The impact of iodine deficiency exposure on thyroid nodule cytology and pathology - A single institute, case-control study.

OBJECTIVE: The association between follicular carcinoma and iodine deficiency (ID) is based on epidemiological studies and their inherent biases. The aim of the study was to assess the impact of long-term ID exposure on thyroid nodule cytology and final pathology in a distinct group of patients within a single institution. METHODS: Ethiopian origin patients were compared to an aged-matched group of non-Ethiopian patients. Demographics, risk factors, clinical presentation, cytology and pathology were collected and compared. Final outcomes were cytology and pathology distribution. RESULTS: A total of 489 (246 Ethiopian, 243 control) nodules of 461 patients (230 and 231 respectively) were included. Ethiopian patients had lower rates of thyroid cancer risk factors (p=0.05). Cytology analysis demonstrated significant group differences (p=0.03), as Ethiopian patients had higher rates of benign cytology (85% vs. 75.7%, respectively). Pathology analysis demonstrated a significantly lower malignancy rate among Ethiopian patients (39.2% (20/51) vs. 63.3% (31/49), p=0.027, respectively). The Ethiopian group had a significant higher rate of follicular carcinoma compared to the control group (25% [5/20] vs. 3.2% [1/31], p=0.034, respectively) and lower rates of papillary thyroid carcinoma (25% [5/20] vs. 61.3% [19/31], p=0.017, respectively). CONCLUSIONS: The association between ID and FC exists years following immigration and exposure to a better iodine diet, implying that differentiation may be affected in earlier stages and levels of exposure.

[SURGEON PERFORMED THYROID AND NECK ULTRASOUND AS A TOOL FOR BETTER PATIENT CARE].

INTRODUCTION: Surgeon performed ultrasound (SUS) has become a valuable tool for the head and neck/endocrine surgeon. It allows for a complementary examination of the neck, following history and physical examination. With its reduced costs and being radiation free, US has become the modality of choice for imaging thyroid, parathyroid and lymph nodes of the neck. In thyroid cancer, the role of US has constantly grown, as reflected in the latest American Thyroid Association (ATA) guidelines: The shift from whole body iodine scans to US has allowed for surveillance in low risk patients who underwent thyroidectomy, follow-up of microcarcinomas, and has a key role in the assessment of a thyroid nodule following initial aspiration. However, US is still limited by operator dependent inherent flaws, which are reflected by a relatively moderate inter-observer agreement, even among experts. When conducted by the same surgeon, SUS allows the patients to enjoy the benefits of US while overcoming this limitation. When compared to radiologist-performed US, several studies have shown that high volume surgeons can reach non-inferior predicative values for malignant nodules, using accepted suspicious sonographic features such as solid texture, hypoechogenicity, microcalcifications, irregular margins and taller rather than wider shape. Several studies have tried to answer the most important utility of SUS - its ability to change the course of management of the cases. In all studies SUS was able to change the management of the cases in 17-45% of the patients, extending surgery in some patients while avoiding unnecessary dissections in others. In summary, SUS is an important, feasible tool for the head and neck and endocrine surgeons. Studies have shown that high volume surgeons can reach excellent rates of prediction and detection, thus saving the patients unnecessary clinic visits, tension and additional imaging, and can even directly influence the management of the patients.

Usefulness of ultrasound and fine needle aspiration cytology of major salivary gland lesions.

PURPOSE: To assess the clinical value of ultrasound (US) and fine needle aspiration (FNA) of salivary gland lesions prior to surgery, for preoperative decision-making and long-term follow-up/outcome. MATERIALS & METHODS: We retrospectively analyzed the medical charts of 98 consecutive patients with major salivary gland lesions who were treated in a single medical from 2008 to 2017. Preoperative US and FNA was performed in all patients. Cytology results were compared with histopathological diagnoses. The correlation between preoperative US findings, cytology and histopathological diagnoses was assessed. RESULTS: Twenty-three specimens were histopathologically malignant, and 75 were diagnosed as benign. Three false-positive results diagnosed as malignant in cytology had a final histology of sialadenitis, pleomorphic adenoma and Warthin's tumor, respectively. In six cases, cytology yielded false-negative results. The overall accuracy of FNA in distinguishing benign from malignant lesions was 91%. Sensitivity was 70% and specificity 93%. There was no significant correlation between US features and final pathology, but larger size had some correlation with malignancy (p = 0.306). No complications were observed during or after performing FNA. CONCLUSION: FNA from salivary gland lesions is safe and in many cases can help in preoperative decision making or surgical planning. Hence, the results of FNA cytology should have an integral role in clinical decision-making and management of major salivary gland lesions. False-negative results do occur and therefore should be used only as an adjunctive measure.

Management of Acute Mastoiditis With Immediate Needle Aspiration for Subperiosteal Abscess.

OBJECTIVES: The management of children with acute mastoiditis (AM) is still debated. Some advocate computed tomography (CT) and cortical mastoidectomy (CM) for all cases while others favor a more conservative management. This study assesses the safety and outcome of a conservative management scheme, with immediate myringotomy and postauricular needle aspiration (PANA) of a subperiosteal abscess (SPA). METHODS: A retrospective cohort of children with AM younger than 12 years admitted to our institute between 1999 and 2017. Data collection includes patient characteristics, signs and symptoms, physical examination, laboratory tests, treatment regime, imaging findings, and long-term outcomes. RESULTS: The study included 283 children. Ninety-eight children (34.6%) had a suspected SPA on admission and underwent a trial of immediate PANA, and 56.1% (55 cases) were positive. Of these 55, 83.6% (46) did not require CM. Twenty-four additional children had an SPA, proven by CT or during surgery, bringing the total SPA cases to 79 (27.9%). Of all children with proven SPA, 70.9% (56) did not require CM, with the practiced conservative management sufficing. Intracranial complication rates were 4.9% (14) and 8.8% (25) underwent CM. Long-term follow-up was available for 250 children. One child had hearing loss with a bilateral mixed hearing loss (50 decibels). There were no cases of neurological sequela. CONCLUSIONS: Conservative management of AM, involving prompt myringotomy for all patients and PANA for SPA, is safe and effective, and reduces the need for CT and CM. Conservative management obviates unnecessary radiation, general anesthesia, and surgery, without increasing the risk of immediate or long-term complications.

Laryngeal syphilis: a case report.

Syphilis is a sexually transmitted disease caused by the spirochete Treponema pallidum. The complexity of the disease gained it the moniker "the great imitator"; it was William Osler who said, "He who knows syphilis, knows medicine." In 1866, Patrick Watson of Edinburgh, Scotland, reported a case of a 36-year-old man in whom syphilis destroyed the larynx.(1) The diagnosis was made postmortem. It was once believed that this was the first reported total laryngectomy, but the credit should actually be given to Christian Albert Theodor Billroth who performed this surgery on a patient with laryngeal carcinoma in 1873.

Dysphagia and dysphonia in a patient with cancer.

A patient with cancer undergoing chemotherapy via Portacath presented with severe progressive dysphagia and dysphonia. Unilateral paresis of the 9, 10, 11, and 12th cranial nerves was found (Collet-Sicard's syndrome or Villaret's syndrome), associated with ipsilateral jugular vein thrombosis identified by imaging. The use of central venous catheters is increasing, and even rare, hitherto unreported, complications need to be recognized. After catheter removal, the patient slowly improved with low-molecular weight heparin treatment and time.