Effects of COVID-19 pandemic on hospital visit of head and neck cancer patients

OBJECTIVE

Head and neck cancer (HNC) often causes respiratory symptoms, so diagnostic delays due to COVID-19 are anticipated. Especially, our institute is a designated medical institute for Class 1 specified infectious diseases, and most of the severe COVID-19 patients in this region were preferentially admitted or transferred. Hereby, we evaluated the trends of the numbers, primary sites and clinical stages of HNC patients before and after COVID-19 pandemic.

METHODS

A retrospective analysis of all patients diagnosed and treated for HNC from 2015 to 2021 was performed. Especially, 309 cases between 2018 and 2021 were extracted in order to examine a direct impact of COVID-19 pandemic, which were dichotomized into "Pre" group in 2018-2019 and "COVID" group in 2020-2021. They were compared about the distribution of clinical stage, the period between onset of symptom and hospital visit.

RESULTS

HNC patients decreased by 38% in 2020 and by 18% in 2021 compared to average number of patients from 2015 to 2019. Patients of stage 0 and 1 in "COVID" group significantly decreased compared to that in "Pre" group. Cases performed emergent tracheostomy in hypopharyngeal cancer and laryngeal cancer increased in "COVID" group (10.5% vs 1.3%).

CONCLUSION

Patients with slight symptoms would hesitated to visit hospital after COVID-19, and only a few delays of HNC diagnosis could have increased tumor burden and caused narrowed airway, especially in advanced HPC and LC.

Concurrent Chemoradiotherapy With Weekly Low-Dose Cisplatin for Japanese Patients With Head and Neck Squamous Cell Carcinoma

Background:

Concurrent chemoradiotherapy (CCRT) with tri-weekly high-dose cisplatin (HDC) is considered the standard regimen. However, due to significant toxicity, various weekly low-dose schedules have been increasingly used. We investigated the tolerability and survival of patients with head and neck squamous cell carcinoma (HNSCC) who underwent CCRT with low-dose weekly cisplatin (LDC) for Japanese population.

Methods:

A retrospective review was conducted among patients with HNSCC who were treated with CCRT/LDC in our institute. Ninety-five patients who met the criteria were enrolled in this study. We evaluated the cycle and cumulative cisplatin dose, completion rate of radiotherapy, adverse events, and survival outcome.

Results:

The mean cycles and cumulative cisplatin dose were 4.7 cycles and 187 mg/m². All patients completed planned dose of radiation without prolonged breaks. Leucopoenia was the most frequent dose-limiting factor and 44% patients developed grade 3 or 4 toxicity. The 2-year overall survival and recurrence-free survival were 93% and 74%, respectively. The significant differences of survival outcomes between the patients with total cisplatin dose (⩾200 mg and <200 mg) or among age distribution (35-55, 56-75, and ⩾76) were not observed.

Conclusions:

Concurrent chemoradiotherapy/LDC can be safely administered with acceptable toxicity and survival outcome even if the patients with higher age, lower eGFR, and so on.

Differential interference contrast microscopy for cells using hard x-ray holography

We propose a differential interference contrast method for cells using hard x-ray Gabor holography and knife-edge filtering in the spatial frequency domain, without relying on beam shearing. A phase object is holographically recorded and reconstructed by computer. Interference between the wavefronts of zeroth order weighted by e^jπ/2 in the positive frequency region produces a dark image. Similarly, interference between the wavefronts of the zeroth order weighted by e^j3π/2 in the negative frequency region produces a bright image. By adding these two intensity distributions, good quality phase-contrast images of 8-μm-diameter polystyrene beads and human HeLa cells were obtained.

CT Features in Second Cancers of the Maxillary Sinus

Five patients with a second maxillary cancer (squamous cell carcinoma), which developed 6 to 17 years after initial treatment for the first cancer on the opposite side, were compared with 21 control cases with a primary cancer on the basis of computed tomography (CT) findings. Generally, the second cancer was found at an earlier stage. The specific CT findings of early sinus carcinoma were uneven soft tissue distribution in the antrum and tumor permeation with bone fragments remaining at the original tumor site. These findings may be helpful for distinguishing this cancer from benign chronic sinusitis and/or other malignant sinus disease. The pterygoid process, medial bony wall, and ethmoid sinus had a tendency to be spared in most of the 5 patients with second maxillary cancer compared to the 21 control cases.

Modeling of neutrals in the Linac4 H(-) ion source plasma: hydrogen atom production density profile and Hα intensity by collisional radiative model

To control the H(0) atom production profile in the H(-) ion sources is one of the important issues for the efficient and uniform surface H(-) production. The purpose of this study is to construct a collisional radiative (CR) model to calculate the effective production rate of H(0) atoms from H2 molecules in the model geometry of the radio-frequency (RF) H(-) ion source for Linac4 accelerator. In order to validate the CR model by comparison with the experimental results from the optical emission spectroscopy, it is also necessary for the model to calculate Balmer photon emission rate in the source. As a basic test of the model, the time evolutions of H(0) production and the Balmer Hα photon emission rate are calculated for given electron energy distribution functions in the Linac4 RF H(-) ion source. Reasonable test results are obtained and basis for the detailed comparisons with experimental results have been established.

