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Ultrasound elastography is a promising new technique in the evaluation of the thyroid nodule. It allows for "virtual palpation" of the nodule, even smaller ones which may not be otherwise palpable clinically. Ultrasound elastography was developed to obtain information on tissue stiffness non-invasively. Due to the superficial location of the thyroid gland, lack of sonological interferences like bowel gas shadow, easy availability of USG, and no need for patient preparation, it is easy and feasible to obtain information regarding the stiffness in the organ or nodule objectively, even by beginners. Elastography is a technique that uses ultrasound to analyse the elasticity of a nodule by measuring the amount of distortion that occurs when the nodule is subjected to external pressure. Shear wave elastography (SWE) provides quantitative assessment in the form of elasticity indices ( E maximum , E mean , E minimum ), and the stiffness of thyroid nodules can be evaluated with shear wave elastography. Malignant thyroid nodules tend to have higher shear wave elastography index. This was a prospective study. All patients with suspicious thyroid nodules who presented to head and neck oncology OPD with thyroid swelling with TIRADS score 3 or 4 and Bethesda III/IV were evaluated from December 2022 to February 2023. All the patients were screened with ultrasound, and reporting was done as per the ACR TIRADS reporting system following which elastography score was given based on the stiffness of the nodule. They further underwent FNAC from the suspicious thyroid nodule. Thyroidectomy was done as per department protocol. Twenty-four patients (38 nodules) were evaluated. There were seven males and 17 female patients included in the study. There were 23 malignant nodules in the final histopathology of the resected specimen. The sensitivity of TIRADS was 82.6%, specificity was 80%, for elastography specificity was 69.6%, sensitivity was 60%, for BETHESDA specificity was 66.7%, and sensitivity was 81.3%. The combined sensitivity and specificity for all three modalities combined were 93.33% and 95.6%. Receiver operator curve (ROC) analysis showed the area under the curve for USG TIRADS was 0.895, for elastography was 0.879, and for FNAC Bethesda was 0.902. AUC for combined tests ES + BETHESD was 0.800 ( p  = 0.013), TIRADS + BETHESDA was 0.833( p  < .01), and for TIRADS + ES + BETHSDA AUC was 0.967 ( p  = 0.00). Ultrasound elastography can be used as an adjunctive tool along with routine grey scale ultrasound for characterising suspicious thyroid nodules., Competing Interests: Conflict of InterestThe authors declare no competing interests., (© The Author(s), under exclusive licence to Indian Association of Surgical Oncology 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Introduction: Pelvic fracture urethral injury (PFUI) is more severe in younger individuals. The adolescent group is prone to protracted morbidity due to severity of the injury and its impact on lifestyle. Hence, treatment options and data on outcomes are crucial in planning management. The adolescents are a subgroup in several series of PFUI, but literature exclusively studying this group is sparse., Materials & Methods: A retrospective review of all adolescents (aged between 10 and 19 years as defined by WHO) who underwent surgical repair for PFUI between January 2005 and December 2019 was conducted. Success was defined as a bell-shaped urine flow curve and Qmax of >15 ml/s, no evidence of re-stricture (on cystoscopy/MCU), and no re-intervention. Measurements of the length of the urethral defect and bulbar urethra were done using a digital scale by the radiologist from micturating cystourethrogram (MCU). The Gapometry/Urethrometry (GU) index was calculated as the ratio of the length of the urethral defect to that of the bulbar urethra. Data was analysed using SPSS software version 20.0 and Stata Version 16. The primary outcome was the success of anastomotic urethroplasty. Secondary outcomes were evaluating factors predicting operative complexity (simple perineal versus elaborate perineal approach)., Results: We studied 22 patients, out of which 8 were referred following prior failed intervention elsewhere. The mean age was 16.5 + 2.7 years. All the patients were treated using a perineal approach with an overall success rate of 90.9%. Two patients had a failure and were managed with Endoscopic Internal Urethrotomy (EIU), and urethral dilatation. The median follow-up was 24 months. All 8 patients with prior failed interventions had a successful outcome. Twelve patients required inferior pubectomy (elaborate perineal approach). The median length of the urethral defect (2.3 cm IQR- 1.45,3.30 vs. 1 cm, IQR-0.65, 1.6) and the mean GU index (0.45 ± 0.18 cm vs. 0.25 cm ± 0.12 cm) were significantly higher in those who required an elaborate perineal approach., Conclusions: The perineal approach for surgical repair (anastomotic urethroplasty) of pelvic fracture urethral injury has a favourable success rate of 90.9% in adolescents. Re-do anastomotic urethroplasty for prior failed repairs also had a high success rate of 100%. Cases requiring an elaborate perineal approach were associated with a significantly higher Gapometry/Urethrometry Index (>0.45) and length of the urethral defect (>2.3 cm). This information may assist in patient counselling and preparation for additional steps during repair., (Copyright © 2024 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

This graphic abstract combines pedigree, dysmorphology features, radiographs, and the PRKG2 protein domain, specifically the CNB-A regulatory domain, which harbors a mutation resulting in premature protein termination., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)