RESUMEN

PURPOSE: To assess the best technique and the diagnostic accuracy of Quasistatic Ultrasound Elastography (QUE) in thyroid nodules. Interobserver agreement was also evaluated. MATERIALS AND METHODS: A preliminary study of 50 patients with 54 thyroid nodules was performed with quantitative software in order to define the best cut-off value of different imaging methods. All patients underwent total thyroidectomy and histopathology findings served as the standard of reference. Thereafter, 154 nodules in 137 consecutive patients were prospectively evaluated by three operators. Findings at fine-needle aspiration cytology and histopathology (N = 60) served as the standard of reference. RESULTS: The most accurate technique was the axial peri-intranodular measurement method which achieved an area under the ROC curve of 0.961 (95 %CI 0.848 - 1.00) and had an optimal cut-off value of 3.00. QUE in the differentiation of thyroid nodules showed for operator 1: sensitivity 90 % (95 %CI 73.5 - 97.9 %), specificity 92.7 % (95 %CI 86.7 - 96.6 %), LR+ 12.40 (6.54 - 23.50), LR- 0.11 (0.04 - 0.32) and accuracy 91.4 % (95 %CI 85.4 - 97.3 %); for operator 2: sensitivity 86.7 % (95 %CI 69.3 - 96.2 %), specificity 87.1 % (95 %CI 79.9 - 92.4 %), LR+ 6.72 (4.16 - 10.80), LR- 0.15 (0.06 - 0.38) and accuracy 86.9 % (95 %CI 80.0 - 93.7 %); for operator 3: sensitivity 80 % (95 %CI 61.4 - 92.3 %), specificity 83.9 % (95 %CI 76.2 - 89.9 %), LR+ 4.96 (3.20 - 7.70), LR- 0.24 (0.12 - 0.49) and accuracy 81.9 % (95 %CI 74.0 - 89.9 %). Interobserver agreement values between operator 1 and operator 2 (k = 0.79) (p < 0.05, 95 %CI 0.684 - 0.904), between operator 1 and operator 3 (k = 0.73, 95 %CI: 0.607 - 0.854) and between operator 2 and operator 3 (k = 0.71, 95 %CI: 0.584 - 0.835) were significant. CONCLUSION: QUE provides accurate quantitative evaluation of thyroid nodules with low interobserver variability.

Asunto(s)

Diagnóstico por Imagen de Elasticidad/métodos , Interpretación de Imagen Asistida por Computador/métodos , Programas Informáticos , Nódulo Tiroideo/diagnóstico por imagen , Adulto , Anciano , Biopsia con Aguja Fina , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Curva ROC , Sensibilidad y Especificidad , Glándula Tiroides/diagnóstico por imagen , Glándula Tiroides/patología , Nódulo Tiroideo/patología , Nódulo Tiroideo/cirugía , Tiroidectomía , Ultrasonografía Intervencional

RESUMEN

Wanting to find a way of identifying patients suitable for early discharge after thyroidectomy, we set out to establish whether ionized calcium concentration is a better predictor of post-surgical hypocalcemia than total serum calcium. Data were analyzed to establish whether serum ionized calcium concentrations are correlated with total serum calcium levels and symptomatic hypocalcemia after thyroidectomy. Sixty-two patients undergoing total thyroidectomy at the Department of Surgical Sciences of the "Sapienza" University of Rome, Italy, in 2010. Ionized calcium was measured before (day 0) and after surgery (days 1, 2 and 60) in all the patients. These measurements were compared with preoperative (day 0) and postoperative total serum calcium levels (days 1, 2 and 60). The preoperative ionized calcium levels differed from the ionized calcium levels recorded on days 1 and 2; this pattern was not observed for the total calcium concentrations. Conversely, total calcium on days I and II correlated significantly with the various ionized calcium measurements. The presence of parathyroid glands in the surgical specimen did not seem to affect suitability for discharge. The statistical analysis showed that ionized calcium measurements are more reliable than total calcium measurements in the immediate and long-term follow-up of total thyroidectomy patients. Applying a 95% confidence interval we established reference values for both total serum calcium and ionized calcium, below which all patients develop postoperative symptomatic hypocalcemia. In conclusion, measurement of ionized calcium, as opposed to total calcium, should be strongly recommended in the immediate and longterm follow-up of total thyroidectomy patients.

