Intractable hiccups: a rare presentation of phrenic nerve schwannoma.

INTRODUCTION: Schwannoma rarely involves the phrenic nerve. We report a unique case of schwannoma as a cause of chronic hiccups due to the involvement of phrenic nerve. CASE PRESENTATION: A 72-year-old male presented with 20-year history of hiccups. He underwent multiple esophagogastroduodenoscopy procedures, all of which were negative. A computed tomography (CT-scan) of soft tissue of the neck was remarkable for left retrosternal mass with central calcification, located adjacent to the thyroid gland. He underwent surgery and this mass was found to be originating from the left phrenic nerve. Resection of the portion of phrenic nerve with mass was performed. Grossly, the specimen was a pale-tan piece of soft tissue, 4.8 cm in maximum dimension with an attached portion of nerve. Microscopically, it showed a well-circumscribed spindle cell lesion with hypercellular and hypocellular areas and multiple Verocay bodies. There was no atypia or significant mitotic activity. On immunohistochemical staining, the spindle cells were positive for S-100, supporting the diagnosis of schwannoma. CONCLUSION: Postoperatively, the patient showed marked improvement in his symptoms and the hiccups were almost completely resolved. Although they are very rare, schwannomas of the phrenic nerve should be considered in the differential diagnosis of chronic hiccups.

Aspiration biopsy of osseous metastasis of occult hepatocellular carcinoma: Case report, literature review, and differential diagnosis.

Fine-needle aspiration (FNA) cytology is a reliable technique for rapid diagnosis in virtually every organ of the body, including bone lesions. We report on the FNA findings in a 61-yr-old male of an osteolytic sacral lesion, which determined the diagnosis of an unsuspected metastatic hepatocellular carcinoma. In this case, the diagnosis was confirmed by FNA biopsy without resorting to surgical biopsy.

Effective dose from radiation absorbed during a panoramic examination with a new generation machine.

OBJECTIVES: The purpose of this investigation was to measure the tissue-absorbed dose and to calculate the whole-body effective dose (E) for a new generation panoramic machine (Planmeca PM 2002 CC Proline), operating in the panoramic examination mode. Comparisons could then be made with historical panoramic and intraoral radiographic dose measurement values and effective dose estimates. STUDY DESIGN: Thermoluminescent dosimeters were embedded in a humanoid, tissue-equivalent phantom at anatomically significant sites, representing key tissues. Absorbed dose measurements were obtained after every 5 panoramic exposures of a 25-exposure total. The measured average tissue-absorbed doses from a single panoramic exposure were used in the calculation of the whole-body E. RESULTS: The whole-body E for the PM 2002 CC Proline panoramic examination is 3.85 microSv. This is below the panoramic average of 6.7 microSv. The PM 2002 CC Proline panoramic examination delivers approximately 5% to 12% of the E of a complete mouth intraoral radiographic examination. CONCLUSIONS: The effective dose from the PM 2002 CC Proline examination is at the low end of the range for other panoramic machines and is far below either a D-speed or E-speed film intraoral radiographic examination.

Intravascular fasciitis in the foot.

Intravascular fasciitis is a rare benign condition characterized by reactive fibroblastic proliferation arising from the superficial or deep fascia and involving arteries and/or veins. Intravascular fasciitis is a distinct variant of a more common condition called nodular or pseudosarcomatous fasciitis, which possesses clinical and histologic features similar but lacks vascular invasion. The fibroblastic violation of the vascular network suggests a malignant component and often leads to an inappropriate diagnosis for this benign condition. A thorough review of the literature revealed less than 25 reported cases of intravascular fasciitis, with this publication being the only case involving the foot or ankle. A case of intravascular fasciitis affecting the plantar aspect of the foot in a pediatric patient is presented and its clinical and histologic features are discussed.

Benign giant cell tumor of the foot.

