The occurrence of liposarcoma in the tongue is rare with only 34 cases published so far. We report six new cases of atypical lipomatous tumor (ALT) of the tongue, and detection of mdm-2 and CDK4 expression by immunohistochemistry and fluorescence in situ hybridization (FISH), respectively, was performed. The series comprised three males and three females, aged 11-78 years. The tumors arose at the lateral side of the tongue, and in one case, multiple tumor nodules were noted. Follow-up information in five cases (range from 4 to 159 months) revealed one local recurrence at 6 months. Microscopically, four cases had features of lipoma-like ALT, whereas two cases displayed patterns of sclerosing ALT. Immunohistochemically, tumor cells revealed expression of vimentin (five of five), S100 (five of five), mdm-2 (three of five), and CDK4 (four of five). Two cases were also examined by FISH; amplification of mdm-2 gene was found in both cases, whereas amplification of CDK4 gene was present in one case only. To the best of our knowledge, this is the third largest series reporting occurrence of ALT in the tongue and the first one where analysis of mdm-2 and CDK4 proteins/genes expression/amplification was performed. Both these markers may be of help in the differential diagnosis of ALT versus lipoma. Although most ALTs of the tongue behave in the nonaggressive fashion, they may recur locally. Based on current data, the term ALT is strongly recommended for tumors occurring in the tongue to prevent inadequate treatment.
The retrospective study was based on 36 open joint surgeries done in 33 consecutive patients with anterior disc dislocation without reduction with severe signs and symptoms and unsuccessful nonsurgical treatment lasting at least 6 months. The patients underwent either discoplasty or discectomy followed by auricular cartilage graft implantation and were evaluated for amount of interincisal mouth opening, severity of pain on VAS scores preoperatively and as well as 12 months postsurgically. The minimum pain levels were preoperatively 50 on VAS for the discoplasty group and 60 on VAS for the discectomy group. After the surgery, the VAS values lower than 20 were reported on 69.4 % of 25 sides (72.7 % in the discoplasty group, 68.0 % in the discectomy group). Using the cutoff point for maximal interincisal opening of more than 35 mm, only 6 patients (16.6 %) fulfilled the criterion at the baseline. Interincisal distance measured vertically 12 months after the operation increased in all but five patients. In three of the five subjects, the opening was at the same level as before the surgery. Almost ninety-one percent of the patients (90.9 %) in discoplasty group and 81.8 % in discectomy group, respectively reached 35 mm or more of vertical opening after the operation. Applying the 1984 Criteria for classification of postoperative results (AAOMS), 12 months after surgery, 24 patients (72.7 %) displayed good results, 6 patients (18.2 %) were evaluated with acceptable results, and in 3 cases (9.1 %) we observed bad results. Although only short-term evaluation is presented, our findings show that both discoplasty and discectomy are effective methods for surgical treatment of patients suffering from severe temporomandibular pain and limited mouth opening. Discoplasty should be reserved only for patients without severe changes of the disc.
Im Zeitraum von 1984 bis 1988 wurden 522 Patienten mit Frakturen der Ober- und Mittelgesichtsetage an der HNO-Klinik und der stomatologischen Klinik in Hradec KrÁlovÉ behandelt. Ohne die Patienten mit isolierten Frakturen des Nasenbeins (218), des Alveolarfortsatzes des Oberkiefers (13) und des Jochbogens (10) wurden 281 Patienten bewertet, bei denen die Bruchlinien in die Orbita hineinreichten. Zwei Drittel dieser Patienten wurden operativ, das restliche Drittel konservativ behandelt. Bei den im Abstand von 1 bis 6 Jahren nach dem Unfall durchgefÜhrten Kontrolluntersuchungen wurden bei 7% der Patienten zurÜckgebliebene SchÄden festgestellt. Die hÄufigsten unmittelbar nach dem Unfall aufgetretenen FunktionsstÖrungen waren Diplopie (43 Patienten) und begrenzte Bulbusbeweglichkeit (31 Patienten), die vor allem bei «Blow-out»-Frakturen beobachtet wurden; zum hÄufigsten Dauer-schaden wurden VisusstÖrungen (von 18 frÜhzeitig beobachteten VisusstÖrungen waren 13 dauernder Natur, davon 9 Amaurosen), die vor allem bei fronto-basalen Verletzungen und bei Splitterfrakturen beobachtet wurden.
Summary: The case is presented of a 23‐year‐old female with maxillary sinusitis causing pain in the left cheek and headache. In a biopsy specimen taken from the maxillary sinus the fungus Paecilomyces variotii Bainier was demonstrated histologically and mycologically. The Caldwell‐Luc operation with exteriorization and aeration of the involved sinus led to cure. The present data on the role in human pathology of fungi of the genus Paecilomyces are summarized. Zusammenfassung: Es wird der Fall einer dreiundzwanzigjährigen Frau mit einer Kieferhöhlenentzündung beschrieben, die Schmerzen in der linken Gesichtshälfte und im Kopf verursachte. In dem bioptischen Material, das aus der Kieferhöhle gewonnen wurde, wies man histologisch und mykologisch den Pilz Paecilomyces variotii Bainier nach. Die Caldwell‐Luc‐Operation mit einer Exteriorisation und Durchlüftung der befallenen Kieferhöhle brachte die Heilung der Patientin. Die Autoren faßten die bisherigen Angaben über die Bestätigung des Pilzes aus der Gattung Paecilomycoses in der Humanpathologie zusammen.
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