Asunto(s)

Calcio/sangre , Hipocalcemia/sangre , Hipocalcemia/etiología , Tiroidectomía/efectos adversos , Adulto , Anciano , Estudios Controlados Antes y Después , Femenino , Humanos , Iones/sangre , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Reproducibilidad de los Resultados , Tiroidectomía/métodos , Adulto Joven

RESUMEN

Intestinal intussusceptions represent a rare cause of intestinal obstruction in adults (about 1% of intestinal obstructions). The principle causes are benign or malignant tumors. In adults, the most frequent localizations of intestinal invaginations are the ileo-cecal segment, ileum and colon as exclusive localization. We report the case of a 56 year-old Caucasian male admitted in our Department complaining with diffuse abdominal pain and severe anemia. The colonoscopy revealed a vegetant, stenosing and ulcerated mass in the hepatic flexure. The computed tomography suggested the additional diagnosis of intestinal intussusception with no evidence of intestinal obstruction. In our experience, surgery is always indicated for the treatment of intussusceptions in adults, especially for the almost constant underlying neoplasm.

Asunto(s)

Enfermedades del Ciego/patología , Neoplasias del Colon/complicaciones , Enfermedades del Íleon/patología , Intususcepción/patología , Dolor Abdominal/etiología , Anemia/etiología , Enfermedades del Ciego/etiología , Enfermedades del Ciego/cirugía , Colonoscopía , Humanos , Enfermedades del Íleon/etiología , Enfermedades del Íleon/cirugía , Válvula Ileocecal/patología , Intususcepción/etiología , Intususcepción/cirugía , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X

RESUMEN

Internal abdominal hernias are a rare cause of intestinal obstruction (0.2-0.9%). Transmesenteric hernia is a rare type of internal hernia and usually in adult people is acquired. We report the case of a 44 year-old caucasian female with a small bowel occlusion after right nephrectomy for clear cell renal carcinoma caused by an acquired transmesenteric hernia. We emphasize the role of CT scanning for a prompt diagnosis and a quick surgical treatment in order to avoid intestinal gangrene.

Asunto(s)

Hernia Abdominal/diagnóstico , Hernia Abdominal/cirugía , Obstrucción Intestinal/diagnóstico , Obstrucción Intestinal/cirugía , Nefrectomía/efectos adversos , Adulto , Femenino , Hernia , Hernia Abdominal/etiología , Humanos , Obstrucción Intestinal/etiología , Intestino Delgado/patología , Intestino Delgado/cirugía , Tomografía Computarizada por Rayos X/métodos

Asunto(s)

Ascariasis/diagnóstico , Ascaris lumbricoides , Colon/microbiología , Divertículo del Colon/cirugía , Albendazol/uso terapéutico , Anastomosis Quirúrgica/efectos adversos , Animales , Antiprotozoarios/uso terapéutico , Ascariasis/diagnóstico por imagen , Ascariasis/tratamiento farmacológico , Colon/patología , Endoscopía , Humanos , Italia , Masculino , Persona de Mediana Edad , Radiografía

RESUMEN

BACKGROUND: Intestinal microbiota manipulation, one of the pathogenetic components of inflammatory bowel disease (IBD), has become an attractive therapy for ulcerative colitis (UC). AIM: To assess in children with active distal UC the effectiveness of Lactobacillus (L) reuteri ATCC 55730 enema on inflammation and cytokine expression of rectal mucosa. METHODS: A total of 40 patients (median age: 7.2 years range 6-18) with mild to moderate UC were enrolled in a prospective, randomised, placebo-controlled study. They received an enema solution containing 10(10) CFU of L. reuteri ATCC 55730 or placebo for 8 weeks, in addition to oral mesalazine. Clinical endoscopic and histological scores as well as rectal mucosal expression levels of IL-10, IL-1ß, TNFα and IL-8 were evaluated at the beginning and at the end of the trial. RESULTS: Thirty-one patients accomplished the trial (17 males, median age 13 year, range 7-18). Mayo score (including clinical and endoscopic features) decreased significantly in the L. reuteri group (3.2 ± 1.3 vs. 8.6 ± 0.8, P < 0.01) compared with placebo (7.1 ± 1.1 vs. 8.7 ± 0.7, NS); furthermore, histological score significantly decrease only in the L. reuteri group (0.6 ± 0.5 vs. 4.5 ± 0.6, P < 0.01) (placebo: 2.9 ± 0.8 vs. 4.6 ± 0.6, NS). At the post-trial evaluation of cytokine mucosal expression levels, IL-10 significantly increased (P < 0.01) whereas IL-1ß, TNFα and IL-8 significantly decreased (P < 0.01) only in the L. reuteri group. CONCLUSIONS: In children with active distal ulcerative colitis, rectal infusion of L. reuteri is effective in improving mucosal inflammation and changing mucosal expression levels of some cytokines involved in the mechanisms of inflammatory bowel disease.

