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Background: Recently, a vertebrate securin [pituitary tumor transforming gene (PTTG) in humans] has been identified that inhibits sister chromatid separation and is involved in malignant transformation and tumorigenesis. Abundance of this protein would disrupt cell division, generate chromosomal instability and thereby increase cell susceptibility to acquisition of further mutations during subsequent division. Esophageal cancer is a disease with poor prognosis with early local invasion and lymph node metastasis. It is important to identify factors that influence the aggressiveness of esophageal cancer. Methods: Expression of PTTG messenger ribonucleic acid (mRNA) was evaluated by real-time reverse transcription polymerase chain reaction in 48 esophageal cancer specimens and matched normal esophageal mucosa. The data were analyzed with reference to clinicopathological factors. Results: Tumor tissue expressed a significantly higher level of PTTG1 mRNA than the corresponding normal tissue (P < 0.0001). PTTG1 mRNA expression was significantly higher in tumors with higher pathological stage (IV vs 0-III, P = 0.0442) or more extensive lymph node metastasis (pathological N factor; N4 vs N0-3, P = 0.003). The median survival for patients with high PTTG1 expression (8.5 months) was less than that for patients with low PTTG1 expression (14.0 months, P = 0.039). PTTG1 expression was one of the significant predictors of survival on univariate analysis (hazard ratio 2.225; 95% confidence interval 1.007-4.915). Conclusions: Detection of high PTTG1 expression in surgically excised esophagus tumor tissues might help to identify patients with aggressive disease who require adjuvant therapy and provide prognostic information.

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 99m Tc-phosphate compounds in the mandible have not yet been fully elucidated. The aim of this study was to determine the localization of 99m Tc-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 99m Tc-MDP accumulation. Results: Radioactivity reflecting accumulation of 99m Tc-MDP was documented encircling the portion of the mandible with cancerous invasion, suggesting that 99m Tc-MDP accumulated in immature bone. High uptake also was found in the periosteal reactive bone around the cortical bone. Conclusions: The amount of increased 99m Tc-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.

Various cutaneous flaps have been used to reconstruct intraoral defects created by tumor resection. Transplanted cutaneous flaps clinically show changes such as color changes and scaling. To better understand the biological conditions of reconstructed flaps that survive in the intraoral environment, patients in whom various periods had passed since reconstruction operations were clinically observed, and biopsy specimens taken from their flaps were examined histologically, histochemically and immunohistochemically.Seventeen major flaps, including delto-pectoral flaps, pectoral major myocutaneous flaps and forearm flaps, were used to reconstruct intraoral defects remaining after the resection of oral cancer. Irradiated flaps were excluded. Biopsy specimens were taken from both the mid-portion of each flap and the junction between the flap and the surrounding oral mucosa. Histological, histochemical and immunohistochemical examinations were performed as follows. A formalin-fixed specimen was dehydrated and embedded in paraffin. Hematoxylineosin, periodic acid-Schiff with and without diastase digestion, and alcian-blue were used to stain the deparaffinized sections of the specimens. The deparaffinized sections also underwent N-(7-dimethylamine-4-methl-3-coumarinyl) maleimide (DACM) staining to examine the distribution patterns of SH groups and SS linkages of cellular proteins in the epidermis. Immunohistochemically, frozen sections were first cut in a cryostat and stained with monoclonal antibodies. Anti-hair keratin monoclonal antibodies (HKN-2, 4, 5, 6, 7), anti-basal cell epithelioma keratin monoclonal antibodies (BKN-1), K92, and RKSE60 were used.The clinical features of cutaneous flaps seemed to depend on their location in the oral cavity rather than the period since operation or the kind of flap. Although the horny layer of the epidermis of the flaps showed thinning histologically, the epidermis showed a normal pattern of SH to SS conversion by DACM staining histochemically, as well as normal keratin expression by keratin staining immunohistochemically. The tongue epithelium adjacent to the flaps often showed flattening. Some specific keratins of the tongue epithelium were still recognized but hard keratin was not. Although cutaneous flaps may be influenced by environmental factors in the oral cavity, the flap tissues seem to retain their original cell differentiation.

