ABSTRACT
PURPOSE: This study was performed to determine the role of magnetic resonance imaging (MRI) in a diagnostic algorithm for thyroid nodules. PATIENTS AND METHODS: Forty-four patients with solitary "cold" thyroid nodules were included in our study. MR images were analyzed visually. RESULTS: Benign nodules were shown as sharply marginated lesions classified by various signal intensity depending on nodule content. Thyroid carcinomas were shown as isointense or slightly hypointense lesions on T1-weighted images and hyperintense inhomogeneous lesions on T2-weighted images compared to normal thyroid tissue; following contrast, malignancies showed marked enhancement in most of the cases. CONCLUSION: In a thyroid diagnostic algorithm, conventional procedures such as ultrasound with fine needle aspiration and radionuclide scintigraphy should be performed first. In comparison with computed tomography (CT), MRI is superior because of better spatial resolution and the absence of ionizing radiation. MRI has its place in the staging of thyroid carcinoma and the preoperative assessment of the extent of malignant invasion of surrounding neck structures.
Subject(s)
Carcinoma/diagnosis , Magnetic Resonance Imaging , Thyroid Neoplasms/diagnosis , Thyroid Nodule/diagnosis , Adult , Aged , Carcinoma/pathology , Female , Humans , Lymphatic Metastasis , Male , Middle Aged , Neck , Thyroid Neoplasms/pathology , Tomography, X-Ray ComputedABSTRACT
Inflammatory response in tissue results from a complex network of interactions between inflammatory cells (mast cells, eosinophils, basophils, macrophages) and resident cells belonging to the lung structure (like endothelial cells, fibroblasts, epithelial cells). Among structural cells, endothelial cells play a critical role. The important role of endothelium is also reflected in the fact that it occupies an area exceeding 1000 m2. Thus, endothelium is the largest and the most active paracrine organ in the body, producing potent vasoactive, procoagulant, anticoagulant, and proinflammatory substances. Endothelial cells have four key functions that alter in the process of inflammation: 1 a) Regulation and control of leukocyte traffic through the expression of adhesion molecules (selectins E and P, molecules of immunoglobulin superfamily ICAM-1, ICAM-2, VCAM); 1 b) They are also able to amplify leukocyte activation through the production of proinflammatory cytokines like IL-1, IL-6 and chemokines like IL-8 and RANTES molecules; 2) Regulation of vascular tone by production of PGI-2, EDRF/NO and elements of local renin-angiotensin system; 3) Regulation of local coagulation by controlling the production of t-PA and PAI-1; 4) Regulation of the vascular permeability. In the states of acute inflammation, the endothelial cell takes on a proinflammatory phenotype and as such becomes chemoattractant, facilitating leukocyte adhesion, activation and migration, becomes prothrombotic and demonstrates enhanced vascular permeability.
Subject(s)
Endothelium, Vascular/physiopathology , Hypersensitivity/physiopathology , Capillary Permeability , Cell Adhesion Molecules/physiology , Endothelium, Vascular/metabolism , Humans , Inflammation , Inflammation Mediators/metabolismABSTRACT
Plasmapheresis is an immunomodulatory procedure with immunosuppressive effect. Plasmapheresis involves taking blood, separating off the plasma and returning the red cell-enriched fraction to the patient. In plasmapheresis improvement is due to the removal of mediators of tissue damage. Therapeutic plasmapheresis has been used in many diseases in which immunological mechanisms are proved. It has been noted that there may be a "rebound" in the level of antibodies and immune complexes after plasmapheresis, perhaps due to elimination of feedback suppressor mechanisms. For that reason, plasmapheresis is only effective when used as part of an immunosuppressive regimen which also includes steroids and/or cytotoxic agents.
Subject(s)
Plasmapheresis , HumansABSTRACT
Human immune globulin administered intramuscularly has been used for more than 40 years. In the last decade intravenous preparations were developed. They do not aggregate and contain IgG molecules with intact recognition and effector functions. These compounds are safe and only minor side effects were reported even when high doses were given. The mechanism by which intravenous gammaglobulin exacts its function is a combination of the Fc receptor blockade in the reticuloendothelial system, a marked increase in the suppressor cell function with down regulation of the antibody production and an intervention in the idiotype-antiidiotype network. Human immune globulin is an important therapeutic tool not only in the antibody deficiency, but also as an immunomodulatory agent in autoimmune disorders.
Subject(s)
Immunoglobulins/therapeutic use , Humans , Immunoglobulins, Intravenous/therapeutic useABSTRACT
The paper is aimed at illustrating the importance of nonspecific and specific bronchoprovokative tests for diagnosing allergic bronchial asthma by pathophysiologic mechanisms of hyperiritability of airways and making of specific "schok tissue". Besides we tried to explain these exeptional cases which we encounter in our practise, where patients, in spite of absence of any complaints related to breathing, normal physical, findings and normal ventilation function tests, have positive specific or nonspecific bronchoprovocative tests. Evaluation of these condition, as a specific stage in development of allergic bronchial asthma, we concluded that nonspecific and specific bronchoprovokative tests is also important for evaluation of possible occurence of this disease as well as deciding on its prevention.
Subject(s)
Asthma/diagnosis , Bronchial Provocation Tests , Asthma/immunology , Bronchial Hyperreactivity , HumansABSTRACT
Having in mind importance of early detection of the disease, in it phase of development, we have reported a case with seasonal allergic rhinitis and allergic reaction of the lower airways in absence of allergic inflammation and clinically evident bronchial asthma.
Subject(s)
Allergens , Asthma/diagnosis , Pollen , Rhinitis, Allergic, Seasonal/diagnosis , Adult , Humans , Male , Rhinitis, Allergic, Seasonal/physiopathologyABSTRACT
The paper presents two patients with seasonal allergic rhinitis. Absence of complaints related to the lower airways, normal physical pulmonary findings, normal functional ventilation findings and negative non-specific bronchoprovokative metacholine test, ruled out bronchial asthma in both patients. However, positive specific bronchoprovokative tests with corresponding allergens were explained by the presence of the specifically sensibilised mast cells at the level of the lower airways and allergic reaction in absence of allergic inflammation and bronchial hyperirritability.
Subject(s)
Rhinitis, Allergic, Seasonal/diagnosis , Adult , Bronchial Provocation Tests , Female , Humans , Male , Skin TestsABSTRACT
Reporting two of our cases we wanted to point to a great dilemma related to the final diagnosis. Recently, such cases have been more frewuently seen, since in all patients with allergic rhinitis conditions of the lower airways is examined before the administration of the specific immunotherapy. Therefore, we may see patients who are still free of pulmonary sings, despite of positive specific and/or non specific bronchoprovocative tests. The presented cases with evidenced allergic rhinitis are probably in the phase of development of allergic bronchial asthma, the phase of "allergic inflammation" of the lower airways, not clinically manifested yet.
