Imaging findings of lipomas in the orofacial region with CT, US, and MRI

OBJECTIVE

The aim of this study was to document retrospectively the imaging findings of lipomas with the use of computed tomography, ultrasonography, and magnetic resonance imaging.

STUDY DESIGN

Thirteen patients with 11 lipomas and 2 lipomatoses were evaluated. Eleven cases were examined by computed tomography, 9 by ultrasonography, and 3 by magnetic resonance imaging.

RESULTS

Lipomas had a density ranging from -134 to -83 Hounsfield units, (mean-108) on the computed tomography images. The margins were ill defined in 9 of 10 cases. The superficial muscles were displaced externally in 8 cases and internally in 2 cases. With ultrasonography, 8 lesions were hypoechoic, and one was hyperechoic. All three lesions had a high signal intensity on both T1- and T2-weighted images.

CONCLUSIONS

Lipomas had a specific range of computed tomography Hounsfield unit values and also displaced the surrounding soft tissue. Although some variation in the ultrasonographic appearance was observed, the lesions tended to be hypoechoic. These findings may be useful for diagnosing lipomas in the orofacial region.

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.

Computed tomography of carcinoma of the upper gingiva and hard palate: correlation with the surgical and histopathological findings

OBJECTIVES

To clarify the diagnostic utility of CT in the evaluation of carcinoma of the maxillary gingiva and hard palate.

METHODS

The CT scans of 27 patients with squamous cell carcinoma of the upper gingiva and hard palate were reviewed. Tumor extent and bone destruction were compared with the surgical and histopathological findings to estimate the sensitivity, specificity and accuracy of CT.

RESULTS

The primary tumor was detected by CT in 89% of patients. The grade of bone destruction determined by CT correlated well with that verified at surgery or by histopathological examination. The sensitivity, specificity, and accuracy of CT for invasion to the buccal mucosa were 64%, 89% and 75% respectively. For maxillary sinus invasion, CT showed low specificity but high sensitivity. The accuracy was 86% when the criterion for sinus invasion was the presence of an enhanced mass continuous with the primary tumor.

CONCLUSION

CT is helpful for the evaluation of tumor extent in the upper gingiva and hard palate carcinoma. However, invasion of the maxillary sinus should be considered carefully, because CT findings suggestive of destruction of the floor of the maxillary sinus are not always consistent with sinus invasion.

Numb chin syndrome as an initial symptom of acute lymphocytic leukemia: report of three cases

This article describes three cases of acute lymphocytic leukemia that presented with mental neuropathy, or so-called "numb chin syndrome," as the initial symptom of the disease. This symptom heralded the initial progression of the disease in the first and second cases and the recurrence of the disease in the third case. In these cases tenderness in the mental foramen, percussion pain of the teeth, loosening and extrusion of the teeth, and radiographic abnormalities were also, if not always, observed in association with mental neuropathy. The radiographic abnormalities included a disappearance of the mandibular canals, an enlarged periodontal ligament space, a loss or thinning of the lamina dura, and a destruction of the alveolar crestal bone. This report indicates that oral manifestations can therefore occasionally play an extremely important role in the early recognition of acute lymphocytic leukemia. The unexplained oral abnormalities such as numbness of the chin and lower lip must thus be considered, potentially ominous indication of acute lymphocytic leukemia.

New trends for practice in telecommunication applied to preventive and environmental medicine

This paper presents survey results of connectivity to the Internet from preventive and environmental medicine-related departments in medical schools and other institutions in Japan and propose means to establish connectivity among them. Of 191 facilities surveyed, 134 (70%) responded by March 31, 1996. The data presented here are from 132 facilities. One hundred seventeen facilities (89%) answered that they were connected to the Internet. More than 80% of them got access to the Internet in the past two years. One hundred three facilities (78%) answered that e-mail was available. Despite the large percentage being connected, only 11 facilities (8%) had their own homepages. However, just 6 months later more than 25 facilities could be found by their own homepages. The Global Health Network (GHNet) has been developed in the USA based upon the concept that the best means to produce improved health is a better surveillance and information system applying the latest telecommunication technology to public health. The GHNet will offer an initial homepage for Preventive and Environmental Medicine related facilities in Japan to promote and establish sustainable connectivity among them.

