Thyroid nodules are a common medical problem, but whether fine-needle aspiration cytology (FNAC) is mandated for smaller non-palpable nodules, is controversial.
To evaluate whether ultrasonographic ...features of thyroid nodules are associated with histological malignancy, and to identify useful criteria for clinical decision-making.
Prospective observational study.
From January 1991 to September 2004, 5198 patients were referred to our hospital for ultrasound evaluation of thyroid nodules. Overall, 7455 nodules (diameters from 6 to 100 mm) were examined; 2865 (38.4%) were <10 mm in diameter. All patients with suspicious or malignant cytology underwent surgery.
Of the 349 nodules undergoing surgery, 284 were malignant. The prevalence of cancer was slightly higher in nodules>or=10 mm in diameter vs. those<10 mm (5.5% vs. 3.0%, p<0.01). However, histological type and local aggressiveness were largely independent of nodule size. Microcalcifications (72.2% vs. 28.7%; p<0.001; OR 6.4, 95%CI 4.9-8.4), blurred margins (52.8% vs. 18.8%; p<0.001; OR 4.8, 95%CI 3.8-6.1), solid hypoechoic appearance (80.6% vs. 52.4%; p<0.001; OR 3.8, 95%CI 2.8-5.1), size>or=10 mm (77.4% vs. 64.9%; p<0.001; OR 1.9, 95%CI 1.4-2.5) and intranodular vascular pattern type 2 (61.6% vs. 49.7%; p<0.001; OR 1.6, 95%CI 1.2-2.0) were all significantly more frequent in malignant than in benign nodules. These associations were similar when large and small nodules were analysed separately.
No single parameter, including nodule size, satisfactorily identifies a subset of patients to be electively investigated by FNAC, although several may be useful in this regard.
Abstract
Objectives:
This article discusses the results of clinical and experimental studies that examine the association of hyperuricemia and gout with cardiovascular (CV) disease.
Methods:
Key ...papers for inclusion were identified by a PubMed search, and articles were selected for their relevance to the topic, according to the authors' judgment.
Results and conclusions:
Significant progress has been made in confirming an association, possibly causal, between hyperuricemia and CV outcomes. Xantine-oxidase (XO) inhibitors appear to be the most promising agents for prevention and treatment of CV consequences associated with hyperuricemia. Several small and medium sized studies have examined the effect of these agents on CV function in a variety of patient populations. Improvements in measures of endothelial function, oxidative stress, cardiac function, hemodynamics, and certain inflammatory indices have been demonstrated. Compounds for XO inhibition with more specific clinical effects and fewer side effects than allopurinol may be promising options to further explore the therapeutic potential in patients with CV disease. It is too early to make clinical recommendations with regard to the benefits of using XO inhibitor allopurinol or the novel febuxostat in patients with asymptomatic increased UA levels and high CV risk because only a small number of studies have shown that they may be beneficial in terms of CV outcomes. More studies are therefore needed to determine the potential of these drugs for reducing the risk of developing CV disease.
Abstract Specific clusters of metabolic syndrome (MetS) components impact differentially on arterial stiffness, indexed as pulse wave velocity (PWV). Of note, in several population-based studies ...participating in the MARE (Metabolic syndrome and Arteries REsearch) Consortium the occurrence of specific clusters of MetS differed markedly across Europe and the US. The aim of the present study was to investigate whether specific clusters of MetS are consistently associated with stiffer arteries in different populations. We studied 20,570 subjects from 9 cohorts representing 8 different European countries and the US participating in the MARE Consortium. MetS was defined in accordance with NCEP ATPIII criteria as the simultaneous alteration in ≥3 of the 5 components: abdominal obesity ( W ), high triglycerides ( T ), low HDL cholesterol ( H ), elevated blood pressure ( B ), and elevated fasting glucose ( G ). PWV measured in each cohort was “normalized” to account for different acquisition methods. MetS had an overall prevalence of 24.2% (4985 subjects). MetS accelerated the age-associated increase in PWV levels at any age, and similarly in men and women. MetS clusters TBW, GBW, and GTBW are consistently associated with significantly stiffer arteries to an extent similar or greater than observed in subjects with alteration in all the five MetS components – even after controlling for age, sex, smoking, cholesterol levels, and diabetes mellitus – in all the MARE cohorts. In conclusion, different component clusters of MetS showed varying associations with arterial stiffness (PWV).
OBJECTIVE:Available data indicate that patients with primary aldosteronism (PA) have an increased risk of cardiovascular (CV) events; furthermore, CV risk seems to be, at least in part, independent ...of blood pressure (BP) elevation. Previous studies have shown that patients with PA have a greater prevalence of left ventricular (LV) hypertrophy, which might contribute to the increase in CV risk. Recently, a non-invasive approach for the estimation of LV mechanical efficiency through the calculation of the ratio between stroke work (SW) and heart rate (HR)–pressure product has been proposed by de Simone and coworkers. This index, which expresses the amount of blood pumped in a single beat in 1 second by the heart, may be easily obtained by echocardiography.
