Dana Stoian

By Dana Stoian, Timar Bogdan, Marius Craina, Mihaela Craciunescu, Romulus Timar and Adalbert Schiller

Elastography is a new technique for evaluating the stiffness of nodules. It is generally recognised that malignant thyroid lesions are harder than benign lesions. Different elastographic techniques are presented, with characteristics, advantages and limitations. Qualitative and semiquantitative methods are described. Comparison of the main existing techniques, static and dynamic elastographies, is presented in this chapter. Strain elastography seems to have a better diagnostic quality than shear wave elastography in the diagnosis of thyroid cancer disease. A positive elastogram, suggestive for malignancy is more useful in diagnosis than a positive grey-scale ultrasound evaluation. Elastography increases the specificity of grey scale ultrasound (US), it should be always integrated with its information and should be considered as a complement of conventional US.

Part of the book: Thyroid Cancer

By Dana Stoian, Ioana Mozos, Marius Craina, Corina Paul, Iulian Velea, Adalbert Schiller and Mihaela Craciunescu

Normal testosterone level is influencing all the steps of the male psychosexual development: intrauterine neonatal and final psychosexual development.. At pubertal stage, the quality of testosterone secretion is conditioning the development of the mature male phenotype. In adult life, eugonadism sustains desire, arousal, determines spontaneous erections, facilitates stimulated erection, influencing the response rate to medication. Moreover, eugonadism sustain daydreaming and phantasies, both needed for a normal sexual life. The pathogenic mechanism of all these actions is presented. Talking about hypogonadism means not only the classical types of hypogonadism: due to classical testicular disease of central, hypothalamic and hypophysis disease, but also the partial testosterone deficiency induces by aging (late onset hypogonadism), weight increase (up to 30% of males with metabolic syndrome and 50% of males with diabetes) or secondary hypogonadism described in chronic use of steroids or after long exposure to stress, especially in young males. All these types of hypogonadism, that affect young, middle aged or old males will be presented separately. A therapeutic approach that is individualized for each type of hypogonadism, should consider positive and possible negative effects and all alternatives will be presented: life style changes, sustained weight loss, increase exercise, supplemental therapy, pro fertility treatment.

Part of the book: Sexual Dysfunction

By Ioana Mozos and Dana Stoian

Signal-averaged ECG (SAECG) is a high-resolution, noninvasive electrocardiographic method enabling detection of late ventricular potentials (LVP), which are low-amplitude and high-frequency signals, predicting reentry ventricular arrhythmias, and sudden cardiac death (SCD). Three criteria are used to detect late ventricular potentials as follows: signal-average ECG QRS duration (SAECG-QRS), the duration of the terminal part of the QRS complex with an amplitude below 40 μV (LAS40) and the root mean square (RSM) signal amplitude of the last 40 ms of the signal < 20 μV (RMS40). Late ventricular potentials can be detected not only at the end of a QRS complex but also as intra-QRS (IQRS) potentials. Signal-averaged ECG was modified to enable the analysis of the P-wave and to detect atrial late potentials (ALPs), low-amplitude potentials at the terminal part of the filtered P-wave, and predictors of atrial fibrillation (AF). Late atrial and ventricular potentials originate from areas of delayed, fragmented, and heterogenous conduction within atrial or ventricular myocardium. This chapter reviews the most important mechanisms explaining the occurrence of late ventricular, intra-QRS, and atrial potentials; their predictive value for arrhythmia, focusing on recent clinical data, long-term follow-up, and outcome; and analysis of SAECG variables in cardiac and noncardiac diseases.

Part of the book: Interpreting Cardiac Electrograms

By Andreea Borlea, Laura Cotoi, Ioana Mozos and Dana Stoian

The most precise evaluation of thyroid masses is by high-sensitive ultrasound. Complementary to B-mode ultrasound, elastography can add valuable information by determining tissue stiffness—an important predictor for malignancy. All major guidelines recommend nodules with high suspicious ultrasound characteristics larger than 1 cm to be addressed to ultrasound-guided fine needle aspiration biopsy (FNAB) to rule out malignancy. The main limitation of this procedure is represented by indeterminate cytology, which accounts for up to 20–25% of biopsy results. Molecular markers imply elevated costs and their performance needs further study. Elastography may be helpful in establishing the optimal therapeutic attitude for this cytological category. Currently, there are two ultrasound elastography methods available for assessing tissue stiffness using the parallel deformation to the applied force direction (strain) or the perpendicular deformation to the force direction (shear wave). These methods will be presented and compared in this chapter, with their indications and limitations for a better understanding of their application in nodular thyroid pathology.

