Side Of Neck Research Articles

Report of A Case of Papillary Thyroid Carcinoma Following Intracranial Germinoma

Introduction The occurrence of second primary thyroid malignancy should be noticed in survivors of brain germinoma treated by irradiation. Case Report A patient with a history of intracranial germinoma who underwent chemoradiotherapy was referred to our endocrine clinic due to impotency and infertility. The patient received replacement therapy due to hypopituitarism. He returned to us 11 years after brain radiation with enlargement of the thyroid gland. Thyroid ultrasonography showed enlargement with a dominant 62*37 mm solid hypoechoic nodule in the right thyroid lobe. Several lymph nodes at both sides of the neck were seen. Total thyroidectomy revealed PTC with regional metastasis. Conclusion Endocrine disruption must be considered in adult cancer survivors and the importance of long-term follow-up should be emphasized in these patients.

Retrieval analysis of neck fracture on uni-modular total hip arthroplasty stems: The contributions of material processing and stem design.

Total hip arthroplasty stem fracture is an important contributor to morbidity rate and increases the cost of revision surgery. Failure is usually caused by issues related to overload, inadequate stem support, inappropriate stem design or dimensions and material processing. In this study, the role of the relationship between material characterization and biomechanical performance in the fracture of retrieved stems was explored. The stems were manufactured with forged stainless steel, had the same length, 12/14 trunnion, and 28-mm head. These stems were evaluated by macroscopic and microscopic examination to identify the causes of premature failure. Each stem was sectioned into four regions, and the cross-sections were used for the microhardness and grain size analysis. Finite element analysis (FEA) was carried out, considering the stem positioned at the femur, a musculoskeletal model, and biomechanical loading. All stems had fractured through a fatigue mechanism, mainly a unidirectional bending loading condition, with crack nucleation on the lateral side and propagation on the medial side. The numerical analysis revealed maximum mechanical stress on the lateral side of the stem neck, but this was below the yield stress calculated via the hardness. The use of a shorter head neck length could reduce the maximum mechanical stress at the neck. At a cross-section near the plane of the stem fracture, the hardness was lower than that normally reported by the ASM, and there were heterogonous and coarse grain sizes on the lateral side. The main cause of failure of the two stems analyzed was a combination of low hardness and coarse grain size, due to inappropriate materials processing, worsen by a high level of stress on the lateral side of the neck due to the large stem-head offset selected by the orthopedic surgeon.

Malignant (Anaplastic) Amelanotic/Hypomelanotic Melanoma in a Kurdish Gelding

We report an 11-year-old Kurdish gelding with an anaplastic malignant melanoma arising from his right lateral of the neck, which developed over 6 weeks. A ~10 cm in diameter, firm, and non-ulcerated nodular subcutaneous mass located at the middle and proximal of the left side of the neck was detected in a physical examination. No evidence of local extent or metastasis was detected. Complete surgical excision was performed under general anesthesia. Gross morphology and histopathological examination of the mass confirmed an anaplastic malignant melanoma, in which the major part of the mass has little or no pigmentation. The gelding was euthanized due to tumor regrowth. The heterogeneity in pigmentation of equine melanocytic tumors can make diagnosis difficult in punch biopsy specimens. Anaplastic malignant melanoma is most often a very aggressive neoplasm and surgical excision was not effective in this case.

Masson’s tumor of the neck: A rare case report

Masson’s tumor is a rare, benign, vascular lesion, commonly affecting the head, neck and peripheries. It is usually asymptomatic and can be confused with malignant tumors. We report a 56-year-old male who presented with a solitary swelling in the right side of neck which was clinically diagnosed as a benign cystic lesion, hence complete excision of the lesion was done. Histopathology demonstrated the papillary proliferation of endothelial cells, in favour of Masson’s tumor.

