Intensity-modulated radiation therapy administered to a previously irradiated spine is effective and well-tolerated

Purpose This study sought to discern the clinical outcomes of intensity-modulated radiation therapy (IMRT) administered to the spine in patients who had undergone previous radiotherapy. Methods A total of 81 sites of 74 patients who underwent previous radiotherapy administered to the spine or peri-spine and subsequently received IMRT for the spine were analyzed in this study. The prescribed dose of 80 Gy in a biologically effective dose (BED) of α/β = 10 (BED10) was set as the planning target volume. The constraint for the spinal cord and cauda equine was D0.1 cc ≤ 100 Gy and ≤ 150 Gy of BED for re-irradiation alone and the total irradiation dose, respectively. Results The median follow-up period was 10.1 (0.9–92.1) months after re-irradiation, while the median interval from the last day of the previous radiotherapy to the time of re-irradiation was 15.6 (0.4–210.1) months. Separately, the median prescript dose of re-irradiation was 78.0 (28.0–104.9) of BED10. The median survival time in this study was 13.9 months, with 1-, 3-, and 5-year overall survival rates of 53.7%, 29.3%, and 26.6%, respectively. The 1-, 3-, and 5-year local control rates were 90.8%, 84.0%, and 84.0%, respectively. Neurotoxicity was observed in two of 72 treatments (2.8%) assessed after re-irradiation. Conclusion Re-irradiation for the spine using IMRT seems well-tolerated. Definitive re-irradiation can be a feasible treatment option in patients with the potential for a good prognosis (AU)

Intensity-modulated radiation therapy administered to a previously irradiated spine is effective and well-tolerated.

PURPOSE: This study sought to discern the clinical outcomes of intensity-modulated radiation therapy (IMRT) administered to the spine in patients who had undergone previous radiotherapy. METHODS: A total of 81 sites of 74 patients who underwent previous radiotherapy administered to the spine or peri-spine and subsequently received IMRT for the spine were analyzed in this study. The prescribed dose of 80 Gy in a biologically effective dose (BED) of α/ß = 10 (BED10) was set as the planning target volume. The constraint for the spinal cord and cauda equine was D0.1 cc ≤ 100 Gy and ≤ 150 Gy of BED for re-irradiation alone and the total irradiation dose, respectively. RESULTS: The median follow-up period was 10.1 (0.9-92.1) months after re-irradiation, while the median interval from the last day of the previous radiotherapy to the time of re-irradiation was 15.6 (0.4-210.1) months. Separately, the median prescript dose of re-irradiation was 78.0 (28.0-104.9) of BED10. The median survival time in this study was 13.9 months, with 1-, 3-, and 5-year overall survival rates of 53.7%, 29.3%, and 26.6%, respectively. The 1-, 3-, and 5-year local control rates were 90.8%, 84.0%, and 84.0%, respectively. Neurotoxicity was observed in two of 72 treatments (2.8%) assessed after re-irradiation. CONCLUSION: Re-irradiation for the spine using IMRT seems well-tolerated. Definitive re-irradiation can be a feasible treatment option in patients with the potential for a good prognosis.

Sialorrhea and gastroesophageal reflux.

It is not unusual for patients who are pregnant or have a hiatal hernia to develop gatroesophageal reflux with the resultant symptoms of heartburn. This article reviews the role reflux plays in causing episodes of increased salivation. Stimulation of the esophagus by gastric acids excites and esophagosalivary reflex. A marked increase in salivary flow ensues, neutralizing the acid content of the esophagus. The dental practitioner is in a strategic position to be consulted about or recognize the existence of the esophagosalivary reflex and the consequent bouts of sialorrhea. Recognition mandates medical consultation.

Long-term occlusal guidance of a severely intoxicated patient with yusho (PCB poisoning): a case report.

