Prediction of nodal metastasis based on intraoral sonographic findings of the primary lesion in early-stage tongue cancer.

The aim of this study was to clarify the correlation between imaging findings obtained using intraoral ultrasonography (US) and pathological findings of tongue cancers, and to examine the predictive value of intraoral US findings with respect to occult nodal metastasis. This was a retrospective study based on the medical records of 123 patients with T1-2N0 tongue cancer. The depth of invasion (DOI) on intraoral US was positively correlated with the pathological invasion depth (PID) (ρ = 0.7080, P < 0.0001). Receiver operating characteristic analyses revealed an optimal DOI cut-off value of 4.1 mm and optimal PID cut-off value of 3.9 mm to detect nodal metastasis. Regarding the margin shape of the primary tumour on intraoral US, the incidence of nodal metastasis was significantly higher for the permeated type than for the pressure type (P < 0.001) and wedge-shaped type (P = 0.002). Furthermore, tumours with peritumoural vascularity assessed by power Doppler US had a significantly higher incidence of nodal metastasis than tumours without (P = 0.003). The sensitivity, specificity, and accuracy of the permeated type to predict nodal metastasis was 53.6%, 95.8%, and 86.2%, respectively. These results suggest that intraoral US findings closely reflect pathological findings and could be useful to predict occult nodal metastasis in patients with early-stage tongue cancer.

Effect of age on bowel management in traumatic central cord syndrome.

STUDY DESIGN: A retrospective multicenter study. OBJECTIVES: To investigate the characteristics of bowel dysfunction in elderly people with traumatic central cord syndrome (TCCS). SETTING: A total of 28 Rosai hospitals in Japan. METHODS: The Rosai Hospital registry included 3006 persons with spinal cord injury during 1997-2007. The study subjects were 186 patients with TCCS (160 men, 26 women; mean age, 61.7±11.6 years, ±s.d.). Patients were divided according to age into the young group (<50 years, n=30), the middle-age group (50-69 years, n=112) and the elderly group (≥70 years, n=44). We assessed the differences in bowel management techniques (spontaneous, rectal medications and manual emptying) and activity of daily living (ADL) with respect to bowel care at discharge among the three groups. RESULTS: Continent spontaneous defecation was the most common bowel management method (50%, 93/186). The percentage of elderly subjects on continent spontaneous defecation (36.4%) was significantly less than that of the young group (66.7%; P<0.05). Furthermore, the percentage of elderly patients who required no bowel care (18.2%) was significantly less than those of the young (53.3%) and middle-age groups (41.1%; P<0.01). However, few differences in bowel care-related ADL were recognized among the three groups in patients who required manual emptying. CONCLUSION: The results identified significantly fewer patients aged ≥70 years with 'continent spontaneous defecation' or 'independent for bowel care' compared with younger patients. The results also highlighted the clinical importance of bowel dysfunction associated with TCCS especially in elderly people.

Glomerulocystic kidney disease in an adult with enlarged kidneys: a case report and review of the literature.

We report the case of a 31-year-old male with enlarged kidneys and glomerulocystic kidney disease (GCKD). The patient had no family history of renal disease or other diseases. On initial presentation he complained of poor eyesight, and hypertensive retinopathy and elevated serum creatinine (5.0 mg/dl) were found at that time. Renal biopsy showed cystic dilatation of Bowman's capsule and atrophy of the glomerular tuft. Thus, an adult case of sporadic GCKD was diagnosed. Based on previous reports, kidney size in patients with adult type GCKD varies from small to large. Our patient's kidneys are the largest ever reported (right kidney was 22 cm×10 cm, left kidney was 19 cm×10 cm). A review of the literature dealing with sporadic adult GCKD suggested that it is difficult to diagnose this disease early in its course.

Patency assessment of the internal jugular vein after neck dissection.

