RESUMO
Sixty-seven consecutive patients undergoing cholecystectomy for symptomatic gallstones were investigated by both ultrasonography (US) and intravenous cholangiography (IVC). This provided the opportunity to compare these methods for assessing the common bile duct (CBD) preoperatively for stones. The results were correlated with a subsequent definitive procedure that formed the diagnostic standard in each case. The CBD diameters of 8 (12%) patients with stones was significantly greater than those without stones (t = 10.96, P < 0.001). Sensitivities of US and IVC were 87.5% and 100% respectively, but there were three unsuccessful IVC investigations that had to be excluded from the calculations. Specificities and overall accuracy of both methods were greater than 95%. The positive and negative predictive value of each test was similar and no difference using McNemar's test was found between US and IVC for providing information relating to CBD stones. Performing both procedures as routine assessment of the CBD is thus unnecessary as US, in conjunction with clinical history and liver biochemistry profile, provide an adequate preoperative screen of the CBD.
Assuntos
Colangiografia , Colecistectomia , Ducto Colédoco/diagnóstico por imagem , Adulto , Idoso , Colangiopancreatografia Retrógrada Endoscópica , Colelitíase/diagnóstico por imagem , Colelitíase/cirurgia , Feminino , Humanos , Infusões Intravenosas , Masculino , Meglumina , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Sensibilidade e Especificidade , UltrassonografiaRESUMO
One hundred and seventy-nine primary malignant tumours of the thyroid seen at The London Hospital between 1945 and 1972 were classified by the system of Woolner et al. (1961) and Hazard (1964). The distinct pathological and clinical features of the differentiated primary carcinomas and the similarities and differences between malignant lymphoma and anaplastic carcinoma were confirmed. This study showed the 'benign' behaviour of more than half the 'differentiated' papillary and follicular carcinomas when treated by thyroid lobectomy and the very malignant nature of anaplastic carcinomas and lymphomas whatever their treatment. The behaviour of medullary carcinoma was closer to that of the other differentiated tumours than to the undifferentiated varieties. Our patients were not thought to have been exposed to known goitrogens or previous thyroid irradiation.
Assuntos
Neoplasias da Glândula Tireoide/classificação , Adolescente , Adulto , Idoso , Carcinoma/classificação , Carcinoma Papilar/classificação , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Linfoma/classificação , Masculino , Pessoa de Meia-Idade , Neoplasias da Glândula Tireoide/radioterapia , Neoplasias da Glândula Tireoide/cirurgia , TireoidectomiaRESUMO
A family in which several members have medullary carcinoma and phaeochromocytoma is described. Four of the 5 patients in this family who had a phaeochromocytoma have died; in one of these the medullary carcinoma may have contributed to death but in general the thyroid cancers were slow growing. In our experience successful diagnosis and treatment of the phaeochromocytomas have presented the greatest challenge. The welfare of future generations with this syndrome would seem to depend upon regular clinical and biochemical surveillance of the individuals and expeditious diagnosis and treatment of their tumours, particularly the phaeochromocytomas.