Subject(s)
Emergency Medical Services , Geriatrics , Wounds and Injuries/therapy , Aged , Emergency Medical Technicians/education , Female , Humans , MaleABSTRACT
The subdermal implant is an effective delivery system for the gonadotropin-releasing hormone analog histrelin in the treatment of central precocious puberty. In younger patients, implantation and replacement of the implant is performed under general anesthesia. This obviates the need for frequent intramuscular injections and has been shown to be preferable to patients and families. However, the implantation procedures have been complicated by fracture during surgical withdrawal. This paper discusses one such case and the intraoperative technique that led to effective withdrawal of the fractured implant.
Subject(s)
Drug Implants/adverse effects , Gonadotropin-Releasing Hormone/analogs & derivatives , Puberty, Precocious/drug therapy , Administration, Cutaneous , Child , Gonadotropin-Releasing Hormone/administration & dosage , Humans , MaleABSTRACT
OBJECTIVE: To determine whether radiographic findings portend to metastatic disease in patients with papillary thyroid carcinoma (PTC) and whether cystic lymph node metastasis can be recognized by preoperative, ultrasound-guided fine-needle aspiration (FNA). METHODS: We performed a retrospective review of patients with cystic lymph nodes in the lateral neck identified on preoperative ultrasonography between March 1996 and December 2009. Factors examined included demographic information; stage; cytologic and final pathologic findings; and imaging characteristics including location, size, and presence of vascularity and calcifications. Time of cystic node identification in relationship to initial diagnosis was also recorded. RESULTS: Thirty patients had cystic lymph nodes in the lateral neck on cervical ultrasonography during the study period. Among this group, 28 (93%) had PTC, 1 (3%) had papillary serous carcinoma of the ovary, and 1 (3%) had poorly differentiated thyroid cancer. Median age at initial cancer diagnosis was 41 years (range, 16-64 years). Twenty-one patients (70%) were women, and median lymph node size was 1.8 cm (range, 0.6-4.8 cm). Twenty-three patients (77%) had a solitary cystic lymph node, and the remainder had more than 1 cystic lymph node. Cystic lymph nodes were identified at initial presentation in 11 patients (37%), while cystic lymph nodes were discovered in 19 patients (63%) after the initial operation. FNA was performed on the cystic lymph nodes of 23 patients (77%). Cytologic findings were positive for metastatic disease in 18 of 23 patients (78%). Among the 5 of 23 patients with negative cytologic findings, thyroglobulin aspirate was obtained in 1 patient, confirming metastatic PTC. Final pathologic review after surgical resection of cystic lymph nodes with negative cytologic findings from FNA was consistent with metastatic disease in 4 of 5 patients (80%). CONCLUSIONS: In patients with PTC, the presence of a cystic lymph node by ultrasonographic examination is highly suggestive of locally metastatic disease. Confirmation of metastatic PTC may sometimes be achieved with thyroglobulin aspirate from cystic lymph nodes when cytologic findings are negative. Clinicians should strongly consider surgical lymph node resection of cystic lymph nodes regardless of the preoperative cytologic findings by FNA.
Subject(s)
Head and Neck Neoplasms/diagnosis , Lymph Nodes/pathology , Lymphatic Metastasis/diagnostic imaging , Adolescent , Adult , Carcinoma , Carcinoma, Papillary , Female , Head and Neck Neoplasms/diagnostic imaging , Humans , Male , Middle Aged , Retrospective Studies , Thyroid Cancer, Papillary , Thyroid Neoplasms/diagnosis , Thyroid Neoplasms/diagnostic imaging , Ultrasonography , Young AdultABSTRACT
PURPOSE: To describe the sonographic characteristics of intramammary lymph node metastasis (ILNM) in patients with breast cancer and to assess the value of sonography and sonographically guided fine needle aspiration biopsy (FNAB) in their diagnosis. METHODS: We retrospectively reviewed the charts and films of 19 women with biopsy-documented ILNM who were seen in our breast diagnostic center between December 1999 and July 2003. The sonographic appearance of the nodes was analyzed and correlated with clinical and mammographic findings and with biopsy results. RESULTS: The ILNMs were clinically and mammographically occult in 7 (37%) of the 19 women. The diameter of the ILNMs was less than 1 cm in 15 (79%) cases. The volume of the central echogenic hilum was less than 50% of the total volume of the node in each of the patients. There was marked decrease in cortical echogenicity of the ILN in all cases. Metastatic involvement was established via sonographically guided FNAB in each of the 19 suspicious intramammary lymph nodes. CONCLUSION: Sonography and sonographically guided FNAB are valuable methods of assessment for ILNM in patients with known or suspected breast cancer. The most consistent sonographic features associated with ILNM were reduction in the volume of the central echogenic hilum and marked hypoechogenicity of the node's cortex.
