Undifferentiated spindle cell carcinoma of the extrahepatic bile ducts: a case report.

Spindle cell carcinoma is a rare tumor that generally occurs in the upper digestive tract. We report an 81-year-old man with spindle cell carcinoma located in the extrahepatic bile ducts, resulting in obstructive jaundice. The patient died 10 months after operation due to local recurrence. The literature on this rare disease is reviewed and discussed.

Synchronous multiple primary cancers of the stomach and duodenum in aged patients: report of two cases.

We describe herein the cases of two aged patients found to have synchronous multiple primary cancers of the stomach and duodenum. The first patient was an 82-year-old man who was preoperatively diagnosed as having gastric cancer after presenting with signs of pyloric stenosis. At laparotomy, duodenal cancer was incidentally found to have infiltrated the transverse colon. A pancreatoduodenectomy and right hemicolectomy with radical lymph node dissection was performed. Two early well-differentiated adenocarcinomas of the stomach and an advanced poorly differentiated adenocarcinoma of the duodenum were confirmed. This patient is now well without any evidence of recurrence more than 5 years after surgery. The second patient was a 77-year-old man who was also diagnosed as having gastric cancer after presenting with signs of pyloric stenosis. Preoperatively, duodenal cancer was detected by endoscopy. A pancreatoduodenectomy and partial colectomy with radical lymph node dissection was performed because the duodenal cancer was suspected of having infiltrated the transverse colon. An early moderately differentiated adenocarcinoma of the stomach and an advanced moderately differentiated adenocarcinoma of the duodenum were confirmed, but the duodenal cancer was not seen to invade the transverse colon microscopically. This patient died of cancer 7 months after surgery. Because multiple primary cancers commonly develop in elderly patients, a precise preoperative diagnosis must be made and optimal treatment applied.

Liver metastasis nineteen years after surgery for typical bronchial carcinoid.

A resected case of metastatic liver carcinoid is presented. A 62 year-old woman, who had undergone removal of a typical bronchial carcinoid 19 years before, was found to have a well-defined, oval hepatic tumor on ultrasonography. The resected specimen was a hard and solid tumor, which was microscopically diagnosed as a carcinoid. Histological review of the previously resected lung tumor revealed that the liver tumor was a metastasis from the primary bronchial carcinoid. The patient is alive without recurrence 42 months after hepatectomy. This case suggests that typical bronchial carcinoid, a slowly growing tumor, may metastasize to distant sites after many years, and that re-excision of metastatic lesions may prolong survival time.

Bonding efficacy and interfacial microstructure between resin and dentine primed with glyceryl methacrylate.

OBJECTIVES: To evaluate the effect of two experimental primers based on glyceryl methacrylate (GM, 2,3-dihydroxypropyl methacrylate) and 2-hydroxyethyl methacrylate (2-HEMA) on the marginal adaptation of light-cured composite placed into cylindrical dentine cavities and to study the interfacial microstructure. METHODS: The bonding efficacy of two experimental dentine primers combined with a dentine cleanser composed of either 0.5 mol l-1 EDTA neutralized to pH 7.4 by sodium hydroxide or 10% citric acid containing 3% ferric chloride (10-3 solution), and a commercial dentine bonding agent containing phosphate ester, were examined by measuring the wall-to-wall polymerization contraction gap of a commercial light-activated resin composite placed into cylindrical dentine cavities. The adhesive interface between the dentine and the dentine adhesive was observed using a transmission electron microscope (TEM). RESULTS: The formation of a contraction gap was completely prevented by priming with GM, regardless of the dentine cleanser used. However, in groups primed with 2-HEMA, gap formation was observed in three and four specimens out of 10 in the groups that were cleaned with the EDTA and 10-3 solution, respectively. In samples primed with GM, a high-density layer was observed by TEM at the superficial dentine in the hybrid layer, which may have indicated a high monomer content, whereas no density variations were observed in the hybrid layer in samples primed with 2-HEMA.

Effects of polyvalent alcohol solutions as dentine primers.

OBJECTIVES: The purpose of this study was to examine the bonding effect of polyvalent alcohols as dentine primers without a methacrylate group, which may cause contact dermatitis. METHODS: The efficacy of polyvalent alcohols as dentine primers was estimated by measuring the wall-to-wall polymerization contraction gap width of a light-activated resin composite filled in a cylindrical dentine cavity in an extracted human tooth. A dentine cavity was cleaned with ethylenediaminetetraacetic acid (EDTA) and primed with an aqueous solution of either ethylene glycol, glycerol, erythritol, xylitol or sorbitol at concentrations of between 25 and 75 wt%. A light-cured resin composite was filled after the application of a commercial dual-cured bonding agent. RESULTS: Contraction gap formation was completely prevented only in the group in which the dentine cavity had been primed with an aqueous solution of 62.5% wt% ethylene glycol. Furthermore, in the measurement of a tensile bond strength to a flat dentine surface, high tensile bond strength (17.5 +/- 4.4 MPa) was observed in the group that was primed with 62.5% ethylene glycol solution. CONCLUSION: These results suggest that it is not necessary to dissolve methacrylates in a dentine primer when the primer is dried with a blast of compressed air before application of a polymerizable, suitable bonding agent. It is concluded that a dentine primer composed of polyvalent alcohol solutions without a methacrylate group which may cause contact dermatitis, is effective as a dentine primer, affects the dentine surface, and promotes the efficacy of the dentine bonding system.

