Stomal recurrence invading the cervicothoracic esophagus and upper mediastinum: resectability and the creation of a safe anterior mediastinal tracheostoma.

Surgical salvage for stomal recurrence is a for midable problem for head and neck surgeons. The two factors of considerable significance are resectability and establishment of a safe anterior mediastinal tracheostoma. A case of stomal recurrence invading the cervicothoracic esophagus and upper mediastinum is presented. Total esophagectomy and upper mediastinal dissection was performed. The esophagus was reconstructed immediately with a pedicled gastric flap. The omentum on the gastric pedicle was wrapped around the trachea to reduce the likelihood of erosion into the great vessels and to supplement the lateral blood supply to the trachea. No serious postoperative complications were observed. We believe that the total esophagectomy improved the resectability, and that the bulk of the gastric pedicle and the use of the omentum prevented significant postoperative complications associated with an anterior mediastinal tracheostoma.

Histological study of periapical tissue healing in the rat molar after retrofilling with various materials.

We histologically examined the effects on the periapical tissue of various dental filling materials applied as retrofillings in rats and compared them with those of amalgam. The 4-META-TBB resin Superbond and the light-cured composite resin produced the least severe inflammatory reaction, with the greatest amount of new bone. In these specimens, regeneration of a part of the periodontal ligament was also observed. These results indicate that these materials might be very biocompatible and thus foster the natural regeneration of the periapical tissue.

Immunohistochemical examination of the distribution of macrophages and CGRP-immunoreactive nerve fibers in induced rat periapical lesions.

To clarify the role of calcitonin gene-related peptide (CGRP) in the development of periapical lesions, we examined the distribution of CGRP-immunoreactive (IR) nerve fibers and macrophages, and the behavior of bone tissues in experimentally induced rat periapical lesions by immunohistochemical and quantitative methods. Although no extensive changes were observed at 7 days after pulp exposure, CGRP-IR nerve fibers increased in number until 28 days with a decrease thereafter. These neural changes were closely correlated with the alteration in number of macrophages except on day 7 when macrophages were significantly increased in number as compared with control rats. Tissue repair began to take place and a decrease in number of osteoclasts was observed when the density of CGRP-IR nerve fibers reached a peak. These results suggested that there might be a close relationship between macrophages and CGRP-IR nerve fibers and that CGRP-IR nerve fibers might participate in tissue repair in experimentally induced rat periapical lesions.

Interleukin-1 receptor antagonist and interleukin-4 in gingival crevicular fluid of patients with inflammatory periodontal disease.

Interleukin-1 receptor antagonist (IL-1ra) and interleukin-4 (IL-4) were detected in gingival crevicular fluid (GCF) by an immunochemical method. However, we could not detect IL-4 in GCF from severe inflammation sites. In addition, we sought to detect which cells had produced cytokines in moderately inflamed gingival tissues by means of immunohistochemistry. The cell types expressing CD 68 were identified as monocytes/macrophages and stained positively for IL-1ra. The helper T cells identified by immunostaining for CD 4 stained positively for IL-4. These results suggest that IL-4 is one of the mediators regulating the degree of local inflammation in periodontal disease.

[An epidemiologic examination on the prevalence of the periodontal diseases and oral pigmentation in Yusho patients].

An epidemiologic examination was carried out to reveal the prevalence of the periodontal diseases and oral pigmentation in Yusho patients 26 years after PCB exposure. The results obtained were as follows. 1) 158 teeth of the total 284 examined teeth had the periodontal pockets deeper than 3 mm and the lower left first molar showed the highest prevalence of the periodontal pocket among the examined six index teeth. There was no definitive difference not only between sexes but also between age groups. However, 42 teeth had the periodontal pockets deeper than 4 mm. 2) Oral pigmentation was observed in 25 Yusho patients (33.8%). Chronological examination revealed that the prevalence of oral pigmentation seemed to be higher in the patients below the age of 49 than in those beyond the age of 50, but there was no definitive difference between sexes. It was of particular interest that the incidence of oral pigmentation appeared to decrease with decrease of the teeth present in number.

In vivo isomerization of retinoic acids. Rapid isomer exchange and gene expression.