Asunto(s)

Colitis Ulcerosa/terapia , Enema/métodos , Limosilactobacillus reuteri , Probióticos/administración & dosificación , Administración Rectal , Adolescente , Niño , Citocinas/metabolismo , Método Doble Ciego , Femenino , Humanos , Mucosa Intestinal/metabolismo , Masculino , Estadística como Asunto , Resultado del Tratamiento

RESUMEN

Retroperitoneal fibrosis (RPF), also known as Ormond's disease, is a rare fibroinflammatory disease with uncertain etiology. RPF is characterized by the presence of a particular retroperitoneal fibrotic tissue which is white, woody and involving retroperitoneal structures such as the great vessels, ureters and psoas muscle. The main complication of RPF is the obstruction of local structures such as the ureters due to the fibrosis and the treatment of this aspect represents the main challenge for this pathology. RPF medical treatment consists of corticosteroids or/and immunosuppressive therapy. We report a case of a patient affected by idiopathic RPF treated with low-dose methotrexate (MTX) and 6-methylprednisolone (6-MP) for two years, describing and confirming the effectiveness and safety of a long-term low-dose MTX and 6-MP treatment associated to ureteral Double-J stenting avoiding more invasive surgical approaches.

Asunto(s)

Metotrexato/administración & dosificación , Metilprednisolona/administración & dosificación , Espacio Retroperitoneal/patología , Anciano , Femenino , Fibrosis , Estudios de Seguimiento , Humanos , Tomografía Computarizada por Rayos X

RESUMEN

Tumor cell infiltration causes the remodelling of peritumoral tissues, determined by an increased lytic activity of extracellular matrix exerted by the neoplastic invasive phenotype. Among the principal lytic enzymes produced by tumor cells and mainly involved in invasion process there are the matrix metalloproteases (MMPs). The Authors compared the plasmatic values of MMPs 2, 3, 9 from patients with breast carcinomas and fibroadenomas in order to evaluate whether there was a significant difference between the two groups of patients. MMPs 2, 3, 9 values were quantified by ELISA test from plasma collected 24 hours before surgery in 50 breast carcinomas and 30 fibroadenomas. MMP2 mean value from the patients with carcinomas resulted significantly higher as compared to that from the patients with fibroadenomas; while for MMP 3 and 9 mean values was not possible to find a significant difference between the two groups of malignant and benign breast tumors. These data confirm the main role played by MMPs during the tumor invasion process. Therefore, it is possible to propose the future inclusion of MMP2 test, together to other biological and clinical data, for prognostic evaluation of neoplastic breast lesions.

Asunto(s)

Biomarcadores de Tumor/sangre , Neoplasias de la Mama/enzimología , Carcinoma/enzimología , Fibroadenoma/enzimología , Metaloproteinasa 2 de la Matriz/sangre , Metaloproteinasa 3 de la Matriz/sangre , Metaloproteinasa 9 de la Matriz/sangre , Adulto , Neoplasias de la Mama/patología , Carcinoma/patología , Femenino , Fibroadenoma/patología , Humanos , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Estudios Retrospectivos , Sensibilidad y Especificidad

RESUMEN

We analyzed a homogeneous sample of 671 patients underwent total thyroidectomy for various pathologies evaluating the final histological diagnosis and seeking the association between thyroiditis and cancer. As is known to the literature the incidence of association between autoimmune disease and cancer is not exceptional. In our experience, we have shown it in 39 cases (18.6%). We also considered the genetic background RET/PTC which is more prevalent in cases of papillary carcinoma in an inflammatory environment; could be stimulant the study of specific molecular markers to identify targets to inhibit the inflammatory status in thyroid cancer prevention.

