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 8,852 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Prevention and treatment of oral disease is required to maintain quality of life and to improve prognosis of patients infected with the human immunodeficiency virus (HIV). Management requires a team approach, and close collaboration with the appropriate responsible physicians and other health care workers is necessary. Oral infection is frequent and usually opportunistic, and management is based on certain principles. Infections may disseminate and can be persistent and severe; multiple concurrent or consecutive infections with different microorganisms are frequent; fungal, viral, and parasitic infections are rarely curable; and long-term antimicrobial therapy may be required. This article reviews the management of oral candidiasis, hairy leukoplakia, and infections with herpes simplex virus, varicella-zoster virus, and cytomegalovirus. The management of Kaposi's sarcoma, lymphomas, aphthous ulceration, gangrenous stomatitis, bleeding, xerostomia, and adverse drug reactions is also described. Treatment should avoid further immunosuppression and inducement of xerostomia or caries, and should be designed to avoid adverse drug reactions and possible drug interactions.
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PMID:Management of oral health in persons with HIV infection. 131 92

Oral manifestations of HIV infection in children include oral candidiasis, herpetic stomatitis, oral hairy leukoplakia, parotid gland swelling, and other bacterial, viral and mycotic infections. The frequency and natural history of those disorders are not fully defined. The purpose of this work is to inform the oral findings in 57 HIV infected children studied at the Hospital Infantil de Mexico. All 57 patients presented nonspecific gingivitis; however it was not feasible to associate it with the HIV infection; in 28 oral candidiasis was observed, and in 3 cases herpetic stomatitis was documented. Oral candidiasis was found regardless the patient's sex, age, clinical stage, treatment, and mode of transmission of the HIV infection. It has been considered that oral candidiasis is a good marker of immunodeficiency; however, in our patients this correlation was not observed. Also, other HIV-associated oral manifestations were not observed in these cases. The severity and rapid clinical course presented by our patients, may explain both, the lack of correlation between candidiasis and immunodeficiency as well as the absence of other lesions.
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PMID:[Oral manifestations in HIV positive children]. 138 84

By tradition oral candidosis has been classified into acute pseudomembranous (thrush), acute atrophic, chronic atrophic, and chronic hyperplastic types. However, pseudomembranous candidosis is not always acute but may last for many months. Furthermore, the value of using the term atrophic to describe an erythematous area is limited. Moreover, some of the various types have been associated with other clinical entities, which appear to have a combined bacterial/mycologic etiology. A revision of the classification should be based on the use of clinical terms, and in a previous study of multifocal oral candidosis, erythematous, plaque-like, and nodular forms were identified. A revised classification of oral candidosis which considers these aspects could be as follows: acute types: pseudomembranous and erythematous; chronic types: pseudomembranous, erythematous, plaque-like, and nodular; and Candida-associated lesions: denture stomatitis, angular cheilitis, and median rhomboid glossitis.
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PMID:Classification and clinical manifestations of oral yeast infections. 218 11

Chlorhexidine's structural characteristics give it potent antimicrobial activity, effectiveness at low concentrations, substantivity that prolongs its therapeutic effect in the oral environment, minimal resorption from the gastrointestinal tract, and the ability to reduce plaque. The use of this agent for oral stomatitis in neoplasia patients has recently been studied. Treatment-associated oral soft tissue inflammation and ulceration were significantly reduced by chlorhexidine in patients undergoing intensive chemotherapy. Reductions in total streptococci and yeast counts were also observed. When used in conjunction with systemic antifungal agents, such as nystatin or clotrimazole, a significantly decreased incidence of clinical oral candidiasis and Candida septicemia was observed. In contrast, in two studies in which high-dose head and neck radiation therapy was applied, there was no reduction in stomatitis. Oral gram-negative bacilli have been shown to increase in high-dose chemotherapy patients who are taking chlorhexidine during the treatment period (3 wk to 2 mo). However, no increase in systemic gram-negative infections or other adverse negative medical consequences were observed. This agent appears to be of therapeutic benefit in reduction of dental plaque, gingivitis, and stomatitis in the high-risk chemotherapy population when used in conjunction with other topical and systemic antimicrobial agents as prophylaxis. Although no toxic or serious adverse effects of chlorhexidine rinse have been observed in the short-term studies to date, the effects of longer-term chlorhexidine administration should be evaluated.
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PMID:Oral antimicrobial agents--chlorhexidine. 218 58

