Functional outcomes and patient satisfaction after vascularized osteocutaneous scapula flap reconstruction of the mandible in patients with benign or cancerous tumours.

Pre- and postoperative longitudinal assessment of oral functions including masticatory force, masticatory ability with solids, speech intelligibility, and subjective satisfaction was conducted for patients who underwent vascularized osteocutaneous scapula flap reconstruction after mandibulectomy. Postoperative changes in oral function and patient satisfaction were examined in relation to tumour type (i.e., cancerous vs. benign). A change in masticatory force was associated with a reduction in the number of occlusal support zones after surgery and clearly differed by tumour type. Despite all patients showing reduced masticatory force postoperatively, all were satisfied with the improvements in eating and chewing, which were greater in patients with benign tumours than in those with cancerous tumours. Although both groups of patients expressed satisfaction with the aesthetic appearance after surgery, patients with cancerous tumours were more satisfied. However, both groups showed decreased speech intelligibility scores and lower satisfaction with speech after surgery. Preoperative support in the form of reassurance and helping to alleviate anxiety about postoperative appearance would be beneficial for all patients, with additional support provided based on the specific tumour type.

Perineural spread of adenoid cystic carcinoma in the oral and maxillofacial regions: evaluation with contrast-enhanced CT and MRI.

OBJECTIVES: The objective of this study was to compare the accuracy of contrast-enhanced CT (CECT) and contrast-enhanced MRI (CEMRI) in the detection of perineural spread (PNS) of adenoid cystic carcinoma (ACC) in the oral and maxillofacial regions. METHODS: This study consisted of 13 ACCs from 13 patients, all of which were histopathologically diagnosed. Both CECT and CEMRI were performed in all patients before the treatment. The images of each patient were retrospectively evaluated for the detection of PNS. The definitions of PNS included abnormal density/signal intensity, contrast enhancement or widening of the pterygopalatine fossa, palatine foramen, incisive canal, mandibular foramen and mandibular canal, and enlargement or excessive contrast enhancement of a nerve. RESULTS: 11 out of 13 cases were proven to exhibit PNS histopathologically. 8 of the 11 cases for which PNS was histopathologically proven exhibited PNS on MR images. Six of the eight cases for which PNS was exhibited on MR images also exhibited PNS on CT images. The sensitivity, specificity and accuracy for the detection of PNS were 55%, 100% and 62% on CT images and 73%, 100% and 77% on MR images, respectively. Although the accuracy of PNS on MR images was slightly superior to that on CT images, there were no statistically significant differences between the detection of PNS on CT images and on MR images. CONCLUSIONS: CT and MR images are equally useful for the detection of PNS of ACC in the oral and maxillofacial regions.

Pathologic and imaging findings of an oncocytoma in the deep lobe of the left parotid gland.

Oncocytoma is a rare salivary gland tumour consisting of oncocytes with many hyperplastic mitochondria. It usually occurs in the parotid gland. Because the features of oncocytoma resemble those of other benign and low-grade-malignant salivary gland tumours, clinical diagnosis is often challenging. This report presents the pathologic and imaging findings of an oncocytoma arising in the deep lobe of the left parotid gland in a 66-year-old man. Oncocytoma was diagnosed on the basis of histological, magnetic resonance imaging, and scintigraphic findings. The tumour showed accumulation of technetium-99m pertechnetate and decreased signal intensity on both T1- and T2-weighted magnetic resonance images.

[Telomerase activity in oral squamous cell carcinoma and leukoplakia].

Telomeres, the physical ends of eukaryotic chromosomes, are important to stabilize the chromosome and have a unique simple repetitive DNA sequence, TTAGGG in humans. In most normal somatic cells, telomere length becomes 50-100 bp shorter with every cell division, and the cells finally go into senescence, while most cancer cells have been reported to maintain the length and thus are immortalized. Telomeres are replicated by a special transcriptase, called telomerase, which is composed of a template RNA (hTR) and at least two component proteins: hTERT (hEST 2/hTRT) and hTEP 1 (hTLP 1/hTP1). In the present paper, I examined the status of telomerase activities in oral squamous cell carcinomas (OSCCs), precancerous lesions, and also cell lines established from OSCCs, by using a non-radioactive PCR-based TRAP (telomeric repeat amplification protocol) assay. Telomerase activities were detected in 23 of 30 OSCCs, 8 of 17 leukoplakias, 0 of 5 normal tissues, and in 8 of 8 OSCC cell lines and 0 of 5 normal human keratinocyte cultures. These results indicated that telomerase activity might have some association with carcinogenesis and might be used as a tumor marker in OSCC.

