Reconstruction Techniques for Tissue Defects Formed after Preauricular Sinus Excision

BACKGROUND: Preauricular sinuses are congenital abnormalities caused by a failure of fusion of the primitive tubercles from which the pinna is formed. When persistent or recurring inflammation occurs, surgical excision of the infected tissue should be considered. Preauricular defects inevitably occur as a result of excisions and are often difficult to resolve with a simple suture; a more effective reconstruction technique is required for treating these defects. METHODS: After total excision of a preauricular sinus, the defect was closed by a plastic surgeon. Based on the depth of the defect and the degree of tension when apposing the wound margins, the surgeon determined whether to use primary closure or a posterior auricular flap. RESULTS: A total of 28 cases were examined. In 5 cases, including 2 reoperations for dehiscence after primary repair, reconstruction was performed using posterior auricular transposition flaps. In 16 cases of primary closure, the defects were closed using simple sutures, and in 7 cases, closure was performed after wide undermining. CONCLUSIONS: If a preauricular defect is limited to the subcutaneous layer and the margins can be easily approximated, primary closure by only simple suturing may be used to perform the repair. If the defect is deep enough to expose the perichondrium or if there is tension when apposing the wound margins, wide undermining should be performed before primary closure. If the extent of the excision exposes cartilage, the procedure follows dehiscence of the primary repair, or the tissue is not sufficiently healthy, the surgeon should use a posterior auricular flap.

Diagnostic Feasibility of Galectin-3 for Suspicious Malignant Thyroid Nodule in Preoperative Fine-Needle Aspiration Cytology

PURPOSE: Fine Needle Aspiration Cytology (FNAC) is considered as the most feasible preoperative diagnostic tool for thyroid lesions. However, the false results of FNAC are not uncommon, and so we need a development of novel supportive preoperative diagnostic modality. In previous studies, galectin-3, a beta-galactosidase-binding protein, was expressed preferentially in thyroid malignancies. In this study, we analyzed whether the galectin-3 immunohistochemistry (IHC) is useful as a preoperative diagnostic tool. METHODS: 79 patients who underwent a definite surgery for thyroid nodule were analyzed. The preoperative routine stained cytology and galectin-3 IHC for fine-needle aspirates and the galectin-3 IHC for postoperative specimen were performed. Individual results were compared with the final diagnoses. RESULTS: Of 79 specimens, 28 (35.4%) were malignant. The false negative rate (FNR) of galectin-3 IHC in the surgical specimen was 10.0%. The FNR of galectin-3 IHC for the fine-needle aspirates was 50.0% and the FNR of routine cytology was 20.5%. However, the FNR of galectin-3 IHC in the fine-needle aspirates was lowered up to 20.0% in thyroid lesions obtained by using ultrasound-guided aspiration. Among the 14 cases reported as suspicious in routine cytology, 13 cases were revealed the accurate correlations in galectn-3 IHC. CONCLUSION: It appears that galectin-3 IHC in preoperative FNAC alone had a little accuracy. However, preoperative galectin-3 IHC in thyroid lesions obtained under the ultrasound guidance could be diagnostic. Especially in suspicious group in FNAC, galectin-3 IHC could be critical method in differentiating malignant lesions from benign lesions of thyroid.

MRI Findings of the Brain in High-Voltage Electrical Burn Patient: Case Report

We report the delayed sequelae arising in a case of electrical injury, reviewing the literature on the subject and focusing on the MRI findings of the brain. A 23-year-old male suffered burns to the left parietal scalp, both feet, and the anterior chest wall. Neurological symptoms and MRI abnormalities appeared 14 days after the insult and continued for about three months. T1-weighted MR images demonstrated homogeneous hypointensity, while T2-weighted images depicted hyperintense finger-like projections. Contrast-enhanced T1-weighted images demonstrated strong band-like enhancement, indicating meningeal hyperemia. Follow-up MR imaging showed that the lesion had disappeared, indicating that the cerebral edema and meningeal hyperemia were reversible.

The evaluation of Fat Saturation Fast Spin-Echo T2WI for Patients with Acute Spinal Trauma

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.

