Granisetron reduces clinical and histological response to intra-arterial neoadjuvant chemotherapy in oral squamous cell carcinoma.

Intra-arterial neoadjuvant chemotherapy (TPP) with pirarubicin, cisplatin and peplomycin produced strong primary effects on oral squamous cell carcinoma, using metoclopramide (MCA) as an anti-emetic. After clinical application of granisetron (GRN), the clinical responses to TPP observed previously were weakened. In this paper, the influence of GRN on TPP is discussed. Sixty-three cases were evaluated with regard to the primary effects of TPP and anti-emetics. GRN was used in 42 cases of the GRN group, and MCA in 21 cases of non-GRN group. The clinical response rate (complete response, CR or partial response, PR) was 95.2% in the non-GRN group, and 76.2% in the GRN group. The rate of CR in the non-GRN group was 47.6%, whereas it was 9.5% in the GRN group. The histological effects in the GRN group were significantly lower (P<0.05) than those of non-GRN group. Concerning the relationship between the clinical responses and the histological responses, 4 of the 18 CR+PR cases (22.2%) in the GRN group showed good histological responses, compared with 6 of the 14 CR+PR cases (42.9%) showing in the non-GRN group. The histological responses in the GRN group were significantly lower (P<0.05) than in the non-GRN group. Our data indicate that GRN reduces the clinical and histological responses of chemotherapy.

A new navigation system based on cephalograms and dental casts for oral and maxillofacial surgery.

Intraoperative navigation systems help surgeons to accurately carry out preoperative plans without injuring anatomically important structures. A system is evaluated that uses cephalograms instead of computed tomographic (CT) scans to create images. Three-dimensional (3D) dental casts provide registration between imaging data and the patient. Cephalograms are widely employed in orthognathic and oral and maxillofacial surgery and expose patients to lower doses of radiation than CT. The system uses a dental cast to register the operation field to a pair of frontal and lateral cephalograms. The cast is transformed to 3D data with a laser scanner and a programme that runs on a personal computer. 3D data describing the dental cast, cephalograms and the oral and maxillofacial region of the patient are integrated with specialized software. The optical tracking system for navigation uses charged-coupled-device (CCD) video cameras and light-emitting diodes (LEDs). Two CCD video cameras follow the 3D coordinates of LED assemblies attached to the head, lower jaw and a handpiece. Errors occurring when a dental cast was transformed to 3D data ranged from 0.08 to 0.21 mm. Mean errors were 0.71 mm (0.21-1.09 mm) for the right maxillary central incisor, 0.62 mm (0.04-1.69 mm) for the right maxillary 2nd molar and 1.02 mm (0.23-1.47 mm) for the left maxillary 2nd molar. This surgical navigation system is sufficiently accurate for use in oral and maxillofacial surgery.

The cleavage and inactivation of plasminogen activator inhibitor type 1 by neutrophil elastase: the evaluation of its physiologic relevance in fibrinolysis.

The effect of the proteolytic cleavage of plasminogen activator inhibitor type 1 (PAI-1) by human neutrophil elastase (HNE) on fibrinolysis was investigated. HNE cleaved active PAI-1 and produced low molecular weight forms of inactive PAI-1, as previously reported. Latent PAI-1 was resistant to HNE treatment. Vitronectin (VN) partially protected the cleavage. NH2-terminal sequence analysis indicated that the cleavage site was Val355-Ser356 (P4-P3). The effects of PAI-1 cleavage by HNE on clot lysis was studied in a purified system. Clot lysis time without PAI-1 was 20.0 +/- 5.0 minutes and was prolonged to 86.7 +/- 2.9 minutes by 68 nmol/L of PAI-1. It was shortened when HNE (from 0.6 nmol/L to 80 nmol/L) was added and returned to the value obtained without PAI-1 by 80 nmol/L of HNE (20.0 +/- 5.8 minutes). However, in the absence of PAI-1, elastase did not enhance clot lysis at all. Euglobulin clot lysis time was also shortened after HNE treatment. The cleavage and inactivation of PAI-1 by HNE was shown to be a novel pathway to enhance fibrinolysis.

The effect of a change in dietary habit upon maze learning ability in rats.

