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At least 325 records · Page 18Linked to original sources

False-positive epidural catheter aspiration tests in needle through needle combined spinal-epidural anaesthesia.

We describe two separate episodes of free aspiration of clear fluid through epidural catheters during needle-through-needle combined spinal-epidural anaesthesia in the lateral position. Although both catheters were assumed to have been located intrathecally, both subsequently gave negative test doses and were used as epidural catheters. In the second patient, the position of the catheter was investigated using contrast spiral computerised tomography scanning, which showed epidural contrast spread only. This is the first time such an occurrence has been recognised, and we consider its significance for catheter site confirmation testing in combined spinal-epidural anaesthesia.

Aged↗

[Single-needle diafiltration and single-needle plasmapheresis in premature infants].

Extracorporal detoxication methods in newborns are most unavailable, contraindicated because of technical problems. We report our experiences with a blood pump unit developed by our-selves for diafiltration and plasmapheresis in newborns. In 6 newborns with acute renal failure, Rh-ery-throblastosis and hypoproteinemia, 13 single-needle-diafiltrations and 6 single-needle-plasmapheresis were performed with the self-constructed double head pump, special tube systems and small models. Our results show that all extracorporal detoxication methods can be carried without problems.

Acute Kidney Injury↗

Safety, tolerability, and lack of antibody responses after administration of a PfCSP DNA malaria vaccine via needle or needle-free jet injection, and comparison of intramuscular and combination intramuscular/intradermal routes.

Introduction of a new vaccine requires choosing a delivery system that provides safe administration and the desired level of immunogenicity. The safety, tolerability, and immunogenicity of three monthly 2.5-mg doses of a PfCSP DNA vaccine were evaluated in healthy volunteers as administered intramuscularly (IM) by needle, IM by jet injection (Biojector or IM/intradermally (ID) by jet injection. Vaccine administration was well-tolerated. Adverse events were primarily mild and limited to the site of injection (98%). Jet injections (either IM or ID) were associated with approximately twice as many adverse events per immunization as needle IM, but nevertheless were strongly and consistently preferred in opinion polls taken during the study. No volunteers had clinically significant biochemical or hematologic changes or detectable anti-dsDNA antibodies. In conclusion, the injection of Plasmodium falciparum circumsporozoite (PfCSP) DNA vaccine appeared to be safe and well-tolerated when administered by any of the three modes of delivery. However, despite improved antibody responses following both jet injection and ID delivery in animal models, no antibodies could be detected in volunteers by immunofluorescence antibody test (IFAT) or enzyme-linked immunosorbent assay (ELISA) after DNA vaccination.

Animals↗

Immunophenotyping lymphomas in dogs: a comparison of results from fine needle aspirate and needle biopsy samples.

The reliability of utilizing cytologic samples for immunophenotyping canine lymphomas was evaluated by a systematic comparison of results from fine needle aspirate (FNA) to needle biopsy specimens stained by immunochemical methods. The specific reactivity of a selected panel of 12 antibodies to cell surface markers and intermediate filaments was assessed in 11 dogs by comparing cytologic to histologic samples. There was excellent correlation of results between immunostained cytologic and histologic samples. FNA sampling is a simple, noninvasive method for determining the lymphoid phenotype in canine lymphoma. In addition, this technique may be useful as a cytodiagnostic aid in differentiating lymphoid from non-lymphoid tumors and in assessing neoplastic vs. reactive or hyperplastic processes.

Journal Article↗

Stage A1 prostate cancer: follow-up with digital rectal exploration, prostate markers, fine-needle aspiration, ultrasonographically guided needle biopsy and biopsies of the residual prostate with resectoscope.

From January 1985 to December 1990, we performed 921 TURP and 23 retropubic adenomectomies. In 70 patients (7.4%) histological examination revealed an incidental carcinoma of the prostate (stage A), 51 of which (72.8%) were A1 and 19 (27.2%) stage A2. In our classification A1 covers cases with < 3 G1 focal lesions [Boxer, 1977]. Thirteen of the A2 cases underwent radical prostatectomy: 1 pT1G1-2, 9 pT2G1-2, 3 pT3G2 (TNM 1978); the remaining 6 were given palliative treatment. The 51 stage A1 patients were recalled for follow-up evaluation, only 20 came for checking. They were reassessed by means of DRE, markers, prostate cytologic aspiration, echo-guided transperineal needle biopsy and resection of the prostatic cavity. Our experience seems to suggest that, if we define A1 as < 3 G1 chips or less, this stage is to be considered an incidental illness that seems not to require further treatment, but only a policy of surveillance with yearly markers, DRE and echo-guided needle biopsy.

Aged↗

In vitro and in vivo stability of electrode potentials in needle-type glucose sensors. Influence of needle material.