Relationship between intracellular Ca2+ store and protein kinase C in agonist-induced contraction of hypertensive rat aortae.

The roles of intracellular Ca2+ store and protein kinase C (PKC) in vascular contractile responses independent of Ca2+ influx were studied using aortic rings from spontaneously hypertensive rat (SHR) and Wistar-Kyoto rat (WKY). The functional sizes of agonist-sensitive intracellular Ca2+ store were estimated as the peak response to agonist after PKC inhibition with calphostin C (Cal-C), a PKC inhibitor. The participation of PKC in 5-hydroxytryptamine-, phenylephrine-, and endothelin-1 (ET-1)-induced contractions in aortae of SHR was equal to, or greater than that in WKY. In contrast, compared with WKY, SHR aortae possessed a greater size of endothelin-1-sensitive Ca2+ store, a similar size of 5-hydroxytryptamine-sensitive Ca2+ store, and a smaller size of phenylephrine sensitive Ca2+ store. Based on these data, both PKC activation and functional size of intracellular Ca2+ store differ between SHR and WKY and these differences are selective among agosists.

A case report of substernal goiter.

A case of substernal goiter is reported. A 78-year-old female was admitted to our hospital with no symptoms. Chest roentgenography on admission showed that a mass of 3 by 5 cm in size with calcification located in the substernal region. Computed tomography of the chest and aortography revealed that the mass was attached to the trachea, but the connection to the great vessels was not clear. Pathological findings of the incisional biopsy specimen showed thyroid tissue with no evidence of malignancy. Our clinical diagnosis was substernal goiter. Surgery was not carried out in this case, based on the literature. Surgery is indicated in case of malignancy or in cases with severe illness such as respiratory disorder and superior vena cava syndrome.

Transoesophageal Doppler echocardiographic measurement of cardiac output by the mitral annulus method.

OBJECTIVE: To compare cardiac output measured by the transoesophageal Doppler and thermodilution techniques. DESIGN: Prospective direct comparison of paired measurements by both techniques in each patient. SETTING: Intensive care unit in a cardiovascular centre. PATIENTS: 65 patients after open heart surgery (mean (SD) age 53 (12) years). INTERVENTIONS: Cardiac output was measured simultaneously by the transoesophageal Doppler and thermodilution techniques. Cardiac output was measured again after a mechanical intervention or volume loading. RESULTS: The limits of agreement were -2.53 to +0.83 1.min-1 for cardiac output measured by the Doppler and thermodilution techniques. This suggests that the Doppler method alone would not be suitable for clinical use. The second measurement of cardiac output by thermodilution was compared with cardiac output estimated from the first and second Doppler measurements and the first thermodilution measurement. The limits of agreement (-0.55 to +0.51 1.min-1) were good enough for clinical use. CONCLUSIONS: After cardiac output had been measured simultaneously by both the Doppler and thermodilution techniques, subsequent transoesophageal Doppler alone gave a clinically useful measurement of cardiac output.

Role of sarcoplasmic reticulum in the contractile function of vascular smooth muscle as studied by 2,5-di-(tert-butyl)-1,4-benzohydroquinone.

The effects of 2,5-di-(tert-butyl)-1,4-benzohydroquinone (tBuBHQ), a potent selective inhibitor of hepatocyte endoplasmic reticulum Ca(2+)-ATPase, were functionally examined in rat aorta in order to assess whether tBuBHQ also acts as a Ca2+ pump inhibitor of sarcoplasmic reticulum (SR) in vascular smooth muscle. tBuBHQ elicited a slowly developing and gradually decreasing contraction which was dependent on extracellular Ca2+. We utilize the phenylephrine (PE)-induced transient contractile response in Ca(2+)-free medium as an indirect index on the status of intracellular Ca2+ store. When preparations, depleted of their PE-sensitive Ca2+ store, were allowed to replete their stores in Ca(2+)-containing medium, a sustained contraction in tBuBHQ-treated preparations was observed, whereas in untreated control preparations, readministration of Ca2+ elicited no contraction, or occasionally a weak, transient contraction. In control tissues, subsequent application of PE in Ca(2+)-free medium after Ca2+ loading resulted in full restoration of the transient contraction to PE; but such a transient contraction was not observed in the presence of tBuBHQ. These results indicated that the sequestration of Ca2+ into the PE-sensitive pool was inhibited by tBuBHQ. We also assessed effects of tBuBHQ on phentolamine-induced relaxation in PE-precontracted tissues in Ca(2+)-containing medium. A slower rate of relaxation was observed in preparations treated with tBuBHQ. In conclusion, our findings are consistent with the hypothesis that tBuBHQ acts as a SR Ca2+ pump inhibitor, interfering with effective refilling of PE-sensitive intracellular Ca2+ stores.

