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Glucagonoma is a rare pancreatic tumor, necrolytic migratory erythema is its distinctive feature and it is often associated with diabetes mellitus, weight loss, anemia, hypoaminoacidemia, glossitis and stomatitis. We reported a case of glucagonoma misdiagnosed as "eczema" and "benign hepatic anginoma" for 3 years. His blood glucagon level was 1,758 ng/L. The results of abdominal B-mode ultrasonography and CT scan were negative, but selected arteriogram showed a tumor mass between the pancreatic body and tail. Before operation, treatment with octreotide and supply of amino acids were given with improvement of the skin lesion. After resection of the tumor from pancreas, necrolytic migratory erythema disapeared, but his blood level of glucagon and amino acids did not improve. It is suggested that any diabetic patient with chronic skin damage should be checked for blood glucagon level. In suspected cases, selected arteriogram will be helpful for location of the tumor. Vigorous resection of the pancreatic tumor should be done as soon as possible, even though there is already metastases.
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PMID:[Report of a case of glucagonoma misdiagnosed as "eczema" and "hepatic angioma" for three years and review of literature]. 764 42

Although several strains of Candida can infect the oral mucosa, the most commonly encountered oral fungal infection is Candida albicans, which may be highly infective because of its greater level of pathogenicity and adherence properties. C. albicans is an oral commensal in as many as 40% to 65% of healthy adult mouths. The papillated dorsal surface of the tongue and palatal mucosa beneath a maxillary denture are favored reservoir sites. Oral candidal infection almost always involves a compromised host. The compromise may be local or systemic. Local factors include decreased salivation and the weaning of dentures. Systemic factors include diabetes mellitus, pernicious anemia, and AIDS. Some have even implicated advanced age and the female gender as being mild predisposing factors. Furthermore, the C. albicans infection itself can depress a host's immune system. A patient with oral candidiasis can present with one or more of the following clinical forms: pseudomembranous, erythematous, hyperplastic, and denture erythematous. Many investigators accept median rhomboid glossitis as a form of chronic oral candidiasis. In some patients with angular cheilitis, genesis of the lesions is secondary to monilial infestation. Because C. albicans is a normal inhabitant in many mouths, diagnostic confirmation of infection often rests with successful response (i.e., resolution of lesions) to antifungal medications. This form of diagnostic confirmation can be further enhanced by culturing the offending microbe, preparing a fungal smear, or even incisional biopsy. The microscopic demonstration of fungal hyphae is highly diagnostic of the candidal infection, whether the hyphae are demonstrated on a PAS smear or on a biopsy within surface stratified squamous epithelium. Numerous medications exist for the treatment of oral candidiasis. They include the antibiotic nystatin as well as clotrimazole, ketoconazole, and fluconazole. Nystatin is safe and is used as a topical agent in rinse or pastille forms. Clotrimazole is used as a topical agent in lozenge form; it is highly effective but can cause liver enzyme changes. Ketoconazole, which is usually prescribed systemically, is highly effective but also capable of causing adverse liver changes. Chlorhexidine can be used as an oral rinse or as a disinfectant for dentures.
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PMID:Fungal infections of the oral cavity. 829 Feb 82

Glucagon-producing neuroendocrine tumors typically present with a characteristic constellation of symptoms including necrolytic migratory erythema, non-insulin-dependent diabetes, weight loss, anemia, glossitis, and an increased thrombotic tendency. Most glucagonomas are solid and arise in the body or tail of the pancreas. We report two cases of cystic glucagonoma, one found incidentally in an asymptomatic patient and one in a patient with weight loss and diabetes but no rash. In the first patient, distal pancreatectomy and splenectomy were curative, whereas the second patient continued to exhibit elevated serum glucagon levels and symptoms of glucose intolerance in the absence of demonstrable metastases. Cystic glucagonoma is a unique variant of classic glucagonoma and should be considered in the differential diagnosis of cystic pancreatic neoplasms.
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PMID:Cystic glucagonoma: A rare variant of an uncommon neuroendocrine pancreas tumor. 1045 11

Glucagonoma is a very rare islet cell tumor of the pancreas. We present a case of pancreatic tail tumor with the typical glucagonoma syndrome of necrolytic migratory erythema (NME), diabetes mellitus (DM), anemia, weight loss and glossitis. After complete resection of the pancreatic tumor, the glucagonoma syndrome subsided. In reviewing 120 cases of glucagonoma in the literature, the average tumor diameter was 3.6 cm. Most (68.1%) of the tumors occurred in the pancreatic tail. Two-thirds of the reported glucagonomas were malignant and 53.5% metastasized to other organs. The curative resection rate was 45.8%. A triad of pancreatic tumor, NME and DM should lead to the diagnosis of glucagonoma.
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PMID:Glucagonoma syndrome: a case report. 1050 56

Glucagonomas are alpha pancreatic islet cell tumors that, when they are active, produce a syndrome characterized by necrolytic migratory erythema, diabetes mellitus, weight loss, anemia, glossitis, thromboembolism, neuropsychiatric disturbances and hyperglucagonemia. We report a 43 years old male presenting with a five years history of dermatological lesions, associated with weight loss, glossitis and onicodystrophy. Serum glucagon was 2200 pg/ml and a CAT scan showed a tumor in the tail of the pancreas. The tumor was surgically excised but one year later, hepatic metastases were found. These were excised surgically, treated with long acting octeotride and finally treated with radiotherapy using Y-DOTATOC. In the last control in November, 2001, the patient is asymptomatic.
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PMID:[Glucagonoma: evolution and treatment]. 1219 91

