THE LEARNING CURVE AND PERFORMANCE OF A NEWLY ESTABLISHED THYROID FINE-NEEDLE ASPIRATION CENTER.

Context: Thyroid fine-needle aspiration (FNA) cytology is the best tool for preoperative diagnosis of thyroid carcinoma; however, its learning curve is poorly described. Our aim was to assess the learning curve of a new thyroid FNA center involving unexperienced operator and pathologist. Methods: We retrieved from our tertiary endocrinology center database all thyroid FNA procedures done by a single operator (endocrinologist with no experience in FNA) between 2018 and 2021. Cytology was assessed by two pathologists with limited or no experience in thyroid cytology. We also got the corresponding sex, age, nodule diameter, EU-TIRADS score, Bethesda category and final pathology report. Results: There were 1872 FNA in 1618 patients. Proportion of Bethesda 1 nodules decreased significantly (p for trend=0.003) from 17% in the first 100 FNA procedures to 4% in the 401-500 group of procedures, and remained constant between 9% and 4% (p for trend=NS) for the rest of the study. Proportion of Bethesda 2 rose steady from 26% in the first 100 nodules to 80.1% in the last 241 nodules (p for trend<0.001). Indeterminate lesions (Bethesda 3 and 4) decreased significantly (p for trend=0.001) from 16% and 35% in the first 100 nodules to 2.5% and 5.8% in the last 241 lesions. Proportions of Bethesda 5+6 categories varied non-significantly over time. There were no time trends in the malignancy rate of surgically removed nodules. Conclusions: At least 300 procedures are needed to reach the standard performance. A steadily state for the whole center is obtained after about 500 procedures.

Role of gadoxetic acid-enhanced 3T MRI combined with diffusion in small HCC diagnosis - case presentation.

We present the case of a patient with chronic viral hepatitis B and cirrhosis referred to the Gastroenterology Department for evaluation. The contrast-enhanced ultrasound and elastography revealed a nodule in the right liver lobe suggesting the diagnosis of dysplastic nodule. The patient performed contrast enhanced multi-detector computer-tomography, showing a subcapsular nodule with enhanced centre and lack of enhancement in the perifery, highly suspicious for HCC. The HCC final diagnosis was assessed by using 3T magnetic resonance imaging system along with hepatocyt specific contrast agents and diffusion sequences, pointing to the importance of state-of-the-art imaging techniques in the liver nodules assessment.

Considerations regarding current diagnosis and prognosis of hepatocellular carcinoma.

Hepatocellular carcinoma is a major health issue, ranked the fifth most common tumor and currently being responsible for a third of the cancer-related deaths globally, with an ever-increasing number of fatalities. Current advances in contrast-enhanced imaging techniques such as contrast-enhanced ultrasonography, multi-detector computed tomography and diffusion-weighted magnetic resonance imaging are improving the rate of hepatocellular carcinoma diagnosis. Contrast-enhanced ultrasonography has widely become the first choice in liver tumor assessment, as it is faster, simpler and safer than other forms of diagnostic imaging. On the other hand, cross sectional computed tomography is frequently employed when a hepatic formation is suspected of malignancy and allows a more accurate characterization of lesions through multiphasic multi-detector computed tomography technology. Diffusion weighted magnetic resonance imaging represents another addition to the wide range of diagnostic and prognostic techniques available for patients with hepatocellular carcinoma and is currently regarded as one of the best tools for the characterization of these lesions. Furthermore, groundbreaking biomarkers for hepatocellular carcinoma are being discovered, although alpha-fetoprotein remains one of the most frequently used serum test in the early stages. Nonetheless, further advances are required for the detection of small liver carcinomas.

The pattern of a T(H)1 cytokine in autoimmune thyroiditis.

This study performed on 51 patients with autoimmune thyroiditis and 15 healthy subjects was aimed at correlating the activation of T cells and the secretion of inflammatory cytokine with echography and thyroid functional assays. A significant increase of activated T cells was observed in Hashimoto patients illustrated by an increased percentage of CD3+ CD25+ T cells (P < 0.01). Similarly, increased amounts of IL-2, TNF-alpha and IFN-gamma were in the serum of patients compared with the control group in which these cytokines are barely detectable. An in vitro study shows a significant increase of IL-2 and TNF-alpha upon the exposure to Concanavalin A. These results suggest that T(H)1 secreting inflammatory cytokines may contribute to pathogenesis of autoimmune thyroiditis.

