Perceptions of the Healthcare System Among Black Men with Previously Undiagnosed Diabetes and Prediabetes.

OBJECTIVE: Given the significant disparities in diabetes burden and access to care, this study uses qualitative interviews of Black men having HbA1c levels consistent with previously undiagnosed diabetes or prediabetes to understand their perceptions of the healthcare system. RESEARCH DESIGN AND METHODS: We recruited Black men from Black-owned barbershops in Brooklyn, NY, who were screened using point-of-care HbA1c tests. Among those with HbA1c levels within prediabetes or diabetes thresholds, qualitative interviews were conducted to uncover prevalent themes related to their overall health status, health behaviors, utilization of healthcare services, and experiences with the healthcare system. We used a theoretical framework from the William and Mohammed medical mistrust model to guide our qualitative analysis. RESULTS: Fifty-two Black men without a prior history of diabetes and an HbA1c reading at or above 5.7% were interviewed. Many participants stated that their health was in good condition. Some participants expressed being surprised by their abnormal HbA1c reading because it was not previously mentioned by their healthcare providers. Furthermore, many of our participants shared recent examples of negative interactions with physicians when describing their experiences with the healthcare system. Finally, several participants cited a preference for incorporating non-pharmaceutical options in their diabetes management plans. CONCLUSION: To help alleviate the disparity in diabetes burden among Black men, healthcare providers should take a more active role in recognizing and addressing their own implicit biases, engage in understanding the specific healthcare needs and expectations of each patient, and consider emphasizing non-medication approaches to improve glycemic control.

Saúde do idoso: política de humanização e acolhimento na atenção básica / Elderly health: humanization and reception policy in primary care / Salud del anciano: política de humanización y acogida en la atención primaria

Objetivo: refletir sobre os avanços e obstáculos da Política Nacional de Humanização do idoso na atenção básica durante seu acolhimento. Método: pesquisa de caráter teórico reflexivo sobre a política de humanização e o acolhimento prestado ao idoso na atenção básica, realizando a interação dos envolvidos sobre o tema e o que se pode desenvolver diante do problema em questão. Resultados: é negligenciada pelos profissionais e gestores devido à falta de interesse e empenho em criar estratégias e ações para a valorização e incentivo ao idoso. Considerações finais: aprimoramento da atenção voltada ao idoso mediante suas necessidades, estabelecendo ações na estrutura, ambiência e promovendo a melhoria na rede assistencial conforme o que o Ministério daSaúde preconiza.

Objective: to reflect on the advances and obstacles of the National Policy for the Humanization of the elderly in primary care during their reception. Method: theoretically reflective research on the humanization policy and the care provided to the elderly in primary care, carrying out the interaction of those involved on the topic andwhat can be developed in view of the problem in question. Results: it is neglected by professionals and managers due to the lack of interest and commitment to creating strategies and actions to value and encourage the elderly. Final considerations: improvement of care aimed at the elderly according to their needs, establishing actions in the structure, ambience and promoting improvement in the care network as recommended by the Ministry of Health.

Objetivo: reflexionar sobre los avances y obstáculos de la Política Nacional de Humanización del anciano en la atención primaria durante su acogida. Método: investigación teórica reflexiva sobre la política de humanización y la acogida brindada a los ancianos en la atención primaria, realizando la interacción de los involucrados sobre el tema y lo que se puede desarrollar frente al problema en cuestión. Resultados: es desatendida por profesionales y gestores por la falta de interés y compromiso en la creación de estrategias y acciones para valorar y incentivar a las personas mayores. Consideraciones finales: mejora de la atención dirigida al adulto mayor de acuerdo a sus necesidades, estableciendo acciones en la estructura, ambiente y promoviendo la mejora en la red de atención recomendada por el Ministerio de Salud.

Hyperbaric oxygen therapy for COVID-19 patients with respiratory distress: treated cases versus propensity-matched controls.

