Thyroglossal Duct Cyst—More Than Just an Embryological Remnant

Thyroglossal duct cyst is a congenital malformation that occurs due to incomplete closure of the thyroglossal duct. Apart from being a quiescent embryological remnant, it presents itself clinically at any age and often requires surgical excision. Twenty four patients were encountered at Sri Ramachandra Medical College and Research Institute between June 2004 and June 2009 with thyroglossal duct cyst. The purpose of the study was to analyse their presentation, associated complications including malignancy and the approach to their management. Operative notes, histopathology files and medical records were used for the retrospective analysis of the patients with thyroglossal duct cyst. Thyroid profile and Radioisotope scan were performed on all the patients to document the position of the thyroid gland. Further, these patients were subjected to Ultrasonography and Computerised Tomography neck to conclusively map the location of the cyst. Fine Needle Aspiration of the tissue was done to diagnose malignancy. It was noted that there was maximum clustering of about 62.5% in males. About 45% of them belonged to the paediatric age group. The total number of symptomatic patients was about 59%. Unlike the various studies in literature, most of the thyroglossal duct cyst patients at our hospital were symptomatic. The symptoms were pain, dyspnoea, dysphagia, discharge and recurrence. Malignancy was diagnosed in two patients who were ironically asymptomatic. Other complications were looked into and treated. Thyroglossal duct cyst is a cervical anomaly that is usually found as an asymptomatic painless cystic swelling. However, most of our patients had a symptomatic presentation. Association with malignancy was noted. Surgical intervention was the cure for all the patients

Prediction of Ischemic Events on the Basis of Transcriptomic and Genomic Profiling in Patients Undergoing Carotid Endarterectomy

Classic risk factors, including age, smoking, serum cholesterol, diabetes and blood pressure, constitute the basis of present risk prediction models but fail to identify all individuals at risk. The objective of this study was to investigate if genomic and transcriptional patterns improve prediction of ischemic events in patients with established carotid artery disease. Genotype and gene expression profiles were obtained from carotid plaque tissue (n = 126) and peripheral blood mononuclear cells (n = 97) of patients undergoing carotid endarterectomy. Patients were followed for an average of 44 months, and 25 ischemic events occurred (18 ischemic strokes and 7 myocardial infarctions). Blinded leave-one-out cross-validation on Cox regression coefficients was used to assign gene expression–based risk scores to each patient. When compared with classic risk factors, addition of carotid plaque gene expression–based risk score improved the prediction of future ischemic events from an area under the curve (AUC) of 0.66 to an AUC of 0.79. The inclusion of gene expression risk score from peripheral blood mononuclear cells or from 25 established myocardial infarction risk single nucleotide polymorphisms only exhibited marginal effects on the prediction of ischemic events. Prediction of ischemic events is improved by inclusion of gene expression profiling from carotid endarterectomy tissue compared with prediction on the basis of classic risk markers alone in patients with atherosclerosis. The method may be developed to identify subjects at very high risk of ischemic events

MATHEMATICS FOR SPECIFICATION AND DESIGN: THE PROBLEM WITH LIFTS . . .

The use of mathematics in the specification and design of practical software systems is discussed. As an example, the formal specification and design of a multiple lift (elevator) system is described, using the notations of Communicating Sequential Processes