Sequential quantitative scintigraphy of parotid glands with chronic inflammatory diseases.

A practical, time-saving procedure for sequential quantitative scintigraphy is introduced and 4 parameters chosen from 12 parameters by discriminant analysis are used to evaluate the function of the parotid gland. The examination was performed in 120 cases, including 16 cases with recurrent parotitis in childhood, 33 with chronic obstructive parotitis (COP), 37 with Sj?gren's syndrome (SS), 4 with sialadenosis, and 30 normal controls. The scintigraphic findings were analyzed and compared with the histologic findings. The diagnostic value of this method was investigated and scaling for differential diagnosis of COP and SS was established. Scintigraphy is considered to be a useful method for evaluation of parotid function and as a diagnostic aid for SS and COP, especially in patients in whom sialography cannot be performed.     

慢性复发性腮腺炎的诊断和治疗进展

慢性复发性腮腺炎是一类非阻塞性的腮腺炎性疾病,常表现为腮腺间断性的反复肿胀,可发生在儿童或成人,但以儿童复发性腮腺炎最为常见。这类疾病病因不明确,临床表现与其他疾病类似,目前缺乏有效的防治办法。本文回顾近年来慢性复发性腮腺炎的病因研究进展,阐述并比较了腮腺造影、超声及内镜分别在本病的诊断与治疗过程中的作用,总结儿童及成人复发性腮腺炎的诊断、鉴别诊断的要点,并分析了慢性复发性腮腺炎与临床上较易混淆的舍格伦综合征两类疾病的关系与鉴别方法。     

Primary sialoangiectasia--a diagnostic pitfall in Sj?gren's syndrome: case report.

A case of primary sialoangiectasia, which in this case was initially misdiagnosed as Sj?gren's syndrome, is described. Other diseases, including HIV infection, psoriatic arthritis, and acute parotitis, may cause glandular changes similar to the changes found in the syndrome. Therefore, sialography must be combined with other methods of assessment of the oral cavity when suspicion is high for Sj?gren's syndrome. Properly applied, sialography provides essential information regarding the severity of glandular damage and the progression of the disease.     

Recurrent parotitis in childhood (report of 102 cases)

This article presents 102 cases of recurrent parotitis in childhood with studies of clinical findings, sialographic manifestations, dynamic functions of the parotid gland examined with radionuclide, laboratory findings and follow-up studies of 28 cases including sialography. The following conclusions are reached: 1. The etiology is retrograde infection induced by mumps virus and upper respiratory infection which lower the resistance of the child. Familial abnormalities are potential factors. Incomplete immune function of the children is also a factor related to pathogenesis of this disease, and following growth and development of the immune system this disease will undergo remission. 2. This disease involves both parotid gland generally. 3. Sialographic manifestations will disappear following subsidence of clinical symptoms, but it may take years. 4. If the disease has not been cured in childhood, it may continue to adult and then healing will take place. Relationship with Sj?gren's syndrome has not been revealed.     

Sialochemistry in Sj?gren's syndrome.

The value of sialochemistry in the study of Sj?gren's syndrome was explored by comparative examination of a spectrum of parotid components in twelve subjects with a positive diagnosis of the disease and twelve control subjects with normal gland function. The subjects with Sj?gren's syndrome all exhibited a marked reduction in flow rate and phosphate concentration and a marked elevation in sodium and chloride concentration. The concentration of IgA was somewhat elevated (commensurate with reduced flow rate); the levels of IgG, IgM, and albumin were normal. The major functional abnormality in the parotid gland in Sj?gren's syndrome appears to be luminal transport in the ductal region; leakage of serum components is minimal. Sialochemistry can be helpful in differentiating Sj?gren's disease from other diseases of the salivary gland and in assessing degree of pathologic change.     

Diagnostic value of sialography with both the conventional and digital subtraction techniques in children with primary and secondary Sj?gren's syndrome.

