Lingual thyroid gland: clinical evaluation and management.

The authors present three illustrative cases of lingual thyroid gland in paediatric age group with a protocol for diagnosis and management of the condition. Elements in the diagnostic and therapeutic evaluation are outlined with attention to the clinical findings, laboratory tests and radiographic imaging studies employed in confirming the diagnosis and planning appropriate treatment. Presentations varied from swelling noticed on routine evaluation for upper respiratory tract infection in one, to dysphagia in the next and sore throat in the third patient. On examination they had swelling on the tongue just behind the circumvallate line. 99mTc thyroid scan confirmed the swelling as lingual thyroid with no thyroid tissue in the normal location. All three children had raised TSH levels and were put on suppressive L-thyroxine. At follow up patients are asymptomatic.

Osteosarcoma of the rib.

Primary osteosarcomas arising from the rib are very rare. The authors report an 11-year-old boy with a primary fibroblastic osteosarcoma of the rib, who underwent wide excision and reconstruction of the chest wall followed by chemotherapy. He is disease free after a follow up of 24 months. The relevant literature is reviewed briefly.

Surgical implications of snakebites.

OBJECTIVE: Snakebites are a common problem in the pediatric age group. Local complications such as necrosis and compartment syndrome threaten limb survival even after control of systemic manifestations. Few recommendations exist about the nature and timing of surgical treatment. METHODS: A retrospective review of all children with snakebites presenting to the hospital was undertaken over a 6-year period. Records were reviewed with special emphasis on the type of surgical lesions seen and the treatment offered and their results. RESULTS: 44 of the 58 children required some form of local therapy. In the majority conservative treatment was successful. 28% of the patients needed debridement for local necrosis, and only 5 needed a skin graft, with good functional results over a period of 1 to 45 days. One child underwent an above knee amputation. Patients who required surgical intervention received significantly more vials of antivenin. CONCLUSION: Local complications of snakebite are frequent, but can be managed conservatively. Delayed excision of the resultant local necrosis is associated with good outcomes. The need for fasciotomy is rare.

Parahiatal hernia with gastric obstruction in a child.

Parahiatal hernia refers to herniation of abdominal viscera into the chest adjacent to an intact hiatus. Spontaneously occurring parahiatal herniae are extremely rare. We report a 4-year-old boy who presented with intermittent vomiting and had such a hernia, where the herniated stomach had undergone partial volvulus. He was symptom-free after surgical repair.