Objective: Given the high mortality and prolonged duration of mechanical ventilation of COVID-19 patients, we evaluated the safety and efficacy of hyperbaric oxygen for COVID-19 patients with respiratory distress. Methods: This is a single-center clinical trial of COVID-19 patients at NYU Winthrop Hospital from March 31 to April 28, 2020. Patients in this trial received hyperbaric oxygen therapy at 2.0 atmospheres of pressure in monoplace hyperbaric chambers for 90 minutes daily for a maximum of five total treatments. Controls were identified using propensity score matching among COVID-19 patients admitted during the same time period. Using competing-risks survival regression, we analyzed our primary outcome of inpatient mortality and secondary outcome of mechanical ventilation. Results: We treated 20 COVID-19 patients with hyperbaric oxygen. Ages ranged from 30 to 79 years with an oxygen requirement ranging from 2 to 15 liters on hospital days 0 to 14. Of these 20 patients, two (10%) were intubated and died, and none remain hospitalized. Among 60 propensity-matched controls based on age, sex, body mass index, coronary artery disease, troponin, D-dimer, hospital day, and oxygen requirement, 18 (30%) were intubated, 13 (22%) have died, and three (5%) remain hospitalized (with one still requiring mechanical ventilation). Assuming no further deaths among controls, we estimate that the adjusted subdistribution hazard ratios were 0.37 for inpatient mortality (p=0.14) and 0.26 for mechanical ventilation (p=0.046). Conclusion: Though limited by its study design, our results demonstrate the safety of hyperbaric oxygen among COVID-19 patients and strongly suggests the need for a well-designed, multicenter randomized control trial.

Concordance and Discordance in the Geographic Distribution of Childhood Obesity and Pediatric Type 2 Diabetes in New York City.

OBJECTIVE: As rates of childhood obesity and pediatric type 2 diabetes (T2D) increase, a better understanding is needed of how these 2 conditions relate and which subgroups of children are more likely to develop diabetes with and without obesity. METHODS: To compare hotspots of childhood obesity and pediatric T2D in New York City, we performed geospatial clustering analyses on obesity estimates obtained from surveys of school-aged children and diabetes estimates obtained from health care claims data, from 2009 to 2013. Analyses were performed at the Census tract level. We then used multivariable regression analysis to identify sociodemographic and environmental factors associated with these hotspots. RESULTS: We identified obesity hotspots in Census tracts with a higher proportion of Black or Hispanic residents, with low median household income, or located in a food swamp. Total 51.1% of pediatric T2D hotspots overlapped with obesity hotspots. For pediatric T2D, hotspots were identified in Census tracts with a higher proportion of Black residents and a lower proportion of Hispanic residents. CONCLUSIONS: Non-Hispanic Black neighborhoods had a higher probability of being hotspots of both childhood obesity and pediatric T2D. However, we identified a discordance between hotspots of childhood obesity and pediatric diabetes in Hispanic neighborhoods, suggesting either under-detection or under-diagnosis of diabetes, or that obesity may influence diabetes risk differently in these 2 populations. These findings warrant further investigation of the relationship between childhood obesity and pediatric diabetes among different racial and ethnic groups, and may help guide pediatric public health interventions to specific neighborhoods.

Positive Lymph Node Counts in American Thyroid Association Low-Risk Papillary Thyroid Carcinoma Patients.

BACKGROUND: Current American Thyroid Association (ATA) guidelines state that patients with intermediate-risk papillary thyroid cancer (PTC) may benefit from remnant ablation. One criterion for intermediate-risk classification is >5 positive lymph nodes (LNs). We investigate whether performing step-sectioning of LNs increases the metastatic detection rate, thereby influencing ATA risk of recurrence (ROR) classification. METHODS: A retrospective review was conducted of cases in which ≥ 5 LNs were removed during thyroidectomy and ≤5 LNs were found positive for PTC. Step-sectioning was performed on the original tissue blocks. All slides were re-reviewed by a senior pathologist. RESULTS: Twenty patients met study criteria. Step-sectioning significantly increased LN yield compared to standard sectioning. In total, we found 12 new positive lymph nodes; seven (58%) were in totally new lymph nodes, while five (42%) were in lymph nodes previously read as negative. All newly discovered metastases were classified as micrometastases (≤2 mm). Of the 15 patients originally classified as low-risk, the step-sectioning protocol impacted two patients (13%), increasing ROR stratification. CONCLUSION: Intensive step-sectioning reveals additional micrometastases. More detailed analysis did not identify clinically significant nodal disease likely to impact the clinical course of patients in this study. Our study supports current standards of pathology specimen handling related to LN assessment and the impact on ATA ROR classification. Nonetheless, it is important for clinicians to understand their institution's sectioning protocol utilized to report positive and total LN counts, which could impact ATA risk stratification and denote the comprehensive nature of the LN dissection that was performed.

