[Enterobius vermicularis infection in Guiyang City, Guizhou Province: a case report]

The report presents a case with Enterobius vermicularis infections in Guiyang City, Guizhou Province, aiming to strengthen the attention to parasitic infections.

Organized Hematoma of the Sphenoid Sinus With Acute Blindness: Insight Into Pathogenesis of Disease

Sinonasal organized hematomas (OHs) are rare lesions that primarily localize to the maxillary sinus. The rate of growth of these masses has not been described in the literature. We present a case of a 59-year-old gentleman with polyostotic fibrous dysplasia who presented with acute loss of vision in the left eye from an expanding OH of the sphenoid sinusitis. After expanded endonasal, transpterygoid approach and debulking, patient experienced significant vision improvement. Close follow-up imaging preoperatively allowed radiologic documentation of the rate of OH growth and this is presented in detail.

Causes of dacryocystorhinostomy failure: External versus endoscopic approach

OBJECTIVES

To compare the causes of failure between external and endoscopic dacryocystorhinostomy (DCR) techniques for the treatment of lacrimal obstruction.

STUDY DESIGN

A retrospective cohort study.

METHODS

The study population consisted of 53 consecutive patients who underwent revision endoscopic DCR from 2002 to 2013 for lacrimal duct obstruction. Identified causes of previous DCR failure were compared between patients whose initial surgery was performed through an external versus an endoscopic approach.

RESULTS

Reasons for surgical failure after external (n = 21) versus endoscopic (n = 32) DCR included cicatricial closure of the internal lacrimal ostium (52.4 versus 53.1%; p = 0.96), inadequate removal of bone overlying the lacrimal sac (23.8 versus 9.4%; p = 0.15), sump syndrome (9.5 versus 9.4%; p = 0.99), and intranasal adhesions (65 versus 37.5%; p = 0.05). Adhesions that involved the middle turbinate were a particularly impactful cause of failure when the DCR was performed through an external versus the endoscopic approach (57.1 versus 28.1%; p = 0.04). Septoplasty was more likely to be needed at the time of revision surgery if the initial procedure was performed externally (71.1 versus 15.6%; p = 0.02). Surgical success rates for revision DCR were comparable between the groups (75.0% external versus 73.3% endoscopic; p = 0.90), with a mean follow-up of 12.7 months.

CONCLUSION

DCR failure associated with intranasal adhesions was more likely to occur when the surgery was performed through an external rather than an endoscopic approach. Endoscopic instrumentation allowed for identification and correction of intranasal pathology at the time of DCR, including an enlarged middle turbinate or a deviated septum, which may improve surgical outcome.

Comparative techniques of medial rectus muscle retraction for endoscopic exposure of the medial intraconal space

OBJECTIVE

The medial rectus muscle (MRM) is the medial boundary to the intraconal space of the orbit, and retraction of the MRM is oftentimes necessary for endoscopic removal of intraconal tumors, e.g., orbital hemangioma. We evaluated each of the reported methods of MRM retraction for endoscopic orbital surgery and quantified the degree of intraconal exposure conferred by each method.

METHODS

Eight orbits from four cadaver heads were dissected. In each orbit, medial orbital decompression was performed and the MRM was retracted by using four previously described techniques: (1) external MRM retraction at the globe insertion point by using vessel loop (external group), (2) transseptal MRM retraction by using vessel loop (transseptal group), (3) transchoanal retraction of the MRM by using vessel loop (choanal group), and (4) transseptal four-handed technique by using double ball retraction by a second surgeon (transseptal double ball group). The length, height, and area of exposure of the medial intraconal space were quantified and compared.

RESULTS

The average ± standard deviation (SD) anterior-posterior exposures for the external group, transseptal group, and transseptal double ball group were 17.51 ± 3.39 mm, 16.59 ± 4.16 mm, and 18.0 ± 15.25 mm, respectively. The choanal group provided significantly less exposure (12.39 ± 3.44 mm, p = 0.049) than the other groups. The average ± SD vertical exposures for the transseptal group, choanal group, and transseptal double ball group were 12.53 ± 4.38 mm, 13.05 ± 5.86 mm, and 13.57 ± 3.74 mm, respectively. The external group provided significantly less exposure (4.51 ± 1.56 mm, p = 0.0072) than the other groups. The transseptal and transseptal double ball groups provided the greatest total access by surface area (58.88 ± 26.96 mm(2) and 62.94 ± 34.74 mm(2), respectively) compared with the external and choanal groups (34.82 ± 23.37 mm(2) and 43.10 ± 23.68 mm(2), respectively). Although the transseptal trajectory of MRM retraction was optimal, the difference in total area of exposure between the static vessel loop retraction and the dynamic, four-handed technique with double ball instrument retraction was not significant. Of note, the exposure provided by the choanal technique required the surgeon to work both above and below the muscle.

CONCLUSION

Retraction of the MRM toward the choanae provided the least length of exposure, and external retraction exposed the least height and total area. Transseptal MRM retraction was most favorable and provided the largest endoscopic corridor to the medial intraconal space. A four-handed approach for endoscopic intraconal surgery of the orbit may offer advantages in dynamic adjustments in retraction.

Volumetric analysis of chronic maxillary atelectasis

BACKGROUND

The relationship between orbit and maxillary sinus volumes in patients with chronic maxillary atelectasis (CMA), commonly known as silent sinus syndrome if enophthalmos is present, is poorly understood.

