Langerhans's cell histiocytosis.

A 42 year-old male, smoker, was referred for evaluation of an ulcer located in the gingiva, during one month, that produced disturbances. On the intraoral examination we appreciated an ulceration of 0.5 cm, on a mandibular torus, in the lingual gingiva of the left first molar (Fig. 1-2). A panoramic x-Ray (Fig. 3), a CT scan (Fig. 4) and a biopsy were taken (Fig. 5-6, Fig. 6 is a S-100 stain).

Avascular jaw osteonecrosis in association with cancer chemotherapy: series of 10 cases.

BACKGROUND: We present a series of 10 patients with osteonecrosis of the jaws (ONJ) that appeared following cancer chemotherapy. MATERIAL AND METHODS: Of the 10 cases with ONJ, six had bone metastases from breast cancers and the other four had multiple myeloma. We analysed the location of bone metastases, as well as the characteristics of the ONJ, and the drugs with which they had been treated for their bone metastases. RESULTS: Of the 10 patients, all had ONJ in the mandible; 50% also had maxillary involvement. The average number of areas of painful exposed was 2.1 per patient (range 1-5). In seven patients a tooth extraction preceded the onset of ONJ. Two patients developed oroantral communications and another a cutaneous fistula to the neck with suppuration. In all the 10 patients the histopatholological diagnosis was of chronic osteomyelitis without evidence of metastatic disease to the jaws. All the patients had received treatment for their malignant bone disease with bisphosphonates. These were the only drugs that all patients had received. CONCLUSION: ONJ appears to have a relationship with the use of bisphosphonates.

Pénfigo vulgar / Pemphigus vulgaris

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Lichen sclerosus et atrophicus manifesting with localized loss of periodontal attachment.

Lichen sclerosus et atrophicus (LSA) is a chronic mucocutaneous inflammatory disorder of uncertain aetiology that is clinically characterized by the appearance of well delimited white plaques or papules, preferentially affecting the skin and genitals, and more rarely the oral cavity. We present the case of a woman with LSA limited to the oral cavity in the form of a well delimited, flat whitish lesion affecting the vestibular gingiva of the right upper incisors and left central incisor, and extending towards the vestibular fundus and frenulum of the upper lip. Widening of the periodontal space was observed, with gingival recession and attachment loss limited to these teeth. Local corticosteroid injections caused the mucosal lesion but not the periodontal alterations to resolve. Emphasis is placed on the importance of knowledge of this condition in relation to establishing a diagnosis, and on its periodontal repercussions.

Oral leishmaniasis in a HIV-positive patient. Report of a case involving the palate.

Leishmaniasis is a parasitic disease caused by a protozoon (Leishmania), with different clinical forms that are endemic in certain countries. The association of this disease in patients who are seropositive to human immunodeficiency virus (HIV) has recently been described. Leishmaniasis can develop in any stage of HIV infection, although the clinical manifestations - and hence the diagnosis - tend to coincide with the periods of maximum immune depression. We present the case of a HIV-positive, ex-intravenous drug abuser (in stage B2 of the CDC, 1992) with concomitant hepatitis C infection who presented with palatinal pain and bleeding for the past 2 months. Exploration revealed a vegetating tumoration of the hard palate. Hematoxylin-eosin and Giemsa staining of the biopsy confirmed the diagnosis of leishmaniasis. The definitive diagnosis was mucocutaneous leishmaniasis (MCL), for a bone marrow aspirate proved negative, and no further lesions could be established. The patient was treated with meglumine antimoniate (Glucantime), followed by improvement of the lesions.

[Angiocentric lymphoma of the palate]. / Linfoma angiocéntrico localizado en paladar.

Angiocentric lymphomas are very infrequent neoplasms in our geographical setting. They tend to develop in the oronasal region in the form of necrotic lesions--specifically in the midfacial zone--with a rapid course and poor prognosis. Immunohistochemically, the malignant cells have been shown to correspond to T lymphocytes. In addition, recent research supports the possible role of Epstein-Barr virus as a possible etiological factor. We present the case of a 67 year old man with an ulcerated palatinal lesion of recent appearance that was diagnosed as angiocentric lymphoma by histopathological and immunohistochemical study. Following diagnosis, treatment was provided in the form of 3 cycles of CHOP type chemotherapy and radiotherapy.

Langerhans' cell histiocytosis restricted to the oral mucosa.

