RESUMO
BACKGROUND: Fine-needle aspiration (FNA) of thyroid nodules is commonly performed, and despite the use of ultrasound (US) guidance, the rate of non-diagnostic FNAs is still significant. The risk of malignancy of thyroid nodules with a non-diagnostic FNA is not clearly defined. However, most studies exclude the majority of patients without a repeat biopsy or surgery, thus increasing the likelihood of selection bias. The aims of this study were to determine the malignancy risk in nodules with an initial non-diagnostic FNA, and to identify the factors associated with malignancy. METHODS: This was a retrospective cohort study of patients with thyroid nodules who underwent US-guided FNA between 2004 and 2010 and had a non-diagnostic result. Patients were followed until confirmatory diagnosis of the nature of the nodule was made. The outcome of malignant or benign disease was based on one of the following: (i) final surgical pathology following thyroidectomy; (ii) repeat biopsy; (iii) clinically, based on repeat ultrasound performed at least three years following biopsy; or (iv) report of thyroid status for patients without follow-up visits contacted by mail. RESULTS: There were 699 nodules from 665 patients included. The mean age was 59 ± 15 years, and 71.7% were women. There was complete follow-up of 495 nodules. After a median follow-up of 2.7 years, thyroid cancer was found in 15 nodules. The prevalence of malignancy was 3% (15/495). The presence of nodular calcifications was the strongest predictor of thyroid malignancy (odds ratio 5.03 [confidence interval 1.8-14.7]). Initial nodule size was inversely associated with malignancy (odds ratio 0.55 [confidence interval 0.28-0.93]). However, the 193 patients without follow-up had smaller nodules compared with those included in the analysis. None of the patients with repeatedly non-diagnostic results were diagnosed with thyroid cancer at follow-up. CONCLUSION: The prevalence of thyroid cancer in nodules with non-diagnostic results is lower than the malignancy rate in thyroid nodules in general, but not negligible. They should be followed as per guidelines with heightened suspicion for nodules containing calcifications. Nodules with repeatedly non-diagnostic FNA results especially in the absence of calcifications have a low risk of malignancy and may be observed.
Assuntos
Descalcificação Patológica/diagnóstico por imagem , Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Nódulo da Glândula Tireoide/diagnóstico por imagem , Centros Médicos Acadêmicos , Adulto , Idoso , Estudos de Coortes , Descalcificação Patológica/epidemiologia , Descalcificação Patológica/patologia , Diagnóstico Diferencial , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Minnesota/epidemiologia , Prevalência , Estudos Retrospectivos , Risco , Centros de Atenção Terciária , Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/epidemiologia , Neoplasias da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/patologia , Carga TumoralRESUMO
BACKGROUND: Pediatric thyroid nodules, while uncommon, have high malignancy risk. The objectives of the study were (1) to identify sonographic features predictive of malignancy; (2) to create a prediction model; and (3) to assess inter-observer agreement among radiologists. METHODS: All available cases of thyroid nodules, surgically removed between 2000 and 2009. Three radiologists reviewed the sonographic images; 2 pathologists reviewed the tissue specimens. Adult prediction models were applied. Interobserver variability was assessed. RESULTS: Twenty-seven subjects, mean age 13.1±3.4 years, were included. Nineteen nodules were differentiated thyroid carcinomas. On multivariate analysis, size was the only significant predictor of malignancy. On recursive partitioning analysis, size >35 mm with microcalcification and ill-defined margins yielded the best prediction model. Radiologist inter-observer agreement regarding malignancy was moderate (κ=0.50). CONCLUSIONS: Larger size, microcalcifications and ill-defined margins on ultrasound demonstrate the best predictive model for malignancy in the pediatric population. Experienced pediatric radiologists demonstrate moderate inter-observer agreement in prediction of malignancy.
