以吞咽困难为首发症状的AL型舌淀粉样变合并多发性骨髓瘤1例报告

系统性轻链型（AL）淀粉样变性（amyloidosis）合并多发性骨髓瘤（multiple myeloma,MM）是一种临床上罕见的浆细胞相关恶性疾病。大多数患者因心脏、肾脏功能损伤或实质性骨髓瘤为主诉就诊,以吞咽困难或其他口腔相关疾病为首发症状的病例罕见,故初诊时易漏诊误诊。本文报告1例以吞咽困难为首发症状的淀粉样变性合并多发性骨髓瘤病例,结合相关文献,对该病的特点、诊断标准及治疗方法进行讨论。     

舌淀粉样变性1例报道

淀粉样变性是一种少见的全身代谢类疾病,偶发于口腔,主要表现为舌淀粉样变性.本文报告口腔黏膜科首诊的舌淀粉样变性1例.患者因舌广泛性肿胀、多发性血疱就诊,伴舌根黏膜下结节及双颊、舌黏膜糜烂和疼痛.骨髓穿刺查见浆细胞显著增加,血液科检查提示浆细胞增多症及骨髓瘤.本文复习相关文献并讨论该病的病理机制,提示对临床原因不明的舌部广泛肿胀和血疱应警惕该病的可能,以对舌淀粉样变性做出及时诊断,这对早期发现和治疗其他脏器的淀粉样变性具有重要意义.     

局限在舌部发生的淀粉样变性肿瘤

淀粉样变性肿瘤由粘多糖和蛋白质构成的淀粉样物质不是沉着于全身脏器的某一部,而是几乎全部沉着于各脏器,破坏组织,损坏脏器功能,产生种种症状的疾患。本病有若干分类即(1)原发性淀粉样变性肿瘤;(2)继发性淀粉样变性肿瘤;(3)合并骨髓瘤的淀粉样变性肿瘤;(4)家族性淀粉样变性肿瘤;(5)局部性淀粉样变性肿瘤。     

颈部多发性淋巴结淀粉样变性1例

1例双侧颈部肿物渐增大8年的患者,因出现憋气感就诊。经穿刺和切取活检,诊断为颈部淋巴结淀粉样变性,行肿物切除后康复出院。局限于颈部的多发性淋巴结淀粉样变性是十分罕见的。本文通过此病例,复习相关文献,以供临床参考。     

口唇活检在淀粉样变性诊断中的意义

淀粉样变性是以淀粉样纤维为主要成分的淀粉样蛋白沉着于组织间隙的原因不明的代谢性疾病。它是众所周知的全身性和局部性疾病,局部性淀粉样变性多局限于特定的脏器,在口腔科领域舌淀粉样变性较多。     

上腭局部的原发性淀粉样变性

很多学者认为淀粉样瘤不同于淀粉样变性,Heller氏的分类是把淀粉样瘤列入胶原周围特发原发性淀粉样变性。局部的原发性淀粉样变性表现为局部淀粉样物质集积而呈肿瘤样的结节。Tillman等认为这种孤立的淀粉样瘤是稀有的,通常发生在上呼吸道,特别是喉、     

下颌骨浆细胞瘤一例

浆细胞瘤(plasma cell sarcoma)又称骨髓瘤(myeloma),来源于骨髓内浆细胞,是分泌免疫球蛋白的单克隆浆细胞恶性增殖性疾病,一般分单发和多发性两种,以多发性为多见,病变常见于颅骨、肋骨和腰椎,单发于颌骨的独立性骨髓瘤较少.自70年代以来,国内有文献报道发生于颌骨的浆细胞瘤约有20多例,多见于下颌骨.我科于2003年3月18日收治1例,报道如下:     

淀粉样变性55例口腔临床病理观察

目的:探讨淀粉样变性在口腔颌面部的临床病理特点及口腔组织活检于淀粉样变性诊断的意义。方法:回顾性分析55例淀粉样变性的口腔临床特点和活检切片的HE染色,刚果红特染,光镜和偏光镜观察,免疫组织化学染色和一淀粉样变性肾组织活检的电镜检查。结果:在总计55例中,46例口腔组织(牙龈、舌、下唇、唇腺)活检切片可见淀粉样物质沉积。口腔组织的活检阳性率为84%。口腔组织切片检查可见黏膜基底膜下、舌肌间粉红均质淀粉样物质沉积,刚果红特染呈砖红色。透色电镜观察淀粉样蛋白为排列不规则,不均匀的絮状结构。结论:淀粉样变性在口腔组织表现主要呈舌体增大、质硬、溃疡。口腔组织活检可提供淀粉样变性病诊断重要依据。     

