MR sialography using half-Fourier acquisition single-shot turbo spin-echo (HASTE) sequences

We describe our preliminary experience with the half-Fourier acquisition single-shot turbo spin-echo (HASTE) sequences for MR imaging of the salivary gland ducts. In the majority of patients, the main parotid and/or submandibular gland ducts and large branches within the glands were detectable on MR images obtained in 2 seconds per section and within 3 minutes for the entire examination. MR sialography using HASTE sequences can be combined with conventional MR studies for the salivary glands.

Countertorque testing and histomorphometric analysis of various implant surfaces in canines: a pilot study

As surface roughness may play a role in the mechanical attachment of an implant surface to bone, various implant surfaces have been prepared and analyzed by removal torque (countertorque) or push-out tests in a variety of animal model systems. Rougher surfaces generally have displayed higher mechanical testing values, indicating a stronger implant-bone interface. This pilot study was undertaken to test the countertorque values for integrated threaded implants with surfaces prepared by machining, blasting, and acid-etching, to compare the various implant surface types histomorphometrically for percentage of bone-implant contact under loaded and unloaded conditions, and to determine the degree of correlation between countertorque values and bone-implant contact with varying degrees of surface roughness. The results of this animal investigation suggest that the strength of the bone-implant interface, as determined by countertorque testing, is influenced by different surface characteristics. Acid-etched surfaces resisted countertorque forces more successfully as compared with blasted or machined surfaces. Histologic evaluation of bone contact with the various implant surfaces did not demonstrate a definite advantage for rougher surfaces in regard to percentage of bone contact at the light microscopic level.

Femoral nonunion fracture treated with recombinant human bone morphogenetic protein-2 in a dog

This is the first report on successful treatment of spontaneous nonunion fracture of a dog by use of recombinant human bone morphogenetic protein-2 (rhBMP-2). A 4-year-old Pomeranian dog with a 2-year history of femoral nonunion fracture was treated with implantation of rhBMP-2. The dog had received surgical correction twice prior to the admission but radiography of the affected limb revealed a typical figure of nonunion fracture. Glossly, the fractured ends were sclerotic and the area between the ends was filled with fibrous tissue. After debridement the femoral shaft was fixed by an 8-hole plate. rhBMP-2 at a total dose of 256 micrograms was implanted with a synthetic carrier into the 8-mm defect formed by the debridement. Callus formation responding to rhBMP-2 was radiographically observed at 2 weeks after implantation and the defect reached radiographic union by 8 weeks after implantation. The plate was removed at 9 months after implantation. Any complications were not observed for 5 months after removal of the plate.

[Effect of 5'-DFUR used concurrently in radiotherapy and immunotherapy uterine cervical cancer--pilot study. Study of 5'-DFUR for Uterine Cervical Cancer]

We conducted a preliminary controlled study in order to evaluate 5'-DFUR dose dependency in efficacy and safety in combination therapy of radiotherapy, 5'-DFUR and SPG for patients with uterine cervical cancer, which was regarded as suitable for cases of radiotherapy. The patients were randomly allocated into group A (5'-DFUR 600 mg/body/day) and group B (5'-DFUR 800 mg/body/day), who underwent radiotherapy with simultaneous administration of 5'-DFUR and SPG (20 mg twice/week or 40 mg/ week). Those enrolled were 33 patients in stage II, III or IV a with histologically diagnosed primary squamous cell carcinoma of uterine cervix. CR was shown in 19, PR in 7, NC in 1, and PD in 2 out of 29 efficacy-evaluable cases, so the overall response rate was 89.7% (26/29, 95% CI 72.7%-97.8%). Regarding safety, some side effects were observed in 26 out of 33 safety-evaluable cases (81.3%, 95%, CI 63.6%-92.8%), but no serious cases. No significant difference in efficacy and safety was observed between the two treatment groups. These results suggested that the combination therapy of radiotherapy, 5'-DFUR and SPG might be one of the therapies whose effectiveness must be confirmed for advanced squamous cell carcinoma of uterine cervix. To confirm dose dependency of 5'-DFUR, it seems further consideration with more patients is needed.

