Natural history of asymptomatic carotid plaque. Five year follow-up study.

A prospective analysis of 296 carotid arteries in 293 asymptomatic patients was undertaken using real-time B-mode ultrasonography. All patients had carotid bifurcation disease and were followed for an average of 46 months. The endpoint for follow-up was a transient ischemic attack or stroke. Patients were categorized according to degree of stenosis (greater or less than 75 percent) and morphologic plaque characteristics (calcified, dense, or soft). Patients with hemodynamically significant stenosis were at greater risk of transient ischemic attack or stroke than their counterparts with less than 75 percent stenosis. However, even patients with less than 75 percent stenosis were at risk if the plaque was less organized (dense or soft). Patients with hemodynamically significant stenosis and morphologically soft plaque were at the greatest risk of transient ischemic attack or stroke. Those patients with calcified plaque and less than 75 percent stenosis had the lowest risk of transient ischemic attack or stroke. Morphologic plaque characteristics, as well as degree of stenosis, is important in determining which patients are candidates for carotid endarterectomy.

Use of thyroid scans in the selection of surgical patients.

The radionuclide scan should not be used for the routine evaluation of the thyroid gland. Instead, it should be used selectively when indicated by careful clinical judgement. The decision as to whether for not to operate should not be based solely on the findings of the thyroid scan. On the other hand, the presence of a solitary cold nodule should not be the only reason for operation in order to exclude the possibility of malignancy, because a significant percentage of thyroid cancers may be found in areas other than cold nodules [4,5]. Again, clinical judgement is the most reliable and cost-effective method to evaluate a thyroid mass.