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[Asphyxic pulmonary edema caused by upper airway obstruction in adults].

A case of pulmonary oedema following acute pharyngo-laryngeal obstruction is reported. The case is compared with the results of the literature. The haemodynamic data suggested a non-cardiogenic effect, with low pulmonary arterial occlusion pressure of 1 mmHg and right-to-left shunting. Positive end-expiratory pressure was used with success. The mechanisms underlying such oedema are not well known, and may include disturbances in the balance of transpulmonary forces or hypoxia. However the outcome is usually favourable.

Adult↗

Papillary carcinoma in a thyroglossal duct remnant with normal thyroid gland.

Carcinoma in the thyroglossal duct remnant is relatively uncommon. Since the first report by Uchermann (1915), more than 150 cases of carcinoma have been reported, and the majority have been papillary thyroid carcinomas (Li Volsi et al., 1974; McNicol et al., 1988). In this report, we present a case of papillary carcinoma in the thyroglossal duct with a normal thyroid gland.

Adolescent↗

[Skin and hair, marker organs for thyroid diseases].

Skin and cutaneous appendages are target organs for thyroid hormones. Thus, a variety of changes of skin, hair and nails occurs in association with thyroid diseases. Most of these cutaneous changes are unspecific, but in their entirety they may nontheless be indicative of thyroid diseases. In this review the specific cutaneous lesions as thyroglossal duct cysts and cutaneous metastases of thyroid carcinoma, the unspecific cutaneous changes of hypo- respectively hyperthyroidism, the typical skin lesions of Grave's disease, and selected skin diseases and syndromes associated with thyroid abnormalities are discussed.

Diagnosis, Differential↗

Management of common head and neck masses.

Head and neck masses are a common clinical concern in infants, children, and adolescents. The differential diagnosis for a head or neck mass includes congenital, inflammatory, and neoplastic lesions. An orderly and thorough examination of the head and neck with an appropriate directed workup will facilitate the diagnosis. The most common entities occur repeatedly within the various age groups and can be differentiated with a clear understanding of embryology and anatomy of the region, and an understanding of the natural history of a specific lesion. Congenital lesions most commonly found in the pediatric population include the thyroglossal duct cyst and the branchial cleft and arch anomalies. The inflammatory masses are secondary to local or systemic infections. The most common etiology for cervical adenopathy in children is reactive lymphadenopathy following a viral or bacterial illness. Persistent adenopathy raises more concerns, especially enlarged lymph nodes within the posterior triangle or supraclavicular space, nodes that are painless, firm, and not mobile, or a single dominant node that persists for more than 6 weeks should all heighten concern for malignancy. In this review, we discuss the current principles of surgical management of the most common head and neck masses that present to pediatricians and pediatric surgeons.

Adolescent↗

Thoracoscopic esophagectomy in children.

Minimal access surgery is an alternative to open surgery in esophageal resections. Thoracoscopic surgery has been utilized for both benign and malignant esophageal lesions and is a complex and challenging surgical procedure that can provide some benefits in comparison with open thoracotomy. Many studies have described laparoscopic or thoracoscopic-assisted esophagectomy in adults. So far, to the best of our knowledge, there is no study about thoracoscopic esophagectomy in children. This report describes 2 pediatric cases of benign esophageal lesions: one stricture after accidental ingestion of caustic soda and one esophageal stenosis after thyroglossal duct complication. Both patients were submitted to thoracoscopic esophagectomy combined with laparotomy and open cervical exploration with success. This procedure presents some potential advantages when compared with open esophagectomy: shorter hospital stay, precise dissection of mediastinal structures, less postoperative pain, less blood loss during surgery and less long-term discomfort. In our cases, thoracoscopic surgery for children showed the same benefits as in adults. Although very feasible, it should not be attempted without sufficient training and should be carried out only in specialized medical centers and by surgeons with adequate experience with open esophagectomy.

Accidents, Home↗

Lingual thyroid carcinoma: a case report and review of the literature.

