Steen Karstrup

HIGH FREQUENCY OF GOITRE IN CIGARETTE SMOKERS

Thyroid function, the clinical occurrence of goitre and ultrasonically determined thyroid gland volume were investigated in 219 healthy subjects randomly chosen from hospital employees. Thirty‐five subjects (16%) had a clinically detectable goitre. The frequency of goitre among smokers was higher (32 of 107, 30%) than among non‐smokers (3 of 112, 3%), (P<0.001). Median thyroid volume was significantly higher in smokers, 26 ml (range 11–55 ml), compared with non‐smokers, 15 ml (range 8–37 ml), (P<0.001). The median serum thyroglobulin levels were significantly higher and median serum thyrotropin levels lower in smokers compared with non‐smokers. There were no differences between the groups regarding serum levels of T4, T3, rT3, free T4 index, free T3 index, thyroglobulin antibodies and 131I uptake (24 h) in the thyroid gland. It is suggested that these findings could partly be due to inhaled thiocyanate and/or increased adrenergic stimulation of the thyroid gland in smokers.

Evidence of cyclic alterations of thyroid size during the menstrual cycle in healthy women

Serum levels of thyroxine, triiodothyronine, triiodothyronine resin uptake, thyroxine-binding globulin, thyrotropin, and ultrasonically determined thyroid gland volume were investigated weekly in 11 healthy women during a normal menstrual cycle, and in five healthy men once a week for 5 consecutive weeks. In the men the thyroid volume was unaltered. In the women, however, a mean variation in thyroid volume of approximately 50% between minimum values (15.4 +/- 3.1 ml, day 9) and maximum values (24.4 +/- 4.8 ml, day 23) was found (p less than 0.01), although no significant differences in the other thyroid variables could be demonstrated. The menstrual cycle seems to be associated with cyclic alterations of thyroid size in healthy women unexplained by alterations in thyroid function variables. This information should be taken into account when goiter frequency, goitrogenic action of drugs, and goiter treatment effects are evaluated.

US-guided fine needle aspiration versus coarse needle biopsy of thyroid nodules.

OBJECTIVEnThe aim of this study was retrospectively to evaluate ultrasound (US) guided fine-needle aspiration (FNA), in combination with US-guided coarse-needle biopsies, (CNB) from solitary or dominant thyroid nodules routinely performed during a 2 year period.nnnMETHODSnSeventy seven patients were biopsied using US-guided FNA and CNB. FNA was performed using a 21-Gauge needle and CNB using a 18-Gauge single action spring-activated needle biopsy system. The biopsies were performed with local anaesthesia. The Department of Pathology routinely examined the biopsy specimens. The retrieval rate in obtaining material for diagnostic evaluation was FNA (97%), CNB (88%), FNA and CNB (100%).nnnRESULTSnIn all, 41 of the 77 patients underwent neck-surgery. The surgical specimens were used to determine the results of diagnosing neoplasia. The accuracy, sensitivity and specificity for FNA were 80, 83, and 77%. For CNB 86, 78, and 94%. For both FNA and CNB 80, 89 and 73%. The diagnostic value of the two methods showed no significant difference (P < 0.05). CNB revealed contrary to FNA, however, one additional cancer. Also a higher number of false positive findings was noticed using FNA. No serious complications were registered. Adequate biopsies were obtained in all the patients using the combination of US-guided FNA and CNB. No patient underwent rebiopsy.nnnCONCLUSIONSnThe study demonstrated that neither US-guided CNB nor the combination of US-guided FNA and CNB were superior to US-guided FNA. US-guided CNB is only recommended in few selected patients.

Ultrasonically guided chemical parathyroidectomy in patients with primary hyperparathyroidism: a follow-up study

OBJECTIVE We evaluated the long‐term results in two different groups of patients with primary hyperparathyroidism treated with ultrasonically guided percutaneous ethanol (96%) injection into parathyroid tumours.

