Smoking induces oropharyngeal narrowing and increases the severity of obstructive sleep apnea syndrome.

OBJECTIVE: Smoking is a known risk factor for snoring, and is reported to be associated with an increased prevalence of obstructive sleep apnea syndrome (OSAS). The purpose of this was to determine the relationship of smoking to the severity of OSAS and examine what local histological changes in the uvular mucosa of OSAS patients might influence this relationship. STUDY DESIGN AND METHODS: Fifty-seven OSAS subjects were included and classified according to smoking history and OSAS severity. Twenty-eight subjects were heavy smokers and 29 were nonsmokers; these 57 patients were divided according to moderate or severe OSAS. Histologic changes in the uvular mucosa were evaluated in all subjects as well as smoking duration and OSAS severity. RESULTS: Among smokers, moderate-to-severe OSAS was more common, and apnea, hypopnea, and oxygen desaturation indices were higher. Moreover, smoking duration and OSAS severity were significantly correlated. Increased thickness and edema of the uvular mucosa lamina propria were observed in moderate and severe OSAS patients, and only smokers had significant changes in uvular mucosa histology. Positive staining for calcitonin gene-related peptide (CGRP), a neuroinflammatory marker for peripheral nerves, was increased in the uvular mucosa of smokers. CONCLUSIONS: Our results suggest that smoking may worsen OSAS through exacerbation of upper airway collapse at the level of the uvula, and that histological changes of the uvular mucosa correlated with smoking might be due to increased CGRP-related neurogenic inflammation.

Periodontal and oral manifestations of marijuana use.

UNLABELLED: Marijuana, prepared from the plant Cannabis sativa, is the most widely used illicit drug in the United States. Marijuana use has been associated with adverse psychosocial and health effects, including effects on oral tissues. Periodontal literature has limited references to the periodontal effects of cannabis use. In this report, we present two cases of marijuana-associated gingival enlargement and review the literature on oral complications of marijuana use. METHODS: Two asymptomatic males, aged 23 and 42 years, presented independently for oral prophylaxis. Both had an unremarkable medical history and related a history of significant marijuana use of 2-16 years duration. Common findings following oral and periodontal examination were nicotinic stomatitis-like lesions, uvulitis and gingival enlargement. Marginal and papillary gingiva of the anterior dentition were the areas primarily affected by gingival enlargement, while some of these areas exhibited a nodular or "pebbly" appearance. RESULTS: Marijuana-associated gingival enlargement was diagnosed in the reported cases. A review of the literature revealed two other reports of marijuana-associated gingival enlargement, all in young adult males with chronic (2 or more years) cannabis use. These authors reported a resemblance to phenytoin-induced enlargement. Biochemical similarities between phenytoin and cannabis active compounds suggest possible common pathogenetic mechanisms. Uvulitis and nicotinic stomatitis appear to be the two most common of the several oral manifestations of marijuana use. CONCLUSIONS: Chronic marijuana use may result in gingival enlargement with clinical characteristics similar to phenytoin-induced enlargement.

To treat snoring with nasal steroids - effects on more than one level?

CONCLUSION: An inflammatory swelling in the uvula and nose due to vibration might be a contributing factor in snoring. The presence of corticosteroid receptors in the uvula indicates the possibility for treatment with local steroids. Use of mometasone furoate (MF) for 3 months reduced snoring and related symptoms in some patients. OBJECTIVE: To investigate the effect of a nasal steroid, MF, on snoring and related discomfort. SUBJECTS AND METHODS: In the first part of the study, uvular and nasal biopsies from six patients with social snoring were examined using immunohistochemistry to evaluate whether corticosteroid receptors were present. Then 100 snoring patients were invited to participate in the second part of the study. In all, 72 men and 22 women with a mean age of 47 years and BMI 27 answered a questionnaire about symptoms, had ENT status assessed and reported sleep and related variables for a 7 day period. After randomization to placebo or MF, they used a nasal spray for 3 months at a dosage of 200 microg. Thereafter the procedure was repeated. RESULTS: Corticosteroid receptors were present in the mucous membranes and around the blood vessels in all uvulas examined. A total of 84 patients were evaluated. No decrease in 'mean snoring score' was seen. Daytime sleepiness showed a slight improvement in the MF group and partners were less disturbed. Minor side effects were equal for both groups.