Numerical study of the inductive plasma coupling to ramp up the plasma density for the Linac4 H(-) ion source

In the Linac4 H(-) ion source, the plasma is generated by an RF antenna operated at 2 MHz. In order to investigate the conditions necessary for ramping up the plasma density of the Linac4 H(-) ion source in the low plasma density, a numerical study has been performed for a wide range of parameter space of RF coil current and initial pressure from H2 gas injection. We have employed an Electromagnetic Particle in Cell model, in which the collision processes have been calculated by a Monte Carlo method. The results have shown that the range of initial gas pressure from 2 to 3 Pa is suitable for ramping up plasma density via inductive coupling.

Equivalent circuit of radio frequency-plasma with the transformer model

LINAC4 H(-) source is radio frequency (RF) driven type source. In the RF system, it is required to match the load impedance, which includes H(-) source, to that of final amplifier. We model RF plasma inside the H(-) source as circuit elements using transformer model so that characteristics of the load impedance become calculable. It has been shown that the modeling based on the transformer model works well to predict the resistance and inductance of the plasma.

Plasma ignition and steady state simulations of the Linac4 H(-) ion source

The RF heating of the plasma in the Linac4 H(-) ion source has been simulated using a particle-in-cell Monte Carlo collision method. This model is applied to investigate the plasma formation starting from an initial low electron density of 10(12) m(-3) and its stabilization at 10(18) m(-3). The plasma discharge at low electron density is driven by the capacitive coupling with the electric field generated by the antenna, and as the electron density increases the capacitive electric field is shielded by the plasma and induction drives the plasma heating process. Plasma properties such as e(-)/ion densities and energies, sheath formation, and shielding effect are presented and provide insight to the plasma properties of the hydrogen plasma.

Kinetic modeling of particle dynamics in H(-) negative ion sources (invited)

Progress in the kinetic modeling of particle dynamics in H(-) negative ion source plasmas and their comparisons with experiments are reviewed, and discussed with some new results. Main focus is placed on the following two topics, which are important for the research and development of large negative ion sources and high power H(-) ion beams: (i) Effects of non-equilibrium features of EEDF (electron energy distribution function) on H(-) production, and (ii) extraction physics of H(-) ions and beam optics.

Analysis of rapid increase in the plasma density during the ramp-up phase in a radio frequency negative ion source by large-scale particle simulation

Numerical simulations become useful for the developing RF-ICP (Radio Frequency Inductively Coupled Plasma) negative ion sources. We are developing and parallelizing a two-dimensional three velocity electromagnetic Particle-In-Cell code. The result shows rapid increase in the electron density during the density ramp-up phase. A radial electric field due to the space charge is produced with increase in the electron density and the electron transport in the radial direction is suppressed. As a result, electrons stay for a long period in the region where the inductive electric field is strong, and this leads efficient electron acceleration and a rapid increasing of the electron density.

Prognosis of critically ill patients with multiple organ failure

The purpose of this study was to determine the mortality rate in 527 critically ill patients with multiple organ failure (MOF), treated in our ICU between August, 1986 and January, 1992, and to compare it with the results obtained in a group of patients studied who had been treated between October, 1978 and July, 1986. The relationship between the mortality rate and each type of organ failure and the extent of organ system involvement was also investigated. The overall mortality rate was 25%, and the rate increased with the number of failed organs. Sepsis and disseminated intravascular coagulation were closely associated with the development of MOF. The mortality rate of patients with the failure of two organs in the present study was significantly lower than that found in those in the previous study. Although artificial organ mechanical life support technology other than that for patients with renal failure is still unsatisfactory, these results suggest that the prognosis of patients with MOF is improving.

Soluble fragments of e-cadherin cell-adhesion molecule increase in urinary-excretion of cancer-patients, potentially indicating its shedding from epithelial tumor-cells

E-cadherin (Ecad) is well known to be a calcium-ion-dependent cell-cell adhesion molecule expressed mostly in epithelial tissues. Previous immunohistochemical studies suggested that this cell adhesion molecule acts as an invasion suppressor and is negligibly detected in cancer metastatic regions. Soluble Ecad fragments derived from the proteolysed membrane-associated form were detected in culture supernatants of two cell lines, COLO 205 and A-431, with normal distribution of cell surface Ecad. Soluble Ecad levels released into culture of COLO 205 exhibiting reduced cell-cell adhesion were apparently elevated above those of A-431 with tight cell-cell adhesion. Furthermore, human circulation and urine continuously contain soluble Ecad which consists mainly of homogeneous 75-85 kDa extracellular domains. Soluble Ecad urinary level per urinary creatinine level was found to be significantly elevated in 53% of patients suffering from various types of cancers including lung, liver, stomach, colon and rectal cancers, as compared with those in the age-matched healthy subjects. These results suggest that dysfunction of cell surface Ecad is responsible for its enhanced proteolytic shedding in tumorigenesis, which may lead to the decrease of cell surface Ecads. Furthermore, excretion of high levels of soluble Ecad fragments potentially indicates the progression of epithelial tumors excessively degrading cell surface Ecad in clinical subjects.

