口腔粘膜早期鳞癌36例临床分析

36例口腔粘膜早期鳞癌的临床特征、治疗和预后分析结果表明:好发部位为舌缘、舌腹、颊和软腭等粘膜。损害最常表现为红色或红白间杂外表(占66.7％),很少发生溃疡和外突性生长,自觉症状不明显,容易漏诊。提示口腔粘膜的红白间杂损害可能是早期无症状鳞癌的最早指征,应全切活检以确诊。     

21例膀胱白斑的诊断与外科治疗

目的：探讨膀胱白斑的临床特点，提高诊疗水平。方法：分析总结21例膀胱白斑的临床资料。结果：21例患者经病理证实为鳞状上皮角化。结论：对反复出现尿路刺激征，且药物治疗疗效较差者，应及时行膀胱镜检查，病灶活检为早期发现和诊断膀胱白斑的有效方法。治疗应首选病灶电切、电灼术。     

AgNOR cut-point to distinguish mild and moderate epithelial dysplasia

Background:  Distinguishing mild and moderate epithelial dysplasia is difficult and controversial. We demonstrated earlier that silver-stainable nucleolar organizer region (AgNOR) is a simple, inexpensive and quantifiable method which can standardize this distinction reliably.
Objective:  To establish a cut-point mean AgNOR count for epithelial dysplasia validated by bootstrapping.
Methods:  One hundred oral leukoplakia biopsies at Dr R. Ahmed Dental College, Kolkata, India, examined for epithelial dysplasia using standard method (gold standard) were assessed for their mean AgNOR counts. A cut-point was selected employing receiver operating characteristic (ROC) curve. This estimate was stabilized by 10 000 resamples (with replacement) using parametric and non-parametric bootstrap, a Monte Carlo statistical method, corrected for bias to estimate standard errors (SE) of cut-point.
Results:  Area under the curve (AUC) was 74%; non-parametric method suggested mean AgNOR cut-point = 2.42 AgNORs/nucleus; parametric method suggested cut-point = 2.57. The cut-point 95% confidence intervals (CIs) (bias corrected and accelerated) from parametric method (2.31; 2.66) was lower than non-parametric (2.43; 2.82).
Conclusion:  Applying a conservative paradigm, taking the lowest of all bootstrap 95% CIs, we suggest that mean AgNOR count of 2.3 be used as a cut-point for distinguishing between mild and moderate dysplasia. This strategy will provide an inexpensive, meaningful, definitive, reproducible and consistent diagnostic test for epithelial dysplasia.     

Macro- and microanatomy of the lateral border of the tongue with special reference to oral hairy leukoplakia

The macro- and microanatomy of the marginal tongue mucosa were studied. Tissues were harvested from 12 individuals at autopsy. Random sections from six different locations along the margin and serial sections representing three defined section planes to the margin of the tongue were evaluated. Vertical, parallel mucosal folds alternating with shallow grooves were a characteristic macroscopical findings on the lateral border of the tongue. The mucosa presented a non-keratinized epithelium with PAS-positive, lightly stained spinous cells and no or slight inflammatory reaction in the connective tissue. Changes in the epithelium mimicking hyperplasia, acanthosis, keratin projections, and focal parakeratosis could be produced by changing the direction of tissue sectioning. The macro- and microscopical parameters recorded in normal marginal tongue mucosa are among other included in criteria for diagnosing oral hairy leukoplakia. The results emphasize the importance of a thorough knowledge of the normal anatomy of a mucosal site to arrive at reliable diagnostic criteria.     

Recurrence Rates of Premalignant Lesions after CO2 Laser Vaporization

Background: Use of the CO₂-Laser (λ = 10.6 μm, continuous wave, defocussed) is an established procedure for treatment of premalignant lesions. Through employment of the sp-mode as well as scanners, thermal laser effects can be reduced but, on the other hand, a lesser degree of destruction of dysplastic cells could lead to an increased recurrence rate. The purpose of this study was to evaluate prospectively the recurrence rates resulting from different methods of CO₂ laser vaporization.Methods: From May 1995 to May, 2002, 56 patients with a total of 68 premalignant lesions of the oral mucosa were treated in a prospective clinical study. Twenty-eight lesions were vaporized with the defocussed CO₂ laser (cw, 15 W, 5–15 s, mean output 2.12 Wcm⁻²). In a further 21 lesions, a scanner (Swiftlase) was additionally employed with all other parameters held constant (mean output 212.4 Wcm⁻²). In the remaining 19 lesions, vaporization was carried out in the sp-mode (pulse duration 80 μs, pulse energy 20 mJ, mean output 228 Wcm⁻²) in which, as above, a scanner was also used. Follow-up examinations were carried out according to a standard protocol. In May, 2002, the recurrence rate in the 3 groups was determined.Results: Clinically, use of the scanner in sp-mode resulted in the most irregular tissue resection. This can be accounted for by the irregular paths of the laser beam and the pulsed delivery of the laser energy. The lowest recurrence rates were yielded by the defocussed cw-technique followed by the cw-scanner and the sp-mode.Conclusions: These results indicate that for treatment of premalignant lesions of the oral mucosa, the best results can be achieved with the defocussed CO₂ laser. The incurrence of a deep thermal effect enhances destruction of deeper-lying dysplastic cells. Apparently, other methods with lesser penetration of thermal effects (e. g. sp, scanner) do not reach the deeper-lying cells and, consequently, render higher rates of recurrence.     

