Sequential treatment by polidocanol and radiofrequency ablation of large benign partially cystic thyroid nodules with solid components: Efficacy and safety

PurposeThe purpose of this study was to retrospectively evaluate the efficacy and safety of a sequential treatment including percutaneous polidocanol sclerotherapy and radiofrequency ablation (RFA) in terms of volume reduction and complication rate in large, benign, partially cystic thyroid nodules with solid components.Materials and methodFrom April 2017 to April 2019, 46 patients with 47 large benign partially cystic thyroid nodules underwent sequential treatment. There were 14 men and 32 women with a mean age of 49.9 ± 11.5 (SD) years (range: 18–75 years). The volume of initial nodules was 12.7 ± 12.3 (SD) mL (range: 2.16–75.62 mL). Volume reduction after percutaneous polidocanol sclerotherapy and further RFA was evaluated respectively. Patients had clinical and ultrasound evaluations at a follow-up time of 12.1 ± 5.3 (SD) months (range: 1.5–23.9 months). Technical success and complications were accessed retrospectively.ResultsAfter unsatisfying results with polidocanol sclerotherapy alone the 46 patients with 47 large benign partially cystic thyroid nodules had further RFA. Mean volume reduction of 47 nodules was 90.5 ± 11.3 (SD) % (range: 43.9–99.3%) one month after RFA, 94.9 ± 6.2 (SD) % (range: 66.9–99.5%) three months after RFA, and 95.8 ± 5.5 (SD) % (range: 71.0–99.8%) six months after RFA. No recurrence or nodule enlargement after RFA was observed at the last follow-up. The complication rate of RFA was 12.5% (8/46 patients), with minor complications only.ConclusionsThe sequential treatment regimen, including percutaneous polidocanol sclerotherapy and RFA, is an appropriate and safe treatment strategy for large benign partially cystic thyroid nodules with solid components.     

Enzymatic cytochemistry,DNA ploidy and AgNOR quantitation in hepatocellular nodules of uncertain malignant potential in liver cirrhosis

Conventional histological examination of echo-guided biopsy specimens can be inconclusive in small nodular lesions in cirrhotic livers. We investigated the diagnostic potential of cytochemical analysis of dipeptidyl-peptidase IV (DPP IV), of image analysis of nuclear DNA content, and of interphase silver-stained nucleolar organizer regions (AgNORs) in 12 cases of small (13- to 29-mm in diameter) hepatic nodules visualized in cirrhotic patients by ultrasonography. All cases underwent an echo-guided liver biopsy at the time of detection and in none of them were histological signs of malignancy found. Characterization with the above-mentioned techniques was always done at the time of histological examination. These patients underwent a mean (±sd) follow-up of 27.0 (±11.2) months after biopsy, with repeated ultrasound (US) examinations. In the seven patients with subsequent neoplastic growth, DPP IV score was altered in five of six; the fraction of mononucleated polyploid cells was altered in six of seven; and the AgNOR quantity exceeded the cutoff value of 4 m² in five of five cases. Among the five lesions whose US appearance remained unchanged during the follow-up, only one abnormality (AgNORs) was found in one case. The combined cytochemical analysis of DPP IV, nuclear DNA content, and quantitative evaluation of interphase AgNORs in biopsy samples may contribute to the differential diagnosis of hepatocellular nodules of uncertain type in the cirrhotic liver.This work was supported by grants from the Ministero per l'Università e la Ricerca Scientifica (fondi 40% e 60%) andA.I.R.C. (Milano).     

CT引导下空针导航联合平静呼吸法在肺亚厘米结节穿刺活检中的应用价值

 目的 探讨CT引导下空针导航联合平静呼吸法在穿刺活检肺亚厘米结节的应用价值。方法 选取2016-05至2018-10武警四川总队医院放射科诊断的肺亚厘米结节(≤1 cm)患者63例,在 CT引导下应用空针导航联合平静呼吸法进行穿刺取材,统计分析穿刺活检成功率、术后相关并发症及术后病理诊断结果。结果 空针导航联合平静呼吸法穿刺活检成功率为98.4%(62/63);术后气胸发生率20.6%(13/63),术后出血发生率31.7%(20/63);病例随访中均未发现感染或肿瘤播散转移等。成功穿刺活检的62例中:鳞癌4例,腺癌21例(原位腺癌3例),转移癌2例,恶性黑色素瘤1例;慢性炎性反应19例,肉芽肿性炎7例,粉尘沉着伴淋巴细胞增生5例,肺泡上皮增生2例,真菌1例。结论 对肺亚厘米结节患者采用空针导航联合平静呼吸法进行穿刺活检安全可靠且成功率高,是诊断早期肺癌的重要手段。     

