Functional results and survival probability of tumor patients after reconstruction of the mouth cavity and oropharynx using a microvascular radial forearm flap

In tumor surgery of the oral cavity and oropharynx function and quality of life should be maintained and large resection margins to avoid recurrences. For these purposes the radial forearm flap has proved to be a versatile tissue transfer since it is thin and pliable and has a long vascular pedicle. From 1987 to 1991 we used the radial forearm flap in performing 70 reconstructions of the oral cavity and oropharynx after resection of squamous cell carcinomas. Forty-six patients had carcinomas of the oropharynx, while 24 patients had carcinomas of the oral cavity. The indications for these reconstructions were tumors of the oral cavity and oropharynx greater than T2 which after resection were not suitable for primary closure of the defect. Thirty-seven patients died during the follow-up period, with 36% dying within the first 2 years after operation. Fifty-five percent of these patients died of recurrences, 17% of metastases and 11% of intercurrent diseases. In 17% of cases the cause of death was unknown. The 2-year survival probability was 52% (Kaplan Meier). Our results show that reconstructions with the radial forearm flap do not improve survival rates when compared to the general survival rate in these cases despite a possibly larger resection margin allowing a more radical tumor resection. Thirty-one of the 33 patients still alive underwent following examinations. Forty-six percent of the patients with tumors of the oropharynx and 57% of the patients with tumors of the oral cavity had severe difficulties in swallowing.(ABSTRACT TRUNCATED AT 250 WORDS)     

The surgeon''s procedure in treating an external intestinal fistula

The course of saccharose adsorption on surface tissues of the oral cavity directly after carbohydrate loading was studied in vivo. The amount of saccharose adsorbed on tissue surface was assessed from its desorption from an isolated site of the solid phase of the oral cavity and was correlated to a unit of tissue surface. Cariogenic potential in the oral cavity was shown to be maintained to a great measure at the expense of soft tissues and, specifically, of the glossal mucosa which is characterized by a high adsorption capacity for saccharose and represents a sort of a saccharose "depot" in the oral cavity. Carbohydrate adsorption appears to be a physical process. Water gargle after sugar intake fails to solve the problem of prevention of a cariogenic situation. Weakly acid gargling appears to be more promising desorbents of saccharose from oral tissues.     

Metabolic alkalosis in children undergoing cardiac surgery

OBJECTIVE: To define the frequency of metabolic alkalosis and its pathogenesis in children after open-heart surgery. DESIGN: Retrospective chart review. SETTING: Multidisciplinary, tertiary, pediatric intensive care unit. PATIENTS: Fifty-six consecutive children undergoing open-heart surgery. MEASUREMENTS AND MAIN RESULTS: Metabolic alkalosis occurred in 29 (52%) of 56 patients. Seventy-two percent of patients < 12 months of age developed metabolic alkalosis as compared with 30% of patients > 12 months of age (p < .01 by chi-square). Patients developing metabolic alkalosis were younger, received more furosemide, had lower serum chloride concentrations, and underwent longer cardiopulmonary bypass times than nonmetabolic alkalosis patients. By stepwise multiple linear regression analysis, only age (p < .05) and serum chloride concentrations (p < .001) had independent correlations with the development of metabolic alkalosis; both variables had inverse correlations with arterial pH (r2 = .42). Patients with metabolic alkalosis also developed significantly (p < .01 by two tailed Student's t-test) lower serum ionized calcium concentrations (4.2 +/- 0.5 mg/dL [1.05 mmol/L]) as compared with nonmetabolic alkalosis patients (4.6 +/- 0.4 mg/dL [1.15 mmol/L]). CONCLUSIONS: Postoperative metabolic alkalosis occurs frequently in children undergoing open-heart surgery. Chloride depletion seems to be the predominant factor in the pathogenesis of metabolic alkalosis. Younger age can serve as a positive predictor for the development of metabolic alkalosis in this subset of patients.     

Experience with segmental reconstruction of the radiated mandible with alloplastic prostheses

Reconstruction of the mandible after radiation therapy and segmental resection is often complicated by wound breakdown, osteoradionecrosis, and crippling of the oral cavity. These complications make patient salvage after radiated oral carcinoma a high-risk endeavor. Although head and neck surgeons have improved the reliability of mandibular reconstruction with microvascular free tissue transfer, medical and oncologic issues may prohibit their application. This report presents 12 selected cases undergoing alloplastic reconstruction of the mandible and soft tissue reconstruction of the oral cavity. Although not as reliable as some reports of free tissue transfers, the results were reproducible and satisfactory in these cases, with time-efficient hospitalization and functional rehabilitation. Ten of 12 prosthetic reconstructions have been durable in this study population for as long as 36 months.     

