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Strauss FJ, Fukuba S, Naenni N, Jung R, Jonker B, Wolvius E, Pijpe J. Alveolar ridge changes 1-year after early implant placement, with or without alveolar ridge preservation at single-implant sites in the aesthetic region: A secondary analysis of radiographic and profilometric outcomes from a randomized controlled trial. Clin Implant Dent Relat Res 2024; 26:356-368. [PMID: 38105498 DOI: 10.1111/cid.13297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 11/08/2023] [Accepted: 11/28/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVES To assess both the radiographic and profilometric outcomes of early implant placement with or without alveolar ridge preservation (ARP) (using two different ARP techniques) after 1 year of loading. MATERIALS AND METHODS Seventy-five patients with a failing single tooth in the anterior maxilla were randomly allocated to three groups (1:1:1): (a) ARP using demineralized bovine bone mineral containing 10% collagen (DBBM-C) covered by a collagen matrix (CM), (b) ARP using DBBM-C covered with a palatal graft (PG), and (c) unassisted socket healing (control). Eight weeks after tooth extraction, early implant placement was performed in all patients. Cone-beam computed tomography (CBCT) and impressions were taken 8 weeks after tooth extraction (ARP/unassisted healing) prior to implant placement and 1-year post-loading. Radiographic and profilometric outcomes were evaluated. RESULTS Out of the 70 patients available for re-examination at 1-year post-loading, 55 datasets could be assessed (ARP-CM 19; ARP-PG 17; Control 19). The need for additional guided bone regeneration (GBR) at implant placement amounted to 31.6% (ARP-CM), 29.4% (ARP-PG), and 68.4% (unassisted healing). Adjusted models revealed that residual buccal bone height and additional GBR at implant placement significantly influenced the magnitude of the alveolar changes at 1 year (p < 0.05). In patients with ARP (group ARP-CM or ARP-PG) without additional GBR, the presence of bone convexity amounted to 36.0% (9/25) at 1-year post-loading. For patients that received ARP and additional GBR at implant placement, the frequency of bone convexity increased to 72.7% (8/11) (p = 0.042). Regarding profilometric measurements, a tendency toward agreement with radiographic outcomes was observed. CONCLUSIONS Early implant placement with ARP can attenuate alveolar ridge changes at 1-year post loading by minimizing both radiographic and profilometric alterations. However, early implant placement with simultaneous GBR consistently yields superior radiographic and profilometric outcomes, regardless of whether ARP is performed.
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Affiliation(s)
- Franz Josef Strauss
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
- Department of Conservative Dentistry, Faculty of Dentistry, University of Chile, Santiago, Chile
- Faculty of Dentistry, Universidad Finis Terrae, Santiago, Chile
| | - Shunsuke Fukuba
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
- Department of Periodontology, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Nadja Naenni
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Ronald Jung
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Brend Jonker
- Department of Oral and Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Eppo Wolvius
- Department of Oral and Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Justin Pijpe
- Department of Oral and Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
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Al-Nawas B, Aghaloo T, Aparicio C, Bedrossian E, Brecht L, Brennand-Roper M, Chow J, Davó R, Fan S, Jung R, Kämmerer PW, Kumar VV, Lin WS, Malevez C, Morton D, Pijpe J, Polido WD, Raghoebar GM, Stumpel LJ, Tuminelli FJ, Verdino JB, Vissink A, Wu Y, Zarrine S. ITI consensus report on zygomatic implants: indications, evaluation of surgical techniques and long-term treatment outcomes. Int J Implant Dent 2023; 9:28. [PMID: 37698775 PMCID: PMC10497463 DOI: 10.1186/s40729-023-00489-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/25/2023] [Indexed: 09/13/2023] Open
Abstract
OBJECTIVES The aim of the ITI Consensus Workshop on zygomatic implants was to provide Consensus Statements and Clinical Recommendations for the use of zygomatic implants. MATERIALS AND METHODS Three systematic reviews and one narrative review were written to address focused questions on (1) the indications for the use of zygomatic implants; (2) the survival rates and complications associated with surgery in zygomatic implant placement; (3) long-term survival rates of zygomatic implants and (4) the biomechanical principles involved when zygoma implants are placed under functional loads. Based on the reviews, three working groups then developed Consensus Statements and Clinical Recommendations. These were discussed in a plenary and finalized in Delphi rounds. RESULTS A total of 21 Consensus Statements were developed from the systematic reviews. Additionally, the group developed 17 Clinical Recommendations based on the Consensus Statements and the combined expertise of the participants. CONCLUSIONS Zygomatic implants are mainly indicated in cases with maxillary bone atrophy or deficiency. Long-term mean zygomatic implant survival was 96.2% [95% CI 93.8; 97.7] over a mean follow-up of 75.4 months (6.3 years) with a follow-up range of 36-141.6 months (3-11.8 years). Immediate loading showed a statistically significant increase in survival over delayed loading. Sinusitis presented with a total prevalence of 14.2% [95% CI 8.8; 22.0] over a mean 65.4 months follow-up, representing the most common complication which may lead to zygomatic implant loss. The international experts suggested clinical recommendations regarding planning, surgery, restoration, outcomes, and the patient's perspective.
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Affiliation(s)
- Bilal Al-Nawas
- Department of Oral and Maxillofacial Surgery, Plastic Operations, University Medical Center Mainz, Mainz, Germany.
| | - Tara Aghaloo
- Section of Oral and Maxillofacial Surgery, UCLA School of Dentistry, Los Angeles, CA, USA
| | - Carlos Aparicio
- Indiana University School of Dentistry, Indianapolis, USA
- Hepler Bone Clinic, ZAGA Center Barcelona, Barcelona, Spain
| | - Edmond Bedrossian
- Department of Oral and Maxillofacial Surgery University of the Pacific, Dugoni School of Dentistry, San Francisco, CA, USA
| | - Lawrence Brecht
- Department of Dental Medicine and Oral and Maxillofacial Surgery, Northwell Health, New Hyde Park, New York, USA
- Division of Prosthodontics and Restorative Dentistry, NYC College of Dentistry, New York, USA
| | | | - James Chow
- Brånemark Osseointegration Center, Hong Kong SAR, China
| | - Rubén Davó
- Medimar International Hospital, Department of Implantology and Maxillofacial Surgery, Vithas Davó Instituto Dental, Alicante, Spain
| | - Shengchi Fan
- Department of Oral and Maxillofacial Surgery, Plastic Operations, University Medical Center Mainz, Mainz, Germany
- Second Dental Center, School of Medicine, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China
| | - Ronald Jung
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Peer W Kämmerer
- Department of Oral and Maxillofacial Surgery, Plastic Operations, University Medical Center Mainz, Mainz, Germany
| | - Vinay V Kumar
- Oral Rehabilitation Center, Bangalore, India
- Department of Surgical Sciences, Odontology and Maxillofacial Surgery, Medical Faculty, Uppsala University, Uppsala, Sweden
| | - Wei-Shao Lin
- Department of Prosthodontics, Indiana University School of Dentistry, Indianapolis, USA
| | - Chantal Malevez
- Department of Oral and Maxillofacial Surgery, Clinique Saint-Jean, Brussels, Belgium
| | - Dean Morton
- Department of Prosthodontics, Indiana University School of Dentistry, Indianapolis, USA
| | - Justin Pijpe
- Department of Oral and Maxillofacial Surgery, Special Care and Orthodontics, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Waldemar D Polido
- Department of Oral and Maxillofacial Surgery, Indiana University School of Dentistry, Indianapolis, USA
| | - Gerry M Raghoebar
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Frank J Tuminelli
- Department of Veterans Affairs, New York Harbor Healthcare System, New York, USA
| | | | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
| | - Yiqun Wu
- Second Dental Center, School of Medicine, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China
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Abstract
Obesity seems to adversely affect oral health-related quality of life. Remakably, several studies show a further decrease of oral health-related quality of life after bariatric surgery despite the weight loss. The objective of this study was to assess the perceived oral health-related quality of life in dentulous, obese patients and in dentulous, bariatric patients at least one year after they underwent surgery. This was assessed using the validated Dutch short version of the Oral Health Impact Profile questionnaire, consisting of 14 questions divided into 7 categories. A higher score on this questionnaire indicate a lower oral health-related quality of life. Based on the collected data of 440 patients, the overall oral health-related quality of life seems unaffected by bariatric surgery: a decrease was however seen regarding the functional limitation subcategory compared to preoperative patients with obesity.
