Clinical, ultrasonographical and histopathological aspects in Hashimoto’s thyroiditis associated with malignant and benign thyroid nodules

Wstęp: Podawane w literaturze dane na temat rozpowszechnienia przewlekłego autoimmunologicznego zapalenia tarczycy związanegoze zróżnicowanym rakiem tarczycy (DTC, differentiated thyroid cancer) cechuje duża rozpiętość. Celem badania była ocena wybranych cechepidemiologicznych, klinicznych, ultrasonograficznych i histopatologicznych operowanych guzków tarczycy u pacjentów z rozlanymautoimmunologicznym zapaleniem tarczycy.Materiał i metody: Do badania włączono 411 przypadków choroby Hashimoto (HT, Hashimoto thyroiditis), z czego 118 pacjentów zgłosiłosię do lekarza z powodu choroby guzkowej tarczycy (TND, thyroid nodular disease). Tyroidektomię wykonano u 76 pacjentów, przy czymu 24 pacjentów badanie histopatologiczne wykazało DTC, a u pozostałych 52 — zmiany łagodne. Postacie DTC były następujące: rakbrodawkowaty tarczycy (PTC, papillary thyroid cancer) (n = 6), wariant pęcherzykowy PTC (FVPTC, follicular variant of papillary thyroidcancer) (n = 6), mikroraki brodawkowate (n = 8), rak pęcherzykowy tarczycy (n = 1) i postać mieszana (klasyczny PTC i FVPTC) (n = 3).Większość guzków łagodnych stanowiły gruczolaki pęcherzykowe (48%) i wole koloidalne (40,3%).Wyniki: Cechy ultrasonograficzne związane z ryzykiem rozpoznania nowotworu złośliwego w przypadkach HT związanej z TND obejmowały:litą strukturę, hipoechogenność i mikrozwapnienia. Charakter brzegów, kształt guzkowaty i typ unaczynienia nie wydają sięużytecznymi parametrami w identyfikacji guzków złośliwych w HT. Biopsja aspiracyjna cienkoigłowa (BAC) wykazała w przypadkachDTC różne obrazy cytologiczne: złośliwy (10), nieokreślony (8), łagodny (2) i niediagnostyczny (4). W grupie z guzkami łagodnymi nieokreślonyobraz cytologiczny stanowił duży procent wyników (n = 12).Wnioski: Częstość występowania TND związanego z HT wyniosła 28,7%. Wśród 76 operowanych pacjentów DTC stwierdzono w 31,5%przypadków. Dokładność BAC w rozpoznaniu przedoperacyjnym cechowała się większą czułością (90,0%) i swoistością (61,5%) w porównaniuz kryteriami ultrasonograficznymi. Intriduction: The reported prevalence of chronic autoimmune thyroiditis associated with differentiated thyroid cancer (DTC) is heterogeneous.The aim of this study was to evaluate some epidemiological, clinical, sonographical and histological features of operated thyroidnodules with background diffuse autoimmune thyroiditis.Material and methods: The study included 411 cases with Hashimoto’s thyroiditis (HT), of which 118 presented thyroid nodular disease(TND). Thyroidectomy was performed in 76 cases. Of these patients, 24 presented histologically confirmed DTC and 52 benign lesions.DTC types were as follows: papillary thyroid cancer (PTC) (n = 6), follicular variant of PTC (FVPTC) (n = 6), papillary microcarcinomas(n = 8), follicular thyroid carcinoma (n = 1) and the mixed form (classic PTC and FVPTC) (n = 3). The benign nodules were dominatedby: follicular adenoma (48%), and colloid goitre (40.3%).Results: The sonographic features with predictive risk for malignancy in cases with HT associated with TND were represented by: solidcomposition, hypoechogenicity and microcalcifications. The characters of margins, the nodular shape and the type of vascularity do notseem to be as useful for identification of malignant nodules in HT. Fine needle-aspiration biopsy (FNAB) showed in DTC cases differentcytological smears: malignant (ten), indeterminate (eight), benign (two), and non-diagnostic (four). In the group of benign nodules, theindeterminate smears represented also a significant percentage (n = 12).Conclusions: The incidence of TND associated with HT was 28.7%. Among 76 operated cases, 31.5% presented DTC. The accuracyof FNAB in the preoperative diagnosis showed higher sensitivity (90.0%) and specificity (61.5%) compared to sonographic criteria

