Loss of cytokeratin 13 expression in squamous cell carcinoma of the tongue is a possible sign for local recurrence.

Cytokeratin (CK) 13 is an intermediate filament protein that is expressed in a cell-type-specific manner, in the tongue and occasionally in tongue squamous cell carcinoma (SCC). Correlations between the clinical features of patients with SCC and CK13 expression in the tumor are here investigated along with CK13's utility as a marker for tongue cancer status. Samples from 121 patients with SCC of the tongue were examined by immunohistochemistry with antibodies against CK13. Correlations between the expression level of CK13 in the tumor and the patients' clinical features were statistically analyzed by univariate and multivariate methods. Univariate analysis showed a more relevant number of local recurrence (P = 0.04) in CK13-negative staining patients. In addition, CK13-negative cases were associated with local recurrence by multiple logistic regression analysis (OR: 3.36; 95% CI: 1.044-10.78; P = 0.04). Our results suggest that the loss of CK13 expression indicates tumors with a high potential for recurrence, and thus CK13 could be useful for determining the best course of treatment.

A prospective study to evaluate a new dental management protocol before hematopoietic stem cell transplantation.

Pre-hematopoietic stem cell transplantation (HSCT) dental treatment is essential to prevent serious infections from oral sources during immunosuppression, in patients who undergo HSCT therapy. This study was planned to establish a dental management protocol for such patients. Forty-one patients scheduled for HSCT to treat hematological malignancies were consecutively enrolled in the prospective trial. The dental status of all patients was evaluated by clinical and radiographic examination at a median of 47 days before the commencement of HSCT therapy. Thirty-six patients had one or more dental diseases; the remaining five had none. Caries was found in 26 patients, apical periodontitis in 19, marginal periodontitis in 24 and a partially erupted third molar in 11. Our policy is to preserve patients' teeth whenever possible, and therefore minimal dental intervention was planned. Treatment was completed for all 36 patients with dental pathologies, before the conditioning regimen began. All patients received the scheduled HSCT therapy without alteration, interruption or delay, and did not show any signs or symptoms associated with odontogenic infection while they were immunosuppressed. This protocol, therefore, appears to be appropriate for the pre-HSCT dental treatment of patients with hematological diseases.

Submandibular abscess caused by Salmonella.

Salmonella species represent uncommon causative agents in focal infections of the head and neck. This article presents a rare case of Salmonella submandibular abscess in a 59-year-old patient with diabetes mellitus, chronic hepatitis and liver cirrhosis. The patient was successfully treated with drainage of the abscess and oral administration of quinolone. An immunocompromised condition can be a critical predisposing factor for Salmonella submandibular abscess.

Purified Human Dental Pulp Stem Cells Promote Osteogenic Regeneration.

Human dental pulp stem/progenitor cells (hDPSCs) are attractive candidates for regenerative therapy because they can be easily expanded to generate colony-forming unit-fibroblasts (CFU-Fs) on plastic and the large cell numbers required for transplantation. However, isolation based on adherence to plastic inevitably changes the surface marker expression and biological properties of the cells. Consequently, little is currently known about the original phenotypes of tissue precursor cells that give rise to plastic-adherent CFU-Fs. To better understand the in vivo functions and translational therapeutic potential of hDPSCs and other stem cells, selective cell markers must be identified in the progenitor cells. Here, we identified a dental pulp tissue-specific cell population based on the expression profiles of 2 cell-surface markers LNGFR (CD271) and THY-1 (CD90). Prospectively isolated, dental pulp-derived LNGFR(Low+)THY-1(High+) cells represent a highly enriched population of clonogenic cells--notably, the isolated cells exhibited long-term proliferation and multilineage differentiation potential in vitro. The cells also expressed known mesenchymal cell markers and promoted new bone formation to heal critical-size calvarial defects in vivo. These findings suggest that LNGFR(Low+)THY-1(High+) dental pulp-derived cells provide an excellent source of material for bone regenerative strategies.

Risk factors for postoperative delirium in patients undergoing head and neck cancer surgery.