Coagulation abnormalities and thrombotic microangiopathy following bone marrow transplantation from HLA-matched unrelated donors in patients with hematological malignancies

Thrombotic microangiopathy is a well-known heterogeneous disorder that occurs as a complication of allogenic bone marrow transplantation (BMT). We evaluated 12 consecutive patients receiving HLA-matched unrelated BMT and 12 consecutive recipients of HLA-identical related BMT for the development of bone marrow transplantation-associated thrombotic microangiopathy (BMT-TM) on days 30 and 60 following BMT. A diagnosis was made in four of 12 (33.3%) unrelated compared to none of 12 (0%) HLA-identical cases. Levels of serum lactic dehydrogenase (LDH), fibrin degraded products (FDP) and de novo thrombocytopenia were elevated in eight of 12 patients (66.7%) receiving unrelated donor BMT, and none of the patients receiving related donor BMT. Our findings suggest clinical or subclinical microangiopathic changes may occur frequently in unrelated donor BMT. FDP elevation is possibly an important marker of microangiopathic changes as early complications of BMT.

[A case of neuroblastoma with abnormal LD isoenzyme]

We encountered a patient with neuroblastoma showing remarkably high total LD activity (12,585 IU/l). His liver and heart function was normal. In the serum LD isoenzyme pattern, LD1 was increased, and LD2 extra band (LD2 ex) was observed on the negative pole side of LD2. However, LD2 ex was absent in erythrocytes of the patient, which demonstrates the exclusion of genetic factors. Neither the enzyme counter current method or immunofixation showed immune complexes, excluding anomalies. The LD isoenzyme in a metastatic lymphnode lesion before treatment showed increased LD1. The LD isoenzymes in the tissue, removed after 5 courses of chemotherapy, showed predominance of LD3 and absence of LD2 ex. Rapid decreases in the serum total LD activity and LD1 fraction and the disappearance of LD2 ex after chemotherapy suggest that these changes in the two LD fractions are associated with production of abnormal LD (LD2 ex) by the tumor.

Molecular heterogeneity of hCGbeta--related glycoproteins and the clinical relevance in trophoblastic and non-trophoblastic tumors

We analyzed immunoreactive hCG/hCGbeta (IR-beta) in the sera and urine of patients with trophoblastic diseases and non-trophoblastic tumors by using enzyme immunoassays (EIAs) specific for intact hCG, free hCG beta, and beta-core fragment of hCG (beta-CF). In trophoblastic diseases, while intact hCG and free hCGbeta were contained in both serum and urine, the beta-CF could be detected only in the urine of the patients. The relative contribution of the beta-CF to the total urinary IR-beta accounted for about 30-50% in normal early pregnancy and hydatidiform mole, and more than 60% in choriocarcinoma. We conclude that intact hCG should be measured in the serum rather than in the urine as a tumor marker for trophoblastic diseases, and suggested that the ratios of intact hCG, free hCGbeta, and beta-CF to each other may be useful indices in the differential diagnosis of trophoblastic diseases. Ectopic IR-beta was also investigated in the sera and urine of the patients with cervical, endometrial, ovarian, lung, and bladder carcinomas. We found that even when IR-beta could not be detected in the serum, the urine of the same patients with cancer often contained the significant amounts of IR-beta. The chromatographic study indicated that these urinary IR-beta were essentially attributed to beta-CF, leading to the evaluation of urinary beta-CF as a tumor marker. The positive rated of urinary beta-CF were 48% for cervical, 38% for endometrial, and 84% for ovarian, 40% for lung, and 42% for bladder carcinomas. We conclude that ectopic production of hCG beta by non-trophoblastic tumors is not a rare phenomenon and it can be recognized as a tumor marker when beta -CF is measured in urine of the patients.

