Longitudinal observation of maxillary sinus bony bridges and septa in childhood.

The rate of septum presence in the maxillary sinus has been reported to be over 30%. It was considered that a bony bridge might change to a maxillary sinus septum with growth in a previous study using dry child skulls. In the present investigation, maxillary sinus bony bridges and septa were longitudinally observed using computed tomography (CT). Multislice CT was performed in three patients. A bony bridge was defined as a bony structure between the maxillary sinus wall and dental germ. Also, a septum was defined as a pointed bony structure in the inferior wall of the maxillary sinus. The height and angle of the bony bridge/septum and the distance between the base of the bony bridge/septum and bony palate were measured. In three patients, the bony bridge in the maxillary sinus floor was observed in the second molar on the first CT, and the maxillary sinus septum was observed on the second CT at the same site. In conclusion, it was longitudinally observed that a bony bridge changed to a maxillary sinus septum with growth, such as root formation and tooth eruption.

Depression of the maxillary sinus anterior wall and its influence on panoramic radiography appearance.

OBJECTIVES: To clarify the depression aspect of the maxillary sinus anterior wall and to investigate its relationship with the panoramic image appearance of a diagonal line from the inferior part of the so-called panoramic innominate line to the medial portion of the orbital floor line. METHODS: Based on CT data, panoramic images were simulated for two typical cases with and without anterior wall depression. Next, on axial CT images of 1689 subjects (3378 sinuses) stored in our image database, the wall depths were measured and analyzed for their relationships with the panoramic appearances of the diagonal line, classified into invisible, obscure and clear patterns. RESULTS: Based on the simulation study, visualization of the diagonal line was verified to alter depending on the morphology of the anterior wall and the position of the panoramic image layer. In 408 (12.1%) sinuses, the diagonal line (clear and obscure patterns) could be seen on the panoramic image. The incidences of the obscure and clear patterns increased with increasing age groups. The mean wall depths were 2.91, 4.80 and 7.28 mm for the invisible, obscure and clear patterns, respectively. The clear pattern showed the highest value for the wall depth, followed by the obscure pattern. CONCLUSIONS: The diagonal line on a panoramic image was verified to be related to depression of the maxillary sinus anterior wall, and its panoramic image appearance can be altered depending on the position of the tomographic image layer.

Reproducibility of maxillofacial landmark identification on three-dimensional cone-beam computed tomography images of patients with mandibular prognathism: Comparative study of a tentative method and traditional cephalometric analysis.

OBJECTIVE: To clarify the reproducibility of a tentative method for identifying maxillofacial landmarks on three-dimensional (3D) images obtained with cone-beam computed tomography (CBCT) for dental use in patients with mandibular prognathism. Also, the influence of level of experience of dentists applying the method was investigated by dividing them into two groups according to experience. MATERIALS AND METHODS: Dentists with less (group A) or more (group B) than 3 years of experience of cephalometry and 3D image manipulation analyzed CBCT data from 10 patients using two different landmark identification methods: method 1 used conventional cephalometric definitions and method 2 used detailed landmark identification definitions developed for each cross-sectional plane. The plotting of nine landmarks was performed twice, and 10 coordinate values were obtained for each landmark. To assess reproducibility, the 95% confidence ellipse method was used. RESULTS: Comparative analysis showed that method 2 was highly reproducible. Group B subjects attained smaller ellipsoid volumes than group A subjects, regardless of the landmark identification method used. With method 1, except for condyle and coronoid process, all landmarks showed a higher level of reproducibility in group A subjects than in group B subjects. With method 2, however, five landmarks showed no differences between the methods. CONCLUSION: The method proposed here may be highly reproducible regardless of the evaluators' experience.

Reproducibility of three-dimensional coordinate systems based on craniofacial landmarks: a tentative evaluation of four systems created on images obtained by cone-beam computed tomography with a large field of view.

