Hamartomatous proliferations of odontogenic epithelium within the jaws: a potential histogenetic source of intraosseous epithelial odontogenic tumors

BACKGROUND

The jawbone is replete with a vestige of odontogenesis. The overall consensus is that intraosseous remnants of the enamel organ and dental lamina are the only histogenetic option for central epithelial odontogenic tumors. Curiously, incipient tumors or possible precursor conditions of residual odontogenic epithelium have rarely been reported in the literature.

METHODS

We microscopically evaluated 39,660 biopsy samples to determine the presence of a tumor-like odontogenic epithelial nodule in the maxilla and mandible.

RESULTS

Seven intraosseous specimens that associated with a focal proliferation of odontogenic epithelium were retrieved. Six hamartomatous processes showed four different morphologic patterns comparable with the tumor nests comprising ameloblastoma (n = 1), squamous odontogenic tumor (n=1), calcifying epithelial odontogenic tumor (n=2) and calcifying cystic odontogenic tumor (n=2). Among six lesions, four were the intrafollicular development. The remaining case of interest was multiple hyperplastic clear rests of Malassez in association with an impacted tooth.

CONCLUSION

Although it is impossible to predict the fate of these microscopic structures of hamartomatous character, the present case series indicates that any of the dormant embryonic residues of odontogenic epithelium can return to an active state, capable of non-reactive, probably neoplastic proliferation of pathological significance.

Prostatic volume and volume-adjusted prostate-specific antigen as predictive parameters for prostate cancer patients with intermediate PSA levels

The object of the study was to examine the usefulness of volume-adjusted prostate-specific antigen (PSA) parameters for prediction of prostate cancer in the patients with intermediate PSA levels. The subjects were 235 patients with intermediate PSA levels (range: 4.1-10.0 ng/ml) whose prostate volume (PV) and prostate transition zone volume (TZV) were evaluated between August 1996 and April 2004. PSA, PV, TZV, PSA density (PSAD) (PSA/PV) and PSA transition zone density (PSATZD) (PSA/TZV) were assessed with the receiver operating characteristic (ROC) curve and the area under the curve (AUC). Simple and multivariate logistic regression analyses were used to analyze the odds ratios of age, PSA, PSAD, PSATZD, PV, TZV, digital rectal examination (DRE) and transrectal ultrasonography (TRUS) findings. Fifty-five patients (23.4%) of 235 patients had biopsy-proven prostate cancer. The univariate analysis revealed significant differences in the mean values of age, PSAD, PSATZD, PV, TZV and DRE between the patients with cancer and the non-cancer patients. The ROC curve analysis revealed that PV, TZV, PSAD and PSATZD had significant predictive values as compared with that of PSA. However, there was no difference in AUC between them. The stepwise logistic regression analysis showed that the age, PV, PSATZD and DRE had significant predictive values, and that PSATZD had the most predictive power. In conclusion, both PSAD and PSATZD had significant predictive values in discriminating prostate cancer. Furthermore, the stepwise logistic regression analysis showed that PSATZD had the strongest predictive value.

