Primary chondrosarcoma of the extraskeletal soft tissue is extremely rare. Extraskeletal chondrosarcoma was first described as entity in 1953 by Stout and Verner, who were able to collect a series of seven cases. Because of the rarity of this lesion in extremities, neither the clinical course nor the preferred method of treatment has been clearly established. Authors report a case of extraskeletal chondrosarcoma which occurred on the right forearm of a thirty-nine-year-old man. The lesion was completely excised with free resection margins. There was no recurrence or metastasis for four years follow up.
Chondrosarcoma ; Extremities ; Follow-Up Studies ; Forearm ; Methods ; Neoplasm Metastasis ; Recurrence

No abstract available.
Head* ; Hypopharynx* ; Mouth* ; Neck* ; Oropharynx*

A buttonhole deformity of the finger is characterized by flexion of the pmximal interphalangeal joint and hyperextension of the terminal interphalangeal joint. When the central slip of the extensor tendon and the triangular ligament are ruptured,(or severed) on the base of the middle phalanx, buttonhole deformity will result.This article is based on clinical and follow up studies of 5 patients with buttonholedeformities. Five cases were treated by the modified Littler method and were followed from 4 months to 24 months postoperatively and good results were obtained in all cases.
Congenital Abnormalities ; Fingers ; Follow-Up Studies ; Humans ; Joints ; Ligaments ; Methods ; Tendons

Synovial chondromatosis is an uncommon benign lesion characterized by metaplastic cartilage formation within the synovial connective tissue which disintegrates into the joint and continues to grow. Of the eight cases of synovial chondromatosis seen by the authors, three cases involved the knee, two of these were bilateral, three cases involved the elbow, one the hip joint and one the proximal phalanx of the right middle finger. The diagnosis of synovial chondroamtosis was made by histopathological findings of the excised mass. Most synovial chondromatosis cases obtained favorable results by removing masses from the joint and at the same time performing a partial synovectomy, except one case in which degenerative arth ritis had developed proeoperatively.
Cartilage ; Chondromatosis, Synovial ; Connective Tissue ; Diagnosis ; Elbow ; Fingers ; Hip Joint ; Joints ; Knee

According to the electromyographic study, the superior and inferior heads of lateral pterygoid, one of the masticatory muscles, are known to perform the reciprocal actions in mandibular movements; the superior head is active in closing movement, whereas the inferior head is active in opening of the jaw. Through these two reciprocal actions of these two heads, the articular disk of TMJ is seated in its resting position. Many reports regarded the superior and inferior heads of the lateral pterygoid as functionally independent muscles, but from a morphological point of view, the origin of the independent nerve innervation and intramuscular branching patterns of the mandibular nerve are unclear. Twenty -four adult hemi -sectioned heads were dissected to clarify the topography of the nerve distribution on two heads of lateral pterygoid and also to determine the anatomico -clinical relevance related with temporomandibular disorder. Most buccal nerves were found to run between the superior and inferior heads of the lateral pterygoid (21 cases, 87.5 %). In 3 cases, buccal nerves passed through the inferior head of the lateral pterygoid (12.5%). In front of the ascending ramus region, most buccal nerves ran in front of the temporalis without being entrapped within the temporalis (16 cases, 66.7%). However, in 8 cases buccal nerve passed in front of the temporalis being entrapped within the anterior fiber of the temporalis (33.3%). In this study, the mandibular nerve trunk was located intimately to the lateral pterygoid. Both heads of the lateral pterygoid muscles were innervated from the mandibular nerve branches, but the patterns of nerve distribution were various. Nerves innervated to the superior head of the lateral pterygoid had different origin. Only in 45.8% (11 cases), they originated from the buccal nerve. In 16.7% (4 cases) the nerve branches originated from the anterior deep temporal nerve only, and in 12.5% (3 cases) from the buccal and anterior deep temporal nerve. In contrast, nerves innervated to inferior head of the lateral pterygoid showed different pattern of distribution. In 58.3 %, nerves distributed on the inferior head originated from both the buccal and mandibular nerve trunk. In 20.8%, they originated from the buccal nerve only, in 12.5% from the mandibular nerve trunk only. In seven categories of the distribution of mandibular nerve branches, in only 20.8% (5 cases), both the superior and inferior heads of the lateral pterygoid had the common source of nerve innervation, the buccal nerve. In contrast, in 45.9% (11 cases) additional nerve twigs from the mandibular nerve trunk were distributed on the inferior head of the lateral pterygoid muscle. Author observed the pterygoid loop (ansa pterygoidea) located between the mandibular nerve trunk and the nerve innervating to the lateral pterygoid in 4 cases. In addition, the intramuscular nerve loop within the inferior head of lateral pterygoid was observed in 5 cases. Summarizing these results, besides the buccal nerve mentioned in an anatomical textbook, nerve twigs originating directly from the mandibular nerve trunk innervated to the lateral pterygoid and the ones originating from the anterior and middle deep temporal nerves distributed on the lateral pterygoid muscle in various manners. Considering the various patterns of nerve distribution on the lateral pterygoid, author concluded that the two heads of the lateral pterygoid are controlled by independent innervation. Furthermore, we found out that nerve entrapments and nerve communications are related with symptoms of temporomandibular disorder and with possible collateral route of motor innervation to the facial expression muscles, respectively.
Adult ; Facial Expression ; Head ; Humans ; Jaw ; Mandibular Nerve* ; Masticatory Muscles ; Muscles ; Nerve Compression Syndromes ; Pterygoid Muscles* ; Temporomandibular Joint ; Temporomandibular Joint Disorders

