überlebensverbesserung eines unizentrischen Gesamtkollektivs aus 20 Jahren

PURPOSE: The development of overall survival of a DOSAK (German-Austrian-Swiss Cooperative Group on tumours of the maxillofacial region) clinic's overall population comprising a time period of more than 20 years (1983-2004) should be assessed. At a cutoff date (January 1st, 1997), a change from a primarily surgically based to a consequent multi-modality treatment regimen was implemented. The periods of time before and after that change should be compared. METHODS AND PATIENTS: The data of the DOSAK registry entries on 1038 patients suffering from primary untreated oral and oropharyngeal carcinomas were updated with respect to follow-up and mortality data to achieve a 100% quality of follow-up. The end point (death) was reached in 67% of the overall population. Statistical analysis was carried out by the Trium Analysis Online corporation, Munich. RESULTS: The portion of female and older tumor patients increased, more than half of all tumor patients were clearly in stage IV of the disease at first referral. The portion of patients operated on persisted approximately (80%), the portion of additional treatment modalities could be increased considerably. The fact of a bony infiltration by the tumor and the operability remained highly significantly relevant for survival in multivariate analysis, despite of multi-modality treatment. The survival rate of the patients remained significantly dependent on the clinical stage of the disease in multivariate analysis but could be improved by 10% in the clinical stages II and III and in the patients who could not be operated on. All in all, the cutoff date was statistically relevant for survival in multivariate analysis, i.[Symbol: see text]e. the change in the treatment regimen had a verifiable positive effect on the survival of a unicentric overall population. CONCLUSION: Survival improvement in an overall population via change in treatment strategy is possible in relatively short time; the clinical stages II and III and the non-operable patients have the greatest benefit from a multi-modality treatment.     

青海地区1204例口腔颌面部肿瘤,囊肿,瘤样病变分析

本文对青海地区1204例口腔颌面部肿瘤、囊肿、瘤样病变的病变部位、性质、年龄及性别进行分析。结果为良性肿瘤634例（52．66％），以血管瘤和涎腺混合瘤最多见。恶性肿瘤232例（1．27％），以鳞状细胞癌居第一位，平均患病年龄48岁，随年龄增长，逐年递增。囊肿306例（25．41％），多发生在去下腺。瘤样病变32例（2．66％），多为牙龈瘤。本组良性肿瘤女性高于男性，血管瘤居第一位。良恶性肿瘤之比为2．73∶1，与国内有关报道略有不同。     

低氧对口腔鳞癌细胞系血管内皮生长因子和MMP-2的影响

目的 :研究低氧对体外培养的口腔鳞癌细胞系血管内皮生长因子 (vascularendothelialgrowthfactor ,VEGF)和明胶酶 A(matrixmetalloproteinase 2 ,MMP 2 )的影响。 方法 :分别用酶联免疫吸附实验 (ELISA)和半定量逆转录聚合酶链反应 (RT PCR)测定了低氧处理不同时间段时口腔鳞癌细胞系TSCCa和GNM细胞的细胞中VEGF和MMP 2的活性和mRNA表达情况。结果 :低氧处理 4h时 ,VEGF和MMP 2的活性便显著增加 ,8h时达到最高 ,GNM细胞中VEGF和MMP 2分别增加 2倍和 2 .5倍 ;而TSCCa细胞中VEGF和MMP 2增加的更为明显 ,分别增加了 6倍和 4倍。RT PCR结果显示GNM细胞VEGF和MMP 2mRNA表达水平均较TSCCa细胞高 (P <0 .0 5 ) ,低氧处理时在TSCCa细胞中VEGF和MMP 2增加的尤为明显。结论 :低氧可通过调节口腔鳞癌细胞VEGF和MMP 2的活性和mRNA的表达在口腔鳞癌血管形成中起重要作用     

Prevalence and localization of nodal metastases in squamous cell carcinoma of the oral cavity: role and extension of neck dissection

Lymph node (LN) metastases represent the most important negative prognostic factor in squamous cell carcinoma (SCC) of the oral cavity, even though controversies still exist regarding their management. The aim of this study was to retrospectively analyze our experience in surgical management of SCC of the oral cavity with particular focus on the prevalence and localization of lymph nodal metastases and recurrences. The clinical records of 89 consecutive patients treated from 1983 to 2002 by concomitant surgery on both the T and N sites, excluding those undergoing salvage surgery, were reviewed. A total of 119 neck dissections (ND) were performed. Survival outcomes were calculated by the Kaplan–Meier method, while univariate comparisons by the log-rank and non-parametric tests were performed between different groups of patients. Five-year overall and determinate survivals were 50 and 57%, respectively. LN metastases were observed in 52% (56% of these showing extracapsular spread) and their presence strongly correlated with determinate survival (p < 0.0001). The prevalence of clinical and occult nodal disease was not related to the pT status. Neck levels II (59%) and I (56%) were most frequently involved. Metastases to level IV accounted for 15% of positive LN, even though 28% of them turned out to be skip metastases. Five neck recurrences were observed, only one of which was salvaged by surgery. The high prevalence of clinical and occult LN metastases in this setting suggests that ND should be performed on a nearly routine basis, even for lesions with a low-T category and a cN0 neck. Moreover, ND should always encompass level IV due to the possibility of skip metastases, particularly in tumors involving the oral tongue. In patients with a cN+ neck, levels from I to V should be addressed, particularly in the presence of metastases at levels III and IV.     