DESIGN AND METHOD:The aim of our study was to evaluate the determinants of myocardial mechanoenergetic efficiency index (MEEi), calculated as SV/HR and indexed to LV mass (MEEi = MEE/LVM) in a large group of patients with primary aldosteronism and in a control group of essential hypertensives (EH). PA was diagnosed in the presence of a positive aldosterone to renin ratio (>30) and post saline aldosterone > 100ng/ml). Ninety-nine patients with PA were compared with 99 EH patients matched for age and BP values.
RESULTS:No differences between groups were observed for age, gender, BMI, BP values, glucose, lipid profile and renal function. LV mass index was greater in PA vs EH (101 ± 34 vs 84 ± 20, gr/m2, p < 0,05); also relative wall thickness was greater in PA vs EH (0.36 ± 0.1 vs 0.32 ± 0.4, p < 0,05). Ejection fraction was not different between groups, while endocardial and midwall fractional shortening were lower in PA vs EH (40 ± 7 vs 43 ± 6, and 18 ± 3 vs 21 ± 2 both p < 0,05). MEEI was lower in PA vs EH (0.44 ± 0.14 vs 0.52 ± 0.10, p < 0,05). A negative correlation was observed between MEEI and aldosterone levels (r = −0.20, p < 0.05).
CONCLUSIONS:In patients with primary aldosteronism MEEI is lower as compared to EH. These findings may contribute to explain the increased risk of CV events in patients with PA.
OBJECTIVE:BackgroundThe CHA2DS2-VASc score is used in patients with atrial fibrillation (AF) for stroke risk stratification. Recent studies have shown that CHA2DS2-VASc is also predictive of ...cardiovascular (CV) events and mortality, whether or not AF is present. Few data are available on the relationship between CHA2DS2-VASc and preclinical organ damage (OD) in the general population.
DESIGN AND METHOD:Aim of our studywas to evaluate the relationship between CHA2DS2-VASc and 10 years Framingham risk scores and preclinical cardiac and vascular organ damage in subjects from a general population.MethodsA total of 478 subjects underwent clinical examination with blood pressure measurement (clinic and 24 hours), and laboratory examinations. Left ventricular (LV) and carotid artery structure were assessed by ultrasound and carotid-femoral PWV was measured. OD was defined according to ESH ESC 2013 Guidelines. CHA2DS2-VASc was calculated as recommended by current AF Guidelines. The Framingham risk score for cardiovascular events (FRS CVD), for stroke (FRS stroke) and for coronary heart disease (FRS CHD) were also calculated.
RESULTS:Resultsmean age was 58 ± 10 (range 43–74 yrs), 44% were males, 69% hypertensives (37% treated). Left ventricular mass index, meanmax IMT and carotid-femoral pulse wave velocity (PWV) were significantly correlated with all the Framingham risk scores as well as with CHA2DS2-VASc (table).(Figure is included in full-text article.)The simultaneous inclusion of CHA2DS2-VASc and FRS (for CVD or Stroke or CHD) in linear regression analysis showed that the relationship between CHA2DS2-VASc and OD is independent of FRS.
CONCLUSIONS:ConclusionsCHA2DS2-VASc score is significantly correlated to preclinical organ damage in patients from a general population.
OBJECTIVE:The evaluation of the morphological characteristics of small resistance arteries in human beings in not easy. The gold standard is generally considered to be the evaluation of the media to ...lumen ratio (M/L) of subcutaneous small vessels obtained by local biopsies and evaluated by wire or pressure micromyiography. However, non-invasive techniques for the evaluation of retinal arterioles were recently proposed, in particular two approaches seem to provide interesting informationscanning laser Doppler flowmetry (SLDF) and adaptive optics (AO); both of them provide an estimation of the wall to lumen ratio (WLR) of retinal arterioles. A non-invasive measurement of basal and total capillary density may be obtained by videomicroscopy/capillaroscopy. No direct comparison of the three non-invasive techniques in the same population was previously performed, in particular AO was never validated against micromyography.
DESIGN AND METHOD:In the present study we enrolled 12 normotensive subjects and 8 hypertensive patients undergoing an election surgical intervention; 11/20 were severely obese). All patients underwent a biopsy of subcutaneous fat during surgery. Subcutaneous small resistance artery structure was assessed by wire myography and the M/L was calculated. WLR of retinal arterioles was obtained by Scanning Laser Doppler Flowmetry and AO (SLDF, Heidelberg Engineering, Heidelberg, Germany and RTX-1, Imagine Eyes, Orsay, France). Functional (basal) and structural (total) microvascular density were evaluated by capillaroscopy (Videocap 3, DS Medica, Milan, Italy) before and after venous congestion.
RESULTS:The results are summarized in the Table (slope of the relationp < 0.01 RTX-1 vs. SLDF).(Figure is included in full-text article.)
CONCLUSIONS:Our data suggest that AO has a substantial advantage over SLDF in terms of evaluation of microvascular morphology, since it is more closely correlated with the M/L of subcutaneous small arteries, considered a gold-standard approach but limited in its clinical application by the local invasiveness of the procedure.
