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PubMed2006

Lung disease 35 years after aspiration of activated charcoal in combination with pulmonary lymphangioleiomyomatosis. A histological and clinicopathological study with scanning electron microscopic evaluation and element analysis.

Activated charcoal provides effective treatment for most toxic ingestions. Accidental aspiration of activated charcoal is rare. Previously, there have been a few single cases reported on charcoal-related pulmonary complications. We describe an unusual case of pulmonary lesions 35 years after accidental aspiration of activated charcoal. The 38-year-old female patient presented with recurrent pneumothorax. A routinely performed chest roentgenogram revealed pulmonary lesions, highly suggestive to lymphangioleiomyomatosis (LAM). Histopathological investigation of the lung tissue demonstrated some features of LAM but showed prominent pneumoconiotic lesions with cystic tissue destruction. The pneumoconiotic reaction was characterized by prominent black deposits accompanied by foreign-body granuloma formation and minimal fibrosis. Scanning electron microscopic investigation of these deposits showed particles measuring up to 300 microm in greatest diameter. Energy-dispersive X-ray spectra of these particles revealed carbon-rich material, presumably charcoal. The aspiration event was confirmed by the clinical history. To our knowledge, this is the first report not only on a long-term follow-up after aspiration of activated charcoal but also on charcoal-related pulmonary lesions in combination with LAM.

Adult↗
PubMed1999

Early prediction of chronic lung disease by tracheal aspirate cytology in ventilated newborns.

UNLABELLED: We assessed the specificity of squamous metaplasia in tracheal aspirates of 69 ventilated newborns (gestational age 25-41 weeks) between days 3 and 7 of life for prediction of chronic lung disease (CLD). CLD was diagnosed when the patient was still requiring ventilation or supplementary oxygen at the postconceptional age of 36 weeks (or postnatal age of 28 days for babies born after 32 weeks gestation) and showed X-ray changes compatible with CLD. In the total population the presence of squamous metaplasia had a sensitivity of 59% and a specificity of 74% for the early diagnosis of CLD. The combination of squamous metaplasia and very low birth weight (VLBW) had a much higher specificity (94%), but a lower sensitivity (45%). Our results show that the presence of squamous metaplasia in VLBW babies during the 1st week of life predicts development of CLD with a specificity of 94% and may be helpful for entering patients into early treatment protocols or trials when a high risk population needs to be identified. As sensitivity of this approach is only 45%, further studies are needed to evaluate the predictive value of the combination of cytology with other markers in tracheal aspirate specimens. CONCLUSION: The presence of squamous metaplasia in tracheal aspirates of VLBW babies between days 3 and 7 of life is significantly associated with the development of chronic lung disease. Simple microscopic evaluation of fresh tracheal aspirates enables us to identify patients at high risk of CLD at a very early stage.

Chronic Disease↗
PubMed2003

Three tests for predicting aspiration without videofluorography.

The videofluorographic swallowing study (VFSS) is the definitive test to identify aspiration and other abnormalities of swallowing. When a VFSS is not feasible, nonvideofluorographic (non-VFG) clinical assessment of swallowing is essential. We studied the accuracy of three non-VFG tests for assessing risk of aspiration: (1) the water swallowing test (3 ml of water are placed under the tongue and the patient is asked to swallow); (2) the food test (4 g of pudding are placed on the dorsum of the tongue and the patient asked to swallow); and (3) the X-ray test (static radiographs of the pharynx are taken before and after swallowing liquid barium). Sixty-three individuals with dysphagia were each evaluated with the three non-VFG tests and a VFSS; 29 patients aspirated on the VFSS. The summed scores of all three non-VFG tests had a sensitivity of 90% for predicting aspiration and specificity of 71% for predicting its absence. The summed scores of the water and food tests (without X-ray) had a sensitivity of 90% and specificity of 56%. These non-VFG tests have limitations but may be useful for assessing patients when VFSS is not feasible. They may also be useful as screening procedures to determine which dysphagia patients need a VFSS.

