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Thứ Bảy, 17 tháng 10, 2015
Thứ Sáu, 16 tháng 10, 2015
THYROID CANCER in JAPAN and ULTRASOUND
Ultrasound shows
thyroid cancer spike after Fukushima
October 14, 2015 --
Just as many had feared, the disaster at the Fukushima Daiichi nuclear power
plant in March 2011 has sparked a sharp increase in thyroid cancer among
children and adolescents in the area, according to a study published online in Epidemiology.
And more cases may be lurking.
One
particularly hard-hit district in the Fukushima Prefecture saw thyroid cancer
rates that were 50 times higher than the national average in Japan among those
18 and younger, reported researchers who participated in a thyroid ultrasound
screening program in the three years after the earthquake. Cancer rates
throughout the prefecture are 30 times higher than in Japan as a whole.
"The
result was unlikely to be fully explained by the screening effect," wrote
the research team led by Dr. Toshihide Tsuda, PhD, of Okayama University.
"In Chernobyl, excesses of thyroid cancer became more remarkable four or
five years after the accident in Belarus and Ukraine, so the observed excess
alerts us to prepare for more potential cases within a few years."
Radiation
exposure
Following
the meltdown of three Fukushima nuclear reactors, approximately 900
petabecquerel of radiation was released into the atmosphere, the radiological
equivalent of one-sixth of the 5,200 petabecquerel released by the Chernobyl
disaster. Based on its preliminary dose estimation in 2012, the World Health
Organization (WHO) predicted there would be an increase in thyroid cancers
among children who had been exposed to the radiation.
WHO
estimated that those in the most affected areas of the prefecture received
thyroid-equivalent doses of 100-200 mSv, while those in the rest of the
prefecture received 10-100 mSv via inhalation, ingestion, and external exposure
from fallout deposits on the ground, according to the researchers (Epidemiology,
October 5).
Nearly
four years after the accident, the group sought to determine accurate and
quantitative estimates from the Fukushima experience to plan for the
population's future health needs.
Thyroid
ultrasound screening
Under a
screening program planned and conducted by the government of the Fukushima
Prefecture, all residents 18 years or younger received thyroid ultrasound
screening sometime during the 2011-2013 fiscal years. Screening was performed
in three areas: in 2011 in the area nearest the disaster, mostly within 50 km
of the Fukushima plant; in 2012 in a middle area of the prefecture; and in 2013
in the least-contaminated area.
A
second round of screening, which will also include residents born in the
prefecture between April 2, 2011, and April 1, 2012, began in April 2014 and is
expected to be completed in March 2016.
Those
with positive ultrasound findings on screening received a secondary exam, followed
by fine needle aspiration (FNA) biopsy if necessary. Patients with detected
cancer cells were followed and operated on at an appropriate time, according to
the researchers.
Of the
367,687 residents 18 years or younger in the prefecture in 2011, 298,577 (81%)
had received the first round of screening by the end of December 2014. There
were 2,251 positive thyroid ultrasound cases by 2014 and 2,067 received a
secondary exam.
From
these, FNA indicated the presence of 110 thyroid cancers, 87 of which had been
operated on by the end of 2014. On histological examination, 86 were confirmed
to be malignant, a number that included 83 papillary carcinomas and three
poorly differentiated carcinomas.
The
researchers compared the prevalence of thyroid cancer for each area by
calculating a prevalence odds ratio in comparison with the least-contaminated
district of the least-contaminated area of the prefecture. For a comparison
with subjects outside of the prefecture, the team calculated incidence rate
ratios in comparison with annual incidence rates nationwide in Japan, taking
into account the prevalence as well as the latent duration (four years) of the
disease.
Thyroid cancer prevalence
|
|||
Area
|
Prevalence of thyroid cancer per 1 million people
|
Prevalence odds ratio compared to least-contaminated district
|
Incidence odds ratio compared to Japan national rates
|
Nearest to Fukushima
|
359
|
1.5
|
30
|
Middle -- not evacuated
|
402
|
1.7
|
33
|
Least contaminated
|
332
|
N/A
|
28
|
The
researchers noted that the highest incidence odds ratio (50; 95% confidence
interval: 25-90) in comparison with the mean Japanese annual incidence of
thyroid cancer was found in the middle area's central middle district -- 50 to
60 km west of the power plant -- where residents were not evacuated. That
district had a prevalence rate of 605/1,000,000 (95% confidence interval:
302-1,082) and a prevalence odds ratio in comparison with the
least-contaminated district of 2.6 (95% confidence interval: 0.99-7.0).
