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PubMed1995

[A case report of epidermoid carcinoma in the cerebello-pontine angle].

A case of epidermoid carcinoma in the cerebello-pontine (CP) angle is presented. A 42-year-old male was admitted with a complaint of experiencing double vision for four months in January, 1992. During neurological examination, right abducens palsy, right facial dysesthesia, and atrophy of the right temporal muscle were noted. Magnetic resonance (MR) imaging revealed a mass of low intensity in the right CP angle, which was prominently enhanced with gadolinium. Malignancy was suspected because the tumor on MR enlarged rapidly in a month, so the first surgical resection was performed. Suboccipital exploration of the right CP angle was performed in February. At first, a fragile, pearly part of the mass typical of epidermoid was exposed behind the seventh and eighth cranial nerve complex. Then, a grayish, fibrous part was exposed, which involved the fifth cranial nerve and was attached to the tentorium and the brainstem. Histological diagnosis of the fragile part of the tumor revealed a typical epidermoid cyst and that of the fibrous part was squamous cell carcinoma. During postoperative examinations on other parts of the body, such as endoscopic studies of the trachea and the esophagus, no abnormality was shown. Therefore the tumor was diagnosed as a primary intracranial epidermoid carcinoma. Post-operatively, conventional fractionated external-beam focal irradiation was carried out, which caused regression of the residual tumor for eleven months. Subsequently, palsy of the right side of the tongue and paresis of the contralateral side of the extremities and face developed with increase of the right abducens palsy. MR imaging indicated regrowth of the tumor. The second operation via the subtemporal approach was unsuccessful, because the tumor was fibrous and firmly attached to the brainstem.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1977

EMG amplitude and frequency at different muscular elongations under constant masticatory force or EMG activity.

The relation between mechanical muscular activity (5 - 7.5 - 10 - 15 - 20 Kp of masticatory force) and electrical muscular activity (EMG) was studied during prolonged isometric contractions of the human masseter and temporal muscles, at different degrees of muscular elongation (0.5 - 5 - 10 - 20 mm of jaw opening). In Series 1, recordings maintaining muscular force values constant show that EMG activity increases with a shorter muscular elongation (0.5) and decreases with maximal elongation studied (20 mm). The slope of EMG activity curves rises as the force applied increases and muscular elongation decreases. Analyzing the relation between muscular force and EMG activity as a quotient between integrated activity and activity rate, we observed a greater influence of amplitude of the interference EMG pattern in small ranges (up to 7.5 Kp). However, with higher forces, the mechanism of frequency rate is the predominant factor. In Series 2, recordings of masticatory force maintaining EMG constant show that, for any chosen percentage of EMG activity, masticatory force increases with the increase of muscular elongation. Results show that there is an optimal muscular elongation of maximal efficiency.

Adult↗
PubMed1994

Systemic phaeohyphomycosis caused by Xylohypha bantiana in a dog.

An 8-year-old, Maltese-cross bitch presented with chronic neck and back pain and an acute onset of circling, hyperaesthesia and constant crying. Clinical examination revealed temporal muscle atrophy, an abnormal hanging reflex, cervical rigidity and severe hepatomegaly. Ultrasonography of the liver showed several disseminated, poorly demarcated, hypoechoic areas which on fine needle aspirates, contained large numbers of pigmented fungal hyphae. Cerebrospinal fluid examination revealed fungal hyphae and numerous Ehrlichia canis morulae. A diagnosis of systemic phaeohyphomycosis secondary to ehrlichiosis was proposed. Treatment was unsuccessful and the dog was euthanased. At necropsy, multiple yellowish-green to black, necro-granulomatous foci were found throughout the liver parenchyma and similar foci were present in the spleen, renal cortices and adrenal glands. Irregular, multifocal, grey to black foci of malacia were present in both the grey and the white matter of the brain. On histopathological examination pigmented fungal hyphae were demonstrated in the liver, spleen, kidneys, portal lymph node and adrenals, as well as in the brain. Cultures of various organs yielded a fungal organism identified as Xylohypha bantiana.

Animals↗
PubMed1994

[Triangular skull. Apropos of trigonocephaly].