A Reversible Posterior Leukoencephalopathy Syndrome(RPLS) consists of neurologic symptoms and signs - headache, consciousness change, seizure, visual impairment - and brain imaging finding showing brain(espicially white matter) edema usually involving the posteior parietal-temporal-occipital areas. The causes are thought to be hypertensive encephalopathy, pre-eclampsia or eclampsia, renal failure with fluid overload and immunosuppressive agents such as cyclosporin A or FK506. RPLS may usually reversible if treated early by decreasing blood pressure and discontinuing offending drugs. A 23-year-old man had been hemodialyzed with chronic renal failure for two years. His blood pressure elevated to 240/150mmHg 3 days before admission and he complained of severe headache, vomiting, and total visual loss at the day of admission. Brain T2-weighted MRI imaging showed increased signal intensity involving the both parietal, posterior temporal, and occipital lobes. After antihypertensive and dexamethason treatment, a follow-up brain MRI performed on 7 days after admission showed nearly normalized findings and all symptoms including visual loss were recovered completely in one week.
Blindness ; Blood Pressure ; Brain ; Consciousness ; Cyclosporine ; Eclampsia ; Edema ; Female ; Follow-Up Studies ; Headache ; Humans ; Hypertensive Encephalopathy ; Immunosuppressive Agents ; Kidney Failure, Chronic* ; Leukoencephalopathies ; Magnetic Resonance Imaging ; Neuroimaging ; Neurologic Manifestations ; Occipital Lobe ; Posterior Leukoencephalopathy Syndrome* ; Pre-Eclampsia ; Pregnancy ; Rabeprazole ; Renal Insufficiency ; Seizures ; Tacrolimus ; Vomiting ; Young Adult

OBJECTIVE: The purpose of this study was to analyze in detail the relationship between outcome and time course of effect in medically refractory primary cervical dystonia (CD) with phasic type that was treated by bilateral globus pallidus internus (Gpi) deep brain stimulation (DBS). METHODS: Six patients underwent bilateral implantation of DBS into the Gpi under the guide of microelectrode recording and were followed for 18.7 +/- 11.1 months. The mean duration of the CD was 5.8 +/- 3.4 years. The mean age at time of surgery was 54.2 +/- 10.2 years. Patients were evaluated with the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) and relief scale using patient self-reporting. RESULTS: The TWSTRS total scores improved by 64.5%, 65.5%, 75.8%, and 76.0% at 3, 6, 12 months, and at the last available follow-up after surgery, respectively. Statistically significant improvements in the TWSTRS scores were observed 3 months after surgery (p = 0.028) with gradual improvement up to 12 months after surgery, thereafter, the improvement was sustained. However, there was no statistically significant difference between the scores at 3 and 12 months. Subjective improvement reported averaged 81.7 +/- 6.8% at last follow-up. Mild dysarthria, the most frequent adverse event, occurred in 3 patients. Conclusions: Our results show that the bilateral Gpi-DBS can offer a significant therapeutic effect from 3 months postoperatively in patients with primary CD with phasic type, without significant side effects.
Deep Brain Stimulation ; Dysarthria ; Follow-Up Studies ; Globus Pallidus ; Humans ; Microelectrodes ; Torticollis

