A Dilated Odontoma in the Second Molar Region of the Mandible

A case of dilated odontoma in the second molar region of the mandible was reported. The patient was a 14-year-old female. Panoramic X-ray and CT examination revealed an oval ring-shaped radiopaque lesion accompanying a radiolucent area in the center at the left second molar region of the mandible. The left second molar and all third molars were not found. The lesion was diagnosed as odontoma and extirpated under general anesthesia. The lesion was a spherical mass of 12x9mm. Histologically, the mass was composed of dentin arranged in an oval ring shape with dentinal tubules. Inside the dentin, immature enamel was present. The central area of the mass was filled with fibrous tissue with a small nest of bone and cementum. Bone tissue was also observed in contact with the immature enamel layer. These morphological and histological features are compatible with those of a dilated odontoma

成体マウス脳の成熟および未成熟オリゴデンドロサイトにおけるコルチコイステロイドレセプタ−の分布

The expression of glucocorticoid receptors (GRs) was investigated immunohistochemically in two different lineages of oligodendrocytes, using carbonic anhydrase (CA) II and neuron glial antigen (NG) 2 as markers of mature oligodendrocytes and oligodendrocyte progenitors, respectively. We focused on the gray matter regions, including CA1, CA3 and the dentate gyrus of the hippocampus, the primary somatosensory cortex barrel field and the basolateral amygdala, and the white matter regions, including the corpus callosum, external capsule and fimbria of the hippocampus. More than 80% of CAII-immunoreactive (IR) cells and more than 95% of NG2-IR cells expressed GRs in various regions of the brain. In contrast, neither CAII-IR cells nor NG2-IR cells expressed mineralocorticoid receptors (MRs) in the same regions. The intensity of GR expression was drastically reduced in CA II-IR cells and NG2-IR cells in the same regions in adrenalectomized mice. Finally, steroid receptor co-activator (SRC)-1 and p300, both of which are cofactors for GR, were expressed in the gray and white matter regions in NG2-IR cells, but not in CAII-IR cells. These results suggest that the expression of GRs in oligodendrocytes and their progenitor cells mediates several functions in vivo, including differentiation and myelination, as a major target of glucocorticoids and their cofactors.博士（医学）・甲620号・平成26年3月17日Copyright © 2014 by The Histochemical Societ

A Foreign Body Granuloma of the Buccal Mucosa Induced by Honeybee Sting

A foreign body granuloma of the buccal mucosa induced by honeybee sting was reported. The patient was an 82-year-old female who presented with a submucous mass at the right buccal mucosa. The mass was 20 mm in diameter, elastically firm, partly mobile without pain or tenderness, and covered with almost normal mucosa. MR image did not delineate the lesion clearly. Under clinical diagnosis of a benign tumor, the lesion was excised under local anesthesia. The excised lesion was 14×11×9 mm in size and solid and yellowish in cut surface. Histologically, the lesion consisted of granulomatous tissue with a few narrow, curved, eosinophilic structures compatible with decomposed fragments of a honeybee sting and was diagnosed as a foreign body granuloma, although the patient did not recall being stung

Cepharanthine and Oral Lichen Planus Efficacy (COLE) study: protocol for a multicentre randomised controlled study assessing the efficacy and safety of cepharanthine with topical corticosteroids in oral lichen planus

