Oral rehabilitation of a 12-year-old patient diagnosed with a central giant cell granuloma using a fibula graft and an implant-supported prosthesis: a clinical report.

This clinical report describes the oral rehabilitation of a 12-year-old boy with a central giant cell granuloma of the mandible. He underwent en bloc resection of a central giant cell granuloma, free vascularized fibula reconstruction, implant placement, and prosthesis fabrication. The multidisciplinary approach successfully restored function and esthetics.

Exploiting phosphonate chemistry in metal-mediated dearomatization: stereoselective construction of functionalized spirolactams from arene ruthenium complexes.

Arene ruthenium complexes possessing beta-amido phosphonate side chains participate in intramolecular spirocyclization reactions to deliver stable cyclohexadienyl ruthenium adducts. Spirocyclization is accomplished via a tandem two-step sequence that involves stereoselective nucleophilic aromatic addition to the ipso position of the coordinated arene, followed by intermolecular Horner-Wadsworth-Emmons olefination. The resulting eta5-cyclohexadienyl complexes can then be diastereoselectively converted to metal-free azaspiro[4.

Functionalized spiro- and fused-ring heterocycles via oxidative demetalation of cyclohexadienyl ruthenium complexes.

Electron-rich alkoxy- and chloro-substituted azaspirocyclic cyclohexadienyl Ru(II) complexes have been converted to either azaspiro[4.5]decane derivatives or functionalized tetrahydroisoquinolines by treatment with suitable oxidizing agents. Copper(II) chloride was found to provide demetalated products in high yield relative to the other oxidants examined (FeCl(3), DDQ, CAN, [Cp(2)Fe][PF(6)], phenyliodine diacetate, IBX).

Oxidative demetalation of cyclohexadienyl ruthenium(II) complexes: a net Ru-mediated dearomatization.

[reaction: see text] An experimentally simple method for the demetalation of spirocyclic cyclohexadienylruthenium(II) complexes has been developed. Treatment of an alkoxy-substituted cyclohexadienyl complex with CuCl(2) affords either azaspiro[4.5]decane derivatives or heavily functionalized tetrahydroisoquinolines.

Serendipitous diagnosis of protein S deficiency.

A 46-year-old male sought periodontal care for a swelling on his right mandibular gingiva. An excisional biopsy revealed a well-differentiated squamous cell carcinoma. Surgical treatment consisted of a right segmental mandibulectomy with ipsilateral right neck dissection and fibular free flap reconstruction.

Evaluation of selective lymph node sampling in the node-negative neck.

Objective: To determine whether intraoperative selective lymph node sampling before neck dissection in the node-negative (N0) neck accurately reflects the disease content of the neck and can be used to assist in treatment selection.

Study Design: A prospective clinical study at a university medical center.

Methods: Over a 2-year period, 36 patients with head and neck squamous cell carcinoma scheduled to undergo 41 elective neck dissections were enrolled.

A possible tektite strewn field in the Argentinian Pampa.

Impact glass associated with 11 elongate depressions in the Pampean Plain of Argentina, north of the city of Rio Cuarto, was suggested to be proximal ejecta related to a highly oblique impact event. We have identified about 400 additional elongate features in the area that indicate an aeolian, rather than an impact, origin. We have also dated fragments of glass found at the Rio Cuarto depressions; the age is similar to that of glass recovered 800 kilometers to the southeast.

Prudent management of the mid-cheek mass: revisiting the accessory parotid gland tumor.

Objectives/hypothesis: The head and neck surgeon's fascination with parotid surgery arises from the gland's spectrum of histopathological presentations, as well as the diversity of its morphological features. A mass arising in the mid-cheek region may often be overlooked as a rare accessory lobe parotid neoplasm. This report serves to revisit the topic of accessory parotid gland neoplasms to emphasize proper management, particularly the surgical aspects, so that consequences of salivary fistula, facial nerve paralysis, and recurrence are avoided.

Transverse lag screw fixation in midline mandibulotomy. A case series.

Vertical midline mandibulotomy has provided a relatively simple and efficient means of obtaining access to intraoral tumors that are too large or too posterior to be removed transorally. Midline mandibulotomy has had the advantage of nerve and muscle preservation and places the osteotomy outside the typical field of radiotherapy, in contrast to lateral and paramedian osteotomies. Plate and screw fixation has been the usual means of osteosynthesis for these mandibulotomies; however, plate contouring over the symphyseal surface has been a time-consuming process.

