Unusual loco-regional presentation in papillary carcinoma of thyroid: A case series

BACKGROUND: Papillary carcinoma of thyroid (PTC) is usually indolent with good prognosis and excellent long-term survival. However, PTC sometimes presents itself in unusual situations, posing diagnostic and therapeutic challenges. Owing to paucity of data, there is lack of consensus as to what treatment should be prescribed in patients with loco-regional spread other than the usual sites. MATERIALS AND METHODS: Six patients of PTC presenting with involvement of the aero-digestive tract, retropharyngeal, and para-pharyngeal lymph nodes and great vessels of the neck are included in this case series. RESULTS AND CONCLUSION: Though rare, unusual loco-regional presentation of PTC poses challenges in diagnosis and treatment. A keen clinical sense is paramount in effectively diagnosing these cases. Aggressive surgical resection and reconstruction results in good functional and aesthetic outcomes. Further studies are required for establishing specific guidelines on the approach to the treatment of these cases

Chronic discharging ear in a child: are we missing something?

Chronic discharging ear, mostly due to middle or external ear infection, is one of the leading causes for seeking healthcare among the paediatric population in a developing country. However, a long-standing forgotten middle ear foreign body forms a rare cause for such presentation demanding a high index of suspicion from the clinicians. Most of them are iatrogenic or accidental, and are removed by conventional permeatal approach; need for tympanotomy is rarely documented in the recent literature. We report the first case where a large stone was introduced into the middle ear through a pre-existing tympanic membrane perforation by the child himself, and only the second documentation of removal of a middle ear foreign body by tympanotomy in a child.

Ocular morbidity among children at a tertiary eye care hospital in Kolkata, West Bengal.

Eye diseases in childhood are important causes of medical consultation and it affects learning ability, adjustment in school and personality. To determine the pattern of ocular morbidity a cross-sectional observational study was conducted among 714 children, attending Ophthalmology department at a tertiary eye care center in Kolkata, West Bengal. All the children less than 15 years of age, attending in Unit II outpatient department were selected by complete enumeration method for duration of one year (January-December 2010). Distribution of association was analyzed by Chi-square test and difference between two proportions was calculated by z test for proportions. The common ocular morbidity were refractive errors (23.67%) followed by allergic conjunctivitis (17.23%), infection of the eye and adnexa (15.13%), ocular trauma (12.74%), and congenital eye diseases (13.59%). Majority of ocular morbidity is treatable and need early attention through eye screening cum intervention program beginning right from the childhood.

Xerophthalmia: a study among malnourished children of West Mednipur District.

To study the correlation of stages of xerophthalmia in different grades of malnutrition, having 200 children clinically diagnosed having malnutrition as per criteria laid down by the Indian Academy of Pediatrics (IAP) were examined to detect the dinical stages of xerophthalmia as proposed by World Health Organisation (WHO). Out of 200 cases with different grades of malnutrition 81 (40.5%), 78 (39.0%), 22 (11.0%) and 19 (9.5%) were found malnourished in grades I, II, III, and IV respectively. Night blindness was earliest feature and seen in 97 cases (48.5%). All the 97 cases of night blindness fell in group of X(N) in which one case had corneal scar and falls in the group of X(S) in clinical staging of xerophthalmia. Thirty-nine (40.2%), 35 (36.1%), 19 (19.6%), 3 (3.1%) and (1.1%) were in clinical stages of xerophthalmia of X(1A), X(1B), X2, X(3A), X(3B)respectively. Severity of xerophthalmia was found directly proportional to severity of malnutrition.

Malignant melanoma of conjunctiva--a case report.

A 65-year-old male patient presented with a rapidly increasing mass in his left eye. It did not show any intra-ocular extension as examined by slit lamp, gonioscopy, indirect ophthalmoscopy and ultrasonography, nor there was any sign of systemic metastasis. The mass was excised completely. Buccal mucous membrane grafting was done to cover up the lower forniceal area and conjunctival autograft taken from right eye and placed over upper fornix and bulbar area. Postoperative radiotherapy was suggested. Histopathological examination of the mass revealed the diagnosis of malignant melanoma of conjunctiva.

Rheumatoid arthritis and ocular involvement.

To study the occurrence and incidence of different ocular manifestations in rheumatoid arthritis a random cross-sectional study was carried out among 54 patients with active rheumatoid arthritis. The patients were examined thoroughly to detect any ocular disease associated with rheumatoid arthritis. Complete ocular examination with special emphasis on anterior segment evaluation and tearfilm study was done. Two-thirds of the patients examined had some kind of visual problem at presentation. Three patients (5.55%) had marked dry eye with another 20 (37.03%) having borderline tear deficiency. Two cases ( 3.70% ) of episcleritis were also seen. No cases of scleritis or retinopathy were found. The most common ocular association with rheumatoid arthritis was secondary Sjogren's syndrome. Other conditions include episcleritis and marginal keratitis.

Clinical pattern of ocular manifestations in vitiligo.

To study the ocular abnormalities in cases of vitiligo, 100 patients were examined who underwent a series of investigations e.g., complete haemogram, urine analysis, blood biochemistry and chest x-ray and 70 cases were taken as control. Patients with systemic diseases such as diabetes mellitus, thyroid and auto-immune disorders were excluded. Detailed ocular examinations including recording of vision, slit-lamp biomicroscopy, gonioscopy, ophthalmoscopy and examination of fundus by 90 D lens were done. Of 100 vitiligo patients, 23% showed hypopigmented sports on the iris, 18% pigmentation on anterior chamber, 9% retinal pigment epithelium hypopigmentation, 5% uveitis, 11% had chorioretinal degeneration and 34% had no ocular findings. There lies a strong association of ocular disorder in patients with vitiligo.

Association of diabetic maculopathy with diabetic nephropathy--a study.

A total number of 100 patients were examined over a period of one year to find out any correlation between diabetic maculopathy and diabetic nephropathy. Twenty-two belonged to insulin dependent diabetes mellitus group and 78 patients were in the non-insulin dependent diabetes mellitus group who were suffering from diabetes over a period of 0-25 years and more. Another group comprising 6 patients were chosen from these 100 patients who were suffering from nephropathy diagnosed clinically and on pathological investigations. Background and proliferative--both types of diabetic retinopathy were found with increased incidence with the persistence of the disease in both types of diabetes mellitus. Nine patients had diabetic maculopathy, out of which 6 patients (66.66%) were suffering from diabetic nephropathy. Proliferative diabetic retinopathy is more common in insulin dependent diabetes mellitus than in non-insulin dependent diabetes mellitus of more than 25 years of duration. Maculopathy is more common in non-insulin dependent diabetes mellitus and there is strong correlation between diabetic maculopathy and diabetic nephropathy.