Multi-centre phase II clinical trial of yttrium-90 resin microspheres alone in unresectable, chemotherapy refractory colorectal liver metastases.

BACKGROUND: This multi-centre phase II clinical trial is the first prospective evaluation of radioembolisation of patients with colorectal liver metastases (mCRC) who failed previous oxaliplatin- and irinotecan-based systemic chemotherapy regimens. METHODS: Eligible patients had adequate hepatic, haemopoietic and renal function, and an absence of major hepatic vascular anomalies and hepato-pulmonary shunting. Gastroduodenal and right gastric arteries were embolised before hepatic arterial administration of yttrium-90 resin microspheres (median activity, 1.7 GBq; range, 0.9-2.2). RESULTS: Of 50 eligible patients, 38 (76%) had received > or =4 lines of chemotherapy. Most presented with synchronous disease (72%), >4 hepatic metastases (58%), 25-50% replacement of total liver volume (60%) and bilateral spread (70%). Early and intermediate (>48 h) WHO G1-2 adverse events (mostly fever and pain) were observed in 16 and 22% of patients respectively. Two died due to renal failure at 40 days or liver failure at 60 days respectively. By intention-to-treat analysis using Response Evaluation Criteria in Solid Tumours, 1 patient (2%) had a complete response, 11 (22%) partial response, 12 (24%) stable disease, 22 (44%) progressive disease; 4 (8%) were non-evaluable. Median overall survival was 12.6 months (95% CI, 7.0-18.3); 2-year survival was 19.6%. CONCLUSION: Radioembolisation produced meaningful response and disease stabilisation in patients with advanced, unresectable and chemorefractory mCRC.

Ultrastructural descriptions of pericyte/endothelium peg-socket interdigitations in the microvasculature of human gastric carcinomas.

BACKGROUND: Angiogenesis requires complex multistep signalling pathways and a high degree of spatial and temporal coordination among endothelial cells and pericytes. The two cell types exhibit numerous contacts in vivo and in vitro, including the occurrence of peg-socket junctions. MATERIALS AND METHODS: Ultrastructural findings in 9 cases of advanced gastric carcinomas were reviewed with special emphasis on endothelium/pericyte peg-socket junctions. RESULTS: The incidence of peg-socket junctions was approximately 8% in 5 out of 9 cases. The remaining 4 cases showed a very low rate, including two cases in whom interactions were totally absent. Peg-socket junctions consisted of cytoplasmic projection from the pericyte protruding into the endothelial indentation. The endothelial cells interacting with pericytes showed ultrastructural signs of partial stabilization such as continuous endothelial lining, regularly constructed interendothelial junctions, more or less integrated pericytes, and multilayered basement membrane. CONCLUSION: Our ultrastructural study confirms previous reports regarding pericyte/endothelial peg-socket interdigitations in murine and human granulation tissues and extends these findings to the microvasculature of human gastric carcinomas.

Granulomatous inflammatory reaction in human gastric adenocarcinomas: a light and electron microscopy study.

Granuloma is a focal, compact collection of inflammatory cells in which mononuclear phagocytes predominate. The authors report 9 cases of papillary-tubular gastric adenocarcinomas characterized by mature granulomas associated with recent microhemorrhages. Mature granulomas were composed of foamy, CD68-positive histiocytes with occasional giant cells. Hemosiderin-containing macrophages were present in the tumor stroma, suggesting phagocytosis of erythrocytes. Under electron microscopy, mature (nonepithelioid) granulomas and clusters containing 1 macrophage and 1-3 eosinophils were found. This study provides morphological examples of skewed type II macrophage infiltration in gastric adenocarcinomas that is involved in scavenging activity, particularly erythrophagocytosis, formation of mature (nonepithelioid granulomas), and heterotypic aggregation with eosinophils.

Delivery of selective internal radiation therapy complicated by variant hepatic vascular anatomy.

"Difficult vascular anatomy" is a challenge for Interventional Radiologists especially in liver directed therapies such as trans arterial radio embolization. Trans arterial radio embolization is a long and difficult procedure in which the basic knowledge of hepatic and gastro-enteric vascularization, with its high degree of variations, is very important in order to correctly administer the therapeutic drug selectively. In this report, we present a case of an atypical patient affected by an unresectable hepatocellular carcinoma, candidate for Radio-embolization treatment. His vascular anatomy was very difficult to manage, but the Interventional Radiologist was not only able to go over the "difficult anatomy," but also to take advantage of it.