Diabetes mellitus affects 5% of the population of Hungary. Its complications in the oral cavity include parodontosis and changes in the oral mucosa (leukoplakia, lichen oris and glossitis). The incidence of leukoplakia (the most frequent precancerous state in the oral cavity) is 2.2% in the normal population, 6.2% among diabetics, and 11.5% among diabetic who smoke. The various forms of leukoplakia in the oral cavity become malignant in 5-20% of the cases, while the erosive, ulcerative lesions do so in 15-20% of the cases. These data led us to examine the blood glucose levels in 318 patients with histologically confirmed malignant tumours in the oral cavity. Diabetes mellitus was found in 56 of them (17.5%), the blood glucose level being elevated in 31 cases (9.75%). The fact that the incidence of diabetes mellitus among these patients was more than 3 times higher than that for the normal population demonstrates that further studies should be performed on the connection between diabetes mellitus and malignant tumours in the oral cavity.
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PMID:[Incidence of diabetes mellitus in patients with malignant tumors of the oral cavity]. 1258 41

Glossopyrosis (Glossodynie, Burning mouth syndrome) is not a independent diagnosis it is only a symptom of a lot clinical pictures. Local diseases like glossitis, allergies and tumors of the tongue are best known from ENT-doctors. But there are also gastrointestinal, immunologic, neurologic, psychiatric and dermatologic diseases cause glossopyrosis. Glossopyrosis may be the first symptom of HIV infection, Diabetes or a depression long before manifestation of the full clinical picture. Also dental materials and drugs are iatrogenic factors for glossopyrosis. The multifarious differential diagnosis were described and discussed.
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PMID:[Glossopyrosis--diagnosis and therapy]. 1594 62

Oral manifestations of diabetes mellitus have been documented, but the effect of glycemic control on the oral tissues has been scantily reported. The oral health status of 65 metabolically controlled adult diabetic patients attending the Diabetes Clinic of Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria, was prospectively assessed over six months and compared with that of 54 non-diabetic acting as controls. The mean duration of diabetes was 100.5+/-85.1 months. The difference in periodontal status of the patients and control, assessed using the Community Periodontal Index of Treatment Needs (CPITN), was not statistically significant (p=0.07). The degree of hyposalivation between the two groups was, however, statiscally significant (p<0.05). No significant difference was observed in the altered taste, burning mouth sensation, angular cheilitis, glossitis, and stomatitis status of the two groups. We conclude, with adequate metabolic control, the oral health status of a diabetic may not be significantly different from that of a non-diabetic except for xerostomia. A good understanding of the interactions between systemic diseases and oral health is imperative for physicians and dental practitioners. The need for early detection and closer linkages between the dental and medical professions in managing diabetic patients is emphasized.
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PMID:Oral health status in a population of Nigerian diabetics. 1629 9

Diabetes Mellitus (DM) is a multisystemic disorder with serious complications and these patients may also have serious problems with their oral cavity probably because of the microangiopathic and neuropathic complications. In diabetic patients, there may be several problems of the oral cavity such as gingivitis, periodontitis, candidiasis, glossitis, oral ulcerations, loss of taste sensations, opportunistic infections and several other conditions dependent on these. One of the recent theories about complications in DM is the contribution of reactive oxygen radicals. Paraoxonase (PON1) is an enzyme that is synthesized in liver and having the capability of hydrolasing the active metabolite of an insectisid, parathion. Previously it was shown that there are two polymorphic areas on the PON1 gene: one causing a Leu --> Met substitution at 55th position, the other causing Gln --> Arg at the 192nd position. We investigated the differences in PON activities related to the oral lesions in Type 2 diabetics and control subjects to see their relationships with PON1 activity levels and the two main gene polymorphisms of PON1 genes, PON1 192 and PON1 55. We had 51 patients and 53 healthy subjects used in the study. PON activity was significantly decreased in Type 2 DM group compared to the control group. Neither PON1 192 nor PON1 55 genotypes had any differential effect on PON1 enzyme activity levels in either group. However, we found that PON1 55 M allele carriers had greater risk for general periodontal and/or gingival problems.
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PMID:The relationship of oral disturbances of diabetes mellitus patients with paraoxonase gene polymorphisms. 1900 35

The mucosal membrane of the oral cavity displays at times classical developmental lesions considered to be variations of normal structures rather than having disease characteristics. Of these lesions leukoedema, Fordyce granules, geographic-, fissured- and hairy tongue, median rhomboid glossitis and lingual varices were studied in 598 patients referred to the School of Dentistry, Tehran, Iran. The prevalence was studied in relation to age, gender, occupation, education, smoking habits, general health, addictions and or drug therapies. Oral developmental lesions were seen in 295 patients (49.3%). Only Fordyce granules (27,9%), fissured tongue (12,9%), leukoedema (12,5%) and hairy tongue (8,9%) had enough cases for statistical analysis. Three of these lesions increased with age but not fissured tongue. All were more common in men. After adjusting for age, the parameters education, occupation and complaints upon referral had little influence on the prevalence of the lesions. Fewer Fordyce granules were seen in oral mucosa of smoking men. Leukoedema and hairy tongue were significantly associated with smoking, leukoedema with diabetes mellitus. We conclude that there was a highly significant association between these oral lesions and age, gender and smoking. Few significant associations were found between oral lesions and general diseases.
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PMID:Evaluation of oral mucosal lesions in 598 referred Iranian patients. 1944 43


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