Entire Floor Research Articles

Ameloblastoma With Lung Metastasis Treated With Radiotherapy: A Case Report

Ameloblastoma is the most common of the odontogenic tumors and it rarely exhibits malignant behavior with metastasis development. Here, we report the case of a 48-year-old patient. In 2001, the patient had been diagnosed with ameloblastoma, as confirmed by computed tomography and histopathology, and had undergone segmental hemimandibulectomy and reconstruction with rib graft. In 2007, the same patient again sought treatment, presenting with an extensive tumor involving the entire floor of the mouth. The patient was referred to a department of head and neck radiotherapy. The response to treatment was excellent, with remission of the lesion. One year later, a tumor was discovered in the left lung and was attributed to the ameloblastoma. The same radiotherapy strategy was adopted. The patient is under rigorous outpatient monitoring and is free of disease. The final considerations are justified by the effectiveness of radiation therapy for a benign tumor, eliminating mandibular recurrence and metastatic lung tumor.

Giants of Orthopaedic Surgery: Melvin J. Glimcher MD.

David R. Eyre was a newly minted PhD in biochemistry from the University of Leeds when he joined Melvin Glimcher’s lab in 1971. Eyre’s new lab in Boston, MA, USA was a far cry from his previous one in the United Kingdom, where he routinely had to hunt for well-worn equipment. Glimcher’s lab featured cutting-edge resources from state-of-the-art protein sequencers to electron microscopes and nuclear magnetic resonance equipment. There was an entire floor dedicated to biochemistry. The lab housed more than 100 scientists, a large program for its day, providing an atmosphere that encouraged collaboration. His lab was even a research center for the training of senior scientists and postdoctoral fellows who wished to develop their own research centers in the basic sciences and musculoskeletal system [9]. “The size and scale of the lab was like nothing I had ever seen before,” Eyre told CORR® in a phone interview. “No one had a lab of this scale. It takes a quite exceptional person to lead a lab of that magnitude.” Melvin J. Glimcher MD was that person (Fig. 1). The scale of Glimcher’s educational background and professional experience matched the scale of his lab. The first tenured Chair in Orthopaedic Surgery at Harvard Medical School at the age of 39, Glimcher was also Chief of Orthopaedic Surgery at Massachusetts General Hospital and Boston Children’s Hospital in Boston, MA, USA. His work in orthopaedics, clinical medicine, biology, mechanical engineering, and the basic sciences afforded him the opportunity to collaborate with exceptional scientists using the most advanced technological tools of the day. Fig. 1 The scale of Glimcher’s educational background and professional experience matched the scale of his lab. Published with permission from Boston Children’s Hospital. “The lab, and more specifically, Glimcher himself, could infuse you with his enthusiasm,” Eyre said. “You were on the cutting edge of everything. This was high-level basic research. It certainly sparked my interest in research.” Glimcher’s decision to pursue a career in orthopaedics reportedly was based on a conversation he had with one of his professors, who told him that orthopaedics was a “barren field” [6]. But Glimcher seemed to understand the potential in orthopaedics early on, and quickly recognized where the field was headed. In 1966, Glimcher told The Boston Globe, “Orthopaedics in the future will not be simply surgery, or medicine, but a combination of both plus knowledge of the whole area of skeletal structure, its biology, chemistry, and biomechanics” [13]. “He thought he could really make a difference in the field,” Laurie Glimcher MD, his daughter and Stephen and Suzanne Weiss Dean of Weill Cornell Medical College in New York, NY, USA told CORR® in a phone interview.