Krukenberg tumour of the ovary: a case report with light microscopy, immunohistochemistry and electron microscopy study.

A rare case of a 46-year-old woman with bilateral Krukenberg tumours is reported. Histologically, oedematous ovarian stroma was infiltrated by signet-ring cells arranged singly, in cords or in nests. Immunoreactivity for cytokeratin-7, carcinoembryonic antigen as well as histochemical positivity for mucins demonstrated the epithelial nature of the tumour. The gastric primary site was suggested by the cytoplasmic immunoreactivity for MUC-5AC and by ultrastructural evidence of gastric differentiation in signet-ring cells such as mucous granules with eccentric dense cores and intracellular microcysts, lined by sparse microvilli. Gastric biopsy, performed after pathological diagnosis, revealed a signet-ring cell carcinoma similar to that in the ovaries, confirming the gastric origin of the Krukenberg tumour. Because none of the individual immunohistochemical markers used for tissue identification is both site specific and site sensitive, electron microscopy in combination with immunohistochemistry is a valuable tool for the pathologist in the diagnosis of the tissue origin of a Krukenberg tumour.

Osteoid osteoma treated with radiofrequency ablation in non-operating room anesthesia. A different way of approaching ablative therapy on osteoid osteoma.

OBJECTIVE: The purpose of this study is to verify the effectiveness and complications occurrence of radiofrequency ablation (RFA) in the treatment of osteoid osteoma (OO) in non-operating room anesthesia (N.O.R.A.). PATIENTS AND METHODS: From 2014 to 2017, 61 patients affected by OO (40 men and 21 women) with an age of 20.7 years on average (range, 4-51 years; 12 patients aged 20 years or younger) underwent computed tomography-guided percutaneous radiofrequency ablation (RFA) in N.O.R.A. (Non-Operating Room Anesthesia). Lesion sites treated were: femur (27), tibia (22), pelvis (2), talar bone (3), distal radius (1), and humerus (6). Mean follow-up time was 36 months. In each case, anesthesiologic support followed a new protocol (N.O.R.A. protocol), approved by our Institute. Primary success rate, complications, symptom-free intervals, and follow-up results were evaluated. RESULTS: Pain relief (evaluated with Visual Analogue Scale - VAS) was significant in 97% of patients; it disappeared within 24 hours of the procedure in 44 patients, within 3 days in 10 patients, and within 7 days in 7 patients. After 6 months of observation time, 60 of 61 patients were successfully treated and had no more complaints. In 2 patients, two major complications were found: infection of the site treated, healed with antibiotics, and a nerve lesion, healed with steroid therapy. No other complications were observed. CONCLUSIONS: RFA is a highly effective, efficient, minimally invasive and safe method for the treatment of OO following N.O.R.A.

A multicentric phase II clinical trial on intra-arterial hepatic radiotherapy with 90yttrium SIR-spheres in unresectable, colorectal liver metastases refractory to i.v. chemotherapy: preliminary results on toxicity and response rates.

BACKGROUND: In patients locally progressing after two lines of chemotherapy, some locoregional approaches showed encouraging results in terms of local control of disease. The aim of our study was to evaluate toxicity, clinical response and quality of life in 48 patients with unresectable colorectal liver metastases submitted to selective internal radiotherapy (SIRT). MATERIALS AND METHODS: Up to now 35 patients with unresectable colorectal liver metastases, refractory to two lines of chemotherapy, underwent intra-arterial infusion of resin microspheres with yttrium-90 (SIR-spheres). Pre-treatment evaluation included a CT scan, blood tests, a PET scan and arteriography of celiac trunk, hepatic and superior mesenteric artery; extrahepatic uptakes and pulmonary shunts more than 10% were excluded by a Scinti-scan. The gastroduodenal artery was embolized before the SIR-spheres injection. Other exclusion criteria were liver dysfunction and anatomical vascular anomalies. The clinical response was evaluated by CT-scan following the RECIST criteria. Median follow-up was 4 months. RESULTS: Median number of metastases was 4 (range, 1-15), 38% of cases presenting hepatic involvement < 25%. The median SIRT dose delivered was 1.7 GBq. Median pulmonary shunt was 6%. No operative mortality occurred; early toxicity (within 48 hours) was 20.6%, shown as fever, acute pain and leucocytosis. The late toxicity was 24.1% with chronic pain, jaundice and nausea being the most frequent. All the toxic events were graded 2 or 3 according to the WHO scale. Preliminary results were available in terms of clinical response after 6 weeks: 12.5% had a partial response, 75% a stable disease, while progression of disease, was observed in 12.5% of the patients. CONCLUSION: SIRT is a safe treatment in terms of acute and late toxicity. Intra-arterial microspheres could represent a good therapeutic option for patients with progressing liver metastases only, after two lines of systemic chemotherapy.