侵及下颌骨多发性骨髓瘤的临床研究

我科自1958～1994年，共收治颌骨多发性骨髓瘤5例．均经病理证实。本文就颌骨多发性骨髓瘤的临床早期发现、X线表现、诊断及治疗等进行临床研究，以期加深对颌骨多发性骨髓瘤的认识，提高诊断与治疗水平。     

口腔活组织检查在诊断淀粉样变性中的应用

目的:探讨口腔组织(如牙龈、舌、下唇和唇腺)活检,对诊断淀粉样变性的临床意义。方法:对2010-05-2012-04期间,38例疑诊为淀粉样变性的病例行口腔组织活检。其中牙龈活检30例(含同时行唇腺活检2例),舌活检7例,下唇活检1例。所有活检标本送病理科,行HE染色和刚果红特染。结果:经口腔组织活检确定淀粉样变性阳性标本13例。在阳性病例中,活检部位牙龈6例、舌5例、下唇组织1例、唇腺1例。阳性的淀粉样变性病理诊断可提供淀粉样变性确诊依据。在25例阴性病例中,仍有2例通过腹壁脂肪活检、1例经前臂脂肪活检和1例经肾活检电镜观察后,其淀粉样变性诊断得以确定。结论:口腔组织活检具有易于取材、创伤小、恢复快的优点,可作为淀粉样变性的一个重要诊断依据。     

柠檬精油对牙周致病菌抑制作用及其安全性初步研究

目的:探讨柠檬精油对牙周致病菌的体外抗菌活性及对细胞增殖的影响。方法:采用微量液体稀释法测定柠檬精油对Pg、Fn、Aa、Pi的最小抑菌浓度(minimal inhibitory concentration,MIC)及最小杀菌浓度(minimum bactericidal concentration,MBC);以较低浓度的MIC为标准稀释LEO作为实验组,采用MTT法测定柠檬精油对HUVECs的毒性作用,明确抑菌浓度下LEO的安全性。结果:柠檬精油对牙周主要致病菌均有抑菌作用,Pg、Fn、Aa、Pi的MIC分别是9.0 g/L、4.5 g/L、4.5 g/L、9.0 g/L,Aa、Fn的 MBC是9.0 g/L,Pg、Pi的MBC未测得。1/2MIC、1/20MIC浓度的LEO能够抑制人脐静脉内皮细胞的生长,而低于1/200MIC浓度的LEO则对人脐静脉内皮细胞的生长没有影响,其中1/200MIC浓度的LEO作用明显优于0.02%的CHX。结论:体外环境中,柠檬精油对牙周致病菌Pg、Fn、Aa、Pi具有抗菌活性,低浓度应用对机体相对安全。     

Oral cancer: molecular technologies for risk assessment and diagnosis

Purpose: The effective biomarkers related to diagnosis, metastasis, drug resistance and irradiation sensitivity of oral cancers will help the pathologist and oncologist to determine the molecular taxonomy diagnosis and design the individualization treatment for the patients with oral cancers.     

Computer-assisted planning for maxillofacial prosthodontic rehabilitation

Computerized tomography (CT) planning and the use of CT derived surgical templates for implant placement have shown promise for restoring function within months after surgical reconstruction of acquired post-oncologic defects.     

Stimulated whole saliva components in children with Down syndrome

The authors report on the components of stimulated whole saliva from children with Down syndrome—including pH, flow rate, sialic acid and protein concentrations, and amylase and peroxidase activity. Saliva samples were collected from 35 children aged 6–10 years. Of the participants, 17 had Down syndrome and 18 did not. To stimulate saliva production, the children chewed a piece of parafilm for 10 minutes before the sample was collected. Soon after collecting the saliva sample, the authors measured pH using a portable pH-meter. Sialic acid levels were determined with a thiobarbituric acid assay. Protein content was determined with Folin's phenol reagent. Amylase was assayed and the authors measured the maltose produced by the breakdown of starch and peroxidase using ortho-dianisidine.
No statistically significant difference was observed in levels of sialic acid (free and total) between the two groups. Protein concentration was about 36% higher in the group with Down syndrome. However, the salivary flow rate, pH, and amylase and peroxidase activities were lower among the children with Down syndrome.     

