Ethanol injection into autonomous thyroid adenomas.
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Adenoma↗
Biomedical subjects
S Karstrup
Publications and source records attributed to S Karstrup.
Interstitial hyperthermia of colorectal liver metastases with a US-guided Nd-YAG laser with a diffuser tip: a pilot clinical study.
Ultrasound (US)-guided interstitial hyperthermia performed with the neodymium yttrium aluminum garnet laser with a diffuser tip involves placement of a laser fiber in solid tissue followed by irradiation from within the center of the tumor to be treated. The authors previously described the development of a US-guided technique that permits simultaneous interstitial laser irradiation and temperature measurements, with real-time US monitoring. With the use of a dedicated diffuser tip modification of the bare laser fiber, it has proved possible to produce spherical coagulations with a diameter comparable to that of liver metastases of clinical relevance. This technique was used in 11 patients with 16 colorectal liver metastases, 12 of which were radically ablated. Real-time US and interstitial temperature monitoring during treatment had a positive predictive value of 86% and negative predictive value of 100% in judging the final result. The technique is feasible, effective, and safe, but the effect on patient survival must be tested in future randomized clinical studies.
Adult↗
Acute puerperal breast abscesses: US-guided drainage.
Breast abscesses typically develop in lactating women. The recommended treatment is surgical incision and drainage with the patient under general anesthesia. Ultrasonically guided percutaneous drainage with local anesthesia was performed in 19 consecutive patients referred for treatment because of clinical signs of acute puerperal breast abscess. Eighteen of the 19 patients (95%) were successfully treated. Long-term follow-up (median, 12 months) did not show any recurrences, and the cosmetic results were excellent. Eight of the 19 patients (42%) continued nursing during and after treatment. Ten of the 19 (53%) were treated on an outpatient basis. On the basis of these results, the authors recommend ultrasonically guided percutaneous treatment for use in patients with acute puerperal breast abscesses.
Abscess↗
Observer variation in ultrasound assessment of the thyroid gland.
In order to determine observer variation in the assessment of the thyroid gland by ultrasonography, two specialists (one endocrinologist and one radiologist) independently evaluated 76 thyroid glands, and assessed the sonogram as homogeneous, inhomogeneous, containing a solitary solid lesion or a solitary cyst in each of 152 thyroid lobes. The observed agreement between the two observers ranged from 0.80 to 0.91. By the use of the kappa coefficient the observed agreement was adjusted for change agreement. Kappa can vary from -1 (total disagreement) to +1 (total agreement) and kappa values between 0.55 and 0.60 were found. Among 152 lobes a solitary solid lesion, i.e. a nodule, was found in 22 lobes by the two observers; however, they only agreed on a classification in 10 lobes (45%). Clinicians should be aware of the moderate agreement between observers in thyroid ultrasonography.
Adult↗
Acute change in parathyroid function in primary hyperparathyroidism following ultrasonically guided ethanol injection into solitary parathyroid adenomas.
Ultrasonically guided percutaneous injection of 96% ethanol into solitary parathyroid tumours in patients with primary hyperparathyroidism may be used as an alternative to surgery in selected patients. Contrary to surgical parathyroidectomy, the acute changes in parathyroid function following ultrasound-guided chemical parathyroidectomy have never been described. Seven consecutive and highly selected patients with primary hyperparathyroidism were treated with ultrasonically guided injection of ethanol (96%) into solitary and biopsy-verified parathyroid tumours. Basic treatment included a maximum of three injections separated by intervals of 24 h. In six of the seven patients normal serum values of ionized calcium were achieved within 36-120 h (median 36 h) and normal serum values of intact parathyroid hormone within 6-78 h (median 24 h). Three patients received two injections and three patients three injections. One patient remained hypercalcaemic in spite of three injections. Subsequent surgery showed the patient to have two parathyroid adenomas, of which only one had been detected ultrasonically. The present study has demonstrate a fast normalization of parathyroid function following two to three ethanol injections into solitary parathyroid tumors in selected patients with primary hyperparathyroidism.
Adenoma↗
[Ultrasonically guided pericardiocentesis].
Ultrasonically guided pericardiocentesis was performed on 25 occasions in 23 consecutive patients. Incipient cardiac tamponade was present in 22 patients and the procedure was performed for diagnostic purposes in one patient. In 21 cases, 5.7 French pig-tail catheters were employed and 1.2 mm lumbar puncture needles in four cases. In 19 out of 22 patients (86%) with incipient cardiac tamponade the ultrasonically guided pericardiocentesis was considered successful. In one patient, the catheter was misplaced in the right atrium, one patient developed pyopericardium and one patient developed transient tachycardia. In two cases, no material could be obtained. Ultrasonically guided pericardiocentesis is preferable to "blind" puncture and the procedure should be carried out by physicians with experience in interventional ultrasound.
Adult↗
Thyroid stimulating immunoglobulins are not influenced by smoking in healthy subjects.