Assuntos
Carcinoma/diagnóstico por imagem , Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Nódulo da Glândula Tireoide/diagnóstico por imagem , Adolescente , Carcinoma/epidemiologia , Carcinoma/patologia , Carcinoma/cirurgia , Criança , Pré-Escolar , Estudos de Coortes , Descalcificação Patológica/diagnóstico por imagem , Descalcificação Patológica/epidemiologia , Descalcificação Patológica/patologia , Descalcificação Patológica/cirurgia , Diagnóstico Diferencial , Feminino , Hospitais Pediátricos , Humanos , Masculino , Variações Dependentes do Observador , Ontário/epidemiologia , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos , Risco , Glândula Tireoide/patologia , Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/epidemiologia , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia , Nódulo da Glândula Tireoide/epidemiologia , Nódulo da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/cirurgia , Carga Tumoral , UltrassonografiaRESUMO
We present a new method for evaluating in vivo changes in bone mineralization in the peripheral skeleton, using computed tomography (CT). A set of bone mineralization indices are generated from numerous CT images of the patient's distal radius. The cross-sectional anatomy displayed by the CT scan allows for separate evaluation of the cortical and trabecular bone. Correction for possible drift of the CT number scale (Hounsfield scale) is achieved by scanning standard solutions of dipotassium hydrogen phosphate simultaneously with the forearm. Preliminary data indicate that this is a precise method for evaluating in vivo changes in bone mineralization.
Assuntos
Doenças Ósseas/diagnóstico por imagem , Distúrbios do Metabolismo do Cálcio/diagnóstico por imagem , Descalcificação Patológica/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adolescente , Doenças Ósseas/metabolismo , Doenças Ósseas/patologia , Cadáver , Descalcificação Patológica/metabolismo , Descalcificação Patológica/patologia , Humanos , Masculino , Rádio (Anatomia)/diagnóstico por imagem , Rádio (Anatomia)/metabolismo , Rádio (Anatomia)/patologia , Fatores de Tempo , Tomografia Computadorizada por Raios X/instrumentação , Ulna/diagnóstico por imagem , Ulna/metabolismo , Ulna/patologiaRESUMO
Protrusio Acetabuli (PA) occurs in various rheumatic conditions and metabolic bone disorders as a result of bony remodeling in the pelvis. We sought evidence of early PA in patients with biopsy-proven postmenopausal osteoporosis and osteomalacia using a quantitative radiographic index of protrusion. The values in osteoporotic patients were not significantly different from those in controls and did not correlate with bone density measurements. In osteomalacia, the index was significantly increased relative both to the osteoporosis and control groups; early PA was found in 50% of patients with osteomalacia. This simple radiographic measurement may be useful in the differential diagnosis of osteopenia.
Assuntos
Acetábulo/patologia , Osteomalacia/patologia , Osteoporose/patologia , Acetábulo/diagnóstico por imagem , Idoso , Biópsia , Osso e Ossos/análise , Descalcificação Patológica/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Humanos , Menopausa , Pessoa de Meia-Idade , Minerais/análise , Osteomalacia/diagnóstico por imagem , Osteoporose/diagnóstico por imagem , Radiografia , SíndromeRESUMO
Shoulder arthrography in a patient with rheumatoid arthritis is performed to differentiate between a rheumatoid flare and limitation of motion secondary to tear in the rotator cuff. Accurate diagnosis is important because of the therapeutic implications. The arthrographic findings characteristic of rheumatoid involvement of the shoulder joint are nodular filling defects of the joint, the subacromial and subdeltoideal bursa in case of rotator cuff tear, irregular capsular attachment, contracted joint space and visualized lymphatic drainage. A dilatation of the biceps tendon sheath has not been shown.
