Case report: follicular adenoma in a thyroglossal duct remnant arising entirely within the hyoid bone

INTRODUCTION

We describe here the first reported case of a follicular adenoma arising from a thyroglossal duct remnant within the hyoid bone in Singapore.

CLINICAL PICTURE

A 32-year-old woman presented with an asymptomatic lump in the anterior midline of her neck of three months' duration. CT scan showed an expansile lesion localised to the medulla of the body of the hyoid.

TREATMENT

A well-defined intrahyoidal mass was found at surgery. Histology revealed a follicular adenoma arising from maldescended thyroid tissue within the hyoid bone.

OUTCOME

Recovery was uneventful.

CONCLUSION

It is important to consider thyroglossal duct carcinomas as a differential diagnosis when evaluating anterior neck lumps.

Management of intraparotid facial nerve schwannomas

BACKGROUND

The purpose of the present paper was to review the management of intraparotid facial nerve schwannoma so as to discuss its clinical presentation, evaluate the various possible diagnostic investigations, and compare the various surgical options and outcome.

METHODS

Case series was undertaken of five (1.3%) patients with facial nerve schwannoma out of 400 consecutive parotidectomies at Singapore General Hospital.

RESULTS

There were three men and two women with an age range of 29-65 years. Three patients presented with painless parotid lumps while two had painful parotid swellings. None had facial nerve paresis. Only one patient had preoperative diagnosis suspicious of schwannoma by fine-needle aspiration cytology (FNAC). Diagnoses were made intraoperatively. Four patients had excision with cable grafting of the nerve defect. achieving facial nerve grade II-IV (House-Brackmann scale). One patient who underwent enucleation of tumour with nerve preservation achieved grade II.

CONCLUSIONS

Preoperative diagnosis is difficult but it is important for discussion of the extent and options of surgery. Fine-needle aspiration cytology holds promise in making a preoperative diagnosis. Enucleation with nerve preservation where possible seems to offer better facial function whereas nerve excision with cable graft can give satisfactory results.

The pattern of nodal recurrence following definitive radiotherapy for nasopharyngeal carcinoma

BACKGROUND

The pattern of nodal metastasis in previously untreated nasopharyngeal carcinoma (NPC) has been studied and reported. In order to analyse the pattern of recurrent nodal disease in previously treated NPC, a retrospective study on 68 patients who underwent radical neck dissection for regionally recurrent NPC was conducted.

METHODS

Seventy-four neck dissections were performed on 68 patients who developed nodal recurrence after a mean disease-free interval of 39.2 months. None of the patients had evidence of local or systemic disease at the time of surgery. Histopathological reports of the 74 neck dissections were analysed with regard to the number of positive nodes as well as the number of involved nodal levels.

RESULTS

Of the 65 neck dissection specimens with analysable data, 31 showed metastatic disease at a single nodal level with a mean number of positive nodes of 1.2, while 34 showed metastatic disease at multiple levels with a mean number of positive nodes of 6.6. Nodal recurrence occurred at level II with the greatest frequency (78.5%). Of the 31 specimens with single level nodal involvement, 21 (67.7%) occurred at level II. Isolated involvement at the other levels did occur, but was uncommon (range 3-16%). Of the 34 specimens with multiple level nodal involvement, 30 (88.2%) showed involvement at level II. Once more than one level was involved, the frequency of involvement at any given level was at least 30%.

CONCLUSION

The predominant involvement at level II and the high frequencies of involvement at all levels support the use of a classical radical neck dissection in treating recurrent nodal disease in NPC.

Oropharyngeal reconstruction after ablative surgery of the head and neck--experience of 93 cases

The surgical defect after radical resection in the head and neck region is extensive and often involves skin, oral mucosa and bone. Primary reconstruction allows for rapid restoration of function and rehabilitation of the patient. We report a series of 93 patients with oropharyngeal reconstruction after ablative surgery in the head and neck. For reconstruction, there were 41 pedicled myocutaneous flaps, 18 random flaps and 7 vascularised free flaps. There were 3 partial and 1 complete flap failures together with 5 persistent fistulas. The factors considered in the choice of reconstruction and our philosophy in this regard are discussed.

The role of a documented allergic profile as a risk factor for radiographic contrast media reaction

To determine the relevance of a documented allergic profile as a predisposing factor in radiographic contrast media (RCM) reaction, we investigated its incidence among 100 subjects who underwent RCM studies. Fifty of these subjects reacted to RCM (reactors) and 50 were non-reactors (controls). All 100 subjects completed an allergy questionnaire, allergy skin testing, and in vitro assay to common allergens. Sixty-eight percent of reactors and 30% of controls had a positive history of allergy/hypersensitivity (P less than .001). Fifty-six percent of reactors and 24% of controls had positive skin test (P less than .005). These data suggest that allergic individuals are at twice the risk for developing adverse RCM reaction as compared with non-atopic subjects.

