Multicentric Intra/Extracranial Cystic Facial Nerve Schwannoma: Case Report and Review of Literature.

To report a case of facial nerve schwannoma which presented a diagnostic and management challenge because of unusual multicentric cystic presentation. A 25-year-old female patient with a history of deep facial pain, parotid gland swelling and normal facial function showed multiple expansive cystic lesions of the temporal bone and parotid gland which turned out to be multicentric cystic facial nerve schwannomas. One should be keep this diagnosis in mind when dealing with a cystic lesions of the temporal bone and parotid gland.

Underestimation tendencies of vehicle speed by pedestrians when crossing unmarked roadway.

To make safe road crossing decisions, the pedestrians need to estimate the distance and speed of oncoming vehicles, in order to make conclusions about the available time gap they need for their road crossing. Since the speed represents combination of distance and time, we focused on pedestrians' ability to estimate the speed of the oncoming vehicles accurately. The aim of this study was to find some characteristics important for the speed mis-estimation tendencies and its values. Seventy participants estimated speed 3920 times in total. Research included three experiments. One vehicle participated in the first experiment, while second and third experiments involved two vehicles, with various combinations of vehicle positions and speeds. Initially it was determined that the pedestrians had tendencies to speed underestimation rather than its overestimation and accurate estimation. When the participants estimated the speed of one vehicle, they were more inclined to underestimation of higher speeds (over 50 km/h). On the other hand, in the situations where the participants estimated the speed of two vehicles, they showed a serious tendency towards underestimation of lower speeds (under 50 km/h) which was completely opposite. The factors such as driving experience, age and gender were identified as statistically important in terms of speed underestimation value. We determined that an increase in task complexity, with introduction of a larger number of vehicles, resulted in more severe speed underestimation. Finally, we identified some of the most risky traffic situations in terms of speed underestimation tendencies showed by our participants.

Diffusion-weighted MRI: impact of the size of the ROI in detecting metastases in subcentimeter lymph nodes in head and neck squamous cell carcinoma.

PURPOSE: Our aim is to determine the impact of the size of ROI in detecting subcentimeter metastatic lymph nodes in patients with head and neck squamous cell carcinoma (HNSCC). Secondary aim is to determine the impact of the histopathologic grade of the primary cancer on the ADC value of the metastatic nodes. METHODS: The prospective study included 51 patients with histopathologically proven HNSCC at the primary site. Primary site includes oral cavity, oropharynx, larynx, and hypopharynx. ADC values of the lymph nodes were measured on ADC maps by placing two ROIs in the lymph nodes (0.2 cm2 in the center of the node and the whole node). Lymph nodes were dissected by levels, marked by the surgeon, and sent to the pathologist. RESULTS: By applying a smaller ROI, ADC values have greater sensitivity, specificity, NPV, PPV, and AUC in detecting metastasis compared to the ADC value of the entire node (88.0%, 80.73%, 90.7%, 75.9%, 0.912% versus 80.0%, 77.98%, 85% ,71.4%, and 0.819%, respectively) p < 0.001. Statistically significant negative correlation was established between the tumor grade and the ADC of lymph node at ROI 0.2 cm2and ROI of the whole lymph node (rho = - 0.425; p = 0.002, and rho = - 0.298; p = 0.038, respectively). CONCLUSION: ROI size affects the ADC value of the nodes. The higher histopathological grade of the primary tumor is inversely correlated with the ADC value of the lymph nodes.

Evaluation of the Head Multislice Computed Tomography Scan in Emergency Department.

The aim of the study was to examine the prevalence of head injuries, acute stroke and brain tumors obtained from computed tomography (CT) scans in the emergency department (ED) during a one-year period. We also assessed the potential effect of seasons on the occurrence of stroke, head trauma and tumors found on CT scans, expressed in monthly intervals. This retrospective review included all patients that underwent emergency head CT from the hospital database. A total of 3888 head CT examinations were performed in adult patients presenting to ED and 1424 CT scans had at least one pathologic finding meeting diagnostic criteria for the study. Of the total number of CT scans analyzed, acute stroke was identified in 552 (14.19%), head trauma in 660 (16.97%), and brain tumor in 212 (5.45%) patients. Head trauma was more commonly found in males (n=465, 70.45%) than in females (n=195, 29.54%). Acute stroke was slightly more common in males than in females. Brain tumors were more frequently found in female patients. There were monthly variations in the number of head injuries and acute stroke diagnosed during the study period. Men and elderly patients were found to account for the greatest number of traumatic head injuries and therefore are at the highest risk of possible brain injury.

Obesity and hypercholesterolemia in patients with prolactinomas: Could DHEA-S and growth hormone be the missing link?

PURPOSE: Increasing evidence exists that hyperprolactinemia alters metabolic profile. The mechanism of this effect is unknown. We aimed to investigate the differences between the metabolic profile of patients with prolactinomas and nonfunctional pituitary adenomas and to evaluate the impact of other pituitary hormones on their metabolic profile. METHODS: Our retrospective study included 86 consecutive patients with prolactinomas and nonfunctional adenomas (29 prolactinomas and 57 adenomas). Body mass index (BMI), blood pressure, serum prolactin, growth hormone (GH), insulin-like growth factor I (IGF-I), adrenocorticotropic hormone (ACTH), cortisol, urinary free cortisol, triiodothyronine (T3), thyroxine (T4), thyroid-stimulating hormone (TSH), dehydroepiandrosterone-sulfate (DHEA-S), testosterone in men, triglycerides, total cholesterol, HDL (high-density lipoprotein) cholesterol, LDL (Low-density lipoprotein) cholesterol, alanine-transaminase, aspartate-transaminase, fasting glucose, and C-reactive protein (CRP) were obtained for all patients. Regression analyses were performed on log-transformed data. RESULTS: After adjustment for age, gender, and tumor size, prolactinomas were associated with higher BMI (OR 5.61, 95%CI 1.70-9.51, p = 0.005), LDL cholesterol (OR 3.60, 95%CI 1.35-5.93, p = 0.015), DHEA-S (OR 1.97, 95%CI 1.23-3.72, p = 0.026), and lower GH levels (OR 0.43, 95%CI 0.03-0.84, p = 0.037). In a linear multivariate regression, the association between DHEA-S, GH, and prolactin remained significant even after adjustment for BMI. GH and IGF-I were associated with BMI and LDL cholesterol, but the association diminished after adjustment for serum prolactin. CONCLUSIONS: Prevalence of obesity is four times higher in patients with prolactinomas than in patients with nonfunctional adenomas. Higher DHEA-S and lower GH levels in patients with prolactinomas may have an important role in prolactin-induced metabolic effects. Further studies are needed.