Cefpiramide distribution in oral tissue and inflamed mouth floor of mice was examined by agar well method. After abdominal administration of Cefpriramide 200μg/g to the mice, the tissue concentration of serum reached d peak in 5 minutes, that of the mandibular bone, tongue, masseter, mouth floor, submandibular gland, and femur in 10 minutes. The tissues in order of concentration were the serum, mouth floor, tongue, submandibular gland, mandibular bone, masseter and femur. After abdominal administration of Cefpiramide 200μg/g to the mice whose mouth floor had been inflamed, the concentration of the inflamed mouth floor reached a peak in 10 minutes. Compared with the normal mouth floor, Cefpiramide was distributed in a low position in inflamed mouth floor, but it seems likely that the maintenance of the concentration is good because of the high distribution in 60 minutes after the administration.
Recently several investigations have reported that Vitamin B compounds have an immunomodulate effect. In this paper, the effects of Vit. B compounds consisting of B1, B6 and B12 (Vitamedin®) on the immunological response were investigated in patients with oral cancer. Five patients with oral cancer (Stage II-IV) who received chemotherapy (PEP, CDDP and MMC) were eligible for this study, and Vit. B compounds were administered at a daily dose of 2 vials during chemotherapy and/or other periods. Lymphocyte blastoid transformation tests with PHA and delayed hypersensitivity (Skin reaction) with PPD and Su-PS were evaluated for monitoring the cell-mediated immunity. The rate of T-cells, B-cells and serum immunoglobulins (IgG, IgA, and IgM) was also measured. Serum immunoglobulins tended to decrease after chemotherapy, and this tendency was prevented and improved by the administration of Vit. B compounds. Delayed skin test (PPD, Su-PS) and lymphocyte blastoid transformation tests with PHA were generaly increased by the administration of Vit. B compounds. The rate of B-cells tended to increase, too. As a result, it is suggested that the improvement of humoral and cell-mediated immunity was caused by the immunomodurate effect of Vit. B compounds consisting of B1, B6 and B12, and the administration of Vit. B compounds for chemotherapy was useful for immunological response in the patients with oral cancer.
When surgical procedures were performed on the irradiated tissue, the incidence of complications were more frequent than in normal tissue. And consequently transplant on to irradiated tissue is rather difficult. The author performed an experiment using 84 sides of rabbit's ear to determine the appropriate of reconstruction time after irradiation. X-ray irradiation was performed on the external side of the car, the dosage of irradiation was 3, 000 R. Each 1, 3 and 9 weeks after irradiation, the tubed pedicle flaps, including the middle branch of the posterior aulicular artery and vein, size of 1.3×4cm, were raised and transplanted on to the irradiated field. Each 3rd, 7th and 21st days after transplantation, the pedicle flaps and recipient area were observed macroscopically and microscopically. The vascularization was investigated by means of acryl plastic injection methods. No necrotic area was found on the flaps transplanted on to the normal area. The group transplanted at 3 weeks after irradiation, had the worst ratio of aliving flaps. The next was at 9 weeks, the best was the group at 1 weeks after irradiation. The vasculary recovery after performance of surgical procedures, was the best on the groups transplanted at 1 week after irradiation. The next was 9 weeks, the necrotic areas of the flaps was at 9 weeks. The author judged the appropriate time for reconstruction, at the clinic is the time of subsided acute inflammation, since “the time of one week after irradiation” already expired at the time of completion of the treatment, the author judged that “nine weeks after irradiation” was a desirable period for reconstruction.
Recently digital subtraction angiography (DSA) has been widely used for diagnosis of neurosurgical and circulatory diseases, however, reports of application in the oro-maxillo-facial area are rare. The authors applied DSA to several patients with diseases of the oro-maxillofacial area and obtained clear images in the cases of a hemangioma of the palatal region and occlusion of the caroted artery. The cases with intraarterial catheterization for cancer chemotherapy were examined using intraarterial digital subtraction angiography (IADSA). The tip of infusion tube and distribution of the drug were shown clearly by the IADSA. DSA can be performed easily and safely even on outpatients. For this reason DSA seems to be useful in oro-maxillo-facial arca.
