Lingual tonsillolith on PR and CT

Objectives: Lingual tonsilloliths are not as well-known to radiologists than palatine tonsilloliths, although they might be common in clinical practice. The aim of this investigation was to clarify the prevalence and imaging characteristics of lingual tonsilloliths using panoramic radiographs and CT images. Methods: This study included 2244 patients without pathology at the base of tongue who had undergone panoramic radiography and CT of the maxillofacial region. The size, number and position of lingual tonsilloliths relative to the mandible and tongue were evaluated. Results: Lingual tonsilloliths were observed in 33 (1.5%) and 108 (4.8%) of all patients on panoramic radiographs and CT images, respectively. The prevalence was higher in patients aged ≥40 years than in those aged < 40 years (χ2, p < 0.01). They appeared as small, round- or rod-shaped calcified bodies, and they always located closely anterior (1–17 mm) to the anterior border of oropharyngeal airway on panoramic radiographs. Lingual tonsilloliths were superimposed over the surrounding soft tissue inferior to the body of the mandible, posteroinferior to the angle of the mandible and posterior to the mandible in 16 (48.5%), 15 (45.5%) and 1 (3.0%) individual, respectively. A significant correlation was observed between the detectability on panoramic radiographs and size (Spearman’s r = 0.961, p < 0.01) of tonsilloliths, as revealed by CT images. Conclusion: Lingual tonsilloliths commonly appear on CT. They also appear on panoramic radiography and may superimpose the surrounding soft tissue of the mandible. Although lingual tonsilloliths may resemble other pathological calcifications including submandibular sialoliths and lingual osseous cholistoma, they can be differentiated by carefully observing panoramic radiographs. When clinicians detect calcified bodies near the base of tongue, lingual tonsilloliths should be included in the differential diagnoses

PREVENTION OF ROS GENERATION VIA STABILIZATION OF Nrf2 ACTIVATION

Chemotherapy‑induced oral mucositis is a common adverse event in patients with oral squamous cell carcinoma, and is initiated through a variety of mechanisms, including the generation of reactive oxygen species (ROS). In this study, we examined the preventive effect of γ‑tocotrienol on the 5‑FU‑induced ROS production in human oral keratinocytes (RT7). We treated RT 7 cells with 5‑FU and γ‑tocotrienol at concentrations of 10 μg/ml and 10 nM, respectively. When cells were treated with 5‑FU alone, significant growth inhibition was observed as compared to untreated cells. This inhibition was, in part, due to the RO S generated by 5‑FU treatment, because N‑acetyl cysteine (NAC), a RO S scavenger, significantly ameliorated the growth of RT7 cells. γ‑tocotrienol showed no cytotoxic effect on the growth of RT 7 cells. Simultaneous treatment of cells with these agents resulted in the significant recovery of cell growth, owing to the suppression of RO S generation by γ‑tocotrienol. Whereas 5‑FU stimulated the expression of NF‑E2‑related factor 2 (Nrf2) protein in the nucleus up to 12 h after treatment of RT 7 cells, γ‑tocotrienol had no obvious effect on the expression of nuclear Nrf2 protein. Of note, the combined treatment with both agents stabilized the 5‑FU‑induced nuclear Nrf2 protein expression until 24 h after treatment. In addition, expression of Nrf2‑dependent antioxidant genes, such as heme oxygenase‑1 (HO‑1) and NAD(P)H:quinone oxidoreductase‑1 (NQO‑1), was significantly augmented by treatment of cells with both agents. These findings suggest that γ‑tocotrienol could prevent 5‑FU ‑induced ROS generation by stabilizing Nrf2 activation, thereby leading to ROS detoxification and cell survival in human oral keratinocytes

シンキン バイヨウ ケンサ ニオケル カンジダ ノ ケンシュツ ニ エイキョウ スル リンショウテキ ヨウイン ノ ケントウ : コウクウ カンソウ ノ カンレン ニツイテ