A Case of Apocrine Carcinoma of the Breast Presenting as Two Cysts.

A case of apocrine carcinoma of the breast presenting as two cysts is reported. A 60-year-old woman had two soft, mobile, well-defined masses measuring 4 x 2.5 cm and 1.5 x2.5 cm in diameter in the lower-inner quadrant of the right breast. Tumor markers such as CEA, CA15-3, BCA225 and NCC-ST-439 were within normal limits. Mammography showed two oval radioopaque masses with microcalcificatin in the smaller one. Ultrasonography disclosed two cysts and papillary projection in the larger one. Fine needle aspiration cytology revealed apocrine carcinoma of the breast. Excisional biopsy confirmed the diagnosis of apocrine carcinoma with focal invasion. Modified radical mastectomy was performed. Pathological study showed that the tumor mainly proliferated in the cysts and the two cysts communicated with each other through an involved duct. There was no apocrine metaplasia in adjacent mammary gland. There were no metastatic lymph nodes. This case may be regarded as intraductal apocrine carcinoma developing two cysts with focal invasion.

Adaptation of a resin composite in vivo.

OBJECTIVE: The adaptation of experimental dentine bonding systems has been evaluated in vivo. METHODS: A cylindrical cavity which extended into dentine was prepared in the facial surface of vital teeth that were to be extracted for orthodontic reasons. The preparations were restored with a commercial light-activated resin composite that was mediated by experimental dentine bonding systems. The restored teeth were extracted as soon as possible following polymerization of the composite. The marginal and internal adaptation of the resin composite restoration was observed under a light microscope in both horizontal and longitudinal sections of the teeth immediately after extraction. RESULTS: Of the experimental dentine bonding systems investigated, those including a primer of glyceryl methacrylate showed complete adaptation whereas those with primers of 2-HEMA showed a contraction gap in three out of 10 specimens.

Efficacy of various commercial dentin bonding systems.

OBJECTIVES: The purpose of this study was to test the bonding efficacy of fifteen commercial dentin bonding systems and also to determine the effect of various commercial dentin cleaners on bonding and dentin hardness. METHODS: Each commercial bonding system was examined by two methods: 1) measuring the maximum contraction gap of a light-cured composite in a cylindrical dentin cavity; and 2) determine the tensile bond strength to a flat dentin surface. In addition, various commercial dentin cleansers were investigated to determine if dentin hardness was reduced after cleaning. As a control, the dentin surface was cleaned with neutralized EDTA prior to the combined application of an experimental dentin primer, a commercial bonding agent, and a commercial light-cured composite. RESULTS: The study demonstrated that complete marginal adaptation was obtained by the experimental dentin bonding system used as the control. However, it was not possible to completely prevent gap formation with the commercial dentin bonding systems tested. A high correlation (R = 0.88) was observed between maximum contraction gap width and reduction of hardness only in the group in which the dentin was rinsed after cleaning. SIGNIFICANCE: It is very important to combine optimal dentin cleansers, primers, and bonding agents to compensate for the polymerization contraction stress of the composite. Therefore, it was speculated that the commercial dentin bonding systems tested in this study consisted of unsuitable materials.

Self-etching dentin primers containing phenyl-P.

The dentin bonding efficacies of two commercial dentin bonding systems and experimental self-etching dentin primers composed of methacryloxyethyl hydrogen phenyl phosphate (Phenyl-P) and either hydroxyethyl methacrylate (HEMA) or glyceryl methacrylate (GM,2,3-dihydroxypropyl methacrylate) were examined. The wall-to-wall polymerization contraction gap width of a commercial light-activated resin composite in a cylindrical dentin cavity and the tensile bond strength to a flat dentin surface were measured. Changes in dentin hardness were determined by Micro Vickers Hardness measurement, and an SEM observation was performed after priming. Formation of a contraction gap was completely prevented by the application of Phenyl-P diluted in HEMA or GM solution combined with a commercial dentin bonding agent, although gap formation was evident in nearly half of the specimens with both commercial dentin bonding systems. The mean tensile bond strengths of the tested groups varied from 16.3 to 20.7 MPa, and there were no significant differences between groups. Based on the measurement of Micro Vickers Hardness and SEM observation after priming, a slight reduction in dentin hardness was observed. However, this reduction in dentin hardness due to self-etching priming did not significantly correlate with either contraction gap width or tensile bond strength.

