Mucosal change of the stomach with low-grade mucosa-associated lymphoid tissue lymphoma after eradication of Helicobacter pylori:Follow-up study of 48cases

Low-grade mucosa-associated lymphoid tissue (MALT) lymphoma of the stomach has been demonstrated to be closely linked to Helicobacter pylori (H. pylori) and to be frequently remissioned after the cure of H. pylori infection. Several previous studies have focused on proliferating lymphocytes but little is known about gastric epithelial change and the duration of the remission after the cure of H. pylori infection. We performed a long-term follow-up investigation on the effects of anti-H. pylori treatment on MALT lymphoma and chronic gastritis at the histologic and molecular levels. Forty-eight patients with low-grade gastric MALT lymphoma and 28 chronic gastritis patients in whom H. pylori infection was eradicated were studied. After eradication, 43 MALT lymphoma patients showed complete histologic remission and continuous remission was observed during follow-up for up to 43 months (mean, 17.8 months). As for epithelial changes after eradication, "emptiness of lamina propria" was more pronounced in the mucosa with MALT lymphoma than that with chronic gastritis, and its severity in MALT lymphoma cases significantly decreased during the observation period whereas the glandular area increased. Cystic change of the fundic gland also occurred more frequently in MALT lymphoma cases than chronic gastritis cases. B-cell clonality before eradication analyzed by reverse transcriptase-polymerase chain reaction (RT-PCR) was detected in almost all MALT lymphoma cases (43cases), but rare in chronic gastritis cases (6cases). After eradication, in spite of histologic regression, 21 MALT lymphoma patients had a persistent monoclonal population during the follow-up period. B-cell monoclonality preceding the malignant transformation was noted in 4 cases. These observations indicate that 1) complete histologic remission of low-grade gastric MALT lymphomas seems stable even if a monoclonal B cell population is detectable in some cases, 2) there may be a stage of disease where monoclonal B cells are present but there is no histologic evidence of MALT lymphoma, and 3) regenerative change of the damaged glands may occur in histologic regressed MALT lymphoma cases

当科において過去9年間（2003年～2012年）に治療を行った歯原性腫瘍75例の臨床的検討

2003年から2012年までの9年間に当科で診断・治療を行った歯原性腫瘍75症例について，2005年WHO分類に基づいて臨床的検討を行った．疾患別症例数は角化嚢胞性歯原性腫瘍が22例，エナメル上皮腫16例，歯牙腫16例，骨性異形性症13例，線維性異形性症3例，石灰化嚢胞性歯原性腫瘍2例，歯原性粘液腫，歯原性線維腫，腺様歯原性腫瘍が各1例であった．男女比は1.5対1であった．手術時年齢は，平均39.8歳であった．発生部位別症例数は，角化嚢胞性歯原性腫瘍，エナメル上皮腫は下顎大臼歯部に多く，歯牙腫は，上顎前歯部に多かった．治療方法は，角化嚢胞性歯原性腫瘍に対しては摘出後閉鎖7例，摘出後開放7例，生検後開窓5例，開窓後摘出3例であった．エナメル上皮腫は摘出後開放8例，区域切除3例，辺縁切除3例，開窓1例，開窓後摘出1例であった．歯牙腫16例に対しては摘出術を施行した．治療成績は75例中71例（94.7％）は再発を認めなかったが，一次症例で，エナメル上皮腫1例，角化嚢胞性歯原性腫瘍1例，歯原性粘液腫1例の3症例，他院で治療後のエナメル上皮腫1例に再発が認められた

Obesity and Craniofacial Abnormalities are Independent Causal Factors for Obstructive Sleep Apnea-Hypopnea Syndrome

OBJECTIVES:Obstructive sleep apnea-hypopnea syndrome is characterised by recurrent episodes offunctional pharyngeal airway obstruction during sleep. Here, we examined the craniofacial characteristicsand body mass index of patients with obstructive sleep apnea-hypopnea syndrome and healthy counterparts,and investigated the relationship between these factors and onset of obstructive sleep apnea-hypopneasyndrome.MATERIAL AND METHODS:Sixty non-edentulous male with obstructive sleep apnea-hypopnea syndromediagnosed by conventional polysomnography were divided into two groups according to their bodymass index, which was used as an index of obesity( <25 kg/m2:non-obese, &#8805; 25 kg/m2:obese). Craniofacialcharacteristics were analysed by cephalogram using Ricketts\u27 method and the Downs-Northwesternmethod.RESULTS:The mean body mass index was greater in patients with obstructive sleep apnea-hypopneasyndrome compared with their healthy counterparts. As for the craniofacial characteristics of patients withobstructive sleep apnea-hypopnea syndrome, the mandible was relatively small and located posteriorly, andthe hyoid bone was at a lower position. However, in patients with obstructive sleep apnea-hypopnea syndrome,there was no significant difference in any of the cephalometric measurements between non-obeseand obese patients.CONCLUSION:Obesity and craniofacial skeletal abnormalities are non-reciprocal, independent causalfactors for obstructive sleep apnea-hypopnea syndrome

