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To determine the intracellular behavior of p62, a marker of selective autophagy, in oral potentially malignant disorders (OPMDs). This retrospective study includes 70 patients who underwent biopsy or surgical resection and were definitively diagnosed with OPMDs. Immunohistochemical staining for p62, XPO1, p53, and ki67 was performed on all samples and positive cell occupancy was calculated. We statistically investigated the correlation between protein expression in OPMDs and the association between malignant transformation, clinicopathological characteristics, and occupancy. ki67 expression was negatively correlated with p62 expression in the nucleus (p < 0.01) and positively correlated with p62 expression in the cytoplasm (p < 0.01). For malignant transformation, the expression of p62 in the nucleus (p = 0.03) was significantly lower in malignant transformation cases, whereas the expression of p62 in the cytoplasm (p = 0.03) and the aggregation expression (p < 0.01) were significantly higher. Our results suggest that the function of p62 is altered by its subcellular localization. In addition, defects in selective autophagy occur in cases of malignant transformation, suggesting that p62 is a potential biomarker of the risk of malignant transformation of OPMDs.

This report presents a rare case of direct invasion from a metastatic submandibular lymph node (SMLN) to submandibular gland (SMG) in a resected specimen of neck dissection (ND) of buccal mucosal squamous cell carcinoma (SCC). The patient was an 82-year-old woman with a clinical diagnosis of the left buccal mucosal SCC (cT4bN2bM0, Stage IVB). The tracheostomy, modified radical neck dissection, buccal mucosal cancer resection including maxillary partial resection, mandibular segmentectomy, and reconstructive surgery with a plate and a free rectus abdominis flap were performed. Pathologically, the infiltrating SCC was observed in the SMG continuous with SMLN metastasis (pT4bN3bM0). No adjuvant therapy was performed for old age and oral intake dysfunction. Contrast CT detected the multiple lung and left scapula metastases at postoperative 5 months, which made the policy of best supportive care. Finally, she died 9 months after the surgery from distant metastases. SMG involvement from direct invasion from a metastatic SMLN is relatively rare. In our case, although the patient died from distant metastases, locoregional control was achieved through curative resection of the primary tumor and ND performed as one block with reconstructive surgery.

Elective neck dissection (END) is recommended for the management of patients with oral squamous cell carcinoma (OSCC) because of the risk of occult metastasis (OM). We hypothesized that some factors predict poor prognosis regardless of a cN0 END. This study aimed to investigate the predictors of OM and prognostic factors in patients with cN0 OSCC who underwent supraomohyoid neck dissection (SOHND). A retrospective cohort study design was created and implemented. The primary predictive variables in this study were OM and risk factors for poor prognosis after SOHND. A Cox proportional hazard model was used to adjust for the effects of potential confounders on the risk factors for poor prognoses. Among 86 patients with OSCC, OMs were observed in 9 (10.5%). The neutrophil-to-lymphocyte ratio (NLR) and vascular invasion are good markers for detecting OM. A Cox multivariable analysis identified two independent predictors of overall survival: pathologic node (pN) and laterality of END. An independent predictive factor for disease-free survival, the surgical margin, was also identified in this study. According to the pN classification, pN1 patients had a worse survival rate than pN2 patients. Therefore, in the case of pN1, regardless of being cN0, additional adjuvant therapy may be necessary.

Lipopolysaccharide (LPS) derived from Porphyromonas gingivalis (P.g.), which causes periodontal disease, contributes to the development of non-alcoholic steatohepatitis (NASH). We investigated the role of Nrf2, an antioxidative stress sensor, in macrophages in the development of NASH induced by LPS from P.g. We generated macrophage-specific Nrf2 gene rescue mice (Nrf2-mRes), which express Nrf2 only in macrophages, using the cre/loxp system. Wild-type (WT) mice, whole body Nrf2-knockout (Nrf2-KO) mice, and Nrf2-mRes mice were fed a high-fat diet for 18 weeks, and LPS from P.g. was administered intraperitoneally for the last 6 weeks. Nrf2-KO mice developed severe steatohepatitis with liver inflammation and fibrosis compared with WT mice, and steatohepatitis was ameliorated in Nrf2-mRes mice. The mRNA expressions of Toll-like receptor (Tlr)-2, which activates inflammatory signaling pathways after LPS binding, and α-smooth muscle actin (αSma), which promotes hepatic fibrosis, were reduced in Nrf2-mRes mice compared with Nrf2-KO mice. The protein levels of LPS-binding protein in livers were increased in Nrf2-KO mice compared with WT mice; however, the levels were reduced in Nrf2-mRes mice despite similar numbers of F4/80 positive cells, which reflect macrophage/Kupffer cell infiltration into the livers. Nrf2 in macrophages ameliorates NASH through the increased hepatic clearance of LPS.