METHODS

A retrospective review of 22 patients who underwent endoscopic sinus surgery (ESS) for CMA from 2005 to 2013 was performed. Computed tomography (CT) images were analyzed using OsiriX 5.8.2 software for volumetric analysis of the orbit and maxillary sinus at presentation and after surgical treatment with ESS.

RESULTS

Pretreatment mean orbit volumes on the diseased side (DS) and the contralateral side (CS) were 29.22 and 26.50 mL, respectively (p < 0.001); mean sinus volumes on the DS and CS were 8.51 and 17.20 mL, respectively (p < 0.001); and pretreatment mean midorbit heights (MOHs) on the DS and CS were 3.39 cm and 3.07 cm, respectively (p < 0.001). The percent decrease in sinus volume on the DS compared to that on the CS did not correlate significantly with the percent orbit-volume increase. Enophthalmos was present in nine (41%) patients, and diplopia was present in three (14%) patients. The measured degree of increased orbit volume and decreased sinus volume secondary to CMA did not significantly predict the presence of enophthalmos at presentation. Seven patients underwent sinus CT more than 6 months after ESS. In these patients, orbit volume on the DS decreased from 29.67 to 27.52 mL (p = 0.005), and sinus volume on the DS increased from 9.78 to 11.84 mL (p = 0.08).

CONCLUSIONS

Volumetric analysis is a powerful and novel method for objectively demonstrating the degree of orbit expansion and maxillary sinus contraction seen with CMA. Spontaneous maxillary sinus expansion and a decrease in orbit volume can occur after ESS, but post-ESS volumes do not return to the normal volume of the CS.

Human papillomavirus infection and biomarkers in sinonasal inverted papillomas: clinical significance and molecular mechanisms

BACKGROUND

The role of human papillomavirus (HPV) in sinonasal inverted papillomas (IPs) is controversial. Determining the prevalence of HPV infection and its impact on the molecular biology of these tumors is critical to characterizing its role in the pathogenesis of IPs.

METHODS

A total of 112 paraffin-embedded IPs from 90 patients were studied. A tissue microarray was constructed and stained for p16, p53, epidermal growth factor receptor (EGFR), and cyclin D1. HPV presence and types were determined using PGMY 09/11 primers and integration using HPV 11 detection of integrated papillomavirus sequences by ligation-mediated polymerase chain reaction (DIPS-PCR).

RESULTS

HPV was detected in 11 of 90 (12%) patients. HPV 11 was found in 9 samples. HPV 6 and HPV 27 were found in 1 sample each. EGFR staining proportion was higher in HPV-positive IPs vs HPV-negative specimens (56.2% vs 23.6%; p = 0.009). Differences in p16, p53, and cyclin D1 staining were not significant. HPV-positive lesions tend to progress to malignancy (p = 0.064). Three samples were analyzed for integration. Viral integration was found in both malignant tumors but not in the precursor IP.

CONCLUSION

Degradation of p53 and p16/cyclin D1 dysregulation are not important mechanisms in low-risk HPV-related IP. The low prevalence of HPV in this series indicates it is not a main etiological factor for IPs; however, when present, low-risk HPV may contribute to the biology of IPs through an increase of EGFR expression and a predisposition for malignant progression by integration into the cellular genome.

A Rare Finding of Schwannoma of the Vidian Canal: A Case Report

Background Schwannomas of the vidian canal are an extremely rare type of intracranial tumor that can have variable clinical presentations including headache, facial pain, facial muscle paralysis, decreased lacrimation, or nasal dryness. We present an atypical case of an incidentally identified asymptomatic vidian canal schwannoma.

Case Description A 49-year-old woman with a history of multiple sclerosis presented for routine surveillance magnetic resonance imaging that detected an ovoid mass originating in the vidian canal. Given the unusual location of the lesion, an endoscopic endonasal biopsy was performed and confirmed the diagnosis of a vidian canal schwannoma, for which the patient chose to receive fractionated radiation therapy.

Conclusion When a vidian canal tumor is identified, endoscopic endonasal biopsy can be used to confirm the diagnosis before pursuing either surgical or radiotherapy treatment. In particular, fractionated radiation therapy offers a radiobiologically safe means of delivering radiation when there is concern for late radiation-related side effects following treatment completion.

Comparison of second-echelon treatments for Ménière's disease

IMPORTANCE

To compare the efficacy of treatments commonly offered to patients with Ménière's disease who fail conservative medical therapy including diuretics and a sodium-restricted diet.

OBJECTIVES

This study compared three second-echelon treatments: the Meniett device, endolymphatic sac decompression, and intratympanic gentamicin injections to determine their comparative effectiveness and capacity to mitigate against the necessity of a surgical labyrinthectomy.

DESIGN, SETTING, AND PARTICIPANTS

Retrospective observational study at an academic tertiary care center. Patients with Ménière's disease who failed primary medical management were evaluated after treatment with a Meniett device (n=20), endolymphatic sac decompression (n=23) or intratympanic gentamicin injections (n=17). Cases were included if auditory and vertigo control data were available before and a minimum of two years after treatment, in patients without previous otologic surgery or intratympanic injections. Average age ranged from 54 to 75 years.

INTERVENTIONS

Use of the Meniett device, endolymphatic sac shunt decompression surgery or intratympanic gentamicin injections using variable doses and injection schedules.

MAIN OUTCOMES AND MEASURES

Proportion of patients with vertigo control and hearing preservation by a modified version of the AAO-HNS criteria after second-echelon treatment, thus not requiring definitive labyrinthectomy.

