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Stone removal using endoscopic papillary large balloon dilation (EPLBD) is extremely effective. However, limited research exists regarding the risk factors for perforation of the duodenal papilla and bile duct, which may be fatal. We aimed to investigate the risk factors for perforation during EPLBD + stone removal. We included patients who underwent EPLBD + stone removal at four medical facilities between January 2008 and December 2018. We retrospectively analyzed the risk factors for perforation and their relationship between overdilation and adverse events. Overdilation was defined as a ratio of the balloon diameter to the diameter of the bile duct that exceeded 100%. The diameter of the distal bile duct was measured using the diameter of the intrapancreatic bile duct at a point 10 mm toward the liver from the narrow distal segment on a cholangiogram. We included 310 patients (177 males; median age: 79 years [range: 46–102 years]). Perforation occurred in five patients (1.6%). Multivariate analysis indicated that no surrounding-pancreas (half or less of the circumference of the intrapancreatic bile duct was surrounded by the pancreatic parenchyma) was a significant risk factor (perforation rate: 8.3%, p = 0.011, odds ratio: 12.7 [95% confidence interval: 1.8–90.5]). No significant difference was found between the overdilation and non-overdilation groups regarding the occurrence of pancreatitis, bleeding, and cholangitis. Perforation rate in patients with no surrounding pancreas + overdilation was 16.7% (2/12). Patients with perforation underwent conservative therapy, which improved their conditions. EPLBD + stone removal should be avoided in patients with no surrounding pancreas. Overdilation is not a risk factor for adverse procedural events; however, it should be limited in patients with surrounding pancreas.

AJM300 is an oral, small-molecule α4-integrin antagonist. We assessed the efficacy and safety of AJM300 in patients with moderately active ulcerative colitis.This multicentre, randomised, double-blind, placebo-controlled, phase 3 study consisted of two phases: a treatment phase and an open-label re-treatment phase. The study was done at 82 hospitals and clinics in Japan. Patients with a Mayo Clinic score of 6-10, endoscopic subscore of 2 or more, rectal bleeding subscore of 1 or more, and an inadequate response or intolerance to mesalazine were enrolled. Patients were randomly allocated (1:1) via a website to either AJM300 (960 mg) or placebo by the minimisation method, which was adjusted centrally by dynamic assignment against the Mayo Clinic score (≥6 to ≤7, ≥8 to ≤10 points), any use of corticosteroid, anti-TNFα antibody, or immunosuppressants during the disease-active period (yes vs no), duration of induction therapy until randomisation (4 weeks vs ≥4 weeks) as the minimisation factors. Patients, investigators, site staff, assessors, and the sponsor were masked to treatment assignments. The study drug was administered orally, three times daily, for 8 weeks, and continued for up to 24 weeks if endoscopic remission was not achieved or rectal bleeding did not stop. The primary endpoint was the proportion of patients with a clinical response at week 8, and was analysed in the full analysis set. Clinical response was defined as a reduction in Mayo Clinic score of 30% or more and 3 or more, a reduction in rectal bleeding score of 1 or more or rectal bleeding subscore of 1 or less, and an endoscopic subscore of 1 or less at week 8. The study is registered with ClinicalTrials.gov, NCT03531892, and is closed to recruitment.Between June 6, 2018, and July 22, 2020, 203 patients were randomly assigned to AJM300 (n=102) or placebo (n=101). At week 8, 46 (45%) patients in the AJM300 group and 21 (21%) patients in the placebo group had a clinical response (odds ratio 3·30, 95% CI 1·73-6·29; p=0·00028). During the 8-week treatment and 16-week extension treatment periods, adverse events occurred in 39 (39%) of 101 patients in the placebo group and 39 (38%) of 102 patients in the AJM300 group. We found no difference in the incidence of adverse events between groups or after repeated administration of AJM300. The most common adverse event was nasopharyngitis (11 [11%] of 101 patients in the placebo group and ten [10%] of 102 patients in the AJM300 group). The most common treatment-related adverse event was also nasopharyngitis (four [4%] of 101 patients in the placebo group and three [3%] of 102 patients in the AJM300 group). Most adverse events were mild-to-moderate in severity. No deaths were reported. A serious adverse event was reported in the AJM300 group (one patient with anal abscess), but this was judged to be unrelated to study drug.AJM300 was well tolerated and induced a clinical response in patients with moderately active ulcerative colitis who had an inadequate response or intolerance to mesalazine. AJM300 could be a novel induction therapy for the treatment of patients with moderately active ulcerative colitis.EA Pharma and Kissei Pharmaceutical.For the Japanese translation of the abstract see Supplementary Materials section.