Zaburzenia czynności tarczy indukowane amiodaronem w regionie bogatym w jod: dane epidemiologiczne i kliniczne

Introduction: The present study aims to evaluate the incidence, types, timing and risk factors in amiodarone (AMD)-induced thyroid dysfunction. Material and methods: The study comprised 229 patients from an iodine-replete area (115 women, 114 men, mean age 63.8 &plusmn; 9.2 years), chronically treated with AMD. The cases were clinically investigated prior to, and during treatment, by thyroid 2D and color Doppler flow sonography, thyroid function tests (TSH, FT3, FT4), and antithyroid antibodies. Results: Of 88 patients (38.4%) who developed thyroid dysfunction, 47 (20.5%) presented AMD-induced thyrotoxicosis (AIT) and 41 (17.9%) AMD-induced hypothyroidism (AIH). There is an evident prevalence of subclinical AIH (29 cases), compared to subclinical AIT (three cases). Regarding clinical forms, these prevailed in AIT (44 patients) (p < 0.001, Fisher&#8217;s exact test). Thyrotoxic patients were classified in pathogenic types as follows: 11 cases as type 1, 15 cases as type 2, and 21 cases as mixed form. The most important risk factor for the development of thyroid dysfunction was represented by the underlying thyroid pathology. The patients with previous thyroid abnormalities (diffuse or nodular goitre and/or positive antithyroid antibodies) developed earlier thyroid dysfunction compared to those with an apparently normal thyroid gland. The thyroid dysfunction occurrence was heterogeneous (4&#8211;84 months). Thyrotoxicosis involved especially young ages, while AIH affected later years.The daily dose, the duration of the treatment and the cumulative dose of AMD do not represent risk factors in thyroid dysfunction development. The determination of serum AMD and desethylamiodarone concentrations does not offer benefits in the diagnosis and treatment of thyroid dysfunction. Conclusions: In the present study, the incidence of AIH was similar to that reported in iodine-replete areas. The incidence of AIT was higher that previously reported, a fact underlining the importance of the proper screening and monitoring of patients. Cases with previous thyroid morphologic and/or immunologic abnormalities require frequent monitoring.Wstęp: Badanie przeprowadzono w celu oceny zapadalności na zaburzenia czynności tarczycy indukowane amiodaronem (AMD). Materiał i metody: Badanie obejmowało 229 chorych zamieszkujących region bogaty w jod (115 kobiet, 114 mężczyzn; średnia wieku 63,8 &plusmn; 9,2 roku), długoterminowo leczonych AMD. Przed i w trakcie terapii u uczestników przeprowadzono ocenę kliniczną, badanie USG 2D i techniką kolorowego doplera, testy czynności tarczycy (TSH, FT3, FT4) oraz oznaczono przeciwciała przeciwtarczycowe. Wyniki: Spośród 88 chorych (38,4%), u których rozwinęły się zaburzenia czynności tarczycy, u 47 (20,5%) stwierdzono indukowaną AMD tyreotoksykozę (AIT), a u 41 (17,9%) &#8212; indukowaną AMD niedoczynność tarczycy (AIH). W badanej grupie odnotowano zdecydowanie więcej przypadków subklinicznej AIH (29 przypadków) niż subklinicznej AIT (3 przypadków). Porównanie częstości jawnych klinicznie postaci zaburzeń czynności tarczycy wykazało przewagę AIT (44 chorych) (p < 0,001, dokładny test Fishera). Osoby z tyreotoksykozą sklasyfikowano w zależności od typu patogenetycznego: 11 przypadków jako typ 1, 15 przypadków jako typ 2 i 21 przypadków jako postać mieszaną. Najważniejszym czynnikiem ryzyka rozwoju badanych zaburzeń były choroby tarczycy. U chorych, u których wcześniej stwierdzono nieprawidłowości w badaniach tarczycy (wole rozlane lub guzkowe i/lub obecność przeciwciał przeciwtarczycowych), zaburzenia czynności gruczołu rozwijały się wcześniej niż u osób, u których wyniki badań były prawidłowe. Zaburzenia czynności tarczycy pojawiały się sie w różnym czasie (w ciągu 4&#8211;84 miesięcy). Tyreotoksykoza występowała głównie u osób młodych, natomiast AIH rozwijała sie w późniejszym wieku. Dawka dobowa, czas trwania terapii i skumulowana dawka AMD nie stanowiły czynników ryzyka rozwoju zaburzeń czynności tarczycy. Określenie stężeń AMD i desetylamiodaronu w surowicy nie było pomocne w rozpoznaniu i leczeniu zaburzeń czynności tarczycy. Wnioski: Zapadalność na AIH w badanej grupie była podobna, jak w innych regionach bogatych w jod. Liczba nowych przypadków AIT była większa niż opisywana wcześniej, co podkreśla znaczenie badań przesiewowych i monitorowania pacjentów. Zwłaszcza osoby z nieprawidłowościami w zakresie budowy tarczycy i zaburzeniami immunologicznymi wymagają częstych badań kontrolnych

