Apport de la radiologie au diagnostic étiologique des hypertensions artérielles d'origine surrénalienne

Radiological investigation of adrenal causes of hypertension includes the widely accepted adrenal arteriography and venography, and also the new techniques of echotomography and computerised axial tomography.The choice of investigations is determined by the patients'clinical and biological profiles.In all cases, the initial investigation should be computerised axial tomography or, according to some authors, echotomography.When pheochromocytoma is suspected, adrenal arteriography should be requested as most pheochromocytomas are hypervascular.On the other hand, patients with suspected primary hyperaldosteronism should undergo adrenal venography. It is the only technique currently capable of diagnosing a very small adrenoma by either the angiography or the very selective blood sampling that may be performed at the same time.     

Course studies in patients with cytologically inconspicuous, decreasingly accumulating struma nodes

In 100 patients with inconspicuous findings of a thin-needle puncture of the thyroid gland after 2 years a clinical and cytological after-examination was performed. All test persons were primarily recommended a treatment with thyroid hormone. During the control in no case references to malignant process of the thyroid gland were the result, so that the puncture cytology also retrospectively showed a high exactness. Meanwhile 16 test persons had been strumectomized, in which cases the present histological findings always showed only regressive changes. The clinical after-examination confirmed former results so that also in decreasingly and not accumulating struma nodes a conservative approach is not promising a success. In 12 patients by application of hormones of the thyroid gland the struma had completely receded.     

Various aspects of the diagnosis and treatment of autoimmune thyroiditis

The authors conducted 4-year investigation of patients with autoimmune thyroiditis. All the patients were women aged 28 to 68 with the duration of disease from 5 mos to 10 yrs. Combined diagnostic methods included radioactive iodine absorption, scanning, puncture biopsy, indirect thyroidolymphography. Antibodies to thyroglobulin, T3, T4, and TTH were determined by RIA. Chronic thyroiditis was diagnosed in all the patients. The authors proposed a method of intraparenchymatous administration of steroid agents into the thyroid. This method was shown to be simple, effective, causing no complications. Conservative therapy of Hashimoto's thyroiditis should be performed not more than 2 years and not less than one year.     

Diagnosis of malignant thyroid tumors by indirect thyroid lymphography

Indirect thyroidolymphography was used for 38 patients with malignant thyroid tumors. A conclusion has been made that indirect lymphography of the thyroid is a simple and rather informative diagnostic method for malignant thyroid tumors and should be followed by spot biopsy.     

Combined clinical, thyroid ultrasound and cytological features help to predict thyroid malignancy in follicular and Hupsilonrthle cell thyroid lesions: results from a series of 505 consecutive patients

OBJECTIVE: The cytological patterns of follicular and Hupsilonrthle cell nodules are included among the indeterminate results of fine-needle aspiration cytology, because distinction between benign and malignant lesion can only be made on histological criteria. The diagnostic value of atypia at cytology, clinical parameters and echographic patterns were examined to establish the risk of malignancy in 505 patients with follicular and Hupsilonrthle cell thyroid nodules at cytology. DESIGN AND PATIENTS: The study included 505 consecutive patients who had undergone thyroidectomy from the period 2002-2005. RESULTS: Histological diagnosis of malignancy was carried out in 125 of 505 (25%) patients, the follicular variant of papillary carcinoma being the most frequent histotype. Only atypia at cytology (P < 0.0001) and spot microcalcifications at ultrasound (P = 0.009) were predictive of malignancy. Male gender, normal thyroid volume, single nodularity, nodule hypoechogenicity, size and blurred margins were associated with malignancy, although not significantly. An arbitrary clinical score allowed the identification of patients with high (41%, 110 patients) and low (16%, 242 patients) risk of malignancy. Combining the clinical score with the presence of atypia at cytology we could identify 30 patients (6%) in whom the risk of malignancy was as high as 63%. CONCLUSIONS: Twenty-five per cent of patients with a cytological result of follicular and Hupsilonrthle cell thyroid lesion had a final diagnosis of malignancy. Only atypia at cytology and spot microcalcifications at thyroid ultrasound were significantly associated with malignancy. Other clinical parameters and thyroid ultrasound patterns can be used to set up a clinical score useful for predicting the individual risk of malignancy before surgery.     

