Accessory joints between basiocciput and atlas/axis in the median plane.

To explore the many osseous irregularities that are found in the area between the basiocciput, the anterior arch of the atlas and the tip of the dens axis we studied 99 cadaver specimens using magnetic resonance tomography (MRT), computed tomography (CT), median saw-cut sections, and histological sections. Additionally, "dry" specimens of the skull (n = 110), atlas (n = 56), and axis (n = 33) were investigated. In the median plane, the dry and cadaver specimens exhibited osteoarthritis-related osseous outgrowths and osteophytes of the articular surfaces of the median atlanto-axial joint (n = 63), and the presence of congenitally developed free ossicles (n = 22) and of third occipital condyles (n = 3). The largest osteophytes (giant osteophytes) (n = 4) of the anterior arch of the atlas formed osseous contact zones with the basiocciput that were visible histologically as real joints and were designated accessory median atlanto-occipital joints. The third occipital condyles also formed osseous contact zones, visible histologically as real joints, with the anterior arch of the atlas or with the tip of the dens, and were designated accessory atlanto-occipital or occipito-odontoid joints. Frequent free ossicles, incorporated into the accessory joint, were found by histological examination to be covered with hyaline cartilage.

Computed tomography of odontogenic myxoma.

OBJECTIVES: The purpose of this study was to clarify the CT features of odontogenic myxoma. METHODS: CT appearances were analysed in 17 patients with histologically verified odontogenic myxoma collected from five dental hospitals in Japan. RESULTS: On the CT images, tumour borders were generally well defined with a smooth margin both for bony and soft tissue structures in all patients. Cortical status was clearly evaluated using CT and the continuity was interrupted in nine patients. Intralesional trabeculations were observed in 13 patients. Of these 13, 6 patients showed the characteristic appearance of angular or straight trabeculations within the tumour. The trabeculations were frequently observed at the peripheral portion of the tumour. In three maxillary tumours, soft tissue margins were observed beyond the cortical margin and/or intralesional trabeculations. In 10 of the 13 lesions evaluated, the majority of the whole tumour area showed relatively lower density compared with surrounding muscles. CONCLUSION: CT clearly demonstrated characteristic features of odontogenic myxoma. CT analysis may contribute to establishing a consensus regarding the interpretation of conventional radiographic appearances in odontogenic myxoma.

Construction of an efficient expression vector for coupled transcription/translation in a wheat germ cell-free system.

Using the expression vector, pEU, which we have constructed, highly efficient in vitro protein synthesis can be achieved: The system works for 150 hours and without further template addition once the reaction has started, yielding 5 mg of enzymatically active protein in a 1 ml reaction.

Autoradiographic evaluation of 99mTc-methylene diphosphonate accumulation in oral cancer invading the mandible.

PURPOSE: Skeletal scintigraphy, a sensitive diagnostic tool used to detect changes in bone, is helpful for evaluating bone invasion by oral cancer. However, the exact sites of accumulation of 99mTc-phosphate compounds in the mandible have not yet been fully elucidated. The aim of this study was to determine the localization of 99mTc-methylene diphosphonate (MDP) in the areas of mandible that have been invaded by cancer. PATIENTS AND METHODS: Seven patients with oral cancer (lower gingiva, 4; tongue, 2; floor of the mouth, 1) who underwent surgical treatment with mandibular bone resection were included in the study. Autoradiography and contact macroradiography were used for evaluation of 99mTc-MDP accumulation. RESULTS: Radioactivity reflecting accumulation of 99mTc-MDP was documented encircling the portion of the mandible with cancerous invasion, suggesting that 99mTc-MDP accumulated in immature bone. High uptake also was found in the periosteal reactive bone around the cortical bone. CONCLUSIONS: The amount of increased 99mTc-MDP circumscribing carcinoma invasion varies among cases. Additionally, uptake may not correspond directly with the amount of the carcinoma invasion; that seen in periosteal bone could be attributed mistakenly to bone invasion in planar scintigraphy.

Protein-losing enteropathy due to thrombophlebitis of the mesenteric vein: report of a case.

