Somatic GNAQ mutation in different structures of port-wine macrocheilia.

BACKGROUND: Port-wine macrocheilia (PWM) involves a congenital, progressive capillary malformation that results in soft-tissue hypertrophy in the lips. Its aetiology has not yet been fully elucidated. OBJECTIVES: To investigate frequencies of GNAQ mutation in different tissues from patients with PWM, including skin, mucosa, gland and muscle, using samples obtained during cheiloplasty. METHODS: Targeted next-generation sequencing of GNAQ was designed and performed to assess DNA extracted from 80 different affected tissues from 20 patients with PWM. RESULTS: The GNAQ R183Q mutation was not detected in gland samples but was found in 90%, 95% and 95% of the skin, mucosal and muscle samples, respectively. The lowest levels of mutations were found in the glands (P < 0·001 vs. skin, mucosa and muscle), and levels were second lowest in the skin (P = 0·023 vs. mucosa; P = 0·012 vs. muscle). The mutation frequencies in mucosa and muscle were the highest and showed no statistically significant difference (P = 0·92). CONCLUSIONS: In patients with PWM, GNAQ was mutated in all tissues except for glands. PWM is congenital, and all tissue layers exhibit primary hypertrophy rather than acquired or partially related hypertrophy. Given the advantages of mucosal biopsy, including practicality, lack of scarring and rapid healing, GNAQ mutation in the lip mucosa may be a useful predictor for early-stage PWM in patients with port-wine stains affecting the lips.

Spatial organization of the excretory ducts and sections of microcirculatory blood flow of the labial salivary glands in older adults.

OBJECTIVE: Introduction: Salivary glands have a significant impact on the state of the homeostasis of the human body, oral cavity in particular, sensitively responding to pathological processes. The reactivity of the salivary glands in response to pathological processes that are organically linked to morphology and functions of the organ's structures, and particularly the excretory ducts of the glands and their microcirculatory blood flow, is one of the problems which have not been solved to date. The aim of the paper was to elucidate the features of the stereomicroscopic structure of the excretory ducts and sectors of the microcirculatory blood flow in labial glands of older adults. PATIENTS AND METHODS: Materials and methods: The object of the study was the labial mucosa of the older adults, which was cut into 3х3 mm pieces and fixed in the buffered 4% glutaraldehyde solution with subsequent 2-hour fixation in osmium. Once the pieces were washed and dehydrated they were embedded into the Epon-812. The series of the semi-thin sections, made from the obtained epoxy blocks, were stained in phosphate buffered 0,1% toluidine blue solution. The serial semi-thin sections were subjected to histological and cytological studies and multilayered plastic reconstruction. RESULTS: Results and conclusions: The series of histological epoxy semi-thin sections, as well as graphic and plastic reconstruction of the sectors of microcirculatory blood flow and excretory ducts of the human labial glands have demonstrated a range of morphological facts that can be used to clarify the intertissue stereological relationships. They also determined the syntopic proximity of the capacitive sectors of microcirculatory blood flow to the excretory ducts of the gland. Such pattern is especially notable in the collecting venules and intralobular ducts. It has been shown that the biggest venule is the collecting venous vessel. Anastomoses between the intralobular arterioles and collecting venules have been found in the microcirculatory blood flow of the labial glands.

Vascular Pattern Analysis on Microvascular Sonography for Differentiation of Pleomorphic Adenomas and Warthin Tumors of Salivary Glands.

