Outcomes and Risk Factors for Complications of Laser Ablation for Thyroid Nodules: A Multicenter Study on 1531 Patients.

BACKGROUND: Image-guided laser ablation therapy (LAT) of benign thyroid nodules demonstrated favorable results in randomized trials with fixed modalities of treatment. The aim of this retrospective multicenter study was to assess the effectiveness, tolerability, and complications of LAT in a large consecutive series of patients from centers using this technique in their routine clinical activity. PATIENTS: Clinical records of 1534 consecutive laser-treated nodules in 1531 patients from eight Italian thyroid referral centers were assessed. Inclusion criteria were as follows: solid or mixed nodules with fluid component up to 40%; benign cytological findings; and normal thyroid function. METHODS: LAT was performed with a fixed-power protocol, whereas the number of applicators and illumination times were different according to target size. From one to three illuminations with pullback technique and with a total energy delivery based on the nodule volume were performed during the same session. Patients were evaluated during LAT, within 30 days, and 12 months after the procedure. RESULTS: Total number of treatments was 1837; 1280 (83%) of nodules had a single LAT session. Mean nodule volume decreased from 27 ± 24 mL at baseline to 8 ± 8 mL 12 months after treatment (P < .001). Mean nodule volume reduction was 72% ± 11% (range 48%-96%). This figure was significantly greater in mixed nodules (79% ± 7%; range 70%-92%) because they were drained immediately before laser illumination. Symptoms improved from 49% to 10% of cases (P < .001) and evidence of cosmetic signs from 86% to 8% of cases (P < .001). Seventeen complications (0.9%) were registered. Eight patients (0.5%) experienced transitory voice changes that completely resolved at the ear-nose-throat examination within 2-84 days. Nine minor complications (0.5%) were reported. No changes in thyroid function or autoimmunity were observed. CONCLUSIONS: Real practice confirmed LAT as a clinically effective, reproducible, and rapid outpatient procedure. Treatments were well tolerated and risk of major complications was very low.

Long-term efficacy of ultrasound-guided laser ablation for benign solid thyroid nodules. Results of a three-year multicenter prospective randomized trial.

BACKGROUND: The aim of the present trial on ultrasound (US)-guided laser ablation therapy (LAT) of solid thyroid nodules is to assess long-term clinical efficacy, side effects, and predictability of outcomes in different centers operating with the same procedure. PATIENTS: Two hundred consecutive patients were randomly assigned to a single LAT session (group 1, 101 cases) or to follow-up (group 2, 99 cases) at four thyroid referral centers. Entry criteria were: solid thyroid nodule with volume of 6-17 mL, repeat benign cytological findings, normal thyroid function, no autoimmunity, and no thyroid gland treatment. METHODS: Group 1: LAT was performed in a single session with two optical fibers, a 1064 nm Nd-YAG laser source, and an output power of 3 W. Volume and local symptom changes were evaluated 1, 6, 12, 24, and 36 months after LAT. Side effects and tolerability of treatment were registered. Group 2: Follow-up with no treatment. RESULTS: One patient was lost to follow-up in each group. Group 1: Volume decrease after LAT was -49 ± 22%, -59 ± 22%, -60 ± 24%, and -57 ± 25% at 6, 12, 24, and 36 months, respectively (P < .001 vs baseline). LAT resulted in a nodule reduction of >50% in 67.3% of cases (P < .001). Local symptoms decreased from 38 to 8% of cases (P = .002) and cosmetic signs from 72 to 16% of cases (P = .001). Baseline size, presence of goiter (P = .55), or US findings (fluid component ≤ 20% [P = .84], halo [P = .46], vascularization [P = .98], and calcifications [P = .06]) were not predictive factors of a volume decrease > 50%. The procedure was well tolerated in most (92%) cases. No changes in thyroid function or autoimmunity were observed. In group 2, nodule volume increased at 36 months (25 ± 42%; P = .04). The efficacy and tolerability of the procedure were similar in different centers. CONCLUSIONS: A single LAT treatment of solid nodules results in significant and persistent volume reduction and local symptom improvement, in the absence of thyroid function changes.