The peculiar dentoorofacial characteristics and 12 years of interdisciplinary management of a patient who was severely intoxicated with the man-made chemical polychlorinated biphenyls (PCBs) are described in this case report. Cephalometric measurements showed that the SNA and SNB angles were reduced but that the developments in height and skeletal maturity were in normal ranges. Gingival hyperpigmentation that was caused by high blood PCB concentration was extremely slow to fade. A cystic mass, diffused trabeculae, and irregular calcification, which were shown on the radiograph and which were caused by high blood levels of PCB, changed gradually. However, the patient had periodontal disease because of horizontal alveolar bone resorption and a deep periodontal pocket, despite good plaque control. After the PCB poisoning the tooth roots were hypoplastic and dilacerated. One root was extracted because of chronic periodontitis. Some teeth were impacted, malposed, or ankylosed.

Relationship between tongue volume and lower dental arch sizes.

The interrelation between the tongue volume and the lower dental arch sizes (arch width and area) was studied by the original methods that we developed. A plane perpendicular to the occlusal plane and 40 mm posterior to the lower incisal point was taken as the posterior border of the tongue and the arch. The tongue volume and the lower dental arch sizes were measured anterior to this border with plaster models. The correlations between the parameters obtained from 74 Japanese adults (37 men and 37 women) with normal occlusion were statistically analyzed. The results showed that (1) both the mean tongue volume and the mean lower dental arch sizes were significantly larger in men than in women; (2) the tongue volume and the lower dental arch sizes were significantly correlated; and (3) these correlations tended to be higher at the more posterior part of the dental arch.

Management and subsequent 13-year progress of a mandibular fracture with malocclusion in a child--case report.

Under acute conditions, maxillofacial injuries may be treated without the opportunity for an assessment of occlusal irregularities, even when there are mandibular fractures, because life-threatening injuries have priority over occlusion. Consequently, mandibular fractures may result in post-trauma malocclusion and facial deformity. The case history reported is of a male patient who had been involved in a traffic accident in childhood and suffered mandibular fractures. The initial incomplete management resulted in persistent deformation of the mandible, disturbance of dental occlusion and difficulty in mastication. These irregularities were corrected during childhood by non-operative orthodontic treatment. When the patient reached adulthood, some permanent teeth were malformed because the fractures had damaged some tooth germs. However, the permanent dentition in general was almost normal as a result of the corrected primary dentition. Although the alveolar deformity due to the injury remained, the mandibular base was satisfactorily remodelled. The case reported supports the view that early restoration of normal dental occlusion before the eruption of permanent teeth contributes to the establishment of good functional dental occlusion of the permanent teeth.

The dimensions of the tongue in relation to its motility.

To obtain basic information about the motility and dimensions of the tongue, the tongue volume was measured and the change in its length and location was noted while the tongue was undergoing protrusion, and then the relationships among those parameters were examined statistically. The tongue was measured at rest from the tip to a point 40 mm posterior corresponding to a plane connecting the lower permanent second molars. The subjects were 100 Japanese men and women. It was found that (1) maximum protrusion of the tongue is accomplished by two functions combined--a forward movement and a longitudinal stretching; the volume of the tongue was significantly correlated with its stretching. (2) The mean length of the tongue in the most protruded position was about 20% longer than its length in the resting position; it was stretched most in the segment from 1 to 2 cm posterior to its tip. (3) The mean tongue volume was 25.3 cm3 in men and 22.6 cm3 in women, a statistically significant sex difference; the volume was about 12% larger in men than in women. (4) There was no correlation between the tongue volume and the length of the most extraorally protruded tongue. The results suggested that the volume of the tongue can be estimated from the stretched length of the tongue in the most protruded position, if it is measured properly.

Immunochemical analysis of the glucomannan from Candida utilis.