Schwann cell-onion bulb tumor of the trigeminal nerve: hyperplasia, dysplasia or neoplasia?

Onion bulbs are concentric lamellar structures formed by Schwann or perineurial cells, which may be seen in several generalized or localized diseases of the peripheral nerve. There is debate regarding the pathogenesis of localized tumefactions displaying these microscopic structures. We report the fifth case, to our knowledge, of a Schwann cell-onion bulb tumor, which arose in the trigeminal nerve of a child with an unclassifiable, probably distinct, neurocutaneous syndrome; we also provide evidence for a neoplastic or hamartomatous origin.

Simultaneous transfer of free fibula and radial forearm flaps for complex oromandibular reconstruction.

Several composite free flaps have been described for use in oromandibular reconstruction. Particularly in extensive defects, there may be no single flap which combines sufficient bone stock with thin, pliable, soft tissue. By combining two free flaps, the best osseous and soft-tissue elements may be independently selected, to yield a result superior to that achievable with one free flap alone.

Pseudoaneurysm of the petrous internal carotid artery after skull base infection and prevertebral abscess drainage.

A 37-year-old woman with a skull base infection sustained massive oropharyngeal bleeding after incisional nasopharyngeal biopsy and drainage of a prevertebral abscess. A pseudoaneurysm originating at the petrous portion of the internal carotid artery was initially misinterpreted on MR images as typical postoperative change within a resolving abscess cavity. Follow-up MR imaging and conventional angiography ultimately disclosed the pseudoaneurysm.

Surgical management of the substernal thyroid gland.

From 1992 to 1996, 19 patients had surgical resection of a substernal thyroid gland at the University of Rochester Medical Center, Rochester, New York. Based on a retrospective review of the 21 procedures performed, an algorithm for evaluation and surgical intervention is proposed. A limited medical workup is indicated and consists of a chest x-ray, thyroid function tests, computed tomography scan, and, possibly, fine-needle aspiration.

Solitary subglottic neurofibroma: MR findings.

We present a case of subglottic neurofibroma, which is of interest because laryngeal neurofibroma rarely occurs in the subglottic space. Nonspecific MR findings did not allow us to exclude the preoperative diagnosis of hemangioma.

Subglottic nerve sheath tumor in a pediatric patient: case report and literature review.

Background: Although nerve sheath tumors (neurilemmoma and neurofibroma) can occur on any nerve with Schwann cells, laryngeal involvement is very uncommon. The vast majority of reported laryngeal nerve sheath tumors have been located in the supraglottic area. Our case report involves the diagnosis and management of a subglottic nerve sheath tumor in a pediatric patient.

Total lower lip reconstruction with a sensate composite radial forearm-palmaris longus free flap and a tongue flap.

The technique of total lower lip reconstruction with a composite radial forearm-palmaris longus free flap was further refined in this report. A ventral tongue flap enhanced the lip aesthetics by recreating the vermilion. Lip suspension was enhanced by securing the palmaris tendon to the malar eminences as well as to the cut ends of the orbicularis oris muscle.

Transverse lag screw fixation of the midline mandibulotomy.

Transverse lag screw osteosynthesis of the midline mandibulotomy is a rapidly performed technique that results in reestablishment of mandibular integrity and avoids placement of hardware directly beneath a suture line. We have performed transverse lag screw osteosynthesis in four patients over the past 14 months. All patients received postoperative radiotherapy.

Thyroid cancers. I. Papillary, follicular, and Hürthle cell.

The well differentiated thyroid carcinomas, papillary, follicular, and Hürthle cell, comprise the majority of malignant thyroid diseases. This article presents guidelines for the evaluation and treatment of these malignancies. Prognostic factors, surgical treatment of the thyroid and regional lymph nodes, postoperative detection of recurrence, and treatment of distant metastases are discussed.

The acute care nurse practitioner in collaborative practice.

Successful collaborative practice between an acute care nurse practitioner and a physician impacts positively on patient care. Collaboration among disciplines can provide the patient with superior care that is organized, efficient, and prompt. Collaboration also gives each partner in the relationship a great deal of professional satisfaction.

Remission of acromegaly caused by pituitary carcinoma after surgical excision of growth hormone-secreting metastasis detected by 111-indium pentetreotide scan.

GH-secreting carcinomas of the pituitary are extremely rare. We describe a 37-yr-old woman with refractory acromegaly 15 yr after transphenoidal surgery and radiotherapy, with no evidence of a recurrent pituitary mass. Scanning with 111-indium pentetreotide revealed an area of intense activity in the left neck.