Relación entre el valor del ratio elastográfico y la clasificación citológica de Bethesda en la patología tiroidea / Relationship between the value of elastography ratio and the cytological classification of Bethesda in thyroid pathology

Objetivo: Presentar nuestra experiencia en la categorización de la patología tiroidea, a través de la utilización de parámetros ecográficos de malignidad y elastografía con medición del ratio de la deformación tisular, y la correlación de los hallazgos obtenidos con la clasificación citológica de Bethesda. Materiales y métodos: Se llevó a cabo un estudio prospectivo y observacional, entre septiembre de 2012 y abril de 2013, que incluyó 137 nódulos tiroideos. Se excluyeron 10 casos Bethesda III-IV. Se realizó ecografía, power Doppler, visualización de micropartículas (Micropure) y elastografía con medición del ratio elastográfico, así como también punción aspirativa con aguja fina guiada por ecografía (con el citólogo presente), utilizando la clasificación Bethesda. Los estudios fueron hechos por el mismo operador con un ecógrafo Toshiba Aplio 400 y los datos estadísticos se evaluaron con el programa IBM SPSS Statistics 20. Resultados: Se estudiaron 127 nódulos en pacientes con una edad promedio de 59±16 anos. El 82% de los casos ocurrió en mujeres. Ciento veinte nódulos (94%) fueron clasificados como Bethesda II. La media elastográfica para Bethesda I-II fue de 1,94±2,12 vs. 7,07±5,46 para V-VI (p: 0,048). El punto de corte elastográfico ≤ 2 (87 de 127) presentó una sensibilidad del 85,7% y una especificidad del 81,7% para predecir Bethesda asociada a patología benigna, con un valor predictivo negativo (VPN) del 99% y un valor predictivo positivo del 15%. Conclusiones: El ratio elastográfico permitió descartar la patología tiroidea maligna con valores ≤ 2 y un VPN del 99%, mejorando la selección de los pacientes a punzar. El incremento del ratio elastográfico se asoció a una mayor probabilidad de patología maligna, aunque no se pudo establecer un valor de corte debido al bajo número de casos con Bethesda V-VI.

Objectives: We present our experience in the categorization of thyroid pathology using the sonographic parameters of malignancy and elastography with measurement elastography strain ratio, to evaluate the relationship between the results found and the Bethesda classification. Materials and methods: Prospective observational study, included 137 thyroid nodules studied between September 2012- April 2013. We excluded 10 cases with Bethesda categories III-IV. Ultrasonography, Doppler, Micropure, elastogrphy strain ratio between the lesion and the normal tissue, fine needle aspiration cytology (FNAC),were the diagnosis methods used. The pathologist was always present and the cytological classi fication of Bethesda was used. All study was made by the same physician used Toshiba Aplio 400 ultrasound unit. Results were analyzed with IBM SPSS Statistics 20. Results: We studied 127 nodules in patients 59±16 years old, 82% were female; 120 were Bethesda II (94%). The average strain ratio for nodules Bethesda I-II was 1.94±2.12 vs. 7.07±5.46 for those nodules Bethesda V-VI (p:0,048). This means that an elastography strain ratio ≤ 2 (87 of 127 nodules) has a sensibility of 85.7% and a specificity of 81.7% of predicting Bethesda associated with benign pathology with a negative predictive value (NPV) of 99% and a positive predictive value of 15%. Conclusion: The elastography strain ratio allowed to discard malignant nodules with strain ratio ≤ 2 with a NPV of 99% improves the selection of patients for FNAC. The increment in the elastography strain ratio was associated to a higher possibility of malignant thyroid pathology, being unable to determine a limit value due to the low amount of cases with nodules Bethesda V-VI.

Relación entre el valor del ratio elastográfico y la clasificación citológica de Bethesda en la patología tiroidea

Objetivo: Presentar nuestra experiencia en la categorización de la patología tiroidea, a través de la utilización de parámetros ecográficos de malignidad y elastografía con medición del ratio de la deformación tisular, y la correlación de los hallazgos obtenidos con la clasificación citológica de Bethesda. Materiales y métodos: Se llevó a cabo un estudio prospectivo y observacional, entre septiembre de 2012 y abril de 2013, que incluyó 137 nódulos tiroideos. Se excluyeron 10 casos Bethesda III-IV. Se realizó ecografía, power Doppler, visualización de micropartículas (Micropure) y elastografía con medición del ratio elastográfico, así como también punción aspirativa con aguja fina guiada por ecografía (con el citólogo presente), utilizando la clasificación Bethesda. Los estudios fueron hechos por el mismo operador con un ecógrafo Toshiba Aplio 400 y los datos estadísticos se evaluaron con el programa IBM SPSS Statistics 20. Resultados: Se estudiaron 127 nódulos en pacientes con una edad promedio de 59±16 anos. El 82% de los casos ocurrió en mujeres. Ciento veinte nódulos (94%) fueron clasificados como Bethesda II. La media elastográfica para Bethesda I-II fue de 1,94±2,12 vs. 7,07±5,46 para V-VI (p: 0,048). El punto de corte elastográfico ≤ 2 (87 de 127) presentó una sensibilidad del 85,7% y una especificidad del 81,7% para predecir Bethesda asociada a patología benigna, con un valor predictivo negativo (VPN) del 99% y un valor predictivo positivo del 15%. Conclusiones: El ratio elastográfico permitió descartar la patología tiroidea maligna con valores ≤ 2 y un VPN del 99%, mejorando la selección de los pacientes a punzar. El incremento del ratio elastográfico se asoció a una mayor probabilidad de patología maligna, aunque no se pudo establecer un valor de corte debido al bajo número de casos con Bethesda V-VI.(AU)

