Long-term follow-up of cystic thyroid nodules treated with percutaneous ethanol injection (PEI) using two different approaches.

BACKGROUND AND AIM: Cystic thyroid nodules (CNs), although generally benign, can cause compressive or aesthetic problems. Percutaneous ethanol injection (PEI) can represent an alternative to surgery. The present retrospective study evaluates: (i) the long-term outcome of CNs after PEI; (ii) the differences between two different PEI protocols; (iii) the CNs response according to the liquid component. MATERIALS AND METHODS: The study comprises 358 nodules post-PEI followed for at least 2 years. PEI was performed according to two different treatment protocols with a single (Foggia) or double (Turin) alcohol injection. CNs were divided according to their composition: cystic (CYS) >90%, mainly cystic (M-CYS) 75-90%, mixed (MIX) 50-75%, solid-mixed (S-MIX) 35-50%. The volume reduction rate (VRR) was defined as nodule volume (mL) after PEI/nodule volume (mL) before PEI x 100. RESULTS: The 1-year VRR was significantly higher than that at 6 months (89.5% vs 72.9%, P = 0.0005), no differences were observed after 1 year. A significant difference between Turin and Foggia was observed only in VRR at early visit (79% vs 86%, respectively, P = 0.002) and recurrence rate (14% vs 24%, respectively, P = 0.001). Minor side-effects were infrequent. In 192 nodules with a 10-year follow-up CYS showed higher VRR than MIX and S-MIX nodules (P < 0.001). CONCLUSION: Our study reported that the long-term outcome of CNs treated with PEI is excellent regardless of the PEI technique utilized; the larger the cystic amount, the higher the VRR. Based on present results, PEI can be considered as the first-line choice for treating thyroid CNs.

Thyroid ultrasonography reporting: consensus of Italian Thyroid Association (AIT), Italian Society of Endocrinology (SIE), Italian Society of Ultrasonography in Medicine and Biology (SIUMB) and Ultrasound Chapter of Italian Society of Medical Radiology (SIRM).

Thyroid ultrasonography (US) is the gold standard for thyroid imaging and its widespread use is due to an optimal spatial resolution for superficial anatomic structures, a low cost and the lack of health risks. Thyroid US is a pivotal tool for the diagnosis and follow-up of autoimmune thyroid diseases, for assessing nodule size and echostructure and defining the risk of malignancy in thyroid nodules. The main limitation of US is the poor reproducibility, due to the variable experience of the operators and the different performance and settings of the equipments. Aim of this consensus statement is to standardize the report of thyroid US through the definition of common minimum requirements and a correct terminology. US patterns of autoimmune thyroid diseases are defined. US signs of malignancy in thyroid nodules are classified and scored in each nodule. We also propose a simplified nodule risk stratification, based on the predictive value of each US sign, classified and scored according to the strength of association with malignancy, but also to the estimated reproducibility among different operators.

Effect of complex wavelet transform filter on thyroid tumor classification in three-dimensional ultrasound.

Ultrasonography has great potential in differentiating malignant thyroid nodules from the benign ones. However, visual interpretation is limited by interobserver variability, and further, the speckle distribution poses a challenge during the classification process. This article thus presents an automated system for tumor classification in three-dimensional contrast-enhanced ultrasonography data sets. The system first processes the contrast-enhanced ultrasonography images using complex wavelet transform-based filter to mitigate the effect of speckle noise. The higher order spectra features are then extracted and used as input for training and testing a fuzzy classifier. In the off-line training system, higher order spectra features are extracted from a set of images known as the training images. These higher order spectra features along with the clinically assigned ground truth are used to train the classifier and obtain an estimate of the classifier or training parameters. The ground truth tells the class label of the image (i.e. whether the image belongs to a benign or malignant nodule). During the online testing phase, the estimated classifier parameters are applied on the higher order spectra features that are extracted from the testing images to predict their class labels. The predicted class labels are compared with their corresponding original ground truth to evaluate the performance of the classifier. Without utilizing the complex wavelet transform filter, the fuzzy classifier demonstrated an accuracy of 91.6%, while utilizing the complex wavelet transform filter, the accuracy significantly boosted to 99.1%.

Cost-effective and non-invasive automated benign and malignant thyroid lesion classification in 3D contrast-enhanced ultrasound using combination of wavelets and textures: a class of ThyroScan™ algorithms.

Ultrasound has great potential to aid in the differential diagnosis of malignant and benign thyroid lesions, but interpretative pitfalls exist and the accuracy is still poor. To overcome these difficulties, we developed and analyzed a range of knowledge representation techniques, which are a class of ThyroScan™ algorithms from Global Biomedical Technologies Inc., California, USA, for automatic classification of benign and malignant thyroid lesions. The analysis is based on data obtained from twenty nodules (ten benign and ten malignant) taken from 3D contrast-enhanced ultrasound images. Fine needle aspiration biopsy and histology confirmed malignancy. Discrete Wavelet Transform (DWT) and texture algorithms are used to extract relevant features from the thyroid images. The resulting feature vectors are fed to three different classifiers: K-Nearest Neighbor (K-NN), Probabilistic Neural Network (PNN), and Decision Tree (DeTr). The performance of these classifiers is compared using Receiver Operating Characteristic (ROC) curves. Our results show that combination of DWT and texture features coupled with K-NN resulted in good performance measures with the area of under the ROC curve of 0.987, a classification accuracy of 98.9%, a sensitivity of 98%, and a specificity of 99.8%. Finally, we have proposed a novel integrated index called Thyroid Malignancy Index (TMI), which is made up of texture features, to diagnose benign or malignant nodules using just one index. We hope that this TMI will help clinicians in a more objective detection of benign and malignant thyroid lesions.

