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1.
Medicine (Baltimore) ; 99(40): e22458, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019434

RESUMO

RATIONALE: Endo-bronchial ultrasound guided trans-bronchial needle aspiration (EBUS-TBNA) has been widely accepted as a safe and efficient technique for diagnosing patients with mediastinal/hilar lymphadenopathy and suspected cases of lung cancer. An effective anesthetic technique should provide comfort and quick recovery of patients while allowing the clinicians to obtain adequate tissue sample. Therefore we combined mask ventilation support (SIMV), BIS monitoring, and short-acting medication to achieve the effect mentioned above. PATIENT CONCERNS: In this report, both patients had lung mass accompanied by cough that lasted for >2 weeks, and were admitted to hospital for further diagnosis and treatment to clarify the nature of the mass. To make a definite diagnosis, EBUS-TBNA examination was performed under general anesthesia. Both patients had no salient past history. DIAGNOSIS: Case 1 was diagnosed as tumor or pneumonia based on the right lung shadow. Case 2 was diagnosed with squamous cell carcinoma of the right lung with right hilar lymph node metastasis. The diagnostic results of both patients were based on pathological examination of tissues obtained by EBUS-TBNA, of which case 1 required further confirmation by lung biopsy. INTERVENTION: Both the patients received antibiotic treatment before EBUS-TBNA. We used the mask ventilation supported by SIMV mode without using muscle relaxant, thus providing a guarantee for rapid and high-quality recovery of patients. OUTCOMES: During EBUS-TBNA, the vital signs of the 2 patients were stable. Both patients recovered within 5 minutes after we stopped pumping general anesthetics. None of the patient complained of any discomfort and felt comfortable. No complications occurred during and 3 months after EBUS-TBNA examination. LESSONS: The obtained results showed that this anesthesia scheme can provide appropriate depth of anesthesia for patients undergoing EBUS-TBNA examination, while ensuring rapid and high-quality recovery of patients.


Assuntos
Anestesia Geral/métodos , Biópsia por Agulha Fina/métodos , Biópsia Guiada por Imagem , Administração Intravenosa , Feminino , Humanos , Intubação Intratraqueal/efeitos adversos , Máscaras Laríngeas , Pulmão/diagnóstico por imagem , Pulmão/patologia , Masculino , Pessoa de Meia-Idade
3.
Rev Assoc Med Bras (1992) ; 66(8): 1030-1035, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32935794

RESUMO

INTRODUCTION: Liver biopsies such as tru-cut (sharp needle) and fine-needle aspiration cytology (FNAC) are the most commonly preferred techniques to detect the grade and stage of certain liver diseases. In this study, we aimed to compare the efficiency of USG-guided tru-cut biopsy and fine-needle aspiration cytology in an experimental alcoholic liver disease model. METHODS: Thirty-six female Wistar albino rats, 4-6 months old, and weighing from 190 to 250 g, were used in this study. The animals were randomly divided into six equal groups: G1 (control), G2 (tru-cut control), G3 (FNAC control), G4 (Alcoholic liver disease model), G5 (Alcoholic liver disease model + FNAC), and G6 (Alcoholic liver disease model + tru-cut biopsy). After a histopathological evaluation by light microscopy, the sensitivity, specificity, positive and negative predictive values of FNAC and tru-cut biopsy for the diagnosis of liver lesions were calculated. RESULTS: No pathology was detected in G1 except for mild congestion. On the other hand, hepatocyte damage, periportal inflammation, congestion, and fatty changes were detected in all liver tissues of the alcoholic liver disease groups. The sensitivity of hepatocyte damage, inflammation, congestion, and fatty change parameters for FNAC were 33.3%, 80%, 0%, and 0%, respectively, while the sensitivity of the same variables for tru-cut were 66.7%, 40%, 100%, and 20%, respectively. DISCUSSION: Both techniques were superior in some aspects. FNAC can be an attractive alternative to tru-cutbiopsy and applied in routine practice in the diagnosis of non-tumoral liver diseases.