Twenty-seven patients with oral malignant tumours, who underwent neck dissection with preservation of the internal jugular vein (IJV), were studied retrospectively to evaluate patency of the IJV. Twenty-three patients underwent ablative surgery of the primary lesion with neck dissection and 4 underwent neck dissection alone. Three patients received simple closure and skin grafting of the primary lesion, and 20 received reconstruction surgery (4 platysma flaps, 3 radial forearm flaps, 3 lateral upper arm flaps, 2 pectoralis major myocutaneous flaps and 8 rectus abdominis myocutaneous flaps). The maximum and minimum diameters of the IJV as measured on computed tomographic (CT) scans were used to assess patency. The cross-sectional area of the IJV and the ratio of its long axis to short axis (L/S ratio) were calculated. The relation between the change in IJV status and the type of flap used for reconstruction was also examined. Occlusion of the IJV was present in 3.7% of the patients, and 'narrowing' was present in 63.6%. The size of the flap significantly correlated with 'narrowing' of the IJV, suggesting that 'narrowing' was caused mainly by compression due to the flap.

Direct evidence of plastid DNA and mitochondrial DNA in sperm cells in relation to biparental inheritance of organelle DNA in Pelargonium zonale by fluorescence/electron microscopy.

The fate of plastid DNA and mitochondrial DNA was followed during spermatogenesis in thin sections of the pollen grains in Pelargonium zonale by epifluorescence microscopy, after staining with 4'-6-diamidino-2-phenylindole (DAPI), by the combination of fluorescence and electron microscopic images by color image processor, and by immunogold electron microscopy. DAPI-stained thin sections showed that there are two different types of fluorescent spots due to organelle DNA in the cytoplasm of generative cells and sperm cells: spherical spots that emit strong fluorescence (SF spots) and a ring-shaped group of tiny spots that emit a pale fluorescence (RG spots). The RG spots correspond to peanut-shaped refractive dense bodies under a phase-contrast microscope. Combination of the fluorescence and electron microscopic images by a color image processor showed that SF spots are not emitted from peanut-shaped electron-dense bodies but are from small spherical granules with cristae-like lamellae. Immunogold electron microscopy using ultrathin sectioning showed that the small spherical granules are mitochondria with typical cristae and that the peanut-shaped electron-dense bodies are plastids. The results clearly indicate that mitochondria and plastids with DNA molecules are present in the cytoplasm of sperm cells. The presence of these plastid DNA molecules may be responsible for the biparental inheritance of plastids. In addition, mitochondrial DNA may also show biparental inheritance.

Cytokinesis by a contractile ring in the primitive red alga Cyanidium caldarium RK-1.

To better understand the mechanism of cytokinesis in eukaryotes, the behavior of the contractile ring in the two unicellular primitive red algae Cyanidioschyzon merolae and Cyanidium caldarium RK-1, which have the smallest genome size among eukaryotes, was examined by fluorescein isothiocyanate (FITC)-phalloidin fluorescence microscopy, fluorometry using a video-intensified microscope photoncounting system, transmission electron microscopy and immunoblotting techniques. Cells in each alga contained one nucleus, one mitochondrion and one chloroplast, which were aligned in that order. During cytokinesis in C. merolae, a contractile ring was not observed by fluorescence microscopy or by transmission electron microscopy. In contrast, in C. caldarium RK-1, a contractile ring appeared at the equatorial region of the dividing cells and began to contract from the side of the chloroplast. During contraction of this ring, the total fluorescent intensities due to FITC-phalloidin remained constant. Electron microscopy revealed outer and inner bands approximately 80 nm wide and 9 nm thick which ran parallel to each other just beneath the cell membrane. These bands were visible at the equator of the cell just before the initiation of cytokinesis and constricted from the pole of the chloroplast. Both bands increased in width as cleavage progressed. The inner ring consisted of a bundle of approximately 20 actin-like filaments which were arranged as a raft. In the outer ring, such fine filaments were not visible. It seems likely that the bundle of filaments, known as the contractile ring, is composed of two different elements: an inner band of actin filaments and an outer band of unknown materials.(ABSTRACT TRUNCATED AT 250 WORDS)

Extraction of total RNA from leaves of Eucalyptus and other woody and herbaceous plants using sodium isoascorbate.

