Renal involvement in cases of spindle epithelial tumor with thymus-like differentiation: a case report and review of the literature

Background: Spindle epithelial tumor with thymus-like differentiation [SETTLE] is a very rare neoplasm of the thyroid first described by Chan and Rosai in 1991. Renal involvement usually occurs as part of a disseminated metastatic picture. SETTLE is believed to arise from branchial pouch or thymic remnants and shows primitive thymic differentiation

Presentation: A 41-year-old male presented with a thyroid mass in 2005. The patient underwent a total thyroidectomy followed by radiation therapy. Pathology concluded papillary thyroid cancer. In 2011, the patient was admitted with worsening cough. CT showed lung involvement, multiple mediastinal lymph nodes, and a left renal mass. A biopsy established the diagnosis of SETTLE. Four cycles of platinum chemotherapy were given. In 2014, the patient was referred to Urology with progressive flank pain and hematuria. CT showed a progression of the renal mass, and results of an U/S guided biopsy of the kidney were consistent with SETTLE. An elective radical nephrectomy was performed in late 2016 to relieve symptoms. The patient is currently being followed as an outpatient

Conclusion: Due to the rare nature of SETTLE, algorithms for the diagnosis, treatment, and outcomes are not established. Although SETTLE presents as a low-grade malignancy, this case, as well as other reported cases with a long follow-up duration, suggested that it can metastasize many years after initial diagnosis. More data is needed to elucidate the risk and prognosis of renal metastasis in SETTLE

Evaluating Full Cup Study, Numeric Pain Rating Scale, and Visual Analogue Scale in Assessing Pain after Surgical Removal of Lower Third Molar

@#The objectives of this study is to evaluate the suitability of full cup test (FCT), numeric pain rating scale (NPRS), and visual analogue scale (VAS) to assess pain after surgical removal of lower third molar and to identify which of these three pain scales is the easiest to use. A total of 50 patients, age between 18 to 30 years who underwent minor oral surgery for removal of impacted third molar were sampled in Faculty of Dentistry, University of Malaya. The patients were provided with forms containing three pain scales and they were required to mark each pain scales – FCT, NPRS and VAS daily for three consecutive post-operative days. The forms were collected a week later when patients came back for review. The validity between NPRS with VAS, FCT with NPRS and FCT with VAS were tested using Spearman rank correlation coefficient. Results showed that the correlation coefficient values for each pair were very high and significant. The findings when comparing Day 1, Day 2 and Day 3 and the combination for those three days showed no significant differences. No evidences indicated that the findings for Day 1 were more superior in comparison with other days. In conclusion, FCT was as valid as NPRS and VAS. The pain scale which was claimed to be the easiest to use by patients was NPRS, followed by FCT and VAS. However, further studies are needed to investigate the reliability and sensitivity of FCT.

Trauma of the eyes in medico legal cases presented at a tertiary care hospital

Background: Ophthalmaic injuries in medicolegal cases in rarely studied and reported. These case are usually encountered in medicolegal practices

Objectives: The aim of the study was to elaborate the ophthalmic medicolegal cases presented in Sh. Zayed Medical College / Hospital, Rahim yar khan, with emphasis on the incidence, type of assault / weapon used and to determine the types of wounds according to Qisas and Diyat ordinance Pakistan

Design: Descriptive study

Place and duration of Study: Total 120 cases were included who were presented in three years [from Aug.2008 to Aug.2011] in Emergency Department of SZMC Rahim yar khan. Out of which 110, cases were referred to Department of Ophthalmology Sh. Zayed Hospital Rahim yar khan by Causality Medical Officers, and 10 patients [12.5%] were re-examined by constituting Medical Board by the order of the courts for expert opinion

Material and Methods: 120 cases of ophthalmic injuries presented for medico legal opinion in Sh. Zayed Medical College / Hospital, Rahim yar khan, during this period. These were grouped according to age, sex, weapons of infliction, mode, and the gravity of vision loss, which was classified according to; total loss of vision or percentage of vision lost. Nature of loss of vision whether reversible on treatment or not was determined. Types of wounds according to Qasis and Diyit Ordinance were also determined. Help of X-Rays, CT-Scan and Ultrasound [B-Scan] was taken where required

Results: Out of 120 persons, only 12 were female [10%] and remaining [90 %] were male. The age group most commonly involved was 21- 40 years [54.1 %], 06 patients [05%] had self inflicted type of injury around the eye. Blunt weapons / assault [60%] were the predominant mode of infliction. Injuries have been categorized according to Qisas and Diyat Ordinance; Shajjah-e Khafifah were 72 [60 %], Shajjah-e-Mudihah were 24 [20 %], patients with corneal ulcer / abrasion leading to permanent scar were 20 [16.7 %] and they were categorized as Itlaf-e-Salahiet-Udw. Those patients who were undergone surgical intervention and had lost their both eye balls were categorized as Itlaf-e-Udw and were only 04 [3.3%]

Conclusion: In our study, only two patients gave proper subjective vision, other patients were malingering for their vision loss, so objective method of vision assessment must be applied. Self inflicted type of injury around the eye to get benefit must be kept in mind that was not vision depriving, only type of wound was modified. Eye Surgeons and the medico legal officers should be very vigilant to make Medico legal reports

