干燥综合征的腮腺和颌下腺损害特点分析

目的：通过比较干燥综合征组和正常对照组进行放射性核素显像的定量参数差异,观察干燥综合征患者的腮腺和颌下腺损害的各自特点。方法：38例干燥综合征患者均符合2002年干燥综合征国际分类（诊断）标准,对照组14例,所有病例按常规行唾液腺动态显像,并计算获得3项摄取功能参数：4min摄取比值（UR4）、15min摄取比值（UR15）、摄取速率（UV）;3项排泄功能参数：最大排泄量（MS）、酸刺激后腺体计数下降到最低所需的时间（Tmin）和1min内排泄速率（SV1min）,将两组定量参数进行t检验和Mann-Whitney U检验。结果：干燥综合征组腮腺不显影或显影不清楚的比例为2/38,干燥综合征组腮腺功能参数SV1min、UR15明显减低。颌下腺不显影或显影不清楚的例数为14/38,干燥综合征组颌下腺功能参数包括：UR4、UR15、UV、MS、SV1min均较对照组明显减低。结论：干燥综合征患者的腮腺与颌下腺功能损害并不是完全一致的。颌下腺损害更加常见,摄取和排泌量及速度均减低。腮腺仅高峰摄取比值和早期排泌速率明显减低,摄取速率和排泄量可表现正常。     

Sonohistology for the computerized differentiation of parotid gland tumors

A system for the computerized differentiation of parotid gland tumors is proposed. The parotid gland is the largest of the salivary glands. It is found in the subcutaneous tissue of the face, overlying the mandibular ramus and anterior and inferior to the external ear. The classification system is based on a multifeature tissue characterization approach, using fuzzy inference systems as higher-order classifiers. Baseband ultrasonic echo data were acquired during conventional ultrasound imaging examinations using standard ultrasound equipment. Several tissue-describing parameters were calculated within numerous small regions of interest to evaluate spectral and textural tissue properties. The parameters were processed by an adaptive network-based fuzzy inference system, using the results of conventional histology after parotidectomy as the "gold standard." The results of the classification are presented as a numerical score indicating the probability of a certain tumor or alteration for each parotid gland. The score can be presented to the physician during examination of the patient to improve the differentiation between various types of parotid gland tumors. The system was evaluated on n = 23 cases of patients undergoing radical parotidectomy. The receiver operating characteristic curve area is A(ROC) = 0.95 +/- 0.07 when using fourfold cross-validation over cases and differentiating between various benign parotid gland tumors and monomorphic adenoma.     

Survey of alpha-amylase activity and isoamylases in autopsy tissue

We quantified total amylase and its isoenzymes in 22 different human tissues obtained at autopsy. Isoenzymes were separated by use of wheat-germ inhibition (WI) and electrophoresis on cellulose acetate (CA) and agarose (AG). Mean (+/- SD) total activity was highest in salivary glands (parotid 1710 +/- 897 U/g, submandibular 605 +/- 354 U/g), and pancreas (258 +/- 137 U/g). All other tissues contained 100- to 1000-fold less amylase. As assessed with WI, pancreas, jejunum, liver, placenta, testis, skeletal muscle, and spleen contained more than 90% pancreatic isoamylase. Salivary glands and thyroid contained more than 90% salivary isoamylase. All other tissues contained a mixture of the two isoenzymes. CA and AG often produced different results. For both CA and AG the most common pancreatic isoforms were P2 and S1. Salivary gland homogenates demonstrated a band migrating in the P3 position on CA. We conclude that both types of amylase isoenzymes can be found in tissues other than salivary gland and pancreas, but that their low total amylase concentrations diminish their clinical importance.     