Assuntos
Artrite Reumatoide/diagnóstico por imagem , Articulação do Ombro/diagnóstico por imagem , Artrite Reumatoide/complicações , Artrite Reumatoide/cirurgia , Descalcificação Patológica/diagnóstico por imagem , Feminino , Humanos , Pessoa de Meia-Idade , Osteoporose/etiologia , Radiografia , Articulação do Ombro/cirurgia , SinovectomiaRESUMO
OBJECTIVE: The objective was to conduct a clinical, radiographic, and histologic follow-up of alveolar socket healing in 8 human cases in which the extraction sockets of the involved teeth were treated with biodegradable root replicas before metallic implants were placed. STUDY DESIGN: Chair side prepared solid and porous forms of root replicas made out of polylactic-polyglycolic acids (PLGA) copolymer were utilized. Five patients were treated with the solid form and 3 with the porous form of the replicas. The cases were followed up at regular intervals postoperatively, and standardized photographs and radiographs were taken. The cylindrical core of biopsies that were removed with trephine for placement of titanium implants were processed and examined by light and transmission-electron microscopy. RESULTS: Both forms of the root replicas were well tolerated and biodegraded by the body. There were no histologically observable pathological tissue reactions at the time of implant application. However, the solid form seemed to cause an initial decalcification of the bone surrounding the extraction sockets that was subsequently repaired along with the bone healing of the extraction sockets. Such initial decalcification of the alveolar process was not observed in the cases that were treated with the porous form of root replicas. There was wide variation in the osseous component of the trephine-harvested biopsies in both treatment groups that suggests inconsistency in bone healing of the alveolar sockets. CONCLUSION: The 2 forms of root replicas under investigation were found to be biocompatible and biodegradable. But the compact solid form may cause an initial temporary lactic acid induced decalcification of the alveolar process, which makes it unsuitable for regular clinical application as compared to the granular porous form. The observed inconsistent and unpredictable bone regeneration calls for further research to develop more optimal replica materials.
Assuntos
Implantes Absorvíveis , Materiais Biocompatíveis/uso terapêutico , Ácido Láctico/uso terapêutico , Ácido Poliglicólico/uso terapêutico , Polímeros/uso terapêutico , Extração Dentária , Alvéolo Dental/cirurgia , Adulto , Idoso , Processo Alveolar/diagnóstico por imagem , Processo Alveolar/patologia , Materiais Biocompatíveis/química , Biópsia , Regeneração Óssea/fisiologia , Descalcificação Patológica/diagnóstico por imagem , Descalcificação Patológica/patologia , Implantes Dentários , Feminino , Seguimentos , Humanos , Ácido Láctico/química , Masculino , Microscopia Eletrônica , Ácido Poliglicólico/química , Copolímero de Ácido Poliláctico e Ácido Poliglicólico , Polímeros/química , Porosidade , Radiografia , Propriedades de Superfície , Titânio , Alvéolo Dental/diagnóstico por imagem , Alvéolo Dental/patologia , Cicatrização/fisiologiaRESUMO
Cystic fibrosis is an inherited, multisystem disorder characterized by an abnormality in exocrine gland function. It leads to chronic pulmonary disease in most cases and pancreatic insufficiency in 85 percent of patients. Although this disease is not uncommon in Caucasians, it has been considered very rare among Japanese. The majority of patients are diagnosed in infancy or childhood. The patient in this case report was a 45-year-old Japanese man who had not been diagnosed as having cystic fibrosis. This patient had recurrent episodes of pulmonary infection that started in childhood, and plain films of the chest showed increased interstitial markings, hyperaeration, and bronchiectasis. CT of the upper abdomen showed a generally enlarged pancreas with complete fatty replacement. Serum and urine pancreatic enzyme levels were low, suggesting pancreatic insufficiency. Repeated sweat tests were positive. A roentgenologic skeletal survey showed general demineralization, which may be multifactorial. In this case, it was concluded that vitamin D deficiency caused by vitamin D malabsorption and/or insufficient sunlight exposure was mainly responsible for the demineralization and that chronic respiratory acidosis might also be partially responsible.