OBJECTIVE: The application of anamnestic data on siccative symptoms required for classifying adult Sj?gren's syndrome is limited in childhood. Instrumental test procedures are therefore necessary for objectively recording the oral and ophthalmologic manifestations of the disease. The aim of this study was to clarify the sialographic changes that occur in Sj?gren's syndrome in children. STUDY DESIGN: A total of 23 sialograms were obtained with both conventional and digital subtraction techniques in 21 children with primary (10 girls and 1 boy) or secondary Sj?gren's syndrome (10 girls). The films were assessed by 3 physicians and submitted for a consensus analysis if necessary. RESULTS: The pathologic features observed in the children varied from a slightly narrowed ductal system to multiple peripheral ductal ectasias and completely destroyed parenchyma. Sialographic examinations demonstrate that, with progressing disease, regression of acinar dilatations and rarification of the ductal system occur. CONCLUSION: The results show that the spectrum of sialographically recordable lesions in Sj?gren's syndrome in children is greater than is described thus far in the literature.     

Histochemical study of labial salivary glands in Sj?gren's syndrome.

Human labial salivary gland biopsies of patients presenting connective tissue diseases associated with Sj?gren's syndrome were submitted to a polysaccharide histochemistry study. The normal acinar secretion is an association of neutral polysaccharides with a sulphosialomucin. In Sj?gren's syndrome, there is a great reduction in the secretory activity of the acinar cells, but no qualitative change was observed. The pathogenesis of this decreased production and its importance regarding the clinical manifestations of Sj?gren's syndrome are discussed.     

Quantitation of human salivary acidic proline-rich proteins in oral diseases

Acidic proline-rich proteins (APRP) were quantitated immunochemically in salivary secretions from groups of: caries-resistant (CR) and caries-susceptible (CS) subjects; heavy- and light-calculus-formers; and patients with Sj?gren's Syndrome, drug-induced xerostomia, and recurrent parotitis. In all groups except the parotitis patients, there were comparable levels of APRP, about 40-50 mg%, with similar values in parotid and submandibular saliva. In chronic recurrent parotitis, the values were somewhat higher (about 60 mg%). There were no differences in the proportion of APRP-A to C in a subset of CR and CS. Taken as a whole, the data support the view that the secretion of APRP is stable and that caries status and propensity to calculus formation are not associated with abnormal levels of these phosphoproteins.     

Alterations in lactoferrin in salivary gland disease.

During the active phase of chronic recurrent parotitis there is a marked elevation in the parotid concentration of lactoferrin (Lf), and iron-binding glycoprotein with antibacterial properties. The Lf concentration decreases during the recovery period, but still remains above normal levels. The changes of Lf in parotitis parallel recent findings in mastitis and pancreatitis. Elevations in Lf were also noted in five of six subjects with Sj?gren's disease, but not in subjects with sarcoidosis, diabetes or "dry mouth" without sialographic changes. The source of the Lf has not been determined; it could arise in part from disrupting polymorphonuclear leucocytes and in part from epithelial cells that synthesize Lf in the salivary glands. Inflammatory stimulation of Lf synthesis would suggest a basic protective mechanism in exocrine glands and should be fully explored.     

~(99m)锝腮腺动态显像对舍格伦综合征的诊断价值

目的 探讨＾９９ｍ锝腮腺动态显像对诊断舍格伦征的价值。方法 应用＾９９ｍ锝对临床诊断为舍格伦综合征的５２例患者进行腮腺动态显像,将所得的结果应用计算机ＲＯＩ程序进行定量分析和动态曲线分析,结果 腮腺外形较正常大者４６例（８８．４％）肿大腮腺轮廓清晰２８例（５３．８５％）轮廓模糊１８例（３４．６２％）腮腺功能正常７例（１３．４６％）轻度受损１５例（２８．８４％）中８度受损１７例（３２．６９％）,重度     

Sj?gren's syndrome.