We report herein the case of a 70-year-old woman with enteropathy accompanied by protein loss, the cause of which was found to be thrombophlebitis of the mesenteric vein. The patient was admitted to our hospital for investigations to determine the cause of hypoproteinemia. She had suffered an episode of left abdominal pain with high fever and vomiting lasting 10 days, 8 months prior to her admission. She also had a 6-year history of uncontrolled diabetes. The alpha1-antitrypsin clearance was 85.7 ml/day, suggesting protein-losing enteropathy. A scintigraphy with 99m-technetium-human serum albumin disclosed protein leakage into the intestine. X-Rays and computed tomography showed a stenotic and thickened area of small intestine 50 cm in length. Thus, a laparotomy was performed to resect this part of the intestine which was found to have undergone past thrombophlebitic changes. Following the operation, the alpha1-antitrypsin clearance decreased to within the normal range and the patient gained 5 kg in weight.

An experimental study of new diagnostic methods for the examination of osseous lesions in the temporomandibular joint.

Digital subtraction radiography, tomosynthesis, bone uptake of radionuclide, and arthroscopy were evaluated for detection and quantification of bony lesions induced unilaterally in the condyles of six dogs. A stereotaxic head-holder facilitated acquisition of reproducible radiographs suitable for subtraction and for circular tomosynthesis. Bone uptake of technetium-99m methylene diphosphonate was measured with a hand-held collimated miniature detector. Arthroscopy was performed with an arthroscope of 2.4 mm diameter. Bone defect mass determined by subtraction radiography correlated highly (r = 0.92, p less than 0.001) with the calcium content of removed bone measured by atomic spectroscopy. Both subtraction radiography and tomosynthesis indicated reshaping of the condyle into a more anterior position over a 10-week follow-up period. Radionuclide uptake was significantly elevated (p less than 0.04) from 2 to 10 weeks after surgery and correlated (r = 0.73, p less than 0.05) with regained bone mass measured by subtraction radiography. Arthroscopy revealed progressive degeneration of cartilage with denudation in the fossa. Both radiographic techniques demonstrated the lesions and bone remodeling, but only subtraction provided quantitative results. Radionuclide uptake predicted quantitatively future bone mass changes, and arthroscopy revealed cartilage and soft tissue status not otherwise observable.

Magnetic resonance imaging of canine salivary glands after ductal ligation and stimulation by pilocarpine.

We performed magnetic resonance imaging in six dogs after submandibular ductal ligation on one side, followed by secretory stimulation with intraperitoneal injection of pilocarpine (5 mg/kg). On the images obtained after ductal ligation but before stimulation, there was no significant change in signal intensity on either side. After injection of pilocarpine the signal intensity of the ligated gland increased significantly (p less than 0.01) in T2-weighted images and nonsignificantly in inversion recovery images, and remained constant in T1-weighted images. Significant (p less than 0.01) volume increases of the glands after ligation and stimulation were measured for the T1, T2, and inversion recovery protocols. These findings likely reflect the retention of saliva caused by pilocarpine stimulation and the absence of drainage through the obstructed duct. The results indicate that the T2-weighted images obtained after pilocarpine stimulation may be useful for studying patients with disturbance of major salivary gland function and may provide an objective basis for the noninvasive diagnosis of unilateral stenosis.

Assessment of bone remodeling in the temporomandibular joint by serial uptake measurement of technetium 99m-labeled methylene diphosphonate with a cadmium telluride probe.

Regional uptake of technetium 99m-labeled methylene diphosphonate was measured serially over time to follow the healing course of surgically generated lesions, induced unilaterally in the condyles of beagles. A small portable cadmium telluride probe was used for radiation detection, with and without a gold collimator attached. Radioactivity was measured at six periarticular sites on both the operated and the contralateral control sides and expressed as a ratio with respect to a reference site over the sagittal suture. The use of a collimator was crucial to separate the activity associated with bone mineralization in the condylar head from that arising in the adjoining bones. The uptake in the condylar region increased 2 weeks after surgery and remained at a constant level above the presurgery baseline (p less than 0.05) until termination of the study (10 weeks). Postmortem histologic examinations confirmed the high bone turnover level by revealing newly formed bone as well as the presence of osteoclasts. The time course of nuclide uptake in the temporomandibular joint is different from the general pattern of rise and fall of activity displayed in other bones and indicates the persistence of bone remodeling processes during a prolonged period of at least 10 weeks.

Studies on focal alveolar bone healing with technetium (Tc)-99m labeled methylene diphosphonate and gold-collimated cadmium telluride probe.