A new approach for assessment of IT programs in health care.

The efficiency of health care programs, on the level of a community, results not only from reducing hospitalization or drugs costs but also from the number of days of health and life gained. This gain can be estimated in monetary terms if we accept that, at least partially, the Gross Domestic Product results from the human activity. In the Center for Health Information and Statistics, Ministry of Health Bucharest. Romania, a methodology based on these premises was developed and non-officially used in assessment of several health programs. In this paper, the core of this methodology, as well as some applications are shown.

Flow electrochemical analyses of zinc by stripping voltammetry on graphite felt electrode.

A flow sensor for trace analysis of zinc, using graphite felt as working electrode is reported here. A flow cell, well-adapted to 3-D porous electrodes and capable to do both the preconcentration step at a cathodic potential and the stripping of the zinc was successfully developed. It was demonstrated that this cell allows to obtain better electrochemical signals for Zn(2+) compared to a standard three-electrodes cell and that the percolation during accumulation increases the kinetics of electrodeposition. The influence on Zn(2+) signal of the deposition potential, the time of deposition and the flow rate was studied. The resulting sensor shows a linear response towards Zn(2+) with a linear range of 10(-6)-10(-4)M and a limit of detection of 5×10(-7) M for an analysis time of 5 min. The interferences study showed that the Cr(3+), Pb(2+), Cd(2+) ions have a small effect on the Zn electrochemical signal, whereas Fe(3+), Cu(2+), Co(2+) and Ni(2+) ions strongly influence it. The electrode was tested on real samples (tap water spiked with Zn(2+), food supplement) with a good recovery by applying the standard addition method.

Epidemiology and histology of malignant thyroid nodules in North East Region of Romania (Moldavia) before and after alimentary salt universal iodination.

UNLABELLED: Research on the relationship between iodine exposure and thyroid cancer risk is limited and the findings are inconclusive. OBJECTIVES: Given this molecular data on iodine we decided to evaluate the changes of incidence and histology of thyroid cancer in the North-Eastern region of Romania (Moldavia) after the government decision from 2004 that introduced the universal iodination of alimentary salt. After this decision values of urinary iodine increased from 50 microg/L (2001-2002) to 117 microg/L (2006 -2008). MATERIAL AND METHODS: We compared the incidence and the histology of thyroid cancer in residents living in an area known as a mild endemic goiter region (Moldavia-Romania) between 2001-2004 with the incidence and the histology of thyroid cancer between 2005-2008 in the same region after the introduction of universal iodization of alimentary salt. RESULTS: The number of papillary cancers increased from 125 cases (2001-2004) to 276 cases (2005-2008). The number of follicular cancer decreased from 52 cases (2001-2004) to 27 cases (2005-2008). The ratio between papillary and follicular cancers increased from 4.80 / 1 (2001-2004) at 10.61 / 1 (2005-2008). The number of medullar thyroid carcinoma increased from six cases (2001-2004) to 24 cases (2005-2008). Thyroid anaplastic carcinomas number increased from 7 cases (2001-2004) to 12 cases (2005-2008). The total number of thyroid cancer has increased dramatically after the introduction of universal iodination of alimentary salt with 178% compared to 2001-2004 (from 190 cases in 2001-2004 to 339 cases in 2005-2008), despite the fact that the number thyroidectomies decreased from 1734 (2001-2004) to 1449 (2005-2008). CONCLUSION: After the introduction the universal iodination of alimentary salt starting from 2004 the total number of thyroid cancers increased comparative with the period before universal iodination of alimentary salt.

[Clinical profile of thyroid nodules in Iasi, Department of Endocrinology, St. Spiridon Hospital, between 2005-2009]. / Profilul clinic al nodulilor tiroidieni in Clinica de Endocrinologie a spitalului "Sf. Spiridon" Iasi in perioada 2005-2009.