Assuntos
Hepatopatias Alcoólicas , Animais , Biópsia por Agulha Fina , Modelos Animais de Doenças , Feminino , Ratos Wistar
4.
Nan Fang Yi Ke Da Xue Xue Bao ; 40(5): 693-697, 2020 May 30.
Artigo em Chinês | MEDLINE | ID: mdl-32897217

RESUMO

OBJECTIVE: To analyze the accuracy and positive rate of ultrasound-guided fine-needle aspiration (US-FNA) cytology for detecting suspected thyroid cancer nodules of different sizes. METHODS: A total of 591 patients with 594 suspected malignant thyroid nodules received examinations with US-FNA cytology. Based on their size, the nodules were divided into group I (4-5 mm), group II (6-10 mm), group III (>10 mm). With the results of pathology as the standard, we analyzed the results of US-FNA cytology for detecting thyroid carcinoma in terms of its accuracy, indeterminate rate, positive predictive value and negative predictive value for nodules of different sizes. RESULTS: The positive rates in group I, group II and group III were 39.2% (40/102), 48.2% (172/357) and 65.2% (88/135), respectively, similar between groups I and II (P=0.107) and differed significantly between groups I and III (P=0.000) and between groups II and III (P=0.001). The accuracy, indeterminate rate, positive predictive value and negative predictive value in the 3 groups were 95.5% (21/22), 97.1% (100/103), and 94.4% (51/54); 2.9% (3/102), 2.8% (10/357), and 1.5% (2/135); 100%, 100%, and 98%; 66.7%, 57.1%, and 33.3%, respectively, showing no significant differences among the 3 groups. CONCLUSIONS: The size of the thyroid nodules can affect the positive rate but does not have significant effects on the accuracy, indeterminate rate, positive predictive value or negative predictive value of US-FNA cytology.


Assuntos
Nódulo da Glândula Tireoide , Biópsia por Agulha Fina , Humanos , Estudos Retrospectivos , Neoplasias da Glândula Tireoide , Ultrassonografia de Intervenção
5.
Wiad Lek ; 73(7): 1323-1329, 2020.
Artigo em Polonês | MEDLINE | ID: mdl-32759413

RESUMO

OBJECTIVE: Introduction: Approximately 10% of fine needle aspiration biopsy (FNAB) of thyroid nodules may be verified as "suspicious for follicular neoplasm"; this category involves follicular adenoma, follicular carcinoma, follicular variants of papillary carcinoma and subclass "suspicious for Hurthle cell neoplasm". At present, there is no diagnostic tool to discriminate between follicular adenoma and cancer. Most patients are required surgery to exclude malignant process. The aim: To define factors correlating with risk of malignancy in patients with FNAB of thyroid focal lesions and nodules verified as Bethesda tier IV. PATIENTS AND METHODS: Materials and Methods: In this study 110 consecutive patients were included. All patients were operated because of FNAB result "suspicious for follicular neoplasm" of thyroid gland at a single institution from January 2016 until March 2020. From this set, six specific categories were defined and the clinical records for patients were collected: sex, age, presence of oxyphilic cells, diameter of the tumour, presence of Hashimoto disease, aggregate amount of clinical and ultrasonographic features of malignancy according to ATA. RESULTS: Results: In 18 patients (16,3%) thyroid cancer occurred. Most frequent subtype turned out to be papillary cancer (66,6%). In group of benign lesion (92 patients) predominance of follicular adenoma was disclosed - (49%). Age, gender, tumour diameter, aggregate amount of clinical and ultrasonografic factors, presence of Hashimoto disease and fine needle aspiration biopsy result suspicious for Hurthle cell neoplasm did not correspond to increased risk of malignancy. CONCLUSION: Conclusions: In patients with FNAB results classified as Bethesda tier IV there are no reliable clinical features associated with low risk of malignancy and surgery should be consider in every case as most appropriate manner to exclude thyroid cancer .