5-year prospective results of trimodality treatment for malignant pleural mesothelioma.

AIM: Even though followed by a prolonged survival in highly selected patients, the promising results of Sugarbaker's trimodality treatment for malignant pleural mesothelioma (MPM) are debated and not yet uniformly replicated. The purpose of this study is to evaluate prospectively the reproducibility of the trimodality treatment results in a patient population with mesothelioma staged by the IMIG classification. METHODS: Fifty-four patients with MPM have been judged candidable to extended pleuropneumonectomy (EPP), to be followed by chemotherapy (paclitaxel+carboplatin) and radiotherapy (50 Gy). RESULTS: At thoracotomy, 44 of the 54 surgical candidates (81%) underwent EPP; 73% of the operated patients completed the entire adjuvant chemo-radiotherapy with no major toxicity. The 30-day or in-hospital operative mortality rate was 4.5% (2 deaths), the major morbidity 36%, and the overall complication rate 50%. At 5 years the projected survival of the 42 surgical survivors submitted to EPP is 19%; median survival is 20 months. The restricted group of patients with epithelial, N0-1, completely resected MPM (microscopic negative margins) exhibits a projected 50% 5-year survival. Clinical understaging has shown up to be noticeable both at the thoracotomy exploration and pathology examination. Most of the disease recurrences are loco-regional and the current insufficiency of intraoperative or postsurgical radicality needs improvement, along with earlier diagnosis, more accurate staging, and preoperative induction for the multimodality treatment of pleural mesothelioma to become an established curative option. CONCLUSIONS: This series confirms the reproducibility of the trimodality treatment for MPM,which is associated with prolonged survival for early-stage tumors at the cost of a not prohibitive treatment-related mortality rate.

Heart transplantation in mildly diabetic patients.

From 1985 to 1989, 67 heart transplantations were performed in our hospital, 6 of them in non-insulin-dependent (type II) diabetic patients. Six pretransplantation type II diabetic male heart recipients (mean +/- SD age 50.0 +/- 7.3 yr) were compared with 61 nondiabetic recipients (mean age 44.5 +/- 11.0 yr; 55 men, 6 women) to define whether a different posttransplantation prognosis may be caused by pretransplantation diabetes. Before transplantation, all diabetic recipients (3 newly diagnosed and 3 with diabetes duration of 5, 6, and 12 yr, respectively) were in good glycemic control (mean fasting blood glucose 7.95 +/- 1.62 mM, mean HbA1c 7.6 +/- 0.2%). None had ocular or renal microangiopathic complications, 5 were treated only with diet, and 1 was treated with oral hypoglycemic agents. All recipients were treated with the same immunosuppressive protocol (cyclosporin, prednisone, and since 1986, azathioprine and antilymphocyte globulin), and mean dose and blood levels of cyclosporin were not significantly different between diabetic and nondiabetic recipients. After heart transplantation (mean follow-up 558 +/- 340 days in diabetic and 379 +/- 338 in nondiabetic recipients), the mortality rate and complications (i.e., rejection episodes, supplementary immunosuppressive treatments, major and minor infections, arterial hypertension, and graft atherosclerosis) showed no significant differences except for the more frequent arterial hypertension in diabetic recipients (P less than 0.05), although pretransplantation incidence of hypertension was lower in diabetic candidates.(ABSTRACT TRUNCATED AT 250 WORDS)

Hyperbaric oxygen in diabetic gangrene treatment.

