Additional malignancies in patients with gastrointestinal stromal tumors (GIST): incidence, pathology and prognosis according to a time of occurrence-based classification.

BACKGROUND: The aim of the study is to clarify if a classification based on the time of occurrence of associated malignancies in GIST patients can help in the understanding of the clinical controversies observed in these patients. METHODS: We retrospectively reviewed all the patients diagnosed with GIST tumors between January 1999 and October 2016. They were divided into GIST patients associated with other tumors (A-GIST) and those not associated (NA-GIST). A-GIST patients were also divided into four types according to the proposed classification. RESULTS: Of 104 GIST patients, 32 (30.7%) (A-GIST group) had at least one additional primary malignancy. The most frequent location of the associated malignancy was the GI tract (26%). Compared to NA-GIST, A-GIST were more often asymptomatic with a lower risk of recurrence. The main cause of death in NAGIST was GIST itself, being associated tumors the main cause of death in A-GIST group. No differences were found in DFS and OS between A-GIST and NA-GIST. CONCLUSIONS: The use of the proposed classification classifies GIST patients with associated malignancies in different subtypes that differ substantially in terms of incidence, type of neoplasms associated, cause of the association and prognosis.

Hacia un mejor manejo de la insuficiencia cardiaca: papel de las unidades multidisciplinares y de la colaboración ntre niveles asistenciales en la continuidad de la asistencia: experiencia en el noroeste de Madrid / No disponible

No disponible

Mitochondrial D-loop nucleotide diversity in Astyanax (Osteichthyes, Characidae) from the upper Paraná and upper Paraguay River basins.

The morphological discrimination between the species Astyanax altiparanae and A. asuncionensis of the upper Paraná River and Paraguay River basins, respectively, has always been difficult. Two D-loop haplogroups of A. altiparanae are known, one with the presence (AltoPR) or the absence (AltoPR-D) of a 32-bp block similar to that in A. asuncionensis. We examined these samples to characterize A. altiparanae and verify whether A. asuncionensis occurred in the upper Paraná River prior to the submergence of the Sete Quedas Falls when Itaipu reservoir was impounded. D-loop sequences were analyzed in A. altiparanae of the upper Paraná and Iguaçu Rivers and those of A. asuncionensis of the upper Paraguay River. The haplogroup AltoPR was found at all sites of the upper Paraná and Iguaçu Rivers, whereas AltoPR-D occurred in the Itaipu reservoir, floodplain and in the Tietê and Grande Rivers. Two haplogroups of A. asuncionensis were identified and both did not have the 32-bp block. However, AltoPR and AltoPR-D differed from one another in 5.1% of their bases and between 8.9 and 12.5% with regard to the haplogroups of the upper Paraguay basin. Further, AltoPR-D occurred in the Grande River upstream the Marimbondo Falls and other older reservoirs than Itaipu. The results reject the hypothesis of the establishment of A. asuncionensis and suggest that the haplogroup AltoPR-D existed in the upper Paraná River before the impounding of the Itaipu reservoir. Moreover, morphological similarity and high genetic variation within the altiparanae/asuncionensis group suggest the existence of a cryptic species complex.

Complicaciones intracraneales de los procesos infecciosos otorrinolaringológicos en la infancia / Intracranial com plications of head and neck infections in children

