Colorimetric analysis of unstained lesions surrounding oral squamous cell carcinomas and oral potentially malignant disorders using iodine.

To determine whether the measurement of staining with 3% Lugol's solution provided efficient criteria for determining the area of resection for oral carcinomas and oral potentially malignant disorders, the authors analyzed the color of unstained lesions (USLs) in relation to histopathological findings. After vital iodine staining, USLs were seen in 48 of 54 patients (88.9%). A significant difference was seen in the value of lightness between stained lesions (SLs) and USLs for patients with moderate and severe epithelial dysplasia (P<0.001). The deviation between the macroscopically observable and the histopathological boundaries was -0.65+/-1.26 mm (range: -4.36 to 1.52). Color charts prepared on the basis of values for lightness and hue reproduced the macroscopic color differences in USLs, suggesting that it may become possible to diagnose USLs histologically on the basis of the measured color values and use of color charts to help determine the resection area in surgery.

Pleural amyloidosis in a patient with intractable pleural effusion and multiple myeloma.

Pleural involvement of systemic amyloidosis has been rarely reported. We report a case with multiple myeloma presenting an intractable right pleural effusion, in which pleural amyloidosis was diagnosed through pleural biopsy using a Cope needle. The diagnosis of pleural amyloidosis is important, because its refractory pleural effusion should be treated with pleurodesis. Since closed pleural biopsy using a Cope needle is much less invasive than thoracoscopy, the former should be attempted first whenever pleural amyloidosis is suspected.

[Diagnosis of pheochromocytoma using 131I-MIBG scintigraphy].

131I-MIBG scintigraphy was performed on 18 patients with pheochromocytoma and 25 patients with essential hypertension. In comparison of grade of 131I-MIBG accumulation in various organs the heart accumulation of pheochromocytoma group was significantly lower than that of essential hypertension group. And between the positive and false negative accumulation group of pheochromocytoma reverse relationship was observed between the heart and tumor. The results of 131I-MIBG scintigraphy for pheochromocytoma included 78% sensitivity, 100% specificity, and 90% accuracy. False negative accumulation of tumors were shown at 6 lesions in 4 cases. On the bases of CT and operative findings, false negative accumulation was observed not only in very small tumors, but also in large cystic tumors with a small amount of tumor tissue or totally hemorrhagic necrosis within the tumor.

[A case of myotonic dystrophy associated with intracardiac conduction abnormalities and aortic regurgitation].

A rare case of myotonic dystrophy with mechanical derangement in a 48-year-old male is reported. The patient was admitted to Fuzisawa City Hospital because of chest discomfort. On physical examination, he had the typical facial appearance of myotonic dystrophy, and displayed grip myotonia. The blood pressure was 120/60 mmHg and the pulse 51, regular. A systolic ejection murmur at the cardiac base, an early diastolic blowing murmur along the left sternal border, and a pansystolic murmur at the apex were heard. The deep tendon reflexes were all normal. Elevation of serum creatine kinase and aldolase were noted. Chest X-ray films suggested moderate cardiomegaly. An electrocardiogram showed sinus bradycardia, atrioventricular block and left bundle branch block, suggesting diffuse involvement of the conduction system. An echocardiography confirmed the presence of left ventricular enlargement, thickened aortic valves, mitral regurgitation, and aortic regurgitation. Selective coronary angiography revealed no abnormalities. Left ventriculography demonstrated diffuse hypokinesis of the entire ventricle. Light microscopy of biopsied right myocardium revealed prominent interstitial fatty infiltration, mild interstitial fibrosis, and variation in the nuclear size. A 22-year-old son also had myotonic dystrophy and had an echocardiography indicative of thickened valves with aortic regurgitation. Myotonic dystrophy is a autosomal dominant disease. Cardiac involvement selectively disturbs the conduction system, sinus node, and to a lesser extent myocardium. Although the presence of aortic regurgitation could be a mere coincidence, we believe that this did not occur by accident, because the patient's son also had aortic regurgitation.