1/183. p53 gene mutation in 150 dissected lymph nodes in a patient with esophageal cancer.For thoracic esophageal cancer, we perform extended three field lymph node dissection, and have achieved nearly 50% of overall 5-year survival. However, patients sometimes develop lymph node recurrences in spite of having no lymph node metastases found by conventional histopathologic examination. In a patient with esophageal squamous cell carcinoma, we sequenced all the p53 cDNA translated regions (exon 2-10) of primary carcinoma, and confirmed one p53 nonsense mutation in exon 10. Then we extracted genomic dna from 150 surgically dissected lymph nodes from that patient, and performed polymerase chain reaction analysis (PCR-RFLP) to detect the same p53 mutation in the lymph nodes. PCR-RFLP analysis showed the same p53 mutation in six lymph nodes. One node was located along the right recurrent laryngeal nerve, where no positive nodes was identified by conventional histopathologic examination. The p53 mutational diagnosis of metastatic cancer may be useful in detecting minimal residual disease.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
2/183. Primary intracranial squamous cell carcinoma--case report.A 50-year-old female presented with primary intracranial squamous cell carcinoma (SCC) at the right cerebellopontine angle manifesting as right facial nerve paresis. She had undergone gross total removal of a right cerebellopontine angle epidermoid cyst 10 years before and had done well until recently. magnetic resonance imaging showed a heterogeneous tumor with markedly enhanced irregular margin. Subtotal removal of the tumor was achieved. Histological examination showed moderately differentiated SCC. After surgery, she underwent chemotherapy and gamma radiosurgery. She is now well 5 years after the diagnosis of SCC.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
3/183. A case of central carcinoma of the mandible arising from a recurrent odontogenic keratocyst: delineation of surgical margins and reconstruction with bilateral rectus abdominis myocutaneous free flaps.A case of central carcinoma of the mandible arising from a recurrent odontogenic keratocyst is reported. A 38-year-old man was admitted to the Tokai University Hospital due to postoperative infection of a recurrent odontogenic keratocyst of the left mandible. He had had a cystectomy for an odontogenic keratocyst 4 years ago. The lesion revealed bony destruction of the mandible with worm-eating shaped margins with extension to the facial skin. A biopsy specimen revealed squamous cell carcinoma. The mandible was resected with facial skin and the sublingual space was dissected to preserve the lingual nerve. The oral and the facial resections were reconstructed with a titanium plate and bilateral rectus abdominis myocutaneous free flaps. The plate was removed due to infection around the margins and readjustment of the flaps was conducted 5 months after the surgery. He has not had a local relapse, metastasis, or incisional hernia for 8 months following surgery. Good occlusion has been attained by the residual mandible, and he is able to eat without any problems.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
4/183. Penile reconstruction: combined use of an innervated forearm osteocutaneous flap and big toe pulp.The use of a radial forearm flap has become the most popular method to reconstruct a phallus in recent years. This method of reconstruction, however, is plagued with problems such as urethral fistula and loss of phallic girth as a result of tissue atrophy, rendering a phallic contour that is cosmetically unsatisfactory. We had the opportunity of modifying the technique of penile reconstruction using a forearm osteocutaneous flap to minimize these problems. Specifically, a segment of the big toe pulp is used to reconstruct a glans penis. Sensory restoration in the "glans" and "penile shaft" is restored by coapting the digital and the antebrachial nerves to the penile nerve remnants. A segment of flexor carpi radialis muscle is included in the design of a forearm flap to reinforce the coaptation site of the urethral tract. An arteriovenous shunt is incorporated in the shaft as a mechanism to elicit erection of the penis by compressing the root of the neophallus. We had used these technical modifications in a 51-year-old man who had undergone penile amputation because of cancer. The cosmetic appearance and erotic and tactile sensation in the shaft and glans were proper and satisfactory at the end of fourth year after the surgery. The coital function was also satisfactory.- - - - - - - - - - ranking = 2keywords = nerve (Clic here for more details about this article) |
