Elastography: A New Ultrasound Technique in Nodular Thyroid Pathology

Elastography is a new technique for evaluating the stiffness of nodules. It is generally recognised that malignant thyroid lesions are harder than benign lesions. Different elastographic techniques are presented, with characteristics, advantages and limitations. Qualitative and semiquantitative methods are described. Comparison of the main existing techniques, static and dynamic elastographies, is presented in this chapter. Strain elastography seems to have a better diagnostic quality than shear wave elastography in the diagnosis of thyroid cancer disease. A positive elastogram, suggestive for malignancy is more useful in diagnosis than a positive grey-scale ultrasound evaluation. Elastography increases the specificity of grey scale ultrasound (US), it should be always integrated with its information and should be considered as a complement of conventional US

Experimental study of the out of plane behavior of masonry infill walls with exterior insulation systems

The objective of this study is to evaluate the out of plane behavior of a masonry infill wall provided with an exterior thermal insulation system. For this purpose there were constructed two 1:1 scale specimens of masonry infill walls in order to compare a simple wall with one having already applied an exterior thermal insulation system composed by a polystyrene insulation and a protection layer of plaster and a glass fiber mesh. The load was applied through a horizontal force, acting at the mid height of the wall. Both specimens were tested in displacement control, using alternate force with 3 cycles per loading step. As it was expected, an increased stiffness and out of plane resistance was observed for the wall provided with the insulation system. Various observations were noticed related to the technology and overall behavior of the infill masonry wall

Hypogonadism in Male Sexual Dysfunction

Normal testosterone level is influencing all the steps of the male psychosexual development: intrauterine neonatal and final psychosexual development.. At pubertal stage, the quality of testosterone secretion is conditioning the development of the mature male phenotype. In adult life, eugonadism sustains desire, arousal, determines spontaneous erections, facilitates stimulated erection, influencing the response rate to medication. Moreover, eugonadism sustain daydreaming and phantasies, both needed for a normal sexual life. The pathogenic mechanism of all these actions is presented. Talking about hypogonadism means not only the classical types of hypogonadism: due to classical testicular disease of central, hypothalamic and hypophysis disease, but also the partial testosterone deficiency induces by aging (late onset hypogonadism), weight increase (up to 30% of males with metabolic syndrome and 50% of males with diabetes) or secondary hypogonadism described in chronic use of steroids or after long exposure to stress, especially in young males. All these types of hypogonadism, that affect young, middle aged or old males will be presented separately. A therapeutic approach that is individualized for each type of hypogonadism, should consider positive and possible negative effects and all alternatives will be presented: life style changes, sustained weight loss, increase exercise, supplemental therapy, pro fertility treatment

Elastographie en temps réel – impact de la réponse d’anélasticité

Université de Médecine et de Pharmacie ”Victor Babes”, Timisoara, Roumanie The IVth Congress of Radiology and Medical Imaging of the Republic of Moldova with international participation, Chisinau, May 31 – June 2, 2018Introduction: L’élastographie mammaire est une technique récente utilisée en complément de l’échographie mammaire dans le dépistage du cancer du sein. L’élastographie fournit non seulement des informations qualitatives (carte à codage de couleur), ainsi que quantitative, liée au rapport d’élasticité du nodule versus le tissu adipeux (FLR). À la lumière de la qualité, il y a controverse sur la valeur de discrimination entre les lésions bénignes et malignes. Actuellement, la limite utilisée dans notre centre est la valeur médiane de 4,88, validée sur une étude comparative avec l’examen histopathologique, une valeur qui assure une sensibilité de 86,5% et une spécificité de 90,4% Matériel et méthodes: L’étude a inclu 344 femmes, âgées de 19 à 76 ans, avec des pathologies mammaires chirurgicales, qui ont eu un résultat histopathologique clair et, dans certains cas, un résultat immunohistochimique clair. Résultats: Sur le total de 344 cas, ont été diagnostiqués lésions bénignes en 186 (54,1%), le cancer du sein dans 158 cas (45,9%). Lorsque nous avons examiné la valeur FLR, on a eu la stratification du risque suivant: faible risque dans 166 cas, 38 cas avec risque intermédiaire et à haut risque 138 cas. La sensibilité et la spécificité de cette stratification considérée isolée, sans l’information fournie par l’échographie 2B, est 92,4% et respectivement 83,9%. Le système conventionnel BIRADS-US n’avait qu’une sensibilité de 75,6%, avec une spécificité de 69,9%. Contrairement à cela, un nombre important de cas classés comme intermédiaires, 97 cas (catégorie BIRADS 4 a), ont été réorganisés dans l’autre catégorie de risque, alors quand ils ont été soumis à l’évaluation élastographique, 23 ont été attribués à un groupe à haut risque en raison de l’anélasticité et 26 ont été attribués à classe de risque faible parce que l’élasticité était présente. Seuls 48 cas sont restés dans la catégorie intermédiaire. Conclusions: Évidemment, l’élastographie apporte un plus pour l’échographie classique, en réduisant le nombre de résultats faux positifs et faux négatifs par rapport à l’échographie classique