Life-threatening uvular angioedema caused by Ecbalium elaterium.

Ecbalium elaterium, known as the wild or squirting cucumber, is a hairy perennial herbaceous vine of the Cucurbitaceae family, endemic to the Mediterranean region. All parts of the plant are toxic, particularly the gherkin-like fruits. It is frequently used in the treatment of sinusitis by nasal aspiration in some parts of the Mediterranean. The studies regarding to Ecbalium elaterium, argue that it has an anti-inflammatory characteristic. Two cases of uvular oedema have been ascribed to the undiluted use of this substance. Since they can threaten life, similar cases arising with the improper use of herbals should not be ignored in the emergency department. In this paper we present a life-threatening uvular angioedema caused by nasal aspiration of undiluted juice of squirting cucumber.

Severe uvular angioedema caused by intranasal administration of Ecbalium elaterium.

A 54-y-o woman presented to the Emergency Department with shortness of breath and sore throat after intranasal administration of Ecbalium elaterium as a folk remedy for her sinusitis. The patient's history included nasal aspiration of the juice of the squirting cucumber (Ecbalium elaterium) for acute maxillary sinusitis. An airway obstruction due to severe uvular angioedema was detected and confirmed by airway X-ray. The patient was treated with 100% oxygen with mask, 0.3 mg epinephrine s.c., and 80 mg prednisolone i.v. Renal and hepatic function tests were normal. After a 24-h observation, the patient was discharged in her previous state of health.

Effect of cisplatin exposure on platinum accumulation and growth inhibition in human neoplastic and normal squamous epithelial cells of the mucosa of the upper-aerodigestive tract.

The aim of the present study was to investigate how normal head and neck epithelial cells (NHNEC) respond to cisplatin compared to their neoplastic counterparts with respect to intracellular platinum (Pt) levels and growth inhibition. A colorimetric assay was used to assess growth inhibition after exposure to cisplatin for 72 h. Growth inhibition did not differ between cultures of neoplastic (n = 5) and normal cells (n = 5). Intracellular Pt levels, determined with atomic absorption spectroscopy were about 30-fold higher in the normal epithelial cells. The main finding of this study is that normal epithelial cells from the head and neck region have a much higher tolerance for cisplatin than their neoplastic counterparts. Interestingly, this characteristic is without consequence for growth inhibition.

[Nicotine concentrations in the palatine tonsil, uvula mucosa and septum cartilage of smokers--a pilot study]. / Nikotinkonzentrationen in der Tonsilla palatina, Uvulaschleimhaut und Septumknorpel von Rauchern--Eine Pilotstudie.

The concentrations of nicotine were determined via radioimmunoassay in the palatine tonsils (n = 22) and in the mucosa of the uvula (n = 5) of eleven male smokers, and in the nasal septal cartilage of four other smokers. The same tissues of five nonsmokers served as controls. The mean values of the nicotine concentrations were 77 ng/g for the tonsils (level of serum: 151 ng/g), 114.5 ng/g for the mucosa of the uvula (level of serum: 215 ng/g) and 36 ng/g for the septal cartilage (level of serum: 97 ng/g). There was no nicotine in the tissues and serum of the control group. The correlations between the nicotine concentrations of the three tissues and the levels of the serum were significant. Another significant correlation was found between the nicotine level of the serum and the daily consumption of cigarettes of the eleven patients on whom tonsillectomy had been performed. These concentrations of nicotine in the three types of tissue and in serum appear to be high after an interval of twelve hours non-smoking. With gas-chromatography/mass-spectrometry also unchanged nicotine was found in the tonsils which is considered to be the damaging substance of tobacco.

[Embryonal rhabdomyosarcoma of the uvula in a 5-year-old child]. / Rhabdomyosarcoma embrionale uvulae u 5-letniego dziecka.

A case of rhabdomyosarcoma embrionale uvulae in 5 years old girl was described. The child was treated at the beginning surgically, then chemotherapy was given according to schema IRS-III. After 2 years observation the child is in a good condition.