5/183. tongue reconstruction with a combined brachioradialis-radial forearm flap.Total glossectomy adversely affects speech and swallowing, and subsequent reconstruction results in limited functional return. The radial forearm flap has been reliably used to resurface glossectomy defects, but has limited bulk with which to aid in palatoglossal contact for speech. The authors have modified the forearm flap by incorporating a segment of brachioradialis muscle, to increase bulk posteriorly and to aid in speech. Sufficient muscle perforators arise from the proximal brachial artery and enter the brachioradialis to permit transfer of the muscle with the fasciocutaneous forearm flap as a single free-flap unit. The muscle is folded onto itself and enclosed within the forearm flap skin to create a neotongue. Coaptation of the antebrachial cutaneous nerves can provide a senate flap. Successful transfer of the combined brachioradialis/forearm flap in a patient who had undergone total glossectomy resulted in a neotongue good shape. speech was rated good by a speech pathologist, and palatoglossal contact was observed on cineoradiograph. No functional loss at the donor site occurred. Inclusion of the brachioradialis muscle with the radial forearm flap as a combined unit results in a neotongue with good form and increased bulk posteriorly at the base, compared to a standard fasciocutaneous flap alone. This is a useful variation of the forearm flap. Sensory return is possible if the medial and/or lateral antebrachial cutaneous nerves of the flap are coapted to the lingual nerve.- - - - - - - - - - ranking = 3keywords = nerve (Clic here for more details about this article) |
6/183. Relief of non-metastatic shoulder pain with mediastinal radiotherapy in patients with lung cancer.Three patients with lung cancer and shoulder pain for which no local cause could be found are described. All three benefited from a course of palliative radiotherapy to ipsilateral mediastinal disease remote from the site of the pain. It is suggested that the pain is referred from intrathoracic involvement of the phrenic nerve by cancer, and that palliative irradiation of the mediastinum should be considered if investigations fail to reveal a local cause for ipsilateral shoulder pain.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
7/183. Great auricular nerve: anatomy and imaging in a case of perineural tumor spread.We present the imaging and clinical findings of a case of recurrent cutaneous squamous cell carcinoma of the face in which CT and MR imaging revealed perineural tumor spread along the great auricular nerve. The great auricular nerve is a superficial cutaneous branch of the cervical plexus, providing sensory innervation to the skin of the parotid and periauricular region. Our purpose was to familiarize the reader with the anatomy of this nerve and imaging's potential role in the diagnosis of perineural tumor spread along this seldom seen structure.- - - - - - - - - - ranking = 7keywords = nerve (Clic here for more details about this article) |
8/183. Nasopharyngeal carcinoma with leptomeningeal dissemination: case report.Nasopharyngeal carcinoma (NPC) is a highly prevalent malignancy in southeast china, hong kong, and taiwan. Spread of this tumor is known to occur via three main routes, i.e., local invasion of adjacent structures, regional metastasis to neck nodes, and hematogenous metastasis to distant organs. In this report, we describe a rare case of NPC disseminated via the leptomeninges, so called meningeal carcinomatosis (MC). The patient was a 62 year-old man who presented with multiple cranial nerve palsies and a headache, and was diagnosed with NPC in August 1988. The primary tumor regressed completely after induction chemotherapy and radiation therapy. Computerized tomography (CT) 17 months after radiation therapy showed multiple enhanced nodules scattered along the temporal meninges. The nodules increased in number and size in the subsequent CT scan 4 months later. The patient declined further invasive procedures and oncologic treatments, and he expired at home 9 months after the development of MC. It is speculated that perineural invasion and access to the subarachnoid space was the major cause of MC in this case. The case, although rare, possibly highlights a rare route of tumor dissemination in NPC.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
9/183. Pituitary metastasis from uterine cervical carcinoma: a case presenting as diabetes insipidus.The authors report a case of symptomatic pituitary metastasis from an adenocarcinoma of the uterine cervix. Only two cases of intrasellar metastasis from an adenocarcinoma of the uterine cervix have been previously reported; both were identified at autopsy. Our patient presented with clinical features of diabetes insipidus and a right sixth nerve palsy. Trans-sphenoidal surgery was performed and partial removal of the tumour was achieved. The tumour was an epidermoidal carcinoma of the uterine cervix located primarily in the posterior lobe of the pituitary. The patient's neurological symptoms were relieved following surgery. The possibility of a secondary location must always be considered in a differential diagnosis when treating an intrasellar lesion in a patient with a documented primary malignancy.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
10/183. phantom limb pain as a manifestation of paclitaxel neurotoxicity.paclitaxel is a chemotherapeutic agent with activity directed against several malignancies. It has multiple adverse effects including neurotoxicity. We describe 2 patients with prior amputation who experienced phantom limb pain (PLP) after receiving paclitaxel therapy. A third patient experienced disabling neurotoxicity in the extremity of a prior ulnar nerve and tendon transposition after receiving paclitaxel. This unique syndrome should be identified as a direct causal effect of paclitaxel. In this report, we review the pathophysiology of PLP and treatment options. physicians should be aware that PLP can occur after initiation of paclitaxel.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
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