Bilaterality and symmetry of c-shaped mandibular second molars in a Mexican Maya and non-Maya population: a CBCT in vivo study / Bilateralidad y simetría de los segundos molares mandibulares en forma de c en una población mexicana Maya y no Maya: estudio in vivo mediante CBCT

SUMMARY: The objective of this study was to evaluate the bilaterality and symmetry in C-shaped mandibular second molars in Mexican Maya and non-Maya populations using cone-beam computed tomography (CBCT). Five-hundred-twenty-five CBCT scans of patients with left and right mandibular second molars were analyzed to determine the prevalence and bilaterality. The teeth were assessed for the presence of C-shaped root canals, according to Fan et al. (2004) criteria. The sample was subdivided by ethnicity, sex, unilateral/bilateral presence, side of the longitudinal groove, and the C-shaped root canal configuration and symmetry, at the cervical, middle, and apical cross- sections of the root. C-shaped mandibular second molars were present in 24.95% of the individuals. Most (60.30%) of those showing this trait had it bilaterally. When comparing by ethnicity, sex, and side, we detected no significant differences. The vast majority (97.33%) presented the groove along the lingual side. The C3 was the most prevalent configuration in the overall sample, while in the Maya group, the C1 was the most common configuration. When analyzed by sex and ethnic group, the non-Maya females tended to deviate from the other groups in terms of bilaterality. Overall, 55.70% of bilateral C-shaped mandibular second molars were also symmetric in the three radicular thirds. The prevalence of C-shaped mandibular second molars was similar to that reported for northernAsian populations, which is consistent with the evolutionary origins of Native American populations. Most of the sample showed bilaterality and half were symmetric. Clinicians must be aware of the ethnic background of their patients and consider the possible variations to do more predictable root canal treatments.

RESUMEN: El objetivo de este estudio fue evaluar la bilateralidad y simetría de los segundos molares mandibulares en forma de C en una población Mexicana Maya y no-Maya mediante tomografía computarizada de haz cónico (CBCT). Material and Métodos: Se analizaron quinientos veinticinco tomografías de pacientes con segundos molares mandibularesderecho e izquierdo para determinar la prevalencia y bilateralidad. Los dientes fueron evaluados según la presencia de conductos en forma de C de acuerdo a los criterios de Fan et al. La muestra fue subdividida por etnicidad, sexo, presencia bilateral/unilateral, lado del surco y configuración y simetría de los conductos en los cortes transversales cervical, medio y apical. Los segundos molares mandibulares en forma de C estuvieron presentes en el 24.95 % de los individuos. La mayoría (60.30%) de los que mostraron este rasgo lo hicieron de forma bilateral. El comparar por etnicidad, sexo y lado, no se encontraron diferencias estadísticamente significativas. La gran mayoría (97.33%) presentó el surco por lingual. C3 fue la configuración más prevalente en la muestra general, mientras que en el grupo Maya el C1 fue la más común. El análisis por sexo y grupo étnico arrojó que las mujeres no Mayas tendieron a desviarse de los otros grupos en términos de bilateralidad. El 55.70% de los segundos molares mandibulares bilaterales fueron simétricos en sus tres tercios radiculares. La prevalencia de los segundos molars mandibulares en forma de C fue similar a la reportada para las poblaciones del norte de Asia, lo cual es consistente con los orígenes evolutivos de las poblaciones nativas americanas. La mayor parte de la muestra presentó el rasgo de forma bilateral y la mitad de éstos fueron simétricos. Los odontólogos deben tomar en cuenta el origen étnico de sus pacientes y considerar las posibles variaciones para realizar tratamientos endodónticos más predecibles.