Assuntos
Adenocarcinoma Folicular , Neoplasias da Glândula Tireoide , Nódulo da Glândula Tireoide , Biópsia por Agulha Fina , Humanos , Fatores de Risco
6.
Wiad Lek ; 73(4): 629-637, 2020.
Artigo em Polonês | MEDLINE | ID: mdl-32731688

RESUMO

OBJECTIVE: Introduction: Follicular-patterned lesions of the thyroid are common; these include follicular adenoma, follicular cancer and follicular variant of papillary cancer. At present, preoperative discrimination between follicular adenoma and follicular cancer is infeasible and most patients require surgery to confirm diagnosis. The aim: To assess the impact of elective central lymph node dissection on postoperative pathological staging and early surgical complication rate in patients operated for suspicion for follicular neoplasm or suspicion for oxyphilic neoplasm of thyroid. PATIENTS AND METHODS: Materials and Methods: Eighty consecutive patients operated between 2016-2018 in Third Department of General Surgery UJCM because of suspicious for follicular neoplasm of the thyroid were included into the study. Inclusion criteria were: the result of fine needle aspiration biopsy " suspicious for follicular/oxyphilic neoplasm", absence of invasive neoplasm features as follows infiltration of surrounding tissue or lymph nodes/distant metastases, informed consent. In all patients elective central lymph node dissection was performed. Surgical early postoperative complications were reported and the rate was compared between the study group and the control group consisting of patients operated on in the same period for benign nodular goitre. RESULTS: Results: In 10 (12,5%) patients thyroid cancer was diagnosed, including 8 (80%) patients with papillary cancer and 2 (20%) patients with follicular cancer. The most common benign lesion was follicular adenoma diagnosed in 42 (60%) patients. There were 129 lymph nodes dissected (mean 1.6 lymph node per 1 patient), all lymph nodes were clear of cancer cells. In 26 patients there were no lymph nodes in postoperative preparation. Metastatic lymph nodes were not identified in any patients of the study group with final diagnosis of thyroid cancer. No significant differences were identified in prevalence of early postoperative complications among the study group and the control group patients: unilateral recurrent laryngeal nerve (RLN) palsy 3.4% vs. 1.49%; p= 0,08), hypocalcemia (5% vs. 5.4%; p=0.86), postoperative hemorrhage (1.25% vs. 0.44; p=0.29). CONCLUSION: Conclusions: Elective central lymph node dissection at experienced surgical hands does not improve postoperative pathological staging and is not associated with higher risk of early postoperative complications.


Assuntos
Biópsia por Agulha Fina , Adenocarcinoma Folicular , Humanos , Linfonodos , Esvaziamento Cervical , Estadiamento de Neoplasias , Estudos Retrospectivos , Neoplasias da Glândula Tireoide , Tireoidectomia
7.
Endocrine ; 70(1): 1-5, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32754886

RESUMO

The recent coronavirus infectious disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is placing health systems in serious challenges worldwide. Shocking statistics each day has prompted the World Health Organization to officially declare the COVID-19 outbreak as a pandemic in March 2020. Preliminary studies have shown increased mortality in patients with solid cancers and infection by SARS-CoV-2. Until now, the evidence on the behavior of COVID-19 in patients with a history of thyroid cancer remains scarce, and most of the recommendations given are based on common sense. Therefore, in this viewpoint, we present a brief review of several challenges we are frequently facing during this pandemic and a series of recommendations based on what we have implemented in our clinical practice at a university hospital currently mostly dedicated to COVID-19.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Neoplasias da Glândula Tireoide/epidemiologia , Biópsia por Agulha Fina/efeitos adversos , Comorbidade , Infecções por Coronavirus/imunologia , Humanos , Sistema Imunitário , Radioisótopos do Iodo/efeitos adversos , Radioisótopos do Iodo/uso terapêutico , Pandemias , Pneumonia Viral/imunologia , Inibidores de Proteínas Quinases/efeitos adversos , Radioterapia/efeitos adversos , Fatores de Risco , Neoplasias da Glândula Tireoide/imunologia , Neoplasias da Glândula Tireoide/terapia , Tiroxina/uso terapêutico , Organização Mundial da Saúde
8.
Rev Med Suisse ; 16(699): 1311-1315, 2020 Jul 01.
Artigo em Francês | MEDLINE | ID: mdl-32608589

