三叶因子1在实验性胃溃疡自愈期大鼠下颌下腺的表达及意义

目的 探讨大鼠实验性胃溃疡自愈期间下颌下腺三叶因子1(TFF1)的表达变化.方法 采用免疫组织化学和RT-PCR法,分别从蛋白水平及基因水平检测42只溃疡组、21只盐水组和6只正常组大鼠下颌下腺TFF1的表达.结果 免疫组织化学SP法显示,正常大鼠下颌下腺颗粒曲管的多颗粒细胞呈TFF1免疫反应阳性,各级导管管腔内也有TFF1阳性物质,纹状管管腔游离面可见线条状TFF1阳性物.溃疡组下颌下腺TFF1肽积分吸光度值明显增加,高于相应的盐水对照组和正常组(P<0.05或P<0.01),其中1d、2d、4d、6d TFF1肽积分吸光度值逐渐增加,6d最高,10d、14d、23d也显著高于盐水对照组.RT-PCR结果 显示,下颌下腺有TFF1 mRNA转录,且溃疡组TFF1/GAPDH mRNA吸光度比值在溃疡2～23d均高于盐水对照组和正常组(P<0.01或P<0.05).结论 下颌下腺TFF1肽在大鼠实验性胃溃疡形成和愈合过程中高表达,主要通过导管系统排泄,参与实验性胃溃疡的愈合.     

Vascular clinical anatomy of the submandibular gland

ObjectiveThe aim of this study is to describe in depth the precise anatomy of the vascular supply of the submandibular gland, trying to determine the existence of patterns of glandular vascularization. Knowledge of these patterns could facilitate surgical management of the gland and the submandibular gland flap.Material and methodsNeck dissections of formaldehyde preserved human cadavers were performed. Submandibular and transmandibular approaches were used during the dissections. All the vascular branches found were registered and classified into 2groups: main or accessory branches. The anatomical data analyzed was: The diameter and length of the main and accessory branches, as well as the most important measurements of the submandibular gland flap pedicle.Results33 glands were dissected to study the arterial supply of the submandibular gland (17 right, 16 left; 17 males, 16 females) and 29 were dissected to study the venous supply (15 left, 14 right; 15 males,14 females). A total of 123 arterial branches were found reaching the 33 submandibular glands (47 main and 76 accessories) and 116 venous branches were found draining the 29 submandibular glands (47 main branches and 69 accessory branches). A constant main venous branch that ran parallel to the Wharton duct and drained in the sublingual vein was found in all of cases (Concomitant Wharton Duct Vein or CWDV).ConclusionThe CWDV is a constant venous branch for the drainage of the gland and should be considered as venous pedicle during the dissection of submandibular gland flaps.     

Sialendoscopy plus laser lithotripsy in sialolithiasis of the submandibular gland in 64 patients: A simple and safe procedure

ObjectiveTo demonstrate the safety and efficiency of holmium laser-assisted lithotripsy during sialendoscopy of the submandibular gland using a retrospective, interventional consecutive case series.MethodsWe performed 374 sialendoscopies between 2008 and 2015 and evaluated all patients regarding clinical symptoms, clinical findings, therapy and outcome. We performed 109 procedures of holmium laser-assisted lithotripsy in 64 patients whose sialoliths measured 5 mm or more in diameter. In addition to retrospective case note reviews, we performed telephone interviews of all patients in January 2017.ResultsWe performed 374 consecutive submandibular gland sialendoscopy procedures in 276 patients between 2008 to 2015. Sialolithiasis had either previously been diagnosed, or symptoms highly suggestive of sialolithiasis of the submandibular gland presented in 197 patients.Holmium laser-assisted Laser lithotripsy was performed in 109 cases (64.9%). Smaller mobile concrement was removed directly either by forceps or wire basket, or following marsupialisation of the submandibular duct. This was the case in 88 patients (29.1%). Three patients (0.8%) required surgical removal of the submandibular gland due to early abscess. The majority of patients (n = 374 procedures; 90.1%) remained symptom-free after two or more years following intervention. In the remaining procedures (n = 37 procedures; 9.9%), patients reported discreet postprandial problems but did not seek medical attention. In total, we managed to preserve the submandibular gland and avoid open surgery in 99% of patients through endoscopic management of submandibular concrement and duct stenosis.ConclusionHolmium laser-assisted lithotripsy is a simple, safe, and effective procedure for treating patients with sialolithiasis of the submandibular gland. Removal of the gland is rarely required, and removing the gland without prior sialendoscopy is no longer recommended. It should be offered to all patients with submandibular gland sialolithiasis, or such patients should be referred to the appropriate centre for sialendoscopy before submandibulectomy is considered.     

The effect of submandibular gland preservation during level 1B neck dissection on postoperative xerostomia

Objective

Compare the presence and degree of postoperative xerostomia following preservation or excision of the submandibular gland (SMG) during level IB neck dissection (ND) without adjuvant radiation.

