Human ; Female ; Aged ; Brain Diseases ; Calcium Metabolism Disorders ; Spasm ; Angiotensins ; Hypocalcemia

Human ; Female ; Middle Aged ; Graves Disease ; Graves Ophthalmopathy ; Skin Diseases ; Methimazole ; Thyrotoxicosis

OBJECTIVES:To determine the diagnostic accuracy of combined ultrasound-guided fine needle aspiration biopsy (USG-FNAB) and intraoperative frozen section examinationin (FSE) in diagnosing malignant thyroid nodules.
METHODOLOGY:Retrospective review of patients undergoing thyroidectomy with intraoperative frozen section examination following ultrasound guided fine-needle aspiration biopsy. Sensitivity, specificity, positive and negative predictive values and accuracy were calculated with respect to final histology.
RESULTS: A total of 2,239 nodules were subjected to USG-FNAB at the Diabetes, Thyroid and Endocrine Center, St. Luke's Medical Center between January 2007 and December 2009. Two hundred fifty-one nodules were surgically excised following USG-FNAB. Frozen section examinations were taken from 90 of 251 nodules. The USG-FNAB yielded 90.3% (n=1,721) adequate specimens and 9.7% (n=185) inadequate specimens. The histologic examination of the 251 surgically excised nodules revealed 182 (73%) benign and 69 (27%) malignant nodules. The sensitivity, specificity, positive and negative predictive values and accuracy rate of USG-FNAB cytology are 70.3%, 92.8%, 76.5%, 90.4% and 87.2%, respectively. The diagnosis by frozen section was benign in 56 cases (62%), malignant in 10 cases (11%) and deferred in 24 cases (27%). By FSE, the sensitivity, specificity, positive and negative predictive values and accuracy rate are 83.3%, 100%, 100%, 96.4% and 96.7%, respectively. A diagnostic accuracy of up to 97.2% was achieved when USG-FNAB and FSE were combined and when their findings were concordant. When USG-FNAB and FSE diagnoses were discordant, the FSE showed superior accuracy (83.3%) than cytology (16.7%). In the group of nodules with indeterminate or inadequate cytology, the diagnostic accuracy of frozen section is 100%.
CONCLUSION:Ultrasound guided fine-needle aspiration biopsy is an accurate preoperative test for the evaluation of nodular thyroid disease. It helps to distinguish malignant from benign lesions. The intraoperative frozen section is a valuable test for confirming the cytologic diagnosis. It is especially important in identifying malignant thyroid nodule in cases with indeterminate cytology. The combination of USG-FNAB and FSE greatly improves the accuracy rate in thyroid cancer detection.

Human ; Male ; Female ; Aged 80 And Over ; Aged ; Middle Aged ; Adult ; Young Adult ; Adolescent ; Biopsy, Fine-needle ; Cytodiagnosis ; Diabetes Mellitus ; Frozen Sections ; Sensitivity And Specificity ; Thyroid Neoplasms ; Thyroid Nodule ; Thyroidectomy

SYNOPSIS: Splenic artery aneurysm (SAA) is an extremely rare vascular pathology. They are clinically important because of their potential for life-threatening rupture. The pathogenesis is not completely understood and its cause remains unknown. The size of SAA rarely exceeds three centimeters and giant SAA (measuring more than 10 centimeters) are extremely rare. We present a case of SAA larger than 12 centimeters, discuss its management and provide relevant literature. To our knowledge, this is the biggest reported SAA and the first documented case of a giant SAA in the Philippines.
CASE SUMMARY: A 58-year-old male with history of essential hypertension and remote history of abdominal trauma was admitted for pain and a pulsatile mass at epigastrium and left upper abdomen. Examination of the abdomen noted pulsatile, nontender, fairly delineated mass at the left hypochondrium, a bruit was appreciated in the area, Traube's space was dull and splenic percussion sign was negative. Laboratory tests showed normal CBC and bleeding parameters, mild azotemia (that improved after hydration) and unremar kable elect rocardiogram
and echocardiogram results. A multislice computed tomography scan with contrast of the abdomen revealed 10.0 x 6.4 centimeters aneurysmal dilatation at the distal third of the splenic artery with intraluminal thrombus formation. The diagnosis was splenic artery aneurysm. Patient underwent splenic aneurysmectomy, splenectomy and di s tal pancreatectomy Gross examinat ion showed an unruptured 12.2x8.0x6.0 centime ters fusiform splenicarteryaneurysm. Histopathology showed hyal inization and focal destruction of aneurysmal wall and this confirmed the diagnosis. Eight months postoperatively, patient was in good health.
CONCLUSION: Early diagnosis and prompt definitive treatment is necessary in its management. This can only be instituted if SAA is considered in the differential diagnosis for pulsatile left hypochondriac mass.