Langerhans' cell histiocytosis comprises a group of disorders with Langerhans' cell proliferation as a common feature. The clinical presentation might be highly varied. Typically, there is bone involvement and, less frequently, lesions might be found in other organs, particularly the lungs, liver, lymph nodes, skin, and mucosae. Lesions limited to the oral mucosa are rare. We describe two patients with unifocal eosinophilic granuloma exclusively limited to the oral mucosa. Triamcinolone acetonide infiltration of a palatal lesion yielded a good result in one patient. Six months later, a similar lesion developed in the mandibular gingival mucosa, but it responded to the same treatment. The lesion in the other patient responded to local radiotherapy.

Psychologic factors and oral lichen planus. A psychometric evaluation of 100 cases.

OBJECTIVE: The purpose of this study was to analyze the importance of psychologic factors in patients with oral lichen planus, and attempts were made to identify possible personality features characteristic of patients with oral lichen planus. STUDY DESIGN: The study involved 100 patients with oral lichen planus (group 1) and 50 control subjects (group 2). We applied the following psychometric tests to both groups: Spielberger State-Trait Anxiety Inventory, Cattell Personality Questionnaire 16PF, Hassanyeh Rating of Anxiety-Depression-Vulnerability, Beck Depression Inventory, Raskin Depression Screen, and Covi Anxiety Screen. RESULTS: The patients with oral lichen planus were found to exhibit greater anxiety, as reflected by statistically significant scores with the anxiety tests that were used (Spielberger State-Trait Anxiety Inventory, Cattell Personality Questionnaire 16PF, Hassanyeh Rating of Anxiety-Depression-Vulnerability, and Covi Anxiety Screen). The patients with oral lichen planus likewise exhibited greater depression than the controls in all 3 depression tests applied (Beck Depression Inventory, Hassanyeh Rating of Anxiety-Depression-Vulnerability, and Raskin Depression Screen) and were more vulnerable to psychic disorders on the basis of the PD subscales (vulnerability) of the Hassanyeh questionnaire. Three features (conformity to the group, astuteness, and rebelliousness) defined the personalities of our patients with oral lichen planus, according to the Cattell 16PF questionnaire. Finally, those patients with erosive lichen planus exhibited higher depression scores than patients with nonerosive lichen planus. CONCLUSIONS: Despite the higher anxiety scores observed in patients with oral lichen planus, it was not established that the observed psychologic alterations constitute a direct etiologic factor of oral lichen planus; nor was it established that such alterations are a consequence of oral lichen planus and its lesions.

[Dental and salivary alterations in patients with liver cirrhosis: a study of 100 cases]. / Alteraciones dentales y salivales en los pacientes con cirrhosis hepática: estudio de 100 casos.

BACKGROUND: The aim of the present study was to investigate the existence of differences in dental status and in quantitative and qualitative salivary values between 100 patients with liver cirrhosis (LC) and a group of controls. MATERIAL AND METHODS: We analyzed the number of carious, missing and filled teeth. Also the unstimulated (UWS) and stimulated whole saliva flow rates (SWS) were determined, along with the stimulated parotid saliva flow rate (PSS) and the concentration in both UWS and SWS of sodium, potassium, total proteins and immunoglobulin A (IgA). RESULTS: A significantly higher number of carious and missing teeth was observed in the patients with cirrhosis (2.4 and 14.6, respectively) than in the control group (1.3 and 10.6, respectively), and a higher stimulated parotid flow rate with LC (0.64 and 0.44, respectively; p < 0.02) with a decrease in sodium and an increase in potassium, total proteins and IgA in patients with cirrhosis. In the LC group, caries were found to affect more teeth in those patients with alcohol-induced LC than in those with liver disease of other causes (3.9 and 1.7, respectively; p < 0.05), but in contrast, no differences were found in the saliva flow rate and the concentration in both UWS and SWS of sodium, potassium, total proteins and IgA. Finally, no relationship was observed between the dental status and functional hepatic tests. CONCLUSIONS: CH patients showed a worse dental status, a higher SPS rate and some electrolytes and proteins alterations.

Preliminary investigation of the association of oral lichen planus and hepatitis C.

