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The objectives of this study were to evaluate survival in 141 patients with stage II-IV oral squamous cell carcinoma (OSCC) treated with preoperative intra-arterial chemotherapy with docetaxel, cisplatin, and peplomycin combined with intravenous chemotherapy using 5-fluorouracil (IADCPIVF) via the superficial temporal artery, and to clarify the prognostic factors. The study population included 59 patients with stage II OSCC, 34 with stage III, and 48 with stage IV. After IADCPIVF, 139 patients underwent surgery; minimally invasive surgeries (MIS) including excisional biopsy were performed on 96 patients with a remarkably good response to IADCPIVF. The primary tumour response rate was 99.3% (complete response rate 56.7%, good partial response rate 17.0%, fair partial response rate 25.5%). Additionally, there were no serious adverse events associated with IADCPIVF. The 5-year overall survival rate was 74.6% (stage II 83.6%, stage III 72.7%, stage IV 64.8%). In the multivariate analysis of survival, T classification and clinical tumour response were significant prognostic factors. Eight (8.3%) of the patients who received MIS had primary recurrence and six were salvaged. In conclusion, IADCPIVF is safe and efficacious for treating OSCC, and MIS could reduce the extent of primary tumour resection in the case of a remarkably good response.

Purpose: We compared the efficacy of sub-Tenon triamcinolone acetonide (STTA) to intravitreal triamcinolone aceto­nide (IVTA) injections during cataract surgery (CS) for patients with diabetic macular edema (DME). Methods: The medical records of 33 eyes (26 patients) with DME which had undergone CS with STTA were compared to those of 34 eyes (27 patients) with DME which had undergone CS with IVTA. Central foveal thickness and best-corrected visual acuity (BCVA) were measured at the baseline and 1, 3, and 6 months after the surgery. Results: The BCVAs after STTA and IVTA were significantly improved at 3 and 6 months. Thirteen eyes in the IVTA group and 21 eyes in the STTA group required other therapies (p < 0.05). One case developed intraocular pressure elevation after IVTA and underwent selective la ser trabeculoplasty. Conclusions: Ophthalmologists should consider the merits and demerits of IVTA and STTA for DME treatment after CS.

PurposeThe purpose of this study is to compare the amplitudes and peak times of the flicker electroretinograms (ERGs) recorded before and after cataract surgery with the RETeval system (LKC Technologies, Gaithersburg, MD, USA) from eyes without dilation.Patients and methodsThirty-two eyes of 32 patients (77.3±6.5 years) that had grade 2 Emery-Little nuclear or cortical cataract without any other abnormalities were studied. Flicker ERGs were recorded with the RETeval system under mydriatic-free conditions. Skin electrodes were used to pick-up the ERGs that were elicited by white light delivered at a rate of 28.3 Hz and intensity of 2, 8, and 32 Td-s. The amplitudes and peak times of the flicker ERGs before and after cataract surgery were compared.ResultsThe mean amplitudes were significantly increased after the removal of the cataractous lenses at the three stimulus intensities (2 Td-s, P0.0001; 8 Td-s, P0.0001; and 32 Td-s, P0.0001). The mean peak times of the flicker ERGs elicited by 2 and 8 Td-s were significantly shortened after the surgery (2 td-s, P0.0001 and 8 td-s, P=0.0127) but not at 32 td-s (P=0.595).ConclusionsThese results indicate that the presence of cataracts will affect both the amplitudes and the peak times of the flicker ERGs even if the cataract is mild. In addition, the results indicate that as stimulus intensity increases, the peak times is less affected by a cataract. The clarity of the crystalline lens should be considered when interpreting the flicker ERGs recorded with the RETeval system.