金嗓散结丸治疗声带白斑67例临床疗效观察

目的 探讨金嗓散结丸治疗声带白斑的临床疗效.方法 选择2001年3月～2009年10月我院耳鼻喉科门诊经动态喉镜检查证实为声带白斑的病人97例,病史1～6个月不等,治疗组67例,采用中成药金嗓散结丸治疗,9g·次-1,tid,疗程4～8 w;对照组30例,使用金果饮,20 mL·次-1,tid,疗程与治疗组相同,两组均予以地塞米松5 mg及庆大霉素8万U喉超声雾化吸入.结果 治疗组,有效56例,占83.58％,其中治愈39例,占58.21％;对照组,有效6例,占20.00％,其中治愈1例,占3.33％.结论 金嗓散结丸对早期声带白斑疗效确切、疗法安全简便、费用低廉,值得推广.     

中西医结合治疗口腔白斑53例临床分析

目的探讨转移因子胶囊联合血府逐瘀口服液治疗口腔白斑的疗效。方法将98例口腔白斑患者随机分成两组。A组（n=53）用血府逐瘀口服液和口服转移因子胶囊;B组（n=45）仅用转移因子胶囊。结果A组显效率及总有效率分别为73.6%和96.2%;B组显效率及总有效率分别为44.4%和86.7%。两组间治疗效果差异有统计学意义（P＆lt;0.05）。结论转移因子胶囊联合血府逐瘀口服液治疗口腔白斑有明显的效果,值得进一步推广。     

Diclofenac in hyaluronic acid gel: an alternative treatment for actinic cheilitis

Objective

Actinic cheilitis (AC) is a precancerous lesion of the lip vermillion caused by prolonged exposure to ultraviolet light. The aim of this study was to evaluate the effect of 3% diclofenac in 2.5% hyaluronic acid gel in the treatment of AC.

Methods

Thirty-four patients with chronic AC were treated twice a day with topical diclofenac during a period of 30 to 180 days. The individuals were followed up every 15 days by means of clinical examination and digital photographic documentation.

Results

Of the 27 patients that completed the study, 12 (44%) showed complete remission of the whitish plaques and exfoliative areas, and 15 (56%) had partial remission of the clinical picture of cheilitis. The latter group was submitted to excision of the leukoplakic areas which diagnosis varied from mild to moderate epithelial dysplasia.

Conclusion

The results suggest a promising role for diclofenac in hyaluronic acid gel in the treatment of AC. This treatment has the advantages of not being invasive and showing few side effects.     

Oral lichen planus and related lesions. What should we accept based on the available evidence?

Recent new terminologies have been proposed for lesions in the sphere of oral lichen planus (OLP) that theoretically present unique aetiological, clinical, prognostic or management characteristics different from those of the so-called typical forms of OLP. We aimed to critically analyse what concepts and terminologies related to OLP should we accept based on the available evidence. A review of the literature was carried out in order to critically analyse the concepts and terminologies related to OLP. New concepts and terminologies include oral lichenoid lesions; contact lichenoid reactions, drug lichenoid reactions or those in the context of graft-versus-host disease; chronic ulcerative stomatitis; lichen planus pemphigoid; and some lesions that are difficult to categorise, such as OLP with features of proliferative verrucous leukoplakia and lichenoid lesions of the upper labial mucosa. A multidisciplinary, multicontinent working group has recently published a guideline with recommendations for modifying definitions and terminologies associated with a disease, among which a reasoned, evidence-based justification for the proposed change is considered essential. An in-depth analysis of the newly proposed terms for OLP-related lesions shows that many of them are not justified. In this paper, we set out our position on the basis of the existing evidence on the appropriateness of the use of these new terms.