Primary intraosseous adenoid cystic carcinoma (PIACC) of the jaw is rare. To our knowledge, only 51 cases have been reported in the English literature. We present a rare case of PIACC arising in the mandible with multiple bone metastases and review the previous articles. A 70-year-old woman presented with paresthesia of the right chin and lower gingiva for 4 months. Radiography revealed an irregular radiolucent region on the right side of the ramus, infiltrating to the mandibular canal. Biopsy revealed a pathological diagnosis of adenoid cystic carcinoma. Multiple bone metastases were present in the sternum, scapula, and thighs. The treatment effect was progressive disease for chemotherapy; therefore, best supportive care was provided for 3 years.

Abstract The systemic inflammatory response is known to be associated with poor outcomes in patients with various types of cancer. The C-reactive protein (CRP)/albumin (Alb) ratio (CAR) has been reported as a novel inflammation-based prognostic marker. We have evaluated the prognostic value of inflammatory markers for patients with oral squamous cell carcinoma (OSCC). The study population included 205 patients treated with OSCC between 2013 and 2018. The primary predictor variable was the inflammatory markers. The primary outcome variable was overall survival (OS). Univariate and multivariate analyses were performed using a Cox proportional hazards model to identify independent prognostic factors. The CAR had the highest area under the curve (AUC) values compared with other markers in the receiver operating characteristic (ROC) curve analysis. The cutoff value for CAR was 0.032 (AUC 0.693, P

This study investigated the effect of postoperative deep sedation after oral cancer reconstructive surgery on the occurrence of early postoperative pneumonia and early postoperative delirium. We obtained medical records of 108 consecutive patients who underwent microvascular reconstructive surgery at Tsukuba University Hospital for oral cancer between January 2013 and December 2021. Forty-six of them woke soon after surgery. Ten of these forty-six patients were restless and required immediate sedation within 3 h after surgery. The comparison between sedation group and no sedation group revealed early postoperative pneumonia in the no sedation group; however, sedation was not related to early postoperative delirium. The preoperative albumin levels of patients with postoperative pneumonia were significantly different (p = 0.03) than those of patients without postoperative pneumonia. The performance status (p = 0.02), preoperative albumin level (p = 0.02), and age 75 years or older (p = 0.02) were significantly associated with postoperative delirium. Restless patients and those who could not be sedated experienced delirium and pneumonia. The risk of pneumonia was increased for patients who were difficult to sedate.

We report the case of a lip epidermoid cyst, caused by piercing in a 23-year-old Japanese woman. She had an exophytic lesion in the lower lip associated with the piercing which was initially diagnosed as a mucous retention cyst. The lesion was resected under local anesthesia, and pathological examination revealed an epidermoid cyst, likely caused by piercings. Piercing-induced epidermoid cysts frequently occur in the tragus. There have been no reports of piercing-induced epidermoid cysts developing in the oral cavity. To our knowledge, this is the first report of a lip epidermal cyst caused by piercings. Six months have passed since the operation, and it has not recurred.

Neck dissection (ND) is a major surgery for head and neck cancer. Currently, some or all of the spinal accessory nerve (SAN), sternocleidomastoid muscle, and internal jugular vein (IJV) are aggressively preserved during ND to reduce postoperative complications. Since the anatomical relationship between the SAN and IJV has several variations, knowledge of these variations is necessary to avoid iatrogenic damage. In the present case, the SAN was observed to pass through the fenestrated IJV at the level of the posterior belly of the digastric muscle during ND in a patient with squamous cell carcinoma of the mandible. Although the anatomical structure of the SAN and IJV is rare, surgeons must be aware of this anatomical variation.

