Thoracic composite hemangioendothelioma with neuroendocrine marker expression.

BACKGROUND: Composite hemangioendothelioma is an extraordinarily rare form of vascular neoplasm which develops predominantly in the skins and soft tissues of the adults. Neuroendocrine marker expression in composite hemangioendothelioma is considered as specifically relevant to the more aggressive behavior. CASE PRESENTATION: The patient was a 71-year-old man complaining continuous back pain. Computed tomography (CT) showed that 10 cm of contrast-enhanced soft tissue mass was occurring on the right posterior chest wall and developing adjacent to the spinal canal. Via the laminectomy, the tumor end was identified and separated from the dura mater. Then, via the posterolateral thoracotomy, the en bloc resection was achieved by separating the tumor from the diaphragm and vertebras. Histologic examination showed a complex combination of epithelioid and retiform hemangioendothelioma areas which were positive for anti-synaptophysin staining. At 12-month follow-up, there were no signs of tumor recurrence on CT, and the patient had no symptom. CONCLUSIONS: We achieved the complete resection of a huge thoracic neuroendocrine composite hemangioendothelioma developing adjacent to the spinal canal. The combination of the posterior lumbar laminectomy and the following posterior thoracotomy is a viable approach to radically resect a thoracic neuroendocrine composite hemangioendothelioma involving chest wall.

Root canal filling materials spread pattern mimicking root fractures in dental CBCT images.

OBJECTIVE: To clarify the cause of artificial tooth-root fracture lines in cone beam computed tomography (CBCT) images caused by root canal filling materials and to enhance the diagnostic performance of CBCT. STUDY DESIGN: We analyzed the CBCT images of 18 extracted human teeth (9 upper central incisors and 9 lower premolars) that were filled with a size 50 gutta-percha cone and inserted into tooth sockets in a human skull. RESULTS: The CBCT images of the incisors displayed artificial lines in the oblique directions, notably the mesiobuccal, distolingual, distobuccal and mesiolingual directions, but only rarely in the cross-directions (buccal, lingual, mesial, and distal). In the premolars, the reverse was true, with lines mainly in the cross-directions, mesial and distal directions particularly. The lines were predominantly at the cervical slice. CONCLUSIONS: Artifacts resulting from root filling material appear along the long axis of the alveolar bones, and resemble root fractures.

Characteristic findings on panoramic radiography and cone-beam CT to predict paresthesia after extraction of impacted third molar.

The purpose of this study was to compare findings on the relationship between impacted molar roots and the mandibular canal in panoramic and three-dimensional cone-beam CT (CBCT) images to identify those that indicated risk of postoperative paresthesia. The relationship between impacted molars and the mandibular canal was first classified using panoramic images. Only patients in whom the molar roots were either in contact with or superimposed on the canal were evaluated using CBCT. Of 466 patients examined using both panoramic and CBCT images, 280 underwent surgical extraction of an impacted molar, and 15 of these (5%) reported postoperative paresthesia. The spatial relationship between the impacted third molar root and the mandibular canal was determined by examining para-sagittal sections (lingual, buccal, inter-radicular, inferior, and combinations) obtained from the canal to the molar root and establishing the proximity of the canal to the molar root (in contact with or without loss of the cortical border and separate). The results revealed that darkening of the roots with interruption of the mandibular canal on panoramic radiographs and the inter-radicular position of the canal in CBCT images were characteristic findings indicative of risk of postoperative paresthesia. These results suggest that careful surgical intervention is required in patients with the above characteristics.

The Effects of Spinal Fusion on Lumbar Disc Degeneration in Patients with Adolescent Idiopathic Scoliosis: A Minimum 10-Year Follow-Up.

