Double congenital bronchoesophageal fistulae in an adult

We report adult congenital bronchoesophageal fistula with both symptomatic fistula and asymptomatic one. A 56-year-old woman with a history of cough after drinking fluids was diagnosed as bronchoesophageal fistula by upper gastrointestinal series that showed a diverticulum in the middle portion of the esophagus with a fistula between the esophagus and right lower lung. Esophagoscopy revealed an orifice of the fistula located 27 cm from the incisors. Computed tomography showed chronic inflammatory change with bronchiectasis in the S6 segment of the right lung. The patient underwent video assisted thoracic surgery that identified two fistulae without missing a symptomatic one, and both were successfully resected. The fistulae were lined by squamous epithelium and smooth muscle without evidence of malignancy, infection or chronic inflammation that were histologically compatible with congenital fistulae.     

Effects of the Implant Design on Peri‐Implant Bone Stress and Abutment Micromovement: Three‐Dimensional Finite Element Analysis of Original Computer‐Aided Design Models

Background: Occlusal overloading causes peri‐implant bone resorption. Previous studies examined stress distribution in alveolar bone around commercial implants using three‐dimensional (3D) finite element analysis. However, the commercial implants contained some different designs. The purpose of this study is to reveal the effect of the target design on peri‐implant bone stress and abutment micromovement. Methods: Six 3D implant models were created for different implant–abutment joints: 1) internal joint model (IM); 2) external joint model (EM); 3) straight abutment (SA) shape; 4) tapered abutment (TA) shapes; 5) platform switching (PS) in the IM; and 6) modified TA neck design (reverse conical neck [RN]). A static load of 100 N was applied to the basal ridge surface of the abutment at a 45‐degree oblique angle to the long axis of the implant. Both stress distribution in peri‐implant bone and abutment micromovement in the SA and TA models were analyzed. Results: Compressive stress concentrated on labial cortical bone and tensile stress on the palatal side in the EM and on the labial side in the IM. There was no difference in maximum principal stress distribution for SA and TA models. Tensile stress concentration was not apparent on labial cortical bone in the PS model (versus IM). Maximum principal stress concentrated more on peri‐implant bone in the RN than in the TA model. The TA model exhibited less abutment micromovement than the SA model. Conclusion: This study reveals the effects of the design of specific components on peri‐implant bone stress and abutment displacement after implant‐supported single restoration in the anterior maxilla.     

Effect of endodontic irrigation on bonding of resin cement to radicular dentin

The influence of endodontic irrigation on shear bond strengths of resin cement to radicular dentin was investigated. Human radicular dentin blocks were divided into four groups and subjected to one of four endodontic irrigations: ethylenediaminetetraacetic acid (EDTA) group, 17% EDTA for 60 s; EDTA/sodium hypochlorite (NaOCl) group, 17% EDTA for 60 s followed by 10 ml of 5% NaOCl for 15 s; NaOCl group, 10 ml of 5% NaOCl for 15 s; and control group, no treatment. Morphological changes of dentin surface after endodontic irrigation were observed by scanning electron microscopy (SEM). A resin block was bonded to the radicular dentin after irrigation using resin cement with either wet-bonding (Uni-Etch/One-Step; Bisco) or self-etching (Tyrian SPE/One-Step Plus; Bisco) adhesives. Shear bond strengths were measured and the penetration of resin tags into dentinal tubules at resin-dentin interface was observed by SEM. With the wet-bonding system, the shear bond strengths for the EDTA/NaOCl group, in which dentinal tubules openings and uniform resin tag penetration into dentinal tubules were observed, were significantly higher than the EDTA and control groups. With the self-etching system, the shear bond strengths were significantly lower in the EDTA group compared with the NaOCl and control groups. The effects of endodontic irrigation on the bonding of resin cement to radicular dentin depended on the dentin bonding system used.     

Application of metallic stents for both inferior vena cava and biliary obstruction by lymph node involvement in a patient with recurrent hepatocellular carcinoma

The authors experienced a case with obstruction of the inferior vena cava (IVC) and the common bile duct due to a recurrent hepatocellular carcinoma. In order to improve severe edema of the lower extremities and obstructive jaundice, IVC metallic stent as well as biliary stent were applied. A Luminexx stent of 8 cm in length was placed in the bile duct via subcutaneous route after biliary drainage. A spiral zigzag stent of 8 cm in length was also inserted into the IVC through the femoral vein following balloon dilatation of the obstructed portion. Subsequently, jaundice and edema were dramatically improved in a short period of time, which resulted in patient discharge from the hospital. Although the patient died of the cancer in 2 months, the quality of life was well maintained until death.     