Sj?gren's syndrome (SS) is a progressive autoimmune rheumatic disorder. Its precise etiology is unknown, although several contributing factors have been identified. One theory is that the condition results from complications related to infection with the Epstein-Barr virus. Primary exposure to or reactivation of Epstein-Barr virus elicits expression of the human leukocyte antigen complex. This is recognized by T lymphocytes (CD 4+) resulting in the release of cytokines (tumor necrosis factor, interleukin-2, interferon-gamma, and others). A genetic marker specific for Sj?gren's syndrome, HLA-DR4, has been identified. According to the World Health Organization, the prevalence of Sj?gren's syndrome is unknown. A recent epidemiologic study in Sweden estimated the prevalence in the adult population to be 2.7%. In the United States, 10 years ago, the number of patients with Sj?gren's syndrome was thought to be fewer than 100,000. This number today is estimated to be more than 1 million. Sj?gren's syndrome has been reported in nearly every major country of the world, and the geographic distribution of cases appears to be relatively uniform. Sj?gren's syndrome typically affects women (90%) during the fourth or fifth decade of life. Isolated cases of Sj?gren's syndrome in children have been reported.     

Salivary and serum soluble interleukin-2 receptor in primary Sj?gren's syndrome.

Salivary and serum concentrations of soluble interleukin-2 receptor (sIL-2R) were studied in a group of patients with Sj?gren's syndrome and a group suffering from dry mouth. Salivary sIL-2R levels was significantly higher (57.9+/-15.1 vs 16.7+/-4.7 pg/ml) (p < 0.05) in the group of 26 patients with Sj?gren's syndrome than in the dry-mouth group. Both the salivary and the serum sIL-2R of normal controls were below the level of detection. No significantly statistical differences were noted between the concentrations of serum sIL-2R in either abnormal groups. No correlations were found between salivary or serum sIL-2R and the erythrocyte sedimentation rate, C-reactive protein, the presence of various autoantibodies or the focus score from lip biopsies in the group of patients with Sj?gren's syndrome. The results show that, although the salivary sIL-2R does not actually reflect the extent of inflammation, it might have an important role in the diagnosis of Sj?gren's syndrome.     

Oral manifestations of Sjögren's syndrome

Sj?gren's syndrome is a common autoimmune rheumatic disease. The most common symptoms of Sj?gren's syndrome are extreme tiredness, along with dry eyes (keratoconjunctivitis sicca) and dry mouth (xerostomia). Saliva plays an essential role in numerous functions of the mouth. Xerostomia can be caused by medications, chronic diseases like Sj?gren's syndrome, and medical treatments, such as radiation therapy and bone marrow transplant. Xerostomia can eventually lead to difficulty in swallowing, severe and progressive tooth decay, or oral infections. Despite having excellent oral hygiene, individuals with Sj?gren's syndrome have elevated levels of dental caries, along with the loss of many teeth, early in the disease. Sj?gren's syndrome alters the protein profile and brings about a change in the composition of saliva. There is an increase in the levels of lactoferrin, beta(2)-microglobulin, sodium, lysozyme C, and cystatin C, and a decrease in salivary amylase and carbonic anhydrase. Up to 90% of individuals with Sj?gren's syndrome have antibodies targeting the Ro 60 and La autoantigens. Natural aging, regardless of Sj?gren's syndrome, is also another factor that brings about a significant change in the composition of saliva. The most prevailing cause of xerostomia in elderly persons is the use of anticholinergic medications. Currently, there is no cure for Sj?gren's syndrome, and treatment is mainly palliative.     

