A spindle cell squamous cell carcinoma on the cheek presenting with in-transit metastases and a satellite lesion

Spindle cell squamous cell carcinoma (SpSCC) is a biphasic tumor composed of squamous cell epithelial and spindle cell mesenchymal components, both of which are malignant. Cutaneous SpSCC can cause diagnostic and therapeutic difficulties because of its rarity, heterogeneity, morphological similarity to other cutaneous spindle cell neoplasms, and uncertain pathogenesis and prognosis, particularly when the squamous cell carcinoma component is minimal or missing. Intransit metastasis and satellite lesion (satellitosis) constitute a spectrum of non-nodal regional metastases. Here the author reports the first known case of cutaneous SpSCC presenting with intransit metastases and a satellite lesion, which were exceptionally aggressive. A 77-year-old female patient presented with a 3× 3× 0.5 cm mass on her right cheek. Despite wide excision and postoperative radiation, the patient resulted in local recurrence and multiple distant metastases within 3 months. If many high-risk factors-particularly satellitosis and in-transit metastases are observed in a tumor with epithelial to mesenchymal transition, then further wide excision and adjuvant chemoradiation should be considered early in the treatment process. A multidisciplinary approach could be the key to cure the most aggressive malignancies of the skin, as in other organs.

The Merits of Mannitol in the Repair of Orbital Blowout Fracture

BACKGROUND: One of the main concerns in orbital blowout fracture repair is a narrow operation field, due mainly to the innate complex three dimensions of the orbit; however, a deep location and extensive area of the fracture and soft tissue edema can also cause concern. Swelling of the orbital contents progresses as the operation continues. Mannitol has been used empirically in glaucoma, cerebral hemorrhage, and orbital compartment syndrome for decompression. The authors adopted mannitol for the control of intraorbital edema and pressure in orbital blowout fracture repair. METHODS: This prospective study included 108 consecutive patients who were treated for a pure blowout fracture from January 2007 to October 2012. For group I, mannitol was administered during the operation. Under general anesthesia, all patients underwent surgery by open reduction and insertion of an absorbable mesh implant. The authors compared postoperative complications, the reoperation rate, operation time, and surgical field improvement between the two groups. RESULTS: In patients who received intraoperative administration of mannitol, the reoperation rate and operation time were decreased; however, the difference was not statistically significant. The total postoperative complication rates did not differ. Panel assessment for the intraoperative surgical field video recordings showed significantly improved vision in group I. CONCLUSIONS: For six years, mannitol proved itself an effective, reliable, and safe adjunctive drug in the repair of orbital blowout fractures. With its rapid onset and short duration of action, mannitol could be one of the best methods for obtaining a wider surgical field in blowout fracture defects.

Radiation absorbed doses of cone beam computed tomography / 대한구강악안면방사선학회지

Purpose: To measure the absorbed doses of cone beam computed tomography (CBCT), which is recently being more frequently used, and to compare them with those of panoramic radiography. Materials and Methods: To measure the absorbed doses of CBCT (PSR-9000N(TM), Asahi Roentgen Ind. Co., Japan), we placed TLD chips on the skin regions above the parotid and thyroid glands, and on the dorsum of tongue in a dental head phantom. We used two image acquisition modes of the Dental and Panoramic modes of CBCT, which differed in the field of view. Also, panoramic radiographs (Auto IIIN, Asahi Roentgen Ind. Co., Japan) were taken to compare with the absorbed doses of CBCT. Result: In the Dental mode of CBCT, the absorbed doses of the parotid gland, dorsum of tongue, and thyroid gland were 3.53, 3.13, and 0.36 mGy, respectively. In the Panoramic mode of CBCT, they were 9.57, 9.15, and 0.85 mGy, respectively. The panoramic mode showed higher absorbed doses than those of the Dental mode. In the panoramic radiography, the absorbed doses of the parotid gland, dorsum of tongue, and thyroid gland were 1.21, 1.19, and 0.16 mGy, respectively. And they were about 1/3 of the Dental mode and 1/9 of the Panoramic mode of CBCT. Conclusion: Absorbed doses of CBCT are higher than those of panoramic radiography, and dependent upon the field of view.

