Contrast-enhanced ultrasound with perfusion analysis for the identification of malignant and benign tumours of the thyroid gland.

The aim of our study was to evaluate, whether the analysis of time intensity curves (TIC) of contrast enhanced ultrasound (CEUS) could help to differentiate between thyroid adenomas and carcinomas in daily clinical routine.B-mode, Colour Coded Doppler Sonography (CCDS), Power Doppler (PD) and CEUS were applied for 50 patients (27 men, 23 women; mean age 51 years, range 16-81 years).CEUS cine-sequences were analysed using time intensity curves (TIC) and calculating time to peak (TTP) as well as the area under the curve (AUC).All 20 patients with carcinomas presented with a complete wash-out in the late phase of CEUS while this occurred only in three out of the 30 patients with adenomas.Marked differences were observed between adenomas and carcinomas concerning the mean AUC in the surrounding thyroid tissue (p = 0.041). In addition, TTP differed clearly between the centre and the surrounding of the carcinomas (p < 0.05) as well as between TTP in the border area and the surrounding tissue (p = 0.01). CEUS in combination with TIC analysis allows a dynamic evaluation of the microvascularisation of thyroid nodules and is helpful for the differentiation of benign and malignant nodules.

Preoperative differentiation of thyroid adenomas and thyroid carcinomas using high resolution contrast-enhanced ultrasound (CEUS).

BACKGROUND: To evaluate the impact of high-resolution contrast-enhanced ultrasound (CEUS) in combination with Color Coded and Power Doppler Sonography (CCDS/PD) in the preoperative differentiation of thyroid adenomas and thyroid carcinomas. METHODS: A total of 101 patients (55 female, median age 54 years) underwent surgery for thyroid adenoma and thyroid carcinoma. CCDS/PD and CEUS were performed in all patients by an experienced examiner using a multifrequency linear transducer (6-9 or 6-15 MHz) and were digitally stored. Reading of the ultrasound images was performed by two experienced radiologists in consensus. A histopathological evaluation was obtained as standard of reference in all patients. RESULTS: Altogether, 75 thyroid adenomas and 26 thyroid carcinomas were detected. Mean diameter of thyroid adenomas and thyroid carcinomas was 27 mm and 32 mm, respectively. The differences in microcirculation of thyroid adenomas and thyroid carcinomas were statistically highly significant (p <  0.01). Representative features for thyroid adenomas were either no wash-out or wash-out with persisting edge in late phase, for thyroid carcinomas a complete wash-out in late phase. Thus, a calculation of sensitivity, specificity, positive and negative predictive value of 81% , 92% , 97% and 63%, respectively, for the differentiation of benignity and malignancy was possible. CONCLUSIONS: Dynamic evaluation of microcirculation using CEUS and CCDS/PD enables a more reliable preoperative discrimination between thyroid adenomas and thyroid carcinomas.

Qualitative exploration of rural focus group members' participation in the Chronic Disease Self-Management Program, USA.

INTRODUCTION: Nearly half of rural residents in the USA have at least one chronic condition, and meeting the complex needs of these individuals has become a challenge for the current healthcare system. A self-management approach enables individuals with chronic illnesses to gain skills needed to improve the management of their conditions. Rural areas have a higher proportion of individuals who are likely to be affected by chronic conditions. Based on these factors, it is necessary to provide programs to help rural residents self-manage their health. The purpose of this qualitative, exploratory study is to explore the benefits perceived by rural residents due to their participation in six weekly group sessions, which are referred to as the Chronic Disease Self-Management Program (CDSMP). METHODS: Individuals who completed the CDSMP were recruited to participate in a focus group regarding their experience with the program. Thirty-four of the 45 respondents (75%) who completed the CDSMP participated in six focus groups. When the respondents returned for the scheduled focus groups, they were asked to share their experience with the CDSMP. Each focus group was located at the same site that housed the program in their community. Phenomenological and consensual qualitative approaches were used in the data analysis for the present study. FINDINGS: The majority (91%) of the participants were female. Of those, 97% were non-Hispanic whites. The mean number of chronic conditions was two, with a range between one and eight chronic conditions per participant. Two prominent themes emerged from the six focus groups: respondent interaction in behavior change and prioritizing health behavior change. CONCLUSIONS: The study findings support that chronic disease self-management programs can initiate positive behavioral changes, and those lifestyle changes can influence and improve the health of rural populations. Similar programs can yield beneficial results on important behavior change for the rural communities, an underserved population with chronic conditions.

