Three-dimensional computed tomography evaluation of postsurgical condylar displacement after mandibular osteotomy.

OBJECTIVE: The purpose of this study was to examine both condylar displacement of the temporomandibular joint after sagittal split ramus osteotomy with rigid osteosynthesis and intraoral vertical ramus osteotomy without osteosynthesis in patients with mandibular prognathism by means of three-dimensional computed tomography. STUDY DESIGN: In this pilot study, five patients treated with sagittal split ramus osteotomy and 5 patients treated with intraoral vertical ramus osteotomy were evaluated. A technique to superimpose a postoperative three-dimensional computed tomography image on its corresponding preoperative image was designed. Postoperative condylar displacement, rotation, and tilting were measured in three-dimensional computed tomography images. RESULTS: Within 3 to 6 months after surgery, changes in the inclination of the condylar axes were distinctly seen, although changes in the position of the condyles within the joints were minimal. In particular, outward rotation of the condylar long axes after intraoral vertical ramus osteotomy was a frequent finding. CONCLUSIONS: The three-dimensional computed tomography superimposition technique was a practical method of evaluating postsurgical condylar displacement after mandibular osteotomy.

Three year prospective, randomized evaluation of intraocular lens implantation through 3.2 and 5.5 mm incisions.

PURPOSE: To compare the long-term clinical results of two small incision cataract surgery procedures. SETTING: Seven centers in Japan. METHODS: Two hundred eyes were randomly assigned to receive a silicone intraocular lens (IOL) through a 3.2 mm incision or a poly(methyl methacrylate) (PMMA) IOL through a 5.5 mm incision. Except for incision size and implantation technique, the surgical methods were identical. Uncorrected and corrected visual acuity, keratometry, flare-cell intensity, specular microscopy, and neodymium:YAG (Nd:YAG) laser posterior capsulotomy rate were analyzed up to 3 years after surgery. RESULTS: Eyes in the 3.2 mm incision group had significantly better uncorrected and corrected visual acuity in the early postoperative period and lower aqueous flare intensity immediately after surgery, but these differences disappeared after the first postoperative month. However, surgically induced astigmatism was significantly less in the 3.2 mm incision group than in the 5.5 incision group throughout the study. The Nd:YAG laser capsulotomy rate was higher in the silicone IOL group (23.5% at 3 years postoperatively) than in the PMMA IOL group (18.4%) but the difference was not statistically significant. CONCLUSION: Smaller incision cataract surgery led to early recovery of visual function in the short term and less induced astigmatism in the long term.

Orthodontic treatment of an open bite patient with oral-facial-digital syndrome.

A case of oral-facial-digital syndrome was treated orthodontically. Characteristics of this case were mandibular protrusion with open bite. Occlusal stability after correction of this malocclusion was achieved with the uprighting of the posterior teeth, surgical reduction of the enlarged tonsils and highly attached tongue frenum, and oral functional training.

Tenascin: growth and adhesion modulation--extracellular matrix degrading function: an in vitro study.

Tenascin (TN), a recently characterised extracellular matrix protein, largely confined to the process with the development of embryo in areas of epithelial-mesenchymal interactions and in areas where there are morphogenetic movements and tissue patterning, has a highly restricted expression in adult tissues. The expression of TN is enhanced in a variety of human neoplastic lesions. However, function(s) and molecular mechanisms of enhanced expression in neoplastic lesions remain unclear. We employed human tongue carcinoma cells (SCCKN), human salivary gland adenocarcinoma cells (SGT-1), normal mouse embryonic fibroblasts (NIH3T3-3) and K-ras-2 transformed fibroblasts (Cle-H3) in an in vitro study to elucidate the biological roles of TN. In in vitro studies, all the cell lines examined had enhanced secretion of TN in the presence of transforming growth factor-beta in a dose-dependent manner and TN itself was found to possess a growth-enhancing activity. Moreover, studies on adhesion of the cell lines on coated substrates of fibronectin (FN), laminin (LN), tenascin (TN), TN/FN and TN/LN showed that all the cells adhere and spread well on FN and LN. However, on TN they attach poorly and remain rounded. The relative concentrations of TN and FN affected the cellular adhesion and morphology. In SCCKN and SGT-1, but not in NIH3T3 and Cle-He3 fibroblasts, a higher concentration of TN inhibited cellular adhesion on fibronectin, suggesting that cells attach poorly on TN, it may interfere with the action of fibronectin, and the relative concentrations of TN, FN or LN may affect cellular adhesion and morphology which may differ in different cell types. When TN was added in the growth medium of exponentially growing cells, the cells lost their cell to cell contact and were seen to be separating. The presence of these extracellular matrix proteins were further tested to determine whether they could modulate the secretion of proteolytic enzymes responsible for extracellular matrix degradation by tumour cells, when the neoplastic cells but not the non-neoplastic cells grown on FN/TN substrate showed positive immunofluorescence for collagenase. FN, LN or TN alone did not induce collagenase in the tumour cells. If the same is true in vivo, although a number of factors and interactions may implicate the ultimate outcome, the enhanced expression of TN in neoplastic lesions may have potential implications for tumour growth, differentiation, cellular adhesion, invasion and metastasis.