Introducción: Las complicaciones intracraneales de las infecciones otorrinolaringológicas (ORL) en niños son infrecuentes, pero potencialmente graves si no se diagnostican y tratan atiempo. Métodos: Estudio descriptivo y retrospectivo de pacientes con complicaciones intracraneales secundarias a infecciones ORL, diagnosticados en un hospital terciario entre 2005 y 2009. Resultados: Presentamos cinco casos de complicaciones intracraneales, tres infecciosas y dos vasculares. Las tres infecciosas fueron: a) absceso epidural secundario a otomastoiditis; b) petrositis con paresia del VI par secundaria a una sinusitis esfenoidal y otomastoiditis, y c) absceso subperióstico orbitario tras una sinusitis etmoidal y esfenoidal. Sólo en el primer caso se aisló el germen causal en hemocultivo (Streptococcus pyogenes). El primer caso requirió evacuación quirúrgica, y todos recibieron antibioterapia parenteral prolongada. Las complicaciones vasculares fueron dos casos de trombosis venosa del seno sigmoide, secundarios a una otomastoiditis. Se halló tambien S. pyogenes en el hemocultivo de uno de ellos. En ambos el estudio de los factores procoagulantes fue negativo. Uno de los dos no se anticoaguló y la recanalización ha sido parcial, aunque el paciente permanece asintomático. Conclusiones: Conocer las complicaciones intracraneales de las infecciones ORL nos permitirá sospecharlas ante un curso recurrente y tórpido o aparición de clínica neurológica. En estos casos se requiere un manejo multidisciplinario medicoquirúrgico, del que dependen las secuelas y el pronóstico. El uso de anticoagulación en niños con trombosis venosa cerebral aún es controvertido por sus riesgos; por ello, a pesar de las recomendaciones internacionales, con frecuencia prevalece una decisión individualizada para cada caso(AU)

Introduction: Though infrequent, intracranial complications of head and neck infections in children can have severe consequences if not diagnosed and treated early. Methods: Review of patients with secondary intracranial complications of head and neck infections diagnosed at a tertiary care hospital over a period of 4 years (2005-2009).Results: There were five cases of intracraneal complications (three non-vascular and two vascular). The three non-vascular cases were: a) epidural abscess secondary to otomastoiditis; b)petrositis with sixth nerve palsy secondary to sphenoid sinusitis and otomastoiditis, and c) subperiostic orbital abscess following ethmoid and sphenoid sinusitis. Only in the first case was the causal germ isolated in haemoculture (Streptococcus pyogenes). The first case required surgical evacuation, and all cases received prolonged parenteral antibiotherapy. The vascular complications comprised two cases of intracranial thrombosis of sinus sigmoid secondary to otomastoiditis. S. pyogenes was also found in the haemoculture of one case. In both patients, the procoagulant factors proved negative. One of the two cases was not put on anticoagulant therapy and rechanneling was partial, though it remained asymptomatic. Conclusions: Knowing these complications will lead us to suspect them in the event of torpid and recurrent disease course, or appearance of related neurological symptomatology. In such cases, multidisciplinary medical-surgical management is required and on that sequelae and prognosis depend. As it is not risk-free, the use of anticoagulation in children with intracranial sinus thrombosis is controversial, and consequently, despite international recommendations, in each case individualized and consensus-based decisions often prevail(AU)

Rol del farmacéutico asistencial desde la perspectiva de los pacientes en Santiago de Cuba / Role of the hospital pharmaceutical from the perspective of the patients in Santiago de Cuba

Objetivo: Caracterizar la práctica profesional farmacéutica a partir de las experiencias, la satisfacción, las barreras, las percepciones y expectativas de pacientes hospitalizados y de la atención primaria en Santiago de Cuba. Método: Estudio descriptivo y transversal en el que fueron realizadas entrevistas estructuradas, a través de la aplicación de un cuestionario validado, a pacientes que otorgaron su consentimiento en participar y fueron seleccionados por muestreo aleatorio estratificado. Resultados: La muestra incluyó 781 pacientes, 440 en la atención primaria y 341 hospitalizados. Los servicios más brindados se relacionan con el suministro y la adquisición de medicamentos (93,5%). El 3,2% de los pacientes manifestaron recibir servicios farmacéuticos clínicos, aquellos que recibieron atención farmacéutica. El 94,9% de los encuestados están insatisfechos con su comunicación con los farmacéuticos y la atención que reciben de éstos. El 93,5% percibe al farmacéutico como vendedor de medicamentos y el 55,3% como experto en medicamentos. Sólo el grupo que recibe atención farmacéutica muestra una elevada satisfacción y percepciones que valorizan el papel del farmacéutico. La principal barrera identificada es el desconocimiento de quién es el farmacéutico (84,8%). Las mayores expectativas precisan que el profesional farmacéutico conozca y resuelva sus problemas con los medicamentos en un 93,2 y un 97,05%, respectivamente. Conclusiones: Se evidencian dificultades en el rol asistencial de estos profesionales desde la perspectiva de los pacientes; se demuestra la importancia de la atención farmacéutica en la transformación de estas percepciones, y la necesidad de perfeccionar las actuales estrategias de implantación de estos servicios en el cuidado a los pacientes (AU)