Presented is a brief discussion of benign giant cell tumors, and a case report of this lesion originating from the lateral aspect of the calcaneocuboid articulation is discussed. The lesion reported is unique in that it is not associated with a tendon sheath. Computerized tomographic and magnetic resonance imaging failed to isolate the soft tissue mass.

Corrected TMJ tomography: effectiveness of alternatives to SMV tracing.

An axial (SMV) radiograph has been widely used to determine parasagittal head position in TMJ tomograms. The purpose of this study was to investigate the efficacy of alternative anatomic methods for patient positioning in TMJ tomograms. The positioning methods studied included (1) rotation of the patient's head toward the film plane on the basis of the condylar orientation as determined by an SMV radiograph, (2) arbitrary rotation of the patient's head 20 degrees toward the film plane, (3) placement of the zygomatic arch parallel to the film plane, and (4) positioning of the posterior occlusal plane parallel to the film plane. Statistical analysis of the accuracy of the positioning techniques revealed no differences in the SMV, the zygomatic arch, and the arbitrary 20 degrees positioning. Aligning the posterior occlusal plane did not adequately align the mandible into a favorable radiographic position.

[Evaluation of radiation risk associated with endodontic radiography]. / Valutazione dei rischi da radiazioni associati alle radiografie in endodonzia.

Endodontic patients are sometimes concerned about the risks of tumors or cataracts from radiation exposure during root canal therapy. By using established dose and risk information, we calculated the extent of these risks. The chance of getting leukemia from an endodontic x-ray survey using 90 kVp was found to be 1 in 7.69 million, the same as the risk of dying from cancer from smoking 0.94 cigarettes or from an auto accident when driving 3.7 km. Risk of thyroid gland neoplasia was 1 in 667,000 (smoking 11.6 cigarettes, driving 45 km) and risk of salivary gland neoplasia 1 in 1.35 million (smoking 5.4 cigarettes, driving 21.1 km). Use of 70 kVp radiography reduced these risks only slightly. To receive the threshold dose to eyes to produce cataract changes, a patient would have to undergo 10,900 endodontic surveys.

Central odontogenic fibroma: clinicopathologic features of 19 cases and review of the literature.

The odontogenic fibroma is a benign neoplasm infrequently reported in the literature (20 cases). Nineteen additional examples are reported. This lesion occurs most frequently in the maxilla anterior to the molars and displays a striking female predilection. On occasion, it may be associated with an unerupted mandibular third molar. Histomorphologically, it is not encapsulated. A spectrum of fibrous connective tissue stroma is present: from myxoid to densely hyalinized and from relatively acellular to cellular. Calcification may or may not be present. It is distinguished by the presence of sparse cords and islands of inactive odontogenic epithelium. Enucleation or surgical curettage is appropriate therapy and recurrence is low. As there appears to be no correlation of histologic pattern with clinical behavior, it seems unnecessary to try to separate the tumor into two variants.

Segmental odontomaxillary dysplasia. Report of eight cases and comparison with hemimaxillofacial dysplasia.

We report an analysis of eight cases with features as described for hemimaxillofacial dysplasia and compare our cases with those of that original report by Miles and associates. Patients were young and had bone and/or gingival enlargement, dental abnormalities, and unique radiographic and histologic features. Osseous and dental abnormalities were confined to the maxillary alveolus extending from the canine region to the tuberosity. Ipsilateral facial hypertrichosis was not observed. The condition seems to remain stable without significant progression and is hypothesized to be a developmental abnormality. We propose the term segmental odontomaxillary dysplasia (SOD) as a more precise descriptor for the constellation of features observed.

Estimated radiation risks associated with endodontic radiography.