OBJECTIVES: Pleomorphic adenomas and Warthin tumors are the most common salivary gland tumors. It is important to differentiate between them because at least a partial parotidectomy is necessary for pleomorphic adenomas, whereas enucleation is sufficient for Warthin tumors. This study aimed to evaluate the usefulness of vascular pattern analysis using microvascular sonography to differentiate between the tumors. METHODS: Sixty-two patients with pathologically proven pleomorphic adenomas (n = 38) and Warthin tumors (n = 24) were included. For all tumors, grayscale, power Doppler, and microvascular sonographic examinations were performed. Differences in vascular patterns (vascular distribution and internal vascularity) on power Doppler and microvascular sonography as well as grayscale sonographic features (size, shape, border, echogenicity, heterogeneity, and cystic change) between pleomorphic adenomas and Warthin tumors were evaluated. A comparison of diagnostic performances of grayscale sonography with power Doppler sonography and grayscale sonography with microvascular sonography was performed. The level of interobserver agreement between 2 reviewers in diagnosing tumors was evaluated. RESULTS: No grayscale sonographic features showed a significant difference between the tumors. Vascular distributions and internal vascularity on power Doppler sonography (P = .01 and .002) and microvascular sonography (both P < .001) were all significantly different. The diagnostic accuracy of grayscale sonography with microvascular sonography (79.0%) was higher than that of grayscale sonography with power Doppler sonography (72.6%). This difference was significant according to the McNemar test (P = .004). Interobserver agreement was excellent in diagnosing tumors on both grayscale sonography with power Doppler sonography (κ = 0.83) and grayscale sonography with microvascular sonography (κ = 0.94). CONCLUSIONS: Vascular pattern analysis using microvascular sonography with other sonographic features is helpful for differentiating between pleomorphic adenomas and Warthin tumors.

Radiation-Induced Microvascular Injury as a Mechanism of Salivary Gland Hypofunction and Potential Target for Radioprotectors.

Radiation therapy is commonly used to treat patients with head and neck squamous cell carcinoma (HNSCC). One of the major side effects of radiotherapy is injury to the salivary glands (SG), which is thought to be mediated by microvascular dysfunction leading to permanent xerostomia. The goal of this study was to elucidate the mechanism of radiation-induced microvasculature damage and its impact on SG function. We measured bovine aortic endothelial cell (BAEC) apoptosis and ceramide production in response to 5 Gy irradiation, either alone or with reactive oxygen species (ROS) scavengers. We then investigated the effect of a single 15 Gy radiation dose on murine SG function. BAECs exposed to 5 Gy underwent apoptosis with increased ceramide production, both prevented by ROS scavengers. Among the 15 Gy irradiated mice, there was considerable weight loss, alopecia and SG hypofunction manifested by reduced saliva production and lower lysozyme levels. All of these effects, except for the lysozyme levels, were prevented by pretreatment with ROS scavengers. Microvessel density was significantly lower in the SG of irradiated mice compared to the control group, and this effect was significantly attenuated by pretreatment with Tempol. This study demonstrates that radiation-induced SG hypofunction is to a large extent mediated by microvascular dysfunction involving ceramide and ROS generation. These findings strongly suggest that ROS scavengers may serve as potential radioprotectors of SG function in patients undergoing radiotherapy for HNSCC.

Iodine deficiency induces a VEGF-dependent microvascular response in salivary glands and in the stomach.

Despite efforts to optimize iodine supply in iodine deficient countries, iodine deficiency (ID) remains a global problem worldwide. Activation of the local microvasculature by ID in the thyroid gland aims at improving the local supply of iodide. For this purpose, the thyrocytes secrete vascular endothelial growth factor (VEGF) that acts on adjacent capillaries, via a reactive oxygen species (ROS)/Hypoxia Inducible factor (HIF)-dependent pathway. Beside the thyroid, other organs including salivary glands and the stomach do express the sodium/iodide symporter (NIS) and are able to take iodide up, potentially rendering them sensitive to ID. To verify this hypothesis, ID-induced effects on the local microvasculature were studied in salivary glands and in the stomach. ID was induced by feeding young mice with an iodide-deficient diet and NIS inhibitor perchlorate in the drinking water. In salivary glands, ID induced a transient increase in HIF-1α protein expression accompanied by a transient, VEGF-dependent increase in blood flow. In the gastric mucosa, ID transiently increased VEGF expression in the mucin-secreting epithelium and in ghrelin-secreting endocrine cells. These observations suggest that microvascular changes in response to ID occur in NIS-expressing tissues other than the thyroid. NIS expressing cells could be viewed as iodide sensors that respond to ID by inducing vascular changes, probably to optimize iodide bioavailability at regional or systemic levels.