Mucormycosis is a rare fungal infection mainly developing in compromised hosts, and the associated mortality rate is high. We encountered a patient with rhinocerebral mucormycosis that had extended into the skull. Amphotericin B (AMPH-B) was markedly effective and saved the patient’s life. The patient was a 51-year-old male with a past medical history of type-1 diabetes and he was being treated with dialysis for chronic renal failure. He visited his family doctor for left cheek pain, and received treatment for a diagnosis of left sinusitis and odontogenic maxillary sinusitis, but the swelling of the left cheek aggravated, and dysesthesia and left palatine mucosal necrosis developed. Thus, the patient was transferred to our department. On the first examination, Horner syndrome and cavernous sinus syndrome were observed, and multiple abscess in the left bucca, mucosal hypertrophy of the paranasal sinus, and lesions in the orbit and skull were noted on CT. Treatment for severe ondontogenic infection was performed, but mucormycosis was diagnosed on the second histopathological examination of the necrotized palatal region. The intravenous administration of AMPH-B (2.5 mg/kg/day) was initiated, and size reduction of the lesions was confirmed on CT after administration for 6 weeks. The lesions completely disappeared thereafter, but the patient died of another disease after 8 years. AMPH-B was markedly effective and saved the patient’s life. When buccal cellulitis and sinusitis develop in a compromised host, it is necessary to take rhinocerebral mucormycosis into consideration.

To determine whether there are significant correlations between the N2 amplitude of the multifocal electroretinograms (mfERGs) and the retinal sensitivity and retinal nerve fiber layer (RNFL) thickness in glaucomatous and normal eyes. Thirty-eight glaucomatous and 11 normal eyes were studied. The mfERGs were elicited by red stimuli presented on a blue background. The responses from the central five elements within a 20° stimulated area were analyzed. The retinal sensitivity was determined by Humphrey Field Analyzer and the RNFL thickness by spectral-domain optical coherence tomography. The correlations between the N2 amplitude and the retinal sensitivity and the RNFL thickness were calculated. The N2 amplitude was significantly smaller in the glaucomatous eyes than the normal eyes in all areas (P

We compared the efficacy of intravitreal aflibercept (IVA) to intravitreal ranibizumab (IVR) injections in eyes with diabetic macular edema (DME). The medical records of 49 eyes of 36 patients who were diagnosed with DME and had received IVR and 46 eyes of 40 patients who had received IVA treatment were reviewed. The central macular thickness (CMT) and best-corrected visual acuity (BCVA) were measured at the baseline and at 1, 3, and 6 months after the IVR or IVA. The mean number of injections of IVR was 2.6±1.1 and of IVA was 2.7±1.4. At 6 months, the CMT was significantly thinner than the baseline after IVR and after IVA. The mean BCVA was significantly better than the baseline after IVR only at 1 and 3 months and after IVA at 1 and 6 months. The BCVA of eyes with serous retinal detachment (SRD) was significantly better at 1 month after the IVR and at 1 month and 6 months after the IVA. The BCVAs improved more significantly in the SRD+ group than in the SRD− group. The effects of IVA persist longer than that of IVR. The effectiveness of both IVR and IVA was not dependent on the presence of SRD (IRB#2107).

Purpose To determine the relationship between preoperative and postoperative characteristics and visual outcomes after successful surgery for unclosed macular hole (MH). Methods The medical charts of 166 eyes of 161 patients who underwent vitrectomy for a MH were reviewed. The MH was not closed in 9 eyes of 9 patients after the initial surgery. The second vitrectomy with additional internal limiting membrane (ILM) peeling and gas tamponade was performed. The preoperative and postoperative best-corrected visual acuity (BCVA), optical coherence tomographic images, MH size, duration of MH before the first operation, and area of ILM peeling were studied. Results The MH was closed in all eyes after the second surgery. The BCVA significantly improved from 0.77 to 0.25 logMAR units (20/118 to 20/36, p = 0.002). The postoperative subfoveal ellipsoid zone (EZ) was distinct and continuous in 3 eyes with good visual recovery. The final BCVA was not significantly correlated with the baseline characteristics and area of ILM peeling but was correlated with the postoperative status of the EZ. Conclusions All MHs were closed and the mean postoperative visual acuity was significantly improved. The reason for poor visual recovery was the reduced microstructural recovery after the second surgery.