[A case of advanced hepatocellular carcinoma responding to suppository of Tegafur]

We report a case of advanced hepatocellular carcinoma (HCC) successfully controlled by the suppository administration of Tegafur alone. Five months after initiation of the drug, excellent reduction of tumors and decrease of serum alpha-feto-protein (AFP) level were seen without any side effects. Also, twenty-four months after of the treatment, no regrowth of tumors or increase in the serum AFP level was seen. Because Tegafur is a time-dependent agent, advanced HCC may be controlled by continuous administration for a long period.

Repair of ulnar segmental defect by recombinant human bone morphogenetic protein-2 in dogs

The efficacy of recombinant human bone morphogenetic protein-2 (rhBMP-2) combined with poly D, L lactic-co-glycolic acid (PLGA)/gelatin sponge complex (PGS) as a carrier on the repair of segmental long-bone defects was evaluated using an ulnar model in dogs. The defect was 2 cm in length and was fixed with bone plating. After implantation of PGS with or without rhBMP-2, the repair process of the defect was evaluated by serial radiography until 16 postoperative weeks. All defects treated with 160 micrograms or 640 micrograms of rhBMP-2/PGS revealed bone union radiographically by 12 postoperative weeks, whereas all defects treated with PGS alone revealed no radiographic evidence of healing throughout the experimental period. In defects treated with 40 micrograms of rhBMP-2/PGS, new bone appeared partially at the defects but did not accomplish union. Bone mineral contents at the defect sites after harvest at 16 weeks postoperatively were significantly (p < 0.05) higher in those treated with 160 micrograms or 640 micrograms of rhBMP-2 than in those treated with 40 micrograms of rhBMP-2 or PGS alone. Histologically, defects radiographically diagnosed as having achieved union showed the appearance of cortical bone and bone marrow cells. These findings suggest the use of rhBMP-2/PGS as a potential bone graft substitute in reconstructive surgery in dogs.

MR of denervated tongue: temporal changes after radical neck dissection

PURPOSE

The purpose of this study was to evaluate the temporal changes of MR imaging in the denervated tongue after a radical neck dissection.

METHODS

One hundred seventy-four consecutive MR studies in 116 patients with radical neck dissections for malignant tumors of the head and neck were evaluated retrospectively. Patients with tumors involving the tongue or hypoglossal nerve were not included in this study.

RESULTS

Abnormal signal intensity and/or hemiatrophy on the side of the tongue operated on was seen in 22 patients who had hypoglossal paralysis after radical neck dissection. The denervated side of the tongue appeared hypointense to hyperintense relative to the normal side on T1-weighted images and hyperintense on T2-weighted images. Signal intensity ratios of the abnormal to normal muscles were 0.9-1.6 on T1-weighted images and 1.3-2.8 on T2-weighted images. High signal intensity on T1-weighted images appeared 5 months or more after the dissection, whereas on T2-weighted images, the most prominent increases in signal intensity appeared in the first several months after denervation. Hemiatrophy of the tongue was observed on MR images obtained more than 6 months after surgery.

CONCLUSION

MR findings in the denervated tongue are compatible with histologic changes and are characterized by an enlarged extracellular fluid space or fatty infiltration. The pattern of signal intensity and the degree of hemiatrophy suggest the duration of denervation.

Responses of laryngeal capsaicin-sensitive receptors to volatile anesthetics in anesthetized dogs

The responses of laryngeal capsaicin (CAPS)-sensitive receptors to halothane, enflurane, isoflurane and sevoflurane were evaluated in anesthetized spontaneously breathing dogs from the afferent activity of the internal branch of the superior laryngeal nerve. The CAPS-sensitive receptors were clearly distinguished from irritant receptors by their responsiveness to CAPS and their lack of responsiveness to water. All the CAPS-sensitive receptors were significantly stimulated by all volatile anesthetics in a concentration-related manner, and the activation by halothane, enflurane, and isoflurane was significantly greater than by sevoflurane. In contrast, responses of irritant receptors to the volatile anesthetics were divided into three types (stimulation, inhibition or non-response), and did not differ among anesthetics. In conclusion, the present study demonstrated that the CAPS-sensitive receptors were consistently stimulated by halogenated volatile anesthetics and especially by halothane, enflurane, and isoflurane, and that these responses were dissimilar to the variable responses of irritant receptors.

