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Control of number and distribution of synapses during ectopic synapse formation in adult rat soleus muscles.

Changes in the number and distribution of synaptic inputs and acetylcholine receptor clusters were studied during the formation of ectopic nerve-muscle junctions between the transplanted fibular nerve and the denervated soleus muscle of adult rats. The tibial nerve was cut 3 weeks after implanting the fibular nerve. New sites of transmission were first detected 3 days after the cut. These sites were located electrophysiologically, marked by dye and found to coincide with clusters of acetylcholine receptors. There were no ectopic clusters away from fibular nerve sprouts and no clusters on muscles which had not been denervated. Three days after cutting the tibial nerve, the acetylcholine receptor clusters, and probably also the sites of transmission, were randomly distributed along individual muscle fibres. Six days after the cut, the clusters continued to be randomly distributed whereas the synaptic inputs were either close together (within 300 microns) or more than 600 microns apart. Two weeks later the spatial distributions of both clusters and inputs were similar with peaks around 100-300 microns, 1200-1400 microns and 2000-2600 microns. No ectopic clusters were closer than 0.5 mm to the original endplate. We conclude that nerve-muscle contacts and associated acetylcholine receptor clusters initially form at random. One or a few of these contacts develop further and, as a result, the surrounding regions undergo changes that prevent the contacts initially formed there from being maintained. Apparently, in this preparation, approximately 1.5 mm length of fibre is needed to support the maturation and maintenance of each ectopic endplate (mean length 111 micron).

Animals↗

Pyramidal neurons with ectopic dendrites in storage diseases exhibit increased GM2 ganglioside immunoreactivity.

Cortical pyramidal neurons in several types of neuronal storage diseases have been shown by Golgi staining to sprout axon hillock-associated dendritic processes. Based on the relative incidence of this ectopic dendritogenesis, and on quantitative analyses of gangliosides in these same tissues, it has been proposed that abnormal accumulation of a specific metabolic product, GM2 ganglioside, is the pivotal event leading to re-initiation of dendritic sprouting [Siegel D. A. Walkley S.U. (1994) J. Neurochem. 62, 1852-1862]. In the present study, a monoclonal antibody was used to determine the cellular location of this ganglioside within the cerebral cortex of animal models of storage diseases with and without ectopic dendrite growth. Diseases exhibiting ectopic dendritogenesis included inherited and swainsonine-induced (juvenile-onset) alpha-mannosidosis, mucopolysaccharidosis type I, Niemann-Pick disease type C, and GM1 and GM2 gangliosidosis. Conditions lacking ectopic dendrite growth included adult-onset swainsonine-induced alpha-mannosidosis, fucosidosis, neuronal ceroid lipofuscinosis (Batten disease) and normal, mature brain. Immunocytochemical staining for GM2 ganglioside indicated that diseases exhibiting new dendritic sprouting with the exception of GM1 gangliosidosis, exhibited abundant GM2-like immunoreactivity within the cortical pyramidal cell population, whereas diseases without dendritic sprouting had GM2-like immunoreactivity limited to glia and/or to non-pyramidal neurons. Cortical tissues from normal animals at comparable ages and processed by similar procedures exhibited occasional glial cell staining but little or no neuronal labelling. Mechanisms by which normal cortical pyramidal regulate dendritic initiation are poorly understood. However, it is known that this event is developmentally restricted, occurring only during early brain development.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Prevalence and long-term significance of exercise-induced frequent or repetitive ventricular ectopic beats in apparently healthy volunteers.

Frequent or repetitive exercise-induced ventricular ectopic beats are often considered a marker for serious cardiac disease or sudden death, or both. However, the prognostic value of these arrhythmias in an unreferred asymptomatic community-dwelling population over a broad age range is unknown. Of 1,160 subjects aged 21 to 96 years who underwent maximal exercise treadmill testing an average of 2.4 times, 80 (6.9%) developed frequent (greater than or equal to 10% of beats in any 1 min) or repetitive (greater than or equal to 3 beats in a row) ventricular ectopic beats on at least one test. These 80 individuals were significantly older than the group without such arrhythmia (63.8 +/- 12.5 versus 50.0 +/- 16.1 years, p less than 0.0001). A striking age-related increase in the prevalence of frequent or repetitive exercise-induced ventricular ectopic beats was seen in men (p less than 0.0001) but not in women. The prevalence of electrocardiographic abnormalities at rest, exercise-induced ST segment depression and thallium perfusion defects, duration of treadmill exercise, maximal heart rate, systolic blood pressure and rate-pressure product did not differ between these 80 study subjects with frequent exercise-induced ventricular ectopic beats and a control group matched for age and gender. Furthermore, the incidence of cardiac events (angina pectoris, nonfatal myocardial infarction, cardiac syncope or cardiac death) (10% versus 12.5%) as well as noncardiac mortality (each 7.5%) was found to be similar for the study and control groups, respectively, over a mean follow-up period of 5.6 years. No study subjects required antiarrhythmic drugs over this time interval.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Cardiomyopathy and myocarditis in children with ventricular ectopic rhythm.

