Quadrant Lesions Research Articles

Pediatric-Specific Lesions in Unstable Pelvic Ring Fractures of Skeletally Immature Children: Impact on Diagnosis and Management Decisions.

Surgical fixation of pediatric pelvic ring injuries is gaining popularity to avoid the poor long-term outcomes of pelvic asymmetry. The surgical techniques and fixation choices depend on the individual injuries affecting the anterior and posterior pelvic ring areas. The immature bony pelvis of young children has anatomic differences including soft bones, elastic ligaments, and the presence of growth centers. Understanding the unique pediatric lesions with unstable pelvic fractures is essential for treatment decisions. Anterior lesions include pubic symphysis disruption through the pubic apophysis, single ramus fractures, pubic rami fractures through the triradiate cartilage, and/or the ischiopubic synchondrosis; ischiopubic ramus infolding injury; or the unstable superior and inferior quadrant lesions. Posterior pelvic lesions include iliac wing infolding and sacroiliac joint dislocation or transiliac (crescent) fracture/dislocations through the iliac apophysis growth plate. Pubic symphysis and sacroiliac disruptions are physeal injuries in children, and they have excellent healing potential. External fixation is an ideal choice for anterior ring fixation including bony and pubic symphysis injuries. Posterior lesions are mostly sacroiliac joint disruptions with iliac apophysis separation that can serve as a landmark for vertical displacement correction. Posterior lesions can be treated by percutaneous iliosacral screw fixation or open reduction techniques.

Correlation Between Site and Stage of Breast Cancer in Women.

IntroductionBreast cancer is a worldwide public health issue and a primary cause of death among women. The present study aimed to assess the correlation between site and stage of breast cancer with respect to age among females.MethodsA prospective observational study was conducted at the Medical Oncology Department, Jinnah Postgraduate Medical Centre, Karachi, Pakistan from May 2020 to June 2021. Female patients of 18 years or older with a confirmed diagnosis of breast cancer were included in the study. Histopathological reports were evaluated for tumor characteristics such as histological type, laterality, location, tumor size, grade, lymph node status, and stage of the tumor.ResultsThe majority of the patients presented with advanced stages of tumor. Among all stages of breast tumor, the upper outer quadrant was the most frequent location of the tumor. The majority of the patients with cancer in the upper inner quadrant were diagnosed with stage I (28.57%) (p = 0.011). In contrast, the majority of the upper outer quadrant lesions were identified as stage III and stage IV (p < 0.0001). In patients of age <40 years, statistically significant differences in proportions of tumor location with respect to the stage of the tumor were observed (p = 0.018).ConclusionThe upper outer quadrant and stage III of tumor are the most common site and stage of breast tumor in our population. There is a significant relationship between site and stage of breast tumor. Younger-aged patients had a significantly higher rate of cancers located in the upper outer quadrant in advance stages as compared to other quadrants.

Intravital Assessment of Cells Responses to Conducting Polymer-Coated Carbon Microfibres for Bridging Spinal Cord Injury.

The extension of the lesion following spinal cord injury (SCI) poses a major challenge for regenerating axons, which must grow across several centimetres of damaged tissue in the absence of ordered guidance cues. Biofunctionalized electroconducting microfibres (MFs) that provide biochemical signals, as well as electrical and mechanical cues, offer a promising therapeutic approach to help axons overcome this blind journey. We used poly(3,4-ethylenedioxythiophene)-coated carbon MFs functionalized with cell adhesion molecules and growth factors to bridge the spinal cord after a partial unilateral dorsal quadrant lesion (PUDQL) in mice and followed cellular responses by intravital two-photon (2P) imaging through a spinal glass window. Thy1-CFP//LysM-EGFP//CD11c-EYFP triple transgenic reporter animals allowed real time simultaneous monitoring of axons, myeloid cells and microglial cells in the vicinity of the implanted MFs. MF biocompatibility was confirmed by the absence of inflammatory storm after implantation. We found that the sprouting of sensory axons was significantly accelerated by the implantation of functionalized MFs after PUDQL. Their implantation produced better axon alignment compared to random and misrouted axon regeneration that occurred in the absence of MF, with a most striking effect occurring two months after injury. Importantly, we observed differences in the intensity and composition of the innate immune response in comparison to PUDQL-only animals. A significant decrease of immune cell density was found in MF-implanted mice one month after lesion along with a higher ratio of monocyte-derived dendritic cells whose differentiation was accelerated. Therefore, functionalized carbon MFs promote the beneficial immune responses required for neural tissue repair, providing an encouraging strategy for SCI management.