Objectives: We present our experience in the categorization of thyroid pathology using the sonographic parameters of malignancy and elastography with measurement elastography strain ratio, to evaluate the relationship between the results found and the Bethesda classification. Materials and methods: Prospective observational study, included 137 thyroid nodules studied between September 2012- April 2013. We excluded 10 cases with Bethesda categories III-IV. Ultrasonography, Doppler, Micropure, elastogrphy strain ratio between the lesion and the normal tissue, fine needle aspiration cytology (FNAC),were the diagnosis methods used. The pathologist was always present and the cytological classi fication of Bethesda was used. All study was made by the same physician used Toshiba Aplio 400 ultrasound unit. Results were analyzed with IBM SPSS Statistics 20. Results: We studied 127 nodules in patients 59±16 years old, 82% were female; 120 were Bethesda II (94%). The average strain ratio for nodules Bethesda I-II was 1.94±2.12 vs. 7.07±5.46 for those nodules Bethesda V-VI (p:0,048). This means that an elastography strain ratio ≤ 2 (87 of 127 nodules) has a sensibility of 85.7% and a specificity of 81.7% of predicting Bethesda associated with benign pathology with a negative predictive value (NPV) of 99% and a positive predictive value of 15%. Conclusion: The elastography strain ratio allowed to discard malignant nodules with strain ratio ≤ 2 with a NPV of 99% improves the selection of patients for FNAC. The increment in the elastography strain ratio was associated to a higher possibility of malignant thyroid pathology, being unable to determine a limit value due to the low amount of cases with nodules Bethesda V-VI.(AU)

Efficacy and tolerability of sertaconazole nitrate 2% cream vs. miconazole in patients with cutaneous dermatophytosis.

Sertaconazole is a new antifungal agent. To compare the efficacy and tolerability of sertaconazole and miconazole cream in cutaneous dermatophytosis, this prospective, randomized, multicentric comparative, phase 4 study was undertaken in 260 patients with cutaneous dermatophytosis after approvals from Institutional Ethics Committees. Patients were assigned to sertaconazole cream (2%) or miconazole cream (2%) topically twice daily for 2 weeks after obtaining informed consent. Efficacy variables included changes in mean scores of erythema, pruritus, desquamation, erythema/itching, burning/weeping, scaling/pustule and overall global assessment. Safety and tolerability were also assessed. A total of 122 patients in the sertaconazole group and 128 in the miconazole group completed the study with 10 drop-outs. There was a significant decrease (P < 0.05) in mean symptom scores and total scores from the first week onwards, sustained till 2 weeks and statistically significant (P < 0.05) in favour of sertaconazole. Moreover, 62.3% patients had complete clinical cure in the sertaconazole group (P < 0.05) compared with 44.6% in miconazole users. Both drugs were well tolerated and five patients in the sertaconazole group and nine in the miconazole group reported mild to moderate adverse events. Therapy with sertaconazole cream (2%) provided a better efficacy and tolerability compared with the miconazole cream (2%) and could thus be a therapeutic option in cutaneous dermatophytosis.

Candida tropicalis: its prevalence, pathogenicity and increasing resistance to fluconazole.

Candida tropicalis has been identified as the most prevalent pathogenic yeast species of the Candida-non-albicans group. Historically, Candida albicans has been the major species responsible for causing candidiasis in immunocompromised and immunocompetent patients. However, infections (candidiasis) due to C. tropicalis have increased dramatically on a global scale thus proclaiming this organism to be an emerging pathogenic yeast. The reasons for this organism's dominance and its resistance to fluconazole have been difficult to elucidate. In addition, the mechanism of this organism's pathogenicity and the consequent immune response remain to be clarified. This paper describes certain predisposing factors potentially responsible for these characteristics and presents a 'root cause analysis' to explain the increasing prevalence of C. tropicalis in developed and undeveloped countries, as well as the organism's acquired drug resistance. Control measures against fluconazole resistance in clinical management have also been discussed.