Correlation between HLA-DR expression and level of poly(ADP-ribose) synthetase in human thyroid carcinoma cells

The expression of MHC class II molecules is normally restricted to antigen presenting cells. Aberrant expression of class II molecules, however, was detected in the thyrocytes of autoimmune thyroid diseases. We attempted to regulate the expression of HLA-DR molecules in thyroid carcinoma cells by expressing the exogenous poly(ADP-ribose) synthetase gene. We transfected a metal inducible expression plasmid capable of expressing poly(ADP-ribose) synthetase gene into thyroid carcinoma 8505C cells and the transformants, treated with metal and IFN-gamma, were separated by Magnetic Cell Separation. The activity of the synthetase was increased in the HLA-DR-enriched transformants as compared with that in control or the HLA-DR+ transformants. RNA blot analysis and flow cytometric analysis revealed that the IFN-gamma-inducible expression of HLA-DR molecules was depressed by the induction of exogenous poly(ADP-ribose) synthetase gene. This result indicates that HLA-DR expression was correlated with the level of poly(ADP-ribose) synthetase in human thyroid carcinoma cells. Furthermore we examined the level of poly(ADP-ribose) synthetase in patients with autoimmune thyroid diseases. We observed a significant decrease in poly(ADP-ribose) synthetase in the patients. Taken together with the previous observation, the decrease in poly(ADP-ribose) synthetase is closely linked to the aberrant expression of HLA-DR molecules in some autoimmune thyroid diseases.

Reliability of ultrasonography and sialography in the diagnosis of Sjögren's syndrome

OBJECTIVE

The purpose of this study was to evaluate quantitatively observer performance with ultrasonography and sialography in the diagnosis of parotid gland involvement of Sjögren's syndrome.

STUDY DESIGN

Sixty-four parotid gland sialograms and 65 ultrasonograms were prepared for observer performance experiments. They included both modalities in 24 Sjögren's syndrome and 19 nonspecific parotitis cases, 21 normal parotid gland sialograms, and 22 normal ultrasonograms in healthy volunteers. The images were randomly sequenced and presented to five observers who were asked to describe several findings and finally to determine the imaging diagnosis by ranking the abnormal features and the diagnosis on a five-point-rating scale. Observer performance was evaluated on the basis of the reliability of findings interpreted and the diagnostic accuracy of each modality from observers' rating scores.

RESULTS

The diagnostic accuracy of sialography was very high, nearly perfect. The diagnostic accuracy of ultrasonography was lower than that of sialography, resulting from the lower incidence of characteristic findings in the disease groups and lower sensitivity on ultrasonography. In the differentiation of Sjögren's syndrome from the normal, however, the diagnostic accuracy of ultrasonography increased to 80% for all cases, and up to nearly 90% in the advanced sialographic stages.

CONCLUSION

Ultrasonography is useful for the diagnosis of Sjögren's syndrome in the advanced stages. Taking the noninvasiveness of this technique into account we recommend first applying ultrasonography to the diagnosis of Sjögren's syndrome and performing sialography when no positive findings are detected on ultrasonography.

[Responses to surgical stress in blood coagulation and fibrinolysis, platelet counts and thromboxane B2 after esophageal cancer operation]

