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Objective l-3-[18F]-fluoro-α-methyl tyrosine (FAMT) is transported into cancer cells by l-type amino acid transporter 1 (LAT1). The purpose of the present study is to correlate the uptake of FAMT and FDG with the cellular proliferative activity measured by the Ki-67 labeling index (Ki-67 LI) in oral squamous cell carcinoma (OSCC).

Clinical application of FDG-PET in head and neck cancer includes identification of metastases, unknown primary head and neck malignancy, or second primary carcinoma, and also recurrent tumor after treatment. In this study, the additional value of PET/CT fusion images over PET images alone was evaluated in patients with initial staging and follow up of head and neck malignancy.Forty patients with suspected primary head and neck malignancy and 129 patients with suspected relapse after treatment of head and neck malignancy were included. FDG-PET/CT study was performed after the intravenous administration of FDG (5 MBq/kg). Target of evaluation was set at primary tumor, cervical lymph node, and whole body. PET images and PET with CT fusion images were compared. Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Results of PET and PET/CT were compared with postoperative histopathological examination, and case by case comparison of PET and PET/CT results for each region was performed. The additional value of CT images over PET only images was assessed. Statistical differences in sensitivity and specificity were evaluated.In the comparative evaluation of 507 targets by PET alone and PET/CT, 401 targets showed agreement of the results. Of the 106 discordant targets, 103 showed a positive result on PET alone and negative result on PET/CT. These results showed a significant difference (p0.01). Sensitivity of PET/CT was slightly higher than that of PET without statistical significance, while specificity of PET/CT was significantly higher than that of PET alone (Initial staging: 90.5% vs. 62.2%, p0.01; Follow up: 97.2% vs. 74.4%, p0.01). In Fisher's direct probability test, a significant difference was noted in the sensitivity (Initial staging: 91.3% vs. 87.0%, p0.01; Follow up: 93.9% vs. 91.4%, p0.01).Combined PET/CT showed improved diagnostic performance than PET alone by decreasing the number of false positive findings in patients with initial staging and follow up of head and neck malignancy.

【背景・目的】 口腔悪性腫瘍は, 治療により摂食嚥下・発音・呼吸などの日常生活にかかわる機能を障害するのみならず, 顔貌という個人のアイデンティティを表す部位にも障害を引き起こす. したがって, より安定した質の高い治療法を選択する必要性が増してきている. 【対象と方法】 2001年1月から2003年12月の3年間に群馬大学歯科口腔外科・歯科にて治療を行った口腔悪性腫瘍症例46例について, 臨床統計学的に検討を行った. 【結 果】 年齢別では, 60歳台が18例 (39.1％) と最も多く, 50歳台から70歳台で38例 (82.5％) であった. 発生部位別では舌が16例 (34.7％), 上下顎歯肉が22例 (47.7％) であった. 病理組織学的には扁平上皮癌が40例 (86.9％) を占めた. 扁平上皮癌はStageII症例が17例 (42.5％) であった. 治療法は, 外科療法を主軸とし, 補助的に放射線療法, 化学療法が施行されていた. 扁平上皮癌症例の5年生存率は71％であり, Stage別では, それぞれStageI : 80.0％, StageII : 85.0％, StageIII : 57.0％, StageIV : 33.0％であった. 【結 語】 高齢の口腔悪性腫瘍症例も増加しており, 全身疾患を考慮した治療法の立案が肝要であると考えられた.

Objectives: To comparel-3-[18F]-fluoro-α-methyltyrosine (FMT)-positron emission tomography (PET) and 2-[18F]-fluoro-2-deoxy-d-glucose (FDG)-PET in the differential diagnosis of maxillofacial tumors.Methods: This study included 36 patients (16 males, 20 females; 31–90 years old) with untreated malignant tumors (34 squamous cell carcinoma, one mucoepidermoid carcinoma, one rhabdomyosarcoma) and seven patients (five males, two females; 32–81 years old) with benign lesions. In all patients, both FMT-PET and FDG-PET were performed within two weeks before biopsy or treatment of the lesions. To evaluate the diagnostic usefulness of FMT-PET and FDG-PET, visual interpretation and semiquantitative analysis were performed. PET images were rated according to the contrast of tumor uptake as compared with background, and were statistically analyzed. As a semiquantitative analysis, standardized uptake values (SUV) of the primary tumors were measured, and the SUV data were analyzed using receiver operating characteristic (ROC) curves.Results: The mean SUV of the malignant lesions were significantly higher than those of the benign lesions in both FMT-PET (2.62±1.58 vs. 1.20±0.30, p

