For evaluation of neo-adjuvant chemotherapy with intraarterial administration of cisplatin (CDDP) plus peplomycin (PEP) or carboplatin (CBDCA) plus PEP, effects of preoperative treatment on the histological findings of resected tumors and prognosis between the patients treated with the above neo-adjuvant chemo-and radio-therapy (NCRT group) and those treated with only radiotherapy (RT group) were compared in previously untreated patients with head and neck squamous cell carcinoma. The NCRT group is consisted of 28 patients, who received intraarterial administration of CDDP 20mg/m2 or CBDCA 80-100 mg/m2 on day 1 and 8, and PEP 5mg/day with daily 2 Gy irradiation from day 1 to 5 and from day 8 to 12 preoperatively. The RT group consists of 27 patients, who received preoperative radiotherapy with γ or electron beam. Sex, age, T-, N- and Stage-classification, and tumor cell differentiation showed no significant difference between the two groups, while total radiation dose of the RT group was significantly more than that of the NCRT group. Three-year-survival rate with Kaplan-Meier's method was significantly higher in the NCRT group than in the RT group. Recurrence rate (in primary lesions, cervical lymph nodes, or distant organs) was significantly lower in the NCRT group than in the RT group. Though the histological findings of the resected materials showed slightly greater effect in the NCRT group than in the RT group, there was no significant correlation between the effect and tumor recurrence rate. From the above findings it was suggested that better prognosis was realized in the NCRT group partly because of relatively great effects on the histological findings by the preoperative treatments in a short period and partly because of supression of local micrometastasis of tumor cells.
The following experiments were designed to study the influence of periosteal wrapping of a cancellous bone graft. The experiments were divided into 6 groups according to whether the cancellous bone graft was fresh or defat-lyophilized, with or without periosteal wrapping, and to autologous or defat-lyophilized periosteum. Each material was transplanted underneath the fascia lata in adult dogs and grafted material was observed with histological and histomorphometric methods. The results were as follows: 1. Fresh autologous cancellous bone grafts without periosteal wrapping induced active bone formation after 1 week, but by 4 weeks, new bone formation at the surface of the graft was almost arrested and partial absorption of transplanted and/or newly-formed bone by surrounding tissues was recognized. 2. Defat-lyophilized cancellous bone homografts did not induce new bone formation, and absorption was observed at the graft margin by encroachment of the surrounding tissue. 3. In fresh autogenous cancellous bone wrapped with fresh periosteum, new bone formation was delayed in the early phase because of retarded revascularization as compared with that which occurred without periosteal wrapping. However, after 4 weeks, the quantity of newly-formed and transplanted bone trabeculae, as well as the amount of newly-formed bone, was much more than that observed without periosteal wrapping. 4. In defat-lyophilized cancellous bone homograft, no difference was noted between the presence and absence of the wrapping with fresh periosteum autograft. 5. Wrapping with homologous defat-lyophilized periosteum hindered new bone formation, in both bone autograft and homograft. The fresh periosteum autograft could support new bone formation and also protect the graft from encroachment by the graft bed in the fresh bone autograft. In contrast, fresh periosteum showed no activity in the defat-lyophilized bone homograft. These results suggest that fresh periosteal wrapping to fresh cancellous bone autograft may facilitate the bone inductive activity, and it is also suggested that these transplantations can be dominated not only by the condition of the periosteum but also by the state of the recipient site.
PCNA score was measured in oral lesions including malignant tumors in a total of 108 cases, and the relationship of it to other cell proliferation markers, Ki-67, S phase fraction, AgNORs was also investigated. Average PCNA scores of 22.8% closely related to Ki-67 scores of 24.1% suggesting that PCNA positive cells represented not only S phase cells but also other cycling phases. The fact that PCNA scores was significantly different between malignant and nonmalignant lesions, suggested the difference in growth activity.
