Niigata University Medical Research Articles

Classification of maxillary canine transpositions in Japanese children: A report of 10 cases

The aim of the present study was to examine the prevalence rate and treatment outcome of maxillary canine transposition in Japanese children according to the conventional standard and our new additional consideration of the classification. From 140 cases with ectopic canines diagnosed in the Pediatric Dental Clinic of Niigata University Medical and Dental Hospital, we selected 10 transposition cases as the present subjects. Out of 10 cases, 4 were males and 6 females. Six were classified into type A: the mesio-distal positional interchange of the canine and the first premolar, 2 cases into type B: the mesio-distal transposition of the canine and the lateral incisor, and the other 2 cases into type C: the present new classification that showed the vertical transposition of the canine and the first premolar within the developmental bone. The prevalence rate of types A and B resembled the previous papers regarding the ratio of sex and bilateral occurrence. Although 3 cases in type A, one case in type B and one case in type C could finally be aligned in the normal tooth order, every one of the types A and B cases were aligned in the reverse order. For every one case in types A and C, the transposed canines were extracted. It is recommended that pediatric dentists take an orthopantomogram during early mixed dentition as a routine practice in order to detect anomalies of tooth eruption, such as tooth transposition, as early as possible.

Gastrojejunostomy as induction treatment for S-1-based chemotherapy in patients with incurable gastric cancer

The development of new generation anticancer agents, including the oral drug, S-1, may alter the clinical importance of gastrojejunostomy in the treatment of incurable gastric cancer. We reviewed a series of patients who underwent gastrojejunostomy for this reason between 2002 and 2005. Fourteen patients underwent gastrojejunostomy followed by S-1-based chemotherapy for incurable gastric cancer with obstruction or stenosis of the gastric outlet at Niigata University Medical and Dental Hospital and two affiliated hospitals. The safety of gastrojejunostomy, outcome of palliation, and survival time were analyzed retrospectively. We compared the survival times with those of patients who underwent palliative gastrectomy or exploratory laparotomy between 1987 and 2001. The median operative time and blood loss were 153 min and 66 ml, respectively. There were no major complications. The median starting time for chemotherapy after gastrojejunostomy was 15.5 days. All patients were discharged after gastrojejunostomy, and the median postoperative home stay ratio was 68%. The median survival time after gastrojejunostomy was 354 days, which was significantly longer than that of patients who underwent palliative gastrectomy or exploratory laparotomy. Gastrojejunostomy for incurable gastric cancer contributes not only to improving quality of life (QOL), but to prolonging survival through the induction and maintenance of S-1-based chemotherapy.

Relationship between severity of sleep-disordered breathing and craniofacial morphology in Japanese male patients

The objective of this study was to assess the influence of factors of obesity and craniofacial morphology on the degree of obstructive sleep apnea syndrome (OSAS) in Japanese individuals. The subjects were 138 adult male patients who visited the Clinic for Snoring & Obstructive Sleep Apnea at Niigata University Medical and Dental Hospital with chief complaints of snoring and apnea. Standardized lateral cephalograms were taken at the first visit, and overnight polysomnography was carried out for evaluation of each subject before treatment. Univariate and multivariate analyses were performed to investigate factors affecting the severity of OSAS. These analyses showed that obesity, skeletal conditions such as short mandibular body and mandibular retreat, size of the tongue and position of the hyoid bone, and shape of the airway were associated with the severity of OSAS. In Japanese male OSAS patients, skeletal abnormalities are thought to be the factors that most greatly affect severity of OSAS.

新潟大学医歯学図書館の危機管理の現状

In recent years, Niigata Prefecture has suffered from natural disasters such as earthquakes, torrential rains and heavy snowfall. In addition, staff members at the Niigata University Medical and Dental Library, where I work, have also had trouble due from the annoying behaviors of some outside users of the library. I reinvestigated the current state of security at my library, alarmed by a blackout caused by the heavy snow a well as trouble with an outside user. In this article, I report some of my attempts to improve the situation.

