New Classification of Polydactyly of the Foot on the Basis of Syndactylism, Axis Deviation, and Metatarsal Extent of Extra Digit

Background  Polydactyly of the foot is one of the most frequent anomalies of the limbs.However, most classification systems are based solely on morphology and tend to be inaccu­rate and lessrelevantto surgical methods and results. The purpose ofthisstudy isto presentour newclassification of polydactyly ofthe foot,which can serve as a predictor oftreatmentand prognosis.Methods  To find a correlation between the various morphologic traits of polydactyly ofthe foot and the treatment plan and outcomes,we reviewed 532 cases of polydactyly ofthefoot in 431 patients treated in our hospital, expanding on our previous study that describedpolydactyly based on the importance of metatarsal bone status and varus deformity. Therecords of patientswere evaluated and comparedwith previousstudies at other centers.Results  Unsatisfactory results were seen in 36 cases, which included 5 cases of incompleteseparation due to syndactylism, 23 cases of axis deviation, and 8 cases ofremnants of extra­digit metatarsal bones. The locus of the polydactyly, or the digit which wasinvolved, did notseemto affectthe final postoperative outcomesin ourstudy. Three factors­syndactylism, axisdeviation, and metatarsal extension­are the major factors related to treatment strategy andprognosis. Therefore,we developed a newclassification systemusing three characters(S,A,M)followed by three groups(0, 1, 2),to describe the complexity of polydactyly ofthe foot,suchas S1A2M2.Conclusions  Our newclassification could provide a communicable description to help deter­mine the surgical plan and predict outcomes

Clinical Manifestations of Recurrent Parotid Pleomorphic Adenoma

Objectives. This study was undertaken to confirm the clinical characteristics of recurrent pleomorphic adenoma (RPA), and to identify those factors that affect the development of malignant transformation (MT) from RPA. Methods. The medical records of 270 patients, who were operated upon for parotid PA, were retrospectively reviewed. The pathologic specimens of a selected series of 23 patients were reviewed for histologic subtype and microscopic multi-nodularity. Results. Mean age of initial operation in RPA without MT (RPA(-MT)) group was significantly lower than that of primary PA group. Mean age of the revision operation in RPA with MT (RPA(+MT)) group was significantly greater than that of RPA(-MT) group. Mean interval from operation to recurrence shortened after each revision operation. The risk of MT and additional recurrence increased significantly with recurrence. In RPA(-MT) group tumor recurrence occurred in 21.4% of patients despite a clear resection margin. Conclusion. The risk factors for MT may be an age of over 45 yr and multiple recurrences. However, younger patients are more at risk of recurrence. A clear resection margin cannot guarantee a cure in RPA, and it seems that parotid pleomorphic adenomas slowly gain malignant characteristics after repeated recurrences.SUH MW, 2005, KOREAN J HEAD NECK O, V21, P146HANNA EY, 2005, CUMMINGS OTOLARYNGOL, P1348Ghosh S, 2003, CLIN OTOLARYNGOL, V28, P262Glas AS, 2002, CANCER, V94, P2211, DOI 10.1002/cncr.10445Glas AS, 2001, HEAD NECK-J SCI SPEC, V23, P311BRADLEY PJ, 2001, CURR OPIN OTOLARYNGO, V9, P100Carew JF, 1999, OTOLARYNG HEAD NECK, V121, P539Junquera L, 1999, HEAD NECK-J SCI SPEC, V21, P652Hancock BD, 1999, ANN ROY COLL SURG, V81, P299Bankamp DG, 1999, LARYNGO RHINO OTOL, V78, P77Hoorweg JJ, 1998, EUR J SURG ONCOL, V24, P452Henriksson G, 1998, CANCER, V82, P617Laskawi R, 1998, BRIT J ORAL MAX SURG, V36, P48Klijanienko J, 1997, HEAD NECK-J SCI SPEC, V19, P629Leverstein H, 1997, EUR ARCH OTO-RHINO-L, V254, P313SunardhiWidyaputra S, 1995, PATHOL RES PRACT, V191, P1186PHILLIPS PP, 1995, ANN OTO RHINOL LARYN, V104, P100BUCHMAN C, 1994, LARYNGOSCOPE, V104, P1231NATVIG K, 1994, HEAD NECK-J SCI SPEC, V16, P213JACKSON SR, 1993, J LARYNGOL OTOL, V107, P546MCGREGOR AD, 1988, BRIT J PLAST SURG, V41, P177FEE WE, 1978, LARYNGOSCOPE, V88, P265SEIFERT G, 1976, HNO, V24, P415NAEIM F, 1976, ARCH PATHOL LAB MED, V100, P271FRAZELL EL, 1954, CANCER, V7, P637