In view of the increasing suggestion of an effect of cigarette smoking on thyroid disease and in particular Graves' ophtalmophathy we investigated thyroid stimulating immunoglobulins in relation to smoking habits in healthy subjects. No difference between smokers and non-smokers could be demonstrated, therefore, our study does not support the previously suggested altered immunologic surveillance of the thyroid in cigarette smokers.
Adenylyl Cyclases↗
Ultrasound guided nephrostomy utilizing a one-step balloon catheter. Introduction of a new technique.
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Aged↗
Ultrasonically guided interstitial Nd-YAG laser diffuser tip hyperthermia: an in vitro study.
Ultrasonically guided interstitial Nd-YAG laser diffuser tip hyperthermia is a new technique that involves placement of a laser fiber in solid tissue under ultrasound guidance followed by irradiation from within the area to be treated. We have previously described a diffuser tip modification of the bare laser fiber, that proved to produce spherical coagulations of predictable size. In the present paper we describe the development of an ultrasonically guided technique which permits simultaneous laser irradiation and interstitial temperature measurements under real time ultrasound monitoring. The laser lesion appeared on the ultrasound image as a hyperechoic area growing in size with time as energy was applied. Macroscopically the laser lesion emerged as a sphere with a central cavity delineated by a rim of charred tissue and beyond this a larger zone of whitish coagulation. The correlation coefficient (Pearson's r) between ultrasonically and macroscopically measured diameter of the laser lesion was calculated to r = 0.89. It is concluded that ultrasonically guided interstitial Nd-YAG laser diffuser tip hyperthermia may have a potential as a tool in the future treatment of ultrasonically visible neoplasias like liver metastases and prostate cancer.
Animals↗
Ultrasonically guided fine-needle biopsies from adrenal tumors.
Ultrasonically guided fine-needle biopsies were performed from 28 adrenal lesions in 28 patients. In 15 patients adrenal enlargement was an incidental finding. In 17 of 18 (94%) patients with metastatic spread combined cytological and histological examination disclosed secondary malignancy, and in 4 of 5 patients with primary neoplastic disease the combined microscopic examination concluded primary neoplasia. However, it was not possible to classify these lesions as being of a malignant or a benign nature. A false positive diagnosis of a hepatocellular carcinoma of the clear cell type was made in one case. In all 5 patients with non-neoplastic adrenal lesions cytological and histological examinations concluded non-neoplastic disease. Electron microscopy was of special benefit in two cases of a non-Hodgkin's lymphoma and a pheochromocytoma. Using ultrasonically guided biopsies it is possible to differentiate between adrenal lesions due to metastatic spread and adrenal lesions due to primary neoplasia or non-neoplastic disease. Compared to other imaging techniques ultrasonically guided punctures of adrenal masses is a simple procedure giving important diagnostic information.
Adrenal Gland Neoplasms↗
US-guided fine needle biopsy of solid renal masses--comparison of histology and cytology.
We report on 134 fine needle biopsies in 127 patients with an ultrasound finding suggesting renal malignancy. Biopsy was performed guided by dynamic ultrasound using an 0.6 mm aspiration needle for cytology and an 0.8 mm Surecut needle for histology. The retrieval rate for cytology was 97.8% compared to 79.1% for histology. Sensitivity for cytology and histology was 89.4% and 70.6%, respectively. The specificity of cytology was 85.4% giving a predictive value of a positive result of 91.6%. Specificity and positive predictive value for histology were both 100%. We conclude that fine needle aspiration biopsy from renal masses in our hands carries too high a false positive rate to be clinically safe. We recommend that fine needle histological biopsy replaces the aspiration biopsy in case of renal masses.
Biopsy, Needle↗
The aortic wall: an in vitro study of the double-line pattern in high-resolution US.
An in vitro study of macroscopically normal aortas from human cadavers was performed with high-resolution ultrasound (US). Rectangular pieces of 10 fresh aortas were submerged in saline solution and scanned from the intimal side. On US images a characteristic double-line pattern, consisting of an inner and an outer echogenic line separated by a relatively hypoechoic line, was seen. This configuration was initially interpreted as tunica intima, tunica media, and tunica adventitia. The thickness of each layer on the US images was measured by means of a computer-assisted procedure and on histologic specimens was measured by means of stereomicroscopy. The correlation between the two measurements was poor. Experiments in which intima and part of the media were removed did not change the US appearance. Plexiglas, metal plates, and plastic foil showed a similar double-line pattern. A needle experiment disclosed that the inner echogenic and the hypoechoic lines were displayed in front of the true water-tissue interface, which was represented by the outer echogenic line. The authors conclude that the double-line pattern is thus an artifact.
Aorta↗
Nonsurgical treatment of primary hyperparathyroidism with sonographically guided percutaneous injection of ethanol: results in a selected series of patients.