Successful treatment of postoperative multiple hepatic recurrence with hepatic arterial infusion of cisplatin and degrable starch microspheres

A 38-year-old man had multiple recurrence of hepatocellular carcinoma (HCC) with portal vein thrombosis after hepatectomy and postoperative transcatheter arterial chemotherapy with 5-fluorouracil (5-FU). He was treated by trans hepatic arterial embolization (TAE) with 100 mg of cisplatin (CDDP) and degrable starch microspheres (DSM). After 3 courses were administered, the recurrent lesions almost disappeared on CT, and the postoperative rise in PIVKA-II level and AFP level normalized. There were no side effects except slight fever and general fatigue. We recognized a partial response, and the patient is still alive 14 months after hepatectomy. This case suggests that TAE with CDDP and DSM might be useful for prolonging the survival of advanced HCC patients.     

Potential of Reduction in Total Tumor Volume Measured with 3D‐MRI as a Prognostic Factor for Locally‐Advanced Breast Cancer Patients Treated with Primary Chemotherapy

Abstract: For accurate assessment of the response to primary chemotherapy (PCT) for locally advanced breast cancer, we measured reduction in total tumor volume (TTV) by using three‐dimensional magnetic resonance imaging (3D MRI), and examined the relationship between this reduction and patient prognosis. Fifty‐one patients with locally advanced breast cancer were treated with four cycles of docetaxel (60 mg/m²) before surgery. Tumor size was measured with calipers, ultrasonography (US) and conventional two‐dimensional (2D) MRI before and after chemotherapy. TTV was measured with 3D MRI. These and other clinicopathological parameters were statistically analyzed to determine the prognosis for the patients. Median follow‐up time was 46 months (1–64 months). Of the 51 patients, 25 developed distant recurrences. Patients whose TTV decreased by 75% or more after PCT showed significantly better prognosis than others, while tumor size measured with calipers, US and 2D MRI showed no significant relationship with patient prognosis. Of the clinicopathological parameters, only reduction in TTV and histological grade showed a significant association with distant recurrence‐free survival (p = 0.03 and 0.02, log‐rank test), while stepwise multivariate Cox’s proportional hazards analysis identified TTV as the strongest independent prognostic factor. Reduction in TTV measured with 3D MRI can be a useful prognostic factor for patients with locally advanced breast cancer treated with PCT.     

Effects of erbium:yttrium–aluminum–garnet and neodymium:yttrium–aluminum–garnet laser hypersensitivity treatment parameters on the bond strength of self-etch adhesives

This in vitro study evaluated the shear bond strength (SBS) of two self-etch adhesives to coronal and root dentin treated with erbium:yttrium–aluminum–garnet (Er:YAG) or neodymium:yttrium–aluminum–garnet (Nd:YAG) lasers for dentin hypersensitivity. The coronal and root dentin surfaces of 60 extracted human cuspids were divided into three groups (n = 20): (1) control (without treatment); (2) treated with Er:YAG; (3) treated with Nd:YAG laser and a one-step (S3) or two-step self-etch adhesive (SE). A nano-composite was applied and SBS tests were performed. The mean SBS values were calculated, failure modes were determined, and data were subjected to statistical analysis (P = 0.05). Control/SE exhibited higher values than did control/S3 and Nd:YAG/S3 on coronal dentin (P < 0.05). No significant differences were observed between the SE and S3 groups in root dentin (P > 0.05). Comparisons of two dentin substrates did not show any difference except control/SE (P < 0.05). The failure modes were mainly adhesive. The SBSs of self-etch adhesives to Er:YAG or Nd:YAG laser-treated surfaces were comparable with control for both coronal and root dentin.     

A facile approach to 2-alkoxyindolin-3-one and its application to the synthesis of N-benzyl matemone

2-Alkoxycarbonylindolin-3-one is synthesized from a methoxyglycine derivative via a 1,2-aza-Brook rearrangement followed by cyclization with bis(trimethylsilyl)aluminum chloride. A short-step synthesis of N-benzyl matemone is successfully carried out using the present indolin-3-one synthesis.

A short-step synthesis of N-benzyl matemone has been successfully carried out using a newly discovered 2-ethoxycarbonylindolin-3-one synthesis.     

Etiological considerations of the loose shoulder from a biochemical point of view--biochemical studies on collagen from deltoid and pectoral muscles and skin]

In order to elucidate the etiology of the loose shoulder, biochemical characteristics of deltoid and major pectoral muscles and skin collagen from patients with loose shoulder have been investigated. Amounts of soluble collagen, reducible cross-links of collagen and their precursors in both muscles and skin from the loose shoulder were found to be higher than those in the control. These data suggest that soft tissues, especially deltoid muscles, of patients with loose shoulder contain relatively immature collagen fibers compared with normal shoulders. In re-operation cases of the loose shoulder, the collagen fibers in skin were more immature, which may reflect the clinical features of the disease.