Simple digital manipulation as a closed reduction technique for favourable nasal bone fractures

Isolated fractures of the nasal pyramid are the most common facial injuries. Accurate diagnosis and appropriate surgical intervention are key in the management of nasal fractures. While these fractures are not-life threatening and normally considered a relatively unimportant injuries, suboptimal treatment can Lead to both aesthetic and functional deformities. Reduction of favourable nasal fractures may be performed under local or general anaesthesia.62 adult patients with clinically displaced nasal fractures were enrolled in the study, of them only 52 completed the follow-up period [three months]. Working with a detailed patient history and a thorough physical examination that included rigid nasal endoscopy, the author formulated an integrated systematic approach to reduce the incidence of posttraumatic nasal deformity. The management was complete by simply moulding the nasal bones with the fingers under a brief general anaesthesia, promoting the patient comfort by not using intranasal packing. The success rate in terms of patients' satisfaction was 94% at the end of the follow up period, while the surgeon was happy with the result an average of 89% of the time. The low incidence of failure is attributed to complete nasal assessment [bony and septum] and to the use of general anaesthesia. Our results show that this simple closed reduction technique is efficient and effective in managing favourable nasal bone fractures. The patient comfort and the cost-effectiveness of the manoeuvre give additional advantages

Blood pressure lowering effects of antenolol in rats: role of Na-K-ATPase, serum, red cell and tissue electrolytes

Beta adrenoceptor blocking drugs have been shown to decrease the incidence of ventricular fibrillation and sudden cardiac death in patients with coronary artery disease. Although the blood pressure lowering effect of atenolol is studied through hormonal mechanisms. There is no specific study available regarding the role of electrolyte alterations in blood pressure lowering effects of atenolol. The present work was designed to investigate the role of serum, red cell and tissue electrolytes and Na-K-ATPase in blood pressure lowering effects of atenolol [a beta blocking drug]. Rats were divided into two experimental groups. Atenolol [4mg/kg body weight] was administered intraperitoneally to the test group. Control group received same volume of vehicle. Systolic blood pressure was significantly reduced after atenolol administration. An increased membrane Na-K-ATPase activity was observed after atenolol administration. Atenolol treatment decreases sodium and increase potassium in red blood cells. Concentration of sodium, potassium, calcium and magnesium was increased in serum after atenolol treatment. Atenolol treatment decreases sodium and calcium content in heart and kidney tissues whereas an increased content of potassium was observed in these tissue. The results reported in the present study suggest that apart from hormonal mechanism an alteration in electrolytes levels in red cell, serum, heart and kidney tissues and membrane Na-K-ATPase are associated with the blood pressure lowering effect of atenolol. The role of increased activity of Na-K-ATPase in the changes of sodium and potassium in red cell, serum, kidney and heart tissue after atenolol administration is discussed

Squamous cell carcinoma of the conjunctiva

A 60 year old lady presented with squamous carcinoma of the conjuctiva that extended onto the cornea. She had keratoconjuctivectomy combined with cryotherapy to the scleral bed, No recurrence occurred. The fact that she had a pterygium removed 12 years ago at the same site, is discussed in the light of recent thoughts of the probable role of UV radiation in the causation of both conditions

Management of severe head injury patients

Severe head injuries [Glasgow Coma Score less than or equal to 7] is associated with high mortality and morbidity which can be improved by early energetic therapy. We are presenting a study of 481 head injury patients admitted in our department during the period 1991 to 1993. Forty percent [193 patients] of them had severe head injuries [GCS 7 or below]. Majority of them were the victims of road traffic accidents [RTA] 60%, the next common cause of trauma was fall from height 28%. They were between the ages of 1 month to 80 years. Despite aggressive surgical treatment and intensive care 80% patients died. In the age groups of 16 to 60 years and 60 to 80 years the mortality rate was 77% and 82% respectively. In the younger group of patients upto 15 years the mortality rate was 49%. Fifty-one percent of patients were treated surgically. We are recommending more efficient system of prehospital services, controlling ventilation, haemodynamics and avoiding any increased intra cranial pressure and speedy and safe transportation of these patients to specialised neurosurgical centers by the peripheral hospitals

Blindness in the United Arab Emirates

There are no known studies of prevalence of blindness in the United Arab Emirates. The prospective study was undertaken to determine the conditions that cause blindness. A hospital-based study was conducted in which 100 males and 57 females were examined. Causes of blindness were cataract [37.9%], corneal opacities [27.89%], glaucoma [24.5%], retinal conditions [7%], phthiasis bulbi [3%] and optic atrophy [1.5%]. Most of the conditions found cause preventable blindness

Contact lens induced keratopathy

A 26 year old man developed soft contact lens induced keratitis severe enough to require penetrating keratoplasty in both eyes. The clinical, histological and ultrastructural changes are described. The role of contact lens wear is discussed

Visual loss in Albright's syndrome

A 21 year old girl with Albright's syndrome developed sudden visual loss. Treatment with steroids resulted in full recovery of vision with no recurrence during two and a half years follow up