Assuntos
Fibrose Cística/complicações , Descalcificação Patológica/etiologia , Osso e Ossos/diagnóstico por imagem , Fibrose Cística/diagnóstico por imagem , Descalcificação Patológica/diagnóstico por imagem , Humanos , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Pâncreas/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
Radiograms of 173 children with unilateral Perthes disease were reviewed with particular reference to the presence of flattening and irregularity of the 'unaffected' epiphyses. The slope and shape of the growth plate were also evaluated. About 35% of children with Perthes disease showed changes of the unaffected proximal femur in the first radiograms of the hip joints. These consisted of small epiphysis, flattening of the epiphysis, contour irregularities (20%), and changes in the growth plate (15%). The radiographic abnormalities were not accompanied by any clinical symptoms of the asymptomatic hip joint and they receded with age during treatment.
Assuntos
Epífises/diagnóstico por imagem , Fêmur/diagnóstico por imagem , Lâmina de Crescimento/diagnóstico por imagem , Articulação do Quadril/diagnóstico por imagem , Doença de Legg-Calve-Perthes/diagnóstico por imagem , Fatores Etários , Estudos de Casos e Controles , Criança , Pré-Escolar , Descalcificação Patológica/diagnóstico por imagem , Epífises/patologia , Feminino , Fêmur/patologia , Lâmina de Crescimento/patologia , Articulação do Quadril/patologia , Humanos , Masculino , RadiografiaRESUMO
Focal demineralization of bone tissue with local dosed vacuum (exposure of up to 20 sec) and 2% lithium chloride electrophoresis (8 sessions daily, 10 min exposure) was tried in 40 white rats (21 reference ones and 19 experimental). The maximal reduction of mineral content was achieved on days 3-7 after the end of the course and made up 76.2 +/- 15.0% (p less than 0.01) and 80.6 +/- 12.5% (p less than 0.001), respectively, as against the reference animals. Mineral content at the site of demineralization gradually normalized by day 21. This transient reduction of mineral content of bone tissue may be used in orthodontic treatment of dentition abnormalities.
Assuntos
Processo Alveolar , Descalcificação Patológica/etiologia , Mandíbula , Processo Alveolar/diagnóstico por imagem , Animais , Densidade Óssea , Cloretos/administração & dosagem , Técnica de Descalcificação , Descalcificação Patológica/diagnóstico por imagem , Modelos Animais de Doenças , Feminino , Iontoforese/instrumentação , Iontoforese/métodos , Lítio/administração & dosagem , Cloreto de Lítio , Masculino , Mandíbula/diagnóstico por imagem , Fotometria , Radiografia , Ratos , Fatores de Tempo , VácuoAssuntos
Descalcificação Patológica/etiologia , Doenças Genéticas Inatas , Hipercalcemia/complicações , Hiperparatireoidismo Secundário/etiologia , Cálcio/urina , Descalcificação Patológica/diagnóstico por imagem , Feminino , Doenças Genéticas Inatas/sangue , Doenças Genéticas Inatas/urina , Humanos , Hipercalcemia/sangue , Hipercalcemia/urina , Hiperparatireoidismo Secundário/sangue , Recém-Nascido , RadiografiaAssuntos
Osso e Ossos/diagnóstico por imagem , Cálcio/análise , Osteoporose/diagnóstico por imagem , Absorciometria de Fóton , Fenômenos Fisiológicos da Nutrição Animal , Animais , Osso e Ossos/análise , Descalcificação Patológica/diagnóstico por imagem , Densitometria , Métodos , Minerais/análise , Osteoporose/etiologia , Ratos , Espectrofotometria AtômicaAssuntos