We treated a group of 18 hospitalized adult diabetic patients (all with retinopathy, 17 with symptomatic neuropathy, and 6 with macroangiopathy) presenting with gangrenous lesions of the foot by a combined regime consisting of strict metabolic control, daily debridement of necrotic tissues, and daily hyperbaric oxygen (HBO) treatments given in a multiplace oxygen chamber. Another group of 10 adult subjects with comparable foot lesions (all with retinopathy, 9 with symptomatic neuropathy, and 4 with macroangiopathy) was treated in exactly the same way except for HBO. In the test treatment group, 16 patients were healed, and the remaining 2 showed no improvement and later underwent amputation. The number of HBO treatments required for healing was significantly related to the size of gangrenous lesions. In the non-HBO-treated group, only 1 patient improved, 5 of 10 showed no change, and 4 of 10 worsened until leg amputation was unavoidable. Comparison of the two groups by chi 2-test revealed a highly significant difference (P = .001). In practical terms, HBO treatment drastically reduced leg amputations in patients so treated in the last 3 yr compared with earlier and current figures for patients not receiving HBO treatment.

Limb saving procedure in metastatic leiomyosarcoma of the femoral vein: case report and literature review.

Primary venous leiomyosarcoma is very rare and first description was made by Perl in 1871. Most cases are from venous system and half of them are reported to originate in inferior vena cava. We report the case of a 77-year-old Caucasian man with a leiomyosarcoma of the femoral vein. A leg preservation surgery was decided. Eight months later, the patient died of tumor progression. A PubMed search using the terms "leiomyosarcoma femoral vein" and "leiomyosarcoma vein" was performed. All cases of composite iliac-femoral leiomyosarcoma were excluded, and as far as possible, only well-documented cases were included. Median age was 55 years, seven men and six women, tumor resection was performed by six authors, six others performed a vascular resection, and one preferred for a thigh excision. Prognosis remains poor if metastasis is present, and in these cases, a conservative surgery is recommended to preserve patients' quality of life.

Divergência fenotípica entre éguas Crioulas das linhagens uruguaia "La invernada", argentina "Cardal" e chilena / [Phenotypic divergence between Criollo mares lines of the Uruguayan "La invernada", Argentine "Cardal" and Chilean]

O objetivo do presente estudo foi analisar a dissimilaridade fenotípica de amostras populacionais de três linhagens de éguas Crioulas, uruguaia (La Invernada), argentina (Cardal) e chilena, para caracteres morfológicos, apontando as características de maior variância intra e entre as diferentes linhagens que são passíveis de seleção. Foram avaliadas 22 características morfológicas de 113 éguas da linhagem uruguaia "La Invernada", 38 argentinas "Cardal" e 73 chilenas puras, totalizando 224 éguas de cria pertencentes à raça Crioula. Para determinação das variáveis lineares e de perímetro, foi utilizada fita métrica, prumo, paquímetro e hipômetro. Verificou-se variabilidade nas características morfológicas entre as três linhagens (P<0,05), incluindo as características lineares altura, perímetro de tórax e perímetro de canela (P<0,01), consideradas de caráter impositivo para fins de registro. Maior variação fenotípica foi observada nas éguas da linhagem chilena em relação aos outros dois grupos genéticos (P<0,01). As características morfológicas altura garupa, perímetro rostral pescoço, comprimento metatarso, largura garupa, profundidade do tórax, comprimento dorsal pescoço e comprimento do corpo foram passíveis de seleção entre as éguas Crioulas pertencentes às linhagens argentina (Cardal), uruguaia (La Invernada) e chilena. Em conclusão, não há homogeneidade entre as linhagens estudadas, o que identifica a diversidade entre as linhagens de éguas Crioulas estudadas.(AU)

The aim of the study was to analyze the phenotypic dissimilarity of morphological characteristics of three strains of Criollo mares, Uruguian (La Invernada), Argentine (Cardal), and Chilena, pointing to the characteristics of higher variance within and among the different strains that are selectable. We evaluated 22 morphological characteristics of 113 mares of the Uruguaian line, 38 Argentines and 73 pure Chilean, totaling 224 breeding mares belonging to the criollo breed. For the determination of the linear and perimeter variables, a metric tape, plumb, pachymeter and hypometer were used. There was variability in the morphological characteristics between the three strains (P<0.05), including the linear characteristics of height, chest circumference and perimeter of cinnamon (P<0.01), considered as taxation for registration purposes. Higher phenotypic variation was observed in the mares of the Chilean line in relation to the other two genetic groups (P<0.01). The morphological characteristics of height croup, rostral perimeter neck, metatarsal length, croup width, chest depth, dorsal neck length, and body length were the selectable characteristics among the breeding mares belonging to the Argentine (Cardal), Uruguaian (La Invernada) and Chilena strains. In conclusion, there is no homogeneity between the studied strains, which identifies the diversity among the lines of Criollo mares studied.(AU)

A new technique for endocavitary irradiation of the esophagus.