Indoor organophosphate and polybrominated flame retardants in Tokyo

In Japan, organophosphate and polybrominated flame retardants are used in building materials and electric appliances to protect them from fire hazards. In this study, to identify the emission sources of these flame retardants to indoor air, the migration rates (flux) of organophosphate and polybrominated flame retardants from building materials and electrical appliances to solid extraction disks that were placed in contact with the interior surfaces were measured. In addition to the migration test, indoor air and outdoor air concentrations of these flame retardants were investigated. With regard to building materials in a newly built house, triethylphosphate (TEP) and tributylphosphate (TBP) were detected in the wall and ceiling coverings, and tris(2-butoxyethyl)phosphate (TBEP) was detected in the wooden flooring cleaned with a floor polish agent. With regard to electrical appliances, triphenylphosphate (TPHP) was predominantly detected in computer monitors and tris(2-chloroethyl) phosphate (TCEP) in television (TV) sets, with the highest median levels. Among the polybrominated compounds, only 2,2',4,4'-tetrabromodiphenyl ether (BDE-47) was detected from a few old TV sets manufactured before 1995. In an indoor and outdoor air survey, nine organophosphates and nine polybrominated flame retardants were detected from indoor air. In outdoor air, only four organophosphate flame retardants were detected. The maximum level of indoor organophosphate compounds was 1260 ng/m(3) with tris(2-chloro-1-methylethyl) phosphate (TCPP), and that of polybrominated compounds was 29.5 ng/m(3) with hexabromocyclododecane (HBCD). Tetrabromobisphenol A (TBBPA) was not detected in this study, although it has the largest demand among flame retardants in Japan. The results of the migration test and the indoor air survey revealed that in indoor air, organophosphate compounds were more predominant than polybrominated compounds in Tokyo.

PRACTICAL IMPLICATIONS

Polybrominated biphenyls (PBB) and polybrominated diphenyl ethers (PBDE) are commonly used as flame retardants in plastics. The use of these two compounds in electric appliances will be banned in 2007 by the EU Directives on waste electrical and electronic equipment (WEEE) and on the restriction of the use of certain hazardous substances (RoHS) in electrical and electronic equipment. In Japan, the use of PBB was banned and that of PBDE diminished in the early 1990s by the self-imposed controls of the Japanese Flame Retardants Conference (Akutu and Hori, 2004). In Japan, the predominantly used organic flame retardants were tetrabromobisphenol A and organophosphate compounds. Tetrabromobisphenol A has been reported to disrupt endocrine systems (Kitamura et al., 2005), and some organophosphate flame retardants were recently reported to have neurochemical hazardous effects. Furthermore, organophosphate compounds were suspected to cause endocrine-disrupting effects (Fang et al., 2003; Ohyama et al., 2005) or attention deficit hyperactivity disorder (ADHD) (Winrow et al., 2003). In this study, organophosphate and polybrominated flame retardants were surveyed in indoor environments in Tokyo.

Intraparotid pseudoglandular schwannoma

A unique intraparotid location of a rare pseudoglandular schwannoma is described. Although the diagnosis of schwannoma could readily be substantiated, accurate subtyping was initially mislabeled. The pitfall was in failing to acknowledge the presence of multiple well-formed gland-like structures, which is instantly thought to be cystically dilated salivary ducts. Immunohistochemically, epithelial-appearing cells lining the duct-like spaces proved to be schwannian in nature. Interpretation of an immediately recognizable gland-like architecture is more problematic when a pseudoglandular variant originates from a nerve coursing through the gland, as here.

Effective dose of A-bomb radiation in Hiroshima and Nagasaki as assessed by chromosomal effectiveness of spectrum energy photons and neutrons

The effective dose of combined spectrum energy neutrons and high energy spectrum gamma-rays in A-bomb survivors in Hiroshima and Nagasaki has long been a matter of discussion. The reason is largely due to the paucity of biological data for high energy photons, particularly for those with an energy of tens of MeV. To circumvent this problem, a mathematical formalism was developed for the photon energy dependency of chromosomal effectiveness by reviewing a large number of data sets published in the literature on dicentric chromosome formation in human lymphocytes. The chromosomal effectiveness was expressed by a simple multiparametric function of photon energy, which made it possible to estimate the effective dose of spectrum energy photons and differential evaluation in the field of mixed neutron and gamma-ray exposure with an internal reference radiation. The effective dose of reactor-produced spectrum energy neutrons was insensitive to the fine structure of the energy distribution and was accessible by a generalized formula applicable to the A-bomb neutrons. Energy spectra of all sources of A-bomb gamma-rays at different tissue depths were simulated by a Monte Carlo calculation applied on an ICRU sphere. Using kerma-weighted chromosomal effectiveness of A-bomb spectrum energy photons, the effective dose of A-bomb neutrons was determined, where the relative biological effectiveness (RBE) of neutrons was expressed by a dose-dependent variable RBE, RBE(gamma, D (n)), against A-bomb gamma-rays as an internal reference radiation. When the newly estimated variable RBE(gamma, D (n)) was applied to the chromosome data of A-bomb survivors in Hiroshima and Nagasaki, the city difference was completely eliminated. The revised effective dose was about 35% larger in Hiroshima, 19% larger in Nagasaki and 26% larger for the combined cohort compared with that based on a constant RBE of 10. Since the differences are significantly large, the proposed effective dose might have an impact on the magnitude of the risk estimates deduced from the A-bomb survivor cohort.