RESUMO

One or more thyroid nodules, most often asymptomatic, may be found in more than half of the population, and they usually do not require specific therapeutic management, except for cancerous nodules. In order to avoid under-diagnosis and over-treatment, we propose a diagnostic strategy in line with current recommendations, based on the collaboration between general internist, radiologist, and endocrinologist. In addition to clinical information and thyroid function tests, thyroid ultrasound remains the first step in assessing the risk of nodule malignancy and setting the indication for fine needle aspiration. Cytology then makes it possible to define the therapeutic strategy, from an observation of the evolution to interventional, surgical or radiofrequency management.


Assuntos
Tomada de Decisão Clínica , Médicos , Especialização , Nódulo da Glândula Tireoide/diagnóstico , Biópsia por Agulha Fina , Humanos , Nódulo da Glândula Tireoide/terapia
10.
J Comput Assist Tomogr ; 44(4): 569-570, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32697528

RESUMO

Crystalloids are occasionally encountered on fine needle aspiration of cystic parotid lesions. This goal of this study was to retrospectively characterize the MRI features of a series benign crystalloid-containing parotid cysts. A total of 4 patients with fine needle aspiration findings of crystalloids and available parotid MRI scans were identified. Review of the imaging revealed that the cystic lesions contain layering material that corresponds to crystals.


Assuntos
Cistos/diagnóstico por imagem , Glândula Parótida/patologia , Neoplasias Parotídeas/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha Fina , Cistos/patologia , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Glândula Parótida/diagnóstico por imagem , Neoplasias Parotídeas/patologia , Interpretação de Imagem Radiográfica Assistida por Computador , Estudos Retrospectivos
11.
Medicine (Baltimore) ; 99(28): e20829, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664077

RESUMO

INTRODUCTION: Anabolic steroids are widely administered to patients with aplastic anemia (AA) and are associated with numerous medical complications. To assist with future diagnoses, we report about a young boy with multiple hepatocellular adenomas (HAs) induced by long-term use of anabolic androgenic steroids (AAS) for AA and present a related literature review. PATIENT CONCERN: A 15-year-old boy who was diagnosed with AA in 2011 had been treated with stanozolol (6 mg per day) and ciclosporin A (120-150 mg per day) for almost 4 years. He presented with epigastric pain and fever, and abdominal computed tomography showed a lesion of heterogenous density measuring 13.5 × 13.0 × 8.0 cm in the left hepatic lobe, which was initially misdiagnosed as a liver abscess. DIAGNOSIS: The patient went into hemorrhagic shock twice after invasive manipulation that aimed at diagnosis and was finally diagnosed with HA using fine needle aspiration. INTERVENTIONS: The patient discontinued AAS and only reserved ciclosporin A for AA treatment. OUTCOMES: Follow-up abdominal computed tomography performed 4 years after AAS discontinuation showed obvious regression of the hepatic lesions. CONCLUSION: It is of great importance for hematologists to completely understand that the long-term use of AAS may cause HA, which carries a great risk of hemorrhage and malignant transformation.


