In 40 patients diagnosed as having head and neck region malignant tumors, we studied the changes of peripheral blood lymphocyte and its subpopulation using OK and T series monoclonal antibody. We divided the patients into three classes: good prognostic cases (13 cases), cancerous cases (16 cases) and death cases (11 cases). Peripheral blood lymphocyte showed tendencies of decreases in the following order: good prognostic cases, cancerous cases and death cases (p<0.01). In death cases, 8 cases (73%). showed that the number of peripheral blood lymphocyte was under 1, 000/mm3. We found no significant correlation in both the percentage and the number of OKT-1+ & NKH-1+. The percentages of OKT-3+ & OKT-8+ showed tendencies of increases in the following order: good prognostic cases, cancerous cases and death cases. But, the number of OKT-3+, decreased in the following order: good prognostic cases, cancerous cases and death cases (p<0.05). The number of OKT-8+, showed the same order of decreases as above. The percent and the number of OKT-4+, decreased in the following: good prognostic cases, cancerous cases and death cases (p<0.05, p<0.01). The “T helper/T suppressor” ratio (OKT-4+/OKT-8+) showed significant increases in the following order: death cases, cancerous cases and good prognostic cases (p<0.01). We considered most probable that the decline of the immunological capacity in head and neck region malignant tumor patients were caused by the decreases in the number of OKT-4+.
We have already reported that a neoplastic human salivary intercalated duct cell line, HSG, which has ultrastructure and biological markers specific to the intercalated duct cells of human salivary gland, can differentiate into both myoepithelial cells and acinar cells after treatment with 5-azacytidine. In addition, these differentiated cells were found to carry decreased tumorigenicity and anchorage-independent growth potential as compared to their parental HSG cells. On the other hand, it has been suggested that cyclic adenosine 3', 5'-monophosphate (cAMP) plays essential roles in controlling cellular proliferation and/or differentiation. For example, in mouse fibroblast lines including 3T3 cells, the growth potentials of cells are inversely associated with the intracellular cAMP levels. In addition, it has been demonstrated that murine erythroleukemia cells and human or murine neuroblastoma cells can be induced to differentiate in response to cAMP. Moreover, an elevation of cAMP in murine neuroblastoma cells has been reported to cause loss of tumorigenicity. Therefore, we examined the differentiation-associated enhancement of cholera toxin-mediated intracellular cAMP production in HSG cells and their differentiated cells. Consequently, the intracellular cAMP levels in response to cholera toxin were higher in the differentiated cells than in their parental HSG cells. Autoradiographic analysis found that the cholera toxin-catalyzed [32P] ADP-ribosylation of Gs protein present in cytoplasmic membranes from the differentiated cells increased as compared to untreated controls. These findings suggest that the cellular proliferation and differentiation in human salivary gland adenocarcinoma cell line HSG are assessed by the levels of cholera toxin-stimulated intracellular cAMP.
At present, a number of antitumor agents to oral malignant tumors are applied. Plant glycoside-ginsenoside has been found by Odashima et al.(1979). to inhibit growth in certain malignant tumors. Concerning the inhibition of proliferation on a chemically induced salivary gland tumor by the ginsenoside, the authors have already demonstrated the favorable results in the previous study. In this paper, an anti-carcinogenesis effect of the ginsenoside in animals was studied regarding the chemically induced salivary gland tumor. Experimental methods: Male dd-strain mice (2 months old) were used as experimental subjects. To induce salivary gland tumors, 10% 20-methylcholanthrene in olive. oil, which roughly amounts to 1.0mg/100g, was injected into the surgically exposed sub-maxillary gland of mice. These mice were divided into three groups, i.e., control group, G-Rh2 group and G 1 group. After procedure of 20-methylcholanthrene injection, ginsenoside G-Rh2 (amounts to 0.1mg/100g) in the G-Rh2 group and/or glycyrrhizin-NH4 (amounts to 10mg/100g) in the G1 group was administered subcutaneously, 2 times weekly, for experimental duration (6 months). After the end of the experiment in the each group, the mice were sacrificed, and the submaxillary gland tumors were examined histopathologically. Experimental results: The first manifestations of induced submaxillary gland tumors became evident at about 11 weeks in the control group, 13 weeks in the G1 group, and 14 weeks in the G-Rh2 group. The incidence of these induced tumors in each group, was as follows: 7 of 20 mice (35.0%), in the control group 3 of 20 mice (15.0%) in the G-Rh2 group and 5 of 20 mice (25.0%) in the G1 group. In addition, the loss of body weight in the G-Rh2 group and the G1 group was suppressed. According to histopathological findings, the histological type of the submaxillary gland tumors was observed to be in variety: Namely epithelial and mesenchymal tumors and their mixed tumor were found in each group. Within these groups, degeneration and/or destruction of the tumor cells were observed at places of the tumor's nest in the G-Rh2 group. From these results, we were impressed not only by the inhibition of proliferation of the induced tumor but also by anti-carcinogenesis due to the ginsenoside Rh2.
