Surgical treatment of the thyroid nodes of uncertain cytological structure

Objective. To determine the clinical factors of the enhanced risk of malignancy in patients, having categories of cytological conclusions III (AUS/FLUS) and IV (FN/SFN). Маterials and methods. There were 11 621 patients examined with cytological investigation of thyroidal nodes under ultrasonographic control. Cytological conclusions of category ІІІ (AUS/FLUS) have characterized 621 nodes, while conclusions of category IV (FN/SFN) - 1215 nodes. There were operated 150 patients, owing cytological conclusions of category III, 436 patients - with cytological conclusions of category IV, and 11 patients, having categories of cytological conclusions III and IV. Results. Papillary and follicular carcinomas were revealed in 36% patients, suffering thyroidal nodes of the Bethesda III category, what is trustworthily more frequently (р < 0.01), than in the patients, suffering thyroidal nodes of the Bethesda category IV (25.1%). There were revealed such factors of risk for malignant properties in patients, suffering thyroidal nodes with the Bethesda category III, as: the node size 2 сm and less, its hypoechogeneicity, uneven borders, irregular form, and presence of hyperechogenic foci (р < 0.01). Cystic degeneration of a node constitutes the sign of its benign origin (р < 0.01). Conclusion. High risk of malignant changes (36%) in thyroidal nodes, in accordance to cytological conclusion of the Bethesda category III revealed, trusts the need for enhanced oncological suspicion and conduction of surgical treatment. Тhe additional factors of malignant changes must be taking into account as well, such as the node size 2 сm and less, its hypoechogeneicity, uneven borders, irregular form, and presence of hyperechogenic foci

ARTHROSCOPIC REPAIR OF LARGE AND MASSIVE ROTATOR CUFF TEARS: CLINICAL OUTCOMES AND POSTOPERATIVE MRI FINDINGS

Purpose of the study – to identify incidence rate of recurrent rotator cuff (RC) tears, to evaluate outcomes of arthroscopic bone-tendon anchor suture, to determine the factors influencing arthroscopic treatment outcomes.Materials and methods. Medical history data, pre-operative x-rays and MRI of shoulder joints of 305 patients (main group) who underwent arthroscopic bone-tendon anchor suture repair of large or massive RC tears during 2010-2016 were included in the study. Follow up period ranged from 1 to 6 years postoperatively with mean value of 25,6±4,5 months. Telephone survey of patients was conducted after the surgery as well as a single examination of patients with evaluation by functional scales – UCLA, ASES, CS, VAS, DN4. Preoperative standard x-rays in AP and axial views were done in all patients. Arthropathy severity was evaluated by K.Hamada classification. Comparison of patient specific data, features of RC lesions and surgical treatment was made by Kruskal-Wallis test.Results. Good outcomes by ASES, CS and UCLA functional scales were obtained in 15 (5%) of patients, satisfactory – in 213 (69.8%), poor – in 77 (25.2%). Postoperative MRI data provided the following sub-distribution of patients: 49 (41.1%) patients with complete repair of RC tendons lesions, 38 (31.9%) patients with partial repair and 33 (27.0%) patients with recurrent tear of reconstructed tendon. Correlation analysis allowed to establish the limits for achieving good outcomes of arthroscopic bone-tendon anchor suturing for significant association with infraspinatus muscle atrophy (not exceeding 40%) and fatty infiltration of supraspinatus muscle (not exceeding 23.5%)