In order to analyze the clinical factors affecting the fungal culture test, we examined the oral mucosae of 89 individuals with various complaints: pain, xerostomia etc. The subjects, age ranged from 36 to 87 years (mean age: 64.8 ± 11.8). Based on the fungal culture, 56 patients were found Candida-positive, and the remaining 33 patients were Candida-negative. The mean ages of the Candida-positive and -negative groups, respectively, were 67.4 ± 12.0 and 60.5 ± 10.3 years old, with the Candida-positive group being significantly older than Candida-negative group. The Candida-positive group showed a smaller amount of salivary secretion (10.9 ± 5.3 ml/10 min) than the Candida-negative group (13.8 ± 6.0 ml/10 min); this difference was also statistically significant. Patients with Candida infection suffered from different diseases and conditions, including hypertension, gastrointestinal disease, and xerostomia. The above findings suggest that one of the factors in the fungal culture test is dry mouth. Specifically, old age, dry mouth, chronic disease or medication leading to dry mouth were the clinical factors affecting the fungal culture test. However, neither the Candida species detected in the fungal culture nor the clinical appearance of the oral mucosa influenced these clinical features

PREVENTION OF ROS GENERATION VIA STABILIZATION OF Nrf2 ACTIVATION

Chemotherapy‑induced oral mucositis is a common adverse event in patients with oral squamous cell carcinoma, and is initiated through a variety of mechanisms, including the generation of reactive oxygen species (ROS). In this study, we examined the preventive effect of γ‑tocotrienol on the 5‑FU‑induced ROS production in human oral keratinocytes (RT7). We treated RT 7 cells with 5‑FU and γ‑tocotrienol at concentrations of 10 μg/ml and 10 nM, respectively. When cells were treated with 5‑FU alone, significant growth inhibition was observed as compared to untreated cells. This inhibition was, in part, due to the RO S generated by 5‑FU treatment, because N‑acetyl cysteine (NAC), a RO S scavenger, significantly ameliorated the growth of RT7 cells. γ‑tocotrienol showed no cytotoxic effect on the growth of RT 7 cells. Simultaneous treatment of cells with these agents resulted in the significant recovery of cell growth, owing to the suppression of RO S generation by γ‑tocotrienol. Whereas 5‑FU stimulated the expression of NF‑E2‑related factor 2 (Nrf2) protein in the nucleus up to 12 h after treatment of RT 7 cells, γ‑tocotrienol had no obvious effect on the expression of nuclear Nrf2 protein. Of note, the combined treatment with both agents stabilized the 5‑FU‑induced nuclear Nrf2 protein expression until 24 h after treatment. In addition, expression of Nrf2‑dependent antioxidant genes, such as heme oxygenase‑1 (HO‑1) and NAD(P)H:quinone oxidoreductase‑1 (NQO‑1), was significantly augmented by treatment of cells with both agents. These findings suggest that γ‑tocotrienol could prevent 5‑FU ‑induced ROS generation by stabilizing Nrf2 activation, thereby leading to ROS detoxification and cell survival in human oral keratinocytes

アタラシイ ゲカ ノ ガイネン ト シュジュツ シュギ ノ シンポ

Although the recent progress in surgery is remarkable, many dentists do not recognize it enough. From three viewpoints, we introduce and exposit new concept of treatment for wound, device (instrument) for arrest of hemorrhage, and operation procedure by surgical knife. It is always important for dentists to continue taking in new knowledge and techniques

Resection of Hepatic Metastasis from Colorectal Cancer : Survival, Factors Influencing Prognosis, and Follow-up

