Initial experience of 3 tesla apparent diffusion coefficient values in differentiating benign and malignant thyroid nodules

Purpose:

To evaluate the role of diffusion‐weighted magnetic resonance imaging (DWMRI) in differentiating benign and malignant thyroid nodules using a 3 Tesla (T) MRI scanner.

Materials and Methods:

Twenty‐eight nodules in 25 patients and 14 healthy control cases were included in the study. DWMRI was acquired with 6 b values with a 3T MRI scanner. The apparent diffusion coefficient (ADC) values of the nodules were calculated from reconstructed ADC map images and were compared with the final histopathological diagnoses.

Results:

The mean ADC value of the benign nodules was 1548 ± 353.4 (×10^?6 mm²/s), and the mean ADC of the malignant nodules was 814 ± 177.12 (×10^?6 mm²/s). The normal thyroid tissue had a mean ADC value of 1323.43 ± 210.35 × 10^?6 mm²/s (958–1689 × 10^?6 mm²/s) in the healthy control group. The ADC values were significantly different among the three groups (P = 0.001). An ADC value of 905 × 10^?6 mm²/s was determined to be the cutoff value for differentiating benign and malignant nodules, with 90% (55.5–98.3) sensitivity and 100% (81.3–100.0) specificity.

Conclusion:

This study suggests that the ADC values of nodules measured with a 3T MRI scanner could help in differentiating benign thyroid nodules from malignant nodules. J. Magn. Reson. Imaging 2013;37:1077–1082. © 2012 Wiley Periodicals, Inc.

     

Remifentanil with thiopental for tracheal intubation without muscle relaxants

Tracheal intubation may be accomplished with remifentanil and a non-opioid IV anesthetic without a muscle relaxant. In this study, we evaluated in double-blinded, prospective, randomized manner the dose requirements for remifentanil with thiopental without muscle relaxant administration to obtain clinically acceptable intubation conditions and cardiovascular responses. After premedication with midazolam 0.03 mg/kg IV, 105 patients were randomized equally to one of three study groups, each receiving the following: remifentanil 2 micro g/kg (Group I), 3 micro g/kg (Group II), and 4 micro g/kg (Group III). Remifentanil was administered over 30 s, and anesthesia was induced with thiopental 5 mg/kg. Tracheal intubation conditions were assessed by the anesthesiologist performing the intubation as: (a) excellent, (b) satisfactory, (c) fair, and (d) unsatisfactory. There were no statistically significant differences among groups regarding to demographic data. Blood pressure and heart rate did not increase in any group after accomplishing intubation. There was a significant improvement in intubation conditions between Groups I and II, I and III, and II and III (P < 0.001). We conclude that remifentanil 4 micro g/kg administered before thiopental 5 mg/kg provided excellent or satisfactory intubation conditions in 94% of patients and prevented cardiovascular responses to intubation. IMPLICATIONS: We evaluated in a double-blinded manner the dose requirements for remifentanil with thiopental without muscle relaxants for obtaining acceptable intubation condition. Our results show that remifentanil 4 micro g/kg administered before thiopental provided excellent or satisfactory intubation condition in 94% of patients.     

No effect of GA-AS (904 nm) laser irradiation on the intact skin of the injured rat sciatic nerve

We evaluated the electrophysiological and histopathological effects of low-energy gallium arsenide (904 nm) laser irradiation on the intact skin injured rat sciatic nerve. Twenty-four male Wistar rats were divided into three groups (n=8 each). At the level of proximal third of the femur the sciatic nerve was crushed bilaterally with an aneursym clip (Aesculap FE 751, Tuttingen, Germany) for half a second. A gallium arsenide laser (wavelength 904 nm, pulse duration 220 ns, peak power per pulse 27 W, spot size 0.28 cm², pulse repetition rate 16, 128 and 1000 Hz; total applied energy density 0.31, 2.48 and 19 J/cm²) was applied to the right sciatic nerve for 15 min daily at the same time on 7 consecutive days. The same procedure was performed on the left sciatic nerve of same animal, but without radiation emission, and this was accepted as control. Compound muscle action potentials were recorded from right and left sides in all three groups before surgery, just at the end of injury, at the 24th hour and on the 14th and 21st days of injury in all rats using a BIOPAC MP 100 Acquisition System Version 3.5.7 (Santa Barbara, USA). BIOPAC Acknowledge Analysis Software (ACK 100 W) was used to measure CMAP amplitude, area, proximal and distal latency, total duration and conduction velocity. Twenty-one days after injury, the rats were sacrificed. The sciatic nerves of the operated parts were harvested from the right and left sides. Histopathological evaluation was performed by light microscopy. Statistical evaluation was done using analysis of variance for two factors (right and left sides) repeated-measures (CMAP variables within groups) and the Tukey–Kramer Honestly Significant Difference test (CMAP variables between laser groups). The significance was set at p 0.05. No statistically significant difference (p 0.05) was found regarding the amplitude, area, duration and conduction velocity of CMAP for each applied dose (0.31, 2.48 and 19 J/cm²) on the irradiated (right) side and the control (left) side, or between irradiated groups. Twenty-one days after injury there were no qualitative differences in the morphological pattern of the regenerated nerve fibres in either irradiated (0.31, 2.48 and 19 J/cm²) or control nerves when evaluated by light microscopy. This study showed that low-energy GaAs irradiation did not have any effect on the injured rat sciatic nerve.     