A bone morphogenetic protein (BMP) that induces differentiation of mesenchymaltype cell into cartilage and bone was partially purified from bovine tooth. In this study, the activity of BMP was assayed by its ability to induce enchondral ossification after injections of samples into rat thigh muscles. Frozen teeth were ground to fine particles and demineralized in 0.6 N HCl. The demineralized tooth matrix was treated with 4 M guanidine hydrochloride to extract BMP. Three volumes of cold ethanol were added to the supernatant obtained by filtration and the insoluble materials formed were collected by centrifugation. These materials were redissolved in 4 M guanidine hydrochloride and subjected to gel filtration using a Superose 12 column. The precipitate formed by adding three volumes of cold ethanol to each fraction was collected by centrifugation and BMP activity was assayed. The molecular weight of BMP of bovine tooth analyzed by electrophoresis on a SDS polyacrylamide gel was 27, 000. The combination of partially purified BMP with 0.5% atelocollagen (in HCl, pH 3) more effectively enlarged the volumes of cartilage and bone than did BMPTalone, indicating usefulness of atelocollagen as a carrier. BMP induced enchondral ossification in the periosteum of the femur as well as in the muscle, suggesting that the periosteum includes cells that differentiate into osteoblasts in response to BMP.
The relation between the surgical excisions or operation methods and speech intelligibility was investigated on 22 glossectomees (11 underwent direct suture, 4 received split-skin grafts and 7 received reconstruction with the free radial forearm flap). Articultory function after glossectomy was assessed mainly by using 100 Japanese syllable speech intelligibility test. Our results are summarized as follows; 1. Speech intelligibility after glossectomy is related to the extent of resected tongue tissue. 2. According to glossal sounds, subjects with more than half of the tongue resected showed low intelligibility scores for sounds produced with the rear portion of the tongue. 3. The glossectomees showed improvement in speech intelligibility for about six months after their operation, reaching a plateau thereafter. According to glossal sounds, speech intelligibility of the sounds produced with the rear portion of the tongue showed remarkable improvement. 4. Comparing the surgical methods among subjects with the same extent of resection, higher speech intelligibility was observed in those treated with split-skin graft and free radial forearm flap reconstruction than in those treated by direct suture. 5. Free radial forearm flap reconstruction has the advantage of high speech intelligibility scores for the sounds produced with the rear portion of the tongue and for plosive sounds. 6. Articulatory function after glossectomy was observed to be influenced more by flexibility of the remaining tongue tissue than by its volume. Therefore, operation methods of preserving the tip of the tongue and conserving the mobility of the rear portion of the tongue should be selected for minimizing post glossectomy speech disorders.