RESULTS

Despite endolymphatic sac surgery demonstrating a longer duration (61 months) prior to labyrinthectomy, no differences were found between the 3 treatment options in terms of patients going on to definitive labyrinthectomy or in the number of months of symptom relief following treatment. There was also no difference in residual auditory perception across the 3 groups.

CONCLUSIONS AND RELEVANCE

No significant therapeutic differences were found between the studied second-echelon treatments for symptom relief of Ménière's disease.

Sinonasal inverted papilloma: prognostic factors with emphasis on resection margins

Objective We review our institution's experience with the treatment of inverted papilloma (IP) with emphasis on the implications of surgical margins for disease control. Design Retrospective chart review of patients with IP treated at the University of Michigan from 1996 to 2011. Setting Tertiary care center. Participants Patients undergoing surgical resection with curative intent for IP. Main Outcome Measures Overall survival, disease-specific survival, and locoregional control were used as main outcome measures. Results We studied 129 patients including 19 with carcinoma arising from IP. Disease-free rates at 2, 3, and 5 years were 79.7%, 77.9%, and 61%, respectively. Overall, 10 of 18 recurrences were detected > 2 years from follow-up, with recurrences detected up to 8 years from surgery. For benign disease, obtaining tissue margins outside of the primary specimen for margin control did not affect disease control rates. Conclusion IP is a disease that requires significant follow-up periods beyond 2 years. For IP without carcinogenesis, acquiring margins outside of the tumor specimen did not appear to affect disease control rates in this study. No clear predictors of malignancy were seen in this study, which highlights the need for further research to predict this phenomenon.

Epidermal growth factor receptor, p16, cyclin D1, and p53 staining patterns for inverted papilloma

BACKGROUND

The aim of this study was better characterize the staining patterns of inverted papilloma (IP) with and without carcinoma by performing immunohistochemistry for p16, epidermal growth factor receptor (EGFR), p53, and cyclin D1 antibodies in a large patient cohort.

METHODS

A total of 162 IP specimens were collected from 147 patients treated at the University of Michigan between 1996 and 2011. Twenty-two specimens contained carcinoma. Tumor was extracted for construction of 2 tissue microarrays and stained for p16, EGFR, p53, and cyclin D1. Tumor staining intensity and percentage staining were scored.

RESULTS

Benign disease was positive for p16 in 64%, EGFR in 50%, p53 in 30%, and cyclin D1 in 76%. IP with carcinomatous degeneration was positive for p16 in 14%, EGFR in 71%, p53 in 62%, and cyclin D1 in 76%. The differences in staining positivity between benign and malignant disease reached significance for p16 and p53 only. Mean percentage staining by tumor surface area for IP and IP with carcinoma was 12% vs 7% for p16 (no statistical significance [NS]), 20% vs 34% for EGFR (NS), 4% vs 24% for p53 (p < 0.001), and 17% vs 21% for cyclin D1 (NS).

CONCLUSION

Important characteristic staining pattern for IP with and without carcinoma are highlighted in this study. Unlike recent trends in human papilloma virus (HPV)-related head and neck malignancies, low expression of p16 is a marker for malignancy in this series. Positive staining for p53 correlates with the development of carcinoma in IP.

Analysis of cervical esophagogastric anastomotic leaks after transhiatal esophagectomy: risk factors, presentation, and detection

BACKGROUND

Transhiatal esophagectomy with cervical esophagogastric anastomosis is a common approach in patients requiring esophagectomy. Factors for developing cervical esophagogastric anastomosis leaks (CEGAL), their presentation, and the value of a routine postoperative screening barium swallow in detecting CEGALs and other complications were analyzed.

METHODS

This single-institution retrospective study used medical records and an esophagectomy database to assess results in 1,133 patients who underwent transhiatal esophagectomy and a cervical esophagogastric anastomosis, 241 for benign disease and 892 for cancer, between January 1996 and December 2006.

RESULTS

Esophagectomy patients who experienced CEGALs included 127 (14.2%) with cancer and 23 (9.5%) with benign disease. Logistic regression analysis identified increasing number of preoperative comorbidities (p < 0.001), active smoking history (p = 0.044), and postoperative arrhythmia (p = 0.002) as risk factors for CEGALs, and a side-to-side stapled cervical esophagogastric anastomosis compared with a manually sewn one as protective (p < 0.001). For cancer patients, higher pathologic stage disease (p = 0.050) was a risk factor for CEGALs. For patients with benign disease, a higher number of prior esophagogastric operations (p = 0.007) is a risk factor for CEGALs. Of the 90.7% of CEGALs that occurred on or before postoperative day 10, cervical wound drainage (63.3%) was the most common presenting symptom. Screening barium swallow identified postoperative complications and influenced outcome in 39 patients (3.8%).

CONCLUSIONS

Higher number of preoperative comorbidities, advanced pathologic stage, postoperative arrhythmia, an increased number of prior esophagogastric surgeries, and active smoking history are risk factors for developing CEGAL, and a side-to-side stapled cervical esophagogastric anastomosis is protective. Screening barium swallow identifies few postoperative complications, but provides quality control.

Evaluation of Free Flaps Transferred by Microvascular Anastomosis in Oral and Maxillofacial Surgery

The authors discuss indications for the use of microvascular free flaps transferred to the oral and maxillofacial region. A series of 139 cases, involving 145 free flaps, is reported over a three year period. The overall success rate for all types of flaps was 89.3%. Advantages and disadvantages of the use of various flaps are presented and suggestions are offered to avoid complications.

[Reconstruction of the common carotid artery with freeze dried arterial allografts in goats]

OBJECTIVE

To observe the patency rate and histopathologic changes at different times after implantation of freeze dried arterial allografts.