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Jonker BP, Strauss FJ, Naenni N, Jung RE, Wolvius EB, Pijpe J. Early implant placement with or without alveolar ridge preservation in single tooth gaps renders similar esthetic, clinical and patient-reported outcome measures: One-year results of a randomized clinical trial. Clin Oral Implants Res 2021; 32:1041-1051. [PMID: 34129708 PMCID: PMC8457170 DOI: 10.1111/clr.13796] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/23/2021] [Accepted: 06/07/2021] [Indexed: 12/24/2022]
Abstract
Objectives To test whether early implant placement with alveolar ridge preservation (ARP) results in different esthetic, clinical and patient‐reported outcome measures (PROMs) compared with early implant placement without ARP. Material and methods Seventy‐five patients requiring single tooth extraction in the anterior maxilla were recruited. Following tooth extraction, the patients were randomly allocated to three groups: (a) ARP using demineralized bovine bone mineral containing 10% collagen (DBBM‐C) covered by a collagen matrix (CM) (n = 25), (b) ARP using DBBM‐C covered with a palatal graft (PG) (n = 25) and (c) spontaneous healing (control) (n = 25). Eight weeks after tooth extraction, a CBCT was taken and early implant placement was performed in all patients. Esthetic, clinical and PROMs were evaluated one year post‐loading. Results A total of 70 patients were available for re‐examination at one year post‐loading. The median mid‐facial mucosal margin change amounted to −0.02 mm (IQR −0.27–0.46) in the CM group, −0.13 mm (IQR −0.44–0.25) in the PG group and −0.14 mm (IQR −0.29–0.07) in the control group, with no significant differences between the groups. Mean PES scores amounted to 7.0 ± 1.4 in the CM group, 7.1 ± 1.5 in the PG group and 7.3 ± 1.7 in the control group without significant differences between the groups. Plaque, bleeding on probing and probing depth did not differ between treatment groups. PROMs in general revealed no significant differences between the groups. Conclusion Early implant placement with ARP using either a collagen matrix or a palatal graft rendered similar esthetic, clinical and PROMs to early implant placement without ARP. When a failing tooth can be replaced with an implant within 2 months after tooth extraction, the added value of ARP might be clinically negligible.
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Affiliation(s)
- Brend P Jonker
- Department of Oral & Maxillofacial Surgery, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Franz J Strauss
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland.,Department of Conservative Dentistry, Faculty of Dentistry, University of Chile, Santiago, Chile
| | - Nadja Naenni
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Ronald E Jung
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Eppo B Wolvius
- Department of Oral & Maxillofacial Surgery, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Justin Pijpe
- Department of Oral & Maxillofacial Surgery, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Oral & Maxillofacial Surgery, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
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Jonker BP, Gil A, Naenni N, Jung RE, Wolvius EB, Pijpe J. Soft tissue contour and radiographic evaluation of ridge preservation in early implant placement: A randomized controlled clinical trial. Clin Oral Implants Res 2020; 32:123-133. [PMID: 33217058 PMCID: PMC7839667 DOI: 10.1111/clr.13686] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 08/24/2020] [Accepted: 10/28/2020] [Indexed: 02/06/2023]
Abstract
Objectives To compare two ridge preservation techniques and spontaneous healing in terms of hard and soft tissue changes 2 months after tooth extraction. Material and methods The study was designed as a randomized controlled trial and included 75 patients. After single tooth extraction in the maxillary incisor/premolar area, patients were randomly allocated to one of the following groups: (a) ridge preservation with a xenogeneic bone substitute covered with a collagen matrix (CM‐group), (b) ridge preservation with a xenogeneic bone substitute covered with a free palatal graft (PG‐group) or (c) spontaneous healing (control). Eight weeks after tooth extraction, implants were placed and clinical, profilometric and radiographic evaluations were performed. In addition, the need for further guided bone regeneration (GBR) at implant placement was assessed. The differences between the treatment groups were compared with the One‐way ANOVA or Kruskal–Wallis test with the corresponding post hoc analysis. The proportions of the categorical parameters were compared with the Fisher´s exact test. Results Seventy‐five patients underwent early implant placement 8 weeks after tooth extraction and were evaluated. CM‐group (−0.9 SD 0.6 mm) and PG‐group (−1.0 SD 0.8 mm) showed less horizontal bone resorption compared to the control group (−3.2 SD 2.1 mm) (p < .001). Moreover, the necessity of GBR at implant placement was significantly less in CM‐group (32%) and PG‐group (24%) when compared to control group (72%) (p = .001). Patients in CM‐group experienced less pain than PG‐group, one week after tooth extraction (p = .042). No significant differences were found regarding graft evaluation, post‐operative complications, and soft tissue contour. Conclusions Ridge preservation using a xenogeneic bone substitute covered with a collagen matrix or a palatal graft, results in less bone resorption and fewer GBR procedures at early implant placement compared to spontaneous healing.
