An unusual reason of parotid gland enlargement; parotid gland tuberculosis

Although pulmonary tuberculosis is common in Turkey, parotid gland tuberculosis is rarely seen. A 39 years old female presented with left side swelling on her face. The diagnosis was made excisional biopsy. Histologic examination of the operative specimen revealed necrotising granuloma concordant with tuberculosis.     

Benign lymphoepithelial parotid lesions in vertically HIV-infected patients

Benign lymphoepithelial parotid lesions (BLL) are frequently reported in HIV-infected patients, although their clinical and prognostic significance in HIV infection has not been clearly defined. Ultrasonography (USG) has been shown to be a reliable method in monitoring the progression of such lesions. The purpose of this study was to describe the spectrum of sonographic and Doppler findings and to monitor any clinically evident physical change of parotid glands in a cohort of congenitally HIV-infected patients taking antiretroviral therapy. USG findings-based on their severity-have been grouped in three different patterns (0, 1, 2). Our cohort consisted of 51 patients with HIV in various Centers for Disease Control (CDC) stages and being given different antiretroviral protocols. The median USG follow-up was 36 months. The most frequent USG pattern was aspecific parotid gland enlargement (type 0, 45,1%). Patients with either lower CD4+ % (p < 0.20) and higher absolute and percent CD8+ cell count (p < 0.001 and p < 0.003) presented more frequently a type 2 USG pattern. None of them had any symptoms ascribed to "sicca syndrome" and only one patient developed non-Hodgkin's lymphoma during the follow-up, although his USG pattern at baseline was type 0. In summary, the spectrum of USG findings of BLL in vertically HIV-infected patients is broad. Because of the reported, although rare, possible malignant transformation of BLL in HIV-infected children, it is advisable to perform-even in asymptomatic patients-USG at least once per year or in concomitance with any physical modification of the parotid lesions.     

Dysphagia in bulimia nervosa

The findings on 13 patients with bulimia nervosa referred for evaluation of salivary glands and swallowing patterns are presented. Each patient completed a medical, oral, and social history questionnaire. A complete oral examination supported by appropriate dental radiographs and photographs was conducted. Unstimulated and stimulated parotid and submandibular saliva was collected. The presence or absence of pharyngeal and velar gag reflexes was ascertained. Real-time ultrasound scanning and barium swallow studies were used to evaluate the oral-motor functions while swallowing on 6 of the subjects. Activity of the pharynx, larynx, and esophagus was recorded during the videofluorographic studies. Saliva concentrations of amylase were determined in the referred subjects as well as 13 age-matched healthy controls. No significant difference was detected between the salivary gland flow rates and amylase concentrations of the two groups, whether stimulated or unstimulated. The pharyngeal gag reflex was absent in 9 of the 13 bulimic patients and a velar gag reflex could be elicited in only 1. All of the normal controls had both gag reflexes. All of the patients with bulimia were found to have abnormal oropharyngeal swallow patterns and an increased duration of dry swallow.     

Gingival enlargement in acromegaly

In this study, we investigated gingival enlargement in patients with acromegaly as a component of the disease. Eleven patients (5 males, 6 females) were evaluated. Diagnosis was confirmed with typical clinical features and laboratory. Oral examinations were carried out by the same periodontist. During the examination, plaque index, gingival index, probing pocket depths, and gingival enlargement values were evaluated. Duration of the disease was between 0.2 and 13 yr. Seven patients had pituitary macroadenomas and four had microadenomas during their initial diagnosis. Only one patient was newly diagnosed. The other patients had previously undergone surgery. Gingival enlargement was found in eight patients. Seven patients with gingival enlargement also had prognathism, and one patient had prognathism associated with gingival enlargement. These findings demonstrate that acromegaly that results in overgrowth in various organs should be considered one of the causes of gingival enlargement.     