Part of the book: Knowledges on Thyroid Cancer

By Ioana Mozos and Dana Stoian

Several studies reported the cross talk between oral health and cardiovascular disorders. The aim of the present chapter is to review the main mechanisms linking oral and cardiovascular disorders, the main pathologies which could be linked, and possibilities for prophylactic and therapeutic interventions. Periodontitis was associated with cardiovascular risk, and the links between the two entities are represented by bacteria and their toxins released into the blood, causing endothelial dysfunction and providing a proatherogenic and prothrombotic effect and an inflammatory and immune reaction. The mentioned mechanisms explain the reported associations of periodontitis with stroke, coronary heart disease, and peripheral vascular disease. Periodontitis was also associated with diabetes mellitus and impaired lipid metabolism. Not all studies confirmed the association between periodontitis and coronary artery disease or stroke. Tooth loss, the most important consequence of periodontitis, has been also associated with cardiovascular disease. Dental and pulpal caries were also found to be independent risk factors for atherosclerosis, while restorations were inversely related to an atherosclerotic burden. Sucrose is involved in both cariogenesis and atherosclerosis. Fluorides prevent aortic calcifications and enamel demineralization and inhibit bacterial metabolism but are cardiotoxic. Heightening awareness of good dental hygiene can improve cardiovascular health.

Part of the book: Understanding the Molecular Crosstalk in Biological Processes

By Cristina Mihaela Cepeha, Andreea Borlea, Corina Paul, Iulian Velea and Dana Stoian

The diagnosis and evaluation of diffuse thyroid pathologies is often a challenge for clinicians. Ultrasonography has an essential contribution in thyroid imaging, but elastography adds more accuracy. Frequently used in the evaluation of thyroid nodules, elastography has become a necessary tool in assessing the risk of malignancy. Diffuse thyroid pathologies such as Graves’ disease, chronic autoimmune thyroiditis, and subacute thyroiditis, are diagnosed based on laboratory tests completed with imaging. Recently it has been shown that elastography is useful in the evaluation and differentiation of these cases due to the differences in elasticity. This chapter describes the general principles of shear-wave elastography, examination technique, features found in diffuse thyroid disease, but also the limitations of this type of investigation for a better understanding of its use in assessing diffuse thyroid pathology.

Part of the book: Elastography

By Andreea Borlea, Laura Cotoi, Corina Paul, Felix Bende and Dana Stoian

Ultrasonography provides a primary stratification of the malignancy risk of thyroid nodules for selecting those that need further evaluation by fine-needle aspiration cytology (FNAC). Ultrasound elastography (USE) methods have been more recently proposed as a promising tool, aiming to increase the accuracy of baseline ultrasound. By means of USE, stiffness is assessed as an indicator of malignancy. Strain elastography was the first method used in thyroid imaging, with very good accuracy in discerning thyroid cancer. More recently, 2D shear-wave elastography also confirmed to be a valuable tool with similar outcomes. The advantages, limitations, and technical details of the elastography methods currently used in assessing thyroid morphology, particularly thyroid nodules, will be presented and compared in this chapter.

Part of the book: Elastography

By Dana Amzar, Laura Cotoi, Andreea Borlea, Calin Adela, Gheorghe Nicusor Pop and Dana Stoian

Primary hyperparathyroidism is a prevalent disease of the parathyroid glands and the third most common endocrinopathy, especially among postmenopausal women. Secondary hyperparathyroidism is a compensatory response to hypocalcemic states due to chronic renal disease, vitamin D deficiency and malabsorption syndromes, and other chronic illnesses. Elastography can be an effective tool in localizing and identifying parathyroid lesions, whether it is a parathyroid adenoma or hyperplastic parathyroid secondary to chronic kidney disease, by differentiating between possible parathyroid lesions and thyroid nodules, cervical lymph nodes, or other anatomical structures. No current guidelines recommendations are available and no established general cutoff values on the elasticity of parathyroid lesions. We have conducted several prospective studies on primary and secondary hyperparathyroidism, using ultrasound imaging and elastography, shear wave, and strain elastography to better identify the parathyroid lesions and improve the preoperative localization and diagnostic. The results were encouraging, allowing us to determine cutoff values that are different for lesions from primary hyperparathyroidism and secondary hyperparathyroidism and comparing them with normal thyroid tissue and surrounding muscle tissue.

Part of the book: Elastography