カンセン セイ シンナイマクエン ハッショウ ニ オケル コウクウ ナイ サイキン ノ カンヨ

本研究では感染性心内膜炎(infective endocarditis:IE)発症における口腔内細菌の関与について検索した.IE 患者47 名の血中から検出された細菌の87.1%は口腔細菌であり,61.7%の患者が口腔内感染巣を有するか,抗菌薬予防投与なしで口腔内観血処置が施行されていた.また,IE 患者あるいはIE 発症リスク患者の27 名の口腔細菌(連鎖球菌とブドウ球菌)の薬剤感受性を検索したところ,92.3%はペニシリン系薬剤に対して感受性を示した.さらに,I E 患者9 名において血中細菌と口腔細菌の16S rRNA の遺伝子配列を決定することにより細菌種の同定を行った.その結果,血中から検出・同定された細菌は全て口腔に存在するStaphylococcus epidermidis とStreptococcus mitis group であった.また,血中細菌と口腔細菌の遺伝子配列は1 症例で100%一致し, 3 症例においては遺伝子配列の100%の一致は見られなかったが,細菌種グループまでは一致した.以上の結果より,IE 発症には口腔内の連鎖球菌とブドウ球菌が原因菌として重要であることが明らかとなった.また,IE 発症の予防には,口腔内感染巣の除去と日々の口腔ケアならびに口腔内の観血処置時には大量のペニシリン系薬剤の予防投与は有用であることが確認できた.In this study, we attempted to clarify the implication of the oral bacteria on the onset of infective endocarditis( IE). In the first experiment, oral bacteria could be found in the blood from 27 of the 47 patients( 57.4%) with IE. Furthermore, 29 of the patients( 61.7%) showed possible oral bacterial foci causing the bacteremia, and 8 of the patients (17.0 %) received the oral surgery or the dental treatment accompanying bleeding. In the second experiment, we isolated the oral bacteria( Staphylococci and Streptococci) from the 27 patients with IE or with high risk for the onset of IE, and determined the susceptibility for several anti-biotics. Ninety two point three percent of the bacteria showed susceptibility against penicillin G and its derivatives. In the third experiment, we identified the bacterial species isolated from oral cavity and blood in nine patients with IE by determining the DNA sequence of the 16S rRNA. The bacterial species isolated from blood in the patients with IE were Staphylococcus epidermidis or Streptococcus mitis group, which usually existed in the oral cavity. DNA sequence of the 16S rRNA in the bacteria( Staphylococcus epidermidis) from blood in one patient was completely identical to that from oral cavity. In three patients, although DNA sequence from blood was not completely identical to that from oral cavity, the species( Streptococcus mitis group) of the bacteria from blood and oral cavity were identical. These results suggest that oral Staphylococci and Streptococci play a crucial role on the onset of IE. Moreover, complete removal of the oral bacterial foci, daily oral care, and the administration of the large amount of penicillin before the oral surgery or the dental treatment accompanying bleeding might be effective to prevent the onset of IE

Protocol for a multicentre, prospective observational study of elective neck dissection for clinically node-negative oral tongue squamous cell carcinoma (END-TC study)

Introduction: In early-stage oral tongue squamous cell carcinoma (OTSCC), elective neck dissection (END) is recommended when occult lymph node metastasis is suspected; however, there is no unanimous consensus on the risks and benefits of END in such cases. The management of clinically node-negative (cN0) OTSCC remains controversial. This study, therefore, aimed to evaluate the efficacy of END and its impact on the quality of life (QoL) of patients with cN0 OTSCC. Methods and analysis: This is a prospective, multicentre, nonrandomised observational study. The choice of whether to perform END at the same time as resection of the primary tumour is based on institutional policy and patient preference. The primary endpoint of this study is 3-year overall survival. The secondary endpoint are 3-year disease-specific survival, 3-year relapse-free survival and the impact on patient QoL. Propensity score-matching analysis will be performed to reduce selection bias. Ethics and dissemination: This study was approved by the Clinical Research Review Board of the Nagasaki University. The protocol of this study was registered at the University Hospital Medical Information Network Clinical Trials Registry. The datasets generated during the current study will be available from the corresponding author on reasonable request. The results will be disseminated internationally, through scientific and professional conferences and in peer-reviewed medical journals

