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PURPOSE: We evaluated the MR and CT findings of the masticator space lesions in order to identify the differences among the malignant and benign tumors and infectious conditions. MATERIALS AND METHODS: MR and CT findings in 46 cases with proven masticator space lesions were reviewed retrospectively. We analysed the involvement of masticator muscles, adjacent spaces, orbit and intracrahium, homogeneity, necrosis, cystic changes, growth patterns, calcifications, enhancement patterns, MR signal intensity, and CT attenuation. RESULTS: Among the 29 cases of malignant tumors, seven cases were mandibular tumors including four chondrosarcomas, and 22 cases were extramandibular tumors. Malignant tumors of mandibular origin showed large masses with severe bone destruction and epicenter of mandible. Extramandiblular malignant tumors showed the epicenter out of the mandible and less severe bone destruction than mandibular tumors: Among the nine benign tumors, four cases were ameloblastomas which showed the well-defined masses and the expansion of the mandible, and four cases were extramandibular tumors which showed well-marginated extramandibular masses with no bone destruction. Among the eight infectious conditions, five cases were mandibular osteomyelitis with or without abscess formations, and the other three cases were infections from adjacent soft tissue or limited to the soft tissue. CONCLUSION: By careful observations of growth patterns, involvement of the masticator and adjacent spaces, bone changes, and epicenter of the lesions, one can discriminate a mandibular lesion from an extramandibular lesion. With this approach, it is thought to be easier to suggest a dignosis among a wide spectrum of masticator lesions.
Abscess ; Ameloblastoma ; Chondrosarcoma ; Magnetic Resonance Imaging* ; Mandible ; Muscles ; Necrosis ; Orbit ; Osteomyelitis ; Retrospective Studies

BACKGROUND: Video assisted thoracic sympathectomy or sympathicotomy is a safe and effective therapy for the treatment of palmar hyperhidrosis with immediate symptomatic imporvement. However the degree of satisfaction may diminish with time due to cmpensatory sweating or excessive hand dryness. Therefore by comparing and assessing the degree of symptomatic improvement or compensatory sweating following sympathectomy or sympathicotomy at various levels we aim to determine the optimal level of sympathetic nerve block which will result in minimal side effects and maximal benefit. MATERIAL AND METHOD: Among 194 patients having undergone video assisted thoracic sympathectomy or sympathicotomy between January 1996 and June 1999, 137 patients who responded to either telephone interview or questionnaire were included in the current study. The patients were divided into three groups. Group I(n=61) ; patients having undergone T2,3,4 sympathectomy group II(35) ; patients having undergone T2 sympathicotomy and group III(41) ; patients having undergone limited T2 sympathicotomy which consist of block of interganglionic neuronal fiber on the third rib. The parameters studied comprised of pre- and post-operative palmar temperature change treatment satisfaction the degree of compensatory sweating or discomfort from palmar dryness postoperative complication and changes in plantar sweating. RESULT: There was no difference in age and sex among the groups and the mean postoperative elevation in palmar temperature was 21.59degrees C without any differences among the groups. Patients expressing satisfaction were 65.6%, 62.9% and 90.24% in groups I, II and III, respectively(p<0.05) Moderate to severe compensatory sweating was present in 65.6% 51.4%, and 24.39%, in group I, II, and III, respectively (p<0.05) Slight but comfortable amount of palmar humidness was expressed in decreasing order group III(41.6%) group I(24.6%) and group II(5.7%) (p<0.05) Ineffectiveness or recurrence was present in 5patients in group I(8.2%) 1 patient in group II(2.9%) and none in group III. With regards to plantar sweating decrease in sweating was expressed in 43 patients(31.4%) while similar degree of sweating in 61 patients(44.5%) and increase in sweating in another 33 patinets(24.1%). CONCLUSION: Limited T2 sympathicotomy resection of the lower interganglionic neuronal fiber of the second sympathetic ganglion on the third rib showed immediate effect in palmar hyperhidrosis and caused lesser compensatory sweating and hand dryness.
Autonomic Nerve Block ; Ganglia, Sympathetic ; Hand ; Humans ; Hyperhidrosis* ; Interviews as Topic ; Neurons ; Postoperative Complications ; Surveys and Questionnaires ; Recurrence ; Ribs ; Sweat ; Sweating ; Sympathectomy

