Minor ossicular anomalies in the middle ear: role of submillimeter multislice computed tomography.

OBJECTIVE: The objective was to elucidate clinical effectiveness of submillimeter multislice 2- and 3-dimensional computed tomography (CT) for diagnosis of congenital middle ear anomaly. MATERIALS AND METHODS: Preoperative CT and operative findings were retrospectively analyzed in 36 ears of 33 patients. The distance between the malleal handle (MH) and the incus long process (ILP) was measured in 28 normal ears. RESULTS: Mean ± SD MH-ILP distance in normal ears was 1.8 ± 0.3 mm. In patients with middle ear anomaly, overall specificity, accuracy, and positive and negative predictive values were 99.7%, 98.7%, 91.7%, and 99.1%, respectively. Overall sensitivity was 82.1%, with relatively low sensitivities for detecting fused incudomalleolar joint, lenticular process defect, stapedial footplate defect, and oval window atresia and high sensitivities (80%-100%) for stapedial crural anomaly and certain fibrous connections. CONCLUSIONS: Submillimeter CT improved detectability of anomalies of the stapedial superstructure; however, it is still difficult to identify abnormalities of the footplate.

Angioleiomyoma of the pulp.

Vascular leiomyomas or angioleiomyomas are benign solitary smooth muscular tumours that rarely occur in the distal finger. I report a 64-year-old man with uncommon clinical appearance in the pulp of the middle finger.

Spontaneous temporomandibular joint herniation into the external auditory canal through a persistent foramen tympanicum (Huschke): radiographic features.

Persistent foramen tympanicum (Huschke) is an anatomical variation located in the anteroinferior portion of the external auditory canal. We present a case of symptomatic temporomandibular joint (TMJ) herniation into the external auditory canal though an enlarged osseous defect. The herniated retrodiscal TMJ tissue moved backward when the patient's mouth was closed, and forward, when opened. Magnetic resonance imaging findings were useful for differentiating TMJ herniation from salivary fistula caused by an ectopic salivary gland.

Statistical Survey of Deaths from Nonmelanoma Skin Cancer in Japan during 54 Years.

The author analyzed the annual trends in the number of deaths from nonmelanoma skin cancer (NMSC) from 1955 to 2008 in Japan on the basis of the data from the Vital Statistics of Japan. The general trends in the number of deaths from NMSC were downward between 1979 to 1994, but upward after 1995. The general trends in age-standardized death rates were roughly downward, although the death rates plateaued after 1995. The recent annual increased ratio of deaths from NMSC was 3.8% (95% confidence interval: 2.7 ∼ 4.9%). The number and proportion of deaths from NMSC among the elderly were increasing in Japan. For females, more than 50% of the deaths occurred recently at or after 85 years of age, whereas, for males, this proportion was at or after 75 years of age, nearly reaching at or after 80 years of age.

Altered expression of sodium channel distribution in the dorsal root ganglion after gradual elongation of rat sciatic nerves.

To elucidate the pathophysiological mechanisms underlying chronic nerve-stretch injury, we gradually lengthened rat femurs by 15 mm at the rate of 0.5 mm/day (group L, n = 13). The control groups comprised sham-operated (group S, n = 10) and naive (group N, n = 8) rats. Immediately after the lengthening, we performed a conduction study on their sciatic nerves and harvested samples. Electrophysiological and histological analyses showed mild conduction slowing and axonal degeneration of unmyelinated fibers in group L rats. Altered mRNA expression of the voltage-gated sodium channels in the dorsal root ganglion was also observed. Tetrodotoxin-resistant (TTX-R) sodium-channel Nav1.8 mRNA expression was significantly decreased and TTX-R sodium-channel Nav1.9 mRNA expression showed a tendency to decrease when compared with the mRNA expressions in the control groups. However, tetrodotoxin-sensitive (TTX-S) sodium-channel Nav1.3 mRNA expression remained unaltered. The immunohistochemical alteration of Nav1.8 protein expression was parallel to the results of the mRNA expression. Previous studies involving neuropathic states have suggested that pain/paresthesia is modulated by a subset of sodium channels, including downregulation and/or upregulation of TTX-R and TTX-S sodium channels, respectively. Our findings indicate that Nav1.8 downregulation may be one of the pathophysiological mechanisms involved in limb lengthening-induced neuropathy.

Immunohistochemical and electron microscopic studies of Langerhans cells in a case of multiple eccrine spiradenomas.