The human oral mucosa atrophies with aging, and at the same time, loss of teeth occurs and the muscles involved in mastication weaken, leading to masticatory hypofunction. The loss of teeth in animal is serious in that it leads to death. For humans, however, dental prosthesis may aim at functional recovery. From the viewpoint of oral functional recovery, it is important to have a firm grasp of the change in the oral environment with aging. Elderly patients who complain of dry mouth may often have glossodynia, stomatitis, dysgeusia, prosthetic disorder, etc. Although atrophy of the salivary gland is mainly responsible for these disturbances, influences of complications and/or medications cannot be ignored. Secretory immunoglobulin A (sIgA) secretion in the saliva of elderly cases showed a concentration comparable to that of young subjects in their twenties and was considered to be satisfactory from the view-point of oral infection control. On the other hand, plate prosthetic wearers may have high incidence of oral candidiasis, so that in case of loss of teeth, prostheses with so-called implant dentures using artificial dental implants are regarded as physiologically preferable to conventional plate denture.
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PMID:[Oral aging and loss of teeth]. 220 Sep 11

Between October 1980 and December 1985, 50 patients with esophageal cancer were treated with combined radiotherapy and chemotherapy (5-fluorouracil [5-FU] and mitomycin C). Thirty patients with stage I or II disease received definitive treatment consisting of 6,000 cGy in 6 to 7 weeks and 5-FU (1,000 mg/m2/24 h) as a continuous intravenous (IV) infusion for 96 hours, starting on days 2 and 29. Mitomycin C (10 mg/m2) was administered as a bolus injection on day 2. Twenty patients received palliative treatment (5,000 cGy plus chemotherapy) for stage III or IV disease (extraesophageal spread or distant metastases). All patients treated in this program had an Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1, or 2. Of the 30 definitively treated patients, 23 had squamous cell cancer, while seven had adenocarcinoma. Follow-up ranged from 6 months to 63 months. The complete response rate at 1 to 3 months following completion of treatment was 87% (26 of 30) documented by barium swallow and endoscopy (+/- biopsy). The actuarially determined local relapse-free rate at 1 year and beyond was 73%, and the actuarial survivals at 1, 2, and 5 years were 68%, 47%, and 32%, respectively. Of the 20 palliatively treated patients, ten had squamous cell carcinoma, eight had adenocarcinoma, and two had undifferentiated carcinoma. Seventeen patients were evaluable for freedom from dysphagia 1 or more months following completion of treatment. Eighty-two percent of evaluable patients (14 of 17) had no dysphagia posttreatment, while 64% (11 of 17) remained free of dysphagia until death or last follow-up, emphasizing the significant local control of those patients. The median survival for this group was 8 months. Treatment was well tolerated, and acute toxicity included esophagitis, stomatitis, oral candidiasis, and hematologic toxicities of thrombocytopenia and neutropenia. Late toxicities were predominantly manifested as a mild to moderate benign stricture, which required dilatation in four patients. One patient developed a perforation into the mediastinum in the absence of tumor, while two patients with persistent local disease developed tracheoesophageal fistula, and radiation pneumonitis was observed in two patients. This combination of radiation therapy with infusional 5-FU and mitomycin C is an effective and relatively well-tolerated regimen in the treatment of esophageal cancer. Surgical resection may not be necessary when high-dose radiation and chemotherapy are used.
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PMID:Nonsurgical management of esophageal cancer: report of a study of combined radiotherapy and chemotherapy. 244 31