Correction of Late Posttraumatic Enophthalmos Using an Antral Balloon

Enophthalmos is the posterior displacement of the ocular globe within the bony orbit. Correction of late posttraumatic enophthalmos is one of the most challenging surgical procedures. We have performed a corrective procedure for late enophthalmos using an antral balloon, with or without minimal bone grafting. All orbital contents were separated from the bone fragments, infraorbital nerve, and mucosa of the maxillary antrum. The remaining orbital floor was fractured by the surgeon's digital pressure from the maxillary antrum. The antral balloon was placed in the maxillary antrum and inflated under direct vision from inside the orbit. After a consolidation period, the patient underwent antral balloon removal. A total of 5 patients underwent repair of late enophthalmos using this antral balloon technique. The median time from initial injury was 14 months (range, 6-90 months). The median antral balloon placement duration was 76 days (range, 53-106 days). Satisfactory symmetries were achieved in 4 patients. Mild residual enophthalmos remained in 1 patient, who had an orbital framework deformity and was missing the entire orbital bony floor preoperatively and who required simultaneous bone grafting. The ideal indication for our technique was the need for orbital floor reconstruction, without an orbital framework deformity. This technique could avoid autogenous bone grafting or permanent alloplastic implantation, which may cause a foreign body reaction, chronic inflammation, and migration. We believe that our new technique is one of the least invasive corrective procedures for late posttraumatic enophthalmos.

Does Onodi cell limit the exposure of sella during transsphenoidal pituitary surgery?

This study aims to evaluate the association between the presence of Onodi cell and sella exposure during endonasal endoscopic transsphenoidal pituitary surgery (EETPS). Forty-two patients who underwent EETPS for a pituitary adenoma with the collaboration of Neurosurgery and Otorhinolaryngology Departments at Katip Çelebi University Atatürk Training and Research Hospital between February 2011 and March 2014 were retrospectively analyzed. Preoperative paranasal sinus tomography and intraoperative findings were evaluated for the presence of Onodi cells. The location of the Onodi cell and its relation with sella exposure during surgery were also assessed. The incidence of Onodi cell was 19%. The Onodi cells were observed in eight of 42 patients on preoperative paranasal sinus computed tomography. The Onodi cells were unilateral in five patients and bilateral in three. Intraoperative findings were correlated with tomographic findings. In seven patients, Onodi cells limited the exposure of sellar floor and the inferior-medial wall of these cells were removed and connected with the sphenoid sinus and the entire sellar floor was exposed. In the remaining one patient, the Onodi cell was smaller and located superolaterally. This cell was not removed, as it did not limited the sellar exposure. The Onodi cell may limit the sella exposure during transsphenoidal surgery. Onodi cell should be removed and connected with the sphenoid sinus cavity for the entire sellar floor exposure.

IJARCCE - Computer and Communication Engineering

In this paper we are coming up with an embedded system with ARM7 processor controlling the operation of the elevator and camera. The microprocessor is programmed to run three tasks namely an elevator, a camera, and an embedded shell. The elevator and camera work together with the camera taking a snapshot of the occupants in the elevator every time the door opens. The tasks need precise timings which require employment of a real time operating system which provides determistic task switching's and precise outputs. This paper employs RTX real-time operating system for the three tasks to run concurrently. The elevator is programmed in a way to accept simultaneous pressing of the entire floor buttons and is based on a UART system which makes display to be connected to it. The camera takes a photo as soon as the door is opened as it is given as a separate task there is no way the camera will fail to take a photo before the door is closed. This paper also includes an embedded shell which can monitor and manipulate any memory location on the target board making it a powerful tool for debugging errors and can read and write data on to various memory locations in the processor. It can be used on any embedded system using an ARM7 processor giving it a wide range of applications.

Effectiveness of a Worksite Social & Physical Environment Intervention on Need for Recovery, Physical Activity and Relaxation; Results of a Randomized Controlled Trial