This paper describes the reparative process of devitalized bone matrix which occurs in cryosurgery. After making a bone cavity on the lower border of a rabbit mandible, experimental freezing was performed. The fate of the nonvital bone was investigated by means of light microscope (H-E stain), microradiography and the labeling method. Repair began with the growth of new bone into the nonvital segment from the adjacent living bone at 5 days after freezing. At 9 weeks the nonvital cortex was completely surrounded with new bone. At 11 weeks osteogenesis was inhibited and the resorption of nonvital bone predominated. So, nonvital cortex became porous. At 24 weeks about half or more of the nonvital cortex was replaced by new bone at muliple sites, particulary from the newly formed Harversian canals. At 36 weeks, reconstruction was almost compeleted and nonvital bone was not observed. At the early stage, bone marrow and cndosteum play important role in the healing process of nonvital bone on the mandible. The reparative process of nonvital cortex was not similar to the process that occurs after any bone grafting procedure described by phemister as “Creeping substitution”, but similar to internal remodeling of bone cortex that occurs continuously throughout life. In the case of freezing for 60 seconds, it was suggested that uniform bone death was produced at about-30°C.
After submandibular lymphadenectomy the opposite lymph node was transported to the vacant area as a free graft in the following experiments. Experiment I: In C3H/He mouse a whole lymph node was transplanted. A lymph node of untreated mouse was used as control. At 1 week after transplantation the number of lymphocytes in the nodes was less than 0.1% of control. At 4 weeks it was increased to about 70% of control, and subpopulation was the same as the control. But mitogenic response to Con A, PHA, LPS was much lower. At 3 months the number was reduced again to about 12% of the control, and mitogenic response was not recovered. Finally most of the nodes degenerated. Experiment II: In Vistar rat a lymph node was cut into two pieces and both were transplanted. A lymph node of untreated rat was used as the control. The transplanted lymph nodes were able to survive. At 1 week after transplantation the number of lymphocytes in the nodes was about 17% of control. The subpopulation was in disorder, and mitogenic response to Con A, PHA, LPS was much lower. After 4 weeks they tended to recover. At 3 months the lymphocyte number was increased to about 50% of the control. The subpopulation and the mitogenic response recovered the same as the contorol. This study demonstrated that lymph nodes cut into two pieces can be transplanted as a free graft and lymphocytes circuration is restored.
Rabbit parotid ducts were ligated unilaterally for 14 days and then the obstructions were removed. The volume of saliva secreted by pilocarpine stimulation was measured at 5, 7, 14 and 2l days after removal of the obstruction. In the group in which merely the obstruction was removed, the secretory activity by pilocarpine stimulation slightly recovered at 7 days. At 21 days, the secretory activity was about 60 per cent of unligated group. In the group having chronic administration of pilocarpine after removal of the obstruction, the secretory activity was increased at 5 and 7 days, and reduced at 14 and 21 days. This reduction was considered due to the decreasing sensitivity to pilocarpine in muscarinic receptors of acinar cells. In the group having chronic administration of atropine after removal of the obstruction, the secretory activity was increased at 5, 7 and 14 days, and reduced at 21 days. As this increased secretory activity by acinar cells was inhibitted by propranolol administration, it's considered that adrenergic fibers participate in this increase.
The outline of the new three dimensional description for the appearance of the face in the maxillo-facial deformity is presented in this paper. First the full face is divided into three parts (“U”: upper part of the face, “M”: middle part of the face, “L”: lower part of the face) vertically and five parts (I-V from the right of the face) horizontally to express the abnormal region. The profile is devided into three parts (“U”, “M”, “L”). Then the regional relation of the each section is expressed using three numerals (“0”, “1”, “2”). “0”: normal condition (symmetry or balanced) “1”: left eccentric or increased condition “2”: right eccentric or decreased condition, And then “A” (Asymmetry of the face), “H” (Height of the face), “W” (Width of the face) and “P” (Profile of the face) are inspected and given a corresponding description for each of them using the regional expression and the numerals in the following formula. A(UML) H(UML)W(UML)P (UML) It seems that this three dimensional description can describe any appearance of the face and gives the standard of diagnosis among various institutions in the case of the maxillo-facial deformity.