Optimal depth of insertion of left-sided double-lumen endobronchial tubes cannot be predicted from body height in below average-sized adult patients

BACKGROUND AND OBJECTIVE

The optimal depth of insertion of left-sided double-lumen endobronchial tubes is strongly correlated with body height in average-sized adults. However, this relationship has not been studied in below average-sized adult patients. We investigated whether or not there is a clinically useful relationship in below average-sized adult patients.

METHODS

One hundred and ninety six consecutive adult patients undergoing thoracic surgery under one-lung anaesthesia (body height < or = 155 cm) were included in this study. Left-sided double-lumen tubes were inserted under the guidance of a fibre-optic bronchoscope. Optimal depth was defined as the proximal surface of the bronchial cuff positioned just below the carina.

RESULTS

There was a statistically significant positive correlation between body height and the optimal depth of insertion (r = 0.61, P < 0.0001); however, the correlation coefficient was low. The actual optimal depth of insertion of one patient was even 4.5 cm shorter than that obtained from the equation.

CONCLUSION

Although there was a statistically significant correlation between body height and the optimal depth of insertion of left sided double lumen tubes in adult patients of short stature (< or = 155 cm), clinical application of the equation is not warranted and these tubes should be inserted under direct vision with a fibre-optic bronchoscope.

Tophaceous gout in the bipartite patella with intra-osseous and intra-articular lesions: a case report

We report a case of a 34-year-old man who had an acute gouty attack with tophi around the accessory bone of the bipartite patella with intra-osseous lesions. As the symptoms did not respond to conservative treatments, the patient was treated surgically. Arthroscopy revealed urate crystals surrounded by inflammatory synovitis on the surface of the bipartite patella. Arthrotomy exposed the abundant crystals around the accessory bone and in the intra-osseous lesion. These findings made us speculate that some pre-existing inflammatory conditions around the accessory bone induced deposition of urate crystals, and the destruction of the barrier between the deposits and the joint led to an acute arthritis. Curettage of the tophi resulted in immediate improvement of knee function. There had been no recurrence of symptoms at the 2-year follow-up.

Mass spectrometric investigation of gaseous YbH, YbO and YbOH molecules

The high-temperature gaseous molecules YbH, YbO and YbOH have been identified and their thermochemistry investigated by the Knudsen effusion mass spectrometry technique coupled with a controlled pressure gas inlet system. Solid ytterbium monosilicide and disilicide samples were made to react in the Knudsen cell with H2(g) and H2(g)/O2(g); in these conditions, several gaseous species (Yb, YbO, YbH, YbOH, SiO, SiO2, H2O) were formed under equilibrium conditions. The temperature dependences of the partial pressures of the observed gaseous molecules were analyzed to derive the Yb--X bond energies (X = H, O, OH). Selected values are D0o(Yb--H) = 179.4 +/- 2.0 kJ mol(-1), D0o(Yb--O) = 384 +/- 10 mol(-1) and D0o(Yb--OH) = 322 +/- 12 kJ mol(-1), and Delta(at)H0o(YbOH) = 746 +/- 12 kJ mol(-1). Density functional theory (DFT) calculations were also performed. Experimental and computational results are discussed and compared to previous data when available. The SiO/SiO2 high-temperature gaseous equilibrium was also observed.

Skin blood flow and plasma catecholamine concentrations during removal of a phaeochromocytoma in a child

A 9-yr-old boy with an adrenal phaeochromocytoma underwent removal of the tumour under general anaesthesia using sevoflurane and nitrous oxide combined with thoracic epidural anaesthesia. Skin blood flow in the first toe, as measured by laser Doppler flowmetry, markedly decreased during manipulation of the tumour and increased after removal of it. Skin blood flow correlated more significantly with plasma catecholamine concentrations than did mean arterial blood pressure. Skin blood flow may be used as a non-invasive measure of plasma catecholamine concentrations during removal of a phaeochromocytoma in paediatric patients.

Use of epidural anaesthesia for surgery in a patient with Kennedy's disease

Use of neuraxial block in a patient with motor neuron disease is controversial. We describe the anaesthetic management by epidural anaesthesia of a patient with Kennedy's disease, a rare lower motor neuron disease characterized by progressive weakness and wasting of limbs and bulbar muscles. The perioperative course was uneventful, and there was no exacerbation of neurologic signs or symptoms. We suggest that a patient with Kennedy's disease may be successfully managed by epidural anaesthesia for surgical internal urethrotomy.

Reconstruction of the medial patellofemoral ligament for the treatment of habitual or recurrent dislocation of the patella in children

We investigated the clinical outcome of a reconstructive procedure of the medial patellofemoral ligament for the treatment of habitual or recurrent dislocation of the patella in four children (6 knees), with a minimum follow-up of four years. The technique involves transfer of the tendon of semitendinosus to the patella using the posterior one-third of the femoral insertion of the medial collateral ligament as a pulley.

There was no recurrence of dislocation after surgery. The mean Kujala score at follow-up was 96.3 points. Radiological assessment showed that the congruence angle, the tilt angle and the lateral shift radio were restored to normal. The lateral and medial stress shift ratios and the Insall-Salvati ratio remained abnormal.