Kaposi's sarcoma in a patient with AIDS.

We report a case of a 40 year old HIV infected male, citizen of Somalia who presented with multiple painful, livid reddish brown plaques, papules and nodules on both lower limbs and purplish red nodules on the hard palate. The cutaneous nodular lesions on biopsy showed characteristic features of Kaposi's sarcoma. This case is reported due to paucity of Kaposi's sarcoma in Indian literature.

[A case of acupuncture needle dermatitis].

A 65-year-old female visited our clinic with painful red vesicular dermatitis of the forehead and around the left eye. She had received acupuncture for headache and shoulder stiffness 6 days before visiting our clinic. A patch test with nickel sulfate gave positive results. We treated her with the greater occipital nerve block and trigger point injection which relieved her pain. We reached the diagnosis of greater occipital trigeminal syndrome with contact dermatitis from the acupuncture needle.

Kawasaki disease.

Mucocutaneous lymph node syndrome has been rarely seen or reported in India because of its rare occurrence and probably because of its close resemblance to many exanthematous conditions. It is a characteristic disease with a unique clinical presentation. Knowledge about this established disease is essential as it can involve the coronary and other medium and small sized arteries causing vasculitis in about 20% of cases. This probably accounts for a significant number of ischemic heart diseases and sudden deaths in the young, i.e. in the second and third decades, later in life for which no other cause is found then. It is a condition diagnosed entirely on clinical basis and hence the need to be aware of its characteristic features.

Impaired endothelial function in patients with rapidly stabilized unstable angina: assessment by noninvasive brachial artery ultrasonography.

BACKGROUND: Endothelial dysfunction may contribute to symptoms of instability in patients with acute coronary syndromes. High-resolution external ultrasound assessment of the brachial artery responses allows noninvasive determination of endothelial function. HYPOTHESIS: This study was conducted to assess endothelial function in patients with unstable angina using a noninvasive technique. METHODS: We studied 189 patients who were subdivided into three groups. Group 1: 60 apparently healthy subjects with no cardiovascular risk factors or symptoms of coronary artery disease; Group 2: 105 subjects with cardiovascular risk factors--arterial hypertension, hypercholesterolemia, cigarette smoking, diabetes, and obesity, but no evidence of coronary artery disease; and Group 3: 24 patients with unstable angina (chest pain at rest within the 24 h preceding study entry). All patients underwent pre- and postischemic brachial artery test evaluation with measurements of internal arterial diameters and blood flow. RESULTS: Results are expressed as percentage change from basal values. Subjects in Groups 1 and 2 showed a diameter increase of 19.1 and 11.9%, respectively, whereas patients in Group 3 showed a diameter change of 1.2% (p < 0.002 and < 0.0001, respectively). Calculated blood flow did not differ significantly in Groups 1 or 2 (74.4 and 56.4%), but was notably lower in Group 3 (18.4%, p < 0.005 vs. Groups 1 and 2). In nine patients of Group 3, the brachial studies were repeated 4 weeks after symptom stabilization and showed values comparable with those in Group 2. CONCLUSIONS: Patients with unstable angina showed endothelial dysfunction compared with control individuals. It is of interest that in patients whose symptoms were stabilized by medical therapy, endothelial function was restored 4 weeks after hospital discharge.

[Changes in ionized magnesium concentrations during general anesthesia].

The change in ionized magnesium (Mg) was investigated during isoflurane-nitrous oxide-oxygen anesthesia. The patients were divided into two groups by induction method of anesthesia. Group 1 was induced with thiamylal 4 mg.kg-1 and Group 2 was induced with ketamine 1 mg.kg-1. The ionized Mg concentration was recorded by NOVA 8 analyzer and observed during anesthesia. We also recorded the serum concentration of total Mg after administration of thiamylal. During induction of anesthesia and surgery, ionized Mg concentration decreased significantly in both groups. The ionized Mg concentration after administration of thiamylal was significantly lower than that after administration of ketamine. The serum total Mg concentration did not decrease throughout the anesthesia course. The ionized calcium concentration decreased, but the concentration of Na and K remained essentially unchanged. We conclude, therefore, that ionized Mg concentration decreases during surgery under general anesthesia, in part, possibly by the effect of anesthetic agent on the cell membrane itself.

High occurrence of HBV among STD clinic attenders in Bombay, India.