Comparative study of intraocular lens implantation through 3.2- and 5.5-mm incisions.

PURPOSE: To prospectively and comprehensively compare the clinical results of two small-incision cataract surgery procedures, silicone intraocular lens (refractive index of 1.46) implantation through a 3.2-mm incision and polymethylmethacrylate intraocular lens implantation through a 5.5-mm incision. METHODS: Two hundred eyes with cataract randomly were assigned to either procedure. Except for incision size, identical surgical methods were used in every case. Data on uncorrected and corrected visual acuity, keratometry, corneal topography, flare-cell measurement, fluorophotometry, specular microscopy, glare disability measurement, and photographic examination of intraocular lens decentration were analyzed up to 6 months after surgery. RESULTS: Eyes in the 3.2-mm incision group displayed significantly better uncorrected and corrected visual acuity in the early postoperative period, lower aqueous flare intensity and cell counts immediately after surgery, less operatively induced astigmatism throughout the study period, and less corneal topographic changes taken 3 months after surgery. No significant between-group differences were noted for other parameters. Complications in the two groups were few and comparable. CONCLUSION: Both procedures of small-incision cataract surgery offered satisfactory clinical results, but 3.2-mm incision cataract surgery allowed significantly earlier recovery of visual function and better preservation of corneal shape.

Multiple symmetrical lipomatosis: no longer just a Mediterranean disease?

Multiple symmetrical lipomatosis is a rare condition, of which the etiology remains unclear. Most reported cases have been from the Mediterranean countries, and it is generally thought of as a disorder characteristic of that region. However, there have been 11 cases reported in Japan since 1978, suggesting that this condition is no longer confined to Mediterranean countries.

Effects of OK-432 on in vitro secondary responses of the non-adherent cells to IL-2 and OK-432 in cancer patients without tumor burden.

We examined the effect of OK-432 intracutaneous injection on the in vitro responses of non-adherent cells to IL-2 and OK-432, along with changes in lymphocyte subpopulations, in early cancer patients who underwent surgery. We found that 1) repeated injections of OK-432 resulted in an enhancement of LAK activity, the peak of which was seen between 7 and 10 days after the first administration, 2) this augmentation of LAK activity was not associated with changes in lymphocyte subpopulations CD8+ CD11- and CD8+ CD11+ phenotypes, and 3) the cytotoxic activity of lymphocytes stimulated in vitro with OK-432 did not show a definite change in specific pattern after in vitro OK-432 treatment. These findings indicate that repeated injections of OK-432 over a period of a week effectively enhanced LAK activity.

A case of paraneoplastic retinopathy.

A 62-year-old male had undergone lung lobectomy for adenocarcinoma which was discovered after visual loss from paraneoplastic retinopathy. He had photopsia, decreased visual acuity, ring scotoma, extremely reduced electroretinogram and narrowing of retinal artery. Fluorescein angiography revealed progressive diminution of peripheral retinal blood flow, slow perfusion and staining of venules. The surgical removal of the tumor resulted in slight recovery of visual acuity and decrease of photopsia and photophobia, which recurred after 8 months. He has been under steroid therapy to prevent the progression of the disease for 10 months.

Effect of OK-432 on cytotoxic activity in cancer patients without tumor burden.