STUDY DESIGN: Retrospective study. OBJECTIVES: This study focused on patients with adolescent idiopathic scoliosis (AIS) who were followed up for more than 10 years, and assessed the influence of spinal balance on lumbar degenerative changes at distal unfused segments (DUS). SUMMARY OF BACKGROUND DATA: Previous studies suggested that longer fusion segments may result in higher rates of occurrence of disc degeneration (DD) at unfused segments adjacent to the distal fused area. However, there are no existing studies that correlate the degree of DD to the location of lower instrumented vertebra (LIV) and the amount of the residual lumbar curve during the follow-up period. METHODS: Radiologic measurements were recorded at the time of surgery, immediately after surgery, and 10 years after surgery. The Pfirrmann grading scale was used to rate the MR images of these patients. The presence of vertebral DD was also used to classify patients into DD+ and DD- groups. RESULTS: 93 patients with AIS participated in this study. The average age at the time of surgery was 15.2 years; the average follow-up time was 154 months. DD was found in 45 patients (48%) and L5/S1 was the most common (40%) location in those patients. The L1 group experienced DD at a frequency of 34%, whereas the frequency increased with lower LIV placement. There was a significant difference between DD+ and DD- in age at the time of operation, the L4 tilt (pre Op. and post. 10 years), and the number of mobile segments. CONCLUSIONS: Disc degeneration occurred in 48% of the patients at the time of postop. 10 years. Disc degeneration had a tendency to occur in patients with greater preoperative and postoperative 10 years L4 tilt angle and fewer mobile segments in the lower lumbar spine. LEVEL OF EVIDENCE: Level III.

Composition of the blood supply in the sublingual and submandibular spaces and its relationship to the lateral lingual foramen of the mandible.

OBJECTIVE: The purpose of this research was to contribute to minimizing arterial disruption during mandibular surgical procedures by clarifying the course of the arteries supplying the sublingual and submental regions. STUDY DESIGN: Heads of 75 human cadavers were dissected to identify the arterial supply of the sublingual and submental regions. Computed tomography scans were performed to visualize the lateral lingual foramina of the mandibles. RESULTS: The facial artery was found to contribute to the composition of almost half of the sublingual arteries studied. Furthermore, it was demonstrated that the arterial supply to an incisor tooth is often from the submental artery. CONCLUSIONS: Our data provide important information for coping with bleeding or hematoma occurring during surgical procedures in the mandibular region.

The T wave inversion score is useful for evaluating the time-course of acute pulmonary embolism.

BACKGROUND: The 12-lead electrocardiogram (ECG) has relatively poor specificity for identifying acute pulmonary embolism (APE). The aim of this study was to investigate ECG abnormalities according to 2 different criteria and their usefulness for assessing changes in APE. METHODS AND RESULTS: Fifty-two APE patients underwent ECG examinations in the acute and chronic phases. ECG abnormalities were assessed according to Stein's criteria (QRS complex abnormalities and T wave inversion in any lead except aV(L), III, aV(R), or V1) and Kosuge's criteria (T wave inversion in any lead except aV(R) or aV(L)). Many patients had electrocardiographic abnormalities in the acute phase, but no specific abnormalities were found. According to Kosuge's criteria, the frequency of T wave inversion was higher than that of abnormal QRS complexes and T wave inversion according to Stein's criteria (P < 0.01). In 20 cases with preclinical ECG records, the time-course of changes in the T wave inversion score (total numbers of T wave inversions per patient) was examined. The peak T wave inversion score was noted at 3 days after onset (P < 0.01). CONCLUSIONS: These results suggest that the T wave inversion score, calculated according to Kosuge's criteria, is useful for predicting the time-course of APE.

Effects of dose reduction on multi-detector computed tomographic images in evaluating the maxilla and mandible for pre-surgical implant planning: a cadaveric study.

OBJECTIVE: To assess effects of dose reduction on image quality in evaluating maxilla and mandible for pre-surgical implant planning using cadavers. MATERIALS AND METHODS: Six cadavers were used for the study using multi-detector computed tomography (CT) operated at 120 kV and the variable tube current of 80, 40, 20 and 10 mA. A slice thickness of 0.625 mm and pitch 1 were used. Multi-planar images perpendicular and parallel to dentitions were created. The images were evaluated by five oral radiologists in terms of visibility of the anatomical landmarks including alveolar crest, mandibular canal, floors of the maxillary sinus and nasal cavity, contours/cortical layer of jaw bones and the details of trabecular bone. Observers were asked to determine the quality of the images in comparison with 80 mA images based on the criteria: excellent, good, fair or non-diagnostic. The average scores of all observers were calculated for each specimen in all exposure conditions. RESULTS: The 40 mA images could visualize such landmarks and were evaluated to be same or almost equivalent in quality to the 80 mA images. Even the 20 mA images could be accepted just for diagnostic purpose for implant with substantial deterioration of the image quality. The 10 mA images may not be accepted because of the obscured contour caused by image noise. CONCLUSION: Significant dose reduction by lowering mA can be utilized for pre-surgical implant planning in multi-detector CT.

Effects of tube current on cone-beam computerized tomography image quality for presurgical implant planning in vitro.