This study was carried out to investigate the effects of intermaxillary fixation (IMF) on noradrenalin (NA) release in the rat brain regions by measuring a major metabolite of brain NA, 3-methoxy-4-hydroxyphenylethyleneglycol sulfate (MHPG-SO4) levels in the regions and plasma corticosterone levels. Male Wistar rats were anesthetized with pentobarbital and IMF was performed. Control rats were only anesthetized. The rats were decapitated 4h, 12h, and 24h after IMF. Weights of spleen, thymus, and adrenal gland were measured only in the rats with or without IMF at 24h. Levels of MHPG-SO4 in the IMF rats were significantly increased in the LC region (4h, 24h), hypothalamus (4h, 12h, 24h), cerebral cortex (4h, 12h, 24h), amygdala (4h, 12h), hippocampus (4h), pons +med. oblongata excluding the LC (4h, 12h, 24h), and midbrain (12h, 24h) as compared to those of the respective control rats. Plasma corticosterone levels were significantly increased by IMF throughout the courses of time. Organ weights in the IMF rats were significantly decreased in the thymus and spleen, and significantly increased in the adrenal glands. These results suggest that IMF could be stressfull for the rats and activates the central NA neuronal system.
Thirty two patients with oral cancers were orally administered 600-800mg/day of SF-S which contains sustained release granules of tegafur before operation. Tegafur and 5-FU concentrations in serum, submandibular lymph nodes, normal and cancerous tissues were evaluated after SF-S administration by the method of chemical assay using HPLC and GC-MS. The mean tegafur concentrations in serum, submandibular lymph nodes, and normal and cancerous tissues were 15.1μg/m/, 9.91μg/g, 9.52μg/g, and 9.84μg/g, respectively. The mean tegafur concentration in serum was significantly higher than that in the other tissues (p<0.001). The mean 5-FU concentrations in serum, submandibular lymph nodes, and normal and cancerous tissues were 22.5 ng/m/, 171.9ng/g, 44.0ng/g and 173.9ng/g, respectively. The mean 5-FU concentration in cancerous tissues was much higher than 50ng/g which was reported to be the minimum effective concentration, and significantly higher than that in serum and normal tissues (p<0.001). Besides, the mean 5-FU concentration in submandibular lymph nodes was similarly higher than that in serum and normal tissues (p<0.01). With regard to the locations of cancerous tissue, the mean 5-FU concentrations in cancerous tissues of maxillary gingiva, mandibula gingiva, tongue, buccal mucosa, and oral floor were 158.8ng/g, 309.7ng/g, 94.1ng/g, 95.2ng/g, and 348.2ng/g, respectively. The mean 5-FU concentration in cancer tissues of mandibular gingiva was significantly higher than those of tongue and buccal mucosa (p<0.05). In conclusion, these results suggest that SF-S could also be effective against oral cancer.
Effects of diet on absorption of two oral cefem antimicrobials, cefteram pivoxil (CFTM-PI) and cefaclor (CCL), were examined in NZW rabbits. Concentrations of the drugs delivered into serum and oral tissues were detc rmined by bioassay and compared by the method of pharmacodynamic analysis. 1. The serum CFTM-PI peak was delayed in the fed group, which exhibited about 1.3 times greater delivery of the drug than the fasting group. 2. CFTM-PI took slightly longer to reach its peak concentration in oral tissues (tongue, gingiva, submandibular gland, parotid gland, submandibular lymph nodes, mandible, and maxilla) than in serum. The peak levels were generally higher in the fed group than in the fasting group. 3. There were no marked differences in the time required for the level of CCL in serum to peak in the two groups. The peak concentration in the fasting group, however, was twice as high as in the fed group. 4. CCL took a little longer to peak in oral tissues than in serum. The fasting group exhibited greater delivery of CCL than the fed group, except that peak levels in the maxilla, mandible, and submandibular lymph nodes were slightly higher in the fed group. No substantial differences were found, however, between the two groups. 5. When CFTM-PI and CCL were compared, the different pharmacodynamics of the two drugs in vivo reflected the peculiarities of their absorption; however, the differences between the two groups were less marked in the oral tissues than in serum. 6. CFTM-PI was less likely to be affected by diet, showing higher delivery in the fed group. In contrast, drug absorption was decreased by feeding in animals given CCL. It was also indicated that the effect of diet on drug delivery to neither tissue nor serum should be underestimated.
