Surgical treatment of drooling by bilateral parotid duct ligation and submandibular gland resection.

We have followed 14 patients for up to 6 years after they had submaxillary gland resections and parotid duct ligations for drooling. Good to excellent results were found in more than 85 percent of them in the control saliva, and there have been no recurrences or fistulae. This procedure is technically simple to do, and it is associated with less morbidity than surgical relocation of the parotid ducts.     

Intraductal laser photocoagulation of the bilateral parotid ducts for reduction of drooling in patients with cerebral palsy

Patients with cerebral palsy who experience drooling are often isolated from social interaction. Surgical treatment is effective in reducing abnormal, profuse drooling in patients who have low cognitive function, but it has a risk of complications. In this study, a new, simple procedure using laser intervention that minimizes surgical complications is described. Forty-eight patients with cerebral palsy and persistent drooling after more than 6 months of conservative treatment were enrolled in this study. An Nd:YAG laser (1064 nm) was used for intraductal laser photocoagulation of the bilateral parotid ducts at 7 to 10 W for 10 seconds. The outcome was evaluated by questionnaire-based, semiquantitative assessments of drooling severity and frequency, collection and measurement of stimulated saliva, and salivary amylase measurement. The entire procedure was completed in 25 to 65 minutes, with a mean duration of 38.4 minutes. Early complications included transient facial swelling in all patients. Swelling persisted for 6 to 37 days (mean, 11 days). One hematoma (2.1 percent of patients), two infections (4.2 percent of patients), and two cystic formations (4.2 percent of patients) also occurred. No obvious xerostomia or visible scar was noted after the procedure. In the final assessment, a significant improvement in drooling severity (p < 0.05) and frequency (p < 0.05) was noted in the majority of cases. Forty patients (83.3 percent) demonstrated remarkable improvement in drooling severity, seven patients (14.6 percent) showed significant improvement, and one patient (2.1 percent), who was also autistic, continued to experience severe drooling after the laser procedure. The decrease in the amount of saliva produced ranged from 20 to 60 percent at 12 weeks after surgery. The decrease in the amount of salivary amylase measured ranged from 4 to 97 percent at 12 weeks after surgery (p < 0.05). In conclusion, the intraductal laser photocoagulation of bilateral parotid ducts is a simple, effective procedure for reducing drooling in patients who have cerebral palsy. This procedure minimizes risks and complications, compared with those associated with conventional surgery.     

Submandibular gland I: an anatomic evaluation and surgical approach to submandibular gland resection for facial rejuvenation

Submandibular gland resection for aesthetic reasons has been hotly debated. Detractors maintain that the procedure is dangerous because it puts too many important structures at risk, notably motor nerves. The present study was undertaken to elucidate the neurovascular and soft-tissue anatomy of the digastric triangle via cadaver dissections so that a surgical approach to achieve safe aesthetic submandibular resection could be performed. Fifteen digastric triangles dissections were performed in fixed and fresh cadaver specimens. The dissection focus was to understand the submandibular neurovascular relationships, capsule as well as fascial layers, and measurements to known structures. The marginal mandibular nerve is located external to the submandibular capsule, approximately 3.7 cm cephalad to the inferior margin of the gland. The hypoglossal nerve is posterior to the digastric sling in a position that is protected deep within the visceral layer of the neck. The lingual nerve is located underneath the mandibular border, crossing anterior to the submandibular duct. The vascular supply is variant, but with an average of one and a half vessels entering medially to the superficial lobe of the gland, one intermediate vessel entering medially to supply the superficial and deep lobes, and one deep perforator that runs from the central portion of the deep lobe to the superficial lobe. Appreciation of this anatomy is critical in the submental approach for partial resection. Although it can be technically challenging, the anatomy is straightforward and partial submandibular gland resection can be executed via a consistent, safe approach to optimize facial rejuvenation in certain patients.     

Family as a factor in cerebral palsy prevention

The aim of the study was to assess maternal perception of family impact on the course and outcome of rehabilitation in children with cerebral motor impairment. The study included 135 children with cerebral motor impairment. Their motor development was followed-up over a one-year period by use of structured interview with the children's mothers after 12-month rehabilitation. The course of rehabilitation was assessed by the method of locomotor system functional evaluation. The improvement achieved in motor development was significantly better in the group of children whose mothers found their relationships with extended family excellent than in those whose mothers considered it good or poor. The study showed that mothers to children with cerebral motor impairment frequently feel the lack of extended family support, being it real or perceived as such by the mothers due to their emotional sensitivity, suggesting the need of additional studies of the reasons for this. These findings indicate that greater attention should be paid by health professionals to the psychological support offered to these mothers.     