Rare case of unilateral hypertrophy of left lamina and spinous process of C6 with associated C2-C3 block vertebra: A case report

We report a rare case of congenital cervical anomaly in a 32 yr old female, who was referred in our department for the complaints of chronic cervical and shoulder pain with a hard cervical mass. Antero-posterior and lateral radiographs of the cervical spine were performed, which show a rib like bony projection, in the left side of neck and on the lateral radiograph, it was corresponding to a hypertrophied C6 spinous process. CT study was done for better delineation of this congenital anomaly, which showed hypertrophied left lamina of C6 and spinous process, crossing midline and towards the left side, extending inferiorly up to the level of thoracic inlet. There was associated fusion of C3 and C4 vertebrae, resulting in block vertebra (Klippel- Feil syndrome Type 1) and unfused spinous process of C6 vertebra.This case report is the first case, where hypertrophied lamina and spinous process of C6 with unfused spinous processes and block vertebra, congenital cervical anomalies were seen in the same patient.

Challenges in Managing Massive Neck Pseudoaneurysm

AbstractPseudoaneurysms in the neck are challenging surgical cases. They need detailed preoperative evaluation, treatment of etiology, and surgical/interventional management at appropriate time.Here, we describe a case of 45-year-old female who presented to emergency with impending rupture of swelling in the right side of neck. On evaluation, it was found to be a pseudoaneurysm of right common carotid artery (RCCA). She was planned for emergency surgery, but the swelling ruptured before the patient could be taken into the operation room (OR). The challenges faced in managing it are described below.

First case of huge classic papillary thyroid cancer rupturing spontaneously leading to ischemic necrosis, perforation and inflammation of overlying skin: Case report and review of the literature.

IntroductionPapillary thyroid cancer (PTC) is the commonest form of well-differentiated endocrine carcinoma. It is categorized into indolent and aggressive, where the indolent subtypes (classic, follicular) rarely demonstrate aggressive behavior. We present a classic PTC presenting with a rapidly growing huge anterior neck mass that subsequently spontaneously ruptured subcutaneously resulting in ischemia, necrosis, and perforation of overlying skin leading to inflammation.Presentation of caseA 37-year-old female with no comorbidities presented to our emergency department with a neck swelling of 2 years duration that rapidly enlarged one week prior to presentation. Though the mass initially appeared of inflammatory nature, the tumor was a PTC, and she underwent total thyroidectomy with selective right side neck dissection and debridement of necrotic skin. The gross specimen revealed a fragmented non-intact right thyroid lobe mass causing pressure ischemia, necrosis and perforation of the skin. Histopathology showed a 9 × 9 × 5 cm classic PTC staged as pT3b N1b. Postoperative course was uneventful, she was discharged by the eighth postoperative day, and then she received a high dose of radioactive iodine ablation (RAI).DiscussionClassic PTC is usually of a smaller size and a relatively benign course compared to other PTC subtypes and thyroid cancers. It is indolent with favorable prognosis. Although it is associated with increased risk of lymph node metastases at the time of diagnosis, it is slow growing with high survival rates approaching 95%.ConclusionDespite that classic PTC progresses slowly, it should still be suspected in neck swellings presenting with rapid and aggressive behavior. Prompt and systematic assessment is required with surgical intervention and radioactive iodine ablation therapy.

DESCRIPTION AND PHYLOGENETIC POSITION OF A NEW SPECIES OF HERPETODIPLOSTOMUM FROM PHRYNOPS GEOFFROANUS IN BRAZIL AND A REEVALUATION OF CHELONIODIPLOSTOMUM.