The present study attempts to elucidate histologic changes and histochemical characteristics of masticatory muscles in rats under bite raising. The bite of experimental rats was raised with 2mm at the mesial surface of the 1st molar by a bite raising appliance, bilaterally and/or unilaterally. The animals were killed 3, 6 and 12 hours, and 1, 2, 3, 5, 7, 10, 15, 20, 30, 60, and 120 days after bite raising. Fresh frozen sections of superficial and deep masseter, temporal, and anterior and posterior digastric muscles were made for myosin ATPase, NADH-tetrazolium reductase, acid phosphatase, acetylcholine-esterase, macrophage, and laminin stainings. The other part of the masseter muscle were used for electronmicroscopic studies. Histologically, alterations in muscle fibers of masticatory muscles following bite raising were found in superficial and deep masseter muscles under bilateral and/or unilateral bite raising, and not found in temporal and digastric muscles. The muscle fibers were conspicuously changed in the deep masseter muscle as compared to the superficial one, irrespective of bilateral or unilateral bite raising. The inflammatory cells appeared among the muscle fibers at 6 hours after bite raising, those cells infiltrated some muscle fibers on day 1, and muscle fibers were regenerated on day 7. During muscle fiber regeneration following bite raising, the I-like type and IIC type muscle fibers identified in superficial masseter muscles. These muscle fiber types are unusual in the normal superficial masseter muscle. Immunohistochemically, most of inflammatory cells in masseter muscle following bite raising were characterized by the existence of positive reaction for anti-macrophage antibody and acid phosphatase staining. The basement membranes of regenerated muscle fibers in inflammatory foci of both superficial and deep masseter muscles were already detected with laminin staining in 3-day specimens. Ultrastructually, myofibrils in 1- and 2-day specimens showed phagocytosis by macrophages, and regeneration of myofibrils and triads in 3-day specimen was recognized. The increase of mandibular alveolar bone height on the untreated side following unilateral bite raising was observed by measuring the dry skull.
This experimental study was undertaken to investigate the effect of anticancer agent (peplomycin (PEP)) and OK-432 (OK) adsorbed on activated carbon particles (CH) upon lymph node metastasis of VX 2 carcinoma implanted in the tongue of domestic rabbits. The drugs (PEP, PEP-CH, and PEP-OK-CH) were given by topical injections into the tumors of the tongues. The preventive effect on lymph node metastasis by these drugs was determined by investigating the positive rate of metastasis and the occupied area rate by metastatic lesion histopathologically. And electron microscopic observations on metastasis in lymph nodes were performed. The following results were obtained: 1. The values of the positive rate and the occupied area rate on lymph node metastasis in the PEP-CH and PEP-OK-CH groups were significantly lower than those in the PEP group. But there wasn't any significant difference between the PEP-CH and PEP-OK-CH groups. 2. Histopathological findings on lymph node metastasis in the PEP-OK-CH group revealed the distinct necrosis, and that many lymphocytes invaded around the degenerated VX 2 carcinoma cells. 3. Electron microscopical findings on VX 2 carcinoma cells in the PEP-CH and PEPOK-CH groups showed an increase of tonofilaments, pycnosis, karyorrhexis, and vacuolization as compared with those in the PEP group. The results of these investigations indicated that topical injections of PEP-CH and PEPOK-CH were effective for preventing lymph node metastasis. Then, it was thought that these drugs would be a useful dosage form for preventing lymphatic metastasis in oral cancer chemotherapy.
The radio-responsiveness of 31 oral squamous cell carcinomas were studied by flow cytometric (FCM) DNA analysis, comparing DNA ploidy and histogram with histological evaluation according to Shimozato-Oboshi's classification. The clinical evaluation and WHO's histological grading did not agree with histological evaluation. The DNA analysis of the tumor was done before and after irradiation (12. 5 Gy-40Gy). The radio-responsiveness was histologically evaluated and the response rate was estimated after irradiation. The response rate was 67% in aneuploid tumors and 81%, in diploid tumors before irradiation. This suggests that ploidy pattern of non-irradiated tumor can not predict the radio-responsiveness. However, the response rate was 20% in aneuploid tumors and 93% in diploid tumors after irradiation. This suggests that ploidy pattern of irradiated tumors can predict radio-responsiveness. It was also found that the DNA histogram of irradiated radio-sensitive tumors resembles the histogram of normal tissues. These results concluded that the flow cytometric DNA analysis is useful in predicting the radio-responsiveness of tumors.
