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Biomedical subjects

M M Schubert

Publications and source records attributed to M M Schubert.

At least 37 records · Page 2Linked to original sources
PubMed1992

Clinical assessment scale for the rating of oral mucosal changes associated with bone marrow transplantation. Development of an oral mucositis index.

Oral complications can be serious and disabling problems for patients undergoing cancer therapy. Therefore, the authors wanted to develop a sensitive and specific instrument to measure oral mucosal changes during therapy. The Oral Mucosa Rating Scale (OMRS) has an examination rating scale to quantify the type and severity of clinically evident oral mucosal changes (atrophy, erythema, ulceration, and pseudomembranous, hyperkeratotic, lichenoid, and edematous changes), with a scale ranging from 0 to 3 (normal to severe). Separate visual analogue scales are obtained for oral pain and dryness. One hundred eighty-eight bone marrow transplant recipients were studied from before transplant through day 42 after transplant. The OMRS then was used to develop a specific index for assessing acute oral mucositis after bone marrow transplant--the Oral Mucositis Index (OMI). The OMI internal consistency measures (Chronbach alpha and Guttman split-half coefficients) were strong (range, 0.84 to 0.93). Support for the validity of the OMI is presented. These scales should help improve the study of oral complications of cancer therapy.

Adult↗
PubMed1991

Oral manifestations of viral infections in immunocompromised patients.

Viral infections are a significant cause of morbidity and mortality in immunosuppressed patients. It is clear that diseases or medical treatments that have cytostatic or cytotoxic effects on lymphocytes and disrupt cytokine production or activity increase the risk of viral infections. While the rate of viral infection varies with the nature and degree of immunosuppression, it is clear that reactivation of latent virus is the most important determinant of the types of viral infections most frequently noted in immunosuppressed patients result from the reactivation of latent virus. Herpesviruses account for the majority of oral viral infections. Herpes simplex virus, varicella-zoster virus, and Epstein-Barr virus infections nearly always result from reactivation of latent virus, while cytomegalovirus infections, besides presenting as reactivated disease, are almost as likely to present as a primary infection in susceptible hosts. Other viral pathogens potentially of concern in immunocompromised patients are enteric viruses (adenoviruses and coxsackieviruses), human papillomaviruses, and possibly the recently identified human herpesvirus type 6. Ninety-eight percent of herpes simplex virus lesions are caused by reactivated disease and tend to be characterized by large, very painful ulcerative lesions throughout the mouth. Varicella-zoster virus is also rarely seen as primary infection, and the herpes zoster lesions involving cranial nerves can cause significant morbidity, including postherpetic neuralgia, corneal scarring, cranial nerve palsies, and deafness. Distinct oral ulcerative lesions caused by Epstein-Barr virus and cytomegalovirus have only recently been described in detail and are usually associated with disseminated disease. Oral human papillomavirus lesions are noted as warts and condylomas. The contribution of enteric viruses and human herpesvirus type 6 to oral disease in immunosuppressed patients is yet to be determined.

Cytomegalovirus↗
PubMed1990

Oral and pharyngeal herpes simplex virus infection after allogeneic bone marrow transplantation: analysis of factors associated with infection.

This study analyzed factors associated with acute oropharyngeal herpes simplex virus (HSV) infection in 627 patients who had undergone allogeneic bone marrow transplantation for leukemia, lymphoma, or aplastic anemia. HSV infection developed in 233 (37%) of the patients; all but two were seropositive for HSV before transplant. Sixty-two percent of the seropositive patients had at least one episode of HSV reactivation during the first 100 days after transplant. Other factors that placed patients at increased risk for HSV infection were a pretransplant diagnosis of leukemia, being in remission at the time of transplant, and/or having been conditioned for transplant with chemoradiotherapy. Recognition of factors that may predispose patients to HSV infection helps determine those transplant recipients who might benefit most from antiviral prophylaxis or other approaches to prevention of HSV reactivation.

Adolescent↗
PubMed1990

Cyclic nucleotide responses in control and cystic fibrosis labial glands.