Farms regional economic developments identified in the FADN PANEL

The paper adresses an approach on indicators from the public database FADN (Farm Accountancy Data Network), at farm level selected from Romania. The study focused on analyzing the data series in 2012 (the latest year reported in the FADN) and the second part of the study was supported by the report on the last six years (2007-2012) and four of the eight regions. The data comes from public database FADN and the methodology consisted of a descriptive analysis of the data and presenting them as graphic and tabular form. The results recorded consisted of highlighting the differences between regions and survey findings have highlighted a decrease in interest and rental costs and also in investment levels, compared to 2012; in the same conditions, the total production and cash flow increased

False positive results of real-time elastography in the diagnosis of thyroid nodal lesions

Victor Babes University of Medicine and Pharmacy, Timisoara, Romania, The IVth Congress of Radiology and Medical Imaging of the Republic of Moldova with international participation, Chisinau, May 31 – June 2, 2018Introduction: L’élastographie en temps réel est une méthode de diagnostic qui ajoute de la qualité dans le diagnostic des lésions nodulaires thyroïdiennes. La méta-analyse actuelle suggère une bonne performance diagnostique avec une spécificité générale de 80% et une sensibilité générale de 85%. La présente étude est une analyse rétrospective des causes les plus fréquentes de faux negatifs et faux positifs résultats rencontrés dans l’échographie thyroïdienne. Matériel et méthodes: Nous avons analysé 433 des lésions nodulaires, opérés et évaluées par l’échographie de la thyroïde classique et l’élastographie, avec la même sonde linéaire, multifréquence, Hitachi Preirus machine, Hitachi Inc., Japon. Les résultats de l’échographie n’ont pas été communiqués au pathologiste. Une analyse rétrospective des résultats a été réalisée. Résultats: Nous avons évalué 433 cas avec des nodules avec un volume moyen de 2,14 ml (allant de 0,78 ml à 10,45 ml). 134/433 cas ont été identifiés avec un cancer de la thyroïde, 251/434 étant bénignes. La sensibilité de l’élastographie était de 82,02%, la spécificité de 83,94%, la précision de 83,37%. Nous avons observé 48 cas de lésions bénignes, identifiées par l’élastographie comme des lésions suspectes – 23/48 lésions avec de cellules Hürthle, sans maladies vasculaires, 8/48 lésions prolifératives potentiellement incertaines, 5/48 prolifération folliculaire, 8/48 thyroïdite myxomateuse / granulomateuse et 12/48 cas de maladie thyroïdienne auto-immune. Nous avons également noté 24 résultats faussement négatifs: 19/24T microcarcinomes papillaires, 5/25 carcinomes folliculaires. Être mentionné que les microcarcinomes qui ont été observés dans les nodules, ont de diamètres supérieurs à 3,5 cm. Conclusions: Les proliférations de cellules Hürthle et les microcarcinomes papillaires sont les conditions pour faux diagnostic le plus fréquent chez l’élastographie de la thyroïde.Introduction: Real-time elastography is an imaging method that adds quality to the diagnosis of nodular thyroid lesions. Meta-analysis data suggest a good diagnostic performance with an overall specificity of 80% and sensitivity of 85%. The present study is a retrospective analysis of the most common causes of false negative and false positive results encountered in thyroid ultrasound. Material and methods: We analyzed 433 nodular lesions, operated and evaluated by classical thyroid ultrasound and elastography, using a linear probe on a Hitachi Preirus machine, Hitachi Inc., Japan: The results of the ultrasound were not communicated to the pathologist. A retrospective analysis of the results was performed. Results: We evaluated 433 thyroid nodules with an average volume of 2.14 ml (ranging from 0.78 ml to 10.45 ml). 134/433 cases were identified with thyroid cancer and 251/434 were identified as benign lesions. The sensitivity of the elastography was 82.02%, the specificity – 83.94%, the accuracy being 83.37%. We observed 48 cases of benign lesions, identified by elastography as suspicious lesions : 23/48 – lesions with Hürthle cells, without vascular diseases, 8/48 – proliferative lesions potentially uncertain, 5/48 – follicular proliferation, 8/48 – myxomatous / granulomatous thyroiditis and 12/48 cases of autoimmune thyroid disease. We also noted 24 false negative results: 19 / 24 – papillary microcarcinomas, 5/25 – follicular carcinomas. Of note is that microcarcinomas that have been observed in nodules, had > 3.5 cm in diameter. Conclusions: Hurtle cell proliferations and papillary microcarcinomas are the most common misdiagnosed conditions in thyroid elastography