Locomotion and righting behavior of sea stars: a study case on the bat star Asterina stellifera (Asterinidae) / Comportamiento de locomoción y enderezamiento en estrellas de mar: un caso de estudio sobre la estrella Asterina stellifera (Asterinidae)

Introduction: The locomotion behavior of an organism involves the integration of aspects like body symmetry, sensory and locomotor systems. Furthermore, various ecological factors seem to be related to locomotion characteristics, such as foraging strategy, migration trends, response to predators and competitors, and environmental stress. Objective: To analyze locomotion and the influence of body symmetry in the crawling and righting movements of the sea star Asterina stellifera. Methods: We carried out laboratory experiments in aquariums in the presence/absence of water current and on a horizontal and vertical surface. Results: The speed is similar to speed in other species of similar size. Both the speed and linearity of displacement were independent of individual body size. A water current leads to faster crawling and straight paths, but there is no rheotaxis: streams do not affect locomotion. Speed and linearity of displacement were independent of individual body size. The displacement pattern described here may be an adaptation of organisms that present dense populations in communities with high prey abundance, as is the case of A. stellifera. Conclusions: Like other asteroids, this species did not show an Anterior/Posterior plane of symmetry during locomotion, or righting movement: it does not tend to bilaterality.

Introducción: El comportamiento de locomoción de un organismo implica la integración de aspectos como la simetría corporal, los sistemas sensorial y locomotor. Además, varios factores ecológicos parecen estar relacionados con las características de la locomoción, como la estrategia de alimentación, las tendencias migratorias, la respuesta a los depredadores y competidores y el estrés ambiental. Objetivo: Analizar el patrón general de locomoción y la influencia de la simetría corporal en la locomoción y enderezamiento de la estrella de mar Asterina stellifera. Métodos: Realizamos experimentos de laboratorio en acuarios en presencia / ausencia de corriente de agua y en superficie horizontal y vertical. Resultados: La velocidad es similar a la velocidad en otras especies de tamaño similar. Tanto la velocidad como la linealidad del desplazamiento fueron independientes del tamaño corporal individual. Una corriente de agua conduce a una velocidad de desplazamiento mayor y a trayectorias más rectas, pero no hay reotaxis: una corriente de agua no afecta el patrón de locomoción. La velocidad y la linealidad del desplazamiento fueron independientes del tamaño corporal individual. El patrón de desplazamiento aquí descrito puede ser una adaptación de organismos que presentan densas poblaciones en comunidades con alta abundancia de presas, como es el caso de A. stellifera. Conclusiones: Al igual que otros asteroides, esta especie no mostró un plano de simetría Anterior / Posterior durante la locomoción o el movimiento de enderezamiento: no tiende a la bilateralidad.

Anatomía quirúrgica de la vena tiroidea media: prevalencia en 100 tiroidectomías totales consecutivas / Surgical anatomy of the median thyroid vein: prevalence in 100 consecutive total thyroidectomies

El estudio de las venas tiroideas no ha recibido una investigación tan exhaustiva como lo tuvieron las arterias tiroideas y los nervios laríngeos en relación a la cirugía tiroidea.De los tres pedículos venosos de la glándula tiroides, el medio, de lejos es el menos estudiado. La vena tiroidea media es inconstante y es el primer elemento vascular de la glándula tiroides que debe ser seccionado antes de luxar el lóbulo hacia medial para evaluar sus relaciones posteriores. Su lesión puede provocar sangrado intraoperatorio dificultando secundariamente la identificación del nervio laríngeo inferior y las glándulas paratiroides, próximas a la misma. Se realizó un estudio descriptivo de corte transversal evaluando la pesencia, número, simetría y asociación de la vena tiroidea media con variables tales como edad y sexo del paciente, así como la hiperfuncionalidad de la glándula tiroides y la presencia del tubérculo de Zuckerkandl en 100 tiroidectomías totales llevadas a cabo en el Instituto Nacional del Cáncer y en el Servicio de Otorrinolaringología del Hospital Central del Instituto de Previsión Social del Paraguay. La prevalencia global de vena tiroidea media fue del 74 %. En el lóbulo derecho, la vena se presentó en el 60 %, mientras que en el lóbulo izquierdo en el 53 %. En el 38 % se encontró la vena en ambos lóbulos. En 4 pacientes se localizaron venas tiroideas medias dobles, en una de ellas fue bilateral. El mayor porcentaje de las venas tiroideas medias se originó en el tercio medio del lóbulo, el 72 % en el lado derecho y el 70% en el izquierdo. No se encontró asociación entre la presencia de la vena tiroidea media y la edad, sexo, estado de hiperfunción glandular, así como tampoco con la presencia del tubérculo de Zuckerkandl.