Purpose To evaluate the microstructure of the inner and outer retina and the visual function after macular hole (MH) surgery using brilliant blue G (BBG) or indocyanine green (ICG) to make the internal limiting membrane (ILM) more visible. Design Comparative, retrospective, interventional case series. Participants Sixty-three eyes of 63 consecutive cases with MH were studied. Thirty-five eyes of 35 cases were treated with BBG between January and August 2011. Twenty-eight eyes of 28 MH cases were treated with ICG from April 2009 through April 2010. Methods Vitrectomy was performed with a 23-gauge system and 0.25 mg/ml BBG or with 0.125% ICG. Main Outcome Measures The best-corrected visual acuity (BCVA) and the microperimetry-determined retinal sensitivity were measured at baseline and at 3 and 6 months after surgery. The length of the defect of the photoreceptor inner segment/outer segment (IS/OS) junction and external limiting membrane (ELM), the central foveal thickness (CFT), and the thickness of the ganglion cell complex (GCC) were measured in the spectral-domain optical coherence tomographic images. Results The average BCVA was significantly better in the BBG group than in the ICG group at 3 months ( P = 0.021) and 6 months ( P = 0.045) after surgery. The mean retinal sensitivity in the BBG group was improved significantly in the central 2° at 3 and 6 months ( P = 0.001 and P = 0.030, respectively), but was not significantly improved in the adjacent 10°. The length of IS/OS junction defect was significantly shorter in the BBG group at 3 months ( P = 0.048), but was not significantly different at 6 months ( P = 0.135). The length of ELM defect and the GCC thickness were not significantly different between the 2 groups at 3 and 6 months. The CFT was significantly thinner in the ICG group than in the BBG group at 3 and 6 months ( P = 0.013 and P = 0.001, respectively). Conclusions The postoperative BCVA and retinal sensitivity in the central 2° were better in eyes after BBG-assisted vitrectomy. The restoration of IS/OS junction was faster in the BBG group, and the CFT was significantly thinner in eyes after ICG. Brilliant blue G may be a better agent than ICG to make the ILM more visible. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Reduction of thickness of ganglion cell complex after internal limiting membrane peeling during vitrectomy for idiopathic macular hole

The aim of our study was to determine the relationship between vision-related quality of life (VRQOL) following the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25) and the macular sensitivity determined by microperimetry in patients with retinitis pigmentosa (RP). The Japanese version of the NEI VFQ-25 was used to assess the VRQOL of 30 patients with typical RP whose decimal visual acuity was ≥0.6. The mean retinal sensitivity within the central 10° was determined by fundus-related microperimetry (MP1). The correlation between the mean of the total composite NEI VFQ-25 score and MP1-determined macular sensitivity was determined. Mean NEI VFQ-25 score was 69.4 ± 14.5 (range 34.6–90.3) in RP patients. There was a significant positive correlation between mean NEI VFQ-25 score and mean retinal sensitivity within 10° (r = 0.673, P = 0.0003). The significant correlation between macular sensitivity and VRQOL measured with the NEI VFQ-25 indicates that sensitivity in the macular area is an important consideration in using VRQOL with RP patients.

Aim: To compare the results of vitrectomy with internal limiting membrane (ILM) peeling to that without ILM peeling for macular edema associated with branch retinal vein occlusion (BRVO). Methods: The medical records of 47 eyes of 47 patients with BRVO-associated macular edema were examined. To treat the macular edema, a posterior vitreous detachment (PVD) was created, and the ILM was removed in 13 eyes (ILM-removed group), whereas a PVD was created and the ILM was not removed in 34 eyes (ILM-preserved group). The best-corrected visual acuity (BCVA) and the optical-coherence-tomography-determined foveal thickness were obtained preoperatively and at 6 months postoperatively. Results: The mean postoperative BCVA was significantly better than the preoperative BCVA in both the ILM-removed and in the ILM-preserved groups (p = 0.0017 and p = 0.0002, respectively). The fovea was significantly thinner at 1 month after surgery in both groups (p = 0.0007 and p < 0.0001, respectively). The postoperative improvement of the mean BCVA and the foveal thickness were not significantly different for the two groups at any postoperative period. Conclusions: Because there was no significant difference in the improvement of BCVA between the two groups at 6 months postoperatively, there may be no additional benefit in removing the ILM for BRVO-associated macular edema.