Efficacy of Periareolar Versus Peritumoral Injection of TC99-Labelled Sulphur Colloid and Methylene Blue Dye for Detection of Sentinel Lymph Node in Patients with Early Breast Cancer: a Comparative Study.

Sentinel lymph node biopsy using dual methods of blue dye and radioactive isotope is what is practised as the standard of care at most of the centres. The combined use of radioactive colloid and blue dye injection is considered the gold standard for axillary sentinel lymph node biopsy in breast cancer with a 97% accuracy rate. The aim of this study is to determine the optimal injection site for methylene blue dye and Tc99-labelled sulphur colloid for sentinel lymph node biopsy in early breast cancer. In both periareolar and peritumoral groups of patients, overall rate of identifying sentinel lymph node (hot, blue and hot and blue nodes) with dual dye was comparable (100% and 96.36%) with p value = 0.475. Also in both groups of patients, overall rate of getting pathological positive sentinel lymph node on final histopathological report was comparable (52.73% and 45.28%) with p value = 0.561. Periareolar versus peritumoral injection of dual dye shows comparable success rates for axillary sentinel lymph node identification and can be considered rapid and reliable method. However, the periareolar route is technically simple and especially privileged in nonpalpable (T0) and upper outer quadrant lesions mainly for the prevention of the shine through phenomenon.

Initial Experience with Simple Oncoplastic Breast Conserving Surgery in Nepal: A Case Report

Oncoplastic breast conserving surgery is increasingly used in the management of early breast cancer. Though its use in Nepal is increasing, it is still under-utilized. We present a case of upper outer quadrant early breast cancer located away from nipple-areola complex managed with radial ellipse segmentectomy 10 years back and under regular follow up. We recommend its usage in upper outer quadrant lesions because of its simplicity, access for sentinel lymph node biopsy and good cosmetic outcome.

Initial Experience with Simple Oncoplastic Breast Conserving Surgery in Nepal: A Case Report

Oncoplastic breast conserving surgery is increasingly used in the management of early breast cancer. Though its use in Nepal is increasing, it is still under-utilized. We present a case of upper outer quadrant early breast cancer located away from nipple-areola complex managed with radial ellipse segmentectomy 10 years back and under regular follow up. We recommend its usage in upper outer quadrant lesions because of its simplicity, access for sentinel lymph node biopsy and good cosmetic outcome.

Magnetic Resonance-guided High-intensity Focused Ultrasound (MRgHIFU) Virtual Treatment Planning for Abdominal Neuroblastoma Utilizing Retrospective Diagnostic 3D CT Images.

Magnetic resonance-guided high-intensity focused ultrasound (MRgHIFU) is a novel treatment for neuroblastoma using ultrasound-induced thermal ablation with real-time MR thermometry. It is unclear which patients would be amenable to MRgHIFU given the retroperitoneal location of many neuroblastomas within the smaller pediatric abdomen. In addition, planning relies on MR scans, which are not routine in the standard pediatric neuroblastoma workup. This study sought to demonstrate that neuroblastomas are targetable with MRgHIFU and available computed tomographic imaging could be utilized for MRgHIFU virtual treatment. Cross-sectional images of 88 pediatric abdominal neuroblastoma patients were retrospectively processed with custom software to be made compatible with the Sonalleve MRgHIFU platform. Targetability measured percent treatment to lesion volume, within adequate safety margins from critical structures. All images were successfully converted into treatment planning files. Median lesion size was 191±195 cm and depth was 29±17 mm. Up to 78 (85%) patients had targetable lesions with a median targetable volume of 15% and ranging up to 79%. Targetability was highest in superficial, right upper quadrant lesions >200 cm, but limited by proximity to bowel and ribs. This study demonstrates the capacity for MRgHIFU to potentially treat the majority of abdominal neuroblastomas and the feasibility of using computed tomographic images for MRgHIFU virtual treatment planning.

