Visible Swelling Research Articles

Intrathyroid Injection of Steroid in Benign Thyroid Swellings.

Benign thyroid swelling disorders are common conditions, frequently encountered in clinical practice. Though medical management has been useful in treating the hormonal variations, it has not been very significant in reducing the size of the swelling. To study the efficacy of intra thyroid injection of triamcinolone in benign thyroid swelling disorders. A total of 20 patients were selected for this study. All the patients with thyroid swellings, were evaluated with history and clinical examination followed by routine blood investigations, thyroid function tests (T3,T4,TSH), Fine Needle Aspiration Cytology (FNAC) and Ultrasonography (USG) of the neck. The treatment adopted in this study was intrathyroid injection of triamcinolone acetonide. In this study there were 20 patients, all were females in the age group of 17- 55 years. Four patients did not come for regular follow up, and hence were excluded. Sixteen patients were followed up regularly. Thirteen (81.25 %) patients showed excellent results with no visible swelling, confirmed sonologically. Two patients (12.5%) showed fair results with residual swellings, and one patient did not show any reduction in size of the swelling. Intrathyroid injection of triamcinolone acetonide is a safe, minimally invasive technique in reducing the size of benign thyroid swellings with minimal or no side effects.

Rare presentation of sacrococcygeal teratoma in a prepubertal girl

Eighty-five percent of sacrococcygeal teratomas, the most common neonatal tumor present in infancy with externally visible swelling. Because of associated risk of malignancy, which increases exponentially with age, majority of the tumors undergo operative intervention. Hence, presentation in an adult that too of a benign mass is extremely rare, with less than 10 reported cases in world literature. We report case of a 9-year-old girl who presented with swelling in the gluteal cleft. Excision of the swelling along with the coccyx was done. Benign cystic sacrococcygeal teratoma was diagnosed on histopathological evaluation of the excised tumor mass. This case is reported for a very unusual presentation of sacrococcygeal teratoma and also brings forth the difficulties encountered during excision of the tumor.

Prognostic factors in outcome of angioedema in the emergency department.

Angioedema is a transient, localized swelling caused by two distinct mechanisms, mediated by histamine and bradykinin, respectively, although a proportion of cases remain idiopathic. Studies that characterize undifferentiated angioedema presenting in emergency departments (EDs) are limited. This study investigates the presentation patterns of undifferentiated angioedema in the ED based on the presumed mechanism of swelling. Medical records from all ED visits to two tertiary care hospitals from July 2007 to March 2012 were electronically reviewed. Records with documented visible swelling on general inspection and/or fiberoptic laryngoscopy and a diagnostic code for anaphylactic shock, angioneurotic edema, allergy unspecified, defects in the complement system, or unspecified drug adverse effects were included. Demographic, clinical, and outcome data were collected via a standardized form. Data were analyzed descriptively, including frequencies and percentages for categorical data and means and SDs for continuous data. Predictors for admission were identified using multivariate logistic regression models. ED records from 527 visits for angioedema by 455 patients were included in the study. Annual rate of angioedema was 1 per 1000 ED visits. Urticaria was associated with peripheral (p = 0.008) and lip angioedema (p = 0.001), and the absence of urticaria correlated with tongue angioedema (p = 0.001) and trended toward correlation with pharyngeal angioedema (p = 0.056). Significant predictors of admission included nonsteroidal anti-inflammatory drug-induced angioedema (odds ratio [OR], 15.3), epinephrine treatment (OR, 8.34), hypotension (OR, 15.7), multiple-site angioedema (OR, 4.25), and pharyngeal (OR, 1.23) and tongue angioedema (OR, 4.62). Concomitant urticaria was associated with a significant longer stay in the ED (p < 0.001). The presence of urticaria correlated with the location of angioedema, need for airway management, length of ED visit, and recurrence. A detailed drug and family history, screening blood work for C1 esterase inhibitor deficiency when indicated, and prompt management of angioedema based on presumed mechanism of swelling are crucial steps in managing undifferentiated angioedema in ED.