软坚散结法治疗甲状腺结节有效性 和安全性Meta分析

目的:系统评价具有软坚散结功效的中药复方治疗甲状腺结节的疗效和安全性。方法:检索具有软坚散结功效的中药复方治疗甲状腺结节的RCTs,进行方法学质量评价并提取数据,用Revman5.3软件进行Meta分析。结果:纳入34篇临床随机对照试验。分析结果显示中药+西药组vs西药组、中药组vs西药组,在总有效率、甲状腺结节直径缩小方面差异有统计学意义。结论:中药治疗甲状腺结节疗效优于西药治疗,且不良反应少,相对安全。     

仝小林教授分类、分期、分证思想在甲状腺结节及甲状腺癌的治疗中的体现

甲状腺结节是指甲状腺细胞在局部异常生长所引起的散在病变。5%～15%的甲状腺结节为恶性。结合现代医疗,仝小林教授在传承传统辨证论治模式,又开启了“分类、分期、分证”的辨证辨病思想,系统阐述甲状腺结节及甲状腺癌的类型、发展及转归等内容,并构建基于甲状腺结节及甲状腺癌分类、分期(根据自然演变过程可以分为郁、瘀、虚3期)、分证思想体系指导下的甲状腺结节及甲状腺癌防治临床实践。分类、分期、分证思想综合考量疾病共性及患者个性,可为现代慢性病中医理论构建提供启示。     

A three-dimensional printing navigational template combined with mixed reality technique for localizing pulmonary nodules

OBJECTIVESLocalizing non-palpable pulmonary nodules is challenging for thoracic surgeons. Here, we investigated the accuracy of three-dimensional (3D) printing technology combined with mixed reality (MR) for localizing ground glass opacity-dominant pulmonary nodules.Open in a separate windowMETHODSIn this single-arm study, we prospectively enrolled patients with small pulmonary nodules (<2 cm) that required accurate localization. A 3D-printing physical navigational template was designed based on the reconstruction of computed tomography images, and a 3D model was generated through the MR glasses. We set the deviation distance as the primary end point for efficacy evaluation. Clinicopathological and surgical data were obtained for further analysis.RESULTSSixteen patients with 17 non-palpable pulmonary nodules were enrolled in this study. Sixteen nodules were localized successfully (16/17; 94.1%) using this novel approach with a median deviation of 9 mm. The mean time required for localization was 25 ± 5.2 min. For the nodules in the upper/middle and lower lobes, the median deviation was 6 mm (range, 0–12.0) and 16 mm (range, 15.0–20.0), respectively. The deviation difference between the groups was significant (Z = −2.957, P = 0.003). The pathological evaluation of resection margins was negative.CONCLUSIONSThe 3D printing navigational template combined with MR can be a feasible approach for localizing pulmonary nodules.     

基于聚类分析和因子分析的肺小结节患者中医证候特点研究

目的分析肺小结节患者中医证候分布特点,为中医治疗肺小结节提供参考依据。方法收集385例肺小结节患者中医四诊信息,运用聚类分析、因子分析方法对肺小结节患者的中医证候特点和分布规律进行分析。结果肺小结节患者中医症状以虚为主,神疲乏力、夜寐不安、舌红、咳嗽、口渴、口干咽燥、面萎黄、气短、脉细弱、食少纳呆等居多。中医证候以肺脾气虚证最多,占52.2%,其余依次为肺阴亏虚证、气虚血瘀证、肝肾不足证。肺脾气虚证主症为喘息、大便稀溏、腹胀、食少纳呆、神疲乏力、自汗、舌淡红、齿痕舌、苔薄白、脉细弱,次症为夜寐不安、面萎黄;肺阴亏虚证主症为口干咽燥、口渴、咳嗽、痰少难咳、盗汗、痰中血丝、裂纹舌、苔少、脉细,次症为烦躁易怒、面红润、舌红;气虚血瘀证主症为头晕、胸痛、气短、面晦黯、舌黯红,次症为心悸;肝肾不足证主症为胸胁隐痛、喜太息、脉细弦、苔白、腰膝酸软、胸闷、耳鸣、便秘,次症为浮肿。结论肺小结节中医证候以肺脾气虚证、肺阴亏虚证、气虚血瘀证、肝肾不足证为主,正气亏虚是肺小结节变化发展的主要病机。