Improving the geographical precision of rural chronic disease surveillance by using emergency claims data: a cross-sectional comparison of survey versus claims data in Sullivan County, New York.

OBJECTIVES: Some of the most pressing health problems are found in rural America. However, the surveillance needed to track and prevent disease in these regions is lacking. Our objective was to perform a comprehensive health survey of a single rural county to assess the validity of using emergency claims data to estimate rural disease prevalence at a sub-county level. DESIGN: We performed a cross-sectional study of chronic disease prevalence estimates using emergency department (ED) claims data versus mailed health surveys designed to capture a substantial proportion of residents in New York's rural Sullivan County. SETTING: Sullivan County, a rural county ranked second-to-last for health outcomes in New York State. PARTICIPANTS: Adult residents of Sullivan County aged 25 years and older who responded to the health survey in 2017-2018 or had at least one ED visit in 2011-2015. OUTCOME MEASURES: We compared age and gender-adjusted prevalence of hypertension, hyperlipidaemia, diabetes, cancer, asthma and chronic obstructive pulmonary disease/emphysema among nine sub-county areas. RESULTS: Our county-wide mailed survey obtained 6675 completed responses for a response rate of 30.4%. This sample represented more than 12% of the estimated 53 020 adults in Sullivan County. Using emergency claims data, we identified 34 576 adults from Sullivan County who visited an ED at least once during 2011-2015. At a sub-county level, prevalence estimates from mailed surveys and emergency claims data correlated especially well for diabetes (r=0.90) and asthma (r=0.85). Other conditions were not well correlated (range: 0.23-0.46). Using emergency claims data, we created more geographically detailed maps of disease prevalence using geocoded addresses. CONCLUSIONS: For select conditions, emergency claims data may be useful for tracking disease prevalence in rural areas and providing more geographically detailed estimates. For rural regions lacking robust health surveillance, emergency claims data can inform how to geographically target efforts to prevent chronic disease.

Age Disparities Among Patients With Type 2 Diabetes and Associated Rates of Hospital Use and Diabetic Complications.

INTRODUCTION: Although screening for diabetes is recommended at age 45, some populations may be at greater risk at earlier ages. Our objective was to quantify age disparities among patients with type 2 diabetes in New York City. METHODS: Using all-payer hospital claims data for New York City, we performed a cross-sectional analysis of patients with type 2 diabetes identified from emergency department visits during the 5-year period 2011-2015. We estimated type 2 diabetes prevalence at each year of life, the age distribution of patients stratified by decade, and the average age of patients by sex, race/ethnicity, and geographic location. RESULTS: We identified 576,306 unique patients with type 2 diabetes. These patients represented more than half of all people with type 2 diabetes in New York City. Patients in racial/ethnic minority groups were on average 5.5 to 8.4 years younger than non-Hispanic white patients. At age 45, type 2 diabetes prevalence was 10.9% among non-Hispanic black patients and 5.2% among non-Hispanic white patients. In our geospatial analyses, patients with type 2 diabetes were on average 6 years younger in hotspots of diabetes-related emergency department use and inpatient hospitalizations. The average age of patients with type 2 diabetes was also 1 to 2 years younger in hotspots of microvascular diabetic complications. CONCLUSION: We identified profound age disparities among patients with type 2 diabetes in racial/ethnic minority groups and in neighborhoods with poor health outcomes. The younger age of these patients may be due to earlier onset of diabetes and/or earlier death from diabetic complications. Our findings demonstrate the need for geographically targeted interventions that promote earlier diagnosis and better glycemic control.

