[Reliability of needle biopsy of solitary thyroid nodules in view of surgical indications]

To evaluate the accuracy of fine-needle biopsy in the management of the solitary thyroid nodules, 320 biopsies without aspiration were performed in 212 patients, iteratively in 91 cases. Among the 212 initial biopsies, 93 smears were found presumably benign (43.9%), 6 malignant (2.8%), 49 benign implying cytologic control (23.1%), 24 suspicious with decision to operate (11.3%), 40 inadequate (18.9%). On 67 surgical indications (malignant or suspicious cytology, or clinical data), 59 operations were performed. The 11 diagnosed cancers (5.2% of the patients; 18.6% of the operations) correspond to six malignant and five suspicious cytologies at the first or second biopsy. On 145 cases without decision to operate, 125 were clinically surveyed, with sometimes another biopsy (mean survey: 27.6 months; range: 6-80 months), and it was never necessary to modify the initial expectancy attitude. Our results, rather similar to those related by most of the previous publications, confirm that the fine-needle biopsy is a reliable and effective means for the etiologic diagnosis of thyroid nodules and the indications for operative intervention. It spares many patients from a useless operation and is worthy to take a leading place in exploring these nodules.

Ultrasonic preparation and obturation of root-end cavities

This study evaluated the preparation of root-end cavities using an ultrasonically activated file, and the obturation of such cavities. In the first part, the root canals of 40 extracted teeth were prepared to size 40 and irrigated with NaOCl and EDTA. The root ends were resected and the teeth inoculated with Enterococcus faecalis, incubated for 10 days and divided into four groups: control; saline; irrigation; hand instrumentation performed via a retrograde approach up to size 50 using saline irrigant; ultrasonic instrumentation with prebent size 40 K-flex file inserted into a Piezon Master using saline irrigant. The teeth were fixed, sectioned longitudinally and viewed under scanning electron microscopy. Bacterial and smear layer scores were obtained at 1, 3, and 5 mm from the resected end. The bacterial scores for control and saline groups were similar; the scores for each instrumentation group were significantly lower than the control group (P<0.001). In addition, there were significantly fewer bacteria in the ultrasonic group compared with the hand instrument group (P<0.001). The smear layer scores for control and saline groups were similar, and significantly lower than in either instrumentation group (P<0.001). In the second part, root-end cavities were ultrasonically prepared in 20 extracted teeth. Ten cavities were filled with amalgam, and 10 with thermoplasticized gutta-percha and Grossman's sealer. After 24-h storage, the root ends were immersed in dye for 48 h. Cross-sectional slices of the obturated part of the root were evaluated using both light and confocal microscopy for dye leakage along the interface of filling material and dentine. There were no statistical differences between the leakage of amalgam and gutta-percha root-end fillings, nor between the two methods of microscopy.

Complications of plombage in a Cuban exile

Collapse of the affected lung, or plombage, was a common operative treatment for tuberculosis in the United States in the 1930s and 40s. Due to the lack of antitubercular drugs, this practice continued in Cuba into the 1950s. After 41 years the plombage material in an exile patient was found to be infected. This resulted in the bronchopleural fistula which required a pectoralis muscle flap to close. Physicians should be aware that many Cuban exiles have been treated for tuberculosis via plombage and are at risk for similar complications.

[Late onset hyperandrogenism caused by 3-beta-hydroxysteroid dehydrogenase deficiency]

OBJECTIVES

Clinical manifestations of hyperandrogenism, including hirsutism and acne with or without dysmenorrhoea are well recognized in late onset hyperandrogenism due to deficiency in 3 beta-hydroxysteroid dehydrogenase (3 beta-HSD), yet the frequency of this deficiency in patients with post-puberty hirsutism is not well established. We therefore evaluated retrospectively this deficiency state in women who consulted our unit for manifestations suggestive of hyperandrogenism from 1990 to 1992.