OBJECTIVE: The objective of this study was to evaluate the histologic features of the myocardium in children with abnormal ventricular ectopic rhythm but a structurally normal heart. BACKGROUND: Abnormal ventricular ectopic rhythm in children with a structurally normal heart is an uncommon but serious condition. Previous studies in adults with these findings have shown that approximately 10% have "primary electrical disease" and that 40% to 100% of these have abnormal histologic findings. METHODS: Endomyocardial biopsy samples were obtained prospectively in 33 subjects presenting with ventricular ectopic rhythm but a structurally normal heart by physical examination and noninvasive studies. Biopsy specimens were evaluated for histologic changes consistent with dilated cardiomyopathy or myocarditis and these results were compared with noninvasive and invasive clinical findings. RESULTS: Of the 33 subjects, 16 (48%) had normal myocardial histologic features (Group A), 14 (42%) had changes similar to the histologic features seen with idiopathic dilated cardiomyopathy (Group B) and 3 (9%) had lymphocytic myocarditis (Group C). Presenting clinical symptoms, surface electrocardiograms (ECGs), exercise stress testing and electrophysiologic stimulation tests failed to predict the biopsy results. Twenty-four-hour ambulatory ECGs showed a statistical difference between sustained and nonsustained ventricular tachycardia in Group A versus Group B (p less than 0.007), with Group A having more sustained ventricular tachycardia. Left ventricular function measured by fractional shortening on echocardiography did not differ between groups, but left ventricular end-diastolic dimension was greater in the subjects with abnormal histologic findings (Group B) (p less than 0.03). CONCLUSIONS: These results provide evidence that approximately 50% of children with abnormal ventricular ectopic rhythm but a structurally normal heart may have subclinical cardiomyopathy or unsuspected myocarditis.

Biopsy↗

Ectopic breast cancer: case report and literature review.

Ectopic breast tissue includes both supernumerary and aberrant breast tissue. The incidence of supernumerary tissue has been reported as high as 6% depending on the ethnic group studied. The incidence of aberrant breast tissue remains unknown. The development of malignancy within these anomalies is rare. In the following paper, the case report of a patient with an ectopic breast cancer and a second primary cancer of the left anatomic breast is described. A review of the world literature on ectopic breast cancer follows. Specific characteristics of ectopic breast cancer are defined and recommendations for management are made.

Breast↗

Effect of ethane-1-hydroxy-1,1-diphosphonate on ectopic bone formation induced by murine osteosarcoma-derived bone-inducing substance.

The effects of ethane-1-hydroxy-1,1-diphosphonate (EHDP) on ectopic bone formation were studied qualitatively and quantitatively in an experimental system for ectopic bone formation induced by murine osteosarcoma-derived bone-inducing substance. At a low dose of EHDP (3 mg/kg per day i.p.), histologic sequelae of ectopic bone formation were normal, and the size of the induced bone mass was unaffected. At a high dose of EHDP (30 mg/kg per day i.p.), an unmineralized bone matrix with hematopoietic bone marrow was formed without evidence of retardation. This osteoid tissue showed no radiologic and histologic evidence of mineralization during the period of EHDP administration. When EHDP was withdrawn, its inhibitory effect on mineralization was reversed. The induced bone mass was almost the same size as that in controls. These results suggest that EHDP might not prevent ectopic bone matrix formation, but its mineralization and withdrawal of EHDP might lead to the formation of a normal bone similar in size to that formed without EHDP treatment.

Animals↗

Preventing chronic ectopic bone-related pain and disability after hip replacement surgery with perioperative ibuprofen. A multicenter, randomized, double-blind, placebo-controlled trial (HIPAID).