Primary amenorrhea due to intrasella arachnoid cyst is a very rare disease and require careful and frequent evaluation because may produce intracranial hemorrhage, elevated intracranial pressure and rapid expansion. Surgical intervention is needed only when visual disturbance, hypopituitarism or enlarging lesion is shown. Thus, we present a case of primary amenorrhea due to intrasella arachnoid cyst which was resected through the transsphenoidal approach.
Amenorrhea ; Arachnoid* ; Female ; Hypogonadism* ; Hypopituitarism ; Intracranial Hemorrhages ; Intracranial Hypertension ; Rare Diseases

BACKGROUND: Video-assisted thoracic surgery (VATS) is being used as a therapeutic modality in many diseases in which thoracotomy has been used. We studied that the VATS can substitute the thoracotomy in benign esophageal disease. MATERIAL AND METHOD: Group I (n=18) underwent video-assisted thoracic surgery, and group II (n=19) thoracotomy. Group I includes 14 leiomyomas and 4 achalasias. Group II includes 16 leiomyomas and 3 achalasias. Operative technique is enucleation in the leiomyoma and modified Heller's myotomy in the achalasia. Analyzing factors of operation-efficacy are anesthetic time, operation time, hospital stay, chest tube drainage amount and chest tube removal day. The degree of the postoperative pain is assessed by the frequency of opioid analgesics injection. RESULT: There was no death in both groups. There were 5 complications in the group I and 2 in the group II. Prolonged pleural effusion and restenosis of achalasia occurred to 1 patient in each group. In the group I, there were 1 temporaty vocal cord palsy and 2 mucosal tear leading to thoracotomy. There were no differences in anesthesia time, operation time, hospital stay, total chest tube drainage amount, chest tube removal day and frequency of opioid analgesics injection. The amount of the chest tube drainage at POD 1 day was significantly lower in group I (155.6+/-77.8cc) than in group II (572.8+/-280.1cc) (p<0.05). CONCLUSION: The results of our data showed that video-assisted thoracic surgery for benign esophageal disease is as effective as thoracotomy and in addition, cosmetic effect is much better. We concluded VATS may be a substitute for thoracotomy in benign esophageal disease.
Analgesics, Opioid ; Anesthesia ; Chest Tubes ; Drainage ; Esophageal Achalasia ; Esophageal Diseases* ; Humans ; Leiomyoma ; Length of Stay ; Pain, Postoperative ; Pleural Effusion ; Thoracic Surgery, Video-Assisted* ; Thoracotomy* ; Vocal Cord Paralysis

Emphysematous pyelonephritis is a necrotizing renal infections characterized by intrarenal and occasional perirenal gas production. Although uncommon (89 cases in the literature), it occurs almost exclusively in diabetic patients (87% of the cases). Prompt and aggressive management is required to sahage these patients. We describe a recent case of a diabetic woman with emphysematous pyelonephritis due to E. Coll, successfully managed with unilateral nephrectomy.
Female ; Humans ; Nephrectomy ; Pyelonephritis*

Primary pericardial mesothelioma is a rare tumor of mesodermal origin that is infrequently diagnosed antemortem and survival is short. A 60 year old male case of pericardial mesothelioma (epitheloid type) is reported. He was admitted to Yeungnam University Hospital because of chest pain, dyspnea, orthopnea and nonproductive cough. Chest x-ray suggested pericardial effusion. 2-D echocardiography showed echo free spaces of massive pericardial effusion and areas of thick hyperrefractile echoes arising from the pericardium. Pericardiocentesis was attempted and aspirated fluid was bloody exudates. Pericardial window operation with biopsy was done. Swan-Ganz catheterization showed equalization between right atrial pressure and pulmonary capillary wedge pressure. The pathologic diagnosis was established by histologic finding at pericardial biopsy.
Atrial Pressure ; Biopsy ; Catheterization, Swan-Ganz ; Chest Pain ; Cough ; Diagnosis ; Dyspnea ; Echocardiography ; Exudates and Transudates ; Humans ; Male ; Mesoderm ; Mesothelioma* ; Pericardial Effusion ; Pericardiocentesis ; Pericardium ; Pulmonary Wedge Pressure ; Thorax

