Background Emerging evidence has linked the long-term use of bisphosphonates with femoral insufficiency fractures. It has been suggested that the prolonged effect on bone remodeling leads to the accumulation of microfractures and weakening of bone.

Although the clinical appearance of the DLN is not an accurate indicator of the presence of unsuspected thyroid cancer, metastatic involvement of the DLN is an adverse prognostic marker in papillary/medullary thyroid cancer. The presence of DLN metastasis in patients with thyroid cancer should alert the surgeon to the high probability of advanced disease and need for greater attention to the central and lateral lymph node compartments.

This is the first study to examine the diagnostic accuracy of all level VI lymph nodes in PTC. While, metastatic involvement of all central nodal groups is indicative of further disease, the DLN is the most accurate predictor.

No abstract

No abstract

No abstract

BackgroundFine needle aspiration cytology (FNAC) is integral to diagnosis and management of patients with thyroid nodules. We introduced synoptic cytology reporting for thyroid nodules in 2004. The aim of the study was to examine the impact of synoptic cytology reporting. MethodsA comparative study of two 2-year periods (1/8/2002-1/8/2004 and 2/8/2004-2/8/2006) prior and post introduction of synoptic reporting was conducted from a prospectively collected database of patients presented with thyroid nodules. All data were analysed using Microsoft excel and statistics calculated with likehood ratio and chi square tests. ResultsThere were a total of 660 patients. Of these 376 were operated and 284 non-operated. The female to male ratio was 1 : 7. Comparing the 2 periods, the overall FNAC sensitivities were 60% vs 79.1%, specificities were 83.7% vs 79.4%, accuracy 76% vs 79.3%, false positive 16.3% vs 20.6% and false negative of 40% vs 20.9%. The non diagnostic rates were 7.4% vs 3.15%. FNAC prompted surgery in 66.7% vs 100% in carcinoma and 56.4% vs 73.6% in adenoma. A benign FNAC prompted surgery in 15% VS 19.8% of cases. The total rate of surgery has decreased by 2.7%. ConclusionsSynoptic cytology reporting has resulted in an overall improvement in all measures of the tests. The rate of surgery has decreased by 2.7%. Synoptic cytology reporting is therefore recommended for all endocrine surgical units.

No abstract