Postoperative ectopic bone formation affects about 40% of people undergoing elective hip replacement surgery. Despite clear evidence that a short course of perioperative nonsteroidal anti-inflammatory drugs (NSAIDs) can substantially reduce the occurrence of ectopic bone, the use of NSAID-based prophylactic therapy is uncommon in Australia or New Zealand. In part, this reflects surgeons' uncertainty about the importance of ectopic bone as a cause of impaired long-term outcome, and in part, concerns about possible increased risk for gastrointestinal complications and excess wound bleeding in patients undergoing orthopedic surgery. To address this uncertainty, a multicenter randomized controlled clinical trial is being conducted amongst 1000 patients undergoing elective total hip replacement (or revision) surgery. Patients are randomly allocated to 14 days of treatment with either 1200 mg ibuprofen (a commonly used NSAID) or matching placebo commencing within 24 h of surgery. Treatment outcomes will be assessed 6-12 months later. The primary outcome will be self-reported pain and physical function. Secondary outcomes include quality of life and physical performance measures. Patient recruitment has commenced in more than 20 orthopedic centers throughout Australia and New Zealand and will be complete by the end of October 2003. The prevention of chronic ectopic bone-related pain and disability after hip replacement surgery with anti-inflammatory drugs study (HIPAID) has been designed to provide precise and reliable information about the overall balance of risks and benefits associated with a short 14-day perioperative course of ibuprofen among individuals undergoing elective total hip replacement surgery.

Anti-Inflammatory Agents, Non-Steroidal↗

Ectopic parvalbumin expression in mouse forebrain neurons increases excitotoxic injury provoked by ibotenic acid injection into the striatum.

A neuroprotective role for Ca(2+)-binding proteins in neurodegenerative conditions ranging from ischemia to Alzheimer's disease has been suggested in several studies. A key phenomenon in neurodegeneration is the Ca(2+)-mediated excitotoxicity brought about by the neurotransmitter glutamate. To evaluate the relative ability to resist excitotoxicity of neurons containing the slow-onset Ca(2+)-binding protein parvalbumin (PV), we injected the glutamate agonist ibotenic acid (IBO) into the striatum of adult mice ectopically expressing PV in neurons. Striatal ibotenic acid injection results in local nerve cell loss and reactive astrogliosis. Light microscopic evaluation, carried out after a delay of 2 and 4 weeks, reveals an enlarged and accelerated neurodegenerative process in mice ectopically expressing neuronal PV. Thus, PV is not neuroprotective, it rather enhances nerve cell death. This result implicates that the increase in cytosolic Ca(2+)-buffering capacity in the transgenic mice impairs other systems involved in Ca2+ sequestration. In addition, ultrastructural morphometric analysis shows that in neurons the mitochondrial volume is reduced in mice ectopically expressing neuronal PV. This is paralleled by a reduction in the amount of the mitochondrial marker enzyme cytochrome c oxidase subunit I (COXI). We conclude that alterations in the Ca(2+) homeostasis present in mice ectopically expressing neuronal PV are more deleterious under excitotoxic stress and largely outweigh the potential benefits of an increased Ca(2+)-buffering capacity resulting from PV.

Animals↗

Ectopic mesothelial cell proliferation in cervical lymph nodes after severe ovarian hyperstimulation syndrome.

OBJECTIVE: To report a case of ectopic mesothelial proliferation in cervical lymph nodes after severe ovarian hyperstimulation syndrome. DESIGN: Case report. SETTING: University-affiliated teaching hospital. PATIENT(S): A 42-year-old woman underwent a successful IVF attempt and developed severe ovarian hyperstimulation syndrome and pathologically enlarged cervical lymph nodes. INTERVENTION(S): Paracentesis, cervical lymph node biopsy followed by cytology, histology, and immunohistochemistry. MAIN OUTCOME MEASURE(S): Resolution of symptoms, pregnancy outcome, correct pathological diagnosis. RESULT(S): Paracentesis resulted in resolution of symptoms of ovarian hyperstimulation. The diagnosis of ectopic mesothelial proliferation in cervical lymph nodes was made after immunohistochemical examination of cervical lymph nodes. The pregnancy progressed normally, and at 40 weeks the patient spontaneously delivered a healthy son weighing 3,060 g. CONCLUSION(S): This case describes ectopic mesothelial cell proliferation localized in and around cervical lymph nodes occurring at 9 weeks' gestation in a patient who earlier developed severe ovarian hyperstimulation syndrome 10 days after ET. Ectopic mesothelial cell proliferation in lymph nodes is an extremely rare event, and this is the first case described after ovarian hyperstimulation. Familiarity with this event is important for the clinician as well as for the pathologist in preventing the misdiagnosis of malignancy.