The effect of low power laser irradiation on rat sciatic nerve was examined. Kept wet with saline, the sciatic nerves were exposed unilaterally, and irradiated by CO2 laser (12J/cm2, 24J/cm2), directly. All the time, the electrophysiological changes of evoked nerve action potential were observed. Immediately after CO2 laser irradiation, nerve conduction accelerated (12J/cm2), and suppressed (24J/cm2). The temperature in the nerve rose to about 45°C (24J/cm2), and nerve conduction was blocked (>24 J/cm2). So the process of nerve regeneration was examined by compared two methods, i. e., the crush of 1 mm in length and the end to end suture after transection. In the result, the regeneration of laser irradiation group was faster than the others. And the main effect of low power CO2 laser seemed to be the heat effect. In addition, the effects of Ga-Al-As diode laser and He-Ne laser irradiation on rat sciatic nerves were observed. No clear change in nerve conduction could be observed after irradiation.
Cisplatinum was administered by intra-venous injection and intra-arterial injection for the treatment of oral cancer patients. The protin-bound platinum levels and non-proteinbound platinum levels in plasma were measured. As results:(1) The non-protein-bound platinum level declined rapidly following the end of administration and cleared below the measurable level within 2 hours. The mean half-life time was 29.2 minutes in intra-arterial injection, and 31.9 minutes in intra-venous injection. Larger doses of cisplatin resulted in higher plasma levels of non-protein-bound platinum, which were not dose-dependent.(2) Total platinum level decreased in a biphasic mode with a mean α-phase half-life time of 57.5 minutes in intra-arterial injection and 51.6 minutes in intra-venous injection. But no significant difference was found in the changes of plasma concentration between intra-arterial and intravenous injection methods.(3) The maximum plasma concentration and area under the curve (AUC) of non-protein-bound platinum varied in proportion to the dose per area of body surface in intra-venous injection cases. In conclusion, it is considered that the optimal method of CDDP administration should be selected not only by the higher plasma concentration and wider AUC of non-protein-bound Pt but also by the decrease of side effects and the increase of antitumor effects.
Serum CEA levels, serum IAP levels and PPD skin reaction were investigated simultaneously in 27 oral cancer (squamous cell carcinoma) patients in our clinic during the period from 1982 to 1985. The following results were obtained: 1) Serum CEA and serum IAP levels increased gradually in accordance with the progress of the oral cancer. On the other hand, PPD skin reaction decreased gradually in accordance with the progress of oral cancer. 2) There was some positive correlation between serum CEA and serum IAP levels. Some negative correlation was also found between serum CEA and PPD skin reaction. Furthermore, there was definite negative correlation between serum IAP and PPD skin reaction. In this respect, the serum level of CEA and IAP, and PPD skin reaction seemed to correlate with the clinical course of oral cancer. 3) In these investigations, it was suggested that simultaneous examination of serum CEA, serum IAP and PPD skin reaction are clinically useful in evaluating the progress of oral cancer and the immune competence of oral cancer patients.
This article presents four cases of erectile hemangioma in the masseter muscle. These four patients, age 48 female, 18 male, 17male, 21 female, had same symptoms; enlargement of masseter portion follows muscle contraction. In all of cases, the swelling lesion took many years to become large. On the clinical examination, the swellings were immediately followed by masseter muscle contraction. The size and the hardness of the swelling gradually reduced during the patient kept contract on. In case 1 and case 2, the operations were performed after injecting silicon impression materials (for dental use) into the main cavities of hemangioma. This method makes it easier to resect the tumor. Case 3 was treated by extraoral approach and case 4 resected by intraoral approach. The pathological diagnosis of the first two cases were cavernous hemangioma and the last two cases were venous hemangioma. No patient had complications and recurrence.
A patient with recurrent oral aphthae due to Belnet's disease was successfully treated with soft laser (He-Ne) irradiation. Oral symptoms that poorly responded to steroid therapy were clearly alleviated by 5-minute exposure to continuous soft laser wave. The surface of the ulcer was covered by a pseudomembrance material immediately after irradiation and spontaneous pain was gradually relieved. The number of ulcers decreased markedly 2-4 days after irradiation with only a few lesions remaining in the buccal and lingual mucosa. From these results, we recommend soft laser irradiation as a symptomatic treatment of painful ulcers.