Radiation absorbed doses of cone beam computed tomography / 대한구강악안면방사선학회지

Purpose: To measure the absorbed doses of cone beam computed tomography (CBCT), which is recently being more frequently used, and to compare them with those of panoramic radiography. Materials and Methods: To measure the absorbed doses of CBCT (PSR-9000N(TM), Asahi Roentgen Ind. Co., Japan), we placed TLD chips on the skin regions above the parotid and thyroid glands, and on the dorsum of tongue in a dental head phantom. We used two image acquisition modes of the Dental and Panoramic modes of CBCT, which differed in the field of view. Also, panoramic radiographs (Auto IIIN, Asahi Roentgen Ind. Co., Japan) were taken to compare with the absorbed doses of CBCT. Result: In the Dental mode of CBCT, the absorbed doses of the parotid gland, dorsum of tongue, and thyroid gland were 3.53, 3.13, and 0.36 mGy, respectively. In the Panoramic mode of CBCT, they were 9.57, 9.15, and 0.85 mGy, respectively. The panoramic mode showed higher absorbed doses than those of the Dental mode. In the panoramic radiography, the absorbed doses of the parotid gland, dorsum of tongue, and thyroid gland were 1.21, 1.19, and 0.16 mGy, respectively. And they were about 1/3 of the Dental mode and 1/9 of the Panoramic mode of CBCT. Conclusion: Absorbed doses of CBCT are higher than those of panoramic radiography, and dependent upon the field of view.

The Difference in Graft Rejection between Two Corneal Preservation Methods(Moist Chamber vs Optisol)

To know the difference in graft rejection after corneal transplantation between moist chamber and Optisol(Chiron Co. Irvine, CA, U.S.A.) as cornea preservation methods, we compared two groups involving 50 patients(71 eyes) who had undergone partially penetrating keratoplasty (PPKP) for the treatment of keratoconus or corneal dystrophy from 1991 to 1995. The graft rejection had occurred in 10 of 40 eyes(25%) in moist chamber group and 9 of 31 eyes(29%) in Optisol group, and the cases of permanent corneal opacity after rejection were 5 of 40 eyes(12.5%), 3 of 31 eyes(9.7%) respectively. No difference in the two groups was statistically significant(P<0.05). We found the fact that the difference did not exist in the results from graft rejection after PPKP using moist chamber method for short preservation period, or Optisol method for the relatively long period allowing serological and immunological screen test.

Evaluation of frontal bone erosion of young rabbit and its recovery after tissue expansion

Among the complications associated with tissue expansion, bony depression under the expander is frequently observed clinically, especially under the tough skin like scalp. To investigate the bony change during the expansion and its reversability, we divided 21 young rabbits into 7 groups. After the insertion of tissue expander on the frontal bone, each groups are sacrificed at 1,2,3 weeks after tissue expansion, 1,2,3 months after removal of tissue expander, and for control, 4 weeks after insertion of expander without expansion. Bony changes are evaluated by gross findings, radiographic findings, and histologic findings. Progressive tissue expansion induces significant gross bony changes in skull of young rabbit. This bony changes consist of erosion underlying tissue expander, with bony ridging and bone deposition at the periphery of the expander. These gross findings correlates with the histomorphologic findings; osteoclastic bone resorption under the expanders with periosteal reation at the periphery of the expanders. The bony changes is not simply a pressure deformation, but also is a remodeling effect. Increased bone resorption and inhibition of bone formation occur until the pressure is removed. After removal of the expanders, reparative bone remodeling begins and nearly complete healing of the cranial defects occurs. On the basis of this study, we conclude that tissue expansion causes significant but reversible effects on cranial bone of young rabbit.