The benefit of using a collimator for a miniaturized cadmium telluride probe was evaluated by monitoring the bone-healing processes for 13 weeks after the induction of small iatrogenic alveolar bone lesions in one side of the mandible in beagles. Technetium (Tc)-99m labeled methylene diphosphonate (200 to 300 MBq, 5.1 to 8.1 mCi, in a solution of 0.5 to 1 ml, intravenously) was used as a bone-seeking radiopharmaceutical. The radioactivity over the bone lesion (L) and the contralateral normal site (C) in the mandible were measured between 1.5 and 2 hours after injection of the tracer, and the activity ratio L/C served as an index of relative bone uptake. A study of six dogs revealed that the healing response to a hemispheric bone defect of 2 mm diameter in the cortical bone could not be detected by an uncollimated probe, and in a repeated study in two dogs the use of a gold collimator (5 mm in diameter, 5 mm in length) did not increase the L/C ratio significantly. A second study in six dogs with 5 mm lesions showed that although systematic trends in the time courses of the L/C ratio obtained both with and without the collimator could be demonstrated, the L/C ratio of collimated versus uncollimated measurements was significantly (p less than 0.005) increased. In three of the latter six dogs, abscesses developed after 9 weeks, leading to a second increase (p less than 0.05) of the L/C ratio with collimation compared with the noninflammation group; without collimation no significant (p greater than 0.15) difference between the two groups could be demonstrated.(ABSTRACT TRUNCATED AT 250 WORDS)

[Clinicopathological study on multiple primary malignant neoplasms, related to the oral-maxillofacial region].

The present study consists of a clinical and histopathological analysis of those cases which were diagnosed as multiple primary malignant neoplasms of the oral-maxillofacial region and the other organs. 9 patients of those multiple primary malignant neoplasms out of 261 patients of malignant neoplasms in the oral-maxillofacial region, who visited in out department from 1975 to 1986, were detected. 3.4% of the incidence rate was calculated. All the cases were male, and these included each 1 case of triple and quadruple. 7 cases were detected prior in the oral-maxillofacial region to the other organs. There seemed to be a preponderance to early detection of a neoplasm in the oral-maxillofacial region. Therefore, the possibility of multiple primary malignant neoplasms should be kept in mind in the routine clinical activities. 2 cases were synchronous, 6 months or less interval between the first and the second neoplasms, the others were metachronous, averaged 5-year interval. The primary sites in the oral-maxillofacial region were tongue (3 cases), floor of the mouth (2), buccal mucosa (2), lower gingiva (1), maxillary sinus (1), all of them were diagnosed as squamous cell carcinomas, histopathologically. The other organs were esophagus (3 cases), stomach (2), colon (2), lung (2), liver (1), urinary bladder (1), hypopharynx (1). Histopathological diagnoses of them were squamous cell carcinomas (3 cases of esophagus, each 1 case of lung, urinary bladder, and hypopharynx), adenocarcinomas (2 cases of stomach and colon, and 1 case of lung), and a hepatoma. It's necessary to differentiate the multiple primary malignant neoplasms from metastases when each of them were diagnosed as squamous cell carcinomas.(ABSTRACT TRUNCATED AT 250 WORDS)

[Clinico-statistical study of medical complication in dental patients].

Eight hundred and fifty two cases, who were introduced from the Dental Hospital to Department of Internal medicine, Medical Hospital at Niigata, The Nippon Dental University, were examined for medical complications. About one hundred and fifty cases were introduced per year from the Dental Hospital, which consisted of about 15% of the total outpatients in the Department of Internal medicine. The age distribution showed a high incidence of patients in their 50's. The number of patients over 60 years old was 220 (25.8%), and the number of patients over 65 years old was 160 (18.8%). There was then a high percentage of elder patients. The reason for the initial medical examinations was the need for a pre-operative medical examination in 42.6% of the total cases. Concerning medical complications among the patients, the highest incidence was hypertension in 116 cases (13.6%); the second highest was hepato-biliary and pancreatic diseases in 114 cases (13.4%); and heart diseases in 81 cases (9.5%). Eighteen cases of HBs antigen positive (2.1%) were seen among the patients with liver diseases. Among those with blood diseases, anemia showed the highest incidence, and a small number had leukemia and hemophilia. Diabetes mellitus showed up in 39 cases (4.6%), most of them being more than 40 years of age. Mentally and physically handicapped patients accounted for 30 cases. Half of them were from the pre-operative examination area, like tooth extraction.

