Atsushi Shinohara

Clinicopathological significance of carbonic anhydrase 9, glucose transporter-1, Ki-67 and p53 expression in oral squamous cell carcinoma.

Carbonic anhydrase 9 (CA9) is a glycoprotein present on the surface of cell membranes. It is expressed in 90% of renal cancer cells, but not in normal kidney tissue. Immunotherapy targeting CA9 is underway, and our group has also conducted a clinical trial using CA9 as a cancer vaccine and confirmed the induction of cytotoxic T lymphocytes, with efficacy in some cases. Expression of CA9 antigen in oral cancer has not been reported in Japan, but our results indicate that immunotherapy targeting CA9 might be possible. We immunohistochemically observed the expression of antigens such as CA9, Ki-67, glucose transporter-1 (GLUT-1) and p53 in 107 subjects with oral squamous cell carcinoma, and examined their correlation with clinicopathological parameters. Immunostaining analysis showed expression of CA9 in 98% of oral cancer subjects, and the survival rate was significantly lower in subjects with CA9 antigen expression in 50% or more cells (P<0.05). Subjects with poorly differentiated, T4 and lymph node metastasis, or Stage IV cancer with high CA9 expression (≥50%) had a worse outcome than those with low CA9 expression. Although GLUT-1 expression was observed in 98% of subjects, similarly to CA9 expression, no significant correlation between its expression and the survival rate was seen. However, subjects with lymph node metastasis had significantly higher GLUT-1 expression, demonstrating that GLUT-1 could be an indicator of lymph node metastasis. Ki-67 was expressed in 92% of subjects, but no correlation with outcome was observed. Expression of p53 was noted in 78% of subjects, and it was found that many oral cancers have p53 genetic abnormalities, but no correlation between p53 and outcome was observed. It was confirmed that CA9 antigen is expressed in most oral cancer subjects, suggesting the possibility of immunotherapy targeting CA9 antigen in oral cancer.

A Tonsillolith: Possible Cause of Halitosis

CLINICAL PRESENTATION A 72-year-old man was referred to our hospital with a complaint of a foreign body sensation in his throat. He had also been warned about his bad breath (halitosis) by his friends. We found a yellow hard mass protruding from the crypts of the left palatine tonsil (Figure 1A, white arrow). A computed tomography scan revealed a calcification in the supratonsillar fossa (Figure 1B, white arrow). We diagnosed it as a tonsillolith, and it was safely removed by curettage. The postoperative course was good, and his symptoms including bad breath disappeared immediately. Pathologically, actinomycetes were found surrounding the stone. These bacteria may be a possible cause of halitosis. Because many people tend to worry about halitosis, a tonsillolith should be considered in the differential diagnosis of halitosis.

Minimally invasive endoscopic osteosynthesis for frontozygomatic fracture: a new approach.

Abstract Miniplate fixation on the lateral face of the orbital rim using existing endoscopic methods for frontozygomatic fracture still has some disadvantages, such as cosmetic disturbance from the lateral brow incision for the trocar, and abnormal palpability of the miniplate. We applied a new method of endoscopic osteosynthesis by access through temporal incisions alone and miniplate fixation on the lateral temporal face of the frontozygoma. Postoperative courses were uneventful in all four cases treated, and we achieved cosmetic improvement (minimizing incision and scars) as well as decreased palpability of the miniplate.

Tortuous innominate artery simulating a supraclavicular subcutaneous tumour.

