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[Ultrasound guided forceps biopsy of the pleura].

AIM: Between cytology of pleural effusion and thorascopy there is a gap for another non invasive biopsy method to diagnose pleural diseases, especially since Adam's and Ramel's blind pleural biopsy is uncommon. Therefore it is suggestive to test feasibility and usefulness of pleural forceps biopsy. METHOD: It is possible to take biopsies under ultrasound guidance with the help of a biopsy-forceps from the diaphragmatic pleura or pleural appositions through a 2.5 mm canula with a stop cock and a rubber vent. The specimen can be used for histological or immunohistochemical examinations. The procedure is coducted in a closed system to avoid pneumothorax. The puncture was done in 12 patients with a puncturable pleural effusion. RESULTS: In 11 of 12 patients it was possible to get the final diagnosis. In one of three cases of mesotheliomas a rebiopsy was necessary. In 9 cases a malign tumor was diagnosed, effusion cytology was negative in 4 of 7 tumors. In 5 patients with a history of a former tumor pleural carcinosis was related three times correctly to the former cancer and twice to a secondary cancer. In one case a fibrous plaque was found. There were two patients with pleuritis, in one case a pulmonary tuberculosis was found 8 weeks later. In one patient with a mesothelioma inoculated metastasis were present in the sites of the punctures. In all pleural forceps punctures we got enough biopsy material for histological and immunohistochemical diagnosis. CONCLUSION: The ultrasound guided forceps biopsy of the pleura is a very promising less invasive method to diagnose pleural tumors. Additional improvements of the equipment are possible. Definitive evaluation of the procedure especially in infectious pleural diseases requires a higher number of cases.

Adult↗

A new technique for endoscopic submucosal dissection for early gastric cancer using an external grasping forceps.

BACKGROUND AND STUDY AIMS: Endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) has improved the success rate of en-bloc resection. We report here on a new technique using an external grasping forceps. PATIENTS AND METHODS: A total of 25 patients with suitable EGCs over 10 mm in diameter located in the gastric body were enrolled. After submucosal injection followed by circumcision of the lesion with a needle-knife, an external grasping forceps was introduced with the help of a second grasping forceps and anchored at the distal margin of the lesion. With gentle oral traction applied with this forceps, the lesion was dissected endoscopically in retroversion from the aboral side. RESULTS: The mean lesion size was 15.0 mm (range 10 - 25 mm). Using the technique described, all lesions could be resected en bloc with free margins. The mean procedure time was 45 min (range 30 - 80 minutes). No significant bleeding requiring blood transfusion or perforation occurred. CONCLUSIONS: This technical modification may simplify and shorten the gastric ESD procedure, except for lesions in distal locations, without compromising the efficacy.

Adenocarcinoma↗

Comparison of snare and large forceps biopsies in the histologic diagnosis of gastric vascular ectasia in cirrhosis.

To compare snare and large forceps biopsies in the histologic diagnosis of gastric vascular ectasia (GVE) in cirrhosis, two groups of patients were studied: (a) 8 cirrhotic patients in whom endoscopy disclosed multiple gastric red spots (GRS), and (b) 5 cirrhotic patients with no GRS. Histologic examination of snare specimens identified dilated capillaries in the mucosa of the stomach in 75% of the cirrhotic patients with GRS, while large forceps specimens enabled the diagnosis of GVE only in 20% of the cases (p less than 0.05). Morphometric analysis of snare specimens demonstrated a significantly greater mean mucosal capillary cross-sectional area in cirrhotic patients with GRS than in cirrhotic patients without these lesions (p less than 0.05), while no differences in this parameter was observed in large forceps specimens. These findings indicate that gastric mucosal specimens obtained with large forceps are not useful for establishing the histologic diagnosis of GVE in cirrhotic patients with GRS.

Aged↗

[Quantifying suture tension of corneal sutures with the suture forceps with strain gauge strips].

To achieve uniform tensions on corneal stiches a modified tying forceps was developed. This forceps provides the possibility to measure the tension which is put to a nylon thread (10-0) by means of surface mounted strain gauges detecting the forceps jaws' bending. The results are registered and displayed electronically. To obtain a preselected tension, a limit value switch and a tare unit is used. A first series of registrations showed reproduceable values and confirmed a linear correlation between forceps jaw bending and traction force. A prototype and possibilities of technical improvement are demonstrated.

Corneal Transplantation↗

Removal of a lateral disc herniation with malleable endoscopic forceps: technical note.