An experimental psychological study was undertaken to assess the effect of a change in dietary habit upon behavioural development, using as a laboratory animal male Wistar rats maintained on natural foods and a processed food. Forty male Wistar rats were weaned at 21 days of age and divided into two equal groups. Group 1 was fed natural food (pressed wheat, dried fish, peanuts, cabbage and soybeans) and group 2 was fed powdered food. At 68 days of age, the rats were tested in a T-maze. The results showed that Group 1 excelled with regard to T-maze learning.

Adaptive and remodeling changes in the fractured mandibular condyle after open reduction using the Kirschner pin.

Six cases of fracture of the mandibular condyloid process in which there was osteosynthesis using the Kirschner pin were followed radiographically for more than 1 year. Tracings were made to analyze the remodeling process. The clinical course of all patients was satisfactory, without functional disturbance or asymmetries of the mandible.

Skin incision parallel with skin cleavage lines for access to the fractured zygomatic arch.

In surgery of the fractured zygomatic arch the skin incision was placed parallel with the skin cleavage lines, directly over the zygomatic arch. The fracture site was exposed by blunt dissection of the subcutaneous tissue. Facial palsy may be predicted as a possible sequel to this incision. In fact, facial paresis occurred in 1/3 of the patients but it disappeared within 6 months. It appeared that the facial nerve was only damaged by stretching during the surgical procedure but was not severed by the incision. The postoperative scars presented no unsightly appearance, if the incision was placed completely parallel with the cleavage lines.

Life-threatening sublingual hematoma in a severely hemophilic patient with factor VIII inhibitor.

The management of a patient with Factor VIII inhibitor in whom a marked hematoma of the sublingual region developed is described. Administration of activated prothrombin complex concentrates and nasotracheal intubation with the fiberoptic laryngoscopy were used in the management of this patient.

Disseminated intravascular coagulation syndrome.

This paper reports a patient with malignant fibrous histiocytoma of the maxilla who developed DIC during the 12-month observation of the hemostatic course, and a case of squamous cell cancer of the tongue associated with post-operative DIC. The triggers in these 2 cases were malignant tumor, infection, shock and operation. Heparin and aprotinin were administered in both cases. Hemostatic improvement was obtained in case 2, but neither cases were cured. The etiology, diagnosis and treatment of DIC are discussed.

Multiple extractions in a patient with factor VII deficiency.

Multiple extractions were carried out in a patient with factor VII deficiency treated with prothrombin complex concentrate. Hemostasis and healing were completely satisfactory. The side effects of prothrombin complex concentrate are discussed.

Dental extraction in a patient with congenital deficiencies of factors V and VIII.

A case of combined congenital deficiencies of factors V and VIII is reported. The patient's right mandibular first molar was extracted and a combination of local hemostatic treatment and the transfusion of fresh plasma resulted in healing of the socket without further postoperative bleeding.

The importance of local hemostatic procedures in dental extractions and oral mucosal bleeding of hemophiliac patients.

Deficient coagulation factor replacement therapy is often indispensable for dental extractions and oral mucosal bleeding in hemophiliac patients. High concentrates are often infused in large amounts of volume, until complete hemostasis is achieved. Considering the various side effects of replacement therapy the volume infused should be reduced to a minimum. Several aspects associated with replacement therapy for the control of oral bleeding are studied. Our conclusion is that local hemostatic procedures are even more important than replacement therapy. The use of surgical packs and band retainers proved to be of benefit in this study.

Hemarthrosis of the temporomandibular joint in a patient with hemophilia B: report of case.

A case of hemophilia B with hemarthrosis in the TMJ, which led to pain and limitation of jaw movement, was successfully controlled by transfusion of Konyne.

Problems involved in grading the severity of hemophilia by test results.

Some problems involved in grading the severity of hemophilia were discussed. No definite correlation existed between the clinical severity of hemophilia and the results of coagulation tests (activity of deficient factors, whole blood clotting time, thromboplastin screening test). There was also no correlation between the presence or absence of oral bleeding or hemarthrosis and the test results. It was concluded that the clinical severity of the disease can be graded more reasonably on the basis of clinical hemorrhagic symptoms than according to the activity of deficient factors.

Mastocytosis in suckling mice.

In suckling mice injected intraperitoneally with mitomycin C on the 1st to 5th day after birth and sacrificed in the course of 24 or 48 h after injection, mastocytosis occurred in the oral mucosa membrane, skin of the trunk or extremities and bone marrow of extremities.