Rapid extraction of total RNA from Eucalyptus leaves is difficult due to the high content of polyphenolics and polysaccharides. A rapid and simple method was developed by using an extraction buffer containing sodium isoascorbate at a concentration of 500 mM. This method consisted of one or two chloroform extractions, one acid guanidium-phenol-chloroform extraction, and isopropanol precipitation alone. The yields of the RNA fractions were 246-1750 micrograms/g fresh weight when leaves of Eucalyptus, five other woody plants, and four herbaceous plants were used as samples. The contamination of the RNA fractions by proteins and polysaccharides was very limited as judged spectrophotometrically. When the RNA fractions were subjected to agarose gel electrophoresis, intact rRNA bands were detected. The RNA fractions could be used for RT-PCR. These results indicate that our new method achieves a simple and rapid preparation of high-quality RNA from leaves of Eucalyptus and other plant species.

Sonography for the detection of cervical lymph node metastases among patients with tongue cancer: criteria for early detection and assessment of follow-up examination intervals.

BACKGROUND AND PURPOSE: Because the presence of cervical metastasis is one of the factors influencing the outcome of patients with carcinoma of the head and neck, its early detection is potentially very important. The purpose of this study was to evaluate the characteristic changes of cervical metastasis revealed by sonography during follow-up and to assess an adequate interval for follow-up sonography of the neck among patients with tongue cancer. METHODS: Forty-three of 44 consecutive patients with squamous cell carcinoma of the tongue, who had undergone interstitial brachytherapy, were examined with sonography of the neck during the posttherapeutic follow-up period. RESULTS: Seventeen cervical lymph node metastases were found in 12 of 43 patients during follow-up. Of these 17 cervical metastases, 16 (94.1%) were accurately diagnosed and one (5.9%) was misdiagnosed as nonmetastatic based on sonographic findings. Sonography of the neck performed in seven patients at an interval of less than 1 month since the last follow-up imaging showed 9 (90.0%) of 10 metastases increased by up to 2 mm in short-axis diameter. Five patients who were followed up at an interval of more than 1 month since the last follow-up imaging had seven metastases increase by 3 to 8 mm in short-axis diameter or a change of echogenicity in the internal structure of lymph nodes or both. Pathologic examinations showed extranodal spread in 3 (42.9%) of these 7 metastases. CONCLUSION: Changes both in size and internal echogenicity can occur as quickly as 2 to 4 weeks between sonographic examinations. Therefore, in high-risk patients, or in those with suspicious sonographic findings, short-interval follow-up sonographic examinations are recommended at least during the first posttherapeutic year. Our findings suggest that follow-up sonography of the neck should be performed monthly, at least during the first posttherapeutic year.

Expression of a bacterial endoglucanase gene in tobacco increases digestibility of its cell wall fibers.

Transgenic tobacco plants exhibiting exogenous cellulase activity were produced by introduction of a truncated cellulase (t-EgI) gene from Ruminococcus albus. They accumulated about 0.1-0.5% t-EgI of the total soluble proteins in the cytoplasm. They were normal in morphology and growth. t-EgI expressed in the transgenic plants degraded their own cell wall materials after the cells were disrupted. The plants expressing the t-egI gene could be used as "cellulase-encapsulating plants" for livestock and food industries.

Solitary intracranial plasmacytoma.

A case of solitary plasmacytoma involving the left cerebral convexity, dura mater, falx, and sagittal sinus is reported. After undergoing subtotal excision, followed by radiation, the patient was still doing well seven years after diagnosis. The importance of electrophoretic studies of the cerebrospinal fluid protein and the serum protein is discussed. The literature on solitary intracranial plasmacytoma is reviewed.

A new, simple method of making a spacer in interstitial brachytherapy for mobile tongue cancer.

