Benign thyroid swelling presenting as Horner's syndrome.

Horner's syndrome is a rare neurological condition seen in association with the disruption in the sympathetic nerve supply. Thyroid swelling is a common condition but rarely causes cervical sympathetic chain compression. We describe a case of a 54-year-old man who presented with Horner's syndrome secondary to a benign thyroid nodule with pressure effect on the sympathetic chain. An association between thyroid pathologies and Horner's syndrome has been mentioned previously, however, to our knowledge, this is the first case of Horner's syndrome being the initial presentation for an underlying benign thyroid swelling.

Kikuchi-Fujimoto Disease and Prognostic Implications.

Kikuchi-Fujimoto disease (KFD) is a rare cause of lymphadenitis seen mostly in Asian populations (Kikuchi in Nippon Ketsueki Gakkai Zasshi 35:379-80, 1972). First described in 1972, KFD is a benign and self-limiting disease characterised by lymphadenopathy, mild fever, fatigue, and leukopenia (Fujimoto in Naika 30:920-7, 1972; Lin et al. in Otolaryngol Head Neck Surg 128(5): 650-3, 2003). We present a case of a 38-year-old woman with a 6-week history of cervical lymphadenopathy. Her ultrasound scan and fine needle aspiration cytology results were inconclusive. Excisional biopsy of the lymph node confirmed presence of KFD. The aetiology of KFD is unknown; however, there is strong association with systemic lupus erythematosus (SLE). Kucukardali reported 9% of European KFD patients and 28% of East Asian patients had concomitant SLE (Kucukardali et al. in Clin Rheumatol 26(1):50-4, 2007). We describe a follow-up algorithm for newly diagnosed KFD cases, based on the current literature. KFD is a rare cause of cervical lymphadenopathy. It is associated with increased risk of developing SLE, therefore early diagnosis and long-term follow-up are recommended.

Effect of Lidocaine on Olfactory Perception in Humans.

OBJECTIVE: The effect of local anesthesia to the nasal mucosa on olfactory acuity is the subject of some debate. This study was aimed to investigate the effect of local anesthesia on olfactory perception. MATERIALS AND METHODS: Six healthy participants, five males and one female, were chosen from the academic population of Cardiff University. Olfactory perception was monitored at intervals following administration of 4% lidocaine to the nasal mucosa in the volunteers. Lidocaine was administered using a nasal spray as used in routine otolaryngological investigations. The olfactory stimulus (amyl acetate) was delivered directly to the nostril using an olfactometer. Olfactory perception was determined by the use of a 13 trial, forced choice scoring task. RESULTS: Lidocaine caused a small, transient reduction in olfactory perception. The maximum reduction in olfactory perception (35%) was achieved by 60 mg lidocaine 15 min following administration, but perception could be increased to almost normal levels by increasing the odor stimulus dose. Detection of the lowest stimulus strength returned to normal levels after 30 min. CONCLUSIONS: Intranasal application of lidocaine, caused a reduction in olfactory perception, however, did not abolish the olfactory function 15 min following administration. Physiological/psychometric olfactory testing would not be precluded under these circumstances, and the effects of anesthesia could be overcome by increasing the stimulus strength.

Subacute carbon monoxide poisoning presenting as vertigo and fluctuating low frequency hearing loss.

It is estimated that up to 25 000 UK residents are exposed to small amounts of carbon monoxide (CO) annually. Symptoms of chronic exposure to CO are vague and non-specific and include dizziness and hearing loss. We describe a case of 38-year-old lady presenting with a 4-month history of vertigo and hearing loss. Initially diagnosed as Meniere's disease, the patient was investigated and followed up in the clinic. She reported leakage of carbon monoxide from her gas fire identified during a routine safety check. Her symptoms fully resolved after disconnecting the faulty gas fire. A rare cause of fluctuating hearing loss and vertigo is described, and the diagnostic challenges are discussed.

A new non-invasive method for recording the electro-olfactogram using external electrodes.

OBJECTIVE: The aim of this investigation was to explore the possibility of recording the electro-olfactogram (EOG) using external electrodes placed on the root of the nose on either side of the bridge and at the medial termination of the eyebrows. The EOG is considered to be the summated generator potential of olfactory receptor cells and therefore represents peripheral olfactory events. Recording of human EOG is technically difficult due to poor access to the olfactory mucosa and the nasal irritation is tolerated by few subjects. METHODS: The evoked potentials at these sites in response to two odourants, n-amyl acetate and benzaldehyde, were recorded simultaneously with the EOG, recorded conventionally with an intranasal electrode, and the olfactory event-related potential (OERP) recorded using scalp electrodes. RESULTS: The extranasal potential recorded at the root of the nose, 0.5-1 cm below the nasion, 1 cm from the ridge and ipsilateral with the stimulus, had the highest degree of correlation with the intranasal EOG. We refer to this site as N1 (left side) and N2 (right side). Further analysis demonstrated that the latency, the time constant of the rising phase and the amplitude of the evoked potential recorded at N1 also had a higher correlation coefficient with the EOG than did those potentials recorded at other sites. Statistical analysis indicated that the latency and time constant of the response recorded externally at N1 were the same as those of the EOG recorded intranasally. CONCLUSIONS: We conclude that an olfactory evoked potential, with many of the characteristics of the EOG recorded from the olfactory mucosa, can be recorded externally at a site close to the bridge of the nose. SIGNIFICANCE: This non-invasive method of recording the EOG will have benefits for the objective assessment of olfactory function.

A rare case of acute on chronic gastric volvulus with Borchardt's triad.

Gastric volvulus is a rare condition with two forms of presentation, either acute or chronic. Since its discovery, there have been no cases of acute on chronic volvulus discussed in the literature. Its vague presentation makes diagnosis and subsequent management difficult. The diagnosis of acute gastric volvulus is made on clinical grounds via Borchardt's triad; however, barium swallow and oesophagogastroduodenoscopy have been shown to play a role. We describe a case of a 95-year-old Caucasian woman who presented with worsening dysphagia, epigastric pain, retching without vomiting and hiccups of 5 months. Initially diagnosed as a hiatus hernia, the patient subsequently died following an acute on chronic gastric volvulus. This rare, life-threatening diagnosis provides an opportunity to discuss characteristics of gastric volvulus and the difficulties in management.

Follicular variant of papillary carcinoma arising from lingual thyroid.

Malignant transformation of ectopic lingual thyroid tissue is an uncommon event; only 43 cases have been reported in the literature. Only 10 of these cases were papillary carcinomas, in contrast to normal thyroid gland neoplasms, of which papillary tumors form the predominant group. We present a case of a follicular variant of papillary carcinoma originating from the lingual thyroid, along with a review of the literature. Our patient was treated with surgical excision followed by (131)I therapy. To date, only 2 other cases of a follicular variant of lingual thyroid tumor have been reported.

Unusual complication of reusable suction catheter during rigid bronchoscopy.

The risk of leaving an iatrogenic foreign body in the bronchus, while using a reusable flexible suction catheter tube during rigid bronchoscopy is reported. A 6-year-old girl underwent rigid bronchoscopy to rule out foreign body inhalation as the possible cause of her unilateral pneumonia and lung collapse. While performing the bronchoscopy the distal end of the plastic suction tube was caught in the ventilation hole of the bronchoscope and was sheared from the main suction tube. This was later recovered from the right main bronchus while clearing the thick secretions. This potential complication occurs with use of reusable plastic suction catheters.