The purpose of this retrospective study was to analyze the surgical results of hepatic resection in our patients with colorectal hepatic metastasis. During a 26-year period, 223 patients among 1,484 patients with colorectal cancer suffered liver metastasis. In 44 curatively resected patients, the one-, three- and five-year cumulative survival rates were 85.9%, 44.9% and 23.0%, respectively. The prognostic importance of seven factors was evaluated. Synchronous or metachronous resection, the type of liver resection, and histologic differentiation did not influence the prognosis, whereas the number and size of metastases, and lymph node involvement did significantly affect prognosis as single factors. The mean diameter of metastatic lesions in the liver was 2.5 cm in the synchronous group and 4.5 cm in the metachronous group, the difference being significant (p = 0.0005). The presence of tumors with large diameters in the metachronous group might mean our failure of early detection of the recurrence of hepatic metastases. It is necessary to make steady efforts such as introducing regular follow-up imaging of colorectal cancer. The median interval between the primary operation and liver metastasis resection was 15.7 months in the lymph node involvement group and 37.7 months in the no lymph node involvement group. In 19 patients among 21 metachronously resected patients, the hepatic resection was done within three years. In conclusion, it was considered that hepatectomy could be done safely, that detection of an earlier lesion could improve the surgical results, and that follow-up for liver metastasis should be done intensively between 12 and 36 months after colorectal cancer surgery

トクシマ ダイガク ビョウイン セイシンカ シンケイカ ニュウイン カンジャ ニ タイスル コウクウ ケア ノ イギ

For patients with mental diseases, safe food-intake and the maintenance of good oral hygiene become difficult due to a decline in the ability of daily livings. In addition, a majority of patients suffer from the lack of reflection of both deglutition and cough as well as clinical silent aspiration, resulting from the extrapyramidal symptom (EPS) caused by antipsychotics. In this clinical study, we evaluated the oral environment in 10 inpatients with psychiatry neurology, and examined the usefulness of professional oral care. They were divided into 2 groups: the physical restriction group (restriction group) and the non-physical restriction group (control group), followed by the estimation of the conditions of oral hygiene and the days accompanied by fever, one of the symptoms of aspiration-related pneumonia, before and after professional oral care intervention. As a result, restriction group had poor oral hygiene condition as compared to the control group. After professional oral care intervention, oral hygiene condition was significantly improved in the restriction group, and reached to the same levels as in the control group. The days with fever were 7.3 and 5.0 days per month in the restriction group before and after the intervention, respectively. In the control group, those were 0.6 and 0 day per month before and after intervention, respectively. The cause of the difference in days with fever between 2 groups was considered to be the effect of clinical silent aspiration by EPS induced by antipsychotics. The professional oral care contributed to the improvement of the oral hygiene in inpatients with psychiatry neurology, resulting in the reduction of aspiration-related pneumonia. Therefore, the role of dentistry in the field of psychiatry neurology would be inevitable in the future