We conclude that this technique can be recommended for the treatment of habitual or recurrent patellar dislocation in children, although hypermobility and patella alta are not fully corrected.

Reconstruction of the medial patellofemoral ligament for the treatment of habitual or recurrent dislocation of the patella in children

We investigated the clinical outcome of a reconstructive procedure of the medial patellofemoral ligament for the treatment of habitual or recurrent dislocation of the patella in four children (6 knees), with a minimum follow-up of four years. The technique involves transfer of the tendon of semitendinosus to the patella using the posterior one-third of the femoral insertion of the medial collateral ligament as a pulley. There was no recurrence of dislocation after surgery. The mean Kujala score at follow-up was 96.3 points. Radiological assessment showed that the congruence angle, the tilt angle and the lateral shift radio were restored to normal. The lateral and medial stress shift ratios and the Insall-Salvati ratio remained abnormal. We conclude that this technique can be recommended for the treatment of habitual or recurrent patellar dislocation in children, although hypermobility and patella alta are not fully corrected.

MR imaging of benign and malignant lesions in the buccal space

OBJECTIVES

To evaluate MRI characteristics of buccal space lesions and to discuss the sensitivity of MRI in predicting malignancy of those lesions.

METHODS

Thirty patients with malignant (n=7) or benign (n=23) lesions originating in the buccal space were reviewed retrospectively. MR images were assessed for the margins, internal architecture, signal intensity of lesions and their relation to the surrounding structures.

RESULTS

Two cases of soft tissue sarcoma were shown as ill-defined masses with infiltration into adjacent muscles and bone. On the other hand, all tumors of minor salivary gland origin, whether malignant (n=4) or benign (n=2), were well-defined and confined within the buccal fat pad without infiltration into surrounding structures. All haemangiomas (n=9) had very high T2-weighted signal intensity. Three out of them contained signal voids on all sequences thought to represent phleboliths, a finding strongly suggestive of the diagnosis. Inflammatory lesions were characterized by the presence of edema in the surrounding fat. When ill-defined margins, infiltration into muscles and bone destruction were used as the criteria for the malignancy, only two out of seven malignant tumors were correctly diagnosed (sensitivity 29%).

CONCLUSIONS

Although MR imaging was useful in demonstrating the extent of buccal space lesions, its diagnostic value in predicting malignancy was very limited. It was especially true for malignant tumors of minor salivary gland origin, which were typically seen as well-defined masses without infiltration into surrounding structures on MRI.

Zernike-type X-ray imaging microscopy at 25 keV with Fresnel zone plate optics

A Zernike-type imaging microscope using a sputtered-sliced Fresnel zone plate (SS-FZP) has been developed and tested at an X-ray energy of 25 keV. The SS-FZP was used as an objective. A copper (Cu) phase plate was placed at the back focal plane of the SS-FZP in order to produce phase contrast. The performance of the Zernike-type imaging microscope was tested with a gold (Au) mesh and a resolution test pattern at undulator beamline 47 of SPring-8. The Au mesh and the resolution test pattern could be imaged in transmission with a magnification of x10.2. Owing to the Cu phase plate, different image contrast was observed compared with the bright-field image contrast. Tantalum microstructures down to 0.5 microm line-and-space have been observed on spatial resolution test patterns.

Development of a multilayer Fresnel zone plate for high-energy synchrotron radiation X-rays by DC sputtering deposition

Hard X-ray microscopy with high spatial resolution (<or=0.1 microm) using a high-energy and high-brilliance X-ray microprobe is expected to be a promising technology for various types of analysis, imaging etc. in materials science, biology and medicine. A multilayer Fresnel zone plate (FZP) could be a promising approach to focusing optics in the high-energy X-ray region (>or=20 keV) because a large thickness (aspect ratio) can be available. Various types of multilayer FZPs have been fabricated by DC sputtering deposition. Their focusing characteristics have been evaluated at the high-brilliance undulator beamline BL47XU of SPring-8. An optical system using a Cu/Al multilayer FZP (with an outermost zone width of 0.25 microm) as the focusing optics fabricated by the optimum deposition condition with precise film (zone) thickness control has attained an almost diffraction-limited microbeam of 0.3-0.35 microm at 8.9 keV. A line-and-space resolution test pattern has been observed: fine structures up to 0.2 microm were clearly observed in the measured image. This FZP has been working since 1995, keeping good focusing characteristics. It can be said from these results that a spatial resolution better than 0.1 microm in the high-energy X-ray region is in prospect by the development of a multilayer FZP with a narrower outermost zone width in the near future.

MR detection of iliac bone marrow involvement by malignant lymphoma with various MR sequences including diffusion-weighted echo-planar imaging

OBJECTIVE

To assess the diagnostic accuracy of MR imaging for detecting bone marrow infiltration by malignant lymphoma.

PATIENTS AND DESIGN

Fifty-three patients with malignant lymphoma underwent MR imaging and bone marrow biopsy. In 80 iliac crests of the 53 patients (13 positive specimens in 9 patients and 67 negative specimens in 44 patients), biopsy results and the signal intensity characteristics were compared. MR sequences included T1-weighted SE, T2-weighted FSE with fat suppression, FSE STIR, and diffusion-weighted EPI with fat suppression at 1.5 T.