Utilidad de las pruebas diagnósticas en el trauma cardiaco cerrado / Utility of the diagnostic tests in blunt cardiac trauma

Introducción. El trauma constituye la principal causa de muerte en los países desarrollados y en vía de desarrollo; la tercera causa de traumas es el cardiaco cerrado, el cual es una entidad que se subdiagnostica, y eso genera consecuencias letales por no brindar un manejo oportuno, y llevar así a altos costos y carga de morbimortalidad por esta causa. Materiales y métodos. Se analizaron 92 pacientes con diagnóstico de trauma cerrado de tórax, mediante un estudio observacional, analítico y prospectivo, en el Hospital Universitario Hernando Moncaleano Perdomo, entre el 1° de enero de 2015 y el 31 diciembre de 2016. Resultados. La incidencia hallada de trauma cardiaco cerrado fue de 29 por cada 100.000 individuos con trauma cerrado de tórax por año. Se encontró un valor de referencia para la troponina I de 0,8250 µg/L, el cual es estadísticamente significativo para el diagnóstico de trauma cardiaco cerrado, aunque es mucho menor que los reportados por distintos autores, los que oscilan entre 1,05 µg/L y 1,5 µg/L. Esto se puede explicar por el método ultrasensible que se utilizó en el laboratorio. Se le practicó un electrocardiograma al 100% de la población sujeto de estudio, a raíz de lo cual se evidenciaron alteraciones electrocardiográficas en el 82,6% de los pacientes, y los hallazgos positivos en las radiografías se correlacionaron con un peor pronóstico. Conclusiones. Se encontró una sensibilidad del 78% y una especificidad del 95%, de la troponina I, y con un aumento estadísticamente significativo a las 6 horas del trauma; las arritmias letales se presentaron en un bajo porcentaje (2 %) y se encontró un aumento de la morbimortalidad de los pacientes con hallazgos radiográficos positivos. Sin embargo, se necesita un mayor número de pacientes para establecer la significancia estadística

Introduction: Trauma is the main cause of death in both developed and developing countries. Blunt cardiac trauma, an underdiagnosed pathology, is the third cause of death, causing lethal consequences because it does not provide timely management, leading to high costs and a burden of morbidity and mortality. Methods: Ninety-two patients with the diagnosis of blunt chest trauma were analysed by means of an observational, analytical and prospective study at University Hospital Hernando Moncaleano Perdomo, Neiva, Colombia, in the period between January 1st, 2015, and December 31st, 2016. Results: The incidence of blunt cardiac trauma was 29 per 100,000 individuals diagnosed with blunt chest trauma per year. A reference value statistically significant for diagnosis was found for troponin I; electrocardiogram was performed in 100 % of the population study, revealing abnormalities in 82.6 % of the patients; positive findings in the radiographs were correlated with worse prognosis. Conclusions: Accurate specificity and sensitivity was found for troponin I with a significant increase 6 hours after trauma; lethal arrhythmias were present in a low percentage of the patients, and an increase in morbidity and mortality was found in patients with positive radiographic findings. However, more patients are needed in order to establish statistical significances

Identifying Geographic Disparities in Diabetes Prevalence Among Adults and Children Using Emergency Claims Data.

Geographic surveillance can identify hotspots of disease and reveal associations between health and the environment. Our study used emergency department surveillance to investigate geographic disparities in type 1 and type 2 diabetes prevalence among adults and children. Using all-payer emergency claims data from 2009 to 2013, we identified unique New York City residents with diabetes and geocoded their location using home addresses. Geospatial analysis was performed to estimate diabetes prevalence by New York City Census tract. We also used multivariable regression to identify neighborhood-level factors associated with higher diabetes prevalence. We estimated type 1 and type 2 diabetes prevalence at 0.23% and 10.5%, respectively, among adults and 0.20% and 0.11%, respectively, among children in New York City. Pediatric type 1 diabetes was associated with higher income (P = 0.001), whereas adult type 2 diabetes was associated with lower income (P < 0.001). Areas with a higher proportion of nearby restaurants categorized as fast food had a higher prevalence of all types of diabetes (P < 0.001) except for pediatric type 2 diabetes. Type 2 diabetes among children was only higher in neighborhoods with higher proportions of African American residents (P < 0.001). Our findings identify geographic disparities in diabetes prevalence that may require special attention to address the specific needs of adults and children living in these areas. Our results suggest that the food environment may be associated with higher type 1 diabetes prevalence. However, our analysis did not find a robust association with the food environment and pediatric type 2 diabetes, which was predominantly focused in African American neighborhoods.