OBJECTIVES: To propose a method for evaluating the reproducibility of anatomical coordinate systems based on craniofacial skeletal landmarks and to tentatively evaluate four systems created on preoperative cone-beam computed tomography (CBCT) data obtained from mandibular prognathism patients in order to confirm the utility for actual patients' data. MATERIALS AND METHODS: In three-dimensional images of 10 patients obtained by a CBCT with a large field of view, six dentists set four coordinate systems that were created in different ways, twice by plotting some landmarks situated in the superior portion of the maxillofacial skeletons. The 95% confidence ellipse of six objective landmarks related to the jaw and teeth (upper incisor, left upper first molar, lower incisor, left lower first molar, menton, and left gonion) were three-dimensionally drawn for each coordinate system. The ellipsoid volume was calculated to evaluate the reproducibility of the coordinate systems. RESULTS: The reproducibility could be evaluated for each coordinate system using the method proposed. The coordinate systems that were created by landmarks situated at greater distances from each other showed relatively small ellipsoid volume in comparison to those with shorter distances between landmarks. CONCLUSION: Anatomical coordinate systems with larger distances between the landmarks used were stable when landmarks related to the jaw and teeth were assigned as objective landmarks. The method proposed here was effective in terms of the reproducibility evaluation of a coordinate system.

Effects of physical exercise prescribed by a medical support team on elderly lower extremity osteoarthritis combined with metabolic syndrome and/or type 2 diabetes.

AIM: The aims of the present study were to investigate the effectiveness of exercise intervention provided by a medical support team specializing in lifestyle-related diseases in the treatment of elderly lower extremity osteoarthritis and to examine the influence of bodyweight decrease on changes in the evaluation indexes. METHODS: Participants were 61 patients (57 women and 4 men, aged 68.3 ± 9.6 years) with lower extremity osteoarthritis (109 total diseased joints) and either one or more of the following diseases: obesity, metabolic syndrome and type 2 diabetes. Indexes relating to metabolic diseases, orthopedic disorders, lifestyle activity level and health-related quality of life (HRQOL) were obtained before and after exercise intervention. RESULTS: The numbers of patients with obesity, metabolic syndrome, type 2 diabetes, gonarthrosis and coxarthrosis were 56, 49, 32, 56 and 9, respectively. The mean intervention period was 4.7 ± 1.6 months (2-10.8 months). Indexes relating to metabolic diseases and orthopedic disorders, activity level and HRQOL were all significantly improved after intervention (P < 0.05). Bodyweight decreased by 10.3% and showed a correlation with other evaluated items. Five explanatory variables were extracted through multiple regression analysis that bodyweight reduction rate was set as the criterion variable: changes of bodyweight, body mass index, percent body fat, glycated hemoglobin and total energy expenditure per bodyweight. CONCLUSION: The exercise intervention provided by our medical support team clearly improved indexes relating to metabolic diseases and orthopedic disorders. In addition, decreased bodyweight was related to improvements in metabolic factors, motor function and HRQOL.

Reproducibility of landmark identification in the jaw and teeth on 3-dimensional cone-beam computed tomography images.

OBJECTIVE: To compare the reproducibility of landmark identification on three-dimensional (3D) cone-beam computed tomography (CBCT) images between procedures based on traditional cephalometric definitions (procedure 1) and those tentatively proposed for 3D images (procedure 2). MATERIALS AND METHODS: A phantom with embedded dried human skull was scanned using CBCT. The acquired volume data were transferred to a personal computer, and 3D images were reconstructed. Eighteen dentists plotted nine landmarks related to the jaws and teeth four times: menton (Me), pogonion (Po), upper-1 (U1), lower-1 (L1), left upper-6 (U6), left lower-6 (L6), gonion (Go), condyle (Cd), and coronoid process (Cp). The plotting reliabilities of the two procedures were compared by calculating standard deviations (SDs) in three components (x, y, and z) of coordinates and volumes of 95% confidence ellipsoid. RESULTS: All 27 SDs for procedure 2 were less than 1 mm, and only five of them exceeded 0.5 mm. The variations were significantly different between the two procedures, and the SDs of procedure 2 were smaller than those of procedure 1 in 21 components of coordinates. The ellipsoid volumes were also smaller for procedure 2 than procedure 1, although a significant difference was not found. CONCLUSIONS: Definitions determined strictly on each three sectional images, such as for procedure 2, were required for sufficient reliability in identifying the landmark related to the jaws and teeth.

Demonstration of the accessory mental foramen using rotational panoramic radiography compared with cone-beam computed tomography.