The predictors and the prognostic significance of axillary lymph nodes involvement in breast cancer

Background: Breast cancer is the most common cancer among women worldwide. The presence of axillary lymph node metastases in breast cancer is an important factor in assessing prognosis and determines management after surgery. The study aimed at identification of the factors that predict axillary lymph node involvement in CA breast. Addressing the prognostic effect of axillary lymph node involvement in turn of predicting the recurrence of CA breast.Methods: This is a prospective review of one hundred cases of Ca breast who have underwent modified radical mastectomy and axillary clearance at Al-Karama Teaching Hospital during the period from January 2014 to December 2018.Results: Positive axillary involvement was found in (74/100, 74%). The highest occurrence of positive axilla was found in (less than 30 and 30-39 years) age groups (27/74, 36%) with the outer quadrants (upper and lower) constituting the majority (50/74, 68%). Positive axillary involvement was mostly notified in tumor grade T4 (39/74, 53%) and in poorly differentiated lesions (47/74, 64%). The highest recurrence rate was found in patients with positive axillary metastases (12/74, 16%), nodal involvement of ten or more nodes (9/41, 22%), nodes with extracapsular extension (10/51, 20%) and in patients who have not taken and/or completed their chemo-radiation sessions (9/11, 82%).Conclusions: Positive axillary lymph node involvement was seen mostly in: young age patients, outer quadrant lesions, tumors with skin involvement, and poorly differentiated lesions.

Gallbladder Papilloma in a Child Unmasking Metachromatic Leukodystrophy: A Case Report With Review of Literature

Background: Metachromatic leukodystrophy (MLD) is a lipid storage disease characterized the accumulation of sulfatides in different viscera including the gallbladder.Case report: A 2-year-old girl had upper right quadrant lesion that was preoperatively thought to be a biliary cystadenoma. Histologically, the gallbladder lesion was a tubulo-villous papilloma with multiple foci of papillary mucosal hyperplasia. Many storage histiocytes containing metachromatic granules, characteristic of MLD, were present in the tips of the papillae. MLD was later confirmed by enzyme studies.Conclusion: Gallbladder papilloma can be the presenting feature of MLD.

Severe abdominopelvic actinomycosis with colon perforation and hepatic involvement mimicking advanced sigmoid colon cancer with hepatic metastasis: a case study

BackgroundActinomycosis is a rare chronic invasive disease caused by Actinomyces spp. Although abdominopelvic actinomycosis, which involves the colon and the pelvic organs extensively, has been frequently reported, abdominopelvic actinomycosis presenting with colon perforation and hepatic involvement concurrently has yet to be reported.Case presentationA 55-year-old woman presented at the emergency room with squeezing epigastric pain. Palpation of the abdomen revealed a hard mass with no acute peritoneal signs. Vital signs were normal range except for tachycardia. Initial laboratory testing revealed leukocytosis, anemia, elevated C-reactive protein (CRP), hypoalbuminemia; and normal AST/ALT and BUN/creatinine. CT scan of the abdomen-pelvis revealed a microperforations of the sigmoid colon, abscess in the left lower quadrant and hepatic lesion. Furthermore, there was a large infiltrating conglomerated mass invading the urinary bladder, left adnexa, sigmoid, left inguinal canal and left pelvic wall area. Ultrasound revealed an intra-uterine device (IUD). All these findings initially raised a suspicion of malignancy such as advanced cancer of the colon with liver metastasis. Despite the rarity of the disease, actinomycosis were not excluded because of the IUD found on ultrasound. Parenteral antibiotics and percutaneous drainage of abdomen abscess as well as fasting with total parental nutrition were prescribed for sigmoid perforation and abscess. After 10 days of conservative treatment, no remarkable change was detected in conglomerated mass invading pelvis. Furthermore, the finding of newly developed mechanical small bowel obstruction warranted surgery. Exploratory laparotomy was performed for the removal of perforated colon, obstructive small bowel and organs involved and postoperative histology confirmed a diagnosis of colonic actinomycosis. The patient made an uneventful recovery and was started on a 6-month course of penicillin.ConclusionsAbdominopelvic actinomycosis presenting with colon perforation and hepatic involvement is extremely rare; however, it is clinically similar to advanced colon cancer with liver metastasis, therefore, complicating the preoperative diagnosis. A diagnosis of abdominopelvic actinomycosis should be considered in patients with a history of IUD and chronic abdominal pain, along with an abdominal mass or cutaneous abscess. If surgery is indicated, preoperative empirical antibiotic therapy for actinomycosis and frozen biopsy during surgery may be considered.