[Clinical significance of serum acid soluble glycoproteins (ASP) and immunosuppressive acidic protein (IAP) in inflammatory diseases and liver diseases].

In order to study the clinical significance of ASP and IAP, we have measured serum concentration of ASP and IAP in 259 patients with inflammatory diseases, non-inflammatory diseases, autoimmune diseases and liver diseases. Significantly higher correlation (coefficient of correlation = 0.922) was found between ASP and IAP. There were good correlation between ASP, IAP levels and erythrocyte sedimentation rate (ESR), C-reactive protein (CRP). Coefficient of correlation were 0.705 and 0.673 between ESR and ASP, IAP; 0.621 and 0.623 between CRP and ASP,IAP, respectively. There were food correlations between ASP levels and thrombo test (TT) and hepaplastin test (HPT). The positive rate and mean concentration of ASP, IAP in patients with inflammatory diseases were significantly higher than noninflammatory diseases. It is suggested that serum ASP, IAP could be one of the useful indicator for evaluating the clinical course of patients with inflammatory diseases. Serum concentration of ASP, IAP in patients with chronic liver diseases were lower than normal subjects, especially serum levels in patients with decompensated liver cirrhosis and chronic hepatitis (active) were significantly lower than normal subjects. In patients with hepatoma with cirrhosis, serum levels of ASP, IAP were significantly lower than the hepatoma patients without cirrhosis. The determination of ASP, IAP in liver diseases seems to be useful for evaluating the severity of diseases, the effects of therapy and the forecast of prognosis.

[Study on renal osteodystrophy using 2-compartment model analysis of bone scintigraphy. 1. Clinical significance of K Index].

The dynamic analyses of bone scintigraphy were performed in 30 cases of hemodialysed patients. The regression analyses between biochemical data or duration and K indexes obtained from the 2-compartment model analysis in the maxillofacial region were carried out. The obtained results were as follows. 1) The duration and K indexes were significantly correlated with 1 or 2% of significance level in the parietal bone and the zygomatic bone. 2) Serum Ca and K indexes were highly correlated in every settled ROI. The correlation coefficients were distributed from 0.58 to 0.79. In the cranial bone the correlation were more higher than in maxilla and mandibular bone. 3) Serum ALP and K indexes have more higher significant level of correlation than the results of Ca. The correlation coefficients were distributed from 0.48 to 0.83. The level of significance were changed by location. The highest correlation coefficient was 0.83 in the parietal bone. 4) Serum c-PTH and K indexes have significant correlation in every settled ROI with the correlation coefficient from 0.59 to 0.69. The significance level were nearly equal in every location. 5) In the case of subtotal parathyroidoectomy the K indexes which were abnormally high in preoperation showed the tendancy to decrease toward normal range in postoperation. These results indicated that K indexes reflected the bone change caused by renal osteodystrophy. And the K indexes considered to be usefull to estimate the bone improvement.

[Clinical evaluation of serum immunosuppressive acidic protein (IAP) and acid soluble glycoproteins (ASP) in patients with malignant tumors].

In order to study the clinical significance of IAP and ASP, we have measured serum concentration of IAP and ASP in patients with different cancer types including digestive organs, head and neck. Significantly higher correlation (coefficient of correlation = 0.924) was found between IAP and ASP. IAP and ASP levels were elevated in about 60-80% of cancer from digestive organs except hepatocellular carcinoma, and in about 56-100% of head and neck tumor. There was no correlation between IAP, ASP and various tumor markers (CEA, CA19-9, AFP) in all malignancies except pancreatic cancer. There was positive correlation between CEA and IAP, ASP in pancreatic cancer. IAP and ASP levels were significantly higher in patients with cancer having evidence of disease than the patients with cancer who had no evidence of disease, and so the determination of IAP and ASP was clinically useful for the diagnosis of tumor existence. At the time of diagnosis of recurrence, the levels of IAP and ASP were elevated in about 70% of patients with cancer recurrence. There was a definite relation between IAP, ASP and the gastric cancer stage. In later state (stage III and IV), serum IAP and ASP levels were significantly higher than the levels of stage I and II. In hepatocellular carcinoma without liver cirrhosis, the levels of IAP and ASP were higher than the patients with cirrhosis. The determination of IAP and ASP seems to be useful for monitoring clinical course, judgement of therapeutic effects.