Evaluation of microvascularization in focal salivary gland lesions by contrast-enhanced ultrasonography (CEUS) and Color Doppler sonography.

OBJECTIVE: To evaluate the dynamic microvascularization of focal salivary gland lesions by contrast-enhanced ultrasound (CEUS) and Color Doppler sonography. MATERIALS AND METHODS: One hundred and sixty-eight patients with 183 major salivary gland lesions (mean age, 56 years; age range, 12-83 years) underwent gray-scale ultrasonography (US), Color Doppler (CD) and CEUS. The CD and CEUS patterns were classified into three types (scores 0-3). Combined score grades were calculated based on the CD and CEUS pattern scores. The time-intensity curve (TIC) parameters of CEUS were then analyzed. Sensitivity, specificity, negative predictive value and positive predictive value of combined score grades were also calculated. RESULTS: Among all the lesions, there were 161 in parotid gland, 22 in submandibular gland and 157 lesions were benign and 26 were malignant. For score grades (combined CEUS patterns with CD types), scores 1-2 were graded as benign; scores 3-4 were graded as indetermination-suspicious benign or malignant and scores 5-6 were graded as malignant.score 5-6 and score 1-2 indicated 24 (92.3%) and 135 (85.9%) malignant and benign lesions confirmed pathologically, respectively. The sensitivity and negative predicted value of combined score grades for malignant lesions were 92.3% and 98.5%, respectively. In addition, TIC analysis indicates that PI and AUC in malignant lesions were higher than those in benign lesions (p = 0.04 and 0.02, respectively). CONCLUSION: The combined score grade could be a useful method to assess the macro-and micro-vascularization and to differentiated diagnose benign and malignant lesions in major salivary glands.

An analysis of microvessel density in salivary gland tumours: a single centre study.

BACKGROUNDS: Microvessel density (MVD) can be used for determining neoplastic neovascularisation. Tumour angiogenesis correlates with prognosis of cancers in many organs. The aims of this study were to evaluate MVD as demonstrated by CD31 and CD105 in salivary gland tumours (SGTs), and to correlate the MVD results with clinicopathological characteristics of the tumours. MATERIALS AND METHODS: Using a retrospective cohort study design, we enrolled SGTs patients at the Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand, over the 22-year period. The predictor variables included demographic, anatomic and histopathological parameters. The outcome measure was average CD31-MVD and CD105-MVD counted by the "hot spot" method. Descriptive, uni- and bivariate statistics were computed, and P <0.05 was considered statistically significant. RESULTS: The study sample consisted of 43 subjects with a mean age of 39.6 ± 17.8 years (range, 9-82), including 26 females (60.5%), diagnosed with SGTs. In this cohort, 58.1% of the cases were benign, and 83.7% were minor SGTs. There was a significant correlation between CD31-MVD and CD105-MVD (r = 0.8, P < 0.001), but mean CD31-MVD and CD105-MVD were 17.7 ± 9.3 and 12.8 ± 7.4, respectively (P = 0.009). Age, gender and tumour site were not individually associated with significant differences between CD31-MVD and CD105-MVD. Tumours with myoepithelial cells had lower MVD than those without myoepithelial cells (P = 0.04 for CD31; P = 0.03 for CD105). Only CD105-MVD showed statistical difference between benign and malignant SGTs (P = 0.01). CONCLUSIONS: These results suggest that MVD in SGTs can be demonstrated by CD31 and CD105. Despite a strong correlation, CD31-MVD is always higher than CD105-MVD and cannot differentiate between benign and malignant SGTs. The presence of myoepithelial cells within SGTs affects the MVD analysis using either CD31 or CD105, while age, gender and tumour location do not.

Assessment of dental caries risk in children based on color Doppler US and the changes in blood perfusion in the salivary glands during salivary stimulation.

