An unusual case of ameloblastoma that underwent malignant change and metastasis during recurrence is described. The primary tumor of the mandible and two independent recurrent lesions found in the base of the coronoid process and in the mandibular notch were cystic ameloblastoma of follicular type, with no histological evidence off malignancy. The second recurrence developed in the soft tissues on the medial aspect of the ascending ramus and consisted of a large solid tumor mass with poorly differentiated ameloblastoma cells, which were seen clustered in blood vessels in close apposition to tumor nests. Apparently these metastasized to the temporal bone in five months. The metastatic tumor was composed of atypical follicles packed with undifferentiated hyperchromatic cells with nuclear atypia and abundant mitoses. The histological diagnosis was malignant ameloblastoma. The cerebral lesion that developed in the skull base, possibly by direct extension of the second recurrent tumor, was also regarded as malignant because of its rapidity and aggressive growth and its high sensitivity to radiotherapy.
Two cases of pathologic fracture of the mandible resulting from chronic osteomyelitis are described. The first case was treated successfully by antibiotic therapy followed by resection of the affected bone and iliac bone grafting after six months of follow-up care. In the second case, a patient with a history of diabetes mellitus, a fracture of the condyloid process occurred because of extension of the Actinomyces infection after extraction of the third molar. Because antibiotics failed to prevent exacerbation of the disease, the patient was given human gamma globulin. Then, all the signs of inflammation disappeared gradually with no evidence of recurrence for more than a year. There was no spontaneous bony healing of the fractured site.
A multi-clinical double-blind study on therapeutic effect of combination preparation of vitamins E and C was undertaken in comparison with single preparation of vitamin E and vitamin C in the treatment of chloasma or pigmented contact dermatitis (PCD). Combination treatment resulted in significantly better clinical improvement than vitamin C alone in both diseases. Objective data compiled from color difference measurements and color photographs revealed significantly better results with combination treatment in chloasma than vitamin C alone and, in PCD, than vitamin E or C alone. Differences in skin luminosity between hyperpigmented and normal areas significantly decreased in all three groups, with the combination group producing the most significant change. The total serum lipoperoxide level and its ratio to total serum lipids tended to decline in the combination group, and decreased significantly in vitamin E group. The sebum lipoperoxide level decreased significantly only in the combination group (EC).
A case of interstitial pneumonia accompanying SLE (lupus pneumonia) was reported. Shortness of breath in this patient was aggravating very rapidly even during methyl prednisolone pulse therapy, but the patient was relieved from this symptom soon after double filtration plasma exchange was carried out. We concluded that some cases which are resistant to pulse therapy and whose prognosis is very poor might be saved by plasma exchange.