Treatment of Benign Cold Thyroid Nodule: Efficacy and Safety of US-guided Percutaneous Ethanol Injection

PURPOSE: The purpose of this study was to evaluate the efficacy and safety of Us-guided percutaneous ethanolinjection for the treatment of benign cold thyroid nodules. MATERIALS AND METHODS: Twenty-five patients withbenign cold thyroid nodules (volume of each at least 2ml proven by PCNA to be adenomatous hyperplasia, and coldnodule by thyroid scan) underwent a total of one to three percutaneous ethanol injections (PEI) at intervals ofone or two months. The mean amount of ethanol used was 6.2(range, 1.5-8)ml, depending on the volume of the nodule. Follow up ultrasonography was performed one to four months after the final session. RESULTS: The initial volumeof nodules was 11.4+/-4.1(range, 2.5-41.4)ml, and in all cases this fell by 56.1+/-22.3%(range, 10.9-92.1%);in allcases, follow-up ultrasonography showed that echogeneity was lower and its pattern was heterogeneous. Trere wereno important longstanding complications; the most common side effect was acute pain at the injection site(n=9),and in one case, transient vocal cord palsy occurred. CONCLUSION: our results show that US-guided percutaneousinjection of ethanol is an effective and a safe procedure for the treatment of benign cold thyroid nodules, and isthus an alternative to surgery of hormone therapy.

The Results of Embolization of Dural Arteriovenous Fistula

PURPOSE: To assess the embolization effect of dural arteriovenous fistula(DAVF). MATERIALS AND METHODS: Weevaluated 23 patients with DAVF who were diagnosed using digital subtraction angiography and treated bytransarterial and/or transvenous emobolization. The locations of DAVFs, as seen on angiography were as follows: 16in the cavernous sinus, four in the major dural sinuses, two in the jugular bulb, one in the torcula Herophili,and one in the tentorium cerebelli. On the basis of venous drainage patterns, Cognard's classification of DAVF wasused. Among our 23 patients, 13 underwent transarterial embolization, six underwent transvenous embolization, andfour underwent both. After embolization, three patients underwent other treatment: surgery, one ; gammairradiation, one ; and both. One. Polyvinyl alcohol particles or glue was used in transarterial embolization, andtungsten, platinum, or Guglielmi detachable coils in transvenous embolization. To analyse the residual lesion inDAF, we compared pre- and post-treatment angiograms ; patients were followed up for 2 to 48 months, and theircondition was assessed as cured, improved, not changed, or aggravated. RESULTS: Nine patients were found to beCognard type I, two were IIa, four were IIa+b, and eight were type III. Of our 23 patients, 12 were cured, tenimproved, and one was aggravated ; of the 13 who underwent transarterial embolization, four were cured, eightimproved, and one was aggravated ; of the six who underwent transvenous embolization, five were cured and oneimproved. The condition of a patient with a lesion in the torcular herophili was aggravated despite surgery andgamma irradiation after embolization. CONCLUSION: DAVF can be managed successfully with endovascular treatment.The outcome of the transvenous approach appears to be better than that of the transarterial approach alone. In acase involving a lesion in the torcular herophili, the outcome was poor and more aggressive treatment wasrequired.

MR Findings of the Intraventricular Tumors

With regard to various pathologic conditions, it is important to understand not only MR findings, which dependon the anatomic location of intraventricular lesions, but also the anatomic location most appropriate for surgicalintervention. In this paper we will analyze and demonstrate the incidence and characteristic MR findings ofvarious intraventricular tumors according to the location of ventricles.

Location of Primary Motor Cortex Function in Cerebral Migration Disorder

PURPOSE: The purpose of this study was to demonstrate by functional MRI (MRI) the location of the primarymotor cortex in patients with schizencephaly. MATERIALS AND METHODS: fMRI was performed in four patients withschizencephaly who complained of seizures;three were right handed and one was ambidex trous. Associated lesionswere agenesis of the corpus callosum in one patient and absence of the septum pellucidum in another. fMRI employedthe single sliced FLASH BOLD technique using a 1.5-T MR imager with a standard head coil, and was obtained in theaxial plane. Thirty consecutive images were obtained on finger movements of each hand were obtained;the motor taskconsisted of repetitive finger to thumb opposition. Percentage change in primary motor cortex signal intensity wascalculated, and ipsilateral activation index was compared betweenthe affected and unaffected hemispheres. RESULTS: Percentage change in signal intensity increase in the activated area of the unaffected hemisphere ranged from4.8% +/-0.9% to 9.2+/-1.2%(mean:5.6%+/-1.5%) of the baseline value. The ipsilateral activation index of the affectedhemisphere was 0-0.38 and that of the unaffected hemisphere was 15.4-Infinity;in patients with schizencephalysignificantly different(p<0.01). CONCLUSION: Our results suggest that increased activation in the unaffectedhemisphere reflect functional reorganization of the primary motor cortex.