Recently, high-dose rate intracavitary irradiation has been used as a boost therapy or a palliative therapy in the treatment of the esophageal carcinoma. The new intraesophageal device is based on a modified Sengstaken-Blackemore tube. On the surface of the esophageal balloon of the S-B tube Cyponil tubes are fixed as iridium containers. The device is placed at the level of the neoplastic lesion. Treatment tolerance is good.

Radiotherapy versus radiotherapy enhanced by cisplatin in stage III non-small cell lung cancer.

Between January 1987 and June 1991, 173 patients with inoperable non-small cell lung cancer, Stage III, were entered into a randomized trial comparing radiotherapy only (RT) (45 Gy/15 fractions/3 weeks) (arm A) versus RT and a daily low dose of cDDP (6 mg/m2) (arm B). An overall response rate of 58.9% was observed in arm A and 50.6% in arm B, respectively. No differences in the pattern of relapse were noted between the two treatment groups. Median time to progression was 10.6 months for arm A and 14.2 months for arm B. Median survivals were 10.3 months and 9.97 months, respectively. Toxicity was acceptable and no treatment-related death occurred in either treatment schedule. In this study no significant advantage of the combined treatment over radiation therapy only was found. The encouraging results achieved in some trials together with the intractability of the disease suggest that further efforts should be made to optimize clinical trial protocols, perhaps by reviewing the radiobiological and pharmacological basis of the combined treatment.

An afterloading technique suitable for carcinomas of the oral cavity.

The authors describe an afterloading brachytherapy to treat oral cavity carcinomas. Catheters for arterial/venous catheterization are inserted percutaneously in the target volume. The internal needles are then removed and replaced with iridium wires inside tubes to form wire loops. This technique has proven to be simple, quick and safe.

Is prophylactic para-aortic irradiation worthwhile in the treatment of advanced cervical carcinoma? Results of a controlled clinical trial of the EORTC radiotherapy group.

From November 1977 to July 1981, 441 patients with cervical carcinoma were randomized between pelvic irradiation and pelvic and para-aortic irradiation. Included were patients with stage I and IIB with proximal vaginal and/or parametrial involvement with positive pelvic lymph nodes either on lymphangiogram or at surgery, and stage IIB with distal vaginal and/or parametrial involvement and III regardless of pelvic node status on lymphangiogram. Patients with clinically or surgically involved para-aortic nodes were not included. The external beam dose to the para-aortic area was fixed at 45 Gy. There was no statistically significant difference between the two treatment arms in terms of local control, overall distant metastases and survival with no evidence of disease (NED), although the incidence of para-aortic metastases and distant metastases without tumor at pelvic sites was significantly higher in patients receiving pelvic irradiation alone (pelvic group). The 4-year NED survival rate was 51%. The incidence of severe digestive complications was significantly higher in patients receiving para-aortic irradiation (para-aortic group). Routine para-aortic irradiation for all high risk patients with cervical carcinoma is of limited value, but patients with a high probability of local control can benefit from extended field irradiation, despite an increase in severe digestive complications.

[Treatment with 32P of carcinoma of the prostate (author's transl)]. / Trattamento con radiofosforo del carcinoma della prostata

Twenty-eight patients affected with disseminated prostate cancer, which proved hormone resistant (after castration and oestrogen administration), have undergone combined treatment with Testosterone (for 13 days) and 32P (for the last 7 days of the Testosterone treatment). During the initial fase of the treatment (Testosterone only), 14 patients experienced pain exacerbation and/or fever and one experienced immediate improvement. The exacerbation quickly disappeared following 32P administration, and 26 of the patients had distinct improvement at some time during or after treatment, with a mean remission duration of 3 months and mean survival rate of 7 months. No lytic or soft part deposit showed improvement; improvement was noticeable only in the mixed type or osteo-sclerotic metastases. This observation suggests that the androgen stimulates uptake of the isotope not inside the tumor cells but in the bone matrix around the tumoral deposit. The patient who showed very early improvement had a subsequent relapse on oestrogens, but later responded to the androgen alone.

Time dependence of hematoporphyrin distribution in selected tissues of normal rats and in ascites hepatoma.