The in vivo isomerization of all-trans- and 9-cis-retinoic acids (RAs) was evaluated by high performance liquid chromatography after oral administration to rats. All-trans (2 ng/ml)- and 13-cis (1.8 ng/ml)-RAs, but not 9-cis-RA, were detected in the serum of normal rats. When an excess of either all-trans-RA or 9-cis-RA (100 micrograms/rat) was intragastrically administered to the retinoid-depleted rats, a rapid isomer exchange between 9-cis- and all-trans-RAs along with appearance of the administered RA occurred shortly after the dose (30 min). RA rapidly isomerized when an excess of either all-trans- or 9-cis-RA (1 mg/rat) was administered to normal rats. To examine whether the isomerized RAs elicit biological actions in vivo, the induction of target genes-[cellular retinol-binding protein type II (CRBP II) for 9-cis-RA and all-trans-retinoic acid receptor beta (RAR beta) for 9-cis- and all-trans-RAs] was determined. The degree of induction of the two genes did not differ 4 h after administration of either 9-cis-RA or all-trans-RA. However, unlike all-trans-RA, the RAR-specific synthetic retinoids did not induce the CRBP II gene. These results suggested that the apparent actions of 9-cis- and all-trans-RAs on gene expression in vivo may be mediated to some extent by the converted stereoisomer.

Immunohistochemical examination on the localization of macrophages and plasma cells in induced rat periapical lesions.

To investigate the role of plasma cells and macrophages in the development of periapical lesions, we immunohistochemically examined the distribution of these inflammatory cells in experimental induced rat periapical lesions after pulpectomy. The number of ED1-positive mononuclear cells increased rapidly, reached a plateau which remained stable between days 10 and 60, and subsequently decreased. Immunoglobulin (Ig)-bearing plasma cells appeared after 60 days, and, of these, IgG-bearing plasma cells were predominant after 90 days. The radiographic and histopathological findings indicated the development of bone destruction at 10 days which continued until 60 days; tissue repair began to take place after 90 days. The results suggested that macrophages had a close relation to bone destruction and that plasma cells might participate in tissue repair rather than the development of periapical lesions.

[A study with diagnostic standard of occult hyperprolactinemia (OHP) and the effect of bromocriptine administration].

It is well known that the transient excessive increase of serum prolactin level is harmful for the mechanism of ovulation or the steroidogenesis of the ovaries. The pathogenesis of latent or occult hyperprolactinemia (OHP) has been investigated recently. The present study was conducted to determine the diagnostic standard of OHP, and to elucidate the efficacy of bromocriptine administration for the treatment of OHP and other ovulatory disturbances. 110 cases of hypothalamic anovulations were selected from 385 cases of infertile patients by the LH-RH and TRH loading tests. Bromocriptine (5mg/day) was administered to all of the subjects for more than three months, and the efficacy of the bromocriptine administration was investigated. Follicular development was observed by transvaginal ultrasonography (mature follicular diameters > or = 20mm), and also luteal function was estimated by the duration of the luteal phase in the BBT charts (high phase > or = 12 days), the mid-luteal serum estradiol (> or = 200pg/ml) and progesterone (> or = 10ng/ml) levels. The subjects were divided into two groups: group A, bromocriptine effective patients (63 cases) and group B, bromocriptine non effective patients (47 cases). The results of the LH-RH and TRH loading tests were compared between these two groups. Serum prolactin levels at 30 min. after TRH loading (PRL30) in group B (61.5 +/- 28.3 vs. 38.0 +/- 19.3ng/ml, p < 0.01). At the cut-off points of 50, 60 and 70ng/ml over in the values of the PRL, the efficacies of the bromocriptine administration were 77.4, 78.9 and 88.5%, respectively. From these facts, it was thought suitable that the diagnostic standard of OHP was PRL30 > or = 70ng/ml, and values of PRL30 from 50 to 70ng/ml were borderline cases of OHP. The efficacy of the bromocriptine administration in the cases without OHP (n = 57) was also investigated. Serum LH levels at 30 min. after LH-RH loading (LH30) were compared between the cases of the bromocriptine effective (n = 22) and non effective (n = 35). As a result, the LH30 of the former was significantly higher than that of the latter (96.5 +/- 64.2 vs. 45.1 +/- 31.5mIU/ml, p < 0.005). In conclusion, the diagnostic standard of OHP was determined as PRL30 > or = 70ng/ml (borderline: 50 > 70ng/ml), and bromocriptine administration was effective not only in cases of OHP, but also in cases of hyperreactivities of LH (so-called endocrinological PCOD).

[Immunohistochemical study on the distribution of CGRP-containing nerve fibers in the PCB poisoned rats with experimental periodontitis].

We have studied immunocytochemically the distribution of CGRP-containing nerve fibers in the PCB poisoned rats introducing experimental periodontitis. The results obtained were as follows. In the PCB poisoned rats, some specimens obtained from periodontitis-affected sites showed a slight increase in both the intensity of nerve staining and the nerve sprouting. However, no discernible difference in the occurrence and the distribution of nerves has been demonstrated between the PCB poisoned rats and clinically healthy rats. Further studies are needed to confirm the effects of PCBs on the initiation and progression of periodontitis.

