Evaluation of bone volume changes after sinus floor augmentation with autogenous bone grafts.

The aim of this study was to establish an objective method for quantitative evaluation of bone volume change after sinus augmentation. 11 sinuses in 9 patients were evaluated by computed tomography images taken before treatment (T0), and 3 months (T1) and at least 1 year (T2) after sinus augmentation. Based on the 3D digital subtraction technique, augmented bone images were extracted and bone volumes were calculated from voxel numbers of the extracted images. The mean augmented bone volumes at T1 and T2 were 2.46 cm3 and 1.85 cm3, respectively. These bone volume changes were statistically significant and the mean bone volume change ± SE was -24.8% ± 6.1%. Loss of augmented bone was observed in all except one of the patients. The correlation coefficient between bone volume change and elapsed time was -0.64, which was statistically significant and indicated that bone resorption progressed with elapse of time after sinus augmentation. The authors' method of analysis enabled visualization of augmented bone and objective assessment of bone volume change. Within the limited number of cases, the present investigation demonstrated a significant decrease in augmented bone volume between 3 and 23 months after surgery.

Assessment of 14 functional gene polymorphisms in Japanese patients with oral lichen planus: a pilot case-control study.

Oral lichen planus (OLP) is a refractory mucosal disease. Its pathogenesis is thought to involve immunologic and genetic alterations. To gain a better understanding of the genetic risk factors, the authors evaluated associations between 14 functional gene polymorphisms and OLP. 32 Japanese patients with OLP and 99 unrelated healthy Japanese controls were genotyped for 14 single nucleotide polymorphisms (SNPs) of genes that regulate host immune responses. Genotyping was performed with a modified version of the serial invasive signal amplification reaction. A trend towards over-representation of tumor necrosis factor receptor 2 (TNFR2) +587 G allele was found in the patients compared with the controls (allele frequency: P=0.049). The other 13 SNPs were unassociated with OLP. These results suggest that TNFR2 +587 gene polymorphism may be associated with susceptibility to OLP.

[Left ventriculoplasty for ischemic cardiomyopathy with a left ventricular aneurysm].

We report 3 cases of left ventriculoplasty (LVP). They were chosen according to classification of the preoperative left venticle (LV) shape; an apex type and anteroseptal type. We think that an apex type has an indication for a Dor operation and the treatment of an anteroseptal type should be chosen between the following 2 methods. One is an overlapping method. It has the advantage of having to use no intracardiac patch which would remain akinetic area. It is therefore suitable for relatively small LV aneurysms without involvement of the proximal diagonal branches. However, it has the disadvantage of having to cut some distal diagonal branches in order to perform the volume reduction. The other method is a septal anterior ventricular exclusion (SAVE) operation. It is suitable for larger LV aneurysms which involve the proximal diagonal branches due to its advantage of being able to perform the LVP without cutting the diagonal branches. However, it has the disadvantage of leaving an akinetic area that corresponds to the intracardiac patch. We believe that choice of the LVP method according to the preoperative LV shape will bring about a better postoperative LV function and shape.

Outbreak of human metapneumovirus detected by use of the Vero E6 cell line in isolates collected in Yamagata, Japan, in 2004 and 2005.

A number of epidemiological studies have shown human metapneumovirus (hMPV) to be one of the most important viral agents associated with acute respiratory infections in humans. However, due to the difficulty in growing the virus, all epidemiological studies of hMPV infection have been performed on the basis of the molecular method. Thus, the development of a cell line suitable for the isolation of hMPV from clinical specimens is a crucial step for further research. Using the Vero E6 cell line, which could be stably maintained for 1 month without passage or medium change, we succeeded in isolating 79 strains from 4,112 specimens obtained in Yamagata, Japan, in 2004 and 2005. The total isolation rate was 1.9% (79/4,112). The monthly distribution revealed that hMPV infections occurred between February and April in 2004 and throughout most of the year in 2005. Phylogenetic analysis indicated that subgenogroup B2 was predominant in 2004, whereas three subgenogroups, A2, B1, and B2, had cocirculated in 2005. Although multiple subgenogroups cocirculated in 2005, each individual subgenogroup strain was found to predominate at specific sites. An infectivity assay of hMPV strains also indicated that the infection efficiency in Vero E6 cells was better than that in LLC-MK2 cells. Finally, we found that Vero E6 cells are useful for the isolation of hMPVs and that this utility might aid further research into hMPVs beyond the epidemiological data shown in this study.