The present study was designed to determine the optimal therapeutic protocol for OK-432, a streptococcal preparation, and to clarify the kinetics of various immunological parameters following intracutaneous administration of OK-432 in 39 disease-free postoperative patients with early cancer. These patients were randomly divided into 4 groups according to the dose (1KE or 5KE) and the frequency of administration (one or 3 times every other day) of OK-432. NK activity 3-4 days after the first injection increased significantly in patients whose pretreatment baseline activity was below the lower level of normal values (60 LU) in all study groups (P < 0.05). The elevation of post-therapeutic NK activity lasted for 2 weeks in the group of patients given repeated injections. The serum content of cytotoxic activity against L-M cells increased significantly after the injection of OK-432 at doses of more than 5 KE doses (p < 0.05). These findings suggest that repeated injections of OK-432 over a period of a week have important immunotherapeutic results.

Thiazolo[4,5-d]pyrimidine nucleosides. The synthesis of certain 3-beta-D-ribofuranosylthiazolo[4,5-d]pyrimidines as potential immunotherapeutic agents.

Novel analogues of the naturally occurring purine nucleosides were synthesized in the thiazolo[4,5-d]pyrimidine ring system to determine the immunomodulatory effects of insertion of a sulfur atom in place of nitrogen at position 7 of the purine ring. In particular, 5-amino-3-beta-D-ribofuranosylthiazolo[4,5-d]pyrimidine-2,7(3H,6H) -dione (7, guanosine analogue), 3-beta-D-ribofuranosylthiazolo[4,5-d]pyrimidine-2,5,7(3H,4H,6H) trione (8, xanthosine analogue), 3-beta-D-ribofuranosylthiazolo[4,5-d]pyrimidine-2,7(3H,6H)-dione (10, inosine analogue), and 7-amino-3-beta-D-ribofuranosylthiazolo[4,5-d]pyrimidin-2(3H)-one (32, adenosine analogue) were prepared, as well as the 8-mercaptoguanosine (14) and 6-mercaptoguanosine (17) analogues. Single-crystal X-ray studies confirmed the structural assignment of 17 and 32 as having the beta-configuration with the site of glycosylation at N3. The nucleosides were evaluated for their ability to potentiate various murine immune functions in direct comparison to the known active agents 8-bromoguanosine (1), 8-mercaptoguanosine (2), and 7-methyl-8-oxoguanosine (3). Two of the guanosine analogues, 7 and 14, were found to exhibit significant immunoactivity relative to the positive control compounds (1-3), while the adenosine, inosine, xanthosine, and 6-mercaptoguanosine analogues were devoid of activity. Compound 7 exhibited greater immunoactivity than any of the other guanosine analogues and derivatives in all test systems. Specifically, 7 was shown to be about twice as potent as 3 in the murine spleen cell mitogenicity assay. In addition, treatment with 7 produced about a 4-fold increase in natural killer cell cytotoxicity, while treatment with 3 afforded a 3-fold increase over controls. Finally, 7 provided excellent protection (92% survivors compared to 0% for placebo controls) against Semliki Forest virus in mice. Induction of interferon may account for the major mode of action of these guanosine analogues.

[A case of carcinoma of the ileum diagnosed as an adenocarcinoma].

A 65-year-old female with a history of cancer of the uterine body and a strong family history of cancer, was admitted with abdominal pain and anemia. During roentgenographic examination of the small intestine, a tumor was recognized about 25 cm from the ileocecal valve, leading us to suspect a carcinoma of the ileum. A colonoscopy demonstrated a constricting, ulcerated lesion, with a round wall: and a subsequent biopsy proved that the patient had a moderately differentiated adenocarcinoma. At surgery, a tumor, measuring 52 x 50 mm, was found to have infiltrated the serosa with a metastasis to the mesenteric lymph node.

A case of the pathogenesis of choledochocele in relation to dysfunction of the sphincter of Oddi.

A 47-year-old woman was admitted for evaluation of pain in the right upper quadrant of the abdomen. Seventeen years previously, she had undergone cholecystectomy for cholelithiasis. Endoscopic retrograde cholangiopancreatography (ERCP) showed a cystic dilatation of the terminal portion of the common bile duct (CBD) protruding into the duodenal lumen and delaying the drainage of contrast medium. In this patient the CBD and the pancreatic duct appeared to be unimportant in the formation of the cyst. Repeated changes in the radius of the cyst suggested dysfunction of the ampullary component of the sphincter of Oddi, with maintenance of normal function of the common duct component. The pathogenesis of the choledochocele in this patient is discussed in relation to dysfunction of the sphincter of Oddi. In addition, 2 criteria for the diagnosis of choledochocele by ERCP are proposed: [1] cystic dilatation of the terminal portion of the CBD protruding into the duodenal lumen, and [2] absence of the narrow segment of the CBD.