Sjogren syndrome: a review of the literature and a case report

Sj?gren syndrome is one of the most prevalent autoimmune diseases in which the body's immune system mistakenly attacks its own moisture producing glands. Although Sj?gren syndrome occurs in all age groups in both women and men, women in their fourties are the most affected. Sj?gren's syndrome can occur alone or in the presence of another connective tissue disease, respectively called primary and secundary Sj?gren syndrome. When two of the three clinical hallmarks: keratoconjunctivitis sicca, xerostomia or connective tissue disease are present, Sj?gren 's syndrome should be considered. To confirm the diagnosis of Sj?gren's syndrome several tests are required. e.g. blood tests, ophthalmologic tests and oral tests. Rheumatologists have the primary responsibility for managing Sj?gren's syndrome. Other specialists can treat the related symptoms. The incidence of lymphoma is higher in patients with Sj?gren's syndrome than in the general population. Therefore patients must be monitored carefully for the development of related autoimmune diseases, lymphoma and other complications. Sj?gren's syndrome is serious but generally not fatal if complications are diagnosed and treated early.     

Analysis of in situ proliferative activity in oral gingival epithelium in patients with xerostomia

BACKGROUND: Sj?gren's syndrome is an autoimmune disease characterized by xerostomia and keratoconjunctivitis sicca. The relationship between xero-stomia and proliferative activity in human gingival epithelium is not known. Proliferating cell nuclear antigen (PCNA) is a nuclear protein associated with the cell cycle. Nuclear PCNA immunoreactivity is found in the proliferative compartment of normal tissues. The aims of this study were to evaluate PCNA expression in oral gingival epithelium of healthy and inflamed gingiva obtained from patients with Sj?gren's syndrome, and to compare the results to age- and gender-matched subjects with normal salivary function. METHODS: Eighteen Sj?gren's syndrome patients and 28 controls (14 with chronic periodontitis and 14 with no clinical evidence of periodontal disease) were included in the study. Biopsies were obtained from both inflamed and healthy gingiva. The expression of PCNA was evaluated in formalin-fixed, paraffin-embedded gingival samples using an immunoperoxidase technique and PC10 monoclonal antibody to PCNA. RESULTS: PCNA expression was observed both in the basal and suprabasal layers, and was found to be more prominent in the suprabasal layers. Proliferative index (PI) in inflamed gingiva was significantly lower in the Sj?gren's syndrome group. However, no significant difference was observed between the study and control groups with respect to PI in healthy gingiva. In both groups, PI was found to be increased due to inflammation. CONCLUSIONS: Our data indicate that proliferative activity is observed in the suprabasal layers and, less frequently, in the basal layer. Inflammation caused increased proliferative activity. However, this positive effect of inflammation on epithelial cell proliferation decreased significantly with a lack of saliva. Therefore, it appears that saliva-derived biological mediators may also contribute to increased proliferative activity observed during inflammation.     

舍格伦综合征亚临床型

目的进一步观察舍格伦综合征（Ｓｊ¨ｏｇｒｅｎ＇ｓｓｙｎｄｒｏｍｅ，ＳＳ）亚临床型的各种表现及治疗。方法对２４例ＳＳ亚临床型患者长期临床观察，并行实验室、腮腺造影及肌内注射胸腺肽治疗。结果２４例患者在出现口干、眼干之前有腮腺反复肿胀史２～１７年（平均７年），均误诊为“慢性化脓性腮腺炎”或“腮腺腺炎”，追踪观察均为典型的ＳＳ。２４例中有１０例患者同时伴有脉管炎或出血性紫癜，占４０％，脉管系统受累较普遍。腮腺造影以末梢导管扩张伴主导管扩张及边缘粗糙为主，１２／２４例，占７０％。肌内注射胸腺肽能明显减少腮腺反复肿胀发作频率。结论提出ＳＳ亚临床型对澄清慢性腮腺炎症命名及分类上的混乱有实际意义，并对早期诊治ＳＳ有指导意义。肌内注射胸腺肽能减少肿胀发作频率。     

Cytokine concentrations in stimulated whole saliva among patients with primary Sjögren's syndrome, secondary Sjögren's syndrome, and patients with primary Sjögren's syndrome receiving varying doses of interferon for symptomatic treatment of the condition: a preliminary study