The etiology, clinical presentation, radiographic findings, diagnostic criteria, differential diagnoses, treatment, and prognosis are reviewed for several clinically important conditions of the equine foot. These include pedal osteitis, sheared heels, distal sesamoid bone (navicular) fractures, subchondral bone cyst of the distal phalanx, distal interphalangeal joint subluxation, congenital phalangeal hypoplasia, bipartite and tripartite distal sesamoid bones, keratoma, ossification of the cartilages of the distal phalanx (sidebones), necrosis of the cartilages of the distal phalanx (quittor), thrush, canker, vesicular stomatitis, and chronic selenium toxicosis.
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PMID:Miscellaneous conditions of the equine foot. 256 57

The present article discusses the rationale for daily use of the combination of amphotericin B (4 lozenges) intraorally and chlorhexidine denture disinfection (15 min) extraorally vs separate use of polyene antimycotics or chlorhexidine in the treatment of infectious denture stomatitis, frequently considered as the most common form of oral candidiasis. The amphotericin B/chlorhexidine combination has been standard treatment of infectious denture stomatitis in Scandinavia for more than 15 years. It was found to be the best among several regimens tested in 100 patients after a series of subjective and objective parameters had been used to record treatment efficacy in controlled clinical and microbiological studies. The fact that there was a significant (5% level) higher reduction of yeasts cultured from the palatal mucosa with this drug regimen than with the other modalities tested, including chlorhexidine lozenges/chlorhexidine denture disinfection, suggested that no drug interaction of clinical importance took place in vivo with this combination. Therefore, care should be taken when extrapolating findings on drug interaction in vitro (12) to the in vivo situation, and guidelines for treatment of oral candidiasis should preferably be based on controlled clinical and microbiological trials with patients. In order to prevent relapse of oral candidiasis after treatment, local and general predisposing factors should be eliminated, in particular reestablishment of plaque on the fitting side of the denture should be prevented.
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PMID:[Few aspects with regard to diagnosis and treatment of oral candidiasis]. 262 22

Oral candidosis is a very frequent diseased state occurring mainly together with severe underlying disease. Clinical manifestation is variable. One can distinguish between oral thrush, denture stomatitis, angular cheilitis, leukoplakia and midline glossitis. Nowadays oral candidosis is also important in connection with HIV-infection. Here the clinical spectrum does not seem to be totally different. Apart from oral thrush (or pseudomembraneous type) a chronic atrophic type, a chronic hyperplastic type, papillary hyperplasia and angular cheilitis are distinguished. Oral candidosis is the most frequent opportunistic infection in HIV-infected patients. Frequency of overt disease is linked to the T4/T8 ratio. In patients with AIDS-related complex oral candidosis seems to be indicative of rapid progression. Candida albicans is the prevailing microorganism. There is, however, a change of biotypes during the course of HIV-infection. There seems to be a selection of certain phenotypes as can be judged from the increasing resistance to 5-fluorocytosine.
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PMID:Clinical spectrum of oral candidosis and its role in HIV-infected patients. 270 Feb 17

Few studies have determined risk factors for diarrheal deaths in developing areas. The Ministry of Health of Lesotho, southern Africa, reported that 9.5% of children under five years of age who were hospitalized for diarrhea in 1984 died. Of 104 children under five years of age who died during hospitalization for diarrhea, 85% were aged 24 months or younger and had nonbloody diarrhea during the warm season. We conducted two retrospective case-control studies of children aged 24 months or younger admitted for diarrhea at two hospitals in 1983 and 1984, comparing 44 who died with 89 who survived. Eight factors were significantly associated (p less than 0.05) with death at one or both hospitals by univariate analysis: diagnosis of a major infection, age under six months, illness for seven days or more before admission, thrush or stomatitis on admission, severe dehydration, history of vomiting, dehydration that had not improved after 12 hours in the hospital, and fever or subnormal temperature. Multivariate analysis of data from one hospital showed the first three factors to be significantly associated with death. Cases and controls were similar in sex and in degree of malnutrition. This study identified children at high risk for death from diarrhea.
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PMID:Risk factors for fatal diarrhea: a case-control study of African children. 319 70


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