Green chitosan–carbon dots nanocomposite hydrogel film with superior properties

In this work we report novel chitosan–carbon dots nanocomposite hydrogel films. A new green source “tea” was used as precursor for carbon dots (CDs). The electrostatic interaction of positive charge on chitosan and negative charge on CDs prepared from tea was used for the successful preparation of a stable and robust chitosan–carbon dots nanocomposite hydrogel film. The hydrogel films were characterized by UV–visible spectroscopy, X-ray diffraction (XRD), Fourier transformed infra-red spectroscopy (FTIR), scanning electron microscope (SEM), fluorescent microscopy, thermogravimetric analysis (TGA) and contact angle analysis. It was observed that chitosan–carbon dots hydrogel films are soft but tough with superior UV–visible blocking, swelling, thermal and mechanical properties in comparison to chitosan hydrogel film. Moreover chitosan–carbon dots films are more water repellent (hydrophobic) as indicated by their high contact angle values. Thus, fabrication of such green soft but tough biocompatible chitosan–carbon dots nanocomposite hydrogel films offers tremendous bio-medical and industrial applications.

Anthracoidea transberingiana, a new smut species on Carex pauciflora from Beringia

The new smut fungus, Anthracoidea transberingiana attacking ovaries of Carex pauciflora, is described and illustrated from Beringia (Alaska and Kamchatka). The new species is compared with Anthracoidea caricis-pauciflorae infecting the same host plant species predominantly in northern Europe, from which it differs in having smaller spores, thinner spore walls, 2–3 weakly visible internal swellings and somewhat less prominent spore ornamentation.

Clypeina lagustensis n.sp., a new calcareous alga from the Lower Tithonian of the Lastovo Island (Croatia)

Clypeina lagustensis n.sp. has been found in the Lower Tithonian deposits of the Lastovo Island (Dalmatia, Croatia). It is visually similar, obviously related and in some sections appearing almost identical, to Clypeina jurassica FAVRE, from which it differs by visible swellings and thinning of the central cavity, more pronounced distance between neighbouring whorls of fertile branches, and shape and structure of the interverticillate thallus parts, characterized by having well developed, hairy, sterile branches. These, after emerging from the exit pore, divide into several bundles which form a common turf with a calcareous envelope in the proximal part. Normal 0 21 false false false HR X-NONE X-NONE

Case report: Pentalogy of cantrell

Pentalogy of Cantrell is a type of ectopia cordis including: defect in anterior diaphragm, pericardium, anterior abdominal wall in addition to extrusion of part of the heart outside the mediastinum and structural heart disease. We were faced by a case of 2 years old girl presented by a visible large pulsating swelling in the lower part of the chest and upper part of anterior abdominal wall in addition to other manifestations of pulmonary congestion and heart failure. After echocardiography, MSCT was done for completing the diagnosis, the cardiac lesion was a large apical VSD with biventricular dilatation and the apex of the heart forms a long tail like swelling passing through a large anterior pericardial and diaphragmatic defect to lie under the anterior abdominal wall. Under full CPB and cardioplegic arrest; the excess aneuresmal part of cardiac apex was excised and the Apical VSD was closed the aneuresmectomy opening because it was in accessible through the RT atrium. The PT needed high inotric support, prolonged ventilation and ICU stay and discharged on day 15 with maximized medical treatment because the ICU and pre discharge echo shows only minimal improvement of the already severely impaired myocardial function EF ∼ 30% and severe PH.

CP-117 Severe calcinosis cutis successfully treated with a topical W/O emulsion of 10% sodium thiosulfate

BackgroundCalcinosis is caused by accumulation of calcium salts in the tissues, with subcutaneous nodules, atrophy and ulceration over the affected area. Treatment with intravenous sodium thiosulfate has been used, since...