METHODS

4 healthy adult goats were used as the experimental models. A segment of the common carotid artery 2 cm in length was surgically removed and bridged with freeze-dried graft of common carotid artery from another goat. The eight necks of 4 animals were divided into A and B group randomly, each containing 4 arteries. In group A, both cut ends of the carotid artery were anastomosed end to end with the arterial allograft. In group B, the proximal end of the carotid artery was anastomosed end to side with the allograft. The patency of the graft was monitored with Laser Doppler Flowmeter within one week and carotid angiography was performed in selected animal. The allografts with anastomoses were harvested at 1 week, 2 weeks, 3 months and 6 months after implantation, respectively. The surgical fresh specimens were prepared and subject to histopathologic evaluation under light microscope, scanning electron microscope and transmission electron microscope.

RESULTS

In Group A, 2 grafts were patent at 1 week and 2 weeks, respectively. One graft was not patent at 3 months, one was largely occluded at 6 months, only 1/4 part of the graft was patent. In Group B, 3 grafts were patent at 1 week, 2 weeks, 3 months, respectively. One graft was occluded at 6 months. There was no significant difference in patency rate between the two groups. Histopathologic examinations showed that in freezed dried arterial homograft, the endothelial cells were lost but the matrix was complete. One week after implantation, mononuclear macrophages were infiltrated into the wall in large amount and adventitia of loose connective tissues was formed. After 2 weeks of implantation, intimia was noted, intimal hyperplasia was also noted at the anastomotic sites and migrated toward the central portions of the graft. At 3 months, the homograft displayed a complete endothelial cell coverage with only small areas of fresh fibrin and endothelial disruption. The rejection reaction was diminished prominently. The medial matrix was largely substituted by proliferation of smooth muscle cells, the homograft was near normal in structure.

CONCLUSION

Reconstruction of carotid artery defect with freeze dried arterial homografts was feasible. The rejection reaction was not significant. If the endothelial lining does not regenerate within 3 months, long term graft patency is hardly achieved.

[Experimental study of the effect of TNP-470 on human salivary adenoid cystic carcinoma cell in vitro]

OBJECTIVE

To investigate the effects of TNP-470 on human salivary adenoid cystic carcinoma cell line ACC M in vitro.

METHODS

Cell proliferation was assessed by MTT assays and dye exclusion counting. Morphological changes of apoptosis were observed with fluorescent microscope. DNA ladder, apoptosis rate and cell cycle were examined by DNA agarose gel electronphores and fluorescence flow cytometry (FCM), respectively.

RESULTS

The 50% inhibitory concentrations (IC50) of TNP-470 on ACC-M cells proliferation by MTT assays and dye exclusion counting were 40.68microg/ml and 46.38microg/ml. Apoptosis were observed by fluorescent microscope. DNA electrophoresis for the cells treated with TNP-470 showed brighter DNA ladder; Sub-G1 peak and G2/M arrest were also determined by FCM (P<0.01).

CONCLUSION

TNP-470 has the effect of inducing apoptosis in ACC-M cells in vitro, which may be one of its antitumor mechanisms.

[Comparison of anti-proliferation effects of two IFNs on Tca8113, ACC-M in vitro]

OBJECTIVE

Comparison of anti-proliferation and anti tumor specificity of two IFNs on Tca8113, ACC-M in Vitro.

METHODS

MTT assay and HTCA were performed to determine direct anti-proliferation effects of two IFNs on Tca8113, ACC-M and L929 cells, respectively.

RESULTS

When Tca8113 cells were treated with 1000U/ml alpha-IFN, gamma-IFN, respectively, cell proliferation inhabition rate was (45.4+/-4.1)% by gamma-IFN, (45.9+/-5.4)% by gamma-IFN; inhibition rate of colony formation was (52.0+/-2.9)% by alpha-IFN, (54.6+/-4.1)% by gamma-IFN; and ACC-M cell proliferation inhibition rate was (23.1+/-2.1)% by alpha-IFN,(26.5+/-1.3)% by gamma-IFN; inhibition rate of colony formation was (23.1+/-2.1)% by alpha-IFN, (26.5+/-1.3)% by gamma-IFN; inhibition rate of colony formation was (26.2+/-2.0)% by alpha-IFN, (27.3+/-1.8)% by gamma-IFN. There was no significant difference between two IFNs (P>0.05). When L929 cells were treated with 1000U/ml alpha-IFN, gamma-IFN,respectively, cell proliferation inhibition rate was (3.9+/-1.1)% by alpha IFN, (4.1+/-0.7)% by gamma-IFN; There was significant difference in antiproliferation on Tca8113 cells and L929 cells (P<0.01).

CONCLUSION

Both alpha-IFN and gamma-IFN have better direct anti-cancer effect on tongue squamous cell cancer and anti-tumor specificity. But anti-proliferation effect of two IFNs on ACC-M cells was not obvious.

[Reconstruction of the common carotid artery with autogenous external jugular vein graft in goats]

OBJECTIVE

To establish a method for reconstruction of carotid artery defect with autogenous graft of external jugular vein, to investigate the patency rate and histopathologic changes at different times after implantation.

METHODS

3 healthy adult goats were used as the experimental models. A segment of 2 cm autogenous external jugular vein was used to bridge a surgical defect of the common carotid artery (2 cm long). The six necks of the three animals were divided into A and B group randomly. In Group A, both cut ends of the artery were anastomosed end to end with the venous graft. In Group B, the proximal end of the artery was anastomosed end to side with the venous graft. The patency rate was recorded at different times. The venous grafts with anastomotic sites were harvested at 2 weeks, 3 months and 6 months after implantation, respectively, for histopathologic examinations.

