PURPOSE: To compare the diagnostic value of electroencephalography (EEG), MRI and PET studies and surgical outcome in patients with medically refractory temporal lobe epilepsy due to hippocampal sclerosis (HS) versus temporal lobe lesions (TLL). METHODS: Records of 122 consecutive patients who underwent surgery for epilepsy from January 1993 to April 2000 were retrieved from the MGH Epilepsy Surgery Database. Fifty eight patients with temporal lobe epilepsy due to pathologically proven HS or TLL were identified and presurgical interictal and ictal EEG, MRI, and 2-[(18)F]fluoro-2-deoxy-D-glucose (FDG)-PET data and surgical outcome were reviewed. Patients with dual or normal pathology were excluded. Pathologically proven HS was present in 32 patients, and 26 patients has temporal lobe lesions (cortical dysplasia in 6 patients, vascular malformation in 6, gliomas in 5, DNET in 4, heterotopia in 1, other pathologies in 4). Comparisons of the diagnostic value of EEG, MRI and FDG-PET studies were performed in 43 patients who were seizure-free after epilepsy surgery. Among 43 patients, HS was in 24 patients and TLL in 19. RESULTS: The occurrence of abnormal interictal and ictal EEG, MRI and FDG-PET findings in the side of operation was not significantly different between patients with HS and with TLL respectively. There was no significant difference in at least one year follow-up surgical outcome between the two groups. CONCLUSIONS: Diagnostic value of presurgical interictal and ictal EEG, MRI and FDG-PET findings, and surgical outcome were not different in patients with mesial versus neocortical temporal lobe epilepsies.
Electroencephalography* ; Epilepsy ; Epilepsy, Temporal Lobe* ; Follow-Up Studies ; Glioma ; Humans ; Magnetic Resonance Imaging ; Neuroimaging* ; Pathology ; Sclerosis ; Temporal Lobe* ; Vascular Malformations

Ever since transplant surgery became a common procedure. The early diagnosis of irreversible cessation of cerebral function has become an important need We analysed the findings of transcranial doppler of five cases. Two was diagnosed brain death by currently accepted criteria. Two cases showed absence of intracranial blood flow and normal to disturbed flow status of the cervical carotid artery. Three cases showed reverberating flow pattern with reflux phenomenon. Transcranial doppler investigation seems to provide a practical, non-invasive. And reliable disgnostic evidence for the arrest of cerebral circulation.
Brain Death* ; Brain* ; Carotid Arteries ; Diagnosis* ; Early Diagnosis

A case of supratentorial ependymoma in a 48-year-old man. After operation and radiological treatment, metastasis to scalp and cervical lymph node occurred, without recurrence of primary focus. 11 cases of intracranial ependymoma with extracranial metastasis were reviewed. Metastasizing intracranial ependymomas are 3 times as frequent in males and originate above tentorium. The most effective transmission of metastasis of ependymoma is through the blood stream and the frequent sites of metastasis are lungs, pulmonary hilus, mediatinum, liver, scalp, vertebra, femoral bone and cervical lymph nodes. Our case is the oldest among reported cases and metastasized to relatively rare site.
Ependymoma* ; Humans ; Liver ; Lung ; Lymph Nodes ; Male ; Middle Aged ; Neoplasm Metastasis* ; Recurrence* ; Rivers ; Scalp ; Spine

