Cavernous sinus thrombosis following odontogenic and cervicofacial infection

Summary Cavernous sinus thrombosis (CST) is rarely seen clinically as a complication of infectious processes since the discovery of penicillin. At the present time, dental abscess is an uncommon cause of CST. We now report our experiences with a 60-year-old diabetic male, who developed CST 38 days after extraction of an infected upper third molar tooth. The importance of eradicating regional cervicofacial foci of infection is stressed.     

Occurrence of tetrodotoxin and paralytic shellfish poison in the Taiwanese crab Lophozozymus pictor

Paralytic toxicity was detected by tetrodotoxin (TTX) bioassay in all 15 specimens of the xanthid crab Lophozozymus pictor collected from northern Taiwan in 1993. The average toxicity of crab specimens was 921 ± 231 (mean ± S.E.) mouse units. The toxin of crab was partially purified and then identified. It was found that the crab toxin contained TTX and gonyautoxin. The ratio of TTX to gonyautoxin for crab toxin was about 9:1.     

Effects of finite angular steps and extent of profile data on the calculation of rotational x-ray dose distributions

Computer algorithms for rotational therapy beams, in most cases, perform dose calculations by summing stored fixed beam data at finite angular steps. Such an algorithm, based on the Bentley beam model, was evaluated by comparing calculations with measured data for an 18-MV x-ray beam. Measurements were made in a specially constructed cylindrical water phantom of 15-cm radius using a 0.1-cm3 ionization chamber for an arc of 180 degrees and for a field size of 7.2 X 7.2 cm2 at 100-cm source-axis distance. This study revealed that the Bentley beam model, with fixed beams summed every 10 degrees, predicts the dose in the treatment volume, centered about the isocenter, with an accuracy of approximately 2%. However, dose at depths between the phantom surface and the treatment volume could be underestimated by as much as 10% (3% of isocenter). This was shown to be partially due to the truncated tails of the off-axis profiles in the Bentley model, which extend only 8 mm outside the edge of the radiation field, and the large angular increment of integration (10 degrees). Using beam profiles extending to 4 cm outside the edge of the radiation field and angular steps of 5 degrees or less for summation of fixed beams reduced errors to less than 5%. Therefore, extended beam profiles and smaller angular steps for summing fixed beams are recommended for photon rotation calculation when increased accuracy is required.     

Multiple Malignant Melanomas at Different Burn Scar Areas: A Case Report

Background. Malignant changes in burn scars occasionally develop, the majority being squamous cell carcinoma. Malignant melanomas (MMs) arising in burn scars occur rarely.
Objective. To present the case of a patient with a multiple MM developed at different burn scar areas.
Methods. A case report and review of literature are given.
Results. One was a large pigmented nodular lesion with central ulceration on right flank. It was widely excised and revealed lentigo MM. After that, we took notice another small pigmented lesion on right arm. It was also reported lentigo MM.
Conclusion. This case provided a valuable lesson. Another kind of tumor may be present even if one tumor is found by pathologic observation, especially in burn scar patients. Clinicians should carefully observe burn scars, chronic ulcers, and other pigmented lesions.     

Umbilical portion of recipient's left portal vein: a useful vascular conduit in dual living donor liver transplantation for the thrombosed portal vein.

We considered performing living donor liver transplantation (LDLT) in a larger-size recipient. When the recipient was large-sized, or when the donor liver was severely steatotic or had a right-to-left volume discrepancy. We devised dual living donor liver transplantation (DLDLT) to make up for graft size insufficiency and to secure the donor's safety. However, portal vein thrombosis (PVT) presented a challenge for DLDLT because of the need for intact right and left portal veins for the implantation of both liver grafts. Our 52-year-old male patient with hepatitis B cirrhosis had suffered from repeated esophageal and gastric variceal bleeding and underwent 2 trials of a transjugular intrahepatic portosystemic shunt (TIPS). He developed TIPS occlusion and PVT involving the area just above the spleno-mesenteric confluence to the right and left PV. Also, the right PV orifice was destructed and difficult to isolate because of severe periportal inflammation and neointima growth in the TIPS mesh. The patient's two sons were inadequate for donation because of right-to-left volume discrepancy. Therefore, DLDLT using 2 left lobes was necessary to compensate for graft-size insufficiency and to secure donor safety, and we substituted an intact umbilical portion of recipient's left PV for the destroyed right PV. The patient recovered well, and liver function has been normal for more than a year. In conclusion, the umbilical portion of recipient's left PV can be a useful vascular substitute for the reconstruction of a thrombosed main portal branch in DLDLT.     

INDICATIONS FOR ENDOSCOPIC MUCOSAL RESECTION FOR EARLY COLORECTAL CANCER: SHOULD THEY BE STRICT OR SHOULD THEY BE EXPANDED?

Endoscopic technologies have been developed greatly. As for early gastric cancer, the indications for endoscopic mucosal resection for early colorectal cancer have been widened recently. Technological advances can support wider and deeper resections using endoscopy but the remaining problem for the endoscopic management of cancer is lymph node metastasis. I discuss here the indication for endoscopic mucosal resection for early colorectal cancer to bring into focus the risk factors for metastasis to lymph nodes.