Prácticas de autocuidado para mejorar la calidad de vida asociada a la salud de los cuidadores primarios informales de niños y adolescentes con parálisis cerebral GMFCS IV-V: revisión sistemática / Self-care practices to improve quality of life of informal primary caregivers of children and adolescents with GMFCS IV-V cerebral palsy: a systematic review

Introduction: Children and young people with cerebral palsy (CP), GMFCS IV-V, are considered dependent individuals requiring long-term care by their families due to significant motor function limitations that prevent them from performing basic and instrumental activities of daily life. The task of taking care of another person implies excess work and the development of health-related quality of life problems for informal primary caregivers due to physical and emotional burden. Strategies used for improving health-related quality of life of caregivers include self-care practices. Objective: To describe self-care practices and their effect on health-related quality of life in individuals taking care of 0 to 20 year-old children and adolescents with GMFCS IV-V CP. Method: A systematic review, including clinical trials and cohort studies with informal primary caregivers of 0 to 20 year-old children and adolescents with GMFCS IV-V CP, assessing self-care practices for improving life quality of caregivers. Results: No studies were found in compliance with the inclusion criteria. Conclusions: No conclusive evidence was found describing self-care practices and their effect on health-related quality of life problems for caregivers of 0 to 20 year-old children and adolescents with GMFCS IV-V CP. It is necessary to carry out high-quality methodological studies on this topic.

Introducción: Los niños y adolescentes con parálisis cerebral (PC), GMFCS IV-V, son considerados como individuos dependientes, que requieren de cuidados de larga duración por parte de las familias debido a que presentan importantes limitaciones motoras que les impiden realizar actividades básicas e instrumentales de la vida diaria. La tarea de cuidar a otro, supone un exceso de trabajo generando la aparición de problemas en la calidad de vida asociados a la salud (CVRS) de los cuidadores primarios informales a raíz de la sobrecarga física y emocional. Dentro de las estrategias que se utilizan para mejorar la calidad de vida asociada a la salud en éstos, se incluye el autocuidado y sus distintas prácticas. Objetivo: Describir las prácticas de autocuidado y su efecto en la CVRS de los cuidadores de niños y adolescentes con PC de 0-20 años de edad, clasificación GMFCS IV-V. Método: Revisión sistemática. Se incluyeron ensayos clínicos y cohortes cuya población estuviera constituida por cuidadores primarios informales de niños y adolescentes con PC de 0-20 años de edad, clasificación GMFCS IV-V y que evaluarán prácticas de autocuidado para mejorar la calidad de vida asociada a la salud de éstos. Resultados: No se obtuvieron estudios que cumplieran los criterios de inclusión. Conclusiones: No se encontró evidencia concluyente que describiera las prácticas de autocuidado y su efecto en la CVRS de los cuidadores de niños y adolescentes con PC de 0-20 años de edad, clasificación GMFCS IV-V. Es necesario realizar estudios de buena calidad metodológica respecto de este tema.

Metastatic squamous cell carcinoma to the superior cervical ganglion mimicking a retropharyngeal lymph node.

BACKGROUND: Metastasis of squamous cell carcinoma (SCC) to the superior cervical ganglion (SCG) has never been reported. Its anatomic location may easily be mistaken for a retropharyngeal lymph node. We present the first case of SCC metastasis to the SCG. METHODS: We report a case of a 69year-old never smoking male, who presented with right retropharyngeal PETCT-avid disease following chemoradiation for squamous cell carcinoma of the tonsil. He was brought to the operating room for resection, intraoperative radiation and reconstruction. RESULTS: Intraoperatively, visualization and frozen section confirmed squamous cell carcinoma located in the superior cervical ganglion. The ganglion was resected, intraoperative radiation was given and the patient was reconstructed with a radial forearm free flap. Postoperatively, the patient displayed features of a Horner's syndrome. CONCLUSIONS: The superior cervical ganglion may be mistaken for a retropharyngeal lymph node. Although extremely rare, these entities may be differentiated on the basis of radiological studies.

Evaluation of ultrasound reporting for thyroid cancer diagnosis and surveillance.