低出力パルス超音波は自己免疫疾患での唾液腺炎による唾液分泌低下を改善する

Introduction: Low-intensity pulsed ultrasound (LIPUS) has been known to promote bone healing by nonthermal effects. In recent studies, LIPUS has been shown to reduce inflammation in injured soft tissues. Xerostomia is one of the most common symptoms in Sjögren syndrome (SS). It is caused by a decrease in the quantity or quality of saliva. The successful treatment of xerostomia is still difficult to achieve and often unsatisfactory. The aim of this study is to clarify the therapeutic effects of LIPUS on xerostomia in SS. Methods: Human salivary gland acinar (NS-SV-AC) and ductal (NS-SV-DC) cells were cultured with or without tumor necrosis factor-α (TNF-α; 10 ng/ml) before LIPUS or sham exposure. The pulsed ultrasound signal was transmitted at a frequency of 1.5 MHz or 3 MHz with a spatial average intensity of 30 mW/cm2 and a pulse rate of 20 %. Cell number, net fluid secretion rate, and expression of aquaporin 5 (AQP5) and TNF-α were subsequently analyzed. Inhibitory effects of LIPUS on the nuclear factor κB (NF-κB) pathway were determined by Western blot analysis. The effectiveness of LIPUS in recovering salivary secretion was also examined in a MRL/MpJ/lpr/lpr (MRL/lpr) mouse model of SS with autoimmune sialadenitis. Results: TNF-α stimulation of NS-SV-AC and NS-SV-DC cells resulted in a significant decrease in cell number and net fluid secretion rate (p < 0.01), whereas LIPUS treatment abolished them (p < 0.05). The expression changes of AQP5 and TNF-α were also inhibited in LIPUS treatment by blocking the NF-κB pathway. Furthermore, we found that mRNA expression of A20, a negative feedback regulator, was significantly increased by LIPUS treatment after TNF-α or interleukin 1β stimulation (NS-SV-AC, p < 0.01; NS-SV-DC, p < 0.05). In vivo LIPUS exposure to MRL/lpr mice exhibited a significant increase in both salivary flow and AQP5 expression by reducing inflammation in salivary glands (p < 0.01). Conclusions: These results suggest that LIPUS upregulates expression of AQP5 and inhibits TNF-α production. Thus, LIPUS may restore secretion by inflamed salivary glands. It may synergistically activate negative feedback of NF-κB signaling in response to inflammatory stimulation. Collectively, LIPUS might be a new strategic therapy for xerostomia in autoimmune sialadenitis with SS

ノウソッチュウ カンジャ ノ コウクウナイ ショケン ト シカ カイニュウ ノ ユウヨウセイ ニツイテ

We analyzed the need for dental intervention in patients with acute cerebral vascular disorders. In this study, we enrolled 43 individuals in SCU (male: 28, female: 15) in need of oral health management. The mean age of the patients was 68.0 ± 14.9. They had been diagnosed as cerebral infarction, cerebral hemorrhage, subarachnoid hemorrhage, or transient ischemic attack. Thirteen subjects were affected with pneumonia and could not handle self-care management. Furthermore, 10 subjects had poor oral hygiene. There were clearly more pneumonia patients in the intubation group compared to the non-intubation group. In addition, 18 cases (41.9%) needed dental treatment, and 5 cases received dental treatment. Patients with acute stroke had poor oral hygiene with disturbance of consciousness and paralysis, suggesting a possible cause of pneumonia in these patients. Half of patients required dental intervention, indicating that oral management may be necessary for stroke patients to prevent the occurrence of pneumonia

トクシマ ダイガク ビョウイン ニオケル シュウジュツキ コウクウ キノウ カンリ ノ ゲンジョウ ト カダイ

It has been shown that oral hygiene affects the onset of perioperative complications. The usefulness of perioperative oral function management aiming at the outbreak decrease in treatment complications and an early discharge was recognized. As a result, perioperative oral function management fee was founded at revision of medical service fees in Fiscal year 2012. 　In this clinical study, we evaluated the implementation of perioperative oral function management in Tokushima University Hospital. We examined 781 patients, including 563 patients for surgery and 218 patients for chemotherapy and radiotherapy. The mean age of patients was 58.8 ± 12.4 years old. 　The implementation rate of perioperative oral function management was 9.7% in the patients of surgery, and 17.4% in those of chemotherapy and radiotherapy. The highly required medical department was neurosurgery in the patients of surgery, and hematology in those of chemotherapy and radiotherapy. The mean number of tooth present was 21.3 ± 7.1 in the patients of surgery, and 19.8 ± 7.2 in those chemotherapy and radiotherapy. The rate of dental treatment was required in 40.5% of total patients who received surgery, and in 51.4% of patients who received chemotherapy and radiotherapy. The rate of patients who received denture treatment attained to 11.9% of the whole patients receiving surgery, and 13.3% of patients receiving chemotherapy and radiotherapy. 　It was revealed that there were many patients required potential demands in perioperative oral function management, and that there were many patients who need dental or denture treatment. We would like to develop perioperative oral function management by the interprofessional collaboration in health and social care