1/14. CT and pathologic findings of a case of subdural osteoma.A 43-year-old female presented with persistent headache and dizziness which had first occurred two years earlier. The physical and neurological findings at admission were unremarkable, though plain radiography revealed the presence of a dense calcified mass in the left frontal area, and CT showed that a homogeneous high-density nodule was attached to the inner surface of the left frontal skull. The hard bony mass found and excised during surgery was shown at histopathologic examination to be a subdural osteoma. We describe the clinicopathologic findings of this entity and discuss the radiological features which suggest its subdural location.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/14. Cranioplasty using allogeneic perforated demineralized bone matrix with autogenous bone paste.The efficacy of allogeneic perforated demineralized bone matrix with autogenous bone paste in the treatment of full-thickness cranial defects was evaluated in 10 consecutive patients between June 1998 and December 1998. The skull defects resulted from trauma in 9 patients and removal of a cranial tumor in 1 patient. The size of the skull defects ranged from 8 x 6 cm to 11 x 12.5 cm. Follow-up averaged 33 months for all patients. Postimplantation evaluations included serial photographs, repeated physical examination, and three-dimensional computed tomography for all patients. Visual inspection of the implanted biomaterial 6 months later was possible in 1 patient. The contour of the reconstructed skull was acceptable aesthetically without any secondary depression noted during the follow-up period. Three-dimensional computed tomographic scans taken 2 years after implantation indicated that the allogeneic perforated demineralized bone matrix provided a matrix for new bone formation with remarkable osteoinductive potential for new bone formation. The autogenous bone paste was able to caulk the demineralized bone matrix and fill the contour irregularities and gaps of the reconstructed cranium. The results from this clinical study indicated that allogeneic perforated demineralized bone matrix with autogenous bone paste is a promising alternative to an autogenous bone graft and or alloplastic material for cranioplasty.- - - - - - - - - - ranking = 12.436343860845keywords = physical examination, physical (Clic here for more details about this article) |
3/14. Undifferentiated small-cell neoplasm of the petrous apex. A case report.We present a rare case of undifferentiated small-cell neoplasm involving the temporal bone petrous apex. The symptoms, physical examination, importance of roentgenographic findings, and pathologic findings are reviewed. While not absolutely conclusive, the collective evidence in this case supports a diagnosis of small-cell carcinoma of the lung with metastasis to the petrous apex. A discussion of temporal bone malignancies, their frequencies, and characteristics is included. To our knowledge, a review of the literature over the past 25 years reveals no other published cases of an undifferentiated small-cell carcinoma in the temporal bone.- - - - - - - - - - ranking = 12.436343860845keywords = physical examination, physical (Clic here for more details about this article) |
4/14. Osteogenic sarcoma of the sella after radiation treatment of a pituitary adenoma.OBJECTIVE: To report an uncommon case of osteogenic sarcoma of the sella turcica after radiation treatment of a pituitary adenoma. methods: We present the clinical history, physical findings, laboratory data, imaging studies, and pathologic findings in a patient found to have osteogenic sarcoma of the sella after radiation therapy for a nonfunctioning pituitary adenoma. RESULTS: Six years after transsphenoidal resection and postoperative fractionated radiation therapy for a nonfunctioning pituitary adenoma that extended to the cavernous sinus, a 45-year-old man presented with a sinus infection, diplopia, and ophthalmoplegia of the right eye. A computed tomographic scan of the head showed a mass in the sella with involvement of the optic chiasm and right cavernous sinus. Transsphenoidal resection and debulking of the tumor revealed an osteogenic sarcoma. The patient was discharged from the hospital with residual diplopia and ophthalmoplegia. He was treated with levothyroxine, testosterone, and hydrocortisone. Six weeks later, the patient was readmitted after he was found unresponsive, and computed tomographic scans disclosed a massive cerebrovascular accident. He died a few days later. CONCLUSION: Osteogenic sarcoma is a rare, late complication of radiation treatment of pituitary adenoma. Although radiotherapy remains an effective adjunctive treatment in patients with pituitary adenomas, particularly those with residual or recurrent tumor, potential complications must be acknowledged.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/14. Importance of precise positioning for proton beam therapy in the base of skull and cervical spine.Using proton beam therapy, high doses have been delivered to chordomas and chondrosarcomas of the base of skull and cervical spine. Dose inhomogeneity to the tumors has been accepted in order to maintain normal tissue tolerances, and detailed attention to patient immobilization and to precise positioning has minimized the margins necessary to ensure these dose constraints. This study examined the contribution of precise positioning to the better dose localization achieved in these treatments. Three patients whose tumors represented different anatomic geometries were studied. Treatment plans were developed which treated as much of the tumor as possible to 74 cobalt-Gray-Equivalent (CGE) while maintaining the central brain stem and central spinal cord at less than or equal to 48 CGE, the surface of the brain stem, surface of the spinal cord, and optic structures at less than or equal to 60 CGE, and the temporal lobes at less than or equal to 5% likelihood of complication using a biophysical model of normal tissue complication probability. Two positioning accuracies were assumed: 3 mm and 10 mm. Both proton beam plans and 10 MV X ray beam plans were developed with these assumptions and dose constraints. In all cases with the same positioning uncertainties, the proton beam plans delivered more dose to a larger percentage of the tumor volume and the estimated tumor control probability was higher than with the X ray plans. However, without precise positioning both the proton plans and the X ray plans deteriorated, with a 12% to 25% decrease in estimated tumor control probability. In all but one case, the difference between protons with good positioning and poor positioning was greater than the difference between protons and X rays, both with good positioning. Hence in treating these tumors, which are in close proximity to critical normal tissues, attention to immobilization and precise positioning is essential. With good positioning, proton beam therapy permits higher doses to significantly more of the tumor in these sites than do X rays.