RESULTS

The grafts in Group A were patent at 2 weeks and 3 months, but occluded at 6 months. The grafts in Group B were patent at 2 weeks and 6 months, but not patent at 3 months. Chi-square test demonstrated insignificant difference in patency rate between Group A and Group B. Histopathologic examinations showed intimal hyperplasia and venous arterialization in venous autografts. The venous wall was loose and edematous, intimal and subintimal hyperplasia was prominent at 2 weeks. Proliferation and migration of smooth muscle cell was found at 3 months after implantation. At 6 months, the venous media was predominantly composed of smooth muscle. Intimal hyperplasia was most prominent adjacent to the anastomosis.

CONCLUSION

Reconstruction of the common carotid artery with autogenous graft of external jugular vein had a higher patency rate. The main histopathologic changes after implantation is intimal hyperplasia and venous arterialization. Intimal hyperplasia is the result of proliferation and migration of host arterial smooth muscle cell, which passes through the anastomosis to the intima of the vein graft.

Dimerization with retinoid X receptors promotes nuclear localization and subnuclear targeting of vitamin D receptors

The vitamin D receptor (VDR) acts as heterodimer with the retinoid X receptor alpha (RXR) to control transcriptional activity of target genes. To explore the influence of heterodimerization on the subcellular distribution of these receptors in living cells, we developed a series of fluorescent-protein chimeras. The steady-state distribution of the yellow fluorescent protein-RXR was more nuclear than the unliganded green fluorescent protein (GFP)-VDR. Coexpression of RXR-blue fluorescent protein (BFP) promoted nuclear accumulation of GFP-VDR by influencing both nuclear import and retention. Fluorescence resonance energy transfer microscopy (FRET) demonstrated that the unliganded GFP-VDR and RXR-BFP form heterodimers. The increase in nuclear heterodimer content correlated with an increase in basal transcriptional activity. FRET also revealed that calcitriol induces formation of multiple nuclear foci of heterodimers. Mutational analysis showed a correlation between hormone-dependent nuclear VDR foci formation and DNA binding. RXR-BFP also promoted hormone-dependent nuclear accumulation and intranuclear foci formation of a nuclear localization signal mutant receptor (nlsGFP-VDR) and rescued its transcriptional activity. Heterodimerization mutant RXR failed to alter GFP-VDR and nlsGFP-VDR distribution or activity. These experiments suggest that RXR has a profound effect on VDR distribution. This effect of RXR to promote nuclear accumulation and intranuclear targeting contributes to the regulation of VDR activity and probably the activity of other heterodimerization partners.

Comparative anti-dandruff efficacy between a tar and a non-tar shampoo

A randomized double-blind clinical study was conducted on two groups of 30 volunteers using either a non-tar shampoo (2% salicylic acid, 0.75% piroctone olamine and 0.5% elubiol) or a 0.5% coal tar shampoo. Subjects were diagnosed as having moderate to marked dandruff. The study consisted of a 3-week washout, followed by a 4-week treatment and a 4-week posttreatment regression phase. The clinical evaluations and subject self-assessments showed that the non-tar shampoo was as effective as the tar shampoo. Both received high approval ratings (> or =70%). Biometrological methods proved to be more sensitive than clinical evaluations to assess the efficacy of the shampoos. The non-tar shampoo yielded a significantly better reduction of Malassezia spp. counts (p<0.02) during the treatment phase and reduced the spontaneous increase in squamometry values (p< 0.01) during the posttreatment phase. It is concluded that a formulation associating salicylic acid, piroctone olamine and elubiol exhibited increased beneficial effects compared to the coal tar shampoo.

[Anatomical and histologic study of the cervical vessels in goats]

OBJECTIVE:To investigate the normal anatomic relations and histologic features of the cervical arteries and veins of goat, with the aim of providing a basis for resection and reconstruction of the common carotid artery.MATERIALS AND METHODS: Surgical dissection was performed on 15 healthy adult goats under general anaesthesia. The external diameters of the common carotid artery (CCA) and external jugular vein(EJV) were measured at their midpoints. 1 cm of the CCA and EJV was subject to light microscopic examination. Direct carotid angiography was performed on 2 selected goats to observe the course and branches of the carotid artery and normal blood flow mapping of the CCA was recorded using Laser Doppler Flowmeter. RESULTS:The average external diameter of the EJV was 5.4 mm for the left side and 5.3 mm for the right side. The average external diameter of the CCA was 3.8 mm for the left side and 3.6 mm for the right side. Histologic examinations found that the media of the carotid artery had 10-15 layers of smooth muscles. The EJV had valvulae, its wall was thin, only 1-2 layers of smooth muscle were contained in its medium. CONCLUSION:The CCA and EJV of the goat had a longer course in the neck, and a larger diameter (3-5 mm). Their histologic structures were similar to that of the human being, which makes it advantageous to be more often used as an animal model in experimental surgery.

[Studies of radiosensitizative effect of BSO on Acc-2 cells]

OBJECTIVE:To study the radiosensitizative effect of buthione sulfoximin (BSO) on Acc-2 cells.METHODS:First,the pharmotoxicity of BSO to Acc-2 cells under hypoxic or aerobic conditions was measured.Second,the radiosensitizative effect of BSO on Acc-2 cells under hypoxic or aerobic conditions was studied.Plating efficiency assay was used in this experiment.RESUTS:The 50% inhibition dose (ID50) of BSO to Acc-2 cells under hypoxic or aerobic condition was 80 micromol/L,120micromol/L,respectively.When the dose of BSO was ID20 and ID10 under hypoxic or aerobic condition the SER was 1.521,1.263 and 1.296,1.153,respectively.CONCLUSION:BSO had radiosensitizative effect on Acc-2 cells both under hypoxic or aerobic condition.The radiosensitizative effect of BSO on Acc-2 cells under hypoxic condition was stronger than that under aerobic condition.