Clinical Analysis of Acinic Cell Carcinoma in Parotid Gland

ObjectivesAcinic cell carcinoma (AciCC) is a rarely encountered malignancy in parotid gland. Because AciCC is rare and was recently recognized as the entity of malignancy, AciCC has been difficult to study. We aimed to analyze the diagnosis and treatment experience for this malignancy in our hospital.MethodsWe retrospectively reviewed medical records of the 20 patients with AciCC of parotid gland diagnosed from 1990 to 2009. The preoperative computed tomography scan, preoperative fine needle aspiration cytology (FNAC) and intraoperative frozen section results were compared with the final diagnosis. The survival and recurrence were analyzed with the cancer stages and treatment modalities.ResultsThere were 10 males and 10 females, with a mean age of 44.4 years, ranging 8-77 years. The AJCC tumor stage distributions of the patients were 70%, 15%, and 15% for stages I, II, and IV, respectively. The sensitivity of FNAC and intraoperative frozen section was 26.7% and 50.0% respectively. The 10-year survival rate was 90.9% with a mean follow-up of 111 months, ranging 17-251 months. The 10-year disease free survival rate was 74.2% and the mean duration of recurrence from initial surgery was 92.3 months.ConclusionAciCC of the parotid gland is a rare malignancy that has features of less aggressive behavior, and good prognosis. Intraoperative frozen section examination may be helpful in the diagnosis of AciCC of the parotid gland because of the low sensitivity of preoperative computed tomography scan and FNAC. Surgery with adjuvant postoperative radiotherapy is satisfactory for disease control

Induction chemotherapy in head and neck squamous cell carcinoma of the paranasal sinus and nasal cavity: A role in organ preservation

Background/Aims: The role of induction chemotherapy (IC) for eyeball preservation has not been established in head and neck squamous cell carcinoma (HNSCC) of the paranasal sinus and nasal cavity (PNSNC). Periorbital involvement frequently leads to eyeball exenteration with a margin of safety. We evaluated the treatment outcomes, including survival and eyeball preservation, of patients who received IC for HNSCC of the PNSNC. Methods: We reviewed 21 patients diagnosed with HNSCC of the PNSNC who were treated with IC. We analyzed response, eyeball preservation rate, and overall survival. Results: Tumors were located in the paranasal sinus (n = 14) or nasal cavity (n = 7). Most patients had stage T4a (n = 10) or T4b (n = 7) disease. More than half of the patients received a chemotherapy regimen of docetaxel, fluorouracil, and cisplatin (n = 11). Thirteen patients (61.9%) achieved a partial response after IC and 15 patients (71.4%) achieved T down-staging. Among 17 patients with stage T4 disease, which confers a high risk of orbital exenteration, 14 (82.4%) achieved preservation of the involved eye. The 3-year overall survival (OS) rate of patients who achieved a partial response to IC was 84.6%. The 3-year OS rate of patients with stable disease or disease progression after IC was 25.0% (p = 0.038). Conclusions: IC could be considered for down-staging patients with advanced T-stage disease. It could also be a reasonable option for eyeball preservation in locally advanced HNSCC of the PNSNC.

Factors Related to Regional Recurrence in Early Stage Squamous Cell Carcinoma of the Oral Tongue