Enzymatic glucose sensors are based on the amperometric detection of an oxidable species generated during the oxidation of glucose by glucose oxidase. This measurement usually requires a working electrode (anode), an auxiliary electrode (cathode), and a reference electrode, the function of the latter being to keep constant the working potential of the anode, which is responsible for current generation. However, in the needle-type glucose sensors proposed so far, the reference electrode is missing, and its function is performed by the auxiliary electrode. We investigated, in vitro and in vivo in rats, the ability of several cathode-needle materials to behave as a reference electrode in two-electrode glucose sensors, i.e., to present a stable auxiliary electrode potential. In vitro, when glucose concentration was raised from 0 to 30 mM, the auxiliary potential of both gold- and silver-coated sensors presented a cathodic drift, whereas that of silver/silver chloride-coated sensors remained stable. In vivo, during insulin-induced hypoglycemia (5.9-2.4 mM), the auxiliary potentials of all sensors remained stable, whereas during glucose infusion (mean blood glucose concentration 11.2 mM), the auxiliary potentials of both gold- and silver-coated sensors presented an anodic drift, whereas those of silver/silver chloride-coated sensors remained stable. We also indirectly quantified the changes in sensor response induced by variations in the working potential in vitro and in vivo, simulating those that might be produced by a drift in the auxiliary potential. Such changes in the working potential could bring about a 30% unspecific variation in sensor response. We conclude that improvements in sensor analytical characteristics should be obtained with silver/silver-chloride-coated cathodes.

Animals↗

Incorrect needle position during lumbar epidural steroid administration: inaccuracy of loss of air pressure resistance and requirement of fluoroscopy and epidurography during needle insertion.

Loss of air pressure resistance leads to a high rate (25.7%) of inaccurate needle-tip placement in the posterior soft tissues of the back during lumbar epidural steroid administration employing a 20-gauge Tuohy needle. Imaging and epidurogram are essential for confident identification of the lumbar epidural space to enable accurate location of steroid administration. Studies assessing efficacy of lumbar epidural steroid injection and individual patient treatments should ensure location of administration with epidurogram to enhance the validity of results.

Adult↗

CT-guided transthoracic fine-needle aspiration versus transbronchial fluoroscopy-guided needle aspiration in pulmonary nodules.

PURPOSE: To evaluate the diagnostic yield of CT-guided (CTNAB) and fluoroscopy-guided transbronchial (TBNA) fine-needle aspiration cytology in pulmonary nodules and to compare their complications. MATERIAL AND METHODS: Thirty patients with pulmonary nodules not abutting upon the chest wall and inaccessible to bronchoscopy were randomised for CTNAB or TBNA. Eighteen patients underwent CTNAB and 16 TBNA. Four patients underwent both procedures. RESULTS: In the CTNAB group, a definitive diagnosis could be made in 14 (78%) out of 18 patients whereas in the TBNA group, a definitive diagnosis was made in 11 (69%) out of 16 patients. This difference was not statistically significant (p > 0.05). The final diagnosis in 29 out of 30 patients comprised primary bronchogenic carcinoma in 14 patients, metastases in 5 patients, and benign lesions in 10 patients (34%) of which 3 lesions (30%) were of tuberculous aetiology. There were 2 asymptomatic pneumothoraces in the CTNAB group and no complication was observed in the TBNA group. CONCLUSION: Both techniques were safe and effective in the diagnosis of peripheral pulmonary lesions. TBNA was best suited for lesions larger than 3 cm and located in the middle and lower lobes while CTNAB could be used for any lesions.

Adult↗

Diagnosis of lymphoma by image-guided needle biopsies: fine needle aspiration biopsy, core biopsy or both?

OBJECTIVE: To determine whether or not concurrent core biopsy adds to results obtained from image-guided fine needle aspiration biopsy (FNAB) in cases of lymphoma. STUDY DESIGN: Twenty-eight FNABs of lymphomas with adjuvant flow cytometry (FC) and concurrent core biopsy were evaluated retrospectively. In each case, completeness of diagnosis by FNAB, including phenotyping and grading, where appropriate, was reviewed. The contribution of core biopsy to the diagnosis in cases where FNAB did not render a complete diagnosis was assessed. Prognostic information not available from the FNAB but obtained from the core biopsy was also evaluated. RESULTS: FNAB with adjuvant FC gave a complete diagnosis, including phenotype and grade, where applicable, in 23 of 28 cases (82%). Core biopsy added to the diagnosis in 3 cases. In 1 case, large B-cell lymphoma was diagnosed on core biopsy when FNAB was unsatisfactory. In the other 2 cases, grade of follicle center cell lymphoma was higher on core biopsy than on FNAB. The addition of the information obtained by core biopsy to that obtained by FNAB raised the diagnostic accuracy to 93%. Core biopsy was used to assess nodularity, which could not be determined on FNAB. Core biopsy was also used to assess prognostic markers by immunohistochemistry (Ki-67 and p53); they were not available with FC. This was done in 11 cases when requested by the oncologist. CONCLUSION: FNAB with adjuvant FC is a useful technique for diagnosing and subtyping lymphomas. However, diagnosis and subclassification are often insufficient. Core biopsy material provides opportunity for obtaining additional diagnostic and prognostic information that may not be easily derived from the FNAB. This allows optimal treatment planning in patients for whom excisional biopsy is contraindicated.

