[Studies on improvement of the diagnosis of salivary gland diseases].
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The authors retrospectively reviewed 45 gallium-67 citrate scans of 28 patients infected with the human immunodeficiency virus (HIV). Abnormal salivary gland radiotracer activity was seen in 13 patients with diffuse infiltrative lymphocytosis syndrome (DILS), five patients with undifferentiated salivary gland disease (USD), and 10 patients with acquired immunodeficiency syndrome (AIDS). More DILS patients (54%) had intense gallium uptake than did the AIDS and USD patients combined (13%) (P less than .05). DILS patients had markedly elevated CD8 cell counts and moderately reduced CD4 cell counts, while AIDS patients had normal CD8 cell counts and markedly reduced CD4 cell counts. These differences were statistically significant (P less than .05). The authors recommend that DILS be considered in the differential diagnosis when abnormal, particularly intense, bilateral salivary gland gallium uptake occurs in HIV-infected patients. This disease is more likely to occur when circulating CD8 lymphocytosis is present, while AIDS is the more likely diagnosis when the patient has a normal CD8 cell count and a markedly depressed CD4 cell count.
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Functional digital subtraction sialography with a water soluble radiopaque agent (verografin) made it possible to investigate the structure and functional changes in the salivary glands of 26 patients with a minimum injury of the glands. The method permitted a decrease in a dose of the agent 4 times as compared to routine sialography; the consumption of x-ray film was decreased 5-fold. Digital processing of images helped avoid superimposing of the cranial bone components, improving the quality of images of the salivary glands. The method is indispensable during differential diagnosis, especially at early stages of diseases of the salivary glands.
PURPOSE: This article describes the use of endoscopy for diagnostic and surgical intervention in the major salivary glands of patients who have obstructive pathology, reviews past experience with this technique, and describes the microanatomy and pathophysiologic findings encountered during endoscopy of these glands. PATIENTS AND METHODS: A total of 154 salivary glands (96 submandibular glands, 57 parotid glands, 1 sublingual gland) suspected of having obstructive pathology (89 males, 65 females; aged 5 to 72 years) were treated using a mini-endoscope. Most procedures were performed under local anesthesia in an outpatient clinic. All patients underwent preoperative and postoperative screening by routine radiography, sialography, and ultrasound. The indications for endoscopy were: 1) calculus removal that could not be performed by conventional methods, 2) screening of the salivary ductal system for residual calculi after sialolithotomy, 3) positive evidence of ductal dilatation or stenosis on the sialogram or ultrasound examination, and 4) recurrent episodes of major salivary gland swellings without known cause. RESULTS: Of the 154 endoscopies performed, 9 were immediate failures as a result of technical problems. Of the remaining 145 glands, 112 had obstructions and 33 had sialadenitis alone. The success rate was 82% for calculus removal. Thirty-two percent of the submandibular and 63% of the parotid sialoliths, and the 1 stone in the Bartholin's duct, were undetected before sialoendoscopy. Multiple endoscopic findings were encountered. No major complications were noted. CONCLUSIONS: Sialoendoscopy is a minimal invasive technique for the diagnosis and removal of obstructive pathologic tissue in the major salivary glands.
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