English

Cystic lymphangioma is a lymphatic malformation which usually occurs at the time of birth or in the first few months of life. Cystic lymphangioma presenting in adulthood is less common. We report a case of a 21 yr. old adult male who presented with a rapidly progressive cystic swelling in the right submandibular region for the past 5 months. Further investigations were suggestive of lymphangioma. Surgical excision was challenging and resulted in complete cure without any morbidity, there was no evidence of recurrence at 3 years of follow up. We review the literature along with the case report of cystic lymphangioma presenting in adults. INTRODUCTION: 'Hygroma' in Greek means water containing tumor. Cystic Hygroma or Cystic lymphangioma is a congenital malformation of the lymphatic system. 50% of these malformations appear at birth and about 80% to 90% manifest by 2year of life 1 . The initial presentation in adults is less common, only about 100 cases have been reported in literature 2 . Lymphangioma can occur anywhere in the body but most common site is the head and neck region 3. No sex preponderance or side predilection has been reported 1. Infection in the respiratory tract or the skin or trauma in the head and neck region is associated with the rapid growth or engorgement with lymph or blood resulting in rapid increase in size. Cervicofacial lymphangioma has been reported to spontaneously regress in size in upto 15% of patients. Malignant change of lymphangioma has not been reported. CASE REPORT: 21 year old male presented to the OPD with history of a rapidly progressive swelling in the right submandibular region for the past 5 months. He noticed that the swelling was bigger on lying down. There was no history of trauma, fever, pain, tooth ache or difficulty in breathing or swallowing. On examination a 5 x 4.5 cm, soft, cystic, non-tender, fluctuant, compressible diffuse swelling (fig.1) was seen in the right submandibular region and upper part of neck extending superiorly to ramus of mandible, inferiorly to thyroid notch, medially just crossing the midline and laterally deep to sternocleidomastoid. Swelling was not reducible did not move on deglutition or protrusion of tongue. There was no cough impulse and transillumination was negative. There was no visible swelling in the floor of mouth and on bidigital palpation submandibular gland was palpable along with the swelling. On auscultation there was no bruit. All the baseline investigations were normal. FNAC from the swelling was inconclusive. CT neck with contrast revealed multiloculated cyst with smooth septa, which enhanced uniformly after contrast injection. (fig.2) Excision of the mass under general anesthesia was performed through a horizontal skin crease incision placed just 3 cm below the ramus of mandible. The finger like multiloculated cyst (fig.3) was seen extending deep to the mylohyoid muscle up to the floor of mouth which was fully

3-D based minimally invasive one-stage lateral sinus elevation – A prospective randomized clinical pilot study with blinded assessment of postoperative visible facial soft tissue volume changes

ObjectiveThe purpose of this prospective and randomized clinical study was to assess differences in patient morbidity between minimally invasive lateral sinus elevation (study group, n = 14) and conventional one-stage lateral sinus elevation (control group, n = 12). It was hypothesized that trauma to soft tissue was reduced in the study group. Materials and methodsOptical 3-D imaging was assessed blinded on days 1 and 7 after surgery to determine the visible soft tissue swelling of the upper lip and cheeks. Postoperative pain and discomfort were evaluated by a visual analogue scale (VAS; scale 0–10). ResultsImmediately and on day 1 after surgery, the study group patients rated pain and discomfort as 2.4 [SD 1.7] and 3.1 [SD 2.1], respectively, on the VAS; while, the controls rated 4 [SD 1.6] and 5.6 [SD 1.7], respectively. The mean facial soft tissue volume change, assessed on day 1 after surgery, was 5.0 cm3 [range: 0.2–9.2] for the study group and 15.5 cm3 (9.3–21.55) for the controls (p = 0.00). ConclusionsDespite the small number of patients in this prospective study, 3-D based minimally invasive one-stage lateral sinus elevation resulted in favourable patient morbidity with less postoperative visible facial soft tissue volume changes.

Evaluation profile of thyroid nodule by fnac in the rural population of khanpur kalan, sonepat, haryana.