Inter-criteria reproducibility of RECIST, WHO, Japanese response criteria for gastric cancer or esophageal cancer: From the response dataset of Japan Clinical Oncology Group (JCOG) phase III trials

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Background: For assessments of tumor response in upper gastrointestinal cancers, Japanese criteria (JPN), which needs X-ray or endoscopic findings for primary lesion, has been generally used in Japan instead of international RECIST or WHO criteria. To compare the inter-criteria reproducibility of these radiological assessments, we analyzed the datasets of tumor responses from two phase III trials. Methods: A total of 115 gastric cancer patients in two treatment arms of JCOG9205, 5-FU and 5-FU plus cisplatin, and 103 esophageal cancer patients in a neoadjuvant 5-FU plus cisplatin arm of JCOG9907 were eligible for this analysis. Overall response rates (ORR) were calculated according to each of three criteria. The tumor responses, furthermore, were divided into four categories (CR, PR, SD, PD), following estimation of kappa statistics between two criteria as agreement measure. Results: As shown in the Table , ORR according to RECIST and WHO were very similar in both cancers. JPN tended to estimate higher ORR comparing to RECIST or WHO, particularly in esophageal cancer. In gastric cancer, kappa for concordance to RECIST were 0.92 for WHO and 0.86 for JPN. While in esophageal cancer, kappa were 0.72 for WHO and 0.40 for JPN. Conclusions: In these trials for gastric cancer and esophageal cancer, there was fairly consistent reproducibility between unidimensional RECIST and bidimensional WHO criteria. JPN criteria, depending on assessment of primary lesion, may give higher ORR particularly in esophageal cancer, and cautious interpretation may be necessary when evaluating ORR from Japanese trials using JPN criteria (Table). Overall response rates of respective treatment arms calculated according to RECIST, WHO and JPN criteria.

[Table: see text]

No significant financial relationships to disclose.

Awareness of the Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2000) and compliance to its recommendations: surveys in 2000 and 2004

Clinic physicians' awareness of the Japanese hypertension guideline (JSH 2000) and compliance with its recommendations were assessed to derive policy implications for effective blood pressure control. Data were obtained from two postal questionnaire surveys conducted in 2000 and 2004, and subjects were 896 and 1425 clinic physicians, respectively, who were engaged in general internal medicine. Recognition rates of JSH 2000 were 63.1% (n = 822) before its announcement in 2000 and 94.4% (n = 1400) in 2004. Rates of access, familiarity and utilisation of JSH 2000 were 87.0, 81.6 and 68.9%, respectively (n = 1400) in 2004. As for major management strategies for low-risk hypertension: in 2000, for patients with 140-149/90-94 mmHg, 81.5% of 812 respondents performed lifestyle modification, and 11.2% prescribed medicines, whereas for patients with 150-159/95-99 mmHg, 71.7% of 807 respondents prescribed medicines, and 24.3% conducted lifestyle modification; in 2004, 90.0% of 1384 respondents conducted lifestyle modification, 22.6% prescribed medicines, 2.5% referred patients to other facilities, and 6.4% did nothing. In 2004, 68.9% of 1388 respondents agreed with the new definition of hypertension, whereas 17.1% preferred 160/95 mmHg. Respondents' age (P<0.05) and a percentage of hypertensives in daily patient load (P<0.0005) significantly associated with the choice of the old criteria. In conclusion, JSH 2000 achieved a substantial improvement in clinic physicians' awareness and their compliance to its recommendations on low-risk hypertension management. One of the strategies for further enhancement in their compliance with JSH 2004 would be its dissemination to those who are old and/or do not see hypertensive patients so frequently.