Sodium azide (NaN(3)) is widely used in industry and agriculture, and also in laboratories as a potent preservative. NaN(3) induces cell death when applied to cultured cells. However, whether the mode of cell death is apoptosis or necrosis remains a subject of debate. There have been no previous reports on NaN(3)-induced cell death in squamous cell carcinoma (SCC), and so we studied the mode of cell death induced by NaN(3) using the rat SCC cell line, SCC131. In this experiment, SCC131 cells died 48-72 h after NaN(3) treatment with concentrations greater than 5 mM. The NaN(3) treatment reduced the mitochondrial membrane potential and ATP content. Terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling and DNA ladder detection assay indicated that no DNA fragmentation occurred. In addition, phosphatidyl serine did not appear on the cell surface, according to the findings of dye-uptake bioassay and flow cytometric analysis of Annexin V labeling. Electron microscopic analysis revealed that the NaN(3)-treated cells showed mitochondrial swelling and rupture of the cell membrane. In conclusion, NaN(3) induces necrotic cell death in SCC131. This experimental model may be used in the study of necrotic cell death.

Purpose To evaluate the efficacy of radial optic neurotomy (RON) on retinal function in patients with central retinal vein occlusion (CRVO). Methods Ten eyes of 10 patients with CRVO underwent pars plana vitrectomy and RON. Standardized combined electroretinograms (ERGs) to full-field bright-flash stimuli were recorded preoperatively and, 3 months postoperatively. The best-corrected visual acuity and foveal thickness were also determined, before and 3 months postoperatively. Results The mean best-corrected visual acuity and mean foveal thickness were both significantly improved after vitrectomy and RON. The mean amplitudes of a- and b-waves did not change significantly, but the mean b/a wave ratio was increased significantly after vitrectomy and RON. An improvement of the b/a ratio was observed in six eyes, however, an improvement of retinal circulation was confirmed on postoperative fluorescein angiograms in two of these six eyes. Conclusions Significant improvements were observed in the b/a wave ratio of the standard combined ERGs after surgery in eyes with CRVO. The improvement of retinal function was most likely due to improved oxygenation of retina caused by vitrectomy and not by RON.

Purpose To compare the effects of sub-Tenon’s capsule triamcinolone acetonide (STTA) injection to that of STTA injection combined with microaneurysm photocoagulation (MAPC; STTA + MAPC) on eyes with diabetic macular edema (DME). Patients and methods The medical records of 138 eyes of 138 patients with DME treated by either STTA or STTA + MAPC were reviewed. The degree of DME was determined by the optical coherence tomographic features: patients with serous retinal detachment (SRD+; 38 eyes) and patients without SRD (non-SRD; 100 eyes). The central macular thickness (CMT) and the best-corrected visual acuity (BCVA) were measured periodically for 6 months after the treatments. Results The BCVA was significantly improved in the non-SRD group after STTA + MAPC. The CMT was significantly improved in all groups and improved considerably more in the non-SRD group than in the SRD+ group after STTA + MAPC. Conclusion Our findings indicate that MAPC has an additive effect in the non-SRD type.

The purpose of this study was to determine the morphological and functional changes in the macula after pars plana vitrectomy with the creation of a posterior vitreous detachment in eyes with diabetic macular edema (DME). A simple posterior vitreous detachment was created during pars plana vitrectomy accompanied by simultaneous cataract surgery in 19 eyes of 17 patients with DME. The visual acuity (log MAR units), multifocal electroretinograms (mfERGs), and optical coherence tomographically (OCT)-determined foveal thickness were determined preoperatively and at 6 months postoperatively. The median preoperative log MAR visual acuity was 0.7 (20/100; range, 0.3-1.1), and it improved significantly to 0.4 (20/50; range, 0.15-1.0) postoperatively (p = 0.016). The median foveal thickness was 510 (range, 194-800) microm preoperatively and was significantly reduced to 201 (range, 60-631) microm postoperatively (p =0.0002). The median of response density of the mfERGs in the macular area was 6.3 nV/ deg2 (range, 2.8-14.8) preoperatively, and 6.1 nV/deg2 (range, 2.4-14.3) postoperatively, a non-significant change (p = 0.27). The median of peak latency of the macular response was 30.0 ms (range, 25.0-44.2) preoperatively and it decreased significantly to 28.3 ms (range, 26.7-35.0) postoperatively (p = 0.003). In conclusion, vitrectomy with the creation of a PVD in eyes with DME improved the visual acuity and foveal thickness significantly. In addition, a decrease of the peak latency of the macular mfERGs suggested an improvement of the physiological function of the macula although the amplitude of the mfERGs was not changed significantly.