OBJECTIVE: The objective of this study is to evaluate the clinical presentation and outcomes of patients with an intracerebral hematoma (ICH) associated with a ruptured middle cerebral artery (MCA) aneurysm, and the correlation factors associated with the aneurysm and characteristics of the hematoma. METHODS: A retrospective evaluation of clinical and radiologic characteristics and outcomes was conducted for 24 patients (11 men and 13 women; mean age, 53 years) with ruptured MCA aneurysms associated with ICH between September 2008 and December 2011. RESULTS: Thirteen (54%) of the 24 patients had a favorable outcome, four (17%) suffered from severe disability, and seven (29%) died. Based on Hunt and Hess grade, one patient was classified as Grade II, three as Grade III, 12 as Grade IV, and eight as Grade V. Patients with an unfavorable outcome had significantly larger aneurysms (p = 0.047) and ICH volumes (p = 0.002), compared with patients in the group with a favorable outcome. The most frequent rupture point of aneurysms was the lateral aspect of the aneurysm (54.2%). When the rupture point is toward the lateral direction, the distribution of ICH tended to be located at the temporal lobe and intrasylvian. CONCLUSION: Results of the present study suggest an association of the initial clinical state, the size of the aneurysm, and ICH volume with outcome. Although no difference was observed between the location of the rupture point and patient outcomes, an accurate assessment of ICH patterns and the rupture point in angiography may help to ensure surgical exposure and a safe aneurysm clipping.
Aneurysm ; Angiography ; Dietary Sucrose ; Hematoma ; Humans ; Intracranial Aneurysm ; Male ; Middle Cerebral Artery ; Retrospective Studies ; Rupture ; Temporal Lobe

PURPOSE: To determine the usefulness of fat saturation fast spin-echo T2WI for patients with mild acute trauma of the spine. MATERIALS AND METHODS: Between July 1998 and June 2002, 36 patients with acute spinal trauma underwent MRI within four months of injury. One, whose clinal symptoms indicated neurological paralysis, was excluded form our study. A superconductive 1.0-T MRI scanner was used, and conventional T1W1, T2WI, and additional fat-saturation fast spin-echo T2WI were performed. Two radiologists compared conventional T2-weighted sagittal imaging and fat-saturation T2-weighted sagittal imaging in terms of the extension of increased high signal intensities in soft tissue and vertebral bodies, bone marrow signal change, disk herniation, and signal change of the disk. RESULTS: The detection rate of focal high signal intensities in soft tissue and bone marrow was significantly higher at fat-saturation fast spin-echo T2WI than at conventional T2WI. CONCLUSION: Fat-saturation fast spin-echo T2WI is useful for the evaluation of patients with mild acute spinal trauma without neurological impairment.
Bone Marrow ; Humans ; Magnetic Resonance Imaging ; Paralysis ; Spine

Myxedema coma is a severe life-threatening form of hypothyroidism that is associated with a high mortality rate. It is known to be common in the elderly, and is mainly accompanied with cardiogenic shock, respiratory failure, central nervous system dysfunction, and body temperature regulation defects. Thus, immediate management is required in order to prevent fatal complications in myxedema coma. However, early detection is difficult and further, it is easily misdiagnosed due to its low incidence rate and nonspecific symptoms. We report a case of myxedema coma which was misdiagnosed for heart failure. The patient was successfully treated with intensive care and oral low dose levothyroxine.
Aged ; Body Temperature Regulation ; Central Nervous System ; Coma* ; Heart Failure ; Humans ; Hypothyroidism ; Hypoventilation ; Incidence ; Critical Care ; Mortality ; Myxedema* ; Respiratory Insufficiency ; Shock, Cardiogenic ; Thyroxine*