Osso e Ossos/diagnóstico por imagem , Distúrbios do Metabolismo do Cálcio/diagnóstico por imagem , Adolescente , Adulto , Fatores Etários , Idoso , Animais , Osso e Ossos/análise , Osso e Ossos/anatomia & histologia , Cálcio/análise , Cálcio/urina , Galinhas , Criança , Pré-Escolar , Descalcificação Patológica/diagnóstico por imagem , Densitometria , Feminino , Dedos/diagnóstico por imagem , Humanos , Úmero/diagnóstico por imagem , Masculino , Métodos , Pessoa de Meia-Idade , Tamanho do Órgão , Osteoporose/diagnóstico por imagem , Radiografia , Rádio (Anatomia)/diagnóstico por imagem , Fatores Sexuais , Asas de Animais/diagnóstico por imagemAssuntos
Descalcificação Patológica/diagnóstico por imagem , Intensificação de Imagem Radiográfica/instrumentação , Interpretação de Imagem Radiográfica Assistida por Computador/instrumentação , Radiografia Dentária/instrumentação , Ausência de Peso , Ecrans Intensificadores para Raios X , Animais , Embrião de Galinha , Feminino , Humanos , Medições Luminescentes , Imagens de Fantasmas , Curva ROC , Intensificação de Imagem Radiográfica/métodos , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Radiografia Dentária/métodos , Ranidae , Reprodutibilidade dos Testes , Salamandridae , Coluna Vertebral/diagnóstico por imagemAssuntos
Doenças Periapicais/diagnóstico por imagem , Doenças Ósseas/diagnóstico por imagem , Descalcificação Patológica/diagnóstico por imagem , Diagnóstico Diferencial , Humanos , Doenças Maxilomandibulares/diagnóstico por imagem , Seio Maxilar , Doenças dos Seios Paranasais/diagnóstico por imagem , Doenças Periapicais/classificação , Doenças Periodontais/diagnóstico por imagem , Radiografia , Reabsorção da Raiz/diagnóstico por imagem , Raiz Dentária/diagnóstico por imagemRESUMO
Patients with chronic renal failure who are undergoing hemodialysis therapy demonstrate problems of significant importance for dental treatment. A case is presented in which secondard hyperparathyroidism, resulting from renal failure and hemodialysis, was noted in a child. Other relationships between renal failure, hemodialysis, and dental care were also presented.
Assuntos
Assistência Odontológica , Falência Renal Crônica/terapia , Diálise Renal , Criança , Descalcificação Patológica/diagnóstico por imagem , Hipoplasia do Esmalte Dentário/etiologia , Humanos , Hidronefrose/congênito , Hiperparatireoidismo/etiologia , Falência Renal Crônica/complicações , Masculino , Radiografia Dentária , Descoloração de Dente/induzido quimicamenteRESUMO
The authors have only reported cases responding to the following criteria: A) necessarily: 1) Clinical appearance of algodystrophy. 2) Intense hyperfixation of the bone scan. 3) X rays repeated a sufficient number of times always normal and submitted to the judgement of six rheumatologists not forewarned, to eliminate the subjective factor in the diagnosis of normality. 4) Clinical cure within the usual period. 5) Return to normal of the bone scan. B) Eventually: 6) Proved decalcifying algodystrophy from another joint site in the past history. 7) Histological appearance compatible with algodystrophy on bone biopsy. Four cases are presented (hip one case, knee two cases, ankle one case) which fulfill the five necessary criteria. The course seems shorter than in the classical decalcifying forms: 2 months instead of 4 1/2 months on average for the hip; 5 months instead of 7 months on average for the knee; 5 months instead of 12 months on average for the foot. This short course is in favour of the theory of early and rapid reconstructive bone changes, which do not leave the algodystrophy the time to demineralise the bone more than 30 to 50% which is the time necessary for the increased radiographic bone transparency to become clear.
