Metastasis of squamous cell carcinoma of the head and neck to the thyroid: a single institution's experience with a review of relevant publications.

The thyroid gland is a rare site of metastasis, and in particular of those of squamous cell carcinoma (SCC) from the head and neck region. We have reviewed the aetiology, pathogenesis, clinical characteristics, radiological features, immunohistochemical profile, prognosis, and management of metastatic SCC from the head and neck region to the thyroid, and searched current publications on the Medline, Embase, and Cochrane databases using the following keywords: "SCC of thyroid", "secondary SCC of thyroid", and "metastasis to the thyroid", for papers published during the last 33 years (April 1984 to October 2017).We found a total of 19 papers that reported a total of 32 cases that were relevant. Four further cases were discovered as an incidental finding on follow-up positron emission tomographic/computed tomographic scans with magnetic resonance imaging of the head and neck at our hospital, which were confirmed with an ultrasound-guided core needle biopsy followed by immunohistochemical examination. For patients who are doing well, whose disease is controlled at the primary site, and who have no evidence of distant metastatic disease, total thyroidectomy could be considered followed by adjuvant radiation or chemoradiotherapy, depending on the presence of intermediate or high-risk features on pathological examination and previous history of radiation. This may help to control the disease and avoid local morbidity.

Successful stenting of a complex inferior vena cava stenosis using a modified sharp recanulization technique.

We describe a case of a 30-year-old male who presented with features of noncirrhotic portal hypertension, who was diagnosed to have inferior vena cava (IVC) obstruction. IVC angiogram and ultrasound study revealed a long-segment (36 mm long), chronic total thrombotic occlusion that was dilated and stented with a satisfactory end result. The unique feature of this case is a modified sharp recanulization technique involving the use of Brokenborough (septal puncture) needle and Mullin dilator to create a track in such a long, chronic total occlusion under simultaneous ultrasound and fluoroscopic guidance.

Broken guidewire fragment: a simplified retrieval technique.

We report a technique for retrieval of a broken angioplasty wire fragment from the coronary system using a more simplified technique that does not involve the use of a snare or any other retrieval tool. With the use of an additional angioplasty wire and a balloon catheter, we could safely remove the broken wire fragment from the coronary system and circulation in a very short time.

Role of ethamsylate in preventing periventricular-intraventricular hemorrhage in premature infants below 34 weeks of gestation.

OBJECTIVE: To determine the role of ethamsylate in prevention of PVH-IVH in premature infants <34 weeks gestational age. DESIGN: Prospective, randomized, controlled study. METHODS: Infants less than 34 weeks gestational age were included in the trial. Neonates with congenital malformations, family history of bleeding disorders and with Apgar scores <5 at 5 minutes were excluded. Subjects were randomized into two groups--Group A infants received intravenous ethamsylate (12.5 mg/kg) six hourly for four days and Group B infants served as a control group. Regular cranial ultrasounds to detect the presence of PVH-IVH were done between days 3-5, 10-14 and 28-30 of post natal age, and before hospital discharge in all infants and weekly in infants detected to have PVH-IVH on earlier scans. Various antenatal and postnatal factors known to affect the incidence of PVH-IVH were recorded. RESULTS: A total of 192 infants underwent the trial, 93 in Group A and 99 in Group B. Antenatal corticosteroids (1 or 2 doses) were administered to 32 ( 34.4%) and 36 (36.3%) women in Group A and Group B, respectively. None of the mothers received phenobarbitone, vitamin K or indomethacin antenatally and none of the infants received phenobarbitone, vitamin E or indomethacin postnatally during the study period. PVH-IVH was seen in 26 infants in Group A, of which Grade I IVH occurred in 9, Grade II in 14, Grade III in 2 and Grade IV in one infant. Twenty-nine infants had PVH-IVH in Group B of which 11 had Grade I, 15 Grade II and 3 Grade III. None of the differences were statistically significant. CONCLUSION: Postnatal administration of ethamsylate did not decrease the incidence of PVH-IVH in the study infants.

Antenatal diagnosis of congenital renal malformations using ultrasound.