Objective: To characterize the pharmacist’ role in the provision of pharmaceutical services from of the patients’ experiences, satisfaction, barriers, perceptions and expectations in different health care settings in Santiago de Cuba. Methods: A descriptive, cross-sectional study, in which structured interviews were applied through a validated questionnaires, to patients who gave their consent to participate and whom were selected by a stratified random sampling. Results: The sample included 781 patients, 440 in primary care and 341 inpatients. The most offered services are related with the distribution and drug acquisition (93.5%). A 3.2% of the patients state they had received clinical pharmaceutical those who received pharmaceutical care. 94.9% of the interviewed were unsatisfi ed with the provision of pharmaceutical care by pharmacists. A 93.5% perceived the pharmacist as a drugs sales person, and 55.3% as a drugs expert. Only the group, which received pharmaceutical attention, shows a high satisfaction and has a perception that values the pharmacist. The main barrier, which was identifi ed, was the not knowing who the pharmacist was (84.8%). The main expectations are that pharmacist knows (93.2%) and resolves drug’s related problems (97.05%). Conclusions: The results show difficulties in pharmacists’ role towards the patients, from their own perspectives. The importance of the pharmaceutical care is needed for the transformation of patients’ perceptions and the need to improve the actual implantation strategies for patient-care services (AU)

Recurrent tuberculosis from 1992 to 2004 in a metropolitan area.

The proportion of recurrent tuberculosis (TB) cases caused by re-infection has varied widely in previous studies. The aim of the present study was to determine the relative frequency of relapse and exogenous re-infection in patients with second episodes of TB, using DNA fingerprinting. A population-based retrospective longitudinal descriptive study was conducted in Madrid (Spain) during 1992-2004. The study consisted of 645 patients with culture-confirmed TB. Of these, 20 (3.1%) were retained because they presented with a second isolate of Mycobacterium tuberculosis. Finally, 12 of these cases were excluded because they did not complete the full treatment prescribed. All strains were typed by restriction fragment length polymorphism analysis and some by mycobacterial interspersed repetitive unit-variable number of tandem repeats analysis. The patients with recurrent TB were compared with those without recurrent TB. For seven out of the eight patients, the restriction fragment length polymorphism patterns of the Mycobacterium tuberculosis strains from the episodes of recurrent disease showed identical initial and final genotypes, indicating relapse; the remaining recurrent case showed different genotypes, suggesting exogenous re-infection. Re-infection is possible among people in developed countries, but the rates are lower than those occurring in high-risk areas. The risk factors for recurrent tuberculosis should be taken into account in the follow-up of treatment and tuberculosis control strategies.