This study was carried out to determine risk factors for delirium after major head and neck cancer surgery. The postoperative experience of 38 patients who underwent major head and neck cancer surgery and were managed in the high care unit was retrospectively examined by reviewing their medical records. Delirium was defined as confusion and abnormal behavior that interfered with postoperative recovery. Postoperative delirium occurred in 10 patients (26.3%) who all had stage IV cancer, flap reconstruction, an operative time of more than 10 h, blood transfusion of more than 4 units or infusion of more than 5000 ml, which together suggested the risk of delirium increased significantly with extensive surgery. Delirium occurred less frequently in patients with minor tranquilizer use for postoperative sleep disorder. Multivariative analyses showed an operative time of >10 h and no use of minor tranquilizer as significant factors for increasing the incidence of delirium, with odds ratios (95% confidence interval) of 11.4 (1.5-83.8) and 9.8 (1.5-66.0), respectively.

Fluorescence photography as a diagnostic method for oral cancer.

This study was carried out to evaluate the diagnostic utility of autofluorescence photography for oral mucosal lesions. The materials consisted of 15 chemically-induced lesions containing carcinomas in 15 hamsters, and 32 oral lesions in 30 patients. In the animal models, orange fluorescence was detected in all squamous cell carcinomas invading the muscle layer, and the intensity of the fluorescence increased with the progress of the lesions. In the clinical application, orange fluorescence was detected in 14 of 16 malignant tumors and in one of 16 benign lesions. These results suggest that fluorescence photography may be useful for the diagnosis of oral cancer, particularly for squamous cell carcinoma.

Peroxiredoxin I expression in oral cancer: a potential new tumor marker.

This study investigates the applicability of the novel antioxidant protein, peroxiredoxin (Prx) I as a marker for tumor status in oral squamous cell carcinoma (SCC). Samples from 53 patients with SCC in the oral cavity were examined by immunohistochemistry. Correlations between the expression level of Prx I and proliferating cell nuclear antigen (PCNA), the clinical features of tumors, and their histopathological classifications were statistically analyzed. Cases exhibiting low Prx I expression level included significantly more with larger tumor mass cases (T-category, P=0.004), positive lymph node metastasis (N-category, P=0.015), advanced stage (P=0.002), and poorly differentiated cells (P=0.020). There was no significant difference between Prx I expression and the other indices.

Heme oxygenase-1 expression in oral squamous cell carcinoma as involved in lymph node metastasis.

Thirty-eight oral squamous cell carcinomas (SCCs) were semi-quantitatively analyzed by immunohistochemical staining, and the relation between heme oxygenase-1 (HO-1) expression and the clinical status were correlated. High immunostaining of HO-1 was detected in lymph node metastasis negative groups (P = 0.0018) and in well-differentiated SCCs (P = 0.0016). There were no significant correlations between heme oxygenase-1 expression and other factors, such as size of the tumor, staging, age and sex. These findings further support the proposition that high heme oxygenase-1 expression in oral SCCs can be useful in identifying patients at low risk of lymph node metastasis.

c-Abl expression in oral squamous cell carcinomas.

c-Abl is proto-oncogene product. c-Abl has roles in signal transduction, cell cycle regulation, and inhibition of apoptosis. There are many reports about c-Abl function in hematopoietic cells, but few are concerned with solid tumors. In the present study, biopsy specimens from 44 patients with oral squamous cell carcinomas were subjected to immunohistochemistry, and the expression levels of c-Abl were correlated with clinicopathological features. Statistical analyses revealed that c-Abl expression was significantly associated with T-category (p = 0.011), sex (p = 0.014), and differentiation (p = 0.007), but no significant difference was observed with N-category, age, primary tumor region, or the other histological gradings. The low c-Abl expression group included more T4, male, and poorly differentiated cases. There was a trend towards longer tendency survival in the high expression group, but the difference was not significant. We conclude that c-Abl is a good candidate for a tumor-expansion marker.

Ultrasonographic assessment for response to radiochemotherapy of metastatic cervical lymph nodes in head and neck cancer: usefulness of grey-scale and color doppler sonography.