Cytochemical localization of carbohydrates in intercalated duct and acinar cells of mouse parotid gland

Summary The glycoconjugate composition of mouse intercalated duct and acinar cells of parotid gland has been compared. Mucins containing 1,2-glycols were demonstrated by the tannic acid-uranyl acetate technique. Hexose residues of glycoconjugates were identified using ferritin conjugated withCanavalia ensiformis agglutinin (Con A),Triticum vulgare or wheat germ agglutinin (WGA),Ricinus communis I agglutinin (RCA-I),Phaseolus vulgaris agglutinin (PHA-E) andArachis hypogaea agglutinin (PNA). Whereas qualitative and quantitative differences were observed in sugar residues of secretory granules in intercalated duct and acinar cells, apical plasmalemmae were labelled sparsely and similarly. This indicates that the glycocalyx composition of apical plasma minae in the parotid acinar and intercalated duct cells is little influenced by secretory granule composition.     

A case-control study of vanishing twin as a risk factor for cerebral palsy.

It has been hypothesized that cerebral palsy of unknown etiology is the result of the death of an unrecognized co-twin--a vanishing twin--in early gestation. We conducted a case-control study of vanishing twin as a risk factor for cerebral palsy of unknown etiology in women who had an obstetric ultrasound during pregnancy. Among mothers of cases, one of 86 had evidence of a vanishing twin on ultrasound, as compared to two of 381 control mothers (odds ratio [OR] 2.2, 95% confidence interval [CI] 0.2-24.8; p = 0.5). Bleeding in early pregnancy, which may indicate the loss of a co-twin, was reported by 14 case mothers and 46 control mothers (OR 1.6, 95% CI 0.8-3.0; p = 0.3). On the basis of results presented here, the vanishing twin syndrome is unlikely to account for a high proportion of cases of cerebral palsy, but there is insufficient statistical power to draw firm conclusions.     

Active participation of apoptosis and mitosis in sublingual gland regeneration of the rat following release from duct ligation

Summary This study was designed to establish how mitotic cell proliferation and apoptotic cell death participate in the regeneration of atrophied rat sublingual glands. To induce atrophy to the sublingual gland of rats, the excretory duct was ligated unilaterally near the hilum, and after 1 week of ligation (day 0) the duct ligation was released to enable gland regeneration. The regenerating glands were examined with routine histology, immunohistochemistry for proliferating cell nuclear antigen (PCNA) as a marker of proliferating cells, terminal deoxynucleotidyl transferase-mediated dUTP-digoxigenin nick end labeling (TUNEL) as a marker of apoptotic cells, and transmission electron microscopy. At day 0, a few acini and many ducts remained in the atrophic sublingual glands, and newly formed immature acini were observed at day 3. Thereafter acinar cells progressively matured and increased in number, although the number of ducts decreased. Many PCNA- and some TUNEL-positive cells were seen in acini and ducts during regeneration. The labeling indices for both cell types were statistically significantly different from that of the control at several time points of the regeneration. Apoptotic and mitotic cells were also confirmed to be present in the experimental sublingual glands by electron microscopy. These observations suggest that apoptosis as well as mitosis of duct and acinar cells actively participate in and play important roles in sublingual gland regeneration.     

Salivary duct carcinoma of the parotid gland: report of a rare case with a comparative study of aspiration cytology and histomorphology

BACKGROUND: Salivary duct carcinomas affecting primarily the parotid gland are extremely rare (0.2-2% of all salivary gland tumors). These carcinomas are considered to be of high grade malignancy, with mortality in up to 70% of cases. They usually affect elderly males and less often young adults. Despite the fact that the histomorphologic characteristics of this tumor are always necessary for its classification, several authors have reported that the cytopathologic approach, using fine needle aspiration (FNA) cytology, can establish the final diagnosis. The aim of this paper is to present a rare case of salivary duct carcinoma of the parotid gland with no typical microscopic findings that was diagnosed by FNA cytology through a combination of techniques on biopsy material. CASE: A 56-year-old male presented with a right parotid mass measuring 6 cm in diameter. The mass appeared to expand subcutaneously and infiltrate the skin of the neck region. Biopsy material from both the mass and skin was obtained using FNA and processed with conventional, cell block and liquid-based cytology techniques. A core biopsy was also performed on the mass for histologic evaluation. CONCLUSION: The findings were consistent with a salivary duct carcinoma of the parotid gland and were confirmed by the histologic report. FNA cytology combined with such techniques as liquid-based cytology provides the potential for the final diagnosis. Liquid-based cytology can improve the cellular morphology of the material and allows immunocytochemistry and other diagnostic techniques. The application of such techniques is significantly restricted by conventional processing; thus, combining liquid-based cytology with other techniques expands the boundaries of cytology as a diagnostic test.     