We present the first, to our knowledge, case of a dedifferentiated low-grade central osteosarcoma (LCOS) of the mandible. A 48-year-old Japanese woman underwent enucleation under general anesthesia after a diagnosis of ossifying fibroma. At the second recurrence, the pathological diagnosis after biopsy was of sarcoma with MDM2(+) and CDK4(+) immunohistochemical staining results. Hemimandibulotomy, supraomohyoid neck dissection, and free-flap reconstruction with a rectus abdominal flap were performed. A retrospective reevaluation of the first specimen with additional immunohistochemical staining for MDM2 and CDK4 yielded a final diagnosis of dedifferentiated LCOS. The patient showed no recurrence or lung metastasis 3 years after the final surgery.

The incidence of needle breakage is estimated to be 0.000007%, and most needle breaks occur during inferior alveolar nerve block (IANB) administration and are localized to the pterygomandibular space. Although immediate surgical intervention is recommended for the removal of the fracture needles, intraoperative localization of a broken injection needle fragment can be challenging. Here, we present the case of a 36-year-old woman who underwent dental extraction of the left lower wisdom tooth under local anesthesia at a private office. At that time, a disposable 33G needle was broken and accidentally inserted into the pterygomandibular space during IANB. A broken injection needle was presented at the base of the left coronoid process of the mandible on computed tomography (CT). We successfully removed the broken injection needle using fluoroscopy and assisted endoscopy under general anesthesia.

Elderly patients with oral squamous cell carcinoma (OSCC) have difficulty undergoing curative surgical treatment due to various factors besides age. The purpose of the present study was to study the factors determining surgery in elderly patients with OSCC. We designed and implemented a retrospective cohort study. The study sample included elderly patients aged ≥ 70 years with OSCC and they were statistically compared between the surgery and non-surgery groups. The primary outcome variable was selecting surgery as the treatment plan, while the secondary outcome was the prognosis of each group. The sample comprised 76 patients aged ≥ 70 years with OSCC, of whom 52 treated with surgery and 24 patients treated with non-surgery. As decision factors, performance status (PS), clinical stage, serum Alb level, body mass index (BMI), and Geriatric Nutritional Risk Index (GNRI) were significantly associated with the selection of surgery. Logistic multivariate analysis identified three independent predictive factors for selecting surgery: Alb (≥3.5 vs.

MicroRNAs (miRNAs) play an important role in carcinogenesis and cancer progression. The purpose of this study was to identify miRNAs associated with carcinoma function in OSCC and to investigate the potential role of the specific miRNAs. First, a comprehensive microarray analysis was performed, and miR-142-5p was identified as a candidate miRNA involved in OSCC. miR-142-5p has been reported to show high expression levels in cancer patients and to be involved in tumor growth and metastasis. However, the expression and function of miR-142-5p in oral squamous cell carcinoma (OSCC) are not fully characterized. We evaluated miR-142-5p expression in both OSCC-derived cell lines and primary OSCC tissues and performed functional analysis of miR-142-5p in OSCC-derived cell lines using mimics and inhibitors. miR-142-5p expression was up-regulated in OSCC tissues and OSCC cell lines. Overexpression of miR-142-5p significantly promoted the proliferation and invasion of OSCC cells. Bioinformatics analysis was performed using TargetScan to predict potential target sites that match the seed region of miR-142-5p. Phosphatase and tensin homolog deleted on chromo-some 10 (PTEN) was identified as a potential target and selected for further analysis. PTEN expression levels were down-regulated and AKT expression levels were up-regulated in miR-142-5p-overexpressing cells. We have shown that miR-142-5p targets the PTEN gene and is involved in cancer progression. Our results suggest that miR-142-5p is involved in the progression of OSCC by controlling the phosphatidylinositol 3-kinase (PI3K)/AKT pathway by targeting the PTEN gene. Our findings suggest that miR-142-5p may be a new target for the treatment of OSCC.