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Affiliation(s)
- Brend Pjotr Jonker
- Department of Oral & Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Alfonso Gil
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Nadja Naenni
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Ronald Ernst Jung
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Eppo Bonne Wolvius
- Department of Oral & Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Justin Pijpe
- Department of Oral & Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Oral & Maxillofacial Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
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Gil A, Jonker B, Naenni N, Strauss F, Jung R, Wolvius E, Pijpe J. Soft tissue contour and radiographic evaluation of ridge preservation in early implant placement: A randomized controlled clinical trial. Clin Oral Implants Res 2020. [DOI: 10.1111/clr.46_13643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Alfonso Gil
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Brend Jonker
- Erasmus Medical Center, Department of Oral‐ and Maxillofacial Surgery, Rotterdam, Netherlands
| | - Nadja Naenni
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Franz Strauss
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Ronald Jung
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Eppo Wolvius
- Erasmus Medical Center, Department of Oral‐ and Maxillofacial Surgery, Rotterdam, Netherlands
| | - Justin Pijpe
- Erasmus Medical Center, Department of Oral‐ and Maxillofacial Surgery, Rotterdam, Netherlands
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Jonker B, Wolvius E, van der Tas J, Tahmaseb A, Pijpe J. Esthetics and Patient-Reported Outcomes of Implants Placed with Guided Bone Regeneration and Complete Native Bone: A Prospective Controlled Clinical Trial. Int J Oral Maxillofac Implants 2020; 35:406-414. [DOI: 10.11607/jomi.7751] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Jonker B, Wolvius E, van der Tas J, Pijpe J. The Effect of Resorbable Membranes on 1-stage Ridge Augmentation in Anterior Single-Tooth Replacement: A Randomized, Controlled Clinical Trial. J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.joms.2019.06.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Jonker B, Wolvius E, van der Tas J, Pijpe J. The effect of resorbable membranes on one-stage ridge augmentation in anterior single-tooth replacement: a randomized, controlled clinical trial. Int J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.ijom.2019.03.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Geuverink E, Kraaijeveld K, van Leussen M, Chen F, Pijpe J, Linskens MHK, Beukeboom LW, van de Zande L. Evidence for involvement of a transformer paralogue in sex determination of the wasp Leptopilina clavipes. Insect Mol Biol 2018; 27:780-795. [PMID: 30039559 DOI: 10.1111/imb.12522] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Transformer (tra) is the central gear in many insect sex determination pathways and transduces a wide range of primary signals. Mediated by transformer-2 (tra2) it directs sexual development into the female or male mode. Duplications of tra have been detected in numerous Hymenoptera, but a function in sex determination has been confirmed only in Apis mellifera. We identified a tra2 orthologue (Lc-tra2), a tra orthologue (Lc-tra) and a tra paralogue (Lc-traB) in the genome of Leptopilina clavipes (Hymenoptera: Cynipidae). We compared the sequence and structural conservation of these genes between sexual (arrhenotokous) and asexual all-female producing (thelytokous) individuals. Lc-tra is sex-specifically spliced in adults consistent with its orthologous function. The male-specific regions of Lc-tra are conserved in both reproductive modes. The paralogue Lc-traB lacks the genomic region coding for male-specific exons and can only be translated into a full-length TRA-like peptide sequence. Furthermore, unlike LC-TRA, the LC-TRAB interstrain sequence variation is not differentiated into a sexual and an asexual haplotype. The LC-TRAB protein interacts with LC-TRA as well as LC-TRA2. This suggests that Lc-traB functions as a conserved element in sex determination of sexual and asexual individuals.
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Affiliation(s)
- E Geuverink
- Groningen Institute for Evolutionary Life Sciences, University of Groningen, Groningen, The Netherlands
| | - K Kraaijeveld
- Department of Ecological Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Leiden Genome Technology Center, Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - M van Leussen
- Groningen Institute for Evolutionary Life Sciences, University of Groningen, Groningen, The Netherlands
| | - F Chen
- Groningen Institute for Evolutionary Life Sciences, University of Groningen, Groningen, The Netherlands
| | - J Pijpe
- University of Applied Sciences Leiden, Leiden, The Netherlands
| | - M H K Linskens
- Groningen Biomolecular Sciences and Biotechnology Institute, University of Groningen, Groningen, The Netherlands
| | - L W Beukeboom
- Groningen Institute for Evolutionary Life Sciences, University of Groningen, Groningen, The Netherlands
| | - L van de Zande
- Groningen Institute for Evolutionary Life Sciences, University of Groningen, Groningen, The Netherlands
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Jonker BP, Wolvius EB, van der Tas JT, Pijpe J. The effect of resorbable membranes on one-stage ridge augmentation in anterior single-tooth replacement: A randomized, controlled clinical trial. Clin Oral Implants Res 2017; 29:235-247. [PMID: 29266485 DOI: 10.1111/clr.13106] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2017] [Indexed: 11/28/2022]
Abstract
AIM To evaluate the effect of resorbable membranes on one-stage ridge augmentation procedures in small (2-4 mm) buccal bony dehiscences in anterior maxillary single-tooth replacement. MATERIALS AND METHODS Patients with a buccal bony dehiscence after implant placement in the esthetic zone were randomly allocated to one-stage ridge augmentation with (M+) or without a membrane (M-). Second-phase surgery was performed after 8 weeks, and follow-up was performed 1, 6, and ≥12 months after loading. Outcomes included implant survival and success, complications, clinical and radiographic parameters, esthetic results and patient satisfaction. RESULTS Fifty-two patients were randomized to one-stage ridge augmentation with (n = 25) or without use of a membrane (n = 27). No significant differences in implant survival and success have been observed. The risk of having a small mucosal dehiscence was more than six times higher in the M+ group than in the M- group (RR 6.24, 95% CI 0.81 to 48.21). At the last follow-up, the bleeding index (BI) was marginally higher in the M+ group (14/9/2/0) compared to the M- group (24/2/0/0) (U = 205, Z = -2.97, p = .003, r = .42). The median change in marginal bone level was statistically lower in the M+ group (0.06 mm) than the M- group (0.60 mm) at last follow-up (U = 120, Z = -2.73 a p = .006 r = .42). Total pink esthetic index (PES) and white esthetic score (WES) and combined PES/WES were not significantly different between treatment groups at more than 12 months after loading. Only the subcategory root convexity/soft tissue color scored significantly lower in the M+ group (1.5) compared to the M- group (2.0) at the last follow-up (U = 172, Z = -2.34, p = .019 r = .34). No differences were found in patient satisfaction. CONCLUSION The use of a resorbable membrane in small buccal bony dehiscences in anterior maxillary single-tooth replacement resulted in less marginal bone loss, but showed more mucosal dehiscences, higher bleeding scores and lower scores on root convexity and soft tissue color after at least one year of loading. No effect was seen on implant survival and success, overall esthetic results, and patient satisfaction. The research protocol was registered at the Dutch Trial Register (NTR) with ID NTR6137.
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Affiliation(s)
- Brend P Jonker
- Department of Oral & Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Eppo B Wolvius
- Department of Oral & Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus University Medical Center, Rotterdam, The Netherlands.,St. Anna Hospital, Geldrop, The Netherlands
| | - Justin T van der Tas
- Department of Oral & Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Justin Pijpe
- Department of Oral & Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus University Medical Center, Rotterdam, The Netherlands.,Catharina Hospital, Eindhoven, The Netherlands
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Jonker BP, Roeloffs MWK, Wolvius EB, Pijpe J. The clinical value of membranes in bone augmentation procedures in oral implantology:
A systematic review of randomised controlled trials. Eur J Oral Implantol 2016; 9:335-365. [PMID: 27990504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE To determine the clinical value of membranes in bone augmentation procedures such as ridge augmentation with simultaneous (one-stage) and delayed (two-stage) implant placement, sinus augmentation surgery, ridge preservation and immediate implant placement. MATERIALS AND METHODS In April 2016, Embase, Medline (Ovid-SP), Cochrane Central, Web of Science and PubMed (as supplied by the publisher) were searched. There were no restrictions regarding language or publication date. Randomised controlled trials that reported membranes in bone augmentation procedures with a minimum follow-up period of 6 months after implant loading or that described geometrical changes of the bone graft at re-entry were included. Membrane placement had to be the only variable in the procedure. Outcomes were implant failure, complications, horizontal bone gain and resorption, graft resorption, defect height reduction, marginal bone loss around implants, aesthetic results and patient satisfaction. The results were pooled using fixed-effect models with mean differences (MDs) for continuous outcomes and odds ratios (ORs) for dichotomous outcomes. RESULTS After screening the titles and abstracts of 1843 papers, 32 potentially eligible articles were selected. Seventeen articles involving 10 trials were included in this review. These studies presented outcome data for 355 patients. Seven trials were considered to be at a high risk of bias, two at a low risk of bias and one at an unclear risk of bias. Insufficient evidence was found to determine whether there were differences in implant failure rates, marginal bone level changes, aesthetic results or patient satisfaction. For one-stage ridge augmentation (two trials; n = 52), there was evidence of more horizontal bone gain (MD: 0.84 mm, 95% CI: 0.46 to 1.21, P < 0.00001; two trials), defect height reduction (MD: 18.36%, 95% CI: 10.23 to 26.50, P < 0.00001; two trials), and prevention of graft resorption (P = 0.004; one trial) in favour of the membrane-covered group, although substantial heterogeneity was found for horizontal bone gain (Chi2; P = 0.05, I2=74%). There was insufficient evidence to determine whether any differences exist in two-stage ridge augmentation (three trials; n = 81), sinus augmentation (one trial; n = 104) and ridge preservation (one trial; n = 20). For immediate implant placement (three trials; n = 98), there was evidence of an increased defect height reduction in favour of the membrane-covered groups (MD: 6.25%, 95% CI: 1.67 to 10.82, P = 0.007; two trials), although with substantial heterogeneity (Chi2; P = 0.03, I2 = 79%). More complications were observed when a membrane was used (OR: 2.52, 95% CI: 1.07 to 5.93, P = 0.03; three trials). CONCLUSIONS There is insufficient evidence regarding the effects of membranes on bone augmentation procedures to support any definitive conclusions. Only 10 studies were included; they had limited sample sizes and short follow-up periods, and the majority were at a high risk of bias. However, no difference in implant failure was found, and the possible clinical value is still unknown, as long-term clinical parameters such as marginal bone loss, aesthetic results and patient satisfaction have been insufficiently studied. Conflict-of-interest and source-of-funding statement: The authors declare that they have no possible conflicts of interest. No funding for this review was received.