Laser ablation and 131-iodine: a 24-month pilot study of combined treatment for large toxic nodular goiter.

CONTEXT: It is normally recognized that the preferred treatment in large toxic thyroid nodules should be thyroidectomy. OBJECTIVE: The aim of the study was to assess the efficacy of combined laser ablation treatment (LAT) and radioiodine 131 (131I) treatment of large thyroid toxic nodules with respect to rapidity of control of local symptoms, of hyperthyroidism, and of reduction of administered 131I activity in patients at refusal or with contraindications to surgery. DESIGN AND SETTING: We conducted a pilot study at a single center specializing in thyroid care. PATIENTS: Fifteen patients were treated with LAT, followed by 131I (group A), and a series of matched consecutive patients were treated by 131I only (group B). INTERVENTION(S): Laser energy was delivered with an output power of 3 W (1800 J per fiber per treatment) through two 75-mm, 21-gauge spinal needles. Radioiodine activity was calculated to deliver 200 Gy to the hyperfunctioning nodule. MAIN OUTCOME MEASURE(S): Thyroid function, thyroid peroxidase antibody, thyroglobulin antibody, ultrasound, and local symptoms were measured at baseline and up to 24 months. RESULTS: Nodule volume reduction at 24 months was: 71.3 ± 13.4 vs 47.4 ± 5.5%, group A (LAT+131I) vs group B (131I), respectively; P < .001). In group A (LAT+131I), a reduction in radioiodine-administered activity was obtained (-21.1 ± 8.1%). Local symptom score demonstrated a more rapid reduction in group A (LAT+131I). In three cases, no 131I treatment was needed after LAT. CONCLUSIONS: In this pilot study, combined LAT/131I treatment induced faster and greater improvement of local and systemic symptoms compared to 131I only. This approach seems a possible alternative to thyroidectomy in patients at refusal of surgery.

Laser thermal ablation in the treatment of small hepatocellular carcinoma: results in 74 patients.

PURPOSE: To evaluate the safety, local effectiveness, and long-term results of laser thermal ablation (LTA) in the treatment of small hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Ninety-two biopsies proved small HCCs (range, 0.8-4.0 cm) in 74 patients who were treated percutaneously with LTA in an outpatient clinic. A laser at a power of 5.0 W was coupled with one to four fibers that were advanced through 21-gauge needle(s) for 6-12 minutes. All lesions were evaluated with computed tomography (CT) for changes in size and vascular pattern, recurrence rates, and cumulative survival rates. Patients were examined for complications. RESULTS: No major complications occurred in 117 LTA sessions, with an average of 1.3 sessions per tumor. At 3 months, CT scans showed a nonenhancing area (complete necrosis) in 89 (97%) of 92 lesions. During follow-up (range, 6-66 months; mean, 25.3 months), 84 tumors (91%) decreased in size. The local recurrence rates (range, 1-5 years) ranged from 1.6% to 6.0%. Recurrence rates (range, 12-60 months) in other liver segments ranged from 24% to 73%. Cancer-free survival rates (range, 1-4 years) ranged from 73% to 24%. Overall survival rates were 99%, 68%, and 15% at 1, 3, and 5 years, respectively. Twenty-one patients (28%) died. CONCLUSION: LTA is a safe and effective treatment for small HCC.

Hepatocellular carcinoma: long-term results of combined treatment with laser thermal ablation and transcatheter arterial chemoembolization.