Hepatectomía en 4 pacientes con litiasis intrahepática / Hepatectomy in four patients with intrahepatic lithiasis

Introducción. La litiasis intrahepática, muy frecuente en países del sudeste asiático, es rara en países europeos y se asocia a estenosis y dilataciones de los radicales biliares, lo que puede obligar a realizar resecciones hepáticas para su resolución definitiva.Pacientes y método. Presentamos 4 pacientes con litiasis intrahepática que requirieron una hepatectomía para su resolución. En un caso se asoció a enfermedad de Caroli del lóbulo hepático derecho que precisó hepatectomía derecha, y los 3 casos restantes presentaron estenosis de radicales segmentarios del lóbulo hepático derecho y precisaron segmentectomías para su resolución. La litiasis intrahepática se manifestó clínicamente por un cólico hepático en un caso y una colangitis aguda en 3 casos. La exploración preoperatoria e intraoperatoria fundamental para el diagnóstico fue la ecografía. Las exploraciones radiológicas (tomografía computarizada, resonancia magnética y técnicas con contraste, preoperatorias e intraoperatorias) fueron importantes para el diagnóstico definitivo.Resultados. No existió mortalidad intraoperatoria ni postoperatoria. Dos pacientes presentaron un absceso subfrénico resuelto con drenaje radiológico. No ha recurrido la litiasis intrahepática tras un seguimiento medio de 29 meses (rango, 17-38).Conclusiones. La hepatectomía resuelve definitivamente aquellos pacientes con litiasis intrahepática cuando existen estenosis y/o dilataciones lobares o segmentarias. Si preoperatoriamente no se sospecha la litiasis intrahepática, los pacientes pueden requerir varias intervenciones para su resolución definitiva. (AU)

Recurrent papillary thyroid cancer: analysis of prognostic factors including the histological variant.

OBJECTIVE: To analyse the factors that influence the development of recurrent papillary thyroid carcinoma, including the histological variant. DESIGN: Retrospective study. SETTING: Teaching hospital, Spain. SUBJECTS: 200 patients who had papillary thyroid cancers resected between 1970 and 1995. MAIN OUTCOME MEASURES: Prognostic factors and disease-free interval assessed by univariate and multivariate analysis. RESULTS: All patients were followed up for a mean of 9 years (range 4-29). 54 patients presented with recurrent disease (27%) of whom 19 (35%) died of their disease. 5-year, 10-year, and 15-year survival for those with recurrent disease were 75%, 68%, and 60%, respectively. The corresponding figures for the whole series were 93%, 90%, and 84%. The significant variables on multivariate analysis were completeness of resection (p = 0.002), extrathyroid involvement (p < 0.002), presence of lymph node metastases (p = 0.002), and histological variant of the carcinoma (P < 0.001). CONCLUSION: Using these risk factors it is possible to draw up a prognostic index and classify patients as being at low, medium, or high risk of recurrence.

Extrathyroid spread in papillary carcinoma of the thyroid: clinicopathological and prognostic study.

INTRODUCTION: The extrathyroid spread (ETS) is one of the risk factors that influence mortality and recurrence in patients with papillary carcinoma of the thyroid (PCT). The aim of this study is to analyze the clinical and histologic features and follow-up of a series of patients with ETS undergoing surgery for PCT and to identify patients with a greater risk of presenting with ETS. MATERIAL AND METHODS: Retrospective study of a series of 200 patients undergoing surgery for PCT, of whom 47 (23.5%) presented with ETS. The clinical and histologic features and follow-up of the patients with ETS were compared with those without ETS using the Pearson chi(2) test. We used a logistics regression model to perform a multivariant analysis for ETS. The survival and disease-free interval rates were calculated using the Kaplan-Meier method. RESULTS: ETS is most associated with patients over 50 years of age, with tumors over 4 cm that are not encapsulated, with lymph node metastasis, and with certain PCT histologic subtypes after the multivariant analysis. The overall rate of recurrence and mortality in patients with ETS was much higher than in patients without ETS. CONCLUSIONS: PCT patients with ETS have a greater risk of tumor-related recurrence and mortality than patients without ETS. There are patients with certain clinical and histologic features who have a greater risk of presenting with ETS.

Tomato plant-water uptake and plant-water relationships under saline growth conditions.