ObjectiveTo investigate the effectiveness of a worksite social and physical environment intervention on need for recovery (i.e., early symptoms of work-related mental and physical fatigue), physical activity and relaxation. Also, the effectiveness of the separate interventions was investigated.MethodsIn this 2×2 factorial design study, 412 office employees from a financial service provider participated. Participants were allocated to the combined social and physical intervention, to the social intervention only, to the physical intervention only or to the control group. The primary outcome measure was need for recovery. Secondary outcomes were work-related stress (i.e., exhaustion, detachment and relaxation), small breaks, physical activity (i.e., stair climbing, active commuting, sport activities, light/moderate/vigorous physical activity) and sedentary behavior. Outcomes were measured by questionnaires at baseline, 6 and 12 months follow-up. Multilevel analyses were performed to investigate the effects of the three interventions.ResultsIn all intervention groups, a non-significant reduction was found in need for recovery. In the combined intervention (n = 92), exhaustion and vigorous physical activities decreased significantly, and small breaks at work and active commuting increased significantly compared to the control group. The social intervention (n = 118) showed a significant reduction in exhaustion, sedentary behavior at work and a significant increase in small breaks at work and leisure activities. In the physical intervention (n = 96), stair climbing at work and active commuting significantly increased, and sedentary behavior at work decreased significantly compared to the control group.ConclusionNone of the interventions was effective in improving the need for recovery. It is recommended to implement the social and physical intervention among a population with higher baseline values of need for recovery. Furthermore, the intervention itself could be improved by increasing the intensity of the intervention (for example weekly GMI-sessions), providing physical activity opportunities and exercise schemes, and by more drastic environment interventions (restructuring entire department floor).Trial RegistrationNederlands Trial Register NTR2553

A multidisciplinary approach to the investigation of “La Caverna dell’Antimateria” (1958–1959) by Pinot Gallizio

Abstract Background This study concerns the application of non-invasive and micro-invasive analyses for the study of a contemporary artwork entitled La Caverna dell’Antimateria (“The Cave of Antimatter”) which was created by Pinot Gallizio in 1958–1959. The work represents one of the most significant examples of industrial painting. It consists of a total of 145 meters of painted canvas, designed in order to cover the entire floor plan of the René Drouin gallery in Paris, where it was displayed for the first time. Gallizio wanted to create an environment in which visitors could find themselves immersed in painting, in what he termed as a “work-environment”. Non-invasive (Fibre Optic Reflectance Spectroscopy) and micro-invasive analyses (Fourier Transform Infrared and micro-Raman Spectroscopies, Pyrolysis-Gas Chromatography and Gas Chromatography/Mass Spectrometry) were performed on three of the canvases which constitute this work of art in order to obtain information regarding the artistic materials used by Gallizio. Results Pigments and unconventional materials (such as metal wires, sand) are present in the canvases that form the ceiling. The colours are unevenly distributed on the surface, thus revealing large areas of the white preparation below. In the canvas of the wall, instead, the paint is applied more uniformly and gives a dark colour cast. The analytical results led to the identification of many of the materials used by Gallizio. The pictorial palette consists of both inorganic and organic pigments, while polyvinylacetate, pure or mixed with a siccative oil, was identified as a binder thus confirming what was reported by the artist in his notes. Conclusions The results of this research provide information concerning the artistic technique used by Pinot Gallizio. The analyses were successfully performed both in situ and on micro-samples in order to characterise the pigments of the coloured area, the ground layer and the organic binders.

Vibration properties of a timber floor assessed in laboratory and during construction

Natural frequencies, damping ratios and mode shapes of a prefabricated timber floor element have been assessed experimentally in laboratory with different boundary conditions and in situ (in field) at different stages of construction. In laboratory the change in modal parameters was studied with free-free boundary conditions and simply supported on two sides. Three different simply supported tests with changes in boundary conditions were carried out; the floor placed on the support without any fastening or interlayer between support and floor, the floor screwed to the supports and the floor placed on an elastic interlayer between support and floor. The in situ tests were carried out first on the single floor element and then on the entire floor of the room into which the floor element was built in. The damping ratio of the floor increased from 1% to 3% when simply supported in laboratory to approximately 5% when placed upon a polyurethane interlayer (Sylodyn®) in situ, and to approximately 6% when fully integrated in the building. Thus the in situ conditions have considerable influence on the damping and the values assessed are very high in comparison with damping values suggested in design codes. Regarding natural frequencies it was concluded that the major change in these occur as the floor element is coupled to the adjacent elements and when partitions are built in the studied room, the largest effect is on those modes of vibration that are largely constrained in their movement.

