Are scintigraphy and ultrasonography necessary before fine-needle aspiration cytology for thyroid nodules?

To evaluate the effi cacy of scintigraphy, ultrasound and fi ne-needle aspiration in thyroid nodules and to establish the best diagnostic pathway in detecting thyroid cancer. Two hundred and sixteen patients with thyroid nodules were examined using high-resolution ultrasonography, 99mTc thyroid scintigraphy and ultrasound-guided fi ne-needle aspiration. Of these, 113 patients subsequently underwent thyroidectomy. The remaining 103 were followed up for two years without any evidence of malignancy. Cytopathology classifi ed 71% of the aspirate as benign, 3% as positive for malignancy, 21% as suspected neoplasia and 5% as unsatisfactory. Fine- needle aspiration cytology had a sensitivity of 87.5% and specifi city of 80%. On ultrasound 33% of malignant nodules were hypo-echoic and on scintigraphy 16% of solitary cold nodules were malignant. Neither test could reliably diagnose thyroid cancer. Ultrasound-guided fi ne-needle aspiration cytology should be the fi rst test performed in euthyroid patients with a thyroid nodule. Scintigraphy and ultrasound imaging should be reserved for follow-up studies and patients who have suppressed levels of thyroid stimulating hormone

Malignant otitis externa and temporal bone osteomyelitis: Complete recovery following the adjunctive use of hyperbaric oxygen and antibiotics

Malignant otitis externa is an uncommon potentially fatal infection of the external ear caused by Pseudomonas aeruginosa. It occurs usually in elderly diabetics and is followed by rapid invasion of the deep periauricular tissue and bone leading to osteomyelitis. We present such a patient whose disease persisted inspite of two months antibiotic therapy until the concomitant use of hyperbaric oxygen therapy was given over a period of four weeks. Complete recovery followed

role Gallium- 67 Whole body scintigraphy in secondary infections in HIV-positive patients

Secondary infections in HIV-positive patients are a major cause of morbidity and mortality. Early diagnosis of these secondary infections is the key to successful treatment and survival. The role of [67] Ga citrate scintigraphy is established as a screening method for opportunistic pneumonia. However, few reports have focused on abdominal [67] Ga imaging and there have been none from the Middle East. This study was designed to assess the role of [67] Ga citrate whole body scintigraphy [[67] Ga WBS] for detection of secondary infections in symptomatic and asymptomatic HIV-positive patients. Thirty-one [67] Ga Wbs studies > were performed on 28 HIV-positive patients; of whom 7 were asymptomatic and 21 were symptomatic. [67] Ga WBS studies were normal in the 7 asymptomatic patients. Abnormal [67] Ga WBS studies were obtained in 9 patients with myocobacteria, in 4 with pneumoncystis carinii, and in 6 with other organisms. [67] Ga WBS studies were normal in 3 patients with salmonella infection. In the symptomatic group as a whole, 18 [75%] showed abnormal abdominal uptake whereas only 12 [50%] showed abnormal chest uptake. [67] Ga WBS detects more lesions than [67] Ga thorax scintigraphy only. In this series the sensitivity and specificity of [67] Ga WBS for the detection of abdominal sites of secondary infections were 84% and 83% respectively, the positive predictive value was 88%, the negative predictive value was 70% and the accuracy was 81%. The examination is very useful in localizing the sites of infections in symptomatic patients