The clinical "masks" of Hashimoto's goiter (the problems of diagnosis)

Retrospective analysis of 240 case records of patients with histologically verified Hashimoto's disease has shown that in 62% it was masked by some other thyroid diseases, especially by multinodular and nodular euthyroid goiter. The most effective diagnosis before operation was made in patients using fine needle aspiration puncture biopsy whereas other methods were auxiliary.     

Cervical artery exploration: choice and need for a non-invasive technique

The different non-invasive exploratory techniques for cervical arteries are compared and classified as hemodynamic exploration methods (continuous and pulsed Doppler testing, frequency profile analysis, oculoplethysmography), and imaging methods (ultrasonic and real-time echotomography imaging). We believe that the best results can be obtained by associating frequency profile analysis with real-time echotomography or Doppler testing with real-time echotomography. The choice between these combined modalities is determined by the clinical context and particularly whether the patient is symptomatic or not. Angiography and therapeutic strategy may be indicated either immediately after a Doppler test or after more extensive examination.     

Complex use of ultrasound tomography in the algorithm of diagnostics for patients with acute destructive pancreatitis]

The article describes the experience of puncture aspiration biopsy in 136 patients (110 males and 26 females at the age of 19-74) with suspected destructive pancreatitis in one-day inpatient conditions, followed by microscopic and microbiological tests. In order to increase the diagnostic accuracy when detecting necrotic zones, 49 patients were examined by ultrasonic tomography using the color Doppler mapping and the method of energetic Doppler with subsequent spot puncture. The results of microbiological and cytological tests of the smear materials taken by fine-needle aspiration under ultrasonic control enable the authors to use the most efficient antibacterial therapy as well as to support the strategy of surgical treatment of destructive pancreatitis in its various forms in the conditions when clinical differential diagnosis is complicated. These methods increase the efficacy of medical treatment for this category of patients.     

Evidence of autoimmunity in chronic periaortitis: a prospective study

BACKGROUND: Chronic periaortitis includes idiopathic retroperitoneal fibrosis, inflammatory aneurysms of the abdominal aorta, and perianeurysmal retroperitoneal fibrosis. It is considered to be due to advanced atherosclerosis, but is often associated with systemic autoimmune disorders. METHODS: We studied 16 consecutive patients who were diagnosed with chronic periaortitis by computed tomography. Each patient underwent a physical examination, routine laboratory tests, measurement of autoantibodies, thyroid echotomography, and chest radiography. Aortic wall or periaortic retroperitoneal samples from 9 patients who underwent surgery were available for histologic examination and immunohistochemical characterization of the inflammatory infiltrate. RESULTS: Twelve patients had constitutional symptoms, 14 had an elevated erythrocyte sedimentation rate, and 13 had an elevated C-reactive protein level. Antinuclear antibodies were positive in 10 patients. Three patients had autoimmune thyroiditis, and 1 had seropositive rheumatoid arthritis. Antineutrophil cytoplasmic antibodies were positive in 3 patients who presented with rapidly progressive renal failure. Pathologic examination of the aortic and periaortic specimens revealed moderate to severe inflammatory infiltration, mainly consisting of B cells and CD4(+) T cells. Vasculitis with fibrinoid necrosis involving the aortic vasa vasorum and the small and medium retroperitoneal vessels was found in seven of the nine histologic samples. CONCLUSION: These clinical and pathologic features support the hypothesis that, at least in some patients, chronic periaortitis is a systemic autoimmune disease, perhaps involving a vasculitic process of small and medium vessels.     

Follow-up study of thyroid function in polytransfused thalassemic patients

The aim of our investigation was to evaluate thyroid function by a follow-up study in 45 polytransfused thalassemic patients, since endocrine abnormalities are frequent consequences of iron overload in thalassemia major. Significant changes of thyroid function have been revealed in the time elapsing the observation, despite unchanged haematological parameters; at the end of the present study five patients were affected by overt hypothyroidism and 15 patients by subclinical hypothyroidism. Ultrasound thyroid volume in 13 randomly selected patients was greatly reduced, while thyroid Magnetic Resonance Imaging (MRI) was not able to detect tissue alterations. Inversely, liver MRI was markedly reduced in 14 patients and negatively related to ferritine levels (P< 0.01). We conclude that polytransfused thalassemics are frequently affected by thyroid disfunction; haepatic haemosiderosis due to iron overload seems influence hormonal peripheral metabolism, although the patients display a moderate compliance with iron chelation therapy. Therefore, periodic thyroid investigation should be carried out in thalassemic subjects in order to detect patients who need hormone replacement therapy.     