Facial form analysis of the lower and middle face in young Korean women

Nowadays facial skeletal contouring which have developed in craniofacial surgery, acquired popularity in aesthetic surgery. On planning aesthetic surgery, patient's desire must be considered first but it seems to be essential to have an objective standard of facial form. Anthropometric analysis, cephalometric analysis, and photogrammetric analysis were developed for this purpose but with a limitation in three dimensional analysis. Barnett and Whitaker(1986) developed a simple three dimensional analytic system of middle and lower face and reported average values and standard deviations for young Caucasian women. We performed the same analysis for age matched young Korean women and found some difference between young Caucasian women and young Korean women as follows; 1. Young Korean women's middle and lower face is wider than young Caucasian women's face in horizontal dimension. 2. Young Korean women's middle and lower face is shorter than young Caucasian women's face in anterior-posterior dimension. 3. The difference in vertical dimension between the two groups is minimal. 4. In angular relationship, young Korean women's anterior and inferior angles are larger than young Caucasian women's angles. These findings are coincident with other author's observations that Oriental face is wider and rounder than Caucasian face and Orientals have more prominent malar area and mandible angle. For Korean people, with many needs for aesthetic correction of prominent zygoma and mandible angle, this three dimensional analytic system will be useful in planning surgery and research for middle and lower face deformities.

Facial form analysis of the lower and middle face in young Korean women

Nowadays facial skeletal contouring which have developed in craniofacial surgery, acquired popularity in aesthetic surgery. On planning aesthetic surgery, patient's desire must be considered first but it seems to be essential to have an objective standard of facial form. Anthropometric analysis, cephalometric analysis, and photogrammetric analysis were developed for this purpose but with a limitation in three dimensional analysis. Barnett and Whitaker(1986) developed a simple three dimensional analytic system of middle and lower face and reported average values and standard deviations for young Caucasian women. We performed the same analysis for age matched young Korean women and found some difference between young Caucasian women and young Korean women as follows; 1. Young Korean women's middle and lower face is wider than young Caucasian women's face in horizontal dimension. 2. Young Korean women's middle and lower face is shorter than young Caucasian women's face in anterior-posterior dimension. 3. The difference in vertical dimension between the two groups is minimal. 4. In angular relationship, young Korean women's anterior and inferior angles are larger than young Caucasian women's angles. These findings are coincident with other author's observations that Oriental face is wider and rounder than Caucasian face and Orientals have more prominent malar area and mandible angle. For Korean people, with many needs for aesthetic correction of prominent zygoma and mandible angle, this three dimensional analytic system will be useful in planning surgery and research for middle and lower face deformities.

The Effect of Wearing Prism in Infantile Nystagmus

In infantile nystagmus, we evaluated the changes in visual acuity, nystagmus intensity and face turning between with prism and without prism. 4 patients chosen in our study had a fusional ability examined by Worth-4Dot test and were not accompanied with strabismus. It was confirmed by the inspection of eyes and electro-oculogram that visual acuity at near fixation was better than that at distant fixation and the nystagmus intensity was decreased by convergence. The age distribution of the patients was between 6 and 20 years old. The period of wearing prism ranged from 2.5 to 8.5 months. Improvement in binocular visual acuity at distant fixation with prism was noted relatively from 4 lines to 1 line, the nystagmus intensity (Amplitude x Frequency) calculated by analyzing eletro-oculogram records resulted in the decrease with prism in comparison with that without prism (p<0.05). And the main cause of decrease in nystagmus intensity was determined by that in amplitude rather than frequency. The ranges of correction of face turning at distant fixation wer between 10 degrees and 20 degrees. As the result of this study, in case that nystagmus intensity can be decreaed by convergence and prism is worn succeedingly without any trouble, we assume that the use of bilateral base-out prism will be one of the effective methods for decrease in nystagmus intensity, improvement in visual acuity and face turning.

THE EFFECTS OF A THIN SHEET OF TYPE I COLLAGEN ON WOUND HEALING OF FULL THICKNESS SKIN DEFECTS

No abstract available.

The Effect of Cyclosporin Therapy on Endogenous Uveitis

Endogenous uveitis is characterized by frequent remissions and exacerbations which lead to visual loss, and treated with immunosuppresive agents. We evaluated the therapeutic effect and complicantions of 15 patients (25 eyes) with endogenous uveitis who were treated with cyclosporin (Implanta). The inflammatory activities of anterior chamber and vitreous were reduced significantly after 1, 3, and 8 month follow-up of cyclosporin therapy, and the visual acuity was improved or sustaind in 52% of all patients. If cyclosporin therapy is intolerable, combining the cyclosporin with low dose of a steroid should be considered.