Three dimensional analysis in medicine is increasingly becoming a valuable tool in preoperative planning, educating to the students, and explainning to the patients. Recently three dimensional reconstruction technology has been coupled with computerized resin hardening processes to create acrylic models from the three dimensional reconstruction data. We have fabricated two anatomical models of the skull by the computer controlled resin hardening device. Three dimensional data were created by the three-dimensional reformation system (TRI). As data entry and storage process, contour of bone tissue is manually drawn from each serial CT photographic image of transverse skull sections. These traces are then input to the frame memory by way of the video camera. The computer stores the X, Y coordinates of points along an outline as it is traced. A depth value into the structure, assigned to each section, provides the Z coordinate, that is, the third dimension. Wire frame image is generated by using the storage data. The final image produced by hidden surface removal and shading is displayed on a full color graphic display monitor. Anatomical resin models were generated by a photo hardening device which is controlled by a minicomputer and three dimensional reconstruction data. He-Cd laser beam (wave length: 325nm) conducted through the fibers scans the bottom of the monomer liquid surface according to the each CT contour data. The elevator moves up after the polymerization of the liquid has been performed in one slice. This device is suitable for the creation of human anatomical structure because the branched form and hollow model can be made easily. Three dimensional resin models are more useful for simulation surgery, education, and explanation than computer aided three-dimensional images.
Whole rat embryos with visceral yolk sac on days 9.5 and 10.5 of gestation were explanted and cultured for 36 and 24 hours respectively, in rat serum containing 0, 10, and 20μg/ml etretinate (ETR) dissolved in 0.125% dimethyl sulfoxide. The effects of ETR on the development and morphogenesis of embryos were examined by light and electron microscopy. When embryos were cultured in the medium containing 20μg/ml ETR, various abnormalities were observed: The diameter of visceral yolk sac, crown-rump length, head length, and number of somites were significantly decreased, and incidences of embryos failing to close the neural tube and turn the body axis, as well as, hypoplasia of maxillary and mandibular swellings were increased, compared with control or low ETR-containing (10μg/ml) cultures. Microscopically, embryos treated with 20μg/ml ETR, showed a decreased number of neuroepithelial and interstitial cells. Occasionally, there were cells exhibiting some degenerative changes including electron dense nuclei and cytoplasm, dispersed chromatin, dark mitochondria with dilated cristae, and large phagosomes. These findings suggest that the failure to close the neural tube, as well as, hypoplasia of maxillary and mandibular swelling may be due to cytological disturbances including cell death induced by ETR. Besides these findings, vascular formation was extensively suppressed in the viceral yolk sac of the embryos cultured with 20μg/ml ETR. In addition, endodermal cells of the yolk sac contained an abundance of electron-lucent vacuoles, lipid dropletes, and dark mitochondria with dilated cristae. Considering that the visceral yolk sac of early embryos plays an important role in nutritional supply, the findings of the present study strongly suggest that ETRinduced dysfunctions of the visceral yolk sac can partly be causes for abnormal development of embryos.
Although the mouth is often involved in Wegener's granulomatosis (WG), oral lesion as the initial sign is rare. The differential diagnosis of WG is difficult, especially in the limited form of the disease. In this paper, we report a case of early WG in which oral and nasal lesion is presented at the beginning of his illness. In addition, we review the reports of WG with oral manifestations, and the classification of WG from other “midline destructive lesions” is discussed. The oral manifestation of WG have received much attention in several journals, which may lead to early diagnosis. The use of immunosuppressive drugs, which is particularly cyclophosphamide, have greatly enhanced prognosis, especially it is when treatment is started before renal involvement. The dentist and oral surgeon may, therefore, be very influential in determining prognosis.