PURPOSE: To determine the potential long-term effectiveness of laser thermal ablation (LTA) followed by transcatheter arterial chemoembolization (TACE) in the percutaneous ablation of large hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Thirty large HCCs 3.5-9.6 cm in diameter (mean diameter, 5.2 cm) and 15 small HCCs 0.8-3.0 cm (mean diameter, 1.9 cm) were treated with ultrasonographically guided LTA with TACE and with LTA alone, respectively, in 30 patients: 19 with a solitary large HCC, and 11 with one to three additional synchronous small HCCS: A 1.064-microm neodymium yttrium-aluminium-garnet (Nd-YAG) laser at a power of 5.0 W was coupled with one to four quartz optic fibers that were advanced through 21-gauge needles. Segmental TACE was performed 30-90 days after LTA. All lesions were evaluated for change in size at computed tomography (CT), alpha-fetoprotein (AFP) levels, recurrence rates, and cumulative survival rates. RESULTS: No major complications occurred in 127 LTA sessions. CT showed complete tumor necrosis in 27 (90%) of 30 large HCCS: Twenty-eight patients were followed up for 6-41 months (mean, 17.1 months). In 25 patients, all lesions appeared stable or smaller at CT. AFP levels decreased to the normal range in all patients with high pretreatment values. The 1-, 2-, and 3-year local recurrence rate was 7% in large HCCS: Complete tumor necrosis was achieved in all 15 (100%) small HCCs; none of them recurred locally. The 1-, 2-, and 3-year cumulative survival rates were 92%, 68%, and 40%, respectively. CONCLUSION: LTA followed by TACE is an effective palliative therapy in treating large HCCS:

Long-term persistence of symptomatic effect of selegiline in Parkinson's disease. A two-months placebo-controlled withdrawal study.

Following a two-months of placebo-controlled withdrawal, the MAO-B inhibitor selegiline was found to maintain a long term significant mild to moderate symptomatic effect on bradykinesia and tremor at rest in nine patients with Parkinson's disease (stage II and III of H&Y), whose functional impairment had also required a dopaminergic therapy with low-dose bromocriptine. Both motor signs found worsened during the wash-out showed a full recovery to pre-withdrawal condition within two months after reinstitution of the drug.

Thyroid tissue: US-guided percutaneous interstitial laser ablation-a feasibility study.

PURPOSE: To evaluate percutaneous interstitial laser photocoagulation (ILP) as a palliative treatment of recurrent thyroid carcinoma untreatable with surgery or radioiodine administration. MATERIALS AND METHODS: By using 18 resected thyroid glands, the volume and histologic pattern of ILP-induced thyroid damage were assessed. In vivo treatment feasibility was evaluated by using a low-energy laser in two volunteers before thyroidectomy for huge autonomously functioning nodules. With ultrasonographic (US) monitoring, a 21-gauge spinal needle was inserted into the thyroid nodules. A 300-microm quartz fiberoptic guide was inserted through the needle lumen, and the fiber tip was placed in direct contact with the tissue. Laser irradiation was performed with a 1.064-nm Nd:YAG laser in surgically resected glands, which were treated with 2, 3, 5, or 7 W. RESULTS: Tissue ablation was well-defined histologically, and its area was related to laser irradiation parameters (range, 0-26 mm). No correlation was found between US images and the actual extent of laser-induced lesions. Large colloid or fluid collections did not permit regular heat diffusion within the tissue. In vivo low-energy ILP was performed without technical difficulties or complications. CONCLUSION: ILP induces well-defined tissue ablation correlated with energy parameters in thyroid glands devoid of cystic areas. ILP could be a therapeutic tool for highly selected problems in thyroid tumor treatment.

Severe thyrotoxicosis due to hyperfunctioning liver metastasis from follicular carcinoma: treatment with (131)I and interstitial laser ablation.

