Study of human Wharton’s duct structure and its relationship with salivary flow

Of all major salivary glands, the human submandibular gland secretes the largest amount of saliva. Along with the sublingual duct, the main duct (Wharton’s duct) is known to open into the sublingual caruncula; however, reports regarding this common opening structure are scarce and details unclear. The structure of Wharton’s duct opening is quite different from that of parotid duct (Stensen’s duct) opening in its overall size and diameter despite what is commonly noted in text books. About 85% of sialolith occurrences in humans is in the submandibular gland and duct, which causes local pain during swallowing in most cases. The details of Wharton’s duct’s inner structure is relatively unknown, and further investigation is necessary to understand its special characteristics and clinical applications. In this study, we observed the inner structure of the ducts’ common opening area by scanning electron microscopy and confirmed a large number of blood vessels present in the connective tissue layer just under the epithelium. In addition, we confirmed the presence of smooth muscle in the same area using smooth muscle actin antibody. These structural findings suggest that Wharton’s duct itself is likely responsible for the regulation of salivary flow

HAMAMATSU-ICG study: Protocol for a phase III, multicentre, single-arm study to assess the usefulness of indocyanine green fluorescent lymphography in assessing secondary lymphoedema

Introduction Secondary lymphoedema of the extremities is an important quality-of-life issue for patients who were treated for their malignancies. Indocyanine green (ICG) fluorescent lymphography may be helpful for assessing lymphoedema and for planning lymphaticovenular anastomosis (LVA). The objective of the present clinical trial is to confirm whether or not ICG fluorescent lymphography using the near-infrared monitoring camera is useful for assessing the indication for LVA, for the identification of the lymphatic vessels before the conduct of LVA, and for the confirmation of the patency of the anastomosis site during surgery. Methods and analysis This trial is a phase III, multicentre, single-arm, open-label clinical trial to assess the efficacy and safety of ICG fluorescent lymphography when assessing and treating lymphoedema of patients with secondary lymphoedema who are under consideration for LVA. The primary endpoint is the identification rate of the lymphatic vessels at the incision site based on ICG fluorescent lymphograms obtained before surgery. The secondary endpoints are 1) the sensitivity and specificity of dermal back flow determined by ICG fluorescent lymphography as compared with 99mTc lymphoscintigraphy—one of the standard diagnostic methods and 2) the usefulness of ICG fluorescent lymphography when confirming the patency of the anastomosis site after LVA. Ethics and dissemination The protocol for the study was approved by the Institutional Review Board of each institution. The trial was filed for and registered at the Pharmaceuticals and Medical Devices Agency in Japan. The trial is currently on-going and is scheduled to end in June 2020

A Case of Crouzon's Syndrome with a True Human Tail

A human tail complicated by Crouzon syndrome is extremely rare, with only eight reported cases of human tails associated with Crouzon syndrome. A human tail is defined as a true human tail or a pseudo-human tail according to the presence or absence of the bone tissue. A 4-year-old boy had a true caudal sacral protrusion from birth and was also diagnosed with Crouzon syndrome. There were no neurological symptoms or vesico-rectal disturbances. The patient underwent a human tail resection at 4 years and 7 months. The postoperative course was uneventful, and there was no recurrence at 6 months postoperatively. Some reports suggested that Crouzon syndrome and the human tail are associated with FGFR2 gene mutation, but the details are currently unknown. Further genetic searches for cases of the combined human tail and Crouzon syndrome in the future are likely to reveal further associations