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Kraaij S, Karagozoglu KH, Kenter YAG, Pijpe J, Gilijamse M, Brand HS. Systemic diseases and the risk of developing salivary stones: a case control study. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 119:539-43. [PMID: 25753448 DOI: 10.1016/j.oooo.2015.01.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 01/14/2015] [Accepted: 01/28/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To investigate the possible relationship between the presence of salivary stones and systemic diseases, medication, smoking, and alcohol consumption. STUDY DESIGN A retrospective, case control study. Medical records of patients with salivary stones and those of control patients without salivary stones were retrospectively reviewed. Data regarding the affected salivary gland, the presence of systemic disease, and the use of medication, tobacco, and alcohol were recorded. Statistical analysis was performed using the Fisher Exact tests. RESULTS Medical records of 208 patients with salivary stones and those of 208 control patients were reviewed. Of the patients diagnosed with salivary stones, the submandibular gland was affected in 85.6% of the patients, the parotid gland in 9.6%, and the sublingual gland in 2.4% of the patients. None of the recorded systemic diseases was more prevalent in patients with salivary stones. Patients with salivary stones used significantly more antibiotics compared with the control group (P = .037). No significant differences were observed for other types of medication. There was no correlation between salivary stone formation, smoking, and alcohol consumption. CONCLUSIONS The present study suggested that systemic diseases, medication, smoking, and alcohol consumption play no or only a limited role in the onset of salivary stones.
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Affiliation(s)
- Saskia Kraaij
- Department of Periodontology and Oral Biochemistry, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands; Department of Oral and Maxillofacial Surgery/Oral Pathology VU University Medical Center and Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - K Hakki Karagozoglu
- Department of Oral and Maxillofacial Surgery/Oral Pathology VU University Medical Center and Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - Yvonne A G Kenter
- Department of Periodontology and Oral Biochemistry, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands; Department of Oral and Maxillofacial Surgery/Oral Pathology VU University Medical Center and Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - Justin Pijpe
- Department of Oral and Maxillofacial Surgery, Catharina Ziekenhuis, Eindhoven, The Netherlands
| | - Marjolijn Gilijamse
- Department of Oral and Maxillofacial Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Henk S Brand
- Department of Periodontology and Oral Biochemistry, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands; Department of Medical-Dental Interaction, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands.
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Jaspers GWC, Schepers RH, Pijpe J, Jansma J. [Wrinkle fillers in cosmetic facial procedures]. Ned Tijdschr Tandheelkd 2014; 121:269-274. [PMID: 24881255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
During the last decade cosmeticfacial procedures have become part of the professional work of both dentists and maxillofacial surgeons. A shift has taken place from invasive surgical treatment towards minimally invasive treatments. Besides the use ofbotulinum toxin type A, non-permanent wrinkle fillers can be an alternative to invasive surgical treatment. Since botulism was first described in the 18th century, the neurotoxin has continued to develop, as a result of which Botox, now available in synthetically produced form, can safely be employed in healthcare. The frequency with which patients visit dentists and maxillofacial surgeons offers the professional group the possibility to inform patients about cosmetic facial treatments and to carry them out according to diagnosis.
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van der Meij EH, Pijpe J, van Ingen JM, de Visscher JGAM. [Sialendoscopy for obstructive disorders of the salivary glands]. Ned Tijdschr Geneeskd 2013; 157:A5675. [PMID: 23388141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Obstructive disorders of the salivary glands usually manifest as a swelling which is associated with meals ('mealtime syndrome') as well as inflammation of the gland. Obstruction of the salivary ducts of the parotid and submandibular glands is usually caused by a salivary stone, mucous plug or by a stenosis. Until recently, the options for diagnosis and treating these conditions were limited. Ultimately, the decision to remove the salivary gland was often made. Sialendoscopy is a recently developed semi-rigid optical technique that can be used to detect and usually treat obstructions in the salivary ductal system. This new, minimally invasive technique has resulted in the reduction of morbidity related to salivary gland obstruction. In many patients, surgical removal of the salivary gland can be avoided by using this technique.
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Affiliation(s)
- Erik H van der Meij
- Medisch Centrum Leeuwarden, afd. Mondziekten, Kaak- en Aangezichtschirurgie, Leeuwarden, the Netherlands.
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Baas EM, Pijpe J, de Lange J. Long term stability of mandibular advancement procedures: bilateral sagittal split osteotomy versus distraction osteogenesis. Int J Oral Maxillofac Surg 2011; 41:137-41. [PMID: 22137334 DOI: 10.1016/j.ijom.2011.10.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Revised: 08/07/2011] [Accepted: 10/27/2011] [Indexed: 11/24/2022]
Abstract
The aim of this study was to compare the postoperative stability of the mandible after a bilateral lengthening procedure, either by bilateral sagittal split osteotomy (BSSO) or distraction osteogenesis (DO). All patients who underwent mandibular advancement surgery between March 2001 and June 2004 were evaluated. There were 17 patients in the BSSO group and 18 patients in the DO group. The decision to use intra-oral distraction or BSSO for mandibular advancement primarily depended on the choice of the patient and their parents. In both groups, standardized cephalometric radiographs were taken preoperatively, postoperatively (BSSO group) or directly post-distraction (DO group) and during the last study measurement in May 2008. Cephalometric analysis was performed using the following measurements: sella/nasion-mandibular point B and sella/nasion-mandibular plane. Point B was used to estimate relapse. This study showed no significant difference in relapse between the BSSO and the DO groups measured 46-95 months after advancement of the mandible (P>.05). It can be concluded from this study that there is no postoperative difference in the stability between BSSO and DO after mandibular advancement after 4 years.