Factors affecting tensile bond strength of composite to dentin.

Five factors which might affect the tensile bond strength of an experimental dentin bonding system to extracted human dentin were evaluated. Flat dentin surfaces of extracted human teeth were cleaned with 0.5 mol/L EDTA and pretreated with 35% glyceryl methacrylate solution. A commercial light-activated composite was then bonded using a commercial bonding agent. The five evaluated factors were: 1) embedding or not embedding the specimens in an epoxy resin, 2) thickness of the specimens, 3) crosshead speed during measurement, 4) storage time of the specimens, and 5) dentin substrate depth. Measurements were made of the bond strengths that resulted from the effects of these varied factors. These measurements were compared to a control group. Only the specimen thickness significantly affected the measured bond strength, and extremely thin specimens (about 1 mm) showed the lowest bond strength.

Marginal adaptation of nine commercial intermediate resins.

The bonding efficacy of nine commercially available intermediate resins was examined by measuring the maximum contraction gap of a light-activated composite in a cylindrical cavity of human dentin. With only one exception, the marginal adaptation of the composite improved significantly when the intermediate resins were combined with an experimental dentin cleaning system of the neutralized 0.5 mol/L EDTA and a dentin primer composed of a 35% aqueous solution of either hydroxyethyl methacrylate (HEMA) or glyceryl methacrylate (GM). Complete marginal adaptation was obtained with four tested materials when dentin was pre-treated with EDTA and GM.

Morphological changes of rabbit skin by application of dentin primer.

The side effects of dentin primer applications on soft tissue were examined pathologically. Of the 4 experimental dentin primers tested, dimethylaminoethyl methacrylate (DMAEM) and glutaraldehyde (GLU) caused irritation to the skin of rabbits whereas hydroxyethyl methacrylate (HEMA) and glyceryl methacrylate (GM) caused only insignificant changes in the substrate. It was concluded that an aqueous solution of GM can be used clinically because of its low irritation to skin and high bonding efficacy, as previously reported, though possible irritation to pulp tissues should perhaps still be investigated. The mechanisms of irritation to operator fingertips caused by repeated direct contact with dentin primers containing HEMA remain unknown.

Efficacy of glyceryl methacrylate as a dentin primer.

The efficacy of pretreatment on the dentin surface with an aqueous solution of glyceryl methacrylate (GM) was examined by measuring the wall-to-wall polymerization contraction of a light activated composite in a cylindrical dentin cavity, and by measuring the tensile bond strength to a flat dentin surface. All of the tested dentin surfaces were cleaned with neutralized 0.5 M EDTA and treated with experimental primers, followed by a marketed dentin bonding agent and composite. The contraction gap formation of the composite was completely prevented by the application of the GM solution at concentrations of 25 and 35% in water. In contrast, half of the specimens treated with 35% HEMA and 35% HEMA containing 5% glutaraldehyde showed gap formation. Furthermore, a considerably high tensile bond strength of more than 18MPa was observed in the above described dentin bonding system.

Effects of self-etching primers on dentin.

The effects of self-etching dentin primers on the hardness of dentin was evaluated by determination of the Vickers Hardness of both untreated dentin and dentin treated with different primers. Several experimental primers were prepared by dilution of dicarbonates or their esterified salts with different ratios of HEMA to obtain ratios of 5% and 35% by weight. Methacryloxyethyl succinate (MES) and Methacryloxyethyl phthalate (MEP) experimental primers caused less softening of dentin than did maleic acid diluted with HEMA or a commercial dentin primer (Scotchprep, 3M). A high correlation was observed between the pH of a primer and the hardness of dentin treated with the primer. A correlation was also observed between the hardness of treated dentin and the wall-to-wall polymerization contraction of a light-curing microfilled resin (Silux, 3M).

Effect of the self etching dentin primers on the bonding efficacy of a dentin adhesive.

The efficacy of marketed and experimental self etching dentin primers which contained dicarboxylic acids or their esterified salts diluted in 35% hydroxyethylmethacrylate (HEMA) solution were studied by measuring the wall-to-wall polymerization contraction of the light curing composite in the cylindrical dentin cavity and the tensile bond strength to the flat dentin surface. In both of the measurements, a marketed dentin bonding agent and resin monomer was applied after the treatment with experimental primers and a marketed primer, respectively. It was revealed that two experimental primers composed of the methacryloxyethyl-succinate or methacryloxyethyl-phthalate and HEMA, exhibited a remarkable effect on the bonding efficacy of a dentin adhesive employed in this study. A marketed primer which contained maleic acid and HEMA could not improve the bonding between the resin and dentin cavity wall although a significantly high bonding strength (11.9 +/- 5.7 MPa) was obtained after 24 hours.