分化型甲状腺癌131Ⅰ治疗后唾液腺损伤评价及预防

目的:探讨分化型甲状腺癌(differentiated thyroid carcinoma,DTC)的患者经131Ⅰ治疗后,唾液腺损伤的影响因素、评价方法及预防措施。方法:78例分化型甲状腺癌的患者经手术切除后行大剂量的131Ⅰ治疗,在131Ⅰ治疗前和治疗后的6个月～3年随访唾液腺功能显像。并进行治疗后传统的唾液腺损伤防护和唾液腺损伤综合预防。结果:78例DTC患者中有23例57次出现急性唾液腺损伤;共有22例(28.2%)出现慢性唾液腺损伤;131Ⅰ治疗累积131Ⅰ剂量、131Ⅰ治疗次数、甲状腺癌转移类型与慢性唾液腺损伤的发生率明显相关。唾液腺损伤的综合预防较传统的预防措施可使急性损伤发生率减少31.1%,慢性唾液腺损伤发生率减少17.7%。结论:甲状腺癌131Ⅰ治疗后唾液腺损伤与131Ⅰ治疗累积剂量、131Ⅰ治疗次数、甲状腺癌转移类型有关,唾液腺损伤的综合预防明显优于传统的预防措施。     

分化型甲状腺癌131I治疗后唾液腺损伤评价及预防

目的:探讨分化型甲状腺癌(differentiated thyroid carcinoma,DTC)的患者经131I治疗后,唾液腺损伤的影响因素、评价方法及预防措施.方法:78例分化型甲状腺癌的患者经手术切除后行大剂量的131I治疗,在131I治疗前和治疗后的6个月～3年随访唾液腺功能显像.并进行治疗后传统的唾液腺损伤防护和唾液腺损伤综合预防.结果:78例DTC患者中有23例57次出现急性唾液腺损伤;共有22例(28.2％)出现慢性唾液腺损伤;131I治疗累积131I剂量、131I治疗次数、甲状腺癌转移类型与慢性唾液腺损伤的发生率明显相关.唾液腺损伤的综合预防较传统的预防措施可使急性损伤发生率减少31.1％,慢性唾液腺损伤发生率减少17.7％.结论:甲状腺癌131 I治疗后唾液腺损伤与131I治疗累积剂量、131I治疗次数、甲状腺癌转移类型有关,唾液腺损伤的综合预防明显优于传统的预防措施.     

免疫球蛋白G4相关性唾液腺炎临床特点及诊疗进展

免疫球蛋白G4相关性唾液腺炎（IgG4-RS）是一种与IgG4密切相关的慢性自身免疫性疾病,其发病率低,病因和发病机制尚不明确,以唾液腺尤其是颌下腺无痛性持续性肿大为主要临床表现,多数患者血清IgG4升高,淋巴浆细胞浸润,后期全身多器官可继发病变,组织病理学是该病最可靠的诊断方法。临床上倾向于传统糖皮质激素作为首选用药,现阶段可尝试应用生物制剂进行靶向治疗。本文根据国内外文献,对IgG4-RS的病因、临床表现、诊断与鉴别诊断、治疗和预后的研究进展作一综述,以期为该病的临床诊疗和研究提供帮助。     

IgG4相关唾液腺炎临床诊疗特点

目的:探讨IgG4相关唾液腺炎的临床特点、诊断和治疗方法。方法:回顾性分析10例IgG4相关唾液腺炎患者临床检查、血清学、病理学和B超检查资料,并观察随访小剂量糖皮质激素疗效。结果:10例IgG4相关唾液腺炎患者均表现为双侧唾液腺持续、对称、无痛性肿大,血清IgG4浓度异常升高,可伴有腺体IgG4+浆细胞浸润合并组织纤维化或硬化;自身抗体均为阴性;B超表现腺体常呈蜂窝状弥漫性病变;小剂量糖皮质激素口服治疗,短期疗效明显。结论:IgG4相关唾液腺炎有其特有的临床表现,应注意与舍格伦综合征(简称SS)和唾液腺肿瘤相鉴别,短期内小剂量糖皮质激素治疗有效。     