[Factors on delayed recovery of otitis media with effusion in children--clinical and bacteriological study].

The resolution of middle ear effusions (MEE) of children with otitis media with effusion (OME) who underwent myringotomy for the bacteriological examination was analyzed in terms of the culture results and the clinical features. The present study consisted of 193 children (258 ears), and the MEE from 77 ears (30%) were culture positive and the respiratory pathogens were detected from 44 ears (17%). Each child was then assigned to receive either a more than two-week course of antibiotics, cefaclor (CCL) or not. At one month following entry, 53 (55%) out of 97 ears in CCL-treated group were effusion-free compared with 31 (40%) out of 78 ears in the control group (P less than 0.05). In the control group, the resolution of MEE was significantly poor in the recurrent cases and the cases with pathogen positive-MEE. The presence of accompanying diseases such as adenoid vegetation, chronic sinusitis and allergy, however, was not related to the resolution of MEE. On the other hand, the cure rate of the cases with pathogen positive-MEE and recurrent cases in the CCL-treated group showed significant improvement. Furthermore, the cases accompanying adenoid vegetation and chronic sinusitis tended to become effusion-free after the antibiotic treatment. Therefore, the persistent bacterial infection in the middle ear and/or surrounding organs such as adenoid plays possibly an important role in the delayed recovery of OME. Antibiotics treatment could increase, to some extent, the resolution of MEE in cases with OME.

Gas permeability of round window membrane.

The perilymphatic oxygen tension in the scala tympani was measured with a polarographic technique after various gases were insufflated into the middle ear cavity of 7 guinea pigs. Pure oxygen, insufflated into the middle ear cavity, easily permeated the round window membrane and elevated the perilymphatic oxygen tension. Oxygen transport to the inner ear, other than by the inner ear vessels, was confirmed. The inner ear function may partially be maintained by oxygenation through this route.

Evaluation of prophylactic postoperative 131I therapy for extended differentiated carcinoma of the thyroid gland.

Varying survival rates have been reported for differentiated carcinoma of the thyroid gland. The rate, however, does progressively decrease over a longer period of time than the usually reported five-year survival rates. Significant local invasion outside the thyroid capsule and of blood vessels yields a poorer prognosis, and mortality is largely attributed to distant metastasis. To improve the long-term survival rate, 1) sharp dissection with ample safety margin including resection of the neighboring organs, 2) reconstruction of the sacrificed organs, if possible, and 3) postoperative prophylactic radioiodine therapy, were adopted for invasive well-differentiated carcinoma for a period of 10 years. Of the 191 well-differentiated carcinomas operated on, in a series of 486 consecutive thyroid operations, 33 patients underwent this prophylactic radioactive iodine therapy (dose amount up to 300 mCi) following ablative surgery including, in several patients, mediastinal dissection. Periodical whole body survey by sodium iodide 131I showing no signs of recurrence up to five years except in three patients indicating two suspected lung metastasis and one death from bone metastasis, demonstrated that this is a promising method for the treatment of invasive well-differentiated carcinoma of the thyroid gland, although further long-term analysis is required.

Laryngeal reconstruction by free flap transfer.

In the two cases reported herein, a laryngeal cavity was successfully reconstructed with a free flap, using microvascular anastomoses. The revascularized free flap contributed significantly to the maintenance of a patent airway and to the reproduction of an appreciable voice. Our experiences with these laryngeal reconstructions encourage us to try to expand the application of free flaps for reconstructions after head and neck cancer surgery.

Subtotal pharyngolaryngectomy conservation surgery for carcinoma of sinus pyriformis extending toward the larynx.

In newly developed surgery for pyriform sinus tumor extending toward the larynx, the supraglottic portion of the larynx and the vertical half of the larynx on the tumor side are included in the area of resection. The arytenoid and cricoid cartilages on the tumor side and the vertical half of the hypopharyngeal wall are resected. Three out of seven patients remain cured at the end of 5 years and this ratio is the same as that for total pharyngolaryngectomy for pyriform sinus tumor. The resulting voice is somewhat hoarse, however, verbal communication is not remarkably affected. It is concluded that in surgical repair for pyriform sinus tumor extending toward the larynx, subtotal pharyngolaryngectomy is the procedure of choice to preserve the laryngeal function and anticipate reasonable prospects for a cure.