PURPOSE: To investigate in otherwise healthy children the association between the caries index, the stimulated salivary flow rate (SFR), and the spectral Doppler findings of the changes in blood perfusion in the salivary glands during the secretion of saliva. MATERIALS AND METHODS: The study group consisted of 38 children with a mean age of 9.47 ± 1.89 years. The caries index was calculated by determining the number of decayed, missing, and filled teeth. Groups A, B, and C represented subjects with low, moderate, and normal SFRs, respectively, calculated by obtaining chewing-stimulated whole saliva. All subjects were examined by color Doppler ultrasonography (CDUS) before and during secretory stimulation with lemon, by which maximum systolic velocity (MSV), pulsatility index (PI), resistive index (RI), and flow volume (FV) were calculated at the external carotid and facial arteries. RESULTS: The differences for spectral indices obtained before and after stimulation were significantly different among Groups A, B, and C at the external carotid artery (P = 0.006 for delta MSV, P = 0.014 for delta PI, P < 0.001 for delta RI, and P = 0.022 for delta FV) and at the facial artery (P = 0.001 for delta MSV, P = 0.004 for delta PI, P < 0.001 for delta RI, and P < 0.001 for delta FV). In addition, significant correlations were calculated between the SFR and the aforementioned delta values. CONCLUSION: CDUS enabled the evaluation of changes in blood perfusion in the salivary glands during salivary stimulation and may be a promising tool for the assessment of caries risk in children.

[Cone beam 3D sialography: preliminary study]. / Sialographie 3D en cone beam: étude préliminaire.

INTRODUCTION: Stones, stenosis and inflammatory lesions are the main causes of mealtime syndrome. The aim of paraclinical exam is to find the cause of these obstructive symptoms. Ultrasound is often sufficient to confirm the lithiasic origin of salivary gland swelling. Non-lithiasic salivary obstructions are more difficult to diagnose. We studied the feasibility and quality of a new medical imaging device: three-dimensional (3D) sialography using the technique of cone beam with flat panel (CPCT). PATIENTS AND METHODS: Five patients were included, referred for diagnostic management of non-lithiasic salivary gland parotid colic. It was performed for each patient in the angiography room, conventional sialography and 3D CPCT. Images were compared to conventional sialography. RESULTS: None of catheterization failure or side effects were observed in five patients. 3D CPCT sialography enabled to view gland ducts until their fifth or sixth division. Compared to conventional sialography, 3D CPCT improves signal and contrast to noise ratio. DISCUSSION: This technique allows an anatomic resolution and signal/noise ratio unmatched. It also allows to reduce metallics artefacts. Its main drawback is those associated with ductal catheterization, exposure to ionizing radiation and potential allergy to iodinated contrast agents.

Extracellular matrix metalloproteinase inducer expression in salivary gland tumors: a correlation with microvessel density.

The purpose of this study was to investigate the expression pattern of extracellular matrix metalloproteinase inducer (EMMPRIN) as well as the correlation between EMMPRIN and microvessel density (MVD) in salivary gland tumors. Extracellular matrix metalloproteinase inducer expression and MVD were examined immunohistochemically on paraffin-embedded tissue specimens from 95 patients with salivary gland tumors, who underwent surgical resection from 1998 to 2006. Reverse transcription-polymerase chain reaction was used to monitor EMMPRIN mRNA expression in frozen samples. Extracellular matrix metalloproteinase inducer expression in mucoepidermoid carcinomas and adenoid cystic carcinomas was significantly higher than in normal salivary gland tissues and pleomorphic adenomas (P < 0.05). The MVD of mucoepidermoid carcinomas and adenoid cystic carcinomas was significantly higher compared with pleomorphic adenomas (P < 0.05). The MVD of the EMMPRIN-positive expression group was significantly higher than the MVD of the EMMPRIN-negative expression group (P < 0.05). Extracellular matrix metalloproteinase inducer mRNA expression in malignant salivary gland tumors was higher than that in pleomorphic adenomas (P < 0.05). This study suggests that EMMPRIN expression is an important feature of malignant salivary gland tumors and can be used as a biologic marker to characterize salivary gland tumors. Extracellular matrix metalloproteinase inducer is also a positive angiogenic factor in salivary gland tumors.