Asunto(s)

Carcinoma Papilar/cirugía , Neoplasias de la Tiroides/cirugía , Tiroidectomía , Tiroiditis/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma Papilar/complicaciones , Carcinoma Papilar/diagnóstico , Carcinoma Papilar/genética , Femenino , Predisposición Genética a la Enfermedad , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Proteínas Oncogénicas/genética , Proteínas de Fusión Oncogénica/genética , Proteínas Tirosina Quinasas/genética , Proteínas Proto-Oncogénicas c-ret/genética , Estudios Retrospectivos , Neoplasias de la Tiroides/complicaciones , Neoplasias de la Tiroides/diagnóstico , Neoplasias de la Tiroides/genética , Tiroiditis/complicaciones , Tiroiditis/diagnóstico , Tiroiditis/genética , Resultado del Tratamiento

RESUMEN

AIM: Radial artery approach for coronary angiography presents advantages in terms of reduction of costs and complications. Opening a diagnostic-only cath lab is controversial in an era of interventional approach. The authors present the data of Carpi diagnostic-only cath lab (Spoke), satellite of the main cath lab situated in Modena (Hub) 20 Kms apart. METHODS: Between January 2004 and December 2007, 1496 coronary angiograms were performed. The indication was ischemic heart disease in 1197 cases (80%), dilated cardiomiopathy in other 165 cases (11%) and valvular heart disease in the remaining 134 patients (9%). The procedure was performed percutaneously via radial artery in 95% (N=1421) of the cases, via brachial artery in 1% (N=15) and via femoral artery in the remaining 4% (N=60) of patients. RESULTS: Among the 1197 patients undergoing coronary angiography for ischemic heart disease, an indication to medical therapy was given in 443 (37%), a surgical indication in 216 (18%) patients and an indication to percutaneous coronary intervention (PCI) in 538 (45%) cases. PCI was performed in the Hub centre the same day and via the same arterial approach of the diagnostic angiography, maintaining the sheath in situ during transport. In 6 patients only it was necessary to shift to a femoral approach. CONCLUSIONS: This model presents many advantages: 1) a cath lab in a peripheral hospital allows a early carrying out of the hemodynamic examination with reduction of hospital stay; 2) transport to the Hub centre cath lab is undertaken only in patients who really need PCI; 3) the PCI is feasible the same day of the diagnostic examination; 4) this model relieves the hub centre congestion, ensuring motivation and professional competence for personnel of peripheral hospital.

Asunto(s)

Cateterismo/métodos , Angiografía Coronaria , Arteria Radial , Anciano , Anciano de 80 o más Años , Angiografía Coronaria/métodos , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad

RESUMEN

Intestinal intussusception is a rare pathology in adults and counts for approximately 5-16% of all invaginations, according to literature. We report the case of a 54 years-old male affected by a double ileo-ileal and ileocecocolic invagination secondary to a submucosal intestinal lipoma. Because of a bowel obstruction symptomathology, the diagnosis was based on abdomen X-rays, abdominal ultrasound and multislice CT scan that showed a probable pre-operative diagnosis of intestinal intussusception. The diagnosis of double invagination was confirmed intraoperatively and was therefore performed a right colectomy extended to a long tract of ileum. Opening the specimen demonstrated the evidence of a submucosal lipoma on the head of the intussusceptum. After the description of this case, we proceed with review of the literature of adult intestinal invagination.

Asunto(s)

Enfermedades del Ciego/etiología , Neoplasias del Colon/complicaciones , Enfermedades del Íleon/etiología , Intususcepción/etiología , Lipoma/complicaciones , Neoplasias del Colon/diagnóstico , Neoplasias del Colon/cirugía , Humanos , Lipoma/diagnóstico , Lipoma/cirugía , Masculino , Persona de Mediana Edad

RESUMEN

The choice of the surgical approach is very relevant in parotid surgery because of the extreme anatomic variability of the parotideal district and the functional importance of the branches of facial nerve. The aim of this paper is to prove how an accurate knowledge of the anatomy and a careful execution of surgery permit radicality in case of tumors and respect of nerves and other structures of the region. We studied anatomy of the different intra- and periparotideal structures to compare two different approaches in parotidectomy, proving how the orthograde technique is safer and more effective in preventing hyatrogenous nerve injuries and other major complications.

Asunto(s)

Glándula Parótida/anatomía & histología , Glándula Parótida/cirugía , Cadáver , Humanos , Procedimientos Quirúrgicos Operativos/métodos

RESUMEN

The recognition of embryos suitable for transfer in human assisted reproduction is important, and there is evidence that the morphology of the cells may influence the results achievable. A procedure for this recognition problem has been formulated based on morphological attributes of the images of the embryos, and it is therefore useful to compare the recognition of experts with that of a machine programme. The aim of this paper is to compare the precision in the recognition of viable embryos by a group of experts to that of a machine recognition procedure, both for a basic set of embryos and a blind set. Experts were asked to classify the images of 249 embryos transferred to 73 patients, indicated as the training set and another set of 103 embryos transferred to 35 patients called the blind set. A machine programme was used for the same classification. For all the experts the results were statistically not significantly different from independence, which means that viable embryos are not recognized as such for both data sets. Instead, the machine algorithm recognizes in a statistically significant way, the membership class for the embryos submitted. Cell morphology is important for IVF, but differences do not appear to be discernable by the senses, clinical insight, experience and/or training, while classification by machine methods provides more accurate results, which could be improved by enlarging the training set.