妊娠時の服薬力ウンセリングに関するデータベースの構築がもたらす効果

Drug counseling during pregnancy plays an important role in eliminating anxiety concerning the adverse effects of drugs on fetuses and explaining the importance of drug administration during pregnancy. In the Outpatient Department of Obstetrics and Gynecology at the Niigata University Medical and Dental Hospital, together with obstetricians, pharmacists have provided information on the adverse effects of drugs administered during pregnancy on fetuses (teratogenicity) since March 22, 1995. Up to March 31, 2006, 269 patients had received such counseling.In this study, we investigated the timing of a decrease in the work of searching for information on drugs, and evaluated strategies for the development of drug counseling.According to the order in which drug counseling was requested by obstetricians, 250 patients were first divided into groups of 50 patients each, and then the quantity of drugs with general names as a percentage of the total number of drugs with trade names was determined. For 247 patients (3 excluded because they were women who had received counseling on drugs prescribed to their husbands), the percentage of drugs with general names of the total of those with trade names was 37.4% (413/1,103).Our results suggested that there would need to be about 650 drugs with general names in the database of information on the adverse effects of drugs taken during pregnancy on the fetus to provide effective drug counseling in the future. They also suggested that the work of searching for information on drugs decreased after counseling 100 patients.

Oral conditions in Japanese infants: A retrospective study

The present study was carried out to investigate the oral status of 234 Japanese infants, who had registered at the Pediatric Dentistry Clinic of Niigata University Medical and Dental Hospital over a period of 26 years, from 1979 to 2005. The 234 infants consisted of 125 males and 109 females and the youngest patient was 2 days old. We divided them into 11 groups based on the diagnosis. The groups consisted of 46 oral mucosal lesions (8 patients were counted again with natal teeth), 45 cleft lip and/or palate infants, 28 with normal oral condition, 26 high maxillary frena, 21 natal or neonatal teeth, 21 traumatic injuries, 15 teeth anomalies, 14 ankyloglossia, 11 eruption problems, 8 occlusal problems, and 7 with other conditions. Among the 234 cases, some very rare conditions were noted, including a prematurely exfoliated supernumerary deciduous tooth in a 2-month-old infant, 3 cases of palatal polyps, and 2 cases of epulides. It was shown that infants exhibit many kinds of oral conditions that require professional attention from pediatric dentists.

Alteration of TH1 and TH2 cells by intracellular cytokine detection in patients with unexplained recurrent abortion before and after immunotherapy with the husband’s mononuclear cells

To elucidate the possible mechanisms of immunotherapy for unexplained recurrent aborters using their husband's mononuclear cells. Prospective clinical study. Institutional practice at the Outpatient Clinic for Infertility, Niigata University Medical Hospital. Fifty-two unexplained recurrent aborters were chosen as an experimental group. Each patient was injected with her husband's mononuclear cells as immunotherapy. Peripheral blood was obtained from the patients. The percentage of CD4-positive cells, TH1 cells, TH2 cells, and the TH1/TH2 ratio were analyzed in the patients before and after immunotherapy. The same analyses were performed in the successful and the unsuccessful group. To date, 42 of the 52 patients have become newly pregnant. Of the 42, 34 patients have already delivered (successful group) and 3 are now pregnant, while the remaining 8 cases experienced repeated abortion (unsuccessful group). The percentage of TH2 cells significantly increased in the total patient population, while the TH1/TH2 ratio significantly decreased in the total patient population and in the successful group. These findings suggest that immunotherapy with the husband's mononuclear cells for unexplained recurrent abortion induces a dominant state of TH2 cells in the patients.