Proximal gastrectomy is preferred for early gastric cancer in the upper part of the stomach to preserve the function of the stomach after surgery, 1,2 Gastroesophagostomy is one of the common reconstructional methods for proximal gastrectomy, but without using an antireflux procedure, this method results in a high incidence of reflux esophagitis, 3 Some modified techniques have been reported to avoid these problems. 4-6 We report a new method of gastroesophagostomy using a double stapling technique after proximal gastrectomy. This procedure is simple and safe, and seems to confer functional antireflux mechanism on the newly formed gastroesophageal junction.

The pallor of the skin and oral mucosa that is associated with anemia is thought to be due to a decrease in hemoglobin in the super ficial blood vessels. However, there has been little systematic research on this subject.The authors of this paper used a tissue spectrum analyzer to measure the Lib (indicating hemoglobin concentration) and the Iso2 (indicating saturation). Experiments were conducted to determine the relationship between anemia and hemoglobin level in the oral mucosa, using the hemoglobin (Hb) value as the indicator.The following conclusions were reached.1. The areas of the oral mucosa which best correlate with the blood Hb level are the upper labial mucosa, lower labial mucosa, the back of the tongue, the sublingual surface, and the soft palate. The patients with secondary anemia showed reduced Lib levels (i. e. anemia) in all of these areas.2. Measurements of IHb were graded to appear in the following order, from highest to lowest: labial mucosa, tongue, and then soft palate.3. These measurements did not show a definite relationship between the IHb and the is in either patients with secondary anemia or in normal healthy people.4. It was conjectured that patients on dialysis would tend to show a somewhat higher IHb on the back of the tongue than in other areas.5. Sudden changes in blood volume, as in transfusions, surgery, etc., influence the oral mucosal hemodynamics. Reductions in the blood volume of thebody as a whole are accompanied by reductions in the blood volume of the oral mucosa. It was conjectured that the degree of this change in the oral mucosa would increase as the severity of anemia increased.6. Among the five parts of the oral mucosa which were investigated, the back of the tongue showed the lowest correlation with the true state of anemia.7. In order to determine the degree of anemia by hemodynamics of the oral mucosa, it is thought that the four parts (the upper and lower labial mucosas, the lower part of the tongue, and the soft palate) are the most reliable ones to observe.From the above, it was concluded that, in secondary anemia (patients on dialysis, those having blood dyscrasis, a malignant tumor of the oral cavity, etc.), there is a distinct correlation between the tissue hemoglobin concentration (IHb) in the mucous membranes of the oral cavity and the true degree of anemia. This could be considered a useful method for clinical diagnosis.

As it is impossible to perform a longitudinal experiment of carcinogenesis of human samples, experimentally induced carcinoma has been used for this purpose. DMBA induced carcinoma on hamster buccal pouch mucosa has been frequently cited for its stability and high induction rate. We have been attending to this aspect of research. This article presents the findings from PAS stained sections on the process of DMBA induced hamster buccal pouch carcinogenesis.The PAS-positive granules in the cytoplasm of epithelial cells, regarded as glycogen, were consumed by digestion of amylase. There was no difference between the experimental groups painted DMBA for no more than 6 weeks and the control groups which contained very little glycogen. But on the groups painted for more than 8 weeks, papillomas accumulated a large amount of glycogen in the cytoplasm of the spinous cell layer, and carcinomas did a little in the keratinized part. Epithelium with atypia revealed less glycogen than that of the other part of the epithelium. Carcinoma in situ contained extremely less.Concerning on the PAS-basement membrane, that is PAS positive membraneous structure at the epithelium-connective tissue junction, there was no distinct difference between the controls and the up to 6-week-painted groups. In the groups painted more than 8 weeks, papillomas occasionally had thin membranes, and carcinomas were absent or faint.Glycocalyx in the intercellular spaces was clearly observed in the controls and the up to 6-week-painted groups. Papillomas reduced the intercellular cohesion, and carcinomas showed wide intercellular spaces without any glycocalyx. The epithelium with atypia and carcinoma in situ also reduced intercellular cohesion.Although PAS staining on the DMBA induced carcinogenesis could not predict the malignant potentiality of the epithelium, it is clarified that the induced tumors and epithelia with atypia closely resembled human oral carcinomas and precancerous lesions.

