Comparison of palpation-versus ultrasound-guided fine-needle aspiration biopsies in the evaluation of thyroid nodules

<p>Abstract</p> <p>Background</p> <p>The aim of this study was to compare the results of palpation-versus ultrasound-guided thyroid fine-needle aspiration (FNA) biopsies.</p> <p>Findings</p> <p>Clinical data, cytology and histopathology results were retrospectively analyzed on all patients who underwent thyroid FNA biopsy in our outpatient endocrinology clinic between January 1998 and April 2003. The same investigators performed all thyroid FNAs (ASC) and cytological evaluations (KP). Subjects in the ultrasound-guided group were older, otherwise there were no differences in baseline characteristics (gender, thyroid function, the frequency of multinodular goiter, nodule diameter and nodule location) between groups. Cytology results in nodules aspirated by palpation (n = 202) versus ultrasound guidance (n = 184) were as follows: malignant 2.0% versus 2.7% (p = 0.74), benign 69.8% versus 79.9% (p = 0.02), indeterminate 1.0% versus 4.9% (p = 0.02), inadequate 27.2% versus 12.5% (p < 0.01). Malignant results were compared with Fisher's exact test. Other cytology categories were compared with chi-square test. Eighteen patients from the palpation- and 23 from ultrasound-guided group underwent surgery. In the palpation-guided group, the sensitivity of FNA was 100%, specificity 94%, positive predictive value 67% and negative predictive value 100%. In the ultrasound-guided group, the sensitivity of FNA was 100%, specificity 80%, positive predictive value 73% and negative predictive value 100%.</p> <p>Conclusion</p> <p>We demonstrate that ultrasound guidance for thyroid FNA significantly decreases inadequate for evaluation category. We also confirm the high sensitivity and specificity of thyroid FNA biopsy in the diagnosis of thyroid cancer. Where available, we recommend universal application of ultrasound guidance for thyroid FNA biopsy as a standard component of this diagnostic technique.</p

Staged, Open, No-Ischemia Nephron-Sparing Surgery for Bilateral-Multiple Kidney Tumors in a Patient with Birt-Hogg-Dubé Syndrome

Hereditary kidney cancer patients with bilateral multiple kidney tumors represent challenges in the era of rapidly growing minimal invasive treatment techniques. Birt-Hogg-Dubé Syndrome (BHDS) is an autosomal dominant genodermatosis characterized by a triad of benign skin tumors (fibrofolliculomas, trichodiscomas, acrochordons) together with an increased risk of developing malignant renal tumors and pulmonary disease such as pneumothoraces and multiple lung cysts. The morbidity and mortality of the affected patients is determined by the presence of the kidney tumors, which tend to be multifocal and bilateral, as observed in other hereditary kidney cancer syndromes like von Hippel-Lindau disease, familial leiomyomatosis, and hereditary papillary renal cell carcinoma. Herein, a patient with BHDS, presenting with synchronous bilateral multiple kidney tumors, is reported. The report describes the management of kidney tumors with two-stage open nephron-sparing surgery in which the nonvascular clamping technique was utilized

Malignant Mesothelioma of the Tunica Vaginalis: Presenting with Intermittent Scrotal Pain and Hydrocele

Paratesticular mesotheliomas are very rare tumors. In this paper, we present the management of a 38-year-old male patient with paratesticular malignant mesothelioma who was initially misdiagnosed and treated as recurrent epididymitis. After the final pathology report defining paratesticular mesothelioma during scrotal exploration, he underwent radical orchiectomy and hemiscrotal excision as a complementary, secondary procedure. His metastatic workup did not show any dissemination. Therefore, he did not receive any adjuvant treatment and remained disease-free for more than 2 years

Fine Needle Aspiration Biopsy Results of Thyroid Nodules According to Their Biopsy Indications

We aimed to compare the fine needle aspiration biopsy results of thyroid nodules in two different groups. One group (group A), consisted of thyroid nodules which had sonographically suspicious criteria for malignancy, the other group (group B) was comprised of nodules which were not sonographically suspicious for malignancy, but referred to biopsy according to clinician’s will. In our clinic, a total number of 132 nodules in 118 patients ( range 25-75 years) were biopsied between June 2004 and October 2005. Sex, age, nodule size, palpability of nodule, ultrasonographic features were compared in both groups with respect the cytopathological results. Sensitivity, spesificity, negative and positive predictive values were calculated for each ultrasonographic feature. Malignancy rates and number of nodules that 1 cm or smaller in diameter were significantly higher in group A, the number of palpable nodules were higher in group B. The number of solid, hypoechoic, irregular bordered nodules with central microcalcification and central vascularity seen by Doppler ultrasound were higher in group A.In conclusion; fine needle aspiration biopsy of solitary or dominant nodules in diameter of ≥ 1 cm, have low malignancy rates, if sonographically unsuspicious for malignancy. Thyroid cancer could be detected even in nodules smaller than 1 cm, if the nodule has sonographically suspicious features for malignancy

Liver Transplantation in a Patient with Absent Inferior Vena Cava: Case Report

Transplantation procedure used if the recipient and donor do not have a special anatomicalvariation today; left lateral segment in the pediatric age group, and right lobe in the adult agegroup. Biliary atresia in children and various liver diseases like metabolic events in adults arethe major causes of liver transplantation. Liver transplantation is challenging in the patientswith congenital vascular anomalies. Infrahepatic interruption of the inferior vena cava (IVC)is a rare congenital anomaly with the incidence of 0.6% to 2% and mostly found withcongenital heart disease. In this study we tried to report a 58-year old male patient with adiagnosis of decompensated liver cirrhosis caused by the hepatitis B virus (HBV) who washospitalized for the first time for living donor liver transplantation.Günümüzde alıcı ve vericinin özel anatomik bir varyasyonunun yokluğunda kullanılan transplantasyon prosedürü; pediatrik yaş grubu için sol lateral segmentin alınması, erişkin yaş grubunda ise sağ lobun kullanılmasıdır. Çocuklarda biliyer atrezi, erişkinlerde ise metabolik olaylar gibi çeşitli karaciğer hastalıkları karaciğer transplantasyonu için başlıca nedenlerdir. Karaciğer transplantasyonu, konjenital damar anomalisi olan hastalar için oldukça zor bir işlemdir. İnferior vena cavadaki, infrahepatik kesinti %0,6 ile %2 oranında gerçekleşen oldukça nadir bir konjetinal anomalidir ve genellikle konjenital kalp hastalığı ile birlikte görülür. Biz bu çalışmada, hepatit B virüsü (HBV) zemininde gelişen dekompanse karaciğer yetmezliği tanısı olan ve canlı vericiden karaciğer nakli için ilk kez hastaneye yatışı yapılan 58 yaşındaki erkek hastayı takdim etmek istedik.2-s2.0-8508528441

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)