Paraneoplastic pemphigus: Diagnostic mimics, confounders and management challenges in a series of five long-term survivors from a single centre.

We present a series of five cases who presented to our institution with treatment-refractory mucosal ulceration, all of whom were subsequently diagnosed with paraneoplastic pemphigus (PNP). This case series highlights the diagnostic and treatment considerations for PNP - in particular, the steroid-dependent, recalcitrant, polymorphic manifestations; the combination of histopathological and clinical findings that may overlap with clinically similar diseases, for example, pemphigus vulgaris and lichen planus; the importance of immunopathological findings for its diagnosis, and the need for surveillance and management of life-threatening bronchiolitis obliterans.

Dental extractions on direct oral anticoagulants vs. warfarin: The DENTST study.

Background: Conflicting recommendations exist addressing the management of direct oral anticoagulants (DOACs) for invasive dental procedures.

Objectives: To determine the safety of DOAC continuation compared to warfarin continuation for dental extractions with regards to bleeding outcomes.

Methods: A single-center, prospective, cohort study was performed to compare 7-day bleeding outcomes between patients who continued their DOAC, and patients on warfarin with an International Normalized Ratio (INR) between 2.

Pemphigus vulgaris disease activity: The role of antibodies to desmogleins and their isotype.

Background: Pemphigus vulgaris (PV) is an autoimmune blistering disease driven by pathogenic antibodies to desmoglein-1 and -3, levels of which correlate with disease activity. Anti-desmoglein-3 IgG4 isotype antibodies are said to predominate in active disease and anti-desmoglein-3 IgG1 in remission; however, these observations arose from vertical studies, with limited assessments of clinical activity. The objective of this study was to examine the relationship between desmoglein autoantibodies, subdivided by isotype and disease activity using the validated PV activity tool "Pemphigus Disease Area Index (PDAI).

Paraneoplastic pemphigus: two cases of intra-abdominal malignancy presenting solely as treatment refractory oral ulceration.

Two patients with initial diagnoses of oral lichen planus and pemphigus vulgaris presented with refractory oral mucosal blistering. Subsequent positive serology results for paraneoplastic pemphigus led to the discovery of occult intra-abdominal malignancies in both, unicentric Castleman's and non-Hodgkin's lymphoma. The diagnosis of paraneoplastic pemphigus should be considered in patients with recalcitrant oral ulceration, even in the absence of clinical features of malignancy.

Comparative study of five serological assays for the diagnosis of paraneoplastic pemphigus.

Paraneoplastic pemphigus (PNP) is an autoimmune mucocutaneous blistering disease driven by autoantibodies against plakins expressed in mucosal epithelium. Diagnosis can be difficult as both clinical and biopsy features overlap with other blistering disorders, thus serology is important. Indirect immunofluorescence (IIF) on rat bladder substrate is the most widely used assay, but plakin-specific autoantibody assays have recently become available.

Pharmacological mythology? Or an evidence-based approach to the pharmacologically-challenged dental patient?

A number of fallacies and even fads and rarely facts have arisen in regard to catering to the medically-complex/pharmacologically-challenged dental patient. Dentists face an ever-increasing problem in addressing the needs of their medically-complex patients, given the increase in their numbers, with the advances in medicine, and the aging of the population, notwithstanding, their increased dental needs. Dentists usually approach such patients with a mixture of fear and trepidation--as undergraduates they had little direct experience in treating such patients, and as graduates, they often end up referring to hospital institutions such complex patients.

Management of oral epithelial dysplasia: a review.

One of the goals of the fourth meeting of The World Workshop on Oral Medicine (WWOM IV) included a review of the pathophysiology and future directions for the clinical management of patients with oral epithelial dysplasia, excluding the lips and oropharynx. In the pathophysiology review of dysplasia since WWOM III (1998-2006), a wide range of molecular changes associated with progression of dysplasia to squamous cell carcinoma were found. These include loss of heterozygosity, dysregulation of apoptosis, aberrant DNA expression, and altered expression of numerous tissue markers.