Abstract Objective Reconstruction plates are used to treat patients with a segmental mandibular defect after oral cancer surgery. Reconstruction plate failure analysis has rarely focused on occlusion, which conducts a mechanical force to the mandible and the plate. To determine the prognostic factors, we retrospectively evaluated patients who underwent reconstruction of a mandibular segmental defect with a reconstruction plate and assessed the number of residual paired teeth. Material and Methods From among 390 patients with oral cancer who visited University of Tsukuba Hospital (Tsukuba, Japan) between 2007 and 2017, we selected and analyzed the data of 37 patients who underwent segmental resection of the mandible and reconstruction with reconstruction plates. Prognostic factors evaluated were patient age, sex, TNM classification, plate manufacturer, treatment with radiotherapy or chemotherapy, whether the patient had diabetes or smoked, and whether the patient had a small number of residual paired teeth, plate length, and use of a fibular‐free flap. Among these 37 patients, eight reconstruction plates had intraoral or extraoral exposure and were removed in 5 years. Results Kaplan–Meier and log‐rank analyses revealed that the prognosis for the 5‐year plate exposure‐free rate was significantly poorer for patients with a small number of residual teeth than for patients with no teeth or those with a large number of residual teeth (.01). Univariate Cox regression analysis revealed that a small number of residual teeth was a significant prognostic factor in the loss of a reconstruction plate (hazard ratio: 5.63; 95% confidence interval [1.10, 25.85]; .04). Conclusions A small number of residual teeth after the segmental resection of oral cancer is significantly involved in reconstruction plate survival and may be important in predicting reconstruction plate prognosis.

Abstract Objective Oral leukoplakia is keratinized lesions in the buccal mucosa, tongue, and gingiva. It is the most common oral precancerous lesion; oxidative stresses and irrelevant autophagy have been reported to be the cause of oncogenesis. p62, a cytoplasmic protein induced by oxidative stress, is an adaptor protein involved in the formation of protein aggregates and induction and inhibition of autophagy. The inhibition of autophagy induces p62 overexpression and promotes oncogenesis via the oncogenic signaling pathway. The aim of the present study was to elucidate the involvement of intracellular expression of p62 in oral leukoplakia and to address its potential clinical implementation as a biomarker to predict malignant transformation. Material and Methods Fifty samples from subjects with confirmed oral leukoplakia were evaluated by immunohistochemical staining for the expression of p62, 8‐hydroxy‐2′‐deoxyguanosine (8‐OHdG), Ki67, and p53. Univariate and multivariate logistic regression analyses were performed to evaluate the association between p62, 8‐OHdG, Ki67, and p53 and clinical characteristics, including epithelial dysplasia. Results Significant associations were observed between p62 expression in the nucleus, p62 aggregation, and epithelial dysplasia (adjusted odds ratio [OR] = 5.75; 95% confidence interval [CI]: [1.28, 26.2]; .024 and OR = 6.16; 95% CI: [1.01, 37.4]; .048, respectively). The expression of p62 in the cytoplasm and the levels of 8‐OHdG, Ki67, and p53 were not significantly associated with epithelial dysplasia. A significant relationship was found between p62 expression in the nucleus and p53 expression (OR = 3.94; 95% CI: [1.14, 13.6]; .031). Conclusions The results suggested that p62 expression in the nucleus and p62 aggregation can be potential markers to predict the malignant transformation of oral leukoplakia.

Oxidative stress (OS) contributes to nonalcoholic steatohepatitis (NASH) and hepatocarcinogenesis. We investigated whether antioxidative self-assembling nanoparticles (SMAPoTN) could reduce the development of NASH and hepatocellular carcinoma (HCC) in p62/Sqstm1 and Nrf2 double knockout (DKO) mice and studied protective mechanisms. We measured disease development in male DKO mice fed a normal chow (NASH model) or a 60% high-fat diet (HFD; HCC model) with or without SMAPoTN administration for 26 weeks. SMAPoTN inhibited liver fibrosis in both groups and prevented HCC development (0% vs. 33%, p < 0.05) in the HFD group. SMAPoTN reduced OS, inflammatory cytokine signaling, and liver fibrosis. RNA-sequencing revealed that SMAPoTN decreased endoplasmic reticulum stress signaling genes in both groups, HCC driver genes, and cancer pathway genes, especially PI3K-AKT in the HFD groups. In the SMAPoTN treatment HFD group, serum lipopolysaccharide levels and liver lipopolysaccharide-binding protein expression were significantly lower compared with those in the nontreatment group. SMAPoTN improved the α-diversity of gut microbiota, and changed the microbiota composition. Oral SMAPoTN administration attenuated NASH development and suppressed hepatocarcinogenesis in DKO mice by improving endoplasmic reticulum stress in the liver and intestinal microbiota. SMAPoTN may be a new therapeutic option for NASH subjects and those with a high HCC risk.