The study of the thyroid veins has not received an investigation as extensive as the thyroid arteries and laryngeal nerves did in relation to thyroid surgery. Of the three veins pedicles of the gland the middle is far the least studied. This vein is inconstant and is the first vascular element of the gland that must be sectioned before the medial lobe is dislocated to evaluate ist posterior relationships. His injury can cause intraoperative bleeding, making it difficult to identify the inferior laryngeal nerve and the parathyroid glands, proximal to it. A descriptive crossseccional study was carried aot evaluating the presence, number, symmetricity and association of the middle thyroid vein with variables such as age and sex of the patient, as well as the hyperfunctionality of the gland and the presence of the Zuckerkandl tubercle in 100 total thyroidectomies undergoing at the National Cancer Institute and the ENT Service of the Social Security Institute´s Central Hospital. The overall prevalence of the middle thyroid vein was 74%. In the right lobe the vein appeared in 60% while in the left lobe in 53 %. Double middle thyroid vein was found in 4 patients, in one of them it was bilateral. The highest percentage of the middle thyroid veins originated in the middle third of the lobe, 72 % on the right and 70% on the left side. No association was found between the presence of the vain and age and sex, the state of glandular hyperfunstion, as well as the presence of Zuckerkandl tubercle.

A Case of Squamous Cell Carcinoma of the Bilateral External Auditory Canals / 대한이비인후과학회지

A malignant tumor of the external auditory canal (EAC) is a rare tumor, with a prevalence of between 1 and 6 people per 1 million population. Common symptoms of the EAC cancer include otorrhea, hearing loss, otalgia, or tinnitus, which are similar to symptoms of otitis media or otitis externa. Therefore, diagnosis may be delayed due to lack of EAC cancer-specific symptoms and the prognosis is also relatively poor despite intensive treatment. The most malignant tumor of the EAC is squamous cell carcinoma (SCC), which usully invades the ear unilaterally. SCC of bilateral EAC is extremely rare. We report here a rare case of bilateral EAC SCC. In this case, unilateral EAC SCC was treated via stereotactic radiosurgery and contralateral EAC SCC developed subsequently. This case implicates that radiosurgery can be a treatment option for EAC SCC but it may have carcinogenic effect. This case also shows that the ear should be examined bilaterally even when unilateral EAC cancer is encountered.

Ovarian tumors – Incidence and histopathological spectrum in tertiary care center, Valsad

Introduction: Ovarian tumors are now the one of the leading cause of death involving a wide spectrum of clinical, morphological and histopathological diagnosis. It frequently does not result in symptoms until the tumor has spread extensively and pose difficulties to clinicians. Objectives: The aim was to study the incidence and histopathological spectrum of ovarian tumors according to WHO classification in different age group and its clinical correlation. Materials and methods: A study was undertaken during a period of May 2011 to December 2017. The tumors were classified according to WHO classification after thorough examination of H&E slides. Data of clinical presentation of patient was also recorded in each case. Results: There were total 162 cases were studied, amongst which surface epithelial tumors were the commonest variety accounting for 126(77.7%) cases, followed by Germ cell tumors 30(18.5%) cases and Sex-cord stromal tumors 6(3.8%) cases. Benign tumors (93.2%) were more common than malignant (6.2%) and borderline (0.6%). Among benign tumors, serous cystadenoma (57.4%) were the most common followed by mucinous cystadenoma (16%) and mature teratoma (16%). Most of the ovarian tumors were unilateral (89.5%) with left sided predominance (49.4%). Majority of benign tumors presented with cystic consistency (67.9%) and mixed consistency (4.3%) in malignant tumors. The age range was 4 year to 70 years. Abdominal pain (48.8%) was the commonest clinical presentation. Conclusion: Ovarian tumors were found to occur in wide range of age with bimodal peak for malignant tumors. Benign tumors were more common across the all age group. An accurate histopathological diagnosis and staging is important for therapeutic and prognostic purpose.