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Affiliation(s)
- E M Baas
- Department of Oral and Maxillofacial Surgery, Isala Clinics Zwolle, The Netherlands
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17
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Pollard RPE, Pijpe J, Bootsma H, Spijkervet FKL, Kluin PM, Roodenburg JLN, Kallenberg CGM, Vissink A, van Imhoff GW. Treatment of mucosa-associated lymphoid tissue lymphoma in Sjogren's syndrome: a retrospective clinical study. J Rheumatol 2011; 38:2198-208. [PMID: 21844152 DOI: 10.3899/jrheum.110077] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To retrospectively analyze the clinical course of patients with mucosa-associated lymphoid tissue (MALT)-type lymphoma of the parotid gland and associated Sjögren's syndrome (SS). METHODS All consecutive patients with SS and MALT lymphoma (MALT-SS) diagnosed in the University Medical Center Groningen between January 1997 and January 2009 were analyzed. Clinical course and treatment outcome of SS and MALT lymphoma were evaluated. RESULTS From a total of 329 patients with SS, 35 MALT-SS patients were identified, with a median followup of 76 months (range 16-153 mo). MALT lymphoma was localized in the parotid gland in all cases. Treatment consisted of "watchful waiting" (n = 10), surgery (n = 3), radiotherapy (n = 1), surgery combined with radiotherapy (n = 2), rituximab only (n = 13), or rituximab combined with chemotherapy (n = 6). Complete response was observed in 14 patients, partial response in 1 patient, and stable disease in 20 patients. In 6 of 7 patients with initially high SS disease activity (M-protein, cryoglobulins, IgM rheumatoid factor > 100 KIU/l, severe extraglandular manifestations), MALT lymphoma progressed and/or SS disease activity increased after a median followup of 39 months (range 4-98 mo), necessitating retreatment. Only 1 patient with MALT who had low SS disease activity showed progression of lymphoma when left untreated. CONCLUSION An initially high SS disease activity likely constitutes an adverse prognostic factor for progression of lymphoma and/or SS. Such patients may require treatment for both MALT lymphoma and SS. In SS patients with localized asymptomatic MALT lymphoma and low SS disease activity, a "watchful waiting" strategy seems justified.
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Affiliation(s)
- Rodney P E Pollard
- Department of Hematology, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
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Pijpe J, Broers GHT, Plaat BEC, Hundeiker M, Otto F, Mastik MF, Hoekstra HJ, van der Graaf WTA, Berg EVD, Molenaar WM. The relation between histological, tumor-biological and clinical parameters in deep and superficial leiomyosarcoma and leiomyoma. Sarcoma 2011; 6:105-10. [PMID: 18521340 PMCID: PMC2395483 DOI: 10.1080/1357714021000065404] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose: Leiomyosarcomas (LMS) of deep and superficial tissues were examined to identify prognostic markers explaining
their different biological behaviour and to define differences between cutaneous and subcutaneous LMS. LMS and leiomyomas
(LM) of the skin were compared to and consistent differences that could aid in the (sometimes difficult) diagnosis. Patients: Material was obtained from 27 patients with a deep LMS, 14 with a superficial LMS, and 21 with a LM. Methods: Proliferation markers (mitotic and Ki-67 indices), DNA ploidy, size, grade, and the amount of apoptosis were
studied. Statistical analysis was performed and survival curves were constructed by the Kaplan-Meier method and compared
by the log-rank test. Results: Superficial LMS were smaller than deep LMS (p < 0.05), and the overall survival of patients with a superficial LMS
was better than with a deep LMS (p < 0.05).Within the group of superficial LMS only entirely subcutaneous, and not cutaneous
tumors metastasized.No differences were found in the other examined parameters. Proliferation and apoptotic indices
were significantly higher in superficial LMS compared to superficial LM. Discussion: The difference in clinical outcome between patients with a superficial and deep LMS, seems to be related to site
and size.The metastatic potential of subcutaneous LMS, however, seems to be related to location alone and not to size.The
amount of apoptosis and proliferation can be used as additional criteria in the differentiation between superficial LMS and
LM.
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Affiliation(s)
- Justin Pijpe
- Department of Pathology University Hospital of Groningen Groningen The Netherlands
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Jaspers GWC, Pijpe J, Jansma J. The use of botulinum toxin type A in cosmetic facial procedures. Int J Oral Maxillofac Surg 2010; 40:127-33. [PMID: 20965695 DOI: 10.1016/j.ijom.2010.09.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2010] [Revised: 07/24/2010] [Accepted: 09/17/2010] [Indexed: 10/18/2022]
Abstract
Over the past decade, facial cosmetic procedures have become more commonplace in dentistry and oral and maxillofacial surgery. An increasing number of patients seek minimal invasive procedures. One of the most requested procedures is treatment with botulinum toxin type A (BoNTA). Treatment of dynamic rhytids and lines with BoNTA is effective and produces high rates of improvement with rapid onset and long duration of action (longer than 4 months for some patients) compared with placebo. This paper considers the history and pharmacology of this neurotoxin, and focusses on the literature concerning the treatment of different facial areas with BoNTA. It also presents clinical guidelines on the treatment of glabellar lines, the frontalis muscle, peri-orbital lines, gummy smile and masseter muscle hypertrophy. Knowledge about the mechanisms of action and the ability to use BoNTA as an adjunctive treatment are mandatory for those working in the field of cosmetic facial surgery.
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Affiliation(s)
- G W C Jaspers
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, Groningen, The Netherlands.
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Pijpe J, Meijer JM, Bootsma H, van der Wal JE, Spijkervet FKL, Kallenberg CGM, Vissink A, Ihrler S. Clinical and histologic evidence of salivary gland restoration supports the efficacy of rituximab treatment in Sjögren's syndrome. ACTA ACUST UNITED AC 2009; 60:3251-6. [DOI: 10.1002/art.24903] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Schortinghuis J, Pijpe J, Spijkervet FKL, Vissink A. Retention of lipiodol after parotid gland sialography. Int J Oral Maxillofac Surg 2009; 38:346-9. [PMID: 19157783 DOI: 10.1016/j.ijom.2008.12.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2007] [Revised: 10/15/2008] [Accepted: 12/09/2008] [Indexed: 11/27/2022]
Abstract
There is limited information about the retention of lipiodol in the parotid gland after parotid gland sialography. This study assesses the prevalence of lipiodol retention after parotid sialography and determines if retention of lipiodol is related to the sialography technique or the underlying salivary gland pathology. Using the electronic hospital database (1996-2006), 66 out of 565 patients were identified who had additional maxillofacial radiographic examinations after the initial sialography. Additional radiographs up to October 2007 were included; these were orthopantomographic radiographs in all cases. In 28 patients (42%) signs of lipiodol retention were observed (mean radiographic follow-up: 15+/-13 months). Retention was characterized by small radiopaque spots in the periphery of the gland. Lipiodol retention was predominantly associated with a fausse route (n=8) or the presence of salivary gland disease (sialectasia; n=17). In 9 patients with signs of lipiodol retention, a series of radiographs was available. Lipiodol radiodensities decreased in size during 28 months, and could disappear gradually (follow-up 14-57 months). Despite the high frequency of retention of small depots of lipiodol for years after sialography in patients subjected to additional radiographic examinations, no clinically adverse effects were observed.
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Affiliation(s)
- J Schortinghuis
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands.
