CVP动脉灌注联合手术治疗晚期上颌窦鳞癌的疗效(附39例分析)

目的 :探讨CVP方案行颞浅动脉灌注术前诱导化疗联合手术治疗 39例晚期上颌窦癌患者的可行性。方法 :39例T4患者采用卡铂、足叶乙甙、平阳霉素诱导化疗 ,然后施行上颌骨扩大切除加同侧根治性颈淋巴清扫术。结果 :所有患者均可耐受化疗 ,化疗疗效评价均为部分缓解。术后失访 5例 ,随访资料完整 34例 ,占87%。所有病例无原发灶复发。其中 4例死于远位转移 ,分别为术后第 5月、第 7月、第 8月和第 12月。 30例无瘤生存。 5年以上 17例 ,3年以上 6例 ,1年以上 4例 ,不足 1年 3例。结论 :CVP颞浅动脉灌注术前诱导化疗联合手术治疗晚期上颌窦癌 ,是提高远期疗效的有效方案。合理的术后化疗及免疫治疗是减少术后远位转移 ,提高远期生存率的重要因素。也是今后需要高度重视的问题     

Langerhans cell disease associated with pathological fracture of the mandible

A 27-year-old male suffered a fractured mandible following extraction of a tooth. It was subsequently found that the fracture occurred in an area pathologically weakened by a localized lesion of Langerhans cell disease. Since lesions of the jaws may be seen either as the first manifestation or as a complication of widespread Langerhans cell disease, the dentist has a major role in the diagnosis and management of such cases.     

6 000 年前成人第三磨牙的研究

目的:观察距今约6 000年前成人第三磨牙的位置情况。方法:研究了200个半坡博物馆内保存的新石器时代人颌骨标本,第三磨牙共383颗(上颌187颗,下颌196颗),观察第三磨牙的萌出情况。第三磨牙未萌出者经X线片证实,按有无第三磨牙牙胚,将其分别归为埋伏阻生组或先天缺失组。结果:上颌第三磨牙先天缺失率为26.74%,下颌第三磨牙先天缺失率为17.35%。上颌第三磨牙阻生率为2.67%,下颌第三磨牙阻生率为14.79%。结论:现代人第三磨牙阻生率与先天缺失率均较新石器时代成人高,人类第三磨牙阻生与先天缺失是伴随整个人类进化而发生的咀嚼器官退化现象的一部分。     

“Transport Distraction Osteogenesis for Reconstruction of Mandibular Defects”: Our Experience

Introduction  

Mandibular defects usually involve a combination of osseous and soft tissue deficiency and are among the most challenging problems in maxillofacial surgery, many options are available for mandibular reconstruction. One of the options discussed in literature recently being distraction osteogenesis.     

Cone-beam computed tomography in assessment of periodontal ligament space: in vitro study on artificial tooth model

The aim of this in vitro study was to compare cone-beam computed tomography (CBCT) to conventional radiography (RG) in the assessment of the periodontal ligament space. A phantom with a variable "artificial" periodontal ligament space (0, 100, 200, 300, and 400 microm) was used as a model. The examinations were performed simultaneously with RG and NewTom 9000 digital volume tomograph. Assorted after increasing widths, 15 RGs and 15 CBCT images were presented for judgment to 20 dentists (DD), 20 dental assistants, and 20 dental students. Several weeks later, the same images were randomly mixed and presented to the same 20 DD again. The trial shows that RG gaps wider than 200 microm could be correctly identified by all participants with an accuracy of nearly 100%. A significant difference was observed between the modalities (p<0.05 and p<0.001) where conventional RGs performed better than CBCT for assessment of periodontal ligament space. Interobserver variation in relation to each technique was evaluated and no significant difference was found (p>0.05). In subjective evaluations of image quality with CBCT, the results were basically inferior for images of artificial periodontal ligament space, regardless of the experience of the observers.     

Weight loss from lifestyle interventions and severity of sleep apnoea: a systematic review and meta-analysis

Background

Excess body weight is a risk factor for obstructive sleep apnoea (OSA). The aim of the systematic review was to establish whether weight loss via lifestyle interventions such as diet and exercise are useful in the treatment of OSA.

Methods

A literature search was conducted between 1980 and February 2012. Systematic reviews and randomised controlled trials (RCTs) with participants who had OSA, were overweight or obese, and who had undergone lifestyle interventions with the aim of improving sleep apnoea were included. Meta analyses were conducted for a subset of RCTs with appropriate data.

Results

Two systematic reviews and eight RCTs were included. Meta-analyses were conducted for four RCTs comparing intensive lifestyle interventions to a control. The overall weighted mean differences for weight change, change in apnoea -hypopnoea index (AHI) and change in oxygen desaturation index of ≥4% were as follows: −13.76 kg (95% confidence interval (CI) −19.21, −-8.32), −16.09 (95% CI −25.64, −6.54) and −14.18 (95% CI −24.23, −4.13), respectively. Although high heterogeneity within the meta analyses, all studies favoured the interventions. Long-term follow-up data from three RCTs suggest that improvements in weight and AHI are maintained for up to 60 months.

Conclusions

Intensive lifestyle interventions are effective in the treatment of OSA, resulting in significant weight loss and a reduction in sleep apnoea severity. Weight loss via intensive lifestyle interventions could be encouraged as a treatment for mild to moderate OSA.     

Improvement in Quality of Life With Left Prefrontal Transcranial Magnetic Stimulation in Patients With Pharmacoresistant Major Depression: Acute and Six Month Outcomes

BackgroundTranscranial magnetic stimulation (TMS) is a safe and effective treatment for major depression. We describe quality of life (QOL) outcomes from acute treatment with TMS, and describe the durability of benefit across 24-weeks.MethodsThree hundred and one medication-free patients with pharmacoresistant major depression were randomized to active or sham TMS in a 6-week controlled trial. Nonresponders to the 6-week blinded phase of the study were enrolled in a 6-week open-label study without unblinding the prior treatment assignment. Responders and partial responders to both the blinded (active or sham treatment) or open acute treatment phases were tapered off TMS over three weeks, while initiating maintenance antidepressant medication monotherapy. These subjects entered the 24-week study to examine the durability of response to TMS. The Medical Outcomes Study-36 Item Short Form (SF-36) and the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) were used to measure overall function and QOL. During the 24-week durability of effect study, QOL assessments were done at study entry and at the end of 24-weeks.ResultsStatistically significant improvement in both functional status and QOL outcomes was observed in patients treated with active TMS compared with sham TMS during the acute phase of the randomized, sham-controlled trial. Similar benefits were observed in patients who entered the open-label extension study. These improvements were sustained across the 24-week follow up study.ConclusionsAcute treatment with TMS improved functional status and QOL outcomes in patients with major depression. This clinical effect was durable in long-term follow up.