BACKGROUND: Despite the importance of ultrasound imaging in thyroid disease care, ultrasound reports vary greatly in the features described. It is essential that ultrasound reports contain and present all components necessary for a clinical decision in a reader-friendly format. METHODS: One hundred ninety thyroid and neck ultrasound reports were scored using the universal ultrasound report template developed by Su et al, along with the American Thyroid Association (ATA) and the American Association of Clinical Endocrinologists/Associazione Medici Endocrinologi/European Thyroid Association (AACE/AME/ETA) guidelines. All ultrasounds were performed on patients seen between August and November 2015 by a single surgeon (M.L.U), and originated from a variety of physicians and institutions. RESULTS: An average of 30.9% of Su et al's criteria was satisfactorily included in the reports. Similar results were reached when the ATA and the AACE/AME/ETA guidelines were applied as scoring templates. CONCLUSION: Our results reveal the wide variation in ultrasound reporting. The standardization of ultrasound reporting would help to improve physicians' ability to properly diagnose and manage patients with thyroid disease.

Primary mucosal melanoma of the palatine tonsil: Report of a case and review of the literature.

BACKGROUND: Mucosal melanoma of the palatine tonsil is extremely rare. Due to its poor prognosis, primary tonsillar melanoma requires prompt recognition and treatment. METHODS: A 62-year-old female presented with a deeply pigmented and exophytic lesion in the left tonsillar fossa. The patient underwent a partial pharyngectomy through a midline labio-mandibulotomy approach along with a left level I-V neck dissection. Reconstruction with a left radial forearm free flap and a pharyngeal constrictor advancement pharyngoplasty was performed. RESULTS: The patient remains free of disease at eight months after adjuvant proton therapy and eleven months after surgery. To our knowledge, less than thirty cases have been either reported or referenced in the literature since the early 1900's. This report is the first in English literature to compile all reported cases of primary tonsillar melanoma. CONCLUSION: Currently, evidence suggests that mucosal melanoma in the palatine tonsil should be treated in the same fashion as other head and neck mucosal melanomas, mindful of the high rates at which locoregional and distant metastases occur.

Systematic review of site distribution of bone metastases in differentiated thyroid cancer.

BACKGROUND: Thyroid cancer is the fastest growing cancer in the United States. A small portion of differentiated thyroid cancers (DTCs; 2% to 13%) develop bone metastases, which can decrease a patient's survival rate by more than 60%. METHODS: A systematic literature search of studies, including patients with DTC with bone metastases, was conducted by following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A case series of patients with DTC diagnosed with bone metastases seen at our institution was also included. RESULTS: A total of 616 bone metastases sites in 317 patients were identified in 14 case series. Ten patients were identified in our institutional case series. The most common sites of metastases are spine (34.6%), pelvis (25.5%), sternum and ribs (18.3%), extremities (10.2%), shoulder girdle (5.4%), and craniomaxillofacial (5.4%). CONCLUSION: The axial skeleton is the primary target of bone metastases in DTC. The relative distribution of bone metastases and red marrow content follow a similar rank. © 2017 Wiley Periodicals, Inc. Head Neck 39: 812-818, 2017.

The Ethical Implications of the Reclassification of Noninvasive Follicular Variant Papillary Thyroid Carcinoma.

BACKGROUND: Several studies have highlighted the lack of consensus in the diagnosis of follicular variant of papillary thyroid carcinoma (FVPTC). An international multidisciplinary panel to address the controversy was assembled at the annual meeting of the Endocrine Pathology Society in March of 2015, leading to the recent publication reclassifying encapsulated (or noninvasive) FVPTC (EFVPTC) as a benign neoplasm. Does this change in histologic taxonomy warrant a change in clinical practice, and how should it affect those who have been given this diagnosis in the past? We consider the financial and psychological impact of this reclassification and discuss the ethical, legal, and practical issues involved with sharing this information with the patients who are affected. SUMMARY: The total direct and indirect cost of thyroid cancer surveillance in patients is significant. High levels of clinically relevant distress affect up to 43% of patients with papillary thyroid carcinoma, as estimated by the Distress Thermometer developed by the National Comprehensive Cancer Network for detecting distress in cancer patients. Although there are currently no legal opinions that establish a precedent for recontacting patients whose clinical status is altered by a change in nomenclature, the prudent course would be to attend to the requirements of medical ethics. CONCLUSION: Informing patients with a previous diagnosis of EFVPTC that the disease has been reclassified as benign is expected to have a dramatic effect on their surveillance needs and to alleviate the psychological impact of living with a diagnosis of cancer. It is important to re-evaluate the pathologic slides of those patients at risk to ensure that the invasive nature of the tumor is comprehensively evaluated before notifying a patient of a change in diagnosis. The availability of the entire tumor for evaluation of the capsule may prove to be a challenge for a portion of the population at risk. We believe that it is the clinician's professional duty to make a sincere and reasonable effort to convey the information to the affected patients. We also believe that the cost savings with respect to the need for additional surgery, radioactive iodine, and rigorous surveillance associated with a misinterpretation of the biology of the diagnosis of EFVPTC in less experienced hands will likely more than offset the cost incurred in histologic review and patient notification.

