International journal of dental and medical specialty

2-4

Authors: Isha Gupta , Bimal Kumar Agrawal , Anand Jindal

The giant goiter is enormously a common endocrine abnormality and the interesting phenomenon of enlarged thyroid gland almost exclusively confined to regions of endemic goiter. Goiters can result from biosynthetic defects, iodine deficiency, autoimmune disease or nodular diseases and if left untreated can lead to some symptoms of dyspnea, dysphagia and hoarseness by compressing the trachea, esophagus, and recurrent laryngeal nerve respectively. A majority of patients with giant goiter frequently desire surgical excision for structural distortion (cosmetic) and social reasons. Some of them, however, experience repeated attacks of intercurrent respiratory tract infection which can complicate the postoperative prognosis and cure. About a fifth of giant goiter patients frequently present with acute respiratory distress that requires emergency surgical intervention like tracheostomy. The peri-operative management of this endocrine disease is both formidable and hazardous. The operative time is not merely larger than for a standard thyroidectomy but mortality can also be unacceptably high. Here, we present a case report of a giant euthyroid goiter found in a 70-year-old female patient. The patient underwent fine-needle aspiration cytology examination.

9-14

Authors: Majumder M I, Harun M A S I

Background: Osteoporosis is imposing public health burden especially in postmenopausal women and elderly population. It is leading cause of morbidity and mortality in postmenopausal women. Among multiple modalities of osteoporosis diagnosis, bone mineral density (BMD) is considered as a gold standard by WHO. Aim: Evaluate the alveolar bone changes in osteopenic and osteoporosis condition of postmenopausal women. Materials and Methods: Totally 1315 postmenopausal women were included in this study. All patients were evaluated by dual-energy X-ray absorptiometry for BMD and dental radiograph such as orthopantomography and radiovesiography. Among those women 72 were normal, 276 were osteopenic and 967 were osteoporotic. Mandibular cortical index (MCI), pixel intensity (PI), mandibular alveolar bone mass (MABM), and Alveolar bone resorption pattern (ABRP) were evaluated from the dental radiograph. Calculation of mean and standard deviation, as well as correlation and difference, were performed using SPSS 11.5 for Windows (Windows XP). Results: The changes in the MCI (C2 and C3) were more in osteoporotic condition (87.48%) rather than osteopenic (31.34%) and normal (12.50%). The numbers of presenting teeth were more in normal and osteopenic women rather than osteoporotic women. PI and MABM were significantly different from normal vs. osteopenic and osteoporosis, osteopenic versus osteoporosis. Horizontal ABRP was more in osteoporosis women (91.21%). Conclusion: Changes in postmenopausal alveolar bone were strongly correlated with the BMD of systemic skeletal bone. This combined relationship can be used as an easy diagnosis tool for innovations in osteoporotic condition.

19-23

Authors: Rajnish Nagarkar, Shirsendu Roy, Mohammad Akheel, Vijay Palwe, Nayana Kulkarni, Prakash Pandit

Aim: Thyroid disorders are common endocrine disorders encountered in the African continent. Environmental and nutritional factors are often implicated in the occurrence of most thyroid disorders that occur in the most part of the world. This is a narrative review that seeks to document the pattern, prevalence, and management of thyroid disorders in the continent. To find the incidence and prevalence of thyroid disorders from total body malignancies at our cancer center. Objective: Implementation of thyroid screening camps among the general population. In India, thyroid disorders in childhood and adolescence have not been sufficiently studied. Where studies are available, they were either conducted decades ago or they involved only adults. The objectives of this study are to describe the pattern of thyroid disorders in each individual seen in our hospital and to highlight the management challenges encountered. Materials and Methods: This is a retrospective medical record analysis performed in our tertiary care cancer center in Nasik, Maharashtra for a period of 6 years from January 2008 to December 2014. The clinical examination, biochemical studies, serological and histological parameters were used to characterize and evaluate the patients of thyroid disorders. Investigations done, surgical treatment type, types and complications of thyroid disorders, incidence according to age, sex and prognosis were all documented in this analysis. Results: Of 16933 cancer patients, 128 patients suffered from thyroid disorders and the prevalence was 0.8%. The prevalence of thyroid disorders was significantly higher in females than males (33.6% vs. 66.4%, χ2 = 27.56, P < 0.001). The prevalence of thyroid disorders was significantly higher in higher aged (≥31 years) patients as compared to lower aged (≤30 years) patients (14.1% vs. 85.9%, χ2 = 132.30, P < 0.001). Of total thyroid disorders, 99 (77.3%) patients had cancers with highest prevalence of follicular cancer (58.6%). Of total thyroid disorders, 79 (61.7%) patients underwent surgery with no postoperative complications and were discharged on 3rd day of surgery. The mortality rate was 4.6%. Conclusion: There are a high risk and burden of thyroid disorders in India due to lack of nutrition and unavailability of proper therapeutic resources. There are a lack and paucity of data on the epidemiology of thyroid disorders. Due to lack of resources, complete screening for thyroid diseases in the general population is not cost-effective. There must be complete family screening with all genetic relatives in all patients with juvenile autoimmune thyroiditis.

28-31

Authors: Shah A, Shah R, Tyagi R, Botchu R

Plasmacytomas occur in bone marrow or in extramedullary sites, typically in the head and neck. Intramuscular plasmacytoma is rare and reported occurring in the orbits and upper limbs. We report a rare case of intramuscular extramedullary plasmacytoma (EMP) occurring in the gluteus medius muscle. In this case, an elderly lady with known multiple myeloma, presented with a lump in her right buttock. Subsequent imaging demonstrated a non-specific intramuscular mass in the right gluteus medius. Treatment is traditionally surgical resection plus/or adjuvant chemotherapy or autologous stem cell transplant. Plasmacytoma was considered among the differentials, despite the non-specific imaging features, and atypical location. It allowed for a rapid multi-disciplinary team discussion about the risks and benefits of a biopsy. Unfortunately, the patient died before treatment could be started. The purpose of this report is to remind clinicians to include plasmacytoma as a differential for soft tissue masses, even in atypical locations. We also discuss the relevant imaging features and management of EMPs.