Adult↗

rh-BMP2-induced ectopic bone for grafting critical size defects: a preliminary histological evaluation in rat calvariae.

The aim of this study was to evaluate histologically the biological usefulness of recombinant human BMP2 (rh-BMP2)-induced ectopically-formed bone as graft material to repair a bone defect model, compared with autogenous bone and frozen allogeneic bone. Forty-five male Wistar rats were used, which were divided into three graft groups. Each of the three graft groups was divided into three observation period groups (3, 6 and 9 weeks after graft). All rats underwent craniotomy to create a bone defect, and then received a bone graft. In the rh-BMP2-induced ectopic bone graft group, marked bone formation was seen from 3 weeks after graft. In the autogenous bone graft group, marked bone formation was seen from 6 weeks after graft. In the group that received a frozen allogeneic bone graft, marked bone formation was seen from 9 weeks after graft. At 3, 6 and 9 weeks after graft, newly formed bone area was significantly greater in the tissue engineered bone (TEB) group than in the auto or frozen allogeneic bone (FAB) group. rh-BMP2-induced ectopically-formed bone graft exhibited better osteoconductivity than autogenous bone graft and frozen allogeneic bone graft. These histological findings indicate that rh-BMP2-induced ectopically-formed bone is suitable as bone graft material.

Absorbable Implants↗

Local and controlled release of growth factors (combination of IGF-I and TGF-beta I, and BMP-2 alone) from a polylactide coating of titanium implants does not lead to ectopic bone formation in sheep muscle.

The osteoinductive potential of growth factors leads not only to a stimulated bone formation in bony tissue but also in extra skeletal tissue. This potential depends on the dosage and potentially on the application method and may limit the clinical use. The aim of the present study was to investigate the potential of IGF-I, TGF-beta1 and BMP-2 released from a newly developed application systems of orthopaedic implants to induce ectopic bone formation in muscles. This bioactive coating showed a stimulating effect on fracture healing in several experimental studies before. Titanium discs were coated on one side with the drug carrier poly(d,l-lactide) (PDLLA), with the carrier plus IGF-I and TGF-beta1 or with the carrier plus BMP-2. The discs were implanted in the Musculus cleidomastoideus of sheep and followed up for 3 months. X-rays were taken after the operation and the day of sacrifice. The muscles plus implant were harvested and prepared for histology. Neither the radiology nor the histology revealed any signs of ectopic ossification in the implant/muscle interface or in a distance to the plate in any group. An influence of the locally applied growth factor, however, was seen in the formation of a soft tissue capsule. Histomorphometric analysis revealed a significantly larger capsule area over the growth factor coated side in comparison to the uncoated side or the pure titanium plate, indicating an effect of the applied growth factors on cells, however, not resulting in osteoinduction in muscle. The result showed that the local and controlled release of growth factors from PDLLA coated implants does not induce ectopic bone formation in sheep muscle and could be used in orthopaedic surgery to increase healing without the risk of ectopic bone formation in the surrounding soft tissue.

Animals↗

Multiple ectopic lesions of focal islet adenomatosis identified by positron emission tomography scan in an infant with congenital hyperinsulinism.

Congenital hyperinsulinism (HI) exists in 2 histologic forms, focal and diffuse, and rarely has been attributed to lesions in ectopic pancreatic tissue. The ability to distinguish focal from diffuse HI and locate focal lesions has been difficult, thus limiting the optimal management of HI. We present a case of HI resulting from focal pancreatic and ectopic pancreatic lesions. After a near-total pancreatectomy failed to improve the patient's condition, a positron emission tomography (PET) scan performed with 18F-fluoro-L-dihydroxyphenylalanine demonstrated a focal lesion remaining in the head of the pancreas as well as 4 hot spots inferior to the remaining pancreas. Surgical exploration found pancreatic rests in the jejunum responsible for the hot spots seen on PET. Resection of the remainder of the pancreas as well as the small intestinal lesions resulted in correction of the patient's HI. Pathology confirmed the presence of focal HI lesions in the pancreatic head and small intestinal specimens. This case supports the ability of ectopic pancreatic tissue to contribute to the pathology of HI. It highlights the ability of PET to successfully identify focal lesions, including ectopic tissue, responsible for hyperinsulinemic hypoglycemia.