The authors present 87 patients with trigonocephaly who were operated on. They take an interest in the consequence of the early synostosis of the metopic suture. The metopic suture combine with the sagittal sutural system, but his spot of manifestation is unambiguous. Its manage the dimension of the frontal bone which himself has repercussions on the set of the orbits. Thereby the fronto-orbito-facial dysmorphy has two component parts. One direct with little frontal bone and a thick sutural spot which extend more or less to the bregma and a second indirect with early deformation of the orbits and late deformation of the parietal bones. Three clinical patterns are described: micro-frontal shape, medio-frontal shape and orbito-frontal shape. In the pure shapes there is no direct impact on the encephalon but the venous stasis is high and probably liable for the encephalic damage when they exist. A single surgical proceeding does not meet the many varieties of deformations. Resection of fused metopic suture from a bifrontal flap; confection of orbito-fronto-nasal band which is opened by greenstick fracture on the metopic site; transposition of an hemicoronal suture between the two hemifrontal valves lateraly translated; foreward mobilisation and interventing temporal flaps. To finish the modeling it is necessary to open the periosteum sheet in order to translate temporal muscles then to overlay with interparietal pedicularly periosteum the anterior step. Metopic synostosis is ordinarily only an aesthetic deformity infrequently associated with intracranial pathology. The treatment must be required for pronounced deformities to prevent significant psychosocial consequences.

Abnormalities, Multiple↗
PubMed1994

[A case of progressive hemifacial atrophy associated with immunological abnormalities].

We reported a case of progressive hemifacial atrophy associated with immunological abnormalities. This patient, a 35-year-old woman, had a history of high fever of unknown etiology associated with anemia and leukocytopenia at the age of 19. Eight months later, right hemifacial atrophy, alopecia and partial lipodystrophy of the right upper arm were developed. And the progression had stopped in the latter twenties. At the age of 35, she visited our hospital because of the hemifacial atrophy. Physical examination revealed right hemifacial atrophy, large alopecia at parietal and right temporal region, and partial lipodystrophy of the right upper arm. CT, MRI and ultrasound tomography of the head and the arm showed skin and scalp atrophy, temporal muscle atrophy and decrease of subcutaneous soft tissues. There was no autonomic dysfunction. Serum IgG was increased, and RA factor, anti-nuclear antibody, anti-DNA antibody and LE cell were positive. In this case, immunological abnormalities were considered to be related to the pathogenesis of hemifacial atrophy.

Adult↗
PubMed1994

[A case of parosteal osteosarcoma at the cranial vault].

A rare case of parosteal osteosarcoma of the cranial vault has been reported. A 32-year-old male was admitted complaining of a hard scalp mass at the left temporoparietal region for several years. On admission he showed no neurological abnormalities. The craniogram, CT and MRI revealed a calcifying mass attached by a small stalk to the skull, and a radiolucent cleft between the tumor and the skull. On operation, the tumor proved to be hard, and it existed between the temporal muscle and the periosteum. A small tumoral attachment existed at the parietal region. The tumor was detached from the skull and the surrounding cranial bone was removed. The histological diagnosis was parosteal osteosarcoma. There have been only 12 cases of parosteal osteosarcoma of the skull reported. The pathological, neuroradiological findings and treatment of parosteal osteosarcoma were the main topics of discussion. This disease should be considered as one of the possible etiologies when a patient with a tumor of the skull is encountered.

Adult↗
PubMed1993

Success and pitfalls in myringoplasty: follow-up study of 404 cases.

Results of 404 primary myringoplasty operations were critically analyzed. Patients who underwent tympanic membrane repair as the only procedure were included. In all cases, temporal muscle fascia was used as graft material. Mean follow-up period was 5.5 years. Overall success rate was found to be 88 percent. Welding injuries did not heal as well as other traumatic perforations or perforations caused by otitis media. Age of the patient, size or site of perforation, or surgical technique (underlay or overlay) did not affect success rate. Twenty-five percent of the failures were considered to be attributable to eustachian tube insufficiency. One percent (5 cases) failed as a result of chronic mastoiditis overlooked by the surgeon. Postoperative cholesteatoma developed in three ears (0.7%). Postoperative air-bone gap within 10 dB was achieved in 61 percent and within 20 dB in 87 percent of patients. In 11 of the audiologic failures, the cause of persistent conductive hearing loss was found to be fixation or erosion of the ossicles overlooked by the surgeon. The most decisive factor influencing results appeared to be the surgeon's experience.

Adolescent↗
PubMed1993

Granulomatous hepatitis in dogs: nine cases (1987-1990).

