Taiichi Nishimura

Differentiation between benign and metastatic cervical lymph nodes with ultrasound

OBJECTIVE The differentiation between benign and metastatic lymph nodes with ultrasound (US) is based primarily on the evaluation of size, shape, margin and internal echo structure. The aim of this study is to determine whether these parameters are reliable indicators and to correlate internal echo structure and histopathological findings. MATERIALS AND METHODS Seventy-one nodes in 21 patients with pathologically proven oral squamous cell carcinoma were examined. The shortest diameter, the short/long diameter ratio (S/L ratio), margins and internal echo structure of the lymph node were evaluated by US. The internal echo structure was divided into six patterns: homogeneous hypoechoic, homogeneous hyperechoic, heterogeneous, eccentric hyperechoic, centric hyperechoic and anechoic pattern. In addition, internal echo structure was correlated with histopathological findings. RESULTS In 71.4% of the metastatic nodes, the shortest diameter was more than 10 mm and the S/L ratio was higher than that of benign nodes (average 0.71). Eleven (84.6%) of the 13 lymph nodes with irregular margins were metastatic. Heterogeneous and anechoic patterns were observed in metastatic nodes, whereas homogeneous hypoechoic and eccentric hyperechoic patterns were present in benign nodes. On ultrasonography with the corresponding histopathological findings, echogenic areas in the homogeneous hyperechoic, heterogeneous and centric hyperechoic patterns of metastatic nodes proved to be necrosis or fibrosis. Eccentric hyperechoic areas in benign nodes corresponded to the hilus and surrounding fatty tissue. CONCLUSIONS The shortest diameter, S/L ratio, margin and internal echo structure were considered to be critical indicators to differentiate between benign and metastatic nodes. Secondary changes caused by tumour infiltration, necrosis, or fibrosis should be assessed when metastatic lymph nodes are differentiated from benign ones by internal echo structure.

The origin of bone formed by heterotopic periosteal autografts

PURPOSE This study tested the hypothesis that a significant amount of the new bone produced by heterotopic periosteal autografts is derived osteoinductively because proliferating periosteal cells express the bone morphogenetic protein (BMP). MATERIALS AND METHODS Rabbit ulnar and radial periosteum were autografted as free grafts (FGs) to the forelimb musculature, and as millipore diffusion chambers grafts (MDCGs) to the rectus abdominus muscle. The grafts were recovered at 3, 5, 7, 14, and 28 days postoperation, fixed in 4% paraformaldehyde, demineralized in 0.6N HCL, and 4.0 microns paraffin-embedded sections were immunostained with monoclonal antibody against recombinant human (rh) BMP-2. RESULTS Sections from FGs recovered 5 to 28 days postoperatively exhibited cartilage and bone; fibrous tissue, cartilage, bone, and osteochondroid differentiated within MDCGs. Although BMP-2 was expressed by mesenchymal cells, osteoblasts, osteocytes, and osteoclasts, none of the MDCGs produced the osteoinductive signature of transmembrane bone formation. CONCLUSIONS These observations indicated that the larger fraction of the new bone produced by heterotopic periosteal autografts is derived from the graft cells.

Metabolic Responses to a New Beta-Adrenoceptor Agonist, ICI 118,587, in Conscious Rats

The effect of a new beta-adrenoceptor agonist, ICI 118,587, on the blood levels of cyclic AMP, glucose, lactate, and FFA was studied in conscious rats. ICI 118,587 (200 micrograms/100 g s.c.) increased the cyclic AMP level in the normal and reserpine-pretreated rat, and increased the FFA level in the reserpine-pretreated rat. Adrenaline (10 micrograms/100 g s.c.) increased the levels of cyclic AMP, glucose, and lactate in the normal rat, and increased the FFA level in the reserpine-pretreated rat. The increases in these metabolites induced by this particular dose of adrenaline were inhibited by ICI 118,587. In the normal or reserpine-pretreated rat, ICI 118,587 acts as a beta-agonist on metabolism, and is capable of antagonizing the metabolic effects of adrenaline.

Malignant Fibrous Histiocytoma of the Mandible

Abstract This report is of a 32-year-old Japanese woman with malignant fibrous histiocytoma of the mandible. Mandibular resection and reconstruction with an osteocutaneous scapular flap were performed. The clinical course showed no signs of recurrence or metastasis after 5 years of follow-up.