Smad5 and DPC4 are key molecules in mediating BMP-2-induced osteoblastic differentiation of the pluripotent mesenchymal precursor cell line C2C12

Since the bone morphogenetic proteins (BMPs) are members of the transforming growth factor-beta (TGF-beta) superfamily that induce the differentiation of mesenchymal precursor cells into the osteogenic cells, we identified the relevant signaling molecules responsible for mediating BMP-2 effects on mesenchymal precursor cells. BMP-2 induces osteoblastic differentiation of the pluripotent mesenchymal cell line C2C12 by increasing alkaline phosphatase activity and osteocalcin production. As recent studies have demonstrated that cytoplasmic Smad proteins are involved in TGF-beta superfamily signaling, we plan to isolate the relevant Smad family members involved in osteoblastic differentiation. We identified human Smad5, which is highly homologous to Smad1. BMP-2 caused serine phosphorylation of Smad5 as well as Smad1. In contrast, TGF-beta failed to cause serine phosphorylation of Smad1 and Smad5. We found Smad5 is directly activated by BMP type Ia or Ib receptors through physical association with these receptors. Following phosphorylation, Smad5 bound to DPC4, another Smad family member, and the complex was translocated to the nucleus. Overexpression of point-mutated Smad5 (G419S) or a C-terminal deletion mutant DPC4 (DPC4 delta C) blocked the induction of alkaline phosphatase activity, osteocalcin production, and Smad5-DPC4 signaling cascades upon BMP-2 treatment in C2C12 cells. These data suggest that activation of Smad5 and subsequent Smad5-DPC4 complex formation are key steps in the BMP signaling pathway, which mediates BMP-2-induced osteoblastic differentiation of the C2C12 mesenchymal cells.

Malignant phyllodes tumour with a noninvasive ductal carcinoma component

A malignant phyllodes tumour with a noninvasive ductal carcinoma component is reported. The patient was an 80-year-old Japanese woman with a breast tumour detected by routine physical examination. A simple mastectomy was performed. The excised tumour was 10.5 x 9.4 x 5.4 cm in size and bulged into the skin with ulceration. The macroscopic appearance was that of a phyllodes tumour. Histologically the tumour consisted mainly of stromal components with a leaf-like structure lined by atypical ductal epithelium. The epithelial component showed gradual evolution to intraductal papillary carcinoma in a few areas. The stromal component was composed mainly of fibrosarcoma with areas of osteosarcoma and rhabdomyosarcoma. Neither stromal invasion of intraductal carcinoma nor transition between the stromal and epithelial elements was seen. Three months after the operation, death occurred, with multiple pulmonary and subcutaneous metastases. This case probably represents malignant change in both the stromal and the epithelial components of a phyllodes tumour. Since the two elements were independent, the possibility that a phyllodes tumour may be one of the origins of true carcinosarcoma is raised.

[Prognostic effect of PyNPase (pyrimidine nucleoside phosphorylase) activity in breast cancer]

To clarify the clinical significance of PyNPase (Pyrimidine Nucleoside Phosphorylase)/ PD-ECGF activity in breast cancer, we examined the possible correlation of PyNPase activity to clinicopathological features and prognosis in 195 patients with primary breast cancer between January 1992 through December 1993. The mean PyNPase activity of primary breast cancer, assayed by ELISA method, was 140.6 U/ml, which was between that of benign breast disease (18.2) and recurrent tumors (270.9). In histological type of breast cancer, tumors with solid-tubular carcinoma had significantly higher levels of PyNPase activity. The activity of ER negative or aneuploid tumors was higher than that of ER positive or diploid tumors, respectively. And there was a significant relationship between PyNPase activity and proliferative activity determined by S-phase fraction (SPF) or DNA polymerase alpha. These findings suggested that PyNPase activity was associated with the degree of malignancy. As regards prognosis, in lower SPF (< 16%) group, patients with higher PyNPase activity had significantly lower disease--free survival rates, whereas those with higher activity had a favorable prognosis in the higher SPF (> or = 16%) group. The contradiction might be explained by the possibility that 5-FU derivatives were effective only in patients with high SPF and PyNPase activity, as all patients were treated by a regimen containing 5-FU derivatives. We suggest that PyNPase activity is associated with progression and proliferation of breast cancer, and that it may be useful for prediction of prognosis and therapeutic efficacy of 5-FU derivatives.