Regulation of interleukin-8 binding and function by heparin and alpha2-macroglobulin

The effect of radiation on speech and swallowing function was assessed for 18 patients surgically treated for oral and oropharyngeal cancer. Nine patients received surgical intervention and postoperative radiation therapy, and nine received surgery only. Patients were matched regarding percentage of oral tongue resected, percentage of tongue base resected, locus of resection, and method of reconstruction. Speech and swallowing function was assessed before and at 1, 3, 6, and 12 months after surgery following a standardized protocol. Speech tasks included an audio recording of a brief conversation and of a standard articulation test; swallowing function was examined with videofluoroscopy. Statistical testing indicated that overall speech function did not differ between the irradiated and nonirradiated patients. Irradiated patients had significantly reduced oral and pharyngeal swallowing performance, specifically, longer oral transit times on paste boluses, lower oropharyngeal swallow efficiency, increased pharyngeal residue, and reduced cricopharyngeal opening duration. Impaired function may be the result of radiation effects such as edema, fibrosis, and reduced salivary flow. Increased use of tongue range-of-motion exercises during and after radiation treatment may reduce the formation of fibrotic tissue in the oral cavity and may improve pharyngeal clearance by maintaining adequate tongue base-to-pharyngeal wall contact.     

Experimental study of epithelialization of the muscle-only flap in the oral cavity

PURPOSE: The purpose of this study was to observe the epithelialization process of the muscle-only flap used for reconstruction of the oral mucosal defects. MATERIALS AND METHODS:Forty-three male adult Japanese rabbits were used. A superiorly based cleidomastoid muscle flap was designed after vascular assessment. The flap was transferred into the oral cavity to cover a mucoperiosteal defect made in the mandibular alveolus. Epithelialization of the flap was histologically evaluated at designated intervals. RESULTS: The flaps survived without ischemic necrosis. By 8 days postoperation, the flap was infiltrated by acute inflammatory cells and being replaced by granulation tissue originating from the adjacent tissues. The oral epithelial cells advanced onto this granulating muscle flap, with eventual coverage by 21 days. The granulation tissue matured to fibrous tissue with significant contraction by 2 months. At 6 months postoperation, abnormally hyperkeratinized epithelium was seen on the flap. This differed from the surrounding parakeratinized oral epithelium. CONCLUSIONS: The muscle-only flap in the oral cavity epithelializes after the granulation process.     

ABB FOCS大电流传感器装置在电解铝行业中的应用

本文介绍了ABB FOCS大电流传感器装置的工作原理、组成部分,以及其在400 kA电解铝企业的应用情况。并结合中国铝业公司下属企业使用ABB FOCS-400大电流直流传感器装置的情况,简单介绍了ABB FOCS-400大电流互感器的运行维护,及其一般故障处理措施。     

Comparison of vacuum extraction delivery between the conventional metal cup and the new soft rubber cup

The authors present a safe, conservative method of endless-loop bougienage (ELB) through the oral cavity and esophagus to a gastrostomy without general anesthesia in three children with corrosive esophageal burns treated since 1966. Esophagogastroscopy was performed to evaluate for esophagitis at an early phase after ingestion of the caustic substance. When esophageal stricture formation was recognized after subsequent conservative treatment, a feeding gastrostomy was made. A continuous string loop with plummets of progressively larger size was positioned to pass through the patient's oral cavity and esophagus to the gastrostomy. Strictures were found in the upper esophagus in two patients and in the middle and lower esophagus in one. The gastrostomy was performed 15 months, 20 days, and 2 months after the injury, respectively, and the periods of ELB were 3, 5, and 2(1/2) years, respectively. The patients were able to start eating at 26, 42, and 29 months after injury, respectively. They are now 30, 18, and 17 years old, and slight dysphagia remains in patients 1 and 2. No patient developed esophageal carcinoma at the site of the corrosive stricture. Our method of ELB through the patient's oral cavity and esophagus to the gastrostomy appears to be safe, reliable, and useful. We believe that most caustic esophageal strictures in children can be treated by this conservative measure.     

A preliminary report on a method for studying the permeability of expanded polytetrafluoroethylene membrane to bacteria in vitro: a scanning electron microscopic and histological study