Adenosine 3',5'-cyclic monophosphate (cAMP) and guanosine 3',5'-cyclic monophosphate (cGMP) levels were measured in labial gland slices from controls and patients with cystic fibrosis (CF). Incubation in vitro with 10 microM epinephrine, 50 microM isoproterenol, or 10 microM carbachol increased cAMP levels by 2.3-fold, 3.1-fold, and 1.8-fold, respectively, in control glands and by similar amounts in CF glands. The only statistically significant CF-related difference was a decreased response to isoproterenol. Addition of MIX (3-isobutyl-1-methylxanthine) increased cAMP levels in control and CF glands by an order of magnitude under all conditions but did not eliminate the CF-related decrease in cAMP level obtained with isoproterenol. cGMP levels were measured only in the presence of MIX. Incubation with carbachol nearly doubled cGMP levels in control and CF glands but only the control gland response approached statistical significance (P = 0.06). cGMP levels in CF glands were nearly threefold greater than those in control glands, and disease-related differences obtained in the presence of carbachol and isoproterenol were statistically significant.

1-Methyl-3-isobutylxanthine↗
PubMed1990

Recognition, incidence, and management of oral graft-versus-host disease.

Acute and chronic graft-versus-host disease (GVHD) are significant complications of allogeneic bone marrow transplantation that occur when immunologically active T-cell lymphocytes are transplanted into an immunosuppressed recipient who is genetically disparate from the marrow donor. Oral GVHD lesions closely resemble those seen with a number of autoimmune connective tissue disease, including lichen planus, systemic sclerosis, lupus erythematosus, and Sjögren's syndrome. Mucosal erythema, atrophy, and ulceration are noted clinically; lichen planus-like lesions are the most distinctive oral lesions. Salivary gland changes include changes in both flow rate and sialochemistry. Oral involvement ranges between 33% and 75% for patients with acute GVHD and upwards of 80% for those with chronic GVHD. Management of oral GVHD lesions depends on successful systemic therapy, although topical steroids can be of help in some instances.

Acute Disease↗
PubMed1990

Gynecological abnormalities following allogeneic bone marrow transplantation.

Forty-four post-pubertal women were studied 261-4628 days after allogeneic transplantation to determine the nature and degree of gynecological abnormalities following bone marrow transplantation. Evaluations included pelvic examinations, exfoliative cytology, serum gonadotropin levels, direct preparations for micro-organisms, and microbial cultures. Pelvic abnormalities were detected in 35 of 44 (80%) women and resembled atrophic changes known to occur after ovarian failure. Findings included reduced vaginal elasticity and rugal folds, pale tissues, small vaginal, uterine and cervical size, atrophic vulvovaginitis, introital stenosis, and loss of pubic hair. Atrophic abnormalities were noted in 33 of 36 recipients of total body irradiation (TBI) compared to two of eight women not prepared with TBI (p = 0.02). Vasomotor symptoms were reported in 67% of TBI recipients compared to 38% of those not given TBI. Elevated serum gonadotropin levels suggested that TBI had caused the ovarian failure. Recognition of these gynecological abnormalities can lead to earlier hormone replacement, alleviating unnecessary discomfort and improving the well-being of the marrow transplant recipient.

Adolescent↗
PubMed1989

Potassium release in labial glands from controls and patients with cystic fibrosis.

Labial glands from patients with cystic fibrosis (CF) were tested for a disease-related decrease in cholinergically-induced K release. Labial gland slices from normal controls and patients with cystic fibrosis were incubated in vitro in the presence or absence of cholinergic and adrenergic agonists and with or without a phosphodiesterase inhibitor. Both control and CF glands released K in response to cholinergic stimulation only; no K release response was detected to alpha- or beta- adrenergic stimulation. In contrast to previous results reported for parotid glands, no CF-related decrease in cholinergically-induced K release was detected. Both normal and CF glands released significantly less K with carbachol stimulation in the presence of the phosphodiesterase inhibitor. Overall, the results suggest considerable interglandular differences in disease sensitivity and functional regulation of K release.

1-Methyl-3-isobutylxanthine↗
PubMed1988

Early oral changes following bone marrow transplantation.

