SALVAGE THERAPY IN PATIENTS WITH UNRESECTABLE HILAR CHOLANGIOCARCINOMA

We describe our methods and outcomes of multidisciplinary treatments in patients with unresectable hilar cholangiocarcinoma. Fifty‐seven patients with a known outcome were enrolled. Thirty‐four of 57 patients were treated and evaluated by salvage therapy. For salvage therapy, we used internal and external radiotherapy, photodynamic therapy, YAG laser therapy and microwave coagulation therapy. The median survival time was 548 days for the group receiving salvage therapy and 198 days for the group not receiving this treatment. In conclusion, although no randomization of the patients was performed in this retrospective study, our present data provide convincing evidence that salvage therapy is a useful therapeutic approach for unresectable hilar cholangiocarcinomas.     

Acquired Dermal Melanocytosis on the Wrist

A 50-year-old Japanese man had a blue-black patch on the dorsum of his right wrist. Light and electron microscopic study of the lesion revealed dermal melanocytes containing mature melanosomes, predominantly in the upper dermis. This case was diagnosed as acquired dermal melanocytosis confined to the right wrist.     

Natural course of nonreducing disc displacement of the temporomandibular joint: changes in chewing movement and masticatory efficiency.

PURPOSE: The purpose of this study was to examine changes of chewing movement and masticatory efficiency during the natural course of nonreducing disc displacement of the temporomandibular joint (TMJ). PATIENTS AND METHODS: The subjects were 15 patients who had been diagnosed with nonreducing disc displacement of the TMJ but had received no treatment. Chewing movement and masticatory efficiency were examined at the initial visit and at a mean follow-up of 21.7 months, using mandibular kinesiography and adenosine triphosphate ebteric-coated granules. As a control, 23 persons who had no current or previous TMJ symptoms were studied. RESULTS: The patients' clinical signs and symptoms tended to be alleviated during the follow-up period. In normal controls, chewing movement showed lateral excursion to the chewing side on both the right and left sides. In patients, chewing movement at the initial visit showed lateral excursion to the chewing side during chewing on the TMJ affected side, but no such deviation was noted during chewing on the TMJ unaffected side in the horizontal plane. However, chewing movement at follow-up became similar to that of controls. In patients, masticatory efficiency became better during the natural course, although that at follow-up did not always reach the control's level. CONCLUSION: In untreated patients with nonreducing disc displacement of the TMJ, chewing movement and masticatory efficiency tend to improve spontaneously.     

Influences of angiogenesis and lymphangiogenesis on cancerous invasion in experimentally induced tongue carcinoma

BACKGROUND: Although it is clear that dissemination via the blood system involves angiogenesis, it is uncertain whether tumors also induce lymphangiogenesis or simply invade existing peritumoral vessels. The purpose of this study was to elucidate changes in tumor blood and lymph vessels in cases involving the invasion of squamous cell carcinoma in the oral cavity, and its significance. Blood and lymph vessels densities in tongue carcinomas induced in hamsters were investigated. METHODS: Tongue cancer was induced by abrading the right margin of the tongue of each hamster with an endodontic barbed broach and subsequently applying 1.0% 9,10-dimenthl-1,2-benzanthracene (DMBA) dissolved in acetone, three times a week, at the same site. Fresh frozen sections were prepared and blood vessels stained blue by perfusion with Coomassie Brilliant Blue and lymph vessels stained brown for 5'-nucleotidase. The effects on the blood vessels and lymph vessels were observed. RESULTS: The results showed that blood and lymph vessel densities were greater in the advanced carcinoma tissues than in normal tissue. These were compared in terms of the mode of cancer invasion. As tumor invasion progressed, the blood vessel density decreased but lymph vessel density tended to be higher in high-degree tumor invasion than in low-degree tumor invasion. The expression of vascular endothelial growth factor-C was seen more frequently as tumor invasion progressed. CONCLUSIONS: The present findings indicated that angiogenesis and lymphangiogenesis are affected by cancerous invasion.     

