In many tissues, programmed cell death plays an important role, under both physiological and pathological conditions, in embryogenesis, metamorphosis, normal tissue turnover, and carcinogenesis. Human oral epithelium renewal is a typical example of the active participation of a cell in its own death process. Cells arising from mitotic activity in the stratum germinativum of the oral epithelium continuously migrate upwards to the stratum corneum, where dead cells are eventually desquamated. Cell death by apoptosis, a mode of cell death with characteristic morphologic features, is considered a major mechanism of programmed cell death, which is thought to be involved in normal development. We investigated morphological changes of nuclei during cell death in human oral epithelium in vivo and in cultured cells from oral epithelium. During cellular progression in stratified squamous epithelium, morphologically altered nuclei, which were flat and had rough contents, were observed in the granular layer. Morphological changes in nuclei were incompatible with typical apoptosis characterized by condensation of chromatin nuclear fragmentation, or both. In contrast, some cultured keratinocytes died while showing a pattern of apoptosis after treatment with bleomycin, a anti-cancer drug effective against squamous cell carcinoma. In addition, several modes of cell death unable to be classified as apotosis or necrosis were observed both in cultured oral keratinocytes and in human oral epitheliumin vivo. The results suggest that the major mode of cell death during differentiation of oral epithelium may not be apoptosis, and that other types of cell death, which are not known yet, may be involved in the development of oral epithelium, oral epithelium-derived carcinomas and cell death induced by treatment with therapeutic agents effective against oral epithelium-derived carcinomas.
Oro-cutaneous fistula is a serious complication following oral reconstruction. It is caused by a decline in blood coagulation factor XIII activity. We studied the relationship between the occurrence of postoperative fistula and blood factor XIII activity. Twenty-nine patients who underwent oral reconstruction at the Department of Oral Surgery, Hirosaki University from November 1991 through August 1994 were studied. Blood factor XIII activity and serum albumin concentrations were measured. Factor XIII activity decreased to the lowest level of 54.7±4.2%, as compared with baseline, on the 7 th postoperative day (POD), and gradually increased to 89.1±5.2% before the 21st POD. On the other hand, the serm albumin concentration decreased to the lowest value of 5.7±0.1g/dl on the 3 rd POD. Nine of 29 patients whose factor XIII activity decreased below 60% on the 3 rd POD had oro-cutaneous fistulas on the 5.6±0.58 POD on average. The incidence of fistula was significantly higher, in patients whose factor XIII activity was below 60% than in those whose factor XIII was above 60%. There was no correlation between the serum albumin concentration and the incidence of fistula. In the 9 patients of the 29 patients who had postoperative fistulas, mean factor XIII activity was 44.6±3.8%. These patients were given plasma factor XIII Their blood factor XIII levels increased promptly, and 7 cases of oro-cutaneous fistula were cured by 17±4.4 POD on average. In conclusion, we demonstrated that a postoperative decrease in blood factor XIII activity was an important causative factor of oro-cutaneous fistula after oral reconstruction. The results suggest that administration of plasma factor XIII is effective in preventing and treating fistulas in patients whose blood factor XIII activity is below 60% postoperatively.
In the past, spindle cell carcinoma was referred to by various names, but it is nowclassified as a subtype of squamous cell carcinoma. A very unusual case of spindle cell carcinomaarising in the mandible in a 45-year-old man is presented. Although chemotherapyand operation were performed, he died approximately 3 years after the onset of symptoms such as paresthesia of the lower lip and swelling of the cheek.
An extremely rare case of metastatic osteosarcoma to the mandibular gingiva in a 22-year-old man is presented. The tumor was completely resected with marginal resection of the mandibular bone. No evidence of local recurrence was detected 2 years after surgery. Metastases to the lung and lumber vertebrae were successfully treated with antitumor agents highly active against cultured tumor cells obtained from the resected specimen.
A case of rhabdomyosarcoma arising in the pterygomandibular space is reported. The patient was a 8-year-old boy who complained of swelling in the left cheek region. Panoramic radiograph examination showed an oval lesion, approximately 4 cm in diameter, with a poorly defined margin in the left ramus of the mandible. Immunohistochemically, the cytoplasm of the tumor cells was stained by desmin. Electronmicroscopic examination showeda Z-band-like structure in the cytoplasm of the tumor cells. Based on findings, the lesion was diagnosed as a rhabdomyosarcoma. The patient received multimodal therapy consisting of radiochemotherapy and surgery. There is no clinical evidence of recurrence as of 2 years and 9 months postoperatively.
A 58-year-old man with benign lympohoepithelial lesions in the right submandibular and accessory parotid glands is reported. The patient had no signs or symptoms other than tumors in the right submandibular and accessory parotid glands. He underwent removal of the tumors under the diagnosis of a submandibular gland tumor with cheek tumors. Histological examination of the surgical specimens revealed loss of acinar tissue with lymphocytic cell infiltration. Lymphoid follicles and epimyoepithelial islands were also found in the lymphoid tissues, but no neoplastic changes were evident in the specimens. Based on these findings, all tumors were histopathologically diagnosed as benign lymphoepithelial lesions. There has been no evidence of recurrence or other systemic diseases as of 34 months after surgery.
Three patients with diffuse sclerosing osteomyelitis of the mandible who had been treated by intra-arterial infusion of urokinase and antibacterial agents including fosfomycin were evaluated. All patients underwent decortication at the same time. They were all free from symptoms an average of 3 years 7 months after treatment. Urokinase and fosfomycin may cause the dissolution of biofilm, which prevents contact between antibacterial agents and causative organism. Thus, the intra-arterial infusion of urokinase, fosfomycin, and other antibacterial agents can efficiently eradicate bacteria in sclerotic bone in osteomyelitis.
We report the clinical course of a case of subacute necrotizing lymphadenitis (SNL). A 45-year-old woman presented at our department because of multiple lymph node swelling in the neck. A biopsy specimen of swollen neck lymph nodes was diagnosed histopathologically to be necrotizing lymphadenitis. The patient had cervical and intraabdominal lymph node swelling, leukocytopenia, a high serum LDH level, and dermatitis. Signs and symptoms resolved spontaneously after 4 months. SNL involving the intraabdominal lymph nodes is quite rare. The results suggested that early biopsy of the affected lymph nodes is important in differential diagnosis between SNL involving the intraabdominal lymph nodes and other malignant types of lymphadenopathy.
Chronic mucocutaneous candidiasis (CMCC) is an uncommon disease characterized by persistent and recurrent Candida infections of the skin, nails, and mucous membranes since childhood. This disease appears to be caused by abnormalities of cell-mediated immunity such as failure of Candida-stimulated T cells to produce lymphokines. We report a case of CMCC in a 3-year-old girl. She was suffering from severe thrush since 1 month of age. She also had nail candidiasis, so suspected immunological abnormalities. Malfunction of T cells was suspected because of low IL-2 production. The patient is continuing to receive treatment at the department of pediatrics to attempt to correct the immunological disorder.
We describe a recent case of photosensitivity associated with piroxicam (Baxo®). The patient was a 62-year-old man. He took a single dose of piroxicam, prescribed at a dental clinic. On the following day, erythema appeared on the face, neck and other parts of the body exposed to sunlight, and he was referred to our department for a workup. His condition was diagnosed as photosensitivity caused by piroxicam, because a piroxicam photopatch test and a thimerosal test were positive.
Patients with maxillary tumors, suffer considerable dysfunction until they wear the final prosthesis. We report the use of a temporary splint made of vinyl acetate ethylene in a patient with a maxillary defect.