Inhibitory effects of glucocorticoids on proliferation of canine mast cell tumor

The inhibitory effect of glucocorticoids (GCs) on proliferation of canine mast cell tumor (MCT) was studied using two types of MCT cells; JuMC cells and LuMC cells derived from spontaneous canine cutaneous and intestinal MCT, respectively. In in vitro study, growth of JuMC cells was significantly inhibited with more than 1 nM GCs and apoptotic-like cell death was seen, while that of LuMC cells was never inhibited even with 10 microM GCs. Growth rate of masses in nude mice developed by inoculation of JuMC cells was reduced in a dose-dependent manner by administration of GC, while growth inhibition of masses developed by inoculation of LuMC cells was minimal with increasing GC doses. Competitive binding studies and Scatchard analysis demonstrated the presence of high-affinity, low capacity GC receptors in both JuMC and LuMC cells. Kd was estimated to be 1.30 nM in JuMC cells and 0.45 nM in LuMC cells, respectively. It is concluded that canine cutaneous MCT cells responded to GCs in vitro and in vivo, whereas intestinal MCT cells did not, though both types of cells had specific GC receptors.

S-100 protein is a differentiation marker in thyroid carcinoma of follicular cell origin: an immunohistochemical study

S-100 protein, a dimer of S-100 alpha and S-100 beta subunits (S-100 alpha and S-100 beta), is widely distributed in human tissue, and several papers describing S-100 protein expression in follicular cells of the thyroid have been published. In the present study, 105 cases of thyroid carcinoma (of which 96 were papillary, four follicular, two undifferentiated, and three medullary) were analyzed immunohistochemically for the expression of S-100 protein, S-100 alpha, S-100 beta, and thyroglobulin. In papillary carcinoma, 188 lesions were studied and classified into well differentiated types (56 papillary, 45 follicular) and poorly differentiated types (41 trabecular, four solid, eight squamoid, three tall, and one insular), because the histological structure of each tumor was heterogeneous. The percentage of lesions which expressed positively for S-100 protein and S-100 alpha, respectively, according to type were: papillary, 96 and 99%; follicular, 96 and 100%; trabecular, 95 and 100%; solid, 50 and 50%; squamoid, 50 and 75%; and tall, 33 and 100%. The insular type was negative for both. For papillary carcinoma, well differentiated lesions showed stronger S-100 alpha expression than poorly differentiated lesions. S-100 alpha expression was weaker in follicular and undifferentiated carcinoma than in papillary carcinoma. Medullary carcinoma also expressed S-100 alpha. S-100 beta was positive in lesions that expressed S-100 alpha strongly. Expression of S-100 protein and S-100 alpha protein correlated with thyroglobulin synthesis in the follicular cells. It was concluded that S-100 protein, mainly S-100 alpha, exists in thyroid follicular cells, that it exists in higher quantity in most of the well differentiated lesions but in lower quantity in poorly differentiated or undifferentiated lesions, and that S-100 protein, especially S-100 alpha, is a differentiation marker in carcinoma of thyroid follicular cell origin.

[Clinical significance of orthostatic blood pressure decline in patients with Binswanger-type infarction]

We analysed the blood pressure change in 40 patients with Binswanger-type infarction after 10 minutes of 90 degrees head-up tilting to clarify the clinical significance of orthostatic blood pressure decline observed in this disease. We investigated the correlation of orthostatic decline in systolic blood pressure to dementia, gait disturbance and nocturnal decrease in 24-hour variation of systolic blood pressure. Orthostatic blood pressure decline in patients with this disease was significantly marked in comparison with that in 50 patients with lacunar infarction, especially in the males. This blood pressure decline was significant in patients with dementia and moderate or severe gait disturbance, compared with those without such symptoms. There was no difference in orthostatic change between patients suffering from this disease with non-dementia and mild or absent gait disturbance and those with only lacunar infarction. Orthostatic blood pressure decline was found to be correlated significantly with the disorder of nocturnal blood pressure decrease. It is suggested that the decline of blood pressure on standing is a parameter indicating the progression of this disease.

