Intramuscular benign lipoma of the sternocleidomastoid muscle: a rare cause of neck mass

Intramuscular benign lipoma commonly is found on the extremities, but is extremely rare in the head and neck region. Intramuscular type lipomas arise between the muscle fibers and pass through the intermuscular septa, infiltrating the surrounding tissue. A 29-year-old male patient presented with the complaint of a painless and slowly growing lateral neck mass on the left side. Physical examination revealed a 4×5-cm mass adjacent to the sternocleidomastoid (SCM) muscle. CT examination revealed a lobulated, well-circumscribed 5.5×2.5-cm diameter mass with adipose tissue signal density inside the SCM muscle. The surgical exploration of the mass was done under general anesthesia, and it was excised totally. Recurrence was not seen in the 3-year follow-up. This rare entity should be considered in the differential diagnosis of intramuscularly located neck masses. Complete removal of the tumor can only succeed if planned and performed after a thorough preoperative clinical and radiological assessment in order to prevent recurrences.     

Antrochoanal polyp: a transmission electron and light microscopic study

Antrochoanal polyp (ACP) is a soft tissue mass originating from the maxillary antrum, emerging from the ostium and extending to the choana through the nasal cavity. Our aim was to investigate the light microscopic and ultrastructural features of ACP and to compare these with nasal polyps originating from the middle meatus (MMP). Seven ACP and seven MMP specimens were evaluated by transmission electron microscopy (TEM) and light microscopy. TEM examination showed epithelial cells with intact cilia covering both polyps. In some MMP cases, degeneration of the epithelium associated with some cilia loss was noted. Goblet cell hyperplasia was more prominent in MMP cases. Degeneration and partial destruction of the endothelial cells of the blood vessels were common findings in ACP cases; however, in the MMP group, endothelial cells were mostly intact with a few aggregates of ribosomes, and intact cell junctions were noted. Light microscopic examination revealed that inflammatory cells in the ACP group were numerous. However, eosinophils were predominant in MMP cases. Squamous metaplasia of the surface epithelium was detected in five ACP cases, but in none of the MMP cases. Basement membrane thickening was detected in two cases of the ACP and in four cases of the MMP group. There was a statistically significant difference between the two groups for inflammatory cells, eosinophilic cell infiltration, squamous cell metaplasia, endothelial cell destruction and goblet cell metaplasia. In conclusion, the low number of eosinophils, the high number of other inflammatory cells, the normal appearing basement membrane and intact and normal surface epithelium may reveal that the etiology of ACP might arise from chronic inflammatory processes rather than allergy. The destruction of the endothelium may be considered as a further sign of chronic inflammation.     

Congenital chylothorax treated with octreotide

Congenital chylothorax is the accumulation of lymphatic fluid within the pleural space. Cases unresponsive to conservative management usually require surgery. Octreotide has been used successfully to treat post-traumatic chylothoraces in the pediatric and adult population. Its exact mode of action is uncertain but it is believed to reduce lymphatic drainage by a direct action on splanchnic lymph flow. We report a case of congenital chylothorax where surgery was avoided with the compassionate trial of the somatostatin analogue, octreotide. A 33 week gestation female infant, born with the presence of large bilateral pleural effusion, was unresponsive to conservative management. Octreotide was commenced on day 15, with 10 days of an octreotide infusion, initially 0.5 μg/kg per hour and increased daily by 1 ug/kg per hour to 10 μg/kg per hour. Treatment was associated with prompt respiratory improvement prior to cessation of pleural drainage over the 10 day. She remains well at 6 months of age. Further studies are required to ascertain its true value in congenital chylothorax.     

Neonatal lupus erythematosus presenting with cholestatic hepatitis: a case report and review of the literature

Neonatal lupus erythematosus (NLE) is a disease primarily characterized by cardiac and/or cutaneous involvement. Hepatic, hematological, neurological and pulmonary involvement are rare manifestations and normally considered as mild and transient complications. But recent studies have shown more frequent hepatic involvement in NLE. We report a two month-old male infant, born to a clinically asymptomatic mother, presenting with significant hepatic involvement and annular, erythematous plaques with hyperkeratotic borders at the eyebrow region and anterior surface of trunk. Both the infant and his mother were positive for anti-Ro (SS-A) and anti-La (SS-B).     