It is supposed to be difficult to diagnose rheumatoid arthritis in the temporomandibular joint due to the lack of diagnostic criteria for this region. Twenty-seven patients with rheumatoid arthritis accumulated in our department of out patients registration. These include seven initially involved cases on temporomandibular joint, six out of these seven suffered exclusively with the temporomandibular joint and the other is involved initially on the temporomandibular joint as well as the other joints, for example PIP, MCP, wrist joint, etc. Clinical research for rheumatoid arthritis in the temporomandibular joint was subjected to these twenty-seven patients, and the possibility of the diagnostic criteria was discussed.Clinical symptoms and radiographic findings are the most important aspects to diagnose this lesion. Crepitus, slight disturbance of mouth opening, pain on jaw functions, and temporomandibular joint stiffness are common clinical symptoms. Xerostomia and anemic complexion and/or color of gingiva are frequently found as the symptoms in the maxillofacial region except the temporomandibular joint area. On the radiographic findings of the temporomandibular joint, resorption on condylar head, fossa, and tubercle as well as faint and narrowed joint space are specific to this lesion. Heat accumulation on the temporomandibular joint area of bone scintigraphy are always recognized. As the referable items to this lesion, seropositive reaction of RF, high content of Gam.rnar Globulin, Ig-G, TTT, ZTT, CRP, and acceleration of BSG are generally found in rheumatoid arthritis. Swelling, pain, stiffness, deformity, and abnormalities on radiographic films of the other joints are also helpful to diagnose this lesion. Miscellaneously, predominanly adult women would visit our clinics with complaints related to the temporomandibular joint, i.e. pain in this region, and with xerostomia. The premonitory symptoms of rheumatoid arthritis could be also experienced with the initial involvement in the temporomandibular joint.This research succeeded to throw light upon the diagnostic items for rheumatoid arthritis in the temporomandibular joint. In the next step we are going to establish d. diagnostic criteria for this lesion, increasing the cases and calculating sensitivity, specificity, and accuracy of these items.

We present a case of a relatively large epulis osteoplastica (epulis osteomatosa), suspected of being a malignant tumor on initial examination, in the mandibular molar region.The patient was a 26-year-old man with a painless mass in his left mandibular gingiva. He had first noticed the mass more than 10 years previously. On initial examination, an eggsized mass was found in the left lower molar region, and x-ray examination revealed calcification in the form of a radiopaque shadow. Various examinations, including biopsy, revealed no evidence of malignancy, and the mass was resected under general anesthesia. The lesion measured 65×50×45mm. Histopathologic examination revealed fairly calcified, chondroid tissue and irregular bone tissue in the mass, and lamination was found at its base. On the basis of these three findings, a diagnosis of epulis osteoplastica (epulis osteomatosa) was made.

In some patients who already have advanced esophageal cancer at the time of presentation, symptoms like the inability to eat, and complications such as bronchoesophageal fistula are so debilitating that palliative resection may be beneficial. However, resection of the esophagus is associated with significant risk, and whether this operation should be performed for palliation remains controversial. Because few reports have been published on this subject, we retrospectively analyzed 24 patients with esophageal cancer who underwent palliative resection.Esophageal resection was performed with palliative intent in 12 patients and with curative intent in another 12 who were left with residual cancer.There was no operative death. All of the ten patients who had been unable to eat preoperatively were able to eat after the operation, and four patients with a life-threatening bronchoesophageal fistula were free of symptoms after the operation. Two patients died in hospital during the postoperative chemotherapy but the other 22 were discharged. The mean survival period was 264 days.With improved postoperative care, the risk of palliative esophageal resection is no longer considered unacceptable.