OBJECTIVE: The use of "seeing" endoscopic malleable pituitary forceps in the removal of a lateral herniated lumbar disc is evaluated. METHODS: A malleable pituitary forceps with an attached endoscope was used to explore the neuroforamina and remove laterally herniated disc fragments without a lateral approach or disruption of the facet joint. RESULTS: In the described case, endoscopic forceps provided easy localization and removal of the disc fragments. CONCLUSION: Because this instrument was used successfully in this case, further evaluation of the use of the endoscopic pituitary forceps should be made.

Diskectomy↗

Preliminary report of multi degrees of freedom forceps for endoscopic surgery.

Laparoscopic suturing requires more complex techniques than conventional open surgery, because of the limited degrees of freedom of endoscopic devices. The prototype multi degrees of freedom forceps was developed with a concept of a flexibility that frees us from the restriction on suturing during endoscopic surgery. It was designed for a needle holder. We calculated the movement of the forceps' distal joint at the time of horizontal suturing. The learning curve was also investigated for ten surgeons. The device was clinically applied in several surgeries. We could perform suturing freely using this prototype forceps at any point and in any directions. The learning curve had its peak within five training sessions, and may be mastered during about ten training sessions. All clinical applications were successfully achieved. With the increased degree of freedom for forceps, the operability for endoscopic surgery was improved.

Analysis of Variance↗

Chest X-ray in collagen vascular diseases. A comparison of chest X-ray with bronchoalveolar lavage and transbronchial forceps biopsy.

The diagnostic value of chest X-ray following the ILO standards was compared with bronchoalveolar lavage (BAL) and the histology of transbronchial forceps biopsy in 83 patients with collagen vascular diseases. BAL in the middle lobe was considered abnormal in case of increased cell count per milliliter and/or lymphocytosis and/or neutrophil granulocytosis and this was found in 32 out of 42 cases (76.2%) with, and in 33 of out 41 cases (80.5%) without abnormal radiological finding. Pathological changes in the histology were found in 14 out of 20 cases (70.0%) with and in 40 out of 63 cases (63.5%) without abnormal chest X-ray in the upper lobe from which the transbronchial forceps biopsy specimens were obtained. In histological specimens obtained from transbronchial forceps biopsy, only fibrosis correlated with abnormal radiological findings in this region. Other inflammatory processes defied prediction by chest X-ray. This suggests that, regardless of chest X-ray findings, BAL should be performed together with transbronchial forceps biopsy for the histological examination of patients with collagen vascular diseases in which interstitial lung involvement is suspected.

Adolescent↗

A new intubating forceps.

A new intubating forceps is described. The forceps grip the endotracheal tube from the front and back instead of from the side as do Magill's forceps. The advantages of the forceps are a more secure grasp; improved field of vision; better manipulating ability and reduced likelihood of trauma to tissues or tube cuff.

Anesthesiology↗

The use of the laryngeal mask airway during guidewire dilating forceps tracheostomy.

Percutaneous tracheostomy has become a common alternative to the classical open tracheostomy because of its convenience, cost effectiveness, and decreased complication rates. We retrospectively reviewed our intensive care practice using a guidewire dilatating forceps percutaneous tracheostomy technique with an endotracheal tube, as compared with the Classic Laryngeal Mask Airway (LMA) for these procedures. From 1998 to 2004, 274 patients underwent a tracheostomy procedure. Two-hundred-fifty-four (92.7%) of these patients underwent a guidewire dilatating forceps tracheostomy and 20 (7.3%) underwent a surgical tracheostomy. In the guidewire dilatating forceps group, 188 (74%) were performed by endoscopy via LMA-guided bronchoscopy, and 66 (26%) were performed through an endotracheal tube. Endoscopic views obtained via the LMA were subjectively better than those obtained with the endotracheal tube. Acute complications were significantly more frequent when using an endotracheal tube as compared with the LMA (6 of 66 versus 4 of 188; P = 0.022 Fisher's exact test, odds ratio = 4.6). There was a significant difference in terms of acute (10 of 254 versus 6 of 20; P < 0.001, odds ratio = 10.5) and chronic (0 of 254 versus 4 of 20; P < 0.001) complications between the 2 groups. There were no ventilatory complications or reports of gastric aspiration. The LMA provides a safe and effective alternative to an endotracheal tube for airway management during guidewire dilatating forceps tracheostomies in selected patients.

Aged↗

Techniques in human airway inflammation: quantity and morphology of bronchial biopsy specimens taken by forceps of three sizes.