The technique of guided tissue regeneration using expanded polytetrafluoroethylene (ePTFE) membranes has been shown to be effective in implant dentistry (bony defects, extremely thin alveolar ridges, and implants placed in fresh extraction sockets). One of the drawbacks associated with the use of membranes is their premature exposure with consequent bacterial contamination. The aim of this study was to examine the possibility that oral bacteria migrate through the occlusive portion of ePTFE membranes and to determine the time needed for microorganisms to pass from the outer surface to the inner surface of the membranes. A removable acrylic device was adapted to the molar-premolar region of one quadrant of the jaws in each of three volunteers. Five cylindrical teflon chambers were glued to the buccal aspect of each device. The chambers were divided into two rooms separated by the inner portion of a ePTFE membrane. The outer room was open to the oral cavity allowing plaque accumulation; the inner room was isolated from the oral cavity by the ePTFE membrane. One of the 5 chambers was completely closed and used as control. The test period lasted for 4 weeks. Every week, one chamber was removed from each device and processed for scanning electron microscopic and histologic examinations. Our study showed the possibility that oral bacteria may contaminate ePTFE membranes exposed to the oral cavity. One specimen showed partial bacterial penetration after 2 and 3 weeks, but after 4 weeks, all membrane specimens demonstrated bacterial contamination.(ABSTRACT TRUNCATED AT 250 WORDS)     

Traumatic dental disease and soft tissue injuries of the oral cavity

Trauma to the oral cavity can result in an array of injuries affecting teeth, bone, and soft tissue. A thorough examination of the oral cavity is often facilitated by employing a full-mouth speculum after the horse has been tranquilized. Identification of broken, loose, or split teeth; fractures of the premaxilla or mandible; and avulsion or laceration of soft tissue structures such as the lips or tongue is usually straightforward. Treatment options vary depending on the structure involved; however, appropriate treatment generally results in a functional and cosmetically acceptable end result.     

Correlation between dietary vitamin A consumption and onset of precancerous lesions in the oral cavity

The efficacy of vitamin A in the prevention of oral cavity cancer has been studied during the last years due to the interest for a possible application of new drugs in the treatment of second primary tumours and multiple neoplasms. Fifty patients with oral precancerous lesions treated at the "Centre for prevention of oral cavity cancer" of the "Regina Elena" Institute in Rome, have been subjected to a rigorous questionnaire about their use of vitamin A in the diet. Moreover a standard sample of fifty healthy people without oral cavity lesions.     

Agency, communion, and cardiovascular reactivity during marital interaction

The development of the epithelia of the secondary tongue of Salamandra salamandra is described on the basis of light microscopic and scanning electron microscopic studies of defined developmental stages. A glandular area with radial ridges and furrows is formed anterior to the primary tongue during the larval phase. Epithelial cones--each a compact anlage of a gland lying in the furrows--displace the lamina propria. The glandular area grows upward and latero-caudad during metamorphosis and forms the secondary tongue by fusing with the primary tongue. Lumina within the gland anlage appear at the beginning of metamorphosis. They open as glandular tubules towards the oral cavity at the climax of metamorphosis. The epithelial lining becomes single layered and differentiates into gland cells. The glands are increasingly surrounded by fibers of the musculus genioglossus. At the orifice of the gland, the gland cells mingle with the multilayered epithelium of the surface of the tongue. This contains two types of goblet cells in addition to the villus-shaped covering cells which leave gaps for the taste buds. The goblet cells are formed before (type I) and during (type II) metamorphosis and replace the typical larval goblet cells. The new mushroom-shaped part of the secondary tongue is characterized by aborally running septae of connective tissue, visible after digestion with pankreatin. The tip of the primary tongue which originally covers the glandular part becomes completely integrated. It is characterized by crypts which become shallower caudally.     

In vivo anti-influenza virus activity of Kampo (Japanese herbal) medicine "sho-seiryu-to"--stimulation of mucosal immune system and effect on allergic pulmonary inflammation model mice

When BALB/c mice were treated with a Kampo (Japanese herbal) medicine "Sho-seiryu-to (SST)" (1 g/kg, 10 times) orally from 7 days before to 5 days after the infection and infected with mouse-adapted influenza virus A/PR/8/34 by nasal-site restricted infection, SST caused increment of the influenza virus hemagglutinin-specific IgA antibody secreting cells in nasal lymphocyte but not in Peyer's patch lymphocyte at 6 days after infection in comparison with water-treated mice. Oral administration of SST also augmented IL-2 receptor beta chain+ (activated) T-cell in Peyer's patch lymphocyte, but not in the nasal lymphocyte. We previously reported that SST showed potent anti-influenza virus activity through augmentation of the antiviral IgA antibody titer in the nasal and broncho-alveolar cavities of the mice (T. Nagai and H. Yamada, 1994, Int. J. Immunopharmacol. 16, 605-613). These results suggest that oral administration of SST shows anti-influenza virus activity in the nasal cavity by activation of T-cell in Peyer's patch lymphocyte and stimulation of production of anti-influenza virus IgA antibody in nasal lymphocyte. When ovalbumin-sensitized allergic pulmonary inflammation model mice were administered orally with SST (1 g/kg) from 8 days before (11 times) or from 2 h after (4 times) to 4 days after the infection and infected with mouse-adapted influenza virus A/PR/8/34, replications of the virus in the both nasal and broncho-alveolar cavities or only nasal cavity were significantly inhibited at 5 days after infection in comparison with water-treated control by augmenting antiviral IgA antibody, respectively. These results suggest that SST is useful for both prophylaxis and treatment of influenza virus infection on patients with allergic pulmonary inflammation, such as bronchial asthma.     