The distribution of hematoporphyrin was determined in normal rats and in rats bearing ascites hepatoma as a function of time after i.p. injection of 10-20 mg/kg of dye. In both cases, hematoporphyrin displayed a high affinity for the tumor cells. At 20 mg/kg, the maximum difference between the amount of hematoporphyrin accumulated in the tumor and in the liver was obtained at 12 h after injection (tumor/liver ratio = 28). Our results suggest that hematoporphyrin is almost exclusively metabolized in the liver and excreted via the biliary tract, whereas only minor amounts are metabolized in the tumor cells. Moreover, the binding between the porphyrin and tumor cells is competitive with serum protein binding.

Ovarian function after pelvic lymph node irradiation in patients with Hodgkin's disease submitted to oophoropexy during laparotomy.

Staging laparotomy for Hodgkin's disease was carried out on 110 women in fertile age at the General Surgery Department of Padua Medical School from 1972 to 1977. An oophoropexy was done during the operation. According to the stage the patients underwent radiation therapy that was associated in some cases to chemotherapy. Complete evaluation was possible only in 66 patients. Eighteen out of the 66 had mantle field and para-aortic lymph node chain radiotherapy. One case of amenorrhoea (5.5%) and five pregnancies (27.8%), were found among them. Nineteen had the same type of radiotherapy with MOPP. 3 cases of amenorrhoea (15.8%) and 3 pregnancies (15.8%) were found. Five had total nodal irradiation (TNI) according to Kaplan and all of them had amenorrhoea (100%). Twenty four had TNI associated to MOPP with 24 cases of amenorrhoea (100%). Our results slightly differ from those of other Authors. They showed: 1) that the oophoropexy is not effective using standard surgical technique (probably because of the size of the central shielding) as it causes amenorrhoea in 100% of the cases; 2) the incidence of permanent amenorrhoea from chemotherapy with MOPP is the same as reported by other Authors; 3) the absence of teratogenic effects by chemotherapy in newborns of these patients.

[The role of ultrasonography in thyroid disease]. / Il ruolo dell'ecografia nella patologia tiroidea.

Ultrasound examination of the thyroid gland is widely used in the diagnosis of thyroid disease. This test is easy and rapid to perform, widely available and the results are readily interpreted. Using ultrasound the image of foci of disease within the gland are easily identified, especially using high frequency probes which enable solid nodules up to approx 3 mm to be revealed with 10 MHz probes. In non-nodular thyroid disease the ultrasonic structure guides the diagnosis (thyroiditis, Graves' disease). During the follow-up of thyroidectomised patients ultrasound can easily reveal postoperative anatomic variations and an early diagnosis can be obtained of any signs of local recurrence of the primary disease. Only hemiagenesia and hypoplasia can be accurately evaluated in congenital disease, whereas in the event of the persistence of the thyroglossal duct the latter can only be diagnosed if it presents a cystic evolution. Thyroid ectopia cannot be identified and must be studied using thyroscintigraphy, preferably performed using 131I as the isotope. The acquired pathology is classified into phlogistic processes, diffuse or nodular hyperplasia, benign and malignant neoplasia. This classification is widely accepted by virtually all authors. In thyroiditis, ultrasound may facilitate the diagnosis of De Quervain's non-suppurative sub-acute thyroiditis (TANS) and Hashimoto's chronic thyroiditis, although always in association with clinical and laboratory tests. The most frequent thyroid pathology is without doubt goitre. This disorder may occur in a non-nodular (widespread goitre with an endemic or sporadic pattern) or nodular form which may be single or multiple. The term goitre is used to indicate the increased volume of the thyroid gland independently of the causes which have provoked it. Common goitre is defined as being endemic when in some geographic area 10% of the general population or 20% of the school-aged population suffers from thyroid hyperplasia (areas of goitrogenic endemic disease). Graves' disease may be included in the group of thyroid hyperplasia diseases, although it is distinguished from the simple versions by the marked glandular hyperactivity which creates manifest hyperthyroidism. In this pathology ultrasonography must be supplemented by colour-Doppler wherever possible. Thyroid nodules are subdivided in terms of their echostructure into 5 types: liquid, mixed (prevalently solid or prevalently liquid), hyperechogenic solid, isoechogenic solid and hypoechogenic solid. The characteristics of benign nodules are: hypoechogenic structure, regular edges, complete and uniform hypoechogenic peripheral halo.(ABSTRACT TRUNCATED AT 400 WORDS)