Ectopic thyroid tissue may reside anywhere along its embryologic path of descent. Most ectopias manifest as simple thyroglossal duct cysts in conjunction with a normally developed thyroid gland in its usual thyroid cervical bed. Lingual thyroid is a rare developmental abnormality characterized by the failure of the thyroid gland, or remnants, to descend from its embryologic site of origin at the foramen cecum to its usual pretracheal position. Carcinoma arising in a lingual thyroid is even more unusual with fewer than 30 cases reported in the literature. We report the second case of lingual papillary thyroid carcinoma and review the clinical features, natural history, diagnosis, and treatment of lingual thyroid carcinoma.

Carcinoma, Papillary↗

Thyroglossal duct carcinoma in children: case presentation and review of the literature.

Carcinoma within the thyroglossal duct (TGDCa) is a very rare pediatric tumor. This report presents the case of a 15-year-old girl with TGDCa, reviews the previously published pediatric cases of this tumor, and provides diagnostic and therapeutic considerations in TGDCa in children. Twenty one cases of TGDCa have been reported, 12 of them in females. Mean age at presentation was approximately 13 years for females and approximately 12 years for males. The duration of a midcervical mass prior to the diagnosis of TGDCa varied from 3 weeks to 8 years. The size of the neck mass at presentation averaged 2 cm-4 cm. All masses were asymptomatic, and the diagnosis of TGDCa was incidental following surgery. All pediatric cases of TGDCa reported thus far were of the papillary type, except for 3 patients who presented with a mixed papillary-follicular carcinoma. Capsular invasion was detected in 10 (45%) patients. Local invasive disease was found in 5 (23%) patients, but all removed thyroid glands (12) were free of carcinoma. One patient had lung metastases. Thyroidectomy with subsequent radioiodine ablation was the treatment of choice in the majority of the cases. The reported prognosis for TGDCa in children was favorable, with only one reported death.

Adolescent↗

Cytologic findings in thyroglossal duct carcinoma.

Approximately 150 cases of thyroglossal duct carcinoma, predominantly of the papillary type, have been reported, but the preoperative fine-needle aspiration (FNA) diagnosis of such neoplasms has rarely been cited. The authors describe FNA findings in four samples obtained from three patients who were 29, 50, and 83 years of age, histologically diagnosed as papillary (n = 2) and squamous (n = 1) thyroglossal duct carcinomas. Atypia and squamous cell carcinoma were the FNA diagnoses in the patients with papillary carcinomas. The remaining case was correctly diagnosed as keratinizing squamous cell carcinoma. Cellularity was scant in two cases and moderate in one, and all displayed a cystic background. The authors also reviewed FNA features in 11 papillary and 2 Hurthle cell carcinomas from the English language literature; diagnostic findings were present in less than one third of the cases. In conclusion, familiarity with the FNA findings of thyroglossal duct carcinoma is limited by its rarity. The presence of large, atypical squamous cells, or psammoma bodies, in the FNA material of a midline anterior cystic neck mass should suggest papillary thyroglossal duct carcinoma.

Adult↗

Thyroid disease in northern Italian children born around the time of the Chernobyl nuclear accident.

BACKGROUND: The Chernobyl nuclear accident of 1986 caused a dramatic increase in the incidence of thyroid cancers in exposed children in Belarus. Airborne radioactivity from the reactor spread over northern Italy, where rainout gave rise to low levels of radioactivity at ground level. PATIENTS AND METHODS: As the latency between exposure to ionising radiation and development of thyroid cancer is thought to be about 10 years, in 1996/1997 all children born in 1985 and 1986 and attending school in an area of Milan, Italy were examined for thyroid nodules. A total of 3949 children were examined by two physicians blinded to the examination and diagnosis of the other. The children were to be reassessed in 2001/2002. RESULTS: In total, 1% had palpable nodules. The nodule diagnoses were: Hurtle cell adenoma (one), thyroglossal duct cyst (one), thyroid cyst (four) and thyroiditis (four). The prevalence of thyroid disease in the cohort was indistinguishable from that of populations not exposed to radioactive pollution. Only 10 children re-presented for examination 5 years later; all were negative. The direct costs of the study were estimated at 21,200 Euros. CONCLUSION: The high cost of the study in relation to reassuring lack of increase in thyroid nodule prevalence suggests that further studies are not justified.

Chernobyl Nuclear Accident↗