RESULTS AND CONCLUSIONS

To detect lymphoma infiltration, T1-weighted SE had the highest sensitivity (92%) and diffusion-weighted EPI with fat suppression and FSE STIR had the highest specificity (92.5% and 92%, respectively). A combination of T1-weighted SE and FSE STIR yielded the highest sensitivity and specificity (85% and 97%, respectively). A combination of T1-weighted SE and FSE STIR sequences seems to be the current choice of imaging protocol for detecting bone marrow infiltration by malignant lymphoma.

Hard X-ray microbeam experiments with a sputtered-sliced Fresnel zone plate and its applications

Hard X-ray microbeam experiments with sputtered-sliced Fresnel zone plates have been performed. Zone plates with an outermost zone width of 0.25 microm (#FZP1) and 0.1 microm (#FZP2) were fabricated and evaluated. In a scanning X-ray microscopy experiment, a line-and-space pattern with structure as fine as 0.1 microm was resolved using #FZP2 at an X-ray wavelength of 1 A. As an application of the microbeam technique, a two-dimensional distribution of constituent elements in forensic samples has been obtained (e.g. section view of human and elephant hairs) using fluorescent scanning microscopy.

Sonographic appearances of malignant lymphoma of the salivary glands

PURPOSE

We undertook this retrospective study to describe the sonographic findings in patients with malignant lymphoma of the major salivary glands.

METHODS

We reviewed the sonograms and medical records of 7 patients with histologically proven lymphoma of the parotid (3 patients) or submandibular glands (4 patients).

RESULTS

Primary lymphoma was found in 1 parotid gland and 2 submandibular glands. The remaining 4 cases were secondary lymphomas. One patient had been diagnosed with Sjögren's syndrome and had been followed up with sonography. In parotid glands, both parenchymal and intraparotid nodal lymphomas were found. All submandibular gland tumors were parenchymal. Intraparotid nodal involvement appeared as multiple small nodules with relatively smooth margins, whereas the parenchymal parotid and submandibular gland lymphomas were larger (25 to 45 mm in longitudinal diameter) and showed various degrees of margin irregularity. All tumors were hypoechoic relative to the normal parenchyma. The primary parotid lymphoma and intraparotid nodal lymphomas had a homogeneous echotexture; the secondary parotid lymphomas and submandibular gland lymphomas were heterogeneous. One submandibular gland lymphoma showed intratumoral echogenic stripes. Neither calcification nor cystic degeneration was observed within the lesions.

CONCLUSIONS

Lymphomas of the salivary glands present a variety of sonographic appearances, ranging from multiple small, hypoechoic nodules to an irregularly shaped heterogeneous mass without cystic areas or calcifications.

Relationship between bone marrow cellularity and apparent diffusion coefficient

This study was performed to determine if there is a relationship between apparent diffusion coefficient (ADC) and cellularity of bone marrow of the posterior ilium. Four groups of various marrow cellularity underwent diffusion-weighted echo-planar imaging: 1) adults with normal hypocellularity (21 patients); 2) adults with normal normocellularity (13 patients); 3) young children with normal hypercellularity (5 patients); and 4) adults with lymphoma-related hypercellularity (3 patients). In all adults, marrow cellularity was confirmed by uni-or bilateral bone marrow biopsies. In children, the iliac marrow was presumed hypercellular because of their ages. A total of 66 ADC values of bone marrow calculated from diffusion-weighted images with b-values of 30 and 300 seconds/mm(2) was evaluated. Hypercellular marrow (normal and lymphoma-related) showed the highest mean ADC, and hypocellular the lowest ADC. Statistically significant differences were found between three groups of normal marrow: hypocellular, normocellular, and hypercellular. There is a positive correlation between ADC and cellularity of bone marrow. J. Magn. Reson. Imaging 2001;13:757-760.

MRI of ranulas

We reviewed the MRI of 20 patients with a ranula (8 simple and 12 plunging) and ten with other cystic masses in the floor of the mouth and/or suprahyoid portion of the neck (three haemangiomas, two neuromas, one monomorphic adenoma, one lipoma, two lateral cervical cysts and one dermoid cyst). Histological diagnoses were obtained in all cases with the exception of one presumed haemangioma. Ranulas were all well-defined, homogeneous masses giving low signal on T1- and markedly high signal on T2-weighted images. While simple ranulas were all confined to the sublingual space, plunging ranulas were centered on the submandibular space and tended to spill into one or more adjacent spaces. They extended into the sublingual space anteriorly (producing a so-called tail sign) in eight of 12 cases and into the parapharyngeal space superiorly in five. Although they sometimes filled a considerable part of the parapharyngeal space, displacement of surrounding muscles or vessels was usually slight, which was thought to reflect the nature of extravasation pseudocysts. All other cystic masses in our study had one or more MRI finding different from those of ranulas and could be easily differentiated from them.

