Serum TSH levels as a predictor of malignancy in thyroid nodules: A prospective study.

BACKGROUND: The role of serum TSH concentrations as a predictor of malignancy of thyroid nodule remains unclear. OBJECTIVE: To prospectively evaluate the usefulness of serum TSH levels as a predictor of malignancy in thyroid nodules. METHODS: Patients with thyroid nodule(s) who underwent fine-needle aspiration biopsy under ultrasonographic guidance in a tertiary, university-based hospital were consecutively evaluated. Patients with known thyroid cancer and/or patients receiving thyroid medication were excluded. Serum TSH levels were measured by two differents methodologies, chemiluminescent (CLIA) and electrochemiluminscent immunoassay (ECLIA). Anatomopathological exam of tissue samples obtained at thyroidectomy was considered the gold standard for the diagnosis of thyroid cancer. RESULTS: A total of 615 patients participated in the study. The mean age was 55.9±14.7 years, and 544(88.5%) were female. The median TSH values were 1.48 and 1.55 µU/mL, using CLIA and ECLIA, respectively. One-hundred-sixty patients underwent thyroidectomy and the final diagnoses were malignant in 47(29.4%) patients. TSH levels were higher in patients with malignant than in those with benign nodules in both TSH assays: 2.25 vs. 1.50; P = 0.04 (CLIA) and 2.33 vs. 1.27; P = 0.03 (ECLIA). Further analysis using binary logistic regression identified elevated TSH levels, a family history of thyroid cancer, the presence of microcalcifications, and solitary nodule on US as independent risk factors for malignancy in patients with thyroid nodules. Additional analyses using TSH levels as a categorical variable, defined by ROC curve analysis, showed that the risk of malignancy was approximately 3-fold higher in patients with TSH levels ≥2.26 µU/mL than in patients with lower TSH levels (P = 0.00). CONCLUSIONS: Higher serum TSH levels are associated with an increased risk of thyroid cancer in patients with thyroid nodules. Using TSH levels as an adjunctive diagnostic test for stratifying the risk of malignancy associated with a thyroid nodule may help on defining the best therapeutic approaches.

Prevalence of abnormal anal cytology in women infected with HIV.

Anal cancer is a rare disease. Nevertheless, it may be a reason for concern among groups in which its incidence is increasing: those who engage in anoreceptive intercourse, promiscuous persons, and those with sexually transmitted infections (HPV and HIV). The aim of this study was to evaluate the prevalence of abnormal anal cytology in women infected with HIV seen at Hospital de Clínicas de Porto Alegre, Brazil. A cross-sectional design was used. Anal smear screening was offered to all women infected with HIV seen at the hospital's outpatient sexually transmitted infections clinic from March 2006 to March 2008. A total of 184 patients were thus enrolled. Only patients who gave written consent were included in the study. The prevalence of abnormal anal cytology was 14.1% (26 patients). Twenty-two patients presented atypical squamous cells of undetermined significance, and four exhibited low-grade intraepithelial neoplasia. Initially, abnormal anal cytology was significantly associated with age, number of pregnancies, smoking, abnormal cervical cytology, CD4⁺ < 200 cells/mm³ and hepatitis C co-infection. After adjustment, only CD4⁺ < 200 cells/mm³ and smoking were found to increase the risk of altered anal cytology. The anal Pap method described is simple and can be used for screening in cohorts of HIV-positive women who are at risk of developing anal carcinoma, mainly those with CD4⁺ counts <200 cells/mm³ and smokers.