Apolipoprotein E4 Frequencies in a Japanese Population with Alzheimer's Disease and Dementia with Lewy Bodies

BACKGROUND: The apolipoprotein E (APOE) ε4 allele has been reported to be a risk factor for Alzheimer's disease (AD) and dementia with Lewy bodies (DLB). Previous neuropathological studies have demonstrated similar frequencies of the APOE ε4 allele in AD and DLB. However, the few ante-mortem studies on APOE allele frequencies in DLB have shown lower frequencies than post-mortem studies. One reason for this may be inaccuracy of diagnosis. We examined APOE genotypes in subjects with AD, DLB, and a control group using the latest diagnostic criteria and MRI, SPECT, and MIBG myocardial scintigraphy. METHODS: The subjects of this study consisted of 145 patients with probable AD, 50 subjects with probable DLB, and a control group. AD subjects were divided into two groups based on age of onset: early onset AD (EOAD) and late onset AD (LOAD). All subjects had characteristic features on MRI, SPECT, and/or myocardial scintigraphy. RESULTS: The rate of APOE4 carrier status was 18.3% and the frequency of the ε4 allele was 9.7% in controls. The rate of APOE4 carrier status and the frequency of the ε4 allele were 47% and 27% for LOAD, 50% and 31% for EOAD, and 42% and 31% for DLB, respectively. CONCLUSION: The APOE4 genotypes in this study are consistent with previous neuropathological studies suggesting accurate diagnosis of AD and DLB. APOE4 genotypes were similar in AD and DLB, giving further evidence that the ε4 allele is a risk factor for both disorders

Immunohistochemical Localization of REG Ia Protein in Salivary Gland Tumors

The regenerating gene( Reg) Ia protein has a trophic effect on gastric epithelial cells, and its overexpressionis reported in gastrointestinal cancers. The salivary gland is a component of the digestive system, andtherefore, REG Ia protein may play some role in the pathophysiology of salivary gland tumors. In the presentstudy, we determined the immunohistochemical localization of REG Ia protein in salivary gland tumorsand moreover investigated its relationship to clinicopathological features. Twenty-eight patients with salivarygland tumor were enrolled. The specimens resected by surgery from those patients were examinedusing immunohistochemistry for REG Ia protein and Ki67. Five of the 16 pleomorphic adenomas (31.3%)were positive for REG Ia protein. Regarding salivary gland carcinomas, four of five mucoepidermoid carcinomas(80%), three of five adenoid cystic carcinomas (60%), one of two polymorphous low-grade adenocarcinomas(50%) were also positive for REG Ia protein. However, no relationships were found betweenREG Ia protein expression and clinicopathological features. Regarding the Ki67 expression, strong signalwas observed in the tumor cells of patients with salivary gland adenoma as well as carcinoma. REG Ia proteinis expressed not only in adenocarcinoma but also precancerous adenoma cells proliferating actively,suggesting that REG Ia protein may play a role at least in part in the development of salivary gland tumors

Relationship Between the Severity of Oral and Maxillofacial Injuries and Helmet Use by Type in Motorcycle Accidents

Helmets are known to be effective in reducing the severity of head injuries in motorcycle accidents. Although, to our knowledge, few reports have examined the relationship between the severity of oral and maxillofacial injuries and helmet use by type in motorcycle accidents. We retrospectively analyzed 54 patients with oral and maxillofacial injuries from motorcycle accidents and attempted to clarify the relationship between injury severity and the protective effects of a helmet. We studied 40 men and 14 women with a mean age of 26.1±15.0 years (range, 15 to 79 years) who sustained oral and maxillofacial injuries in motorcycle accidents treated in Dokkyo University Hospital from 1994 through 2003. In each case, we examined the mechanism of injury, type of helmet the injury severity score, the 1990 revision of the Abbreviated Injury Scale (AIS-90) score, and the length of hospitalization. Of these 54 patients, 47 patients wore a helmet. Of these 47 patients, 8 (14.8%) wore a full-face type of helmet and 39 (72.2%) wore an open-face type of helmet. The injury severity scores and the Abbreviated Iniurv Scale scores for head and neck were not significantly different by helmet use or type of helmet. However, the AIS-90 scores for facial injuries were significantly decreased with helmet use. The scores for facial injuries in the patients who wore the full-face type of helmets (1.4±0.5) were significantly lower than those in the patients who wore the open-face type of helmets (1.8 ±0.4, p<0.05) and in patients without helmets (1.9±0.4, p<0.05). Wearing a helmet effectively prevented oral and maxillofacial injuries; although, it could not fully prevent all oral and maxillofacial injuries in motorcyclists. These injuries may have been caused by indirect forces transmitted through the helmet

