RESUMO
BACKGROUND: Cytological examination of fine needle aspirates (FNA) is the standard procedure for discriminating potentially malignant thyroid nodules to be referred to surgery. In a fraction of cases, ultrasound (US) examination could provide information theoretically sufficient to avoid FNA, when typical US features suggesting malignancies are lacking. AIM: The aim of this study was to construct a simple US score predicting malignant nodules so as to reduce the number of unnecessary FNA. SUBJECTS AND METHODS: In a series of 1632 consecutive patients undergoing US-guided FNA (1812 nodules), echostructure, echogenicity, margins, halo, microcalcification, and vascularization were assessed. RESULTS: At multivariate analysis, the following parameters showed a strong predictive value for positive cytology (Thy 4 and Thy 5, suspicious and diagnostic for malignancy, respectively, according to the Thyroid British Association): solid echostructure, irregular margins and hypoechogenicity [adjusted odd ratio (OR) 5.13 (1.58-16.66), 3.03 (1.70-5.39), 2.05 (1.17-3.57), respectively]. A 10-point Thyroid Risk Ultrasound Score (TRUS) was constructed on the basis of the adjusted OR. A TRUS≥6 identified malignant nodules with sensitivity and specificity of 73% and 65%, respectively. Among the patients with follicular lesions (Thy 3) and final diagnosis of carcinoma, about 65% had a TRUS≥6.0. CONCLUSIONS: The sensitivity of TRUS, although higher than that of other scores, could still be insufficient for the identification of patients who could avoid FNA in routine clinical practice, whereas its predictive value for Thy 3 lesions deserves further investigations.
Assuntos
Nódulo da Glândula Tireoide/diagnóstico por imagem , Nódulo da Glândula Tireoide/patologia , Ultrassonografia Doppler em Cores , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha Fina , Citodiagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Adulto JovemRESUMO
OBJECTIVE: To determine the need of total thyrodectomy for patients with follicular nodules of thyroid. SUBJECTS AND METHODS: From January 2005 through June 2008, 2249 consecutive patients (438 males, 1811 females; mean age 54 yr, range 9-87) with thyroid nodules were submitted to 2518 ultrasound-guided fine-needle aspiration (USgFNA) for cytological examination. USgFNA were performed by experienced surgeon (RP) and endocrinologist (RGG) under ultra- sonographyc guidance, using a 10-MHz linear transducer. Liquid-based cytology was used. RESULTS: All cytological samples were classified in 5 diagnostic classes (THY1, THY2, THY3, THY4, THY5) in agreement with the British Thyroid Association (BTA); 1.4% specimen were classified as THY5, 2.1% as THY4, 7.6% as THY3, 79.5% as THY2 and 9.4% as THY1. In 97% of THY5 patients, malignancy was found. Among THY4 patients, 95.5% were positive for thyroid tumor. Among THY3 patients, malignancy was found in 29.1%. THY3 patients with thyroid tumors were younger than those with benign lesions (46 ± 14.1 yr vs 50 ± 13.8 yr; p<0.05, t test). No statistical difference was found neither in malignancy frequency among men and women nor in mean size of nodules (24 ± 11.8 mm malignant vs 23 ± 9.4 mm benign). CONCLUSIONS: this study provides evidence that USgFNA offers a very sensitive and accurate method in reducing THY1 samples and in detecting malignancy (>95% both in THY5 and THY4, and >29% in THY3 lesions). Our proposal is to submit to total thyroidectomy all patients with THY5 and THY4 lesions and THY3 thyroid nodule >1 cm.
Assuntos
Glândula Tireoide/patologia , Glândula Tireoide/cirurgia , Nódulo da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha Fina/métodos , Criança , Citodiagnóstico/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Glândula Tireoide/diagnóstico por imagem , Nódulo da Glândula Tireoide/classificação , Nódulo da Glândula Tireoide/diagnóstico por imagem , Tireoidectomia , Ultrassonografia , Adulto JovemRESUMO
The efficacy and tolerability of nimesulide and naproxen were compared in a randomised double-blind study of patients with pain and inflammation after haemorrhoidectomy. Both drugs appeared similarly effective in reducing pain and oedema and no adverse reaction was detected. These data extend the information on the anti-inflammatory and analgesic efficacy of nimesulide in the postoperative setting.
Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Inflamação/tratamento farmacológico , Naproxeno/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Complicações Pós-Operatórias/tratamento farmacológico , Sulfonamidas/uso terapêutico , Adulto , Idoso , Método Duplo-Cego , Feminino , Hemorroidas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Sulfonamidas/efeitos adversosRESUMO
The authors describe a case of diverticular disease of the appendix. The diagnosis is intraoperative and histological while therapy is based on surgical treatment. The authors seem to be favorable to surgical treatment in case of diverticulosis of the appendix in order to avoid dangerous complications.
Assuntos
Apêndice , Divertículo , Adulto , Doenças do Ceco/diagnóstico , Doenças do Ceco/cirurgia , Diagnóstico Diferencial , Divertículo/diagnóstico , Divertículo/cirurgia , Humanos , MasculinoRESUMO
The authors report a case of thyroid cancer which developed in a patient with a history of childhood therapeutic irradiation to the head for hemangioma. They confirm the importance of radiation as a risk factor for thyroid cancer and suggest some guidelines for the management and therapy of these particular neoplasms.
Assuntos
Carcinoma Papilar/etiologia , Neoplasias de Cabeça e Pescoço/radioterapia , Hemangioma/radioterapia , Neoplasias Induzidas por Radiação/etiologia , Radioterapia/efeitos adversos , Neoplasias da Glândula Tireoide/etiologia , Adulto , Fatores Etários , Carcinoma Papilar/cirurgia , Feminino , Humanos , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia , Fatores de TempoRESUMO
The majority of surgeons view the preliminary identification of the recurrent laryngeal nerve (RLN) as an essential stage in thyroidectomy in order to preserve thyroid integrity. This conviction is based on the fact that the anatomical relations of the recurrent nerve during the cervical tract with adjacent structures are highly variable. The preparation of the RLN in a series of 42 thyroidectomies performed by the 1st Department of Pathological Surgery of the University of Florence confirmed this variability above all with regard to relations with the trachea, Berry's ligament and the branches of the lower thyroid artery. As a result, it is justified to consider the identification and preliminary preparation of the RLN on both sides as a fundamental and unavoidable stage in thyroidectomy.
Assuntos
Nervo Laríngeo Recorrente/anatomia & histologia , Nervo Laríngeo Recorrente/cirurgia , Glândula Tireoide/anatomia & histologia , Glândula Tireoide/cirurgia , Tireoidectomia , Adulto , Artérias/anatomia & histologia , Feminino , Humanos , Masculino , Glândula Tireoide/irrigação sanguínea , Glândula Tireoide/inervaçãoRESUMO
Twenty-four patients with Raynaud's phenomenon, without ARA criteria for classification, were examined, after clinical history, by means of esophageal manometry, combined gastric and esophageal pH-monitoring, endoscopy. The results showed in these patients a high incidence of esophageal motor abnormalities (66.6%), of gastroesophageal reflux (50%), and of duodenogastric reflux (45.8%).
Assuntos
Refluxo Duodenogástrico/fisiopatologia , Transtornos da Motilidade Esofágica/fisiopatologia , Refluxo Gastroesofágico/fisiopatologia , Doença de Raynaud/fisiopatologia , Estudos de Coortes , Refluxo Duodenogástrico/etiologia , Transtornos da Motilidade Esofágica/etiologia , Junção Esofagogástrica/fisiopatologia , Esofagoscopia , Feminino , Refluxo Gastroesofágico/etiologia , Gastroscopia , Humanos , Concentração de Íons de Hidrogênio , Masculino , Manometria , Pessoa de Meia-Idade , Doença de Raynaud/complicaçõesRESUMO
The authors speak about their experience on the giant incisional hernias. The surgical treatment of these lesions in not always easy, especially when exist some conditions such as the loss of parietal substance and the loss of residence right. In these cases the use of prosthetic meshes and the Goni Moreno's pneumoperitoneum are very helpful. The Authors point out how important is, for a successful treatment, as well as a correct surgical procedure and opportune pre and post operative management.
Assuntos
Hérnia Ventral/cirurgia , Adulto , Idoso , Humanos , Pessoa de Meia-Idade , Cuidados Pós-Operatórios , Próteses e Implantes , Recidiva , Telas CirúrgicasRESUMO
The Authors, before examining their case history, which includes 103 major and minor hepatic resections performed during the last decade, briefly show the surgical technique concerning hepatic ischaemia and the new technologies proposed to reduce the hematic loss during hepatic resections. The constant adoption of these techniques and the careful evaluation of some parameters concerning hepatic functionality allowed to decrease postoperative complications and mortality, which currently is around 5-10%. These data are confirmed by the Authors experience.