A citologia na prevenção do câncer anal / The cytology in anal cancer prevention

O câncer anal não tem sido considerado problema de saúde pública. No entanto, sua incidência vem aumentando em pessoas que praticam sexo anal receptivo, promíscuos e portadores de doenças sexualmente transmissíveis, principalmente HPV (papilomavírus humanos) e HIV (vírus da imunodeficiência humana). Nos últimos anos, em vários países, a incidência do câncer anal aumentou 1,5 vezes entre os homens e triplicou nas mulheres. Embora a literatura não reforce o rastreamento de rotina das lesões intraepiteliais anais nas populações de risco, seu uso racional baseia-se no sucesso obtido com o rastreamento por meio da citologia cervical na redução da incidência do câncer cervical. Neste artigo revisamos os métodos diagnósticos disponíveis e as possibilidades de tratamentos das lesões precursoras anais a fim de prevenir a evolução para o câncer anal. Os aspectos biológicos das lesões precursoras anais são semelhantes aos das lesões cervicais. Dessa forma, como o ginecologista é o principal responsável pelo acompanhamento das mulheres, poderia

Anal cancer was not considered a neoplasm of public health concern until recently. Nevertheless, it may be object of attention in groups in which its incidence is increasing: people who have anoreceptive intercourse, promiscuous people and people who have sexual transmitted diseases (HPV and HIV infection). The incidence of anal cancer increased 1.5 fold among men and tripled among women in recent years. Although there is no strong literature evidence that document the value of screening for ASILs (anal squamous intraepithelial lesions) in the risk population, the rationale screening relies upon the success of cervical cytology screening in the reduction of cervical cancer incidence. It was reviewed the availability of screening modalities that effectively diagnosis the precursor lesion and the possibility of treatments that can prevent ASILs from progressing to anal cancer. The biologic consequences of anal dysplasia or ASIL are considered analogous of those of cervical dysplasia so the gynecologists may contribute to this diagnosis and to the prevention of anal cancer.

Doença renal e síndrome de imunodeficiencia adquirida / Renal disease and acquired immune deficiency syndrome

Alteraçöes renais têm sido descritas em 10-30% dos pacientes com síndrome de imunodeficiência adquirida (AIDS). No presente estudo säo analisadas amostras de tecido renal de 13 pacientes com AIDS submetidos

Cancer pulmonar em paciente jovem: relato de um caso / Pulmonary cancer in young: a case report

Os autores relatam o caso de um homem de 27 anos de idade, näo fumante com história de derrame pleural recidivante, tosse e expectoraçäo sanguinolenta com quatro meses de duraçäo. Teve evoluçäo desfavorável indo ao óbito sem diagnóstico. Necrópsia evidenciou Carcinoma Epidermóide de pulmäo com metástases em múltiplos órgäos

Avaliaçäo de 23 pacientes com hidatidose / Evaluation of 23 patients with hydatidosis

Revisam-se os prontuários de 23 pacientes com hidatidose internados em dois hospitais gerais de Porto Alegre. Deu-se ênfase aos seguintes aspectos: idade, sexo, procedência, localizaçäo dos cistos identificados e sua relaçäo causal com os sinais e sintomas e alteraçöes bioquímicas, radiológicas, ultrasonográficas e cintilográficas apresentadas e as respectivas opçöes de tratamento. O local de procedência da maioria dos pacientes foi a regiäo sul do estado. Os cistos localizaram-se preferencialmente no fígado e pulmöes, isolados ou em associaçäo. Dor abdominal e hepatomegalia foram os principais achados em pacientes portadores de cistos hepáticos e dor torácica e hemoptise nos de cistos pulmonares. Para o diagnóstico da doença e da localizaçäo dos cistos, os exames mais úteis foram a reaçäo de Casoni, pesquisa de arco-5 por imunoeletroforese, radiografias de tórax e abdômen, cintilografia hepato-esplênica e ecografia abdominal A cirurgia provou ser o tratamento de escolha, apresentando os melhores resultados

Lipoma de língua / Lipoma of the tongue

Lipomas da cavidade oral säo raros e geralmente assintomáticos. Apresenta-se um caso de lipoma de terço anterior esquerdo da língua de uma mulher de 47 anos. Histologicamente, os lipomas säo compostos de células adiposas maduras. Sua etiologia é desconhecida. Após a excisäo cirúrgica completa näo há recorrência