Studies on responses to surgical stress in blood coagulation and fibrinolysis, platelet counts and thromboxane B2 (TXB2) were carried out with 18 esophageal cancer patients who had undergone radical esophagectomy through right thoracotomy and reconstruction with gastric tube. Plasma levels were measured for the following for coagulation assessment: thrombin.antithrombin III complex (TAT), soluble fibrin monomer complex(SFMC), fibrinogen, antithrombin III, protein C and thrombomodulin. Selected fibrinolytic markers are: tissue plasminogen activator.plasminogen activator inhibitor 1 complex (tPA.PAI1C), plasminogen, alpha 2 plasmin inhibitor, plasmin. alpha 2 plasmin inhibitor complex(PIC), FDP and D-dimer. Peripheral venous blood samples were taken from the patients before the operation, immediately after the operation and on each of the first, second, third, seventh and fourteenth day after the operation. It was observed that TAT, SFMC, tPA.PAI-1C and TXB2 were remarkably altered immediately after the operation. This indicates that the major surgical stress significantly activated coagulation, fibrinolysis and platelets. Higher plasma levels of TAT compared to the pre-operation level was recorded for two weeks after the operation. Furthermore, in four cases, SFMC became positive during three to seven days after operation. These facts indicate that the activation of coagulation persisted during the days after operation. PIC began to increase from the 2nd to 3rd days after operation, reaching the maximum on the 7th day. Biphasic changes which peaked twice on the 1st and 7th days after operation were shown in plasma levels of FDP and D-dimer. These results indicate that the activation of fibrinolysis also persisted during the days after operation. The activation of coagulation and fibrinolysis may persist at least for two weeks after major surgical operation. Careful observation for the states of these systems was thought to be needed during the post-operative days, and the molecular markers could be useful to assess subclinical changes of these systems.

[Decreasing heart rate and shortening of the arterial pulse propagation time by acupuncture in the spectral analyses]

By utilizing NAITO's analytical indices of the high frequency energy (HFEI) [sigma p x f (0.15 Hz < frequency < 0.45 Hz)] and the low frequency energy (LFEI) [sigma p x f (0.025 Hz < f < 0.15 Hz)] of R-R intervals combined with UEDA's index of fluctuation in propagation time of radial arterial pulses (i.e. R-P intervals), the author investigated relation between elongation in R-R and shortening in R-P intervals by application of electrical acupuncture (1 Hz) on traditional acupoints (HT7:SHENMEN and PC4: XIMEN). The spectral heart rate analyses have been performed in 16 males and 14 females (total 30, i.e. 18 physically healthy volunteers and 12 patients). Those who were suffering from any cardiovascular diseases were excluded. Results obtained are as follows; (1) The mean R-R intervals were significantly prolonged from 10 minutes after needle insertion to the end, i.e. 10 minutes after removal of the needles. (2) The R-P intervals were significantly shortened after 10 minutes of needle insertion. It is assumed that the decrease in heart rate by acupuncture was due to relative superiority of the vagal tone and the shortened R-P intervals, and was due to sympathetic nerve activities stimulated by acupuncture, so as to expedite arterial pulse wave propagation by the arterial contraction. Thus, increased activities of both sympathetic and vagal nerves can coexist simultaneously during acupuncture.

Undifferentiated carcinoma of the broad ligament in a 28-year-old woman--a case report and results of immunohistochemical and electron-microscopic studies

A case of undifferentiated carcinoma of the broad ligament is reported. The patient was a 28-year-old Japanese woman who underwent laparotomy for a cystic and solid tumor of the left broad ligament. The tumor measured 9 cm in diameter and was unattached to the uterus, ipsilateral ovary, or salpinx. Histological examination revealed tumor tissue consisting of solid nests of irregular configuration and rather small to medium-sized undifferentiated epithelial cells. The tumor cells were positive for cytokeratin, but negative for CA125, epithelial membrane antigen, S-100 protein, amylase, carcinoembryonic antigen, chromogranin A, synaptophysin, HHF35, desmin, and vimentin. Electron-microscopic examination revealed gap junctions and primitive cellular junctions, but no intracytoplasmic mucous granules or microvilli on the surface of the tumor cells. This is the first report of undifferentiated carcinoma of the broad ligament as far as we have been able to determine from a search of the literature.

Multiple pleomorphic adenomas arising in the parotid and submandibular lymph nodes

We report rare case of multiple pleomorphic adenomas arising in the parotid and submandibular lymph nodes of a 21-year-old man. These tumours were surrounded by lymphoid tissue which was almost identical to that of the cortex of lymph node. The possibility of metastasizing pleomorphic adenomas was discounted because the mitotic activity was low and there were no signs of infiltration. Heterotopic salivary gland tissue was also found in the lymph nodes that contained the tumours, and each tumour expressed a similar immunohistochemical staining pattern to that of the salivary gland tissue. These findings indicate that these pleomorphic adenomas probably arose from the salivary gland tissue within the lymph nodes.