Bernard-Soulier syndrome (BSS) is a rare hereditary autosomal disorder characterized by prolonged bleeding time, normal clot retraction and thrombocytopenia with large and abnormal platelets. A 20-year-old woman with mandibular prognathism, who had been treated orthodontically as a preoperative therapy for 16 months, was referred to us for sagittal splitting osteotomy of the mandibular rami. Since platelet count using automatic blood cell counter indicated severe thrombocytopenia (3, 000/mm3), the patient was examined in detail hematologically. The result disclosed BSS with normal platelet count (245, 000/mm3), normal clot retraction and large sized platelets which could not be measured by an automatic counter. For anesthesia, modified NLA was chosen and platelet retention rate was monitored during and after anesthesia because the alteration of the platelet function in BSS under anesthesia with vaporizing anesthetic agents, which can affect normal platelet function, is unknown. In addition, platelet-rich plasma was also prepared in advance. The surgery was carried out successfully and uneventfully.
This paper describes the incidence of complications following the surgical removal of impacted third molars in our department. Also dry soket, which had a highest incidence, were investigated for causal factors; skill of operator, age or sex of the patient. Results: 1. The complication was found in 8.89% of 574 surgical removals. The incidence of dry socket was 5.57%, delay in healing was 1. 57%, postoperative infection was 0.87%, postoperative nerve paralysis was 0.35%, postoperative bleeding was 0.17% and other complication was 0.35%. 2. The incidence of dry socket was 0.68% in the young patient group (under 20), 6.60% in the middle group (20-29) and 8.80% in the high age group (30-). The differences between in the young patient group and other patient groups were highly significant. These data suggested that age of the patient is one of the etiological factor of dry socket.
Report of a 29-year old female with von Recklinghausen's disease by the presence of pachydermatocele, multiple cafe-au-lait spot and benign neurofibroma. The tumor, which hung down to an upper eyelid, the cheek, the nose, and oral cavity on the right side, existed and the lower eyelid was swollen upwards.(pachydermatocele) 1. Resection of tumor: We made excisions on the intra-oral and mid-facial tumor. Histopathologicaly, both of them, were Neurofibroma. 2. Reconstruction: The lacking of skin part was formed again by using D-P flap. 3. Plastic surgery: The form of the eyelid was corrected by Mustarde flap. Lower eyelid and transplant were raised with iliotibial tract. The facial configuration, which was able to be satisfied mostly with the above-mentioned operation, was obtained. Prosthodontic treatment was given to the toothless area and the occlusal function has been improved. The tumor does not recrudescence, and the passage is excellent now.
Apatite bone-filling material is an artificial biomaterial widely used today in re-constructive surgery in place of living body tissue. We studied the application of hydroxyapatite ceramics as bone and tissue occupying material in the oral-maxillofacial region. Herein, we present a summary of our study on patients with external nose deformities of cleft lip and palate. The subjects were 15 cases of marked external nasal deformity. In 6 cases, clefts were bilateral and in 9 cases, unilateral. Breakdown by sex was 10 males and 5 females. The oldest was 62 years and the youngest was 13, with a 23.4 year average. Course observation ranged from seven months to seven years and seven months. Surgical correction was at the nasal column, tip, dorsum, and base. Surgical procedure basically involved insertion of a preshaped apatite porous blocks into an ample filling cavity secured by making an incision from the lateral aspect of the column medial to the anterior nostril, which was followed by abrasion extending from the subcutaneous dorsum to the base of the nose, taking care to avoid the alar cartilage. Next, the external nose shape was corrected and the defect filled in with the block. The apatite porous block was readjusted, as necessary, and the incised part sutured to complete the procedure. The apatite porous block (Apaceram ® from Asahi Optical Co., Ltd) was used whole or divided into thirds, depending on the individual case. As a clinical result, postoperative infection occurred in 4 cases. In three patients in whom the block had been in the column, infection occurred within two weeks postoperativelly necessitating complete removal of the apatite porous block. In one patient in whom the block had been in the nasal tip and dorsum, the infected part of the block was removed, and the larger remaining portion fared well after being re-sutured.