Effect of Pingyangmycin on human venous malformation endothelial cells

Purpose: Venous malformations are common vascular anomalies with a propensity of the head and neck. Intralesional injection of Pingyangmycin (PYM, bleomycin A5 hydrochloride) is a widely used sclerotherapy method for the treatment of venous malformation.     

替牙期骨性Ⅲ类错牙合患者颞下颌关节特征的锥形束CT研究

目的:采用锥形束CT(CBCT)研究替牙期骨性Ⅲ类错牙合患者颞下颌关节的影像学特征,探讨Ⅲ类功能状态下,颞下颌关节的生长、改建机制。方法:从就诊于昆明医科大学附属口腔医院正畸科的患者中选取符合纳入标准的替牙期骨性Ⅲ类错牙合患者及骨性Ⅰ类错牙合患者各20名,使用NNT viewer 5.3图像处理软件进行三维重建及线距和角度的测量,并进行统计学分析。结果:替牙期骨性Ⅲ类错牙合患者组和替牙期骨性Ⅰ类错牙合患者组对比结果为:矢状面双侧关节前间隙偏小、双侧关节上间隙偏小、双侧关节结节斜度偏小;冠状面双侧关节内间隙偏小,双侧关节上间隙偏小,双侧关节外间隙偏小,右侧髁状突角度偏小;横截面右侧髁状突前后径偏小。结论:替牙期骨性Ⅲ类错牙合患者颞下颌关节发育不充分,呈现髁状突,关节窝深度,关节结节斜度;冠状面关节内、外间隙均较小的特征。骨性Ⅲ类错牙合患者髁状突在关节窝中处于前置近关节窝顶位置。骨性Ⅲ类错牙合患者颞下颌关节影像学特征与其功能状态相适应。     

牙髓再生的研究现状

目前,根管治疗术在临床上已得到了广泛的应用并成功的保存了患牙,但其仍有许多术后并发症。随着组织工程技术在口腔领域的应用,构建一种组织工程化牙髓进行牙髓-牙本质复合体的再生治疗成为可能。近年来国内外已有很多关于牙髓再生的研究,并且已经取得了一定成果。本文将对目前国内外牙髓再生的研究进展现状作一综述。     

Ghlorhexidine as a root canal medicament for treating inflammatory lesions in the periodontal space

Abstract— The purpose of the present study was to investigate the therapeutic effect of intra-canal application of chlorhexidine on inflammatory root resorption. Dental pulps from monkey incisors were infected and resealed prior to extraction of the teeth. Root dentin was mechanically exposed and the teeth were replanted under aseptic conditions. After 4 weeks, the experimental teeth were dressed with chlorhexidine gel and resealed. Animals were sacrificed 4 weeks later, and their jaws prepared for histologic examination. Results showed that both marginal and apical periodontal inflammation and resorption were reduced in the chlorhexidine-treated teeth. It was concluded that the use of intra-canal chlorhexidine may be a useful adjunct in the treatment of inflammatory root resorption, but further human trials need to be undertaken before its clinical use can be recommended.     

小鼠牙髓干细胞同种异体移植后体内免疫反应初探

目的:初步探究小鼠牙髓干细胞同种异体移植后的全身免疫反应。方法:牙髓干细胞分离获得自C57BL/6 小鼠牙髓组织,培养至第3 代,与纳米羟基磷灰石(n-HA)复合培养形成复合物,扫描电镜观察其生长黏附情况。40只4周龄的C57BL/6 小鼠随机分成两组。实验组将复合物移植入上背部皮下,对照组将纳米羟基磷灰石植入上背部皮下,术后均使用外科方法严密缝合创口。两组动物术后均观察4周、6周处死,分离脾脏,制成脾淋巴细胞悬液,流式细胞仪测定CD4⁺、CD8⁺的值。结果:牙髓干细胞在体外与纳米羟基磷灰石结合良好;免疫组化染色实验组4周、6周均可见牙本质涎蛋白(dentin sialoprotein,DSP)阳性表达;实验组与对照组相比,术后4周、6周CD4⁺/CD8⁺值均无明显差异。结论:牙髓干细胞同种异体移植后,尚不能够引起机体的免疫排斥反应,其在体内仍具有低免疫原性,有望成为组织工程同种异体种子细胞来源。