Adolescent↗
PubMed2006

Surgery for aspiration: analysis of laryngotracheal separation in 23 children.

The aim of this study was to analyze the efficacy of laryngotracheal separation (LTS) in eliminating aspiration in children by comparing pre- and postoperative conditions. This prospective study used an internal control group. Children with neurologic impairment and a diagnosis of chronic aspiration were subjected to LTS at the Associação de Assistência à Criança Deficiente (AACD). Twenty-three children had undergone LTS with the modified Lindeman technique. All of them gained complete control of aspiration. Frequency of hospitalization, number of respiratory infections, and level of secretion were statistically reduced. After surgery only 21.7% of the children were capable of oral intake exclusively. LTS is an effective and safe technique that can be used in children resulting in aspiration control in 100% of the patients and without repercussions in the respiratory secretion and pulmonary infections.

Adolescent↗
PubMed2007

Needle track dissemination of follicular thyroid carcinoma following fine-needle aspiration biopsy: report of a case.

Few reports have been concerned with the risk of needle track dissemination of tumor cells following fine-needle aspiration biopsy, especially for follicular thyroid nodules. A 61-year-old woman who underwent fine-needle aspiration biopsy and surgery 5 years previously for follicular thyroid adenoma presented with nodules that had developed in the sternocleidomastoid and omohyoid muscles of the anterior neck. These nodules were located along a line from the skin to the thyroid that coincided with the needle track of the previous biopsy. Following surgical resection, histological diagnosis determined the nodules to be follicular carcinoma. The clinical course and linear arrangement of the lesions were highly suggestive of needle track dissemination of tumor cells following fine-needle aspiration biopsy. Although fine-needle aspiration biopsy is a useful tool for the diagnosis of thyroid nodules, it is important to consider the risk of tumor cell dissemination.

Adenocarcinoma, Follicular↗
PubMed2005

Experience with aspiration in cases of amebic liver abscess in an endemic area.

The study presented here was performed to evaluate the need for aspiration in patients with amebic liver abscess (ALA). Patients older than 12 years with a diagnosis of ALA based on clinical features, ultrasound results, and positive amebic serology were included in the study (n=144). Serological testing was performed to detect the presence of immunoglobin G antibody against Entamoeba histolytica, and a value of more than 0.4 optical density units was considered positive. All patients were given intravenous metronidazole (500 mg every 8 h) and their clinical progress and need for abscess aspiration was documented. Fever, pain in the upper abdomen, and tender hepatomegaly was seen in 133 (92.3%), 128 (88.8%), and 144 (100%) patients, respectively. Multiple abscesses were seen in 40 (27.7%) patients. Six (4.1%) patients died. Seventy-one (49.3%) patients responded to metronidazole alone. A total of 73 (50.69%) patients required aspiration of the abscess. This study shows that almost 50% of the patients with amebic liver abscess failed to respond to metronidazole and required aspiration.

Adolescent↗
PubMed2003

CT-guided stereotactic aspiration of brain abscesses.

The effective treatment of intracranial abscess remains controversial. Progress in technology, linked with the development of neuronavigational systems, has made stereotactic aspiration and drainage of intracerebral abscesses effective and valid alternatives to traditional methods, namely, conservative medical treatment or open surgical excision. Between 1995 and 2002, 12 patients at our hospital underwent drainage of intracerebral abscesses under stereotactic guidance. Ten patients had solitary lesions and two had multiple abscesses. The appropriate antibiotic schemes were administered following culture of the aspirated material. The size of the abscess, the mass effect, and response to antibiotic treatment were followed up by repeated CT scans. All patients showed improvement and, at the end of treatment, returned to their previous activities. There were neither deaths nor any postoperative complication. A second aspiration was required in one patient due to recurrence of the abscess. The CT-guided stereotactic aspiration of brain abscesses helps achieve all treatment goals. It drains the contents of the abscess, reduces mass effect, and confirms diagnosis. It is minimally invasive, carries minimal morbidity and mortality, and can be performed on compromised patients under local anesthesia.