The
finding that southernmost districts within the middle and the
least-contaminated areas of the prefecture had higher incidence rates than the
northernmost districts was consistent with the flow of indium-131 being
primarily in a southern direction from the Fukushima release.
2nd
round of screening
In the
second screening round that began in 2014, 106,068 (49%) of 218,397 total
subjects have been screened so far. Of the 71% of exams with a decision as to
whether the secondary exam was necessary or not, there were 611 positive
studies.
The
secondary exam has been performed on 377 subjects (62% of the positive
studies), and 262 received a final diagnosis on the secondary exam. FNA was
performed on 22 subjects (8%) and detected eight new thyroid cancer cases by
cytology as of December 31, 2014. All eight had negative ultrasound findings in
their first round of screening.
New
data released in May 2015 added two additional thyroid cancer cases from the
first round of screening and seven more cases from the second round (for a
total of 15). As a result, the incidence ratio so far from the second round of
screening is 13.7 (95% confidence interval: 7.7-23).
The
authors concluded that within as few as four years after the disaster, there
has been an approximately 30-fold increase in thyroid cancer among children and
adolescents in the Fukushima Prefecture. As the number of thyroid cancer cases
has increased faster than predicted by the WHO, it's possible that the
organization's previous exposure estimates for residents were too low,
according to the group.
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Thứ Sáu, 9 tháng 10, 2015
Thứ Sáu, 2 tháng 10, 2015
Thứ Bảy, 19 tháng 9, 2015
Thứ Hai, 31 tháng 8, 2015
J MEDICAL ULTRASOUND Sept 2015
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articles you selected
Ultrasound and Retained Products of
Conception
Accepted: March 2, 2015; Published
Online: May 04, 2015
Early pregnancy loss is a serious
psychological emergency in obstetrics [1]. In this issue, Esmaeillou et al
[2] offer a highly educative article entitled Accurate detection of retained
products of conception after first- and second-trimester by color Doppler
sonography. Making an accurate diagnosis of retained products of conception
(RPOC) is a major clinical challenge. Because RPOC may cause prolonged
bleeding, endometritis, and intrauterine adhesion—Asherman's syndrome—with
subsequently impaired fertility in the future [3], therapeutic intervention is
mandatory.
© 2015 Published by Elsevier Inc.
Renal Tumors
Received: February 12, 2015; Accepted:
March 10, 2015; Published Online: June 18, 2015
Renal tumors can be classified as
benign or malignant. The former include angiomyolipoma, renal cell adenoma, and
oncocytoma; the latter include renal cell carcinoma, urothelial cell carcinoma,
and other less common primary or metastatic cancers [1,2]. This article
addresses the renal tumors that are most commonly observed in a clinical
setting: angiomyolipomas, renal cell carcinomas, and urothelial cell
carcinomas.
© 2015 Published by Elsevier Inc.
Physician-performed Focused Ultrasound: An Update on
Its Role and Performance
Received: February 13, 2015; Accepted:
February 25, 2015; Published Online: March 26, 2015
There is an increase in the use of
focused ultrasound (US) by physicians because it offers the major benefit of
reduction in time to diagnosis. Some of these physicians have received formal
training on focused US, others have not received any such training. However,
among the formal training given on focused US, there is inconsistency across
the teaching protocols. This review presents performances of focused US
commonly performed by physicians, compared with radiology US. The various
teaching protocols are also discussed.
© 2015 Published by Elsevier Inc.
Ultrasound-guided Corticosteroid
Injection for the Treatment of Athletic Pubalgia: A Series of 12 Cases
Received: August 5, 2014; Accepted: November
24, 2014; Published Online: February 24, 2015
Surgical treatment for athletic
pubalgia is the standard of care, however, it poses risks. This study
investigated the use of ultrasound-guided corticosteroid injections as an
alternative treatment. Twelve consecutive patients underwent injections into
the area of degeneration in the rectus abdominis and/or adductor longus aponeurosis.