A systematic approach of process planning and scheduling optimization for sustainable machining

The implementation of sustainability in manufacturing companies, whose activities are usually characterized by high variety and low volume, has been crippled by the lack of effective process planning and scheduling solutions for sustainable management of manufacturing shop floors. To address the challenge, an innovative and systematic approach for machining process planning and scheduling optimization has been developed. This approach consists of a process stage and a system stage, augmented with intelligent mechanisms for enhancing the adaptability and responsiveness to job dynamics in machining shop floors. In the process stage, key operational parameters for machining a part are optimized adaptively to meet multiple objectives and constraints, i.e., energy efficiency of the machining process and productivity as objectives and surface quality as a constraint. In the consecutive system stage, to achieve higher energy efficiency and shorter makespan in the entire shop floor, sequencing/set-up planning of machining features, operations and scheduling for producing multiple parts on different machines are optimized. Artificial neural networks are used for establishing the complex nonlinear relationships between the key process parameters and measured data sets of energy consumption and surface quality. Intelligent algorithms, including pattern search, genetic algorithm, and simulated annealing, are applied and benchmarked to identify optimal solutions. Experimental tests indicate that the approach is effective and configurable to meet multiple objectives and technical constraints for sustainable process planning and scheduling. The approach, validated through industrial case studies provided by a European machining company, demonstrates significant potentials of research applicability in practice.

Hitchhiker's guide to the literature. Journal: Cell.

Well, I've been avoiding the topic, but finally the time has come to talk about impact factors. Before we start, I want you to picture your humble Hitchhiker's Guide to the Literature correspondent. He is sitting in the JPCH editorial offices. If you choose, you may assume that these offices occupy the entire top floor of a waterfront skyscraper. Sweeping Sydney Harbour views, soft leather couches and the dulcet tones of the in-house string quartet all work together to aid the concentration of the journal's staff, in general, and your intrepid reviewer, in particular. Got that mental picture firmly in mind? Stick with me, this is going somewhere, I promise. Well, here at the journal (yes, thank you, I will have another chocolate truffle), as you can easily imagine, we are above such irrelevancies as impact factors. We have other, loftier yardsticks by which we measure ourselves. But sadly, many journals live or die by their impact factors. The higher the impact factor, the greater the prestige. If your impact factor is high, authors will send their best papers to you, desperate to be published in your pages. If it is low, papers will come limping to you, tattered and bleeding, only after rejection by several other journals (no, I had a foot massage earlier, thanks). Publishing the best papers raises your impact factor, publishing poor ones lowers it. This virtuous or vicious cycle (depending on where you stand in the rankings) is a huge force in modern medical publishing, moving advertising dollars and shaping editorial policy. What is the impact factor and how is it calculated? The full answer lies in the realm of the occult (a small glass, perhaps … wait, what year is it? The '94?), but in brief, this is a measure of how many times other authors cite papers published in a journal, divided by the total number of papers published by that journal. If you look at the top 20 journals as listed by impact factor, some interesting patterns emerge. Firstly, fully 10 of the 20 (including the ‘top’ journal, Ca – A Cancer Journal for Clinicians) publish only review articles, consensus statements and the like, which tend to attract more citations than original research. Some of them publish very few papers, making the denominator for calculating the impact factor smaller. Eight of the 20 are Nature journals (not all Nature Reviews journals). That leaves only half a dozen independent journals in that stratospheric realm which publish original research. One of them is Cell. What is it like? I haven't a clue. I tried to read an issue, on your behalf, but I could not understand a word of it. Sample article title: ‘The ATAC acetyltransferase complex coordinates MAP kinases to regulate JNK target genes’ Scientific importance: ***** General interest to paediatricians: *****