MALT-lymphomas in Sjogren's disease

AIM: To develop algorithm of early diagnosis of extranodal lymphoma arising in patients with Sjorgen's disease (SD). MATERIAL AND METHODS: SD diagnosis was made in 457 patients treated in Rheumatology Institute clinic in 1999-2004, 38 (8.3%) females aged 19-82 had lymphoproliferative diseases. MALT-lymphomas were diagnosed in 15 (42.2%) patients. All the patients have undergone morphological, immunomorphological investigations of the salivary glands, postoperative material was analysed in some patients. In addition, the following investigations were made: ultrasonography of the salivary glands, lymph nodes, viscera; scintigraphy; trephine biopsy of the bone marrow; myelograms; CT of the chest, abdomena and brain; tests for monoclonal immunoglobulins in the serum and light chains in urine; biopsy of the parotid gland. Clinical, morphological and immunophenotypical characteristics of MALT-lymphomas were assessed by WHO classification. Lymphoma stages were classified according to Ann Arbor. RESULTS: Parotid glands were affected with MALT-lymphoma most frequently. Predominant were extranodal lymphomas of the parotid submandibular, minor salivary glands of the lip and lacrimal glands of stage I E-II E. Extranodal lymphoma with nodal lesion of stage IV occurred less frequently. Untreated long existing MALT-lymphomas of the parotid glands may transform into B-large cell lymphomas deteriorating SD prognosis. The presence of long-term (> 12 months) massive enlargement of parotid/submandibular salivary and lacrimal glands, massive infiltration, monoclonal immunoglobulins in blood serum and their light chains in the urine predict development of MALT-lymphoma in SD. CONCLUSION: In SD, MALT-lymphomas develop primarily in target organs--salivary and lacrimal glands. SD patients with persistent enlargement of the parotid glands need biopsy for early detection of malignant lymphoproliferation.     

唾液腺显像诊断干燥综合征

目的 探讨唾液腺显像诊断干燥综合征的价值。方法 回顾性分析44例临床怀疑干燥综合征（SS）患者的唾液腺显像资料,在双侧腮腺、颌下腺勾画ROI获得时间-放射性曲线（TAC）,对曲线进行定量分析获得唾液腺摄取指数（UI）和排泌分数（EF）,分析UI和EF与唾液腺显像定性分级诊断结果的相关性,并比较其诊断SS的效能。结果 与非SS患者相比较,SS患者唾液腺UI和EF均明显减低（P均<0.05）。定性诊断评价唾液腺功能受损程度分为0~3级,双侧颌下腺、腮腺UI与定性诊断分级呈负相关（P均<0.001）;除右侧颌下腺EF与唾液腺显像定性分级呈负相关外（r=-0.312,P=0.039）,其余腺体EF与定性诊断分级无相关性（P均>0.05）。UI的综合诊断效能均高于定性诊断,但是其ROC曲线下面积与定性诊断比较差异无统计学意义（P均>0.05）。结论 唾液腺显像定量分析可准确评价唾液腺功能,对诊断SS具有重要价值。     

二维超声联合声触诊组织成像定量技术诊断唾液腺干燥综合征

目的 观察二维超声联合声触诊组织成像定量（VTIQ）技术诊断唾液腺干燥综合征（SS）的价值。方法 收集43例SS患者（SS组）和60例非SS患者（对照组）,观察并对比其唾液腺病灶二维超声评分及剪切波速度（SWV）,绘制受试者工作特征（ROC）曲线,评估二维超声评分、VTIQ及二者联合诊断唾液腺SS的效能。结果 SS组唾液腺二维超声评分及唾液腺SWV均明显高于对照组（P均<0.01）。以2.12、2.38 m/s为唾液腺（腮腺、下颌下腺）SWV最佳截断值,其诊断唾液腺SS的敏感度、特异度、约登指数和曲线下面积（AUC）分别为83.70%、88.30%、0.72和0.90;以二维超声评分2分为最佳截断值,其诊断唾液腺SS的敏感度、特异度、约登指数和AUC分别为76.70%、90.00%、0.67和0.91;以二维超声评分为1分且唾液腺SWV=2.12、2.38 m/s为最佳截断值,联合诊断唾液腺SS的敏感度、特异度、约登指数和AUC分别为95.30%、60.00%、0.55和0.78。结论 二维超声联合VTIQ技术有助于诊断唾液腺SS。     

Human parathyroid hormone is secreted primarily into the bloodstream after rat parotid gland gene transfer