The prevalence of medication-related osteonecrosis of the jaw (MRONJ) associated with molecular-targeted therapies such as bevacizumab and sunitinib has been constantly increasing in recent years. MRONJ frequently occurs after invasive dental procedures such as tooth extraction in patients currently or with a previous history of receiving antiresorptive agents including bisphosphonates and/or denosumab. Here, we report a rare case of spontaneously occurring MRONJ of the mandible in a 52-year-old Japanese woman with chronic myelogenous leukemia (CML) who was administered imatinib for 9 years. She had never been treated with antiresorptive agents, and her MRONJ developed spontaneously. Although there have been few reports of MRONJ related to imatinib, our case reported here indicates that imatinib may be capable of causing spontaneous MRONJ.

Various treatments for oral vascular malformation (VM) have been reported. Polidocanol and absolute ethanol have also been reported for sclerotherapy. However, there are still few reports on the therapeutic effect and dosage of polidocanol sclerotherapy. Therefore, we examined its therapeutic effects on oral VM. There were 17 sites of VMs, with nine patients diagnosed with oral VM at the Department of Dental and Oral Surgery, Tsukuba University Hospital. The medical records were retrospectively investigated to determine the site, hemangioma volume, polidocanol injection volume, and therapeutic effect. The volume of hemangiomas was calculated using magnetic resonance images. Based on the site, oral VMs were observed in the tongue, buccal mucosa, lips, and oral floor in eight, three, five, and one patients, respectively. The average size of the site was 3071 mm3. The average injection dose of polidocanol at one site was 2.86 mL, the average number of administrations was 1.6, and the response rate was 88.2%. No adverse events were observed. The median numerical rating scale scores were 2/10 (0–6/10) and 0/10 (0–1/10) the day after surgery and 1 week after surgery, respectively. Univariate regression analysis of the total dose in successful cases provided the following formula: 1.3 + 0.00025 × volume (mm3) (mg). Polidocanol sclerotherapy is an effective treatment method for oral VM.

D-dimer levels are reported to relate with tumor stage, prognosis, and lymph node involvement, as well as overall survival (OS) in patients with solid tumors. The purpose of this study was to investigate association between the value of D-dimer and the prognosis of oral cancer (OC). We designed a retrospective cohort study and enrolled a sample of patients who were diagnosed with OC and treated with surgery and/or radiotherapy. The predictor was the D-dimer and outcome variable was OS. Other variables included age, neutrocyte count, neutrophil lymphocyte ratio (NLR), C-reactive protein (CRP), and management. Differences in OS rate were analyzed by log-rank test. A Cox proportional hazards model was used to adjust for the effects of potential confounders. Differences with a P value less than 0.05 were considered statistically significant. In 88 patients with OC, D-dimer median value for the predicting OS was 0.7 µg/mL. There was a significant difference in OS when patients were stratified according to D-dimer, with an OS rate of 77.8% for patients with low D-dimer (p = 0.035). Univariate analyses revealed close correlations between OS and age, neutrocyte count, NLR, CRP, and D-dimer (p = 0.006) as independent predictive factors for OS. There was a significant difference in OS when patients were stratified according to D-dimer with low (p = 0.035). Though, as a predictive factor, management was associated with OS.