Endodontic patients are sometimes concerned about the risks of tumors or cataracts from radiation exposure during root canal therapy. By using established dose and risk information, we calculated the extent of these risks. The chance of getting leukemia from an endodontic x-ray survey using 90 kVp was found to be 1 in 7.69 million, the same as the risk of dying from cancer from smoking 0.94 cigarettes or from an auto accident when driving 3.7 km. Risk of thyroid gland neoplasia was 1 in 667,000 (smoking 11.6 cigarettes, driving 45 km) and risk of salivary gland neoplasia 1 in 1.35 million (smoking 5.4 cigarettes, driving 21.1 km). Use of 70 kVp radiography reduced these risks only slightly. To receive the threshold dose to eyes to produce cataract changes, a patient would have to undergo 10,900 endodontic surveys.

Axial temporomandibular joint morphology: a correlative study of radiographic and gross anatomic findings.

In degenerative diseases of the temporomandibular joint the mandibular condyle demonstrates changes in contour, including flattening and enlargement, resulting in an increased diameter of the articular surface. The purpose of this study was to determine if such alterations in the shape of the mandibular condyle can be visualized in submentovertex (axial) radiographs and correlated with pathologic changes of the temporomandibular joint. Submentovertex radiographs of 18 human cadaver specimens were made. The radiographic condylar dimensions, morphologic condylar outline, and angle of the condylar axis with respect to the transmeatal line were determined. The specimens were dissected and disarticulated, and radiographic findings were compared to anatomic structure. Osseous abnormalities were found in 21 of the 36 joints studied (58%). Perforations of the disk were found in nine of 31 joints (29%) investigated. No statistically significant differences between the normal condyles and condyles displaying osseous abnormalities were found in any of the radiographic parameters studied.

Radiation absorbed from dental implant radiography: a comparison of linear tomography, CT scan, and panoramic and intra-oral techniques.

Absorbed radiation dose in bone marrow, thyroid, salivary gland, eye, and skin entrance was determined by placement of lithium fluoride thermoluminescent dosimeters (TLD's) at selected anatomical sites within and on a human-like x-ray phantom. The phantom was exposed to radiation from linear tomographic and computer-assisted tomographic (CT) simulated dental implant radiographic examinations. The mean dose was determined for each anatomical site. Resulting dose measurements from linear tomography and computer-assisted tomography are compared with reported panoramic and intra-oral doses. CT examination delivered the greatest dose, while linear tomography was generally lowest. Panoramic and intra-oral doses were similar to those of linear tomography.

Absorbed radiation by various tissues during simulated endodontic radiography.

The amount of absorbed radiation by various organs was determined by placing lithium fluoride thermoluminescent chip dosimeters at selected anatomical sites in and on a human-like X-ray phantom and exposing them to radiation at 70- and 90-kV X-ray peaks during simulated endodontic radiography. The mean exposure dose was determined for each anatomical site. The results show that endodontic X-ray doses received by patients are low when compared with other radiographic procedures.

Human cervical and hamster oral epithelial neoplasia--colposcopic similarities.

Epithelial dysplasias and squamous carcinomas were experimentally produced in the cheek pouches of Syrian hamsters. These lesions were observed and photographed in the living animals with the aid of a stereoscopic microscope at magnifications of 20 and 40 times. Very apparent similarities were noted in the vascular patterns and epithelial configurations between the hamster oral dysplasias and carcinomas and the corresponding lesions seen in published cases of cervical intraepithlial neoplasia and invasive squamous carcinoma. It is speculated that these similarities reflect common factors in the interaction between neoplastic squamous epithelium and its blood supply. These findings are important in understanding the biology of cervical neoplasia and may be useful in the diagnosis and management of human oral neoplasia.

Isobutyl cyanoacrylate: a clinical and histologic comparison with sutures in closing mucosal incisions in monkeys.

Bilateral vertical incisions were made in the maxillary and mandibular labial mucosa of eight young green vervet monkeys. Incisions were closed with either interrupted 4-0 black silk sutures or by the application of isobutyl cyanoacrylate. Mucosal specimens containing the incisions were examined histologically and scored for degree of inflammation at 1, 3, 10, and 20 weeks. The results showed that cyanoacrylate and sutures did not produce similar inflammatory responses.