As part of our ongoing investigation of risk and predictive factors associated with temporomandibular disorders, we used magnetic resonance imaging (MRI) to identify risk factors for sideways disk displacement of the temporomandibular joint in 26 patients with MRI-confirmed unilateral pure sideways disk displacement (medial or lateral disk displacement) and normal positioning of the contralateral temporomandibular joint. Coronal morphologic harmonization between the condyle and fossa, angle between the axis of the ramus and condyle, and angle between the lateral pterygoid muscle (LPM) and condyle were evaluated. Only angle of the LPM related to the condyle was significantly correlated with mediolateral disk position; the angles of joints with medial, normal, and lateral disk positions were 70.2°, 66.7°, and 60.1°, respectively. These results suggest that a greater angle of the inferior head of the LPM to the axis of the condyle on axial MRI images may cause medial disk displacement, while a smaller angle may result in lateral disk displacement. (J Oral Sci 58, 29-34, 2016).

This study investigated the prevalence and distribution of anomalies of permanent dentition in the current Japanese population by examining an unbiased sample. We conducted a survey of dental anomalies by mass dental screening at eight high schools in 2012. Participants were all students with permanent dentition. Dental anomalies were classified as hypodontia, supernumerary teeth, peg-shaped teeth, fused teeth, and talon cusps. Students with one or more dental anomalies on oral examination were given a differential diagnosis by three specialists. The final sample comprised 9584 participants (5062 boys, 4522 girls). Hypodontia was present in 372 students (3.88 %) with no significant sex difference (191 boys, 181 girls). Frequent sites were the right or left mandibular second premolar, right or left maxillary second premolar, and right or left maxillary lateral incisor. Supernumerary teeth were observed in three boys (0.06 %) and one girl (0.02 %). Peg-shaped teeth were observed in 74 students (0.77 %; 27 boys, 47 girls), differing significantly between sexes; they were most prevalent among maxillary lateral incisors. Of affected students, 18 students (0.19 %) also had hypodontia (3 boys, 15 girls). Fused teeth were present in two boys (0.04 %) and three girls (0.07 %) (gemination in one boy and fusion in the remaining four students). Sites were limited to maxillary and mandibular central and lateral incisors. Talon cusps were observed in two boys (0.04 %) and four girls (0.09 %). The present survey of a large unbiased sample can be considered to reflect the prevalence and distribution of anomalies of permanent dentition in the current Japanese population.

Although central giant cell granulomas (CGCGs) appear to be benign, their radiographic findings are active. These tumors become severely invasive with the stimulus of surgery, resembling malignant tumors. Achieving the correct diagnosis is reportedly difficult because CGCGs are very similar to odontogenic jaw tumors. We herein describe an intriguing case of a 21-year-old male patient who was referred to our outpatient clinic with persistent swelling of the left buccal region. After making a provisional diagnosis of ameloblastoma from panoramic and computed tomography images, a biopsy was performed. Nine days after this operation, the intraoral lesion started to enlarge, causing facial disfigurement. Soon afterward, this lesion was examined by computed tomography, magnetic resonance imaging, and by both bone and tumor scintigraphy. Segmental resection of the mandible was conducted in the hospital, and the histopathological appearance was consistent with CGCG. Although CGCG tends to be indolent, the present case suggests that the stimulus of surgery can trigger clinically invasive behavior more characteristic of malignancy. CGCG exhibits variable features, but with the stimulus of surgery, its clinical behavior becomes extremely invasive, resembling a malignant tumor. The CGCG in the present case showed unusual development and intriguing radiographic and histopathological findings. It is important to be aware of the findings that can help to achieve a correct diagnosis.