Multiple eccrine spiradenomas are rare. In the present study, a detailed investigation of eccrine spiradenoma was performed, focusing in particular on the presence of Langerhans cells (LCs) in the tumor, and their immunohistochemical and ultrastructural characterization. The patient was a woman in her mid-forties who underwent resection of two tumors of the head that were 2.0 and 0.7 cm in size. They were diagnosed as eccrine spiradenoma and were composed of small and large tumor cells with a dense fibrous capsule in the dermis. Immunohistochemically, staining by antibodies to cytokeratins (AE1/AE3, CAM5.2) and CK 5/6 was diffusely positive in all tumor cells, although not in intermingled LCs, which harbored interdigitated nuclei. The cytoplasm of LCs was positive for S-100 protein and CD1a, and their nuclei were also occasionally positive for S-100 protein. Antibody to epithelial membrane antigen was positive for the surface of both intracytoplasmic and true glandular lumina. Fine structural examination revealed the presence of LCs among the tumor cells, extending fine irregular processes among the tumor cells. Birbeck granules were clearly demonstrated in the cytoplasm of LCs. Other fine structural findings included intracytoplasmic lumina with microvilli on their surfaces in some tumor cells. In these examinations of eccrine spiradenoma, LCs, approximately 15/HPF in the tumor, were distinctly detected even at light microscopic level as negative for various types of cytokeratin stains, although they were positive for S-100 protein and CD1a, whereas on ultrastructural examination Birbeck granules were demonstrated in their cytoplasm. Determination of the significance of these LCs in eccrine spiradenoma requires further investigation of a larger number of cases.

Chondrolipoma of the popliteal fossa and Japanese reports.

A rare case of chondrolipoma of the right popliteal fossa in a 24-year-old female was reported with review of the Japanese published work. Eleven patients with chondrolipoma including lipoma with cartilaginous metaplasia, including my case, have been reported in Japan. The patients ranged in age from 7-79 years. All cases occurred in adults except for one. Six patients were male and five were female. Two lesions each arose on the tongue, upper back and popliteal fossa, and one each on the buccal submucosa, shoulder, breast, lateral chest and sole. The duration of the lesions ranged from 1 month to 20 years. The lesions ranged 1-10 cm in greatest dimension. The presented tumor was an early one because of the shortest duration and the smallest size in Japan. Recent criteria for a benign mesenchymoma including a chondrolipoma were also described.

Synchronous microcystic adnexal carcinoma and gastric cancer with review of the literature.

A microcystic adnexal carcinoma (MAC) on the left lateral chest was synchronously accompanied by both an adenocarcinoma and a granular cell tumor of the stomach in a 70-year-old Japanese male. The MAC lesion had first appeared approximately 20 years earlier and had slowly increased without symptoms. After a definitive diagnosis was made by an excisional biopsy, a second operation was performed with wider excision, followed by split thickness skin grafting. Meanwhile, a punch biopsy from an erosive lesion, which was performed three days before the second operation, demonstrated gastric cancer. Consequently, a gastrectomy was undertaken 20 days later. The patient had since been followed for 2 years and 3 months without any sign of recurrence nor metastasis. Subsequently, soft lymph nodes in two regions of the left axilla were noticed. Three lymph nodes were excised for diagnostic purposes and found to be reactive hyperplasia without metastasis of skin tumor cells. To our knowledge, in the literature, 11 patients have been reported with MAC associated with double or multiple cancers which developed syn- or meta-chronously; ours is the 12th patient.

Changing trends in the number of deaths from nonmelanoma skin cancer in Japan, 1955-2000.

BACKGROUND: The incidence and number of deaths from nonmelanoma skin cancer (NMSC) have been reported to increase in many countries. However, those in Japan over a long time span have not been analyzed yet. OBJECTIVE: To analyze the changing trends in the numbers of deaths from NMSC in Japan. METHODS: We analyzed the annual trends in numbers of deaths from NMSC from 1955 to 2000 in Japan on the basis of the data from the Vital Statistics of Japan, Statistics and Information Department, Minister's Secretariat, Ministry of Health, Labor and Welfare. RESULTS: The general trends in numbers of deaths from NMSC were downward between 1979 and 1994, but upward after 1995. The recent annual increased proportion of deaths from NMSC was 3.8% (95% confidence interval: 1.3-6.3%). The general trends in age-standardized death rates were roughly downward, although the death rates plateaued after 1995. The number and proportion of deaths among the elderly were increasing. In recent years, more than 50% of the deaths among females occurred at or after 85 years of age, and the corresponding age for males was 75 years or after. CONCLUSION: Elderly individuals should be a focus of health promotion activities.

Metastatic microcystic adnexal carcinoma: an autopsy case.