ゼツヘンペイジョウヒガン ニ オケル センチネル リンパセツ セイケン ニ カン スル ケンキュウ : OSNA ホウ ニ ヨル イデンシ カイセキ ノ ユウヨウ セイ ニ ツ イテ

癌においてリンパ節転移は,重要な予後因子であることより,正確な診断が必要となる.そこで,より正確なリンパ節転移診断を行う方法として,センチネルリンパ節(sentinel lymph node:SLN) 生検が導入され,また,さらなる診断精度の向上を図るために遺伝子解析による転移診断が応用され,その有用性が報告されている.しかしながら,口腔癌のSLN 生検における遺伝子解析は,従来の病理組織学的診断に比べ精度が高いとする報告がある一方,ほぼ同等とする報告もあり,なお一定の見解が得られていない.本研究では,舌扁平上皮癌に対するSLN 生検における遺伝子解析の有用性について検討を行った.対象は,SLN 生検を施行した舌扁平上皮癌StageI,II症例28 例で,病理組織学的診断ならびにone-step nucleic acid amplification(OSNA) 法による遺伝子解析を用いてSLN における転移診断を行い,それぞれを比較検討し,さらに治療成績について,SLN 生検導入前のStage I,II症例23 例と比較検討した.その結果,病理組織学的診断にてリンパ節転移陽性と診断された症例は28 例中5 例(17.9%)で,そのうちの1 例は,当初病理組織学的診断では転移陰性であったが,遺伝子解析にて転移陽性と診断されたため,亜連続切片にて再度検索を行い,病理学的にも転移陽性と診断されたものであった.OSNA 法による遺伝子解析では28 例中6 例(21.4%) が転移陽性で,病理組織診断との一致率は,27 例(96.4%)であった.5 年累積生存率は,SLN 生検施行群94.4%,SLN 生検未施行群86.7%で,有意差はないもののSLN 生検施行群に高い傾向を示した.後発転移は,SLN 生検施行群にはなかったが,SLN 生検未施行群では23 例中3 例(13.0%) に認められ,有意に多かった.以上の結果より,舌扁平上皮癌においてもSLN 生検は有用で,OSNA 法による遺伝子解析は,その診断精度を高めると思われた.Background:Metastasis of cervical lymph node is the most important prognostic factor in oral cancer. In this study, we evaluated the efficacy of one-step nucleic acid amplification (OSNA) assay for intraoperative diagnosis of sentinel lymph node (SLN) metastasis compared with conventional examination in patients with carcinoma of the tongue. The aim of this study was to investigate availability of the genetic diagnosis in carcinoma of the tongue.Patients and Methods:We investigated patients with T1 and T2 squamous cell carcinoma of the tongue with a clinical diagnosis of N0 who underwent SLN biopsy (SLN group;n=28) in comparison with those who did not undergo SLN biopsy (non-SLN group;n=23). SLN biopsy consisted of not only intraoperative pathological examination, but also genetic analysis using the OSNA method.Results:Lymph node metastasis was detected in five of 28 patients in the SLN group( 17.9%). One discordant case was observed between pathological examination and OSNA assay. This case was positive metastatic lymph node according OSNA assay, but negative lymph node at pathological examination. Subsequent cervical lymph node metastasis was not seen in the SLN group, it was seen three patients in the non-SLN group( 13.0%). Five-year survival rate was higher in the SLN group (94.4 %) than the non-SLN group( 86.7%), but this difference was not significant.Conclusion:These results suggest that in early oral cancer, SLN biopsy is highly useful for detecting lymph node metastasis. The high accurate OSNA method can be used in intraoperative diagnosis as a tool for detecting metastasis in the sentinel lymph nodes of tongue carcinoma