A case of primary amyloidosis diagnosed by morphological and immunological examination was reported. The patient was a 71 year-old woman who had tumorous masses at the retromolar pad, the left buccal mucosa and the tongue. The specimens taken from the lesions displayed green birefriegence after Congo red staining on polarization microscopy, and proliferation of plasma cell around the amyloid substance was obsereved. Also, positive reaction of λ type antisera with those cells, as well as the amyloid substance were shown by immunohistochemical method. Besides, the quantitative analysis of immunogloblin and immunoelectrophoresis of the patient's serum wre examined; increased IgGλ type monoclonal protein was revealed. However, there were no findings associatedwith multiple myeloma by several systemic examinations, e. g., X-ray and Tc-scintigram. From those findings described above, this case was finally diagnosed as “primary amyloidosis with plasma cell dyscrasia”.
Fibrous dysplasia is a benign fibro-osseus lesion characterized by the replacement of fibrous connective tissue within the spongiosa of the affected bone. The term “fibrous dysplasia” was coined by Lichtenstein in 1938 to describe certain distinctive benign fibro-osseus skeletal changes. The pathological etiology of fibrous dysplasia is unknown, but now, it is believed that the cause was perverted activity of a specific bone-forming mesenchyme. We recently experienced two cases in which these diseases broke out in the maxilla. Case 1. A 44-year-old man with chief complaint of swelling in the right maxilla body at our department of oral surgery May 11, 1981. Under the diagnosis of suspected fibrous dysplasia, the lesion of the disease was curetted at the 1 st operation. 1 week after the 1st operation, recurrence was found. 4 months after the 1 st operation, excision of lesion including the normal region was made. The histo-pathological and scanning electron microscopic findngs of the specimens showed fibrous dysplasia. The prognosis is favorable without any relapse tendency 4 years and 6 months since the 2nd operation. Case 2. A 10-year-old boy with chief complaint of swelling in the left maxilla body at our department of oral surgery on January 31, 1983. Under the diagnosis of suspected fibrous dysplasia, curettage of the lesion was made. The histo-pathological and scanning electron microscopic findings showed fibrous dysplasia. The prognosis is favorable without any relapse tendency 4 years and 6 months since the operation.
Hemangiopericytoma was first reported by Stout and Murray in 1942, when it was thought that the tumor originated from the pericyte first described by Zimmermann in 1923. This tumor is considerably less common than the other vascular tumors and seldom occurs in the head and neck region. While this tumor is usually regarded as benign, it sometimes shows metastasis and malignant degeneration. Zimmermann thought that the pericyte existed around the capillaries, enveloping them with cytoplastic processes. Moreover, he thought the pericyte might have been modified from smooth muscle cells. Generally, this tumor histologically resembles other vascullar tumors such as Glomus tumor, Hemangioendothelioma, and Vascular leiomyoma, so the primary problem was the differential analysis of the original development of the tumor cell. Despite the many theories expressed on the subject since the original report, there has been no final determination of the tumor histology. In this instance, a case of hemangiopericytoma in a 53-year-old female was found to have progressed in the right cheek region for 20 years. The tumor was excised and the operation wound treated with plastic surgery by the rotation and advancement of the cheek skin flap. After consideration of the literature, following histopathological examination by optical and electronmicroscopes, it was determined that this tumor belonged to the benign hemangiopericytoma of Battifola type A. However, no final conclusions as to the tumors histology were possible from the original analysis. The details of this case are as follows.
The incidence of leukemic cell infiltration to the jaw bones has been reported to be relatively higher than supposed, especially in younger patients. However, tooth germ involvement has rarely been reported in the literature. In the two cases of childhood, i.e., a 2-year-old girl and a 4-year-old boy herein reported, enlarged and highly radiolucent changes of the tooth germs were the characteristic, initial radiographical findings suggestive of the clinical diagnosis. Organization potential of the tooth germs may be high enough to be the site of the initial targets of the leukemic cell infiltration. Careful analysis of the panoramic radiographs appears to be valuable for detection of the lesions even in the earliest infiltration stage.