Growth and water uptake both decreases when tomato plants are irrigated with saline water. To determine the relative contribution of physiological traits to these decreases plant fresh and dry weight, leaf area, leaf water (Psi(w)) and osmotic (Psi(Pi)) potentials, gas exchange parameters, stomatal density, leaf chlorophyll and Na content were investigated in the tomato (Lycopersicon esculentum) cultivars, Daniela and Moneymaker. Plants were grown in greenhouse, in sand culture, and irrigated with a complete nutrient solution supplied with 0 (control), 35 and 70 mM NaCl over a period of 2 months. Salinity reduced plant dry weight, height and number of leaves even at 35 mM NaCl. Leaf Psi(w) and Psi(Pi) decreased with salinity but leaf turgor pressures were significantly higher in salinised than in control plants which suggests that bulk tissue turgor did not limit growth under the saline conditions tested. Increasing salinity in the irrigation solution led to both morphological changes [(reduction of plant leaf area and stomatal density) and physiological changes [reduction of stomatal conductance, transpiration, and net CO(2) assimilation (A(CO(2)))] Plant water uptake, measured as the difference between volume of nutrient solution supplied and drainage collected, was closely related to transpiration, stomatal conductance, and stomatal density. Chlorophyll content per unit of leaf area increased with salinity. Reduction of net A(CO(2)) with salinity was explained in higher degree by stomatal conductance and stomatal density than by Na accumulation in the leaves. Although plant water uptake was similar for the two cultivars, Daniela transported, per unit of water uptake, more Na to the leaves than did Moneymaker. However, Daniela reduced leaf area less than did Moneymaker. Water use efficiency, calculated either as the ratio between total plant dry matter and total plant water uptake, or as the ratio between net A(CO(2)) and transpiration, did not change under our saline growth conditions. The contribution of the observed salt-responses to reduction in shoot water loss, plant water uptake and salt loading, while keeping water use efficiency, is discussed in relation to salt tolerance. Because some of these salt-responses take a long time to develop, growing seedlings in seedbeds with saline media could be of interest to better tolerate further salty conditions in the field or greenhouse.

Relation of biochemical, cytologic, and morphologic parameters to the result of gammagraphy with technetium 99m sestamibi in primary hyperparathyroidism.

The aim of this study was to analyze the possible relation of biochemical, cytologic, and morphologic parameters to the results of parathyroid gammagraphy with Tc 99m sestamibi in primary hyperparathyroidism. We studied 46 consecutive patients with primary hyperparathyroidism who were undergoing surgery. All the patients were given a preoperative parathyroid gammagraphy with Tc 99m sestamibi and a complete preoperative biochemical study. During the surgical intervention we recorded the weight and size of the pathologic glands to calculate the volume of each. We also determined the percentage of the chief and oxyphil cells in the pathologic glands. Tc 99m sestamibi sensitivity is higher in adenomas (91%) than in hyperplasia (67%) or double adenomas (50%). No relation was found between biochemical or cytologic parameters and gammagraphic results. Weight and gland volume were significantly greater for adenomas than for hyperplasia (P < 0.0014 and P < 0.0004, respectively), and statistically significant differences in both of them were observed between the glands with positive and negative sestamibi.

Clinical and histological differences in anaplastic thyroid carcinoma.

OBJECTIVE: To report our experience in patients with anaplastic thyroid carcinoma and try to establish differences between cases in which the histological study showed that there was an associated thyroid carcinoma and those that were strictly anaplastic or pure. DESIGN: Retrospective study. SETTING: University hospital, Spain. SUBJECTS: 14 patients with anaplastic thyroid cancer treated over a period of 26 years; 7 presented with associated thyroid tumours and 7 were pure. MEAN OUTCOME MEASURES: Clinical data (age, sex, symptoms), treatment, histological study (associated thyroid disease, spread, involved lymph nodes) and follow-up. RESULTS: 13 of the 14 tumours had spread locally. 5 patients were treated by total thyroidectomy, 3 subtotal thyroidectomy, 5 excision of the tumour, and 1 patient had a biopsy alone. There were associated thyroid tumours in 7 cases: 2 follicular, 2 tall cell papillary, 1 solid papillary, 1 medullary and 1 Hurthle cell tumour. 12 patients died. Another 2 are still alive having survived 61 and 70 months respectively, both with associated anaplastic cancers (follicular and solid). The mean survival was 14 months (24 for associated anaplastic carcinoma and 4 for pure anaplastic carcinoma). CONCLUSION: There is a subgroup of anaplastic cancers in which a better differentiated thyroid carcinoma coexists with the anaplastic carcinoma. The prognosis in this subgroup is better than that for primary pure anaplastic carcinoma.