Peripheral odontogenic tumor: a clinicopathologic study of 30 cases. General features and hamartomatous lesions

BACKGROUND

Peripheral odontogenic tumors (POT), either neoplastic or hamartomatous, are rare. This study briefly summarizes the general features of POT and selectively reviews the histomorphologic spectrum of under-recognized hamartomatous lesions that we have designated peripheral odontogenic hamartomas (POH) in order to shed more light into the pathogenesis of POT.

METHODS

Archival material accessioned at our institutions between 1970 and 2004 was systematically searched to identify examples of POT/POH.

RESULTS

Among 39 660 biopsies, we retrieved 25 cases of 'classical' POT and five cases of 'unique' POH. Odontogenic fibroma and ameloblastoma were by far the most common. Of POH, two purely epithelial lesions showed multiple strands of basaloid rests [odontogenic gingival epithelial hamartoma (OGEH)] and a conglomerate of polyhedral epithelium, ghost cells and concentric calcifications (calcifying epithelial odontogenic tumor-like hamartoma), respectively. OGEH and peripheral squamous odontogenic tumor (PSOT) deserve to be a related entity. In two types of mixed POH, ectomesenchymal elements appeared juxtaposed to the squamous lining (gingival cyst-like organoid hamartoma) and ghost cells aggregated in the enamel organ of a microdont (peripheral odontoma). None of POH exhibited continuity with the surface epithelium.

CONCLUSION

On the basis of this relatively limited series of cases, POH, to conceptualize a unified histogenetic source, are speculated to arise from the soft-tissue remnants of dental lamina. Gingival rests of Serres seem to retain the ability to pursue epithelial-ectomesenchymal interactions that are necessary leading to odontoma formation.

Preliminary results of moisture checker for Mucus in diagnosing dry mouth

OBJECTIVE

To evaluate the ability of Moisture Checker for Mucus (MCM), a device which measures the weight percent of water content in the oral mucosal epithelium, for the diagnosis of dry mouth.

METHOD

Forty-three consecutive patients seen at the Dry Mouth Clinic of Tsurumi University were divided into two groups by the diagnostic criteria of hyposalivation defined by the stimulated salivary flow rate < or =10 ml per 10 min. The MCM values in the buccal, tongue and labial mucosa in each group were compared.

RESULTS

The value of the normal salivation group was significantly higher when compared with that of the hyposalivation group both in the buccal and tongue mucosa, P = 0.01 and P = 0.046, respectively.

CONCLUSION

Moisture Checker for Mucus has the potential to be a useful device in the screening of hyposalivation.

Ameloblastoma ex calcifying odontogenic cyst (dentinogenic ghost cell tumor)

Calcifying odontogenic cyst (COC) has shown to be of extensive diversity in its clinical and histopathological features, as well as in its biological behavior. In this report, a rare case is described of ameloblastoma ex COC (dentinogenic ghost cell tumor) and the relevant literature is briefly reviewed.

Influences of mothers' dieting behaviors on their junior high school daughters

We investigated the influences of mothers' dieting behaviors on their junior high school daughters. We assessed dieting behaviors and eating habits in 221 pairs of mothers and their junior high school daughters using questionnaires. The subjects were classified into an extraordinary-diet (Ex-D) group, who attempted to diet rapidly with unhealthy methods, a structured-diet (St-D) group, who attempted to diet gradually with healthy methods, and a non-diet (N-D) group, using the questionnaire scores. 1) A significant correlation was observed in the distribution of dieting behavior groups between the mothers and their daughters. 2) The scores for dieting behavior of the mothers whose daughters were classified into the Ex-D group were significantly higher in several question items compared with those of the mothers whose daughters were classified into the N-D group. 3) The scores for eating consciousness of the mothers whose daughters were classified into the Ex-D group were significantly lower for the item "Cooking is a fun pastime" compared with those of the mothers whose daughters were classified into the St-D or N-D groups. 4) The number of experiences of conversation with daughters about diet for the mothers whose daughters were in the Ex-D group was significantly higher than that for the mothers whose daughters were classified into the N-D group. The mothers' dieting behavior, eating consciousness, and number of conversations with daughters about diet influenced dieting behaviors in their junior high school daughters. Appropriate education of mothers would be useful to prevent their daughters' inappropriate diet.