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Meijer JM, Pijpe J, Vissink A, Kallenberg CGM, Bootsma H. Treatment of primary Sjögren syndrome with rituximab: extended follow-up, safety and efficacy of retreatment: Figure 1. Ann Rheum Dis 2009; 68:284-5. [DOI: 10.1136/ard.2008.092601] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Hu S, Wang J, Meijer J, Ieong S, Xie Y, Yu T, Zhou H, Henry S, Vissink A, Pijpe J, Kallenberg C, Elashoff D, Loo JA, Wong DT. Salivary proteomic and genomic biomarkers for primary Sjögren's syndrome. Arthritis Rheum 2007; 56:3588-600. [PMID: 17968930 PMCID: PMC2856841 DOI: 10.1002/art.22954] [Citation(s) in RCA: 259] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To identify a panel of protein and messenger RNA (mRNA) biomarkers in human whole saliva (WS) that may be used in the detection of primary Sjögren's syndrome (SS). METHODS Mass spectrometry and expression microarray profiling were used to identify candidate protein and mRNA biomarkers of primary SS in WS samples. Validation of the discovered mRNA and protein biomarkers was also demonstrated using real-time quantitative polymerase chain reaction and immunoblotting techniques. RESULTS Sixteen WS proteins were found to be down-regulated and 25 WS proteins were found to be up-regulated in primary SS patients compared with matched healthy control subjects. These proteins reflected the damage of glandular cells and inflammation of the oral cavity system in patients with primary SS. In addition, 16 WS peptides (10 up-regulated and 6 down-regulated in primary SS) were found at significantly different levels (P < 0.05) in primary SS patients and controls. Using stringent criteria (3-fold change; P < 0.0005), 27 mRNA in saliva samples were found to be significantly up-regulated in the primary SS patients. Strikingly, 19 of 27 genes that were found to be overexpressed were interferon-inducible or were related to lymphocyte filtration and antigen presentation known to be involved in the pathogenesis of primary SS. CONCLUSION Our preliminary study has indicated that WS from patients with primary SS contains molecular signatures that reflect damaged glandular cells and an activated immune response in this autoimmune disease. These candidate proteomic and genomic biomarkers may improve the clinical detection of primary SS once they have been further validated. We also found that WS contains more informative proteins, peptides, and mRNA, as compared with gland-specific saliva, that can be used in generating candidate biomarkers for the detection of primary SS.
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Affiliation(s)
- Shen Hu
- University of California, Los Angeles
| | | | - Jiska Meijer
- University Medical Center Groningen, Groningen, The Netherlands
| | | | | | | | - Hui Zhou
- University of California, Los Angeles
| | | | - Arjan Vissink
- University Medical Center Groningen, Groningen, The Netherlands
| | - Justin Pijpe
- University Medical Center Groningen, Groningen, The Netherlands
| | - Cees Kallenberg
- University Medical Center Groningen, Groningen, The Netherlands
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Pijpe J, Spijkervet FKL, van der Wal JE, Kallenberg CGM, Vissink A. Comment on: parotid gland biopsy compared with labial biopsy in the diagnosis of patients with primary Sjogren's Syndrome: reply. Rheumatology (Oxford) 2007. [DOI: 10.1093/rheumatology/kem152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
The gain in knowledge regarding the cellular mechanisms of T and B lymphocyte activity in the pathogenesis of Sjögren's syndrome (SS) and the current availability of various biological agents (anti-TNF-alpha, IFN- alpha, anti-CD20, and anti-CD22) have resulted in new strategies for therapeutic intervention. In SS, various phase I and II studies have been performed to evaluate these new strategies. Currently, B cell-directed therapies seem to be more promising than T cell-related therapies. However, large, randomized, placebo-controlled clinical trials are needed to confirm the promising results of these early studies. When performing these trials, special attention has to be paid to prevent the occasional occurrence of the severe side effects.
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Affiliation(s)
- Jiska M Meijer
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, The Netherlands.
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van den Berg I, Pijpe J, Vissink A. Salivary gland parameters and clinical data related to the underlying disorder in patients with persisting xerostomia. Eur J Oral Sci 2007; 115:97-102. [PMID: 17451498 DOI: 10.1111/j.1600-0722.2007.00432.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This study assessed salivary gland parameters and clinical data in patients referred to our clinic because of persisting xerostomia of unknown origin, in order to facilitate early diagnosis and recognition of the underlying disorder. Most patients were referred for diagnostic analysis of a possible Sjögren's syndrome (SS). A complete diagnostic work-up was available in all patients (n = 176), including data on salivary gland function, saliva composition, sialography, salivary gland swelling, pattern of complaints, general health, and medication. Patients were diagnosed with SS (n = 62), sialosis (n = 45), sodium retention syndrome (n = 30), or medication-induced xerostomia (n = 9). In 30 patients no disease related to salivary gland pathology was found. Unstimulated whole salivary flow was decreased in all patients, except in patients with sodium retention syndrome and in patients without salivary gland pathology. Submandibular/sublingual salivary flow was lowest in SS patients. SS and sialosis patients had increased salivary potassium concentrations, whereas only SS patients had increased sodium concentrations. About half of the sialosis patients mainly complained of persistent parotid gland swelling. Xerostomia-inducing medication was used by most patients. It was concluded that gland-specific sialometry and sialochemistry is useful in discriminating between the various disorders causing persisting xerostomia.
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Affiliation(s)
- Ianthe van den Berg
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Pijpe J, Kalk WWI, van der Wal JE, Vissink A, Kluin PM, Roodenburg JLN, Bootsma H, Kallenberg CGM, Spijkervet FKL. Parotid gland biopsy compared with labial biopsy in the diagnosis of patients with primary Sjogren's syndrome. Rheumatology (Oxford) 2007; 46:335-41. [PMID: 16891656 DOI: 10.1093/rheumatology/kel266] [Citation(s) in RCA: 113] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To assess the value of the parotid biopsy as a diagnostic tool for primary Sjögren's syndrome (pSS), and to compare the parotid biopsy and the labial biopsy with regard to diagnostic value and biopsy-related morbidity. METHODS In 15 consecutive patients with pSS and 20 controls, the parotid biopsy was assessed as a diagnostic tool based on the presence of lymphocytic foci, benign lymphoepithelial lesions and lymphoid follicles. These new histological criteria were compared with established diagnostic criteria for the labial biopsy in 35 consecutive patients suspected for pSS who underwent simultaneous biopsies from both sites. In addition, both biopsies were compared for morbidity. RESULTS The first analysis revealed a focus score of >or=1 or lymphocytic infiltrates (not fulfilling the criterion of a focus score of 1) combined with benign lymphoepithelial lesions as diagnostic criteria for pSS. When comparing the parotid biopsy with the labial biopsy sensitivity and specificity were comparable (sensitivity 78%, specificity 86%). Level of pain was comparable and no loss of motor function was observed. No permanent sensory loss was observed after parotid biopsy, while labial biopsy led to permanent sensory loss in 6% of the patients. Malignant lymphoma was detected in one parotid biopsy by chance, without involvement of the labial salivary gland. CONCLUSION A parotid biopsy has a diagnostic potential comparable with that of a labial biopsy in the diagnosis of pSS, and may be associated with less morbidity.