Adult↗
PubMed1991

Value of direct fine needle aspirative cytology in diagnosing palpable abdominal masses.

PURPOSE: Fine needle aspirative cytology is a well-established diagnostic tool for evaluating tumor masses. The goal of the current study was to determine the diagnostic accuracy of direct (nonimaging-guided) fine needle aspiration of palpable abdominal masses excluding the liver. PATIENTS AND METHODS: Direct aspiration of a palpable abdominal mass was performed in 190 patients in order to confirm or to rule out malignancy. Based on histologic, cytologic, and clinical findings, final diagnoses were reached in 165 patients, of whom 130 had a malignant abdominal mass and 35 a benign abdominal mass. The cytologic findings were verified by correlation with histologic, cytologic, and clinical findings. RESULTS: Among the 130 patients with a malignant abdominal mass, the cytologic findings failed to reveal malignancy in 12 patients (9.2%), but did reveal suspected malignancy in five (3.8%) and malignancy in 113 patients (86.9%). Among all 35 patients with a benign abdominal mass, the cytologic findings were reported as nonmalignant. The overall sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy of cytologic findings were 90.8%, 100%, 100%, 74.5%, and 92.7%, respectively. A nonfatal case of bile peritonitis and a case of localized peritonitis that, in retrospective, could have been avoided were the only major complications that followed the fine needle aspirative procedure. CONCLUSION: With careful patient selection and meticulous attention to the proper procedure, direct fine needle cytology is a simple, safe, and highly accurate method for diagnosing palpable abdominal masses.

Abdominal Neoplasms↗
PubMed1986

Comparison of low- and high-volume irrigation-aspiration systems for extracapsular cataract extraction.

A low-volume irrigation-aspiration system with a 1-mm tip (0.3-mm aspiration port) has been developed for extracapsular cataract extraction. This autoclavable system uses approximately 36% less irrigating fluid during the irrigation and aspiration of cortical material when compared to currently available models. The time required for cortical aspiration is also shortened by 33%. After three years of clinical experience with the low-volume system at the Miami Veterans Administration Medical Center, where almost all extracapsular cataract surgery is now performed with the new system, there have been no adverse effects and subsequent capsulotomy has rarely been necessary.

Aged↗
PubMed1984

Fine needle aspiration in the diagnosis and management of solid breast lesions.

Follow-up data were obtained for 449 fine needle aspirations of solid breast masses from January 1979 through December 1980. The accuracy with which a concordant benign or malignant diagnosis was made was 92 percent. There was a 9.6 percent false-negative rate and a 0.9 percent false-positive rate. Emphasis was placed on the utility of fine-needle aspiration for assessing patients with chronic fibrocystic disease. In 104 cases, patients with a benign cytologic report were followed clinically for 12 months or more. There was a 1.7 percent false-negative rate in this group of patients. We stress that a biopsy should be immediately performed on any worrisome mass, despite the repeatedly negative results of fine needle aspiration. Guidelines for the prevention of false-negative and unsatisfactory cytologic reports have been presented herein. We believe that by careful clinical assessment of the mass, careful performance of the procedure, and close follow-up of the patient, the number of inaccurate fine needle aspirations can be kept at a minimum.

Adult↗
PubMed1989

An appropriate negative bronchoscopy rate in suspected foreign body aspiration.