[Evaluation of cryosurgery for the management of oral malignant mucomembranous melanoma-A survey of 107 cases reports]

OBJECTIVE:There were 13 cases underwent operation.24 cases underwent cryosurgery only and 70 cases received comprehensive management,which as cryosurgery,operation,chemotherapy and immuno-therapy.RESULTS:The 3'and 5' year survival rate of three groups were 0.0%,0.0%,37.50%,31.25% and 57.14%,36.07%.There are significant differences between operation group and cryosurgery group and between operation group and comprehensive treatment group.Although the third group got the better result,but the difference between late two groups was not statistical significant.CONCLUSION:It is suggested that comprehensive treatment be the routine regime of melanoma in head and neck. Our experience with review of literature covered the classification, surgical principle and complication was presented.

[Experimental study of radiosensitization of buthionine sulffoximine (BSO) on Acc-2 transplanted tumor]

OBJECTIVE:The effect of radiosensitization of BSO on Acc-2 transplanted tumor was studied in vivo.METHODS: There were four groups in this experiment:control group,radiation group and BSO+radiation group.The drug dose of BSO is 5mmol/kg and the radiation dose was 10Gy. RESULTS:The result demonstrated that the tumor inhibitive rate was 8.5%,12.6% and 45.37% respectively compared with control group. CONCLUSION: BSO has radiosensitizative effect on Acc-2 transplanted tumor.

Skin necrosis due to photodynamic action of benzoporphyrin depends on circulating rather than tissue drug levels: implications for control of photodynamic therapy

In an ideal world, photodynamic therapy (PDT) of abnormal tissue would reliably spare the surrounding normal tissue. Normal tissue responses set the limits for light and drug dosimetry. The threshold fluence for necrosis (TFN) was measured in normal skin following intravenous infusion with a photosensitizer, benzoporphyrin derivative monoacid ring A (BPD-MA) Verteporin as a function of drug dose (0.25-2.0 mg/kg), wavelength of irradiation (458 and 690 nm) and time interval (0-5 h) between drug administration and irradiation. The BPD-MA levels were measured in plasma and skin tissue to elucidate the relationship between TFN, drug kinetics and biodistribution. The PDT response of normal skin was highly reproducible. The TFN for 458 and 690 nm wavelengths was nearly identical and the estimated quantum efficiency for skin response was equal at these two wavelengths. Skin phototoxicity, quantified in terms of 1/TFN, closely correlated with the plasma pharmacokinetics rather than the tissue pharmacokinetics and was quadratically dependent on the plasma drug concentration regardless of the administered drug dose or time interval between drug and light exposure. This study strongly suggests that noninvasive measurements of the circulating drug level at the time of light treatment will be important for setting optimal light dosimetry for PDT with liposomal BPD-MA, a vascular photosensitizer.

[Clinical study of benign cementoblastoma: A report of 32 cases]

This paper reported 32 cases of benign cementoblastoma and studied both clinical and radiographic features and also discussed their treatment.It was found that cementoblastoma was occurred more often than it was being described at past.The main site of tumor involvement is retromolar area of the jaw with common symptom of pain and swelling.In sciagram,the mass was more linked with teeth roots and periodontium,there is compact radiolucency in peripheral part.The tumor's image was seen often as a single,lower radiolucency area.We suggest a regime of curettage and tooth extraction to get a good therapeutic result.

Predictive dosimetry for threshold phototoxicity in photodynamic therapy on normal skin: red wavelengths produce more extensive damage than blue at equal threshold doses

The goal of this investigation was to establish methodology to determine and prevent phototoxic responses of normal skin to photodynamic therapy (PDT). The drug used was a second-generation photosensitizer, benzoporphyrin derivative monoacid ring A (BPD-MA). The dependence of skin phototoxicity on drug dose (0.5-2.0 mg/kg), fluence (1.2-390 J/cm2), and wavelength (690 nm and 458 nm) was studied in the New Zealand albino rabbit in the first 5 h after injection. Skin responses were recorded for 2 wk after irradiation. Noninvasive measurements of drug fluorescence were made on unexposed skin sites during the first 5 h after drug injection. Immediate responses to PDT included erythema induced by 458 nm light and blanching induced by 690 nm light. Delayed reactions included edema on the day of exposure, purpura at 24 h, eschar by day 2 or 3, and scar by the end of follow-up. The threshold fluence for immediate responses correlated strongly with the threshold fluence for delayed reactions. The induction of threshold purpura on day 1 was a reliable index for skin phototoxicity that led to necrosis. The minimum purpura dose on day 1 after irradiation increased exponentially with the interval between drug injection and irradiation, independent of irradiation wavelength, for all drug doses. The action spectrum for threshold purpura mimics closely the absorption spectrum of BPD-MA. The in vivo drug fluorescence correlated with skin phototoxicity, thus allowing predictive dosimetry. This model system defines the safety limits for skin phototoxicity of PDT with BPD-MA.