Characteristics of breast metastases from non-breast solid tumors in 22 patients from a southern Chinese population.

Breast metastases from solid non-breast tumor types are rare; however, they should be always considered in the differential diagnosis of a breast lesion owing to the associated poor patient prognosis and the requirement of different therapeutic strategies compared with those used to treat primary breast cancer. The aim of the current study was to summarize the characteristics of metastases to the breast in a southern Chinese population. The medical records and pathological sections of 22 patients with pathologically confirmed extra-mammary metastases to the breast that presented to Sun Yat-sen University Cancer Center between January 2000 and December 2015 were retrospectively reviewed. The median age of onset for breast metastasis was 43 years (range, 10–62 years) and 19 (86.4%) patients had a known history of a primary tumor. The mean interval from diagnosis of the primary tumor to breast metastasis was 16.5 months (range, 6–56 months). A unilateral (45.5% left, 36.4% right), upper outer quadrant (15/22, 68.2%) lesion of the breast was most frequently initially detected by self-checking (63.6%). The most common origin of the primary tumor was the lung (22.7%). Nasopharyngeal carcinoma accounted for a high proportion of the metastases (18.2%). The median duration of survival from the time of diagnosis of a breast metastasis was 14 months (range, 2–74 months). A total of 10 patients (45.5%) succumbed to the disease. The results also indicated that overall survival in patients that underwent surgery was improved compared with patients who did not undergo surgery. The results of the present study demonstrated that clinical history, imaging findings, pathology from the primary tumor and immunostaining were required in combination to establish an accurate diagnosis. Further investigation into the improvement of the prognosis of patients with metastases to the breast following surgery is required.

High-Grade Cervical Intraepithelial Neoplasia Detected by Colposcopy-Directed or Random Biopsy Relative to Age, Cytology, Human Papillomavirus 16, and Lesion Size.

The aim of the study was to determine whether p16 positive/cervical intraepithelial neoplasia (CIN) 2, 3, and cancer (p16 + CIN 2/3+) detected by colposcopy-directed or random biopsy differ by age, referral cytology, human papillomavirus (HPV) 16, and lesion size. Data from the Shenzhen Cervical Cancer Screening Trial II where, at colposcopy, women who had directed and random cervical biopsies were reviewed to find women with CIN 2, 3, or cancer; 227 such women identified had their paraffin-embedded tissue blocks recut, reviewed, and then immune stained for p16. Data were analyzed by χ, Fisher exact test, and linear regression. After histopathologic review and p16 staining of CIN 2, 175 women were diagnosed with p16 + CIN 2/3+. When compared with those diagnosed by colposcopy-directed biopsy (n = 138), those diagnosed by random biopsy (n = 37) were more likely to have Cytology-Lo (cytology of negative, atypical squamous cells of undetermined significance, or low-grade squamous intraepithelial lesion; p = .07), less likely to have HPV 16 (p = .041), more likely to be 51 years or older (p = .022), and more likely to have 1 quadrant lesions (p < .001). Logistic regression analysis showed p16 + CIN 2/3+ diagnosed by random biopsy was predicted by 1 quadrant lesions (p < .0001) and age of 51 years or older (p = .03) but not by Cytology-Lo (p = .71) nor HPV 16 (p = .26). Women with p16 + CIN 2/3+ diagnosed by random biopsy are older and less likely to have HPV 16; hence, CIN diagnosed by random biopsy may not be as virulent as CIN diagnosed by colposcopy-directed biopsy. Regardless, we advise that CIN diagnosed by random biopsy be viewed like CIN diagnosed by colposcopy-directed biopsy.