[Validation of Doppler arterial flow in humans].

A method of measuring volumetric flow in human arteries with pulsed Doppler technique was developed. Doppler flowmetry was assessed in 11 adult patients whose admission-diagnoses included aneurysm of the aorta or dissections. During surgery, regional blood flows of the left common carotid artery, terminal aorta, common iliac artery, external iliac artery or common femoral artery were measured by Doppler method and electromagnetic flowmeter. Eighty four arterial flow determinations were obtained from the 11 patients studied. On comparison of simultaneous electromagnetic and Doppler measurements of blood flow, an excellent correlation (r = 0.93) was found between the two methods. The slope of the regression line was 0.587. Regional blood flow was measured with Doppler flowmetry in another 9 patients. The values of the left common carotid, celiac, superior mesenteric and terminal aortic flows were 251 +/- 62, 608 +/- 399, 687 +/- 381, 783 +/- 324 ml.min-1, respectively. This method provides an easy, reliable way of measuring regional blood flow.

Effects of intraaortic balloon pumping on mitral flow dynamics in patients with coronary artery bypass operations.

We evaluated the improvement in left ventricular function in 26 patients after coronary artery bypass grafting who were treated with intraaortic balloon pumping (IABP). Mitral flow velocity-time integral in the rapid filling phase (IntR) and that in the atrial contraction phase (IntA), the sum of IntR and IntA (IntR+IntA), and the ratio of IntA to IntR (IntA/IntR) were calculated with patients on and off balloon pumping (IABP ON-OFF test). IABP increased IntR and IntR+IntA, decreased IntA/IntR, and did not change IntA, suggesting that a decreased afterload or augmented coronary perfusion improves left ventricular relaxation. When the balloon inflated on every other beat (IABP 1:2 test), IntR and IntR+IntA increased without balloon assist, IntA/IntR decreased off IABP, and IntA did not change. The afterload reduction or augmented coronary perfusion on the previous beat with IABP might help ventricular filling on the next beat without balloon assist. A drastic decrease in IntR after IABP stopped indicated the need to continue IABP. Since the change in IntR during IABP ON-OFF test was significantly correlated with that in IntR during IABP 1:2 test, the change in IntR during IABP 1:2 test could help to predict the optimal time of weaning.

[Surgical decisions for active infective endocarditis in patients with acute neurological complications].

The surgical management of 7 patients with active infective endocarditis and recent (within 16 days) neurological injury was presented. All patients had preoperative computed tomographic scans which revealed no evidence of intracranial hemorrhage and underwent successful corrective cardiac surgery. In the early postoperative period, 4 patients died of cerebral hemorrhage, subarachnoid hemorrhage, or progression of cerebral edema. Two of the 3 surviving patients showed no aggravation of cerebral infarcts postoperatively. In the remaining surviving patient, intracerebral mycotic aneurysms were resolved spontaneously after postoperative antibiotic therapy, although new cerebral hemorrhage, a complication of emboli, occurred after open heart surgery. The results of this study indicated that 1) cerebrovascular complications were the causes of the 4 deaths in this series, and 2) although heparinization during open heart surgery may result in intracerebral hemorrhage from mycotic aneurysm or infarction, early surgical intervention after recent cardiogenic embolic strokes may save patients with minor cerebral infarcts.

[Influences of intra-aortic balloon pumping on peripheral hemodynamics].

The influences of intra-aortic balloon pumping (IABP) on peripheral dynamics were assessed by Doppler echocardiography. The subjects were 20 patients requiring IABP support, postoperatively, to control low cardiac output state. The flow velocity integral in systole (Int S) and that in diastole (Int D) were measured from left common carotid, superior mesenteric, and terminal aortic flow pattern, and the sum of Int S and Int D (Int S + Int D) was calculated with and without balloon pumping. 1) IABP increased cardiac output significantly (p less than 0.01). 2) Common carotid flow: IABP increased Int S significantly (p less than 0.01), but neither Int S nor Int S + Int D changed significantly with IABP. 3) Superior mesenteric flow: IABP increased Int D significantly (p less than 0.01), but both Int S and Int S + Int D remained unchanged with IABP. 4) Terminal aortic flow: None of Int S, Int D and Int S + Int D changed significantly with IABP. These results suggest that the carotid area can receive much of the increase in cardiac output in systole with IABP, and that the superior mesenteric area can receive much of the volume of blood displaced in the aorta by balloon inflation in diastole.

