Frequency and intensity of pain related to thyroid nodule fine-needle aspiration cytology

BACKGROUND

Quality of life is an important issue in endocrine tumors because of the high prevalence of benign tumors and the indolent course of most malignant tumors.

OBJECTIVE

To evaluate the frequency and the intensity of pain and anxiety in patients undergoing thyroid nodule fine-needle aspiration cytology (FNAC) and to identify factors associated with pain.

METHODS

Single center prospective study in the setting of a one-stop outpatient diagnostic clinic for thyroid nodules. Pain was evaluated using a 100-mm visual analogue scale (VAS) immediately following (VAS1) and 30 minutes after (VAS2) FNAC and was considered significant if ≥ 30. Anxiety symptoms were assessed prior to FNAC using a self-report measure questionnaire: the state form of Spielberger State-Trait Anxiety Inventory (STAI, form Y-A). FNAC was performed with a 25-gauge needle and a moderate aspiration and two passes for each nodule.

RESULTS

Two hundred eighteen consecutive patients (163 females, 55 males; mean age 53 years, range 12-84 years) undergoing FNAC of one to three nodules were included. VAS1 was ≥ 30 in 24% of the patients and VAS(2) was ≥ 30 in 13% of the patients. Independent significant factors correlated to a VAS1 of ≥ 30 were age under 25 years and the number of nodules being biopsied. Independent significant factors correlated to a VAS2 of ≥ 30 were VAS1 ≥ 30 and female sex. No correlation was found between pain and nodule size or nodule depth, nor the duration of application of the eutectic mixture of local anesthetics (EMLA) patch prior to FNAC. The mean STAI score for anxiety was 37 ± 12. The average STAI score was significantly higher in women (39) than in men (33; p = 0.01). There was no significant correlation between STAI score and age under 25 years, previous FNAC, number of nodules biopsied, or acetaminophen administration, but the STAI score was significantly correlated to VAS1 and VAS2.

CONCLUSIONS

FNAC-related pain is frequent and correlates with the number of nodules biopsied, age under 25 years, female sex, and anxiety.

[Characteristics and one-year follow-up of patients with peripheral arterial disease. Initial results of the COPART I registry]

INTRODUCTION

Almost all patients with the most severe peripheral arterial diseases (PAD) patients are hospitalised. This means that the hospital is a particularly good place to observe the characteristics and outcome of PAD patients. It is for this reason that the hospitalised patient registry (COPART I) was created.

RESULTS

From June 1st 2004 to May 31st 2005, we included 187 patients surviving at hospital discharge. As expected the majority were men (68.4%). The median age was 72 (+/- 13 years). Almost one third of the PAD of patients suffered from intermittent claudication and two thir (63,6%) from permanent ischemia. A large majority of this latter group had critical limb ischemia. We found a mortality rate of 17.1% at the on year follow-up. These deaths were mainly of cardiovascular origin (9.1%). Almost 2/3 of the deaths had already occurred by six months. One patient in four undergone major or minor amputation during the follow up 2/3 of them involving major amputation. This figure rose to fou patients in ten for critical limb disease. A previous history of both major and minor amputation is strongly related with new amputations (RR = (CI: 1.2-7.5) P = 0.02). After one year of follow-up, almost four patients in ten (42.6%) with permanent ischemia had died, undergone major amputation, or suffered an MI or an IS.

CONCLUSION

Peripheral arterial disease remains a severe chronic disease linked to excess mortality of cardiovascular origin. Therefore patients should be given optimal treatment.