Functional activity of rabbit salivary glands in reduced and restored regional arterial blood supply conditions.

BACKGROUND: Although the vascular pathology of carotid arteries is widespread, the function of salivary glands in reduced arterial flow conditions is not much investigated clinically and in experiments. At the same time blood supply is a keystone to normal functioning of every organ and especially of salivary secretion. The aim of this study was to estimate functional activity of salivary glands in reduced and restored blood supply conditions in experiment by sialoscintigraphy which is an approved method for functional assessment of salivary glands. METHODS: The ligature of a. carotis communis dextra was performed on 20 Californian rabbits. After 28 days sialoscintigraphy with Tc99 pertechnetate and revascularization through resection of the occluded part of a. carotis communis and reconstruction with venous autograft was performed. One month later sialoscintigraphy was done. RESULTS: The functional activity of rabbit salivary glands after the ligature of a. carotis communis is strongly depressed. The revascularized glands accumulated isotope slowly, but the level of accumulation was higher than on the control side. CONCLUSION: The ligature and reconstruction of a common carotid artery on rabbits confirm the important role of the arterial blood supply in functional activity of salivary glands and may be an appropriate experimental model for investigation of ischemic disease of salivary glands.

Assessment of angiogenesis by CD105 antigen in epithelial salivary gland neoplasms with diverse metastatic behavior.

BACKGROUND: Information on the biology of metastasis development in salivary gland tumors is scarce. Since angiogenesis seems associated with this phenomenon in other tumors, we sought to compare salivary gland tumors with diverse metastatic behavior in order to improve the knowledge and management of these lesions. METHODS: Samples from the most important salivary gland tumors were segregated according to its metastatic behavior and submitted to routine immunohistochemistry to identify vessels positive for CD105 expression. Frequency of positive cases and intratumoral microvessel density (IMD) was compared among the group of lesions. RESULTS: CD105 positive vessels were absent in normal salivary gland tissue, were rare in pleomorphic adenomas and adenoid cystic carcinomas (ACC), more common in polymorphous low-grade adenocarcinomas and highest in mucoepidermoid carcinomas. Only ACC with such feature were metastatic. IMD was higher in malignant rather than benign tumors. CONCLUSION: Immunostaining of CD105 in salivary gland tumors implies participation of angiogenesis in the development of malignant lesions, as well as some role for myoepithelial cells in the control of new vessel formation. In addition, suggest that ACC with positive CD105 vessels are at higher risk for metastasis.

The effects of cigarette exposure on rat salivary proteins and salivary glands.

OBJECTIVE: Passive smoking is the involuntary inhalation of cigarette smoke (CS) and has an adverse impact on oral health. We examined the effect of CS exposure on saliva and salivary glands (SGs). METHODS: Cigarette smoke-exposed rats were intermittently housed in an animal chamber with whole-body exposure to CS until killed. Whole saliva was collected before CS exposure (0 day), and 15 and 30 days after the start of CS exposure. Saliva secretion was stimulated by administration of isoproterenol and pilocarpine after anesthesia. SGs were collected on 31 days. RESULTS: The increase in body weight of the CS-exposed rats was less than that of the control rats. Salivary flow rates did not differ at 0, 15 or 30 days after the start of CS exposure. However, the amylase and peroxidase activities and total protein content in the saliva were significantly lower in 15-day CS-exposed rats than in 15-day control rats. Histological examination of the SGs of CS-exposed rats showed vacuolar degeneration, vasodilation and hyperemia. CONCLUSION: These results suggest that CS exposure has adverse impacts on salivary composition and SGs, which could aggravate the oral environment.

Necrotizing sialometaplasia of the palate associated with angiocentric T-cell lymphoma.

In this article we present 2 cases of necrotizing sialometaplasia (NS) associated with angiocentric lymphoma of the midline. Immunohistochemical analysis confirmed a T-cell origin, and in situ hybridization in one case revealed its relationship to Epstein-Barr virus. These findings suggest that vascular occlusion by the neoplastic cells produces ischemia, which leads to local infarction contributing to the salivary gland lesion. To our knowledge, the association between angiocentric lymphoma and NS has been previously reported in only one instance, and we suggest that this particular type of lymphoma should be added to the list of related conditions for NS.