Clinical significance and usefulness of quantification of telomerase activity in oral malignant and nonmalignant lesions.

We quantified telomerase activity (TA) in patients with oral and maxillofacial malignant and nonmalignant lesions, and compared it with their clinical status and grade of malignancy. Fifty-two malignant and 52 nonmalignant lesions were analyzed. All malignant lesions were pathologically diagnosed as oral squamous cell carcinoma (OSCC). Normal gingival tissue served as a control. These specimens were obtained by biopsy or surgical resection, and stored at -80 degrees C until use. TA was quantified by a fluorescence-based TRAP method. TA levels ranged from 0.00 to 95.24 (average 33.24)U/microgP in 52 malignant lesions, and from 0.00 to 79.35 (average 11.91)U/microgP in 52 nonmalignant lesions (P < 0.0001). TA was detected in 96.2% of malignant and 65.4% of nonmalignant lesions. There was no relationship between TA levels and clinical stages or YK classification. However, under WHO classification, there were significant differences (P < 0.05) between Grades I and III or II + III. Among nonmalignant lesions, epithelial dysplasia showed a significantly higher TA level than that of oral lichen planus (P < 0.05) and other benign lesions (P < 0.0001). Oral lichen planus also significantly differed from other benign lesions (P < 0.05). These results suggest that TA is related to the histological grade of malignancy, and is also useful as a prognostic predictor for precancerous lesions and conditions.

Effect of local hyperthermia on metastases in oral squamous cell carcinoma.

In this experimental study, hamsters with oral squamous cell carcinoma (O-1N), which has a high potential for lymph node metastasis, received treatment with local hyperthermia. The effect of hyperthermia on regional lymph node metastases was examined pathologically. O-1N was heated twice, each session consisting of radiofrequency capacitive heating (13.56 MHz) for 40 min at 43 degrees C. Cervical lymph nodes were excised 14, 17, 21, and 28 days after heating and were examined histologically. Hamsters in the sham and control groups were killed on the same days and specimens were examined in a same manner. The incidence of lymph node metastasis was significantly lower in the hyperthermia group (36.4%) than in the sham (68.5%) and control (65.0%) groups (both P=0.02). The patterns of lymph node metastasis in the sham and control groups were more advanced than that in the hyperthermia group. The incidence of lymph node metastasis was very low (7.7%) in hamsters with no evidence of tumour after hyperthermia. On multivariate analysis, hyperthermia correlated with inhibition of cervical lymph node metastasis (P=0.02). Our findings suggest that local hyperthermia inhibits lymph node metastasis when the primary tumour responds histologically to treatment.

[Clinical result of thermochemoradiotherapy for advanced head and neck cancer].

Since 1986, we have applied thermochemo (CDDP) therapy combined with radiotherapy to 18 patients with 25 advanced and/or recurrent head and neck cancers (thermochemoradiotherapy: TCR). In this report, the effects of TCR were compared with those of radiochemotherapy (RC) without hyperthermia for 22 patients with 27 cancers before 1985 in our department. Thermochemotherapy was performed twice a week, for a total of 8.8 times on average. Three kinds of heating system were used: a radiofrequency system, a microwave system, and a RF interstitial system. In the TCR group, 11 lesions (44.0%) showed a complete response (CR), 12 lesions (48.0%) a partial response (PR), and 2 lesions (8.0%) no change (NC). Therefore, the total response rate was 92.0%. After treatment with only RC, 5 lesions (18.5%) showed a CR, 12 lesions (44.5%) a PR, and 10 lesions (37.0%) NC, giving a total response rate of 63.0%. There was a significant difference in the CR and total response rate between these two groups. Furthermore, the 5-year cumulative local control and survival rates in the TCR group were 68.2% and 44.4%, and in the RC group were 22.2% and 18.2%, respectively. There was a significant difference in the local control rate between these two groups. In conclusion, thermochemoradiotherapy is an effective strategy for patients with advanced head and neck cancers.

[5-FU concentration in the serum and the tumor tissue after administration of UFT 200 mg/day to patients over 80 years of age with oral cancer].