【目 的】 術後疼痛管理において先制鎮痛の有用性が注目されるようになってきた. 今回, 下顎埋伏智歯抜歯後疼痛に対し, 作用機序の異なる非ステロイド性消炎鎮痛薬による先制鎮痛効果について検討した. 【対象と方法】 下顎埋伏智歯抜歯症例33例に対し, 無作為に抜歯開始1時間前にZaltoprofen (抗bradykinin作用を有するcyclooxygenase (COX)-2選択的阻害薬 : Z群), Loxoprofen sodium (COX-2非選択的阻害薬 : L群), Etodolac (COX-2選択的阻害薬 : E群) のいずれか1錠を内服させた後, 抜歯を行い, 薬剤内服6時間後にVisual Analogue Scale (VAS) による疼痛評価を行った. 【結 果】 Z群9例中2例, L群10例中3例では疼痛は発現せず, 鎮痛剤は不要であった. また, 各群の6時間後のVASペインスコアについては, Z, L群は, E群 と比較し, 有意に低い値であった. 【結 語】 下顎埋伏智歯抜歯後の疼痛を管理するための先制鎮痛にはCOX-2のみの阻害では十分とはいえず, COXを非選択的に阻害する薬剤, あるいは抗bradykinin作用をも有する薬剤の方が有用と考えられた.

【背景と目的】 癌の外科療法の際, センチネルリンパ節を検討することによる縮小手術が望まれている. そこで, 口腔癌においてもセンチネルリンパ節理論が適応できるかを検証した. 【対象と方法】 2002年4月から2003年7月に, 群馬大学歯科口腔外科・歯科で治療した口腔扁平上皮癌症例7例を対象とした. 99mTc標識フチン酸をトレーサーとし, 術前リンパ節シンチグラフィーおよび術中ナビゲーションによるセンチネルリンパ節の同定, 頸部郭清材料から得られたリンパ節の病理組織学的および核医学的検討を行った. 【結果】 7例全例で顎下リンパ節, うち3例は頸部リンパ節もセンチネルリンパ節と同定された. 3例でセンチネルリンパ節は転移陽性であり, うち1例は下流のリンパ節にも転移を認め, 別の1例では郭清範囲より下流に後発転移を生じた. 【結語】 本法によるセンチネルリンパ節の検出は可能であり, 口腔癌においてもセンチネルリンパ節理論が成り立つことが示唆された.

【背景・目的】 歯槽骨の吸収, 喪失は種々の原因によって生じ, 高度の場合には可轍式義歯の安定に大きく影響を生じる. またインプラント埋入は, 感染の問題から非可動性粘膜部に植立させる必要があるため, 歯槽骨高度吸収, あるいは歯槽骨欠損症例では可動性粘膜の位置を移動させる必要が生じる. そこで補綴前処置について検討を行った. 【対象と方法】 1998年3月から2002年10月の4年7ヶ月間に, 群馬大学歯科・歯科口腔外科を受診し, 各種原因により下顎歯槽骨が全顎的に高度に吸収, あるいは欠損した4症例に対し, 歯槽堤を相対的に高める歯槽堤形成術を行った. 【結果】 4症例ともに, 術後義歯装着に必要な顎堤の深さが十分保たれた. オトガイ孔下方移動術を施行した1例は知覚麻痺が軽快した. 【結語】 補綴前処置として相対的歯槽堤形成術およびオトガイ孔下方移動術が有用であることが示唆された.

Mandibular metastatic tumours are uncommon and differential diagnosis is difficult. A 49-year-old man with a metastatic tumour of the mandible from a primary bronchial tumour is reported.

A rare case of suppurative arthritis of the temporomandibular joint (TMJ) is reported. A 47-year-old man was referred to our hospital because of diffuse swelling and pain in the right TMJ and malocclusion caused by a left shift of the mandible. The patient had been treated for periodontitis at a dental clinic during the previous 2 months. The swelling and pain increased after extraction of the right upper third molar.A radiograph revealed anterior deviation of the right condyle. The anterior region of the right TMJ showed a low density area on computed tomographic examination.After administration of antibiotics (ABPC+CLDM), lavage of the right TMJ cavity was performed.The results of microbiological examination were negative, and there was no evidence of ankylosis or other disorders of TMJ. The symptoms subsequently resolved.We suspected that the inflammation associated with the upper third molar affected the TMJ and caused the symptoms in this patient.