The occurrence of ameloblastic fibro-odontoma (AFO) in the oral region is unusual and accounts for 1-3% of all odontogenic tumors. AFO presents mixed radiopaque patterns within the lesion with diverse findings; therefore, it is important to compare this tumor with other odontogenic tumors that radiographically present with calcified bodies. Herein, we observed the calcification patterns within the lesion in seven AFO cases (five males, two females; mean age, 8.3 years; age range, 4-13 years). Periapical and panoramic radiographs were obtained from all seven cases. Five cases underwent conventional computed tomography (CT) scanning, and one underwent cone beam CT. Classification of the calcifications primarily involved the following two characteristics on the X-rays: appearance and location of the lesions. All seven cases were located in the molar regions of the mandible in association with impacted teeth. The calcification patterns of these AFOs were mixed or inhomogeneous within the lesion with various findings, including complex odontoma-like calcifications. However, the patterns differed between panoramic radiography and CT in some cases. The radiolucent lesions in AFO demonstrated varying calcification patterns and were associated with impacted teeth on the CT images.(J Oral Sci 58, 533-537, 2016).

The mental foramen (MF) is an important anatomical landmark for the diagnosis of mandibular lesions or pre-implant diagnosis. Some rare cases with normal variations of the MF, such as accessory foramina or retromolar foramen, have been reported. The aim of this article is to report a very rare normal variation, bilateral absence of the MF, which was detected incidentally by cone-beam computed tomography performed prior to a dental implant.

Ameloblastoma, desmoplastic type, is a rare lesion for which radiographic images are even less common, and such lesions are sometimes considered to be variant types. It is defined as a variant of ameloblastoma with specific imaging and histological features. This lesion occurs with the same frequency in the maxilla and mandible, although the predominant site is the anterior-premolar site in both the mandible and maxilla. For our case of ameloblastoma, desmoplastic type, resected from the right anterior to premolar maxilla, the radiographic appearance and histopathological findings were compared. Computed tomography images revealed that the lesion had a multilocular structure with many smaller septa at its periphery. Although expansion toward the maxillary sinus was suggested radiologically, invasion of the mucosa into the floor of the maxillary sinus was found on histopathological examination.

The aim of this study was to evaluate the usefulness of magnetic resonance imaging (MRI) in measuring thickness of the roof of the glenoid fossa (RGF) of the temporomandibular joint (TMJ).Minimum RGF thickness in 95 TMJs of 59 patients with temporomandibular disorders were measured and compared on both sagittal-section MRI and cone-beam computed tomography (CBCT). RGF thickness on MRI was also compared with MRI, CBCT, and arthrographic findings.Minimum RGF thickness was greater on MRI (1.46 mm) than on CBCT (0.90 mm). Spearman's correlation coefficient by rank for these 2 types of measurements was 0.63. RGF thickness on MRI differed significantly between those with and without degenerative joint changes (1.69 vs 1.32 mm; P.01) and between those with and without disk displacement (1.58 vs 1.35 mm; P = .04), but showed no associations with disk deformity, joint effusion, or disk perforation.MRI is useful in measuring RGF thickness from diagnostic as well as radiation protection standpoints.

The aim of this report was to introduce a new method of three-dimensional (3D) reconstruction for fibro-osseous lesions (FOLs) using binary images transformed from histopathological images and to describe its usefulness. A sample of multiconfluent FOL was used (one of the five types of FOL according to a radiographic classification) which was diagnosed histopathologically as ossifying fibroma. Approximately 30 pathological images were assembled into a composite image of the slide using Tiling Boutique software version 3 for Windows (Sanyo Electric, Osaka, Japan). The tiling images were transformed into 8-bit scale images and then into binary images using ImageJ software ver.1.37 (National Institutes of Health, Bethesda, MD). These images were used for 3D reconstruction using ImageJ software. Images were loaded at the same matrix size and were reconstructed into layers of two-dimensional image stacks, adjusted so that contiguous images were aligned based on their centre points, and arranged with long axes horizontal. 3D findings aided the visual understanding of morphological features in the lesion. The 3D reconstruction can be displayed with arbitrary rotation. In this case, the 3D reconstruction, using Real Image software version 4.01 for Windows (KGT, Tokyo, Japan), was created from an arbitrary section. This allowed us to determine the pattern of calcification between groups of connected osteoids and to compare the internal structure of such lesions that are not visible on histopathological findings. Differentiation of features was even more pronounced with a two colour display indicating fibrous connective tissue and osteoid tissue. A 3D reconstruction of a multiconfluent ossifying fibroma was created using binary images transformed from histopathological images. The quality of the images depends above all on the functionality of the image-processing software. Comparison of each pattern of FOL might allow more simple assessment of the morphological features of FOLs.

