T. C. A. Doyle

Urinary iodine and thyroid status of New Zealand residents.

Objectives: The aim of this project was to assess the clinical significance of our low iodine excretions in terms of thyroid hormone status and thyroid volume in an adult population in a low soil iodine area of the South Island of New Zealand.Design and setting: Two-hundred and thirty-three residents of Otago, New Zealand collected two 24 h urine samples for assessment of iodine status. Thyroid status was determined from serum total T4, TSH and thyroglobulin, and thyroid volumes. Relationships between urinary iodide excretion and measures of thyroid status were determined and subjects were allocated to one of three groups according to low, medium and high iodide excretion, for comparison of thyroid hormones and thyroid volumes.Results: Significant correlations were found for relationships between measures of urinary iodide excretion and thyroid volume and thyroglobulin. Multiple regression analysis of data for subjects divided into three groups according to 24 h urinary iodide excretion (<60, 60–90; >90 μg iodide/day) or iodide/creatinine ratio (<40; 40–60; >60 μg/g Cr) showed significant differences in thyroid volume (P=0.029; P=0.035, respectively) and thyroglobulin (P=0.019; P=0.005, respectively) among the groups.Conclusions: The results of this study confirm the low iodide excretions of Otago residents, and indicate that the fall in iodine status is being reflected in clinical measures of thyroid status, including enlarged thyroid glands and elevated thyroglobulin. Our observations suggest the possible re-emergence of mild iodine deficiency and goitres in New Zealand. This situation is likely to worsen should iodine intakes continue to fall and continued monitoring of the situation is imperative.Sponsorship: Health Research Council of New ZealandEuropean Journal of Clinical Nutrition (2001) 55, 387–392

Left-sided and duplicate inferior vena cava: a case series and review.

Left‐sided and duplicate inferior vena cava (IVC) are two major anatomical variants within the spectrum of IVC malformations, both of which are developmental abnormalities of the supracardinal veins. Four clinical cases are described to highlight the computed tomographic appearances of these vascular malformations and provide novel data on venous dimensions. A systematic review of the recent literature (2000–2011) was conducted focusing on the anatomy, demographics, and associated pathology (congenital and acquired) of isolated left‐sided and duplicate IVC. A total of 73 relevant articles were retrieved, consisting of case reports and small case series. The prevalence of left‐sided IVC is about 0.1–0.4% and that for duplicate IVC about 0.3–0.4%; both anomalies show a slight male preponderance. In each condition, there are documented variations in the course and tributaries of the IVC. The clinical importance of these anomalies lies in three principal areas: the potential for misdiagnosis on imaging; technical difficulties during retroperitoneal surgery (particularly abdominal aortic aneurysm repair and live donor nephrectomy); and their significance in relation to the etiology and management of venous thromboembolism. Clin. Anat. 26:990–1001, 2013.

Impact of independent double reading of mammograms from the inception of a population-based breast cancer screening programme

Summary The Otago-Southland Breast Screening programme was set up to find out how acceptable and effective breast screening would be for New Zealand women aged between 50 and 64 years. This report examines the performance of the radiologists in the first 18 months of the pilot programme. The majority, 5659 (80.0%), of the two view mammograms from 7074 women, were read independently by two radiologists. Women, who both radiologists believed had an abnormality, were automatically referred for further assessment. The mammograms of those thought to have an abnormality by only one were reconsidered before a referral by consensus was made. The majority of cancers (58) were detected in mammograms read by radiolo- gists A and B. The positive predictive value for those read as abnormal by both was 12.4%. If only one had read the mammograms the number of cancers detected would have been 56 or 55 depending on the radiologist. Overall 73 women were found to have cancer, 67 of whom were identified by two radiologists. The positive predictive value for all the radiologists was 10.5% (95% CI 7.7–12.4). The inter-observer agreement for radiologists A and B about whether or not a woman should be referred for further assessment measured by kappa was 0.65. Because of the debate about whether or not kappa is the most appropriate measure of agreement other measures are also presented. Alpha which is based upon the idea that mammograms fall into two classes, those that can be consistently classified by two observers according to some well defined rules and those, that because they are more difficult, are classified by chance. In this study alpha was 0.82 for radiologists A and B suggesting that they were in accord, taking account of chance, for 82% of the mammograms. The intraclass correlation, a measure of agreement among all radiologists was 0.64. These measures show higher levels of agreement than have been reported in other larger studies.

Minimal-preparation abdomino-pelvic CT in frail and elderly patients: prognostic value of colonic and extracolonic findings

AIM To examine the overall survival of patients who had had been referred for minimal preparation abdomino-pelvic computed tomography (MPCT), and to assess the prognostic value of the colonic and extracolonic findings detected. METHODS AND MATERIALS The survival of a cohort of 1029 elderly and frail patients, with clinical symptoms and signs suspicious for colorectal cancer (CRC), who had undergone MPCT between 1995 and 1998 was investigated. Univariate and multivariate survival analyses were undertaken according to the presence of CRC and extracolonic abnormalities (ECA). RESULTS The median age of the 1029 patients was 79.4 years. The overall median survival following MPCT was 5.4 years; and 6.6 years if no abnormality was detected. On multivariate analysis, age, sex, CRC status, and number of ECAs were significant factors in overall survival. Median survival for those with confirmed CRC [n=91 (prevalence, 8.8%)] was 1.1 years, compared with 5.9 years without CRC (p<0.0001); and 2.4 years for those with one or more ECA [n=245 (prevalence, 23.8%)], compared with 6.1 years without ECA (p<0.0001). Survival was progressively shorter for increasing numbers of ECAs; and shorter for previously unknown non-CRC malignancies (n=24) compared with CRC (p<0.0001). CONCLUSIONS MPCT appears to have prognostic potential in this patient population, with significant reductions in survival if a CRC or ECA is detected. The detection of ECA would appear to have at least as important an impact on the usefulness of the examination as the detection of CRC.