Aspiration of foreign bodies in children can lead to illness and even death if not recognized and treated promptly. Seventy-six patients were referred to our hospital for suspected foreign body aspiration. The following is a retrospective review of their diagnosis and treatment. There was no foreign body found at bronchoscopy in seven patients (9 percent), and there were nine patients (12 percent) with bronchial foreign bodies who had a delay in diagnosis of foreign body aspiration. The delay averaged 35 days. These children, as a result of a prolonged period before diagnosis, were treated unnecessarily for pneumonia and asthma. Once correctly diagnosed, they had a significantly longer hospital stay. We propose that some negative bronchoscopies are necessary in order to prevent the morbidity that occurs from a missed foreign body aspiration.

Adolescent↗
PubMed1994

Alkaline gastroesophageal reflux: assessment by ambulatory esophageal aspiration and pH monitoring.

The pathophysiologic effect of duodenal contents in the refluxed gastric juice of patients with gastroesophageal reflux disease (GERD) is controversial. We evaluated the composition of the refluxed gastric juice in 43 normal volunteers and 52 patients with GERD using a newly developed device that allows ambulatory esophageal aspiration. The findings were correlated with the results of 24-hour esophageal pH monitoring and the presence of complications of GERD. Compared with bile concentrations in normal volunteers, the total bile acid concentration in the reflux aspirates was higher in patients with GERD (p < 0.01). There was a significant correlation between the bile acid concentration in the aspirates and the percentage of time the pH was above 7 on ambulatory 24-hour esophageal pH monitoring (r = 0.59, p = 0.006), and both were highest during the night (p < 0.01). The bile acid concentration and the percentage of time pH was greater than 7 were particularly increased in patients with strictures or Barrett's esophagus (p < 0.01). Both an increased bile acid concentration in aspirates and the percentage of time with pH greater than 7 on pH monitoring were observed primarily in patients with a destroyed gastroduodenal barrier [status post Billroth II resection (BII), Billroth I resection (BI), or pyloroplasty] or after cholecystectomy. An increased bile acid concentration also occurred in a substantial number of patients without previous foregut surgery, although this did not usually result in an increase in the time that pH was above 7. These data suggest that contamination of the refluxed gastric juice with bile acids predisposes the patient to the development of strictures and Barrett's esophagus. An increased time that pH is greater than 7 on esophageal pH monitoring indicates biliary reflux and occurs primarily after previous foregut surgery. A normal-time pH above 7 does, however, not exclude contamination of the refluxed gastric juice with duodenal contents.

Bile Acids and Salts↗
PubMed1991

Ultrasonic surgical aspirator for lung resection.

The ultrasonic surgical aspirator was originally developed for neurosurgical procedures and hepatic resections. Ultrasonic vibration at the tip of the instrument results in lysis of the parenchymal cells, leaving more resistant fibrous tissue such as blood vessels and bronchi intact and, thus, minimizing blood loss. We have studied the feasibility of applying the ultrasonic surgical aspirator for segmental and subsegmental lung resection for primary and metastatic neoplasms of the lung. Over the past 5 years, 27 patients underwent segmental or limited lung resection using the ultrasonic surgical aspirator. Except for prolonged air leak in 6 patients postoperatively, no other serious morbidity was noted. We observed several advantages: (1) the ultrasonic surgical aspirator dissects out the pulmonary vessels and bronchi, allowing the surgeon to perform segmental and subsegmental resections with minimal blood loss, (2) it permits lung-sparing operation for centrally located tumors that would otherwise have required lobectomy, and (3) it allows direct visualization of lung parenchyma during dissection, thus assuring grossly adequate margins.

Adolescent↗
PubMed1989

The activity pattern of phrenic motoneurons during the aspiration reflex: an intracellular study.

