BACKGROUND: The relationship between preoperative pulmonary function tests (PFTs) and postoperative aspiration and deglutition complications in supraglottic laryngectomy (SL) has not been adequately analyzed. The effects of numerous other variables are either controversial or have not been studied. METHODS: A retrospective chart review was performed on 46 SL patients, analyzing preoperative PFTs and arterial blood gases, demographic factors, stage of disease, extended resections, cricopharyngeal myotomy, hyoid preservation, neck dissection, and postoperative radiotherapy with regards to aspiration and deglutition problems. RESULTS: Eighteen (39%) patients had no problems, 15 (33%) had moderate problems, and 13 (28%) had severe problems; of these, 39 (85%) were ultimately successful with no further swallowing dysfunction, whereas seven (15%) suffered intractable aspiration difficulties. Decreasing FEV1/FVC was significantly correlated with a poorer outcome, as was a greater number of pack-years of smoking. The effect of FEV1/FVC was shown to be independent from pack-years, whereas the converse was not clearly demonstrated. Extensions of the standard procedure did not correlate significantly with increased problems. CONCLUSIONS: An FEV1/FVC less than 50% signifies a greater risk for severe aspiration and deglutition complications, although it must be regarded as one factor among many in determining operability. With careful attention to reconstruction, extensions of the standard SL procedure can be safely performed.

Adult↗

PubMedDate not supplied

Transjugular liver biopsy: assessment of safety and efficacy of the Quick-Core biopsy needle.

BACKGROUND: We assessed the safety and efficacy of transjugular liver biopsy with the Quick-Core biopsy needle. METHODS: Fifty consecutive patients with liver failure and contraindications to percutaneous liver biopsy were referred for transjugular liver biopsy. Eighteen (36%) patients had thrombocytopenia (platelet range = 44-92/microL, mean = 66/microL), 31 (62%) patients had elevated prothrombin times (international normalized ratio range = 1.3-3, mean = 1.6), and 19 (38%) patients had ascites. The Cook Quick-Core biopsy needle was used. RESULTS: Average procedure time was 30 min. Transjugular access to the hepatic veins was successful in 49 of 50 cases. A transfemoral approach was used in one patient. Tissue specimens were satisfactory for histologic diagnosis in all cases. Established cirrhosis was present in 37 (74%) patients. The mean number of cores was 2.2 (range = 1-3). The mean number of portal triads per core was 10.4 (range = 6-20). There were no procedure-related complications. CONCLUSION: Transjugular liver biopsy with the Quick-Core biopsy needle is safe and effective in patients in whom the percutaneous route is contraindicated by coagulopathy or ascites.

Biopsy, Needle↗

PubMedDate not supplied

Transrectal ultrasound-guided biopsy of the prostate gland: value of 12 versus 6 cores.

We investigated the effect on prostate carcinoma detection of 12 versus 6 core biopsies at transrectal ultrasound (TRUS), when all biopsies are taken from the lateral peripheral zone. This was a prospective study of 202 consecutive men, ages 51 to 81 years, referred for TRUS-guided biopsy of the prostate gland. All patients had prostate serum antigen levels higher than 4.0 ng/mL and/or abnormal digital rectal examination. In each case three biopsies were taken from the peripheral zones of the right and left lobes of the prostate. Biopsies were taken at the apex, midway between the apex and the base, and at the base. A second set of biopsies was taken from the same regions and analyzed separately. In total, twelve biopsies were taken. Note was subsequently made of additional carcinoma diagnosis increase in Gleason grade, and new diagnoses of carcinoma in the opposite side of the gland diagnosed on the second set of biopsies alone. Seventy-eight of the 202 men (38.6%) had prostatic carcinoma diagnosed on TRUS-guided biopsy. Of these 78 patients, six were diagnosed with malignancy based on the second set of biopsies alone, a 2.9% increase in the 202 patients, representing an increased yield of 8.3% (95% confidence interval, 5.3-28.6%). In nine cases (12.5%; 95% confidence interval, 6.2-22.9%), the Gleason tumor grade was increased on the second set of sextant biopsies; in an additional nine cases, carcinoma was detected in the opposite side of the gland. There were two complications (1%). A 12- versus six-core biopsy strategy for TRUS-guided biopsy of the prostate gland improves detection and histologic grading of prostate carcinoma. The added benefit of additional biopsies was lower in this series than in some prior studies using extensive biopsy protocols.

Biopsy, Needle↗

PubMedDate not supplied

Bile duct hamartomas (von Meyenburg complexes): value of MR imaging in diagnosis.

We present a case of a patient initially believed to have multiple liver metastases based on ultrasound and computed tomography findings in whom a diagnosis of multiple bile duct hamartomas (von Meyenburg complexes) was indicated after ultrasound-guided liver biopsy. Magnetic resonance imaging aided greatly in confirming the diagnosis of von Meyenburg complexes, thereby avoiding laparotomy and open liver biopsy.

Bile Duct Diseases↗

PubMedDate not supplied

MR diagnosis of haemorrhagic cystic renal cell carcinoma.

OBJECTIVE: We report two cases of cystic renal masses considered indeterminate on sonography and CT, in which haemorrhagic contents were demonstrated on MRI. MATERIALS AND METHODS: Spin echo T1-weighted axial and coronal (TR 700 ms; TE 17 ms) and T2-weighted axial (TR 3,000 ms; TE 90 ms) upper abdominal scans were obtained on a 1.5 T MR machine. RESULTS: Cyst contents were of high signal on both T1- and T2-weighted sequences, indicating internal haemorrhage, which was confirmed at surgery. CONCLUSION: There is a high propensity for haemorrhagic renal masses to mask carcinoma. By distinguishing blood from other contents, MRI had a noninvasive role in diagnosis and further management.

Carcinoma, Renal Cell↗

PubMedDate not supplied

Calcifying fibrous pseudotumor of pleura: radiologic features in three cases.

PURPOSE: Our goal was to describe the radiologic features of calcifying fibrous pseudotumor (CEPT) of pleura. METHOD: Chest radiographs and CT images of three patients, aged 23-34 years, with pathologically proven CFPT of pleura were reviewed with regard to lesion size, location, and appearance. RESULTS: Chest radiographs showed well marginated, noncalcified pleural masses in all cases. Two patients had solitary masses and one had multifocal ipsilateral masses. All masses were located in the inferior aspect of the chest and measured 3-12 cm. All masses were calcified on CT. The calcifications were thick and band-like in two cases and punctate in one. There was no chest wall invasion, pleural effusion, or parenchymal disease. CONCLUSION: CFPTs of pleura are rare lesions that manifest as calcified pleural masses in young adults.

Adult↗