Twelve patients with primary hyperparathyroidism were treated with sonographically guided percutaneous injection of ethanol (96%) into solitary parathyroid tumors verified by biopsy. The patients were all selected for nonoperative chemical parathyroid ablation either because of acute severe hypercalcemic symptoms (four patients), a high surgical risk or an advanced age (four patients), or refusal of a surgical intervention (four patients). Before treatment, the serum concentration of ionized calcium ranged from 1.38 to 2.39 mmol/l (median, 1.59 mmol/l), and after the last treatment the serum concentration ranged from 0.80 to 1.47 mmol/l (median, 1.32 mmol/l) (p less than .001). Normocalcemia was achieved in eight patients, and evident clinical improvement was seen in seven patients. The only complication was a permanent unilateral vocal cord paralysis due to involvement of the recurrent laryngeal nerve. The present study confirms the possibility of percutaneous treatment of hyperactive parathyroid glands. However, the treatment was not found to be beneficial to all patients and hypercalcemia recurred. On the basis of our experience with these patients, we conclude that sonographically guided chemical parathyroidectomy should be considered an alternative treatment to surgery in patients who are not suited for surgical intervention.
Aged↗
Ultrasonically guided percutaneous drainage of breast abscesses.
Four patients with breast abscesses developed during lactation were successfully treated by ultrasonically guided percutaneous drainage under local anaesthesia. Three patients continued nursing during and after the period of treatment and 2 patients were treated as out-patients. The cosmetic results were excellent. No recurrence of abscess was observed following the treatment. Ultrasonically guided percutaneous drainage as an alternative to surgery is discussed.
Abscess↗
[Intraoperative ultrasonic scanning during hepatic, biliary and pancreatic surgery].
Intraoperative ultrasound (US) is one of the most recent applications of US technology. Intraoperative US is currently used within several surgical fields. Intraoperative US may better define the normal anatomy and target pathology than preoperative studies. The method has proved to be an attractive diagnostic tool in surgery of the biliary tract, pancreas and liver. However, one difficulty that has prevented general acceptance of the method is the surgeon's unfamiliarity with the use of diagnostic ultrasound. In order to obtain successful outcome of intraoperative US, close cooperation between the surgeon and the ultrasonologist is essential.
Biliary Tract Surgical Procedures↗
Parathyroid identification by ultrasonically guided aspiration cytology. Is correct cytological identification possible?
Reliable parathyroid identification is necessary before percutaneous inactivation of parathyroid tumours is carried out. Aspiration cytology is one of the methods used for this purpose. Some, but not all, investigators have found it difficult or impossible to make a cytological distinction between thyroid and parathyroid cells. In a blind morphological study of 16 parathyroid and 16 thyroid aspirations the specificity of a cytological diagnosis of parathyroid cells was 100%. The sensitivity of the same diagnosis was 9/16 = 56% if only certain diagnosis of parathyroid cells was considered, but 14/16 = 88% if also diagnoses of "probably parathyroid cells" were considered.
Biopsy, Needle↗
Ultrasound-guided, histological, fine-needle biopsy from suspect parathyroid tumours: success-rate and reliability of histological diagnosis.
Ultrasound-guided, fine-needle tissue biopsies were performed in 60 suspected parathyroid tumours in 55 consecutive patients with biochemically proven hyperparathyroidism. The specimens were randomly arranged and re-read "blind" by two pathologists. The interobserver agreement, corrected for chance agreement, was 0.92 (= kappa coefficient). Twenty-three of the 60 suspect parathyroid tumours were verified histologically following surgery. No diagnostic errors were seen but the percentage of insufficient biopsies from suspect parathyroid tumours or surgically verified parathyroid tumours was high (45 and 47%, respectively). We conclude that a reliable tissue diagnosis can be made by ultrasound-guided, fine-needle tissue biopsy. However, when the material is insufficient for histological diagnosis, we recommend the additional use of ultrasound-guided, fine-needle aspiration for cytology or parathyroid hormone determination.
Adult↗
Ultrasound-guided chemical parathyroidectomy in patients with primary hyperparathyroidism: a prospective study.
Twenty of 31 consecutive ultrasound examined patients with primary hyperparathyroidism were selected for treatment with ultrasound-guided percutaneous injection of ethanol (96%) into biopsy-verified solitary parathyroid tumours following a strict protocol with regard to dose, number of treatments and a minimum of 6 months follow-up. Of 18 patients completing the above protocol, a biochemical improvement was observed in 12, of whom eight became normocalcaemic during the follow-up period of 6 months after the last treatment. An obvious clinical improvement was seen in eight of the patients. In four patients, a unilateral vocal cord paralysis was observed, but was permanent in only one patient. Progressive fibrosis of the parathyroid tumours following injections impeded the intraglandular dissemination of ethanol. Another problem noted was the inability of ultrasound to detect multiglandular involvement. We find ultrasound-guided chemical parathyroidectomy an attractive alternative to surgery in patients who are not well suited for surgical intervention. However, the technique has not been fully developed, and in the present study, possible improvements are indicated.
Adult↗