Assuntos
Adenoma de Células Hepáticas/induzido quimicamente , Anemia Aplástica/complicações , Neoplasias Hepáticas/patologia , Estanozolol/efeitos adversos , Congêneres da Testosterona/efeitos adversos , Dor Abdominal/etiologia , Adenoma de Células Hepáticas/patologia , Adolescente , Adulto , Assistência ao Convalescente , Idoso , Anemia Aplástica/tratamento farmacológico , Biópsia por Agulha Fina/métodos , Ciclosporina/uso terapêutico , Erros de Diagnóstico , Feminino , Febre/etiologia , Humanos , Imunossupressores/uso terapêutico , Abscesso Hepático/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Choque Hemorrágico/diagnóstico , Choque Hemorrágico/etiologia , Estanozolol/uso terapêutico , Congêneres da Testosterona/uso terapêutico , Tomografia Computadorizada por Raios X/métodos
12.
BMC Infect Dis ; 20(1): 516, 2020 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-32677915

RESUMO

BACKGROUND: The role of ultrasonography-guided percutaneous fine-needle aspiration (PNA) for pyogenic liver abscess (PLA) remains without consensus, especially in abscesses 3 to 6 cm in diameter. The objective of this study was to evaluate the comparative effectiveness and safety of PNA combined with antibiotics. METHODS: This was a retrospective study of patients with PLA that were from 3 to 6 cm in diameter who treated at two medical centers in Shanghai, China, from January 2014 to March 2019. Patients were divided into groups treated by PNA plus antibiotics or antibiotics alone. Patients demographics and clinical data related diagnosis, antibiotic treatment, and patient outcomes were analyzed. RESULTS: Out of a total of 94 PLA patients, 42 (44.7%) patients received PNA combined with antibiotics, and 52 (55.3%) received antibiotics alone. There were no complications related to PNA. In the PNA group, 13 (31.7%) patients with negative blood culture and 8 (19.5%) patients without blood culture were microbiologically confirmed via aspiration. The time for temperature normalization (P < 0.001) and the reduction rate of C-reactive protein within the first week (P = 0.031) were significantly lower in the PNA group. In the multivariate analysis, treatment with PNA was more likely to result in clinical improvement of PLA (odds ratio = 0.33, 95% confidence intervals (CI): 0.11-0.96, P = 0.043). CONCLUSIONS: PNA combined with antibiotics appears to be a safe, effective, and promising treatment for PLA of 3-6 cm in size. Furthermore, the technique allows for direct microbial sample, which can improve the selection of antibiotics.


Assuntos
Drenagem/métodos , Abscesso Hepático Piogênico/diagnóstico , Abscesso Hepático Piogênico/terapia , Ultrassonografia de Intervenção/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Biópsia por Agulha Fina/efeitos adversos , Biópsia por Agulha Fina/métodos , China , Terapia Combinada , Drenagem/efeitos adversos , Feminino , Humanos , Abscesso Hepático Piogênico/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Ultrassonografia de Intervenção/efeitos adversos
13.
J Laryngol Otol ; 134(8): 680-683, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32613916

RESUMO

BACKGROUND: The coronavirus disease 2019 pandemic requires urgent modification to existing head and neck cancer diagnosis and management practices. A protocol was established that utilises risk stratification, early investigation prior to clinical review and a reduction in aerosol generating procedures to lessen the risk of coronavirus disease 2019 spread. METHODS: Two-week wait referrals were stratified into low, intermediate and high risk. Low risk patients were referred back to primary care with advice; intermediate and high risk patients underwent investigation. Clinical encounters and aerosol generating procedures were minimised. A combined diagnostic and therapeutic surgical approach was undertaken where possible. RESULTS: Forty-one patients were used to assess feasibility. Thirty-one per cent were low risk, 35 per cent were intermediate and 33 per cent were high risk. Thirty-three per cent were discharged with no imaging. CONCLUSION: Implementing this protocol reduces the future burden on tertiary services, by empowering primary care physicians to re-refer low risk patients. The protocol is applicable across the UK and avoids diagnostic delay.