Biochemical and physical analysis of subcellular membranes in rat parotid gland enlarged by chronic isoproterenol administration

1. Chronic administration of isoproterenol caused similar alterations of membrane lipid profile in at least two rat parotid subcellular fractions, secretory granular and microsomal. 2. Typical changes in phospholipid classes and fatty-acyl chain groups were an increase of phosphatidylcholine and a decrease of sphingomyelin, and an increase of octadecadienoyl chain and a decrease of eicosatetraenoyl chain, respectively. 3. Electron spin resonance study showed that the isoproterenol-treatment also affected a membrane physical property, which may be through these compositional changes in membrane constituents.     

The relationship between lower limb muscle volume and body mass in ambulant individuals with bilateral cerebral palsy

Background

Individuals with cerebral palsy have smaller muscle volumes normalised to body mass than their typically developing peers. The aim of this study is to investigate the relationship between lower limb muscle volume and body mass in young people with bilateral cerebral palsy and their typically developing peers.

Methods

Twenty-five participants with bilateral cerebral palsy (aged 14.7±3.0 years, GMFCS level I-III) and 25 of their typically developing peers (aged 16.8±3.3 years) took part in this study. None of the participants had undergone orthopaedic surgery, botulinum toxin injections, or serial casting in the previous year. All participants underwent magnetic resonance imaging of both lower limbs. Nine major muscles of each lower limb were individually manually segmented and the muscle volumes calculated.

Results

Body mass and total lower limb muscle volume were significantly linearly related in both the cerebral palsy (R² = 0.75, p<0.001) and typically developing (R² = 0.77, p<0.001) groups. The slope of the relationship between muscle volume and body mass was significantly shallower in the cerebral palsy group compared to the typically developing group (p=0.007).

Conclusions

This cross-sectional study suggests that the increase in size of lower limb muscles relative to body mass is reduced in adolescents and young adults with cerebral palsy. Longitudinal studies are required to further investigate altered muscle growth trajectories in this group and their impact on long-term mobility.

     

Actinobacillus actinomycetemcomitans: a new cause for granuloma of the parotid gland and buccal space

A case of chronic granuloma of the buccal space and parotid gland is described which was caused by the unusual organism Actinobacillus actinomycetemcomitans. A review of the literature describing its pathogenesis and other clinical presentations is offered.     

The functions of cyclic AMP and calcium as alternative second messengers in parotid gland and pancreas.

Biochemical and ultrastructural studies of rat parotid gland slices have led to the identification of alpha- and beta-adrenergic receptors and a cholinergic receptor, all operating within the same secretory cell. While cyclic AMP serves as the second messenger in the beta-adrenergic response of enzyme secretion, Ca++ serves as the second messenger in the alpha-adrenergic and in the cholinergic responses which both lead to K+ release and water secretion. Ca++ also serves as a second messenger for the muscarinic cholinergic receptor in rat pancreas slices in which it causes enzyme secretion. Analysis of this information leads to the conclusion that neither the neurotransmitter, nor the receptor, nor the second messenger are unique for a certain type of response. The latter seems to be dictated by a component of the specific response pathway which is affected by the second or a subsequent messenger. By having different neurotransmitters operate the same response and a single neurotransmitter operate different responses diversity of control is achieved.     

Interaction between prostanoids and nitric oxide in the control of tubular function in rats with chronic bile duct ligation.

Recent work indicates that both nitric oxide and cyclooxygenase products play an important role in the renal alterations of liver cirrhosis, although the interactions between them have not been completely established. The purpose of this study was to assess the effect of simultaneous blockade of nitric oxide synthase and cyclooxygenase in rats with chronic bile duct ligation and in control, sham-operated rats. Compared with control rats, chronic bile duct ligation rats, 23-25 days after surgery, showed a decreased mean arterial pressure, natriuresis, and kaliuresis, without differences in glomerular filtration rate, and an increased urinary nitrite excretion. Nitric oxide synthesis inhibition by administration of N(G)-nitro-L-arginine methyl ester induced, in control rats, an increase in mean arterial pressure, without significant changes in natriuresis or glomerular filtration rate. In chronic bile duct ligation rats, N(G)-nitro-L-arginine methyl ester induced an increase in mean arterial pressure, natriuresis, and kaliuresis, together with a reduction in urinary nitrite excretion and an increase in prostaglandin E2 excretion. Cyclooxygenase inhibition with indomethacin induced in both experimental groups a marked inhibition in urinary prostaglandin E2 excretion without significant changes in Na+ or K+ excretion, and a significant increase in urinary nitrite excretion in control rats. N(G)-Nitro-L-arginine methyl ester in addition to indomethacin prevented the indomethacin-induced increase in nitrite excretion and dramatically reduced sodium excretion in both experimental groups. Thus, the present study suggests that both nitric oxide and cyclooxygenase products interact in the control of urinary sodium excretion and that each system is activated in the absence of the other one.     