New terpenoid components from the volatile oils of the soft corals Clavularia viridis and Sarcophyton acutangulum

A new tetracyclic terpenoid hydrocarbon, cyclosinularane (1), and (+)-alloaromadendrene (2), the enantiomer of terrestrial (-)-alloaromadendrene, have been isolated from the volatile oil of the soft corals Clavularia viridis and Sarcophyton acutangulum, respectively. Their structures have been determined on the basis of NMR spectral analysis and their chiroptical properties.

Primary malignant lymphoma of the maxillary sinus: CT and MRI

We reviewed the CT and MRI of seven patients with primary malignant lymphoma of the maxillary sinus to find if there are characteristic imaging findings suggestive of the disease. The images were analysed for appearance, size, signal, internal characteristics, extent of tumour, bone change and lymph node enlargement. In two patients, the tumour first presented with mucosal thickening. In the remaining five, the tumours were an expansile mass 4-6 cm in diameter at the time of detection. Although it was difficult to distinguish tumour from mucosa or obstructed fluid on CT, T2-weighted MRI enabled us to separate tumour from normal mucosa or fluid. In two patients, the tumours were heterogeneous. Calcification and haemorrhage were observed in one patient. Periantral soft-tissue infiltration was always present, even when tumour appeared as slight mucosal thickening. Posterior extension was seen in all patients. Permeative and lytic bone destruction accompanied most cases of periantral soft-tissue infiltration; mixed destruction and sclerosis was also observed. Mucosal thickening with periantral soft-tissue infiltration may suggest malignant lymphoma of the maxillary sinus in its early form. Various types of bone change may accompany the periantral soft-tissue infiltration.

Recurrent pleomorphic adenoma of the head and neck

We reviewed the clinical and imaging files of 15 patients with pathologically confirmed recurrent pleomorphic adenomas of the head and neck. The primary tumours were in the lacrimal gland (1 case), cheek (2), palate (5), parotid gland (4), and submandibular gland (3). Recurrence was generally late, with an average of 14.9 years between initial surgery and recurrence. Multiple recurrent tumours, measuring 5-50 mm were found in eight patients. In all palatal cases recurrence was large and solitary. Most recurrent pleomorphic adenomas were well delineated with smooth margins, like most primary tumours. Irregularity of the margins was seen in four patients. In four of the five tumours of the palate and in the orbital lesion, the recurrent tumours caused bone destruction, thus mimicking malignant lesions. Irregular-margined recurrences seem to be rather small and found among multiple recurrent nodules.

Identification of HLA-A24 epitope peptides of carcinoembryonic antigen which induce tumor-reactive cytotoxic T lymphocyte

Carcinoembryonic antigen (CEA), which is expressed in several cancer types, is a potential target for specific immunotherapy. HLA-A24 is the most frequent allele among Japanese and is also frequently present in Asians and Caucasians. We tested CEA-encoded HLA-A24 binding peptides for their capacity to elicit anti-tumor cytotoxic T lymphocytes (CTL) in vitro. For this purpose, we used CD8+ T lymphocytes from peripheral blood mononuclear cells (PBMC) of a healthy donor and autologous peptide-pulsed dendritic cells as antigen-presenting cells. This approach enabled us to identify 2 peptides, QYSWFVNGTF and TYACFVSNL, which were capable of eliciting CTL lines that lysed tumor cells expressing HLA-A24 and CEA. The cytotoxicity to tumor cells by the CTL lines was antigen-specific since it was inhibited by peptide-pulsed cold target cells as well as by anti-class I major histocompatibility complex (MHC) and anti-CD3 monoclonal antibodies (MAbs). The antigen specificity of the 2 CTL lines was examined using several tumor cell lines of various origins and for their peptide-dose responses. The identification of these novel CEA epitopes for CTL offers the opportunity to design and develop epitope-based immunotherapeutic approaches for treating HLA-A24+ patients with tumors that express CEA.

Identification of HLA-A24 epitope peptides of carcinoembryonic antigen which induce tumor-reactive cytotoxic T lymphocyte

Carcinoembryonic antigen (CEA), which is expressed in several cancer types, is a potential target for specific immunotherapy. HLA-A24 is the most frequent allele among Japanese and is also frequently present in Asians and Caucasians. We tested CEA-encoded HLA-A24 binding peptides for their capacity to elicit anti-tumor cytotoxic T lymphocytes (CTL) in vitro. For this purpose, we used CD8+ T lymphocytes from peripheral blood mononuclear cells (PBMC) of a healthy donor and autologous peptide-pulsed dendritic cells as antigen-presenting cells. This approach enabled us to identify 2 peptides, QYSWFVNGTF and TYACFVSNL, which were capable of eliciting CTL lines that lysed tumor cells expressing HLA-A24 and CEA. The cytotoxicity to tumor cells by the CTL lines was antigen-specific since it was inhibited by peptide-pulsed cold target cells as well as by anti-class I major histocompatibility complex (MHC) and anti-CD3 monoclonal antibodies (MAbs). The antigen specificity of the 2 CTL lines was examined using several tumor cell lines of various origins and for their peptide-dose responses. The identification of these novel CEA epitopes for CTL offers the opportunity to design and develop epitope-based immunotherapeutic approaches for treating HLA-A24+ patients with tumors that express CEA.