Clinical evaluation of a potassium nitrate dentifrice for the treatment of dentinal hypersensitivity

Abstract The effectiveness of a 5% potassium nitrate dentifrice as a daily home treatment for dentinal hypersensitivity was evaluated in a double-blind study in 36 Japanese subjects who complained of cold and/or tactile hypersensitivity. The subjects were divided into 2 groups, with 18 being given a 5% potassium nitrate dentifrice (treated group) and the other 18 a vehicle paste (control group). Both groups were instructed to brush their teeth 2 × a day. The hypersensitivity levels of the affected teeth were assessed by 2 stimuli, one tactile and the other cold air, and by the perception of pain. The results of all 3 assessment methods indicated that the potassium nitrate dentifrice significantly decreased the level of hypersensitivity at weeks 4, 8, and 12. In the treated group, a rapid decrease of positive scores for both the cold air stimulus and the subjective symptoms appeared from week 2. Although a significant decrease of the assessment score was also observed in the control group, the reduction rate of the score was much greater in the treated group by ail 3 assessment methods at weeks 4, 8, and 12. Complete relief of subjective symptoms throughout the 12 weeks’examination was noted in 67% of the subjects in the treated group, but in only 6% in the control group. These results suggest the usefulness of a 5% potassium nitrate dentifrice in Japanese patients with dentinal hypersensitivity.     

Distinctive Serial Magnetic Resonance Changes in a Young Woman with Rapidly Evolved Neurocysticercosis,with Positron Emission Tomography Results

A woman aged 21 years noticed numbness of the left hand, dysarthria, and right hemiparesis. Magnetic resonance imaging (MRI) showed homogeneously enhanced lesions in the bilateral cerebral white matter; these enlarged within 2 weeks, showing ringlike enhancement, and then spontaneously decreased in size and enhancement. Neurocysticercosis was confirmed by repeated, significantly positive serology results and the dramatic response to praziquantel. Subsequently, positron emission tomography (PET) revealed persisting regions of possibly decreased cerebral uptake of [18F]2–fluoro–2–deoxyglucose. This is the first documentation of such distinctive serial MRI changes and the results of PET in neurocysticercosis.     

Transurethral evaporation of prostate (TUEP) with Nd:YAG laser using a contact free beam technique: Results in 61 patients with benign prostatic hyperplasia

Objective. This prospective study was undertaken to evaluate the safety and efficacy of neodymium:yttrium-aluminium-garnet (Nd:YAG) laser for treatment of symptomatic benign prostatic hyperplasia (BPH).Methods. A total of 61 patients at a mean age of 71.6 years with symptomatic bladder outlet obstruction due to BPH underwent transurethral evaporation of prostate (TUEP) using Nd:YAG laser. Twelve of the patients were experiencing acute retention. Pre- and postoperative evaluation consisted of American Urological Association (AUA) symptom questionnaire and a sexual function questionnaire, uroflowmetry, postvoid residual urine, electrolytes, blood urea nitrogen, creatinine, hematocrit, and prostate volume estimation by transrectal ultrasound. TUEP was achieved by employing a side-firing Nd:YAG laser fiber with a durable quartz reflector and high-power density (Ultraline, Heraeus LaserSonics, Milpitas, CA) that was used in a contact mode.Results. All patients have been evaluated for three months, 26 for six rnonths, and 7 for twelve months. Mean prostatic size was 41.1 g. The mean improvement in symptom scores at one, three, six, and twelve months was 69.8 percent, 70.9 percent, 76.0 percent, and 70.9 percent, respectively (P = < 0.0001). The mean increase in maximum uroflow at one, three, six, and twelve months was 63.4 percent, 66.7 percent, 41.94 percent, and 164.52 percent, respectively (P = < 0.0001). There was no instance of significant fluid absorption or bleeding. The duration of postoperative catheterization was two days in 43 patients, three to seven days in 16 patients, and two to three weeks in 2 patients. There were no deaths. All patients evaluated by TRUS at six months had open channeling defects. Videocystoscopy performed in 16 patients at two to three months postoperatively revealed tissue slough. At repeat cystoscopy in these patients at six months, the prostatic fossa was completely healed with no evidence of tissue slough.Conclusions. It is concluded that the technique of TUEP using Nd:YAG laser is safe and, in preliminary results, appears apparently effective in the management of BPH.     

A case of metastatic rib tumor from thyroid cancer confirmed by the presence of thyroglobulin]

A 63-year-old female, with a chief complaint of right chest pain was referred to our hospital because of an abnormal right chest wall shadow on chest X-ray. A rib tumor was suspected based on her chest CT scan. Percutaneous needle biopsy yielded a diagnosis of well-differentiated adenocarcinoma. As metastatic rib tumor was suspected, the primary tumor was sought for. A thyroid gland nodule was recognized by ultrasonography, and the cytological diagnosis was class V. Immunohistological demonstration of the thyroglobulin studies of the rib tumor tissue revealed papillary and trabecular patterns of cell arrangement and the presence of thyroglobulin existence. Definitive diagnosis of metastatic rib tumor from thyroid cancer was established. Immunohistological examination is useful to confirm the diagnosis of metastatic cancer of thyroid origin.