The use of real-time elastography in the assessment of gallbladder polyps: preliminary observations.

AIMS: Gallbladder polyps often have a benign nature. Current guidelines suggest surgical removal of polyps greater than 10 mm. However, the accuracy of the size criteria is limited because neoplasia can be found in gallbladder polyps less than 10 mm. The aim of this study was to evaluate the feasibility of real time elastography for gallbladder polyps and to demonstrate the elasticity properties of the polyps. MATERIAL AND METHOD: Fifty-three polypoid lesions of the gallbladder were prospectively examined with real-time elastography. Of these patients, 52 had a diagnosis of benign gallbladder polyps and one patient was accepted as a gallbladder carcinoma due to its clinical and radiological findings. B-mode and real-time elastographic images were simultaneously presented as a two-panel image, and the elastogram was displayed in a color scale that ranged from red (greatest strain, softest component), to green (average strain, intermediate component), to blue (no strain, hardest component). RESULTS: The mean size for benign gallbladder polyps was 7.2 +/- 3 mm (range, 5-21 mm). All benign gallbladder polyps on consecutive real-time elastographic images appeared as having a high-strain elastographic pattern. Only one patient who was accepted with gallbladder carcinoma had a gallbladder polyp with low elasticity properties. CONCLUSIONS: Our study showed that real time elastography of gallbladder polyps is feasible. This novel approach may be useful for the characterization of polypoid lesions of the gallbladder.

Effect of nodule size on the reliability of fine-needle aspiration biopsy in thyroid nodules.

BACKGROUND/AIM: To investigate the reliability of fine-needle aspiration biopsy (FNAB) in thyroid nodules and benign/malignant discrimination, particularly in large nodules. MATERIALS AND METHODS: A retrospective analysis of 1466 nodules in 402 patients with thyroid nodules who underwent thyroid surgery was made. The pathologic results of the thyroid nodules from preoperative FNAB and postoperative surgical pathology results were compared. RESULTS: FNAB was found to be in accordance with the postoperative pathologic results. A concordance between the FNAB and postoperative pathologic results, particularly in nodules less than 3 cm in size, was detected. However, a similar finding was not detected in nodules larger than 3 cm in size. The rates, calculated without taking into consideration the nodule dimensions, were found to be: sensitivity, 47.65%; specificity, 93.98%; false-negative, 52.35%; and false-positive 6.02% CONCLUSION: In our experience, the false-negative rate of FNAB in nodules larger than 3 cm was high. Therefore, we have concluded that in the event of malignant FNAB, this rate is significant; however, in the event of benign FNAB, it should not be trusted too much.

The short term effects of infected gallstones lost intraperitoneally.

In this experimental study, an animal model was set up to evaluate what sort of complications may cause intraperitoneal retained bile stones. Forty rats were divided into 4 groups. The first group was assigned as the control group and the subjects had only laparatomy. In the 2nd group, during laparotomy, sterile bile and bile stones were placed within the peritoneal cavity. In the 3rd group, contaminated bile and bile stones were placed within the peritoneal cavity. In the 4th group, again contaminated bile and bile stones were placed and prophylactic antibiotic (Ceftriaxon) was used for 7 days. After a 4 week interval, survivors were subjected to laparatomy and necropsy. As a conclusion, the peritoneal adhesion difference between the infected bile and stone inooculation group without antibiotic and the other group with antibiotic usage may show that antibiotics might prevent further complications in case of abdominal contamination. Available clinical and experimental data is not enough to recommend laparatomy to collect stones. We conclude that more detailed studies with larger series are necessary to clarify the issue (Tab. 1, Fig. 1, Ref. 26).

The PlasmaKinetic tissue management system in thyroid surgery.

BACKGROUND: Thyroid surgery involves meticulous devascularization of the gland. Although conventional technique being a highly efficient technique for vessel bleeding control, it takes long time. The aim of this study was evaluate the efficacy of PlasmaKinetic to the conventional technique. METHODS: We reviewed the medical records of 86 patients who underwent primary thyroid surgery by the same surgeon at our clinic between June 2006 and January 2008. Total thyroidectomy was performed at all of the patients in the study group. RESULTS: When the incidence of postoperative cord palsy was 2.32%, transient hypoparathyroidism was 4.6%. There was no significant difference in consideration of age, gender, thyroid gland weight, and complication rates between the PlasmaKinetic group and conventional group (p>0.05). Operation time, mean drainage from the suction drain and duration of hospital stay of the patients in PlasmaKinetic group were significantly lower than those in conventional group (p<0.05). CONCLUSION: PlasmaKinetic technique decreases the operation time to a level of less than 50 minutes with no increase at complication rate (Tab. 3, Fig. 3, Ref. 14). Full Text (Free, PDF) www.bmj.sk.

Family history of acute appendicitis.

OBJECTIVES: To evaluate the association of acute appendicitis with age, sex, Alvarado score (AS) and family history. METHODS: Medical records of 2670 patients, who were admitted to our hospital's emergency department between January 2005 and June 2007, were reviewed. These patients were referred as acute abdominal pain by general practitioners. The data of patients were devided into sub-groups according to their age, sex, operative status, AS status and having a pathologically confirmed postoperative diagnose of acute appendicitis or not. Logistic regression analysis was performed to find out relationships among the sub-groups. RESULTS: Male gender (1.37), age < 50 (2.4), positive family history (3.16), AS 5-6 (13) and AS 7 (31) increased the risk of acute appendicitis. The sensitivity and specificity of AS was 91.5% and 60.5% respectively. The sensitivity and specificity of family history was 68.9% and 75.4% respectively. CONCLUSION: Family history is an important parameter while predicting acute appendicitis.

Bilateral Paget disease of the male nipple: first report.

Bilateral breast carcinoma is reported to occur in 5-10% of all patients with breast cancer. Paget disease of the breast represents 1-3% of all breast malignancies [Ashikari R, Park K, Huvos AG, Urban JA. Paget's disease of the breast. Cancer 1970;26:680-5; Marshall JK, Griffith KA, Haffty BG, Solin LJ, Vicini FA, McCormick B, et al. Conservative management of Paget disease of the breast with radiotherapy. Cancer 2003;97:2142-9]. However, synchronous bilateral Paget disease of the nipple is extremely rare. We report synchronous bilateral Paget disease with infiltrative ductal carcinoma in a 74-year-old man who underwent bilateral mastectomy.