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Thursday, October 30, 2008

PUBMED and how to define words

I found the following Abstract in PUBMED

If you find the abstract interesting you should see the full article.

Please note:
If you find a word you do not understand, go to google and type in Define: word

For example: Define: mucosal
Define: epithelial
Define: antigenicity


Oral lichen planus: clinical presentation and management.



J Can Dent Assoc. 2002 Sep;68(8):494-9.
Edwards PC, Kelsch R.
Department of Dental Medicine,
Long Island Jewish Medical Center,
New Hyde Park, New York 11040, USA.

Oral lichen planus (OLP) is a chronic mucosal condition commonly encountered in clinical dental practice.

Lichen planus is believed to represent an abnormal immune response in which epithelial cells are recognized as foreign, secondary to changes in the antigenicity of the cell surface.

It has various oral manifestations, the reticular form being the most common. The erosive and atrophic forms of OLP are less common, yet are most likely to cause symptoms. Topical corticosteroids constitute the mainstay of treatment for symptomatic lesions of OLP. Recalcitrant lesions can be treated with systemic steroids or other systemic medications. However, there is only weak evidence that these treatments are superior to placebo. Given reports of a slightly greater risk of squamous cell carcinoma developing in areas of erosive OLP, it is important for clinicians to maintain a high index of suspicion for all intraoral lichenoid lesions. Periodic follow-up of all patients with OLP is recommended.

PMID: 12323106

Friday, October 24, 2008

Much Improved

It was seven hours away from home by myself. I really must find someone to keep me company next month when I return!

This is what the doctor said:

Mouth looks very much improved. (she took more pictures to present to her students for comparison to last month's erosions and the month before.) Unbenownst to me I do have a raw lesion on the right side of my tongue. She thought it would hurt, but honestly, I have had so much pain for so long that it really doesn't hurt to my knowledge. That is, until she started poking at it. But, that's to be expected. I don't feel my chronic pain so much until something pokes it, or presses on it.

She wants me to continue on prednisone only and decrease it to 5mg every other day. I need to have another blood test to see if my white cells are returning to normal yet. Then, I will return again in a month.

I think it is pretty good news for a long drawn out, (and pretty scenery) day.

Friday, October 17, 2008

Pimecrolimus AKA Elidel®

I came across an abstract today which I found interesting. The intro says:

"Erosive oral lichen planus (EOLP) is a T-cell mediated inflammatory disease leading to severe pain and impairment. As current therapies are of limited efficacy, application of calcineurin inhibitors is considered to be a potential option.

Objective: To investigate the efficacy of pimecrolimus cream 1% (Elidel®) compared with vehicle cream in the treatment of EOLP"

This is my understanding of the abstract. Essentially, this is a study where they took EOLP patients, divided them in half, gave one group the Elidel cream, and the other group a placebo for 30 days. The result was that seven out of ten patients who used the Elidel for 30 days had improvement. ("erosions cleared completely") They were followed up another 30 days later and they continued to be in the same condition, except for the three who didn't respond at first. Those three continued the Elidel and then had improvement

I found this next part really fascinating:

"Following termination of the therapy, sustained remission of EOLP was detected in 83% of patients demonstrating long-lasting effects of pimecrolimus treatment."

This is the name of the study, the authors and publication:

Pimecrolimus cream 1% in erosive oral lichen planus— a prospective randomized double-blind vehicle-controlled study

Authors:
Volz, T.; Caroli, U.; Lüdtke, H.1; Bräutigam, M.2; Kohler-Späth, H.; Röcken, M.; Biedermann, T.

Source:
British Journal of Dermatology,
Volume 159, Number 4,
October 2008 , pp. 936-941(6)

Wednesday, October 8, 2008

Comparing Oral Lichen Planus Studies

I recently read an abstract of an article: Oral Lichen Planus in Relation to Transaminase Levels and Hepatitis C Virus. The researchers, Doctors Suresh and Ali had 40 OLP patients and compared them to 40 people who did not have the diagnosis. Among them, they learned that OLP patients had a higher percentage of diabetes and SGOT/SGPT levels. (also known as AST/ALT) But, they found none with HCV.

I found their conclusions interesting. However, I feel they didn't have a large enough cohort. I found an article published in 1998 where there were 263 OLP patients in the study and there were a higher percentage of those with HCV as opposed to the control group (people without OLP).

I have been tested and don't have diabetes, but do have an elevated alkaline phosphatase, and it has been that way a long time. I do not have Hepatitis C, either.

I will be returning to my local doctor next week to learn the results of my latest blood tests.

Sunday, October 5, 2008

Recovering

I went to my family doctor in order to ask her to order the blood tests that the UCSF doctors wanted for comparison to previous tests. It's easier if they are done down here at home rather than my traveling 80 miles to get it done by requisition.

I am so glad my doctors are willing to work together. My primary orders my prescriptions. Definitely, I would not want to try to get a refill on an RX by having to drive all the way to SF just to find out they didn't put it through my insurance correctly!!!

Anyhow, I have the requisition for my blood tests in my purse right now. I just couldn't get out of the doctor's office early enough. I Was "wasted" on Friday, so I need to wait til Monday. It's just for a simple CBC with differential (my lymphocytes were below normal last time, and I had no monocytes) and a liver panel to see where the alkaline phosphatase is... last time pretty high. So, it will be probably the end of the week before I can have my results.

I don't feel as lousy as I did last week, so I am willing to bet the numbers have improved.

I am getting good deep rest and tons of dreams, mostly pleasant, for a change.

My SF doctor wants me to recover first before considering another drug. Right now, I just need to maintain low dose prednisone. If things get worse, I might need to increase the dose. I LOVE and hate Prednisone. I love how wonderful and energetic it makes me feel, but hate the other side effects, and worry about the long term, too.


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