BACKGROUND: Cardiac tamponade is a rare but fatal complication of subclavian catheter insertion and maintenance. This happens due to erosion of the cardiac wall or the superior vena cava distal to the CLPR (cephalic limit of pericardial reflection). This study is designed to present a method of locating the catheter tip proximal to the CLPR, and to evaluate its results. METHODS: Forty adult patients with intracranial hemorrhages who needed craniotomies and central venous catheter insertions were recruited. The right subclavian vein was selected as the insertion route. On Chest AP film, clavicle, supraclavicular notch and trachobronchial tree were used as landmarks. The CLPR was assumed to be at the level of the angle between the right main bronchus and the trachea. Needle depth was measured from the skin puncture site to the point where blood was regurgitated by the Chest AP landmarks. Intravascular depth was measured from the point where blood was regurgitated to the CLPR. The sum of these two points was regarded as being the appropriate depth of the subclavian catheter insertion. In the control group (n = 40), the right subclavian catheter was inserted to the depth of height (cm)/10 minus 2 cm. RESULTS: In study group, the catheter tips were located proximal to the CLPR in about 2/3 (27/40) of the patients, and there was no case in which catheter tip was distal to the superior vena cava-right atrium junction. In the control group, catheter tips were proximal to the CLPR in only 10% of the patients and distal to the SVC/RA junction in 42.5%. CONCLUSIONS: This method decreased the incidence of locating the tip of the catheter distal to the CLPR, and prevented any intracardial location of the catheter tip.
Adult ; Bronchi ; Cardiac Tamponade ; Catheters* ; Central Venous Catheters ; Clavicle ; Craniotomy ; Humans ; Incidence ; Intracranial Hemorrhages ; Needles ; Punctures ; Skin ; Subclavian Vein ; Thorax* ; Trachea ; Vena Cava, Superior

BACKGROUND: Cardiac tamponade is a rare but fatal complication of subclavian catheter insertion and maintenance. This happens due to erosion of the cardiac wall or the superior vena cava distal to the CLPR (cephalic limit of pericardial reflection). This study is designed to present a method of locating the catheter tip proximal to the CLPR, and to evaluate its results. METHODS: Forty adult patients with intracranial hemorrhages who needed craniotomies and central venous catheter insertions were recruited. The right subclavian vein was selected as the insertion route. On Chest AP film, clavicle, supraclavicular notch and trachobronchial tree were used as landmarks. The CLPR was assumed to be at the level of the angle between the right main bronchus and the trachea. Needle depth was measured from the skin puncture site to the point where blood was regurgitated by the Chest AP landmarks. Intravascular depth was measured from the point where blood was regurgitated to the CLPR. The sum of these two points was regarded as being the appropriate depth of the subclavian catheter insertion. In the control group (n = 40), the right subclavian catheter was inserted to the depth of height (cm)/10 minus 2 cm. RESULTS: In study group, the catheter tips were located proximal to the CLPR in about 2/3 (27/40) of the patients, and there was no case in which catheter tip was distal to the superior vena cava-right atrium junction. In the control group, catheter tips were proximal to the CLPR in only 10% of the patients and distal to the SVC/RA junction in 42.5%. CONCLUSIONS: This method decreased the incidence of locating the tip of the catheter distal to the CLPR, and prevented any intracardial location of the catheter tip.
Adult ; Bronchi ; Cardiac Tamponade ; Catheters* ; Central Venous Catheters ; Clavicle ; Craniotomy ; Humans ; Incidence ; Intracranial Hemorrhages ; Needles ; Punctures ; Skin ; Subclavian Vein ; Thorax* ; Trachea ; Vena Cava, Superior

Central hyperthermia is a very rare disease; however, once it happens, it is associated with a poor prognosis and high mortality for patients with severe brainstem strokes. Following a pontine hemorrhage, a 46-years-old female developed prolonged hyperthermia. Work-ups to the fever gave no significant clues for the origin of fever, and hyperthermia did not respond to any empirical antibiotics or antipyretic agents. The patient's body temperature still fluctuated in a range of 37.5degrees C to 39.2degrees C. Considering the lesion of hemorrhage, we suspected central hyperthermia rather than infectious diseases. We started with baclofen administration at a dose of 30 mg/day. The body temperature changed to a range of 36.6degrees C to 38.2degrees C. We raised the dose of baclofen to 60 mg/day. The patient's body temperature finally dropped to a normal range. Central hyperthermia, caused by failures of thermoregulatory pathways in brainstem, following the pontine hemorrhage rarely occurs. Baclofen can be used to treat suspected central hyperthermia in a patient with pontine hemorrhage.
Anti-Bacterial Agents ; Antipyretics ; Baclofen* ; Body Temperature ; Brain Stem ; Communicable Diseases ; Female ; Fever* ; Hemorrhage* ; Humans ; Mortality ; Pons ; Prognosis ; Rare Diseases ; Reference Values ; Stroke