Field Measurements of Sound Insulation in Large, Open Rooms

The international standards governing the measurement of sound insulation in buildings (ISO 140) do not explicitly cover the methodology of taking measurements in large open rooms. A building with open plan floors, each of about 1300 m2, is considered here. The ISO 140-14 standard, through an analysis of sound level distribution, allowed smaller partitions to be identified and used as reference volumes. Different index calculation methods allowed critical issues to be highlighted. The impact sound index was strongly affected by geometry (i.e., volume); therefore, its calculation using different virtual volumes gave differing results. Furthermore, the index calculated using the logarithmic average of the indices for each virtual volume and an extended analysis of measurements over the entire floor provided different results. The airborne sound insulation index was demonstrated to be independent of the choice of virtual volumes; it could be consistently calculated using either the logarithmic average or the extended analysis.

Responding To The Concerns Of Student Cultural Groups: Redesigning Spaces For Cultural Centers

This paper describes the engagement of a student committee in redesigning an entire floor of a university union to accommodate student cultural centers and provide space in a fair and equitable manner. The reorganization focused on the process as well as the task of allocating space, with an emphasis on the opportunity to foster the development of student leadership skills. Theories guiding the process included Chickering’s seven vectors of college student development, the campus ecology model, the Social Change Model of Leadership, and universal design.

Experimental investigation of a ventilation system based on wall confluent jets

The flow behavior of isothermal and non-isothermal wall confluent jets (WCJ) ventilation system was investigated experimentally in a mock-up office environment. Two flow regions were identified: first, a primary region is developed below the supply device, with axis along the inlet wall, and a secondary wall-jet forms along the floor. The velocity and temperature fields were recorded by traversing a hot wire and thermistor anemometers for both primary and secondary regions. The results show self-similarity characteristic of the velocity and temperature profiles for both isothermal and non-isothermal WCJ. Maximum velocity decay and its spreading rate are linear and independent of the inlet airflow rate. Minimum temperature difference and its spread also show linear decay. The spreading rates for maximum velocity are similar in both the primary and secondary regions normal to the inlet wall and floor, respectively, which is consistent with previous studies on wall jets. The variation of draught rating is evaluated via mean velocity, turbulence intensity and temperature. Although the WCJ has slow velocity decay, which enables it to cover almost the entire floor of the test room, the draught is acceptable in the occupied zone according to ISO 7730. PMV (predicted mean vote) and PPD (predicted percentage dissatisfied) are presented for the occupied zone of the room.

The role of charophytes in a Mediterranean pond created for restoration purposes

A small, shallow basin was created and flooded with groundwater in a Reserve Area in Albufera de València Natural Park (AVNP) under the scope of a restoration program intended to mimic typical environments such as freshwater springs, abundant in the past but currently suffering from deterioration (desiccation, pollution, etc.), with the ultimate goal of increasing local biodiversity of submerged macrophytes, particularly charophytes. In this study we have monitored, from April 2009 (a few months after its first flooding) to September 2012, the dynamics of charophyte growth and related physical, chemical and biotic variables to highlight the factors determining charophyte success. Just after flooding, five charophyte species grew spontaneously when oospores germinated in the sediments. Chara hispida populations largely dominated the community and developed dense meadows that covered virtually the entire pond floor. Charophytes exerted a negative influence on phytoplankton densities, increasing water transparency. C. hispida stands precipitated substantial CaCO3 in the form of incrustations on the plants, accompanied by coprecipitation of inorganic phosphorus, maintaining low concentrations of soluble P in the water. Reduced groundwater inflow, increased salinity, nutrient concentration, turbidity and augmented feeding pressure by waterfowl, separately or by synergistic effects, considerably reduced charophyte development during the final year of the study; however, charophytes still represent one of the most extensive and dense stands of submerged vegetation within AVNP, verifying the achievement of the goal of the restoration plan. The knowledge obtained has allowed us to recommend several measures to counteract the decrease of charophytes, which can also be applied in other regions affected by the same stressors.

