Cost-effectiveness of fine-needle-aspiration cytology of thyroid nodules with intranodular vascular pattern using two different needle types

Objective: To compare the cytological findings of hypoechoic thyroid nodules with intranodular vascular pattern (pattern II) obtained by two different needles (Neolus 25 gauge, Chemil, Wenzhou, China vs Yale Spinal 25 gauge, Becton Dickinson, Madrid, Spain) in euthyroid patients and to evaluate their cost-effectiveness. Methods: From January 2001 to December 2003, 480 euthyroid patients with a hypoechoic thyroid nodule pattern II were referred for US-FNAC. The nodules were alternatively evaluated by Neolus or by Yale Spinal with the stylet (YS+) or without the stylet (YS−), in order to evaluate if the cytological results could be due to the presence of the stylet or to the different length of the two needles. For each nodule two passes were performed and the material was obtained by capillary action. Material was smeared on slides, fixed, and stained by Papanicolaou techniques. Cytological specimens were evaluated in blind by the same experienced cytopathologist. Results: Inadequate cytological specimens because of blood contamination were present in 30 (18.7%) samples by Neolus needle and in 22 (13.8%) by YS− compared to only 5 (3.1%) by YS+. In 6 (20%) cases of the 30 repeated US-FNAC by Neolus and in 4 (18%) of the 22 US-FNAC by YS−, material remained inadequate for diagnosis because of blood contamination. All the five repeated samples obtained by YS+ became adequate for diagnosis and resulted benign nodules. Direct costs of US-FNAC procedure are currently Э 72.30 including cytological examination. The cost of Neolus and Yale needles is Э 0.19 and Э 3.0, respectively. The estimated total cost to obtain a cytological diagnosis by a Neolus needle (160 + 30 repeated US-FNAC) was Э 13809.2 vs Э 12919.5 by Yale Spinal needle (160 + 5 repeated US-FNAC). Conclusion: This study demonstrates that the use of Yale Spinal needles greatly reduces inadequate cytological specimens, and therefore limits both direct and indirect costs.     

The external laryngeal nerve: surgical and anatomic considerations. Report of 50 total thyroidectomies

This surgical anatomy study aimed to evaluate the possibility of identifying the external laryngeal nerve during thyroid surgery and the possible variations of nerves at risk. Fifty patients underwent total thyroidectomies during a period of 12 months. Using a neurostimulator, the distal motor branch of the external laryngeal nerve was searched. Electrical stimulation of a nervous branch aimed to provoke a global contraction of the cricothyroid in order to identify with certitude the external laryngeal nerve. The external laryngeal nerve was identified in 20% of cases. Its course was, with almost equal frequency, either (1) between the vessels of the superior thyroid pedicle or (2) superficial and anterior to the fascia of the cricothyroid muscle. The external laryngeal nerve is hard to find during thyroid surgery, even with a neurostimulator. It can be vulnerable during thyroid surgery but only in cases of anatomic variations. Searching for the nerve systematically during thyroid surgery does not seem to be useful. Several precautions when dissecting the superior pole of the thyroid gland seem to be necessary and sufficient to respect the external laryngeal nerve.     

Computer-Assisted Detection of Pulmonary Nodules: Preliminary Observations Using a Prototype System with Multidetector-Row CT Data Sets

The continued revolution in multidetector-row CT (MDCT) scanning increases the quality of lung imaging but at the cost of a greater burden of data for review and interpretation. This article discusses our preliminary experience with prototype software for lung nodule detection and characterization using MDCT data sets. We discuss the potential role of computer-assisted detection (CAD) as applied to the automatic detection of lung nodules. We also review the process of CAD, outline its potential results, and explore how it may fit into existing radiology practice. Finally, we discuss MDCT data-acquisition parameters and how they may affect the performance of CAD.     

Possible Relation of p53 and mdm-2 Oncoprotein Expression in Thyroid Carcinoma: A Molecular-Pathological and Immunohistochemical Study on Paraffin-Embedded Tissue

Routinely processed tissues from a series of benign and malignant thyroid lesions were immunohistochemically investigated with antibodies against p53 and mdm-2. p53 was immunolocalized in <10% of nuclei in 2/80 nodular goiters, 2/60 follicular adenomas, 26/68 follicular carcinomas, 7/40 papillary carcinomas, 3/10 “insular” carcinomas, and 10/31 anaplastic carcinomas. More than 10% positively stained nuclei were found in 2 widely invasive follicular, 2 insular, and 15 anaplastic carcinomas. All p53-positive cases showed a concomitant immunohistochemical mdm-2 expression; an immunohistochemical colocalization on serial section was demonstrated in 12 anaplastic carcinomas. Screening by polymerase chain reaction single-strand conformation polymorphism (PCR-SSCP) analysis of these 12 cases revealed no relevant mutations in the coding regions of exons 2–11 of the p53 gene. Additionally, 1 follicular adenoma, 6 follicular carcinomas (4 minimally and 2 widely invasive), 1 papillary, and 2 poorly differentiated insular carcinomas were mdm-2 positive without immunohistochemically detectable p53 expression. These results provide evidence that wild-type p53 expression in thyroid carcinomas may be associated with mdm-2 induced formation of stable complexes. However, the role of p53 mutations and p53 protein inactivation owing to other factors (e.g., mdm-2) in the progression of thyroid carcinomas is still poorly understood.     