Thyroid disease is most common endocrine disorder and is different from other endocrine diseases because of its visible swelling and ease of diagnosis. If left untreated, thyroid disease makes a person more prone for heart disease, infertility and osteoporosis. In India, significant burden of thyroid diseases exist with an estimation of around 42 million cases. The thyroid status and autoimmune status of adult Indian population in the post iodinization phase is largely unknown. The main objective of this study was to generate valuable epidemiological data regarding the prevalence of thyroid disorders in rural population of Khanpur Kalan, Sonepat in the post-iodinisation era in India. To assess whether thyroid autoimmunity or goitrogens along with environmental factors play role in the development of thyroid.This paper is being presented in view that no such study has been carried out in the rural population of this region in Haryana. The present study was conducted in Department of Pathology, Bhagat Phool Singh Medical College for Women, Khanpur Kalan, Sonepat between August 2011 to July 2013. It included retrospective analysis of cytomorphology of fine needle aspiration cytology material of 206 patients presenting with thyroid nodule in the Department of Pathology. The commonest age group affected was 31-40 yrs. The female patients (93.4%) outnumbered the male patients (6.6%).The cytomorphological analysis of 206 patients revealed 190 cases (92.2%) of neoplastic lesions, 10 cases (4.8%) were neoplastic and 6 cases (2.9%) had indeterminate cytomorphology. Maximum number (65.5%) of patients was suffering with goiter followed by lymphocytic thyroiditis (26.2%). Amongst the malignant cases three cases were of papillary carcinoma and one case of medullary carcinoma. Two out of the six cases of follicular neoplasm proved to be follicular adenoma on histopathology. Four patients with high T3 levels were under treatment with neomercazole. They showed change in cytomorphology from hyperplasia to colloid goiter. Only one case of acute suppurative thyroiditis was reported which shows rarity of its type. The increased prevalence of goiter in this post iodinisation era can be attributed to goitrogens, autoimmune thyroid disease and micronutrient deficiency of iron and selenium. Higher prevalence of autoimmune thyroiditis in females is linked with both genetic and environmental factors such as infection, stress.

Transconjunctival Elimination of Keratin From an Intratarsal Meibomian Cyst

An unusual example of an intratarsal meibomian keratinous cyst is described in a 69-year-old man with spontaneous transepithelial (conjunctival) elimination. The lesion created an externally visible lump in the eyelid, which on eversion was found to be accompanied by yellow-whitish protruding material with a surrounding circular mound of reactive tissue. Excision revealed a large mass and smaller fragments of anuclear keratin (trichilemmal-type) embedded and sequestered in fibrous tissue with a granulomatous response. A re-excision was required because of persistent and irritating keratinous material, contrasting with the more indolent course of an uncomplicated epidermoid cyst of the eyelid dermis. This is the first documented instance of spontaneous rupture and extrusion of a meibomian tarsal cyst's keratin contents.

Evaluation of tropical sugarbeet genotypes under Bangladesh condition

An investigation was undertaken to study the feasibility of sugarbeet cultivation under Bangladesh condition during winter season of 2009-2010. Seeds of 14 sugarbeet genotypes were sown in the experimental field of Horticulture Research Centre of BARI, Gazipur on 10 November 2009. Visible root swelling in all genotypes started between 36 and 40 days after sowing (DAS). Nine genotypes had white root colour while rest were red purple. Plant height varied from 26.8 cm to 55.0 cm at 165 DAS. Similarly, whole plant weight among the genotypes ranged from 0.76 kg to 1.60 kg. Mean root yield in all genotypes was 66.22 t/ha when harvested at 165 DAS, which was decreased to 56.29 t/ha at 180 DAS. However, the highest root yield was recorded from the genotypes SB001 (85.30 t/ha) closely followed by SB006 (84.40 t/ha) at 165 DAS. All the genotypes showed lower yield potential at 180 DAS compared to 165 DAS. Severe leaf shedding and drying up of the root in the later stage might be the reason for yield reduction. Nine genotypes had more than 10% sucrose and can be considered for sugar producing genotypes. Five genotypes had very less sucrose content in the root and can be useful for vegetable purpose. The genotypes SB001 and SB006 had comparatively high amount of sucrose (13.0%) in the root. The fungal disease Sclerotium root rot and the insect Spodoptera litura were found the most limiting factor for sugarbeet cultivation. DOI: http://dx.doi.org/10.3329/bjar.v37i4.14396 Bangladesh J. Agril. Res. 37(4): 721-728, December 2012

