[Long-term results of echographically guided percutaneous ethanol injection in the treatment of the autonomous thyroid nodule]. / Risultati a lungo termine dell'iniezione percutanea di etanolo sotto guida ecografica (PEI) nel trattamento del nodulo autonomo tiroideo.

Ultrasound-guided percutaneous ethanol injection (PEI) was performed as a therapeutic procedure on twenty-four patients affected by toxic autonomously functioning thyroid nodules (AFTN). After treatment patients were followed up for a mean period of 12 months. PEI induced persistent and complete (clinical and hormonal) disease control in 19/23 cases (82.6%) that completed the procedure, normalization of serum FT4 and FT3 associated with a still suppressed TSH in 2/23 cases (8.6%) and failed to control hyperthyroidism in 2/23 cases (8.6%). After PEI all AFTN became smaller at clinical and US examination with a 60% mean volume decrease. Nodule shrinkage was related to cytological and histological findings of well circumscribed coagulative necrosis, granulomatous inflammation and progressive fibrosis. PEI induced two cases of temporary complications: 1 case of acute worsening of thyrotoxicosis and 1 case of self-resolving vocal cord paresis. No increase of serum autoantibodies (TgAb, TPOAb, TRAb) was detected during the follow-up period.

Percutaneous ultrasound-guided ethanol injection: a new treatment of toxic autonomously functioning thyroid nodules?

Twenty autonomously functioning thyroid nodules were treated with ultrasound-guided percutaneous ethanol injection (PEI) and followed for 12 months. PEI was performed on symptomatic and biochemically proven thyrotoxic patients by injecting 2.0-4.0 mL sterile ethanol and was repeated 3-8 times, depending on nodule size. Serum thyroglobulin increased immediately after PEI, peaked at 6-10 h, and declined thereafter. Free T4 progressed slowly during the first 24 h. Free T3 showed a delayed and not significant increase. By the end of the treatment (4 weeks), PEI had produced clinical improvement and hormonal normalization. Three months later, serum TSH was detectable and responsive to TRH in 17 of the 20 patients. All nodules had a significant shrinkage at ultrasound evaluation. The previous hot thyroid areas manifested hypofunction at technetium-99 m-pertechnetate scintiscan, and the surrounding parenchyma returned to normal function in all but the 3 cases with still suppressed TSH. The histological features of a nodule that had been operated upon and the fine needle aspiration biopsy patterns obtained after PEI showed coagulative necrosis, with scanty follicles, some fibroblasts, but no lymphocytic infiltration. The procedure was generally well tolerated, but in 1 case it induced temporary dysphonia, and in another patient, it caused a transient exacerbation of thyrotoxicosis.

[Percutaneous treatment under echographic guidance of toxic thyroid nodules. Technique for its performance and preliminary results]. / Trattamento percutaneo sotto guida ecografica dei noduli tossici della tiroide. Tecnica di esecuzione e risultati preliminari.

Six patients affected by toxic thyroid nodules (Plummer disease) were treated by percutaneous ethanol injection (PEI). Treatment was performed injecting under ultrasound guidance 2-4 mL of 95% sterile ethyl alcohol through a spinal needle (22 gauge, 75 mm length). Treatment was performed once-twice weekly and repeated as an outpatient procedure 4-6 times. PEI induced clinical improvement and hormonal control by the end of the treatment (one month) and no complications took place. After PEI all hyperfunctioning thyroid nodules became smaller at clinical and ultrasound examination. Three months after PEI hot areas appeared cold at 99mTc and 1311 scintiscan. Serum levels of FT3, FT4, AbT, AbM, TG reached the normal range and serum TSH levels were significantly increased and responsive to TRH stimulation.

[Fluoroangiography of glaucomatous optic papilla]. / Considerazioni fluoroangiografiche della papilla ottica glaucomatosa.

Authors describe the fluoroangiography of the optic pupil in 15 patients who were suffering from chronic open-angle glaucoma and found a lessening of the fluorescence of the optic disk. It can be attributed to a hypoperfusion of the optic nerve. The results obtained and that is an constant ipofluorescein, even with different levels in relation to the type of glaucoma damage noticed, they look to support this etiopathogenetic hypothesis.