Bilateral Occurrence and Morphologic Analysis of Complete Discoid Lateral Meniscus

PURPOSE: The aim of the study was to investigate and analyze bilateral incidence and morphology of complete discoid lateral meniscus (DLM) with possible relation to tears and symptoms in knee joints. MATERIALS AND METHODS: Thirty-eight consecutive patients with symptomatic or already-torn complete DLM on magnetic resonance imaging in a unilateral knee underwent diagnostic arthroscopy on both knee joints upon agreement. The presence and shape of complete DLM as well as presence and pattern of tear were recorded accordingly. RESULTS: In total, 89.5% (34 of 38 patients) showed bilateral complete DLM, and 84.2% yielded bilateralism with identical shape. Cape-slab was the most frequent shape, comprising 68.8% of patients with identically-shaped bilateral DLM overall. Tear patterns were more frequent, in the order of longitudinal, simple horizontal, radial, and degenerative; however, the morphological shape of complete DLM was not significantly related to tear incidence or pattern. Meniscus tears and knee symptoms occurred in the contralateral knee with incidences of 32.4% and 26.5% in patients with bilateral complete DLM, respectively. CONCLUSION: Based on these findings, more aggressive warning on the presence of discoid pathology and the need for evaluation on the contralateral knee should be considered during consultation with patients with symptomatic complete DLM in a unilateral knee in the outpatient clinic.

The Clinical Features and Progression of the Disease in Posterior Polymorphous Corneal Dystrophy (PPCD)

PURPOSE: To analyze the clinical features and the relationship between endothelial cell changes and progression of posterior polymorphous corneal dystrophy (PPCD) disease by evaluating a case series of 74 eyes in 37 patients. METHODS: From 1995 to 2012, patients were selected from those referred with a probable clinical diagnosis of PPCD to a special study group. Selection was based on the slit-lamp appearance of each case. A total of 37 patients who were diagnosed as PPCD were assessed with respect to gender, age of onset, genetic influences, and affected eyes (unilateral or bilateral). Additionally, we observed the relationship between the changes of the patients' lesions, progression of disease and the rate of loss of corneal endothelial cells. RESULTS: On slit lamp examination, a tram-track line appearance of posterior corneal surface was detected in a majority of patients. Most lesions lied horizontally except for 1 patient (vertically located). At the time of initial diagnosis, the patients' endothelial cell count was under 2,000 cells/mm2, a slow unilateral progressive loss of endothelial cells was observed over 10 years and there was no associated gender differences. Most patients were diagnosed after their 30's during incidental visits. No specific gene mutations were found in screening of the coding sequence of genes for mutations. Most patients were asymptomatic, although 1 patient underwent penetrating keratoplasty (PKP) due to bullous keratopathy and 2 patients had glaucoma surgery because of iridocorneal adhesion. CONCLUSIONS: In PPCD, there was no gender difference and most lesions were unilateral. Additionally, no remarkable gene mutations were observed. When significantly different endothelial cell counts between patient's eyes were detected, a tram-track line appearance on a patient's cornea surface was observed. Some patients had corneal dysfunction and glaucoma, but the frequency was lower.

Analysis of Clinicopathologic Factors Associated with Bilateral Thyroid Micro Papillary Carcinoma / 대한내분비외과학회지

PURPOSE: Papillary thyroid carcinoma is the most common malignant tumor originating from the thyroid. The recent increase in frequency of thyroid ultrasonography is increasing the diagnostic rate of thyroid cancer, especially of the small-sized cancer. The appropriate extent of surgery for thyroid micropapillary carcinoma is still under debate, and bilaterality of the tumor may be an important factor determining the extent. Therefore, this study analyzed the clinicopathologic factors related to tumor bilaterality in order to help decide the extent of treatment. METHODS: Subjects included 134 patients who received total thyroidectomy and central neck lymph node dissection at Wonju Christian Hospital under the diagnosis of thyroid micropapillary cancer from January 1(st), 1994 to December 31(st), 2009. The frequency of bilateral tumor among the subjects were studied, and the relationship between bilaterality and clinicopathologic factors, including patients' gender, age, tumor size, multiple mass in single lobe, capsule invasion, extrathyroidal extension, lymphovascular space invasion, central neck node invasion and lateral neck node invasion was analyzed. RESULTS: There were 32 cases (23.9%) of bilateral tumor. Statistically significant factors related to bilaterality included two or more mass in a single lobe, perithyroidal soft tissue invasion. CONCLUSION: When we plan thyroidectomy for thyroid micropapillary cancer, one cannot rule out the possibility of bilateral thyroid micropapillary cancer in patients with clinicopathologic factors related to bilaterality. Closer preoperative examination is thought to be required for such patients.