An unusual case of monosomy 18p: minor malformations with speech delay

An unusual case of monosomy 18p with molecular cytogenetic characterization of 18;21 whole arm translocation who had mild speech delay and normal motor development is presented. A 3.5-year-old boy with complaints of speech delay, open mouth and drooling saliva was the child of a 33-year-old healthy mother and 35-year-old nonconsangineous father with unremarkable prenatal history. Beside delayed speech, hyperactive movements, flat nasal bridge, prominent ears, micrognathia, hypotonia, and overriding of left 3rd the on 2nd toe were present. Cytogenetic studies revealed de novo 45,XY del (18) t(18;21)-21 karyotype, which was confirmed by fluorescence in situ hybridization (FISH).     

Cerebral salt wasting in tuberculous meningitis: treatment with fludrocortisone

Three cases of cerebral salt wasting complicating tuberculous meningitis are described. Diagnosis was based on hyponatraemia associated with high urinary sodium excretion and inappropriately high urine output in the presence of dehydration. Treatment with fludrocortisone resulted in sodium and fluid homeostasis.     

Megaureter visualization on Tc-99m DMSA scintigraphy

We present a patient with left-sided obstructed megaureter secondary to neuropathic bladder. He was referred for technetium-99m dimercaptosuccinic acid ((99m)Tc-DMSA) renal cortical scintigraphy to evaluate renal cortical function. Images obtained 4 hr after injection showed significant activity in the dilated left ureter. When the ureter is visualized on DMSA scan, obstructive megaureter should be considered in the differential diagnosis.     

Spectral broadening of ophthalmic arterial Doppler signals using STFT and wavelet transform

In this study, short-time Fourier transform (STFT) and wavelet transform (WT) were used for spectral analysis of ophthalmic arterial Doppler signals. Using these spectral analysis methods, the variations in the shape of the Doppler spectra as a function of time were presented in the form of sonograms in order to obtain medical information. These sonograms were then used to compare the applied methods in terms of their frequency resolution and the effects in determination of spectral broadening in the presence of ophthalmic artery stenosis. A qualitative improvement in the appearance of the sonograms obtained using the WT over the STFT was noticeable. Despite the qualitative improvement in the individual sonograms, no quantitative advantage in using the WT over the STFT for the determination of spectral broadening index was obtained due to the poorer variance of the wavelet transform-based spectral broadening index and the additional computational requirements of the wavelet transform.     

The prevalence of asthma and allergic diseases in children of school age in Adana in southern Turkey

The aim of this study was to determine the prevalence of asthma and other allergic disorders as well as the factors affecting these disorders in school-children in Adana. This cross-sectional population-based study using the International Study of Asthma and Allergies in Childhood (ISAAC) protocol was carried out on 3164 school-children aged between 6-18 years during March to June 1997. There were 1521 (48.1%) boys and 1643 (51.9%) girls. The prevalence of asthma, allergic rhinitis and eczema in the 6-18 year-old children was found to be 12.6%, 13.6% and 8.3%, respectively. The prevalence of asthma was highest in 6-10 year-old school-children (14.7%), and lowest (6.0%) in 15-18 year-old children. The prevalence of asthma diagnosed by a doctor was 5.0%. The cumulative and current prevalences of wheezing were found to be 19.0% and 13.5%, respectively. The cumulative prevalence of allergic disorders was found to be 23.4%. The presence of domestic animals at home and dampness of the home were found to be important risk factors for asthma. Family histories of asthma, eczema, and diagnosis made by a doctor, and history of frequent sinusitis were found to be significantly higher in asthmatics. In conclusion, asthma is an important chronic disease of childhood in Adana in southern Turkey.     

Deletion analysis and clinical correlations in patients with Xp21 linked muscular dystrophy

We carried out molecular deletion analysis on 142 patients with Duchenne/Becker muscular dystrophy which covered 25 exons of the dystrophin gene. We also evaluated the results by comparing with the clinical findings and examples in the literature. A deletion ratio of 63.7% was achieved. Exon 46 was the most frequently affected region. Interestingly we also observed four cases with muscle promoter (Mp) region deletions which have been rarely reported in the literature.