To determine the psychological state and personality traits of patients with retinitis pigmentosa (RP) or glaucoma so that a closer and better relationship can be developed with the patients.The Yatabe-Guilford personality test was administered to 75 RP patients and 42 glaucoma patients. The latter group included 29 cases of primary open-angle glaucoma, 6 of primary angle-closure glaucoma, and 7 of normal-tension glaucoma. The patients were being treated at the Department of Ophthalmology, Chiba University Hospital. As controls, 47 age-matched volunteers were tested.A comparison of these three groups showed that the proportions of patients with cyclic tendency, rhathymia, and lack of cooperativeness traits were significantly higher in the RP group than in the glaucoma group. The lack of cooperativeness value was especially higher in the RP than in the glaucoma group and the control group (Fisher exact test, P.05). On the other hand, the nervousness value was significantly higher in the glaucoma group than in the RP group and than in controls (Fisher exact test, P.05). Factors of sex, age, type of disease, corrected visual acuity, and central visual fields did not influence the profiles of the RP and glaucoma groups.RP patients had relatively well-stabilized personalities and were optimistic, while glaucoma patients tended toward nervousness in comparison with RP patients and controls.

The effect of an intravitreal injection of ornithine on the retina of rats was studied electroretinographically. Rats were injected intravitreally with 5 µl of 0.02, 0.25 and 0.5 M ornithine. Electroretinograms (ERGs) were recorded before, and 1, 3 and 9 days after the injection. High doses of ornithine (0.5 M) reduced while low doses (0.02 M) enhanced the ERG amplitudes. The implicit time of the a-wave was delayed at all concentrations after ornithine injection, which suggests that implicit times may be a more sensitive parameter of the ornithine effect. There were significant changes in the stimulus intensity necessary to obtain the one half of the maximum amplitude of the b-wave that may have been caused by damage of the photoreceptors and retinal pigment epithelium cells by ornithine. We conclude that the effect of ornithine on retinal function is dose dependent and can either enhance or depress the ERG amplitudes.

To compare the surgical outcomes during pars plana vitrectomy (PPV) for diffuse diabetic macular edema (DME) with pretreatment to those without pretreatment.The medical charts of 43 eyes of 46 patients who underwent PPV for DME were reviewed. The previously treated (Prev. Tx) group included 19 eyes of 20 patients who were pretreated with intravitreal bevacizumab, sub-Tenon injection of triamcinolone acetonide, and/or subthreshold micropulse diode laser photocoagulation before the PPV. The treatment naïve (Tx.Naïve) group included 24 eyes of 26 patients who underwent PPV alone. The central macular thickness (CMT) and best-corrected visual acuity (BCVA) were measured before treatment and 1, 3, and 6 months after.In both groups, BCVA at 3 and 6 months and CMT at 1 month or later were significantly better than preoperative visual acuity. CMT at 1 month or later significantly decreased from the preoperative value (p0.05). The differences in the BCVA and CMT between the Prev. Tx and Tx.Naïve group were not significant.PPV either with or without preoperative treatments can significantly improve the BCVA and reduce the CMT in patients with diffuse DME.

Purpose. To determine the relationship between the retinal thickness and sensitivity of the macular region after successful reattachment of an acute macula-off rhegmatogenous retinal detachment (RRD). Methods. Twenty-three eyes of 23 patients with an acute macula-off RRD were studied (17 men, 6 women). The mean age of the patients was 53.2±14.7 years with a range from 20 to 73 years. The interval between the decrease in vision and surgery was Results. Ten eyes were treated by scleral buckling (SB) and 13 eyes by pars plana vitrectomy (PPV), and the retina was reattached in all eyes. The mean BCVA was significantly improved at 3 and 6 months postoperatively (pConclusions. The delay in the recovery of outer retinal thickness may be the cause of the lower sensitivity of the macula.