This study assessed and analyzed the early oral changes following chemoradiotherapy and bone marrow transplantation. The most notable changes involved mucosal color (white and red), atrophy, vascularity, ulceration, increased salivary viscosity and xerostomia, and the patients' subjective complaints of dryness and oral pain. The ventral tongue, buccal and labial mucosa, and marginal gingiva manifested the most notable changes, while the palate was least affected. The overall trend was for the oral changes to begin slightly before transplantation, to worsen over the first 2 weeks after transplantation, and then to resolve progressively over the remainder of the study period. These oral changes appear to result from a number of insults, including the conditioning chemoradiotherapy, posttransplant immunosuppressive chemotherapy, xerostomia, local trauma, oral infections (especially those caused by HSV), and possibly acute GVHD. Oral HSV infection and/or acute GVHD should especially be considered if the oral status markedly worsens 21 days or more after transplant.

Adolescent↗
PubMed1987

Use of human minor salivary glands in basic and applied secretion research.

Previous findings from studies utilizing human labial and palatine minor salivary glands are reviewed. These studies took histopathological, biochemical, and ultrastructural approaches, and focused on control and diseased glands. Disease-oriented summarization are used, and control results are discussed in the context of disease-related findings. Findings are reviewed separately for electrolytes, macromolecules, and ultrastructure. In control subjects, minor gland salivary electrolyte concentrations are dependent on flow rate, and this dependence may be altered by diseases such as cystic fibrosis as well as by inflammatory situations such as graft-versus-host disease. There is also evidence that salivary electrolyte secretion processes are not similar in labial and palatine minor glands. Studies of salivary macromolecular composition are reviewed for control subjects and for patients with graft-versus-host disease and Sjögren's syndrome. The findings indicate that the macromolecular contents of labial and palatine gland saliva are similar, but that both are significantly different from that for major gland saliva. Finally, studies attempting to measure disease-related changes in intracellular composition are reviewed. It is concluded that the minor salivary glands are important models for the study of exocrine gland physiology and pathophysiology in man.

Cystic Fibrosis↗
PubMed1987

Iatrogenic causes of salivary gland dysfunction.

Saliva is important for maintaining oral health and function. There are instances when medical therapy is intended to decrease salivary flow, such as during general anesthesia, but most instances of iatrogenic salivary gland dysfunction represent untoward or unavoidable side-effects. The clinical expression of the salivary dysfunction can range from very minor transient alteration in saliva flow to a total loss of salivary function. The most common forms of therapy that interfere with salivation are drug therapies, cancer therapies (radiation or chemotherapy), and surgical therapy. These therapies can affect salivation by a number of different mechanisms that include: disruption of autonomic nerve function related to salivation, interference with acinar or ductal cell functions related to salivation, cytotoxicity, indirect effects (vasoconstriction/dilation, fluid and electrolyte balance, etc.), and physical trauma to salivary glands and nerves. A wide variety of drugs is capable of increasing or decreasing salivary flow by mimicking autonomic nervous system actions or by directly acting on cellular processes necessary for salivation: drugs can also indirectly affect salivation by altering fluid and electrolyte balance or by affecting blood flow to the glands. Ionizing radiation can cause permanent damage to salivary glands, damage that is manifest as acinar cell destruction with subsequent atrophy and fibrosis of the glands. Cancer chemotherapy can cause changes in salivation, but the changes are usually much less severe and only transient. Finally, surgical and traumatic injuries interfere with salivation because of either disruption of gland innervation or gross physical damage (or removal) of glandular tissue (including ducts).

Bone Marrow Transplantation↗
PubMed1987

Direct ultrastructural evidence of target-directed polarization by cytotoxic lymphocytes in lesions of human graft-vs-host disease.

Cytotoxic lymphocytes are thought to kill target cells by means of potent cytotoxic granules that congregate near the microtubular organizing center and the Golgi apparatus at one pole of the killer cell. We searched for evidence of this type of polarization in 12 lip biopsy specimens from patients with acute and/or chronic graft-vs-host disease (GVHD) compared with two lip specimens from normal individuals. Lymphocytes with such polarization were found in contact with epithelial cells of the squamous mucosa in all 12 cases of GVHD, and cells of the cuboidal minor salivary duct epithelium were found in two of 11 evaluable cases. The data add support to the hypothesis that cytolytic lymphocytes attack epithelial cells in GVHD.