Short communication: Experimentally induced mastitis reduces weight shifting between the rear legs while standing in dairy cows

The objectives of this study were to evaluate changes in weight shifting between legs while standing on a weighing platform in response to endotoxin-induced clinical mastitis, and to evaluate the effect of the nonsteroidal antiinflammatory drug flunixin meglumine on weight distribution between legs while standing in dairy cattle with endotoxin-induced clinical mastitis. Clinical mastitis was induced in 10 primiparous and 9 multiparous lactating dairy cows (days in milk=55±12; mean ± standard deviation) by intramammary infusion of 100µg of Escherichia coli lipopolysaccharide (LPS) into the right rear quarter. Four hours later, 10 animals were randomly assigned to receive flunixin meglumine intravenously (2.2mg/kg of body weight; treated group) and 9 received an equivalent volume of sterile isotonic saline solution (control group). Body temperature was monitored rectally 3d before LPS infusion, immediately before LPS infusion, and 4, 7, 10, 13, 16, and 28h after LPS infusion. The weight applied to each leg was recorded while cows were standing on a weighing platform on the day before the challenge and 7, 10, 13, 16, and 28h after LPS infusion. Two measures of weight shifting between the rear legs were calculated for each recording session: the standard deviation of the weight applied to the legs over time and the frequency of steps. The LPS infusion resulted in a consistent case of clinical mastitis approximately 4h after the LPS infusion, as assessed by the presence of visible swelling and elevated rectal temperature in all cows. However, control animals had a higher temperature 7h after LPS infusion compared with treated animals (40.8 vs. 39.0°C; standard error of the difference=0.2). Overall, weight shifting between the rear legs was decreased 7h after the LPS infusion compared with baseline, and this decrease was not affected by treatment with flunixin meglumine. It is likely that weight shifting increases friction between the swollen udder and the legs, increasing the pain experienced by the cow. Thus, cows with endotoxin-induced mastitis avoided shifting weight, particularly at the times when the most severe signs of inflammation occurred. Further research is needed to assess the efficacy of flunixin meglumine in mitigating udder pain and the accuracy of behavioral measures such as weight shifting in assessing analgesia in cows with mastitis.

Correction of Infraorbital Dark Circles Using Collagenase-Digested Fat Cell Grafts

A number of factors, including visibility of the orbicularis oculi muscle through thin skin, can cause dark circles around the eyes. Fat grafts have been used to augment the lower eyelid skin to correct dark circles, but irregularities caused by leaving visible lumps of the fat can occur. We used collagenase-digested fat cell grafts to correct these deformities. Fat was aspirated from the medial thigh using the Coleman method. After centrifugation, the middle fat layer was segregated, digested using Clostridium histolyticum-derived type II collagenase, and mixed with Hartman's solution. The grafts were injected into the infradermal layer using blunt 22-G needles. Eighty-two patients were evaluated for improvement using photographic evidence; 55 (67.1%) showed improvement, 23 (28%) showed no difference, and four (4.9%) had worsened from preoperative findings. There were no visible lumps of fat, contour irregularities, or fat necroses. Postoperative edema and ecchymosis were minimal. Collagenase-digested fat cell grafts provide another option for correcting dark circles by augmenting thin skin. Further histologic evaluation of the grafted collagenase-digested fat cells is recommended.

A rare case presentaion of osteochondroma of scapula

A 17-year-old female presented with complains of swelling in left scapular region since the age of 5 years, which had progressively increased in size. This condition was asymptomatic, but caused visible cosmetic concern to the patient and her parents as she was approaching a marriageable age. An En bloc excision of exostoses scapula was done; the patient had full functional recovery with no visible swelling. Histopathology, the diagnosis of osteochondroma was established. The patient was satisfied after the surgical resection of the tumor as, cosmetically, she looked near normal.