Picosecond grating spectroscopy for characterizing the acoustic properties of biological material

We present measurements of the ultrasound attenuation and sound velocity of a number of liquids, transparent biological materials (the vitreous and lens of the bovine eye), and biological fluids (whole blood) at frequencies between 925 and 1020 MHz by using a picosecond thermal grating. Sound velocity and attenuation measurements of liquids (e.g., methanol and ethanol) agree very well with those reported in the literature. The sound velocity in the biological materials studied also agrees with the reported values in the literature. In contrast, the attenuation coefficients measured for biological materials, 2000-5000 dB/cm, are much higher than would be extrapolated from published low-frequency data.

[The management of the treatment and diagnosis for the calcifying odontogenic cyst]

18 Patients with calcifying odontogenic cyst underwent surgery in our Department from 1977 to 1993 were reported.8 male and 10 female aged from 11 to 52 with medium or 33 years were included.16 cases were pathologically confirmed as primary intraosseous cyst(central),and 2 as extraosseous cyst(peripheral).There was no recurrence after the local excision for preripheral calcifying odontogenic cyst and local curettage for central one.There were 3 in 6 cases of tumor typed cyst who had recurred postoperatively,two of them had recurred repeatedly and cured by means of local radiotherapy.The authors recommend that the tumor type of intraosseous calcifying odontogenic cyst be classified as a border-line tumor and treated as well as the principles of low malignant tumor.Post-operative radiotherapy could be used for recurrent cases.

[A randomized clinical trial for the evaluation of head and neck squamous cell carcinoma treating with traditional Chinese medicine]

This paper described the research design,research process and statistical analysis of randomized clinical trial by treatment with traditional Chinese medicine in patients with squamous cell carcinoma of the head and neck.At first we found there was no significant difference between treating group and contral group(P>0.05) using log-rank test on Kaplan-Meier survival curves. With further multivariate analysis Cox model and after adjusting for sex,age,legth of taking the assigned medication,grade of tumor differentiation and using of chemotherapy,the rate of tumor-related death for control group was significantly higher than that for treating group :hazards ratio estimate was 1.939(95% confidence interval 1.008-3.729,(P<0.05).The length of taking Chinese medicine was one of the most important prognostic factors(P<0.001).The results suggest that the prescribed medication contributed to the improved survival,and it was an independent prognostic factor.

[Effect of Chinese traditional prescription "Shen Yang" on the immune function of oral squamous cells carcinoma patients.]

This report tries to compare the immunologic function of being take the Chinese medicine "Fu-Fang Shen Yang" or placebo C which is based on randomized clinical trials after operation for 238 cases of oral squamous cancer.DNCB test is for observable index.The results as follows:DNCB position rate of 1 "Shen Yang" group is significantly increased to compare with the placebo C group,after 3m(P<0.01) 6m (P<0.001).Two groups are significantly increased after one year.This suggestion that "Fu-Fang Shen Yang" can enhance immunologic function after operation fro oral squamous cells carcinoma patients.

[The Chinese traditional treatment with "ShengYang" prescription as a post-operative auxiliary method using on the oral squamous cells carcinoma patients.]

This paper observed the clinic investigation.Which prove the relationship among the Chinese dialectical fur condition pulse condition,dialectical divided into types and survival time,immunity function before and after therapy,which will provide scientific basis and new train of thinking for recovery of stomatological carcinoma patient following operation.These patients according to dialectical type.were divided into type of feeble kidney and type of mixed excess and deficiency syndrome that the survive time compare with control group through treat by statistics,were P<0.05.The positive cases of immunity response of administration group were more increased than control group, the rate was 22.2%,maintenance and decrease rate were 7.5% and 14.6% compare with control group,with multiple factor computer analysis in two groups.There is some evidence that the traditional Chinese prescription of "ShengYang" treat in tumor patients with the type of feeble kidney and type of mixed excess an deficiency syndrome were remarkably regulate the immunity function and promote the action of anti tumor.For recovery therapy after tumor operation which reach a fairly action.

[The evaluation of panoramic sialography applied in the diagnosis of parotid tumas]

Panoramic sialography is a new method applied in the diagnosis of parotid tumors.we have examined 33 cases of parotid tumors by this way and: 1.In sialograms of benign tumors,we discovered obvious filling-deficiency areas and moving position of ducts as well as margins of mass. 2. We also found interrupted branches of duct and transudation of contrast medium in sialograms of malignant tumor,in addition, the region of tumor could be depicted. 3.Thus,panoramic sialography has its distinctive advantages in nature of parotid tumors according to variations of ducts and globs with parotid gland.

[Evaluation of effect of the surgical therapy for the oral and maxillofacial arteriovenous malformations.]

Since 1986,the diagnosis and treatment of 23 patients with oral and maxillofacial malformations have been prospectively studied.We have put forward a planned managing programme including the selective external carotid arterograph,accessory preoperatively arterial embolization,radical resection of lesion and immediate reconstruction of defect after primary resection for oral and maxillofacial arteriovenous malformations.We have got a satisfactory clinical effect.All these patients were followed up.The longest follow-up time was 6 years and 10 months.The average follow-up time was 4 years and 3 months.The rate of recurrence was only 4.3%(1/23).In this paper,we compared the different effect between the accessory arterial embolization and the arterial ligation.The result of comparing between two methods was that the arterial embolzation was superior to the arterial ligation.