Mandibular metastasis of thyroid carcinoma is extremely rare. We present the case of a 46-year-old woman who had bilateral huge cheek masses that had grown rapidly over several years. Intra-oral mucosal tissue biopsy and imaging work-up including computed tomography scan and magnetic resonance imaging were performed and the initial diagnosis was presumed to be central giant cell granuloma. Incidentally detected thyroid lesions were studied with ultra-sonography guided fine needle aspiration and diagnosed as simple benign nodules. Due to continuous oral bleeding and the locally destructive feature of the lesions, we decided to excise the mass surgically. To avoid functional deficit, a stepwise approach was performed: Firstly, the larger left mass was excised and the mandible was reconstructed with a fibular free flap. The final pathologic diagnosis was follicular thyroid cancer. Postoperative I-131 thyroid scan and whole body positron-emissions-tomography were performed. Right side mass was revealed as a thyroid malignancy. Multiple bony metastases were detected. Since further radioactive iodine therapy was required, additional total thyroidectomy and right side mandibulectomy with fibular free flap reconstruction was performed. The patient also underwent high dose radioactive iodine therapy and palliative extra-beam radiotherapy for the metastatic lumbar lesion. Follicular thyroid carcinoma should be considered as a differential diagnosis for mandibular mass lesions.
Adenocarcinoma, Follicular ; Biopsy ; Biopsy, Fine-Needle ; Cheek ; Diagnosis, Differential ; Female ; Free Tissue Flaps ; Granuloma, Giant Cell ; Hemorrhage ; Humans ; Iodine ; Magnetic Resonance Imaging ; Mandible ; Mucous Membrane ; Neoplasm Metastasis ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy

Congenital sialo-cutaneous fistula arising from the accessory parotid gland is extremely rare. Although the fistula tract can be successfully excised after making a skin incision along the skin tension line around the fistula opening, a facial scar inevitably remains. We here report a case of sialo-cutaneous fistula that was treated with chemocauterization with trichloroacetic acid (TCA). TCA cauterization is an easy and effective option for the treatment of congenital fistula from an accessory parotid gland, especially from the aesthetic point of view.
Cicatrix ; Fistula ; Parotid Gland ; Skin ; Trichloroacetic Acid

Hemimasticatory spasm is a rare disorder that often accompanies facial hemiatrophy and is characterized by spasm in one or more of the jaw-closing muslces supplied by the fifth cranial nerve. We report a clinical and electrophysiological observation of a patient of hemimasticatory spasm, who presented involuntary spasm on masseter muscle and hemiatrophy of the face on the right side for 7 years.
Facial Hemiatrophy ; Humans ; Masseter Muscle ; Spasm* ; Trigeminal Nerve

BACKGROUND AND OBJECTIVES: Diagnosis of thyroid disease requiring surgery and subsequent thyroidectomy may affect patients' emotion and quality of life. The purpose of this study is to evaluate the patients' understanding and concern about the disease and recovery rate after thyroidectomy, and therefore to enhance the satisfaction of hospitalization. SUBJECTS AND METHOD: MethodZZSeventy-seven patients undergoing thyroidectomy in a tertiary hospital from April 2009 to October 2009 were enrolled. Questionnaires were filled out on the admission day, discharge day, and 2 weeks after operation. Questionnaires consisted questions regarding the understanding of the disease, details of concern, recovery rate after surgery, and satisfaction on hospitalization duration. Retrospective chart review was also performed. RESULTS: Many patients (42.9%) acquired their knowledge of thyroid cancer through the internet. The possibility of voice change was the major concern before surgery (46.8%), whereas the major postoperative concern was adjuvant therapy (37.7%). The patient group with higher understanding of the disease showed higher recovery rate than the others at the time of discharge (mean postdischarge surgical recovery 67.4% vs. 55.3%, p=0.01). The patient group with lower understanding wanted longer hospitalization than the other group at discharge (p<0.001). CONCLUSION: Patient education about the thyroid disease may reduce patients' anxiety and therefore may enhance subjective recovery rate and satisfaction of hospitalization.
Anxiety ; Cognition ; Hospitalization ; Humans ; Internet ; Patient Education as Topic ; Quality of Life ; Surveys and Questionnaires ; Retrospective Studies ; Tertiary Care Centers ; Thyroid Diseases ; Thyroid Neoplasms ; Thyroidectomy ; Voice