As presently recognized, Herpetodiplostomum is a small genus of proterodiplostomid digeneans parasitic in crocodilians. Most members of Cheloniodiplostomum, a genus of proterodiplostomids that parasitize chelonians, were originally placed within Herpetodiplostomum. The 2 genera were distinguished based on the presence/absence of papillae on the holdfast organ and anterior extent of vitellarium. Our study of Herpetodiplostomum and Cheloniodiplostomum revealed a lack of consistent morphological differences between the genera. Therefore, we consider Cheloniodiplostomum to be a junior synonym of Herpetodiplostomum. Recent molecular phylogenetic studies included a number of proterodiplostomid taxa; however, DNA sequence data are not available for any Herpetodiplostomum or Cheloniodiplostomum species. Herein, we describe a new Herpetodiplostomum species from Geoffroy's side-necked turtle Phrynops geoffroanus from Mato Grosso State, Brazil. The new species can be distinguished from other Herpetodiplostomum species based on the distribution of vitellarium, level of development of holdfast papillae, and ratio of prosoma:opisthosoma width, among other characters. We provide the first molecular phylogeny of the Proterodiplostomidae that includes a Herpetodiplostomum species. The limited geographic distribution of Herpetodiplostomum spp. within the geographic ranges of caimans suggests a secondary host switching event from crocodilians to chelonian definitive hosts in the evolution of Herpetodiplostomum.

Robotic-Assisted Removal of Parapharyngeal Space Tumor via a Retro-auricular Approach: A Case Report

Parapharyngeal space (PPS) tumors are rare and excised most commonly via the transcervicalapproach. A female patient presented with a left side neck swelling of size 5cm x 4cm, progressivelyincreasing in size. Radiologically a well-defined soft tissue intensity mass lesion in left parapharyngeal space (PPS) was noted suggesting paraganglioma (Schwannoma). Resection of the tumorwith robotic assistance via the retro-auricular approach was planned and resected. The roboticassistance resection of PPS mass via retro-auricular tunnel has the advantages of lessening theextent of dissection and better instrument access eliminating blind dissection.

Topographic Evaluation of Superior Thyroid Artery-A Terrain to be Well Versed for Surgeon's Knife.

Observing the origin, varied branching configurations of superior thyroid artery (STA) and evaluating morphometric details with its surrounding relations was aimed at in this cadaveric neck dissection study to avoid surgical mishaps and its repercussions. This observational study was conducted on 40 fresh frozen embalmed and colored latex infused cadavers in the Department of Otorhinolaryngology and Head and Neck Surgery in collaboration with Department of Anatomy of our institute, which involved systematic evaluative dissection of both sides of neck especially focusing on superior thyroid artery, its branching variations and morphometric details with its surrounding relations. Details were measured using digital caliper. The collected data was statistically analyzed by applying chi-square test and significance was set at 5% level (p < 0.05). The analysis revealed the location of the origin of the superior thyroid artery of cadavers from carotid bifurcation and above it in 40% and from above the level of superior border of thyroid cartilage in 40% of cases. The distribution patterns of the superior thyroid artery were classified into three types depending on the branching pattern typical and variant glandular branching patterns were observed in 85% and 15% of the specimens respectively. A sound knowledge of the regional anatomy and its possible variations helps the surgeon in isolating and preserving the vital structures and avoid iatrogenic complications.

An early bothremydid from the Arlington Archosaur Site of Texas

Four turtle taxa are previously documented from the Cenomanian Arlington Archosaur Site (AAS) of the Lewisville Formation (Woodbine Group) in Texas. Herein, we describe a new side-necked turtle (Pleurodira), Pleurochayah appalachius gen. et sp. nov., which is a basal member of the Bothremydidae. Pleurochayah appalachius gen. et sp. nov. shares synapomorphic characters with other bothremydids, including shared traits with Kurmademydini and Cearachelyini, but has a unique combination of skull and shell traits. The new taxon is significant because it is the oldest crown pleurodiran turtle from North America and Laurasia, predating bothremynines Algorachelus peregrinus and Paiutemys tibert from Europe and North America respectively. This discovery also documents the oldest evidence of dispersal of crown Pleurodira from Gondwana to Laurasia. Pleurochayah appalachius gen. et sp. nov. is compared to previously described fossil pleurodires, placed in a modified phylogenetic analysis of pelomedusoid turtles, and discussed in the context of pleurodiran distribution in the mid-Cretaceous. Its unique combination of characters demonstrates marine adaptation and dispersal capability among basal bothremydids.