To predict the response of lymph node metastasis to preoperative radiochemotherapy sonographically, the correlation between ultrasonographs and histologic features was retrospectively examined in 43 metastatic cervical lymph nodes from 24 patients with squamous cell carcinoma in the oral and maxillofacial region. Ultrasonographs were compared among poor-, good-, and complete-response lymph nodes. Before radiochemotherapy, hypoechoic internal echo and intranodal blood perfusion demonstrated many complete-response nodes; in contrast, most poor-response nodes showed peripheral blood perfusion and an avascular pattern, but did not have specific internal echo intensity. Complete-response nodes showed a significant reduction in their maximum and minimum diameters after radiochemotherapy. These results indicate that ultrasonography is useful for predicting the response of cervical lymph node metastasis to radiochemotherapy.

Longitudinal changes of symptoms of temporomandibular disorders in Japanese young adults.

Longitudinal changes of symptoms of temporomandibular disorders in 275 Japanese university students were investigated through use of questionnaires in 1990 and in 1994. A comparison of the 1990 responses with the 1994 responses revealed that the prevalences of temporomandibular joint sounds, mouth opening restriction, and pain significantly increased from 28.7% to 49.8%, from 12.7% to 22.5%, and from 7.6% to 18.5%, respectively. The increase in the prevalence of symptoms mainly resulted for students who did not have symptoms of temporomandibular disorders at the first examination. Subjects who had been frequently aware of symptoms of temporomandibular disorders showed a tendency toward a decrease in their frequency of awareness. Although 66 students (24.0%) reported discomfort from symptoms of temporomandibular disorders during the period, only three (1.1%) visited medical facilities to receive treatment. These results suggest that symptoms of temporomandibular disorders evaluated through the use of questionnaires are longitudinally fluctuant, and that few students developed temporomandibular disorders.

Energy value and digestibility of dietary oil containing mainly 1,3-diacylglycerol are similar to those of triacylglycerol.

Diacylglycerol (DAG) is a component of various vegetable oils. Approximately 70% of the DAG in edible oils are in the configuration of 1,3-DAG. We recently showed that long-term ingestion of dietary oil containing mainly 1,3-DAG reduces body fat accumulation in humans as compared to triacylglycerol (TAG) oil with a similar fatty acid composition. As the first step to elucidate the mechanism for this result, we examined the difference in the bioavailabilities of both oils by measuring food energy values and digestibilities in rats. Energy values of the DAG oil and the TAG oil, measured by bomb calorimeter, were 38.9 and 39.6 kJ/g, respectively. Apparent digestibility expressed according to the formula: (absorbed) x (ingested)(-1) x 100 = (ingested - excreted in feces) x (ingested)(-1) x 100 for the DAG oil and the TAG oil were 96.3+/-0.4 and 96.3+/-0.3% (mean +/- SEM), respectively. The similarity in the bioavailabilities of both oils supports the hypothesis that the reduced fat accumulation by dietary DAG is caused by the different metabolic fates after the absorption into the gastrointestinal epithelial cells.

Chromatic analysis of autofluorescence emitted from squamous cell carcinomas arising in the oral cavity: a preliminary study.

Chromatic analysis was carried out to characterize the color quality of autofluorescence emitted from oral squamous cell carcinomas (SCC) and to objectively compare autofluorescence among various tissues. The following specimens were studied: 33 SCC, 3 epithelial dysplasias, 39 benign lesions, 31 dorsa of the tongue and 18 dental plaques. Autofluorescence depicted on fluorescence photographs was measured with a chroma meter. Chromatic values of autofluorescence differed significantly between SCC and non-cancerous tissues and between different stages of SCC. Autofluorescence of SCC tended to shift from orange to reddish orange with advancement of stage. These results suggest that autofluorescence of oral SCC chromatically differs from that of other tissues and depends on the stage of cancer.

Usefulness of fluorescence photography for diagnosis of oral cancer.

