BACKGROUND: Prenatal tongue development may affect oral-craniofacial structures, but this muscular organ has rarely been investigated. METHODS: In order to document the physiology of prenatal tongue growth, we histologically examined the facial and cranial base structures of 56 embryos and 106 fetuses. RESULTS: In Streeter's stages 13-14 (fertilization age [FA], 28 to 32 days), the tongue protruded into the stomodeal cavity from the retrohyoid space to the cartilaginous mesenchyme of the primitive cranial base, and in Streeter's stage 15 (FA, 33 to 36 days), the tongue rapidly swelled and compressed the cranial base to initiate spheno-occipital synchondrosis and continued to swell laterally to occupy most of the stomodeal cavity in Streeter's stage 16-17 (FA, 37 to 43 days). In Streeter's stage 18-20 (FA, 44 to 51 days), the tongue was vertically positioned and filled the posterior nasopharyngeal space. As the growth of the mandible and maxilla advanced, the tongue was pulled down and protruded anteriorly to form the linguomandibular complex. Angulation between the anterior cranial base (ACB) and the posterior cranial base (PCB) was formed by the emerging tongue at FA 4 weeks and became constant at approximately 124degrees-126degrees from FA 6 weeks until birth, which was consistent with angulations measured on adult cephalograms. CONCLUSIONS: The early clockwise growth of the ACB to the maxillary plane became harmonious with the counter-clockwise growth of the PCB to the tongue axis during the early prenatal period. These observations suggest that human embryonic tongue growth affects ACB and PCB angulation, stimulates maxillary growth, and induces mandibular movement to achieve the essential functions of oral and maxillofacial structures.
Adult ; Axis, Cervical Vertebra ; Embryonic Structures* ; Fetus* ; Humans ; Mandible ; Maxilla ; Mesoderm ; Parturition ; Physiology ; Skull Base ; Tongue*

Heart transplantation is the last treatment option in refractory end stage heart failure, which can prolong survival. The number of heart transplantations has increased and the survival rate has improved during the last few decades which was contributed by advanced understanding of immunologic mechanism of rejection, pharmaceutical development and clinical management of donors and recipients. However, only a fraction of patients can be offered to transplantation due to shortage of donor heart and many patients suffer high mortality while waiting. Meanwhile, technical advancement of mechanical assist device in recent years enabled long term implantable left ventricular assist devices (LVAD) to bridge the patients with high mortality in the waiting list to transplantation and to assist as a long term destination therapy for patients who are not eligible for transplantation. Development of solid phase assay increased the sensitivity and the specificity of detection of anti-human leukocyte antigen (HLA) antibodies in the recipient. It enabled identifying unacceptable HLA antigens, acquire calculated Panel Reactive Antibodies and perform virtual cross match that can enhance the efficacy of donor allocation system to decrease the waiting time, obviate prospective cross match to decrease ischemic time and to assess the risk of rejection in presensitized patients. Antibody mediated rejection is a challenging entity in diagnosis and management. However, standardized classification of histology and immunology of endomyocardial biopsies was made recently and immunotherapy is moving toward targeted therapies directed at antibody production and function. This review focuses on those major changes in the heart transplantation field in the last decade.
Allergy and Immunology ; Antibodies ; Antibody Formation ; Biopsy ; Classification ; Diagnosis ; Graft Rejection ; Heart ; Heart Failure ; Heart Transplantation* ; Heart-Assist Devices* ; HLA Antigens ; Humans ; Immunotherapy ; Leukocytes ; Mortality ; Sensitivity and Specificity ; Survival Rate ; Tissue Donors ; Waiting Lists

PURPOSE: We analyzed the oncological outcome and prognostic factor of the chondrosarcoma arising from benign bone tumor due to malignant transformation. MATERIALS AND METHODS: From April 1986 to April 2009, 18 cases were considered eligible. We analyzed retrospectively the patient's characteristics and prognostic factors that affect to the local recurrence and distant metastasis. RESULTS: As classified by primary benign bone tumor, 4 cases were solitary osteochondroma, 11 cases were multiple osteochondromatosis and 3 cases were multiple enchondromatosis. The mean follow-up period was 85 months. The 5-year disease free survival rate of 18 patients was 85.9%. Their overall MSTS score was 25.2 (84%). There were local recurrence in 3 cases and no distant metastasis. We found that tumor location and surgical margin affected to the prognosis significantly. CONCLUSION: In secondary chondrosarcoma patients, the prognosis was good relatively and tumor location and surgical margin are important prognosis factor.
Chondrosarcoma ; Disease-Free Survival ; Enchondromatosis ; Follow-Up Studies ; Humans ; Neoplasm Metastasis ; Osteochondroma ; Osteochondromatosis ; Prognosis ; Recurrence ; Retrospective Studies

PURPOSE: To evaluate the functional outcomes of the severely comminuted intra-articular calcaneal fractures that were selectively treated with primary subtalar arthrodesis. MATERIALS AND METHODS: This study is based on the 9 patients, 10 feet of intra-articular severely comminuted calcaneal fractures that were treated with open reduction and internal fixation with primary subtalar arthrodesis due to inability to reconstruct the subtalar articular surface with follow-up of more than 1 year. Postoperative clinical evaluation was performed with AOFAS Hindfoot functional scores. The patient satisfaction, returning to previous occupation and complications were also investigated. RESULTS: Follow-up period was average 20.3 months. Overall AOFAS functional score at final follow-up was average 71.8 points and VAS pain score was 3.9. Fifty percent of the patients were satisfied with the surgery and 80% of the patients were able to return to their previous occupations at average 8.4 months after trauma. Post-operative complications were 2 cases of sural nerve injuries and 1 hindfoot valgus malunion. CONCLUSION: We concluded that the primary subtalar arthrodesis is a viable surgical option for severely comminuted calcaneal fractures with favorable functional result and early returning of most patients to their previous occupations.
Arthrodesis* ; Calcaneus ; Follow-Up Studies ; Foot ; Fractures, Comminuted* ; Humans ; Occupations ; Patient Satisfaction ; Sural Nerve

