Thyroglossal duct calcifications.
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Ectopic thyroid gland is a well-known developmental anomaly. We present a child with a unique anatomical variant of this anomaly, namely double ectopic thyroid. The purpose of this report is to demonstrate the scintigraphic findings and to emphasize the importance of performing a thyroid scan in every case of thyroid ectopia to accurately identify all sites of functioning thyroid tissue.
The most common cystic malformations of the neck are the result of abnormal embryogenesis involving the thyroglossal duct (TGD), lymphatic primordia and the branchial apparatus. When the basic embryology of these structures is considered, a reasonable differential diagnosis-and in some cases a definitive diagnosis-can be achieved based on the location and the imaging characteristics of the cystic mass.
This article focuses on small-parts US in children. The differential diagnosis of cystic neck masses primarily includes lymphangiomas, thyroglossal duct cysts and branchial cleft cysts. Solid masses may be represented from lymphadenopathies, cervical extensions of mediastinal thymus, fibromatosis colli, rhabdomyosarcomas and neuroblastomas. Salivary gland lesions are uncommon in children. Thyroid is best evaluated by US and nuclear scintigraphy. If US shows abnormal thyroid gland, the isotopic scan may be a good complementary method to confirm the diagnosis. Normal parathyroid glands are not visualised routinely by US because of their small size. Parathyroid adenomas are unusual in paediatrics. Ultrasound can be successfully used in the differential diagnosis of the painful scrotum especially with colour flow Doppler. The hallmark of ischaemia is a completely avascular testis. In the paediatric age group, the most common application of US to the musculoskeletal system is the evaluation of the infant hip in the first 6 months of life; however, the refinement of new transducers has further improved the ability of US equipment to evaluate a variety of other musculoskeletal disorders in children, involving tendons, muscles, nerves as well as soft tissue masses. Ultrasound can be a useful screening tool in newborns suspected of having closed spinal dysraphism.
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Thirteen patients with suspected extrathyroidal neck masses were investigated with the combination of fluorescent scanning and echography. Iodine content, the solid or cystic consistency of the lesion, and the position of the lesion with respect to the thyroid were determined preoperatively to estimate thyroidal origin and benignity or malignancy of the lesions. Pathologic diagnoses correlated well with these totally noninvasive studies of extrathyroidal neck masses.
A retrospective review was carried out of 338 patients with thyroglossal duct remnants and 274 patients with branchial cleft anomalies who had undergone surgery at the Mayo Clinic from 1954 to 1975. Attention was directed to the preoperative history of these lesions, their clinical presentation, the nature of surgery performed, the complications of surgery, and the incidence of recurrence. The recurrence rate after the Sistrunk procedure for thyroglossal duct remnants was 2.6 per cent, whereas the recurrence rate after surgery for branchial cleft anomalies was 5.8 per cent. The findings suggested that these lesions are a significant source of morbidity and that surgery should be performed before infection occurs and should be radical in the first instance if the recurrence rate is to be minimized.
BACKGROUND: To determine the pharmacokinetics of the 5-HT3 antagonist ondansetron in children, informed written consent was obtained from the parents of 21 healthy children aged from 3 to 12 years scheduled for ear, nose, and throat surgery. METHODS: The children were stratified according to age: 3 to 7 years and 7.1 to 12 years, and a single intravenous infusion of 2 or 4 mg ondansetron, respectively, was administered over 5 minutes before induction of anesthesia. After completion of the infusion, anesthesia was induced intravenously and maintained with inhalational anesthesia. Whole blood (3 ml) was obtained before administration of ondansetron, at completion of the infusion, at the beginning and end of surgery, and at 3, 4, 6, 8, 10, and 12 hours after start of the infusion. Pharmacokinetic variables were determined with use of standard noncompartmental techniques. RESULTS: Mean plasma clearance was 0.50 L.hr-1.kg-1 and 0.39 L.hr-1.kg-1, the mean volume of distribution at steady-state was 1.70 L.kg-1 and 1.61 L.kg-1, and the mean plasma terminal half-life was 2.6 hours and 3.1 hours for the 2 mg and 4 mg groups, respectively. On a body surface area basis, mean plasma clearance was 14.0 and 13.7 L.hr-1.m-2 and mean volume of distribution was 47.7 and 55.9 L.m-2 for the 2 and 4 mg groups, respectively. There were no serious adverse events attributable to ondansetron. CONCLUSIONS: These data indicate that the pharmacokinetics of ondansetron in children from 3 to 12 years old are predictable and similar to those in adults. The elimination half-life of ondansetron increases in parallel with age. However, clearance is constant when normalized to body surface area, but the volume of distribution increases over the age range studied.
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A case of a benign tumor of vestigial brown fat (hibernoma) is presented. The circumstances surrounding an associated odontogenic infection are discussed. The case and a review of the literature are presented to clarify a pathologic condition rarely included in the differential diagnosis of head and neck masses.
A case of thyroglossal duct anomaly showing an unusual finding of foci of cartilage is presented. Although the concept of choristoma may explain the pathogenesis of cartilage within the present congenital anomaly, the histologic features were more in favor of a metaplastic process. In addition, the history of recurrent bouts of local inflammation supports the latter view.
Teratoma of the tongue is a rare tumor of the oral cavity with only six reported cases in the literature. Teratomas are composed of ectoderm, mesoderm and endoderm with differentiation to identifiable tissues and organs. Embryologically, they are thought to occur as a result of displacement of cells from normal tissue during fetal life. In the tongue, the teratoma may result from misplaced cells from the tuberculum impar. Differential diagnosis of tongue lesions includes thyroglossal duct cyst, lingual thyroid, lymphangioma, hemangioma, dermoid cyst, granular cell myoblastoma and heterotopic gastric mucosal cyst. Computerized tomography is useful in differential diagnosis and defining extent of disease. Surgical excision with laser is curative and recurrence is rare.
Cutaneous manifestations of thyroid disease are protean in nature and affect all age groups. This review focuses on normal thyroid gland physiology, specific cutaneous/thyroid lesions such as the thyroglossal duct cyst and metastatic thyroid malignancies, nonspecific cutaneous alterations of the hyperthyroid and hypothyroid states, and the numerous associations of thyroid disease with other cutaneous and/or systemic disorders.
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