Correlation between Seralyzer reflectance photometer theophylline assay and an Emit assay

Recently a method for theophylline assay on the Ames Seralyzer was introduced. We compared the interday variability of this method to the established interday variability of an enzyme multiplied immunoassay (Emit) technique used in the service laboratory of a hospital. Control sera and calibrator prepared to known concentrations (10, 15, and 25 micrograms/mL) were assayed singly daily for ten days with the Seralyzer machine. Assays were done singly to simulate the in-office use of the machine. Their respective coefficients of variations (CVs) were 6.96%, 5.50%, and 5.23%, which compared favorably with the established CVs for the Emit of 6.7%, 5.8%, and 6.1% respectively at comparable test concentrations. Two hundred and fifty-one sera were assayed in parallel on both machines in eight batches. Linear regression analysis of these data showed a slope of 0.995, intercept of 0.468, and a correlation coefficient of 0.945. These data suggest that the Seralyzer values compared favorably with the Emit values.

Absorption inhibition and enhancement of elimination of sustained-release theophylline tablets by oral activated charcoal

The effect of orally administered activated charcoal (OAC) on the first 12 hours of absorption and elimination of sustained-release theophylline tablets (SRT) was investigated in 20 normal children ages 8 to 18 years. The theophylline absorption-elimination characteristic of all subjects was determined after ingestion of 10 mg/kg SRT. Blood for theophylline was sampled at 0, two, four, six, eight, ten, 12, and 24 hours. After a 72-hour theophylline washout period, the subjects were assigned randomly to one of four study groups and received 10 mg/kg SRT. OAC then was given as a single dose one hour later to Group 1 subjects. Group 2 subjects took four doses of OAC at three-hour intervals beginning at one hour after SRT dosing. Group 3 subjects also received four doses of OAC at three-hour intervals with the first dose given three hours after SRT; Group 4 subjects received three doses at similar intervals with the first dose administered six hours after SRT dosing. OAC administration reduced the 12-hour area under the concentration time curve for theophylline (AUC) by 61% in Group 1, by 68% in Group 2, by 37% in Group 3, and by 18% in Group 4. The differences in AUC between treated and untreated subjects were significant at P less than .01 for Group 1, at P less than .001 for Group 2, at P less than .02 for Group 3, and not significant for Group 4. These data indicate that early OAC administration can inhibit SRT absorption significantly and enhance elimination of previously absorbed theophylline.

Intrinsic polymorphonuclear chemotactic defect in a boy with chronic granulomatous disease

A six year old boy is described who suffured from recurrent and protracted infections of multiple organs by various catalase positive bacteria. A severe episode of osteomyelitis involving several bones was caused by Aspergillus fumigatus. Studies of his PMNs revealed impaired metabolic as well as microbicidal functions characteristic of CGD. Chemiluminescence in response to both opsonized zymosan and sodium fluoride was markedly depressed, while control PMNs showed significant responses. Control leukocytes suspended in patient's serum likewise evoked normal chemiluminescence. Microbicidal activity against staphylococcus aureus 502A was also decreased using patient's PMNs, whereas control PMNs were able to reduce the number of colony forming bacteria by 2 logs in 120 minutes. Viable intracellular bacteria after lysis of extracellular bacteria formed 3 X 10(7) colonies from patient's PMNs and less than 2 X 10(5) colonies from the control. NBT dye reduction studies of the family members suggested an x-linked recessive mode of inheritance. The extraordinary nature of this case lies in the discovery of an associated intrinsic cellular defect of chemotaxis involving his polymorphonuclear leukocytes. Specifically, the Rebuck skin window showed predominantly mononuclear cells from 4 up to 24 hours. In addition, the patient's PMNs failed to migrate in response to cultured filtrates of E. coli as the chemoattractant. This abnormality persisted in the presence of autologous plasma or serum as well as in control plasma or serum. Control PMNs showed normal chemotaxis in the presence of the patient's plasma or serum. The extent to which the rare coexistence of these two phenomena influence the clinical disease is not known and remains to be elucidated.

Reaginic sensitivity to Mus musculus extract in a group of Chicago urban asthmatics

Thirty-nine out of 103 urban asthmatics reacted on prick test to rodent hair extract (MME). One out of 68 and one out of 50 reacted among suburban asthmatics and normal controls, respectively. Ten skin-test reactive and three non-reactive urban asthmatics underwent bronchial provocative challenge tests (BPT). Results were significant at p less than 0.001. Twenty-one out of 26 skin-reactive and one out of 25 skin non-reactive asthmatics had specific IgE antibody, p less than 0.001. These data suggest that rodent hair might be a relevant allergen in some urban asthmatics.

Serum IgE levels in healthy black American children: a case for environmental influences on IgE

Serum IgE was determined in 115 healthy, non-atopic black American children, aged 0-16 years, living in Urban Chicago. The mean IgE level varied from 1.48 u/ml at birth to 70 u/ml at adolescence. These values are comparable to those observed in American whites but differ significantly from the IgE levels of both African blacks and European Caucasians. Thus, environmental factors apparently exert a strong influence on IgE production in non-atopic individual.