Assuntos
Infecções por Coronavirus/transmissão , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Neoplasias de Cabeça e Pescoço/patologia , Procedimentos Cirúrgicos Otorrinolaringológicos/estatística & dados numéricos , Pneumonia Viral/transmissão , Aerossóis , Betacoronavirus/isolamento & purificação , Biópsia por Agulha Fina/instrumentação , Protocolos Clínicos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Diagnóstico Tardio/prevenção & controle , Estudos de Viabilidade , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Londres/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Encaminhamento e Consulta , Medição de Risco , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia , Ultrassonografia de Intervenção/métodos
14.
Clín. investig. ginecol. obstet. (Ed. impr.) ; 47(2): 69-71, abr.-jun. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-193713

RESUMO

La mastopatía diabética es una entidad infrecuente. La presentación más común suele ser en forma de nódulo único o múltiple. Sus características clínicas y radiológicas pueden simular un cáncer de mama, por lo que debe tenerse en cuenta este diagnóstico diferencial en las pacientes jóvenes y con antecedentes de diabetes mellitus. Un correcto diagnóstico puede evitar tratamientos quirúrgicos innecesarios. Presentamos 2 casos que hemos diagnosticado en nuestra área sanitaria así como la revisión de la bibliografía al respecto


Diabetic mastopathy is an uncommon disorder, in which the most frequent presentation is as a single or multiple nodules. It can imitate breast cancer both clinically and radiologically. A differential diagnosis should be done in young patients with a personal history of diabetes, in order to avoid unnecessary surgical interventions. Two cases are presented that were diagnosed in our health area, as well as a review of the literature on this pathology


Assuntos
Humanos , Feminino , Adulto , Doença da Mama Fibrocística/diagnóstico por imagem , Doença da Mama Fibrocística/cirurgia , Doença da Mama Fibrocística/complicações , Diagnóstico Diferencial , Fibroadenoma/complicações , Mama/diagnóstico por imagem , Mama/patologia , Biópsia por Agulha Fina/métodos , Diabetes Mellitus/diagnóstico
15.
Niger J Clin Pract ; 23(6): 842-847, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32525121

RESUMO

Background: The most widely accepted approach nowadays in nodal staging of non-small cell lung cancer (NSCLC) is the combined use of 18-Fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) and endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA). However, this approach may not be sufficient, especially for early stages. Aims: Our aim was to assess whether more satisfactory results can be obtained with standardized uptake value maximum lymph node/standardized uptake value mean mediastinal blood pool (SUVmax LN/SUVmean MBP), SUVmax LN/Primary tumor, or a novel cut-off value to SUVmax in this special group. Subjects and Methods: Patients with diagnosed NSCLC and underwent FDG-PET/CT were reviewed retrospectively. 168 LNs of 52 early stage NSCLC patients were evaluated. The LNs identified in surgery/pathology reports were found in the FDG-PET/CT images. Anatomic and metabolic parameters were measured. Statistical analysis was performed by using of MedCalc Statistical Software. Results: Regardless of LNs size; sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of SUVmax >2.5 were 91.5%, 65.9%, 58.2%, and 95.1%, respectively. Optimum cut-off value of SUVmax was >4.0. Sensitivity, specificity, PPV, and NPV were found as 81.0%, 90.0%, 81.0%, and 90.0% respectively. Optimum cut-off value of SUVmax LN/SUVmean MBP was >1.71. Sensitivity, specificity, PPV, and NPV were found as 94.7%, 80.0%, 71.1%, and 96.7%, respectively. Optimum cut-off value of SUVmax LN/Primary tumor was >0.28. Sensitivity, specificity, PPV, and NPV were found as 81.1%, 85.1%, 72.9% and 90.1%, respectively. Conclusion: SUVmax LN/SUVmean MBP >1.71 has higher PPV than currently used, with similar NPV and sensitivity. This can provide increase in the accuracy of combined approach. In this way, faster nodal staging/treatment decisions, cost savings for healthcare system and time saving of medical professionals can be obtained.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Fluordesoxiglucose F18/metabolismo , Neoplasias Pulmonares/diagnóstico por imagem , Estadiamento de Neoplasias/métodos , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Biópsia por Agulha Fina , Carcinoma Pulmonar de Células não Pequenas/metabolismo , Carcinoma Pulmonar de Células não Pequenas/patologia , Endossonografia/métodos , Feminino , Humanos , Neoplasias Pulmonares/metabolismo , Neoplasias Pulmonares/patologia , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Metástase Linfática/patologia , Masculino , Mediastino/patologia , Pessoa de Meia-Idade , Imagem Multimodal , Compostos Radiofarmacêuticos/administração & dosagem , Compostos Radiofarmacêuticos/metabolismo , Estudos Retrospectivos , Sensibilidade e Especificidade
16.
Chirurg ; 91(9): 712-719, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32548696

