本稿では, 口腔扁平上皮癌の治療例を対象として, 術前化学療法の効果を癌の細胞, 生物学的特性, とくに増殖動態の制御の観点から解析した結果に基づき, 器官温存手術の適応決定について癌細胞の増殖動態の制御の面から概説を試みたので, 以下の項目に従って報告する.
1.口腔癌の腫瘍発育先進部における核DNA量の臨床的意義
2.核DNA量と核分裂指数からみた術前化学療法による増殖動態の制御とその臨床的意義
3.増殖動態の制御とgrowth fraction rateおよびapoptotic index
4.増殖動態の制御と器官温存手術高分化口腔扁平上皮癌で核DNA量が少なく, 増殖能が低い癌は, differentiated cell deathまたはapoptosisを生じ, 化学療法に著効を示す症例が多く, 器官温存手術のよい適応になる.一方, 術前化学療法によって増殖動態が制御されない癌は, 高悪性の難治癌であり, これらの癌に対する新たな治療戦略の必要性が示唆された.また, 口腔扁平上皮癌における器官温存手術の適用とその予後の点から, 術前化学療法効果の術前予測と, 効果無効と予測された症例に対する治療法の開発が今後の研究課題となった.

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The purpose of this study was to investigate the effects of streptozotocin-induced diabetes on the recruitment of foreign body giant cells elicited by subcutaneously implanted polyvinyl sponges. Our result showed that, in diabetic rats, the recruitment of macrophages and foreign body giant cells that occurred as a response to the implants, was impaired. These cells were smaller and did not migrate as deeply into the implant as those seen in normal rats. Futhermore, ultrastructurally, giant cells in diabetic rats showed poor development of cytoplasmic organelles and basal membranes. These data indicate that there is a deficiency in the ability of diabetic rats to mount a foreign body giant cell response to an implanted sponge, characterized by a deficiency in the recruitment of precursor cells that are capable of either full development and spreading or migration into the implanted sponge.

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One hundred forty-six teeth on the fracture lines of mandibular fractures (85 patients) treated at the Department of Oral and Maxillofacial Surgery, Shimane Medical University Hospital, from 1980 to 1998, were clinicostatistically analyzed. The results were as follows:
1. The age of patients was widely distributed. The peak incidence was the second and third decades (74.1%). The male and female ratio was 4 to 1.
2. The cause of fracture was 26 cases (30.6%) in the traffic accident, 21 cases (24.1%) in falls, 17 cases (20.0%) in sports, 10 cases (11.7%) in beating, 9 cases (10.6%) in work accidents and 2 cases (2.4%) in others.
3. Teeth on the lines of mandibular fractures were found in 35 teeth (20.4%) in the wisdom teeth and in 34 teeth (23.4%) in the canine teeth and in 77 teeth (56.2%) in the others.
4. Seventy-three teeth (85.6%) out of all teeth were preserved without teeth extractions.
5. Teeth on the mandibular fracture lines could be classified into four types (I-IV) according to our original classification ; type I was 19.2%, type II was 49.4%, type III was 19.2%, and type N was 12.2%.
6. We investigated whether the teeth on the lines of the mandibular fractures were preserved or not after treatments-91.3% of the teeth had been preserved for more than one year after treatments.

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In this study, I attempted to analyze osteoinductive activity in prefabricated neovascularized bone flap using an experimental model of autologous bone and allogenic freeze-dried bone, in rats.
Wistar rats were divided into two groups according to transplanted bone that is autologous iliac bone and allogenic freeze-dried bone.
All flaps were reharvested at 2, 4, 8, and 12 weeks after transplantation for radiographic, histological, and immunohistochemical examinations.
The results obtained were as follows:
1. In the autologous iliac bone group, osteogenesis was observed at the second week after transplantation. Immunohistochemical expression of osteopontin was observed in new bone matrix.
2. In the allogenic freeze-dried bone group, weak osteoinduction, such as endochondral bone formation, was observed at the fourth week after transplantation. However, transplanted bone chips were absorbed at the twelfth week after transplantation.
3. In the autologous iliac bone group, new bone formation with bone bridges between bone chips was observed around the vascular bundle. The newly formed bone expressed osteocalcin immunohistochemically at the twelfth week after transplantation.
4. The method of prefabricated neovascularized bone flap using autologous iliac bone chips was found to be a useful axial pattern flap with osteoinductive properties, and possibility of clinical application in bone reconstruction was shown.

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A 23-year-old female patient with primary hyperoxaluria associated with dental and maxillomandibular bone changes was retrospectively discussed. The first clinical symptom was proteinurea, then falled into renal failure. Remarkable deposits of calcium oxalate crystals were noted in her resected kidney and iliac bone, from resected and biopsied specimens. Particular oral symptoms were anemia of oral mucosa, gingival hyperplasia, and remarkable movement of all remaining permanent teeth. Radiographic examination showed remarkable absorption of all dental roots and disappearance of lamina dura, as well as overall frosted glass-like jawbones, with an unclear trabecular pattern and partially with an osteoporotic images. Bone scintigraphy demonstrated abnormal accumulations at every joint and maxillomandibular bone. Subjective and radiographic observations showed internal absorption reaching the coronal pulp horn area, and partially at the enamel layer beyond each resorpted root. White-colored, sherbetlike alveolar bone changes were also observed around tooth extracted sockets. Histopathological findings of dentin and alveolar bones indicated staining by calcium oxalate crystals along the growth line after physiological dentin formation, with pathological dentin being formed on its dental pulp side. Dental pulp and alveolar bones were in a necrobiotic or necrotic state, remarkable calcium oxalate crystals were also noted in the gingiva, and osteoids formed at the alveolar bones corresponded to the stanning of calcium oxalate crystals. This patient died, due to DIC, at age 28. Autopsy findings showed the presence of calcium oxalate crystals in kidney, cardiac muscle, bone marrow, joints, the thyroid gland, lymph nodes, and also the thymus.

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