Thyroid cytology and histology

Fine needle aspiration (FNA) is an economical procedure that allows prompt evaluation of a thyroidal mass. Careful attention to each step of the aspiration will allow good specimens to be obtained. The cytopathologist should obtain the aspirates or else should accompany the clinician performing the aspirations. Unsatisfactory specimens should constitute less than 5% of the total. Reliable diagnoses can be made of papillary carcinoma, medullary carcinoma, anaplastic carcinoma, chronic lymphocytic thyroiditis, benign cystic lesions and the usual colloid-rich adenomatoid nodules. The diagnosis of follicular neoplasms and some cellular adenomatoid nodules remains problematical. Therefore, some thyroid operations inevitably yield benign follicular lesions.     

Long-term effect of mandibular midline distraction osteogenesis on the status of the temporomandibular joint, teeth, periodontal structures, and neurosensory function

Purpose: This study retrospectively evaluated the long-term effects of transverse symphyseal distraction osteogenesis (DO) on the temporomandibular joint (TMJ) symptoms, periodontal health, tooth vitality, and nerve injury after surgery.Patients and Methods: Twenty-three patients were treated with symphyseal DO during a 4-year period. Fifteen patients were available for follow-up from 7 to 45 months postoperatively (ave, 24.5 months). The patients were clinically evaluated for TMJ symptoms, periodontal pocket formation, tooth vitality and mobility, crestal bone loss, and attached gingival tissue changes. Radiographs of the mandibular anterior teeth were used to evaluate for periodontal bone loss, periapical lesions, or widening of the periodontal ligament (PDL).Results: Preoperatively, 47% of the patients had TMJ symptoms. No patient had symptom worsening or developed new symptoms postoperatively. Five patients' TMJ symptoms improved, and 3 experienced complete resolution of symptoms. No periodontal bone loss or soft tissue recession were evident. Tooth vitality was maintained in 13 patients. Two patients developed Class II mobility of 1 mandibular central incisor, 1 patient had tooth pain and a widened PDL adjacent to the osteotomy/corticotomy site, and 1 patient experienced mental nerve paresthesia.Conclusions: DO can be used to treat transverse discrepancies of the mandible with limited morbidity.     

Practice guidelines for patients with gastrointestinal surgical diseases

Conclusions The rauonale for practice gmdehnes has been elucidated It is hoped that these guldehnes will result in changes in chnlcal care Perhaps the origin of these guldehnes may be a cnucal factor m whether they become widely accepted. Our purpose in developing guldehnes for gastrolntesunal surgical disorders is to promulgate reformation that is needed to evaluate patients with diseases that require surgery and to provide mformatlon concerning expected outcomes following specific operattve procedures As pracuce patterns and technology evolve, these guldehnes will need to be changed accordingly.     

Distribution of scattered radiation during intraoral radiography with the patient in supine position

Objective. The purpose of this study was to investigate the spatial distribution of scattered radiation during intraoral radiography with the patient in a supine position to determine the exposure to an operator without a suitable barrier.Study Design. A phantom was placed in the supine position on a dental chair with the occlusal plane perpendicular to the floor, and four intraoral periapical radiographic examinations in the anterior and posterior regions of the maxilla and mandible were performed. The scattered radiation was measured with an ionization chamber at distances ranging from 25 to 200 cm at 25 cm increments and at intervals of 45 degrees. Measurements were made at two different heights: level with the occlusal plane and 30 cm below it. The exposure was converted to an air-kerma/absorbed dose in air.Results. The distribution of scattered radiation was symmetric during examinations of the anterior region. Circular iso-exposure curves of up to 0.5 μGy were observed at the level of the occlusal plane, and curves of up to 0.1 μGy were observed 30 cm below the plane. The lowest exposures were measured 30 cm below the occlusal plane and behind the chair. The distribution of scattered radiation was not symmetric during examinations of the posterior region. Iso-exposure curves of up to 0.25 μGy were observed at the level of the occlusal plane during exposure of the maxilla, and curves of up to 0.5 μGy were observed during exposure of the mandible. Circular iso-exposure curves of up to 0.1 μGy were observed 30 cm below the occlusal plane. Lower values for scattered radiation were observed 30 cm below the occlusal plane between 135 and 180 degrees behind the phantom.Conclusion. The spatial distribution of scattered radiation with the patient in a supine position was not the same in eight directions around the chair. Although the preferred position for the operator is behind a suitable barrier, the preferred position in the absence of a barrier is 200 cm behind the patient.