RESUMO

The indications for surgery of benign goiter should be balanced and professional as the prevalence of benign nodular goiter in Germany is high and not all goiters must be surgically treated. Thyroid nodules are detected in up to 76% of healthy people using modern high-resolution ultrasound (US) and only a few of these nodules are malignant or symptomatic. Even today a thorough medical history, detailed examination of the neck region, a qualified US of the thyroid gland, a 99m-technetium scintigraphy and fine needle aspiration help to select patients who will benefit from thyroid surgery. In the last 10 years several thyroid imaging reporting and data systems (TI-RADS) classifications have been introduced. The TI-RADS classification is a standardized assessment of thyroid nodules and risk stratification system in thyroid US which helps to select those nodules with a high risk of cancer. Asymptomatic euthyroid nodular goiter without any suspicion of malignancy and scintigraphically cold thyroid nodules without any other evidence of malignancy are not indications for thyroid surgery. The decision to operate should be made on an interdisciplinary basis in conformity with the relevant guidelines and exhaustion of diagnostic tools.


Assuntos
Bócio Nodular , Nódulo da Glândula Tireoide , Biópsia por Agulha Fina , Alemanha , Humanos , Neoplasias da Glândula Tireoide , Ultrassonografia
17.
Arkh Patol ; 82(3): 24-30, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32593263

RESUMO

AIM OF STUDY: A comparison of papillary cancer variants diagnosed on the basis of cytological findings of pre-surgery puncture biopsies with a histological variant of papillary cancer. MATERIALS AND METHODS: The findings of two experts specializing in cytological diagnostics of thyroid nodules that diagnosed a possible variant of papillary cancer were compared with histological findings based on the study of material from surgically removed neoplasms. RESULTS: It was shown that the cytological examination at the pre-surgery stage has significant limitations in diagnosing the histological variant of the tumor, despite high sensitivity of method in diagnosing papillary cancer in general. The variability of results of the cytological determination of papillary cancer variant between the two experts was not so significant, it concerned small fluctuations in the frequency of the diagnosing og normal, follicular, cystic and Uortino-like variants. Based on the data of cytological method, it is not possible to establish the encapsulated variant and papillary microcarcinoma; there are limitations in the diagnosis of follicular and high tumor cell variants. CONCLUSIONS: Currently, the advisability of the recommendation to determine the variant of papillary cancer using the cytological method is questionable. However, this does not mean that it is necessary to stop the search for reliable cellular and molecular genetic characteristics of clinically aggressive variants of papillary cancer.