Farms regional economic developments identified in the FADN PANEL

The paper adresses an approach on indicators from the public database FADN (Farm Accountancy Data Network), at farm level selected from Romania. The study focused on analyzing the data series in 2012 (the latest year reported in the FADN) and the second part of the study was supported by the report on the last six years (2007-2012) and four of the eight regions. The data comes from public database FADN and the methodology consisted of a descriptive analysis of the data and presenting them as graphic and tabular form. The results recorded consisted of highlighting the differences between regions and survey findings have highlighted a decrease in interest and rental costs and also in investment levels, compared to 2012; in the same conditions, the total production and cash flow increased

Evaluation of medical decision errors during the transition period to telemedicine

The context of the Coronavirus pandemic has fundamentally changed the way we approach medical services. Beyond setting up new technological possibilities, it has propelled telemedicine to become a reality, bringing undeniable practical benefits. The questions that arise are both justified and worrying: can digitalization replace a direct interpersonal relationship that involves a physical examination, while preserving the quality of the medical act and the degree of patient satisfaction? Isn\u27t there a risk that the digitization of the medical record will cancel out the deep human character of classical medicine that has evolved since the time of Hippocrates? Should the implementation of telemedicine be the state-of-art of modern medicine, in accordance with the co-evolution of digital technology? It is hard to believe that once used in this period, telemedicine will be abandoned. However, telemedicine must be analyzed not only in the short term but also in the long term, in order to be able to evaluate both its usefulness and possible deficiencies

Nerve compression due to benign tumors or ganglion cysts in the upper limb – case series

Tumor nerve compressions in the upper limb are relatively rare, usually involving ganglion cysts and benign tumors. We present a case series of five patients with peripheral nerve compression in the upper limb due to tumor or cystic masses- ulnar nerve compression in the Guyon’s tunnel due to a ganglion cyst, large median nerve schwannoma compressing anterior interosseous nerve and median nerve, voluminous lipoma compressing median nerve in the proximal forearm, superficial branch of radial nerve compression by a synovial cyst and elbow region lipoma compressing radial nerve. In the beginning, those benign lesions are asymptomatic but, as they continue to grow adjacent to a peripheral nerve clinical manifestations appear progressively as compressive neuropathies. After a preoperative imagistic analysis, tumor resection with careful dissection, in order to preserve the neurovascular structures, is the elective surgical procedure in order to obtain an optimal functional recovery