A case of metastatic thyroid carcinoma near the left mandibular ramus with a cyst-like appearance on rotational panoramic radiographs is reported. A 55-year-old woman complained of a continuous sense of incongruity for 3–4 years since extraction of the left mandibular third molar. The lesion, with apparent gingival swelling around the left second molar, was painless and was cyst-like in appearance on plain radiographs. On the basis of the radiological findings, a benign odontogenic tumor was suspected, but computed tomography (CT) showed destruction of the lingual cortical bone with soft tissue invasion to the masticator space. The final histopathological diagnosis was metastatic follicular carcinoma of the thyroid gland. When investigating cyst-like radiolucent lesions with thick sclerotic margins and irregular areas on plain radiographs, we recommend using CT to evaluate the effect of the lesion on cortical bone.

The usefulness of narrow band imaging (NBI), which is based on the principle that the depth of light penetration depends on its wavelength, has been accepted for evaluating malignant or benign lesions in the pharynx, the upper, and lower gastrointestine. The purpose of the present paper was to investigate NBI for diagnosing biliopancreatic disease. Using NBI it has become easy to detect the surface microstructure of biliary mucosa and subjacent vascular network of the bile duct, and inflammatory scarring stenosis is visualized as a whitish scar and multiple inflammatory red spots. However, bile duct cancer was detected as a stenosis with abnormal subjacent vessels and irregular surface. Concerning pancreatic duct, NBI has clearly shown vascular network and spreading of branch-type intraductal papillary mucinous neoplasm to the main pancreatic duct. In contrast, bile juice has been detected as red fluid and bleeding as black red. Therefore, it is important to flush the biliary system before observing with NBI.

We measured the gonial angle (GA) on panoramic radiography (PR) and analyzed the correlation between the GA on PR and lateral cephalometric radiography (LCR). In total, 49 PR films and LCR films from dentate young adults were evaluated. Orthodontists plotted four points (articulare, menton, posterior gonion, and lower gonion) on the PR and carefully traced them. Using a protractor, two radiologists measured the GA on LCR images. A simultaneous experimental study of two dry skulls was performed to compare the GA on LCR and PR. The GA was slightly smaller on the PR of the dry mandible than on the LCR and tended to decrease continuously with magnitude toward the Frankfort horizontal plane. The mean GA was 115.1 ± 5.2° on PR and 122.2 ± 6.4° on the LCR. The values were highly correlated (Pearson product-moment correlation coefficient, 0.801). The GA on PR was nonsignificantly smaller than that measured on LCR. The difference may be due to head position, the inclination angle of the mandibular body, and/or the direction of the incident X-ray beam.

The purpose of this study was to clarify the relationship between the thickness of the roof of the glenoid fossa (RGF) and magnetic resonance imaging (MRI) findings of temporomandibular joint (TMJ) disorders (TMDs).Eighty-seven patients with symptoms and indications of TMD in one or both TMJs were referred for MRI. Cone-beam CT (3DX) was used to measure the thickness of the RGF at its thinnest point. Linear measurements were made three times on the monitor by three separate investigators and the mean values obtained were used for the statistical analyses.The joints were categorised as normal (70 joints), anterior disc displacement with reduction (ADWR; 53 joints) or anterior disc displacement without reduction (ADWOR; 51 joints). The joint disorders were also categorised into the following subgroups: with osteoarthritis (OA) (21 joints), without OA (153 joints), with disc deformation (33 joints), without disc deformation (141 joints), with joint effusion (JE) (61 joints) and without JE (113 joints). The average minimum thickness of the RGF was 0.85 mm for normal joints, 0.90 mm with ADWR, 0.93 mm with ADWOR, 0.99 mm with OA, 0.87 mm without OA, 0.87 mm with disc deformation and 0.89 mm without disc deformation. There was no significant difference between these figures. There was a significant difference in the thickness of the RGF with (0.97 mm) and without (0.84 mm) JE.These results suggest that RGF thickness is influenced by JE, but is unaffected by disc position and configuration.