THE IMPACT OF HYPERTENSION AND ASSOCIATED COMORBIDITIES ON QUALITY OF LIFE ASSESSMENT QUESTIONNAIRE SF-36 V2

Abstract Hypertension is a common cardiovascular disease insufficiently treated and monitored due to nonspecific symptomatology. Untreated hypertension causes cardiovascular complications: coronary artery disease, heart failure or stroke which, alongside other comorbidities affect the patients&apos; family, social and professional life Using SF-36 v2 quality of life assessment questionnaire, the present study aimed to analyze the influence the pathologies associated with hypertensive disease have on areas that make up its physical and psychosocial functions and its impact on patients&apos; daily activities. This could help to improve the quality of health services in optimizing the adherence of the patients to the treatment. The study compared the quality of life indicators between the group of patients and a control group comprising healthy individuals. Comparing the scores obtained by the two groups, lower values in all subdomains were found for the study group compared with control group. The regression analysis showed that strong negative impact pathologies in all areas were heart failure, coronary heart disease, diabetes and anemia. The other pathologies differently influenced the physical and psychosocial functions. Rezumat Hipertensiunea arterială reprezintă patologia cardiovasculară cu incidenţa cea mai mare în populaţie datorită faptului că este insuficient tratată şi monitorizată. Netratată FARMACIA, 2013, Vol. 61, 3 504 cauzează complicaţii cardio-vasculare: boala coronariană, insuficienţă cardiacă, accidente vasculare ischemice care afectează pacientul din punct de vedere familial, social şi professional. Studiul de faţă a avut ca scop compararea şi interpretarea indicilor de calitate a vieţii între lotul de pacienţi şi un lot martor care cuprinde indivizi sănătoşi. S-a observat că, la lotul de pacienţi valorile tuturor scorurilor sunt inferioare celor de la lotul martor, iar analiza de regresie a demonstrat impactul negativ puternic pe care îl prezintă insuficienţa cardiacă, boala coronariană, diabetul şi anemia asupra indicilor de evaluare a calităţii vieţii. Scopul unei astfel de analize este acela de a ameliora calitatea vieţii pacienţilor prin optimizarea schemelor terapeutice şi îmbunătăţirea complianţei

Analytical and Numerical Model of Sloshing in a Rectangular Tank Subjected to a Braking