Cardiovascular reflex mechanisms by topical instillation of capsaicin and distilled water into the larynx in anesthetized dogs

Cardiovascular reflex mechanisms by topical laryngeal instillation of capsaicin (CAPS) or distilled water were evaluated in anesthetized chronic tracheostomized dogs. Both CAPS (10 micrograms/ml) and water instillation into the isolated upper airway caused a significant decrease in heart rate (P < 0.05) and a significant increase in blood pressure (P < 0.05) from the values before instillation under both spontaneous and controlled ventilation. The bradycardia was significantly reduced by atropine pretreatment (P < 0.05) and the hypertension was significantly decreased by phentolamine and propranolol pretreatments (P < 0.01). A higher concentration of CAPS (100 micrograms/ml) instillation considerably reduced the response to subsequent CAPS (100 micrograms/ml) instillation, whereas the response to water was sustained, indicating the desensitization of laryngeal CAPS-sensitive endings. All the reflex responses to CAPS and water were eliminated by topical anesthesia with lidocaine. It was concluded that the laryngeal cardiovascular reflex responses were mediated by the afferents such as the laryngeal CAPS-sensitive presumably C-fiber endings or water-responsive receptors and by both the parasympathetic and sympathetic nervous systems as efferents.

Wiskott-Aldrich syndrome protein is associated with the adapter protein Grb2 and the epidermal growth factor receptor in living cells

Src homology domains [i.e., Src homology domain 2 (SH2) and Src homology domain 3 (SH3)] play a critical role in linking receptor tyrosine kinases to downstream signaling networks. A well-defined function of the SH3-SH2-SH3 adapter Grb2 is to link receptor tyrosine kinases, such as the epidermal growth factor receptor (EGFR), to the p21ras-signaling pathway. Grb2 has also been implicated to play a role in growth factor-regulated actin assembly and receptor endocytosis, although the underlying mechanisms remain unclear. In this study, we show that Grb2 interacts through its SH3 domains with the human Wiskott-Aldrich syndrome protein (WASp), which plays a role in regulation of the actin cytoskeleton. We find that WASp is expressed in a variety of cell types and is exclusively cytoplasmic. Although the N-terminal SH3 domain of Grb2 binds significantly stronger than the C-terminal SH3 domain to WASp, full-length Grb2 shows the strongest binding. Both phosphorylation of WASp and its interaction with Grb2, as well as with another adapter protein Nck, remain constitutive in serum-starved or epidermal growth factor-stimulated cells. WASp coimmunoprecipitates with the activated EGFR after epidermal growth factor stimulation. Purified glutathione S-transferase-full-length-Grb2 fusion protein, but not the individual domains of Grb2, enhances the association of WASp with the EGFR, suggesting that Grb2 mediates the association of WASp with EGFR. This study suggests that Grb2 translocates WASp from the cytoplasm to the plasma membrane and the Grb2-WASp complex may play a role in linking receptor tyrosine kinases to the actin cytoskeleton.

Cardiopulmonary effects of sevoflurane, compared with halothane, enflurane, and isoflurane, in dogs

OBJECTIVE

To evaluate cardiopulmonary effects of sevoflurane (Sevo), compared with halothane (Hal), enflurane (Enf), and isoflurane (Iso).

ANIMALS

24 healthy Beagles, randomly assigned to 4 groups of 6 dogs each.