Adolescent↗
PubMed1987

The use of benzydamine HCl for the management of cancer therapy-induced mucositis: preliminary report of a multicentre study.

A multicentre study was undertaken to determine the effectiveness of benzydamine, a non-steroidal antiinflammatory drug, in relieving oral pain and inflammation due to cancer chemotherapy or chemoradiotherapy-induced mucositis. Benzydamine or placebo mouthwash was administered in a double-blind fashion to patients with established mucositis who complained of at least moderate mucositis pain. Preliminary review of the data reveals encouraging trends, subjects who received benzydamine consistently reporting more effective pain relief than those receiving placebo. Benzydamine mouthwash provided good to excellent relief of oral mucositis pain when rated by patients after one day (68% vs 47%) and by examiners both after one day (60% vs 40%) and overall (60% vs 42%). When only very good to excellent responses were considered, observer impressions of benzydamine's effectiveness were found to be statistically significant (p less than .04). These initial results are encouraging and, though not all results are statistically significant, appear to support the potential usefulness of benzydamine mouthwash in managing oral mucositis due to cancer therapy.

Administration, Topical↗
PubMed1986

Head and neck aspergillosis in patients undergoing bone marrow transplantation. Report of four cases and review of the literature.

Aspergillus infection can be a major cause of morbidity in immunocompromised patients, especially when there is pulmonary involvement. Diagnosis of aspergillosis is often complicated by the varied clinical presentation and compromised medical status of such patients. Four cases of head and neck Aspergillus infections in bone marrow transplant patients are presented. Involvement predominantly was limited to the oral cavity and/or sinuses, and in one case, the ear. Two cases were successfully managed with a combined antibiotic and surgical approach, and one case with antibiotics only. The fourth case was managed with antibiotics and surgery, but fatal hemorrhage secondary to sinus involvement developed.

Adult↗
PubMed1985

Graft versus host disease-related secretory immunoglobulin A deficiency in bone marrow transplant recipients. Findings in labial saliva.

Graft versus host disease-dependent decreases in salivary IgA levels were sought in labial gland saliva samples from bone marrow transplant recipients. Transplantation-associated, irradiation-related effects were also present, but these could be avoided if analyses were performed at 1 year or later after transplantation. Sampling of minor gland saliva eliminated the possibility of contamination with IgA-rich serum transudates arising from gingival or mucosal pathways which obscured results from previous studies using whole saliva samples. Patients with active extensive clinical disease had significantly depressed levels of salivary IgA. Since labial saliva is a principal source of total salivary IgA, the present findings may explain why patients with graft versus host disease are susceptible to infection via the sinobronchial portal.

Adult↗
PubMed1984

Cognitive modification of pain: information in combination with N2O.

The present study sought to discover whether information clarifying how the analgesic/sedative drug nitrous oxide (N2O) works would result in increased analgesic responses to painful stimuli when various concentrations of N2O were administered. Subjects were provided with high and low levels of information regarding the action and use of N2O as an analgesic and sedative. Absolute sensation threshold (AST), pain threshold (PTh), and pain tolerance (PTo) to tooth pulp shock were measured in microamperes during administration of each of 3 concentrations of N2O (15%, 30%, and 45%, with oxygen). Subjects rated stimulus intensity and stimulus aversiveness in response to a fixed painful stimulus, and completed questionnaires regarding the perceived efficacy of N2O and their subjective mood state throughout the session. The marked differences observed in pain reports between the high information group and the control group confirm that providing information to people receiving a drug for pain relief yields higher sensation thresholds, pain thresholds, and tolerance of pain. In addition, we observed that in the presence of N2O an equivalent fixed painful stimulus will be perceived as less painful after appropriate information is provided. These findings suggest that experimentally influencing thought processes, in combination with an analgesic, can have the effect of increasing analgesia.

Adult↗