Hypoparathyroidism is a hormone deficiency syndrome that leads to low blood calcium levels and for which current replacement therapy is inadequate. Gene transfer to salivary glands leads to safe and abundant secretion of therapeutic protein into either saliva or the bloodstream. We previously reported the successful transduction of rat submandibular glands with an adenoviral vector encoding human parathyroid hormone (Ad.hPTH), but unfortunately most of the hPTH was secreted into saliva. Because submandibular and parotid glands are morphologically and functionally different, we hypothesized that hPTH sorting might be different in parotid glands. After 2 days, the pattern of hPTH secretion from transduced parotid glands of intact rats was reversed from that of transduced submandibular glands, that is, most transgenic hPTH was detected in serum (5?×?10(10) viral particles per gland; the saliva-to-serum ratio of total hPTH secreted was 0.04). Vector copies were localized to the targeted parotid glands, with none detected in liver or spleen. Ad.hPTH next was administered to parotid glands of parathyroidectomized rats. Two days after delivery no hPTH was detectable in saliva, but high levels were found in serum, leading to normalization of serum calcium and a significant increase in the urinary phosphorus-to-creatinine ratio. This study demonstrates for the first time differential sorting of transgenic hPTH between submandibular and parotid glands, suggesting that hPTH may be a valuable model protein for understanding the molecular basis of transgenic secretory protein sorting in these exocrine glands. We also show the clinical potential of salivary gland hPTH gene therapy for patients with hypoparathyroidism.     

Antioxidant parameters and lipid peroxidation in salivary glands of streptozotocin-induced diabetic rats

BACKGROUND: There is evidence suggesting an unbalance between oxidant and antioxidant status associated with diabetes. Considering that salivary function is essential for the maintenance of oral and systemic health, this study was designed to examine the levels of reduced and oxidized glutathione and the activities of the antioxidant enzymes, such as superoxide dismutase, catalase, and glutathione peroxidase, in salivary gland of streptozotocin-induced diabetic rats. METHODS: The content of malondialdehyde was determined in the blood and in the salivary glands. The antioxidant status was investigated in the submandibular and parotid salivary glands. RESULTS: Diabetic rats showed an increase in the content of malonaldehyde in the blood and in the submandibular salivary gland, but not in the parotid gland. Both forms, reduced and oxidized glutathione content present higher values in the diabetic submandibular gland compared with controls. No difference in the activity of superoxide dismutase between the diabetic and control glands was observed in either gland. Catalase showed higher specific activity in the parotid gland of the diabetic rats than control; however, in the submandibular gland, only when expressed as unit per gland was it higher than control. The specific activity of glutathione peroxidase was higher in the diabetic parotid gland than control; however, in the submandibular gland, its activity per gland was lower than controls. CONCLUSION: The streptozotocin-induced diabetes in rats caused different results comparing the submandibular and parotid salivary glands.     

Sialorrhea: a management challenge

Sialorrhea (drooling or excessive salivation) is a common problem in neurologically impaired children (i.e., those with mental retardation or cerebral palsy) and in adults who have Parkinson's disease or have had a stroke. It is most commonly caused by poor oral and facial muscle control. Contributing factors may include hypersecretion of saliva, dental malocclusion, postural problems, and an inability to recognize salivary spill. Sialorrhea causes a range of physical and psychosocial complications, including perioral chapping, dehydration, odor, and social stigmatization, that can be devastating for patients and their families. Treatment of sialorrhea is best managed by a clinical team that includes primary health care providers, speech pathologists, occupational therapists, dentists, orthodontists, neurologists, and otolaryngologists. Treatment options range from conservative (i.e., observation, postural changes, biofeedback) to more aggressive measures such as medication, radiation, and surgical therapy. Anticholinergic medications, such as glycopyrrolate and scopolamine, are effective in reducing drooling, but their use may be limited by side effects. The injection of botulinum toxin type A into the parotid and submandibular glands is safe and effective in controlling drooling, but the effects fade in several months, and repeat injections are necessary. Surgical intervention, including salivary gland excision, salivary duct ligation, and duct rerouting, provides the most effective and permanent treatment of significant sialorrhea and can greatly improve the quality of life of patients and their families or caregivers.     