METHODS

We included 32 women with clinical manifestations of hyperandrogenism for whom a partial deficit in 3 beta-HSD could be searched for on the basis of hormone assays. Their mean age was 27.5 years (range 14 to 46) and the clinical manifestation was hirsutism in 21 cases, acne in 13, alopecia in 5 and dysmenorrhoea in 11. Diagnostic tests included adrenal stimulation with 0.25 mg beta 1-24 corticotrophin and immunoradioassay of plasma levels of 17-hydroxypregnenolone (17-OHPreg), 17-hydroxyprogesterone (17-OHP), dehydroepiandrosterone (DHA) and cortisol (F). Pang's criteria for the diagnosis of partial deficiency in 3 beta-HSD were retained. We defined deficiency in 3 beta-HSD as certain when the 4 following criteria were present 60 minutes after stimulation: 17-OHPreg > 17.5 ng/ml; DHA > 20 mg/ml; 17-OHPreg/17-OHP > 9; 17-OHPreg/F.10(-3) > 53. Diagnosis was considered probable when only 3 criteria were met and was excluded in all other cases.

RESULTS

Positive diagnosis of deficiency in 3 beta-hydroxysteroid dehydrogenase was made in 4 of the 32 patients and probable in 4 others.

CONCLUSION

Based on our series of patients, late onset hyperandrogenism due to 3 beta-hydroxysteroid dehydrogenase deficiency would thus appear to be a relative frequent deficiency state. Since therapeutic measures can be taken, this deficiency should be carefully searched for in all young patients presenting with manifestations suggesting hyperandrogenism.

[The results of using Unifas cement for denture fixation]

Unifas cement was used for fixation of cermet dentures in 104 patients. Clinical follow-up of 3 months to 3 years duration demonstrated sufficiently high adhesive characteristics, resistance to oral fluid and mechanic loading effects of this cement, which is recommended for wide clinical practice.

The effect of postplacental insertion of the spiked and the standard Lippes loop on uterine involution

The spiked Lippes loop was inserted in 53 women and the standard loop in 55 women immediately following the delivery of the placenta after normal vaginal delivery. A group of 50 recently delivered women with no IUD was studied as a control. The cases were followed up for 1 year. Ultrasonic scanning was performed during the 6th week after insertion for 47 cases with the spiked loop and 43 cases with the standard loop. All loops were correctly positioned within the uterine cavity except in two cases; one using the spiked and the other using the standard loop. The loops were found displaced downwards and as there was excessive bleeding, the devices were removed. Regarding the effect of the IUD on uterine involution, it was found that the fundus to internal os length for the cases with IUDs was shorter than that among the controls, also this length among the standard loop users was significantly shorter than that of the controls (P less than 0.01). Postplacental IUD insertion did not delay uterine involution, on the contrary, it helped involution. Regarding the effect of lactation, the fundus to internal os length for the fully lactating women either using a loop or not, was found to be significantly shorter than that of the non-lactating cases (P less than 0.002).

Application of difference spectroscopy to the determination of some pharmaceutically important nitro compounds

A simple and selective spectrophotometric method for the determination of some pharmaceutically important nitro compounds has been developed. The suggested method depends upon the spectral changes induced by reduction using either Zn/HCl or Zn/NH4Cl. The different experimental parameters were studied and incorporated into the procedure. The mean percentage recovery ranged from 99 to 101. The proposed method was applied to the determination of the studied compounds in dosage forms, and the results obtained were compared favourably with those given with the compendial ones.

Socio-medical factors affecting the utilization of different contraceptive methods at Al-Azhar rural family health clinic

"The present study aimed at assessing the patterns of contraceptive use by rural women. 1,781 married, sexually active women, were interviewed.... They were served by the Family Health Clinic in Tokh El-Karamos Centre in El-Sharkia Governorate [Egypt]. They were classified according to the type of contraceptive method used. There were statistically significant differences of method users according to the level of education, occupation, history of pregnancy wastage, time lag between last labour and administration, breast feeding, menstrual characters and the type of last method used."

Constituents from Salmaliamalabaricum

The phytochemical investigation of the root of Salmaliamalabaricum has resulted in the isolation and identification of n-triacontanol, β-sitosterol, and a new glycoside which was characterized as 5,7,3′,4′-tetrahydroxy-6-methoxyflavan-3-O-β-D-glucopyranosyl-α-D-xylopyranoside on the basis of spectral and degradative studies.