Introduction Oral lichen planus (OLP) is a chronic, inflammatory oral condition leading to a range of symptoms from mild discomfort to severe pain, affecting patients’ quality of life. Standard therapy involves the use of topical corticosteroids, although some patients respond insufficiently or develop resistance to therapy. We aim to explore if adding cepharanthine, an herbal extract from Stephania cepharantha Hayata, can enhance the efficacy of corticosteroid therapy in symptomatic OLP.Methods and analysis This open-label, parallel-group, multi-centre, randomised controlled study will be conducted at three Japanese hospitals. It will compare safety and efficacy of integrated oral cepharanthine and corticosteroid therapy versus standard corticosteroid therapy. 50 symptomatic OLP patients will be randomised 1:1 to receive cepharanthine (30 mg/day) plus topical dexamethasone, or topical dexamethasone alone for 8 weeks. The primary outcome will be changed in pain intensity while drinking room-temperature water, measured on a visual analogue scale. The primary outcome is the change in pain intensity from baseline when drinking room-temperature water, evaluated using a visual analogue scale. Secondary outcomes are changes in the longest diameter of the target lesion from baseline to weeks 4 and 8, improvement and deterioration rates according to appearance and severity criteria at weeks 4 and 8, change in pain intensity when drinking room-temperature water from baseline to week 4, changes in pain intensity at rest from baseline to weeks 4 and 8, and the rates of adverse events.Ethics and dissemination This protocol was approved by the Certified Review Board of Nara Medical University (CRB5200002). Participants will provide informed consent. Results will be disseminated in peer-reviewed journals and conferences.Trial registration number Japan Registry of Clinical Trials (jRCTs051220130)

Immune Thrombocytopenic Purpura Detected with Oral Hemorrhage: a Case Report

Immune thrombocytopenic purpura (ITP) is an immune-mediated acquired disease found in both adults and children. It is characterized by transient or persistent decreases in the platelet count. We report a case of ITP detected based on oral hemorrhagic symptoms. The patient was a 79-year-old female with no significant past medical history. She presented with sudden onset of gingival bleeding and hemorrhagic bullae on the buccal mucosa. Gingival bleeding was difficult to control. Laboratory tests revealed severe thrombocytopenia with a platelet count as low as 2000/μL. Under a provisional diagnosis of a hematological disorder, she was referred to a hematologist. A peripheral smear showed normal-sized platelets. A bone marrow examination revealed increased numbers of megakaryocytes without morphologic abnormalities. The patient was diagnosed with ITP and treated with a combination of pulsed steroid therapy and high-dose immunoglobulin therapy. However, her severe thrombocytopenia was refractory to these treatments. Then, a thrombopoietin receptor agonist was begun as a second-line treatment. Her platelets rapidly increased, and no bleeding complications were reported. Because oral symptoms can be one of the initial manifestations of ITP, dentists should be familiar with the clinical appearance of ITP, and attention must be paid to detect and diagnose unidentified cases

Data from: Risks of postextraction bleeding after receiving direct oral anticoagulants or warfarin: a retrospective cohort study

Objective: The effect of direct oral anticoagulants (DOACs) on the risk of bleeding after tooth extraction remains unclear. This study aimed to evaluate the incidence of post-extraction bleeding among patients who received DOAC and vitamin K antagonists (VKAs), such as warfarin. Design: This study was a retrospective cohort analysis. Incidence rates and propensity score matched regression models were used to compare the risks of bleeding after tooth extractions involving DOACs and VKAs. Setting: The study took place in a single university hospital in Japan. Participants: Between April 2013 and April 2015, 543 patients underwent a total of 1,196 simple tooth extractions. Primary outcome measure: The primary outcome measure was the occurrence of post-extraction bleeding, which was defined as bleeding that could not be stopped by biting down on gauze and required medical treatment between 30 minutes and 7 days after the extraction. Results: A total of 1,196 tooth extractions (634 procedures) in 541 patients fulfilled the study criteria, with 72 extractions (41 procedures) involving DOACs, 100 extractions (50 procedures) involving VKAs, and 1,024 extractions (543 procedures) involving no anticoagulants. The incidences of post-extraction bleeding per tooth for the DOAC, VKA, and no anticoagulant extractions were 10.4%, 12.0%, and 0.9%, respectively. The incidences of post-extraction bleeding per procedure for DOACs, VKAs, and no anticoagulants were 9.7%, 10.0%, and 1.1%, respectively. In comparison to the VKA extractions, the DOAC extractions did not significantly increase the risk of post-extraction bleeding (odds ratio: 0.69; 95% confidence intervals: 0.24–1.97; p=0.49). Conclusions: The risk of post-extraction bleeding was similar for DOAC and VKA extractions

bmjopen-2017-015952R2data

bmjopen-2017-015952R2dat