[Studies on metoclopramide (MCP) loading test during pregnancy and puerperium for the evaluation of lactating capacity].

To evaluate the correlation between prolactin (PRL) secreting capacity and puerperal lactation, 66 women who had delivered normally without any complications during pregnancy were studied. They were divided into two groups depending on the lactating state a month after the delivery: The breast feeding group (group A, 40 cases), and the supplementary feeding group (group B, 26 cases), respectively. 10 mg of metoclopramide (MCP) loading was carried out in the 36th week of gestation and in the third day of the puerperium, and serum levels of PRL (at 0, 30, 60 min. after the MCP loading) were measured by RIA. Serum levels of insulin, glucose, triglyceride, free fatty acid, cholesterol and lipoproteins were also examined. There was no significant change in the serum levels of the various, substances during pregnancy and puerperium. Also, no significant change could be seen in the MCP loading test in the 36th week of gestation. However, on the third day of puerperium, serum PRL after 30 min. of the MCP loading showed a significant increase in group B compared with group A (587.1 +/- 202.9 vs. 431.2 +/- 196.6 ng/ml, p less than 0.02, mean +/- standard deviation). These results suggested that the MCP loading test during the early stage of puerperium might be an important index to use in determining whether the mother was ready to breast feed.

[Comprehensive approach to clinical background and effect of bromocriptine administration in patients with endocrinological polycystic ovarian disease].

Present study was performed to elucidate the clinical features and the treatment of so-called endocrinological polycystic ovarian disease (PCO). 36 cases out of 189 infertile patients who had various ovulatory disturbances were subjected during past four years. They were selected by the definitions as follows; 1) serum LH levels greater than or equal to 30 mIU/ml and serum FSH levels less than or equal to 15 mIU/ml, 2) hyper-response of LH secretion by LH-RH (100 micrograms) loading test; maximum values greater than or equal to 250 mIU/ml. Serum androstenedione (ASD), dehydroepiandrosterone-sulfate (DHA-S), estrone (E1), estradiol (E2), progesterone (P, in the mid-luteal phase) and testosterone (T) levels were examined by RIA method for the purpose of the evaluation of the endocrinological background of the PCO in Japanese women. The same examinations were also done in 8 volunteer women who had normal ovulatory menstrual cycles for the control study. In 6 cases of the PCO patients who showed biphasic BBT charts, the endometrial biopsy was done in the mid-luteal phase at the same time of the blood sampling. And the correlation between various serum hormone levels and the endometrial morphology in the PCO patients was also discussed. Then bromocriptine (5 mg/day) was administered in these patients for more than 30 days and the effect of the treatment was investigated. Serum ASD levels in the PCO patients were significantly higher than those in the control (2.52 +/- 1.30 vs. 1.43 +/- 1.21 ng/ml, M +/- S.D., p less than 0.05), while serum E2 and P levels in the patients were significantly lower than those in the control (E2: 118.6 +/- 39.5 vs. 192.5 +/- 53.9 pg/ml, p less than 0.005. P: 7.26 +/- 5.08 vs. 124.4 +/- 4.6 ng/ml, p less than 0.005, respectively). There were no significant differences in serum levels of the other hormones. By the administration of bromocriptine, serum ASD levels decreased (1.62 +/- 1.34 ng/ml, p less than 0.05), and E2 (177.9 +/- 48.6 pg/ml, p less than 0.025) and P (11.8 +/- 4.3 ng/ml, p less than 0.005) levels increased significantly into the levels of control. Serum LH levels of the patients were also suppressed by the treatment of bromocriptine (42.5 +/- 13.7 vs. 27.4 +/- 12.0 mIU/ml, p less than 0.005), however there was no change in serum FSH levels.(ABSTRACT TRUNCATED AT 400 WORDS)

[Histological study on the gingiva in PenCB poisoned beagle dogs].

We examined toxic effect of PenCB and therapeutic effect of squalane on the gingiva in PenCB poisoned beagle dogs. The results obtained were as follows. 1) PenCB exerted blood level-dependent changes of epithelial cells in which appearance of intracellular vacuoles and swollen mitochondria were observed. 2) Large vacuoles might be caused by degeneration of nerve ending were observed within the supra-basal layers. 3) We could not detect the definitive improvement in the gingiva of the PenCB poisoned beagle dogs followed administration of squalane.

[A study on pathogenesis and treatment of normoprolactinemic galactorrhea syndrome].

