护理干预对艾滋病并口腔干燥症患者的影响

目的：探讨护理干预对艾滋病并口腔干燥症患者的影响效果．方法对2010年10月至2012年4月收治的53例AIDS并口腔干燥症患者治疗期间进行护理干预,采用自行设计的评估表对护理干预前后患者的口腔干燥情况进行评价．结果护理干预前后患者口腔干燥发生程度有显著变化（P＜0.01）,从0级向4级递减,4级患者减少了11.4%,0级患者增加了9.4%．患者随着干预时间的延长和疗效呈正比例关系．形成了有效的口腔护理卫生行为,通过护理干预帮助患者建立健康的生活方式．结论及时给予护理干预对缓解艾滋病口腔干燥症有重要意义.     

The influence of xerostomia after radiotherapy on quality of life

Introduction Xerostomia is a common complication of radiotherapy for head and neck cancer because irreparable damage is caused to the salivary glands if they are included in the radiation fields. The aim of the study was to evaluate the degree of xerostomia in survivors of head and neck cancer and to determine its impact on quality of life. Methods and materials A xerostomia questionnaire consisting of three parts (xerostomia score, quality of life survey, and visual analogue scale) was completed by 75 head and neck cancer patients, more than 6 months after radiotherapy and without evidence of disease. Results The majority of patients (93%) suffered from a dry mouth, and 65% had moderate to severe xerostomia (grade 2 to 3). Both dysphagia (65%) and taste loss (63%) were common, although oral pain was less frequent (33%). The emotional impact of xerostomia was significant, causing worry (64%), tension (61%), or feelings of depression (44%). Furthermore, patients reported problems with talking to (60%) or eating with (54%) other people and to feel restricted in amount and type of food (65%). Quality of life was influenced by T classification, clinical stage, a higher radiation dose or the use of concomitant chemotherapy, but was independent of the interval since the end of radiotherapy. Conclusions Xerostomia after radiotherapy for head and neck cancer is extremely common and significantly affects quality of life. No recuperation is seen over time, and the use of concomitant chemotherapy significantly increases the oral complications of radiation. These results warrant the continuing efforts put into the development of salivary gland-sparing radiotherapy techniques and effective treatments of radiation-induced xerostomia.     

唾液腺动态显像对口干患者唾液腺功能受损的诊断评价

目的探讨唾液腺动态显像（salivary gland scintigraphy, SGS）对疑为干燥综合征口干患者唾液腺功能受损的诊断评价,并探讨定量功能参数的临床意义。方法疑为干燥综合征口干患者22例行Tc99mO4- SGS,通过肉眼影像、时间-放射性曲线和功能参数定量分析（前3min的初始摄取率UR1-3min、第18分钟最大摄取比值UR18 min,最小排泌时间Tmin）评价唾液腺功能受损情况,对照组8例。功能受损程度不同组与对照组间各功能参数的比较采用方差分析;并依据抗SSA/SSB抗体、抗ANA抗体、抗ds-DNA抗体和RF（类风湿因子）是否阳性,比较唾液腺功能受损情况。结果（1）SGS显示唾液腺功能受损为82%（18/22）,左右侧腮腺或颌下腺基本同步受损;功能正常为18%（4/22）。功能重度受损组与其他组间UR1-3 min、UR18 min均有统计学差异;功能正常组、中度受损组与对照组间UR18 min有统计学差异;功能正常组与对照组Tmin无统计学差异,功能中及重度受损组无或极少量排泌。（2）抗ds-DNA抗体均阴性,抗SSA/SSB抗体、抗ANA抗体及RF阳性分别为8、10和8例,抗SSA/SSB抗体阳性组和阴性组在唾液腺功能受损程度不同组间具有统计学差异。结论（1）SGS能敏感的发现口干患者唾液腺功能受损情况,但应将摄取和排泌功能分开评价;UR1-3 min、UR18 min和Tmin分别是评价唾液腺摄取和排泌功能不同程度受损的灵敏指标。（2）SSA/SSB自身抗体阳性者,唾液腺功能受损程度较重。     

Sjogren’s syndrome–An interesting case

ObjectiveTo present a case of Sjogren syndrome with pulmonary manifestations in an adult female and discuss its assessment and management.DesignCase Report.SettingTertiary care hospital.PatientOne.ResultsA 50 yrs female admitted with complaints of dryness of eyes with decreased salivation causing difficulty in swallowing since last 3 years, with persistent dry cough since 10–15 days and progressive dyspnea since 4–5 days. Anti-nuclear antibody (ANA) profile revealed Anti- Ro/SS-A and Anti- La/SS-B Positive. Also, sub-lingual excisional biopsy was done which was consistent with findings of Sjogren's syndrome. Patient showed significant improvement after starting oral glucocorticoids, systemic anti inflammatory agents (Tab. HCQS), artificial tear drops, oral iron supplements and other supportive treatment.ConclusionSjögren syndrome (SS) is a chronic inflammatory disorder characterized by diminished lacrimal and salivary gland function and associated with lymphocytic infiltration of exocrine glands, and can affect extraglandular organ systems including the skin, lung, heart, kidney, neural, and hematopoietic systems. We present a case of Sjogren syndrome in an adult female presenting with xerostomia and dyspnea and was diagnosed upon detection of anti-Ro and anti-La antibodies and confirmed by histopathological examination of lip biopsy. Patient was started on oral steroids and other supportive treatment, General condition improved significantly and is doing very well on regular follow-up.     