IgG4相关唾液腺炎的临床研究进展

<正>IgG4相关疾病是一类新近被认识的与IgG4淋巴浆细胞密切相关的慢性系统性疾病,以病变组织弥漫性肿大、密集的淋巴浆细胞浸润(富含IgG4+浆细胞)、席纹状纤维化为特征,常伴有血清IgG4浓度升高。20世纪60年代人们首次发现自身免疫性胰腺炎(autoimmune pancreatitis,AIP)这一对激素治疗敏感的炎性疾病,直到2001年,Hamano等[1]偶然发现AIP患者常伴有血清IgG4浓度升高,胰腺穿     

IgG4相关唾液腺炎研究现状

IgG4相关唾液腺炎(IgG4-related sialadenitis,IgG4-RS)是近年来才被认识的一类自身免疫性疾病,发病机制尚不明确。IgG4-RS主要累及下颌下腺和腮腺,特征性表现为双侧唾液腺或(和)泪腺的弥漫性无痛性肿大,持续时间一般在3个月以上。部分患者伴有听力下降或听力障碍、鼻窦炎、淋巴结肿大等症状;近一半患者存在不同程度的唾液腺分泌障碍。大多数患者血清IgG4浓度升高,但不能将其做为诊断的唯一标记物。组织病理学仍是诊断的"金标准",目前多采用下颌下腺活检来诊断。组织病理学显示淋巴浆细胞浸润,闭塞性静脉炎,席纹状纤维化;免疫组化显示IgG4^+/IgG^+浆细胞>40%,且IgG4^+浆细胞/高倍镜视野>10。糖皮质激素被视为治疗该疾病的一线药物,临床上常与环磷酰胺为代表的免疫抑制剂联合用药,但尚没有形成标准规范的用药方案。大部分患者短期治疗效果显著,长期预后仍需进一步研究,对有复发倾向的患者要及时调整激素剂量。未来仍需对该病的发病机制及治疗方案进一步研究,以提高临床诊断率及治疗效果。     

IgG4相关唾液腺炎3例报告及文献复习

目的分析探讨IgG4相关唾液腺炎病例的临床特点、诊断及治疗预后,提高对该病的认识。 方法回顾性分析3例IgG4相关唾液腺炎的临床表现、血清学、病理学及治疗效果并进行相关文献复习。 结果（1）病例报告：3例患者主要临床表现为颌下腺肿大,其中双侧颌下腺2例、单侧颌下腺1例。血清学检测显示IgG4、IgG、κ链、λ链、SAA、补体C3、C4等不同程度升高;超声显示腺体弥漫性肿大;病理学检测显示,以淋巴细胞、浆细胞浸润为主,IgG4（+）浆细胞≥30个/HPF,IgG4/IgG≥40%;治疗主要采用糖皮质激素,治疗效果良好未复发。（2）文献复习：国内有关IgG4相关唾液腺炎的报道80例,均表现为单侧或双侧唾液腺无痛性肿胀或肿块,部分患者血清IgG4表达升高,病理学表现为以淋巴细胞、浆细胞浸润为主,IgG4（+）细胞≥50个/HPF,IgG4/IgG≥40%。糖皮质激素及免疫抑制剂联合治疗预后良好。 结论IgG4相关唾液腺炎属自身免疫性疾病,表现为唾液腺无痛性肿大、血清IgG4异常升高,病理特征为组织内大量IgG4（+）浆细胞浸润,临床上怀疑此病时应尽早行活检或血清学检查,确诊后首选糖皮质激素及免疫抑制剂联合治疗的方案,避免不必要的手术及放化疗。     

辐射损伤唾液腺机制及治疗的研究进展

颌面及颈部的恶性肿瘤是最常见的恶性肿瘤之一,治疗以手术治疗、放疗、化疗相结合为主,同时治疗存在着很多不良反应,如放疗存在诸多并发症,其中便以放射性唾液腺炎最为常见.此外还有口腔干燥、口腔黏膜炎、猛性龋、放射性颌骨骨髓炎等,导致吞咽、咀嚼问题以及味觉功能障碍等一系列变化.目前,放射性唾液腺炎的研究进展迅速,但其机制较为复...     