Oral involvement in chronic graft-versus-host disease after allogeneic bone marrow transplantation

We examined 37 patients who had undergone an allogeneic bone marrow transplantation and compared their oral findings to their systemic involvement with chronic graft-versus-host disease. Among the clinical signs and symptoms in their oral region, only the presence of oral lichenoid lesions had a statistically significant relationship to the diagnosis of chronic graft-versus-host disease. The histologic findings in the labial salivary glands and buccal mucosa closely reflected the status of chronic graft-versus-host disease. Statistically, the presence of diffuse and periductal lymphocytic infiltration in labial salivary glands, subepithelial lymphocytic infiltration and epithelial changes in buccal mucosa also showed a significant relationship to the diagnosis of chronic graft-versus-host disease. The present study suggests that a systematic oral examination, especially pathologic examination of the labial salivary glands and buccal mucosa, is useful in evaluating the status of chronic graft-versus-host disease.

T cell receptor V alpha and V beta gene usage by tumour-infiltrating lymphocytes in oral squamous cell carcinoma

Oral squamous cell carcinomas (SCC) are often infiltrated by a large number of T lymphocytes. To clarify the nature of the tumour-infiltrating lymphocytes (TIL), we examined T cell receptor (TCR) V alpha and V beta gene usage by TIL and peripheral blood mononuclear cells (PBMC) obtained from 10 patients with oral SCC. We obtained RNA from TIL and PBMC, synthesized complementary DNA, and used the polymerase chain reaction (PCR) method with a panel of primers specific for the V gene segment subfamily (V alpha 1-18/V beta 1-20). We thus found that TIL showed more restricted usage of V beta gene families in contrast to PBMC of the same patients while two unique V beta gene (V beta 6 and V beta 5.2) segment transcripts were overexpressed in the TIL of more than half of the patients. On the other hand, no major difference was observed in the V alpha gene usage between the TIL and PBMC of most patients. To characterize these T cell subpopulations with unique V beta gene segment transcripts further, we sequenced the complementarity-determining region 3 in V beta 6-C beta and V beta 5.2-C beta PCR products derived from TIL and PBMC of two selected patients in each case. Although no usage of the conserved amino acid sequence by TIL was detected, the frequent use of V beta 6/J beta 1.1 in one patient and the V beta 6/J beta 2.7 gene segments in another patient was observed. Regarding the V beta 5.2 transcripts, obtained from the other two patients, no preferential usage of specific J beta gene segments by TIL was observed. These results suggest that the unique T cell populations are amplified in patients with oral SCC, possibly as a consequence of an in situ immune reaction.

A comparison of glandular involvement between chronic graft-versus-host disease and Sjögren's syndrome

Patients with chronic graft-versus-host disease (cGVHD) occasionally suffer from symptoms of xerostomia and xerophthalmia, which are also features of Sjógren's syndrome (SS). To identify differences in the glandular involvement between cGVHD and SS, we measured the proportions of infiltrating lymphocyte subsets and the expression of HLA-DR antigen and cell adhesion molecules in labial salivary glands (LSG). In cGVHD, more than 90% of the infiltrating lymphocytes were T cells with a slight predominance of CD8+ over CD4+ cells. In SS, CD4+ cells were predominant, and B cells accounted for 10-30% of the infiltrating lymphocytes. Ductal epithelial cell associated with lymphocytic infiltration expressed HLA-DR antigen in both cGVHD and SS. In SS alone, HLA-DR antigen expression also occurred without associated lymphocytic infiltration. The expression of adhesion molecules on ductal epithelial cells, especially vascular cell adhesion molecule 1, was more intense in SS than in cGVHD, while that on endothelial cell was similar in cGVHD and SS. These data suggest that the pathogenesis of glandular involvement of cGVHD is different from that of SS.