Our objectives were to determine the accuracy of antenatal sonography for the detection of congenital renal malformations and to characterize the type of malformations, seen in a 3-year prospective study at a university-affiliated maternity hospital. Participants were 31,217 pregnant women, during the study period, and subjects were 65 fetuses in whom renal malformations were detected on antenatal ultrasound. Pelvic ultrasound scans were performed at least once between 20 and 37 weeks' gestation on all pregnant women attending the antenatal clinic of the hospital for the detection of renal malformations. Fetal urinary sampling, diversion procedures, or termination of pregnancy were carried out as required in those detected to have renal anomalies. Postnatal diagnosis was confirmed by sonography or autopsy. Diagnostic procedures and renal surgery were performed postnatally if indicated. Sixty-five fetuses (0.2 per cent) were diagnosed to have congenital renal malformation antenatally at a mean gestational age of 28.4 weeks. A dilated urinary system was seen in 39, cystic renal disease in 15, agenesis/hypoplasia in six, combined lesions in four, and a horseshoe kidney in one. Oligohydramnios was noted in 20 (31 per cent) pregnancies. Multiple congenital malformations associated with renal anomalies were detected in 12 pregnancies. Termination was carried out at 20 weeks in two pregnancies for lethal malformations; fetal urinary sampling was done in two fetuses with obstructed uropathy, and a vesicoamniotic shunt inserted in one. Postnatal ultrasound confirmed a dilated urinary system in 32, cystic renal dysplasia in 15, renal aplasia/hypoplasia in five, combined lesions in six, and a horseshoe and an ectopic kidney in one each. Five infants were found to be normal. There were seven stillbirths and seven neonatal deaths. Radionuclide scans showed obstruction in nine, decreased renal function in six, and absent renal functions in 10 infants. Micturating cystourethrography demonstrated reflux in 11 and a non-refluxing non-obstructive dilated renal system in five babies. Renal surgery was performed in nine infants. The conclusions drawn from this study were that antenatal detection of renal disease is fairly accurate, even in an extremely busy hospital and certain types of malformations reported in other studies were not observed, despite a large cohort.

Cisapride use during human pregnancy: a prospective, controlled multicenter study.

The objective of this prospective multicenter study was to determine whether cisapride is associated with increased risk of malformations, spontaneous abortions, or decreased birthweight when used during pregnancy. Cases were paired for age, smoking, and alcohol consumption with controls exposed to nonteratogens, as well as with disease-paired controls. One hundred and twenty-nine pregnant women were exposed to cisapride during pregnancy, including 88 during the period of fetal organogenesis. There were no differences in maternal history, birthweight, gestational age at delivery, and rates of livebirths, spontaneous or therapeutic abortions, fetal distress, and major or minor malformations among groups. It is concluded that exposure to cisapride during pregnancy is not associated with a major increased risk of malformations or spontaneous abortions or with decreased birthweight.

Nursery outbreak of neonatal fungal arthritis treated with fluconazole.

Eight preterm infants with mean gestational age of 31.6 +/- 1.16 weeks and a mean birth weight of 1310 +/- 201.7 g presented at a mean postnatal age of 26 +/- 11.4 days with knee joint swellings and pedal oedema. There was no other clinical, haematological or microbiological evidence of bacterial sepsis. Fungal cultures yielded growth of Candida spp. from blood in five, from urine in four, from cerebrospinal fluid in one, and from all the three babies in whom the joints were aspirated. Radiographic changes of metaphysitis of the involved joints were noted in all. All infants had received prior antibiotic therapy. No infant had received total parenteral nutrition or had central lines inserted. All infants were treated with fluconazole in doses of 7.5 mg/kg/day for 6 weeks. Six of eight were thriving well at 3 months of age without any evidence of residual joint disease. One infant succumbed to disseminated disease and one was lost to follow-up. Candidial arthritis is an uncommon presentation of neonatal candidiasis. Fluconazole therapy proved effective.

Neonatal bacterial sepsis in a neonatal intensive care unit: a 5 year analysis.

OBJECTIVE: To study the pattern of neonatal sepsis in a neonatal intensive care unit (NICU) during a 5 year period and assess the relationship between maternal risk factors and early onset sepsis (EOS). METHODOLOGY: The study reported here was a retrospective analysis of 209 episodes of septicaemia and 5 episodes of bacterial meningitis in 198 newborn infants, 22 of whom died. Eighty-one infants had EOS (< or = 72 h) and 117 infants had late onset sepsis (LOS > 72 h). All infants had clinical evidence of sepsis, a computerized haematological score for sepsis of 4 or greater, and either treatment with antibiotics for 7 days or more or had earlier death due to sepsis. The organisms causing neonatal sepsis were analyzed according to the day of onset, gestational age, birthweight and year of infection. RESULTS: Sepsis occurred in 5.6 per 1000 live births and 3.8% of NICU admissions. There were 81 episodes of EOS and 128 of LOS. Coagulase negative staphylococci (CONS) 38.8%, group B Streptococcus (GBS) 20.1% and Gram-negative bacilli (GNB) 20.1% were the common causes of sepsis; and GBS (50.6%) and CONS (60.9%) were the most common organisms in EOS and LOS, respectively. The mean gestational age and birthweight were higher in babies with EOS than compared with LOS. The higher likelihood of probable rather than definite infection in infants with EOS was related to more mothers in the EOS group receiving intrapartum antibiotics. GNB infection was more common in their babies. CONCLUSIONS: GBS and CONS were the most common causes of EOS and LOS, respectively. The use of maternal intrapartum antibiotics interferes with neonatal blood culture results. Because blood cultures are not always positive in neonatal septicaemia, a combination of clinical, haematological and other microbiological evidence should be used when diagnosing neonatal septicaemia.