Brucellosis is a common zoonosis in many parts of the world; the best regimen for the treatment of brucellosis has not been clearly determined. We have carried out a multicenter, open, controlled trial in five general hospitals in Spain to compare the efficacy and safety of doxycycline and rifampin (DR) versus doxycycline and streptomycin (DS) for the treatment of human brucellosis. The study included 194 ambulatory or hospitalized patients with acute brucellosis, without endocarditis or neurobrucellosis. The diagnostic criterion was isolation of Brucella species from blood or other tissues (n ؍ 120) or a standard tube agglutination titer of 1/160 or more for anti-Brucella antibodies with compatible clinical findings (n ؍ 74). Patients were randomly assigned to receive either 100 mg of doxycycline twice daily plus rifampin, 900 mg/day, in a single morning dose for 45 days (DR group) or the same dose of doxycycline for 45 days plus streptomycin, 1 g/day, intramuscularly for 14 days (DS group). A lack of therapeutic efficacy developed in 8 of the 100 patients in the DR group (8%) and in 2 of the 94 patients in the DS group (2%) (P ؍ 0.10). Relapses occurred in 16 of the 100 patients in the DR group (16%) but in only 5 of the 94 patients in the DS group (5.3%) (P ؍ 0.02). When relapse was considered in combination with initial lack of efficacy, 26 patients in the DR group (24%) and 7 patients in the DS group (7.45%) failed to respond to therapy (P ؍ 0.0016). In general, therapy was well tolerated, and only four patients (4%) in the DR group and two (2%) in the DS group had episodes of adverse effects necessitating discontinuation of treatment (P > 0.2). We conclude that a doxycycline-and-rifampin regimen is less effective than the doxycycline-and-streptomycin regimen in patients with acute brucellosis.
Os nódulos da tireoide são achados muito frequentes, principalmente com o advento da ultrassonografia. Embora o câncer de tireoide não seja comum, sua incidência vem aumentando, principalmente, em mulheres e idosas. A grande maioria dos pacientes com carcinoma evolui bem quando diagnosticado e tratado precocemente, sendo os índices de mortalidade parecidos com o da população geral. Apesar disso, alguns pacientes apresentam recidivas e outros, evoluem para óbito. Por isso é importante usar todos os recursos necessários para o diagnóstico de malignidade nesses pacientes e ao mesmo tempo, evitar procedimentos e cirurgias desnecessárias. Neste trabalho, falaremos especificamente sobre o uso da ultrassonografia de tireoide e região cervical no diagnóstico e manejo dos nódulos dessa glândula tão importante para o ser humano, assim como sobre as principais características ultrassonográficas de malignidade, a punção aspirativa com agulha fina (PAAF), o uso do Doppler como método coadjuvante e o sistema TIRADS (Thyroid Imaging Reporting and Data System).
Abstract: Thyroid nodules are very common findings, especially with the advent of ultrasound. Although thyroid cancer is not common, its incidence has been increasing, especially in women and elderly. The vast majority of patients with carcinoma, progressed well when diagnosed and treated early, and the similar mortality rates to the general population. Nevertheless, some patients have relapses and others, progressing to death. So, it is important to use all necessary resources for the diagnosis of malignancy in these patients and at the same time avoiding unnecessary procedures and surgeries. In this work, we will talk specifically about the use of thyroid ultrasound and cervical region in the diagnosis and management of nodules of this gland so important for humans as well as on the main sonographic features of malignancy, needle aspiration (FNA), the use of Doppler as an auxiliary method and TIRADS system.
Keywords: Thyroid nodule. Ultrasonography. Neoplasms. Biopsy. Fine-needle.
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