To investigate the pathogenesis of the normoprolactinemic galactorrhea syndrome, the response of prolactin secretion to TRH administration and the circadian profile of serum prolactin levels were examined in 13 women with galactorrhea whose resting levels of serum prolactin were lower than 25 ng/ml. Bromocriptine (5mg/day) was administered for 30 days and the mid-luteal serum estradiol and progesterone levels, as indicators of luteal function, were also measured before and after the administration. The basal levels of serum prolactin in these patients were significantly higher than those of the control (p less than 0.05), and the response of prolactin secretion also increased significantly at 30, 60, 90 and 120 min. after TRH administration compared to those of the control (p less than 0.005). The circadian profile of serum prolactin showed significantly higher levels from 22 to 8 o'clock compared to the control (p less than 0.05 approximately 0.005). And serum prolactin levels of these patients were higher than 25 ng/ml during the nocturnal period. When bromocriptine was administered, serum prolactin levels of these patients dropped conspicuously, and the nocturnal surges of prolactin also suppressed. Serum estradiol and progesterone levels in the mid-luteal phase normalized apparently due to the administration of bromocriptine (p less than 0.005, p less than 0.005), and galactorrhea also disappeared. These facts suggested that the normoprolactinemic galactorrhea syndrome might be caused by transient occulted hyperprolactinemia, and the treatment with bromocriptine was useful not only in suppressing galactorrhea but also in improving the luteal function in these patients.

Intubation for the membranous laryngotracheobronchitis.

A 49-year-old housewife with membranous laryngotracheobronchitis (the membranous croup) was referred to our clinic because of difficulty in breathing. Instant intubation in the emergency room did not relieve her breathing trouble, thus, following emergency tracheostomy accompanied by irrigation with mucolytic agents and antibiotics proved effective. Preceding intratracheal intubation made the patient suffocate because it induced membranous debris to detach and become lodged in the tracheal wall. In addition, dryness seemed to worsen her respiratory distress, thus high humidification was felt to be instrumental in relieving her symptoms. No pathological bacteria were found in specimens detached from the tracheal wall.

Experimental study of the mechanism of the decrease in endocochlear d.c. potential after administration of nitrogen mustard-N-oxide.

20 mg/kg of body weight of nitrogen mustard-N-oxide hydrochloride ( NMNO ) causes a transient decrease in the magnitude of the endocochlear d.c. potential (EP) in the same manner as does nitrogen mustard (NM). NMNO does not, however, change the electrical resistance of the cochlear partition. When the administered dose of NMNO is increased to 40, 60 and 80 mg/kg body weight, a corresponding diminution in the EP is not observed. No ultrastructural changes in the stria vascularis are observed, even in animals administered 80 mg/kg body weight. The reduction of the EP with NMNO could not be attributed to a loss of the electrical insulator effect of the cochlear partition, or to a functional derangement of the stria vascularis. In the experimental animals whose organ of Corti was already destroyed with kanamycin sulfate (KM), NMNO did not reduce the magnitude of the EP. The organ of Corti may be central in understanding the mechanism of NMNO -induced reduction of the EP.

[Clinical effect of cefotiam on otorhinolaryngologic infections].

The clinical effectiveness and safety of cefotiam (CTM) in infectious diseases in the field of otorhinolaryngology was evaluated from 30 patients (otitis media 18, pharyngeal infection 4, chronic paranasal sinusitis 1, esophagitis 1, acute bronchitis 1, others 4). Side effect (fever, nausea) was found in a 14 years old male patient. Skin test revealed positive in 1 patient. These cases were excepted from evaluating clinical effectiveness of CTM. In 28 patients, the overall ratio of clinical effectiveness was 60.7%. In patients of otitis media, the clinical effectiveness ratio was 41.2%, whereas the ratio was 75.0--100% in patients of other diseases. In particular, the clinical effect was fair or poor in patients to whom the drug was given only once a day. These results suggest that this chemotherapeutic drug should be administered at least twice a day, particularly to the patients of otitis media. The bacteriological response to CTM was evaluated from 53 strains, isolated from 28 patients before treatment. Eradication rate of bacteria was 60.4%. No abnormal laboratory findings, relating to the drug, were observed after treatment.

[Clinical study of cefsulodin on Pseudomonas aeruginosa infections in otorhinolaryngology].

The clinical effect of cefsulodin (CFS) on Pseudomonas aeruginosa infections in otorhinolaryngology was studied in 10 patients. The overall clinical effectiveness was 80% (excellent 2, good 6, poor 2). Eradication rates of P. aeruginosa was 60%. No side effect and positive skin test were found in any cases. Examination of laboratory data before and after the administration revealed no abnormal findings in every cases.