Ultrasonographic biometry in salivary glands

Specifications about the size of healthy salivary glands are not available to date. Therefore, we determined the size of the submandibular and the parotid glands by ultrasonography in 50 subjects (25 men, 25 women, mean age 45 y, range 20–68) with no history of disease affecting the salivary glands. The subjects were equally distributed concerning gender and age. Body weight did not differ more than 20% from the ideal weight following Broca's formula (mean body weight 71 kg, range 46–95 kg). In the submandibular glands we found an anterior-posterior length of 35 mm ± 5.7 mm, a paramandibular dimension to the depth of 14.3 mm ± 2.9 mm and a dimension in frontal scanning of 33.7 mm ± 5.4 mm. The parotid glands were measured 46.3 mm ± 7.7 mm in the axis parallel to the mandibular ramus and 37.4 mm ± 5.6 mm in the transversel axis. The dimension of the parotid parenchyma was measured with 7.4 mm ± 1.7 mm lateral to the mandible and 22.8 mm ± 3.6 mm dorsal to the mandible. No statistically significant difference to the 5%-level was found concerning gender. The dimension of the parotid glands correlated statistically significantly with body weight (p = 0.03). This correlation was not found in the dimension of the submandibular glands. Age did not correlate with the dimension of salivary glands. Results of the submandibular glands were compared with volume measurements of submandibular glands from cadavers.     

弥散加权磁共振成像评价鼻咽癌患者调强放疗前、后唾液腺功能的变化

目的评价DWI检测调强放疗(IMRT)对鼻咽癌(NPC)患者唾液腺功能影响的临床价值。方法对23例NPC患者行IMRT,并于放疗前、后行唾液腺静息状态DWI和酸刺激条件下重复DWI。计算双侧腮腺及颌下腺ADC值,并进行统计学分析。结果放疗前,静息状态腮腺平均ADC值明显低于颌下腺(P<0.05),酸刺激后腮腺及颌下腺ADC值表现出先降后升的变化趋势,最小值、最大值与静息状态相比差异有统计学意义(P<0.05)。放疗后,静息态腮腺及颌下腺平均ADC值显著高于放疗前(P<0.05),酸刺激条件下失去先降后升的变化趋势。结论 MR DWI可无创观察腮腺及颌下腺功能,较好地评价放疗后患者腮腺和颌下腺功能的变化。     

干燥综合征患者涎腺的超声表现

目的 探讨干燥综合征患者涎腺的超声表现。方法对15例确诊为干燥综合征的患者，利用高频超声观察其涎腺(主要是腮腺和颌下腺)的超声声像图特征并进行总结。结果 15例患者的腺体均有不同程度的超声改变。根据声像图特点将其主要分为4种类型：不均匀型、结节型、纤维化型和混合型。结论干 燥综合征患者的涎腺改变具有一定的超声特征，这对我们评价干燥综合征患者涎腺受累的程度有一定的临床价值。     

Increased fluid secretion after adenoviral-mediated transfer of the human aquaporin-1 cDNA to irradiated miniature pig parotid glands.

The treatment of most head and neck cancer patients includes ionizing radiation (IR). Salivary glands in the IR field suffer irreversible damage. Previously, we reported that adenoviral (Ad)-mediated transfer of the human aquaporin-1 (hAQP1) cDNA to rat submandibular glands following IR restored salivary flow to near normal levels. It is unclear if this strategy is useful in larger animals. Herein, we evaluated AdhAQP1-mediated gene transfer after parotid gland IR (20 Gy) in the miniature pig. Sixteen weeks following IR, salivation from the targeted gland was decreased by >80%. AdhAQP1 administration resulted in a dose-dependent increase in parotid salivary flow to approximately 80% of pre-IR levels on day 3. A control Ad vector was without significant effect. The effective AdhAQP1 dose was 2.5 x 10(5) pfu/microl infusate, a dose that leads to comparable transgene expression in murine and minipig salivary glands. Three days after Ad vector administration little change was observed in clinical chemistry and hematology values. These findings demonstrate that localized delivery of AdhAQP1 to IR-damaged salivary glands increases salivary secretion, without significant general adverse events, in a large animal model.     

Sonographic appearances of malignant lymphoma of the salivary glands.