Using Air Curtains in Gas Sensing System to Enhance Its Directivity

Over the past decades, there has been growing interest in developing mobile robots that can localize gas sources. Potential applications of such robots include searches for gas leaks and environmental pollutants. The searches for hazardous chemical sources can be too risky for human workers, and therefore, are better suited for robots. However, to find a gas source is not a straightforward task for robots. Molecular diffusion is generally an extremely slow process. Therefore, the gas molecules released from their source are carried by airflow and trail in the downwind direction. The resultant aerial trail of the released gas is called a plume. Since the plume has a shape elongated in the downwind direction, the gas concentration gradient along the airflow direction is extremely small. Moreover, the airflow in environments of practical interest is almost always turbulent. Since the turbulence of the airflow makes the plume meanders randomly, the measurement of the small gas concentration gradient becomes even harder. The airflow direction can be used as a reliable cue to estimate the direction of the gas source. However, a bulky ultrasonic anemometer is required to accurately measure the direction of the weak airflow in indoor environments.Here we propose to use actively generated air curtains to enhance the directivity of the gas sensors on a mobile robot. We have developed an active stereo nose, which consists of two gas sensors and a single air nozzle. Air is sucked using pumps into laterally aligned two intake pipes in which the gas sensors are placed. The exhaust of the pumps is ejected from the nozzle, which is placed between the two intake pipes. An air curtain generated from the nozzle has been found effective in enhancing the difference between the two gas sensor responses. The direction of a gas source can be determined simply by comparing the left and right gas sensor responses. Here we show the extension of this method to two-dimensional directional determination. The proposed system has four gas sensors, and therefore, is termed active quad nose (AQNose). A number of small nozzles are aligned to form air curtains between the front, left, back, and right gas intake pipes.In the experiments, saturated ethanol vapor was released from a gas source at a constant rate of 100 mL/min. Two arrays of DC fans were placed in the room to generate a circulating airflow field mimicking the natural convection. The velocity of the airflow near the floor was 10 cm/s, and was almost uniform over the entire floor. A metal oxide gas sensor (TGS2620, Figaro Engineering) was placed in each of the four intake pipes to detect the ethanol gas. Air was sucked into each intake pipe at 3.0–4.4 L/min. The sensor response was defined as the ratio of the sensor resistance in gas to that in air. Since the sensor resistance decreases with the gas concentration, the sensor response value also decreases with the gas concentration. AQNose was placed at various locations from 50 cm upwind of the gas source to 200 cm downwind. At all locations tested, the gas sensor facing to the gas source showed the largest response change, and the direction of the gas source was successfully determined by comparing the response values of the four sensors. The results show the effectiveness of the active air curtain generation.

Predicting Hydrodynamic and Heat Transfer Effects of Sparger Geometry and Placement Within a Column Photobioreactor Using Computational Fluid Dynamics

This research investigates the effects of the sparger on flow patterns and heat transfer within a column photobioreactor (PBR) using computational fluid dynamics (CFD). This study compares two types of spargers: a porous membrane, which occupies the entire floor of the reactor, and a single sparger, which is located along the centerline of the PBR floor. The PBR is modeled using the Lagrangian–Eulerian approach. The objective of this research is to predict the performance of PBRs using CFD models, which can be used to improve the design of PBRs used to grow microalgae that are used to produce biofuels and bioproducts.

A 100-year extreme snow-avalanche record based on tree-ring research in upper Bødalen, inner Nordfjord, western Norway

This paper analyses with the help of tree-ring studies the recurrence of extreme snow avalanches in a path situated in the upper Bødalen valley and originating from an outlet glacier of the Jostedalsbreen ice cap. By analysing tree-ring patterns of 91 trees, four extreme snow-avalanche events, extending over the entire valley floor and up to a distance of 800m from the foot of the slope, are clearly highlighted during the 20th century and at the beginning of the 21st century. Return periods of 15 to 20years for the most extreme events are extracted from the analyses, and recurrence intervals of 10 to 15years for avalanches presenting distinct deposition lobes uphill of the distal torrent. Results obtained by tree-ring analyses are successfully compared with available documents at different spatial and temporal scales. Rock-face snow-avalanche occurrences in the area, of small to medium size, are associated with heavy wintry precipitation combined with strong winds. However this normal situation is not valid for extreme snow avalanches crossing the path investigated in the paper, which result from the outlet glacier located in the starting zone; this glacier commands spatial and inter-annual variations of snow accumulation in the departure zone.