Internal hernias: a brief review

Hernias are very familiar to a core surgical trainee in the setting of clinics and the surgical assessment unit. By definition, a hernia is an abnormal protrusion of a viscus from one compartment to another. In clinic, they are visible lumps, exhibiting a cough reflex often with a well definable history making them readily identifiable. In the acute setting, they are the third commonest cause of small bowel obstruction in the developed world. Ventral and inguinal hernias account for the majority of these with only a small proportion due to internal hernias. This article aims to educate the core surgical trainee on the anatomy and distinguishing clinical features of these rare but important types of internal abdominal hernias.

Anaesthesia and common oral and maxillo-facial emergencies

Odontogenicor dental-related infections begin with decay and progress to pulpitis, which is inflammation of the nerve chamber in the centre of the tooth. Infection then spreads into the bone and causes perforation of the bone cortex into the subperiosteal region. Fascial planes of the head and neck are virtual spaces, bounded by muscle attachments and bone. The muscle attachments and fascial planes will govern in which direction the infection spreads to the soft tissue spaces. Knowledge of the orofacial musculature is needed to predict the path of infection. The commonly affected fascial spaces are illustrated in Figures 1 and 2. Infection can spread from these into the infra-temporal fossa, sub-temporalis, and parapharyngeal spaces. This describes the local or direct spread. The spread from the pre-maxillary region (soft tissue anterior to the maxilla containing the canine and part of the buccal space) can progress to orbital cellulitis. If left unchecked, this can lead to cavernous sinus thrombosis. A parapharyngeal abscess often has little clinical signs until the airway is compromised, as the swelling is intra-oral or parapharyngeal. A frequent culprit is a wisdom tooth which also causes submasseteric inflammation and trismus. Examination of the pharynx is almost impossible in the presence of severe trismus and patients are often falsely downgraded in priority, due to lack of visible swelling. Complications of spread to cervical fascial planes include airway obstruction, mediastinitis, and pulmonary aspiration of pus either through spontaneous rupture or iatrogenic rupture during attempts at intubation. The haematogenous spread can lead to thrombophlebitis, bacteraemia, prosthetic valve, or joint involvement and systemic sepsis. The spread of infection is affected by compromised host defences such as diabetes mellitus, malignancy, or immunosuppression.

512 Neonatal Testes Torsion: Case Report

IntroductionTorsion of the testes results from twisting of the spermatic cord, which leads to a compromised testicular blood suply and subsequant testicular infarction. The consequant ischemic damage affects long-term testicular...

Prevalence, predilection sites and pathological findings of &lt;i&gt;Taenia multiceps&lt;/i&gt; coenuri in slaughtered goats from south-east Iran

Coenurosis is a zoonotic disease in a variety of ruminants caused by the metacestode of Taenia multiceps. The coenuri in the brain and spinal cord of sheep and goats have been identified as Coenurus cerebralis whilst those reported in other tissues have been named Coenurus gaigeri. This study was conducted during the spring and summer of 2011. Out of 25 739 goats inspected in slaughterhouses, 23 carcasses (0.09%) revealed one or multiple visible swellings on the different muscles and visceral organs. The coenuri, of variable sizes, were found mainly in the muscles of the thigh, shoulder and neck, and were less common in the abdominal muscles and subcutaneous tissues. Coenuri were also found in the diaphragm, tongue, intercostal muscles, lung, parotid area and tunica adventitia of the aorta in a goat with severe infection. The brains of slaughtered goats that had coenuri in their skeletal muscles were examined and coenuri were found in two specimens (8.69%). The coenuri were located in the occipital lobe, the anterior part of the right cerebrum and the parietal lobe of the left cerebrum. Histopathologically, coenuri in the brain caused pressure atrophy and liquefactive necrosis in the surrounding tissues, hyperaemia, perivascular cuffing, neuronal degeneration, neuronophagia, satellitosis, diffuse microgliosis and astrocytosis. Coenuri in the skeletal muscles caused degenerative and necrotic changes, hyalinisation and myositis. In the lung, tissues around the coenurus revealed atelectasis and focal interstitial fibrosis. In the present study, concurrent occurrence of coenuri in the central nervous system and skeletal muscles supports the hypothesis that C. cerebralis and C. gaigeri are different names for the metacestodes of the same species of tapeworm.