Adenoma, Islet Cell↗

Ectopic expression and knockdown of a zebrafish sox21 reveal its role as a transcriptional repressor in early development.

Sox proteins are DNA-binding proteins belonging to the HMG box superfamily and they play key roles in animal embryonic development. Zebrafish Sox21a is part of group B Sox proteins and its chicken and mouse orthologs have been described as transcriptional repressor and activator, respectively, in two different target gene contexts. Zebrafish sox21a is present as a maternal transcript in the oocyte and is mainly expressed at the developing midbrain-hindbrain boundary from the onset of neurulation. In order to understand its role in vivo, we ectopically expressed sox21a by microinjection. Ectopic expression of full length sox21a leads to dorsalization of the embryos. A subset of the dorsalized embryos shows a partial axis splitting, and hence an ectopic neural tube, as an additional phenotype. At gastrulation, injected embryos show expansion of the expression domains of organizer-specific genes, such as chordin and goosecoid. Molecular markers used in somitogenesis highlight that sox21a-injected embryos have shortened AP axis, undulating axial structures, enlarged or even radialized paraxial territory. The developmental abnormalities caused by ectopic expression of sox21a are suggestive of defects in convergence-extension morphogenetic movements. Antisense morpholino oligonucleotides, designed to functionally knockdown sox21a, cause ventralization of the embryos. Moreover, gain-of-function experiments with chimeric constructs, where Sox21a DNA-binding domain is fused to a transcriptional activator (VP16) or repressor (EnR) domain, suggests that zebrafish Sox21a acts as a repressor in dorso-ventral patterning.

Animals↗

Ectopic placement of AMS 800 urinary control system pressure-regulating balloon.

OBJECTIVES: The AMS 800 sphincter urinary control system (artificial urinary sphincter) is frequently placed in patients with scarred retroperitoneal spaces. Placement of the pressure-regulating balloon (PRB) requires a second abdominal incision in the traditional perineal surgical technique. In the new transverse scrotal incision method of sphincter placement, the transversalis fascia is pierced to place the PRB in the space of Retzius. We present a novel technique of ectopic PRB placement requiring neither a second incision nor piercing the fascia. TECHNICAL CONSIDERATIONS: Nineteen patients underwent ectopic PRB placement during artificial urinary sphincter placement. Most patients (n = 17) were incontinent after radical prostatectomy, two were incontinent after transurethral resection of the prostate. Cuff placement was through a scrotal (n = 10) or perineal (n = 9) incision. In all patients, the incision was displaced toward either inguinal ring. A finger was passed through the ring forcibly cephalad and a space developed anterior to the transversalis fascia but beneath the abdominal muscles. The PRB was passed into this space. CONCLUSIONS: The results of our study have shown that ectopic placement is easier and quicker. The PRB is usually not palpable. Two PRB hernias into the upper scrotum were noted after vigorous coughing. Two patients developed urethral atrophy under the cuff at 3 and 5.5 years. No erosions, infections, or mechanical failures were noted. Early outcomes with ectopic PRB placement seemed similar to that of traditional locations.

Atrophy↗

Discrete functional elements required for initiation activity of the Chinese hamster dihydrofolate reductase origin beta at ectopic chromosomal sites.

The Chinese hamster dihydrofolate reductase (DHFR) DNA replication initiation region, the 5.8 kb ori-beta, can function as a DNA replicator at random ectopic chromosomal sites in hamster cells. We report a detailed genetic analysis of the DiNucleotide Repeat (DNR) element, one of several sequence elements necessary for ectopic ori-beta activity. Deletions within ori-beta identified a 132 bp core region within the DNR element, consisting mainly of dinucleotide repeats, and a downstream region that are required for ori-beta initiation activity at non-specific ectopic sites in hamster cells. Replacement of the DNR element with Xenopus or mouse transcriptional elements from rDNA genes restored full levels of initiation activity, but replacement with a nucleosome positioning element or a viral intron sequence did not. The requirement for the DNR element and three other ori-beta sequence elements was conserved when ori-beta activity was tested at either random sites or at a single specific ectopic chromosomal site in human cells. These results confirm the importance of specific cis-acting elements in directing the initiation of DNA replication in mammalian cells, and provide new evidence that transcriptional elements can functionally substitute for one of these elements in ori-beta.