The Western Ontario and McMaster Universities (WOMAC) scores were used to
evaluate treatment effectiveness. The average WOMAC score was 90.9. With a mean
follow up of 8.7 months (range, 6–19 months), eight of the 12 patients reported
complete symptom resolution. In conclusion, corticosteroid injections alleviate
pain in patients with athletic pubalgia and provide an alternative to surgery.
© 2014 Published by Elsevier Inc.
Evaluation of Therapeutic Effect of
Contrast-enhanced Ultrasonography in Hepatic Carcinoma Radiofrequency Ablation
and Comparison with Conventional Ultrasonography and Enhanced Computed
Tomography
Received: November 4, 2014; Accepted:
January 30, 2015; Published Online: March 24, 2015
Objective
This paper aims to discuss the
evaluation of the therapeutic effect of contrast-enhanced ultrasonography
(CEUS) in radiofrequency ablation (RFA) for liver cancer and its application
value.
Methods
A total of 80 patients (120 hepatic
malignant tumor lesions) were treated using RFA, and CEUS was conducted on the
liver before and after the treatment. Sixty-five patients (85/120 tumor lesions)
had primary hepatic carcinoma and 11 (30/120 tumor lesions) had metastatic
hepatic carcinoma (6 cases of 15 lesions had colorectal carcinoma, 3 cases of 8
lesions had lung carcinoma, and 2 cases of 7 lesions had gastric carcinoma).
Four patients (5 lesions) had recurrence. Prior to the treatment, CEUS
accurately guided the RFA of lesions, and after the treatment, the accuracy of
CEUS was compared with conventional ultrasonography and enhanced computed
tomography (CT).
Results
After the RFA, there were two cases
of bile leakage, two cases of bleeding, and three cases of hydrothorax, and 20
cases had fever. In the CEUS performed after the operation, 114 of the 120
lesions (94.6%) were not filled with contrast agent in the arterial phase,
venous phase, and delayed phase, indicating that the tumor lesions were totally
inactivated. In the remaining six lesions, the arterial phase was enhanced
partially on the edge, indicating suspected partial residues of tumor lesions.
The final diagnosis was based on the aforementioned two kinds of imaging
examinations in combination with the level of tumor markers, needle biopsy, and
follow-up visits of over 1 month. Based on the therapeutic effects on the tumor
after the operation with the final diagnosis as the standards, the accuracy of
CEUS was 94.6%, whereas that of contrast-enhanced CT (CECT) and conventional
ultrasonography was 93.4% and 60.5%, respectively. A comparative analysis was
performed, which indicated that the difference between CEUS and conventional
ultrasonography was of statistical significance (χ2 = 5.42,
p < 0.05). A comparison between conventional
ultrasonography and CECT was also of statistical significance (χ2 = 5.14,
p < 0.05); however, the comparison between CEUS and CECT
indicated no statistical significance (χ2 = 7.54, p > 0.05).
Conclusion
CEUS has important value of clinical
application both prior to and after RFA operations. Prior to the operation,
CEUS can accurately guide the RFA treatment, whereas after the operation, CEUS
is an important method to evaluate the inactivation after the treatment, and
can be an important means for follow-up visits for partial treatment of hepatic
carcinoma.
© 2015 Published by Elsevier Inc.
Accuracy of Sonographic Fetal Weight
Estimation in Bangladesh
Received: November 27, 2014; Accepted:
February 16, 2015; Published Online: March 26, 2015
Objective
This study was conducted to
determine the accuracy of estimated fetal weight (EFW) by ultrasound, compared
with birth weight (BW), in Bangladesh.
Methods
This is a prospective,
cross-sectional study on well-dated singleton fetuses. The accuracy of
weight-prediction formula is determined by assessing how well the formula works
in a group of fetuses scanned close to delivery. Results of previous studies
were compared with those of this study.
Results
A total of 73 infants were included
in the analysis to determine the accuracy of EFW. The mean absolute difference
between ultrasound EFW and BW was −64.5 (±218.5) g, and the mean relative
difference or the mean percentage error of fetal weight estimation was −1.4%
(±7.6%).
Conclusion
Ultrasound is a reliable modality
for estimating fetal weight in a Bangladeshi population using the head
circumference, femur length, and abdominal circumference formula of Hadlock.
© 2015 Published by Elsevier Inc.
Contrast-enhanced Ultrasound of
Kidneys in Children with Renal Failure
Department of Diagnostic Imaging,
National University Hospital, Singapore
Received: January 28, 2015; Accepted:
April 15, 2015; Published Online: June 04, 2015
Ultrasound (US) has been an
important tool for evaluating and imaging renal pathology in children.