ObjectivesThis study analyzed various clinical and histopathologic factors for patients with early stage squamous cell carcinoma (SCC) of the oral tongue to define a high risk group for regional recurrence and finally to find out the indication of elective neck dissection (END).MethodsRetrospective chart review was performed for 63 patients with T1-T2N0 SCC of the oral tongue who underwent partial glossectomy with/without END. Clinical and histopathologic factors assessed were age, gender, clinical T stage, tumor cell differentiation, depth of invasion, pathologic nodal status, and intrinsic muscle involvement, perineural invasion, lymphovascular emboli and resection margin involvement.ResultsFive year overall survival rate was 97.1% in stage I and 76.2% in stage II, and 5-yr disease free survival rate was 76.7% in stage I and 43.5% in stage II. Rates of occult nodal metastasis in stage I and II were 15.4% and 42.9%, respectively. Overall regional recurrence rate was 15.9%, which consisted of 10.2% in stage I and 35.7% in stage II. The success rate of salvage treatment was 100% in stage I and 40% in stage II. Higher T stage, higher histologic grade, depth of invasion ≥3 mm, presence of intrinsic muscle involvement were significantly related to regional recurrence (P=0.035, P=0.011, P=0.016, P=0.009, respectively). In stage I, the non-END group (n=36) showed 13.9% of regional recurrence rate, while END group (n=13) did not have any regional recurrence (P=0.198). Five year disease free survival rate of END group was significantly higher than non-END group (100% and 68.7%, respectively, P=0.045).ConclusionWe recommend to perform END in early stage SCC of the oral tongue if the primary tumor has T2 stage, and T1 stage with higher histologic grade, depth of invasion more than 3 mm, or presence of intrinsic muscle involvement

Calibration of Sm-Nd mixed spike by teflon powder method

Isotopic composition of Sm-Nd mixed spike was calibrated by teflon powder method. Sm and Nd isotopic compositions of the spike were externally calibrated with reference to the nNdβ standard and normal Sm. Sm and Nd concentrations in the mixed spike were determined by isotope dilution protocol. Sm and Nd were separated by teflon powder method from the mixture of the spike with an interlaboratory standard (CIT Sm-Nd standard). We confirmed that precise Sm/Nd ratio (< 0.1 % error) and undisturbed Nd isotopic composition can be measured at the same time on condition that the sample to spike ratio is optimized. Garnet from the shear zone between the Gyeonggi massif and the Imjingang belt (Gyeonggi shear zone) was dated as a practical test of our experimental procedure. The Sm-Nd data of garnet, K-feldspar and whole rock samples from the shear zone define an Early Proterozoic age of 1730±71 Ma, indicating that Sm-Nd system of the garnet was not disturbed during Triassic deformation

Cooperative Monitoring Center Occasional Paper/12: ENTNEA: A Concept for Enhancing Nuclear Transparency for Confidence Building in Northeast Asia

Nuclear energy continues to be a strong and growing component of economic development in Northeast Asia. A broad range of nuclear energy systems already exists across the region and vigorous growth is projected. Associated with these capabilities and plans are various concerns about operational safety, environmental protection, and accumulation of spent fuel and other nuclear materials. We consider cooperative measures that might address these concerns. The confidence building measures suggested here center on the sharing of information to lessen concerns about nuclear activities or to solve technical problems. These activities are encompassed by an Enhanced Nuclear Transparency in Northeast Asia (ENTNEA) concept that would be composed of near-term, information-sharing activities and an eventual regional institution. The near-term activities would address specific concerns and build a tradition of cooperation; examples include radiation measurements for public safety and emergency response, demonstration of safe operations at facilities and in transportation, and material security in the back end of the fuel cycle. Linkages to existing efforts and organizations would be sought to maximize the benefits of cooperation. In the longer term, the new cooperative tradition might evolve into an ENTNEA institution. In institutional form, ENTNEA could combine the near-term activities and new cooperative activities, which might require an institutional basis, for the mutual benefit and security of regional parties

Three-Directional Reconstruction of a Massive Perineal Defect after Wide Local Excision of Extramammary Paget's Disease

Extramammary Paget's disease (EMPD) is a rare, slow-growing intraepithelial malignancy that mainly involves the genital region, including the vulva, penis, scrotum, perianal, and periurethral areas. Although several treatment options exist, wide local excision with a safe margin is considered the treatment of choice. After resection of the lesion, it is often challenging to reconstruct the defect because defects in the perineal region require adequate volume for protection and are susceptible to infections, which is a particularly significant risk for large defects. We report a case of perivulvar EMPD that was reconstructed with three-directional local flaps after wide excision of the tumor. We covered the defect sequentially using the following 3 flaps: a gracilis myocutaneous flap from the left thigh, a bipedicled V-Y advancement flap from the lower abdomen, and an internal pudendal artery perforator-based island flap from the right buttock. To the best of our knowledge, this report is the first to describe a three-directional approach to extensive perivulvar reconstruction