Asunto(s)

Embrión de Mamíferos/fisiología , Testimonio de Experto , Reconocimiento de Normas Patrones Automatizadas , Técnicas Reproductivas Asistidas , Adulto , Algoritmos , Estudios de Casos y Controles , Transferencia de Embrión , Femenino , Humanos , Método Simple Ciego , Supervivencia Tisular

Asunto(s)

Neoplasias Gástricas/cirugía , Factores de Edad , Anciano , Ensayos Clínicos como Asunto , Gastrectomía , Humanos , Escisión del Ganglio Linfático , Pancreatectomía , Pronóstico , Estudios Prospectivos , Ensayos Clínicos Controlados Aleatorios como Asunto , Estudios Retrospectivos , Esplenectomía , Neoplasias Gástricas/mortalidad , Factores de Tiempo

RESUMEN

Acute administration of high-dose testosterone in men with coronary artery disease improves endothelial function.

Asunto(s)

Arteria Braquial/fisiopatología , Enfermedad Coronaria/fisiopatología , Hormonas Esteroides Gonadales/farmacología , Testosterona/farmacología , Anciano , Estudios Cruzados , Método Doble Ciego , Endotelio Vascular/efectos de los fármacos , Humanos , Masculino , Persona de Mediana Edad , Flujo Sanguíneo Regional/efectos de los fármacos

RESUMEN

STUDY OBJECTIVE: To determine whether the pain and discomfort of routine hysteroscopy with endometrial biopsy to diagnose infertility and endometrial pathology can be minimized by topical application of mepivacaine. DESIGN: Prospective, randomized, double-blind study. SETTING: The Department of Obstetrics and Gynecology at a teaching hospital in Rome, Italy. PATIENTS: Eighteen women undergoing diagnostic hysteroscopy. INTERVENTIONS: Hysteroscopy and endometrial biopsy were performed after transcervical injection of 5 ml 2% mepivacaine or 5 ml saline solution into the uterine cavity. MEASUREMENTS AND MAIN RESULTS: Difficulty introducing the hysteroscope was rated by the operator on a scale of 1 to 3. An observer scored visible signs of each woman's distress using a three-point scale. The patients reported their pain 15, 30, 60, 120 minutes after the procedure on a visual analog scale. Mepivacaine was more effective than placebo according to all measurements. CONCLUSIONS: Topical mepivacaine reduced the pain experienced during and after hysteroscopy and endometrial biopsy.

Asunto(s)

Anestesia Local/métodos , Anestésicos Locales/administración & dosificación , Endometrio/patología , Histeroscopía , Infertilidad Femenina/diagnóstico , Mepivacaína/administración & dosificación , Hemorragia Uterina/diagnóstico , Adulto , Anestésicos Locales/uso terapéutico , Biopsia con Aguja , Método Doble Ciego , Femenino , Humanos , Infertilidad Femenina/patología , Inyecciones Intralesiones , Mepivacaína/uso terapéutico , Persona de Mediana Edad , Dimensión del Dolor , Satisfacción del Paciente , Estudios Prospectivos , Hemorragia Uterina/patología

Asunto(s)

Citoplasma , Riñón/citología , Virus de la Rubéola , Animales , Bovinos , Línea Celular , Membrana Celular , Nucléolo Celular , Técnicas de Cultivo , Aparato de Golgi , Haplorrinos , Técnicas Histológicas , Cariometría , Microscopía Electrónica , Mitocondrias , Conejos

Asunto(s)

Piel/patología , Vaccinia/patología , Biopsia , Técnicas de Cultivo , ADN Viral , Fibroblastos , Humanos , Microscopía Electrónica , ARN Viral

Asunto(s)

Núcleo Celular , Piel/patología , Vaccinia/patología , Preescolar , Humanos , Leucocitos , Masculino , Microscopía Electrónica

Asunto(s)

Núcleo Celular , Piel/patología , Vaccinia/patología , Biopsia , Preescolar , Cristalización , Humanos , Microscopía Electrónica , Mitosis