OBJECTIVES: This article demonstrates a new method of making a spacer that increases the distance between the mandible and implanted radioactive sources in interstitial brachytherapy for patients with mobile tongue cancer. STUDY DESIGN: Fifty-three patients with mobile tongue cancer underwent interstitial brachytherapy with spacers made by this new technique. RESULTS: Our spacer is not difficult to create or to use. The spacer was made from a plastic splint by using thermoforming techniques and quick self-curing resin, which did not need waxing, wiring, or casting. The surface of the spacer, which comes in contact with the tongue, is smooth because it is covered with tissue-conditioning material. There were no complaints of pain from the patients. Osteoradionecrosis of the mandible developed in only 1 (1.9%) of these patients. CONCLUSIONS: This spacer is simple to make and prevented osteoradionecrosis.

Value of contrast-enhanced magnetic resonance imaging in differentiation of hemangiomas from lymphangiomas in the oral and maxillofacial region.

OBJECTIVE: The purpose of this study was to investigate the ability of contrast-enhanced magnetic resonance imaging to differentiate hemangioma from lymphangioma in the oral and maxillofacial region. STUDY DESIGN: Contrast-enhanced magnetic resonance imaging was performed in 20 patients (21 masses: 17 hemangiomas and 4 lymphangiomas) through use of either a 0.2-T permanent system or a 0. 5-T superconductive system and spin-echo pulse sequences. RESULTS: After intravenous administration of contrast medium, enhancement was observed in all hemangiomas in areas corresponding to those with high signal on T(2)-weighted images. Unequivocally increased signal was observed in 10 masses, and slightly increased signal was observed in 7 masses. On the other hand, none of the lymphangiomas showed an enhancing mass on contrast-enhanced T(1)-weighted images. CONCLUSIONS: Although contrast-enhanced T(1)-weighted imaging may not improve delineation of masses in all cases, it can be used to differentiate between deep hemangiomas and lymphangiomas.

Morphologic analysis of odontogenic cysts with computed tomography.

PURPOSE: The purpose of this study was to analyze the effects of lesion site and epithelial keratinization on the morphologic characteristics of odontogenic cysts and clarify determinate factors for cyst morphology. MATERIAL AND METHODS: Computed tomographic images of 92 odontogenic cysts were analyzed: 31 primordial, 31 dentigerous and 30 radicular. Thirty-four cysts were located in the maxilla (6 primordial, 10 dentigerous, and 18 radicular) and 58 in the mandible (25 primordial, 21 dentigerous, and 12 radicular). Histologically, 31 cysts showed epithelial keratinization (18 primordial and 13 dentigerous). No keratinization was seen in radicular cysts. The morphologic features of cysts were assessed by measuring long length parallel to dental arch and short length vertical to it and calculating the long/short ratio. In addition, the computed tomography pattern of the cyst was classified into unilocular, lobulated, and multilocular patterns. Appearance of the sclerotic rim and surrounding cortex were classified into three and four patterns respectively to evaluate the developmental features of the cyst. RESULTS: As a whole, the long length of the primordial cysts was statistically larger than the other two cyst groups and resulted in a larger long/short ratio. Statistical differences of CT pattern were also seen among cyst groups. There was no preference in any cyst group for the appearance of the sclerotic rim and cortex. There were statistical differences between maxilla and mandible in short axis and long/short ratio. The maxillary cysts generally showed round shapes irrespective of their histologic characteristics. A multilocular pattern was more frequent in the keratinized group of mandibular primordial cysts. In dentigerous cysts, a multilocular pattern was seen only in the keratinized group and the long/short ratio was statistically larger; cyst shape was elliptical along the long axis. CONCLUSION: Our results demonstrated morphologic differences of odontogenic cysts caused by lesion site and keratinization. The dentigerous cyst with predominant keratinization should be included in the primordial cyst (odontogenic keratocyst) group.

Assessment of image quality in dental radiography, part 1: phantom validity.