超声弹性成像技术在IgG4相关唾液腺炎诊断和随访中的应用

目的: 探讨超声弹性成像技术在IgG4相关唾液腺炎诊断和随访中的应用价值。方法: 回顾分析2018年5月—10月就诊于上海交通大学医学院附属第九人民医院口腔外科,诊断为IgG4相关唾液腺炎3例患者的临床资料。所有患者均接受口服小剂量糖皮质激素治疗,采用超声弹性成像技术应变率比值法和声辐射力脉冲成像法,对治疗前、后患者下颌下腺进行弹性超声检查,观察超声影像学特点及疗效。结果: 3例患者临床表现均为双侧下颌下腺无痛性肿大超过3个月,血清IgG和IgG4浓度均异常升高,下颌下腺活检病理及免疫组织化学染色结果提示符合IgG4相关唾液腺炎。治疗前弹性超声成像显示腺内大范围蓝色区域对应低回声区,应变率比值（SR）较正常腺体减小而剪切波速值（SWV）较正常腺体增大,表示该区域腺体质地比正常腺体明显较硬。所有患者经小剂量糖皮质激素治疗1个月后随访,临床表现原本肿大的下颌下腺明显消退,触诊质地软化,血清IgG和IgG4浓度明显下降,弹性超声显示蓝色区域范围明显缩小,黄色和绿色区域范围增大,对应SR增大而SWV减小,客观且半量化地反映腺体质地较治疗前软化。结论: 超声弹性成像技术通过测量SR或SWV,可以客观半量化地反映病变唾液腺质地。结合患者的临床表现、血清学指标和组织病理学表现,可以辅助IgG4相关唾液腺炎的诊断,并初步评价疾病的严重性和进展程度。     

下行性坏死性纵隔炎的诊疗进展

下行性坏死性纵隔炎（descending necortizing mediastinitis,DNM）是口腔颌面部感染的重症并发症,最常见的病因为牙源性感染和咽部感染,当感染沿着颈部间隙扩散至纵隔时,临床表现为颌面部肿胀,颈胸部发红、肿胀,呼吸困难等。DNM的早期诊断和治疗可有效降低死亡率。目前,DNM的治疗尚无标准化的通用指南,临床上常用的治疗方式多为外科手术清创引流联合抗生素治疗。本文就近年来国内外有关DNM诊疗的研究进展作一综述。     

Salivary evaluation in radioactive I131 treated patients with thyroid carcinoma

Background and objective: radioiodine treatment (I¹³¹) used to treat thyroid carcinomas produces side effects (sialadenitis, xerostomia, dysphagia and caries susceptibility) reflecting in a poor patient quality of life. This study aimed to evaluate the effect of I¹³¹ on salivary function and possible oral impairment.

Material and methods: Thirty-seven patients undergoing I¹³¹ were submitted to oral examination, answer questions regarding xerostomia/hyposalivation and collect saliva at three moments (M1: 30–45 days before I¹³¹, M2: 1–2 days after I¹³¹ and M3: 7–10 days after treatment). Saliva was assayed for flow rate and calcium/phosphate concentrations.

Results and conclusions: significant difference in calcium/phosphate concentration was shown between M1 and M2, with evident decrease at M2. Flow rate reduced right after treatment with 41% of patients returning to previous rate at M3 (no statistical difference). A higher number of patients related xerostomia and difficulty in swallowing food at M2. The results showed that xerostomia/hyposalivation, dysphagia and calcium/phosphate concentration decrease may be considered early radioiodine side effects.     

Recent trends of saliva omics biomarkers for the diagnosis and treatment of oral cancer

BackgroundRecent advances in surgery, radiotherapy, and chemotherapy have no significant effect on oral cancer survival rates due to late diagnosis, poor tumor response to chemotherapy and radiotherapy, as well as a lack of effective biomarkers for early diagnosis.HighlightsTherefore, an investigative study aimed at identifying genomics, proteomics, metagenomics, and, metabolomics derived biomarkers for early diagnosis may improve the survival rate of oral cancer patients. Identification and application of saliva-based ‘‘omics’’ biomarkers may overcome painful invasive procedures currently being used for the diagnosis of oral cancer. One single biomarker may not be able to differentiate between oral squamous cell carcinoma (OSCC) and controls. Thus, multiple sensitive and specific biomarkers may be needed for screening high-risk patients and following them up for early signs of OSCC occurrence. Validation of these biomarkers in large patient cohorts is, however, required before they can be used in clinical practice.ConclusionIn this review, we summarize the potential of omics derived salivary biomarkers as diagnostic and prognostic tools in oral cancer detection and the future clinical benefits associated with these markers.     

Advances in the diagnosis and treatment of oral cancer.