Pycnodysostosis is a rare systemic bone disease whose cardinal features are generalized osteosclerosis and dwarfism. Characteristic skeletal defomities ensue, such as failure of closure of cranial sutures, obliquity of the mandibular angle, and defects of the terminal phalanges. This disease is suspected to be congenital heredity. In this report, a case of pycnodysostosis of a 20-year-old man with pathological fracture caused by osteomyelitis was presented. We discussed the treatment of osteomyelitis associated with this disease.
Ninety four patients of squamous cell carcinoma of the tongue were reviewed between 1970 and 1985. In fifty-seven patients (about 60%), retreatments were needed because of recurrent or metastatic disease after initial therapy. However, only 35 patients underwent further curative treatment and 22 patients could not be radically treated because of an advanced, inoperable disease and the general poor systemic status. As the clinical stage advanced, recurrence rate increased but curative treatment decreased. Therefore, the prognosis in recurrence cases of advanced stage was poor. The favorable salvage rates were found in the following cases: local recurrence of early stage without nodal involvement, cervical metastasis without primary recurrence, and the case in which aggressive salvage operation could be performed. The 2-year-crude survival rate of nonrecurrence cases after initial therapy was 73.0% (27/37), 29.8% (17/57) in all recurrence cases and 49.0% (17/35) when limited to cases in which curative salvage treatment was possible. The overall 2-year crude survival rate was 46.8% (44/94).
We reported a case of chronic cheek cellulitis which caused difficulty in differential diagnosis from chronic osteomyelitis of mandible. By means of diagnostic imaging, using 3 phase bone scintigraphy, we obtained useful information. At first we suspected from clinical appearance, that this case was mandibular osteomyelitis, but dynamic and pool scintigram showed increased radioactivity in the cheek lesion, and later scintigram did not show abnormal RI accumulation in the mandibular bone. This indicated that infectious change was localized in the soft tissue, but did not exsist in the bone. In conclusion, 3 phase bone scintigraphy can evaluate the diffrentiation between cellulitis and bone infection, and would be instrumental in determining for diagnosis and prediction of prognosis.
A case of giant cell granuloma associated with ameloblastoma of the mandible is presented. The patient, a 47-year-old man, complained of tumor of the lower gingiva. A operation was performed with block dissection of the mandible included the oral mucosa and reconstruction with sternocleidomastoid osteomusclocutaneous flap. After the operation, there has been no recurrence of the tumor and prognosis is excellent. It is surmised that a reactive process, whereby the stroma is transformed into a giant cell granuloma, has taken place secondary to bone damage by ameloblastoma or marsupialization 14 years ago.
Hemangioma occurs frequently in the head and neck region. There are, however, relatively few reports of phleboliths occurring with hemangioma. This report describes a case of multiple hemangiomas occurring with phleboliths in the oral region. A 45-year-old Japanese man was referred to this clinic with a chief complaint of tumors in the oral cavity. Hemangiomas were found on the bilateral buccal mucosa, tongue, right mandibular gingiva, oral floor and lower lip. Surgical resection and Laser treatment were applied, and two phleboliths were extirpated. One of these phleboliths was dissected and its cut surface was examined with an X-ray microanalyser. The cut surface was of a stratiform construction in a concentric configuration. Ca, P, Mg, S, Na, O, C, Cl and Al were detected by point analysis. The concentration distributions of Ca and P were almost equal by line analysis. Postoperatively, round and oval radiopaque shadows were seen on a CT scan at the anterior border of the right masseter, the interior border of the internal pterygoid muscle and the left superior submandibular gland.
The pyogenic granuloma is a distinctive clinical entity originating as a response of the tissues to a nonspecific infection. The most startling features are the occurrence of vast numbers of endothelium-lined vascular spaces and the extreme proliferation of fibroblasts and budding endothelial cells. We have recently experienced two cases of pyogenic granuloma which appeared in the tongue in 75-year-old and 55-year-old men and reported on them with some comments based on the literature. The prognosis in both cases is fairly good after surgical treatment and there is no recurrence at present.