Splenosis: A Benign Phenomenon Mimicking Metastatic Cancer

Splenosis is the benign heterotopic transplantation of splenic tissue that results from traumatic splenic rupture or splenectomy. Many clinicians are unfamiliar with this phenomenon, therefore it is often misdiagnosed and most patients undergo unnecessary invasive diagnostic procedures. We present a rare case of liver and splenic bed splenosis mimicking metastatic cancer. This is the case of a 58-year-old male with medical history of hypertension, migraine, bronchial asthma and nephrolithiasis who presented with diffuse abdominal pain, left flank pain and dark-colored urine for the past two days. He denied fever, chills, hesitancy, dribbling, or any other symptoms. Past medical history notable for splenectomy at age 5 secondary to a motor vehicle accident. Physical exam and laboratory tests were unremarkable except for hematuria on urine analysis. A non-contrast abdominopelvic CT identified a calculus at the ureterovesical junction with associated hydronephrosis. Also revealed evidence of prior splenectomy, a solid exophytic lesion at the right hepatorenal fossa measuring 1.8 cm x 2.3 cm, left upper quadrant lesion near the stomach measuring 1.8 cm x 1.5 cm, and small nodular lesion anterior to the rectum measuring 1.4 cm. Further evaluation included a colonoscopy which was essentially normal. A PET CT showed a bilobulated soft tissue density on the splenic bed and perihepatic soft tissue nodularities most likely representing splenosis. A Tc99m sulfur colloid liver-spleen scan demonstrated localized uptake by soft tissue densities localized on the splenic bed, left pelvic wall and right abdomen just below the right liver lobe compatible with active reticuloendothelial activity as it seen with post-traumatic migratory splenosis. We present a very interesting case of splenosis, which results from the auto-implantation of splenic pulp tissue usually due to trauma or following abdominal surgery. Frequency of splenosis varies according to type of injury, being more common after trauma that following elective surgical removal of the spleen. Spleen implants tend to be multiple as are seen in this patient who had spleen trauma at an early age. These are usually confined to the abdominal cavity; although there are reports of thoracic splenosis. On routine radiological studies, these lesions are usually indistinguishable from other benign or malignant lesions for which radioisotope studies are usually recommended to establish the diagnosis. Although most patients are asymptomatic, abdominal pain due to adhesion, torsion or spontaneous rupture can occur. Splenosis should be considered in all splenectomized patients; especially in presence of unexplained or asymptomatic abdominal mass. Whenever this entity is suspected, diagnosis is feasible through radioisotope scanning, avoiding the need of invasive procedures.

Postoperative radiotherapy of internal mammary nodes in breast cancer

Internal mammary nodes are part of the first stop of mammary gland lymphatic drainage.It plays an important role in the process of occurrence and development of breast cancer.Whether irradiation internal mammary nodes or not is still a larger controversy.At present,for the early stage patients,the efficacy of internal mammary lymph node irradiation is not clear.For the patients with positive axillary lymph nodes,inboard or central quadrant lesions,postoperative radiotherapy of internal mammary nodes has a certain value. Key words: Breast neoplasms ; Radiotherapy; Internal mammary nodes

Disconnective surgery in posterior quadrantic epilepsy: a series of 12 paediatric patients.