The technique of covering a mucosal defect with fibrin glue and a polyglycolic acid sheet (MCFP) for the resection of mucosa is applied in oral cancers. The MCFP technique for partial glossectomy provides faster relief from postoperative pain and the prevention of scar contracture, unlike primary closure. However, it has a major complication of postoperative bleeding. This study sought to compare postoperative bleeding between the MCFP technique and primary closure. We designed a retrospective study with a cohort of 57 patients who underwent partial glossectomy with the MCFP technique or primary closure. Our primary predictor variable was the wound closure procedure (primary closure or the MCFP technique). The primary outcome variable was postoperative bleeding, and the other variables were patient characteristics, excision area and depth, tooth contact for the wound, and antithrombotic therapy. Statistical evaluation was performed with Pearson’s chi-squared test, Welch’s t-test, and multiple logistic regression. P < 0.05 was considered statistically significant. The MCFP technique was selected for cases with a large excision area (1433 vs. 963 mm2, P = 0.029). Total postoperative bleeding occurred in 10 of 57 patients (MCFP technique: 7 of 37 cases; primary closure: 3 of 20 cases). There was no significant difference in bleeding between the two groups (P = 0.71). Postoperative bleeding was significant in patients with antithrombotic therapy (MCFP: 40% vs. primary closure: 2%, P = 0.0024). Postoperative bleeding timing was significantly different in the MCFP technique (6.4 days) from that of primary closure (1 day; P = 0.0076). Postoperative bleeding was not associated with the MCFP technique or primary closure. However, postoperative bleeding with the MCFP technique occurred later than that with primary closure. The MCFP technique is not recommended for patients on antithrombotic therapy.

Pulmonary nodules are frequently considered to be a metastatic disease or primary lung tumors in oral cancer patients. We present a case of pulmonary cryptococcosis in a 68-year-old man with oral and lung cancer. This lung cancer was treated with thoracoscopic resection of the right inferior lobe and mediastinal lymph node dissection. Lower gingival cancer was treated with a mandibulectomy, neck dissection, and reconstruction after chemoradiotherapy. A 20 mm cavitary nodule appeared at the left lung S6 one-month after surgery, during post-operative computed tomography. Thoracoscopic partial resection of the left inferior lobe was performed under the suspicion of lung metastasis. Pathology results revealed a pseudo-epithelial granuloma with necrosis and many yeast-shaped fungi with capsules. A pathological diagnosis of Cryptococcus infection was made. The patient was prescribed the antifungal agent fosfluconazole, which was administered intravenously for 1 week and intraoral fluconazole for 12 months. No recurrence of the Cryptococcus infection has been noted after 1.5 years.

The combined squamous cell carcinoma (SCC) with neuroendocrine (atypical carcinoid (AC)) tumor is extremely rare in the head and neck. We present here the first case of SCC with AC arising in the floor of the mouth of 65-year-old man. The tumor is comprised of two components of SCC and AC in the biopsy specimen. Neuroendocrine tumor component was classified as AC from the punctate necrosis and 2–10>/10 HPF. Immunohistochemical staining was HMW-CK/34B (+) and P63 (+) in SCC and synaptophysin (+) and CD56 (+) in AC. The pathological diagnosis of SCC with AC was made from both the morphological and immunological exam. Concurrent chemoradiotherapy was performed with radiotherapy 70.2 Gy and chemotherapy of CDDP and VP-16. Although the treatment effect was complete response both of primary tumor and of neck metastases, the recurrence of the primary tumor was after 6 months. Bilateral modified radical neck dissection and tumor resection of the floor of the mouth with reconstructive surgery of anterior lateral thigh free flap were performed. Although the primary and neck tumor did not recur, the multiple lung metastases and mediastinum lymph node metastases occurred at 6 months after surgery.

A typical carcinoid is extremely rare in the oral cavity. We here present a case of a typical carcinoid arising in the sublingual gland of a 62-year-old woman. The tumor was removed by primary excision with 10 mm surgical margins and submandibular dissection. Examination of the tumor showed medium-sized tumor cells that were positive for CD56 and chromogranin A, with no necrosis, and with a mitotic count less than 1/10 HPF. A pathological diagnosis of typical carcinoid was made from both morphological and immunological examinations. One year after excision surgery, there was no tumor recurrence or neck metastasis.

A 65-year-old woman with rheumatoid arthritis treated by tocilizumab (TCZ) presented with tongue squamous cell carcinoma. While surgery was performed without any complications the aspiration pneumonia rapidly worsened by postoperative day 2 and severe pulmonary suppuration in the right lung field with infection-induced systemic inflammatory response syndrome (SIRS) was diagnosed. Antibiotic and respirator treatment improved her condition. The anti-inflammatory effect of TCZ may mask the symptoms and signs of severe infection with SIRS.