Upper gastrointestinal tract dysfunction in bulimia

Bulimia nervosa is a health problem of increasing magnitude that is estimated to affect 2–5% of the American adolescent and young adult female population. Because of the magnitude of this clinical problem and because of the importance of the upper gastrointestinal tract in its expression, a intradepartmental program of health care for patients affected with the disease was initiated. Eleven consecutive symptomatic bulimic individuals have been evaluated jointly by the gastroenterology and the psychiatry departments of the University of Pittsburgh. Five of these 11 individuals were found to have clinically important upper gastrointestinal pathology including ulcerative esophagitis, erosive gastritis, duodenal ulcer, and delayed gastric emptying. These gastrointestinal conditions could have been either a result of or have contributed to the symptomatology of these five patients. These data suggest that bulimic subjects have clinically important gastroenterological disease processes that require specific diagnosis and treatment independent of the psychiatric treatment provided for the bulimic condition.This work was supported in part by grants from NIDDK AM 32556.     

Decreased serum leptin in bulimia nervosa

The eating disorder bulimia nervosa has been associated with impaired satiety, decreased resting metabolic rate, and abnormal neuroendocrine regulation. Preclinical studies suggest that such alterations could be associated with impaired leptin function. Thus, the goal of this study was to assess whether leptin function is decreased in bulimia nervosa. Serum leptin levels measured in women with bulimia nervosa (n = 18) and in women who had maintained stable recovery from bulimia nervosa (n = 15) were compared with values in healthy female controls (n = 20). Subjects were studied during the follicular phase of their menstrual cycle after an overnight fast and bed rest. Baseline serum samples were analyzed for leptin concentration by RIA. Subject groups were matched for age and body weight. Analysis of covariance, adjusting for percent body fat, demonstrated abnormally low serum leptin levels in the bulimia nervosa group (P: = 0.02), with a trend toward an inverse correlation between frequency of binge episodes and serum leptin concentration (P: < 0.1). Additionally, the remitted patient group demonstrated abnormally low leptin values (P: = 0.01). These results are consistent with the hypothesis that decreased leptin function may be associated with alterations in eating patterns, metabolic rate, and neuroendocrine regulation in bulimia nervosa.     

Gonadotropin secretion in bulimia nervosa.

Twenty-two normal weight women with bulimia nervosa (BN) were studied (mean age, 25 +/- 5 yr; body mass index, 20.2 +/- 2.6 kg/m2). Sixteen of them reported menstrual cycles in the range of 21-42 days, and 6 had experienced absence of menstruation for at least 3 months. Twenty-one healthy women with regular menstrual cycles (mean age, 23 +/- 2 yr; body mass index, 20.7 +/- 1.4) served as the control subjects. Frequent morning blood samples for estradiol (E2) and progesterone (P4) determinations were obtained for the duration of 1 menstrual cycle or for 6 weeks in the case of amenorrhea. LH, FSH, cortisol, and insulin secretion were studied on day 3, 4, or 5 after the onset of a menstrual cycle or on a random day in the 6 BN women with amenorrhea. Blood samples were collected at 15-min intervals from 1800-0600 h for LH and FSH and at 30-min intervals from 2400-0600 h for cortisol and insulin. Nineteen of the 21 controls, but only 10 of the 22 BN women, fulfilled the following standard criteria: maximum E2 above 440 pmol/L, maximum P4 above 19 nmol/L, and luteal phase length of 9 days or more. The 10 BN women with normal menstrual cycles had lower mean insulin concentrations than the controls (70 +/- 20 vs. 120 +/- 30 pmol/L; P less than 0.01), but gonadotropin secretion, cortisol, and T3 concentrations were similar. The 8 BN women with amenorrhea or ovulatory dysfunction (maximum E2, less than 440 pmol/L; maximum P4, less than 6 nmol/L) displayed decreased mean LH pulse frequency (2.6 +/- 2.4 vs. 5.7 +/- 2.0 pulses/12 h; P less than 0.01), increased mean cortisol (120 +/- 40 vs. 80 +/- 20 nmol/L; P less than 0.01), decreased mean insulin (90 +/- 40 vs. 120 +/- 30 pmol/L; P less than 0.05), and decreased mean T3 concentrations (1.5 +/- 0.3 vs. 1.8 +/- 0.2 nmol/L; P less than 0.01). The data suggest that BN in normal weight women is associated with an increased rate of ovarian dysfunction; decreased pulsatile LH secretion seems to be an important mechanism. Increased cortisol in the disturbed subgroup indicates that activation of the hypothalamic-pituitary-adrenal axis may play a role in the pathogenesis of gonadal dysfunction in bulimia nervosa.     