After the development of the mechanical radial scanning echoendoscope by Olympus Medical Systems (Tokyo, Japan), endoscopic ultrasonography (EUS) has become an indispensable examination in the clinical fields. Although mechanical radial EUS has no Doppler function because of its scanning method, Olympus Medical Systems developed a new electronic 360° radial EUS in 2003. Newly developed electronic radial EUS provides better penetration, fewer artifacts, color Doppler and power Doppler function, and tissue harmonic imaging. Its maneuverability is nearly the same as conventional mechanical radial EUS. With Doppler function it is easy to differentiate solid tumors such as pancreatic cancer, islet tumor etc., and to diagnose vascular invasion. Although there are some problems, electronic radial EUS has a promising future and it is believed that electronic radial EUS will become the standard model for the next generation of EUS equipment in imaging diagnosis.

Radiographic findings of enostosis often resemble those of focal condensing osteomyelitis of inflammatory origin, and the location and state of these lesions cannot be precisely diagnosed using rotational panoramic radiography. Consequently, a differential diagnosis approach is required. This study examined the situation and characteristics of mandibular enostosis using limited cone-beam computed tomography (CBCT) in comparison with rotational panoramic radiography. Forty-four radiopaque lesions were examined on rotational panoramic radiography and CBCT. The lesions were diagnosed as enostosis from radiographic features on CBCT that had been performed for other clinical diagnoses or dental treatments. For each lesion, the site, margin, density, and relationship to tooth roots were determined on rotational panoramic radiography, and the shape of the cortical bone was determined on CBCT. Enostosis occurred in the premolar region of the mandible in 25 cases (57%) and displayed numerous patterns of relationships to adjacent teeth on rotational panoramic radiography. All lesions displayed an ovoid external form on rotational panoramic radiography. On CBCT, enostosis arose from buccal cortical bone in 13 cases and from lingual cortical bone in 25 cases; a lingual origin was suspected in the remaining six cases. The periodontal ligament space of adjacent teeth near the lesion was clearly apparent on both rotational panoramic radiography and CBCT. Rotational panoramic radiography and occlusal radiography cannot diagnose exactly the location and state of enostosis. The diagnosis of enostosis can be difficult for lesions influenced by secondary infection in the roots of surrounding teeth; diagnosis in these cases may be facilitated by clarifying the manifestation involving the periodontal ligament space of adjacent teeth and confirming bone thickening arising from the inner surface of cortical bone.

The authors evaluated the imaging performance of cone-beam computed tomography (CBCT) for dental use using 3DX multi-image micro-CT (Morita Co., Kyoto, Japan) and four-row multi-detector helical computed tomography (MDCT) using an Asteion (Toshiba, Tokyo, Japan). A dried right maxillary bone was cut into eight slices 2 mm thick toward the zygomatico-palate and used as a phantom. Images of the phantom were then taken using 3DX and MDCT. The images of two bone slices were evaluated by five dentists for image quality and reproducibility of cancellous bone, as well as enamel, dentin, pulp cavity, periodontal ligament space, lamina dura and the overall image. Using the MDCT images as the standard, the 3DX images were evaluated with a subjective 5-level scale: 3 for an image equal to the MDCT image, 4 or greater for better, and 2 or lower for worse. The scores for all parameters exceeded 4 points. Maximum mean score was 4.8 for the lamina dura. Statistically significant differences were found for all items (P < 0.01). Our subjective evaluation of imaging performance clarified that 3DX was superior to MDCT. The results of this study suggest that 3DX is useful for imaging in the dental field.

