A randomized, double-blind, crossover study comparing two- and four-dose hydrocortisone regimen with regard to quality of life, cortisol and ACTH profiles in patients with primary adrenal insufficiency.

CONTEXT: Current guidelines on how to divide the daily cortisol substitution dose in patients with primary adrenal insufficiency (PAI) are controversial and mainly based on empirical data. OBJECTIVE: To assess how an equal dose of hydrocortisone (HC) given either four times daily or twice daily influence diurnal profiles of cortisol and ACTH, patient preferences and health-related quality of life (HRQoL). DESIGN: Double blind, crossover. METHODS: Fifteen patients with PAI (six women) were included. Capsules of HC or placebo were given at 07:00, 12:00, 16:00 and 22:00 h in 4-week treatment periods: either one period with four doses (10 + 10 + 5 + 5 mg) or one period with two doses (20 + 0 + 10 + 0 mg). Diurnal profiles of cortisol and ACTH were collected, and area under the curve (AUC) was calculated. Questionnaires were used to evaluate patient preferences and HRQoL. RESULTS: The four-dose regimen gave a higher serum cortisol before tablet intake in the morning (P = 0·027) and a higher 24-h cortisol(AUC) (P < 0·0001) compared with the two-dose period. In contrast, a lower median plasma ACTH in the morning before tablet intake (P = 0·003) and a lower 24-h ln(ACTH(AUC) ) were found during the four-dose period. The patients preferred the four-dose regimen (P = 0·03), and the HRQoL scores tended to be higher (high score indicates better HRQoL) for the four-dose period. In summary, a four-dose regimen gives increased availability of cortisol and an enhanced effect with a less elevated ACTH in the morning in comparison with a two-dose regimen but the effect on HRQoL remains inconclusive.

Inter- and intra-individual variations in saliva secretion rates--a comparison of unsupervised and supervised sample collection.

The aim of this study was to investigate if unsupervised measurement of saliva secretion could be used instead of supervised measurement at the dental clinic. One hundred patients attending a dental clinic for regular dental care were asked to participate (group A). A control group of 40 subjects was recruited (group B). Saliva samples were collected and stimulated saliva secretion rates were determined. After instruction, subjects in both groups collected the first sample at day 1 at the dental clinic. Subjects in group A continued to collect 2 more samples at day 1 and 3 samples at each of day 3 and day 5 outside the clinic. Subjects in group B did 3 saliva samplings at day 1, day 3, and day 5 under supervision at the dental clinic. In total 9 samples from each subject were collected. Median secretion rates in group A were, in day 1, 2.1 ml/min (range: 0.1-5.1); day 3, 1.9 ml/min (range: 0.1-5.3); and day 5, 1.9 ml/min (range: 0.1-5.5). Corresponding rates in group B were, in day 1, 2.1 ml/min (range: 0.6-4.4); day 3, 2.0 ml/min (range: 0.7-4.6); and day 5, 2.0 ml/min (range: 0.9-4.1). No significant difference in secretion rates appeared between groups A and B at day 1, 3, and 5 or during the 5 days of observations. Analysis of intra-individual differences in secretion rates showed that in group Athere was a significant difference between measurements, while in group B measurements did not differ significantly. The intra-individual variation expressed as mean coefficient of variation during the 5-day period was 20.4% in group A and 17.3% in group B. In conclusion, measurement of saliva secretion capacity under unsupervised conditions may be a feasible method to judge saliva secretion capacity in clinical practice.

Recurrence rates after surgical removal of oral leukoplakia-A prospective longitudinal multi-centre study.