Synovial osteochondromatosis is a disease of cartilagenous metaplasia of synovial membrane accompanied with loose bodies within the articular cavity. It occurs most often in the knee and is also seen fairly often in the elbow and the hip, however involvement of the temporomandibular joint (TMJ) is very rare. A 36-year-old woman visited our clinic with a pain in the right TMJ region. After an accidental blow to the chin seven years earlier, she had acquired a crepitus in the right TMJ. On examination, there was slight right preauricular swelling and tenderness. Panoramic radiograph, arthrography, CT scan and arthroscopy revealed calcified loose bodies in the superior articular cavity. Removal of all loose bodies, synovectomy, discectomy and condylectomy were performed. The loose bodies were 22 white nodules 3 to 6mm in diameter. Histological examination of the loose bodies demonstrated cartilagenous metaplasia. 27 months after surgery there had been no recurrence of the symptoms. We reviewed 39 cases of the TMJ reported in the literature, and found that trauma may play an etiological role and synoviectomy and condylectomy may be necessary in some cases.
Thirteen cases of adenoid cystic carcinoma originating from the salivary gland treated in our Department from 1966 to 1987 were studied clinically and pathologically, in an attempt to clarify its correlation between clinical stage, histological grade and prognosis. Both sexes were almost equally represented (7 male and 6 female) and the patients ranged from 39 to 79 years old. The primary sites of the tumors were 7 submandibular gland, 4 palate, 1 parotid gland and 1 buccal mucosa. The cases were classified according to the TNM classification (UICC 1987) and the histological grading (Szanto et al. 1984). The results were defined as follows: 1) It was suggested that the histological grade and the clinical behavior should be correlated to each other. The prognosis of patients with the tumor of Grade III and Stage IV was most poor. All of these patients died of distant metastasis. 2) In addition to histological grading, primary site, perineural invasion and bone invasion should be considered as other important factors. These findings appeared to be useful in predicting the prognosis. 3) Patients with finding of positive surgical margin had the tendency that local recurrence was generated. Clinically, however, complete removal of the primary tumor was difficult, especially in the minor salivary gland. The planned combination of surgery and irradiation, adjuvant immunochemotherapy and multidisciplinary therapy should be considered.
Toxoplasmosis is an infectious disease common both in humen and animals. There are congenital and acquired manifestations of this condition. We had a case of a 10-year-old boy with a painless mass resembling a lymph node in the submental lesion of about four days duration. The indirect hemagglutination test which is one of the toxoplasma serologic tests was suspected positive. Excisional biopsy revealed a dark-red, well-capsulated tumor. Histopathologically, the excised lymph node showed reactive hyperplasia with small clusters of epithelioid histiocytes. These small clusters were composed of variable numbers of epithelioid histiocytes distributed throughout the paracortex and cortex. Tingible body macrophages were seen in the secondary reactive follicles. There was no necrosis nor caseation, and giant cells were rarely seen. Neither distinct toxoplasma, nor cystic form of it was identified in histological sections, but an immunohistochemical test showed positive reaction. Following the biopsy, toxoplasmosis titer was varying. But the patient recovered uneventfully and the follow-up has remained asymptomatic.
Two cases of reconstructed oropharyngeal defect with free radial forearm flap are presented. Two male patients of forty-six and fifty-one years of age had wide resection including radical neck dissection for advanced squamous cell carcinoma (T4 Ni MO), in the left retromolar trigone in one case, and in the right buccal mucosa in the other. Both patients received surgical reconstruction using the forearm flap in the large defect of the oropharynx and oral mucosa. Their postoperative courses were uneventful, except for slight paresthesia in the anatomical “snuff box” of the hand. Local recurrence and metastasis have not appeared as of 13 and 12 months respectively after operation. Postoperative speech function and velopharyngeal closure are satisfactory in both cases. Consequently, the free radial forearm flap is considered to be suitable and functional for treating oropharyngeal defects in which rehabilitation with conventional flaps or maxillomandibular prosthesis is difficult.
