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Ganglion cyst is a pseudocyst, which rarely occurs in patients with temporomandibular joint (TMJ). Although symptoms of ganglion cyst of the TMJ typically involve pain and trismus, it remains unclear why pain and trismus develop due to a simple cystic lesion. A 53-year-old man presented to our clinic with trismus, pre-auricular pain, and aural fullness on the right side. Imaging examinations suggested temporomandibular joint osteoarthritis (TMJ-OA) and cystic lesion. Visually guided irrigation (VGIR) revealed TMJ-OA with synovitis. After 3 months of VGIR, the patient’s pain and trismus disappeared; however, aural fullness remained. Magnetic resonance imaging examination revealed a remaining cystic lesion of the TMJ. Surgery was performed to excise the cystic lesion, and pathological examination revealed a ganglion cyst. After surgery, the aural fullness was resolved. The findings in this case suggest that pain generally originates from TMJ-OA, rather than the ganglion cyst, because ganglion cysts are often accompanied by TMJ-OA.

Intravascular papillary endothelial hyperplasia (IPEH) is histopathologically characterized by papillary proliferation of vascular endothelial cells. IPEH in the mandible is very rare, such that only four affected patients have been described in the English-language medical literature. Thus, there is a poor understanding of the pathogenesis and clinical features of IPEH in the mandible. This case report describes a patient with IPEH in the mandible who had a history of repeated trauma involving the mandible due to boxing-related and baseball-related injuries. Imaging examinations had diagnostic limitations, in that they showed a multilocular radiolucency suggestive of a simple bone cyst of the mandible, whereas intraoperative findings revealed a fluid-free unicystic cavity lined by a thin red membrane. Thus, histopathologic examinations were necessary for definitive diagnosis. The specimen demonstrated a spongy structure consisting of many small papillary fibrous tissues, lined by a typical monolayer endothelium that expressed CD34, but did not express D2-40 or AE1/AE3. Moreover, the Ki-67 labeling index was

Background Non-surgical treatment has generally been recommended for stage II medication-related osteonecrosis of the jaw (MRONJ) in preference to surgery. However, non-surgical treatment is not empirically effective. The aim of this study was to evaluate whether surgical or non-surgical treatment leads to better outcomes for stage II MRONJ. Material and Methods In this retrospective study, surgery was performed in a total of 28 patients while 24 patients underwent non-surgical treatment. The outcomes of both treatment approaches after 6 months were evaluated and statistically compared. In addition, risk factors for surgical and non-surgical treatments were assessed for each. Results Surgical treatment in 25 patients (89.3%) resulted in success, with failure in 3 patients (10.7%). Non-surgical treatment was successful for 8 patients (33.3%) and failed in 16 patients (66.7%). There was therefore a significant difference between surgical and non-surgical treatment outcomes (P

It is not widely known that incorrect use of oral bisphosphonates (BPs), such as chewing the medication, can cause oral ulcers. An 83-year-old woman with dementia was referred to our clinic with multiple oral ulcers. Blood and histopathological examinations were inconclusive. Further questioning revealed that the patient chewed the oral BP, resulting in oral ulceration. Patients with loss of cognitive function, such as dementia, are at risk of oral ulcers caused by incorrect use of BPs.

Rationale: Although an ototoxicity is well-known as adverse event of the radiotherapy, it is not widely known that immunosuppressed patients who underwent radiotherapy in head and neck region have risk of malignant external otitis. Patient concerns: A 68-year-old man with diabetes, who had been diagnosed as intraosseous squamous cell carcinoma of the right mandible, underwent surgical resection. He received a total of 60 Gy/30Fr postoperative radiation. Four months after the course of radiation, he suffered from right aural fullness, otalgia and otorrhea. Diagnoses: Clinical examination revealed granulation and existence of Pseudomonas aeruginosa in the external auditory canal. Computed tomography showed expansive inflammation and erosion in the temporal bone. The patient is elderly and diabetes. These findings led to the diagnosis of malignant external otitis. Interventions: The ear irrigation and administration of quinolones were started. Afterwards, fistula was formed in the oral cavity, and connected to the right external auditory canal. Therefore, irrigations were performed not only from ear but also from the oral fistula. Outcomes: Eight weeks after starting treatment, the malignant external otitis was completely healed. Lessons: Physicians should raise awareness of malignant external otitis in immunosuppressed patients with oral cancer after radiotherapy.

