Incidence of nodular thyroid disease as well as that of functioning thyroid nodules (FTN) increases dramatically in iodine deficient (ID) areas. Cancer is extremely rare in FTN; thus, some do not routinely biopsy and treat them with radioactive iodine (RAI) straight away or follow-up. The outcome of 296 patients followed or treated at our institution for solitary or multiple FTN were retrospectively evaluated. Hospital records of 224 female, 72 male patients, with a mean +/- SD age of 54.9 +/- 12.4 yr and followed for 22 (0-156) months were examined. 175 patients had solitary, 121 had multiple hot or warm nodules. 230 (77.7%) of the patients received RAI treatment. 402 fine needle aspiration biopsies (FNABs) were performed on 260 patients and on 343 FTN (381 benign and 21 suspicious diagnoses). Eleven of the patients were operated for suspicious FNAB results and 10 were followed-up. Only one nodule turned out to be malignant. Malignancy is extremely rare in functioning thyroid nodules (0.34%) and some of malignant cases could be predicted by their suspicious clinical features. Routine practice of treating FTN with RAI therapy is reasonable in clinically low-risk patients. FNAB is reserved for cases with suspicious clinical features, resulting in fewer surgeries and reduced cost.
We report an unusual case of overlap syndrome that had the coexistence of five autoimmune diseases. A 45-year-old woman initially developed seropositive erosive rheumatoid arthritis (RA) 11 years ago. She then developed progressive systemic sclerosis (PSS) (including pulmonary hypertension, esophageal dysfunction, cardiac involvement and sclerodactilitis), systemic lupus erythematosus (SLE) (including photosensitivity, nephritis, leukopenia, lymphopenia, thrombocytopenia and Coombs positive hemolytic anemia and positive anti-dsDNA), and secondary Sjögren's syndrome (SSS) in the last 7 years before she was admitted to our clinic. The patient fulfilled classification criteria for RA, SLE, PSS and SSS, as determined by American College of Rheumatology. Hypothyroidism with positive autoantibodies due to Hashimoto's thyroiditis, the beginning of which could not be defined, was coexistent with this overlap syndrome. In the literature, although overlap syndromes in different combinations were reported, we very rarely observed a complex case like this patient. In our opinion, this is the first well-documented case of RA, PSS, SLE, SSS and Hashimoto's thyroiditis existing together in the same patient. Although immunosuppressive therapy was administered, the disease rapidly deteriorated and the patient died.
The presence of Salmonella spp. in minced meat that is consumed in nine different sites of Istanbul is evaluated by using conventional culture (ISO 6579:2002), immunomagnetic separation (IMS) and fluorescent in situ hybridization (FISH) methods. Salmonella spp. was isolated from five of 50 (20%) minced meat with ISO 6579 method, and three of 50 (6%) minced meat using IMS method. Bacteria isolated from both ISO and IMS methods were identified as Salmonella choleraesuis ssp. arizonae and Salmonella spp. The presence of Salmonella spp. was determined from 37 of 50 (74%) minced meat by using FISH method. In the current study, it has been shown that ISO 6579 method was found more to be susceptible than IMS method for determining presence of Salmonella spp., FISH method is the best method to determine the presence of Salmonella spp. Even if the quick determination of the epidemics of international importance occured as a result of the contamination by pathogens derivated from foods, the results of the use of new methods should be supported by the conventional culture method. Keywords: Conventional culture method (ISO 6579 reference method), Fluorescent in situ hybridization (FISH) method,Immunomagnetic separation method, Minced meat, Salmonella Kıyma Örneklerinde Salmonella spp. Tespitinde Farklı Yöntemlerin Karşılaştırılması Özetİstanbul'un dokuz farklı semtinde tüketime sunulan kıyma örneklerinde geleneksel kültür yöntemi (ISO), immünomanyetik ayırma (İMA) ve floresanlı yerinde hibritleme (FISH) yöntemleri kullanılarak Salmonella cinsi bakterilerin varlığı tespit edilmiştir. İncelenen 50 kıyma örneğinin, geleneksel kültür yöntemi ile 5' inden (20%), İMA yöntemi ile 3' ünden (6%) Salmonella cinsi bakteri izole edilmiştir. Gerek geleneksel kültür yöntemi gerekse de İMA yönteminde besiyeri üzerinde üreyen kolonilerden elde edilen izolatlar Salmonella choleraesuis ssp. arizonae ve Salmonella spp. olarak tanımlanmıştır. İncelenen 50 kıyma örneğinin 37'sinde (74%) ise FISH yöntemi ile Salmonella cinsi bakterilerin varlığı tespit edilmiştir. Çalışmamızda Salmonella cinsi bakterilerin varlığını belirlemede geleneksel kültür yönteminin, İMA yöntemine göre daha duyarlı bir yöntem olduğu, FISH yönteminin ise Salmonella cinsi bakterilerin varlığını belirlemede en iyi yöntem olduğu tespit edilmiştir. Gıda kaynaklı patojenlerle kontaminasyon sonucunda ortaya çıkan uluslararası önemdeki salgınların hızlı tespiti ne kadar önemli olsa da, uygulanan yeni yöntemlerin sonuçlarının geleneksel kültür yöntemi ile desteklenmesi gerekmektedir.
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