Human ; Male ; Middle Aged ; Abdomen ; Abdominal Cavity ; Aneurysm ; Azotemia ; Diagnosis, Differential ; Dilatation ; Early Diagnosis ; Hypertension ; Multidetector Computed Tomography ; Pain ; Pancreatectomy ; Philippines ; Spleen ; Splenectomy ; Splenic Artery ; Thrombosis

Objective: To assess the diagnostic accuracy of ultrasound guided fine-needle aspiration biopsy (USGFNAB) in detecting malignancy of the thyroid nodule. Setting: Tertiary care academic medical center in the Philippines. Study Design: Retrospective review of patients undergoing surgery following ultrasound guided fine-needle aspiration biopsy for nodular thyroid disease. Sensitivity, specificity, positive and negative predictive values and accuracy were calculated with respect to final histology. Subjects: A total of 2,239 nodules from 1,737 consecutive patients were subjected to ultrasound guided fine-needle aspiration biopsy at Diabetes, Thyroid and Endocrine Center, St. Luke’s Medical Center. Two hundred fifty-one of the nodules were surgically excised following FNAB. Results: The USG-FNAB yielded 90.3% (n=1,721) adequate specimen and 9.7% (n=185) inadequate specimen. Cytology results were 1,448 (76%) benign, 63 (3.3%) malignant and 210 (11%) indeterminate for malignancy. Histologic examination of the 251 surgically excised nodules revealed 182 (73%) were benign and 69 (27%) were malignant. There were 11 false negative and 8 false positive FNAB cytology. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy rate of USG-FNAB are 70.3%, 92.8%, 76.5%, 90.4% and 87.2%. The USG-FNAB identified malignancy in 37.7% of the cases and its yield for carcinoma is 27.5% when applied preoperatively. Conclusion: Our experience confirms that ultrasound guided fine-needle aspiration biopsy of the thyroid nodules is a powerful diagnostic tool in identifying malignant thyroid disease. Although, the diagnostic accuracy is good, the test remains limited by indeterminate and inadequate samples.

BACKGROUND: The long term complications of diabetes lead to diminished quality of life. As a means to avoid these complicationss, insulin therapy had evolved into a specialized regimen to achieve physiologic control of blood glucose, the so-called Multiple Daily Insulin (MDI) regimen which is a relatively new technique in the Philippines.
OBJECTIVE: To study the efficacy of Multiple Daily Insulin regimen in controlling plasma glucose and to evaluate patient's satisfaction with MDI regimen among Filipino type 2 diabetics who have been on MDI for at least 2 months.
RESEARCH DESIGN AND METHODS: Filipino patients (n=107) with uncontrolled diabetes were included in the study protocol. The majority were male, more than 60 years old and had been diabetic for more than 6 years. The mean body mass index was 27 kg/m2 and the mean baseline HbA1c was 9.2% + 2.65. This prospective cohort study was conducted between January 2006 to September 2008 at Cebu Doctors University Hospital Out-Patient Department. Efficacy was evaluated by HbA1c and treatment satisfaction was assessed with the Diabetes Treatment Satisfaction Questionnaire (DTSQ). Enrolled patients were followed up at week 12, 24 and 48.                                                                                                      
RESULTS: Mean HbA1c fell by 2.43 + 2.68 at week 12, 2.03 + 2.35 at week 24 and 1.73 + 2.23 at week 48 showing a statistically significant decrease of HbA1c among the 3 groups was not statistically significant (p = 0.52). The proportion of patients achieving an HbA1c of < 7% at week 12, 24, and 48 were 42%, 52% and 42%, respectively. Treatment satisfaction improved significantly (p = 0.000) with MDI regimen using the DTSQ at the end of the study.        
CONCLUSION: Multiple Daily Insulin Regimen is an effective treatment modality based on a significant lowering of HbA1c among the study population with uncontrolled type 2 diabetes mellitus. Patients were satisfied with the ragimen based on the positive treatment satisfaction. This, however, is contrary to popular belief that patients' quality of life is affected by insulin administration. Keywords: Multiple Daily Insulin Injection, Type Diabetes Mellitus, Treatment Satisfaction.

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Blood Glucose ; Diabetes Mellitus, Type 2 ; Insulin ; Insulin Infusion Systems ; Outpatients ; Philippines ; Physician-patient Relations ; Prospective Studies ; Quality Of Life ; Treatment Outcome