Hepatoprotective and antifibrotic effects of sodium molybdate in a rat model of bile duct ligation

ProjectCholestasis liver fibrosis has been increasingly recognized as a cause of high morbidity and mortality in humans. The accumulation of toxic bile salts in a bile duct ligation (BDL) animal model plays a pivotal role in the induction of liver fibrosis. Cholestatic liver fibrosis is characterized by excessive collagen production and deposition, which is mediated by reactive oxygen species (ROS). Molybdenum is an essential micronutrient trace element which acts as a cofactor in many detoxification system enzymes. The aim of the present study was to evaluate the antifibrotic effect of sodium molybdate on liver cholestasis induced by bile duct ligation in rats.ProcedureAfter BDL, rats were given sodium molybdate (0.05 or 0.1 or 0.2 g/kg) or urosodeoxycholic acid (UDCA, 25 mg/kg) via intragastric gavage for 45 consecutive days (once per day).ResultsBDL drastically increased the serum levels of aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, total bilirubin and direct bilirubin, whereas it reduced the levels of antioxidant enzymes, superoxide dismutase and catalase in the liver. Treatment of BDL rats with sodium molybdate significantly attenuated these changes. As determined by Masson's trichrome staining, BDL markedly induced the liver fibrosis. These alterations were also significantly attenuated by sodium molybdate administration.ConclusionsThe results of this study indicate the hepatoprotective and antifibrotic effect of sodium molybdate in the cholestatic liver. Sodium molybdate, by inhibiting the activation of Ito cells, decreases the collagen production in the liver. The antifibrotic effect of sodium molybdate is likely due to the antioxidative and free radical scavenging effects of this trace element.     

Perspective: cerebral palsy as a model of bone development in the absence of postnatal mechanical factors

To ensure optimal skeletal development, mechanical loading is imperative. The consequences of the removal of, or complete absence of, mechanical loading are illustrated by the clinical condition of cerebral palsy (CP). Clinical and radiological evaluation of children with CP provides an insight into how the growing skeleton develops when mechanical loading is reduced due to non-physiological muscle function. The poor bone status or "physiologic osteopenia" that these children suffer is multifactorial compromised of both mechanical and non-mechanical effects; primarily it is the lack of normal loading from the musculature which causes the development of a bone incapable of withstanding daily activities. Fractures occur during daily activities such as dressing and handling. Increased bone resorption during periods of immobilisation after fracture or surgery, also increases bone fragility. Trials of physical, nutritional and pharmacological treatments in CP children result in increased bone mineral density. Trials that include fracture prevention as the primary end point are required in this vulnerable group of children.     

The duct system of the avian salt gland as a transporting epithelium: structure and morphometry in the duck Anas platyrhynchos

Summary The duct system of the nasal salt gland of the duck comprises central canals, secondary ducts and main ducts. The secondary and main ducts consist of a layer of columnar cells overlying a layer of small cuboidal cells. The columnar cells have complex intercellular spaces showing evidence of Na⁺ K⁺ -ATPase at the apical regions. Approximately 70% of surface area of the duct system is external to the gland. During adaptation to salt water the duct system increases in size as does the gland. Although the components of the gland of adapted ducks, including the duct system within the gland, increase in size compared with normal ducks, the percentage volume densities of the components remain similar in both categories of ducks, i.e. the duct system increases in size in proportion to the glandular tissue. The volume of the duct system external to the gland is six to seven times larger than the volume within the gland. Thus, if ductal modification of secreted fluid occurs, it will be most likely to take place in the ducts external to the gland.Total surface areas of the duct system were measured from serial sections of glands and ducts from one normal and one adapted duck. These were used to calculate possible flux rates of water and sodium across the duct epithelium, assuming the occurrence of either water reabsorption or sodium secretion. Although these flux rates are high it is shown that they are similar to calculated flux rates across the luminal surface of the secretory tubules.