The effect of watching live arthroscopic views on postoperative anxiety of patients

Surgery is a stressful experience. Many minor interventions have been shown to cause considerable anxiety in patients, but whether arthroscopy leads to such anxiety is not well-known. Methods for lowering perioperative anxiety have been sought and listening to music or watching a movie have been recommended. The method of permitting patients to watch their own endoscopy has been studied infrequently. Our aim in this study was to find out the effect of watching simultaneous arthroscopic views on postoperative anxiety. A total of 63 patients were randomly divided into two groups: those watching their own arthroscopy formed group W, while patients that were only verbally informed formed group NW. The mean age of patients in both groups were 33 and 34, respectively. Meniscal surgery was the most commonly performed procedure (49/63 patients). The patients filled in state scale of State-trait anxiety inventory (STAI) forms and the study questionnaire (SQ) prepared for this study, just before and after the arthroscopy. Group W had significantly lower postoperative scores of STAI-S, whole questionnaire (Q-score) and all but one of individual statements in SQ. Having a previous operation history did not affect STAI scores. Age and level of education was not correlated with any of the studied parameters either. The ratio of patients that were pleased with the arthroscopy experience in group W and NW were 94 and 63%, respectively. Watching live arthroscopic views has led to a significant decrease in postoperative anxiety and worries about the surgery and the postoperative period, while increasing overall understanding and satisfaction of the patient.     

Renal antioxidant status in rats with hypertension induced by N sup omega nitro-L-arginine methyl ester

Nitric oxide (NO) has a role in the etiopathogenesis of hypertension. Relaxation of vascular smooth muscles is failed when NO production is reduced leading to increased vascular peripheral resistance. N sup omega nitro-L-arginine methyl ester (L-NAME) is one of the inhibitors of NO production. The aim of this study was to investigate oxidant-antioxidant systems of renal tissue in rats with hypertension induced by L-NAME. Rats were divided into three groups: control group and study groups treated with 100 or 500 mg/l L-NAME in drinking water for 15 days. The activities of catalase (CAT), glutathione peroxidase (GSH-Px) and superoxide dismutase (SOD), and the levels of malondialdehyde (MDA) and NO were studied in the renal tissue after hypertension induction. Arterial blood pressure was increased in both L- NAME groups. CAT activity of 500-mg L-NAME group was higher than control. GSH-Px activity of 500-mg L-NAME group was decreased compared with 100-mg ones. NO level was lower in 500-mg L-NAME group than control. MDA levels in both L-NAME groups were decreased compared with control. In conclusion, hypertension was induced with oral L-NAME treatment. Increased CAT activity was compensated with decreased GSH-Px activity in 500-mg L-NAME group. Both study groups were protected from lipid peroxidation with NO inhibition.     

Treatment of Anogenital Warts by Pulsed Dye Laser

BACKGROUND: Treatment of anogenital warts is difficult in that the disease spectrum is wide. Moreover, varying degrees of improvement are obtained. OBJECTIVE: To study the treatment of persistent anogenital warts by pulsed dye laser. METHODS: Pulsed dye laser was used with the following settings: spot size 7 mm, pulse duration 1500 microsec, and fluence 7.5 J/cm2. Two different wavelengths were used: 585 and 595 nm. RESULTS: Lesions healed completely using both wavelengths after one treatment. CONCLUSION: Pulsed dye laser has been found to be safe, effective, satisfactory, and less traumatic compared to other options for treatment of perianal warts in children.     

A New,T-Shaped Adaptor for Easy,Quick and Efficient Fat Harvesting During Liposuction

Although there is a controversy about success and failure of autologous fat tissue transfers, it is a widely accepted method for soft tissue augmentation and is performed by many plastic surgeons as well as dermatologists all around the world. Its advantages are that it does not cause reactions, its absorption rates have been reduced by increased knowledge, experience, and techniques, it can yield good, long-term results, and there are now preservation techniques that allow reinjections when necessary. However, no single ideal technique has been determined. In this paper a new, simple, T-shaped adaptor for easy, quick, and efficient fat harvesting during liposuction is described. This study not only describes the clinical use of the adaptor, but also histologically examines its effects on fat cells under various vacuum pressures (-250 mmHg, -500 mmHg, -700 mmHg). The study shows that the cell structure of fat tissue harvested under medium power (with vacuum pressures of -250 mmHg and -500 mmHg) is not disrupted, while that of tissue harvested with a vacuum pressure of -700 mmHg was traumatized and occasional cell wall fragmentation occurred. In conclusion, it is shown that the T-shaped adaptor allows harvesting of the desired amount of fat tissue without causing trauma to fat cells when it is used with medium-power suction.     

Cryopreservation of Hair Follicles at -20C°: Can It Work in Staged Hair Transplantation

Androgenic alopecia is a serious problem for a large proportion of the population, especially males, and causes them to seek medical help. Many methods have been described for treatment of androgenic alopesia. Among them are punch grafts, strip grafts, scalp grafts, scalp reductions, tissue expanders, and flap combinations, and hair transplantations with minigrafts and micrografts. The latter has become popular in the last two to three decades and has been investigated extensively. Improvements in hair replacement with minigrafts and micrografts may allow an ideal result with a nearly normal appearance. However, hair replacement with these grafts has important disadvantages. It requires a long operational time and only a limited number of grafts can be placed in one session. In this study, we investigated morphological structures of micrografts stored at 4 degrees C and those stored at -20 degrees C. We found that morphological structures of the grafts stored at 4 degrees C started to be impaired in the fifth day, but that the morphological structures of the grafts stored at -20 degrees C remained unaltered for 15 days. If this method is put into practice, the use of minigrafts and micrografts available will not only obviate the second graft harvesting, but also allow reconstruction of a large area in a short period of time.