Vascular endothelial growth factor expression (VEGF) in salivary glands of diabetic rats.

This study is aimed at evaluating vascular endothelial growth factor (VEGF) expression in the salivary glands of diabetic rats. Our study was carried out on 1 group of male Wistar rats and 1 group of male Bio Breeding Wistar (BB/W) pre-diabetic rats. The first group (control) was composed of 11 rats (4 months old), and the other (test) of 11 rats (4 months old) which showed diabetes at day 85 of life. This kind of diabetes can be compared to human diabetes mellitus type 1. The submandibular glands were removed and processed for immunohistochemical analysis of VEGF. Diabetes increased salivary gland VEGF expression in the rats. The tissues analyzed (vascular endothelium, ductal endothelium, mucinous glands) always expressed VEGF, thus demonstrating that not only vascular endothelial cells, but also the other elements evaluated, have a role in the neoangiogenesis process. In both control and diabetic rats, the VEGF expression was constantly negative only in serous acini; thus demonstrating that serous acini are not involved in the neoangiogenetic processes. The vascular growth is a fundamental part of normal salivary gland development, therefore we speculate that strategies aimed at preservation or promotion of salivary gland VEGF expression may mitigate or attenuate diabetic-induced gland microvascular injury.

Prevention of irradiation-induced salivary hypofunction by microvessel protection in mouse salivary glands.

Treatment of most head and neck cancers includes radiotherapy. Salivary glands (SGs) in the irradiation (IR) field are irreversibly damaged resulting in severe hyposalivation. We evaluated the importance of SG endothelial cells to this IR-induced injury, and whether serotype 5 adenoviral (Ad5) vector-mediated transfer of basic fibroblast growth factor (AdbFGF) or vascular endothelial growth factor (AdVEGF) complementary DNAs would afford radioprotection. Four hours after IR, microvessel density (MVD) in SGs decreased by approximately 45%. However, if mice were pre-treated with either AdVEGF or AdbFGF 48 hours before IR the loss in MVD was significantly reduced. An irrelevant vector, AdLacZ, encoding Escherichia coli beta-galactosidase, was without effect. After 8 weeks, IR reduced salivary flow by approximately 65% in untreated mice. Mice pre-treated (using 5 x 10(9) particles/gland 48 hours prior to IR) with AdLacZ exhibited a reduction in salivary flow similar to untreated mice receiving IR. However, irradiated mice pre-treated with AdbFGF or AdVEGF showed a significant improvement in their salivary flow, to approximately 70% (P < 0.01) and 80% (P < 0.01), respectively, compared to non-irradiated control mice. These results are consistent with the notion that injury to the adjacent microvasculature may play an important role in SG radiation damage. Furthermore, our results suggest that a local transient treatment directed at protecting SG endothelial cells may be beneficial for patients undergoing IR for head and neck cancer.

Analysis of salivary gland proteins of the mosquito Armigeres subalbatus.

Quantitative studies of total salivary gland protein of Armigeres subalbatus mosquito revealed that the total salivary gland protein increased dramatically during the five days after emergence as adults. The amount of salivary gland protein of female and male mosquitos at day five after adult emergence were on the average 11.55 and 1.32 microg/pair gland respectively. SDS-PAGE studies showed that salivary gland protein profiles of Armigeres subalbatus demonstrated 9 major polypeptide bands of 68, 65, 60, 55, 40, 30, 28, 21, and 15 kDa. The 21 and 65 kDa bands were found only in the distal lateral region of the mosquito salivary gland and were depleted after the female mosquito took a blood meal.

Sialorrhea: a review of a vexing, often unrecognized sign of oropharyngeal and esophageal disease.