Development of US contrast agents and dedicated software for the detection of
microbubbles has given this radiological investigation a new dimension,
especially in children with renal impairment. Application of contrast-enhanced
US (CEUS) brings US into the domain historically occupied by computed
tomography and magnetic resonance imaging. We retrospectively studied nine
children who had undergone CEUS (age range 3–16 years). This pictorial essay
draws on our experience and illustrates the safety and accurate depiction of
enhancement pattern of focal renal lesions.
© 2015 Published by Elsevier Inc.
Discrepancy Between Duplex
Sonography and Digital Subtraction Angiography When Investigating Extra- and
Intracranial Ulcerated Plaque
Received: November 21, 2014; Accepted:
January 5, 2015; Published Online: March 24, 2015
Noninvasive color-coded duplex
sonography has become a good, convenient, and reproducible screening tool for
the general population when studying cerebral hemodynamics and atherosclerotic
disease. Digital subtraction angiography (DSA) is still the gold standard for
the diagnosis of carotid stenosis, although other noninvasive imaging tools are
also available. At present, ultrasound scanning, followed by confirmatory DSA,
is a cost-effective way to survey patients suspected of suffering from cerebral
arterial stenosis. We report two patients who had cerebral ischemic symptoms
due to high-grade stenosis of either the cervical internal carotid artery (ICA)
or the middle cerebral artery (MCA), combined with an ulcerated plaque.
Ultrasonographic Doppler analysis identified high-grade stenotic lesions as
marked elevations in the turbulent flow of the cervical ICA in one patient and
of the middle cerebral artery in the other patient. Subsequently, huge plaque
ulceration was found by color B-mode scanning of the patient with cervical ICA
stenosis. However, DSA was able to demonstrate only a mild–moderate degree of
stenosis associated with the lesions. High-grade stenotic lesions of the ICA
and the middle cerebral artery were reconfirmed by computed tomography
angiography and magnetic resonance angiography. An atheromatous plaque with
ulceration is believed to be the cause of this discrepancy between ultrasonography
and DSA.
© 2015 Published by Elsevier Inc.
Ultrasound-guided Perineural Vitamin B12
Injection for Peripheral Neuropathy
Received: May 14, 2014; Accepted: January
27, 2015; Published Online: March 26, 2015
The objective of this article is to
present an innovative treatment for peripheral neuropathy using
ultrasound-guided perineural vitamin B12 injection. A 37-year-old
patient presented with a progressive dropped foot for 2 months. Preceding
trauma was denied. On examination, severe weakness of ankle dorsiflexion was
revealed. Ultrasound showed peroneal nerve swelling. Nerve conduction velocity
and electromyography study showed results compatible with peroneal neuropathy.
Under the diagnosis of peroneal neuropathy, the patient was given 500 μg
of methylcobalamin around the peroneal nerve under ultrasound guidance two
times, with an interval of 2 weeks. The patient showed improvement of muscle
power within 2 weeks. Full muscle power was regained after 3 months. There was
no adverse symptom after ultrasound-guided perineural vitamin B12
injection. Ultrasound-guided perineural vitamin B12 has the
advantage of precise delivery of high-dose vitamin B12 directly
around the defective nerve.
© 2015 Published by Elsevier Inc.
A Mass on the Right Fifth Middle Phalanx in a
48-year-old Man with Chronic Hyperuricemia
Published Online: January 07, 2015
A 48-year-old male with a history of
hyperuricemia had a painful mass over his right fifth middle phalanx for 6
months, which made it difficult to flex his right little finger (Fig. 1A).
Milk-like materials were occasionally released from a small pore on this mass.
Ultrasound images of the mass in the short-axis view, in the long-axis view,
and under the power Doppler mode are shown in Figs. 1B, 1C, and 1D,
respectively.
Posterior Knee Pain and Swelling
Published Online: June 24, 2015
A 68-year-old woman presented with
gradual onset of right knee pain for 2 weeks. She reported discomfort at the
back of right knee and difficulty squatting. Initial physical examination
showed swelling of the right posterior knee without redness (Figure 1). Knee
flexion was limited at 130°. Sonographic images are shown in Figures 2A and
2B.What is the diagnosis?
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