“TUBERCULOUS THYROIDITIS: A RARE CASE REPORT”

Tuberculosis of thyroid gland is a rare entity even in countries with high prevalence of tuberculosis. The diagnosis of extra-pulmonary tuberculosis, especially in the rare sites like thyroid, pancreas, striated and cardiac muscles is difcult. Thyroid tuberculosis, if at all present, is more commonly associated with either miliary or disseminated tuberculosis or with contagious involvement from adjacent viscera and vertebral body. Hence, for an accurate diagnosis of thyroid tuberculosis, pathological examination with demonstration of acid-fast bacilli is important along with a proper clinico-radiological evaluation. Herein we report a case of 30-year-old male with swelling on the right side of neck who presented with a “solitary thyroid nodule” on ultrasound and “colloid” in ne needle aspiration cytology (FNAC) with scattered epithelioid like cells along with benign follicular epithelial cells. However, no denitive diagnosis could be given on cytology due to pauci-cellularity. Tuberculous thyroiditis was diagnosed on histopathology since the patient underwent right hemithyroidectomy for right side solitary nodule. The patient was started on Anti-tubercular therapy (ATT) and had no complications in 6 months follow up period. Although rare, thyroid tuberculosis should be kept in mind in differential diagnosis of thyroid nodules, even in patients with no history and symptoms of TB disease elsewhere specially in TB endemic areas.

Coexisting Metastatic Papillary Carcinoma Thyroid and Clear Cell Neuroendocrine Tumour in Thyroid- A Rare Case Report

Coexisting Metastatic Papillary Carcinoma Thyroid and Clear Cell Neuroendocrine Tumour in Thyroid- A Rare Case Report

Stem Cells and Heart's “Little Brain”

Intriguing role of “little brain” neurons of heart in control of myocardium functional state is analyzed with addiction after appearance of this term in the articles by J.A. Armor on the border of the second and third millennia. The “little brain” neural network of heart modifies adrenergic and cholinergic afferent and efferent signals in accordance with functional state of brain, myocardium and heart automation nodes. Thus, the “little brain” of heart is the guarantor of implementation of stochastic principle at the level of key vital organ of mammals. It is advisable to try to find ways to optimize heart activity by influencing the “little brain” neural networks. This idea initiated an attempt by the authors to test the effectiveness of the method of perineural delivery of mesenchymal stem cells (MSCs) to damaged areas of myocardium, including “little brain” structures. First group of male Wistar rats weighing 200-220 g (n=10) was subjected to vagus damage on the right side of neck with subsequent injection of 50000 PKH67-labeled MSCs in 50 µl of phosphate buffer solution into left vagus under ketamine-xylazine-acepromazine (55.6, 5.5 and 1.1 mg/kg, respectively) anesthesia. Only vagus on the right side of neck was damaged in the second group of Wistar rats (n=8) under anesthesia. Heart rate variability disturbances were recorded in rats of both groups on the next day after the operation. Heart rate was analyzed using non-invasive pulse recorder L120E INSELT (USA). One rat from the second group died in two days after the operation, and the heart rate variability was restored in all rats of the first group. Decapitation of three animals from the first group was performed on the third day of observation, horizontal slices of heart (8 µm) were made using a Microm HM525 freezing microtome (Germany). MSCs distribution was visualized using Zeiss AxioVert 200M fluorescence microscope with Zeiss AxioCam HRm CCD camera. The dominant location of MSCs was recorded near sinoatrial and atrioventricular nodes. Ten serial heart slices were taken with the interval of 50 µm and stained in hematoxylin-eosin; structural changes were visualized using MPV-2 microscope (Leitz, Germany) with Leica DC 300F camera (Germany). An accumulation of 10-15 nerve cells, 15-25 µm in size, was found near sinoatrial and atrioventricular nodes. Therefore, experimental simulation of heart rhythm disturbances on rats allowed finding that perineural implantation of MSCs (n.vagus) is one of the ways to correct disturbed heart rhythms. Neurotrophic factors of MSCs are the basis of reparative effects, which is accompanied by an increase in efficiency of corrective action of the “little brain” neurons near sinoatrial and atrioventricular nodes. Implementation of such method in clinical practice will be an alternative or addition to surgical methods in the treatment of patients with cardiac arrhythmias.

