Asunto(s)
Accidentes por Caídas , Lesiones Encefálicas/etiología , Encéfalo/patología , Anciano , Encéfalo/diagnóstico por imagen , Lesiones Encefálicas/diagnóstico por imagen , Lesiones Encefálicas/patología , Vértebras Cervicales/lesiones , Imagen de Difusión por Resonancia Magnética , Edema/diagnóstico , Edema/etiología , Embolia Grasa/diagnóstico , Embolia Grasa/etiología , Encefalocele/diagnóstico , Encefalocele/etiología , Femenino , Fémur/lesiones , Fracturas Óseas/diagnóstico , Fracturas Óseas/etiología , HumanosRESUMEN
BACKGROUND: Fine needle aspiration biopsy (FNAB) is the tool of choice for evaluating thyroid nodules with the majority classified as benign following initial assessment. However, concern remains about false negative results and some guidelines have recommended routine repeat aspirates. We aimed to assess the utility of routine repeat FNAB for nodules classified as benign on initial biopsy and to examine the impact of establishing a multidisciplinary team for the care of these patients. METHODS: We performed a retrospective review of 400 consecutive patients (413 nodules) who underwent FNAB of a thyroid nodule at our hospital between July 2008 and July 2011. Data recorded included demographic, clinical, histological and radiological variables. RESULTS: Three hundred and fifty seven patients (89 %) were female. Median follow-up was 5.5 years. Two hundred and fifty eight (63 %) nodules were diagnosed as benign. The rate of routine repeat biopsy increased significantly over the time course of the study (p for trend = 0.012). Nine Thy 2 nodules were classified differently on the basis of routine repeat biopsy; one patient was classified as malignant on repeat biopsy and was diagnosed with papillary thyroid carcinoma. Eight were classified as a follicular lesions on repeat biopsy-six diagnosed as benign following lobectomy; two declined lobectomy and were followed radiologically with no nodule size increase. CONCLUSIONS: The false negative rate of an initial benign cytology result, from a thyroid nodule aspirate, is low. In the setting of an experienced multidisciplinary thyroid team, routine repeat aspiration is not justified.
Asunto(s)
Neoplasias de la Tiroides/patología , Nódulo Tiroideo/patología , Biopsia con Aguja Fina , Reacciones Falso Negativas , Humanos , Irlanda , Guías de Práctica Clínica como Asunto , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Factores de TiempoRESUMEN
We present a rare case of an insulin-like growth factor-2 (IGF-2)-secreting tumour of the thorax. This patient demonstrated the combination of fasting hypoglycaemia and impaired glucose tolerance on oral glucose tolerance testing, which has not been previously described in this condition. A review of the literature of IGF-2-secreting intrathoracic tumours is presented here.
Asunto(s)
Hipoglucemia/sangre , Hipoglucemia/complicaciones , Neoplasias Torácicas/complicaciones , Neoplasias Torácicas/diagnóstico , Glucemia/metabolismo , Femenino , Prueba de Tolerancia a la Glucosa , Humanos , Hallazgos Incidentales , Persona de Mediana Edad , Periodo Posoperatorio , Periodo Preoperatorio , Neoplasias Torácicas/cirugíaRESUMEN
Collagenous colitis is a condition characterized by chronic, watery diarrhoea, which is diagnosed histologically as most cases reveal a normal colonoscopic appearance. The aetiology is poorly understood, but nonsteroidal anti-inflammatory drugs or infections may act as triggers for an immune-mediated process. In this report, an unusual case of collagenous colitis associated with pseudomembrane formation is described. Stool assay was negative for Clostridium difficile cytotoxin B. There are only three reports of pseudomembranes in collagenous colitis in the absence of C. difficile infection. In addition, the patient had a deficiency in immunoglobulin production, which may suggest an infective trigger to collagenous colitis. This is the first report of an association between an immunoglobulin deficiency and this unusual variant of collagenous colitis. The implications of these findings are discussed.