July 1994, Volume 44, Issue 7

Case Reports

Abstracts From the Journals of the East

Fatema Jawad  ( 7/6, Rimpa Plaza, M. A. Jinnah Road, Karachi. )

Solitary Cold Nodule of the Thyroid Gland. Chaudhry, A.M., Majeed, F. Specialist, Pak.J.Med.Sci, 1993;9:137-139.
Cold solitary nodule of the thyroid gland was diagnosed in 45 patients from the 179 thyroidectomies performed from January 1989, to December, 1991 in the North Surgical Ward of Mayo Hospital, Lahore. Diagnosis of the solitary nodule was made clinically and confirmed by scintigraphic studies. Indirect laryngoscopy was performed and all cases were euthyroid. Isthmectomy was carried outon5 subjects whereas bilateral subtotal lobectomy was done on 9 cases. The age of the patients was between 13 and 65 years with the peak incidence at 25 years. There were 5 males and 40 females. Hoarseness was complained by 3 and dysphagia by 5 individuals. The histopathological studies revealed a colloid nodule in 21 patients and adenonm and a thyroid cyst in eight cases each One patient had pyogenic thyroiditis, two had Hashimotos thyroiditis, two tuberculous thyroiditis and three had malignant lesions. Of these two had papillary and one follicular carcinoma. Post- operative complications consisted of chest infection in one case and seroma in another. Solitary nodule was the second commonest thyroid pathology in the series presented. Colloid nodules found in 21 cases is attributed to cystic degeneration within a nodule. Malignancy should be excluded in solitary nodules of the thyroid and fine aspiration cytology is a helpful procedure. Tubemulosis of the thyroid is a rare entity but it should be considered in the differential diagnosis.
Lipoid Proteinosis. Seth, L.S., Bhargava, S.K., Dan­derkar, K.N., Ogale, S.B. Pak.J.OtolaryngoL, 1993;9:203-205.
The case of a 33 year old male with hoarseness of the voice since the age of 16 years, dryness of the skin especially on the arms, hands and face and a tendency to bruise, is presented. He also complained of recurrent ulceration of the mouth, inability to protrude the tongue and dysphagia for 3 months. Examination revealed a waxy wrinkled face, papul­lunodular lesions on the elbows, forearms, knees, buttocks and hands, thick and pale lips and a thick tongue tethered with ankyloglossia. The palate, uvula and pharynx were also pale and thick. Systemic examination, serum proteins and X-ray skull were all normal. Microlaiyngoscopy was performed and biopsies from multiple sites taken. The histopathology examination showed features of lipoproteinosis. Lipoidpmteinosis is a rare genetic disorder characterised by deposition of anamoiphous material in the skin and mucous membrane especially of the upper aerodigestive tract. The etiology of the condition is unknown. The most widely accepted theory being congenital fragility of the terminal blood vessels which on exposure to trauma release an enzyme from their wall causing increased perme­ability to circulating substances as lipids and proteins and these get deposited in the sub-mucosa. There is no effective treatment but a careful follow-up is advisable to prevent complications as respiratory obstruction.
Retinoblastoma: A Histopathological Study of 33 Cases. Luqman, M., Malik, LA., Khalilullah, Muzaffar, M. Pak.J.Pathol., 1993;4:25-29.
The analysis of33 cases of retinoblastoma, studied over a period of 11 years, at the Pathology Department of the Army Medical College, Rawalpindi is presented. The eye balls received were fixed in 10% formal saline. Inspection for gross changes, measurement and sectioning was done. Staining was carried out with haematoxylin and eosin and microscopic examination performed. The patient population comprised of 22 males and 11 females with a mean age of 4.65 years. White eye reflex was found in 90 percent cases. A light grey friable growth extending to the anterior segment was present in 66.7 percent specimens. Gritty areas of calcification were encountered in 39.4 percent cases. All had degenerative areas with mucoid changes. The scleral coat was invaded in 75.8 percent and the optic nerve in 84.9 percent patients. The retinoblastoma is a malignant neoplasm of the eye ball involving children between 16 months and 2 years. In the presented study the mean age was higher and the tumour incidence relatively uncommon. Most of the tumours were in the late stage due to delayed reporting leading to an adverse prognosis.
The Psychotropic Drugs Abuse among Male Students of Lahore. Nisar, S. Pak.J.Med.Res., 1992;31:208-210.
A study was conducted to assess drug abuse in 2170 male students of Lahore; 860 from medical colleges, 600 from law colleges and 710 from the university. The ages of the students ranged from 18 to 24 years and the drugs used were diazepam and lorazepam, to a large extent whereas ampheta­mines and phonetics were relatively less abused. Medical students were the highest in number (17.3%) to use drugs and majority of them were started on by friends (52.3%). Introduc­tion to drugs by relatives was a much smaller percentage in all the 3 groups. The study revealed that use of tranquilizers and stimu­lants among students is much more than that of hypnotics. Medical students being more aware of the effects of mood modifying substances were using the drugs in larger numbers. Friends having a greater influence were the ones to start the drug abuse. Relatives due to inhibitions were lesser in number to be the introducers.

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