Changing patterns of thyroid cancer in Sri Lanka. Has the iodination programme helped?

OBJECTIVES: To ascertain if there has been a change in the pattern of thyroid cancer in Sri Lanka. If so, whether there is a correlation to the implementation of the programme of iodination. DESIGN: Retrospective (1974-1986) and prospective (1987-2001). SETTING: Kandy Hospital (1974-1982), Peradeniya Hospital (1982-2001) and private hospitals in Kandy (1979-2001). METHOD: Three hundred consecutive patients with cancer of the thyroid seen over 28 years (1974-2001) period were reviewed for demography, histopathology and extent of spread at presentation. Seventy one patients of this group had a pre-existing goitre of greater than 10 years' duration and were similarly reviewed. RESULTS: A highly significant reduction of anaplastic thyroid cancer and a highly significant reduction in the extent of extra-thyroidal spread at presentation of differentiated thyroid cancer were observed after 1995. In malignancy supervening on pre-existing goitre, a significant reduction in anaplastic carcinoma and a highly significant increase in papillary carcinoma were noted in the post-1996 period. A significant reduction of extra-thyroidal spread was also observed. CONCLUSION: A trend towards more differentiated thyroid cancer with lesser degree of spread was observed in recent years. The iodination programme implemented in 1995 is likely to be responsible for this change.

Thoracic duct cyst presenting as a left supraclavicular mass.

Thoracic duct cysts may occur either in the mediastinum or in the neck. The majority of such lesions occurring in the neck consist of chylous fistulae and are secondary to surgery on the neck. Fewer than five cases have been reported in the literature of primary thoracic duct cysts occurring in the neck (1).

Lipid patterns in patients with chronic occlusive arterial disease affecting lower limbs.

114 consecutive patients with chronic occlusive arterial disease of lower limbs (COADL) had their serum lipid pattern compared with that of 62 controls. 53 had abnormal lipids and 36 multiple abnormalities emphasising the common prevalence of atherosclerosis among patients with COADL in Sri Lanka. 48.6% of patients under 40 years had a lipid abnormality. Smoking and lipid disorders were the main risk factors in the under 50 age group. 14 of 16 patients with aortic occlusions and five of eight patients under 45 years with iliac disease had lipid disorders. 21 of 50 patients with femoropopliteal occlusive disease also had lipid disorders. A consistent dominant lipid disorder affecting most, was not found. Total cholesterol/HDL cholesterol ratio was found to be the commonest abnormality. Serum lipid studies are advocated for those with aortoiliac and femoropopliteal disease.

Insensible water loss in resting adults in Kandy, Sri Lanka.

Sixty three adults (44 men) were observed over a 4 hour period in Kandy to measure insensible water loss. Six adult men were similarly studied over 24 hours. The average loss per day, computed from the 4 hour studies was 1,333 ml for men and 1,230 ml for women. The 24 hour study showed an average loss of 1,423 ml. A reasonable working estimate for insensible water loss for resting adults in Kandy would be about 1,000 to 1,200 ml per day. However, when renal excretion of water is impaired, it is safer to err on the side of mild dehydration than to attempt complete hydration.