The temporalis muscle is usually described as a single layer originating at the temporal line, converging to a tendon, and inserting onto a narrow site of the coronoid process. However, recent studies have shown that the temporalis muscle can be divided into two or three separate segments and the distal attachment continues inferiorly beyond the coronoid process. Therefore, the aims of this study were to analyze the morphology of the temporalis muscle focusing on the tendinous attachment onto the coronoid process and to provide educational values. The temporalis muscle was carefully dissected in 26 cadavers and classified based on the muscle fascicle direction. Each divided part was sketched and measured based on bony landmarks to elucidate its tendinous insertion site onto the coronoid process, and the results obtained were reviewed through the literature. The temporalis muscle ends at two distinct terminal tendons with wider insertion sites than usually presented in textbooks and atlases and separates into two parts that combine to act as a single structural unit. The superficial part is a large fan-shaped muscle commonly recognized as the temporalis muscle. This converges infero-medially to form the superficial tendon and the lateral boundary of the retromolar triangle. Meanwhile, the deep part is a narrow vertically oriented rectangular muscle that converges postero-laterally to form the deep tendon and the medial boundary of the retromolar triangle. These results indicate that understanding the temporalis muscle’s insertion site onto the coronoid process will be useful clinically with educational values during surgical procedures.

The temporalis muscle is usually described as a single layer originating at the temporal line, converging to a tendon, and inserting onto a narrow site of the coronoid process. However, recent studies have shown that the temporalis muscle can be divided into two or three separate segments and the distal attachment continues inferiorly beyond the coronoid process. Therefore, the aims of this study were to analyze the morphology of the temporalis muscle focusing on the tendinous attachment onto the coronoid process and to provide educational values. The temporalis muscle was carefully dissected in 26 cadavers and classified based on the muscle fascicle direction. Each divided part was sketched and measured based on bony landmarks to elucidate its tendinous insertion site onto the coronoid process, and the results obtained were reviewed through the literature. The temporalis muscle ends at two distinct terminal tendons with wider insertion sites than usually presented in textbooks and atlases and separates into two parts that combine to act as a single structural unit. The superficial part is a large fan-shaped muscle commonly recognized as the temporalis muscle. This converges infero-medially to form the superficial tendon and the lateral boundary of the retromolar triangle. Meanwhile, the deep part is a narrow vertically oriented rectangular muscle that converges postero-laterally to form the deep tendon and the medial boundary of the retromolar triangle. These results indicate that understanding the temporalis muscle’s insertion site onto the coronoid process will be useful clinically with educational values during surgical procedures.

BACKGROUND AND OBJECTIVES: Cervical metastasis of unknown origin (MUO) comprises 3-5% of all head and neck malignancy. Standardized diagnostic approach is not established and standard treatment regimen is not established either. The purpose of this study was to evaluate diagnostic approaches to detect the primary site in patients with neck mass of metastatic squamous cell carcinoma and analyze treatment modalities and their outcomes as well. SUBJECTS AND METHOD: Of 710 patients who had been diagnosed with squamous cell carcinoma of the head and neck site from Jan. 1992 through Dec. 2005, 73 patients were referred to or visited our clinic regarding the presence of neck mass. With retrospective review of the medical record, the diagnostic approaches were evaluated. Thirty patients, in whom the primary sites were not found after all, were included for analysis of treatments and outcomes. RESULTS: The diagnostic steps that revealed the primary sites were as follows: physical examination in 29 cases (39.7%), conventional imaging (CT or MRI) in 5 cases (6.8%), PET scan in 1 case (1.4%), OPD based directed biopsy in 3 cases (4.1%), and intraoperative directed biopsy in 5 cases (6.8%). Primary sites were not detected in 30 cases (41.1%). Complete remission was obtained in 24 patients, for whom 5-year disease free survival rate was 62.1%. CONCLUSION: Thorough physical examination and directed biopsy are strongly recommended for the diagnosis of MUO, but the diagnostic value of PET scan needs to be followed up with more cases.
Biopsy ; Carcinoma, Squamous Cell ; Diagnosis ; Disease-Free Survival ; Head ; Humans ; Medical Records ; Neck ; Neoplasm Metastasis ; Physical Examination ; Positron-Emission Tomography ; Prognosis* ; Retrospective Studies