BACKGROUND: Microcystic adnexal carcinoma is a clinically aggressive, local destructive sweat gland carcinoma with a high rate of recurrence, but regional or distant metastasis is quite rare. OBJECTIVE: The objective was to describe an autopsy case of microcystic adnexal carcinoma with hematogenous metastasis and perineural intracranial spreads. METHODS: This is an autopsy case of a 73-year-old woman with hematogenous metastasis of microcystic adnexal carcinoma followed for more than 20 years. RESULT: The autopsy study revealed that the metastatic lesions were located in the perineural intracranial spread, left clavicle bone, bilateral 12th ribs, and liver. CONCLUSION: Physicians should be aware that microcystic adnexal carcinoma is capable of metastasis to the liver and bones with intracranial spread along the optic nerve into the cranium.

Changing trends in numbers of deaths from malignant melanoma in Japan, 1955-2000.

BACKGROUND: The incidence and number of deaths from cutaneous malignant melanoma have been reported to increase in many countries. However, those in Japan have not been analyzed yet. OBJECTIVE: To analyze the changing trends in the number of deaths from melanoma in Japan. METHODS: We analyzed the annual trends in numbers of deaths from melanoma from 1955 to 2000 in Japan on the basis of the data from the Vital Statistics of Japan, Statistics and Information Department, Minister's Secretariat, Ministry of Health, Labor and Welfare. RESULTS: The general trends in numbers of deaths from melanoma were upward. The annual increased ratio of deaths from melanoma was 6.3% (95% confidence interval: 4.6-8.1%). There was no gender difference in the annual increase in mortality (p < 0.05). The general trends in age-standardized death rates were also upward, although the death rates slowed between 1977 and 2000. The number and proportion of deaths among the elderly were increasing. The peak age group of deaths was roughly the fifties in 1955-1960, the sixties in 1961-1977 and the seventies after 1978. More than 50% of deaths occurred at or after 60 years of age after 1975 in both sexes, increasing to over 70% in 2000. CONCLUSION: Elderly individuals should be a focus of health promotion activities.

Nerve conduction and microanatomy in the rabbit sciatic nerve after gradual limb lengthening-distraction neurogenesis.

To clarify how the peripheral nerve adapts to elongation during gradual limb lengthening, electrophysiological and histomorphometric examinations were performed on the sciatic nerves in 18 rabbits. External fixators were used to lengthen the right femora by 30 mm (30%), at a daily rate of 0.5 mm (Group 1) or 2.0 mm (Group 2). Examinations were performed immediately after the limb lengthening procedure. Electrophysiologically, mild conduction slowing was observed in Group 1; a conduction block was evident in Group 2. Histologically, the mean diameter of myelinated fibers was unchanged in Group 1, but a significantly decreased diameter was observed in Group 2. Electron microscopy revealed that mild degenerative change of unmyelinated axons occurred sporadically in two cases in Group 2, but neither group showed evidence of thinning of myelin sheath of myelinated fibers. The mean internodal length (between nodes of Ranvier) of teased fibers was 1216+/-295 microm in the control contralateral side, 1484+/-347 microm in Group 1, and 1467+/-322 microm in Group 2. Thus the internodes were lengthened by 22.1% (Group 1) and 20.7% (Group 2) in comparison with those of the controls. Straightening of the geometry of paranodal myelin sheath was significantly correlated with the rate of distraction. These results indicate that myelinated nerve fibers adapt to gradual elongation by lengthening each Schwann cell body, not by proliferation of Schwann cells.

Multiple eccrine spiradenomas on the hand, forearm and head.

The first case of multifocal eccrine spiradenomas on the hand, forearm and scalp is described. This case is unusual in that the tumors located on the little finger included the nail matrix and occurred in a linear/zosteriform distribution, resulting in a nail deformity. The nodules on the forearm and scalp were in a random distribution. Histologically, each tumor was highly cellular and composed of two cell types: small darkly staining basaloid cells and larger, pale cells. Ultrastructural observations often showed an intracellular lumen with numerous microvilli in larger pale-staining cells.

Microcystic adnexal carcinoma: review of 51 Japanese patients.

BACKGROUND: Microcystic adnexal carcinoma (MAC) has been reported to occur predominantly in Caucasians. However, the number of cases in Japanese subjects seems to have recently been increasing. OBJECTIVE: To review the Japanese cases of MAC. METHODS: We collected and analyzed the data of 51 Japanese patients recorded in case reports or abstracts over a number of years. RESULTS: Twenty-five of the cases were reported between 1987 and 1996, and the remaining 26 cases between 1997 and 2000. Forty-three lesions were located on the face, 2 on the scalp, 2 on the chest, 1 on the axilla, 1 on the buttock, 1 on the palm and 1 on the toe. One of the above occurred at the site of previous radiotherapy. Fifteen tumors were initially misdiagnosed histopathologically. CONCLUSION: Our review shows that MAC also occurs in the Japanese, in whom it may be more common than previously observed.