Clinical features and treatment outcome in Japanese patients with social anxiety disorder: Chart review study

The lifetime prevalence of social anxiety disorder (SAD) is high at 3-13%, but there have been only limited reports investigating the clinical features of this disorder in a large number of Japanese patients. The authors have conducted a retrospective, chart review study of 52 patients with SAD and obtained the following results. (i) The proportion of SAD in first visit outpatients at the Department of Psychiatry, Niigata University Medical and Dental Hospital, Niigata, Japan, was 1.04%. The male : female ratio was 1:0.73, so male patients appeared to be more common in the sample. (ii) With regard to subtype, generalized type (73% of the patients) was more common than non-generalized type (27%). (iii) The mean age of onset was 18.6 +/- 7.8 years, and there was a trend towards onset of disease at a younger age in the generalized type compared to the non-generalized type. (iv) The most common chief complaint was anxiety and tension in front of others (40.4%). (v) Pharmacotherapy resulted in improvement in 63.5% of the patients. Treatment by fluvoxamine and alprazolam resulted in high response rates of more than 70%.

Eruption disturbances in Japanese children and adolescents

The aims of this report were to determine the nature of eruption disturbances and to establish the pattern of management for these teeth in a group of Japanese children and adolescents. Data were collected from the clinical records of patients in the Pediatric Dental Clinic of Niigata University Medical and Dental Hospital. There were 700 patients (364 males and 336 females) and 748 teeth (26 primary teeth and 722 permanent teeth) who were treated for eruption disturbances between 1979 and 2002. During this period, 17,365 new patients visited the clinic, of whom approximately 4% had eruption disturbances. The most frequently affected permanent teeth were the maxillary central incisors (38.6%), followed by the maxillary canines (15.4%). Of the permanent teeth, 52.5% were in males and 47.5% in females. Although there were more cases of maxillary central incisors in males than in females, the number of cases involving maxillary canines was higher in females. Whereas delayed eruption was noted in 76.7% of maxillary central incisors, 18.6% were impacted and 4.7% demonstrated abnormal direction/position which required treatment. In contrast, a higher percentage (64.8%) of maxillary canines that showed abnormal direction/position was treated. Eruption disturbances were found in 40% of the patients during routine examinations. This suggests that regular routine examinations are important for pediatric dentists to detect and treat eruption disturbances early.

Middle Ear Carcinoma Originating from a Primary Acquired Cholesteatoma: A Case Report

To describe middle ear carcinoma originating from the matrix of primary acquired cholesteatoma in a 43-year-old man and to discuss the relationship between middle ear carcinoma and cholesteatoma. Case report. Department of Otolaryngology, Head and Neck Surgery of Niigata University Medical and Dental Hospital, which is a tertiary care center, Niigata, Japan. A 43-year-old man demonstrated symptoms resembling those of cholesteatoma: facial palsy, gradually progressive hearing loss, and chronic draining of the right ear. Other objective findings also supported a finding of cholesteatoma, but a computed tomographic scan and magnetic resonance imaging scan showed a well-enhanced mass and extensive bony erosion in the middle ear. At surgery, a granulous tumor in the mastoid cavity was diagnosed as squamous cell carcinoma, and closely coexisting cholesteatoma was found. Surgical specimen demonstrated carcinoma and cholesteatoma in the same field. Radiation and chemotherapy were performed followed-up by mastoidectomy. Because middle ear carcinoma has a poor prognosis, it is important to detect lesions early. It is necessary to consider that middle ear carcinoma arises from not only chronic otitis media or surgical invasion but also from primary acquired cholesteatoma.

Operative Treatment of Pelvic Tumors

Hideaki E. Takahashi, Tetsuro Morita, Tetsuo Hotta, and Akira Ogose, editors. Tokyo: Springer-Verlag; 2003. 216 pages. $119.00. This concise textbook on the operative treatment of pelvic tumors represents the thirty-year experience of the senior editor and author, Dr. H.E. Takahashi, at the Niigata University Medical Hospital in Japan. Dr. Takahashi (who has some forty years of experience in the operative treatment of musculoskeletal tumors) and his contributors have done a very nice job of organizing a concise, readable, and generally well-illustrated surgical text. This single-volume textbook is tastefully constructed …

Simultaneous detection of colorectal carcinoma liver and lung metastases does not warrant resection

