The diagnostic accuracy of ultrasound guided fine-needle aspiration biopsy and intraoperative frozen section examination in nodular thyroid disease / Journal of the ASEAN Federation of Endocrine Societies

OBJECTIVES:To determine the diagnostic accuracy of combined ultrasound-guided fine needle aspiration biopsy (USG-FNAB) and intraoperative frozen section examinationin (FSE) in diagnosing malignant thyroid nodules.METHODOLOGY:Retrospective review of patients undergoing thyroidectomy with intraoperative frozen section examination following ultrasound guided fine-needle aspiration biopsy. Sensitivity, specificity, positive and negative predictive values and accuracy were calculated with respect to final histology.RESULTS: A total of 2,239 nodules were subjected to USG-FNAB at the Diabetes, Thyroid and Endocrine Center, St. Luke's Medical Center between January 2007 and December 2009. Two hundred fifty-one nodules were surgically excised following USG-FNAB. Frozen section examinations were taken from 90 of 251 nodules. The USG-FNAB yielded 90.3% (n=1,721) adequate specimens and 9.7% (n=185) inadequate specimens. The histologic examination of the 251 surgically excised nodules revealed 182 (73%) benign and 69 (27%) malignant nodules. The sensitivity, specificity, positive and negative predictive values and accuracy rate of USG-FNAB cytology are 70.3%, 92.8%, 76.5%, 90.4% and 87.2%, respectively. The diagnosis by frozen section was benign in 56 cases (62%), malignant in 10 cases (11%) and deferred in 24 cases (27%). By FSE, the sensitivity, specificity, positive and negative predictive values and accuracy rate are 83.3%, 100%, 100%, 96.4% and 96.7%, respectively. A diagnostic accuracy of up to 97.2% was achieved when USG-FNAB and FSE were combined and when their findings were concordant. When USG-FNAB and FSE diagnoses were discordant, the FSE showed superior accuracy (83.3%) than cytology (16.7%). In the group of nodules with indeterminate or inadequate cytology, the diagnostic accuracy of frozen section is 100%.CONCLUSION:Ultrasound guided fine-needle aspiration biopsy is an accurate preoperative test for the evaluation of nodular thyroid disease. It helps to distinguish malignant from benign lesions. The intraoperative frozen section is a valuable test for confirming the cytologic diagnosis. It is especially important in identifying malignant thyroid nodule in cases with indeterminate cytology. The combination of USG-FNAB and FSE greatly improves the accuracy rate in thyroid cancer detection.

Giant splenic artery aneurysm

SYNOPSIS: Splenic artery aneurysm (SAA) is an extremely rare vascular pathology. They are clinically important because of their potential for life-threatening rupture. The pathogenesis is not completely understood and its cause remains unknown. The size of SAA rarely exceeds three centimeters and giant SAA (measuring more than 10 centimeters) are extremely rare. We present a case of SAA larger than 12 centimeters, discuss its management and provide relevant literature. To our knowledge, this is the biggest reported SAA and the first documented case of a giant SAA in the Philippines.CASE SUMMARY: A 58-year-old male with history of essential hypertension and remote history of abdominal trauma was admitted for pain and a pulsatile mass at epigastrium and left upper abdomen. Examination of the abdomen noted pulsatile, nontender, fairly delineated mass at the left hypochondrium, a bruit was appreciated in the area, Traube's space was dull and splenic percussion sign was negative. Laboratory tests showed normal CBC and bleeding parameters, mild azotemia (that improved after hydration) and unremar kable elect rocardiogramand echocardiogram results. A multislice computed tomography scan with contrast of the abdomen revealed 10.0 x 6.4 centimeters aneurysmal dilatation at the distal third of the splenic artery with intraluminal thrombus formation. The diagnosis was splenic artery aneurysm. Patient underwent splenic aneurysmectomy, splenectomy and di s tal pancreatectomy Gross examinat ion showed an unruptured 12.2x8.0x6.0 centime ters fusiform splenicarteryaneurysm. Histopathology showed hyal inization and focal destruction of aneurysmal wall and this confirmed the diagnosis. Eight months postoperatively, patient was in good health.CONCLUSION: Early diagnosis and prompt definitive treatment is necessary in its management. This can only be instituted if SAA is considered in the differential diagnosis for pulsatile left hypochondriac mass.

The efficacy of multiple daily insulin injection (MDI) and patient's satisfaction with MDI regimen among Filipinos

BACKGROUND: The long term complications of diabetes lead to diminished quality of life. As a means to avoid these complicationss, insulin therapy had evolved into a specialized regimen to achieve physiologic control of blood glucose, the so-called Multiple Daily Insulin (MDI) regimen which is a relatively new technique in the Philippines. OBJECTIVE: To study the efficacy of Multiple Daily Insulin regimen in controlling plasma glucose and to evaluate patient's satisfaction with MDI regimen among Filipino type 2 diabetics who have been on MDI for at least 2 months. RESEARCH DESIGN AND METHODS: Filipino patients (n=107) with uncontrolled diabetes were included in the study protocol. The majority were male, more than 60 years old and had been diabetic for more than 6 years. The mean body mass index was 27 kg/m2 and the mean baseline HbA1c was 9.2% + 2.65. This prospective cohort study was conducted between January 2006 to September 2008 at Cebu Doctors University Hospital Out-Patient Department. Efficacy was evaluated by HbA1c and treatment satisfaction was assessed with the Diabetes Treatment Satisfaction Questionnaire (DTSQ). Enrolled patients were followed up at week 12, 24 and 48.                                                                                                       RESULTS: Mean HbA1c fell by 2.43 + 2.68 at week 12, 2.03 + 2.35 at week 24 and 1.73 + 2.23 at week 48 showing a statistically significant decrease of HbA1c among the 3 groups was not statistically significant (p = 0.52). The proportion of patients achieving an HbA1c of CONCLUSION: Multiple Daily Insulin Regimen is an effective treatment modality based on a significant lowering of HbA1c among the study population with uncontrolled type 2 diabetes mellitus. Patients were satisfied with the ragimen based on the positive treatment satisfaction. This, however, is contrary to popular belief that patients' quality of life is affected by insulin administration. Keywords: Multiple Daily Insulin Injection, Type Diabetes Mellitus, Treatment Satisfaction.