Assuntos
Perna (Membro)/diagnóstico por imagem , Distrofia Simpática Reflexa/diagnóstico por imagem , Idoso , Descalcificação Patológica/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Radiografia , Cintilografia , Fatores de TempoRESUMO
The purpose of this in vitro study was to examine radiographic changes in dog alveolar bone during simulated osteoporosis (decalcification) and to determine the minimal amount of generalized bone loss that can be detected under optimal radiographic conditions with the use of digital subtraction. Five samples of dog maxillary alveolus were progressively decalcified at timed intervals with 0.1 N hydrochloric acid solutions. The percentage of calcium lost during each interval was quantified with calcium assays. Sets of four radiographs from each sample were exposed at 30 kVp and 50 kVp initially and after each decalcification interval. The radiographs were digitized and bone profiles (scan lines) were generated between images of lead markers. To suppress contaminating image noise each set of four profiles were superimposed and averaged on a pixel-by-pixel basis. The averaged profile from each stage of decalcification was subtracted from the averaged initial profile on a pixel-by-pixel basis, the mean profile intensity change for each decalcification stage calculated, and this mean change compared to the initial mean intensity to yield the percentage mean profile intensity change for each sample for each decalcification stage. Statistical analysis was performed with repeated measures analysis of variance. Results indicate that generalized decalcification of less than 7.5% was detected in all samples of dog maxillae with exposures of 30 kVp and that generalized decalcification of less than 19% was detected with exposure of 50 kVp.
Assuntos
Perda do Osso Alveolar/diagnóstico por imagem , Doenças Maxilares/diagnóstico por imagem , Osteoporose/diagnóstico por imagem , Técnica de Subtração , Análise de Variância , Animais , Descalcificação Patológica/diagnóstico por imagem , Cães , Intensificação de Imagem Radiográfica , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
Patients on long-term hemodialysis therapy may develop secondary hyperparathyroidism with oral symptoms. As the life expectancy of the dialysis patient increases, the dentist is seeing these manifestations with increasing frequency. A review of the subject is presented along with a case illustrating dramatic roentgenographic changes in a patient who was placed on hemodialysis when the technique was in its infancy.
Assuntos
Distúrbios do Metabolismo do Cálcio/etiologia , Descalcificação Patológica/etiologia , Hiperparatireoidismo Secundário/etiologia , Doenças Maxilomandibulares/etiologia , Diálise Renal/efeitos adversos , Adulto , Calcitonina/fisiologia , Cálcio/metabolismo , Descalcificação Patológica/diagnóstico por imagem , Humanos , Hiperparatireoidismo Secundário/complicações , Doenças Maxilomandibulares/diagnóstico por imagem , Falência Renal Crônica/complicações , Assistência de Longa Duração , Masculino , Hormônio Paratireóideo/fisiologia , Radiografia , Vitamina D/fisiologiaRESUMO
Bone mineralization and serum osteocalcin level were evaluated in 15 children with Grave's disease. Two groups were constituted according to the presence (group I: n = 9) or absence (group II: n = 6) of a severe bone demineralization. A spontaneous fracture and a collapsed vertebra were found in one group I patient. Patients in group I were younger than in group II (8.3 +/- 4.9 vs 11.5 +/- 4.3 yrs). One patient in group II and six in group I were prepubertal with advanced bone age and increased growth velocity. Osteocalcin measurement (Oc) was performed in 10 patients (group I: n = 6; group II: n = 4) at the time of biological hyperthyroidism. The six patients with bone demineralization had elevated Oc levels. In group II, two patients had normal Oc levels and two had elevated Oc levels. In treated patients with good control of hyperthyroidism, all group II patients except one, had normal serum Oc levels and bone mineralization remain normal (n = 5) after 0.6 to 4.6 yrs of follow-up. In group I patients, although height velocity was normal, elevated (n = 4) or slightly elevated (n = 1) serum Oc levels and severe bone demineralization (n = 7 cases) persisted after 0.5 to 3 yrs of good control of the hyperthyroidism. Although the method used for measuring bone mineralization is potentially less precise than bone densitometry and not all the patients had serum osteocalcin measurements at the same time of the illness, our results emphasize that skeletal demineralization may be particularly marked in young children with Grave's disease and should be carefully evaluated.