UFT was administered orally at a dosage of 200 mg/day, 2 times a day, to patients over 80 years of age with oral cancer. The concentration of 5-FU in the serum and tumor tissue, as well as the side effects, were investigated. The results were as follows: 1. The concentration of 5-FU in the serum peaked (0.017 to 0.066 microgram/ml) 1 or 2 hours after UFT administration. The concentration 8 hours after administration was relatively high (0.016 to 0.041 microgram/ml). 2. The 5-FU concentrations in the tumor tissues in 3 out of 5 cases were greater than 0.05 microgram/g, which is considered to be the effective level. The concentration tended to be higher with increased duration of administration. 3. A minor side effect, bone marrow dysfunction, was observed. No effect on the function of the liver or digestive system was observed.

[A case of polymyalgia rheumatica with excessive increase of rheumatoid factor].

A 76 year-old woman suffered from muscle pain and stiffness of acute onset in her shoulder girdle and pelvic girdle, which were followed by mild left temporal headache and transient arthralgia. Neither joint swelling nor sicca symptom was observed. Laboratory data showed high ESR (128 mm/hr), positive CRP (12.9 mg/dl), increased fibrinogen (485 mg/dl) and high titer of rheumatoid factor (RF) (RAHA x 640). Other autoantibodies examined were negative. Muscle enzymes and electromyogram were within normal limits. Joint X ray didn't reveal the finding suggestive of RA. After the treatment with prednisolone (PSL) 15 mg/day, clinical symptoms and laboratory data improved dramatically. Though she had excessive increase of RF (RAHA x 10240) during therapy, no recurrence of articular symptoms were recognized. She continues to be well with PSL 5 mg/day after 1 year 5 months from onset. As for polymyalgia rheumatica (PMR) followed by RA, the appearance or exacerbation of arthritis corresponding to the elevation of RF occurred in all previously reported 17 cases. Recurrence of arthralgia corresponding to the elevation of RF was not recognized in this case. In addition, Hunder et al reported that PMR with little or no observable joint swelling after several weeks of symptoms is unlikely to develope RA. Therefore, it is speculated that this case in unlikely to develope RA and assessment of arthritis corresponding to the elevation of RF is important to differentiate PMR and elderly-onset RA. This case of PMR is the 5th case with excessive increase of RF in Japan.

Effects of prostaglandin E1 on the cardiovascular response to tracheal intubation.

STUDY OBJECTIVE: To evaluate the efficacy of prostaglandin E1 in attenuating the hypertensive response to laryngoscopy and intubation. DESIGN: Controlled, comparative, and randomized study. SETTING: Induction of anesthesia for elective surgery at a university hospital. PATIENTS: Thirty normotensive patients (ASA physical status I) undergoing elective surgery divided into three groups. Each group consisted of ten patients. INTERVENTIONS: Anesthesia was induced with thiopental sodium 5 mg/kg intravenously, and tracheal intubation was facilitated with vecuronium 0.2 mg/kg. Either 0.3 micrograms/kg of prostaglandin E1, 0.6 micrograms/kg of prostaglandin E1, or saline (control) was injected 15 seconds before starting direct laryngoscopy (within 30 seconds), which was attempted 2 minutes after administration of thiopental sodium and vecuronium. MEASUREMENTS AND MAIN RESULTS: Patients receiving saline showed a significant increase in mean arterial pressure and rate-pressure product associated with tracheal intubation. These increases following tracheal intubation were significantly less in prostaglandin E1-treated patients than in the control group (p less than 0.05). CONCLUSIONS: A single rapid intravenous administration of prostaglandin E1 is a practical pharmacologic and safe method to attenuate the hypertensive response to tracheal intubation. The use of 0.6 micrograms/kg of prostaglandin E1 as a supplement during induction is recommended for reducing the pressor response to intubation on the basis of rate-pressure product and mean arterial pressure following intubation as an index.

Inhibitory effect of barbiturates and local anaesthetics on protein kinase C activation.

A calcium- and phospholipid-dependent protein kinase C subspecies purified from rat brain was inhibited by thiamylal, thiopentone, pentobarbitone, mepivacaine and bupivacaine. This was attributed to the inhibition of the activation process rather than to direct interaction with the active site of the enzyme. It is well established that unsaturated diacylglycerol markedly increases the affinity of protein kinase C for calcium ions. Kinetic analysis suggested that pentobarbitone brought about the inhibition by competing with the diacylglycerol diolein and that mepivacaine and bupivacaine competed with the phospholipid phosphatidylserine used in the assay. The possibility exists that the effects of local anaesthetics on the function of various tissues are due, in part, to an inhibitory action on protein kinase C.