UNLABELLED: Thyroid nodules are common, with up to 50% of the adult population having palpable nodules. With the use of ultrasound, up to 10 times more nodules are likely to be detected. Given this we decided to evaluate by retrospective study the incidence of thyroid nodule in the North-Eastern Region of Romania (Moldavia) between 2005-2009. MATERIAL AND METHOD: We reviewed the records of patients admitted in the Department of Endocrinology, St. Spiridon Hospital Iasi between 1.01.2005-31.12. 2009 (4712 patients) and with selected the cases with nodular goiter. RESULTS: A total of 3105 cases of nodular goiter were identified. The women were most affected and highest prevalence was noticed for the patients with ages between 51-60 years. Most of the nodules were found in the right thyroidian lobe and the majority of the patients were euthyroid . The peak of incidence of nodular hyperthyroidism was different from that of diffuse hyperthyroidism. CONCLUSIONS: Thyroid nodules are the most common endocrine problem and the increasingly frequent detection of nonpalpable thyroid nodules in asymptomatic patients requires new approaches for their management.

Pathobiology of the heart in experimental diabetes: immunolocalization of lipoproteins, immunoglobulin G, and advanced glycation endproducts proteins in diabetic and/or hyperlipidemic hamster.

Diabetes is known to be accompanied by atherosclerotic disease and general cardiovascular complications. Hamsters were previously shown to develop hyperlipemia-induced atherosclerosis, similar in many respects to the human atherosclerotic process. To study the effect of hyperglycemia on heart vessels and valves, male Golden Syrian hamsters were rendered either diabetic or hyperlipemic and diabetic; controls were age-matched normal hamsters. At time intervals ranging from 2 to 24 weeks, animals were killed; plasma glucose, cholesterol, and lipid peroxides were measured; and the aortic arch and valves, coronary arteries, and heart microvessels were examined for ultrastructural modifications and for the presence of low-density lipoproteins (LDL), immunoglobulin G (IgG), and advanced glycation endproducts (AGE) proteins. Elevation of plasma glucose, peroxides, and cholesterol were observed in both diabetic as well as hyperlipemic and diabetic animals, along with characteristic diabetic changes: microangiopathy of the myocardium (ie, capillary narrowing, hyperplasia of basal lamina, and proliferation of extracellular matrix) and macroangiopathy of the aortic arch, valves, and coronary arteries (ie, intimal proliferation, fatty-streak formation, and calcification). LDL, IgG, and AGE-proteins were immunolocalized in focal deposits, ie, in the shoulder and cap of the plaques; these antigens were distributed diffusely in the extracellular space or within macrophage-derived foam cells and smooth muscle cells. Our findings indicate that hyperglycemia alone induces atherosclerotic lesions in the coronary arteries, aortic arch, and aortic valves as well as alterations of the extracellular matrix of heart microvessels and cardiomyocytes, changes which together may lead to cardiomyopathy, a common and severe complication of diabetes. In addition, the present study suggests that when hyperglycemia is accompanied by hyperlipemia, detectable amounts of modified LDL (possibly oxidized or glycated) and AGE are present in the intima of atherosclerotic arteries; and also that modified lipoproteins can act as immunoactive components of the atheroscerotic process generated by hyperglycemia.

Immunodetection of modified lipoproteins in plasma and arterial walls of patients with coronary heart disease.