PROCEDURE

Dogs under spontaneous ventilation were anesthetized with Sevo, Hal, Enf, or Iso. After minimum elveolar concentration (MAC) of each anesthetic was determined, anesthesia was maintained at light (1 MAC), moderate surgical (1.5 MAC), and deep (2 MAC), stages and cardiopulmonary variables at conscious state (baseline) and each anesthesia stage were measured.

RESULTS

In dogs of the Sevo group, heart rate increased significantly from the baseline value at all anesthesia stages. Systemic vascular resistance during Sevo anesthesia decreased gradually with increasing anesthesia stage, which was accompanied by dose-dependent decreases in systolic, mean, and diastolic arterial blood pressures. At 1.5 and 2 MAC Sevo, stroke index decreased slightly but significantly from the baseline value; however, cardiac index was unchanged because of the significant increase in heart rate. Respiratory rate decreased significantly at 2 MAC from that at 1 MAC Sevo. Tidal volume and dead space-to-tidal volume ratio were unchanged at all anesthesia stages of Sevo, resulting in significantly decreased expired and alveolar ventilation at 2 MAC, compared with values at 1 and 1.5 MAC Sevo. PaCO2 increased and pHa decreased significantly, depending on anesthesia stage; PaO2, increased significantly from baseline values, and remained constant because of inhalation of 100% O2.

CONCLUSION

Cardiovascular effects of Sevo were greater than those of Hal, similar to those of Iso, and less than those of Enf. Respiratory effects of Sevo were similar to those of Iso at all anesthesia stages, greater than those of Hal at 2 MAC, and less than those of Enf at 1.5 and 2 MAC. Up to the moderate surgical anesthesia stage, Sevo can be used safely in dogs undergoing spontaneous ventilation.

An implant-supported fixed-removable prosthesis with a milled tissue bar and Hader clip retention as a restorative option for the edentulous maxilla

Restoration of the edentulous maxilla with implant retained and supported prosthesis is challenging because of inherent anatomic limitations present after the loss of teeth. A fixed-removable prosthesis is one treatment choice for restoration of the edentulous maxilla with implants. This prosthesis meets the requirements for esthetics, phonetics, comfort, and hygiene, as well as favorable biomechanical stress distribution to the implants. This article presents a procedure for fabrication of a fixed-removable prosthesis with a precision milled bar, Hader clip attachments, and a superstructure prosthesis. The criteria for patient selection and the advantages and disadvantages of this prosthesis are discussed.

MR evaluation of radiation otomastoiditis

PURPOSE

The purpose of this study was to evaluate the incidence of radiation otomastoiditis, on using T2-weighted magnetic resonance (MR) imaging, in relation to radiation fields, doses, intervals, and clinical symptoms after radiotherapy that included the temporal bone in the fields.

METHODS AND MATERIALS

We performed follow-up MR examinations at various intervals after radiotherapy including the temporal bones for 270 ears of 114 patients with various diseases of the head and neck and intracranial regions. The middle ear and mastoid air cells on T2-weighted images were scored as follows; showing no high signal intensity, a local high signal intensity area, or a high signal intensity area occupying the entire middle ear and all mastoid air cells. The radiation fields as depicted on the lateral simulator films classed as anterior to the clival line, posterior to the clival line, or both.

RESULTS

The incidence of radiation otomastoiditis depicted on T2-weighted MR images increased in the patients who had received irradiation doses of 50 Gy or more. In the patients with doses of less than 50 Gy, the incidence was 18% within 6 months following radiotherapy, 13% at between 6 and 12 months, and 8% after 12 months, whereas it was more than 50% at any period after radiotherapy in the patients with 50 Gy or more. The incidence of radiation otomastoiditis was quite high in the patients whose radiation fields included region both anterior and posterior to the clival line.

CONCLUSION

The incidence of radiation otomastoiditis as demonstrated on T2-weighted MR images is increased at irradiation doses of 50 Gy or more. To reduce the incidence of severe radiation otomastoiditis, the irradiation fields of the temporal bone when the dose is 50 Gy or more should be limited to as small as possible. The clival line is considered to be a good landmark in reducing the irradiation field when doses of 60-70 Gy are delivered in curative radiotherapy.