The purpose of this study was to clarify the CT features of odontogenic myxoma.CT appearances were analysed in 17 patients with histologically verified odontogenic myxoma collected from five dental hospitals in Japan.On the CT images, tumour borders were generally well defined with a smooth margin both for bony and soft tissue structures in all patients. Cortical status was clearly evaluated using CT and the continuity was interrupted in nine patients. Intralesional trabeculations were observed in 13 patients. Of these 13, 6 patients showed the characteristic appearance of angular or straight trabeculations within the tumour. The trabeculations were frequently observed at the peripheral portion of the tumour. In three maxillary tumours, soft tissue margins were observed beyond the cortical margin and/or intralesional trabeculations. In 10 of the 13 lesions evaluated, the majority of the whole tumour area showed relatively lower density compared with surrounding muscles.CT clearly demonstrated characteristic features of odontogenic myxoma. CT analysis may contribute to establishing a consensus regarding the interpretation of conventional radiographic appearances in odontogenic myxoma.

Objective. We sought to compare a new limited cone beam computed tomography (CT) machine for dental use (3DX) with the multidetector CT machine for image quality and skin doses. Study Design. Images of the right maxillary central incisor and the left mandibular first molar of an anthropomorphic phantom were taken by both the 3DX and the multidetector CT. A 5-point method was used to evaluate the depiction of cortical and cancellous bone, enamel, dentin, pulp cavity, periodontal ligament space, lamina dura, and overall impressions. Furthermore, the skin doses for both modalities were compared. Results. The image quality of the 3DX was better than the multidetector CT for all items (P

We experienced a case of plasma cell granuloma of the mandible appearing as a malignancy in a 22- year-old man. Plasma cell granuloma tends to be diagnosed as a potential malignancy as radiography reveals irregular bone destruction with an obscure margin. Therefore, plasma cell granuloma is classified as an inflammatory pseudotumor which may occur in any organ or soft tissue, including lung, vagina, bladder, and larynx. In the present case, the lesion was initially diagnosed as a malignant lesion on the basis of imaging analysis, but was later diagnosed histopathologically as a inflammatory lesion.

The purpose of this study was to evaluate the efficacy of three-dimensional (3-D) images produced with a helical CT for the diagnosis of lesions occurring in the maxillofacial region. Thirty-four patients, who had lesions in the maxillofacial region, were examined by plain radiography (intra and extraoral) and the helical CT. Further, 3-D images were reconstructed from the data provided by the helical CT using the volume rendering method. These images were compared with plain radiographic images and conventional two-dimensional (2-D) CT images in terms of the information they provided for diagnosis. Using the 3-D images for tumors, bone destruction, inner components, extent of the lesion, the relationship between the lesion and surrounding anatomical landmarks, and the roots of the adjacent teeth were observed in overall views. We conclude that 3-D images produced by helical CT may provide useful information for the diagnosis of lesions. (J. Oral Sci. 42, 211-219, 2000)

Objective To evaluate whether morphological discrepancy between the mandibular condyle and fossa of the temporomandibular joint (TMJ) is related to disk displacement on magnetic resonance imaging (MRI). Study design This study included 61 patients with unilateral internal derangement based on both MRI and clinical examination. Coronal morphologies of the condyle and fossa were divided into four groups based on Oberg's classification. According to the coronal morphology of the condyle and fossa, all joints were dichotomized into either harmonized group or a discrepancy group (e.g., angled condyle and concave fossa). The incidence of discrepancy and the relationship of the discrepancy to other findings on MRI were statistically evaluated. Results The discrepancy had a significantly higher incidence on the affected side. The discrepancy correlated with incidence of disk deformity on the affected side. Conclusion Morphological discrepancy between the condyle and fossa is related to development of anterior disk displacement in the TMJ.

Fibrous dysplasia is a relatively rare tumorous lesion in the maxillofacial region. The radiographic appearance of this lesion varies widely in the jaw. Generally, the occurrence rate is higher in the maxilla than in the mandible.