Human squamous cell carcinoma cell line, Ueda-1, derived from the floor of the mouth was used as source of immunogen to generate monoclonal antibodies (MoAbs) to head and neck cancer cells. Eight MoAbs were obtained and 4 of them were tested by avidin-biotin peroxidase complex (ABC) method on Ueda-1.
Picomorphic adcnomas of major salivary glands were examined to determine the nature of the cell within the epithelial elements, the myxoid stroma, and cartilage by applying inununohistochemical technique. The nroplastic myoepithelial cells were divided into differentiated (actin-containing) and undifferentiated (S-100 protein-and prekeratin-containing) cell types. Tumor-associated mesenchyms (myxoid and chondroid tissues) may be related to nervous tissue, because these tissues were positively stained with S-100 protein antibody, glial fibrillary acidic protein antibody, and γ-neuron specific enolase antibody. Thus, it seems reasonable to postulate that the parent cells of the pleomorphic adcnomas may have a common origin with those derived from embryonic ectoderm (epithelial components) and neural crest (inesenchymal components).
Cytoskeletal proteins; microtuble, microfilament, and intermediate-sized-filament proteins participate in mitosis, mobility, formation and maintenance of cells, as well as in malignant transformation. Immunohistochemical stainings of those proteins are available for differential diagnosis of tumor or investigation of several pathological lesions. Monoclonal antibodies to them have been used for more specifically detect to the subject. In the present study, total 246 cases of epithelial lesions and tumors; bening epithelial lesions (82), semimalignant lesions from epithelial origin (14), basal cell carcinomas (26) and squamous cell carcinomas (124) were examined by the use of immunohistochemical stainings for anti-total keratin (TK; 41-65 kDa), monoclonal anti-keratins (KL1; 55-57 kDa, PKK1; 41-56 kDa), vimentin, clesmin and actin. In normal stratified squamous epithelium, TK and KL1 showed strong staining in granular and upper spinous cell layer, moderate in lower spinous layer and negative in basal cell layer. PKK1 was limited to basal layer cells. Normal stratified squamous epithelia expressed regular distribution to keratin proteins. Almost all papillomas and other benign epithelial lesions indicated regular distribution of keratins as in normal epithelia. In Bowen's disease, the staining of TK and KL1 displayed an irregular pattern and that of PKK1 disappeared in basal layer cells. Basal cell carcinoma showed irregular distribution of TK and, KL1 and had negative to PKK1 staining. Squamous cell carcinoma showed irregular distribution to TK and KL1 with little decreased staining, and negative PKK1. Staining of vimentin, clesmin and actin were generally negative in benign lesions and tumors, however, these proteins existed in a few cases of squamous cell carcinoma. These findings suggested that cytoskeletal proteins in malignant tumors may change in their expression.
In this paper, a rare case of osteosarcoma arising in polyostotic fibrous dysplasia (p. f. d.) is reported. The patient was 30 year-old woman who had been diagnosed to be a p. f. d. at 10 years old. The fibrous dysplasia of the left mandible became malignant, resulting in an osteosarcoma. The patient was operated surgically and, moreover, administered a highdose Methotrexate with citrovorum factor rescue in combination of other chemotherapeutics. There has been no recurrence more than two years and five months after the treatment. 1) In the histology, osteosarcoma is the most frequent neoplasm (58.1%), followed by fibrosarcoma (25.6%), chondrosarcoma (12.8%) and others (3.5%). 2) From the standpoint of the clinical classification of fibrous dysplasia, p. f. d. tends to become malignant more frequently than that monostotic fibrous dysplasia (m. f. d.) does. There are some differences between m. f. d. and p. f. d., in consideration of the histology after malignant transformation, age, sex, anamnesis of radiation therapy, change of Al-Pase value and prognosis. 3) The jaws seem particularly to be frequent sites of malignant change.