OBJECTIVE:Epidemiological studies have suggested that even mild enlargement of the ascending aorta may have independent prognostic significance for cardiovascular events. Therefore, some Authors have ...proposed that dilatation of the ascending aorta could be considered as a form of preclinical vascular damage in hypertensive patients. Aim of our studywas to assess the correlation between clinic and 24 hours BP values and the dimensions of the aorta, measured at level of the sinuses of Valsalva (Val), at the left ventricular outflow tract (LVOT), and at the level of the proximal ascending aorta (AscAO) in subjects from a general population.
DESIGN AND METHOD:250 subjects (43% males, mean age 56 ± 4 years, 42% hypertensives-HT) underwent laboratory examinations, clinic and 24 hours BP measurement, cardiac and carotid ultrasound, carotid-femoral pulse wave velocity measurement (AoPWV).
RESULTS:Aortic diameters were greater HT as compared to NT (Val3.41 ± 0.54 vs 3.25 ± 0.41 cm, LVOT 2.10 ± 0.28 vs 2.04 ± 0.26, AscAo 3.39 ± 0.45 vs 3.18 ± 0.38, all p < 0.05). Aortic diameters were all correlated to clinic and 24 hours BP values. The coefficients of correlation were greater for 24 hours BP (Tab). Val, AscAo, LVOT were also significantly correlated with left ventricular mass (r = 0.61, r = 0.48, and r = 0.43, all p < 0.001), meanmax intima media thickness (r = 0.13, r = 0.24, and r = 0.13, all p < 0.05) and with AoPWV (r = 0.16, p < 0.05, r = 0.28 p < 0.001, r = 0.08 p = ns).(Figure is included in full-text article.)
CONCLUSIONS:The dimensions of the proximal ascending aorta are significantly related to BP values in normotensive subjects and in hypertensive patients. Aortic dimension are more strictly related to twenty-four hours BP values than to clinic BP values. In this sample of general population a significant correlation between aortic dimensions and measures of cardiac and vascular organ damage was also observed, confirming the parallelism between different forms of organ damage
Abstract Background and aims The independent role of serum uric acid (SUA) as a marker of cardio-renal risk is debated. The aim of this study was to assess the relationship between SUA, metabolic ...syndrome (MS), and other cardiovascular (CV) risk factors in an Italian population of hypertensive patients with a high prevalence of diabetes. Methods and results A total of 2429 patients (mean age 62 ± 11 years) among those enrolled in the I-DEMAND study were stratified on the basis of SUA gender specific quartiles. MS was defined according to the NCEP-ATP III criteria, chronic kidney disease (CKD) as an estimated GFR (CKD-Epi) <60 ml/min/1.73 m2 or as the presence of microalbuminuria (albumin-to-creatinine ratio ≥2.5 mg/mmol in men and ≥3.5 mg/mmol in women). The prevalence of MS, CKD, and positive history for CV events was 72%, 43%, and 20%, respectively. SUA levels correlated with the presence of MS, its components, signs of renal damage and worse CV risk profile. Multivariate logistic regression analysis revealed that SUA was associated with a positive history of CV events and high Framingham risk score even after adjusting for MS and its components (OR 1.10, 95% CI 1.03–1.18; P = 0.0060; OR 1.28, 95% CI 1.15–1.42; P < 0.0001). These associations were stronger in patients without diabetes and with normal renal function. Conclusions Mild hyperuricemia is a strong, independent marker of MS and high cardio-renal risk profile in hypertensive patients under specialist care. Intervention trials are needed to investigate whether the reduction of SUA levels favorably impacts outcome in patients at high CV risk.
Abstract Aims To briefly review available data regarding changes in the structure of microvessels observed in patients with diabetes mellitus, and possible correction by effective treatment. Data ...synthesis The development of structural changes in the systemic vasculature is the end result of established hypertension. In essential hypertension, small arteries' smooth muscle cells are restructured around a smaller lumen and there is no net growth of the vascular wall, while in some secondary forms of hypertension, hypertrophic remodeling may be detected. Moreover, in non-insulin-dependent diabetes mellitus hypertrophic remodeling of subcutaneous small arteries is present. Indices of small resistance artery structure, such as the tunica media to internal lumen ratio, may have a strong prognostic significance in hypertensive and diabetic patients, over and above all other known cardiovascular risk factors. Therefore, regression of vascular alterations is an appealing goal of antihypertensive treatment. Different antihypertensive drugs seem to have different effects on vascular structure. In diabetic hypertensive patients, a significant regression of structural alterations to the small resistance arteries with drugs blocking the renin-angiotensin system (ACE inhibitors, angiotensin II receptor blockers) was demonstrated. Conclusion Alterations in the microcirculation represent a common pathological finding, and microangiopathy is one of the most important mechanisms involved in the development of organ damage as well as of clinical events in patients with diabetes mellitus. Renin-angiotensin system blockade seems to be effective in preventing and/or regressing alterations in the microvascular structure.
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