Ultrasound-guided Fine-needle Aspiration Biopsy of Thyroid Nodules: Comparison of the Pain Scale according to the Application of Local Anesthesia

PURPOSE: This study was designed to evaluate the difference in the degree of patient pain during an ultrasoundguided fine-needle aspiration biopsy (US-FNAB) with the use of a one-needle puncture for thyroid nodules with the application of local anesthesia. MATERIALS AND METHODS: We prospectively examined patients who simultaneously received US-FNAB for two thyroid nodules, for one nodule in the right lobe and one nodule in the left lobe, where the nodules were larger than 10 mm in the maximum diameter. US-FNAB with or without local anesthesia was performed with the use of a 23-guage needle in all patients. The degree of pain after performing US-FNAB was evaluated by the use of an 11-point numeric rating scale. RESULTS: For all 20 patients, US-FNAB was performed with an alternative selection of the nodules. There were 14 patients with a higher pain score where local anesthesia was administered, two patients with a higher pain score where local anesthesia was not administered and four patients with the same score where both methods were used. There was a statistically significant difference in the pain score between the use of the two methods (Wilcoxon sign rank test, p = 0.014). The mean value of the pain score was 3.1 in patients who received local anesthesia and 2.1 in patients that did not receive local anesthesia, respectively. CONCLUSION: The use of local anesthesia is not superior to the use of no anesthesia regarding pain relief if USFNAB is performed with a one-needle puncture.

Serum ALT and HBV DNA Levels in Patients with HBeAg-Negative Chronic Hepatitis B / 대한간학회지

BACKGROUND/AIMS: HBeAg-negative chronic hepatitis B (CHB) has a poor long-term prognosis. Since no precise clinically relevant HBV thresholds are known in HBeAg-negative CHB, the decision to treat is difficult. The aim of this study was to evaluate the levels of serum HBV DNA and transaminase and to investigate the correlation of these values in patients with HBeAg-negative CHB. METHODS: The study analyzed the sera from 82 patients with HBeAg-negative CHB, 61 men and 21 women. The mean age was 45 years. The patients were divided into two groups according to serum ALT levels: the patients with lower ALT level (n=52, UNL or= 2 X UNL). The level of serum HBV DNA was determined by the Cobas Amplicor HBV Monitor(TM) (Roche). RESULTS: The median serum HBV DNA level was 2.7 X 10(5) copies/mL in patients with HBeAg-negative CHB. The median serum HBV DNA level of patients with a higher ALT level (1.0 X 10(6) copies/mL) was significantly higher than that of patients with a lower ALT level (5.6 X 10(4) copies/mL)(p<0.001). The serum ALT level was correlated with serum HBV DNA levels in patients with HBeAg-negative CHB (r=0.416, p<0.001). The serum level of HBV DNA in patients with cirrhosis (median 2.0 X 10(5) copies/mL) did not differ from patients without cirrhosis (median 4.7 X 10(5) copies/mL). CONCLUSIONS: The level of serum HBV DNA was higher in patients with higher serum ALT level than it was in patients with lower serum ALT, and it was closely correlated with serum ALT levels in HBeAg-negative CHB.