The purpose of this study was to investigate degree of observer reliance (RD) on specific diagnostic elements in differential diagnosis of ameloblastoma (AB) and keratocystic odontogenic tumors (KOT) on panoramic images. The RD for 12 diagnostic elements, including 2 clinical and 10 radiographic elements, as recorded by eight dental radiologists on an ordinal ranking scale, was determined for 9 ABs and 9 KOTs. Intraobserver (IaOC) and inter-observer concordance (IeOC) for both ABs and KOTs were statistically analyzed in terms of RD. Significant differences in IeOC were also investigated between ABs and KOTs. The ranking of diagnostic elements was identified in each case of AB or KOT and classified according to IeOC. The mean rating scores of the 10 radiographic elements were then statistically compared and the RD for radiographic elements classified in each group. Good IaOC and IeOC were identified for the RD for the 12 diagnostic elements. IeOC differed significantly between the AB and KOT groups: the AB group showed higher concordance than the KOT group. Ameloblastoma lesion groups where IeOC was relatively high (χ(2)≥70, 70χ(2)≥60) enabled ranking into four groups. Keratocystic odontogenic tumor lesion groups with χ(2) values of ≥50 and50 showed ranking into five groups and two groups, respectively. In particular, the AB lesion groups showed a highly significant difference for the specified element of "adjacent radicular state". In panoramic diagnosis, the RD of dental radiologists for diagnostic elements is more consistent for AB than for KOT. In particular, "radicular state adjacent to a lesion" may be an decisive element in distinguishing between AB and KOT.

BACKGROUND: Various factors, such as the optimal number of passes, aspiration pressure, and the use of 19-gauge and Trucut biopsy needles, have been studied to improve the diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). We retrospectively compared the diagnostic accuracy of EUS-FNA between 25- and 22-gauge needles, which have been widely used recently. SUBJECTS AND METHODS: The study group comprised 47 consecutive patients who underwent EUS-FNA with both 22- and 25-gauge needles from October 2007 through March 2010. Their underlying diseases were pancreatic cancer in 24 patients, submucosal tumors in 11, other pancreatic tumors in 4, chronic pancreatitis in 4, enlarged lymph nodes in 3, and gall bladder cancer in 1. Tissue specimens, which were pushed out of the puncture needle, were placed into physiological saline solution. Gray-whitish, worm-like specimens were used for histologic diagnosis. The remaining specimen was centrifuged, and the sediment was plated on slides and examined by a cytopathologist to obtain the cytologic diagnosis. RESULTS: A total of 75 punctures (mean, 1.6) were performed with 25-gauge needles, and 69 punctures (mean, 1.4) were performed with 22-gauge needles. The overall tissue-sampling rate for cytology was 100% (47/47), which was significantly (p=0.01) superior to 83% (39/47) for histology. The overall diagnostic accuracy on the cytologic and histologic examinations was 79% (37/47) and 85% (33/39) (p=0.48). According to needle type, the tissue-sampling rate for cytology and histology on each puncture was 97% (73/75) and 56% (42/75) with 25-guage needles, and was 97% (67/69) and 58% (40/69) with 22-guage needles, the accuracy of cytologic diagnosis on each puncture was 73% (53/73) with 25-gauge needles and 66% (44/67) with 22-gauge needles (p=0.37); the accuracy of histologic diagnosis on each puncture was 60% (25/42) and 75% (30/40) (p=0.14), respectively. No patient had complications. CONCLUSIONS: The tissue-sampling rate and diagnostic accuracy did not differ significantly between 22- and 25-gauge needles in patients with pancreatic or gastrointestinal diseases who underwent EUS-FNA.