[Influences of intra-aortic balloon pumping on superior mesenteric flow dynamics].

The influences of intra-aortic balloon pumping (IABP) on arterial flow of the superior mesenteric artery were assessed by Doppler echocardiography. The subjects were 13 patients postoperatively, requiring IABP support to control low cardiac output state, in which distal aspects of balloons were distal to the superior mesenteric artery. Superior mesenteric flow velocity integral in systole (IntS) and that in diastole (IntD) were measured from superior mesenteric flow pattern, and the sum of IntS and IntD (IntS + IntD) was calculated ON and OFF balloon pumping (IABP ON-OFF test). The same parameters were obtained with balloon inflating on every other beat (IABP 1:2 test); the cardic cycle with balloon assist was defined as "1:2 ON", and that without balloon assist was defined as "1:2 OFF". 1) IABP ON-OFF test. IABP increased IntS from 7.07 +/- 2.56 cm to 9.20 +/- 3.19 cm (p less than 0.05), IntD from 3.00 +/- 1.18 cm to 3.62 +/- 1.40 cm (p less than 0.05), and IntS + IntD from 10.07 +/- 3.48 cm to 12.82 +/- 4.04 cm. Cardiac output increased from 3.89 +/- 1.34 l/min to 4.24 +/- 1.64 l/min with IABP support. The increments in IntS, IntD and IntS + IntD with IABP are attributed, to a large extent, to an increase in cardiac output. 2) IABP 1:2 test. Without balloon inflation, IntS increased (1:2 ON; 7.16 +/- 2.91 cm, 1:2 OFF; 8.41 +/- 3.30 cm, p less than 0.05), and IntD decreased (1:2 ON; 3.51 +/- 1.60 cm, 1:2 OFF; 2.33 +/- 1.25 cm, p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

[Secondary hypothermia with brain tumor in an elderly woman and the circadian rhythm of body temperature].

An elderly case of secondary hypothermia associated with brain tumor was reported. An 84-year old woman developed hypothermia. Although her rectal temperature remained below 37 degrees C, the circadian rhythm of rectal temperature was preserved. Brain computerized tomography (CT) and brain magnetic resonance imaging (MRI) revealed a solitary brain tumor involving the hypothalamus. It appears that her hypothermia may not be due to inability to thermoregulate but to stem from her abnormal target temperatures. Body temperature is normally controlled at around 37 degrees C, but in this patient thermoregulation might have been reset at a lower temperature.

[Effects of intra-aortic balloon pumping on mitral flow dynamics after aortocoronary bypass surgery].

Improvement in left ventricular function following intra-aortic balloon pumping (IABP) in 15 patients (aged 51 to 86 years) after coronary artery bypass grafting was evaluated. Using transesophageal atrial echocardiography, the mitral flow velocity integrals in the rapid filling phase (IntR) and in the contraction phase (IntA) were measured from transmitral flow patterns, and the sum of IntR and IntA (IntR + IntA), and the ratios of IntA to IntR (IntA/IntR) were calculated for ON and OFF states of balloon pumping (IABP OFF test). The same parameters were determined during 1:2 assist balloon pumping (IABP 1:2 test); the cardiac cycle with balloon assist was defined as "ON", and that without balloon assist as "OFF". 1. IABP OFF test: IABP increased IntR from 6.4 +/- 1.6 cm to 7.6 +/- 1.9 cm (p less than 0.01), suggesting that a decreased afterload improves left ventricular relaxation. IntA did not change with balloon assist (ON 3.5 +/- 1.2 cm, OFF 3.7 +/- 1.2 cm). IntR + IntA increased from 10.0 +/- 2.0 cm to 11.1 +/- 2.4 cm during IABP (p less than 0.01). IABP reduced the IntA/IntR from 0.62 +/- 0.25 to 0.50 +/- 0.20 (p less than 0.01). The increment in the IntA/IntR without IABP suggests that impaired diastolic filling of the left ventricle due to an increased afterload may be compensated for by enhanced left atrial contraction.(ABSTRACT TRUNCATED AT 250 WORDS)

[Brain function and blood flow velocity in the middle cerebral artery in subarachnoid hemorrhage: evaluation with multimodality evoked potentials (MEPs) and transcranial Doppler (TCD) ultrasound].