Granulomatous hepatitis (GH) is an uncommon histopathologic diagnosis in dogs. On the basis of clinical reports, fungal infections appear to be the most common cause of GH in dogs, but many other potential causes have been identified. The medical records and histopathologic findings for 9 dogs with GH were reviewed to identify additional specific causes of GH in dogs. Diseases associated with GH included intestinal lymphangiectasia (n = 2), lymphosarcoma (n = 1), histiocytosis (n = 1), dirofilariasis (n = 1), and histoplasmosis (n = 1). In 1 dog, no other disease process was identified. Of the remaining 2 dogs, 1 had concurrent granulomatous pneumonitis of unknown cause, and the other had periportal hepatitis and temporal muscle wasting. All 9 dogs with GH had clinical evidence of liver disease, such as hepatomegaly, icterus, and ascites, or had high serum alkaline phosphatase and alanine aminotransferase activity. Because of the wide variety of potential causes of GH in dogs, an accurate diagnosis should be sought so that appropriate treatment can be chosen and an accurate prognosis given.

Animals↗
PubMed1995

[Standard electromyographic and kinesiographic parameters in a sample of healthy population].

The authors have examined through the electromygraphic-kinesiographic system provided, the mandibolar movements and the electric activity of the masseter and temporal muscles of group of 25 subjects, aged 22-25 (15 women and 10 men), with complete natural dentition, whose history and clinical examination of cranio-mandibular disorders were negative. The aim of the study is to analyse the values come out by these instrumental researches and to compare them with the already existing literature, trying to obtain standard data of "normality", to be used as comparative and diagnostic parameters for this age range and, on the other hand, as a further method of evaluation for electromyiografic-kinesiographic and electromyiographic analysis of subjects suffering from algic-dysfunctional pathology of the cranio-mandibular apparatus. The analysed champion of healthy subjects, with symmetrical electromyiographic normal values (temporan muscles 0.5-2.5 microvolts, masseter muscles 0.5-2.0 microvolts), presents physiological mandibular movementes along the three space axes: furthermore the results outlined by the existing literature, according to which the female champion has a lower muscular electric potential and mandibular dinamic paths than the male champion, are confirmed. The authors point out the importance of computerised clinical research, not only to get data, but also to store them and to be able to compare them in long term.

Adult↗
PubMed1996

Tympanoplasty in adults: a five-year survey.

In order to identify factors that could influence the success of tympanoplasties in adults, a retrospective study of 291 tympanoplasties performed on patients aged 15 years and older during the years 1984-1989 was carried out. Surgical success was defined as an intact membrane after two years follow-up and hearing improvement of at least 15 decibels. The success rate of the tympanoplasties was 90%. A functioning eustachian tube was found to be important for graft take. No difference was found in the rate of graft take regardless of whether fascia of the temporal muscle or tragal perichondrium was used or if fibrin glue was used. An audiological improvement was seen in 77% of the patients, and no significant difference regarding hearing gain was found between the different prostheses. It is concluded that tympanoplasty in adults is a simple operation with a high probability of success which can improve the quality of life of those operated upon.

Adolescent↗
PubMedDate not supplied

[Use of spectral luminescent analysis for objective evaluation of the state of tissues in surgical and laser effects].

An optic spectral multichannel analyzer demonstrated a stimulating effect of He-Ne laser on repair processes. For the first time the spectral luminescent analysis was used to determine viability of the transplanted tissue (temporal muscle fascia)in tympanoplasty. Spectral measurements gave grounds for designing policy of the post-tympanoplasty patients' management. The paper presents spectral characteristics of different tissues of the external and middle ear.

Animals↗
PubMed1996

[Survey of 80 myringoplasty].

We report a retrospective study about 80 myringoplasties performed on 75 patients. The single occlusive myringoplasty technique was undergone in 33.7 percent of cases, while the tympanomeatal flap procedure was used in 66,2 percent. The grafted material was temporal muscle fascia (63.7%) or tragus perichondrium (36.2%). In 30 percent of instances some retouches were achieved on the ossicular chain. The anatomic success rate accounted for 67.5% and a good functional issues for 59.7% of cases.

Adolescent↗
PubMed1997

[A case of cranial osteomyelitis after head injury with exaggeration and remission for thirty years].