Cancer of the oral cavity is fortunately rare in the Western world. However, rates are rising and are comparatively high in lower socioeconomic groups and in many metropolitan areas. Whenever possible, cancer of the oral cavity should be distinguished from "head and neck" cancers, because "site" is so important in the behavior of the disease. This review discusses the advantages and disadvantages of various methods of diagnosis, therapy, reconstruction, social rehabilitation, and pain control of oral cancer and of head and neck cancer.     

Epithelial–myoepithelial carcinoma of the maxillofacial and sinonasal region: a systematic review of presenting characteristics,treatment modalities,and associated outcomes

Epithelial–myoepithelial carcinoma (EMC) is a rare salivary gland malignancy. Controversy exists in the literature regarding the effectiveness of treatment modalities employed in the management of EMC. This systematic review was undertaken to understand the presenting characteristics of EMC and identify the most common treatment modalities and their associated outcomes, in order to help guide an evidenced-based approach to the algorithm of care. The MEDLINE (PubMed) and Embase databases were searched (up to February 23, 2022), and the review was performed in accordance with the PRISMA statement. Fifty-seven studies (51 case reports and six case series) describing 91 cases of EMC were included in this review. In the included studies, a slow-growing painless mass was the most common presenting clinical feature. EMC was most frequently treated with surgery alone (65%). Local disease recurrence occurred in 24% of the cases and metastatic disease in 11%. A positive surgical margin was found to be associated with a higher risk of recurrence (P < 0.001), while adjuvant radiotherapy was associated with a decreased risk of local disease recurrence (P = 0.034). Metastatic disease and multimodal therapy were found to be associated with decreased disease-free and overall survival (all P < 0.05). The current literature supports surgery with clear margins as the mainstay of treatment for EMC of the salivary and seromucous glands of the head and neck. In certain situations, radiotherapy may improve disease-free survival.     

糖尿病患者胰岛素治疗前后唾液葡萄糖含量分析

目的:研究糖尿病患者胰岛素治疗前后唾液中葡萄糖含量的改变,并观察唾液糖与血糖的关系。方法:实验组为40例糖尿病患者。收集糖尿病患者胰岛素治疗前后清晨非刺激状态下自然分泌的全唾液,进行葡萄糖含量分析,同时行空腹血糖分析。结果:治疗前患者的唾液葡萄糖含量为(2.081±0.287)mmol/L,高于治疗后的(1.571±0.193)mmol/L,二者有显著性差异(P<0.01);治疗前患者的唾液葡萄糖含量与血糖浓度有显著直线相关性(P<0.05);治疗后患者的唾液葡萄糖含量与血糖浓度无显著直线相关性(P>0.05)。结论:糖尿病患者唾液中的葡萄糖含量明显增加,说明唾液腺分泌功能发生改变;良好的胰岛素治疗不仅可以达到良好的血糖控制,还可以控制减少唾液葡萄糖的分泌量。     

Pilocarpine for the treatment of salivary glands' impairment caused by radioiodine therapy for thyroid cancer

OBJECTIVES: To study the effect of single-dose pilocarpine hydrochloride 5 mg on the whole unstimulated and stimulated salivary flow in patients suffering from thyroid cancer treated with radioiodine therapy, and to investigate the changes in vital signs during the treatment. SUBJECTS AND METHODS: Five such patients were referred with complaints of dry mouth, rampant caries, and pain in the parotid gland region or history of chronic recurrent suppurative sialodenitis. A single dose of 5 mg pilocarpine hydrochloride was administered to each patient and blood pressure, heart rate, body temperature and salivary secretion rate were monitored at 1, 2 and 3 h. RESULTS: A significant elevation of unstimulated and stimulated saliva flow rate was observed in four patients without significant alteration of the monitored vital signs. CONCLUSIONS: Treatment with pilocarpine hydrochloride may be beneficial in the case of impaired salivary function in patients treated with radioiodine.     