Ultrasonic examination of the thyroid gland: Possibilities and limitations

In 440 patients with various thyroid disorders scintiphotography and ultrasonography were carried out. For ultrasonic examination both the A-mode and B-mode display technics were employed. Included in the study were 324 patients with hypofunctioning solitary nodules; a histopathologic diagnosis could be obtained in 151 of these. The method proved to be especially valuable for differentiating between solid and cystic nodules. This is of practical importance because completely cystic nodules are nearly always benign and may be treated by thin needle puncture with aspiration of the cyst fluid. In addition, ultrasonography is of some value in making a better functional classification of nodules, better estimating the size of the thyroid and in the follow-up of patients with various thyroid disorders who are under treatment or untreated. Differentiating between benign and malignant solid nodules was not possible with the technic used. The examination can be safely carried out in pregnancy. The limitations of the technic are discussed.     

加强老年甲状腺疾病研究，提高临床诊治水平

老年甲状腺疾病谱涉及甲状腺功能减退症、甲状腺功能亢进症、甲状腺结节、甲状腺癌等。与非老年患者相比较,老年甲状腺疾病患者有其自身的病情特点,异质性较大,治疗方案及控制目标需要个体化。应积极开展针对老年甲状腺疾病的研究工作,以更好地提高临床诊治水平。     

Tissue identification of carotid lesions using ultrasound

Technical progress in echotomography has made it possible to identify a number of structures within the atheromatous lesion itself. Such echotomographic data were compared with peroperative findings and histology of the endarterectomy specimen in the context of carotid pathology. Appearances were differentiated in terms of the density and homogeneity of the echos obtained. Heterogeneous and relatively undense lesion corresponded in the majority of cases with moveable intraluminal matter or intraplaque hematomas. False negatives were due in one case to technical impossibility (calcifications) and in one case to multiple ulcerations. Regular and homogeneous appearances corresponded to fibrous plaques, rich in collagen and free of potential emboligenic material. Preoperatively, echotomography may be used to assess the histological characteristics of a plaque with a high degree of sensitivity and good specificity. This new approach may help in the choice of treatment and will improve knowledge of the natural history of carotid lesions necessary for the study of preventive treatment, in particular in asymptomatic patients.     

Histopathological characterization of carotid plaques echotomography

The positive correlation between cerebral ischemia and carotid atherosclerosis of extracranial tract has been well established. The reliability of echotomography as diagnostic and prognostic tool in the evaluation of the carotid atherosclerotic lesions is now intensively investigated. Most of the attention has been payed to the accuracy in the determination of the carotid stenosis. A percentage of cerebrovascular accidents do not correlate to the vascular stenosis but to the other modifications induced by the atherosclerotic plaque, such as the release of emboli, acute stenosis for intraplaque haemorrhage or thrombosis. Thus the evaluation of the composition of the plaque may represent a good prognostic tool. In the present study, fifty-two carotid obtained at surgery from patients, who preoperatively underwent ultrasonographic scanning of both carotid arteries, were examined by histological methods. In calcified tissues a significant correlation between findings obtained with both techniques was observed. In the complicated plaques atheromasic gruel, intraplaque haemorrhages and thrombosis could not be discriminated by echotomography.     

Neovascularization is not a major cause of varicose vein recurrence

Neovascularization is often seen as an important cause of varicose vein recurrence. Is this a convenient expression to explain some bad results in surgery? This clinical retrospective study (from 1/1/94 to 12/31/98) included 1880 patients (1348 females: 71.7%, 532 males: 28.3%, with the median age of 52) who received limb varicose vein operations. 2455 legs were operated on (575 bilateral). 1122 out of the 1880 patients (60.3%) were assessed by echotomography, 84% of them by the same investigator. All the recurrences were confirmed by echotomography. Surgical interventions consisted of long saphenous vein (LSV) stripping: 1822 (74.2%) and short saphenous vein (SSV) stripping: 304 (12.4%). Recurrence in LSV area was 258 (10.5%), in SSV area: 36 (1.5%), and miscellaneous perforators: 35 (1.4%). 91% of the patients showed good result. Bad results (9%) were documented by echotomography and were encountered in neglected lesions, multiple recurrences and obesity. Neovascularization was never observed, but in 14 cases (4.2%) was a primary cause of recurrence. In spite of the serpentine vessels at the saphenofemoral junction (SFJ), there was always a stump to function as a “feed faucet.” Thirty three recurrences (1.3%) localized at the groin area were due to perineal veins connected to the hypogastric system. Neovascularization, considered a normal process, is unable to remodel the anatomy of the SFJ. Prevention of neovascularization is incumbent upon accurate interpretation of duplex scanning, total resection of tributaries and a stripping of saphenous trunk.     