Pleomorphic adenomas are the most frequently occurring salivary gland tumors involving both the major and the minor glands. The predominant location of this tumor is the parotid of the major salivary gland, and the palate of the minor salivary glands. The lip is the site where this tumor rarely developes. We have recently experienced two cases of pleomorphic adenomas occurring in the minor salivary gland in the upper lip. Clinical features of two cases were presented and the literature on minor salivary gland tumors was reviewed.
A case of subacute necrotizing lymphadenitis in a, 26-year-old man was reported. He showed the typical clinical features: swelling cervical lymph-nodes, slight fever with poor response to antibiotics and erythemas on the skin. No abnormal findings were presented in the chest X-ray, and the PPD reaction test was negative. WBC was 3, 800/mm3 in which lymphocytes comprised 50%. Biopsies from the lymph-nodes demonstrated the characteristic features histopathologically: 1) focal lymphocytic and histiocytic proliferation, 2) necrosis involving not only paracortex but also cortex and 3), nuclear debris and phagocytosis in the necrotic foci. However, the biopsies were free from neutrophilic leucocytes infiltration in any specimens. Subacute necrotizing lymphadenitis has been recognized as a new disease classification in recent years, and 6 cases have been reported by oral surgeons in Japan.
In order to reconstruct the perfect shape of jaw bones, we developed the new operation procedures by using reimplantation of resected jaw portion treated by freezing and warming. The operation procedures which we developed are as follows. One is the one-stage procedure in which immediate reconstruction is performed intraorally, indicated for benign tumors and tumorlike conditions. The other is the two-stage procedure in which late reconstruction is performed extraorally, indicated for malignant tumors. We resect the affected jaw bone with the intact part included, and remove the affected parts from the resected jaw portion under direct observation, then decorticate the inner layer of the cortical bone and drill small holes on the cortical bone to prevent the cracking by deep freezing and to ensure the revascularization from the surrounding soft tissue. In order to kill the tumor cells within the resected jaw bones totally, we use two different freezing and warming treatments. The resected jaw portion is put into the freezing chamber at-85 degrees C for 45 minutes, and then immersed into physiological saline solution at+ 45 degrees C for 15 minutes. When the freezing apparatus is not available, the resected jaw portion is immersed into liquid nitrogen at-195 degrees C for 5 minutes, and then immersed into phisological saline solution at 45 degrees C for 10 minutes. These treatments are repeated three times respectively. After the treatment the cells in the lesion decreased in number and became low staining drastically. In the malignant cases the resected jaw portion is treated by the freezing and warming mentioned above, then lyophilized and stored in a vacuous bottle at the room temperature for over 18 months. The combination of resected jaw portion and fresh autogenous marrow and cancellousbone are used for reconstruction. The former is expected to play a role as an anatomical template, and the latter is used as a material capable of inducting osteogenesis. The one-stage procedure was performed in 6 cases and two-stage procedure in 2 cases. The mandibular reconstruction was performed in 7 eases and maxillary reconstruction in 1 case. No tumor recurrence was observed and satisfactory results without complication were obtained. At the postoperative biopsy of time reimplanted area, a large number of bone cells were observed in the bone that presented layers and remodelling, implying the absorption and new bone formation in the reimplanted bone.
Dermoid and epidermoid cysts occur throughout entrapped ectodermal tissue during embryonic development, or inflammatric and traumatic implantation of the epithelium. Epidermoid cysts are lined by a thin even layer of keratinizing stoatified squamous epithelium surrounded by loose collagenous connective tissue. The cyst cavity is filled with keratin, but contains no skin appendages. These may occur on the floor of the mouth, but may uncommonly occur in the mandible. The authors have experienced with one case of epidermoid cyst in the mandible of a 29 years old woman, and reported on it with some comments based on the literature. This lesion was diagnosed by histopathological examination.In the treatment, the lesion was surgically enucleated. Threre was no lesion recurrence over the course of approximately 2 years.