Sialoendoscopy with and without holmium:YAG laser-assisted lithotripsy in the management of obstructive sialadenitis of major salivary glands

Obstructive sialadenitis is a major cause of dysfunction of the salivary glands, and increasingly sialoendoscopy is used in both diagnosis and treatment. At present the limit of the endoscopic approach is the size of the stone as only stones of less than 4 mm can be removed. Endoscopic laser lithotripsy has the potential to treat many stones larger than this with minimal complications and preservation of a functional salivary gland. The holmium:YAG laser has been widely and safely used in urology, and its use has been recently proposed in salivary lithotripsy for the removal of bigger stones. We describe our experience with sialoendoscopy for stones in the parotid and submandibular glands and assess the feasibility and the efficacy of holmium:YAG laser lithotripsy. We have used the procedure 50 times for 43 patients with obstructive sialadenitis; 31 patients had sialolithiasis, 15 of whom (48%) had stones with diameters between 4 and 15 mm (mean 7). Total extraction after fragmentation was possible in 14 of the 15 patients without complications. Intraductal holmium:YAG laser lithotripsy is effective and safe, and allows the treatment of large stones in Stensen's and Wharton's ducts.     

Long-term success of dental implants in patients with head and neck cancer after radiation therapy

The purpose of this study was to analyze the long-term success and factors potentially influencing the success of dental implants placed in patients with head and neck cancer who underwent radiation therapy with a minimum total dose of 50 Gy during the years 1995–2010. Thirty-five patients (169 dental implants) were included in this study. Data on demographic characteristics, tumour type, radiation therapy, implant sites, implant dimensions, and hyperbaric oxygen therapy (HBOT) were obtained from the medical records and analyzed. Implant survival was estimated using Kaplan–Meier survival curves. Seventy-nine dental implants were placed in the maxilla and 90 in the mandible. The mean follow-up after implant installation was 7.4 years (range 0.3–14.7 years). The overall 5-year survival rate for all implants was 92.9%. Sex (P < 0.001) and the mode of radiation therapy delivery (P = 0.005) had a statistically significant influence on implant survival. Age, time of implantation after irradiation, implant brand and dimensions, and HBOT had no statistically significant influence on implant survival. Osseointegrated dental implants can be used successfully in the oral rehabilitation of patients with head and neck cancer with a history of radiation therapy. Risk factors such as sex and the mode of radiation therapy delivery can affect implant survival.     

Ⅰ型神经纤维瘤病诊治进展

Ⅰ型神经纤维瘤病(NF1)是一种常染色体显性遗传神经皮肤疾病,其临床表现多样、复杂,治疗困难。分子生物学和影像学技术的进步以及大鼠模型的建立,使人们对其病因、发病机制和临床表现的认识更加深入,有望在治疗方面取得突破。本文复习相关文献,对NF1的发病机制、诊断标准、主要鉴别诊断、临床表现以及监测、处理NF1并发症的当前策略进行了概述。     

Salivary evaluation of pediatric patients with cancer,before and after antineoplasic treatment

J Oral Pathol Med (2012) 41 : 527–532 Aims: This study evaluated the salivary biochemical and immunological status of children with cancer undergoing to antineoplasic treatment in an attempt to identify alternatives for a less invasive and less painful monitoring of these patients. Materials and Methods: Unstimulated whole saliva samples were obtained from 115 children without cancer (control) and 32 children with cancer (CA). Children with cancer were also evaluated after antineoplasic treatment (CAT, n = 17). The salivary concentrations of glucose, triglycerides, total cholesterol, alkaline phosphatase, gamma‐glutamyltransferase (GGT), urea, insulin, thyroid‐stimulating hormone (TSH), triiodothyronine (T3), levothyroxine (T4), and immunoglobulin A (IgA) were determined. Results: Acute lymphocytic leukemia, acute myeloid leukemia, and Hodgkin’s lymphoma were the most frequent cancers, although cases of non‐Hodgkin’s lymphoma, medulloblastoma, ependymoma, osteosarcoma, nephroblastoma, Ewing’s sarcoma, and endodermal sinus tumor were also observed. The salivary concentration of cholesterol, triglycerides, or GGT did not differ between groups. Instead, the concentrations of alkaline phosphatase and T4 were higher in patients with cancer, irrespective of treatment. TSH levels were higher in the CA group and urea concentration was lower in the CAT group. T3 was undetectable in all groups. Antineoplasic treatment increased the glucose level and decreased the insulin concentration. Salivary concentration of total IgA was lower in children with cancer, irrespective of treatment. Conclusions: Cancer and antineoplasic treatment affected biochemical and immunological parameters in the saliva of children, shedding new light on the potential usefulness of saliva for monitoring children with cancer, especially to patients undergoing immunosuppressive therapy.