Bilaterality of Papillary Thyroid Carcinoma: Analysis of Clinicopathologic Factors and the Value of Preoperative Ultrasonography / 대한내분비외과학회지

PURPOSE: Papillary thyroid carcinoma (PTC) is the most common endocrine malignancy. The extent of the initial surgical treatment for PTC is still controversial and the bilaterality of PTC is an important factor for determining the extent of surgical resection. The aim of this study was to analyze clinicopathologic factors and the value of preoperative ultrasonography (PU) for bilateral tumor. METHODS: We retrospectively reviewed clinicopathologic factors and PU findings of 91 patients who underwent total thyroidectomy for PTC at the Dongguk University Ilsan Hospital from January 2006 to April 2009. RESULTS: Of the 91 patients, 28 (30.7%) had bilateral PTC in postoperative pathology. Of these 28 patients, only 18 patients (64.3%) were checked for bilateral PTC by PU findings and fine needle aspiration cytology. Sensitivity and specificity for bilaterality of PTC were 64.3% and 85.7%, respectively. The presence of benign nodules or malignant nodules in the same lobe in PU (P=0.008) and post-operative pathology (P=0.014) were statistically correlated with bilaterality. CONCLUSION: For the surgical care of PTC, bilaterality must always be considered, even though the tumor is diagnosed unilateral small PTC. PU in PTC patients has limited diagnostic value for bilateral PTC.

Analysis of the Relationship between Bilaterality and Other Clinicopathological Factors in Papillary Thyroid Carcinoma / 대한내분비외과학회지

PURPOSE: The extent of the initial surgical treatment for patients with papillary thyroid carcinoma (PTC) is controversial. Many surgeons think thattotal thyroidectomy is the most optimal treatment for PTC because of its potential bilaterality. Therefore, bilaterality is an important factor for determining the extent of surgical resection. The aim of this retrospective study is to analyze the relationship between tumor bilaterality and the other clinicopathological factors. METHODS: We conducted a retrospective analysis of 140 patients with PTC and who underwent total thyroidectomy with central lymph node dissection from January to December 2007 at our institution. RESULTS: Among 140 patients, 50 patients (35.7%) had PTC in the bilateral lobes. Of these 50 patients, only 17 patients (34.0%) were operated on under the preoperative diagnosis of bilateral PTC. Two factors, 1) presence of the capsular invasion (P=0.007) and 2) an increase of the tumor size (P=0.023), were statistically correlated with bilaterality. There were no significant associations between bilaterality and the other clinicopathological factors,including age, extrathyroidal invasion and lymph node metastasis. CONCLUSION: For the surgical care of PTC, bilaterality must always be considered even though the tumor is diagnosed preoperatively as unilateral PTC. Furthermore, thorough preoperative evaluation is mandatory if unilateral lobectomy is regarded as a therapeutic option for PTC patients.

Papillary Thyroid Cancer: Clinicopathologic Characteristics and Factors of Contralateral Jugular Lymph Node Metastasis after Lymph Node Dissection / 대한내분비외과학회지