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/14. Benign osteoblastoma of vertebral column and skull. Report of two cases.osteoblastoma of the spine is a rare but important cause of back pain and the sciatica syndrome in young adults. osteoblastoma of the skull is rare and the involvement of the orbital roof is very unusual. Clinical complaints and physical examination are not specific enough to provide a lead to the diagnosis. Bone scans and computerized tomography scans should be performed in all cases, to show the extent of vertebrae or calvarium infiltration by the tumor. To prevent recurrence and malignant transformation, the tumor should be completely removed whenever possible. If tumor excision is incomplete, a continuous follow-up is necessary to detect any recurrence or malignant transformation, which normally appears 5-10 years after the first operation (in one of our cases 7 years later).- - - - - - - - - - ranking = 12.436343860845keywords = physical examination, physical (Clic here for more details about this article) |
7/14. magnetic resonance imaging in the diagnosis of temporal bone and skull base lesions.Six patients are presented in whom total reliance on magnetic resonance imaging (MRI) interpretations would have resulted in less than ideal treatment. The misleading information on magnetic resonance imaging could be divided into two types; as follow: type I were those in which there was no signal but nonosseous pathology was present, and in type II an abnormal signal was present but misinterpreted. In three of these patients (cases, 2, 3, and 5), information gained from more traditional means (history, physical examination, audiologic and vestibular testing, and computed tomography) led to proper treatment, whereas, in two patients (cases 4 and 6), treatment exceeded that required by the disease process. In one patient (case 1), ideal therapy resulted, despite a negative magnetic resonance imaging study, when a small intracanalicular tumor was found fortuitously during a translabyrinthine vestibular nerve section for vertigo. Although magnetic resonance imaging provides excellent supplemental information to more traditional means of diagnosis, it cannot be used entirely in their place. As gadolinium-diethylene triamine pentaacetic acid (Gd-DTPA) becomes more readily available, as the resolution of magnetic resonance imaging improves, and as we gain more familiarity with this diagnostic modality, misleading information from these studies should decrease.- - - - - - - - - - ranking = 12.436343860845keywords = physical examination, physical (Clic here for more details about this article) |
8/14. Surface reconstructions from computerized tomographic scans for evaluation of malignant skull destruction.The head and neck surgeon is dependent on radiographic technology to diagnose deformity, plan surgery, and evaluate operative results. The development of computerized tomographic scanning has facilitated osseous definition as well as allowed study of intracranial and extracranial soft tissue. Nonetheless, the computerized tomographic image slice format requires an educated interpreter and a fertile imagination for correlation with physical findings. We have created computer software that presents computerized tomographic data as surface images that resemble photographs of the patient or a specimen skull. The program runs on standard computerized tomographic scanners, requires no operator intervention, and is efficient in computation time and space. The surgeon can directly visualize the osseous deformity and mathematically relate it to the overlying soft tissue. The surface images can be viewed from a variety of perspectives, with or without selected structures, such as removing the body of the mandible in the pseudo-water's projection to demonstrate the palate. The image data can be manipulated to obtain a variety of useful results beyond the images themselves. The addition of this technology to the preoperative evaluation and longitudinal follow-up of patients with head and neck cancer has increased our understanding of the extent of their malignancy.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/14. Metastatic carcinoma with an unknown primary.The patient is a 54-year-old white female who was well until 3 weeks prior to admission when she noted vague right upper quadrant pain exacerbated by meals. She lost 12 lbs over that period of time. She complained as well of posterior scalp, left hip, and back pain on initial presentation. physical examination at the time of admission to hospital showed a middle-aged female in no acute distress. Her vital signs were normal. There was a 1.5 X 1.5-cm firm, tender nodule over the occiput. There was no peripheral adenopathy. The breasts, lungs, and heart were normal. The liver was 14 cm in span. The remainder of the physical examination including a pelvic examination was unremarkable. On admission, the only abnormal laboratory studies were SGOT 106, SGPT 139, and alkaline phosphatase 190. Her chest X ray, flat plate of the abdomen, and mammograms were all normal.- - - - - - - - - - ranking = 12.436343860845keywords = physical examination, physical (Clic here for more details about this article) |
10/14. endolymphatic sac tumors: histopathologic confirmation, clinical characterization, and implication in von hippel-lindau disease.The term "endolymphatic sac tumor" (ELST) was coined to identify the likely origin of aggressive papillary tumors of the temporal bone. To evaluate the validity of this designation, the temporal bone collection at the massachusetts eye and Ear Infirmary was accessed in an effort to determine the pathologic relationship between these tumors and the endolymphatic sac. The search resulted in the identification of a de-novo papillary epithelial lesion arising within the confines of the endolymphatic sac in a patient with von Hippel-Lindau (VHL) disease who harbored a large, destructive ELST in the opposite temporal bone. This finding provides the most substantial evidence to date regarding the origin of the ELST and the accuracy of its nomenclature. Seven additional clinical cases of ELST were identified and analyzed in order to define the natural history of these tumors. All patients had a history of sensorineural hearing loss diagnosed an average of 10.6 years prior to tumor discovery. The presence of a polypoid external auditory canal mass, facial paralysis, and evidence of a destructive mass arising on the posterior fossa surface of the temporal bone were common physical and radiographic findings. The management of these patients, as well as those who are probably prone to such tumors (i.e., VHL patients), is discussed.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
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