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Affiliation(s)
- J Pijpe
- Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, PO-Box 30.001, 9700 RB Groningen, The Netherlands
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Pijpe J, Vissink A, Kallenberg CGM, Spijkervet FKL. Parotid gland biopsy compared with labial biopsy in the diagnosis of Sjogren's syndrome: reply. Rheumatology (Oxford) 2006. [DOI: 10.1093/rheumatology/kel361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Pijpe J, Kalk WWI, Bootsma H, Spijkervet FKL, Kallenberg CGM, Vissink A. Progression of salivary gland dysfunction in patients with Sjogren's syndrome. Ann Rheum Dis 2006; 66:107-12. [PMID: 16728458 PMCID: PMC1798390 DOI: 10.1136/ard.2006.052647] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Salivary gland dysfunction is one of the key manifestations of Sjögren's syndrome. OBJECTIVES (1) To assess prospectively loss of function of individual salivary glands in patients with primary and secondary Sjögren's syndrome in relation to disease duration and use of immunomodulatory drugs. (2) To study changes in sialochemical and laboratory values and subjective complaints over time. METHODS 60 patients with Sjögren's syndrome were included in this study. Whole and gland-specific saliva (parotid and submandibular/sublingual (SM/SL)), samples were collected at baseline and after a mean of 3.6 (SD 2.3) years of follow-up. Disease duration was recorded for all patients. RESULTS Patients with Sjögren's syndrome with short disease duration had significantly higher stimulated flow rates at baseline than those with longer disease duration (p<0.05). When compared with healthy controls, the decrease in SM/SL flow rates at baseline was more prominent than that in parotid flow rates (p<0.05). Over time, there was a significant further decrease of stimulated flow rates, especially of the parotid gland, accompanied by increasing problems with swallowing dry food (p<0.05). The decrease was independent of the use of corticosteroids or disease-modifying antirheumatic drugs (DMARDs). Sialochemical variables remained stable. CONCLUSIONS Early Sjögren's syndrome is characterised by a decreased salivary gland function (parotis>SM/SL), which shows a further decrease over time, regardless of the use of DMARDs or steroids. Patients with Sjögren's syndrome with longer disease duration are characterised by severely reduced secretions of both the parotid and SM/SL glands. These observations are relevant for identifying patients who would most likely benefit from intervention treatment.
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Affiliation(s)
- J Pijpe
- University Medical Center Groningen, University of Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands
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Abstract
The aim of this study was to estimate the accuracy and reproducibility of citric-acid-stimulated parotid saliva sampling. In healthy volunteers a strong correlation (r2 = 0.79) between flow rates from the left and right parotid gland was observed. In patients with Sjögren's syndrome this correlation (r2 = 0.90) was even stronger. The intraindividual variation in healthy volunteers was 23.3 +/- 5.9%. Increasing the number of collections did not reduce this variation significantly. In head and neck cancer patients, to estimate whether repeated measurements result in more reliable baseline values for use in clinical studies, repeated collections did not result in a significant reduction of intrapatient variation, similar to the results with the healthy volunteers. Thus, notwithstanding the good agreement between left and right flow rates, a high variation in parotid flow rates has to be considered when planning clinical trials evaluating the effects of treatment on salivary gland functioning.
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Affiliation(s)
- Fred R Burlage
- Department of Radiotherapy, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands.
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Mooijaart SP, Brandt BW, Baldal EA, Pijpe J, Kuningas M, Beekman M, Zwaan BJ, Slagboom PE, Westendorp RGJ, van Heemst D. C. elegans DAF-12, Nuclear Hormone Receptors and human longevity and disease at old age. Ageing Res Rev 2005; 4:351-71. [PMID: 16051528 DOI: 10.1016/j.arr.2005.03.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2005] [Revised: 03/09/2005] [Accepted: 03/11/2005] [Indexed: 01/12/2023]
Abstract
In Caenorhabditis elegans, DAF-12 appears to be a decisive checkpoint for many life history traits including longevity. The daf-12 gene encodes a Nuclear Hormone Receptor (NHR) and is member of a superfamily that is abundantly represented throughout the animal kingdom, including humans. It is, however, unclear which of the human receptor representatives are most similar to DAF-12, and what their role is in determining human longevity and disease at old age. Using a sequence similarity search, we identified human NHRs similar to C. elegans DAF-12 and found that, based on sequence similarity, Liver X Receptor A and B are most similar to C. elegans DAF-12, followed by the Pregnane X Receptor, Vitamin D Receptor, Constitutive Andosteron Receptor and the Farnesoid X Receptor. Their biological functions include, amongst others, detoxification and immunomodulation. Both are processes that are involved in protecting the body from harmful environmental influences. Furthermore, the DAF-12 signalling systems seem to be functionally conserved and all six human NHRs have cholesterol derived compounds as their ligands. We conclude that the DAF-12 signalling system seems to be evolutionary conserved and that NHRs in man are critical for body homeostasis and survival. Genomic variations in these NHRs or their target genes are prime candidates for the regulation of human lifespan and disease at old age.
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Affiliation(s)
- S P Mooijaart
- Department of Gerontology and Geriatrics, C-2-R, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
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Pijpe J, van Imhoff GW, Spijkervet FKL, Roodenburg JLN, Wolbink GJ, Mansour K, Vissink A, Kallenberg CGM, Bootsma H. Rituximab treatment in patients with primary Sjögren's syndrome: An open-label phase II study. ACTA ACUST UNITED AC 2005; 52:2740-50. [PMID: 16142737 DOI: 10.1002/art.21260] [Citation(s) in RCA: 317] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To investigate the safety and efficacy of B cell depletion treatment of patients with active primary Sjögren's syndrome of short duration (early primary SS) and patients with primary SS and mucosa-associated lymphoid tissue (MALT)-type lymphoma (MALT/primary SS). METHODS Fifteen patients with primary SS were included in this phase II trial. Inclusion criteria for the early primary SS group were B cell hyperactivity (IgG >15 gm/liter), presence of autoantibodies (IgM rheumatoid factor, anti-SSA/SSB), and short disease duration (<4 years). Inclusion criteria for the MALT/primary SS group were primary SS and an associated MALT-type lymphoma (Ann Arbor stage IE) localized in the parotid gland. Patients were treated with 4 infusions of rituximab (375 mg/m2) given weekly after pretreatment with prednisone (25 mg) and clemastine. Patients were evaluated, using immunologic, salivary/lacrimal function, and subjective parameters, at baseline and at 5 and 12 weeks after the first infusion. RESULTS Significant improvement of subjective symptoms and an increase in salivary gland function was observed in patients with residual salivary gland function. Immunologic analysis showed a rapid decrease of peripheral B cells and stable levels of IgG. Human anti-chimeric antibodies (HACAs) developed in 4 of 15 patients (27%), all with early primary SS. Three of these patients developed a serum sickness-like disorder. Of the 7 patients with MALT/primary SS, complete remission was achieved in 3, and disease was stable in 3 and progressive in 1. CONCLUSION Findings of this phase II study suggest that rituximab is effective in the treatment of primary SS. The high incidence of HACAs and associated side effects observed in this study needs further evaluation.