PURPOSE: We undertook this retrospective study to describe the sonographic findings in patients with malignant lymphoma of the major salivary glands. METHODS: We reviewed the sonograms and medical records of 7 patients with histologically proven lymphoma of the parotid (3 patients) or submandibular glands (4 patients). RESULTS: Primary lymphoma was found in 1 parotid gland and 2 submandibular glands. The remaining 4 cases were secondary lymphomas. One patient had been diagnosed with Sj?gren's syndrome and had been followed up with sonography. In parotid glands, both parenchymal and intraparotid nodal lymphomas were found. All submandibular gland tumors were parenchymal. Intraparotid nodal involvement appeared as multiple small nodules with relatively smooth margins, whereas the parenchymal parotid and submandibular gland lymphomas were larger (25 to 45 mm in longitudinal diameter) and showed various degrees of margin irregularity. All tumors were hypoechoic relative to the normal parenchyma. The primary parotid lymphoma and intraparotid nodal lymphomas had a homogeneous echotexture; the secondary parotid lymphomas and submandibular gland lymphomas were heterogeneous. One submandibular gland lymphoma showed intratumoral echogenic stripes. Neither calcification nor cystic degeneration was observed within the lesions. CONCLUSIONS: Lymphomas of the salivary glands present a variety of sonographic appearances, ranging from multiple small, hypoechoic nodules to an irregularly shaped heterogeneous mass without cystic areas or calcifications.     

The importance of postoperative radiotherapy against polymorphous low-grade adenocarcinoma of the parotid gland: case report and review of the literature

Polymorphous low-grade adenocarcinoma (PLGA) of the salivary gland is a disease entity that is a recently described form of adenocarcinoma. PLGA most commonly arises in the minor salivary glands. We report two cases of PLGA of the parotid gland. Case 1: A 52-year-old female visited the University of Tsukuba Hospital with a painless mass in the left parotid region. A superficial parotidectomy and postoperative radiotherapy were performed. The patient has been free from disease for 50 months. Case 2: A 55-year-old female initially noticed a painless slowly growing mass in the left parotid region. The tumor was removed with a superficial parotidectomy. The local recurrence was found 6 years after the initial surgery. The recurrent tumor was removed, and radiotherapy was administered thereafter. The patient has been free from the disease for 33 months since the last treatment. The treatment for the primary lesion is crucial for the prognosis since metastasis to the regional lymph node or to distant region is unusual in PLGA. Although surgical extirpation is the recommended modality for treatment of PLGA, wide resection with a safety margin is often difficult in the parotid gland because of the presence of the facial nerve. Our two cases were successfully treated with surgery and postoperative radiotherapy. Although our literature search revealed 32 previously reported cases of PLGA of the parotid gland, only five of the 32 cases were treated postoperative radiotherapy. We highlight the importance of postoperative radiotherapy for PLGA of the parotid gland.     

Imaging of the major salivary glands

The major salivary glands, submandibular, parotid and sublingual glands play an important role in preserving the oral cavity and dental health. Patients with problems of the major salivary glands may present with symptoms such as dry mouth, dysphagia and obstruction of duct, inflammation, severe dental caries or swelling. Imaging plays an important role in visualization of morphology and function, to establish a diagnosis, for treatment, and for surgical planning. There are several options for diagnostic imaging: plain radiography, sialography, ultrasound (US), magnetic resonance imaging (MRI), computed tomography (CT), salivary gland scintigraphy and ¹⁸F‐FDG positron emission tomography (PET). We present an overview of the modalities in relation to common salivary gland disease.     

Tissue peroxidase in the normal and neoplastic salivary gland.

Peroxidase activity was measured by two colorimetric methods in six neoplastic tumors of the parotid salivary gland. When p-phenylenediamine was used as the hydrogen donor co-substrate, peroxidase activity was absent or reduced from 6 to 22% of normal in these tumors. Cross reactivity with normal peroxidase antibody could not be demonstrated in tumors exhibiting negative activity. Two neoplastic salivary glands had well-described, encapsulated tumors which showed reduced peroxidase activity when compared with the normal uninvolved portion. However, when guaiacol was substituted for p-phenylenediamine, normal activity was recorded. After dialysis, peroxidase activity was not enhanced. Mixing experiments showed no effect of the tumor extract on the peroxidase activity of normal saliva, nor on salivary gland supernatant. Normal salivary gland peroxidase was inhibited 90% by 10(-2) g/L amino-triazole, but neoplastic tumors were inhibited less (13 and 73%). It is suggested that peroxidase is a simple marker for the detection of neoplasia and can be of value in the differentiation of benign tumors.     