Liver metastases from differentiated thyroid tumors are unusual clinical findings, and are only rarely hyperfunctioning. We report a case of thyrotoxicosis caused by a huge and surgically unresectable liver metastasis from follicular thyroid cancer, unresponsive to treatment with large doses of thionamides. To avoid the hazardous side effects of (131)I treatment in a severely thyrotoxic patient, a preliminary debulking of the liver mass was performed by means of percutaneous interstitial laser photocoagulation. Three treatments (total energy delivery: 7200 J) were performed under ultrasound guidance, with no serious complications, during a 2-week period. One month later, serum thyroid hormones had decreased, general condition was improved, and magnetic resonance evaluation revealed large and well-defined areas of necrosis of metastatic tissue. During the following 10 months, the patient underwent 3 radioiodine treatments. Eighteen months after diagnosis, thyroid hormones were within normal levels, liver mass decreased, and the clinical condition markedly improved. The combination of percutaneous interstitial laser photocoagulation treatment and radioiodine therapy made possible the effective management of a hyperfunctioning and surgically untreatable liver metastasis from thyroid follicular carcinoma, avoiding the side effects of (131)I therapy in a thyrotoxic patient and increasing the effectiveness of radioiodine-induced neoplastic tissue ablation.

Evaluation of the vascular pattern of hepatocellular carcinoma with dynamic computed tomography and its use in identifying optimal temporal windows for helical computed tomography.

The aim of this work was to study the vascularization of hepatocellular carcinoma (HCC) by means of dynamic CT and to demonstrate the existence of optimal temporal windows for visualization of HCC in order to develop new protocols for helical CT of the liver. We studied, by means of dynamic CT, 42 histologically proved HCCs in 30 patients after injecting contrast medium (100 ml, 3 ml/s). We performed a time-density analysis of the aorta, liver, portal vein, spleen and lesion. We identified three temporal curves of attenuation of the neoplastic tissue. Curve 1 was three-phasic: hyperattenuation, isoattenuation and hypoattenuation; curve 2 was two-phasic: hyperattenuation and isoattenuation; curve 3 was two-phasic: isoattenuation and hypoattenuation. Thirty-two lesions were homogeneous (curve 1 in 22 cases, 68.7 %; curve 2 in 7 cases, 21.8 %; curve 3 in 3 cases, 9.4 %), whereas 10 lesions were non-homogeneous. Two optimal temporal windows were identified: the first, with predominantly hyperattenuating lesions (range 29-65 s, 90.4 % sensitivity); the second, with predominantly hypoattenuating lesions (range 132.1-360 s, 76.1 %). There is an interposed time range of reduced visualization (range 62-127 s, 54.7 %) in which lesions are isoattenuating. Combined CT study during the first and second temporal windows improves the detection of HCCs especially for homogeneous and small lesions. The intermediate isoattenuation time range does not increase lesion detection rate.

[Interstitial photocoagulation with laser in the treatment of liver metastasis]. / La fotocoagulazione interstiziale con laser nel trattamento delle metastasi epatiche.

Interstitial laser photocoagulation (ILP) causes tumor necrosis with local hyperthermia produced by laser light energy. We treated with US-guided ILP 14 patients (7 men and 7 women; mean age: 67 years) and 20 metastases: 9 of them were < 3 cm in max. diameter and 11 were > 3 cm (mean diameter: 2.9 cm); 14 metastases were from colon carcinoma, 5 from breast cancer and 1 from lung cancer. ILP was performed with 300 and 600 microns quartz fiberoptic guides advanced in 21-18G Chiba needles and a continuous-wave Nd: YAG laser with 1064 nm wavelength. We used single expositions of 5-6 minutes with an irradiation power of 5 watts and scheduled 3 treatment sessions, performing CT scans and biopsies at the end of each session. The extent of induced necrosis was classified as follows on the basis of CT findings: grade 1 = 100% necrosis; grade 2 = necrosis > 50%; grade 3 = necrosis < 50%. The average follow-up was 6 months. After the 3 scheduled treatment sessions, CT showed grade 1 necrosis in all the lesions < 3 cm in diameter and in 4/9 (44%) lesions > 3 cm and grade 2 and 3 necrosis in the remaining cases (necrosis > 50% in 95% of the lesions and 92% of the patients). The cytologic findings were in agreement with CT results in all grade 2 and 3 cases, but in one grade 1 necrosis cytology showed residual viable tumor. To conclude, ILP is a safe and well-tolerated procedure. Maximum efficacy was observed in the lesions < 3 cm, while lesion volume was markedly reduced in the lesions > 3 cm. US is a useful tool in the real-time monitoring of this procedure and CT is the most accurate imaging technique to assess treatment efficacy.

