p27, a cyclin‐dependent kinase inhibitor, regulates progression from G1 to S phase. There have been a few clinical reports of low p27 expression associated with poor survival among patients with cancer. However, there have been no reports of such an association in cases of head and neck cancer. The authors investigated whether p27 expression in patients with oral tongue squamous cell carcinoma was associated with their prognosis. Ninety‐four patients with oral tongue squamous cell carcinoma were analyzed. The authors performed p27 immunohistochemistry on all patients and Western blot analysis on 19 available patients. Cox proportional hazards regression analysis that included gender, history of smoking and alcohol usage, presence of multiple primary cancers, stage, histologic grade and p27 status was used to identify the multivariate predictive value of prognostic factors. Twenty‐six patients had high p27 expression (≥50% tumor cell nuclei positive), and 68 patients had low p27 expression (<50%) by immunohistochemistry. In those with low p27 expression, N(+) and advanced T (T3 or T4) were significantly higher than in those with high p27 expression (P=0.02 and 0.04). The 5‐year survival rate in the low p27 group was 44%, whereas that in the high p27 group was 68%, indicating a significant difference (P=0.04). p27 expression was inferred from Western blot analysis, and an arbitrary quantity (<1, 1–5, or ≥5) from the ratio of tumor to normal tissue density was used to characterize patients, resulting in 8 (42%), 3 (16%) and 8 (42%) patients in the low (<1 fold), intermediate (1–5 fold), and high (≥5 fold) groups, respectively. Results of immunohistochemical analysis for p27 were significantly correlated with those of Western blot analysis (P=0.02). Multivariate analysis revealed that low intensity of p27 expression and advanced stage (Stage III or IV) were predictors of reduced survival (P=0.02 and 0.001). Low p27 expression was associated with increasing lymph node metastasis and stage of tumor and resulted in a poor prognosis for patients with oral tongue squamous cell carcinoma. p27 is apparently a significant predictor of survival. Henk Tideman

Background: To assess the effect of clinicopathologic factors on local tumor control and survival in patients with mandibular alveolar carcinoma. Methods: Fifty patients with mandibular alveolar carcinoma treated surgically were included in this study. There were 3 patients with T1, 25 with T2, 5 with T3, and 17 with T4 disease. Clinical evidence of bone invasion was noted in 47 patients. A hemi- or segmental mandibulectomy was performed on 37 patients, whereas 10 patients had a marginal mandibulectomy. The impact of clinicopathologic variables on local tumor control and patient survival was assessed by univariate analysis. Variables included T and N stage, dental extraction, treatment modality, tumor differentiation, nodal status, surgical margin, and bone invasion. Results: Eleven patients (22%) develop recurrent disease, including 8 local recurrences, 1 neck, and 2 distant metastases. Overall, the 5-year actuarial rates of local control and disease-specific survival were 85 and 73%, respectively. Most local recurrences after surgical treatment were caused by inadequate resection margins. When resection margins were negative, the survival and local control rate were significantly better than when there were positive resection margins (survival, 91 vs. 11%; local control, 100 vs. 49%; p < 0.01). Neither T and N stages, clinical stage, tumor differentiation, dental extraction, bone invasion, extent of bone resection, nor treatment modality influenced outcome. Conclusions: The status of surgical margins was of major importance for the outcome of patients with gingival carcinoma of the mandible.

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By using the zygomatic approach, temporal mesial and polar epileptic foci are easily accessible through an incision in the inferior temporal gyrus. In this approach, a major part of the superior and middle temporal gyrus is preserved, and there is no risk of postoperative dysnomia even on the dominant side for speech. Combined use of depth and subdural electrodes is advisable for precise determination of focus distributions throughout the mesial and lateral structures of the temporal lobe. We have applied this approach in 5 patients with satisfactory results.

Multiple subpial transection (MST) was applied to 12 cases with intractable epilepsy, the foci of which were located in unresectable essential areas. The result proved that MST is effective in controlling seizures, and no explicit neurological deficits have incurred postoperatively.

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We report a patient with paroxysmal aphasia evoked by ictal epileptiform discharges localized to the left fusiform gyrus, where a small brain tumor existed. The intracranial EEG recordings during other seizures demonstrated a close functional link between the left fusiform gyrus and Wernicke's area. The patient also showed transient aphasia with electrical stimulation of the left fusiform gyrus.

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