OBJECTIVE: The purpose of this study was to describe and validate an image-quality phantom to be used in dental radiography for comparison of film and digitally acquired images. STUDY DESIGN: An aluminum block of 12 steps, with 7 holes in each step, was covered by acrylic blocks. This phantom was radiographed with Kodak Ultra-speed and Ektaspeed Plus films at 70, 65, and 60 kVp with the whole exposure range available. All together, 50 dental films were randomly sequenced and presented to 7 observers. The average number of perceptible holes from all steps was plotted against exposure for each tube voltage and film type, generating a modified perceptibility curve. The tentative optimum exposure level was determined from perceptibility curves in each experimental condition and compared with that determined by means of the standard aluminum stepwedge and the preset time of the x-ray machine. The density range of this phantom at the optimum exposure was compared with that of clinical dental radiographs. Validity of the phantom was evaluated according to the optimum exposure level from the modified perceptibility curves and the overall density range. Finally, the average maximum numbers of perceptible holes at the tentative optimum exposure level were compared for each tube voltage and film type. The statistical test used was a 2-way factorial analysis of variance. RESULTS: The exposure at the perceptibility curve peak approximated that obtained by means of the standard aluminum step-wedge and the time preset by the manufacturer. The overall density range at the perceptibility curve peak covered the clinical density range for each tube voltage and film type. There were no statistically significant differences between film types or among tube voltages. CONCLUSIONS: The x-ray attenuation range for this phantom seemed to approximate clinical conditions. In addition, differences in image quality could be quantitatively evaluated by means of the number of the holes seen in the phantom.

Assessment of image quality in dental radiography, part 2: optimum exposure conditions for detection of small mass changes in 6 intraoral radiography systems.

OBJECTIVE: The purpose of this study was to compare 2 film systems and several digital intraoral systems with regard to visual image quality through use of a test phantom developed for this purpose. STUDY DESIGN: The detectors used for digital imaging were as follows: Computed Dental Radiography (CDR), Digora, Dixel, and Sens-A-Ray without scintillator layer. Two types of digital images were prepared for the observer performance test: one with original gray scales and another with contrast enhancement. Images with and without enhancement from the 4 systems were displayed to 7 observers. The change in the average number of perceptible holes was plotted against exposure, and modified perceptibility curves were created and compared with curves for the film systems. The exposure level at which the maximum number of holes was perceived was defined to be optimum. The optimum exposure levels were determined for each digital system and compared with that of the film systems. At the optimum exposure, the average maximum numbers of perceptible holes in each digital system with and without contrast enhancement were compared with the maximum numbers for the film systems. The minimum exposure levels were determined to be those at which the number of perceptible holes exceeded the number for film, and the possibility of exposure reduction was evaluated. RESULTS: All digital systems except the Digora system showed lower optimum exposures than E-speed film. In all digital images without enhancement, however, the maximum number of perceptible holes was significantly lower than that for the film systems at that exposure. With contrast enhancement, all digital systems except the Sens-A-Ray system showed visibility superior to that of the film systems. With the CDR, Digora, and Dixel systems, exposures could be further reduced by a considerable amount, with greater retention of information than was associated with film. CONCLUSIONS: Our results strongly suggest that digital systems, if properly used, can exceed film systems in the detection of small mass changes.

Submandibular gland duct endoscopy. Diagnostic value for salivary duct disorders in comparison to conventional radiography, sialography, and ultrasonography.

The purpose of this study is to evaluate the usefulness of endoscopy as a procedure for the diagnosis of submandibular gland duct disorders. Endoscopy of the submandibular glands was performed on 12 patients with symptoms of obstructive sialoadenitis to identify the cause of obstruction. The endoscopic findings were then compared to those of diagnostic procedures such as conventional radiography, sialography, and ultrasonography. Six normal subjects also underwent endoscopy to better understand the normal findings of the duct system. Endoscopy demonstrated salivary gland calculus in 5 of 12 patients, which was revealed as filling defects on sialograms and as strongly echogenic structures on ultrasonograms in 4 of the patients. Endoscopy revealed secretion plugs, secretion plaques, and/or stenosis, which could not be seen by any other diagnostic procedures in 5 patients, as the cause of recurrent swelling in all 7 patients not demonstrating sialolith. Abnormal findings of the duct wall such as vasodilatation, fibrosis, edema, or erythema were seen in four patients, three of whom exhibited dilatation of the duct system on sialograms. In four patients, a decreasing internal echo level of the gland was seen on ultrasonograms. Our initial results for submandibular gland duct endoscopy thus appear to be promising.

