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

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

Preparation and Characterization of a Collagen-Liposome-Chondroitin Sulfate Matrix with Potential Application for Inflammatory Disorders Treatment

Smart drug delivery systems with controllable properties play an important role in targeted therapy and tissue regeneration. The aim of our study was the preparation and in vitro evaluation of a collagen (Col) matrix embedding a liposomal formulation of chondroitin sulfate (L-CS) for the treatment of inflammatory disorders. Structural studies using Oil Red O specific staining for lipids and scanning electron microscopy showed an alveolar network of nanosized Col fibrils decorated with deposits of L-CS at both periphery and inner of the matrix. The porosity and density of Col-L-CS matrix were similar to those of Col matrix, while its mean pore size and biodegradability had significantly higher and lower values (P<0.05), respectively. In vitro cytotoxicity assays showed that the matrix system induced high cell viability and stimulated cell metabolism in L929 fibroblast cell culture. Light and electron micrographs of the cell-matrix construct showed that cells clustered into the porous structure at 72 h of cultivation. In vitro diffusion test indicated that the quantity of released CS was significantly lower (P<0.05) after embedment of L-CS within Col matrix. All these results indicated that the biocompatible and biodegradable Col-L-CS matrix might be a promising delivery system for local treatment of inflamed site

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

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

NEW DISPOSITIONS WITH REGARD TO FILIATION

The new Romanian Civil Code1 is a milestone for the profound reform of our judiciary as regards the matter of private law relationships, on the grounds of valuating the national and international experience.2 The novelties are represented, mainly, by the review of certain legal institutions and promotion of new principles and solutions. On this backdrop, the regulation of family relationships also received a new face. The present task is devoted to highlighting the amendments interfered in the matter of filiation, by presenting the systematization method of legal regulations and the critical analysis of its content

PRIMARY REGIME AS REGULATED BY THE NEW ROMANIAN CIVIL CODE

The regulation of patrimonial relations between spouses shall find a modern approach in the new Civil Code1, according to the legislation of the European countries, which shall provide any family the possibility to choose its matrimonial regime applicable to the concrete situation and interests.Moreover, in order to protect the interest of the family and its life environment, the new Civil Code establishes a set of general provisions, applicable to any family, irrespective of the matrimonial regime chosen by the spouses to regulate their patrimonial relations. Even though the legal text summons those norms under the title of „Common provisions”2, the doctrine assumed the name most used in the law systems having similar provisions, namely the „primary regime”.Among the objectives of this work it is also the analysis of provisions setting up the primary regime applicable to spouses in the new Romanian Civil Code, and also its implications on the protection of the family life from a patrimonial perspective

Classic Ductal Sonographic Criteria versus Real Time Elastography Criteria in Diagnosing Nodular Breast Lesions

Objectives: Sonoelastography is a noninvasive, real time procedure, complementary diagnostic method that increases the diagnostic qualities of conventional ductal ultrasound. We want to evaluate the added diagnostic value of sonoelastography in cases of apparent benign lesions in conventional ultrasound.Method: Prospective Study: 1115 women, under 45 years of age, mean age 34.5±5.17 years, who came in in our Ultrasound Unit for a routine breast evaluation.Recruitment Period: January 2011-APRIL 2013. Ductal breast ultrasound and elastography was performed with a HITACHI EUB 7500 HV machine, with 6-13 MHz variable frequency linear probe, with water bag, Hitachi Medical System Tokyo, Japan. Ueno score and also strain ratio were measured for all described lesions. All cases with BIRADS-US 4 evaluation were operated. Extemporaneous and postsurgical histopathological exam was performed in all cases. Some BIRADS –US 3 lesions were also referred to the surgeons because of cosmetic, pre-pregnancy, need of hormonal contraception use reasons.Results: From the total of 1115 cases, we diagnosed 416 solid tumors, of which 273were referred to the surgeon, and only 174 did have surgery with histopathological result. Diagnostic value of classical ultrasound was medium, with a sensitivity of 48.61% and specificity of 66.66%. Doppler US had higher diagnostic value (51.38%, respectively 75.49), combined information being better in diagnostic (68.42% and 50.75%). Real time elastography had the highest diagnostic values, in both qualitative and quantitative technique, with a sensitivity of 90.41%, respectively 94.4%, with the same specificity of 94.4% and 94.11%.Conclusion: real time elastography should be considered as a useful diagnostic tool in preoperative evaluation of solid breast masses

Individualized Follow-up of Pregnant Women with Asymptomatic Autoimmune Thyroid Disease

Maternal hormones are essential for the normal fetal development during pregnancy. Autoimmune thyroid disease is a frequent pathology in our iodine replete region. The aim of this study is to evaluate the occurrence of subclinical hypothyroidism (SCH) in cases with known autoimmune thyroid disease, which were in a euthyroid state prior to pregnancy, and to assess the association between supplemental treatments administered and the outcome of the pregnancy. The study is a prospective interventional controlled study. The two cohorts comprise the interventional group, consisting of 109 pregnant women with known autoimmune asymptomatic thyroid disease, without any levothyroxine (LT4) treatment and an aged-matched control group, with an unknown thyroid disease. After the pregnancy, a monthly evaluation of TSH, FT3, and FT4 was performed. Offspring evaluation was made at birth time. 88.8% of the women developed SCH in the first four weeks of pregnancy. Average LT4 doses increased as the pregnancy progressed. The monthly adjustment was 12.5 or 25 μg. All SCH cases developed in the first trimester of pregnancy. There was no significant difference regarding the gestational week, weight, or length at birth between the interventional group and controls, when TSH values were in the optimal range, during the whole pregnancy. Premature birth was described in one case in the interventional group

Characterization of Novel Hybrid Materials Conditioned as Sheets for Skin Repair

The association of natural or synthetic polymers with metal nanoparticles resulted in hybrid [...