[The diagnosis value of malignant tumors in the Oral and Maxillofacial region using healthy person's free radical of hair]

Electron spin Resonance(ESR) was used to determine the free radical of hair from 324 cases.These cases included 185 healthy persons,33 benign tumor patients,84 malignant cases and 22 oral mucosa disease cases.The determined results were controlled with pathologic diagnosis to analyse the accordance. The result showed the positive rates of above mentioned cases were 5.9%,6.1%,84.52%and 9.1% respectively.The significant differences were observed when comparing the results of malignant cases with healthy person and benign tumor cases with healthy person and benign tumor cases(P<0.01).The ESR saturation power points of some malignant cases rose to above border-line(>10.0mW) after treatment.These results indicated using ESR to diagnosis early malignant cases and follow treatment effect possess certain clinical value.

[The measurement of EMG and deglutition pressure after glossal reconstruction]

Newly designed computer system (SAMP-EMG) was utilized,to measure the myoelectric signal in each region of the 100ms integral values and do the power spectral analysis in 10 normal people and 20 patients.At the same time,the pressure of deglutition was determined with the liquid pressure conducting electronic device.The results were :1.In normal EMG,the myoelectric power in anterior tongue is the highest,that in the margin of the tongue is the second,that in dorsum central area is the lowerest;2.There in no effective myoelectric signal detected in any kind flap;3.Normal swallowing pressure is 21.1+/-5.7kPa,the average value of FA is 10.3kPa,PM is 10.8,GC is 14.6.

[A contour and mineral content comparison of vascularized and non-vascularized bone grafts]

This study made a comparison between vascularized bone graft (VBG) and non-vascularized bone graft (NVBG) in mandible of canine by using electron computer to assess the contour of grafted bone and measuring the mineral contents. On the 3rd, 5 th, 7 th, 15 th postoperative day, the contour of VBG and NVBG were similar and all of them kept the original contour. On the 30 th,60th,90th,180th postoperative day, VBG remained the original contour, but the contour of NVBG became thicker obviously than that of VBG for the remained cortical bone(most of which was resorbed) were enveloped with a lot of new bone. The kind of resorption of NVBG cortical bone in our study was characterized by extensive resorption on the surface just like nibbling of silkworm, unlike "tunnel" described in the literatures. There were no statistically differences between mineral contents of VBG and that of NVBG.

[A preliminary study of BCG adjuvant therapy in oral and maxillofacial malignant melanoma.]

Malignant melanoma is a kind of tumor with higher malignant and lower therapeutic effect.it is demonstrated by experiment that melanoma cells have antigenicity and refer to immunology.BCG is a kind of biologic response modifier(BRM).it is able to promote physical antitumor ability.There were 42 patients with oral and maxillofacial malignant melanoma who received freezing therapy and surgery in this paper.11 cases of them added BCG immunotherapy.The result is that the median survival time of therapy plus BCG group is 4 years,and 3 years,5 years,7 years survival rate are 89%,72% and 32%,over 8 years survival rate is 18%.The median survival time of another group is 2 years,and 3 years,5 years,7 years survival rate are 55%,24% and 12%,over 8 years survival rate is 3%.There is a statistically significant difference between these two groups and BCG group has a longer survival time.This preliminary study demonstrated that BCG adjuvant therapy could decrease recurrence of metastases and increase patients survival time.

[Clinical assessment of rehabilitation after radical surgery of tongue cancer.]

It is same important to consider both patient's own evaluation and the clinical examination.It is helpful to judge the state of the functional rehabilitation. We have followed up 128 cases of tongue cancer postoperatively,recieved 104 letters and checked up 87 patients in the clinic.It has been discovered:1.the female patients paid more attention to the speech and apperance,while the male to the eating;2.on the donor site of flaps,some patients complained of the numbness in the fingers and the obvious scars in the forearm flap,while the fracilis myocutaneous flap is a relatively good method;3.in the cases of 1/2 anterior glossal defect,the forearm flap is available;to that more than 2/3 defect of the tongue,we used the myocutaneous flaps which have great volume of tissue;4.it is necessary to concern the mobility of the essential factors effecting the functional rehabilitation.

[A study of absorbed x-ray doses and protection to critical organs of the head and neck during siaglography]

A tissue equivalent phantom was used in the study and absored x-ray doses.It measuring for some important organs of head and neck by four routive sialography methods (panoramic conventional x-ray radioagraphy,tomography,fluoroscope,CT) and also the X-ray absorbed doses of thyroid and len when lead containing loop and spectacles of head containing glass were used for prevention.All the data were processed statistically and a compartive study of absorbed x-ray doses of four sialography methods:Doses of submandibular gland were higher in CT,tomography and fluoroscope among them,CT was the highest indicating that it was superior to other methods for accurately locating that it was superior to other methods for accurately locating the within-gland tumor.Fluoroscope will be use more frequently in clinic,because it can observe the living gland panoramic and normal radiography can be used routinely because they had the minimum doses in measured organs.2.The absorbed x-ray doses of len and thyroid decreased by 93%-% when prevention was taken in CT or fluoroscope,65%-85% doses was decreased in normal radiography or panoramic with prevention.

[Reconstruction of large performated maxillofacial defect with immediated revascularized flap]

Patients with large perforated maxillofacial defects resulting from combined craniomaxillofacial resection or extended extra cranio-maxillofacial resection due to malignances in this region had been reconstructed with large revascularized myocutaneous flap or combined pedicled myocutaneous flap with revascularized flap.Since January,1981,a total of 29 flaps was used,of which 28 flaps survived successfuly,whereas one free forearm flap being failed to survive due to venous embolization was replaced with pedicled forehead flap.The results in postoperative appearance and rehabilitation of physiological function were relatively satisfactory.Finally,selection of flap and method of reconstruction were introduced and experiences on immediate reconstruction after malignance resection reported.