OBJECTIVE: The purpose of this study was to evaluate the effect of tube current reduction on the quality of cone-beam computerized tomography (CBCT) images of the maxilla and mandible for presurgical implant planning. STUDY DESIGN: Six cadaver heads were imaged with a CBCT (3D Accuitomo) operated at 80 kVp and variable tube current (8, 4, 2, or 1 mA) in full-scan mode. For the posterior region of maxilla and mandible, half-scans were also performed at similar settings. The images were evaluated independently by 5 oral radiologists for 15 anatomic landmarks regarding presurgical implant planning. The quality of images were compared with their respective reference images at 8 mA and ranked on a 4-point rating scale as excellent, good, fair, or nondiagnostic. The scores of all observers were averaged for each landmark at every exposure condition, and Bonferroni test (P<.05) was performed. RESULTS: The 4 mA images at full-scan mode could visualize each landmark of maxilla and mandible and were evaluated to be the same or almost equivalent in quality as the 8 mA images. Even 2 mA images in full-scan mode and 4 mA in half-scan mode could be used for implant planning. The 1 mA images were unacceptable owing to the substantial degradation in image quality. CONCLUSION: Significant dose reduction can be achieved by reducing tube current without substantial loss of image quality for presurgical implant planning in CBCT.

Effect of computer assistance on observer performance of approximal caries diagnosis using intraoral digital radiography.

Logicon Caries Detector (LDDC) is the only commercially available computer-assisted diagnostic system for caries diagnosis. The object of this study is to elucidate the efficacy of LDDC when used by inexperienced dentists. Fifty extracted teeth were imaged using an RVG6000. Seven dentists who had just passed the Japanese National Dental Board Examination observed those images without LDDC (woLDDC) and assessed the probability that caries lesions were present, then re-assessed the same teeth using LDDC (wLDDC). The areas under the receiver operating characteristic curves (Az) were compared. No statistically significant difference was found between woLDDC Az values and wLDDC Az values when caries lesions of all depths were considered. When positive cases were restricted to caries lesions in the inner half of the enamel or to dentine caries lesions, however, wLDDC Az values were significantly larger than woLDDC (p = 0.043 and 0.018, respectively).

Assessment of the blood supply to the lingual surface of the mandible for reduction of bleeding during implant surgery.

OBJECTIVES: The aim of this study was to assess the frequency of the foramina and their canals on the lingual surface of the mandible using computed tomography (CT), which was carried out for dental implant planning. MATERIAL AND METHODS: First, the visibility of the lingual canals of the CT image was verified by dissecting five cadavers. CT images of 200 patients, who had decided on implant treatment, were used in this study. The visibility of the foramina and their canals on the lingual surface of the mandible were assessed. RESULTS: The foramina were divided into two groups by the positions of the mandible, the medial lingual foramen and the lateral lingual foramen. At least one foramen was found in all patients. In the medial group, a higher level of mental spine was seen in 190 patients, the same level of mental spine was observed in 99 patients and a lower level of mental spine was observed in 114 patients. The lateral lingual foramina were found in 160/200 patients and 88/200 patients presented bilaterally. CT can predict the position and the size of the foramina and their canals on the lingual surface of the mandible. All the patients had more than one foramen in the middle of the lingual surface of the mandible on the CT image. CONCLUSION: The frequency of the lingual foramina in the medial region was 100% and that in the lateral region was 80%. It would also be useful to emphasize the significant variation in the precise location of these lingual foramina, and that these can only be visualized presurgically with volumetric imaging modalities, such as CT or Cone beam 3D systems.

Transforming growth factor beta 2 promotes the formation of the mouse cochleovestibular ganglion in organ culture.

The inner ear structures are derived from the otic vesicle (OV) which is formed by thickening and invagination of the otic placode of the surface ectoderm. A number of neuroblasts, which arise from epithelial cells of the otic vesicle, delaminate and differentiate into neurons of the cochleovestibular ganglion (CVG). We have found that transforming growth factor-BEta2 (Tgfbeta2 ) was expressed in the otic epithelium at the OV stages between Embryonic days (E) 9.5 and 11.5 and that anteroventrolateral localization of its expression in the OV overlapped with that of NeuroD, which is a marker of delaminating CVG precursors. The expression of TGFbeta type I and type II receptors in the otic epithelium and the nuclear localization of phosphorylated-Smad2 in both the otic epithelium and CVG suggested that TGFbeta2 signaling plays some roles in CVG formation. In order to examine the roles of TGFbeta2 in differentiation of the inner ear, otic vesicle explants of E10.5 mouse embryos were treated in vitro with TGFbeta2 or the TGFbeta type I receptor kinase inhibitor, SB431542. Addition of TGFbeta2 peptide to the culture led to Enlargement of the CVG, while the inhibitor reduced its size. These findings strongly imply that TGFbeta2 contributes to the development of the CVG in mouse embryos.