表皮嚢胞は単発ないし多発性に全身, 特に顔面・頭部の真皮または皮下層に生じる.これは真皮または皮下層に生じた類表皮嚢胞と同一の疾患と思われる.症例1 : 34歳, 女性.嚢胞は視診で左側の顎下部に境界明瞭な腫瘤として認められ, 触診で柔らかく可動性を認めた.その嚢胞は全身麻酔下にて口腔外より容易に摘出できた.筆者らは病変部に医学的な既往がないため, この嚢胞は先天的な起源を有すると考えた.症例2 : 22歳, 男性.嚢胞は左側頬部皮膚に境界明瞭で20×15mmの腫瘤として認められた.触診にて疼痛はなく可動性を認めた.病変の摘出に困難を感じ, 口腔内と口腔外よりのアプローチを必要とした.筆者らは患者には数年前に病変部に外傷の既往が認められたため, 本嚢胞は後天的な起源を有すると考えた.

今回我々は, 未治療糖尿病のために, 爪楊枝によるほんの些細な外傷により, 重篤な頬部蜂窩織炎を生じた1症例を経験したので報告する.患者は64歳男性.未治療の糖尿病があり, 爪楊枝により頬粘膜に些細な外傷を受傷.炎症は同部より始まり, 下唇, 口底, 顎下部に急速に広がった.患者は, 切開排膿に続き抗生剤による化学療法, 糖尿病の治療を受けた.今回の報告は, 未治療糖尿病患者の感染症の臨床的症状と治療を示唆する.

FDG-PET検査は広く悪性腫瘍の診断法として有用であるが, 頭頸部領域の悪性腫瘍についても例外ではない。扁平上皮癌を中心とした頭頸部悪性腫瘍への集積は, 他の領域の腫瘍より高い傾向があり, 我々の施設ではSUV4前後が良性病変と悪性病変の境界であった。FDG-PETはリンパ節転移の検索にも有用であり, 我々の施設での検出率は93%であった。また, 近年の装置はFDG-PETの全身イメージングが可能であり, 頭頸部腫瘍のFDG-PET検査に新たな臨床上の役割がでてきた。すなわち, (1) 遠隔転移の診断, (2) 原発不明の頸部リンパ節転移症例における原発巣検索, (3) 頭頸部腫瘍患者の second primary tumor の検索といった頭頸部以外の病巣検索を行うことである。PET検査はFDG以外のトレーサの開発も行われており, さらに診断精度の高い検査法となる潜在能力を有している。

L-3-[¹⁸F]-fluoro-α-methyl tyrosine (FAMT) is transported into cancer cells by L: -type amino acid transporter 1 (LAT1). The purpose of the present study is to correlate the uptake of FAMT and FDG with the cellular proliferative activity measured by the Ki-67 labeling index (Ki-67 LI) in oral squamous cell carcinoma (OSCC).Twenty-five patients with OSCC were enrolled in this study. Both FAMT-PET and FDG-PET were performed within 4 weeks before surgery in all cases. The uptake of FAMT and FDG was compared by semiquantitative analysis with maximal standardized uptake values (SUVmax) of the primary tumors. Ki-67 LI of the tumors was analyzed by immunohistochemical staining and correlated with the clinicopathologic variables and the uptake of PET tracers.For primary tumor detection, FAMT-PET exhibited a sensitivity of 84%, whereas that of FDG-PET was 88%. In all visible lesions, mean FDG uptake determined by average SUVmax was 9.7 (range 4.2-15.9) and mean FAMT uptake was 3.5 (range 1.3-8.5). The SUVmax of FAMT tended to show a better correlation with Ki-67 LI (r = 0.878) than that of FDG (r = 0.643).Uptake of FAMT correlated with cellular proliferation of OSCC. FAMT-PET may be a useful procedure to evaluate tumor proliferation of OSCC.

We experienced a case of unexpected ECG abnormality with hyperkalemia. A 65-year-old man was suffering from maxillary sinus cyst and Caldwell-Luc procedure was scheduled. He had diabetes mellitus and hypertension for 15 years, and was taking oral hypoglycemic agent and hypotensive drug (angiotensin converting enzyme and angiotensin receptor blockers : ARB). Abnormal findings were HbA1c 7.7% and glycosuria over 1,000 mg x dl(-1). ECG and other laboratory tests were within normal limits. The patient was monitored with 3 leads ECG during the operation. At one hour and 33 minutes after the start of operation, we detected sudden ECG changes consisting of wide QRS wave and peaked T wave. We consider hyperkalemia and checked blood potassium concentration three times. The results were 5.8, 6.3, 6.2 mmol x l(-1), respectively. We treated the patient with calcium gluconate injection, saline infusion, furosemide injection and glucose-insulin therapy. The ECG was normalized one hour and 23 minutes after the abnormal ECG finding and the potassium concentration decreased to 4.8 mmol x min(-1). After the operation, the potassium concentration and creatinine clearance were within normal limits. Hyperkalemia in this case might have been induced by diabetes mellitus, administration of ACEI and ARB, and hypovolemia.