Unrelated donor bone marrow transplantation for 100 pediatric patients: a single institute's experience

In all, 100 unrelated donor bone marrow transplantations (UD-BMT) were performed in our institute between October 1993 and January 2003. Of 93 evaluable patients, 73 patients had hematological malignancy, 13 had nonmalignancy and seven had lymphoproliferative disease. The estimated 9-year event-free survival (EFS) rate was 57.1+/-5.5% in all patients. In the following analyses of the patients with hematological malignancy, the standard group had significantly better EFS than the high-risk group (61.5+/-7.0 vs 35.6+/-9.7%, P=0.02), and the EFS rate of the tacrolimus (FK-506)+methotrexate (MTX)+/-methylprednisolone prophylactic group for graft-versus-host disease was superior to that of the FK-506 without MTX group (75.7+/-8.0 vs 55.8+/-7.6%, P=0.02). When we compared the EFS rates of the FK506+MTX+/-methylprednisolone (mPSL) group and the HLA-matched related donor BMT group in our institute, these were almost similar (75.7+/-8.1 vs 68.4+/-9.3%). Therefore, UD-BMT using FK-506+MTX+/-mPSL is a safe and useful method for children with hematological malignancy who require allogeneic BMT.

Unilateral agenesis and hypoplasia of the internal carotid artery: a report of three cases

We report one patient with agenesis and two with hypoplasia of the internal carotid artery (ICA) from an angiographic series of 1275 consecutive patients. In all three patients, MRI and MR angiography were used to establish the anatomical situation; however, they may not clearly distinguish between hypoplasia and agenesis or acquired stenosis or occlusion of the ICA. In such cases, CT of the skull base may be obtained to clarify matters. In all patients, retrograde flow via a large posterior communicating artery was demonstrated. Single-photon emission computed tomography confirmed both the adequacy of cerebral perfusion and the preservation of vasomotor reactivity.

Sclerosing mucoepidermoid carcinoma of the oral cavity

Sclerosing mucoepidermoid carcinoma (SMEC) with eosinophilia is a rare but distinctive tumor usually affecting the thyroid. SMEC involvement of salivary gland is exceptional, with only six cases in the literature. We present here the first case of an intermediate-grade SMEC, arising from the intraoral minor salivary glands. A particularly interesting finding is the cytoplasmic accumulation of eosinophilic hyaline granules in carcinoma cells, similar to aberrant zymogen-like granules previously described in salivary sclerosing polycystic adenosis.

Fifteen to twenty-eight years' follow-up results of high tibial valgus osteotomy for osteoarthritic knee

A long-term follow-up study was performed on 75 knees of 53 patients after high tibial valgus osteotomy. The earlier results have previously been reported. There were 15 knees in 11 men and 60 knees in 42 women. The follow-up period ranged from 15 to 28 years with a mean of 19 +/- 3 years. The age at osteotomy ranged from 46 to 73 years with a mean of 59.6 +/- 6.7 years. The diagnosis was medial compartmental osteoarthritis (OA) in 68 knees (46 patients) and spontaneous osteonecrosis of the medial femoral condyle in 7 knees (7 patients). Valgus osteotomy was performed above the tibial tuberosity, with removal of a laterally based wedge in all cases, aiming for anatomical valgus angulation of 10 degrees . The American Knee Society Score showed a Knee Score of 37 +/- 20 and a Function Score of 38 +/- 16 preoperatively and 87 +/- 13 and 80 +/- 19 at the final 15 to 28 years' follow-up. The femoro-tibial angle in standing was 186 +/- 6.5 degrees (6 degrees of anatomical varus angulation) before and 171 +/- 7.5 degrees (9 degrees of anatomical valgus angulation) at final follow-up (p < 0.0001), with no apparent loss of limb alignment.