Perioperative effect of methylprednisolone given during lung surgery on plasma concentrations of C3a and C5a.

Methylprednisolone or saline (placebo) solution was infused intravenously in 28 patients undergoing elective lobectomy for lung cancer. The state of the complement system during and after surgery and the effects of methylprednisolone on biologically active products of complement were studied by measurements of plasma C3a and C5a anaphylatoxins and leukocyte counts in peripheral blood perioperatively. In the placebo group plasma concentrations of C3a were significantly increased on postoperative days 1 and 2, whereas C5a had risen significantly 6 hours after surgery and on days 1 and 2. Methylprednisolone infusion during surgery eliminated the postoperative elevation of C3a and C5a. The postoperative leukocyte count in peripheral blood was higher in the methylprednisolone group than in the controls. The observations indicated that methylprednisolone may reduce the influx of leukocytes from peripheral blood into the airways by attenuating production of biologically active complements.

Continuous infusion of vecuronium in children.

The average dose of vecuronium required in children continuous infusion to attain a steady state block of 90% was determined. The electromyographic (EMG) response and mechanical response to supramaximal stimulation of the ulnar never recorded simultaneously, were significantly correlated in four children. The steady-state infusion rate requirement of vecuronium was 1.4 +/- 0.03 micro g/kg/min during 2% enflurane anesthesia and 3.1 +/- 0.03 micro g/kg/min during 1% halothane anesthesia. The spontaneous recovery time to 25% of the control by EMG during halothane and enflurane anesthesia was 12.6 +/- 1.1 and 10.3 +/- 1.5 min, respectively, after termination of the infusion. There was no cumulative effect after prolonged vecuronium infusion.

Eventration of the diaphragm in infants and children.

The study reviews 18 infants and children with eventration of the diaphragm who were treated over a period of eight years. The affected diaphragm and pulmonary tissue were examined by light and electron microscopy. The 18 patients, ranging in age from 10 days to 6 years, were divided according to Thomas' classification into a group with the congenital (10 patients) and a group with the acquired type (8 patients). Fifteen of these patients underwent surgery with diaphragmatic plication. On microscopic examination, biopsies of the lung showed atelectasis and pneumonia. These pathological changes became increasingly diffuse and severe with age. The diaphragm in patients with the congenital type of eventration was occupied by diffuse fibroelastic tissue. In patients with the acquired type, the cross-striated muscles of the diaphragm showed degenerative changes such as fragmentation, and interstitial fibrosis of the diaphragm became prominent with age. The results of this clinical study suggest that, in order to reduce the pathological changes in the lung, early surgical plication should be performed even in patients with the acquired type, if respiratory and digestive symptoms are noted.

[Clinical evaluation of imipenem/cilastatin sodium in the pediatric field].

Imipenem/cilastatin sodium (MK-0787/MK-0791) was evaluated for its safety and efficacy in 7 pediatric patients with infections. The clinical efficacy ratio was 100 percent. No side effect was observed except for elevations of S-GOT and S-GPT and eosinophilia in 1 patient. It may be considered that MK-0787/MK-0791 is a safe and useful antibiotic for the treatment of pediatric infections.

[Clinical study of SM-4300 in infectious diseases of pediatrics].

SM-4300, a new developed immunoglobulin preparation with ion-exchange treatment, was used intravenously for 12 infectious diseases. These 12 cases (under 10 years old) were including 4 sepsises, 3 pneumonias, 1 pyothorax, 1 ventriculitis, 1 purulent meningitis, 1 aseptic meningitis and 1 cellulitis. To evaluate the effect of SM-4300, 2 cases were excluded from evaluation because of blood transfusion or immediately death. Since antibiotics were used at the same time, it was surely difficult to evaluate the effect of SM-4300. In 10 cases, 2 cases were excellent effective, 4 cases were fairly effective and others were not effective. Including fairly effective cases, the rate of efficacy was 60%. In all cases, there were no significant side effects regarding clinical findings and laboratory examinations. SM-4300 may be available for severe infectious diseases with antibiotics therapy.