Endoscopic ultrasonography (EUS) has widened its applications and been become an indispensable examination. Recent advances is as follows: Electronic radial scanning EUS, three-dimensional EUS (3D-EUS), enhancement, elastography, and EUS-FNA. Because of electronic radial scanning EUS, we can employ Doppler function. 3D-EUS have introduced not only preciseness for preoperative evaluation for EMR and ESD but also surface rendering similar to endoscopic image. Enhancement and elastography have a possibility of tissue chracterization. First EUS-FNA, in which Vilmann reported fine needle aspiration cytology of pancreas cancer and Grimm treated a case with pseudocyst, were made in 1992. Then EUS-FNA has become popular in the clinical fields and the accuracy of diagnostic EUS-FNA has been reported 70 to 100%. Furthermore EUS-FNA has also widened its applications to therapeutic techniques such as pseudocyst drainage, biliary drainage, pancreatic duct drainage, celiac plexus neurolysis (CPN), ethanol injection therapy, radiofrequency ablation (RFA), immunotherapy, and gene therapy etc. Finally, EUS-FNA is the future promising technique which has potential for developing new treatments.

We recently encountered an interesting tumour, containing both a diffuse sclerotic border and calcified bodies, which was eventually diagnosed as a central odontogenic fibroma. The patient was a 40-year-old man with a painless radiolucent area in the crown area of the unerupted left lower third molar shown by panoramic radiography. Clinically, the lesion was thought to represent an odontogenic tumour involving a calcified body, i.e. calcifying cystic odontogenic tumour, calcifying epithelial odontogenic tumour or ossifying fibroma. Diagnosis by radiographic findings was extremely difficult.

Since endoscopic ultrasonography (EUS) for gastroenterological diseases was first reported in 1980, EUS has widened its indications and has become an indispensable examination in the clinical field. However, it had been necessary to obtain cytology or histology also because of unsatisfactory EUS diagnostic accuracy. Then, the first report of EUS-FNA (fine-needle aspiration) was made by Vilmann and Grimm in 1992. After its introduction, EUS-FNA has widened its indication with high accuracy and a low complication rate in the clinical field. Also, the EUS-FNA technique has been improved as to the size of the needle, stroke, number of passes, and negative aspiration pressure. Furthermore, pseudocyst drainage, celiac trunk neurolysis, etc., have been established and immunotherapy such as dendritic cell injection and gene therapy has been applied. EUS-FNA seems to be a promising technique and will improve day by day.

This study examined correlations between radiographic patterns and the shape of osteoid tissue formations, as determined histopathologically.20 cases of fibro-osseous lesions were investigated, comprising 5 radiographic patterns: focal (n = 3), target (n = 6), lucent (n = 4), calcification (n = 3) and multiconfluent (n = 4). Histopathological images in the central area of a full-section specimen were transformed into binary images and then into 8-bit scale images. Bone complexity and density of bone distribution were calculated and compared between patterns.Bone complexity score was 7384.64 for lucent, 2029.85 for focal, 2713.40 for multiconfluent, 8388.63 for calcification and 1364.27 for target pattern. The results could be broadly separated into two types: small (target, focal and multiconfluent patterns), and large (lucent and calcification patterns). Density of bone distribution was relatively low in all areas for lucent and calcification patterns, and high for focal, multiconfluent and target patterns. No significant differences in bone complexity or density of bone distribution were seen between individual patterns.Correlations appear to exist between image patterns from radiography and the shape of osteoid tissue on histopathology, but reorganization of the five patterns may be warranted.

The reliability of the estimated parameters is evaluated by using the entropy to posterior distribution in the 2-parameter lognormal distribution. When λ and ζ are parameters representing the expectation and the variance of the hydrological value transformed into logarithm respectively, the following cases are discussed.(1)λ: unknown, ζ: known, (2)λ: known, ζ: unknown, (3)λ, ζ: unknown. In each case, the posterior distribution of the unknown parameter (s) is derived from Bayes Theorem, and its entropy is developed. This model is applied to monthly rainfall, and the increase of the reliability, accompanied by the increase of the number of data, is investigated.

Even in the case of implant loss, replacement of the implant and refabrication of the superstructure are often sufficient, as long as the bone and soft tissue are in good condition. However, if implant loss accompanied by serious bone resorption occurs with a fixed implant superstructure supported by multiple implants, it is very difficult to treat. This clinical report describes the process by which multiple implant-supported fixed metal ceramic restorations were repaired with a metal ceramic resin-bonded fixed partial denture without complete refabrication after removal of one of the implants due to severe bone resorption. The 3-year follow-up indicated excellent serviceability and a well-satisfied patient.