Preoperative diagnosis of thyroid adenomas using high resolution contrast-enhanced ultrasound (CEUS).

To evaluate the impact of high-resolution contrast-enhanced ultrasound (CEUS), Color Coded and Power Doppler Sonography (CCDS/PD), in the preoperative recognition of thyroid adenomas. A total of 64 patients (36 female, median age 54 years) underwent surgery for thyroid adenoma. CEUS with linear multifrequency probes (6-9 or 6-15 MHz) and CCDS/PD was performed in all patients preoperatively by an experienced examiner and images were stored in PACS. Reading of the ultrasound images was performed in consensus by two experienced radiologists. Histopathology was achieved as standard of reference in all patients. Median diameter of the tumor lesions was 27 mm. 31 nodules were found on the left side. In B-Scan mode 13 (20%) adenomas showed complex cystic echo pattern and 44 (69%) had a complete and sharp hypoechoic edge. 43 (67%) thyroid adenomas had strong hypervascularization in CCDS/PD. In 61 (95%) adenomas early contrast enhancement was present in CEUS and 50 (78%) adenomas proved no wash-out or central wash-out with persisting edge enhancement. In 47 (73%) cases early contrast enhancement was combined with no washout or with central wash-out with persisting edge enhancement. 45 (70%) thyroid lesions had preoperatively been classified as benign lesions correctly. Dynamic evaluation of microcirculation by CEUS and CCDS/PD enables a more reliable preoperative characterization of thyroid adenomas.

[The pro-inflammatory immunological memory : twist1 as a marker for chronically activated T lymphocytes]. / Das Entzündungsgedächtnis des Immunsystems : Twist1 als Markergen von chronisch aktivierten T-Lymphozyten.

State-of-the-art immunosuppressive therapies, though efficient in the treatment of rheumatic inflammatory disorders, in most cases do not provide a cure. Complete immunablation and the associated deletion of the reactive immunological memory followed by reconstitution of the "healthy" immune system from stem cells results in a therapy-free remission in many patients suffering from rheumatic diseases. Chronically activated T helper (Th) lymphocytes seem to play a critical role in this reactive pathogenic memory. We have shown that the transcription factor twist1 is specifically expressed in chronically activated, inflammatory Th cells. Twist1 as a biomarker for such Th cells enables the identification and elucidation of the role of Th cells in chronic inflammation and opens new therapeutic options for the targeted manipulation of the pathogenic, reactive memory, such as the targeted deletion of twist1 expressing pathogenic Th cells.

[Traumatic chronic instability of the proximal tibiofibular joint]. / Traumatische chronische Instabilität des proximalen Tibiofibulargelenkes.

The rare condition of chronic instability of the proximal tibiofibular joint can be of traumatic or idiopathic origin and can lead to secondary arthritis. After conservative treatment for 6 months and persistent pain, operative treatment should be considered. We present a case of traumatic instability, ligament reconstruction with a part of the biceps femoris tendon, and postoperative return to full and painless sport activities.

[A 56-year-old patient with Gaucher's disease sustaining a pathologic subcapital fracture of the humerus]. / 56-jährige Patientin mit pathologischer subkapitaler Humerusfraktur bei Morbus Gaucher.

We present a case of a pathologic humerus fracture in a patient with the initial diagnosis of Gaucher's disease, which is the most frequent form of lipidosis transmitted as an autosomal recessive trait. It often results in orthopaedic complications with pain, osteonecrosis, fractures and joint infractions. If there is cause for suspicion, beta-glucocerebrosidase in white blood cells should be measured because of the important consequences for treatment. Therapy with a modified enzyme is effective in managing the disease.

Recombinant Newcastle disease virus (NDV) with inserted gene coding for GM-CSF as a new vector for cancer immunogene therapy.