Estudio Ultrasonográfico de las Estructuras Nerviosas del Canal Vertebral a Nivel de la Articulación Atlantooccipital en Caninos Adultos / Ultrasonographic Study of the Nervous Structures of the Vertebral Canal at the Atlantooccipital Joint Level in Adult Dogs

Los objetivos de este estudio fueron describir y comparar, mediante el ultrasonido, las estructuras nerviosas que se encuentran en el canal vertebral a nivel de la articulación atlanto-occipital en caninos adultos de talla corporal pequeña y grande. Se utilizaron 20 caninos adultos clínicamente sanos: 10 caninos de talla corporal pequeña (peso < a 10 kg) y 10 a caninos de talla corporal grande (peso > a 20 kg). Se realizó el examen ultrasonográfico con un transductor de 7,5 MHz, utilizando para ello el espacio atlantooccipital como ventana ecográfica. Se midieron diámetros verticales y horizontales del saco dural y médula espinal, y áreas del saco dural, médula espinal y espacio subaracnoídeo. Se calcularon razones entre algunas mediciones. Las estructuras estudiadas se observaron ecográficamente de modo similar en los caninos de ambos grupos. La duramadre se observó como una línea hiperecoica continua, adherida al borde óseo del canal vertebral. La médula espinal se observó como una estructura ovalada hipoecoica, con un parénquima homogéneo. Los diámetros verticales y horizontales del saco dural, médula espinal y las áreas del saco dural, médula espinal y espacio subaracnoídeo fueron significativamente menores (p<0,05) en los caninos de talla corporal pequeña. Las diferencias entre las áreas de médula espinal entre los grupos fue menor a 0,1 cm² y entre las áreas de saco dural y espacio subaracnoídeo fue de aproximadamente 1 cm². Se concluye que el ultrasonido permite visualizar adecuadamente la médula espinal y estructuras asociadas en la región de la articulación atlanto-occipital en caninos adultos. Finalmente, existieron diferencias mínimas en los valores de áreas de médula espinal y notoriamente mayores en los valores de áreas del saco dural y espacio subaracnoídeo entre ambos grupos de animales.

The goals of this study were to describe and compare by ultrasound the nervous structures in the vertebral canal at the atlanto-occipital joint region in small and large size adult dogs. A total of 20 healthy adult dogs were selected for the study. They were 10 small dogs (< 10 kg) and 10 large dogs (> 20 kg). Ultrasonographic examination was performed with a 7,5 MHz transducer and using the atlanto-occipital space as an echographic window. In transverse images, vertical and horizontal diameters of the dural sac and spinal cord and areas of the dural sac, spinal cord and subarachnoid space were measured. Some ratios between measurements were also calculated. Analysed structures were observed in a similar way in both groups of dogs. The dura mater was observed as an echogenic continuous line and attached to the bony border. The subarachnoid space has an anechoic appearance. The pia mater was observed as a thin echogenic line covering the spinal cord surface. The spinal cord was observed as an oval hypoechogenic structure inside the vertebral canal and with a homogeneous parenchyma without differentiation between gray and white matter. Vertical and horizontal diameters of the dural sac and spinal cord and areas of the dural sac, spinal cord and subarachnoid space were significantly different (P<0,05) in both group of dogs. Differences of spinal cord areas between small and large dogs were minimal (<0,1 cm²), compared with differences between dural sac and subarachnoid space areas (around 1 cm x). In conclusion, ultrasound allows an adequate examination of spinal cord and associated structures at the atlanto-occipital joint region in adult dogs. Differences between groups are minor in areas of spinal cord and larger in areas of dural sac and subarachnoid space.