To report a series of 6 cases of sterile endophthalmitis that developed consecutively after an intravitreal injection of bevacizumab (IVB).On April 13 and 14, 2009, we performed IVB for consecutive 12 eyes of 12 patients in a sterile condition. Within two days after injection, blurred vision without ocular pain, anterior chamber inflammation, and vitreous opacity were developed in 6 of the eyes of 6 patients. Hypopyon was not observed in any patient. Anterior chamber fluid from each eye and all syringes of bevacizumab that have been separated from the same bottle of same lot number were sent for bacterial culture examination.No bacterial colony was developed from the anterior chamber fluid of any of the patients nor from any of the syringes. Antibiotic treatment of all 6 patients was unsuccessful. The symptoms improved in all cases following treatment with topical corticosteroid within several days.Both the clinical course and the results of bacterial culture, lead to the possibility that our patients developed sterile endophthalmitis rather than infectious endophthalmitis. The exact causes of the endophthalmitis were not identified in our cases, but similar events are reported by several institutions, endophthalmitis following IVB needs to be considered a possibility.

BACKGROUND AND OBJECTIVE To evaluate the efficacy of vitrectomy with simultaneous intravitreal injection of triamcinolone acetonide for macular edema associated with branch retinal vein occlusion. PATIENTS AND METHODS A retrospective study of 45 eyes with macular edema associated with branch retinal vein occlusion. A posterior vitreous detachment was created and the vitreous cortex was completely removed, after which 23 eyes immediately had an intravitreal injection of triamcinolone acetonide (triamcinolone acetonide group) and 22 eyes did not (no triamcinolone acetonide group). Visual acuity, fluorescein angiograms, and foveal thickness determined by optical coherence tomography were examined preoperatively and postoperatively. RESULTS Mean postoperative visual acuity at 12 months was significantly better than the preoperative visual acuity in both groups. The fovea was significantly thinner 1 month postoperatively in both groups. Foveal thickness gradually decreased until 12 months in the no triamcinolone acetonide group; however, foveal thickness increased for 12 months in the triamcinolone acetonide group. A recurrence of macular edema was more frequent in the triamcinolone acetonide group than in the no triamcinolone acetonide group (P = .006). CONCLUSIONS Because there was no significant difference in the improvement of best-corrected visual acuity between the groups 12 months postoperatively, there may be no benefit in the use of intraoperative intravitreal triamcinolone acetonide. [Ophthalmic Surg Lasers Imaging 2009;40:6-12.] &nbsp

Catheter placement for continuous intra-arterial chemotherapy in head and neck cancer is generally performed via the superficial temporal artery. If placement via this artery is impossible, other arteries, such as the occipital artery, are chosen. A surgical method has been developed for catheter placement in the occipital artery by approaching from the posterior of the mastoid process. Catheter placement was performed by this method in 15 patients with oral squamous cell carcinoma. Target arteries were the lingual artery in seven cases, facial artery in three cases, maxillary artery in three cases, superior thyroid artery in one case, and the occipital artery itself in one case. The occipital artery was exposed without fail and catheter placement was completed in all patients. The wound healed without complication after treatment. This approach via the occipital artery is a useful technique to achieve continuous intra-arterial chemotherapy in head and neck cancer, especially for cases in which catheter placement is impossible via the superficial temporal artery.