We report a case of cranial osteomyelitis after head injury with exaggeration and remission for 30 years. A 41-year-old man was referred to our hospital with redness, swelling and pain in the left frontal region. He had noted a hard mass in the same region after an injury at the age of 12 years, and local heat and redness again in the same region which had disappeared without definite treatment at the age of 20 years. Presently, skull roentogenogram showed an erosive lesion in the left frontal bone. Plain CT revealed bone defect, epidural mass lesion, calcification of the dura mater and thickness of the extracranial soft tissue in the left frontal region. T1-weighted MR images showed an isointense lesion and T2-weighted MR images showed a high intensity lesion in the inner table and a diploic layer in the left frontal bone. 99thTc MDP bone scinntigram showed abnormal uptake in the same region. Operation performed through a left frontotemporal craniotomy revealed a degeneration of temporal muscle and frontal bone, and granulation tissue and pus in the subcutaneous and epidural spaces. These were removed together with the calcified dura mater. The subdural space was intact. Dural plasty was performed using fascia lata, but the craniotomied bone was replaced. Histological examination revealed typical findings of osteomyelitis. Postoperative course was uneventful, and he was discharged without neurological deficit. Cranioplasty was performed 8 months after the first surgery. The mechanism by which osteomyelitis continued over a long course of time was suspected to be the formation of a focus of recurrent inflammation due to the head injury 30 years earlier.

Adult↗
PubMed1997

Cause and repair of flap necrosis over cochlear implant.

OBJECTIVE: The aim of this report was to study the cause and treatment of flap-related complications over cochlear implant. SETTING: The study was performed in an academic tertiary referral center. PATIENT: A 53-year-old Japanese male patient had had two retro-auricular skin incisions for tympanomastoidectomy in the postauricular region before implantation of a cochlear implant. He also had worn a helmet daily during work in his factory. INTERVENTIONS: Corrective surgery was performed for reformation of the local blood supply to the overlying skin flap and reinforcement of the tissue overlying the implant by use of a superiorly based temporal muscle and fascia flap that were sutured with an inferiorly based muscle and fascia flap. RESULTS: We successfully transposed the flap covering the implant without explantation of the implant. CONCLUSIONS: The delayed development of flap necrosis was thought to be due to pressure necrosis produced by the band in the patient's helmet lying on the skin over the implant and to poor local blood supply in the postauricular area stemming from the two previous skin incisions for mastoid surgery performed for cholesteatoma. In those patients who wear helmets, it is important to position the cochlear implant sufficiently behind the ear and to avoid the use of a helmet.

Cochlear Implants↗
PubMed1997

[Are convulsions necessary for the antidepressive effect of electroconvulsive therapy: outcome of repeated transcranial magnetic stimulation].

Sismotherapy (ST) brings about numerous neurobiological changes, particularly changes in neuromediators and their receptors, second messengers, neuropeptides and neurotropic factors, a number of which are hypothesized to play a role in the pathophysiology or therapeutics of affective disorders (M. Fink). What is not yet known is which of these mechanisms is crucial for the psychotropic and anticonvulsant effects of ST. However, it is clear that the effects of ST tend to be relatively acute, and do not attack the deep-seated abnormalities that are the underlying causes of recurrences of affective disorders. This is corroborated by the fact that in animals, most of the effects of ECS on catecholamines and their receptors (and on receptors for benzodiazepines or neuropeptides such as TRH) tend to be relatively transient, and in most cases have been found to represent compensatory adaptations to the induced motor convulsions. However, recent preclinical data using attenuation, and clinical findings using reiterated transcranial magnetic stimulation (rTMS), suggest that it may not be necessary to provoke a clonic convulsion in order to achieve the beneficial psychotropic and anticonvulsant effects of ST. In rodents receiving stimulation to the cerebellar tonsil, seven daily subacute low-frequency sessions (stimulation at 1 Hz for 15 minutes) produced clear improvement in clonic convulsions and in post-discharge thresholds, together with durable inhibition of convulsions when stimulation was resumed (Weiss et al., 1995). Stimulation at 1 Hz for 15 minutes was more effective than stimulation at 10 or 20 Hz in attenuating convulsions. Although reiterated ECS also induced an anti-triggering effect, this dissipated rapidly over five days (Post et al., 1984). It is of great interest that recent publications have shown that rTMS at 10 or 20 Hz to the left frontal cortex, administered to patients suffering from refractory depression (George et al., 1995) or to patients (hospitalised or not) with milder degrees of depression (Pasquale-Leon et al., 1996), had a moderate or marked antidepressant effect. In these studies, rTMS showed few unwanted effects (other than mild pain in some patients, due to contraction of the temporal muscles); it did not induce motor convulsions, and did not, as such, appear to be associated with the memory loss described in subjective accounts or in preliminary neuropsychological tests (Little and Kimbrell et al., 1996). The optimal frequencies, durations and positions for rTMS to maximise its antidepressant effect still remain to be determined. However, the first controlled and open studies have tended to show that (because of the capacity of rapid magnetic fluxes to produce sub-convulsant electrical discharges that are relatively localised in the brain), rTMS may be found to be a clinically useful antidepressant model. This would suggest the possibility that some of the neurochemical changes induced by the clonic convulsions of ECS could be directly induced by stimulation at the very edge of the threshold (but still below it); this would open up the hope that one day these endogenous neurochemical processes could be identified and exploited in an optimal way for therapeutic purposes.

