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Author(s): Sunil T. Pandya (corresponding author) [1]; J Sai Krishna [1] Sir, Ultrasound has been the gold standard in cannulating central veins and now has been incorporated as a mandatory [...]

A patient who has a mass in his or her neck may have a branchial cleft cyst rather than swollen salivary glands. For this reason, these patients should have a thorough exam because surgery is the best treatment for this condition. These cysts in the neck are believed to be a congenital abnormality.

Cervical dystonia results from the abnormal involuntary contraction of some muscles of the neck. The condition is sometimes called spasmodic torticollis, but this term can be misleading. The muscle contractions may not be spasmodic, and the resulting movement of the head may not always be in the twisting direction implied by the word ''torticollis.'' A review was conducted of 321 cases; after causes such as neurodegenerative disease and Wilson's disease were ruled out, 300 cases of cervical dystonia remained for tabulation. The average age of onset of cervical dystonia was 42 years, and female patients outnumbered male patients by about 50 percent. The neck was not the only part of the body affected by dystonia in many patients. Dystonia affected the mouth and face in 49 and 36 patients, respectively, and 30 patient had blepharospasm, a spasmodic blinking of the eyes. Other body parts affected included the arms, legs, trunk, tongue, and jaw. Medical treatment was useful for many patients; 79 percent gained some benefit from treatment. Botulinum toxin is often used in the treatment of dystonia. This poison, which comes from botulism bacteria, is used to partially paralyze the contracting muscle. This treatment produced some improvement in over 90 percent of the patients in whom it was tried. Pain was a common complication among the patients with cervical dystonia, affecting two thirds. Tremor was present in 71.3 percent of the cases. Tremor has been a common finding among dystonia patients in previous studies, but the physiological relationship of the tremor to the dystonia is still poorly understood. Almost 20 percent of the dystonia patients suffered from some psychiatric disorder; the most common was depression. (Consumer Summary produced by Reliance Medical Information, Inc.)

A 21-week old fetus had a cystic hygroma, a large lymph system tumor (lymphangioma) and hydrops, the abnormal accumulation of fluid, in the abdomen. When the infant was born, it had a webbed neck, a characteristic feature of Turner syndrome, a disorder of gonadal differentiation, marked by short stature, undifferentiated (streak) gonads, and other abnormalities including a webbed neck and heart defects. Early in its infancy, the patient's aorta had to be repaired to fix a stricture or contraction (coarctation) of the aorta. The case provided an opportunity to study the evolution of Turner syndrome in a fetus. If lymphangioma sores are detected before birth, the possibility of survival for patients with Turner syndrome may increase.