Pseudo-Sjogren's syndrome and bulimia

INTRODUCTION: Bilateral parotid enlargement are presenting features of some metabolic and systemic disease but also of chronic emesis. CASE RECORD: A 24-year old woman consulted during three years many physicians asking for the treatment of a painless parotid swelling confusing with a Sjogren's syndrome. After an initial denial, the weight history, alteration of tooth wear and hypokaliemia conducted to admit a self inducing vomiting with bulimia nervosa. CONCLUSION: Gender, young age, weight history, tooth alteration and electrolytic disorders are the main diagnostic tool of this dissimulated etiology of parotid swelling.     

Pancreatic enlargement in obstructive jaundice

To verify the influence of obstructive jaundice on pancreatic growth, the anteroposterior width of the pancreas was measured by computed tomography in 30 cholangiocarcinoma patients excluded patients with distal bile duct tumor (jaundice group) and 74 control subjects. Follow-up examinations were performed on 12 patients with and without internal biliary drainage to elucidate the temporal relationship between pancreatic enlargement and the diversion of the obstructed biliary stream. Histologic analysis on autopsy samples from 13 control and 10 jaundice cases also was performed. Mean pancreatic head and body widths in the jaundice group were 2.93±0.3 cm and 2.01±0.3 cm, respectively. These values were significantly greater than those of the controls (2.13±0.3 cm and 1.49±0.3 cm,P<0.01). The glandular widths returned to their normal sizes following internal biliary drainage. No changes were seen in patients who underwent external drainage alone. Histologic examination revealed that enlargement of the acinar cells or of the islet of Langerhans was often seen in the jaundiced patients. Therefore obstructive jaundice is thought to cause pancreatic growth through a trophic effect by interrupting biliary circulation.     

Adiponectin in anorexia nervosa and bulimia nervosa

To study the role of adiponectin, a novel adipocyte-specific secreted protein, on the pathophysiology of eating disorders, circulating levels of fasting adiponectin, leptin, insulin, and glucose were measured in 31 female patients with anorexia nervosa (AN) and in 11 with bulimia nervosa. Hormone levels were compared with 16 age-matched, normal body weight controls, six healthy constitutionally thin subjects, and nine obese subjects. Moreover, changes in levels were reevaluated after nutritional treatment and weight gain in 13 patients with AN. Serum adiponectin concentrations in AN and bulimia nervosa were significantly lower than those in normal-weight controls. These results were unexpected because the levels were high in constitutionally thin subjects and low in obese subjects, which provide a negative correlation with body mass index (BMI) and body fat mass. In contrast, serum leptin levels correlated very well with BMI and fat mass among all the patients and controls. The insulin resistance was significantly low in AN and high in obese subjects. The concentrations of adiponectin after weight recovery increased to the normal level despite a relatively small increase in BMI. These findings suggest that abnormal feeding behavior in the patients with eating disorders may reduce circulating adiponectin level, and weight recovery can restore it.     

The loss of control in bulimia nervosa

The sense of loss of control that accompanies the binge-eating episodes in bulimia nervosa is pathognomonic for the disorder. This experiment, with bulimics and control subjects, examined the role of cognitive and of dietary factors in an increased appetite. Subjects were required to eat a breakfast that was high or low in carbohydrate, with and without knowledge of its contents. When bulimics knew they had had a breakfast containing carbohydrate, they ate significantly more at the test meal 3 h later. Knowledge had no similar effect on controls. Moreover, the higher intake was largely accounted for in terms of carbohydrate; there were no differences in the amount of protein they ate. These findings are discussed in terms of their implications for understanding and for treating the loss of control in bulimia nervosa. © 1997 John Wiley & Sons, Ltd and Eating Disorders Association.