To assess the surgical outcomes of temporo-parieto-occipital (TPO) and parieto-occipital (PO) disconnection surgery for children with intractable posterior quadrantic epilepsy and a unilateral posterior quadrant lesion based on MRI and functional imaging abnormality in the TPO region on one side. A retrospective review of data of 12 children who underwent TPO or PO disconnective surgery was carried out from September 2009 to September 2012. Three-dimensional surface reconstructions of MRI scans and intraoperative electrophysiological monitoring were used during surgery. Drugs were not discontinued after surgery in any patient. The affected hemisphere was the left in seven patients and the right in five patients. The mean ages at seizure onset and at surgery were four years and 12.3 years, respectively. At the time of surgery, 3 children had atonic seizures, 4 had symptomatic epilepsy with focal seizures and alteration of conscioussness, 4 had secondarily generalised seizures, and 1 child had spasms and tonic seizures. All patients had developmental delay. A pure TPO disconnection was performed in 11 patients and a PO disconnection was performed in the remaining patient. On pathological examination, 3 patients were shown to have focal cortical dysplasia (FCD) Ib, 2 with FCD IIa, 5 with FCD IIb, 1 with gliosis, and 1 with gliosis plus FCD IIa. Following surgery, 2 patients had oedema; 1 required another operation to resect the occipital lobe. At a mean follow-up of 34.5 months, 9 patients (75%) were classified as Engel class I, 2 as Engel Class II, and 1 as Engel class III. All 12 children had contralateral hemianopia postoperatively and improvement in median IQ (p=0.04) was reported three months postoperatively. With respect to the limits of a retrospective and relatively small sample size series TPO and PO disconnection are safe and effective motor-sparing epilepsy surgical procedures in selected patients with the epileptiform zone located in the posterior quadrant on one side.

The impact of method of biopsy on the incidence of breast cancer sentinel lymph node metastases

The dislocation of the malignant cells along the needle tract during breast cancer (BC) diagnosis has been demonstrated by several studies. However, the published experiences that relate the diagnostic technique with sentinel node (SN) involvement are few and controversial. The aim of our analysis was to evaluate the impact of different techniques for preoperative BC biopsy among prognostic factors of metastases occurrence in SN. We reviewed the institutional clinical database of our Center. A total of 674 patients were diagnosed between February 1999 and December 2006 with invasive BC. SN metastases classification followed the 2002 American Joint Committee on Cancer (AJCC) TNM pathological staging: macrometastases, micrometastases, isolated tumor cells or negative. Only macrometastases and micrometastases were considered positive. Concerning fine-needle aspiration cytology, we used disposable needles of the size of 21-27G. For percutaneous biopsy we used cutting needle type "tru-cut"; the Gauge needle ranged between 14 and 20. At univariate analysis of specific parameters using positive SN as outcome, percutaneous diagnostic technique did not affect significantly the SN positivity (p=0.60). At multivariate models only central quadrant lesion (p=0.005) and lymph vascular invasion (LVI) presence (p<0.0001) maintained the statistical significance as risk factor for positive SN status. Polytomic logistics models showed that only LVI maintained the statistical significance both for prediction of micrometastases and macrometastases. Our analysis showed that different techniques used for BC diagnosis did not influence SN status.

Anatomical correlates of recovery in single pellet reaching in spinal cord injured rats

Modeling spinal cord injury (SCI) in animals is challenging because an appropriate combination of lesion location, lesion severity and behavioral testing is essential to analyze recovery of motor function. For particular tests such as single pellet reaching, the contribution of individual descending tracts to recovery has been investigated using specific tract ablation or graded lesions. However, it has not been established whether single pellet reaching is sufficiently sensitive for assessing the efficacy of treatments for cervical SCI (e.g., one of the currently most successful treatment approaches: rehabilitative training). To address this issue, we trained adult rats in single pellet reaching before and after a cervical (C4) spinal lesion. Animals with lesions of increasing severity were grouped into categories based on damage to anatomical structures such as the corticospinal tract (CST) and the rubrospinal tract (RST), two descending motor tracts that have been implicated in fine motor control of the forelimb. We related lesion extent to spontaneous recovery and plasticity-promoting post injury training and found that reaching performance was not correlated with lesion size or the extent of CST or RST injury. Interestingly, the dorsolateral quadrant (DLQ) lesion category, in which the unilateral dorsal CST and most of the unilateral RST are lesioned, was the only category that showed a clear effect of plasticity-promoting treatment (i.e., training), indicating its usefulness as a lesion model for this testing paradigm. The DLQ lesion likely strikes a balance between tissue sparing and functional impairment and is, therefore, best suited to maximize the potential to observe treatment effects of plasticity-promoting treatments using single pellet reaching. Because of the specific lesion size that is necessary to observe treatment effects, the single pellet skilled reaching task can be considered a stringent behavioral test and therefore may be useful for predicting translational success of potential treatments. However, due to the variability in the success rate, the labor-intensive nature, and the limited usefulness to test functional outcome of a wide range of lesion severities, we are hesitant to continue to use single pellet reaching to assess the effectiveness of currently available treatments for cervical SCI.