PURPOSE: Contralateral jugular lymph node metastasis (CJLNM) of papillary thyroid cancer (PTC) is rarely found during operative procedures. HoweverPTC is being diagnosed with increasing frequency and lymph node metastasis is now recognized as a factor of prognosis and recurrence. Therefore, this study was conducted to evaluate the clinical and histological characteristics of papillary thyroid cancer and to determine the factors that lead to CJLNM. METHODS: Two-hundred patients with PTC were treated in our hospital between March 2005 and October 2006. A retrospective analysis of the patient's clinical and histological features and lymph node metastasis was conducted. RESULTS: The total ratio of CJLNM to PTC was approximately 7.5%, the male to female ratio was 1:6.5, and the mean tumor size was 14.93 mm. In addition, the multiplicity was 53.3% and the bilatrality was 53.3%. Further, there were 4 cases involving benign thyroid disease combined with goiter. In addition, the capsule invasion was 100%. Age under 40 years, bilaterality and capsule invasion were found to be significant clinicopathologic factors of CJLNM induced by PTC. CONCLUSION: A contralateral jugular lymph node biopsy of PTC may be considered in cases involving patients under 40 years of age with, bilaterality and capsular invasion.

Clinical significance of CA19-9 in mature cystic teratoma of the ovary / 대한산부인과학회지

OBJECTIVE: The aim of this investigation was to analyze the association between ovarian tumor markers and the clinicopathologic features of ovarian mature cystic teratoma. METHODS: The medical records of 195 patients whose pathologic diagnosis were made as mature cystic teratoma after surgery from June, 2000 to July, 2006 at Ewha Womans University Mok-dong Hospital were reviewed. The proportions of elevation of each tumor marker were evaluated in all patients and CA19-9 which showed the greatest elevation rate was selected as a promising relevant tumor marker. The patients were alloted to either Group I showing elevated CA19-9 or Group II showing normal level of CA19-9. The relationship between CA19-9 level and demographic data or clinicopathologic features were investigated by usual statistical method. RESULTS: The mean age of all patients was 35.4+/-12.8, and the average size of tumor was 7.1+/-3.5cm. Bilaterality of the mature cystic teratoma was 12.8%. The proportion of the patients showing elevated levels was greatest in CA19-9 as 33.3% (65/195), compared with 12.0% in CA-125, 5.8% in CEA, 1.1% in AFP. Significant difference between Group I and Group II were found in age, parity, tumor size, and bilaterality. Bilaterality and tumor size were greater in Group I, and age and proportion of parous women were lower in Group I. On the other hand, the rate of ovarian torsion or laparotomy conversion showed no difference. Likelihood ratio for bilaterality which may be clinically used during surgical procedure were 2.2 for CA19-9 suggesting its potential role in gynecologic practice. CONCLUSION: This study shows that CA19-9 may be a useful tumor marker associated with tumor size and bilaterality in ovarian mature cystic teratoma. Further confirmative study with larger sample size is in need in order to establish its definite clinical role in ovarian mature cystic teratoma.

Less than 0.5 cm Papillary Thyroid Cancer / 대한내분비외과학회지

PURPOSE: The authors analyzed the characteristics of papillary thyroid microcarcinomas less than 0.5 cm in diameter to investigate an optimal extent of surgical resection. METHODS: Between October 1994 and October 2003, out of 635 cases of papillary thyroid microcarcinomas, 229 cases less than 0.5 cm in diameter were reviewed retrospectively to analyze their clinical and pathological characteristics. RESULTS: Mean diameter of the carcinomas was 3.9±1.2 mm for carcinomas less than 0.5 cm in diameter (group 1) and 7.7±1.4 mm for carcinomas between 0.5 and 1.0 cm in diameter (group 2). Total thyroidectomy, subtotal thyroidectomy, lobectomy & isthmectomy in group 2 were carried out in 308 (75.9%), 72 (17.7%) and 26 (6.4%) cases. Follow by group 1 were carried out in 109 (47.6%), 84 (36.7%) and 36 (16.7%)cases respectively. Between the two groups, perithyroidal invasion was 29.3% and 49.0%, multifocality was 24.9% and 32.8%, bilaterality was 13.1% and 21.4%, lymph node metastasis was 10.1% and 18.3% respectively with each data showing statistical significance (P<0.05). Completion thyroidectomy was carried out in 14 cases, of which 8 cases revealed carcinomas in the residual thyroid lobe. The group 1 required completion thyroidectomy more than the group 2 (P=0.026). There were less cases of lymph node metastasis among the group 1. Nine out of the 36 cases (25%) of the group 1 which underwent lobectomy & isthmectomy needed completion thyroidectomy, among them 6 cases (66.7%) revealed papillary carcinoma in the residual thyroid lobe. CONCLUSION: Micropapillary cancer was discovered more frequently by increasing the use of ultrasonography. Multifocality, bilateraluty and perithyroidal invasion were observed higher in group 2 rather than group 1. However, the relation between these facts and prognosis will need long term follow up.

