Surgeon-performed ultrasound in the management of thyroid malignancy

Surgeon-controlled real-time ultrasound (US) is a new adjunct in the management of patients with thyroid malignancy. The introduction of US as a routine evaluation tool has increased the recognition of nonpalpable thyroid cancers and cervical lymph node metastases. We report our experience and the change in management of patients with thyroid cancer due to the use of US. We reviewed the records of all patients undergoing neck operations for thyroid cancer since 2002. US was performed by a surgeon preoperatively in all patients and intraoperatively when non-palpable cervical lymph nodes were present. Suspicious nonpalpable thyroid nodules underwent US-guided fine-needle aspiration (FNA) for cytology. Seventy-two patients underwent operations for thyroid cancer. US influenced the management in 57 per cent (41/72) of patients. US was useful in 1) identification and guidance for the FNA of nonpalpable cancers in 28 per cent (20/72), 2) identification of nonpalpable nodules in the contralateral lobe in 38 per cent (27/72), 3) preoperative diagnosis of nonpalpable metastatic lymph nodes in 24 per cent (17/72), and intraoperative guidance for their excision. Surgeon-performed US changed and enhanced the pre- and intraoperative management in more than half the patients with thyroid cancer.     

Diffuse hepatic hemangiomatosis--case report

Hemangiomatosis of the liver is growing in the last decades, because of the abdominal imaging progresses: brain CT scan, MRI. In the presented case, the onset was with symptoms and biochemical disorders characteristic for acute viral hepatitis, with negative serological markers for the A and B hepatitis viruses. The persistence of the clinical symptoms and of the hepatic and biliary retention tests, determined the abdominal echography; which orient the diagnosis to vascular tumour with liver metastasis. Intraoperatively was found: diffuse hemangiomatosis of the liver. The patient didn't benefit from liver transplantation and died due to subfulminant hepatic failure.     

Colonic diverticulosis--current issues in etiopathogenesis, diagnosis and treatment

Diverticular disease of the colon, which is an acquired disorder caused by mucosal herniation through the colonic wall, has been termed both a "disease of the 20th century" and a "disease of Western civilization" due to its increasing prevalence in modern times and its striking geographical variability. There are complex relations between colonic structure, motility, and dietary factors, and it is likely that all of these play a role in the pathogenesis to a greater or lesser degree. Although present in two thirds of the elderly population, the large majority of patients will remain entirely asymptomatic. Nonetheless, 20% of those affected may manifest clinical illness and complications. Barium exploration indicates the extent and severity of colonic diverticular disease. Colonoscopy is preferred in positive diagnosis of uncomplicated diverticulosis. Computed tomography is especially useful in complicated diverticular disease. The use of high fibre diets in the prevention and treatment of the symptoms of diverticular disease has now become commonplace. The morbidity and mortality associated with complications, demand that this condition should receive greater attention in terms of aetiology, prevention and management.     

Autoimmune hepatitis: new diagnostic and therapeutic approach

Autoimmune hepatitis is a self-perpetuating hepatocellular inflammation. The diagnosis is established by a number of diagnostic criteria, defined by the International Autoimmune Hepatitis Group, and the exclusion of other causes of chronic hepatitis. There are two fundamental goals in therapy: induction of remission and maintenance of remission. The standard initial treatment is prednisone monotherapy or combination therapy with prednisone and azathioprine, which induce a clinical, biochemical and histologic remission in 65-87% of patients within 3 years. Other typical treatment endpoints in autoimmune hepatitis are an incomplete response, treatment failure and intolerance of the administrated drugs. If the treatment results are unsatisfactory, liver transplantation and alternative drugs such as Cyclosporin A, tacrolimus, cyclophosphamide, mycophenolate mofetil, budesonide, ursodeoxycholic acid should be considered; however, efficacy in clinical trials has not been shown. Future investigations must focus on the clarification of pathogenic mechanisms, characterization of target autoantigens, identification of host susceptibility factors, and assessment of alternative treatment strategies.     

Right versus left internal jugular vein catheterization for hemodialysis: complications and impact on ipsilateral access creation

This study investigated whether the anatomical differences between right and left internal jugular vein catheterization (RJVC and LJVC) would lead to differences in the frequency of complications, in particular, central vein occlusion (CVO). A group of 479 jugular vein catheterizations, 403 RJVC and 77 LJVC done in 294 prevalent hemodialysis patients were analyzed. A right-sided carotid pseudoaneurysm was the only major puncture-related complication. A total of 78 RJVC and 17 LJVC were inserted more than once in the same position. Of the RJVC, 44 (10.9%) of 403 were removed because of infection compared with 16 (20.8%) of 77 LJVC (P < 0.02). The overall incidence of infections was 1.58 episodes of infection per 1000 catheter days, 1.57 for RJVC and 3.72 for LJVC, respectively. Catheter dwell times were not different. A group of 127 patients with former RJVC and 44 with LJVC had ipsilateral arteriovenous access (RJVC+ and LJVC+ group, respectively). Four diabetic LJVC+ developed severe arm swelling secondary to CVO leading ultimately to access ligation. The RJVC+ group had no access ligated. LJVC may cause CVO in diabetics.     

Molecular detection of prostate cancer: a role for GSTP1 hypermethylation

OBJECTIVE: Prostate cancer is a leading cause of cancer-related mortality and morbidity in Western world. Curative treatment is feasible provided the disease is diagnosed in its earliest stages, but current screening methodologies are characterized by low specificity. DNA-based markers are a class of new and promising tools for cancer detection. Promoter hypermethylation is a common epigenetic alteration affecting cancer-related genes. METHODS: We critically reviewed the most relevant reports on prostate cancer detection using DNA methylation analysis in prostate tissue and body fluids. RESULTS: The epigenetic silencing of the glutathione-S-transferase P1 (GSTP1) gene is the most common (>90%) genetic alteration so far reported in prostate cancer. Methylation-specific PCR (MSP) methods allowed for the successful detection of GSTP1 methylation in body fluids (serum, plasma, urine, and ejaculates) from prostate cancer patients. In addition, the development of highly specific quantitative MSP assays augmented standard histopathology for the diagnosis of prostate cancer in tissue biopsies, accurately distinguishing benign from malignant prostate lesions. CONCLUSIONS: Further advances in the epigenetic characterization of prostate cancer are likely to yield powerful tools for patient diagnosis and management.     

Impact of reversible trapping of tracer and the presence of blood metabolites on measurements of myocardial glucose utilization performed by PET and 18F-fluorodeoxyglucose using the Patlak method

In this study we demonstrated that significant egress of FDG from myocardium occurs within the first hour after tracer injection leading to nonlinear Patlak plots. There are also significant amounts of acidic FDG metabolites present in the blood. However, the impact of these metabolites on the estimates of myocardial glucose utilization (MGU) is negligible. Although further studies will be required to elucidate the reason for the egress of tracer from myocardium, not accounting for it will result in erroneous estimates of MGU.