Toshiyuki Oshitari, Sakiko Nonomura, Miyuki Arai, Yoko Takatsuna, Eiju Sato, Takayuki Baba, Shuichi Yamamoto Department of Ophthalmology and Visual Science, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan Purpose: To compare the effects of sub-Tenon's capsule triamcinolone acetonide (STTA) injection to that of STTA injection combined with microaneurysm photocoagulation (MAPC; STTA + MAPC) on eyes with diabetic macular edema (DME). Patients and methods: The medical records of 138 eyes of 138 patients with DME treated by either STTA or STTA + MAPC were reviewed. The degree of DME was determined by the optical coherence tomographic features: patients with serous retinal detachment (SRD+; 38 eyes) and patients without SRD (non-SRD; 100 eyes). The central macular thickness (CMT) and the best-corrected visual acuity (BCVA) were measured periodically for 6 months after the treatments. Results: The BCVA was significantly improved in the non-SRD group after STTA + MAPC. The CMT was significantly improved in all groups and improved considerably more in the non-SRD group than in the SRD+ group after STTA + MAPC. Conclusion: Our findings indicate that MAPC has an additive effect in the non-SRD type. Keywords: diabetic macular edema, sub-Tenon's triamcinolone acetonide injection, microaneurysm photocoagulation, best-corrected visual acuity, central macular thickness

Background. The sentinel node concept has become one of the most interesting topics in the treatment of head and neck cancer. The aim of this article is to report the results of our feasibility study and clinical application of sentinel lymph node (SLN) radiolocalization and biopsy in patients with clinically negative neck oral cancer. Methods. Individuals with previously untreated N0 oral cancer participated in the study. The radioactive tracer used was 99m Tc phytate. Lymphoscintigrams were taken in the feasibility study, and fusion images of SPECT and CT were obtained in the clinical SLN biopsy (SLNB) group. In the feasibility study, metastases to SLNs and other nodes were analyzed in permanent specimens. In the clinical application group, we investigated the comparative effectiveness of multi-slice frozen section analysis and imprint cytology for the intraoperative diagnosis of SLNB. Results. Fifteen individuals participated in the feasibility study. Six SLNs in five patients were cancer-positive, and two thirds of the SLNs were micrometastases. The SLN concept was established, and SLNs with the highest to the third highest radioactivity reflected the patients' neck status accurately. Twelve patients participated in the clinical application group of SLNB. Intraoperative diagnosis of the three hottest SLNs correctly predicted the neck status of 10 patients. Three patients underwent modified radical neck dissection on the basis of the intraoperative diagnosis of cancer metastasis to SLNs, whereas neck dissections were spared in patients with no evidence of such metastases. There were two false-negative cases. One involved a failure of the intraoperative diagnosis of SLNB, and the other had cancer-negative SLNs and cancer-positive non-SLNs. Considering intraoperative diagnosis, multi-slice frozen section analysis was found to be superior to imprint cytology in its sensitivity, specificity, and overall accuracy on a lymph node basis. No differences were found in any of these indices of intraoperative SLNB on a patient basis. The fusion images of SPECT and CT proved very useful during intraoperative SLNB. Conclusions. The sentinel node concept was established in the head and neck region. Analyzing the three hottest SLNs suffices to predict a patient's neck status. Multi-slice frozen section analysis was shown to be superior to imprint cytology for detecting micrometastasis to SLN. Intraoperative SLNB based on fusion images of SPECT and CT proved to be an easy, accurate, and reliable method. © 2005 Wiley Periodicals, Inc. Head Neck27: XXX–XXX, 2005

Purpose To describe a patient with a central retinal vein occlusion (CRVO) who developed central retinal artery occlusion after radial optic neurotomy. Design Interventional case report. Methods A 70-year-old woman with CRVO underwent a radial optic neurotomy on her right eye. Her preoperative visual acuity in the affected eye was 20/400. Results Radial optic neurotomy was performed after phacoemulsification and aspiration for a cataract with intraocular lens implantation. At the insertion of a CRVO knife, pulsating bleeding occurred from the cup of the optic disk; the bleeding was stopped within 2 minutes by elevating the intraocular pressure to 80 mm Hg. On the following day, the patient noticed that she had lost light perception. Fluorescein angiography showed a marked delay of arterial filling, indicating a central retinal artery occlusion. Retinal circulation returned to normal 2 months later; however, her vision was still no light perception. Conclusions Ophthalmologists should be aware that severe complications such as central retinal artery occlusion can be associated with radial optic neurotomy, which is an unproven surgical procedure with a questionable pathophysiologic mechanism.