The pattern of sexually transmitted disease (STD) is the basis for designing surveillance of specific STD, their trends and syndromic management protocols. Two hundred and fifteen consecutive first-time STD clinic attenders at a teaching hospital in Bombay were recruited for the study in October 1995. Thorough clinical examination and the following investigations were done: wet mount, Gram stain, Giemsa stain, modified Thayer-Martin (MTM) medium culture, Fontana stain, Venereal Disease Research Laboratory (VDRL), Treponema pallidium haemagglutination test (TPHA), HBsAg and HIV. Ulcerative STD constituted 73.5% of total STD while 15.8% were discharges and 10.2% were genital growths. Ulcers in decreasing order of frequency were chancroid (51.9%), genital herpes (29.1%) and syphilis (14.5). 76.5% of genital discharges were due to gonococcal infection. The high rate of ulcerative STD is possibly an important co-factor for the high HIV prevalence of 31.2% in Bombay. Of 182 patients tested for HBV, 16 (8.8%) were reactive for HBsAg, revealing a high prevalence among STD attenders. A high co-relation of HBsAg positive with either HIV or VDRL requires urgent attention for HBV intervention strategies in this population.

PIP: Analysis of the pattern of various sexually transmitted diseases (STDs) in a given region is essential to the design of surveillance programs and syndromic management protocols since the pattern varies from area to area. Enrolled in the present study were 215 consecutive, first-time STD clinic attenders at a teaching hospital in Bombay, India, in October 1995. Patients were grouped into 5 categories--genital ulcer disease, genital discharges, buboes, genital growths, and others--and tested accordingly. The mean age of the 193 male STD patients was 26.6 years, while that of the 22 female patients was 22.9 years. Genital ulcer disease constituted 73.5% of all STDs in this series, while 15.8% were discharges and 10.2% were genital growths. Ulcers were chancroid (51.9%), genital herpes (29.1%), and syphilis (14.5%). 76.5% of genital discharges were due to gonococcal infection. HIV was detected in 60 men (31.1%) and 7 women (31.8%), for an overall prevalence of 31.2%. 70.1% were infected with HIV-1, 8.9% with HIV-2, and 21% were positive for both HIV-1 and HIV-2. The high rate of ulcerative STD in this sample is a likely co-factor in the high HIV prevalence. Hepatitis B surface antigen prevalence was 8.8%, and one-quarter of these patients were also HIV-infected. This finding indicates a need for more widespread hepatitis B vaccination in India.

RM y ecografía transrectal en la evaluación de la extensión del cáncer de cuello uterino con y sin neoadyuvancia / Staging of uterine cervix carcinoma: comparison of transrectal ultrasound and MR in 56 patients

El carcinoma de cuello uterino es una de las principales causas de muerte en mujeres. Su estadificación clínica utilizando los dictámenes de la FIGO, tiene una tasa de error de 34 al 39 por ciento. El objetivo del presente estudio es evaluar la utilidad de la RM y la ecografía transrectal en la extensión del carcinoma cervical, para lo cual se estudiaron en forma consecutiva 56 pacientes con diagnóstico de carcinoma de cuello. Observamos que la RM y la eco/TR son buenos métodos para evaluar la presencia de compromiso de los tabiques vesicales y rectales y la precisión del compromiso parametral aumentó combinando la RM y eco/TR. En conclusión, estos métodos son buenos complementos de la evaluación clínica y la planificación del tratamiento (AU)

RM y ecografía transrectal en la evaluación de la extensión del cáncer de cuello uterino con y sin neoadyuvancia / Staging of uterine cervix carcinoma: comparison of transrectal ultrasound and MR in 56 patients

El carcinoma de cuello uterino es una de las principales causas de muerte en mujeres. Su estadificación clínica utilizando los dictámenes de la FIGO, tiene una tasa de error de 34 al 39 por ciento. El objetivo del presente estudio es evaluar la utilidad de la RM y la ecografía transrectal en la extensión del carcinoma cervical, para lo cual se estudiaron en forma consecutiva 56 pacientes con diagnóstico de carcinoma de cuello. Observamos que la RM y la eco/TR son buenos métodos para evaluar la presencia de compromiso de los tabiques vesicales y rectales y la precisión del compromiso parametral aumentó combinando la RM y eco/TR. En conclusión, estos métodos son buenos complementos de la evaluación clínica y la planificación del tratamiento

Diagnóstico del cáncer de próstata mediante ecografía transrectal y antígeno prostático específico / Prostatic cancer: PS antigen and transrectal ultrasound

Se estudia un grupo de 64 pacientes con sospecha de cáncer de próstata, mediante ecografía prostática transrectal (EPT), biopsia prostática transrectal y dosaje sérico de antígeno prostático específico (APE). La combinación de hallazgo ecográfico de nódulo hipoecoico con elevación del APE (>=10ng/ml) aportó los mejores resultados diagnósticos para cáncer de próstata: sensibilidad, 78,9 por ciento, especificidad, 75 por ciento y valor predictivo positivo del 88,2 por ciento (AU)