OBJECTIVE: The aim of this investigation was to determine if an association exists between hepatitis C virus and oral lichen planus. STUDY DESIGN: Three groups of subjects were selected: 505 patients with hepatitis C virus infection (group 1), 100 patients with oral lichen planus (group 2), and a randomly selected control group (age- and gender-matched) of 100 healthy subjects (group 3). The prevalence of oral lichen planus was determined in groups 1 and 3, and the prevalence of hepatitis C virus infection was established in groups 2 and 3. RESULTS: The prevalence of oral lichen planus was 3.36% (n = 17) in group 1 and 1% (n = 1) in the control group; the prevalence of hepatitis C virus infection was 23% (n = 23) in group 2, and 5% (n = 5) in the control group. No significant differences were observed in the incidence of oral lichen planus in group 1 between those patients who received interferon and those who did not. The 17 patients in group 1 who manifested oral lichen planus and hepatitis C virus infection simultaneously exhibited a marked tendency to have only reticular lesions (70.6%), with involvement of the buccal mucosa in 88.2% of these patients, the tongue in 29.4%, and the gingiva in 11.8%. Analyzing a randomized subgroup of 143 patients from group 1 (subgroup 1) that was matched by age and gender with groups 2 and 3, we found that the incidence of oral lichen planus in patients with hepatitis C virus infection (subgroup 1) was greater than in the control group (5.59% vs 1%), though this was not statistically significant (chi2 = 0.119; p = 0.06). In contrast, group 2 exhibited a statistically significant higher incidence of hepatitis C virus infection (23%) than the controls (5%; chi2 = 0.259, p = 0.0002). CONCLUSIONS: The prevalence of hepatitis C virus infection in patients with oral lichen planus was greater than in the control series. In our opinion this observation warrants the investigation of potential concomitant hepatitis C virus infection in patients with oral lichen planus.

[Description of the habits of agricultural workers in relation to the applying of pesticides]. / Descripción de los hábitos de los agricultores en relación con la aplicación de plaguicidas.

OBJECTIVES: To find the habits of farm-workers when they apply these products, to detect dangerous practices, to find the most important defects in farm-workers' protection and to analyse the personal variables associated with the level of self-protection. DESIGN: Descriptive cross-sectional study. SETTING: Primary Care. Rural Health Centre. PARTICIPANTS: Farm-workers and spouses in our Health Area who underwent a health examination. MEASUREMENTS AND MAIN RESULTS: A questionnaire was designed specifically for the study and filled out by the doctor or nurse at the centre where the person interviewed was registered. 72.8% of the farm-workers had inadequate protection. 79.3% said they had suffered on some occasion symptoms related to pesticide use. CONCLUSIONS: In the rural health areas where there is intensive agriculture, exposure to pesticides is a major health problem, as these substances are hazardous and people applying them wear inadequate protection. Action strategies in this field involve integrating health at work services into health centres. Health education tasks have to be coordinated with the agricultural organisations in the area, such as associations for the defense of plants, cooperatives, etc.

[Symptoms related to the use of agricultural pesticides. The perspective from the primary care service]. / Síntomas relacionados con el uso de plaguicidas agrícolas. La perspectiva desde la consulta de atención primaria.

OBJECTIVE: To find whether agricultural workers seen in the general medical clinic attend due to symptoms connected with the use of pesticides. DESIGN: A crossover descriptive study comparing agricultural workers with a control group. SETTING: Primary care. PARTICIPANTS: The clinical histories of 40 agricultural workers and a control group (sample of 58 paired for age and gender) who had been seen over the previous year. MEASUREMENTS AND MAIN RESULTS: Age, gender, frequency of attendance, motives for consultation, risk factors and the number of consultations for symptoms possibly due to exposure to pesticides--in line with a previously composed list. There were no differences in frequency of attendance, overall reasons for consultation or risk factors. It was seen that agricultural workers consulted 4 times more than the control group for suspected pesticide poisoning (p = 0.0015). CONCLUSIONS: In our health area agricultural workers present symptoms which should probably be attributed to insufficient protection against pesticides. The primary care doctor working in rural zones where these products are heavily used must be able to identify these symptoms and take appropriate measures.

Oral lichen planus and diabetes mellitus. A clinico-pathological study.

A study was made of 72 patients with oral lichen planus associated (n = 28) or not with diabetes mellitus (n = 44). No significant differences were observed between both groups in terms of the location of the lichen planus lesions on the buccal mucosa, palate, gums or floor of the mouth. On the other hand, the diabetics exhibited a greater frequency of oral lichen planus on the tongue. Atrophic-erosive lesions were more common in patients with lichen planus associated with diabetes. Finally, no differences were observed between the two groups in terms of absolute inflammatory infiltrate in the connective tissue of the oral lichen planus lesions.