Membrane potential trajectories and discharge characteristics were measured intracellularly in 29 phrenic motoneurons of anesthesized, paralyzed and artificially ventilated cats during hypercapnic respiration and the aspiration reflex. Fifteen 'active' cells discharged spontaneously during inspiration, and the remaining 14 'quiescent' cells exhibited no discharge in spite of strong central respiratory drive. The mean membrane potential of the quiescent cells during inspiration (-62 +/- 4 mV) was significantly lower than the threshold level determined for the active cells -52 +/- 4 mV). The mean axonal conduction velocity was slower for the active (60.4 +/- 8.7 m/s) than quiescent cells (67.4 +/- 6.9 m/s). All phrenic motoneurons discharged during the aspiration reflex with maximum instantaneous frequencies ranging from 6 to 357 Hz. No differences were found for the maximum discharge frequency during the reflex between the active and quiescent cells. Although there were differences in the slopes of the depolarization during inspiration between the groups of cells, no such difference existed in the slopes during the aspiration reflex. The threshold level for the first spike during the reflex was the same as that during inspiration but the level for successive spikes became progressively less negative while spike amplitude decreased and duration increased. Stimulation of the nasopharynx to elicit the aspiration reflex was found to alter the timing of the subsequent respiratory cycles.

Action Potentials↗
PubMed1988

Transbronchial aspiration of subcarinal lymph nodes.

Transbronchial needle aspiration of subcarinal lymph nodes has been undertaken in 60 consecutive patients with pulmonary malignancies undergoing routine fibreoptic bronchoscopy. Four aspirates from the subcarinal nodes contained malignant cells; three squamous cell carcinoma and one adenocarcinoma. Four of 40 (10%) of patients with non-small-cell carcinoma of the lung had a positive aspirate. We have not confirmed the high positive rate previously reported, but nevertheless transbronchial needle aspiration provided useful staging information in some patients. The technique is rapid, safe and simple, and can easily be applied in a routine bronchoscopy service for all patients with suspected cancer, or selected patients under active consideration for surgery.

Adenocarcinoma↗
PubMed1982

beta-Glucuronidase in gastric aspirate after oral cimetidine in the diagnosis of carcinoma of the stomach.

The activity of beta-glucuronidase was studied in the gastric aspirate from normal individuals, cases of duodenal ulcer with pyloric stenosis and carcinoma of the stomach. The optimum pH for the activity of this enzyme in the gastric aspirate is 4.0 to 5.5. Cimetidine, a H2-receptor antagonist, was administered orally to obtain the optimum pH for the enzyme activity, when the pH of the gastric aspirate was less than 4.0. It is observed that the enzyme activity in cases of carcinoma of the stomach is markedly elevated (p less than 0.01), when compared with other cases in this study. It is suggested that the elevated enzyme activity in the gastric aspirate could be used as a biochemical marker in the diagnosis of carcinoma of the stomach.

Administration, Oral↗
PubMed1990

Early termination of pregnancy: medical induction with prostaglandins versus surgical aspiration under local anesthetic.

Termination of pregnancy at 4-8 weeks gestation in 1085 patients using either local prostaglandin instillation (n = 820) or uterine aspiration under local anesthetic (n = 265) have been analyzed. Morbidity for both methods was similar although the incidence of side-effects (0.4%) and the transfusion rate (0%) were lower after aspiration than the respective rates of 59% and 1.3% after prostaglandin treatment. However the rates of genital tract trauma (0.75%) and uterine sepsis (1.8%) after aspiration were higher than the respective rates of 0.3% and 0.9% after prostaglandin treatment. The major disadvantage of prostaglandin treatment was the rate of re-admission for evacuation (8.5%) compared with (0.9%) after aspiration, although patient acceptability for both techniques was similar. In view of the advantages, more widespread use of both methods of termination is indicated.

Abortion, Induced↗
PubMed1992

The role of the prosthodontist regarding aspirative dysphagia.

Certain swallowing disorders characteristically may follow head and neck surgeries and neurologic disorders. Aspiration is one of the possible symptoms of dysphagia. Since aspiration can be life-threatening, prosthodontists should help to identify patients who aspirate. This article describes the normal swallowing physiology, the pathophysiology of swallowing disorders, and the prosthetic role in the treatment of patients experiencing head and neck surgical operations and neurologic disorders that may cause aspiration.

Deglutition↗

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