Substernal goiter: clinical experience of 72 cases.

The aim of this work was to study the clinical management and surgical approach of substernal goiters. We studied the clinical data, preoperative evaluation, surgical treatment, histopathologic data, complications, and follow-up of 72 patients found to have substernal goiter over a period of 15 years, from a total of 780 patients with goiter who underwent surgery. In this group, 83% were women, and the mean age was 61 years. The most common symptoms were the existence of a palpable cervical mass (93% of cases) and dyspnea (40%). The most successful study to diagnose substernal goiter was computed tomography (100%), followed by chest radiography (75%), gammagraphy (19%), and ultrasound (15%). All but 7 patients received a Kocher cervicotomy, and 49% of the cases underwent a total thyroidectomy. The histologic study revealed 3 carcinomas (4%). There was 1 permanent unilateral recurrent laryngeal nerve injury (1.4%) and 1 instance of permanent hypoparathyroidism (1.4%). We regard surgery as the most successful treatment for patients with substernal goiter, even in those without compressive symptoms. We base our choice on the low morbidity and zero mortality obtained.

Insular carcinoma: an infrequent subtype of thyroid cancer.

BACKGROUND: Insular carcinoma is a little-known thyroid cancer, characterized by the presence of well-defined nidi of small uniform cells with frequent areas of tumor necrosis and microfollicles with thyroglobulin. It was described by Carcangiu in 1984, but its prognosis is not yet clear. STUDY DESIGN: Six of 335 patients undergoing surgery for thyroid carcinoma had the insular type. We studied age, gender, treatment, histology (tumor size, coexistence of another tumor, extrathyroid spread, vascular invasion, multicentricity, and metastatic adenopathies), TNM, and followup (recurrences, mortality, and survival). These results were compared with those published in the literature. RESULTS: Insular carcinoma was more common in women (4 of 6), and mean patient age was 32 years. Three patients had metastatic adenopathies. Four patients presented with other thyroid tumors (2 papillary, 1 follicular, and 1 anaplastic) and 2 were simple. Two patients had vascular invasion, and another 2 were extrathyroid. Only 1 case was multicentric. Three recurrences were detected in 2 patients over 50 years old: 1 lymph node at 60 months, 1 pulmonary at 132 months, and the other a bone recurrence at 8 months. Two patients died at 12 and 140 months. CONCLUSIONS: Insular carcinoma is a special type of thyroid cancer, and the prognosis is poorer than for the classic differentiated thyroid carcinoma.

Value of repeated fine-needle aspiration cytology and cytologic experience on the management of thyroid nodules.

Although fine-needle aspiration is being currently accepted as the most reliable method to select patients with thyroid nodules for surgery, controversy remains about the accuracy in distinguishing benign nodules. We present our results from 636 fine-needle aspirations performed from 1984 to 1989. Our article focuses on the value of cytologic expertise and repeated punctures for follow-up of benign nodules. We found annual figures for specificity and positive predictive value to increase steadily from 1984 to 1989, thus suggesting that the power of the test is proportional to the experience of the cytologist. We also state that the value of performing repeated punctures for the follow-up of unselected benign nodules is low.

Ultrasonography and computed tomography reduce unnecessary surgery in abdominal rectus sheath haematoma.