THE HUMAN SECRETORY IMMUNOGLOBULIN SYSTEM: IMMUNOHISTOLOGICAL LOCALIZATION OF γA,SECRETORY "PIECE," AND LACTOFERRIN IN NORMAL HUMAN TISSUES

The immunohistological localization of γA, secretory "piece" (SP), and lactoferrin (LF) in the mucosae of a variety of normal human tissues was investigated using specific fluoresceinated antisera. γA staining was localized in the apical portion of the mucosal epithelium, intercellular spaces, basement membrane area, and plasma cells of the interstitium or lamina propria of a number of normal human tissues. SP was ubiquitous in the mucosal epithelium of all tissues studied which included parotid and submaxillary glands, bronchi, pancreas, GI tract, sweat glands, kidney, and gall bladder. In addition, SP staining was localized in the intercellular spaces and on the surface of the epithelial cells lining the lumen of the secretory glands. No SP staining was observed in the plasma cells of the interstitium or lamina propria surrounding the secretory glands in these tissues, and no SP staining was observed in sections of normal spleen or lymph node tissue. SP staining was observed in the sweat glands, pancreas, and kidney in the absence of γA staining. LF was much less ubiquitous in the epithelial cells of the various tissues studied and appeared to be restricted primarily to the acinar epithelium of the bronchial mucosae, parotid, and submaxillary salivary glands, and was also found in renal tubular cells. A hypothetical model for the transport of γA and SP across mucosal membrane epithelium is presented.     

Sonographic detection of secondary MALT lymphoma of the submandibular gland.

This report describes a case of mucosa-associated lymphoid tissue (MALT) lymphoma of the lacrimal glands that recurred in the submandibular salivary glands. Gray-scale sonography showed small hypoechoic nodules, measuring less than 0.5 cm in diameter, in both submandibular glands. The echogenicity and echotexture of the rest of the submandibular glands and of the parotid glands was normal. Power Doppler sonography revealed increased vascularity within the nodules. A sonographically guided aspiration biopsy of the nodules revealed MALT lymphoma. Secondary MALT lymphoma should be considered in the presence of multiple small hypoechoic nodules in the salivary glands in patients with a history of MALT lymphoma at another location.     

Simultaneous Quantitative Measurement of 131I-Iodine and 99mTc-Pertechnetate Uptake by Human Salivary Glands Using Scintiscanning with Validation by Direct Estimation in Biopsy Samples

Abstract. ¹³¹I-iodide and ⁹⁹Tc-pertechnetate concentration in human salivary glands has been measured simultaneously in vivo by quantitative scintiscanning in 7 thyrotoxic subjects. The mid scan times were 5, 12 and 20 min. and the gland to plasma ratio (G/P) of ¹³¹I rose to 4.03±0.82 (s.e.) in the parotid and 10.7 ±3.1 (s.e.) in the submandibular glands. Corresponding values for G/P ^99mTcO₄-were 2.70 ±0.34 in the parotid and 5.3 ± 1.2 in the submandibular glands. Values obtained at parotidectomy 1 h after intravenous administration of a mixture containing ¹²⁵I^- and ^99mTcO₄^- to 6 patients were 4.13 ± 0.85 for G/P ¹²⁵I- and 2.50 ± 0.62 for G/P^99mTcO₄-. G/P¹³¹I- (or G/P¹²⁵I-) and G/P ^99mTeO₄-, derived by both methods, were significantly correlated in parotid and submandibular glands. There was a significant correlation between G/P ¹³¹I-/G/P ^99mTcO₄- in the parotid glands and G/P¹³¹I-/G/P^99mTcO₄- in the submandibular glands. -It is concluded that 1. salivary gland values of ¹³¹I^- and ^99mTcO₄,^-as measured by scintiscanning are very close to values obtained by direct counting of excised human salivary gland tissue and 2. that the secretion processes in both glands are physiologically related.