No abstract available.
Cystadenocarcinoma, Mucinous* ; Female* ; Humans ; Mucins*

Prostate cancer commonly manifests with bony metastases. Visceral metastasis can also occur in the lungs and liver. However, stomach metastasis related to prostate cancer is rare. Here, we report a case of prostate cancer metastatic to the stomach. A 66-year-old male was diagnosed with prostate adenocarcinoma. He was noted as having abdominal discomfort, nausea, and vomiting 18 months after the diagnosis. A histopathologic examination and an esophagogastroduodenoscopic gastric biopsy revealed stomach-metastatic adenocarcinoma. He was also noted as having cerebellar metastatic lesions, which were identified by using a brain magnetic resonance imaging (MRI) scan. The patient died of cardiovascular complications 5 months after the diagnosis of stomach metastasis.
Adenocarcinoma ; Aged ; Biopsy ; Brain ; Humans ; Liver ; Lung ; Magnetic Resonance Imaging ; Male ; Nausea ; Neoplasm Metastasis ; Prostate ; Prostatic Neoplasms ; Stomach ; Vomiting

No abstract available.
Ascitic Fluid* ; Endometriosis* ; Female ; Humans ; Interleukins*

A dedifferentiated liposarcoma of the retroperitoneum is an extremely rare tumor. A 51-year old man was admitted to our department because a retroperitoneal mass was seen on abdominal computed tomography at another hospital. Computed tomography of the abdomen and magnetic resonance imaging showed a large pelvic mass located in the right hemipelvis, and it was pushing the right ureter and invading the right kidney, duodenum, colon and inferior vena cava. The patient underwent right radical nephrectomy, pylorus preserving pancreatoduodenectomy, right hemicolectomy and artificial blood vessel replacement for the inferior vena cava. The histopathological diagnosis was dedifferentiated liposarcoma and the patient was free from recurrence on the computed tomography that was done 6 months after the operation.
Abdomen ; Blood Substitutes ; Colon ; Duodenum ; Glycosaminoglycans ; Humans ; Kidney ; Liposarcoma ; Magnetic Resonance Imaging ; Nephrectomy ; Pancreaticoduodenectomy ; Pylorus ; Recurrence ; Ureter ; Vena Cava, Inferior

The Iinvolvement of subaortic structures in the aortic valve endocarditis appears more commonly than previously recognized. These subaortic complications are most commonly located in the mitral-aortic intervalvular fibrosa and may be presented as abscess, or as pseudoaneurysm with or without perforation. Perforated pseudoaneurysm can lead to the development of communication between the left ventricular outflow tract and various cardiac chambers, most commonly the left atrium. These complications are related with poor prognosis. Early and precise recognition of these complications is important for optimal treatment. At present, transesophageal echocardiography (TEE) has been validated as the technique of choice. We describe a case of infectious pseudoaneurysm of mitral-aortic intervalvular fibrosa featuring the connection of the fistulous simultaneously to the left atrium and aorta. In our case, accurate interpretation of TEE imaging revealing the subaortic structures was not so easy due to interference of both aortic and mitral prosthetic valves. We expect the further development of (Ed-confirming that here you don't intend, "We expect to further develop") TEE and other imaging modalities to substantially improve the future diagnosis of these undesirable complications.
Abscess ; Aneurysm, False* ; Aorta ; Aortic Valve* ; Diagnosis ; Echocardiography, Transesophageal ; Endocarditis* ; Fistula* ; Heart Atria ; Prognosis

BACKGROUND/AIMS: Idiopathic portal hypertension (IPH) is defined as portal hypertension with splenomegaly and hypersplenism in the absence of cirrhosis or obstruction of portal vein or hepatic vein. It has been recently suggested that hypercoagulable state and thromboembolic event of small portal veins have an important role in the pathogenesis of IPH. In this study, we evaluated the clinical and pathological characteristics of IPH. METHODS: We reviewed clinical, endoscopic, radiologic and liver biopsy findings of 10 cases of IPH retrospectively. RESULTS: The tests for antithrombin III deficiency, protein C deficiency, protein S deficiency, resistance to activated protein C, lupus anticoagulant, antiphospholipid antibodies, anticardiolipin antibodies were normal. Pathologic findings revealed portal vein dilatation (10/10), loss of portal vein (6/10), portal vein sclerosis (1/10), dilated megasinusoids (9/10), dilation of terminal hepatic vein (8/10), narrowing of terminal hepatic vein (2/10), hairline fibrous septa (1/10), and regenerative nodule (1/10). CONCLUSIONS: The pathologic finding of IPH showed various manifestations of obliterative portal venopathy although there was no hypercoagulable state.
Antibodies, Anticardiolipin ; Antibodies, Antiphospholipid ; Antithrombin III Deficiency ; Biopsy ; Dilatation ; Fibrosis ; Hepatic Veins ; Hypersplenism ; Hypertension, Portal* ; Liver ; Lupus Coagulation Inhibitor ; Portal Vein ; Protein C ; Protein C Deficiency ; Protein S Deficiency ; Retrospective Studies ; Sclerosis ; Splenomegaly