Saliva is produced by the major salivary glands (parotid, submandibular, and sublingual), as well as several smaller glands. Salivary flow can be altered by multiple entities. There is much written regarding xerostomia ("dry mouth"), the condition related to inhibited or decreased salivary flow. This condition is widely recognized in certain systemic diseases, particularly Sjögren syndrome, diabetes mellitus, after anticholinergic, antihistamine, and decongestant medications, as well as states of enhanced sympathetic drive, such as anxiety or emotional disturbances and various other psychosocial conditions. On the other hand, sialorrhea or ptyalism, the condition of increased salivary flow, is rarely discussed in the clinical literature. Sialorrhea can occur with various neurologic disorders, infections, the secretory phase of the menstrual cycle, heavy metal poisoning, Wilson disease, Angelman syndrome, as well as a relatively unknown condition called idiopathic paroxysmal sialorrhea. Normal salivation may be altered by drugs (such as clozapine, risperidone, nitrazepam, lithium, and bethanecol) that have a cholinergic effect that induces sialorrhea. This report focuses on sialorrhea as it relates to disorders of the oropharynx and esophagus. The patient typically recognizes a problem with excessive "foamy mucus" but does not understand its origin. Infections and obstruction are the most common oropharyngeal causes. Increased salivary flow occurs as a typically subtle manifestation of gastroesophageal reflux disease. This occurrence is referred to as water brash. Idiopathic achalasia and megaesophagus due to the parasite Trypanosoma cruzi are regularly associated with sialorrhea. Esophageal obstruction (foreign body, cancer, or stricture formation), infection, and nasogastric intubation are the more common conditions associated with the symptomatic sequelae of sialorrhea. Sialorrhea-related respiratory and pulmonary complications are greatest in those with a diminished sensation of salivary flow and hypopharyngeal retention. Extremes of age, the chronically debilitated, or those in chronic care facilities, especially associated with cerebrovascular accidents and esophageal cancer, typically comprise this population. For the patient with an intact awareness of saliva, sialorrhea can present with significant social stigmas. Occult drooling or regular oral evacuation into a tissue or "spit cup" is socially incapacitating. This report provides a review of the physiology, pathogenesis, clinical manifestations, and therapeutic options for sialorrhea. Physicians and other healthcare professionals should recognize the importance of sialorrhea as a possible indicator or complication of a variety of disease states of the oropharynx and esophagus as well as its impact on the patient's physical and social quality of life.

Decrease of mosquito salivary gland proteins after a blood meal: an implication for pathogenesis of mosquito bite allergy.

Salivary gland protein profiles ofAedes aegypti (L.) and Culex quinquefasciatus (Say) pre- and post-blood feeding were analyzed. SDS-PAGE studies before blood feeding of Ae. aegypti demonstrated 8 major polypeptide bands of 20, 35, 37, 42, 45, 47, 70 kDa and a high molecular weight band >118 kDa, whereas those of Cx. quinquefasciatus demonstrated 9 major polypeptide bands of 20, 26, 36, 38, 45, 47, 49 kDa and 2 high molecular weight bands >118 kDa. After a blood feeding, salivary gland polypeptides of Ae. aegypti at 35, 37, 45, 47, 70 kDa and high molecular weight band >118 kDa were depleted, while the polypeptide bands of 20, 26, 36, 38 kDa were depleted in Cx. quinquefasciatus. The presented study suggests that these major polypeptides were introduced into vertebrate hosts when a mosquito took a blood meal. Further investigation in molecular, biochemical and immunological aspects of these salivary gland polypeptides may provide information for better understanding in the role of these proteins in mosquito bite allergy.

Dermatomyositis associated with Sjögren's syndrome: VEGF involvement in vasculitis.

Two patients with dermatomyositis complicated with Sjögren's syndrome (SjS), are reported. Both patients exhibited sensory-dominant polyneuropathy, compatible with neurologic involvement in SjS. Vascular endothelial growth factor (VEGF) levels were increased in their plasma. Histological examination demonstrated vasculitic changes in biopsied specimens of muscle and salivary glands from the patients, and VEGF was overexpressed in the vasculitic lesions. These findings suggest that VEGF overexpression was associated with the development of vasculopathy in skeletal muscle and salivary glands and possibly in the peripheral nervous system.