电离辐射对大鼠颌下腺形态及功能的影响

目的：观察电离辐射对大鼠颌下腺形态及功能的影响。方法：一次性15Gy X射线局部照射大鼠唾液腺区，观察照射后30天内动物体重、颌下腺重量、毛果芸香碱的潜伏期（lag phase)、唾液流率、电解质、组织学等变化。结果：照射后大鼠体重及颌下腺重量减轻，唾液流率降低，Na^ 降低、K^ 升高，Ca^2 变化不显著、毛果芸香碱的潜伏期延长。早期主要是细胞形态结构的变化，晚期主要是唾液腺实质细胞萎缩，数量减少。结论：照射后大鼠颌吓腺发生了形态变化及不可逆性功能障碍。卷曲颗粒导管（CGT）细胞是靶细胞。     

鼻咽癌放疗后口干燥症的临床分析

口干燥症是鼻咽癌放疗后最常见的后遗症之一,严重影响患者的生存质量。本研究旨在探讨鼻咽癌放疗后口干燥症的严重程度及其对日常生活的影响。     

Quantitative dose-response analysis of salivary function following radiotherapy using sequential RI-sialography

A total of 216 99mTc-pertechnetate-sialographies, by applying stimulations by citric acid, were performed for studying radiation effects on the salivary glands in 145 patients. From a scintigram of the salivary gland, the time-activity-curves were obtained for analysis of salivary function. The shape of the time-activity-curve with respect to stimulus-response pattern was classified into four types according to the degree of radiation-induced dysfunction. We found that the acid stimulation was enhancing accumulation of the isotope into the salivary gland as well as influencing salivary discharge. A ratio (Rc) of pre- and post-stimulation counts permitted a construction of quantitative dose-response curves; the curve for the parotids had a slight rise of Rc's over 0-20 Gy, whereas that for the submandibular glands had a significant rise over 10-30 Gy; in both glands the rise of Rc's was followed by a steep fall. The parotids appeared to be more sensitive to radiation than the submandibular glands at 0-3 months following 20-70 Gy, but after 3 months both glands were similarly impaired. The gland volume irradiated was also of great importance in determining the degree of salivary dysfunction. The maximum uptakes averaged per unit area (salivary-to-background ratio) and determined during the initial 30 minutes were greater in the submandibular than in the parotid glands following greater than 20 Gy. In both glands the maximum uptakes were gradually impaired with time over 3-36 months following 50-70 Gy.     

The imprint of salivary secretion in autoimmune disorders and related pathological conditions

Xerostomia is a state of oral dryness associated with salivary gland dysfunction and is induced by stress, radiation and chemical therapy, various systemic and autoimmune diseases, and specific medications. Fluid secretion is interrupted by the stimulation of neurotransmitter-induced increase in cytosolic calcium ([Ca²⁺]_i) in salivary gland acinar cells, prompting the mobilization of ion channels and their transporters. Salivary fluid and protein secretion are principally dependent on parasympathetic and sympathetic nerves. Various inflammatory cytokines allied with lymphocytic infiltration cause glandular damage and Sjogren's syndrome, an autoimmune exocrinopathy associated with hyposalivation. A defect in IP₃Rs, a major calcium release channel, prompts inadequate agonist-induced [Ca²⁺]_i in acinar cells and deters salivary flow. The store-operated calcium entry-mediated Ca²⁺ movement into the acini activates K⁺ and Cl^? channels, which further opens a water channel protein, aquaporin-5, and triggers the release of fluid secretion from the salivary glands. The cellular mechanism of salivary gland dysfunction and hyposalivation has not yet been elucidated. In this review, we focused mainly on the proteins responsible for deficient saliva, the correlation between inflammation and salivation, autoimmune disorders and other ailments or complications associated with hyposalivation.     

Burning mouth complaints: clinical characteristics of a Brazilian sample

OBJECTIVE: Evaluation of the clinical characteristics of burning mouth complaints (BMC) in a series of Brazilian patients referred to a large teaching hospital. MATERIALS AND METHODS: 66 patients with burning mouth complaints were evaluated through a standardized protocol. RESULTS: 56 women and 10 men were examined, ranging in age from 35-83 years. The primary location of the complaints was reported to be the tongue. Thirty-six patients reported a precipitating event. The mean VAS pain levels were 7.5 in women and 6.11 in men. The average estradiol levels in women were low (<13 pg/ml); 80% of all patients reported a concomitant chronic disease, 55% of all patients wore total dentures, 54% of all patients reported subjective xerostomia, 48% of all patients reported sleep disturbances and 66% reported phantom taste. No statistical differences were found between groups with or without a precipitating event in VAS: (p=0.139), in the Number of Words Chosen (NWC) (p=0.259) and Pain Rating Index (PRI) (p=0.276) sections of the McGill Pain Questionnaire (MPQ). CONCLUSION: The existence of systemic comorbidities, self-reported sleep disturbances and taste alterations indicates possible correlations and the need for a careful systemic evaluation of each patient; there were no differences between patients with and without precipitating events.     

Complete agenesis of major salivary glands

A 4 year-old female patient was treated for persistent right-sided dacryocystitis and xerostomia. MRI was performed to screen for a dry syndrome; which resulted in the diagnosis of agenesis of the parotid and submandibular glands as well as lacrimal duct malformation. An MRI of each parent was normal. The mother's history revealed 4 days of pyrexia during the 8th week of amenorrhea. This was an isolated case, with no family history, characterized by a febrile episode during pregnancy at the period of main salivary gland genesis. Epigenetic mechanisms could be implicated.