This study was carried out to evaluate the validity of fluorescence photography as an adjunctive diagnostic method for oral cancer. Fluorescence photography was performed on 130 oral lesions in 130 patients. Lesions showing red, orange or pink fluorescence on the photographs were defined as positive, while all other lesions were considered negative. Seventy-two (91.1%) of 79 carcinomas and 6 (85.7%) of 7 epithelial dysplasias were judged as positive, whereas two (4.5%) of 44 benign lesions that were not dysplasias showed positive fluorescence. Sixty-nine (94.5%) of 73 squamous cell carcinomas showed positive fluorescence. These results suggest that fluorescence photography is useful as an adjunctive diagnostic method for oral squamous cell carcinoma.

Ultrasound-guided surgical drainage of face and neck abscesses.

An ultrasound-guided surgical drainage technique in which grey-scale and colour Doppler ultrasonography were combined is described. The technique was performed for eight deep subcutaneous abscesses subsequent to odontogenic infection, and provided easy detection and accurate, reliable penetration of abscesses that were difficult to locate by physical examination. Colour Doppler ultrasonography is particularly useful for differentiating blood vessels from the static space of abscesses.

Flexure deformation of the temporomandibular joint disk in pseudodynamic magnetic resonance images.

OBJECTIVE: The purpose of this study was to determine correlation of flexure disk deformation during jaw movement with other findings on magnetic resonance images and with clinical signs and symptoms in patients with anterior displacement of the temporomandibular joint disk. STUDY DESIGN: T(1)-weighted magnetic resonance images and gradient recalled acquisition in steady state magnetic resonance images were obtained in 62 subjects with flexure deformed disk in the jaw opening phase. Each disk deformation observed on a pseudodynamic image during jaw opening was classified as an upward or downward flexure deformation. The relationships between type of disk deformation, clinical signs and symptoms, and other findings on the magnetic resonance images were statistically analyzed by chi(2) test.Results. Of 80 delineated joints, 30 showed upward deformation and 50 showed downward deformation. There were significant differences between the upward and downward deformations in TMJ sound, TMJ pain, restricted jaw opening, extent of anterior displacement, and presence of disk reduction. CONCLUSIONS: The type of disk deformation appeared to correlate with the clinical signs and symptoms and with the progress of internal derangement.

Micro-anatomy of primary lymphatics in oral mucosa: a scanning electron microscopic study.

Primary or initial lymphatics cannot readily be recognised by conventional histological methods because they have usually collapsed in excised tissues. We have investigated the distribution of 81 initial lymphatics in 24 specimens of normal tissue and specimens from 11 squamous cell carcinomas and their relationship with the invasion of carcinoma. We used indirect injection methods and the distended initial lymphatics were observed by scanning electron microscopy. The lymphatics were arranged in a network consisting of integrated lymph capillaries and precollectors in the subepithelial area. There was a zone of high density 100 microm below the epithelium. The arrangement of initial lymphatics in oral mucosa was similar to that in the skin of head, in contrast to initial lymphatics in the skin at other sites. We saw no carcinoma cells penetrating into initial lymphatics and the route of tumourous infiltration into lymphatics deserves further investigation.

The effect of oral management on the severity of oral mucositis during hematopoietic SCT.

Oral mucositis (OM) is a frequent adverse effect of allogenic or autologous hematopoietic SCT. It results from direct toxic injury to the mucosal epithelial cells by the immunosuppressive regimen. Here, we compared the incidence and severity of OM between a group of 24 patients who received proper oral management during hematopoietic SCT and a group of 24 who did not. The oral management group received pre-hematopoietic SCT instruction on oral care and an oral examination in the clean room. Differences in the incidence and severity of OM between the two groups were examined statistically. OM was observed in 14 (58.3%) patients in the oral management group and 22 (91.6%) in the control group. The median of the OM score was 1 for the oral management group (range 0 to 3) and 2 for the control group (range 0 to 3). There was a significant difference in the OM score (P<0.05) and in the incidence of OM between the two groups (P<0.01). This study shows that oral management may decrease the occurrence of OM. Our results also suggest that it is important to include an oral management provider on the hematopoietic SCT team.