Background. Neuroleptic malignant syndrome (NMS) is a rare but life-threatening complication of neuroleptic drugs, which are used widely in head and neck cancer (HANC) patients who develop delirium. Methods and Results. Postoperative delirium in a 39-year-old man with tongue cancer was treated with haloperidol and chlorpromazine. Three days after the first administration of antipsychotics, the patient exhibited elevated body temperature, autonomic and extrapyramidal symptoms, and impaired consciousness. A definitive diagnosis was made using the research diagnostic criteria for NMS in the DSM-IV, and the antipsychotics were immediately discontinued. The patient was given dantrolene and bromocriptine to treat the NMS. The patient’s hyperthermia, elevated creatinin kinase (CK), and muscle rigidity improved gradually, with all symptoms of NMS resolving completely by 13 days after the diagnosis. Conclusions. HANC surgeons must be alert for early signs of NMS and use antipsychotics conservatively to avoid NMS and its potentially fatal outcome.

Radiation-induced carotid artery stenosis (RI-CS), a life-threatening condition, can occur after external radiation for head and neck cancer. We here describe a case of asymptomatic RI-CS in a 73-year-old patient treated with chemoradiotherapy and radical neck dissection for a basaloid squamous cell carcinoma of the oral floor. Stenosis of the left carotid artery, diagnosed as RI-CS, showed on an MRI performed 1.5 years after radiotherapy. Blood from the left side of the anterior cerebral artery and the middle anterior artery was flowing to the brain through the anterior and posterior communicating arteries, so no stent surgery or other treatment was necessary. The cancer has not recurred during approximately 5 years of followup after radiotherapy, and the patient has had no adverse effects from the RI-CS since it was diagnosed 3.5 years ago. This case emphasizes the necessity of early scrutiny for RI-CS in patients given radiotherapy for oral cancer.

Measurement of chlorophyll a in the Indian sector of the Antarctic Ocean was carried out during the cruise of R. V. KAIYO MARU of the Fisheries Agency, from December 1979 to March 1980. The chlorophyll a content in the surface water was measured at stations from Fremantle to the station of 61°S, 100°E (1/7-1/15,1980) and from the station of 61°S, 120°E to Melbourne (1/27-2/8,1980). The surface water chlorophyll a content in the former course ranged from 0.05 to 0.44mg/m^3,and in the latter it ranged from 0.02 to 0.18mg/m^3. Surface water chlorophyll a was larger on the outward leg than on the homeward leg. The chlorophyll a content at 36 stations which were arranged along five transections in the survey area was measured on water samples taken from 10 layers between the surface and the depth of 200m. The chlorophyll a content ranged from 0.00 to 0.95mg/m^3. The water mass which contained more than 0.5mg/m^3 chlorophyll a could be regarded as a core in the subsurface water. The chlorophyll a peaks were observed near the picnocline at most of the stations.

During the cruise of the R. V. KAIYO MARU (Fisheries Agency of Japan) in the Indian Sector of the Antarctic Ocean from December 1979 to March 1980,the surface observation between Australia and Antarctica and serial observation in the area bounded by 100°-120°E and 61°-65°S off the Budd Coast of Wilkes Land were carried out on board, in order to determine contents of dissolved oxygen, phosphate-phosphorus, silicate-silicon, nitrite-nitrogen and nitrate-nitrogen. Surface observation revealed marked longitudinal changes of nutrient matters related to the existence of the Subtropical Convergence and the Antarctic Convergence. Serial observation showed that distributions of nitrate and phosphate were quite homogeneous below the depth of 100-150m. Relatively low dissolved oxygen content and high silicate content were found up to 100m in the region of about 63°-64°S. This phenomenon may be attributed to the upwelling of water in the region of the Antarctic Divergence. The ratio of nitrate to phosphate in the sea off the Budd Coast was 15.2±0.6 : 1. This ratio was relatively higher than those in other oceans.

Background: Venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT), is known to occur frequently during the perioperative period. Particularly, patients with oral cancer (OC) who undergo reconstructive surgery are at risk of VTE in oral and maxillofacial surgery. Additionally, chemotherapy is an independent risk factor for thromboembolic events in patients with cancer. Case Presentation: In this report, we present three cases that developed PE during OC treatment. One case developed PE during chemotherapy, and the other two cases developed PE and DVT during chemoradiotherapy and the perioperative period. Conclusion: Before treatment, the risk assessment should be undertaken in patients with OC who undergo surgery or chemotherapy. [ABSTRACT FROM AUTHOR]