BACKGROUND: Rectus sheath haematoma is a rare cause of abdominal pain. If accurately diagnosed, surgery can be avoided in most cases. This study assessed the role of ultrasonography and computed tomography (CT) in the diagnosis of rectus sheath haematoma. METHODS: Thirty cases of rectus sheath haematoma diagnosed over 18 years were reviewed. Mean patient age was 59 years; there were 20 women and ten men. The results of imaging investigations were reviewed to determine their efficiency. Ultrasonography was performed in 21 patients and CT in nine. RESULTS: Arterial hypertension, anticoagulant therapy and strained coughing were the most frequent predisposing factors. The most common clinical manifestation was abdominal pain with a palpable mass. Leucocytosis occurred in 18 patients and the haematocrit fell in 13 patients but markedly in seven. Ultrasonography was diagnostic in 15 of 21 patients imaged, and CT was diagnostic in all nine. Treatment was conservative in 22 patients. Eight patients required surgery: four for diagnosis and four for treatment. CONCLUSION: Surgery can be avoided in most patients with rectus sheath haematoma. Although the numbers were small, CT appeared to be more accurate than ultrasonography in facilitating the diagnosis.

Papillary thyroid microcarcinoma: clinical study and prognosis.

OBJECTIVE: To study the anatomical and prognostic characteristics of papillary thyroid microcarcinomas (10 mm or less in size). DESIGN: Retrospective review. SETTING: Community hospital, Spain. SUBJECTS: 36 patients with papillary microcarcinomas diagnosed over a period of 20 years from a total of 158 papillary carcinomas with complete follow-up. MAIN OUTCOME MEASURES: Symptoms, treatment, histopathological confirmation and follow-up compared with those of papillary carcinomas more than 10 mm in size. RESULTS: Six of the patients with microcarcinomas presented with adenopathy, the remaining 30 being admitted for treatment of associated thyroid diseases. In 15 cases the tumour was 5 mm or less in size. Thirty were well-differentiated, 2 were follicular, and 2 showed signs of diffuse sclerosis. Three had recurred after total thyroidectomy, but no patient died. When the results were compared with those of the patients with larger tumours, we found differences in histological type (p = 0.001), the incidence of adenopathy (p = 0.03), TNM stage (p = 0.001) and mortality (p = 0.04). CONCLUSIONS: There are clinical, histopathological, and prognostic differences between microcarcinomas (which do well) and larger papillary tumours.

High-resolution ultrasound associated with aspiration biopsy in the follow-up of patients with differentiated thyroid cancer.

OBJECTIVE: To assess the value of ultrasound in the follow-up of patients undergoing surgery for differentiated thyroid carcinoma. SUBJECTS: The study included 89 patients (70 women and 19 men) with differentiated thyroid carcinoma (76 papillary and 13 follicular cancer). METHODS: High-frequency ultrasound (US) was used in the evaluation of 89 subjects who underwent surgery for thyroid carcinoma. Fine-needle aspiration was performed in cases with positive US. In addition, determinations of thyroglobulin (Tgb) in serum, scintigraphy with (131)I, and cervical palpation were evaluated. We determined sensitivity, specificity, and overall accuracy for each of these diagnostic methods. RESULTS: Ultrasonography was positive in 22 subjects, 16 in the nodal area and 6 in the thyroid bed. Twenty-two subjects received fine-needle aspiration with US control; 13 (59%) of 22 were positive for cancer. The results of the US for detecting neoplastic disease showed a sensitivity of 65%, specificity of 86%, and overall accuracy of 82%. The overall accuracy for scintigraphy was 88% and for Tgb, 91%. CONCLUSION: We concluded that US can be included in the follow-up protocol for patients undergoing surgery for differentiated cancer of thyroid, as a valuable tool to localize the recurrence. This technique is particularly useful in the evaluation of patients who are found to have elevated Tgb levels.