Increased expression of glucose transporter-1 (Glut-1) and glucose transporter-3 (Glut-3) has been reported in many human cancers. The mechanism of glucose entry into oral squamous cell carcinoma (OSCC) remains unclear. In this study we investigated, in untreated human OSCC, the relationship between tumour fluorine-18 fluoro-2-deoxy-d-glucose (FDG) accumulation and the expression of Glut-1 and Glut-3, as well as the association between the expression of Glut-1 and of Glut-3. All patients underwent FDG positron emission tomography (PET) pre-operatively. Standardised uptake values (SUVs) were used for evaluation of tumour FDG uptake. Final diagnoses were established by histology. Immunohistochemical staining results were evaluated according to the percentage (%) of positive area, intensity and staining score. Tumour sections were stained by immunohistochemistry for Glut-1 and Glut-3. Glut-1 immunostaining revealed that 18 (94.7%) of the 19 tumours stained positively, while Glut-3 immunostaining yielded positive findings for 16 (84.2%) tumours. Overall, a relatively low level of agreement (36.8%) in the staining score was observed between Glut-1 and Glut-3 expression. No relationship was found between the staining pattern and tumour differentiation or T grade classification in either Glut-1 or Glut-3 immunostaining. Furthermore, no relationship was found between increased FDG SUV and tumour differentiation, but the former did correlate with T grade. In conclusion, high FDG uptake values were seen in OSCC with overexpression of Glut-1 and Glut-3. However, no significant correlation was found between FDG SUV and Glut-1 or Glut-3 expression.

Background : It is still controversial whether FDG uptake is correlated with cellular proliferation and prognosis of oral squamous cell carcinoma (OSC). In this study, we performed PET study and immunohistochemical analysis to elucidate the relationship between FDG uptake and expression of cellular proliferative markers and pathological prognostic markers in patients with OSC. Methods : FDG PET and immunohistochemical staining have been carried out in sixteen patients with OSC. Tumor uptake of FDG was expressed with standardized uptake value (SUV). The expression of Ki-67, Topoisomerase IIα (Topo IIα), p53, and p63 in cancer cells was quantitatively assessed with positivity of the immunohistochemical staining. SUV was compared with the results of immunohistochemical analysis. Results : FDG PET study revealed that SUV ranged from 3.6 to 22.1 with average of 10.4. Average positive rate of Ki-67, Topo IIα, p53, and p63 was 68.9%, 58.9%, 72.0%, and 65.2%, respectively. Pearson product-moment correlation coefficient analysis revealed that SUV was significantly correlated with Ki-67 (r=0.616, p=0.01), Topo IIα (r=0.677, p=0.004), p53 (r=0.613, p=0.01), and p63 (r=0.710, p=0.002), respectively. Conclusion : The present preliminary study indicated that FDG uptake was closely correlated with pathological cellular proliferative and prognostic markers in patients with OSC.

Accurate detection of head and neck cancer is crucial in patients' quality of life. The head and neck area consists of many complicated anatomical structures. Conventional imaging procedures such as CT and MRI provide much detailed information, but accurate estimation of the spread of cancer is still limited. Positron emission tomography (PET) using 2-deoxy-2-[18F]fluoro-D-glucose (FDG) is clinically useful in detecting head and neck cancer, providing accurate estimates of head and neck primary cancer especially in cases that are equivocal on CT and/or MRI. FDG-PET is able to show metastatic lymph nodes that may appear normal on CT and/or MRI. Further, whole body FDG-PET makes it possible to detect distant metastases. The clinical usefulness of FDG-PET in head and neck cancer is discussed in this review.

Objective: The aim of this study is to clarify the clinical utility of 2-deoxy-2-[18F]fluoro-d-glucose (FDG) positron emission tomography (PET) in determining the TNM classification in patients with oral cancer.Methods: Twenty-five consecutive patients (14 male and 11 female; age range, 40 yr to 86 yr) with oral cancer were included in this study. The diagnostic accuracy for detecting cervical lymph nodes was investigated by comparing the results of CT and/or MRI and physical findings. For the semi-quantitative analysis, the tumor standardized uptake value (SUV) and tumor to background SUV ratio (T/B ratio) were assessed in primary tumors and cervical lymph nodes.Results: All primary lesions were visualized on FDG-PET images. Even though artifacts from dental materials near the lesion hampered the delineation of primary tumors on CT/MRI, the extent of primary tumors was accurately assessed by FDG-PET. The SUV and T/B ratio in the primary tumor classified in higher T grade (T3 and T4) was significantly higher than that in lower T grade (T1 and T2) (mean ± SD of SUV; 8.32±2.99 vs. 5.15±3.77, p