Ameloblastoma is an epithelial neoplasma that consists of proliferating odontogenic epithelium lying in a fibrous stroma. Usually the ameloblastomas are found in people between the ages of 20 and 50 years. About 80% occur in the mandible and fewer of them in the maxilla. A 77-year-old woman was referred for evaluation and treatment of her right maxilla due to buccal with diffused swelling. An excisional biopsy was performed and it was diagnosed as ameloblastoma. She neither wanted to enter the hospital, nor have a radical operation. So we treated it to remove the mass, little by little over seven treatments under local anesthesia with a CO2 laser and electrocautery. Now a small mass, the tumor partially remains in the maxillary sinus. About one year has passed, and there is neither tumor growth, nor invasion, nor local bone destruction.
A case of squamous ccll carcinoma of submandibular region, where it was difficult to determine against primary site, was reported. The patient, a seventy-year old male, had hen's egg-sized swelling of submandibular region and white lesion in the left part of floor of the mouth. But the findings from the remainder of the head and neck examination were within normal limits. A biopsy from submandibular lesion demonstrated squamous cell carcinoma. After preoperative chemotherapy and extra irradiation of the submandibular tumor, total neck dissection, excision of floor of the mouth, and segmental resection of mandible were performed in en block. No local recurrence occurred, but two years and seven months after surgery, he died of contralatcral cervical lymph node metastasis. By this time, no evidence of the primary tumor could obtained. The clinical course and close histological examination suggested lymph node metastasized cancer, the primary lesion of which was early carcinoma in the white lesion of the floor of the mouth.
Benign cementoblastoma is a tumor of the cementum that occurs in connection with the dental root and is believed to be a very rare lesion. We experienced two cases of this tumor. Case 1 was a 13-year-old girl with the lesion at the |6 root apex. Case 2 was a 20-yearold man with the lesion at the 16 root apex. The excised mass was dove's egg size in both cases. Both patients were diagnosed as having benign cementoblastoma as a result of a synthetic judgement of the clinical and histopathological findings and other factors. Decalcified and nondecalcified staining sections of the same specimen were prepared from each patient for pathological examination. The nondecalcified staining sections were examined for calcification by color analysis using the M-301 B image analysis system after the microradiogram was prepared. In these two cases, hard tissues with calcification of the same degree as that of the cementum and/or dentin were dendritically or radially arranged around the dental root. In the peripheral area, narrow hard tissues with hypocalcification were arranged. Sections with the same hypocalcification as that in this area were scattered in the central area. The dental roots adjacent to the hard tissues were adsorbed vermicularly, and these hard tissues were transferred to the cementum. We reported these two patients, together with 41 previously reported cases, with references to the literature.
Three cases of radiation-induced cancer in the oral regions were reported with relation to radiation therapy. One was the general radiation-induced cancer following radiotherapy for the hemangioma. The other two cases, which belonged in the B-1 group of Sakai and his coworker's diagnostic criteria for radiation-induced cancer, were those occurring after radiotherapy for the malignant tumors. Due to the relatively high dosage exposure by the patient in the radiotherapy it is necessary to look out the latency of the radiation-induced cancer. After radiotherapy, careful and periodical observation is important for immediate treatment in an early stage for the radiation-induced cancer to have a favorable prognosis. In addition careful observation of the changes after radiotherapy helps in discovering the precancerous lesions from the therapy. For the radiation-induced cancer, surgical treatment would be the best, however, radiation therapy is also effective in certain cases.
A double blind comparative study was performed on TA-60, a new anti-inflammatory deug of phenylpropionic acid group, for the treatment of pain after dental extraction and there has been difficulty in determining the optimal dosage. The subjects consisted of a total of 151 cases of which 38 cases were assigned to the 200mg group, 37 cases to the 400mg group, 41 cases to the 600mg group and 35 cases to the placebo group. There was a definite dosage correlation with respect to the rate, onset and duration of efficacy and also for clinical usefulness. One case of 200mg group (0.9%) experienced adverse reaction possibly related to TA-60. On the basis of the present results the optimal close of TA-60 was estimated to be around 400mg.