Assuntos
Câncer Papilífero da Tireoide , Neoplasias da Glândula Tireoide , Adenocarcinoma Folicular , Biópsia por Agulha Fina , Humanos , Câncer Papilífero da Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/diagnóstico
18.
BMC Infect Dis ; 20(1): 399, 2020 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-32503446

RESUMO

BACKGROUND: Disseminated cryptococcosis is a well-characterized complication in immunocompromised patients with cryptococcal pneumonia or meningitis; however, isolated cryptococcal osteomyelitis is a rare entity that occurs in approximately 5% of patients with cryptococcosis. Cryptococcal osteomyelitis in the head and neck region is extremely rare. To the best of our knowledge, no cases of cryptococcal osteomyelitis affecting only the zygomatic bone have been reported to date. CASE PRESENTATION: A 78-year-old man without other comorbidities presented with progressive swelling of the right cheek along with pain and trismus. Clinical examination revealed a tender swelling in the right zygomatic region; the maximal mandibular opening was about 2 cm. Laboratory data showed mildly elevated inflammatory indices (C-reactive protein: 0.45 mg/dL; erythrocyte sedimentation rate: 35 mm/h). Computed tomography showed a 30-mm-diameter lesion at the right zygomatic arch. A part of the lesion has extended to the subcutaneous area of the cheeks with signs of bone destruction and surrounding contrast effects. Histopathological examination of fine-needle aspirate and needle biopsy showed cryptococcus. Furthermore, culture of the aspirate showed growth of Cryptococcus neoformans. No evidence of any other site involvement was observed. Therefore, the patient was diagnosed with isolated cryptococcal osteomyelitis and was initiated on fluconazole therapy. The treatment was effective, and all symptoms were resolved in 4 weeks. Fluconazole therapy was stopped after 6 months. There are no signs of recurrence as of 15-month follow-up. The patient has no cosmetic abnormalities or sequelae. CONCLUSIONS: Fine-needle aspiration cytology, needle biopsy, and fungal culture were useful for definitive diagnosis. Immunocompetent patients with isolated osteomyelitis may be cured with oral fluconazole alone.


Assuntos
Cryptococcus neoformans/isolamento & purificação , Osteomielite/diagnóstico , Idoso , Antifúngicos/uso terapêutico , Biópsia por Agulha Fina , Fluconazol/uso terapêutico , Humanos , Hospedeiro Imunocomprometido , Masculino , Osteomielite/tratamento farmacológico , Osteomielite/microbiologia , Tomografia Computadorizada por Raios X , Zigoma/diagnóstico por imagem , Zigoma/patologia
20.
Clinics (Sao Paulo) ; 75: e1594, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32578823

RESUMO

OBJECTIVE: Fine-needle aspiration cytology is the risk stratification tool for thyroid nodules, and ultrasound elastography is not routinely used for the differential diagnosis of thyroid cancer. The current study aimed to compare the diagnostic parameters of ultrasound elastography and fine-needle aspiration cytology, using surgical pathology as the reference standard. METHODS: In total, 205 patients with abnormal thyroid function test results underwent ultrasound-guided fine-needle aspiration cytology on the basis of the American College of Radiology Thyroid Imaging-Reporting and Data System classification and strain ultrasound elastography according to the ASTERIA criteria. Histopathological examination of the surgical specimens was performed according to the 2017 World Health Organization classification system. Moreover, a beneficial score analysis for each modality was conducted. RESULTS: Of 265 nodules, 212 measured ≥1 cm. The strain index value increased from benign to malignant nodules, and the presence of autoimmune thyroid diseases did not affect the results (p>0.05 for all categories). The sensitivities of histopathological examination, ultrasound elastography, and fine-needle aspiration cytology for detection of nodules measuring ≥1 cm were 1, 1, and 0.97, respectively. The working area for detecting nodule(s) in a single image was similar between strain ultrasound elastography and fine-needle aspiration cytology for highly and moderately suspicious nodules. However, for mildly suspicious, unsuspicious, and benign nodules, the working area for detecting nodule(s) in a single image was higher in strain ultrasound elastography than in fine-needle aspiration cytology. CONCLUSION: Strain ultrasound elastography for highly and moderately suspicious nodules facilitated the detection of mildly suspicious, unsuspicious, and benign nodules.


Assuntos
Biópsia por Agulha Fina/métodos , Técnicas de Imagem por Elasticidade/métodos , Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/diagnóstico por imagem , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/patologia , Tireotropina/sangue
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