Morphological changes in a hyperfunctioning thyroid adenoma after percutaneous ethanol injection: histological, enzymatic and sub-microscopical alterations.

Ultrasound-guided ethanol injection (PEI) is an effective treatment of autonomously functioning thyroid nodules (AFTN) but little is known about the tissue lesions induced by alcohol. We report morphological changes of an AFTN which was removed after successful PEI treatment. At histological evaluation, the adenoma showed multiple areas of coagulative necrosis with eosinophilic ghost follicles, hemorrhages, small vessel thrombosis and a wedge-shaped hemorrhagic infarction. The peripheral adenomatous tissue and the surrounding thyroid parenchyma were free of regressive changes and/or lympho-monocytic inflammatory reactions. Enzyme histochemistry confirmed the hyperfunctioning character of the lesion and showed reduction of succinic dehydrogenase and cytochrome-c-oxydase activity in the viable tissue surrounding the central necrotic areas. By electron microscopy, the hyperfunctioning follicular epithelium showed submicroscopical alterations of the adenomatous cells surrounding the areas of coagulative necrosis. These results suggest that control of hyperthyroidism, after PEI, is due to: a) directly induced, irreversible damage (coagulative necrosis and vascular thrombosis with hemorrhagic infarction) in the central areas of the lesion; b) potentially reversible damage (reduction of intracellular enzyme activity and ultrastructural changes) in the peripheral areas.

Ultrasound guided percutaneous ethanol injection in the treatment of cystic thyroid nodules.

OBJECTIVE: The management of cystic lesions in the thyroid remains controversial. We examined the efficacy and safety of ultrasound guided percutaneous ethanol injection for the treatment of benign cystic thyroid nodules in euthyroid patients. STUDY DESIGN: (A) Preliminary randomized trial: 20 patients with predominantly cystic thyroid nodules were randomized in two groups and followed up for 1 month. Group 1 underwent fine needle aspiration of the fluid component of the nodules; Group 2 underwent percutaneous ethanol injection at the end of fine needle aspiration of the cyst fluid. (B) Prospective study: 32 patients with the same clinical characteristics (Group 3) were treated by fine needle aspiration and percutaneous ethanol injection, and followed up for 12 months. METHODS: Groups 1 and 2: clinical evaluation, thyroid ultrasonography, thyroid scintiscan and serum thyroid hormone profile were performed before treatment and one month later. Group 3: clinical evaluation, thyroid ultrasonography and serum thyroid hormone profile were performed in basal conditions and 1, 3, 6, 9, 12 months after treatment. Thyroid scintiscan was performed before treatment and 3-6 months later. RESULTS: (A) Randomized study: one month after treatment, nodule volume decrease in Group 2 was significantly higher than in Group 1 (Group 2: median 14.75 range 6-29.9 ml; Group 1: median 3.65 range 0.2-18.5 ml; P < 0.01). Nodule volume reduction was greater than 50% versus baseline in 8 (80%) patients in Group 2 and in 3 (30%) patients in Group 1 (P < 0.01). (B) Prospective study (Group 3): a significant nodule volume reduction (P < 0.01 vs pretreatment) was observed 1 and 12 months after percutaneous ethanol injection (pretreatment: median 14.5, range 1.5-65.8 ml; 1 month: median 3.5, range 0.4-38.9 ml; 12 months: median 2.5, range 0.4-34.5 ml). Nodule volume reduction greater than 50% was recorded in 24 (80%) patients. Groups 1-3: recurrence of cyst fluid was demonstrated by ultrasonography in 8 patients of Group 1, in 3 patients of Group 2 and in 1 patient of Group 3. No relevant adverse effects or significant biochemical changes were observed. CONCLUSIONS: Ultrasound guided percutaneous ethanol injection of cystic thyroid nodules is a safe, low-cost and effective therapeutic procedure in patients with benign thyroid cystic nodules. Indeed, nodule volume reduction was significantly greater and more frequent in patients treated by percutaneous ethanol injection than in those patients who underwent fluid aspiration alone. These results were confirmed in a long-term prospective trial and only one fluid recurrence was observed during 12 months of follow-up.