Treatment outcomes of sialendoscopy for submandibular gland sialolithiasis: The minor axis of the sialolith is a regulative factor for the removal of sialoliths in the hilum of the submandibular gland using sialendoscopy alone

Objective

To assess the general guidelines for the removal of sialoliths for submandibular gland sialolithiasis using sialendoscopy alone.

182例颈深部多间隙脓肿的回顾性分析

目的回顾性分析与总结颈深部多间隙脓肿的临床诊治经验,以提高临床医生对本病的认识与诊疗水平。方法选取2008年3月～2018年3月于陆军军医大学第一附属医院就诊的颈深部多间隙脓肿182例患者,对其临床特点、相关检查、治疗及随访情况进行回顾性分析。结果182例患者中,男女患者数之比为1.98∶1,27例合并有全身系统性疾病,其中25例为糖尿病,1例高血压3级,1例慢性肾病2期。最常见的临床症状为颈部包块和颈部疼痛。下颌下间隙是最常累及的间隙,其次是咽旁间隙,牙源性和上呼吸道感染是最常见的致病原因。对所有患者的脓液进行细菌学培养,其中45例（24.7%）培养阳性,阳性结果中最常见的致病菌为链球菌属（43.6%）。在糖尿病患者中,4例细菌培养阳性,全为肺炎克雷伯杆菌。所有患者选用敏感抗生素治疗,其中152例患者行脓肿切开引流术;最常见并发症为气道阻塞,其中33例（18.1%）行气管切开术;有合并症患者给予对症处理。住院治疗2～43 d,151例患者获治愈,31例患者缓解,没有死亡病例。出院后随访1个月情况良好,感染无复发。结论颈深部多间隙脓肿男性患病率较女性高,起病急,进展迅速,脓肿切开引流和联合应用敏感抗生素仍然是本病的主要治疗方法。脓液细菌培养呈现出大量的阴性结果,因此细菌学培养仅仅作为使用抗生素的参考,气管切开仍然是保障术后安全的必要条件,对于减少并发症及改善预后起到了重要作用。治疗中要特别关注合并全身系统性疾病和老年患者并发症的处理。     

Occurrence of a third type of secretory cell in the acinus of the rat submandibular gland

A new, third type of secretory cell was found in the acini of the submandibular gland in rat. In paraffin sections stained with hematoxylin-eosin or reacted with periodic acid-Schiff, acini containing the third type of secretory cells were found as a mass of darkly stained secretory endpieces at the periphery of the lobule. In semi-thin sections stained with toluidine blue, these cells showed numerous dense secretory granules in their cytoplasm. Some acini consisted entirely of these cells, whereas other acini consisted of an admixture of such cells and typical seromucous cells. Acini containing the third type of secretory cell tended to form clusters. Electron microscopically, the cells had well-developed rough endoplasmic reticulum and Golgi apparatus. The secretory granules showed a wide range of variation in substructure, even within the same cell. Well-developed intercellular interdigitation and intercellular canaliculi also were observed between adjacent third type of secretory cells. Although little is known about the biological significance of these cells and the properties of their secretory granules, the present study shows that the rat submandibular gland possesses three types of secretory cells in their secretory endpieces. © 1993 Wiley-Liss, Inc.     

Immunolocalization of enamel proteins during amelogenesis in the cat

Amelogenesis in the cat has been suggested to closely resemble enamel formation in human teeth. In order to further characterize the sequence of events leading to enamel formation in the cat, the expression and distribution of enamel proteins throughout amelogenisis were examined by postembedding immunocytochemistry using an antibody to mouse amelogenins and the high resolution protein A-gold technique. Enamel proteins were first immunodetected in ameloblasts and in the extracellular matrix during the presecretory stage. Secretory stage ameloblasts showed the most intense cellular reactivity. In these cells, protein synthetic organelles, secretory granules, and large lysosome-like structures were all intensely labeled. Extracellulary, numerous gold particles were observed over enamel and over patches of material found at the baso-lateral surfaces of these ameloblasts. During the early maturation stage, the protein synthetic organelles and secretory granules of ameloblasts still showed some immunoreactivity, although the most conspicuous labeling at this later stage was found over enamel and over material present amoung the extensive apical membrane infoldings of ruffle-ended ameloblasts. Qualitative analysis of lysosome-like elements in ameloblasts suggested that their frequency and immunoreactivity in the maturation stage were relatively lower than in the secretory stage, where some groups of cells often showed numerous large labeled structures. The enamel matrix was intensely labeled at all stages; however, cervical-occlusal and surface-depth gradients were readily apparent by conventional staining and by quantitative analysis of immunolabeling in the late secretory and early maturation stages. These data suggest that the cellular and extracellular distribution of enamel proteins in the cat is generally similar to that reported in other species, although some particularities were observed, perhaps reflecting variation in the timing of developmental parameters. © 1992 Wiley-Liss, Inc.