Background: Recent evidence suggests that metastasectomy is efficacious for selected patients with hepatic and pulmonary metastases from a colorectal primary. The aim of this study was to identify a subgroup of patients who best benefit from hepatic and pulmonary metastasectomy among those with colorectal carcinoma metastases. Study Design: We analyzed retrospectively a total of 136 patients who underwent resection of hepatic or pulmonary metastases of colorectal origin at Niigata University Medical Hospital between 1982 and 2000. The median followup period was 94 months. Eighty-four patients underwent hepatectomy alone, 25 underwent pulmonary resection alone, and 27 underwent both hepatic and pulmonary resection. The 27 patients undergoing hepatic and pulmonary resection were divided into two groups: 17 patients with sequentially detected hepatic and pulmonary metastases and 10 patients with simultaneously detected metastases. Survival time was determined from the date of initial metastasectomy. Differences in cumulative survival were evaluated using the log-rank test. Sixteen factors were assessed for their influence on the survival of the 27 patients undergoing resection of hepatic and pulmonary metastases; univariate and multivariate analyses were used in this evaluation. Results: Patient survival after hepatic and pulmonary resection was comparable with that after hepatectomy alone (p = 0.536) and that after pulmonary resection alone (p = 0.294). Among the 27 patients undergoing hepatic and pulmonary resection, the outcomes after resection were significantly better in patients with sequentially detected metastases (cumulative 5-year survival of 44%) than in those with simultaneously detected ones (cumulative 5-year survival of 0%) (p < 0.001). On multivariate analysis sequential detection of hepatic and pulmonary metastases was the strongest independent favorable prognostic factor (p < 0.001). Conclusions: Patients with sequentially detected hepatic and pulmonary metastases from a colorectal primary are good candidates for aggressive metastasectomy. Simultaneous detection of these metastases does not warrant resection.

Liver fatty acid-binding protein is a new prognostic factor for hepatic resection of colorectal cancer metastases

Liver fatty acid-binding protein (L-FABP) is reported as a biological marker for enterocytic differentiation. We evaluated the prognostic value of L-FABP expression for patients undergoing hepatic resection of colorectal cancer metastases. The study group comprised 68 patients who underwent hepatic resection for colorectal cancer metastases between 1982 and 1996 at Niigata University Medical Hospital, Niigata, Japan. L-FABP expression was immunohistochemically studied in metastatic liver tumors and their primary colorectal cancers. The relationship between L-FABP expression and patient prognoses was statistically analyzed. L-FABP was positively stained in 56% (38/68) of liver metastases from colorectal cancers and in 56% (38/68) of their primary tumors. Of 68 cases, 54 (79%) showed similar immunohistochemical findings between primary and metastatic tumors. Patients with L-FABP-positive liver metastases showed better prognosis than patients with L-FABP-negative metastases (P = 0.046). L-FABP expression in primary colorectal cancers more significantly (P = 0.009) affected long-term survival after hepatic surgery. Multivariate analysis revealed that the prognostic effect of L-FABP expression in primary colorectal cancers was exerted independently and that its impact was larger than conventional pathological prognosticators. L-FABP expression is suitable for use as a new presurgical prognostic factor for patients undergoing hepatic surgery for colorectal cancer metastases.

Liver fatty acid‐binding protein is a new prognostic factor for hepatic resection of colorectal cancer metastases