[Cerebral blood volume, cerebral hemoglobin and cytochrome AA3 during hypotension induced by prostaglandin E1 or epidural anesthesia under general anesthesia]

The effect of hypotension induced by PGE1 or epidural anesthesia under general anesthesia on cerebral blood volume (CBV), cerebral tissue hemoglobin, cytochrome AA3 was studied using a near infrared spectrophotometry in 20 patients undergoing abdominal operation. In PGE1 group (n = 10), CBV, cerebral oxyhemoglobin (HbO2) and deoxyhemoglobin (Hb) were unchanged during hypotension. However, cerebral HbO2 decreased and Hb increased slightly in a case of severe hypotension more than 40 percent of control, but CBV did not show any significant change. On the other hand, in epidural anesthesia group, HbO2 decreased significantly along with MAP reduction (r = 0.84) and Hb increased slightly. Cytochrome AA3 did not show any significant changes in both groups. From these results, we concluded that PGE1 drip infusion was better than epidural anesthesia to sustain the cerebral blood volume during hypotension.

Cytokine messenger RNA expression in the labial salivary glands of patients with Sjögren's syndrome

OBJECTIVE

To characterize the initiation and progress of localized autoimmune damage in Sjögren's syndrome (SS), an autoimmune disease that is also considered to be a lymphoaggressive disorder, by examining the pattern of cytokine production at the site of autoimmune damage.

METHODS

Using a polymerase chain reaction-based method, cytokine messenger RNA (mRNA) expression in the labial salivary glands of 15 patients with SS was investigated. In addition, the infiltrating lymphocytes in the labial salivary glands were examined immunohistochemically.

RESULTS

Messenger RNAs of Th1 cytokines, such as interleukin-2 (IL-2) and interferon-gamma, were consistently detected in all patients, while Th2 cytokine mRNAs, such as IL-4 and IL-5, were detected in some cases, in association with strong B cell accumulation in the labial salivary glands. Other cytokine mRNAs produced by a variety of cell types, including IL-10, IL-6, and transforming growth factor beta (TGF beta), were also consistently detected in all patients, while IL-12 mRNA was detected in some of the patients.

CONCLUSION

These results suggest that Th1 cytokines, as well as IL-10, IL-6, and TGF beta, are essential in the induction and/or maintenance of SS, while Th2 cytokines are involved in the progression of the disease process, especially local B cell activation.

Infective endocarditis caused by Campylobacter fetus after allogeneic tooth transplantation: a case report

A patient developed infective endocarditis caused by Campylobacter fetus. He gave a history of recent dental extraction and allogeneic tooth transplantation. He was treated with various antibodies to which the organism was said to be sensitive, but it was not until the transplanted tooth was removed that he started to improve. The mode of infection was thought to be blood borne through the open tooth socket from the raw chicken that he ate regularly.

Cerebral oxygen metabolism measured by near-infrared laser spectroscopy during laparoscopic cholecystectomy with CO2 insufflation

To clarify the influence of carbon dioxide (CO2) on cerebral oxygen metabolism and blood volume during laparoscopy with CO2 insufflation in 12 patients who underwent laparoscopic cholecystectomy, changes in the concentrations of cerebral oxyhemoglobin (HbO2), reduced hemoglobin (HbR), total hemoglobin (total Hb), and oxidized cytochrome aa3 (Cyt aa3) were measured using near-infrared laser spectroscopy. Anesthesia was maintained with nitrous oxide (66%)-oxygen-sevoflurane. Pneumoperitoneum was maintained at an endoabdominal pressure of 10 to 12 mm Hg using CO2. Minute ventilation was constant before and after CO2 insufflation. End-tidal CO2 tension (PETCO2) increased significantly, from 33.9 +/- 1.3 to 52.8 +/- 3.3 mm Hg, after CO2 insufflation. The concentration of HbO2 increased significantly, from 0 to 7.3 +/- 2.8 mumol/L, after CO2 insufflation. The concentration of HbR increased significantly, from 0 to 2.2 +/- 1.2 mumol/L, after CO2 insufflation. Therefore, the concentration of total Hb increased significantly, from 0 to 8.8 +/- 3.3 mumol/L after CO2 insufflation. The concentration of Cyt aa3, however, did not change significantly during pneumoperitoneum. These results suggest that cellular respiration remained intact despite a concomitant increase in PETCO2 and cerebral blood volume during laparoscopy with CO2 insufflation.