Malignant fibrous histiocytoma rarely occurs in the jaws. A case of malignant fibrous histiocytoma originated from the maxillary sinus is reported. The patient was a 25-year-old man who had had a pain in the left cheek for four months before his first visit to our hospital. Radiographic findings revealed wide destruction of the left maxilla. The biopsy taken from the maxilla showed histopathologic findings of malignant fibrous histiocytoma. Accordingly he underwent surgery of partial resection of the left maxilla. The tumor was observed to have developed extensively outside the maxillary sinus. After the surgery, the patient received anticancer chemotherapy both intra-arterially and intra-venously. Pre-and post-operative radiotherapy was also given to him in total of 70 Gy by a linear accelerator. The patient showed various somatic paralysis with gradual tumor progression and died approximately one year and seven months after the first visit to out hospital. Autopsy revealed tumor recurrence at the back of the upper part of the left maxillary sinus and the tumor had invaded the pons. No distant metastasis was found. It can be noted that this was a very peculiar case of malignant fibrous histiocytoma of the maxilla expired without any distant metastasis.
Congenital lower lip fistula is a comparatively rare malformation. We report here 2 such cases accompanied by cheilognathopalatoschisis. Besides, some additional consideration in the literature was given to a total of 102 cases including cases found between 1933 and 1986 and 2 cases of ours. Our 2 cases were males, whose hereditary backgrounds remained uncertain. Two fistulas of about 10mm depth were found bilaterally at the central prolabium of the lower pit. These fistulas, which showed discharge of mucoid fluid upon compression, were totally resected according to Kaptansky's method. Cases reported in our country comprised of males and 46 females with one unknown sex, 81 of which had 2 fistulas. Inter-fistular distance averaged about 8mm, and fistulas with mention of the depth amounted to 63 with an average inter-fistular distance of 8.2mm. About half of the patients with this malformation had some cleft malformations within their identical lineages. Surgical resection was most frequently adopted.
Presently a large number of statistical observations and case reports on mandibular fractures have been made public. To our knowledge, however, none of these published studies was made in private hospitals which are prepared to accept emergency patients. Under such circumstances, the authors recently performed a statistical analysis of 70 patients with mandibular fractures who visited our department in a 5 year period from May 1980 (When our hospital opened) to April 1985. The results were as follows: (1) Mandibular fracture was seen in 70 of the 100 patients with maxillofacial fractures. (2) The largest portion (40.0%) of patients were between 10 and 19 years of age; traffic accident was the predominant injury cause (61.4%). (3) In a majority (58.7%) of patients, the number of fracture line was one; the predominant fracture site was the articular process (29.5%). (4) The largest portion of patients with multiple maxillofacial fractures had fractures in the mandibular and maxilla. (5) The teeth on the fracture line could be preserved in 87.9% of the cases. (6) The largest portion (87.2%) of patients were hospitalized the same day injury occurred; reduction of fractures was started on the same day in the largest portion (32.9%) of patients. A majority (55.7%) of patients were directly carried from the accident site to our hospital by ambulance. (7) Closed reduction was applied to 63.0% of patients; the predominant period of fixation was 30-39 days. (8) The prognosis results were mostly satisfactory according to the examination questionnaire.
Oral metastatic tumor of testis is rare. Here we report a case of embryonal carcinoma of the left upper and lower gingiva in a 19-year-old man. His left testis gradually began swelling 13 months ago. Oral tumor surface was elastically soft, uneven, darkly-reddish, and easily hemorrhagic. Bone resorption was not detected. Histopathologic examination of lower gingiva and lung revealed embryonal carcinoma. Diffused metastatic tumor of liver was found by abdominal cchogram. He died of lung failure 10 days later. In a review of literature from 1885 to 1986, 8 cases of oral metastasis of testis tumor were reviewed and discussed.