Data from literature indicate that immune processes play an important role in atherogenesis. Modified lipoproteins might be immunogenic and generate autoantibodies in plasma. To determine whether the level of such circulating autoantibodies correlates with the extent of atherosclerosis expressed as cholesterol values in plasma (C), very low density (VLDL-C), low density (LDL-C), and high density lipoproteins (HDL-C), we compared the level of plasma autoantibodies of a group of coronary heart disease patients (CHD-P) with that of normal, age-matched donors, with no history of cardiac disease (N). All CHD-P (even normocholesterolemic) were characterized by an LDL-C/HDL-C ratio > 4, while all N (even hypercholesterolemic) had this ratio < 4. A double level of circulating autoantibodies against VLDL and LDL in CHD-P as compared to N group was detected. The anti-LDL antibodies level correlated well with LDL-C level and was negatively correlated with the age of patients. For tissue localization of native and modified LDL (as well as other possibly modified proteins) we used immunohistochemical techniques, employing antihuman LDL, antihydroxynonenal-lysine (HNE-Lys), and antiadvanced glycation end-products (AGE) proteins. Antibodies were applied on consecutive cryosections of the aortic arch, valves and coronary arteries of CHD-P. The immunodetected antigens were colocalized in focal deposits, in the cap and shoulders of the atheroma. Native LDL and modified proteins (AGE, HNE-Lys) were detected either diffuse-extracellularly or associated with macrophage-derived foam cells and smooth muscle cells of the intima. These data indicate the following: a) the existence of an elevated level of circulating autoantibodies against VLDL and LDL, which correlates negatively with the age of CHD patients; b) the presence of LDL (possibly glycated or oxidized) in detectable amounts in the intima of atherosclerosis-affected arteries; c) the modified lipoproteins are immunoactive components in the atherosclerotic process.

[The incidence of influenzal, para-influenzal and adenoviral antigens in keratoconjunctivitis patients during immunization with NIVGRIP vaccine]. / Incidence des antigènes grippal, paragrippal et adénoviral chez des sujets à kérato-conjonctivite durant l'immunisation avec du vaccin NIVGRIP.

Repeated intranasal administrations of NIVGRIP, influenza inactivated vaccine, to patients with chronic recurrent keratoconjunctivitis, led to a significant reduction of respiratory virus incidence, as revealed by the immunofluorescence test in the conjunctive epithelial cells. The effect is probably due to endogenous interferon stimulation by the vaccine, at the nasopharyngeal level.

Rapid detection by immunofluorescence of multiple viral infections in patients with keratitis.

The presence of 12 viral (herpes 1 and 2, influenza A(H1N1), A(H3N2) and B, parainfluenza 1, 2, 3, adenovirus 5) and inframicrobial (Chlamydia, mycoplasma, Rickettsia burneti) antigens was investigated by direct or indirect immunofluorescence (IF) reactions in exfoliated conjunctival cells from 110 patients with nonbacterial keratitis and keratoconjunctivitis. A rapid etiological diagnosis could be obtained in 101 (92%) of the cases, parainfluenza and herpes antigens being the most frequently detected. In most of the cases the simultaneous presence of several antigens was made evident. Encouraging results were obtained by the application of a specific treatment based on the diagnosis provided by the IF reaction.

Associated respiratory and herpes virus infections in patients with acute keratitis.

Viral antigens were detected by immunofluorescence in exfoliated conjunctival cells from 100 out of 110 keratitis patients investigated. The overall prevalence of respiratory virus antigens (parainfluenza, influenza, adenovirus) was twice as high as that of herpes antigens. The ratio between respiratory and herpes virus antigens was of 4:1 in the patients with acute respiratory syndromes in the past history, as against 2:1 in those who had had no respiratory illness.

Clinical manifestations in the West Nile virus outbreak.

During the summer of 1996 an unusual clustering of meningoencephalitis cases was recorded in the Capital City, Bucharest, and in some areas from South-East Romania. After an initial suspicion of an enteroviral etiology was discarded, the West Nile etiology was confirmed by specific antibodies demonstration through hemagglutination-inhibition and ELISA tests. This study included 251 patients with the diagnoses of West Nile acute encephalitis (166 cases), acute meningitis (57 cases) and acute febrile disease (33 cases). The patients' age ranged from 1 to 89 years (mean 51.1 years). The most frequent clinical manifestations were: fever (95.7% of cases), cephalalgia (92.6%), stiffness of the neck (89.1%), vomiting (62.5%), marked asthenia (46.5%), myalgia (28.9%). In addition, patients with encephalitis exhibited: alteration of consciousness (89.2% of cases), tremor of extremities (40.4%), ataxia (44%), paralysis (15.1%). The fatality rate was 15.1% in acute encephalitis, 1.8% in acute meningitis and 0% in the acute febrile disease.