Indoor air pollution by alkylphenols in Tokyo

The purposes of this study were to develop an analytical method for airborne alkylphenols (APs) using the gas chromatography/mass spectrometry (GC/MS)-SIM method and to investigate airborne C4-C9 APs pollution in houses, offices, and outdoor points in Tokyo. In addition, to identify APs emission sources in a newly built house, migration tests of APs from interior surfaces to solid extraction disks were performed. Air samples were collected from houses, offices, and outdoor points. The recovery of APs from air samples was increased by addition of ascorbic acid to the filters. 4-tert-butylphenol (4-t-BP), 4-tert-octylphenol (4-t-OP), and 4-nonylphenol (4-NP) were detected in both indoor and outdoor air. Their concentrations and detection frequencies were higher in indoor air than outdoor air. The maximum levels of 4-t-BP, 4-t-OP, and 4-NP in indoor were 387, 45.7, and 680 ng/m(3), respectively. 4-t-BP and 4-NP were detected with high frequencies (more than 97%) in indoor air samples. The concentrations of 4-t-BP, 4-t-OP, and 4-NP in indoor air were significantly correlated with room temperature (P < 0.01), and tended to be higher in newly built houses. The migration rates of APs from the floor, wall, and ceiling in the newly built house were higher in polyvinyl chloride coverings than in other materials. Practical Implications Alkylphenol ethoxylate (APE) are widely used surfactants in both industrial and domestic detergents. When these detergents are released into the environment, APE are biodegraded to the smaller chain ethoxylates and alkylphenols (APs). There are many reports about APs in aquatic environments because of their estrogenic effect on wildlife. In building materials, APs are used as antioxidant for polymer resins such as wall or floor coverings. Although APs has a lower vapor pressure, these agents are released into indoor air from the surface of polymer resins. This study surveyed concentrations of airborne AP in indoor air and outdoor air in Tokyo. In addition, to identify APs emission sources in a newly built house, migration tests of APs from interior surfaces to solid extraction disks were performed.

PRACTICAL IMPLICATIONS

Alkylphenol ethoxylate (APE) are widely used surfactants in both industrial and domestic detergents. When these detergents are released into the environment, APE are biodegraded to the smaller chain ethoxylates and alkylphenols (APs). There are many reports about APs in aquatic environments because of their estrogenic effect on wildlife. In building materials, APs are used as antioxidant for polymer resins such as wall or floor coverings. Although APs has a lower vapor pressure, these agents are released into indoor air from the surface of polymer resins. This study surveyed concentrations of airborne AP in indoor air and outdoor air in Tokyo. In addition, to identify APs emission sources in a newly built house, migration tests of APs from interior surfaces to solid extraction disks were performed.

Observation of three cases of temporomandibular joint osteoarthritis and mandibular morphology during adolescence using helical CT

Temporomandibular joint (TMJ) osteoarthritis (OA) is a potential cause of craniofacial deformity. If TMJ OA appears during orthodontic treatment, the mandible usually rotates posteriorly, resulting in an unsatisfactory profile, especially in patients with pre-treatment mandibular retrusion. Although it is important to confirm the kind of TMJ pathosis at the start of orthodontic treatment, the relationship between TMJ OA, condylar remodelling and changes in craniofacial morphology remains unclear because of a lack of longitudinal studies. Elucidating this relationship might allow better prediction of post-treatment craniofacial morphology. In the present case reports, helical computed tomography and cephalometry were used to analyse relationships between the pattern and location of condylar remodelling and the changes in craniofacial morphology in three patients with TMJ OA.