Radiologic measurements of the mandible: a comparison between CT-reformatted and conventional tomographic images.

This study was carried out to compare the accuracy of determination of the mandibular contour and the position of the mandibular canal in cadaver mandibles by the multiplanar reconstruction method (MPR-CT), which has recently come to be used widely for preoperative examinations, with those by tomographic techniques and to evaluate the usefulness of MPR-CT. Using three imaging systems, i.e. Quantum CT scanner, Scanora, and OP-100, a total of 6 sites were scanned in the molar regions of 3 cadaver mandibles. The images obtained were measured twice each by 4 radiologists. The anatomic structures measured were the height and thickness of the mandible, distance from the alveolar crest to the mandibular canal, and distance from the buccal cortical bone to the mandibular canal. After scanning, the scanned areas of the mandibles were sliced at a thickness of 2 mm, and soft X-ray images of these slices were obtained. The values of the above 4 anatomic structures obtained by measurements in the soft X-ray radiograms using digital-display calipers were regarded as true values. When compared with the true values, the errors in the distance from the alveolar crest to the mandibular canal were within 1 mm (+/- 1 mm) in 93.7% of the measurements by Direct-CT, 89.6% of the measurements by MPR-CT, 87.5% of the measurements by Scanora, and 47.9% of the measurements by OP-100, and the accuracy of the 4 methods ranked in the order of Direct-CT, MPR-CT, Scanora, and OP-100. A similar tendency was observed in the measurements of other anatomic structures, and statistically significant differences were observed among the methods. Thus, MPR-CT allows more accurate measurements than by the other 2 tomographic techniques,and to be useful as a preoperative examination for implant surgery.

Indian hedgehog gene is a target of the bone morphogenetic protein signaling pathway.

Bone morphogenetic proteins (BMPs), a large subgroup of the transforming growth factor-beta family of growth factors, are key mediators of many fundamental processes in embryonic development. The BMP target genes mediating these effects and the mechanism of their selective regulation are poorly characterized. In this study, we used a chromatin immunoprecipitation-based gene cloning method to identify BMP target genes in a mouse embryonic carcinoma cell line. We identified the Indian hedgehog (Ihh) gene as a target of BMP signaling. Both reporter and reverses transcription-PCR assays revealed that Ihh is up-regulated in embryonic cells upon BMP treatment. The BMP response element of the Ihh promoter contains multiple GC-rich motifs known as the "Mad/Medea binding box" found in the Drosophila tinman gene and in the mouse Id1 gene. DNA binding studies revealed that Smad4 binds to these GC-rich motifs. These findings indicate that BMP stimulates Ihh expression. We also suggest expression of the Ihh gene, which contains multiple Smad binding sites, might be finely regulated by a gradient of BMP concentrations.

Mouse Snail family transcription repressors regulate chondrocyte, extracellular matrix, type II collagen, and aggrecan.

Snail family genes are conserved among species during evolution and encode transcription factors expressed at different stages of development in different tissues. These genes are involved in a broad spectrum of biological functions: cell differentiation, cell motility, cell cycle regulation, and apoptosis. However, little is known about the target genes involved in these functions. Here we show that mouse Snail family members, Snail (Sna) and Slug (Slugh), are involved in chondrocyte differentiation by controlling the expression of type II collagen (Col2a1) and aggrecan. In situ hybridization analysis of developing mouse limb demonstrated that Snail and Slug mRNAs were highly expressed in hypertrophic chondrocytes. Inversely, the expression of collagen type II mRNA disappeared during hypertrophic differentiation. Snail and Slug mRNA expression was down-regulated during differentiation of the mouse chondrogenic cell line ATDC5 and overexpression of exogenous Snail or Slug in ATDC5 cells inhibited expression of collagen type II and aggrecan mRNA. Reporter analysis revealed Snail and Slug suppressed the promoter activity of Col2a1, and the E-boxes in the promoter region were the responsible element. Gel shift assay demonstrated the binding of Snail to the E-box. Because type II collagen and aggrecan are major functional components of extracellular matrix in cartilage, these results suggest an important role for Snail-related transcription repressors during chondrocyte differentiation.