Background and Objectives Liver fatty acid-binding protein (L-FABP) is reported as a biological marker for enterocytic differentiation. We evaluated the prognostic value of L-FABP expression for patients undergoing hepatic resection of colorectal cancer metastases. Methods The study group comprised 68 patients who underwent hepatic resection for colorectal cancer metastases between 1982 and 1996 at Niigata University Medical Hospital, Niigata, Japan. L-FABP expression was immunohistochemically studied in metastatic liver tumors and their primary colorectal cancers. The relationship between L-FABP expression and patient prognoses was statistically analyzed. Results L-FABP was positively stained in 56% (38/68) of liver metastases from colorectal cancers and in 56% (38/68) of their primary tumors. Of 68 cases, 54 (79%) showed similar immunohistochemical findings between primary and metastatic tumors. Patients with L-FABP-positive liver metastases showed better prognosis than patients with L-FABP-negative metastases (P = 0.046). L-FABP expression in primary colorectal cancers more significantly (P = 0.009) affected long-term survival after hepatic surgery. Multivariate analysis revealed that the prognostic effect of L-FABP expression in primary colorectal cancers was exerted independently and that its impact was larger than conventional pathological prognosticators. Conclusions L-FABP expression is suitable for use as a new presurgical prognostic factor for patients undergoing hepatic surgery for colorectal cancer metastases. J. Surg. Oncol. 1999;72:83–87. © 1999 Wiley-Liss, Inc.

Human leukocyte antigen class II genotype in patients with recurrent fetal miscarriage who are positive for anticardiolipin antibody

Objective: To elucidate the relationship between human leukocyte antigen (HLA) class II genotypes and patients with recurrent fetal miscarriage who are positive for anticardiolipin antibody. Design: Prospective clinical study. Setting: Institutional practice at the outpatient clinic for infertility, Niigata University Medical Hospital. Patient(s): Patients with recurrent fetal miscarriage who were positive for anticardiolipin antibody and normal fertile women. Intervention(s): Genomic DNA was extracted from peripheral mononuclear cells. Main Outcome Measure(s): Human leukocyte antigen class II genotype was determined using a polymerase chain reaction–restriction fragment length polymorphism method. Result(s): The frequencies of DRB1∗0403 and DRB1∗0410 were significantly higher in the patient group than in the control group. The frequency of DRB1∗04 also was significantly higher in the patient group. As for HLA-DQ genotype, the frequency of HLA-DQB1∗0501 was significantly lower in the patient group. Conclusion: Human leukocyte antigen systems appear to be involved in the genesis of antiphospholipid syndrome.

Planned pregnancy and delivery in a patient with congenital afibrinogenaemia and heterozygous protein C deficiency

H. Takahashi is with the Blood Transfusion Division, Niigata University Medical Hospital, 1–754 Asahimachi, Niigata 951, Japan. Tel: (+81) 25–223–6161 Ext 3570; Fax: (+81) 25–222–0781. K. Wada and A. Shibata are with the First Department of Internal Medicine, Niigata University School of Medicine, 1–757 Asahimachi, Niigata 951, Japan. Address correspondence to H. Takahashi.

前立腺 (全) 剔除術, 特に恥骨後前立腺 (全) 剔除術の手術経験

A study of 753 cases with prostatic diseases is reported in this article. Those cases were seen in the Department of Urology, Niigata University Medical School during the period from 1950 to 1956 and in the Department of Urology, Osaka University Medical School during the period from 1957 to 1965. Prostatectomy was performed upon 724 cases and the rest, 29 cases had no bloody operation. Retropubic prostatectomy was performed on 508 cases (70%), and suprapubic and perineal prostatectomies on rather fewer cases.All the cases were analysed under various factors such as age, preoperative symptoms, operative technique, postoperative course, survival rate, duration of both hematuria and indwelling urethral catheter, postoperative complications, and cause of death.The urinary retention absolutely indicates prostatectomy and the respiratory disturbances were relative contraindication. The ratio between benign prostatic hypertrophy and prostatic cancer was 7 to 1. The mortality rate of retropubic prostatectomy for benign prostatic hypertrophy was 4.3% and the rate for prostatic cancer, 11.8%. The highest occurrence of operative death was seen in age 71 to 80. The five year survival rate after prostatectomy for benign prostatic hypetrophy was 90% and for prostatic cancer, 67%. It was a notable fact that postoperative infection by germs gradually increased during the last three years. And consequently, prophylactic vasectomy ineffectively prevented the occurrence of postoperative epididymitis.The results showed that retropubic prostatectomy is at least one of the most effective methods for prostatic diseases and the authors believe that it might be very much desirable to stick to one and the same method.