Brain dysfunction and blood flow velocity changes in the middle cerebral artery (MCAFV) were studied in 59 patients with ruptured cerebral aneurysms presenting subarachnoid hemorrhage. Brain function and blood flow velocity were evaluated by multimodality evoked potentials (MEPs) consisting of ABR, SEP and VEP as reported, and transcranial Doppler (TCD) ultrasound. The abnormality on MEPs were graded into 4 grades. Nearly normal, mildly abnormal, moderately abnormal and severely abnormal. The results on MEP study were compared with clinical Hunt and Hess (H. H) grade or Fisher's CT group of subarachnoid hemorrhage in 44 patients. MCAFV was measured in 15 patients and mean velocity as well as CO2 reactivity and effect of head elevation were studied. Control value of MCAFV was 64 +/- 13 cm/sec in 50 healthy adults. CO2 reactivity was determined by K values obtained from the modified formula of cerebral blood flow by Olesen et al. MEP grade in H. H grade III and IV patients showed, on admission, variations in their grades in comparison with those in H. H grade I II and V patients. There was no definite correlation between the abnormality in MEPs and the degree of subarachnoid hemorrhage in Fisher's group 3 and 4 patients. When the surgical results in early and late operation in H. H grade III and IV patients were compared, it was shown that the outcome was favourable in early operated patients of H. H grade III if initial MEP grades were between I-III.(ABSTRACT TRUNCATED AT 250 WORDS)

Differentiation of disseminated superficial actinic porokeratosis from the superficial disseminated eruptive form of porokeratosis of Mibelli.

Two cases of porokeratosis are reported here, one of which can be classified as the superficial disseminated form of porokeratosis of Mibelli and the other as disseminated superficial actinic porokeratosis. The relationship between these two diseases is discussed briefly.

[The penetration of cefoperazone into the cerebrospinal fluid in patients on acute or chronic stage].

Cefoperazone (CPZ) was administered to 10 patients with cerebrovascular disturbances at acute and chronic phases to investigate its passage into the cerebrospinal fluid. The antibiotic was administered at dosages of 1 g and 2 g to patients in the acute phase to examine the dose-dependency. The results obtained are summarized as follows: 1. Serum concentrations Peak values of CPZ were 46.9 +/- 4.42 microgram/ml in acute phase patients in 1 g dosage group (acute group 1), 253.1 +/- 63.2 micrograms/ml in acute phase patients in 2 g dosage group (acute group 2), and 197.9 +/- 15.7 micrograms/ml in chronic phase patients in 2 g dosage group (chronic group 2) at 1 hour after CPZ administration. Concentrations of CPZ varied about 5-fold between the 1 g dosage group and the 2 g dosage groups. The acute group 2 showed generally higher values of CPZ concentrations than the chronic group 2. 2. Cerebrospinal fluid concentrations. Peak values were 0.96 +/- 0.30 microgram/ml (at 3 hours) in acute group 1, 4.55 +/- 3.41 micrograms/ml (at 1 hour, except 1 case) in acute group 2, and 1.29 +/- 1.28 micrograms/ml (at 1 hour) in chronic group 2. Acute group 2 showed generally higher values than chronic group 2. 3. CPZ was considered useful for the prevention of postoperative infections in the field of brain surgery.

[A comparison between stereotaxic operation and conservative therapy for thalamic hemorrhage].

The subjects studied in this report included 17 surgical cases which underwent evacuation of hematoma by means of BRW CT stereotaxic system approximately 14 days after its onset, and 11 non-operated cases. The average age was 65.5 years for the operated and 68.7 years for the non-operated groups. The neurological grades on admission were Grade III or above (slight or mild disturbance of consciousness). The evaluation of the cases was made according to (1) laterality of the hematoma on the left or right, (2) neurological grading, (3) maximum anterio-posterior, lateral diameters, and maximum depth of the hematoma, (4) CT classification (Kanaya, 1981) and ADL (5 grades) at 4.5 months after onset. No correlation was found between ADL and the laterality of the lesion in both groups. As for neurological grading I and ADL on admission, 6/8 cases in the operated and 3/8 in the nonoperated groups recovered to ADL grade 2 or above and 2 bed-ridden cases were included in the latter group. In regard to the extent of the hematoma, the mean ADL was 1.83 in the operated group. While 2.75 in the non-operated group where the hematoma was 25 mm or less in its maximum anterio-posterior diameter. On CT, there existed a significant difference in ADL at IIb and 4/5 of the operated and 1/4 of the non-operated groups appeared to be ADL 2 or above. Assessment of the activities (mental change, willingness) as well as the muscle strength was performed within 3 days after surgery in operated group and 88.2% and 35.3% improvements were observed, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)