Purpose compare the results of vitrectomy with or without arteriovenous (AV) crossing sheathotomy for macular edema associated with branch retinal vein occlusion (BRVO). Design Interventional case series. Methods A retrospective study of 36 eyes with BRVO-associated macular edema. Twenty eyes underwent AV sheathotomy (AS group), and 16 eyes underwent posterior vitreous detachment (PVD group). Best-corrected visual acuity (BCVA), fluorescein angiography (FA), and optical coherence tomography to determine foveal thickness were conducted preoperatively and at 12 months postoperatively. Results The mean postoperative BCVAs were significantly better in both the AS and the PVD group ( P = .008 and P = .001, respectively). Foveal thickness decreased significantly 1 month after surgery in both groups ( P = .002 and P = .007) and continued to decrease up to 12 months. The postoperative mean BCVA and improvement of BCVA and foveal thickness were not significantly different for the two groups at any postoperative period. Postoperative FA showed reperfusion of the occluded vein in 10 eyes in the AS group and 2 eyes in the PVD group, and formation of shunt vessels at the AV crossing site or around the macular region in all of the other eyes of both groups. Conclusions Both AV sheathotomy and simple PVD significantly reduced macular edema associated with BRVO. However, there was no significant difference in the improvement of macular function following either procedure. Postoperative improvement of retinal circulation by either reperfusion of the occluded vein or collateral vessel formation was found. This accounted for functional and morphologic improvements.

A lipid-binding protein identical to the rat intestinal bile acid-binding protein, termed I-15P, was expressed in steroid hormone-producing tissues such as ovary and adrenal gland, but not testis. In immature rats, I-15P was expressed in intestine but not in ovaries. The expression of I-15P in the ovaries of immature rats was induced to the level in immature rats by gonadotropin treatment. This suggests that the expression of I-15P in the ovaries is controlled by the ovarian cycle. The present results indicate that the expression of I-15P is developmentally and hormonally controlled in a tissue-specific manner.

The purpose of this study was to investigate whether nipradilol, a β-blocker having both vasodilating and α1-blocking activities, can protect retinal cells from the injury induced by ischemia and reperfusion. Rats were anesthetized and, after an intravitreal injection of nipradilol, the intraocular pressure was raised for 45 min to induce retinal ischemia and reperfusion. Before, and 3 and 7 days after the ischemia, electroretinograms were recorded. After the ischemia, the mean amplitude of the b-waves in rats receiving 5 µl of 1.0 × 10–6 M nipradilol was significantly larger than of controls (injected with phosphate-buffered saline). Histologically, the reduction in the number of retinal ganglion cells (1.0 × 10–6 M), and the thickness of the inner and outer plexiform layers and the inner nuclear layer (1.0 × 10–6, 10–7 and 10–8 M) was suppressed by nipradilol. These results indicate that nipradilol protected the retina against retinal ischemia and reperfusion and should be considered for therapeutic use in cases of transient retinal ischemia.

We have isolated a cDNA encoding a human intestinal 15-kDa protein (I-15P) from a human ileal lambda gt 11 cDNA library, using a full-length rat I-15P cDNA. One clone encompassed 571 nucleotides and encoded a 128-amino-acid protein with a calculated molecular mass of 14355 Da. The deduced amino acid sequence of human I-15P showed high similarity to the rat counterpart (78%), mouse ileal lipid-binding protein (80%) and porcine gastrotropin (75%). It also exhibited 36% similarity to human liver fatty-acid-binding protein (L-FABP). Northern blot analysis of human I-15P revealed a single transcript only in ileum, however, the reverse-transcription/PCR demonstrated expression in ovary and placenta, but it was much lower than in ileum. Transformation of Escherichia coli with the I-15P cDNA resulted in the efficient expression of a protein that was identical to the ileal cytosolic I-15P. In vitro binding studies revealed that the bacterially expressed recombinant I-15P showed much lower affinities for palmitate and oleate than L-FABP. However, it showed similar affinity for taurocholate, compared with a control, BSA. Comparison of the structural features of human I-15P and human L-FABP suggested that loss of a long alpha-helix region and hydrophobic profile of I-15P may be attributable to a unique ligand-binding specificity of I-15P.