[In vivo wear of posterior composites and its counterplan before or after insertion].
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Biomedical subjects
Publications and source records attributed to H Hosoda.
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A new multidisciplinary treatment for head and neck cancer was shown by focusing on the maxillary and oropharyngeal carcinoma. Neo-adjuvant chemotherapy which consists of cisplatin and peplomycin was incorporated into it. In terms of maxillary carcinoma, 2 courses of chemotherapy were given with an interval of 2 weeks, followed by radiotherapy (40 Gy) combined with intraarterial chemotherapy (5-FU). When no cancer cells were detected at the completion of this therapy, adjuvant chemoimmunotherapy was given. When an apparent tumor was still revealed by CT, radical surgery was performed. When cancer cells were detected only by histological examination, additional radiotherapy up to 60 Gy was given by Linac. The results obtained were analysed in 14 cases. We also presented another type of multidisciplinary treatment in oropharyngeal carcinoma.
The authors have studied preoperative chemotherapy for head and neck cancer since 1963, focusing on intra-arterial chemotherapy. The results obtained revealed that preoperative chemotherapy played an important role in the improvement of 5-year survival in maxillary sinus carcinoma and tongue carcinoma. However, functional and cosmetic damage after radical surgery has newly energed as problems to be resolved. The appearance of cisplatin has raised an important the level of effectiveness of cancer chemotherapy in recent years. Since the combination of cisplatin and bleomycin analogs revealed a remarkable synergistic effect in experimental chemotherapy, it has been used clinically as preoperative or preradiation chemotherapy for advanced Stage III and IV head and neck cancer. Under the above-mentioned circumstances, treatment for head and neck cancer has undergone various changes over the past twenty years. At present it is no exaggeration to say that the period in which dependence was placed on only surgery and/or radiation is over. The authors would like to emphasize that preoperative chemotherapy should be carried out as a part of multidisciplinary approach under a new concept of neo-adjuvant chemotherapy which includes not only preoperative chemotherapy but also preradiation chemotherapy. The role of preoperative chemotherapy, its current status and future prospects are discussed in this paper, looking back on the history of chemotherapy for head and neck cancer.
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During the period 1957-1982, 227 patients with maxillary carcinoma were treated. These cases were divided into 4 groups according to periods and methods of treatment. Five-year determinate survival figures for each group are as follows: I (1957-1966) 22%, 20/91, II (1967-1973) 40%, 27/67, III (1974-1978) 37%, 13/35, IV (1979-1982) 56%, 9/16 (3-year survival). The incorporation of intraarterial chemotherapy into the treatment of maxillary carcinoma has much contributed to an improvement of 5-year survival. Since 1982, a new multidisciplinary treatment containing neo-adjuvant chemotherapy has been introduced into the treatment of this type of carcinoma. Neo-adjuvant chemotherapy: day 1, cisplatin ( CPDD ) 50 mg/m2 or 80 mg/body i.a. over 2 hr., day 2-6, peplomycin (PEP) 5 mg/day i.a. over 5 hr. Two courses of chemotherapy were given with an interval of 2 weeks. Radiotherapy combined with intraarterial chemotherapy: Linac. 40 Gy/4 wks., 5-FU i.a. 250 mg/day q.d. (for 10 days). When no cancer cells were detected at the completion of this therapy, adjuvant chemoimmunotherapy was given. When an apparent tumor was still revealed by CT, radical surgery was performed. When cancer cells were detected only by histological examination, additional radiotherapy up to 60 Gy was given by Linac. The results obtained were analysed in 9 patients who completed this therapy. At the completion of CPDD and PEP treatment, complete response was achieved in 5 cases and partial response in 3 cases with a response rate of 89%. In 2 out of the 9 cases, no cancer cells were detected by histological examination after chemotherapy. No cancer cells were detected in 2 other cases after 40 Gy by Linac. combined with 5-FU i.a. infusion, and in 3 other cases after 60 Gy by Linac. combined with 5-FU. Two patients had radical surgery because of uncontrolled tumors. Periods of follow-up are too short, but it is expected that this new multidisciplinary treatment results in the higher survival.
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The basic concept behind the Black system in the restoration of teeth is a mechanical one. It aims at the retention of restorations by perfect contact with, and the grip of, resilient sound dentinal cavity walls. This necessitates the cutting of sound dentin which is sometimes accompanied by pain and pulpal irritation. For the complete removal of infected carious dentin the conventional technique has depended upon the operator's perception of discoloured dentin and its changed hardness. It has been shown that carious dentin consists of two layers. Namely, a superficial layer which is infected, not remineralizable and necrotic, whereas the deeper layer is uninfected, remineralizable and vital. The first step in the tooth substance saving restorative technique is to use a dye to differentiate between the two layers. Pain on caries removal is virtually eliminated by the selective removal of the stained and necrotic superficial layer while assuring complete removal of all infected dentin. The second step is to use chemically adhesive composite resins which have been developed for both anterior and posterior use. They adhere to enamel and sound dentin and also to the deeper layer of carious dentin. Cutting painful tissue so as to provide the retention form of the classical technique is not required, nor is amalgam as a restorative material in operative dentistry.
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