[White lesions: diagnosis and cryotherapy].
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Biomedical subjects
Publications and source records attributed to G Fiore-Donno.
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The authors report a case of apparently primary amyloidosis in which macroglossia was the clinical presentation, confirmed by lingual biopsy. They take advantage of this case to review the therapeutic possibilities, though stating that from a stomatological standpoint there is virtually nothing available.
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The four maxillary incisors and two maxillary premolars of a 25-year-old male patient were used to study epithelial and connective tissue attachment 67 days and 164 days after flap surgery and cutting of an horizontal intradentinal groove near the buccal cervical region. Three teeth were topically conditioned for 3 minutes with citric acid pH = 1. The three other teeth were used as controls. The histologic examination was carried out in double-blind conditions; the examiners did not know which specimens were acid treated until the end of the study. Two of the three cases treated with citric acid showed improved healing conditions, when compared to the controls; a more coronal position of the epithelial attachment in the dentin nick as well as a relatively important gain in connective tissue attachment. Two types of connective tissue attachment were observed. The first consisted of an attachment to dentin, without cementum formation and was characterized by a mineralization of decalcified dentin collagen spliced with collagen, newly secreted by fibroblasts. The second type involved cementum formation. Topical citric acid treatment, however, can not be considered as a completely reliable clinical procedure since in one experimental case the type of attachment observed was not better than that seen in the control.
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Described by Lloyd and Dennis in 1963, Cowden's disease is a familial affection in which are found associated lesions of the buccopharyngeal mucosa (papillomatosis, papules, scrotal tongue), various types of skin lesions (verruciform keratotic papules, papilloma, lipoma, angioma, etc...), visceral manifestations usually related to lesions in the thyroid, breasts, or digestive tract (hamartoma or malignant tumors), and skeletal dysmorphism. The two patients were from different families, were aged 65 and 28 years, and had presented for consultation because of buccal mucous membrane papillomatosis, and in one case, hemorrhagic gingivitis. Cowden's disease was diagnosed from the clinical examination, past history, and investigations after hospital admission. The main value of the mucosal and cutaneous lesions is their diagnostic significance, enabling a synthesis of the multiple dispersed manifestations to be made, and a possible visceral tumor to be discovered in the early stages.
Stomatodynies are functional manifestations often observed in anxious and depressive individuals, in the form of glosso-, cheilo-, uranodynia. It may show itself in disturbances of the mucosa or of salivary secretion. It is necessary to reassure the patients, to explain the nature of the disease and to prevent them from autotherapy of local or psychic factors.
Means to detect pemphigus vulgaris at an early stage are described. Its grave evolution in absence of treatment makes an early diagnosis imperative. The first signs are frequently localized in the oral mucosa and sometimes the disease remains confined to this mucosa only. Efficient and early therapy may favourably influence the course of disease, and the dentist is in a prime position to detect the characteristic lesions.
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The clinical, radiological and histological aspects of acute histiocytosis X of Letterer-Siwe disease are reviewed after personal observation of such cases. In spite of many advanced hypotheses the etiopathogenesis of Histiocytosis X is wide open to research. The diagnosis became possible by the discovery of histiocyte cells of a special order, the X-bodies, under the E. M. Recent research allows a classification of Letterer-Siwe disease, Hand-Schüller-Christian disease, and the eosinophilic granuloma under the same nosologic grouping. Finally, the prognosis of the Letterer-Siwe disease-so far much in the dark-may be improved by a properly conducted therapy.
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These 8 cases of multiple hamartoma syndrome are the first reported in Switzerland. Two men aged respectively of 65 and 28 years presented a cobblestone appearance of the gingiva and of the tongue ("pebbly tongue"), which suggested Cowden disease. This diagnosis was confirmed by the discovery of numberous skin lesions, a thyroid goiter, gastrointestinal polyposis, and a mild skelettal dysmorphosis. The older patient had a grade one carcinoma of the bladder; his son and his daughter presented the syndrome, which was also discovered in the family of the second patient (his father, his brother, his sister and one of her daughters). The ultrastructural study of two skin biopsies demonstrated anomalies of the fibroblasts and collagen fibers.