BACKGROUND: In recent years, fiberoptic bronchoscopy has been introduced successfully in the research of bronchial asthma. Bronchial biopsy specimens obtained by this procedure are small, and an optimal biopsy technique is necessary to obtain high-quality tissue samples, as sufficient length of intact basement membrane and sufficient depth of submucosal tissue are required. METHODS: We compared size and qualitative aspects of bronchial biopsy specimens from nonasthmatic subjects, obtained by forceps of three different sizes, types FB-19C, FB-21C, and FB-35C (Olympus; Tokyo, Japan). RESULTS AND CONCLUSIONS: We conclude from this study that the hypothesis that the bigger the biopsy forceps, the larger the biopsy specimen and the better the quality of the tissue does not hold. Bronchial biopsy specimens obtained with forceps type FB-35C and FB-21C were equal in size, but the FB-35C biopsy specimens showed more damage and crush artifacts, whereas biopsy specimens obtained with forceps type FB-21C had more intact basement membrane, more submucosal depth, and well-preserved morphology.

Biopsy↗

Three-way bipolar forceps: a novel bipolar coagulator system for nerve stimulation and detection of nerve potentials.

Preoperative characterization of brain anatomy by magnetic resonance imaging and intraoperative functional characterization of the nervous system is essential in patients undergoing radical resection of brain tumors. A novel integrated system was developed combining conventional bipolar forceps with an electric stimulator and an oscilloscope. The system consists of a mechanical switching circuit allowing a wide range of electric characteristics and was designed to perform intraoperative electrophysiological studies, including functional mapping and measurements of motor evoked potentials (MEPs) and somatosensory evoked potentials (SEPs). This system achieved a significant reduction in exchange time (from 3.63+/-1.00 sec to 1.12+/-0.42 sec) between coagulation and stimulation, and reproducible measurement of MEPs from porcine limbs by cortical stimulation using the bipolar forceps. Functional mapping under awake craniotomy was carried out by cortical stimulation in patients with glioblastoma, and median nerve SEPs with high signal-to-noise ratio were elicited from the bipolar forceps on the sensory cortex of patients under general anesthesia. This integrated system is technically easy to operate and allows functional monitoring of an area that would otherwise be difficult to access using conventional methods. This three-way bipolar forceps system may reduce postoperative complications in patients undergoing neurosurgical procedures.

Adult↗

Forceps biopsy and brush cytology during endoscopic retrograde cholangiopancreatography for the diagnosis of biliary stenoses.

BACKGROUND: For evaluating pancreaticobiliary stenoses during endoscopic retrograde cholangiopancreatography (ERCP) tissue sampling techniques may be important. Brush cytology and forceps biopsy during ERCP are two potential, but so far only incompletely evaluated, tools for the diagnosis of malignant biliary or pancreatic stenoses. METHODS: Between 1992 and 1995 we acquired 133 cytologic and/or histologic samples from 119 patients who underwent ERCP because of biliary duct stenoses. Sixteen patients had to be excluded from the study due to insufficient follow-up information. After papillotomy, brush cytology was performed in 65 cases (63 patients), and forceps biopsy in 119 cases (106 patients under fluoroscopic guidance. Both methods were applied in combination 51 times (48 patients). The nature of the stenoses was confirmed by surgery, autopsy, or by the subsequent clinical course. RESULTS: The sensitivity was 46.7% for brush cytology and 64.9% for forceps biopsy. The combined application of both methods resulted in superior sensitivity (70.4%). Specificity was 100% for all methods. CONCLUSIONS: These numbers lead us to recommend a combined and more frequent application of brush cytology and forceps biopsy of bile duct stenoses to enhance the diagnostic yield whenever substantial influence on therapy can be expected.

Aged↗

Isotonic mannitol and the prevention of local heat generation and tissue adherence to bipolar diathermy forceps tips during electrical coagulation. Technical note.

The authors observed temperature levels of saline and mannitol on the tips of bipolar diathermy forceps during application of power to the forceps and compared the effects of irrigation with saline and isotonic mannitol on electrical coagulation of vessels during neurosurgical operations. There was a marked rise in the temperature of saline corresponding to increased output power of the coagulator; there was no rise in the temperature of the mannitol. Irrigation with isotonic mannitol during surgery resulted in a considerable reduction of adherence of burned tissue and blood clots to forceps tips during coagulation of both arteries and veins compared with that which occurred during irrigation with saline. These results demonstrate that irrigation with an isotonic mannitol surpasses that with conventional ionic fluids, such as a saline, for prevention of both tissue adherence to bipolar diathermy forceps and removal of heat generated during electrical coagulation.