Rationale:Oral adenosquamous carcinoma (ASC) is rare and its origins are controversial. We here present a patient with oral ASC that developed after surgery for oral squamous cell carcinoma (SCC).Patient concerns:A 70-year-old man with SCC on the oral floor underwent surgical resection. Howe

Rationale, aims and objectives To investigate the subsequent behaviour of doctor-shopping patients (defined as those attending multiple hospitals for the same complaint) who consulted our department and factors related to cessation of doctor shopping. Methods Patients who presented without referral to the Department of General Medicine at Chiba University Hospital in Japan (our department) completed a questionnaire at their first visit. A follow-up questionnaire was also sent to them in order to assess doctor shopping after 3 months. Then items in the questionnaires were investigated for significant differences between patients who continued or stopped doctor shopping. Logistic regression analysis was performed with items showing a significant difference between patients who stopped doctor shopping and those who continued it, in order to identify independent determinants of the cessation of shopping. Results A total of 978 patients who presented spontaneously to our department consented to this study, and 929 patients (95.0%) completed questionnaires correctly. Among them, 203 patients (21.9%) were identified as doctor shoppers. The follow-up survey was completed correctly by 138 patients (68.0%). Among them, 25 patients (18.1%) were found to have continued doctor shopping, which was a significantly lower rate than before (P

研究ノート

From 1998 to 2001, using questionnaires, we surveyed the use of travel vaccines among Japanese expatriates in developing countries. The percentage of those using more than one type of travel vaccine before departure increased significantly (45.6% in 1998 to 53.4% in 2001 (p

Paralysis of the mental nerve is one of the principal complications of surgery of the mandibular canal and mental foramen region. The position of mental foramen can be clearly depicted on CT scans. The mental foramen is bilaterally located at the mandibular premolar region and appears as a dimple on the bone surface. However, several reports have described an accessory mental foramen (AMF). We examined CT pictures taken from patients with implants for missing mandibular teeth to detect variations of the AMF. The results were follows: 1) AMFs were present in 28 patients (24.6 %). 2) Unilateral AMFs were found in 24 patients, and bilateral AMFs in 4 patients. 3) Among patients with unilateral AMFs, 21 had AMFs with one foramen, and 3 had AMFs with two foramens. Among patients with bilateral AMFs, 2 patients had one foramen on each side, and 2 had two foramens on one side. 4) The position of AMF relative to that of the mental foramen was as follows: 18 foramens were superior mesial, 8 were superior distal, 6 were inferior mesial, and 5 were inferior distal.These results suggest that one quarter of patients with missing mandibular teeth may have AMFs around the mental foramen.

In order to study the prevalence of intestinal parasites among Japanese expatriates of developing countries, we conducted fecal specimen examinations annually from 1995 to 2000. Fecal specimens were collected from Japanese expatriates of each area: Asia, the Middle East, East Europe, Africa and Latin America. The specimens were fixed with 10% formalin in the local area, and then examined in Japan. We used the formalin-ether sedimentation method to find protozoan cysts or helminth eggs. In 1995, the infection ratio was 3.0% (N = 981), decreasing to 2.4% (N = 1,275) in 1996, 2.3% (N = 1,620) in 1997 and 1.6% (N = 1,574) in 1998. However, the ratio began to increase in 1999 (2.0%, N = 1,713) and 2000 (2.5%, N = 1,806). The ratio in Africa was the highest in each year, followed by Asia and Latin America. Heterophyidae (51 cases), Giardia lamblia (42) and Trichuris trichiura (30) were detected most frequently. In Egypt, the ratio of Heterophyidae rose by 28.8% in 2000. This was the prime reason for the increase in the overall ratio of infections worldwide. Most of the Japanese infected with Heterophyidae in Egypt had ingested dried mullet roe. This may explain the reason for the increase in the infection ratio there. Although the prevalence of intestinal parasites among Japanese expatriates in developing countries is decreasing, those who eat fish in these areas are still at risk. In order to eradicate intestinal parasitosis from this group, we must continue preventive measures such as health education.