Increase in memory (CD4+CD29+ and CD4+CD45RO+) T and naive (CD4+CD45RA+) T-cell subpopulations in smokers

To examine the effects of smoking on lymphocyte subpopulations, we measured the following cell subpopulations: CD4+ T-cell subpopulations (i.e., CD4+CD29+, CD4+ CD45RO+, and CD4+CD45RA+ cells); CD8+ T-cell subpopulations (i.e., CD8+CD11a+ and CD8+CD11b+ cells); and natural killer cell subpopulations (i.e., CD16+CD57-, CD16+CD57+, and CD16-CD57+ cells). We measured these subpopulations, together with total CD4+ T, total CD8+ T, total CD3+ T, B (CD19+), and total lymphocytes, in 10 male heavy smokers, 38 male light-to-moderate smokers, and 33 male nonsmokers. The mean ages were 30 y, 31 y, and 32 y, respectively, and ages did not vary significantly among the smokers. CD4+CD29+ and CD4+CD45RO+ (memory T) cells in heavy smokers were significantly more numerous than those in light-to-moderate smokers and nonsmokers. Also, these memory T-cell subpopulations were significantly more numerous in light-to-moderate smokers than in nonsmokers. The number of CD4+CD45RA+ (naive T) cells was significantly larger in heavy smokers than nonsmokers; numbers of CD4+CD45RO+ T and CD4+CD29+ T cells (memory T cells) were significantly correlated with daily cigarette consumption. Numbers of CD3+ T, CD4+ T, CD19+ B, and total lymphocytes in heavy smokers were significantly larger than in nonsmokers. There were significantly more CD3+ T, CD4+ T, and total lymphocytes in light-to-moderate smokers than in nonsmokers. The numbers of CD4+ T lymphocytes in heavy smokers were significantly larger than in light-to-moderate smokers. Perhaps CD4+ T cell subpopulations, especially memory T cells, are most susceptible to the effects of smoking on lymphocyte subpopulations.

Synthesis and antiallergic activity of dimethyl-2-(phenylcarbamoyl)ethylsulfonium p-toluenesulfonate derivatives

The derivatives of dimethyl-2-(phenylcarbamoyl)ethylsulfonium p-toluenesulfonates were synthesized and evaluated for antiallergic activity. The 2,3-dihydroxyethoxy group was introduced to the phenyl ring from the standpoint of lipophilicity and electronic effects of substituent. The IgE-induced rat passive cutaneous anaphylaxis (PCA) was inhibited by oral administration of several substituted 2-[(4-propoxyphenyl)carbamoyl]ethyldimethylsulfonium p-toluenesulfonate derivatives. Among them (+/-)-2-[N-[4-(3-ethoxy-2-hydroxypropoxy)phenyl]carbamoyl]ethyldimeth ylsulfonium p-toluenesulfonate (1a, IPD-1151T) was found to possess considerable activity in the PCA test, and it was launched as Suplatast tosilate in Japan.

Malignant lymphoma of the gingiva: MR evaluation

PURPOSE

Our purpose was to document the MR imaging findings of malignant lymphoma of the gingiva.

METHODS

Five patients with histologically proved malignant lymphoma of the gingiva were studied by MR imaging. The MR images were analyzed for tumor size, extent, and signal characteristics, bone involvement, and associated cervical lymph node enlargement.

RESULTS

Clinical examination tended to underestimate the size of lymphomatous lesions. The signal intensity of the lesions was isointense to hyperintense relative to muscle on noncontrast T1-weighted images and showed variable contrast enhancement patterns. On T2-weighted images, signal intensity was isointense to hypointense relative to the oral mucosa. In one case, the mass extended to the submandibular space; in the remaining cases, the masses were limited to the gingiva and the adjacent bone. MR imaging revealed that gingival lymphomatous masses were broad-based along the mandible or maxilla and eroded through the cortex into the marrow space, but the cortex was still recognizable. No nodal involvement was noted in any of the patients with malignant lymphoma.

CONCLUSION

The signal characteristics of gingival lymphoma overlap those of other tumors. The cortex separating marrow involvement from the broad-based gingival mass generally appears to be permeated with small erosions but is still recognizable.

Rupture of the left main-stem bronchus by the tracheal portion of a double-lumen endobronchial tube

We report a rupture of the left main-stem bronchus following the insertion of a left-sided double-lumen endobronchial tube in a 76-yr-old woman with a short trachea. A fiberoptic bronchoscope was not used during the initial insertion of the tube and the depth of insertion resulted in approximately 5 cm in excess of the optimal level for this patient. The rupture had been caused by the tracheal portion of the double-lumen tube. This damage may have been avoided if a fiberoptic bronchoscope was used routinely as an introducer and for positioning of the endobronchial tube under direct vision.

[Anesthetic management of a patient with tuberous sclerosis]

Tuberous sclerosis is characterized by facial angiofibromatosis, epilepsy, and mental retardation. There have been only a few reports of anesthetic management of patients with tuberous sclerosis. We managed a 22-year-old patient with tuberous sclerosis using nitrous oxide (67%) in oxygen supplemented with fentanyl and midazolam. There were no untoward events related to anesthesia and surgery. Problems in managing patients with tuberous sclerosis are also discussed.

