic acid buffer. Lactoferrin and lysozyme concentrations were measured in the eluates. Concentration of lysozyme in basal tears was: 65 +/- 43 mg% in normals; 44 +/- 26 mg% in KCS, and 81 +/- 50 mg% in CL wearers. Concentration of lysozyme in reflex tears was: 160 +/- 73 mg% in normals, 74 +/- 41 mg% in KCS, and 186 +/- 83 mg% in CL wearers. Concentration of lactoferrin in basal tears was 137 +/- 102 mg% in normals, 154 +/- 82 mg% in KCS, and 157 +/- 80 mg% in CL wearers. Concentrations of lactoferrin in reflex tears was: 327 +/- 187 mg% in normals; 171 +/- 69 mg% in KCS, and 302 +/- 160 mg% in CL wearers. The lactoferrin concentration in all tear samples was consistently higher (1.6-3.5 times) than lysozyme. In basal tears, lactoferrin concentrations were not significantly different in the three groups. In reflex tears, however, lactoferrin was significantly lower in KCS than normal or CL wearers. The concentration of lysozyme in both basal and reflex tears was significantly lower in the KCS when compared to normal or CL wearers. Lysozyme and lactoferrin concentrations in both basal and reflex tears were similar in CL wearers and normal controls. The sampling and elution of basal and reflex tears as described appears to be a feasible technique for analysis of lysozyme and lactoferrin concentrations by the electroimmunodiffusion technique and has potential diagnostic value.

Immunochemical quantitation of human submandibular-sublingual lysozyme.

A method for quantitating lysozyme by using carbamylated antiserum (commercially available) to human lysozyme in a electroimmunodiffusion technique has been developed. The method measures specific protein not lytic activity as the lyso-plate method does. We have applied this method to tears, parotid saliva, submandibular-sublingual saliva, nasal secretions, serum, and minor salivary gland secretions. We specifically selected submandibular-sublingual saliva for a comparison test with the lyso-plate method because of the known mucin content of the submandibular-sublingual saliva. Our findings indicate that no pretreatment is necessary for the electroimmunodiffusion technique. The lyso-plate method, on the other hand, requires pretreatment with Tris-acetate pH 4.5 to dissociate the mucin-lysozyme complex and give accurate values.

Studies of secretory IgA in caries-resistant and caries-susceptible adults.

Caries resistant subjects appeared to possess a greater potential for production of secretory IgA than caries susceptible subjects, at least in stimulated parotid and submaxillary secretions. There was considerable overlap, however, among subjects in all groups examined. There are no consistent differences in s-IgA among groups in unstimulated parotid and submaxillary saliva. It would appear, therefore, that s-IgA secretion per se is not a critical determinant of caries resistance. The tendency to higher s-IgA values among resistant people, however, may indicate a greater propensity to specific antibody production. This aspect of caries protection requires independent investigation.

Effects of ethidium bromide on the respiratory chain and oligomycin-sensitive adenosine triphosphatase in purified mitochondria from the cellular slime mold Dicyostelium discoideum.

Mitochondria were isolated from the cellular slime mold. Dictyoostelium discoideum, and partially purified by sucrose density gradient fractionation. The most purified mitochondrial fraction from the gradient contained essentially no contaminating lysosomes and minimal amounts of contaminating peroxisomes as determined by the marker enzymes N-acetyl-glucosaminidase and catalase. A mitochondrial fraction with the same amount of lysosomal and peroxisomal contamination was also isolated from cells which had been treated with ethidium bromide for 5 days. The most purified mitochondrial fraction from control and ethidium bromide-treated cells had an identical buoyant density of 1.181 to 1.182 g per ml, suggesting that treatment with the drug does not result in any drastic structural changes in the mitochondrial membrane which would affect its density. In the purified mitochondria from ethidium bromide-treated cells, the content of cytochromes a-a3 was decreased over 80% and that of cytochrome oxidase and oligomycin sensitive ATPase were reduced approximately 50%. By contrast, the specific activities of NADH and succinate dehydrogenases were identical in the purified mitochondria from control and ethidium bromide-treated cells. Previously, we had reported that the specific activities of these two enzymes had nearly doubled in whole cells maintained in ethidium bromide for a time equivalent to six or seven generations after growth had stopped (Stuchell, R. N., Weinstein, B. I., and Beattie, D. S. (1973) Fed. Eur. Biochem. Coc Lett. 37, 23-26). These results suggest that continued formation of new mitochondrial membranes, with an identical complement of succinate and NADH dehydrogenases, must occur despite the cessation of cell growth which occurs as a result of the ethidium bromide induced loss of mitochondrial enzymes. Consequently, the amount of mitochondria, or mitochondrial protein per cell, calculated from the activity of NADH and succinate dehydrogenases has increased nearly 50%. Possible models to explain the control of mitochondrial biogenesis are discussed to explain these results.