Percutaneous drainage of appendiceal abscess

Twenty-seven consecutive patients with ultrasonically verified appendiceal abscesses, measuring from 2 to 10 cm in diameter, were studied. Ultrasonically guided percutaneous drainage was performed in 19 by means of one to five punctures, and in eight with one or two catheters. In 16 and 7 patients, respectively, the abscesses resolved without further intervention. Four patients were operated on, two for suspected (but unverified) abscess perforation, one for bowel obstruction, and one because of failed drainage, resulting in a success rate of 85 percent. Hospitalization ranged from 3 to 23 days; however, normal sonograms were not obtained until after nine to 62 days. Follow-up revealed no diagnostic errors. Two patients (8 percent) had recurrent appendicitis, and late sequelae were observed in four patients, three of these after surgery. Ultrasonically guided percutaneous drainage of appendiceal abscesses with the technique described is indicated whenever feasible, as a safe, gentle, and relatively atraumatic procedure with few complications and late sequelae.

HIGH INCIDENCE OF NORMAL THYROID GLAND VOLUME IN PATIENTS WITH GRAVES' DISEASE

Thyroid function and thyroid gland volume, ultrasonically determined, were investigated in ninety consecutive untreated patients with GRAVES disease.

Optimal set-up for ultrasound guided punctures using new scanner applications: an in-vitro study.

OBJECTIVEnTo investigate if US-visualisation of the needle tip echo during US-guided punctures could be improved by use of new technological applications.nnnMETHODnan US-guided 18 G Trocar needle was inserted into targets of a puncture phantom. The punctures were performed in series of 10 using different settings of the US-scanner (GE Logic 700 Expert). At 7-cm of puncture depth the quality of the echo was tested using four different settings; normal (N), N + automatic tissue optimising (ATO), coded harmonic imaging (CHI), CHI + ATO and at 13-cm of puncture depths six different settings; N, N + ATO, coded excitation (CE), CE+ATO, CHI, CHI+ATO. In total 100 (40 + 60) images were randomly numbered and read independently by three radiologists with regard to scoring of the quality of the echoes from the needle tip, needle shaft and the target.nnnRESULTSnUS visualisation of the needle tip was significantly (P < 0.005) improved as compared to normal settings (N) when the settings of ATO and CE were used. CHI resulted in the lowest score. A high agreement between observers was registered. Similar results were registered with regard to scorings from the needle shaft and target.nnnCONCLUSIONnNot only changes of needle designs and puncture techniques can enhance echoes from the needle but also changes in the settings of the US-scanner with the use of new technological applications can improve visualisation of the needle echo.

Sonography in soft-tissue trauma of the shoulder

Seventy-five patients with soft-tissue trauma in the shoulder region were examined by ultrasonography. Normal conditions were found in 21 patients, distension of the acromioclavicular joint in 17, muscle hematoma or edema in 9, biceps tendinitis in 8, hematoma or partial rupture of the biceps tendon in 5, rupture of the biceps tendon in 1, and supraspinatus tendinitis or partial rupture in 14. A correlation was found between the sonography and clinical course; normal sonography was consistent with recovery in less than 1 week, whereas patients with pathologic changes in the supraspinatus or biceps tendon generally had symptoms for at least 1 month. We concluded that sonography is a useful diagnostic tool for evaluation of soft-tissue trauma in the shoulder.

Breast ultrasound in symptomatic patients

Abstract Objective: The purpose of the study was to assess the value of ultrasound in detecting focal lesions of the breast, in differentiating between benign and malignant lesions and in detecting axillary dissemination of a malignant disease, and to assess the clinical impact of the implementation of breast ultrasound in symptomatic patients. Materials and methods: A prospective, consecutive, blinded study was conducted, comparing the results of the ultrasonic examination of the breast with those of mammography. One hundred and ninety nine patients with a mean age of 48 years (range: 19–80 years) were examined according to a strict methodological design. All these patients were referred for X-ray mammography as they were suspected of having a malignant disease of the breast; they were all affiliated to the general surgery ward (responsible for breast surgery). Specified analytic criteria (tumor shape and margins, architectural distortion and retrotumoral acoustic effect) were used to assess the findings. Results: There were 28 cancers. Ultrasound detected 27, whereas mammography detected 22. McNemars test yielded a P value of 0.037 for patients with malignant disease, thereby showing a tendency towards breast ultrasound being a better diagnostic method than X-ray mammography. The same tendency applies to the benign findings. Conclusion: In this study, breast ultrasound had better results than mammography in detecting focal lesions, in differentiating the nature of the lesions, as well as detecting dissemination of malignant disease. A more liberal use of breast ultrasound is advocated.