Kunichika Yamamoto

Preoperative concurrent chemoradiotherapy plus radical surgery for advanced squamous cell carcinoma of the oral cavity: an analysis of long-term results.

Locoregionally advanced squamous cell carcinomas of the head and neck continue to be a major clinical problem. We demonstrated in 1996 that preoperative concurrent cisplatin- or carboplatin-based chemotherapy and radiotherapy plus radical surgery in advanced oral cancer had minimal toxicity, had high clinical tumor response rates, was well tolerated and produced impressive complete response rates and a high 5-year survival rate. The purpose of the present study was the long-term follow-up of this treatment regimen for advanced oral carcinoma. Forty-eight patients with squamous cell carcinoma of the oral cavity (including soft palate) were treated preoperatively with cisplatin- or carboplatin-based chemotherapy in combination with simultaneous irradiation to a target volume of 40 Gy, and 2-6 weeks later underwent curative surgery. All patients with advanced Stage II (n=7), Stage III (n=22) and Stage IV (n=19) were treated and followed for an average of 7.2 years (range: 61-144 months). The overall actuarial survival of all patients was 81.3% at 5 years and also at 10 years. Progression-free survival at both 5 and 10 years was 84.8% for all patients, and 85.7% for Stage II, 90.0% for Stage III, and 78.9% for Stage IV patients. Progression-free survival rates according to the histopathologic regression grade of primary tumor following preoperative chemoradiotherapy at 10 years were 40. 0% for Grade IIa, 88.9% for Grade IIb, 100% for Grade III, and 87.5% for Grade IV. Patients who achieved good responses histopathologically (Grades IIb, III, IV) had superior survival rates in comparison to patients with extensive residual tumor (Grade IIa) in surgically resected specimens (p=0.0012). A better histologic regression grade was also associated with a higher survival rate even in the long-term analysis. This treatment regimen for advanced oral cancer produced high clinical and pathologic complete response and survival rates with an acceptable acute toxicity profile and lack of late therapeutic complications. The long-term follow-up showed gratifying results even for advanced oral cancers without a substantial increase in distant metastasis and second primary malignancy.

Genetic changes in prostate cancer.

Recent advances in molecular biology have allowed us to understand that it is the accumulation of genetic alterations which leads to each step of tumor genesis. What the specific alterations may be, however, often varies with each neoplasm. Prostate cancer is somewhat unique in its presentation to the pathologist of a bewildering array of histologies difficult to assign to diagnostic categories and contributing to misinterpretations of underlying molecular events. As with any malignancy, It is of utmost importance to thoroughly analyze and record the genetic aberrations found in prostate cancer with the objective of correlation to the pathology and natural history of the disease. Multiple ontogeny and tumor suppressor genes have been investigated in both clinical and latent cancers using conventional mutational analyses. To probe deeper Into these genes and to uncover novel molecular events, genomic tumor DNA were examined using restriction landmark genomic scanning (RLGS), a method which allows the Identification and comparison of specific genetic alterations within large segments and multiple samples of DNA at a time. This article reviews what has been identified based on numerous molecular studies, focusing on the genetic alterations peculiar to human prostate cancer.

Genomic aberrations in renal cell carcinomas detected by restriction landmark genomic scanning.

In order to reveal and characterise genetic events occurring in renal tumorigenesis, samples of sporadic renal cell carcinomas (RCCs) were examined using restriction landmark genomic scanning (RLGS), an electrophoretic separation technique which detects gene amplification and deletion. We were able to find two fragments frequently amplified and 10 others commonly showing reduced signal intensity within the 16 tumour samples analysed. These altered spots were located on chromosomes 2, 3, 9-12, 16, 17 and 18 according to chromosomal assigned RLGS. A subset of reduced fragments appeared to be correlated to tumour type and were located within a new chromosomal region, suggesting genetic specificity within the process of renal carcinogenesis.

Genomic alterations in oral squamous cell carcinoma cell lines detected by two-dimensional gel analysis

To initially analyze the genomic abnormalities in human oral squamous cell carcinoma, DNA extracted from each of four oral carcinoma cell lines (Ca9-22, HO-1-u-1, HSC-2, KB) was examined using restriction landmark genomic scanning (RLGS), a method especially conducive to detection of amplifications and rearrangements of genomic DNA. Isolated cell line and normal oral epithial DNAs were sequentially cleaved with specific restriction enzymes, radiolabelled and separated in two-dimensional gel electrophoreses. Thirteen distinct fragments were commonly amplified in the oral cancer cell lines, six of which were evident in all samples. These results suggest genetic alterations characteristic of oral squamous cell carcinogenesis.

Tooth Extraction in Congenital Protein C and Protein S Deficiency — Management of Thrombotic Risk

Abstract Tooth extraction was performed in 1 patient with protein C deficiency and another with protein S deficiency — congenital hypercoagulation disorders. The clinical management of these patients is described.

Risk Factors Affecting Duration of Management of Odontogenic Maxillofacial Cellulitis

Abstract Purpose: To elucidate the risk factors influencing the duration of management of odontogenic maxillofacial cellulitis. Patients and Methods: Forty five consecutive patients with odontogenic maxillofacial cellulitis were enrolled. By a retrospective chart review, the duration of surgical drainage was investigated in relation to the following variables: age, body temperature at presentation, underlying medical conditions (diabetes mellitus and liver disease), number and location of involved surgical spaces, duration from the onset of inflammatory swelling to surgical drainage, and laboratory findings. Results: Age, body temperature, number and location of involved spaces, and duration from the onset of inflammatory swelling to surgical drainage strongly correlated with duration of surgical drainage. Furthermore, patients older than 50 years with a body temperature of 37.8°C or higher, 4 or more involved spaces, deep site infection, duration from the onset of inflammatory swelling to surgical drainage of 6 days or more, and diabetes mellitus indicated significantly longer duration of surgical drainage than other patients. Conclusion: These results contribute to predicting the duration of management of odontogenic maxillofacial cellulitis based on the correlations reported.