[ Ethanol injection: technique and method of performance]. / Alcolizaazione: tecnica e metodica di esecuzione.

The authors describe the technique used in the treatment of autonomously functioning thyroid nodules by percutaneous ethanol injection (PEI). They illustrate the free-hand technique followed in their hospital from January 1990 to October 1992 in a group of 25 patients. Results, advantages and disadvantages of this technique are reported and compared with the ultrasound-guided technique. In the latter, widely used, the needle is positioned in the target nodule by means of an ultrasound probe with a specially designed guiding device which forces the needle in the correct direction. This makes the manoeuver rapid and safe as the needle tip can be easily visualized. In this case, the most important drawback lies in the impossibility of changing the ultrasound scanning plane during the ethanol injection as the probe and the needle are fast together. So the correct spreading modality of ethanol inside the tissue is not completely checked. Another disadvantage is the cost of disposable guiding device necessary in order to avoid contamination. On the other side, in the free-hand technique the needle is aimed at the nodule and inserted during an ultrasound examination without restrain on the probe movements. In this way, it is possible to focus the attention on the critical structures to prevent their damage stopping ethanol injection as soon as a seepage outside the thyroid occurs. Furthermore, this technique is particularly inexpensive as a standard probe is used and the risk of contamination can be avoided by just wrapping the probe with a sterline plastic film.(ABSTRACT TRUNCATED AT 250 WORDS)

A prospective randomized trial of levothyroxine suppressive therapy for solitary thyroid nodules.

OBJECTIVE: We examined the effects of L-thyroxine therapy versus placebo over a 12-month period on volume of solitary thyroid nodules. DESIGN: Prospective randomized clinical trial; placebo and control groups followed for one year in three centres. PATIENTS: One hundred and one euthyroid patients with single palpable colloid thyroid nodules. MEASUREMENTS: Serum thyroid hormones, TSH, thyroglobulin, anti-thyroglobulin and anti-thyroid peroxidase antibodies measured at the first visit and after 2, 6 and 12 months; nodule volume and contralateral thyroid lobe thickness measured by ultrasound in double blind fashion; nodule diameter measured by palpation every 6 months. RESULTS: In the treatment group the nodule volume measured by ultrasound decreased progressively but not significantly; in the placebo group no changes were demonstrated. The number of nodules which decreased in size was however significantly larger in the treatment group. None of the initial parameters was predictive for the response. In the treatment group the nodule size assessed by palpation showed a significant decrease after 12 months when compared to baseline. CONCLUSIONS: In non-endemic areas TSH suppression induces nodule volume reduction measured by ultrasound which, although not significant, seems to be progressive and occurring only in a subgroup of patients. Significant palpatory nodule reduction is probably related to decreased thickness of the surrounding thyroid tissue still responsive to TSH.

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.

A randomized trial of ultrasound-guided anterior subcostal liver biopsy versus the conventional Menghini technique.