Indoor location awareness based on received signal strength ratio and time division multiplexing using light-emitting diode light

We propose and demonstrate an indoor location awareness method for an autonomous robot vehicle using light-emitting diodes (LEDs). The location is estimated by measuring received signal strength ratio (RSSR), which is the relative ratio of optical powers detected between each LED and optical receiver. In this method, multiple LED lamps on the indoor ceiling are used, which can radiate light only during the individual time slot assigned to each of them. Using the RSSRs, circle or straight line equations are obtained and the crossing point among those equations determines the location of the object. In the experiment, four LED lamps are iden- tified by time-division multiplexing with room dimensions of 1.0 × 1.0 × 1.3 m 3 , and the results show that the mean of the location error is 3.24 cm in the entire floor area. © The Authors. Published by SPIE under a Creative Commons Attribution 3.0 Unported License. Distribution or reproduction of this work in whole or in part requires full attribution of the original publication, including

Oral floor and gingival metastasis of cholangiocarcinoma: a case report and review of the literature.

The oral cavity is very unusual site of metastases even though wide spread metastatic disease may be present. The most common primary sites that metastasize to the oral cavity are lung, kidney, breast, and hepatocellular carcinoma. We present a rare case of a 77-year-old Caucasian female with metastasis from a cholangiocarcinoma to the oral floor contiguous with lingual gingival mucosa. The patient presented with left sided rib pain. A CT scan of the chest, abdomen, and pelvis showed multiple pulmonary nodules and a single dominant mass in the right lobe of the liver. This tumor was 6.5 cm with multiple satellite lesions surrounding it. The liver biopsy was diagnostic of a moderately to poorly differentiated adenocarcinoma, consistent with a primary cholangiocarcinoma. After undergoing one cycle of gemcitabine chemotherapy, the patient noticed an extremely rapidly growing mass involving her right lower gingiva and the entire right floor of her mouth. The biopsy of that mass also showed a moderately to poorly differentiated adenocarcinoma. The gingival tumor had a similar cytomorphology and immunophenotype as her cholangiocarcinoma. Therefore, an unusual site for metastatic cholangiocarcinoma was confirmed.

Minimally invasive transnasal medial maxillectomy for treatment of maxillary sinus and orbital pathologies

Conclusion: Minimally invasive transnasal medial maxillectomy with preservation of the nasolacrimal duct may provide an alternative method for surgical treatment of selected maxillary sinus and inferior orbit pathology if more extensive endonasal or external approach procedures are to be avoided. Objectives: To present a modification of the transnasal endoscopic approach to the maxillary sinus leading through its medial wall, anteriorly to the nasolacrimal duct that considerably improves access to the antero-inferior part of the maxillary sinus and entire orbital floor. To discuss indications for the procedure along with surgical outcome after at least 12 months of follow-up. Methods: A total of 22 selected patients with extensive/refractory inflammatory maxillary sinus disease that could not be cleared completely through middle meatal antrostomy or pathologies of the inferior orbit that required uncompromised access to the orbital floor were operated with this method. The effectiveness of the treatment was evaluated through clinical symptomatology and endoscopic examination to confirm eradication of the disease. Results: The presented method allowed for good overall symptom control and eradication of disease confirmed endoscopically in about 90% of cases with an inflammatory type of disease. The visualized reach within the maxillary sinus with commercially available endoscopic instruments was conspicuously improved as compared with middle meatal antrostomy.