Burns↗

Correction of CAPD catheter displacement using gastric biopsy forceps: the push-pull method.

We corrected malpositioned continuous ambulatory peritoneal dialysis catheters in six patients using a new technique named the "push-pull method". A gastric biopsy forceps was advanced through the catheter to near its tip. After manipulating the tip of the forceps through the abdominal wall, the forceps was opened and pulled out slowly. Repeated insertion and removal of the forceps induced the catheter to return to the pelvic cavity. This push-pull method was successful for Swan neck straight (n=2) and coiled (n=4) catheters in all patients. The time required for the procedure was only 5-10 minutes and there were no complications.

Adult↗

Multipronged laparoscopic forceps.

Use of conventional two-pronged forceps in laparoscopic surgery can be problematic. Fallopian tubes tend to slip and ovaries are difficult to grasp securely. In addition, when removing the forceps to obtain an ovarian biopsy specimen prior to cauterization of the biopsy site, the ovary must be released; it is the often difficult to regrasp promptly. Spring-loaded laparoscopic instruments that are provided with multiple prongs offer certain advantages. These instruments hold tissue more securely and with even tension, and with them it requires a minimal effort to maintain tissue in a stable position. The author designed multipronged forceps, which were used for tubal sterilization and ovarian mobilization and biopsy in a series of more than 125 cases. No complications were noted from the use of the forceps.

Biopsy↗

[Endoscopic hemostasis using high-frequency hemostatic forceps for hemorrhagic gastric ulcer].

Gastric ulcer is a major responsible lesion for upper gastrointestinal bleeding. Several methods for endoscopic hemostasis are widely used throughout Japan to treat the ulcerative lesion. High-frequency hemostatic forceps is one of the endoscopic coagulation devices developed solely for hemostasis. Unlike biopsy forceps, it has narrow opening angle, a small cup and a dull edge to make pinpoint holding of the target lesion possible. We applied high-frequency hemostatic forceps for eleven cases of hemorrhagic gastric ulcer with exposed vessels. All of the cases were treated by endoscopic hemostasis with the device. Initial hemostasis obtained in all of the cases(100%), and no rebleeding was observed. Additional treatment, however, was necessary in four cases(36%). No serious complication, like perforation, was observed. We concluded that endoscopic hemostasis using high-frequency hemostatic forceps for hemorrhagic gastric ulcer is safe and effective method.

Hemostasis, Endoscopic↗

A mechanical contact model for the simulation of obstetric forceps delivery in a virtual/augmented environment.

During the process of human childbirth, obstetric forceps delivery can be a justified alternative to emergency Caesarean section when normal vaginal delivery proves difficult or impossible. Currently, training of forceps interventions is mainly done on real patients which poses a risk. This paper describes a pilot project on the simulation of training of obstetric forceps delivery, using Virtual Reality technology. We first give a brief historical review of the concept of 'birth simulation' and describe the current implementation of the interface. Then we report a number of experiments, conducted to test the feasibility of a real-time mechanical contact model to describe the interaction between the forceps and fetal head, eventually to be interfaced with a multi-purpose haptic feedback device. It is concluded that an explicit dynamic model to calculate the deformation of the main fetal skull bones only, or a quasi-static model to calculate the deformation of the fetal head in its entirety, can reach real-time performance.

Computer Simulation↗

[Choriocentesis: comparison of the effectiveness of a new choriocentesis needle and a transcervical biopsy forceps].

71 samples taken by the transabdominal route were compared with 71 samples taken by forceps through the cervix. A fine (1 mm) transabdominal choriocentesis needle with a thin wall (0.1 mm), a short bevel, and a lateral hole was made to bring together simplicity, effectiveness and safety; success was obtained in 95% of the cases (39/41) of our last 41 samples on the first attempt. For comparison with the forceps, the success rate on the first attempt was only 66% (26/41), but it rose to 97.5% if the patient could take 3 attempts at most. The forceps made it possible to collect a mean quantity large enough (19.9 mg) but it was quite variable (16.7 mg being the range) of complete villi, whereas the choriocentesis needle only gathered a smaller volume (12.7 mg) but more reliable (the range being 3.7 mg). The villi were fragmented, however. To work out the study of the DNA and the karyotype, there is a choice between the forceps and the needle. This choice depends principally on the damage the two techniques can do. This has not been worked out yet in our study except indirectly.

Biopsy↗