An ultrasound-guided double pass biopsy technique using a large bore cutting needle via an anterior subcostal route (USAB) is described. The diagnostic adequacy of this biopsy procedure was evaluated in comparison with the traditional Menghini technique in 200 cases of suspected chronic liver disease randomly assigned to the two different procedures. Retrieval rate was better in the USAB group. The sample length was less than 15 mm in four cases in the USAB group and in 19 cases in the Menghini group. In three cases in the USAB group the second pass modified the diagnosis of the first specimen from chronic active hepatitis to active cirrhosis. In order to evaluate the safety and discomfort of the two procedures 340 patients assigned to the different techniques had liver ultrasound scans 6 and 24 h following percutaneous biopsy. USAB was associated with a reduced frequency of complications (one out of 170 patients vs. seven out of 170 patients who had the intercostal Menghini procedure). In our study, USAB seems to offer better sampling and size of individual samples, together with reduced frequency of major and minor complications.

[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.

[Fine needle aspiration biopsy (FNAG) guided with tomodensitometry of pulmonary and mediastinal masses. Personal experience]. / La biopsia per aspirazione con ago sottile (FNAB) sotto guida tomodensitometrica (TC) delle masse polmonari e mediastiniche. Esperienza personale.

CT-guided fine-needle aspiration biopsy (FNAB) was performed on the patients with pulmonary or mediastinal masses to obtain material for cytologic/histologic diagnosis. Diagnostic accuracy and safety of the technique were evaluated in 75 patients affected with thoracic lesions still undiagnosed after thorough radiological and endoscopic investigations. The cytologic and/or microhistologic samples allowed a correct diagnosis to be made in 61 cases (81%), with no false positives and 7 false negatives (9%). The samples were inadequate for diagnostic purposes in 7 cases (9%). Specificity, sensitivity, and diagnostic accuracy were 68%, 76%, and 81%, respectively. No major complication was recorded and a case of asymptomatic pneumothorax resolved spontaneously within 48 hours. CT-guided FNAB of space-occupying lesions in the lung and mediastinum is therefore a rapid and valuable diagnostic tool and is quite safe when performed by skilled operators.

Hepatocellular carcinoma: magnetic resonance imaging after ultrasonically guided percutaneous alcohol treatment. Preliminary report.

Percutaneous alcohol injection (PAI) is reported as a safe, inexpensive and effective method of treatment of small HCC in severely ill patients. Nevertheless, residual cancer can persist after treatment and multiple bioptic manoeveurs are needed to ascertain the actual completeness of treatment. In two cases of HCC treated by ethanol injections, MRI on T2 weighted sequences showed a characteristic change from the previous hyperintense or isointense signal to a hypointense one. This MRI pattern, quite different from the usual HCC features, was correlated to the histologic findings of complete coagulative necrosis of the tumoural mass. Further observations are needed to assess reproducibility and specificity of this finding and the MRI pattern needs to be evaluated also in unsatisfactory percutaneous alcohol treatment of HCC in order to demonstrate that cases with persistent neoplastic tissue display a different pattern. If our report should be confirmed, MRI might be a not invasive tool in evaluating the effectiveness of PAI in patients at risk for multiple histologic samplings. Furthermore MRI could be very useful in assessing the degree and extent of tissutal changes in response to local therapy also after the tumour and its margin are masked by US guided ethanol injections.

Specific IgE to food and inhalant allergens in intestinal washings of children affected by atopic eczema.

Serum and rectal total and specific IgE were measured in eleven children with atopic dermatitis and eight with atopic dermatitis and associated wheezing. Specific IgE to food and inhalant allergens in rectal washings were found in fourteen patients. Of the seventy-six allergens which gave positive results, twenty were positive in both serum and intestine, thirty in serum alone and twenty-six in intestines alone. Specific intestinal IgE were confirmed by food challenge in three out of four patients whose skin-prick test and serum RAST were both negative. Local production of these antibodies was demonstrated by the 'double ratio' of Deuschl and Johansson, and the 'specific activity ratio' of Platts-Mills. Positive ratios (greater than 1) were obtained with both formulas for twelve of fourteen allergens tested. These data suggest that gut-associated lymphoid tissue may play a role in the pathogenesis of atopic disease.