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MESH Headings
- Adult
- Aged
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Murine-Derived
- Female
- Health Status
- Humans
- Immunologic Factors/therapeutic use
- Lacrimal Apparatus/drug effects
- Lacrimal Apparatus/metabolism
- Lacrimal Apparatus/physiopathology
- Lymphoma, B-Cell, Marginal Zone/complications
- Lymphoma, B-Cell, Marginal Zone/drug therapy
- Lymphoma, B-Cell, Marginal Zone/pathology
- Male
- Middle Aged
- Parotid Gland/immunology
- Parotid Gland/physiopathology
- Parotid Neoplasms/pathology
- Rituximab
- Saliva/metabolism
- Salivary Glands, Minor/drug effects
- Salivary Glands, Minor/metabolism
- Salivary Glands, Minor/physiopathology
- Severity of Illness Index
- Sjogren's Syndrome/complications
- Sjogren's Syndrome/drug therapy
- Sjogren's Syndrome/physiopathology
- Tears/metabolism
- Treatment Outcome
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Affiliation(s)
- J Pijpe
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, Groningen, The Netherlands.
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Pijpe J, van Imhoff GW, Vissink A, van der Wal JE, Kluin PM, Spijkervet FKL, Kallenberg CGM, Bootsma H. Changes in salivary gland immunohistology and function after rituximab monotherapy in a patient with Sjogren's syndrome and associated MALT lymphoma. Ann Rheum Dis 2004; 64:958-60. [PMID: 15576414 PMCID: PMC1755505 DOI: 10.1136/ard.2004.030684] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To report the successful use of rituximab on salivary gland immunohistology and function in a patient with Sjogren's syndrome (SS) and associated MALT lymphoma. CASE REPORT The patient was a 42 year old woman with primary SS and associated MALT lymphoma located in the parotid gland and the hard palate. Four infusions of rituximab (375 mg/m(2)) weekly resulted in complete remission of the lymphoma. An incision biopsy of the parotid gland before and after treatment showed improvement of the (immuno)histopathological characteristics of SS, with possible regeneration of salivary gland tissue. Furthermore, salivary analysis showed decreased inflammatory characteristics and increased stimulated salivary flow. DISCUSSION Rituximab is a promising agent in the treatment of SS associated MALT lymphoma. In addition to the effect on MALT lymphoma, B cell depletion by rituximab may also attenuate the activity of SS. This case report is the first to describe the effect of rituximab on histological and sialometric/chemical characteristics of SS. The efficacy of rituximab in the treatment of SS warrants further investigation.
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Affiliation(s)
- J Pijpe
- Department of Oral and Maxillofacial Surgery, University Hospital Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands.
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Pijpe J, Vissink A, Van der Wal JE, Kallenberg CGM. Interstitial nephritis with infiltration of IgG-kappa positive plasma cells in a patient with Sjögren's syndrome. Rheumatology (Oxford) 2004; 43:108-10. [PMID: 14681564 DOI: 10.1093/rheumatology/keg429] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Pijpe J, Kalk WW, Bootsma H, van der Wal JE, van Imhoff GW, Vissink A. [Bilateral swelling of the parotid glands as part of a systemic disease]. Ned Tijdschr Geneeskd 2004; 148:206. [PMID: 14974316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
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Pijpe J, Kalk WW, Bootsma H, van der Wal JE, van Imhoff GW, Vissink A. [Bilateral swelling of the parotid glands as part of a systemic disease]. Ned Tijdschr Geneeskd 2003; 147:2309-15. [PMID: 14679981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
In four patients, a man aged 34 years and three women aged 35, 32 and 55 years respectively bilateral swelling of the parotid glands was caused by systemic disease i.e. HIV-salivary gland disease, mucosa-associated lymphoid-tissue (MALT) lymphoma, sarcoidosis with coexisting Sjögren's syndrome, and sialosis and hypothyroidism, respectively. The HIV patient was treated with antiretroviral therapy, the first two women were treated expectantly and the third woman was given a thyroid hormone supplement which resulted in regression of the bilateral parotid enlargement. Bilateral enlargement of the parotid glands is not necessarily caused by infection, it can also be of systemic origin. Minimal invasive investigations of the salivary glands, such as sialography, measurement of salivary secretion rate (sialometry) and analysis of salivary composition (sialochemistry) can offer valuable information about the origin of the parotid gland swelling. Histopathological investigation of an incision biopsy of the parotid gland is an easy way to confirm the diagnosis. The morbidity associated with parotid biopsy is negligible.
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Affiliation(s)
- J Pijpe
- Afd. Mondziekten en Kaakchirurgie, Academisch Ziekenhuis, Postbus 30.001, 9700 RB Groningen.
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Bouma I, Pijpe J, Vissink A. [Sjögren' syndrome: a progressive disease]. Ned Tijdschr Tandheelkd 2003; 110:316-20. [PMID: 12953384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Sjögren'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 Sjögren'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 Sjögen'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.
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Affiliation(s)
- I Bouma
- Kliniek voor Mondziekten, Kaakchirurgie en Bijzondere Tandheelkunde, Academisch Ziekenhuis Groningen, Postbus 30.001, 9700 RB Groningen
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Pijpe J, Kalk WWI, Vissink A. Clinical and immunological factors associated with low lacrimal and salivary flow rate in patients with primary Sjögren's syndrome. J Rheumatol 2003; 30:206-7; author reply 207. [PMID: 12508418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
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Plaat BE, Hollema H, Molenaar WM, Torn Broers GH, Pijpe J, Mastik MF, Hoekstra HJ, van den Berg E, Scheper RJ, van der Graaf WT. Soft tissue leiomyosarcomas and malignant gastrointestinal stromal tumors: differences in clinical outcome and expression of multidrug resistance proteins. J Clin Oncol 2000; 18:3211-20. [PMID: 10986053 DOI: 10.1200/jco.2000.18.18.3211] [Citation(s) in RCA: 181] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Several studies have reported clinical behavior and chemotherapy resistance in leiomyosarcomas, but these studies did not differentiate between soft tissue leiomyosarcomas (LMS) and malignant gastrointestinal stromal tumors (GIST). Multidrug resistance (MDR) has been associated with the expression of P-glycoprotein (P-gp), multidrug resistance protein (MRP(1)), and lung resistance protein (LRP). The aim of the present study was to compare LMS and GIST with respect to clinical outcome and MDR parameters. PATIENTS AND METHODS Clinical outcome was evaluated in 29 patients with a primary deep-seated LMS and 26 patients with a primary malignant GIST. Paraffin-embedded material, available for 26 patients with LMS and 25 with GIST, was used for immunohistochemical detection of P-gp, MRP(1), LRP, and c-kit. RESULTS Mean overall survival (OS) was 72 months for LMS patients and 31 months for GIST patients (P: <.05). Metastases occurred in 16 (59%) of 27 assessable LMS patients and in 10 (56%) of 18 assessable GIST patients. LMS predominantly metastasized to the lungs (14 of 16 patients), whereas GIST tended to spread to the liver (five of 10 patients) and the abdominal cavity (three of 10 patients; P: <.001). P-gp and MRP(1) expression was more pronounced in GIST than in LMS (P: <.05): the mean percentage of P-gp expressing cells was 13.4% in patients with LMS and 38.4% in patients with GIST, and the mean percentage MRP(1) expressing cells was 13.3% in patients with LMS and 35.4% in patients with GIST. LRP expression did not differ between LMS and GIST. c-kit was expressed in 5% of the LMS patients and in 68% of the GIST patients. CONCLUSION LMS patients have a better survival than GIST patients, and the metastatic pattern is different. Expression of MDR proteins in LMS is less pronounced than in GIST.
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Affiliation(s)
- B E Plaat
- Department of Pathology, University Hospital Groningen, The Netherlands.
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