Amalgam-related chronic ulceration of oral mucosa.
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Biomedical subjects
Publications and source records attributed to M Jolly.
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Thirty-eight healthy white British Caucasian subjects were hydroxylator phenotyped with sparteine and acetylator phenotyped with sulphadimidine. The results showed that there was no significant difference in the mean sparteine metabolic ratio between eight rapid acetylator extensive hydroxylators and 27 slow acetylator extensive hydroxylators.
By means of small waterproof chambers held on the backs of rats with adhesive, areas of skin were exposed continuously to sterile distilled water for I-, 2-, and 3-day periods. All test areas showed discernible changes and many exhibited vesicles, bullae or abscesses in the epidermis. Dermal changes ranged from mild inflammatory cell infiltration to severe oedema and haemorrhagic inflammation.
Seven cases of the erosive type of lichen planus, as well as normal tissue, were studied with the optical and electron microscope. The study was concerned with the distribution and formation of colloid bodies. These bodies were located at the epithelial-proprial junctions and occasionally inter-epithelially. They were seldom larger than basal epithelial cells and were macrophages which contained fragments of phagocytosed epithelial cells. They probably correspond to cytoid bodies which have a similar size and a similar distribution.
Superficial, transitional and polygonal buccal epithelial cells from patients with the erosive type of lichen planus were compared with similar cells from non-keratinizing human buccal mucosa. Transitional cells from non-keratinizing buccal mucosa had glycogen lakes and membrane-coating granules with electron dense cores. Surface cells were not keratinized and pathological cells were less granular. In lichen planus membrane-coating granules were numerous, markedly electron dense, and some showed an internal lamellar structure. Surface cells were keratotic or parakeratotic. Processes of macrophages were associated with the pathological membrane-coating granules.
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Correction of proven vitamin deficiencies in patients with oral lichen planus resulted in both clinical and subjective improvement in the majority treated but did not produce complete remission of the lesions. The common finding of low levels of vitamins B1 and B6 in both the lichen planus group and in healthy controls suggests that this is a reflection of dietary habits of the local community not generally appreciated.
Several factors influence substantially the order of accuracy of oral biopsy procedures. This paper evaluates some of these factors and suggests methods whereby accuracy can be improved. The surgeon's responsibility extends beyond the operating theater and into the laboratory if maximum value is to be derived from each biopsy specimen. It is suggested that present sucess rates of surgical treatment of oral carcinoma can be improved by attention to laboratory procedures by the clinician.
Cryosurgery offers a means of destroying tissue by subjecting it to extreme cold. The mechanisms by which cells die are as yet poorly understood, but reliable and predictable clinical results have been obtained in the treatment of a wide range of benign and premalignant oral lesions. Its effectiveness in the primary treatment of malignant oral lesion has not been adequately assessed but at least it offers palliation and relief of intractable pain where conventional cancer therapy has failed. The use of carbon dioxide 'snow' has been tested and found to be a simple and effective means of treating superficial benign lesions of the mouth.
The term premalignant lesion is defined and an explanation of the logical use of the term leukoplakia is given. The more common premalignant lesions of the mouth are described. Known and suspected aetiological factors in the development of oral carcinoma are discussed. It is emphasised that oral squamous cell carcinoma is, very largely a preventable disease. Signs of premalignancy in the mucosa can usually be detected clinically and remedial action at an early stage is generally effective in eliminating the lesions and avoiding their recurrence.
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