Survivin, a new member of the inhibitor-of-apoptosis (IAP) family, has been reported to be expressed in many cancers but not in differentiated normal tissue. Its expression in esophageal cancer, however, has not been reported. We investigated 51 esophageal cancers and their adjacent normal epithelial tissues for mRNA expression of survivin by RT-PCR. The survivin expression in esophageal cancer tissue was significantly higher than that in normal esophageal tissue (0.211 ± 0.226 vs. 0.057 ± 0.135, p < 0.0001). pN4 tumors had significantly higher survivin expression than the pN0-3 tumors (p = 0.0093). Fourteen patients with advanced esophageal cancer had received chemotherapy prior to surgery. The survivin expression in the cancer tissue in patients who achieved a partial response (PR) was significantly lower than that in patients with no change (NC) and in patients with progressive disease (PD; 0.099 ± 0.134 vs. 0.320 ± 0.222, p = 0.0434). The median survival for patients with high survivin expression (9.0 months) was less than that for patients with low survivin group expression (30.0 months, p = 0.0023). Survivin expression was one of the significant predictors of survival on univariate analysis (hazard ratio 2.471; 95% confidence interval 1.104-5.533). The results suggest that survivin expression may provide prognostic information in patients with esophageal cancer. © 2001 Wiley-Liss, Inc.

A necropsy case suggested that only sarcomatous element was metastasized in the upper gingival region, also spread in other systemic organs, from mammary carcinosarcoma is clinically and histopathologically discussed and presented.Summarized conclusions were as follows:1. Characteristic features of this gingival tumor were a polypoid and pedenculated growth in clinical and constructed by sarcomatous structures with spindle shaped or multangular cells, fibrous tissues combined with osteoid formation slightly in microscopic.In particular, this metastatic tumor was quite similar to the sarcomatous part of primary carcinosarcoma in mammary gland histopathologically.2. The patient was dead due to serious rapid systemic metastases, then necropsy was performed.3. Remarkable common histological findings in each examined metastatic tumors were a nodular and polypoid in shape, osteoid formation with cartilaginous metaplasia in part, spindle or multangular cells as well as oral tumor and osteoclast like multinucleated giant cells as a result of a stromal reaction.4. Based on these findings, gingival tumors were considerred as one of the systemic metastasized sarcomas from mammary carcinosarcoma.Entity and metastatic pathway of this tumor may attribute to the cancer genesis and requires more investigation to identify this entity.

We have examined the estimated blood loss of 200 patients had a maxillary sinus radical operation in the central operating room of The Nippon Dental University, School of Dentistry at Niigata Dental Hospital from February 1979 to May 1987.The subjects included 106 males and 94 females, ranged from class 1 to class 2, according to ASA classification. Their ages ranged from 1. 5 to 73 years and the average age was 42.1±12.6 years. Their body weights ranged from 7.9 to 92.8kg and the average body weight was 56.4±10.0kg.Referring to the methods of anesthesia, nitrous oxide-oxygen-halothane was applied to 94 cases, nitrous oxide-oxygen-enflurane to 60 cases, and neurolept anesthesia to 46 cases, 181 cases in which vasoconstrictors were used during operation.A correlationship was observed between body weight and estimated blood loss.The estimted blood loss would increase with an increase in the operative time, a correlationship was observed between these factors.Cases of odontogenic maxillary sinusitis had larger estimated blood loss than those of postoperative maxillary cyst, with a statistically significant difference observed.There were no statistically significant differences observed in relation to methods of anesthesia, kinds of vasoconstrictors used, and whether or not a vasoconstrictor was used.The least estimated blood loss was shown by the group having an average systolic blood pressure (SBP) of 100 mmHg or lower, resulting in statistically significant differences from the respective groups having 101 to 120 mmHg and 121 mmHg or higher.

Thirteen patients maintained by hemodialysis with secondary hyperparatyroidism were mainly studied using Tc 99m-MDP bone scintigraphy and lamina dura index (LDI) which was judged by dental films. After parathyroidectomy (PTX), the most prominent change appeared on the calvaria, maxilla, and mandible in scintigrams. Intensity of Tc 99m-MDP accumulation was represented by using a quantitative method of bone-to-soft tissue uptake ratio (4 hr-B/St ratio). 4 hr-B/St ratio gradually decreased and became normal within one and a half years after PTX. The accumulation of Tc 99m-MDP on the calvaria may reveal the status of bone metabolism in the patients with secondary hyperparathyroidism. Also, LDIes gradually decreased during 4 through 6 months after PTX. However it was considered that these indexes might need a long term to return to normal range. We couldn't differenciate which method was superior in the diagnostic value for detecting early skeletal changes between roentogenograms and bone scintigraphy as a indicator of post-PTX bone improvement. However, bone scintigraphy should be added to conventional examinations for following the courses of patients that underwent PTX because this procedure has many other advantages.