This is the first report describing recombinant (rec) Newcastle disease virus (NDV) as vector for gene therapy of cancer. The gene encoding granulocyte/macrophage colony-stimulating factor (GM-CSF) was inserted as an additional transcription unit at two different positions into the NDV genome. The rec virus with the strongest production of the gene product (rec(GM-CSF)) was selected for our study. The insertion of the new foreign gene did neither affect the main features of NDV replication nor its tumor selectivity. The gene product was biologically active and stable. Tumor vaccine cells infected by rec(GM-CSF) stimulated human peripheral blood mononuclear cells (PBMC) to exert antitumor bystander effects in vitro in a tumor neutralization assay. These effects were significantly increased when compared to vaccine infected by rec(-) virus. Furthermore, rec(GM-CSF) led to a much higher interferon-alpha (IFN-alpha) production than rec(-) when added as virus or as virus-modified vaccine to PBMC. Two distinct cell types, monocytes and plasmacytoid dendritic cells were shown to contribute to the augmented IFN-alpha response of PBMC. In conclusion, the already inherent anti-neoplastic and immunostimulatory properties of NDV could be further augmented by the introduction of a therapeutic gene whose product initiates a broad cascade of immunological effects in the microenvironment of the vaccine.

Assessing medically impaired older drivers in a licensing agency setting.

An exploratory study is being conducted jointly by the California Department of Motor Vehicles and the National Highway Traffic Safety Administration to develop a licensing agency assessment battery for elderly drivers with dementia or other aging-related medical conditions. A preliminary battery of nondriving tests and road tests is described; test results for a small pilot sample are presented, and the tests are evaluated in terms of their utility for detecting functional impairment and predicting driving performance. Some considerations that shape construction of a test battery for licensing agency use are discussed in relation to these goals and the givens of a driver licensing environment.

Accidents, mileage, and the exaggeration of risk.

The usual interpretation of accidents per mile as a measure of risk exaggerates the apparent risk of low-mileage groups--for example, teenagers and the elderly. The assumption of a linear proportional relationship between mileage and accidents is shown not to fit obtained data. Neither would it be expected to fit hypothetical data derived from a "standard driver" or a group of equally competent drivers driving different numbers of miles. People driving low mileages tend to accumulate much of their mileage on congested city streets with two-way traffic and no restriction of access, while high-mileage drivers typically accumulate most of those miles on freeways or other divided multilane highways with limited access. Because the driving task is simpler, the accident rate per mile is much lower on freeways, and beyond a certain point, a person driving half as many miles as another would be expected to have considerably more than half as many accidents. This and other considerations lead to the suggestion that an induced exposure approach would be a more valid method of correcting accident rates for mileage.

Safety effects of relaxing California's clean-record requirement for driver license renewal by mail.

A pilot program was established in California in 1982 authorizing mail renewal of driver licenses for persons under age 70 lacking clean (accident- and conviction-free) 4-year driving records, but showing clean 2-year records at selection. Such drivers constitute about 14% of California's renewal population, or about 500,000 renewees per year. Eligible drivers whose licenses expired in 1983 were subjects of the present study. Half of them were randomly assigned to a group whose members were sent offers of renewal by mail and the other half were sent standard renewal notices requiring appearance in a field office and successful completion of vision and traffic law tests. Traffic accidents and convictions following the mailout of these documents were tracked for both groups; results presented here cover a 4-year period subsequent to mailout. During this period (a normal license term in California), no significant overall difference was shown between the groups with respect to subsequent convictions or accidents. However, significant detrimental effects on accidents were noted for a subgroup of drivers who had experienced recent traffic violations or accidents which were not on their records at selection. Implications of these results are discussed.

Identification of metabolic risk factors for posterior subcapsular cataract.

To determine the possible role of glucose and lipid metabolism in the formation of cataract in elderly people we studied 463 patients undergoing cataract extraction. Of 188 males, 35 (19%) had posterior subcapsular cataract (group 1), 27 (14%) had cortical cataract (group 2), and 24 (13%) had nuclear cataract (group 3). Of 275 females, 27 (10%) belonged to group 1, 44 (16%) to group 2, and 33 (12%) to group 3. Patients in group 1 were significantly younger than those of group 2 and 3. In addition, patients in group 1 had higher concentrations of fasting serum triglycerides than patients of group 2 or 3. No difference in mean concentrations of serum cholesterol was observed between the different groups. However, fasting plasma glucose concentrations were higher in group 1 patients than in those of group 2 or 3. Patients in group 1 had a higher 'Broca index' than those in group 2 or 3, with the exception of males in group 3. These results suggest that the association of hypertriglyceridemia, hyperglycemia and obesity favors the formation of a specific morphologic type of lens opacity, posterior subcapsular cataract, occurring at an early age. They imply the possibility of effective modes of preventive therapy for a subgroup of patients with 'senile' cataract.