Limited Predictive Ability of Hippocampal Single Voxel MR Spectroscopy in Surgically Proven Epilepsy

OBJECTIVE: The authors evaluate the predictability of single voxel proton magnetic resonance spectroscopy(MRS) for hippocampal abnormalities in medial temporal lobe epilepsy(MTLE), lateral temporal lobe epilepsy(latTLE) and extratemporal lobe epilepsy(extraTLE). METHODS: Twenty healthy volunteers and 42 patients with MTLE, 17 with latTLE and 23 with extraTLE, were examined preoperatively with MRS. The NAA/(Cho+Cr) ratios were calculated from the MRS peaks obtained bilaterally from both hippocampi. RESULTS: The mean NAA/(Cr+Cho) ratios showed a stepwise increase from the ipsilateral hippocampus in the MTLE group to the normal control group. In the 42 MTLE patients, the mean NAA/(Cho+Cr) ratio value for the ipsilateral hippocampus was 0.39. This was 17.3% lower than the 0.489 measured for the contralateral hippocampus (p=0.005). This was also significantly lower when compared with the hippocampi of latTLE and extraTLE patients ipsilateral to the epileptogenic zone and also with the normal control group (p< 0.05). The mean ratio value of the contralateral hippocampi was also significantly lower when compared with the normal control group (p=0.000). The mean ratio value measured on postoperative MRS showed little metabolic recovery in the MTLE (from 0.455 to 0.481, p=0.48) compared to the latTLE (from 0.438 to 0.52, p=0.09). CONCLUSION: The MRS might be inconclusive in determining whether the non-epileptogenic hippocampus is affected by epileptiform discharge propagation from the epileptogenic hippocampus or from the remote epileptogenic zone other than the hippocampus. Therefore, physicians should be cautious when determining whether the contralateral hippocampus in MTLE or both hippocampi in neocortical epilepsy is abnormal and whether they should be resected together with the epileptogenic zone.

Two Cases of Bilateral Antrochoanal Polyps in Children / 대한이비인후과학회지

Antrochoanal polyp (ACP) is usually unilateral and occurs most commonly in children. However, bilateral ACP in children is extremely rare. In this paper, we report two such cases of bilateral antrochoanal polyps removed by functional endoscopic sinus surgery and discuss the etiology, diagnosis and management of nasal polyps in children.

Fetal Rhabdomyomatous Nephroblastoma: A case report

A fetal rhabdomyomatous nephroblastoma is considered to be a predominantly monophasic mesenchymal variant of Wilms' tumor, which acts less aggressively than a conventional Wilms' tumor despite its much larger size. Bilaterality of this tumor in a nine month-old girl, however, may negatively affect the overall prognosis. A radical nephrectomy for bulky masses in the left kidney and a partial nephrectomy for right kidney with five small tumor masses was performed at the same time. Two small tumor masses in the upper part of right kidney were left behind because of preserving minimal renal functional capacity. Pathological study revealed a mixed type of nephroblastoma which was composed predominantly of mesenchymal components with fetal rhabdomyomatous differentiation. After post-operative chemotherapy with vincristine, actinomycin D and adriamycin, and radiotherapy(2,130 rad), residual tumor masses became a single tumor 5 cm in diameter and well demarcated, which was resected at 15 months after first operation when the size and renal function of remained right kidney was appropriate to resect out the residual tumor. The tumor resected out at second operation was entirely composed of scattered differentiated fetal skeletal muscle cells in the fibrovascular tissue. Only a few entrapped epithelial components were seen but no blastemal cornponents were present. Follow up abdominal CT and ultrasonographic examinations revealed no evidence of tumor recurrence. The girl has developed normally without disease.