甲状腺细针抽吸细胞学检查及临床应用评价

本文复习甲状腺细针穿刺活检方法 ,超声引导细针穿刺和常见甲状腺疾病的细胞病理学特点。并对其临床应用价值进行了讨论。     

Color Doppler ultrasonography: diagnosis of ectopic thyroid gland in patients with congenital hypothyroidism caused by thyroid dysgenesis

The etiology of congenital hypothyroidism (CH) may play an important role in determining disease severity, outcome, and, therefore, its treatment schedule. Radionuclide imaging (RI) is currently the most precise diagnostic technique to establish the etiology of CH. Conventional ultrasound can identify an athyrotic condition at the normal neck position and has gained acceptance for the initial evaluation of CH; however, its ability in delineating ectopic thyroid is limited. We used color Doppler ultrasonography (CDU) to assess blood flow and morphology in the detection of ectopic thyroid in 11 CH patients disclosed by neonatal screening; thyroid glands were undetectable at the normal location by gray-scale ultrasonography (GSU). The patients studied consisted of two infants for initial investigation and nine children for reevaluating the cause of CH. All of the patients underwent GSU, CDU, RI, and magnetic resonance imaging (MRI) investigation. We set RI as the defining diagnostic test for detecting ectopic thyroid and compared the imaging of CDU with those of GSU and MRI. The results of RI showed 10 ectopic thyroids and one athyreosis. In the patients with ectopic thyroid, the sensitivity of CDU, GSU, and MRI for detecting ectopic thyroid was 90, 70, and 70%, respectively. We conclude that CDU is superior to GSU and MRI for detecting ectopic thyroid and that CDU may be adopted as the diagnostic tool for the initial investigation of suspected CH.     

Thyroid structure and size and two-year follow-up of solitary cold thyroid nodules in an unselected population with borderline iodine deficiency

OBJECTIVE: Multinodular goitre has been found with a high prevalence in iodine-deficient areas, but less frequently in iodine-replete areas; the iodine intake sufficient to prevent goitre has not been established, however. METHODS: We report data from an ultrasonic investigation of the thyroid glands of 2656 randomly selected subjects aged 41 to 71 years in an area with borderline iodine deficiency. RESULTS: Median iodine concentration in spot urine samples was 70microg/l. Multinodular thyroid structure was found in 23% of the population, increasing in women from 20 to 46% with increasing age, and in men from 7 to 23%. Solitary, scintigraphically cold, thyroid nodules >10mm were found in 2.4% of the population with the same prevalence in the different age and sex groups. Two years of follow-up of these cold nodules revealed no signs of malignancies. Median thyroid volume was 11.0ml. Thyroid enlargement (>18ml for women and >25ml for men) was found among 13. 1% of the women and 6.2% of the men, and the prevalence increased with age. The presence of thyroid nodules was related to positive anti-thyroperoxidase antibody (TPO Ab) titres, whereas thyroid enlargement was associated with iodine excretion <50microg/day. CONCLUSIONS: Thyroid enlargement was associated with low iodine excretion and median thyroid volume was slightly increased compared with iodine-replete areas. Multinodular thyroid structure was found with a high prevalence and was associated with TPO Ab >200kU/l. Cold thyroid nodules were moderately prevalent, with no cases of detected malignancies during 2 years of follow-up.     

Ultrasonic study of the liver, spleen and their large veins in patients with chronic post-infarct aneurysm of the left ventricle

Computerized echotomography demonstrated abnormal structure or size of the liver, the spleen or major hepatic and splenic veins in all patients with left ventricular chronic postinfarction aneurysm. Notably, congestion of the greater circulation can be detected instrumentally at a preclinical level. Flow impairment in the vena cava inferior affects acoustic properties of blood which can be detected by ultrasound.