葡萄糖筛选试验在妊娠期糖尿病诊断及治疗中的价值

目的　探讨 5 0 g葡萄糖筛选试验 (GCT)在妊娠期糖尿病 (GDM )诊断及治疗中的价值。 方法　选择 2 0 0 0年 1月～ 2 0 0 3年 6月在我院行产前检查并分娩的 5 0 gGCT异常的孕妇 36 8例 ,按血糖值分为 5组 :≥7.8～ <8.0mmol/L为Ⅰ组 ,≥ 8.0～ <9.0mmol/L为Ⅱ组 ,≥ 9.0～ <10 .0mmol/L为Ⅲ组 ,≥ 10 .0～ <11.0mmol/L为Ⅳ组 ,≥ 11.0mmol/L为Ⅴ组。比较 5组 75 g口服葡萄糖耐量试验 (OGTT)异常的比例及需用胰岛素治疗的病例数的差异。结果　 5组GDM的发生率分别为 6 .9%、8.5 %、2 1.3%、4 7.8%和 85 .0 % ,75 gOGTT异常的发生率分别为 19.0 %、2 4 .2 %、5 1.1%、87.0 %和 90 .0 % ,且用胰岛素治疗的病例数随 5 0 gGCT血糖值的上升而增加。结论　 5 0 gGCT在GDM的诊断及治疗方案的预测方面均有重要价值。     

正畸固定矫治前后牙齿冷光美白疗效的对比研究

目的:了解经固定矫治的正畸患者在牙齿美白治疗后牙齿表面中部出现较规则斑块的成因。方法:分别对正畸及非正畸治疗患者、正畸治疗前后拔除的离体牙进行牙齿美白治疗,对牙列组进行视觉对比,对离体牙组进行扫描电镜对比。结果:经正畸治疗的牙列在美白治疗后牙面有色斑存在,而正畸治疗后拔除的离体牙的扫描电镜结果则显示有釉质-树脂突嵌合层存在。结论:经正畸治疗后牙齿表层的釉质-树脂突嵌合层是导致牙面出现色斑的原因。     

深覆盖患者正畸矫治后的面部软组织美学特征改变

目的:对两例生长发育高峰期后的骨性下颌后缩患者成功矫正深覆盖后的面部软组织改变进行研究。方法:患者矫治前后的头颅侧位X线片进行描图和重叠,分析软组织的变化。结果:软组织主要变化有:下面高增加,下唇明显前移,上唇后移,颏唇沟变浅,唇肌紧张度改善。结论:固定矫治器配合Forsus矫治器和II类间牵引使两例严重深覆盖患者的侧貌得到了明显改善。但矫正效果主要为牙颌-牙槽代偿,临床中需谨慎应用,注意病例选择。     

The bactericidal activity of pulsed Nd-YAG laser radiation in vitro

Pulsed Nd-YAG laser irradiation of bacteria has been suggested as a possible means of treating contaminated intra-oral sites although relatively few studies have been conducted. In this investigation, the antimicrobial activity of a pulsed Nd-YAG laser was assessed in vitro for a range of oral bacteria using several pulse energies and exposure durations. Pure cultures of each organism were lased in saline suspensions followed by standard colony counting techniques for test and control samples. Microbial inhibition was found to be organism-dependent and varied with energy dose and pulse energy. For all nine test species 120-mJ laser pulses proved more efficient than 80-mJ pulses, with 99.9% kills compared with around 90% kills after exposure to 1800 pulses. These killing activity levels compare favourably with those achieved with other lasers in vitro.     

组织工程化口腔粘膜的构建技术初步研究

目的　探索组织工程化口腔粘膜的构建方法。方法　用 Dispase中性蛋白酶分离提取未长毛的 SD乳鼠硬腭口腔粘膜细胞 ,用角化细胞培养液对口腔粘膜细胞进行培养 ,以自制藻酸钠薄膜作为支架材料构建组织工程化的口腔粘膜。结果　 Dispase中性蛋白酶可较好地分离提纯口腔粘膜细胞 ,用 Dispase消化酶分离获取上皮后 ,再用胰蛋白酶消化上皮为单细胞的最佳时间为 10 m in,过低的细胞密度不易形成克隆 ,鼠口腔粘膜细胞培养的最适密度为 1.5× 10 5/ cm2 。角化细胞培养液能对鼠口腔粘膜细胞进行培养 ,且没有成纤维细胞污染 ;口腔粘膜细胞在藻酸钠薄膜上生长良好。结论　利用角化细胞培养液作为培养基 ,藻酸钠薄膜作为支架材料可成功构建组织工程化口腔粘膜