Animals↗

Prognostic value of predischarge exercise testing, ejection fraction, and ventricular ectopic activity in acute myocardial infarction treated with streptokinase.

The relative importance of prognostic parameters that delineate left ventricular function, myocardial ischemia, and arrhythmogenic potential after thrombolytic therapy is not clear. This study investigated 112 patients with acute myocardial infarction who were treated with thrombolysis to determine the relative prognostic value of predischarge treadmill exercise testing, radionuclide ventriculography, and ambulatory electrocardiographic monitoring for ventricular ectopic activity. During a mean follow-up period of 18 months (range 6 to 30), 42 first cardiac events were recorded, consisting of 3 deaths, 6 reinfarctions, 16 bouts of unstable angina, 16 episodes of heart failure, and 1 arrhythmic event. Univariate analysis revealed ejection fraction, exercise time, and ventricular ectopic count of > or = 10/hour to be predictive of future cardiac events. Subsequent multivariate analysis showed ejection fraction (p <0.001) and exercise time (p=0.002 to have independent prognostic value, but ventricular ectopic activity did not provide additional information. Ventricular ectopic count > or = 10/hour was additionally predictive only when combined with either ejection fraction (R2=5.4%) or exercise time (R2=2.9%). Event-free survival analysis revealed hazard ratios for ejection fraction <40% and exercise time <7 minutes of 3.63 (p=0.001) and 2.16 (p=0.01), respectively. Although ejection fraction and exercise time were able to predict future episodes of heart failure, neither could adequately identify patients at risk of recurrent ischemic events.

Aged↗

[Supernumerary ectopic hyperfunctioning parathyroid gland: a potential pitfall in surgery for sporadic primary hyperthyroidism].

STUDY AIM: The aim of this retrospective study was to report a series of nine patients with a sporadic primary hyperparathyroidism, operated on for an ectopic supernumerary hyperfunctioning parathyroid gland. PATIENTS AND METHOD: From 1973 to 1998, among a total of 1,307 patients operated on for a primary hyperparathyroidism, 9 (0.69%) had an ectopic supernumerary hyperfunctioning gland. There were six women and three men (mean age: 63 years) with a sporadic hyperparathyroidism. Initial cervicotomy was performed in our institution in 6 cases. The nine patients underwent 19 operations including one through sternotomy. The ectopic parathyroid gland was localized in the eight patients who had preoperative localization studies. RESULTS: The supernumerary gland was located in the anterior mediastinum (n = 6), in the carotid sheath (n = 2) and within the vagus nerve (n = 1). In three patients, it was found during the initial cervicotomy. In the 6 other patients, it was found in the course of a reoperation. With a mean follow-up of five years, all the patients were biochemically cured. One patient had a permanent recurrent nerve palsy and a definitive hypoparathyroidism. CONCLUSIONS: The low incidence of an ectopic supernumerary hyperfunctioning parathyroid gland in sporadic hyperparathyroidism does not justify the routine use of preoperative localization studies and intra-operative quick parathormon assay. During an initial conventional cervicotomy the search for a 5th gland is highly recommended when 4 normal glands have been found in the neck. This research should also be performed in case of multi-glandular disease.

Aged↗

[Ectopic thyroid: two cases].

Ectopic thyroid is a rare condition (1/4000 to 1/8000 among patients with hypothyroidism). The underlying etiological pathogenic mechanisms remain unknown. Diagnosis is established on the basis of imaging findings. We report two cases of hypothyroidism in adult females who had ectopic sublingual thyroid glands. The first patient was a 20-Year-old woman who had been treated for hypothyroidism since the age of 13 Years before the diagnosis of ectopic thyroid 7 Years later. In both patients, the thyroid gland was palpable. In the first patient the physical examination revealed an ectopic sublingual gland. Scintigraphy confirmed the diagnosis in both patients. The CT-scan and MRI were positive in the second patient. Hormonal substitution therapy using L-thyroixine was given.

Adult↗