With no significant preoperative clinical or sonographic predictors for thyroid malignancy and given the high specificity of iFSE, our results support the use of iFSE for patients with preoperative FNA cytology of SFM-Bethesda V who are undergoing thyroid surgery, to determine the extent of required surgery.
ObjectiveStripping of the membranes is an established and widely utilized obstetric procedure associated with higher spontaneous vaginal delivery rates, reduced need for formal induction of labor and a lower likelihood of post-term pregnancy. Due to the theoretical concern of bacterial seeding during the procedure many practitioners choose not to sweep the membranes in Group B Streptococcus (GBS) colonized patients. We conducted ‘the STRIP-G study’ in order to determine whether maternal and neonatal outcomes are affected by GBS carrier status in women undergoing membrane stripping.Study designWe conducted a prospective study in a tertiary referral center, comparing maternal and neonatal outcomes following membrane stripping among GBS-positive, GBS-negative, and GBS-unknown patients. We compared the incidence of composite adverse neonatal outcomes (primary outcome) among the three study groups, while secondary outcome measure was composite adverse maternal outcomes.ResultsA total of 542 women were included in the study, of which 135 were GBS-positive, 361 GBS-negative, and 46 GBS-unknown status. Demographic, obstetric, and intra-partum characteristics were similar for all groups. Adverse neonatal outcomes were observed in 8 (5.9%), 31 (8.6%), and 2 (4.3%) in the GBS-positive, GBS-negative, and unknown groups, respectively (P = 0.530), (Odds Ratio between GBS-Positive vs. GBS-Negative groups 0.67 (95%, CI = 0.30–1.50)); while composite adverse maternal outcomes occurred in 9 (6.66%), 31 (8.59%), and 5 (10.87%) in the GBS-positive, GBS-negative, and unknown groups, respectively (P = 0.617).ConclusionsAntepartum membrane stripping in GBS carriers appears to be a safe obstetrical procedure that does not adversely affect maternal or neonatal outcomes.
Participants:The data of all patients who underwent surgeon-performed ultrasound (SUS) between 7/2009 and 9/2012 were retrospectively reviewed.
Main outcome measures:A correlation between sonographic features and a nonbenign cytology\malignant pathology.Results: Four hundred ninety-eight nodules were included. Solid texture, irregular margins, hypo-echogenicity and intranodular vascularity were significantly associated with malignancy when benign to non-benign cytology was compared, and when compared to malignant pathology. Lack of suspicious features was significantly associated with benign lesions, with a negative predictive value of 94%. Except for taller than wider shape, malignancy odds ratio was significantly higher for known suspicious features, reaching 4.81 for irregular borders (CI 2.42-9.55, P < .001).Conclusions: SUS has proven to be a reliable and consistent tool to assess the thyroid nodule risk stratification. Surgeons should recognise the potential of this tool and its implementation.
Smoking follows a consistent sequence of events, defined by specific anatomic configuration and relatively persistent duration. The fast turbulent flow of the smoke over the narrow glottic aperture and at the areas of bifurcation at the trachea and bronchi may have a role in the high relative risk for carcinoma in these areas.
Background
The management of large thyroid nodules remains controversial. Mandatory resection is recommended by some authors.
Methods
All patients with thyroid nodules ≥3 cm between January 2009 and January 2013 were followed until August 2017. Follow‐up data were collected using an integrated hospital‐community system.
Results
A total of 141 nodules were included. Of these, 37/141 (26%) nodules were initially referred to surgery, resulting in a 32% malignancy rate (12/37). The remaining 104/141 (74%) were referred to follow‐up. During the follow‐up period, 24 additional operations were done, resulting in a 4% malignancy rate (1/24). An indication of nonbenign cytology was significantly associated with malignancy compared with other indications. Median follow‐up was 53.5 months. No patient developed regional or distal diseases. The mean change in nodule size during the follow‐up period was a 7% reduction, with no significant trend of change over time.
Conclusion
Careful patient selection based on clinical, sonographic, and cytologic features can reduce diagnostic surgery allowing for safe follow‐up of large thyroid nodules without surgery.
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