Oral leukoplakia (OL) is a potentially malignant oral disorder. The Gold Standard treatment is to remove surgically the OL. Despite optimal surgery, the recurrence rates are estimated to be 30%. The reason for this is unknown. The aim of this study was to investigate the clinical factors that correlate with recurrence after surgical removal of OL. In a prospective study data were collected from 226 patients with OL. Forty-six patients were excluded due to incomplete records or concomitant presence of other oral mucosal diseases. Overall, 180 patients proceeded to analysis (94 women and 86 men; mean age, 62 years; age range, 28-92 years). Clinical data, such as gender, diagnosis (homogeneous/non-homogeneous leukoplakia), location, size, tobacco and alcohol use, verified histopathological diagnosis, and clinical photograph, were obtained. In patients who were eligible for surgery, the OL was surgically removed with a margin. To establish recurrence, a healthy mucosa between the surgery and recurrence had to be confirmed in the records or clinical photographs. Statistical analysis was performed with the level of significance set at P<0.05. Of the 180 patients diagnosed with OL, 57% (N = 103) underwent surgical removal in toto. Recurrence was observed in 43 OL. The cumulative incidence of recurrence of OL was 45% after 4 years and 49% after 5 years. Fifty-six percent (N = 23) of the non-homogeneous type recurred. Among snuff-users 73% (N = 8) cases of OL recurred. A non-homogeneous type of OL and the use of snuff were significantly associated with recurrence after surgical excision (P = 0.021 and P = 0.003, respectively). Recurrence was also significantly associated with cancer transformation (P<0.001). No significant differences were found between recurrence and any of the following: dysplasia, site of lesion, size, multiple vs. solitary OL, gender, age, use of alcohol or smoking. In conclusion, clinical factors that predict recurrence of OL are non-homogeneous type and use of snuff.

Combined Testing of p16 Tumour-suppressor Protein and Human Papillomavirus in Patients With Oral Leukoplakia and Oral Squamous Cell Carcinoma.

BACKGROUND: Oral leukoplakia (OL) is a potentially malignant oral mucosal disorder. A casual association between OL, oral squamous cell carcinoma (OSCC) and human papillomavirus (HPV) infection has been suggested, but no conclusive evidence has been presented. p16, a tumour-suppressor protein, is used as a surrogate marker for HPV infection. The aim of this study was to investigate how overexpression of p16 correlates with HPV infection in OL and in OSCC. PATIENTS AND METHODS: Seventy-four patients with OL and 13 with OSCC with p16 overexpressed, were analyzed by immunohistochemistry visualizing p16 and a real-time polymerase chain reaction (PCR) assay targeting HPV types 6, 11, 16, 18, 31, 33, 35, 39, 45, 52, 56, 58 and 59. RESULTS: Overexpression of p16 was observed in 18% of patients with OL. None of the HPV subtypes were detected by PCR analysis in patients with OL. In the p16-positive OSCC specimens, 38% were also HPV16-positive. CONCLUSION: Overexpression of p16 was not found to be a reliable biomarker for HPV infection in patients with OL and OSCC.

Secretion rate from minor salivary glands in patients with malignant haematological diseases receiving chemotherapy--a pilot study.

The aim of this pilot study was to investigate the secretion rate from minor salivary glands in 16 patients (mean age 62 years) with myeloma, lymphoma or other malignant haematological diseases receiving chemotherapy (study group). An age- and sex-matched control group (n = 16) was recruited. The secretion rate from the minor salivary glands on the inside of the lower lip, measured using the Periotron method, was in mean 2.8 microliters/cm2/min in the study group compared with 4.5 microliters/cm2/min in the control group (p < 0.01). No difference was found in the secretion rate of paraffin-stimulated whole saliva. There were more individuals who experienced dry mouth in the study group (n = 7) than in the control group (n = 2). The conclusion from this pilot study is that the secretion rate from the minor salivary glands might be reduced in cancer patients treated with chemotherapy.

[New routines makes tooth extraction possible during warfarin treatment]. / Nya rutiner möjliggör tandextraktioner under pågående waranbehandling.

We conclude that it is possible to successfully extract teeth without interrupting or reducing the dose of anticoagulant medication with warfarin. We also conclude that patients with anticoagulant medication are treated differently depending on where they have their dental treatment done.