Dentin contamination protection after mechanical preparation for veneering.

PURPOSE: To evaluate in vivo the efficacy in preventing post-operative sensitivity and bacterial invasion of primed dentin that was left unprotected for 4 days after laminate veneer preparation. MATERIALS AND METHODS: Twelve vital, periodontically involved anterior teeth were prepared for experimental laminate veneers and divided into three groups: (1) Control group, in which the prepared surfaces were left unprotected after preparation; (2) Prepared dentin surfaces were cleaned with Tubulicid Red Label and covered with Tubulitec Primer; (3) All-Bond 2 Primer was applied to the prepared dentin surface. Post-operative sensitivity was evaluated immediately and a second appointment, 4 days later. The teeth were then extracted and examined by SEM. RESULTS: The application of a primer (Groups 2 and 3) prevented all sensitivity. After 4 days, the teeth in Group 1 were still sensitive to air blasts. Bacterial penetration into the unprotected tubules was observed in Group 1, but not in Groups 2 and 3.

Contraction gaps in Class II restorations with self-cured and light-cured resin composites.

PURPOSE: To evaluate in vitro the cervical gap formation in composite restorations in which an increment of autopolymerizing composite was interposed between the light-cured filling material and the dentin bonding system. Two different self-cured materials and two different adhesives were used and compared. MATERIALS AND METHODS: In 40 Class II cavity preparations with the gingival margins in dentin or cementum, an increment of either of two different autopolymerizing composites, Palfique or Bisfil 2B, was interposed between the light-cured filling material (Palfique Estelite) and either of two different dentin bonding systems, All-Bond and Superbond D (20 restorations each). The specimens were immersed in toluidine blue dye. A section was taken from each specimen and examined under an optical microscope. The extent of dye penetration was measured. The specimens were then stored in water for 1-4 months and replicas of the sections were examined by SEM. RESULTS: Good marginal adaptation was observed for All-Bond/Bisfil 2B in all the restorations. All-Bond/Palfique showed good adaptation in 7 out of 10 cases, the failures occurring between bonding agent and composite. Superbond D/Palfique and Superbond D/Bisfil 2B showed marginal gap formation in 8 out of 10 and in all the restorations respectively. In the latter, four gaps occurred between bonding agent and dentin. As a consequence, a very significant difference (P<0.001) was found between All-Bond and Superbond treatments; no significant difference was found between Bisfil 2B and Palfique in each group treated with either All-Bond or Superbond. After 1-4 months storage in water, hygroscopic expansion of the restorative materials reduced the total number of gaps and the efficacy of the treatments was no more significantly different.

Smear layer removal by root canal irrigants. A comparative scanning electron microscopic study.

The effect of six endodontic irrigants on smear layers created by hand instrumentation was evaluated in vitro in the middle and apical sections of 53 root canals. The irrigants evaluated were: 1% and 5% sodium hypochlorite, a combination of 24% phosphoric acid and 10% citric acid, 0.2%, 17%, and 3% ethylenediaminetetraacetic acid. After instrumentation and treatment with the respective irrigants, the root canal specimens were examined by scanning electron microscopy to determine the presence or absence of smear layer. The two sodium hypochlorite solutions did not remove the smear layer, even when 5% sodium hypochlorite was scrubbed on the dentinal walls. The 0.2% ethylenediaminetetraacetic acid solution was more effective than sodium hypochlorite, but it did not completely remove the smear layer, especially at the orifices of the dentinal tubules. The other three solutions effectively removed the smear layer, but no significant difference was found between them (p > 0.05). The solution of 3% ethylenediaminetetraacetic acid was as effective as phosphoric-citric acid and 17% ethylenediaminetetraacetic acid. Ethylenediaminetetraacetic acid, however, did not show the marked demineralizing effect on the dentinal walls and tubules as the acidic solution.

[Resistance of cavity walls of composite filled teeth]. / Resistenza delle pareti cavitarie di denti otturati in composito.

The purpose of this study was to evaluate whether etching, bonding and filling with composite a cavity increase tooth resistance to fracture, considering that in posterior teeth stressed cusps are likely to bend. MOD conservative cavities (isthmus width/intercuspal distance = 0.25) were made in 10 extracted upper premolars, filled with P30 (3M) and tested by using a MTS machine. A metal bar (5 mm in diameter and 10 mm in length) was employed to load the cusps and their fracture resistance was recorded. The control group consisted of 16 extracted upper premolars: MOD cavities were made in only 9 teeth, then filled with amalgam. As a result, MOD cavities treated with Scotchbond, filled with P30 and tested by a MTS machine don't seem to be more resistant to a static load than cavities filled with amalgam.