OBJECTIVE: Rotational panoramic radiography is routinely used in dental practice. It has not been clarified, however, whether an accessory mental foramen can be demonstrated using this technique. The visibility of accessory mental foramina on rotational panoramic radiographs was compared with those on para-panoramic images reconstructed from cone-beam computed tomographic (CBCT) images. MATERIALS AND METHODS: A total of 365 patients (130 males and 235 females) were retrospectively analyzed. Para-panoramic images were reconstructed from CBCT images with the accessory mental foramen/foramina using three-dimensional visualization and measurement software, and then the accessory mental foramen on rotational panoramic images was compared with that on para-panoramic images. RESULTS: A total of 37 accessory mental foramina were observed in 28 patients on CBCT images. The rate of being able to visualize the accessory mental foramen or bony canal between the point of bifurcation from the mandibular canal and the accessory mental foramen on rotational panoramic radiographs was 48.6% (18 of 37 accessory mental foramina). CONCLUSION: Approximately half of the accessory mental foramina-positive CBCT images demonstrated the accessory mental foramen, or bony canal between the point of bifurcation from the mandibular canal and accessory mental foramen on rotational panoramic radiographs.

Adherence with long-term asthma management in patients who experienced hospitalized asthma exacerbation.

BACKGROUND: In Japan, the number of asthma deaths has been gradually decreasing. However, in the management of asthma, there are still some problems originating from patient-related factors and iatrogenic factors, both of which should be further analyzed. METHODS: We investigated clinical and background characteristics of 164 patients with asthma who were admitted to our hospital with acute exacerbations, by reviewing their clinical records. RESULTS: Fifty-two patients had received long-term management (LTM) based on the guidelines (the LTM group), while 112 had not (the non-LTM group). In patients whose asthma severity had been intermittent (step 1), the proportion of severe and near fatal exacerbations was significantly higher in the non-LTM group than in the LTM group. However, even in the LTM-group, 23% of mild persistent (step 2) and 38% of moderately and severely persistent (step 3 & 4) patients had severe or near fatal exacerbations. In these patients, the peak expiratory flow rate significantly improved after discharge, and poor adherence was also significantly higher in the non-LTM group than in the LTM group. A multivariate analysis revealed that the factors associated with poor adherence were: 1) no history of previous admission due to asthma exacerbation; 2) the patient was male; and 3) the patient was young (<60 years). CONCLUSIONS: In the LTM group, re-evaluation of the actual severity of asthma and prompt treatment corresponding to the severity of disease should still be encouraged. In the non-LTM group, establishing countermeasures against factors causing poor adherence would be the next step in ensuring strong adherence with LTM.

Reproducibility of maxillofacial anatomic landmarks on 3-dimensional computed tomographic images determined with the 95% confidence ellipse method.

OBJECTIVE: To assess the plotting reproducibility of landmarks on 3-dimensional computed tomography (3D-CT) images through use of the 95% confidence ellipse in order to propose sufficiently stable coordinate systems for 3D-CT measurements. MATERIALS AND METHODS: Six dentists plotted 19 landmarks twice on 3D-CT images. Scatterplots and the 95% ellipses were produced 3-dimensionally, and the areas of the ellipses were calculated for evaluating the reproducibility of landmarks. RESULTS: The plotting reproducibility of each landmark showed characteristic features. Among five landmarks (the sella [S], nasion [N], basion [Ba], orbitale [Or], and true porion [Po]) that are frequently used as reference points on cephalograms, Ba showed the smallest areas for all three coordinate axes, indicating high reproducibility. The coronoid process (CP) and the tooth-related landmarks showed relatively high reproducibility. CONCLUSION: Sufficiently stable coordinate axes could be proposed for different treatments and studies.

Visceral larva migrans due to Ascaris suum which presented with eosinophilic pneumonia and multiple intra-hepatic lesions with severe eosinophil infiltration--outbreak in a Japanese area other than Kyushu.

A 32-year-old man presented with the chief complaint of severe cough. Examination of peripheral blood showed a marked increase in eosinophils. Chest CT demonstrated multiple ground glass opacities in both lungs. Bronchoalveolar lavage showed abundant eosinophils. Abdominal CT demonstrated multiple low attenuation areas in the liver. Liver biopsy with ultrasonography revealed severe eosinophil infiltrations around the portal veins. Serologically, a multi-dot enzyme linked immunosorbent assay (DOT-ELISA) and ELISA inhibition test using microtiter plates were positive for Ascaris suum. Thus, visceral larva migrans due to Ascaris suum was diagnosed. Outbreaks of this disease in Japan have previously been confined to the Kyushu area. The present case which occurred outside that area, illustrates the importance of constant attention to the epidemiology of this disease.