A glucomannan isolated from a Candida utilis mutant having a new chemotype was further studied by inhibition of the homologous precipitin reaction with oligosaccharides obtained from the glucomannan by partial acid hydrolysis and controlled acetolysis. Oligosaccharides having at least two consecutive alpha-(1----2)-linked mannose residues at the non-reducing end and gluco-manno-pentasaccharide were effective inhibitors. Thus, it appears that the glucomannan had two groups of antigenic determinants, one corresponding to the side chains of two, three, and four mannose units connected by alpha-(1----2)-linkage, and the other corresponding to a side chain composed of an O-alpha-D-glucopyranosyl-(1----6)-O-alpha-D-mannopyranosyl- (1----2)-O-alpha-D-mannopyranosyl-(1----2)-D-mannose unit. These results support a probable structure of repeating units for the glucomannan presented previously. The relative susceptibility of intersaccharidic linkages to acid hydrolysis in the mannan is discussed.

[An easily and immediately releasable intermaxillary fixation appliance for use after the correction of surgical orthognathic cases of jaw deformity or fracture].

In oral surgery, intermaxillary fixation is routinely applied after surgery in cases of surgical orthognathic correction of jaw deformity or fractures. Intermaxillary fixation requires two conflicting factors: Stiff fixation and quick release in an emergency, as in nausea and vomiting. Conventional methods of intermaxillary fixation require multiple stiff ligation after an operation, but in an emergency these ligations can not be cut quickly to free the airway. We have developed a new fixation method placing a third wire (locking bow) above the upper splint or below the lower splint. The locking bow is hooked onto the splint on the unoperated side and firmly ligated to the splint on the jaw being operated upon. The ligatures can be quickly and easily released by pulling out the locking bow. This can be done by the patient himself or another person. This article describes the principles and clinical application of the method. We have found it to be useful in clinical practice.

A cell wall proteo-heteroglycan from Piricularia oryzae: isolation and partial structure.

A purified proteo-heterolgycan, [alpha]D + 72.5 degrees, was isolated from Piricularia oryzae, a pathogenic fungus of rice blast disease (Imochi-byo), by means of hot citrate buffer extraction, cetavlon fractionation, and DEAE-Sephade chromatography. It was found to be homogeneous by electrophoresis and by analytical ultracentrifugation to have an s value 6.1 and to contain 91% (w/w) of carbohydrate, which consists of D-mannose, D-glucose, and D-galactose in a molar ratio of 6:2:1. Partial acid hydrolysis and methylation analysis of the carbohydrate moiety of the proteo-heteroglycan indicate that the molecule is composed of mannan, the side chain terminals of which are partially modified with D-glucopyranose and D-galactofuranose. Enzymatic hydrolysis with bacterial alpha-D-mannanase has been shown to remove most of the side chains from the heteroglycan, leaving an (1-6) linked mannan back-bone with a small amount of side chains, the terminals of which must be modified with D-glucopyranose or D-galactofuranose. The carbohydrate to protein linkage of the proteo-heteroglycan was shown by alkaline beta-elimination, to be mannosyl serine or mannosyl threonine.

A cell wall proteo-heteroglycan from Piricularia oryzae: further studies of the structure.

The carbohydrate part of a proteo-heteroglycan from Piricularia oryzae was further studied by chemical and immunological methods. Acetolysis studies of the proteo-heteroglycan and exo-alpha-D-mannanase resistant core showed a (1 leads to 6) mannan back-bone structure with side chains composed of one to four mannose units, and some of which are terminated by D-glucose or D-galactofuranose. The mode of attachment of the terminal glucose was characterized to be alphaGlc(1 leads to 6)Man by inhibition reaction with oligosaccharides. Rabbit anti-serum formed against P. oryzae cells had three specificities, the first one for alphaGlc(1 leads to 6)alphamannosyl, the second one for alphaMan(1 leads to 3)alphamannosyl, and the last one for alphaGal-f(1 leads to 2)alphamannosyl residues. The most immunodominant side chain structure of the P. oryzae heteroglycan was shown to be alphaGlc(1 leads to 6)alphaMan(1 leads to 2)alphaMan(1 leads to 2)Man.