This paper examines the movement of waves that occur in a fuel tank—both with and without a wave breaker—when a car is travelling at a constant speed and then suddenly brakes. This phenomenon is known as slosh noise, and the paper presents an analysis of the movement of free surfaces in relation to the level of noise generated. The paper focuses on mathematical models of the fluid flow for both tanks—one without any technical solutions for breaking waves, and the other with a solution for breaking waves. The model is constructed based on a set of initial hypotheses about the fluid flow within the tank, by developing the speed potential in a series of fundamental solutions and considering the main variables that affect the phenomenon of sloshing, such as the depth of the liquid, the tank’s geometry, and the frequency and amplitude of the initial external force acting on the tank. The analysis of free surface movement is used to find the correlation with the sound generated in the tank. Nonlinearities that arise from the sudden braking are also modelled and numerically studied using MATLAB software. Following the mathematical model, a technical wave-breaking solution was implemented and tested, and it was shown that the amplitude of the movement of the free surface is reduced by half. Further research on the correspondence between the free surface movement based on the behaviour of potential energies in the two cases may be developed

CONCORDANŢA TESTELOR NOINVAZIVE DE EVALUARE A FIBROZEI HEPATICE LA PACIENŢII CU INFECŢIE CRONICĂ VHC PROPUŞI PENTRU TERAPIA CU ANTIVIRALE DIRECTE

Odată cu introducerea terapiei cu antivirale directe în opţiunile terapeutice ale hepatitei C, s-au stabilit şi criterii de eligibilitate pentru tratament. În România, în anul 2016, s-a aprobat, în cadrul unui program naţional, tratamentul cu ombitasvir / paritaprevir / ritonavir şi dasabuvir pentru pacienţii cu fibroză stadiu F4 dovedită prin Fibromax sau biopsie hepatică. Scopul acestui studiu a fost evaluarea eligibilităţii pacienţilor pentru terapie şi a concordanţei între testele serologice, elastometrice şi imagistice pentru evaluarea fibrozei într-o cohortă de pacienţi cu hepatită C. Au fost evaluaţi atât pacienţi nou diagnosticaţi, cât şi pacienţi cunoscuţi cu hepatită cronică C cu fibroză avansată, pe durata a 7 luni, între 1 noiembrie 2015 şi 31 mai 2016. S-au colectat date clinice, biologice, ultrasonografice, elastografice şi endoscopice. Au fost evaluaţi 146 de pacienţi pentru eligibilitatea la terapia antivirală fără interferon. Dintre aceştia, 89 (61%) au fost femei şi 57 (39%) bărbaţi, cu o medie de vârstă de 60 ± 8 ani. În ceea ce priveşte terapiile antivirale anterioare, 58 (52,5%) au fost naivi, 30 (27,4%) nonresponderi, 19 (17,81%) relapseri si 3 (2,74%) netoleranţi la biterapie. 80 (54,8%) au prezentat valori crescute ale alfa-fetoproteinei, fiind evaluaţi imagistic pentru excluderea unui hepatocarcinom – dintre aceştia, 8 pacienţi au fost diagnosticaţi cu hepatocarcinom. Ecografic, apoape jumătate dintre pacienţi aveau dilataţie de ax spleno-port, iar la endoscopia digestivă superioară 42% aveau varice esofagiene. Elastografia Fibroscan a fost efectuată la 88 / 146 de pacienţi: 82,95% aveau fibroză F4, 1,14% F3-F4, 9,09% F3 şi 7,2% <F3; 20% dintre pacienţi prezentau steatoză importantă (S≥2). La analiza concordanţei dintre testele de evaluare a fibrozei, 7 pacienţi prezentau fibroză uşoară conform markerilor serologici, dar avansată la examinarea elastografică. Toţi pacienţii aveau genotip 1b, cu excepţia a doi dintre ei (unul cu genotip G2 şi altul G3), media încărcăturii virale fiind 1.812.994 UI / ml. Argumentele de neeligibilitate au fost: prezenţa hepatocarcinomului, ciroza decompensată şi fibroza <F4, fără argumente de ciroză sau contraindicaţii pentru terapia cu interferon. În lotul nostru, a existat o rată mare de pacienţi care a întrunit criteriile de eligibilitate. Discordanţa dintre testele neinvazive de evaluare a fibrozei a fost mică în grupul nostru (7,95%)