Sj?gren's syndrome is an autoimmune disorder which causes diminished salivary flow due to autoimmune sialoadenitis. This decrease in saliva flow is the result of inflammation and atrophy of the salivary glands. Most treatment regimens are palliative in nature, but treatment with interferon (IFN) holds promise for Sj?gren's syndrome sufferers. Several studies have investigated cytokine concentrations in the salivary glandular tissues from Sj?gren's syndrome patients; however, there is little information concerning cytokine expression in saliva. This is especially true with respect to treatment modalities and their effects on local cytokines. A clinical study was conducted to determine salivary interleukin (IL)-6, IFN, and IL-2, concentrations among subjects diagnosed with primary and secondary Sj?gren's syndrome and a healthy control group. The primary Sj?gren's syndrome showed significantly higher salivary IL-2 and salivary IL-6 than the control and secondary Sj?gren's groups. There were no between group differences for salivary IFN concentrations. In addition, the study assessed salivary IL-6, IFN, and IL-2 concentrations among 18 Sj?gren's syndrome patients before and after administration of IFN via the oral mucosal route. The results of the study showed that the mean values for the pre- and post-treatment groups for stimulated whole saliva flow rates were 3.15 and 3.74 ml/5 min, respectively. The post-treatment group exhibited a 16.8% increase in stimulated whole saliva flow rates. The salivary IL-6 concentration was 53.3% lower for the post-treatment group (17.79) as compared to the baseline value (33.35). The values for salivary IFN and salivary total protein were virtually unchanged from their baseline values. Salivary IL-2 values, however, were 50% lower in the post-treatment group (3.07) when compared to their respective baseline values (6.10). The results of this study suggest that healthy individuals exhibit lower salivary IL-2 and IL-6 as compared to individuals suffering from primary and secondary Sj?gren's syndrome. The results also suggest that administration of IFN via the oral mucosal route may increase salivary flow rates and depress certain cytokines (IL-2, IL-6) associated with inflammatory destruction of salivary glandular tissues in Sj?gren's syndrome patients.     

Sjögren' syndrome: a progressive disease

Sj?gren's syndrome is an auto-immune disease resulting in, among other problems, serious eye and mouth dryness. The course of the disease, especially from an early towards a later phase, is largely unknown. The purpose of this study was to evaluate the symptoms and salivary gland function of Sj?gren's syndrome patients, in order to gain insight in the possible progression of the disease. Forty-three patients were followed during a mean period of 3.5 years. Patients with a longer duration of oral symptoms showed more subjective complaints and less salivary flow when compared to patients with recent oral complaints. The differences in both the subjective and objective signs disappeared almost completely during follow-up. From this study it was concluded that Sj?gen's syndrome is a progressive disease when diagnosed early. By asking specific questions the dentist can play an important role in early diagnosing the syndrome.     

Oral and periodontal status in Sj?gren's syndrome.

Sj?gren's syndrome is a multi-system chronic inflammatory disease of the exocrine glands. Inflammation of the salivary glands leads to reduction in salivary output, which imposes a significant impact on oral health. Dentists and dental hygienists are the primary healthcare providers to identify early signs and symptoms of Sj?gren's syndrome. Early diagnosis of Sj?gren's syndrome is fundamental for effective management of the disease.     

Hydrallazine-induced Sj?gren's syndrome

4 years after initiation of therapy with hydrallazine hydrochloride (for treatment of hypertension), a 60-year-old male patient developed clinical features of Sj?gren's syndrome, with immunological features of drug-induced systemic lupus erythematosus. In addition, the patient described rheumatoid arthritis-like symptoms and had reduced lacrimal and parotid salivary flow, but lacked the typical features of Sj?gren's syndrome on labial gland biopsy. 1 year after discontinuation of hydrallazine therapy, the clinical parameters returned to normal.