In the oral field, it is rare for acute promyelocytic leukemia (APL) to be reported. A patient, who presented a chief complaint of bleeding tendency after a minor oral surgical procedure, was referred to us. The diagnosis of APL was reached and herein the case is reported. A 52-year-old male developed continuous gingival bleeding from the operative wound and fever after his 2 root apex was resected. He was referred to our department for further workups of fever and controlling the bleeding and was admitted on the spot. Intraoral findings revealed that the area was packed with spongel and bosmin gauze and that the amount of bleeding was minimal. The nearby gingivae were swollen and the lips were slightly anemic. CBC on admission reported the following values: RBC 188×104/mm3; Hgb 6.3g/dl; Hct 18.5%; PLT 6.1×104/mm3; WBC 59, 700/mm3, 81% myeloblasts, 12.5% promyelocytes, 1% myelocytes. Chromosomal study revealed the presence of 46 XY t (15;17). Based on some other studies, the diagnosis of APL or M3 variant according to the FAB classification, associated with DIC was established. A complete remission resulted after courses of DNR therapy. A temporary denture has been put in after the extraction of 32 tooth. His clinical course has been uneventful without bleeding tendency.
A double-blind study of the antipyretic analgesic AD-1590 20 mg (Group A) was conducted to evaluate its utility in pain after difficult tooth extraction using the standard drug mefenamic acid 500 mg (Group M) and placebo (Group P) as controls. 1. Out of 271 cases studied, 203 were analyzed. There was no significant difference in patient characteristics among the three groups. 2. The onset of analgesic effect tended to be more rapid in Group A than in Group P. The duration of analgesic effect in Group A tended to be slightly shorter than that in Group M and tended to be longer than that in Group P. Group M showed a significant longer duration of effect than Group P. 3. Both Group A and Group M were significantly superior in patient's impression to Group P. There was no significant difference between Group A and Group M. 4. In overall improvement, both Group A and Group M were significantly superior to Group P. There was no significant difference between Group A and Group M. 5. No side effect was found. In safety rating, all cases were rated as safe. 6. In utility, both Group A and Group M were significantly superior to Group P. There was no significant difference between Group A and Group M. The above results suggest that AD-1590 has a rapid onset of effect and is a useful and highly safe drug in the management of pain after tooth extraction.
Various hypotheses have so far been built up for the etiology of chronic recurrent aphtha and Behget disease. Although there seems to be some hypotheses common to both diseases, neither definite theory nor established therapy has been formed yet. On this occasion, the authors have tried a therapy with 2% tetracycline (hereinafter referred to as TC) solution gargle and dental chronic focus treatment on a total of 38 cases comprising 25 of chronic recurrent aphtha and 13 of Behget disease accompanied with recurrent aphthous stomatitis, and examined therapeutic effects on clinical symptoms and changes in various clinical tests values. On the other hand, as a contribution to the search for the etiology of recurrent aphthous stomatitis, intraoral live mycoplasma count and serum antimycoplasma antibody titer were also examined. The results obtained are as follows; 1) In terms of therapeutic effects on recurrent aphthous stomatitis, dental chronic focus treatment tended to cause temporary symptomatic improvement and 2% TC solution gargle was highly effective in the direction of remarkably controlling the incidence of recurrence, reducing the size and pain of ulceration. 2) Treatment with 2% TC solution gargle also has a obvious effect on systemic symptoms of Behget disease, but took a longer period of time for its improvement compared with oral symptoms. 3) Clinical test findings after the start of 2% TC solution gargle for Behget disease were suggestive of an improvement in the morbid picture. 4) Intraoral live mycoplasma count tended to be a little higher for Behget disease, as was the same as serum anti-mycoplasma antibody titer. However, in view of the observed tendency to the improvement in serum anti-mycoplasma antibody titer after the start of TC solution gargling, partial involvement of mycoplasma in the pathogenesis of recurrent aphthous stomatitis in Behget disease was also suggested.