Brain↗
PubMed1976

[Paratrigeminal epidermoid originated in the meckel's cave (author's transl)].

We have reported a case of paratrigeminal epidermoid originated in the Meckel's cave. A 30 years old man was admitted to the department of neurosurgery with chief complaints of continuous right facial pain and numbness of entire right side of the face of three years duration. The positive neurological findings were hypesthesia over the distribution of the right trigeminal nerve, absence of the right corneal reflex and nystagmus on left lateral gaze. Caloric response was absent on the right side, however the audiogram showed normal. Cerebrospinal fluid examination was within normal limit. Electromyography showed giant spike in the right masseter and temporal muscles. Radiogram of the skull revealed a bone-destroying lesion over the medial florr of the right middle fossa involving the apex of the petrous bone (Fig 1). Right carotid angiography showed straightening and forward displacement of C4- C5 portion of the carotid siphon in the lateral view, and vertebral angiography showed displacement of basilar artery to the left side, upward displacement of the right posterior cerebral and superior cerebellar artery in the frontal view (Fig. 2, 3). At the time of operation, an epidermoid was identified in the Meckel's cave and totally removed microsurgically. Small amount of the tumor extending into the posterior fossa was also removed (Fig. 4, 5, 6, 7). Postoperative course was uneventfull except for an episode of headache and high fever of short duration, suggesting the signs of meningial irritation. Two months postoperativelly patient was relived of facial pain and was discharged with sensory impairment of the right trigeminal nerve distribution. Only 11 cases of paratrigeminal epidermoid, including the cases localized in the Meckel's cave have been reported in the past literatures (Table 1). In this paper we have discussed about the symptomatology and clinical data of paratrigeminal epidermoid and compared with those of trigeminal neurinoma, and meningioma originated in the same region. We would like to emphasize that the importance of differentiating the idiopathic trigeminal neuralgia from the paratrigeminal epidermoid, if the initial symptom of this tumor were tic douloureux. The total removal of epidermoid with capsule is essential treatment following the early diagnosis, however the attempt of total removal is sometimes difficult because of the relationship between the origin, size and extension of this kind of tumor to other important brain structures. And if some of the tumor is left behind at the time of operation, cholesterin meningitis is an important complication.

Adult↗
PubMed1998

[The characteristics of the muscular activity of the maxillofacial area in persons with partial tooth loss depending on the extent of the dentition defect].

The electromyogram (EMG) amplitude of the masticatory and temporal muscles is decreased and EMG amplitude of suprasublingual muscles increased during mastication or voluntary occlusion in patients with class I dentition defects in comparison with the controls. The changes were the greater, the more antagonist pairs were missing. The duration of masticatory period and the number of masticatory movements increased. The most notable changes in the muscular activity are observed in subjects with 4 antagonist pairs missing.

Dentition, Permanent↗
PubMed1997

[Extrameatal myringoplasty in the treatment of tympanic membrane perforations].

The clinical analysis of the patients after tympanic membrane reconstruction with the temporal muscle fascia has been conducted. The total number of 145 patients, operated at the Otosurgery Department Medical University of Lodz, was divided into 2 Groups. Group 1 (n = 75) patients with chronic otitis media (central perforation and mobile ossicular chain). The preoperative mean conductive hearing deficit of 20 dB was observed in all evaluated patients. After surgery a satisfactory hearing improvement was observed in 90% of the patients. Group 2 (n = 70) patients with the reconstructed postero-superior part of the tympanic membrance and if necessary external auditory canal wall reconstruction. The mean conductive hearing deficit of up to 30 dB was observed before the surgery. Postoperatively in 75% of patients the hearing improvement was observed as well as the satisfactory healing of fascia implant. The postoperative evaluation indicates a better hearing improvement after the myringoplasties with the prefascial lamina than in the myringoplasties performed in the traditional ways.

Hearing Disorders↗