甲状腺疾病患者血清可溶性白细胞介素2受体测定的临床意义

某些甲状腺疾病时血清可溶性白细胞介素２受体（ｓＩＬ－２Ｒ）水平及其与游离甲状腺素（ＦＴ＿４）、游离三碘甲腺原氨酸（ＦＴ＿３）和促甲状腺素（ＴＳＨ）水平的相关性比较。结果发现甲状腺机能亢进症（甲亢）未治疗组（Ａ）及甲亢未治疗伴突眼组（Ｄ）血清ｓＩＬ－２Ｒ明显升高；甲状腺机能减退症（甲减）经治疗甲状腺功能灭常组（Ｇ）ｓＩＬ－２Ｒ明显高于甲减未治疗组（Ｆ）；１０例毒性弥漫性甲状腺肿（Ｇｒａｖｅｓ病）患者经抗甲状腺药物治疗后ｓＩＬ－２Ｒ明显降低；Ｇｒａｖｅｓ病及甲减患者血清ｓＩＬ－２Ｒ均与ＦＴ＿３呈正相关。提示除自身免疫外，甲状腺素水平也是甲状腺疾病患者血清ｓＩＬ－２Ｒ水平的重要调节因素。     

自体甲状腺组织与干细胞移植治疗甲状腺功能减退症的研究进展

不可逆性甲减患者需要终身服用甲状腺激素，对患者的日常工作和生活造成了很大的不便。随着近年来对自体甲状腺组织与干细胞移植研究的进展，有望解决甲减病人终身服药这一问题。自体甲状腺组织移植的动物实验以及人体试验均表明：甲状腺移植物不但能够存活，而且能够发挥作用。最新的胚胎干细胞（Embryonic stemcell，ESC）研究证明，ESC可以分化为甲状腺滤泡细胞。     

重症SIRS患者的正常甲状腺病态综合征

目的：探索全身炎症反应综合征（SIRS）患者的正常甲状腺病态综合征（ESS）的发生规律。 方法： 测定50例SIRS病人的总三碘甲状腺原氨酸（TT3）、总四碘甲状腺原氨酸（TT4）、游离三碘甲状腺原氨酸（FT3）、游离四碘甲状腺原氨酸（FT4）、促甲状腺素（TSH），并根据是否多脏器功能障碍综合征（MODS）分组。计算急性生理和慢性健康评估Ⅱ（APACHEⅡ）评分，记录病人转归以及从发病到检测的时间（患病时间）。 结果： TT3或FT3降低的45例。TT3与APACHEⅡ评分呈对数负相关（r＝－0.330，P<0.05）,TT3/TT4与患病时间呈对数负相关（r=－0.316, P<0.05）。MODS组的TT3、TT4、FT3水平显著低于无MODS组（P<0.05）。 结论： SIRS和MODS病人发生低T3、低T4可能性大，反映炎症反应对甲状腺轴的影响，随着病情加重、患病时间延长，影响进一步深化。     

核辐射对机体的影响

机体受到一定剂量核辐射后会出现多个器官结构和功能的改变.本文综述了机体受到低剂量核辐射后出现的免疫细胞数量和功能变化,包括淋巴细胞总数和部分亚群数量、淋巴细胞转化率、血清免疫球蛋白含量以及单核细胞功能等变化.同时还综述了核辐射对内分泌及遗传的影响.     

Cyclooxygenase-2 in normal,hyperplastic and neoplastic follicular cells of the human thyroid gland

This study was undertaken to investigate cyclooxygenase-2 (COX-2) expression in follicular cells of the human thyroid. COX-2 expression was studied immunohistochemically in a total of 174 samples. COX-2 immunoreactivity was confined to the cell cytoplasm with the nuclei remaining unlabelled. COX-2 expression was observed in five cases (17.2%) of normal follicular cells and in one case (16.6%) of solid cell nests. Follicular carcinoma expressed COX-2 more frequently than follicular adenoma (93.4% vs 21.1%) (p0.001). A higher percentage of cases of papillary microcarcinomas up-regulated COX-2 in comparison with all papillary carcinomas (p0.05). However, we could not establish any relationships among COX-2, patients ages or lymph node metastases in papillary carcinomas. COX-2 expression was found in 12 (92.3%) poorly differentiated carcinomas and in 13 (92.8%) undifferentiated carcinomas. We found that COX-2 is not always useful as a marker of malignancy. Our results suggest that COX-2 plays a role in progression of all thyroid carcinomas, but in papillary carcinomas, seems more important only in the early stages. COX-2 expression in the undifferentiated carcinoma deserves special consideration due to its prognosis and to the fact that selective COX-2 inhibitors were found to enhance tumour response to radiation in some studies.     

Incidental langerhans cell histiocytosis of thyroid: case report and review of the literature

We report a case of a 42-yr-old woman with Langerhans cell histiocytosis (LCH) confined to the thyroid and associated with lymphocytic thyroiditis and a papillary microcarcinoma. This patient remains free of symptoms 14 mo after surgery. Thyroid LCH is rare. In children, it usually occurs as part of a multisystemic disease, whereas it is usually exclusive in adults. Isolated thyroid LCH is frequently associated with another thyroid disease, especially lymphocytic thyroiditis, suggesting that it is a reactive process rather than a neoplastic proliferation. The prognosis of isolated thyroid LCH is good. However, because it can rarely precede or reveal a multisystemic disease, additional investigations as well as a prolonged follow-up are justified.