Mucoepidermoid carcinoma in the mandible: findings of panoramic radiography and computed tomography.

Six patients with mucoepidermoid carcinoma in the mandible were studied with both panoramic radiography and computed tomography. Lesion shape and margin were evaluated on panoramic radiography, and bony expansion and cortical plate destruction were evaluated on computed tomography. In addition, a possible correlation among radiographic findings, histologic findings, and prognosis was investigated. Lesions found on panoramic radiography were classified into three types; each type pertained to two of the six patients. The lesion types were as follows: cystic, characterized by a large, cystic radiolucent area; rarefying, characterized by rarefying changes of the trabeculae; and infiltrative, characterized by a central ill-defined area of bony destruction. The results show that computed tomography is useful in the identification of tumor extent, bony expansion, and cortical plate destruction resulting from tumors. None of the patients whose lesions were of the cystic or rarefying type showed evidence of disease after surgery. In contrast, both of the patients whose lesions were of the infiltrative type died of their tumors. Histologic findings of the cystic and rarefying types showed tumors that were well-differentiated or moderately well-differentiated, whereas findings of the infiltrative type showed poorly differentiated tumors. Radiographic findings correlated with histologic findings and prognosis of mucoepidermoid carcinoma in the mandible in this limited series.

Isokinetic strength of elbow extensor muscles correlates with race time in wheelchair half marathon racers.

It has been reported that grasping power and isometric muscle strength of elbow extensors in fine wheelchair racers were greater than the poor racers in the wheelchair full marathon. The purpose of the present study was to investigate the relationship between muscle strength of elbow extensors and flexors and the race time in wheelchair half marathon race. Four wheelchair half marathon racers who completed the half marathon division of the 16th Oita International Wheelchair Marathon (OIWM) in 1996 participated in the present study. The day before the race, all subjects reported to the training room and the isokinetic muscle strength of elbow extensor and flexor muscle groups was measured at angular speeds of 60 degrees, 120 degrees and 240 degrees/sec using the isokinetic dynamometer. There was a significant correlation between race time and isokinetic muscle strength of the elbow extensors at 60 degrees, 120 degrees and 240 degrees/sec, but not flexor muscles. Our findings suggest that increased muscle strength of elbow extensors may improve the race time in wheelchair half marathon race.

Marsupialisation for keratocystic odontogenic tumours in the mandible: longitudinal image analysis of tumour size using 3D visualised CT scans.

The purpose of this study was to determine how keratocystic odontogenic tumours (KCOTs) in the mandible are reduced during marsupialisation, and to predict the best time for secondary enucleation by analysing computed tomography (CT) images. 15 patients with KCOTs were treated with marsupialisation surgery, and 42 series of CT data taken during the marsupialisation process were analysed. CT data were reconstructed in three-dimensional (3D) images. The 3D images were used to measure the diameter and volume, and to analyse the changes that occurred after marsupialisation. Marsupialised KCOTs tended to be reduced equally towards the window in the tumour. The amount of volume reduction per day (V(r)) was reduced in proportion to the volume (V) with the formula V(r)=-0.0029×V. The formula manipulation for V was V=V(0)×e(-0.0029t) (t=duration after marsupialisaton (day)). The volume of marsupialised KCOTs was reduced by half over a 239 day cycle. These results demonstrate that the future shape of marsupialised mandibular KCOTs, under good control, could be predicted with significant accuracy using CT data. This prediction could decrease the prolonged marsupialisation state in patients with KCOTs.