The aim of the present study was to investigate the relationship among the clinical and laboratory signs in response to insulin resistance evaluated by a homeostasis model (HOMA-IR) in Japanese non-obbbbese men working abroad. A significantly positive correlation was observed between body mass index (BMI) and HOMA-IR values in the normal weight (r=0.34; p

To investigate the subsequent behaviour of doctor-shopping patients (defined as those attending multiple hospitals for the same complaint) who consulted our department and factors related to cessation of doctor shopping.Patients who presented without referral to the Department of General Medicine at Chiba University Hospital in Japan (our department) completed a questionnaire at their first visit. A follow-up questionnaire was also sent to them in order to assess doctor shopping after 3 months. Then items in the questionnaires were investigated for significant differences between patients who continued or stopped doctor shopping. Logistic regression analysis was performed with items showing a significant difference between patients who stopped doctor shopping and those who continued it, in order to identify independent determinants of the cessation of shopping.A total of 978 patients who presented spontaneously to our department consented to this study, and 929 patients (95.0%) completed questionnaires correctly. Among them, 203 patients (21.9%) were identified as doctor shoppers. The follow-up survey was completed correctly by 138 patients (68.0%). Among them, 25 patients (18.1%) were found to have continued doctor shopping, which was a significantly lower rate than before (P0.001). Logistic regression analysis selected the following factors as independent determinants of the cessation of doctor shopping: 'confirmation of the diagnosis' (odds ratio: 8.12, 95% confidence interval: 1.46-45.26), and 'satisfaction with consultation' (odds ratio: 2.07, 95% confidence interval: 1.42-3.01).Doctor shopping decreased significantly after patients consulted our department, with 'confirmation of the diagnosis' and 'satisfaction with consultation' being identified as contributing factors.

It has been proposed that lithium ion desensitizes neuronal receptors that function via the inositol phospholipid signaling mechanism. We examined the effects of lithium chloride on the morphologic outcome after 5 minutes of cerebral ischemia induced in gerbils by occluding both common carotid arteries under brief halothane anesthesia. In three treated groups of 10 gerbils each, 5 meq/kg i.p. lithium chloride was given 2 days, 1 day, and 2 hours before ischemia; 2 hours before ischemia; or immediately after the end of ischemia. Corresponding control groups of nine or 10 gerbils each received equivalent volumes of saline injected at comparable times. All gerbils were perfusion-fixed 1 week later, and neuronal density of the hippocampal CA1 pyramidal cells was determined. Lithium induced very mild intraischemic systemic hypothermia, but postischemic hyperthermia developed in both treated and control groups. Neuronal densities were equal in corresponding groups. The results indicate that our regimen of lithium administration provides no benefit in survival of hippocampal neurons, and intraischemic hypothermia of less than 0.8 degrees C is not protective. Other strategies to inactivate the signal transduction system that is specific for excitatory neurotransmission should be evaluated.

OBJECTIVE Familial Mediterranean fever (FMF) had been considered a rare disease in Japan, but since the identification of the causative gene (MEFV) for pyrin/marenostrin in 1997, the occurrence of FMF has been successively reported. We reviewed the clinical features of 7 patients diagnosed with FMF by gene analysis. METHODS During April 2003 and March 2005, we investigated the clinical symptoms, treatment and MEFV types of 7 FMF patients who consulted the General Outpatient Clinic of Chiba University Hospital. RESULTS Six patients were in their 20-30s, and one was 54 years of age. There were 4 males and 3 females including a mother and child, and an adult male and his female cousin. Three were solitary incidences. In addition to intermittent fever, 4 patients had chest pain, 1 had abdominal pain, and 1 had chest or abdominal pain. The frequency of attacks was once per 3 months to 1 year in the early stage of the disease, but it slowly increased with disease progression. Leukocytosis and C-reactive protein (CRP) elevation were noted during attacks in all patients. On investigation of MEFV, heterozygosity for the compound pyrin L110P-E148Q/M694I, E148Q/M694I, L110P/E148Q and heterozygosity for pyrin variant M694I alone were detected. Daily administration of colchicine at 0.5 mg prevented attacks in 6 patients, however 1 patient required 1.0 mg for adequate prevention. CONCLUSIONS Although the incidence is rare, internists should be aware of the characteristic symptoms of FMF: periodic fever and serositis symptoms, and its presence in Japan despite the disease name.