Femoral strength and strains in sideways fall: Validation of finite element models against bilateral strain measurements

Low impact falls to the side are the main cause of hip fractures in elderly. Finite element (FE) models of the proximal femur may help in the assessment of patients at high risk for a hip fracture. However, extensive validation is essential before these models can be used in a clinical setting. This study aims to use strain measurements from bilateral digital image correlation to validate an FE model against ex vivo experimental data of proximal femora under a sideways fall loading condition. For twelve subjects, full-field strain measurements were available on the medial and lateral side of the femoral neck. In this study, subject-specific FE models were generated based on a consolidated procedure previously validated for stance loading. The material description included strain rate dependency and separate yield and fracture strain limits in tension and compression. FE predicted fracture force and experimentally measured peak forces showed a strong correlation (R2 = 0.92). The FE simulations predicted the fracture initiation within 3 mm distance of the experimental fracture line for 8/12 subjects. The predicted and measured strains correlated well on both the medial side (R2 = 0.87) and the lateral side (R2 = 0.74). The lower correlation on the lateral side is attributed to the irregularity of the cortex and presence of vessel holes in this region. The combined validation against bilateral full-field strain measurements and peak forces has opened the door for a more elaborate qualitative and quantitative validation of FE models of femora under sideways fall loading.

An uncommon presentation of pleomorphic adenoma

80-90% of tumours of the parotid gland are benign, the most common being pleomorphic adenoma. It is characterized principally by epithelial and myoepithelial components distributed in varied patterns through an abundant matrix of mucoid, and chondroid supporting tissue. Classically it presents as swelling in front, below and behind ear, Raises ear lobule and Retro mandibular groove is obliterated. Here we present a case of a swelling over left side of neck over submandibular triangle near the angle of the mandible. The case is presented as clinical presentation of pleomorphic Adenoma was not classical.

Pressure side and tension side comminution of femoral neck cortex are independent risk factors for aseptic necrosis after femoral neck fracture surgery

To investigate the related factors of aseptic necrosis of femoral head after closed reduction and internal fixation of femoral neck fracture. From January 2009 to January 2016, 236 patients with femoral neck fracture were treated with closed reduction and internal fixation with 3 hollow lag screws, including 111 males and 125 females, aged from 19 to 89 (50.17±12.88) years. According to the follow-up results, the correlation of aseptic necrosis of femoral head was analyzed. Univariate analysis of age, gender, injured side, body weight, injury mechanism, preoperative waiting time, Garden classification and whether there was comminution of femoral neck cortex was conducted to obtain the independent variables with significant difference. Then binary logistic regression analysis was conducted to explore the independent risk factors of avascular necrosis of femoral head. The average follow-up period of 236 cases was 4.58 years. There were significant differences in the range of injury (24.69% vs. 5.16%, χ2=19.405, P=0.000), operation waiting time>48 hours (20.00% vs. 6.38%, χ2=10.065, P=0.002), Garden type Ⅲ/Ⅳ (18.52% vs. 2.97%, χ2=13.357, P=0.000), femoral neck cortex comminution (66.67% vs. 4.88%, χ2=39.968, P=0.000). Multivariate logistic regression analysis showed that:injury mechanism [high energy injury, Exp (B)=4.397, 95%CI=(1.672-11.562), P=0.003], preoperative waiting time >48 h [Exp (B)= 3.060, 95%CI=(1.176-7.966), P=0.022], comminution of femoral neck cortex [comminution of femoral neck pressure side cortex, Exp (B)=3.944, 95%CI=(1.245-12.494), P=0.020;comminution of femoral neck pressure side and tension side cortex, Exp(B)= 23.761, 95%CI=(3.805-148.374), P=0.001) were independent risk factors for avascular necrosis after internal fixation of femoral neck fracture. Garden type Ⅲ/Ⅳ was not an independent risk factor in this study [Exp (B) = 1.985, 95%CI=(0.436-9.032), P=0.375]. High energy injury, preoperative waiting time (>48 h) and comminution of femoral neck cortex were independent risk factors for aseptic necrosis of femoral head. In addition, cortical comminution on the pressure side and tension side of the femoral neck is a strong prognostic risk factor for aseptic necrosis of the femoral head, because it indicates a more serious and complex injury mechanism.