The relation between an esophageal cancer and associated cancers in adjacent organs

BACKGROUND

The relation between esophageal cancers and head and neck tumors was studied in order to improve the treatment results in patients with multiple cancers.

METHODS

We reviewed the records of 3,375 patients with an indexed squamous cell carcinoma of the head and neck treated at our institution between 1960 and 1994; and 81 patients were found to have an associated esophageal carcinoma. Similarly, the records of 434 patients with an indexed esophageal cancer were reviewed; and 54 patients had cancers in other organs or in the residual esophagus. A total of 135 esophageal cancers with 154 synchronous or metachronous cancers were entered into the analysis.

RESULTS

The risk of developing esophageal cancer was ten times higher in male patients with head and neck cancer than in female patients. Synchronous or metachronous esophageal cancer associated with head and neck cancer was most frequently seen with pharyngeal cancer (28/360 = 7.8%), followed by in the oral cavity (47/2148 = 2.2%).

CONCLUSIONS

Better knowledge of the relation between an esophageal cancer and a head and neck cancer may lead to the early detection of subsequent small, potentially curable neoplasms sited in either the esophagus or the head and neck region.

External and interstitial radiotherapy in the treatment of oropharyngeal squamous cell carcinoma

The records of 165 patients with squamous cell carcinoma of the oropharynx treated at our hospital with external and/or interstitial radiotherapy between 1971 and 1990 were reviewed to evaluate the treatment results, focusing on primary control and complications. All cancers were restaged according to the UICC 1987 TNM staging system. Of these 165 patients, 11% were in Stage I, 55% in Stage II, 24% in Stage III and 8.5% in Stage IV. Local control and complications were analysed in 140 patients. The remaining 25 patients died of intercurrent or metastatic disease during the first 2 years following treatment and were excluded from the analysis. 70 patients were treated by interstitial implant using permanent implant seeds (Rn-222 in eight patients, Au-198 in 62 patients) with or without external radiation. 56 other patients received external irradiation alone and another 14 patients received pre-operative external irradiation plus surgery. 2-year recurrence-free rates were 73% (100% for T1, 76% for T2, 36% for T3 tumours) in the patients who received interstitial implant with or without external radiation and 36% (67% for T1, 48% for T2, 13% for T3 tumours) in the patients treated by external irradiation alone. The incidence of soft-tissue or bone complications requiring long-term treatment was 14%. Based on these findings, it is believed that an interstitial implant using Au-198 grains combined with external beam irradiation is a useful treatment modality for small lesions of the oropharynx.

Squamous cell carcinoma of the oral cavity: MR findings and value of T1-versus T2-weighted fast spin-echo images

OBJECTIVE

The purposes of this study were to describe the characteristics of squamous cell carcinomas of the oral cavity on unenhanced and contrast-enhanced T1-weighted spin-echo (SE) MR images and unenhanced T2-weighted fast spin-echo (FSE) MR images and to determine which sequences best delineate the margins and extent of the tumors.

MATERIALS AND METHODS

Forty-four patients with proved squamous cell carcinoma of the oral cavity (tongue, 24; floor of mouth, seven; buccal mucosa, four; maxillary gingiva, two; and mandibular gingiva, seven) underwent unenhanced axial T2-weighted FSE MR imaging and unenhanced and enhanced axial and coronal T1-weighted SE MR imaging. The appearance, signal characteristics, and extent of the tumors were assessed, and the delineation of tumor margins with each sequence or combination of sequences was evaluated by use of a grading system ranging from 1 (poor) to 3 (excellent). Three patients were excluded because of artifacts on the MR images caused by dental restorations.

RESULTS

Tumors in all 41 patients were depicted on unenhanced T1-weighted SE images, but in four patients, tumors were not visible on T2-weighted FSE images. Except for tumors that invaded the maxillary gingiva, the tumors generally had homogeneous, low signal intensity on unenhanced T1-weighted images and nonhomogeneous, high signal intensity on T2-weighted FSE images. All tumors showed enhancement, 76% with a nonhomogeneous appearance. The delineation of tumor margins was excellent (grade 3) in 31 cases and fair (grade 2) in 10 cases. The highest rating was given for unenhanced T1-weighted images in 10 cases, for contrast-enhanced T1-weighted images in 10 cases, for the combination of both unenhanced and contrast-enhanced T1-weighted images in 18 cases, for the combination of unenhanced T1-weighted and T2-weighted FSE images in five cases, and for T2-weighted FSE images in one case. In three cases, the highest rating was given for both combinations of pulse sequences.

CONCLUSION

An unenhanced T1-weighted sequence should be used as the basic pulse sequence for MR imaging of tumors of the oral cavity. When tumor margins are not clearly delineated with this sequence, T2-weighted FSE and contrast-enhanced T1-weighted sequences should be added. Although both of these sequences provide supplementary information, the contrast-enhanced T1-weighted sequence is more useful in delineating the margins and extent of tumors than is the T2-weighted FSE sequence.