When a subcutaneous mass is noticed in the anterior neck of a patient, we usually consider a diagnosis of skin tumour, lymph node swelling (1), or thyroid tumour (2). Vascular diseases, such as a tortuous major artery, aneu-rysm, or haemangioma are extremely rare (3–7). We describe here a case of a right tortuous innominate artery in which it proved impossible to detect pulsation because of the skeleto-muscular structures shielding the affected area. If either an aspiration or an open biopsy were to be performed near a tortuous innominate artery simulating a subcutaneous mass, a major artery might be damaged, possibly with lethal consequences. We present here clinical findings that call for caution in dealing with a tortuous innominate artery simulating a supraclavicular subcutaneous tumour.CASE REPORTA 73-year-old woman presented at our hospital complaining of an anterior neck mass that she had noticed only 4 weeks previously. She was not obese (BMI = 19.3), nor was her medical history regarding hypertension, hyperlipidaemia and syphilis particularly remarkable. She had no dyspnoea or dysphagia, but her husky voice and severe throat discomfort were clearly alarming. A fibroscopic examination revealed no abnormality in the pharynx or larynx. We palpated a 1.5-cm subcutaneous mass in the right supraclavicular fossa (Fig. 1), but were unable to detect any obvious pulsation of the mass. Ultrasonography revealed that our access to a view within the mass was blocked by the clavicle, which covered the lower part of the mass. Computerized tomography (CT) showed a tortuous innominate artery protruding from the mediastinal space (Fig. 2A). In addition, magnetic resonance angio-graphy (MRA) revealed that the forward and lateral arterial bending becomes the substance of the mass (Fig. 2B). From these examinations, we diagnosed it as a tortuous innominate artery simulating a subcutaneous neck tumour. Since her symptoms were not accompa-nied by neurological signs, we kept the patient under careful observation for 12 months. DISCUSSIONThis case revealed a tortuous innominate artery, which had initially been observed as a subcutaneous mass within a supraclavicular lesion. We could detect no obvious pulsation of the mass, but subsequent CT and magnetic resonance imaging (MRI) revealed a tortuous innominate artery. From our experience, when a sub-cutaneous tumour occurs near the clavicle, one should look for signs of an abnormal course of the innominate arteries, since their evanescent character is related to blood pressure levels (4). Initially, a radiological survey including CT, MRI, or MRA should be conducted.

Oral Appliance Therapy for Mild Obstructive Sleep Apnoea Syndrome

Abstract We report a 42-year-old man who was admitted to the Aichi Medical University Hospital, Aichi, Japan, following cardiac arrest and was successfully revived using an automated external defibrillator. Percutaneous catheter intervention was performed and a cardioverter-defibrillator was implanted. The patient was also diagnosed with mild obstructive sleep apnoea syndrome and treated using an oral appliance. His apnoea-hypopnoea index improved from 13.5/ hour to 2.7/hour following the oral appliance treatment, which was continued for more than 3 years after his discharge.

Fundamental Studies on Tissue Reaction after Low Power Laser Irradiation

It is generally recognized that the lower power Nd: YAG laser provides some therapeutic effects on tissue without irreversible changes. On the other hand, high power laser causes irreversible changes. The criterion about low and high power laser is, however, not established. The aim of this study is to verify the effect of lower and high power laser on wound healing of rat skin by measuring blood flow and histomorphologic findings with HE and SEM. Each laser were irradiated to the center of 6mm round full-thickness skin defect at the back of the rat at either (1) 300mW×3min, (2) 500mW×3min, (3) 700mW×3min, (4) 300mW×20min, (5) 500mw×20min, (6) 700mW×20min.The results obtained are as follows;1) The histological findings showed that irradiation time caused more tissue damage in the deeper layer, whereas irradiation power caused more damage to the surrounding tissue.2) Small craters were starred on the bottom of the damaged tissue by laser irradiation at 700 mW x 20min. The formation of these craters was related to the absorption of laser irradiation.3) On the irradiated area, blood volume decreased significantly as irradiation power increased. However, both blood flow and tissue damage increased as irradiation time increased. As for the surrounding tissue, the findings showed an increase in the blood flow and tissue damage as irra diation power increased.4) High power laser at 700mW caused tissue damage regardless of irradiation time. On the other hand, 500mW irradiation power caused minimum damage to the tissue. Therefore, the range between 300 to 500mW and the irraditation time over 3min to less than 20min are classified as a lower power laser.

The Effect of Low-Power Laser Irradiation

We postulated that low-power laser irradiation could produce analgesia, nerv ous activation, and enhancement of wound healing in association with changes in the microcirculation. In order to confirm this hypothesis, we monitored blood flow in rats be fore and after laser treatment. A Ga-Al-As semiconductor laser (wave length: 810nm) was used. Rats were treated at either (1) 300mW×3min, (2) 500mW×3min, (3) 700mW×3min, (4) 300mW×20min, (5) 500mW×20min, or (6) 700mW×20min. Blood flow was monitored in the dorsal skin before and after irradiation using a Laser-Doppler flowmeter. The peripheral circu lation was improved by 20min of irradiation with a 300mW or 500mW semiconductor laser without any irreversible tissue damage, and it was inferred that tissue restoration would result from this change. Different responses were produced depending on the irradiation condi tions, and this suggested that there is a safe range between transition from non effective to effective and from effective to irreversible damage. This range was considered to be the saf est and most effective for low-power laser treatment.