ABSTRACT
INTRODUCTION: Thyroid nodules (TN) are a prevalent pathology that can generate morbidity, in which case the traditional treatment is usually surgery. OBJECTIVE: To analyse the efficacy of radiofrequency ablation (RFA) treatment as a therapeutic alternative in the combined clinical, morphological, and functional control of predominantly solid, benign and clinically relevant TNs in patients not subsidiary to surgery. MATERIALS AND METHODS: A descriptive, retrospective, case series study was carried out to assess the efficacy and safety of the use of RFA. According to medical criteria, the selected patients underwent a clinical, ultrasound, and biochemical assessment prior to the procedure and then after the procedure at 1, 3, 6, and 12 months and then every 6-12 months according to medical criteria. RESULTS: A total of 100 RFA were performed on 83 patients with 85 TNs of ≥2.5â¯cm with an initial volume (IV) of 21.48⯱â¯15.89â¯ml. After a mean of 1.17 RFA sessions per TN, the volume decreased progressively and significantly (pâ¯<â¯0.01 for all times compared to the initial value), with a mean volume reduction rate (VRR) in relation to the IV of 54.43⯱â¯19.56% at 1-month follow-up; 67.69⯱â¯17% at 3 months; 70.38⯱â¯15.46% at 6 months; 70.67⯱â¯17.27% at 12 months and 70.24⯱â¯17.7% at the last follow-up. 88% of the patients followed up >6 months achieved the combined objective of a volume reduction rate of more than 50% of the VI, thyroid normal function and absence of clinic; and in all of these, it was maintained until the final follow-up date. Acute complications (mostly mild and all transient) were reported in 9 of the 100 RFA performed. CONCLUSION: Our findings validate in our setting the efficacy and safety of RFA in predominantly large and solid TNs, and add undescribed information to position the technique more favourably as a therapeutic alternative.
Subject(s)
Radiofrequency Ablation , Thyroid Nodule , Humans , Radiofrequency Ablation/methods , Retrospective Studies , Thyroid Nodule/surgery , Thyroid Nodule/pathology , Treatment OutcomeABSTRACT
BACKGROUND: Inferior petrosal sinus sampling (IPSS) is indicated in the diagnosis of adrenocorticotropic hormone (ACTH)-dependent Cushing's syndrome (CS), especially when the results of the initial diagnostic tests are discordant. OBJECTIVE: To describe the patients who underwent this invasive functional test in a tertiary hospital. METHODS: This was an observational study of a retrospective cohort of patients with ACTH-dependent CS and IPSS between 2004 and 2019. We determined their epidemiological, hormonal, radiological and functional characteristics, and evaluated their diagnostic capacity and optimal cut-off points to differentiate between Cushing's disease (CD) and ectopic Cushing's syndrome (ECS). RESULTS: 23 patients were evaluated, of which 65.2% were women with the average age of 42 (36-62) years. ACTH secretion of pituitary origin was evident in 82.6% of the patients and of ectopic origin in 17.4%. Plasma cortisol, urinary free cortisol, and ACTH levels were higher in patients with ECS. Regarding IPSS, the baseline central/peripheral ACTH gradient detected 89.5% of patients with CD and after stimulation with CRH, 100%. The optimal cut-off points in the diagnosis of CD were 2.06 at baseline and 2.49 after CRH stimulation. CONCLUSION: IPSS with CRH stimulation is a test with a high diagnostic accuracy for correctly classifying patients with CD and ECS. The cut-off points of the gradients may be different from the classic ones. Therefore, we recommend that each center perform its own evaluation.
Subject(s)
Corticotropin-Releasing Hormone/therapeutic use , Cushing Syndrome , Petrosal Sinus Sampling , Adrenocorticotropic Hormone , Adult , Cushing Syndrome/diagnosis , Female , Humans , Hydrocortisone , Male , Middle Aged , Pituitary ACTH Hypersecretion/diagnosis , Retrospective Studies , Tertiary Care CentersABSTRACT
Objectives . To determine the risk factors for arterial hypertension (HTN) in the adult resident population of the city of Cuenca, Ecuador Materials and methods A cross-sectional analytical study of adults selected via multistage random sampling who underwent clinical, anthropometric, and laboratory evaluations. The diagnosis of HTN was defined according to the JNC-7 criteria. A multiple logistic regression model was performed Results A total of 318 persons were included. The prevalence of HTN was 25.8% (males: 27.2% vs. females: 24.7%; p = 0.617). In the multiple logistic regression model, the risk factors for HTN were age > 60 years (OR, 8.68; 95% CI, 3.56-21.14; p < 0.001), obesity according to body mass index (OR, 2.36; 95% CI, 1.04-5.70; p = 0.042), high caloric intake (OR, 2.06; 95% CI, 1.01- 4.53; p = 0.044), and family history of HTN (OR, 1.58; 95% CI, 1.02-2.90; p = 0.040) Conclusions The presence of HTN in this population is associated with both intrinsic and environmental factors, which should be considered in routine evaluations to ensure its early identification and control.
Subject(s)
Hypertension/epidemiology , Adult , Aged , Body Mass Index , Cross-Sectional Studies , Ecuador , Female , Humans , Male , Middle Aged , Prevalence , Risk Factors , Urban PopulationABSTRACT
RESUMEN Objetivos Determinar los factores de riesgo para hipertensión arterial (HTA) en población adulta residente en la ciudadde Cuenca, Ecuador Materiales y métodos Estudio transversal analítico realizado en adultos seleccionados mediante muestreo aleatorio multietápico, a quienes se les realizó evaluación clínica, evaluación antropométrica y de laboratorio. El diagnóstico de HTA fue definido según los criterios del JNC-7. Se realizó un modelo de regresión logística múltiple Resultados Se incluyeron 318 personas. La prevalencia de HTA fue de 25,8% (hombres: 27,2% vs mujeres: 24,7%; p=0,617). En el modelo de regresión logística múltiple, los factores de riesgo para HTA fueron la edad > 60 años (OR 8,68; IC 95%: 3,56-21,14; p<0,001), obesidad según índice de masa corporal (OR 2,36; IC 95%: 1,04-5,70; p=0,042), alto consumo calórico (OR 2,06; IC 95%: 1,01-4,53; p=0,044) y el antecedente familiar de HTA (OR 1,58; IC 95%: 1,02-2,90; p=0,040) Conclusiones La presencia de HTA en esta población se asocia a factores intrínsecos como medioambientales, los cuales deben ser considerados en la evaluación rutinaria para la identificación y control temprano de esta enfermedad.
ABSTRACT Objectives . To determine the risk factors for arterial hypertension (HTN) in the adult resident population of the city of Cuenca, Ecuador Materials and methods A cross-sectional analytical study of adults selected via multistage random sampling who underwent clinical, anthropometric, and laboratory evaluations. The diagnosis of HTN was defined according to the JNC-7 criteria. A multiple logistic regression model was performed Results A total of 318 persons were included. The prevalence of HTN was 25.8% (males: 27.2% vs. females: 24.7%; p = 0.617). In the multiple logistic regression model, the risk factors for HTN were age > 60 years (OR, 8.68; 95% CI, 3.56-21.14; p < 0.001), obesity according to body mass index (OR, 2.36; 95% CI, 1.04-5.70; p = 0.042), high caloric intake (OR, 2.06; 95% CI, 1.01- 4.53; p = 0.044), and family history of HTN (OR, 1.58; 95% CI, 1.02-2.90; p = 0.040) Conclusions The presence of HTN in this population is associated with both intrinsic and environmental factors, which should be considered in routine evaluations to ensure its early identification and control.
