RESUMO
Squamous metaplasia and cystic change can appear in the thyroid and mimic a variety of lesions. In this report, a patient with two dominant left thyroid nodules underwent fine needle aspiration (FNA) biopsy for each nodule. One of the nodules was diagnosed as consistent with papillary carcinoma and the other as suspicious for papillary carcinoma. Subsequent near total thyroidectomy revealed both lesions to be part of a goiter with extensive squamous metaplasia. This article discusses a potential pitfall in the interpretation of fine needle aspirates of squamous metaplastic cells in the thyroid.
Assuntos
Biópsia por Agulha Fina , Carcinoma Papilar/patologia , Carcinoma de Células Escamosas/patologia , Erros de Diagnóstico , Bócio/patologia , Neoplasias da Glândula Tireoide/patologia , Idoso de 80 Anos ou mais , Carcinoma Papilar/cirurgia , Carcinoma de Células Escamosas/cirurgia , Feminino , Bócio/diagnóstico por imagem , Bócio/cirurgia , Técnicas de Preparação Histocitológica , Humanos , Achados Incidentais , Neoplasias do Mediastino/diagnóstico , Metaplasia , Timoma/patologia , Timoma/cirurgia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia , UltrassonografiaRESUMO
BACKGROUND: The Accreditation Council for Graduate Medical Education has recently enacted an 80-hour workweek, which has been in effect in New York State for several years. We surveyed surgical residents from all four State University of New York (SUNY) surgical programs to determine their perceptions of the impact of the 80-hour workweek on patient care, surgical education, and personal life. METHODS: A survey instrument to address the three areas of concern was developed and administered to all surgical residents at the four SUNY programs. Anonymity of the responders was maintained. Responses to the questions were in numeric rank scores and were analyzed by descriptive statistics, chi-square analysis, and analysis of variance. RESULTS: Response rate was 59%. Factors perceived to be affected negatively by the residents were continuity and safety of care, their operative experience, and their relations with attendings. The factors affected positively were increased personal time and decreased fatigue at work. Interestingly, the latter did not appear to decrease the rate of medical errors in their perception. CONCLUSIONS: The 80-hour workweek has the potential to have adverse effects on patient care despite improving the level of fatigue at work. Reengineering the surgical residencies will be needed to take full advantage of the restricted work hours.