Oncoplastic Breast Surgery Using Spindle Shaped-Partial Mastectomy for Early Breast Cancer in the Upper Quadrant Area

Background: Oncoplastic surgery is becoming more common, however, only several reports have been published in Japan. We report the results of simple oncoplastic surgery for Japanese patients with early breast cancer in the upper quadrant area. Methods: In seven patients with a past history of breast-feeding and ptotic breasts, we performed oncoplastic surgery involving partial mastectomy and the resection of excess skin and parenchymal tissue. Results: None of the patients received a contralateral operation to produce symmetrical breasts. The width of the resected excess skin tissue ranged from 20 to 50 mm, with the mean width being 30 mm, and its length ranged from 50 to 90, with the mean length being 77 mm. The width of the resected gland tissue ranged from 40 to 65 mm, with the mean width being 53 mm, and its length ranged from 70 to 100 mm, with the mean length being 97 mm. The cosmetic results were excellent. Conclusions: Oncoplastic surgery using spindle shaped-resection was successfully performed in patients with upper quadrant lesions, and the cosmetic results were excellent.

Congenital cholesteatoma: clinical features and growth patterns

ObjectiveThe clinical features and patterns of growth, relative to age, were examined in patients with congenital cholesteatoma to investigate disease progression and site of origin. Patients and methodsWe retrospectively reviewed 72 children younger than 15 years with intraoperatively confirmed congenital cholesteatoma diagnosed using the inclusion criteria of Levenson et al. Patient demographics, history, and otoscopic and operative findings were evaluated. Correlation between mass volumetric and operation age was analyzed in patients with closed-type masses. Parameters of disease extent of middle ear quadrant, ossicular erosion, attic involvement, invasion of the mastoid cavity, and type of mass were assessed relative to age at operation. ResultsMean patient age was 63.1 months (range, 20–179 months), with 51 patients (70.8%) being asymptomatic and diagnosed incidentally. Nineteen patients (26.4%) had closed-type cystic masses, and 53 (73.6%) had open-type lesions. The volume of closed-type masses was linearly correlated with age at operation. Logistic regression showed that increased age at operation was associated with a lower proportion of anterosuperior quadrant lesions, resulting in uncertainty about the site of origin. The possibility of open-type masses also increased according to age at operation. ConclusionCongenital cholesteatoma shows growth and extension over time. Early detection and intervention are necessary to avoid advanced disease.

Temporoparietooccipital disconnection in children with intractable epilepsy

Temporoparietooccipital (TPO) disconnection is described mainly in children with diffuse posterior quadrant lesions and concordant electroencephalography (EEG) findings. The authors report on 16 children who underwent TPO surgery, including 4 with no definite epileptogenic lesion and 8 with generalized electroclinical manifestations. The authors conducted a retrospective review of clinical, neuropsychological, EEG, imaging, and histopathological data in 16 children with intractable epilepsy who underwent TPO disconnection and/or resection at their center between December 1998 and March 2010. Seizure onset occurred between the ages of 1 and 24 months, and TPO surgery was performed between the ages of 0.2 and 17 years. All children had refractory seizures, including epileptic spasms in 10 and tonic seizures in 7, and all had developmental delay. Twelve children had epileptogenic lesions on MR imaging, including 6 with posterior quadrant dysplasia. Four children had only subtle white matter signal change or unusual sulcation on MR imaging, associated with subtle but concordant EEG and functional imaging abnormalities. After a mean follow-up of 52 months (range 12-114 months), 9 children (56%) are seizure-free and 5 (31%) experienced seizure reduction of greater than 50%. Focal or regional background slowing on EEG was correlated with favorable seizure outcome. Five children showed developmental progress and 3 had acceleration in development following surgery. None of the children developed new motor deficits postoperatively. Temporoparietooccipital disconnection is an effective, motor-sparing epilepsy surgery procedure for selected children with refractory focal or generalized seizures with localization to the posterior quadrant on 1 side, with or without a discrete lesion on MR imaging.