Necrotising Fasciitis of Neck in a 7 Day Neonate Following Insect Bite.

Necrotizing fasciitis is severe inflammation of the muscle sheath that leads to necrosis of the subcutaneous tissue and adjacent fascia. The disease entity is more commonly described in adults and the literature seems quite sparse with respect to children and even lesser in neonates. Monomicrobial infection with necrotizing fasciitis in Neck following insect bite is rare and even rarer in neonates. 07day old neonate had history of rapid onset discoloration and swelling of the Right side of Neck following an insect bite which was followed fever and irritability and eventually black discoloration. The neonate was irritable with excessive crying, had tachycardia, tachypnea and was febrile. There was a diffuse swelling in the right side of neck with multiple patchy areas of tissue necrosis in form of blackening of the skin over the swelling Management: Necrotizing fasciitis was identified early and the neonate prepped for surgery. All the biochemical parameters were WNL. CRP was raised. Empirical treatment with Cefotaxime, Clindamycin and cloxacillin started and neonate taken for local debridement. All necrotic tissue was removed including tail of parotid. Over next 5days serial debridement and wound wash with Hydrogen peroxidase, Betadine, saline and metronidazole was done. The edges of the wound became healthy with no new slough formation and necrotic tissue. An early diagnosis and definitive management with both surgery and antibiotics is the key to a reduce mortality in the neonates. It needs to be followed up with good local wound care.

Clinical and Cytology Description of Various Neck Lumps in Madani Medan Hospital

This study aims to determine the clinical and cytological features of various neck lumps. This study used a descriptive observational method with a cross-sectional approach to determine the clinical and cytological features of various neck lumps. This study used secondary data of patients with indications of a neck lump who were undergoing treatment or examination at the Medan Madani Hospital in 2018 - 2019. The population in this study were all patients with symptoms and positives experiencing a lump in the neck, at Madani Hospital Medan. Data processing is carried out after the observation and recording of medical record data is in accordance with what is needed, the data obtained is tabulated and coded for later analysis. The results of this study indicated that respondents who experienced thyroid nodules were more dominant in female respondents with a total of 11 respondents, with the most common type of thyroid nodule adenoma follicular thyroid, namely 9 respondents with female gender. Respondents who experienced inflammation were dominated by female respondents with a non-specific chronic inflammation process on the right side of the neck with a total of 10 respondents with a percentage of 23.8%.

A three-dimensional shoulder protector based on ergonomics for workers

PurposeThe use of shoulder protectors is strongly recommended when carrying objects on the shoulder to ensure the health and safety of workers. Thus, this study aimed to develop and verify an ergonomic shoulder protector that considers human body shape and carrying posture from an ergonomic perspective. Ultimately, this study will present a shoulder protector with enhanced fit and safety for carrying workers at construction sites.Design/methodology/approachThe shoulder protector was designed and printed using three-dimensional printing technology with variable side neck points and shoulder point heights to reflect the human body's shoulder line shape and to position the carried object stably on the shoulder. The developed shoulder protectors were evaluated in terms of their fit according to the work posture of the carrier, adherence upon motion and durability through structural analysis.FindingsThe design of the shoulder protector for carrying workers followed the shoulder line. It is best placed above the side neck point by 1.0 cm and above the shoulder point by 2.0 cm. Its length is slightly shorter than the human shoulder for superior fit and safety.Originality/valueThe final shoulder protector (FSP) for carrying workers reflects the body curvature while enhancing fit and safety by considering activity and protective factors. As functional studies and evaluations on the need for protectors are scarce, this study provides fundamental data in the evaluation of protective gears.