Radiation-induced acute immediate nuclear abnormalities in oral cancer cells: serial cytologic evaluation

OBJECTIVE: To evaluate the dose-response relationship of nuclear abnormalities in tumor cells collected by serial scrape smears from oral cancer patients on fractionated radiotherapy. STUDY DESIGN: The study included 31 patients with squamous cell carcinoma of the oral cavity treated by radiotherapy (60 Gy in 25 fractions; 2.4 Gy per fraction). Serial scrape smears were taken from each tumor before treatment and after delivery of various fractions, usually 2 (4.8 Gy), 5 (12.0 Gy), 8 (19.2 Gy) or 12 (28.8 Gy). The smears were stained by Giemsa stain and evaluated by light microscopy, and the number of micronucleated, binucleated, nuclear budded and multinucleated cells were scored. Their relation to cumulative dose was analyzed by Kruskal-Wallis one-way analysis of variance. The results were expressed in terms of 1,000 mononucleated cells. RESULTS: Even before treatment, most of the tumors showed various abnormally nucleated cells, and, despite the high intertumoral variation (as indicated by the high variance), all of them showed statistically significant dose-related increases. The mean values before treatment and after irradiation with 28.8 Gy, respectively, were 2.8 and 19.5 (P < .0001) for micronucleated cells, 1.5 and 8.5 (P < .000001) for nuclear budded cells, 8.2 and 35.5 (P < .0001) for binucleated cells, and 3.7 and 16.8 (P < .0001) for multinucleated cells. When the different types of nuclear abnormalities were combined and analyzed as "abnormally nucleated cells," the mean count before treatment and after 28.8 Gy were 7.9 and 44.9 (P < .00001), respectively. CONCLUSION: The study showed that radiation-induced micronucleation, multinucleation, binucleation and nuclear budding in oral cancer cells has statistically significant dose-related increases that become evident in the initial few days of radiotherapy and that they can be differentiated well by cytology. This dose-response relationship and the high intertumoral variations suggest that serial assay of these changes has potential use for radiosensitivity prediction.     

Dermoid cysts of the oral cavity

The authors describe ethiology, clinical picture, diagnosis and treatment of the dermoid cyst of oral cavity floor. They show the advantages after using ultrasonography and computer tomography in treatment of these cysts.     

Reconstruction of the oral cavity after obliterative surgery for cancer

Simple and reliable methods for reconstruction of the oral cavity after obliterative surgery for carcinoma include (1) nasolabial cheek flaps, (2) hemiforehead and total forehead flaps, and (3) temporal island flaps. In general, the nasolabial flap is sufficient for resurfacing areas of the oral cavity anterior to the second molar tooth, while the temporal island flap provides satisfactory coverage posterior to this area. The forehead flap, which is very durable and reliable, is reserved for reconstruction of the more massive defects. Technics and use of each reconstructive procedure are described.     

Primary reconstruction of the mandible after resection for oral cancer

Forty-seven patients with cancer of the lower half of the oral cavity underwent primary restoration of mandibular continuity with a threaded wire after "en bloc" resection. The overall 3 years tolerance rate of the wire calculated according to the actuarial method is 0.29. Preoperative radiotherapy and inclusion of the wire into silastic reduced tolerance of the prosthesis. The occurrence of an oral fistula required removal of the wire.     

5 children with hypokalemia, hypomagnesemia and hypocalciuria (Gitelman syndrome) in one family

Gitelman's syndrome was diagnosed in five siblings. The parents were relatives in the third remove. Gitelman's syndrome is a rare autosomal recessive hereditary magnesium reabsorption defect in the distal tubule. It is characterized by episodes of muscle weakness, usually accompanied by abdominal pain and vomiting. Tetany may occur during a febrile illness. Patients are of normal height and weight and have normal blood pressures. Sometimes eczematous skin lesions are found. Biochemically there is hypokalaemia, hypomagnesaemia and alkalosis. Urinary excretion rates of potassium and magnesium are elevated, the excretion of calcium is diminished. Treatment consists of oral suppletion of magnesium, sometimes also with oral potassium. A potassium-sparing diuretic may be used. The prognosis appears to be good.     

ABB电气系统在北满特钢的应用

本文介绍了北满特钢北兴公司轧钢电气设备的构成,论述了所使用ABB电气系统的结构和基本的控制过程,重点是ABB设备性能的阐述。