Adult↗

[Atypical ductal hyperplasia of the breast. Its diagnostic imaging and the role of percutaneous needle biopsy with a 14-gauge needle].

PURPOSE: To investigate the yield of core biopsy in the histologic characterization of atypical ductal hyperplasia (ADH) and to assess the radiological patterns, if any, of this condition. MATERIAL AND METHODS: January 1993 to October 1997 we studied 553 lesions, 8 of them with a diagnosis of ADH made on microhistologic samples obtained with 14G needles. Biopsy was performed under US guidance in 81.7% of cases and under mammographic guidance in 18.3%. The breast lesions were studied with mammography, US and MRI, the latter in one case. ADH was diagnosed by strict application of Page's and lesion extent criteria. RESULTS: Seven of 8 lesions with a core biopsy diagnosis of ADH were submitted to surgical biopsy. The diagnosis was changed in as many as 6 of 8 cases, into typical ductal hyperplasia (1 case) and carcinoma (1 papilliferous, 3 ductal infiltrating and 1 in situ lesions). ADH was confirmed in one case only. DISCUSSION: In agreement with other authors, we found no specific radiological patterns of ADH. Moreover, the core biopsy diagnosis of ADH requires a surgical biopsy, because ADH is often associated with carcinoma. CONCLUSIONS: Surgical biopsy is needed to diagnose ADH and therefore it is useless to perform more invasive procedures than 14G core biopsy.

Biopsy, Needle↗

The roles of fine needle aspiration and needle core biopsies in the diagnosis of primary prostatic cancer.

For more than 50 years, needle core and aspiration biopsy techniques have been used to detect carcinoma of the prostate. Each has had vigorous proponents and many technical innovations have been made to improve the techniques. This report summarizes the developmental history of the techniques, examines their individual merits, reviews studies comparing the methods, and discusses the complications associated with each. Presently, in patients with abnormal rectal examinations, small-gauge transrectal core biopsy and transrectal aspiration biopsy offer similar detection and false-negative rates with very low frequencies of complications.

Biopsy, Needle↗

Fine needle aspiration biopsy of the islet cell tumor of pancreas: a comparison between computerized axial tomography and endoscopic ultrasound-guided fine needle aspiration biopsy.

The objective of the present study is to compare the cytologic features of islet cell tumor (ICT) of pancreas obtained by endoscopic ultrasound guided fine needle aspiration (EUS-FNA) and computed tomography guided FNA (CT-FNA). We also describe the cytologic features associated with malignant ICT. Eleven cytology samples from 121 CT- FNA and 30 EUS- FNA of the pancreas were obtained from nine patients with ICT. Diff-Quik, Papanicolaou, and immunohistochemical stains to determine neuroendocrine differentiation and the hormonal status were evaluated. Cytologic features and specimen adequacy were compared between the two techniques. Cytologic features noted in both benign and malignant ICT were also compared. Nine patients (5 men, 4 women) ranging in age from 29 to 84 years (mean age, 53.8 years). Diagnoses consisted of benign (4) and malignant (5) ICT. EUS-FNA was superior to CT-FNA in obtaining adequate cells (2/2 v 7/9) for the diagnosis and increased cellularity to perform additional immunohistochemical stains (2/2 v 4/7). Single, plasmacytoid cells with finely granular chromatin distribution characterized ICT on cytology. Mitoses (3/5) and necrosis (1/5) were noted in malignant ICT but not in benign ICT. EUS-FNA is superior to CT- FNA for obtaining cells for the diagnosis of ICT. Detection of mitoses and or necrosis from patients with ICT should initiate a search for metastasis.

Adenoma, Islet Cell↗

Comparison of palpation-guided fine-needle aspiration biopsy to ultrasound-guided fine-needle aspiration biopsy in the evaluation of thyroid nodules.

OBJECTIVE: Although fine-needle aspiration biopsy (FNAB) of thyroid nodules is a reliable and simple method, the diagnostic value may be limited by inadequate and false-negative results. In this prospective study, we compared palpation-guided FNAB (PGFNAB) with ultrasound-guided FNAB (UGFNAB) to establish the rates of inadequate material and cost-effectiveness. DESIGN: A total of 285 thyroid nodules in 215 patients were included in the study. Palpable nodules with the greatest diameter between 1 and 2.5 cm were included in the study. PGFNAB and UGFNAB techniques were applied to the same nodule by the same operator. Cytologic evaluations were performed by the same cytologist in a blinded fashion. To provide cost analysis, the prices obtained from different hospitals were evaluated. MAIN OUTCOME: The rates of inadequate material for PGFNAB and UGFNAB were significantly different as 32.3% and 21.4%, respectively (p = 0.004). There was significantly higher inadequate material rate in PGFNAB group for small-sized nodules (greatest nodule diameter between 10 and 15 mm) (p = 0.009), despite inadequate material rate was not significant for both procedures for larger sized nodules. False-negative results were 15.8% for PGFNAB and 5.6% for UGFNAB. Regarding cost analysis, the difference between the two methods was 20 dollars on average for each patient. CONCLUSIONS: We consider UGFNAB to be superior to PGFNAB for obtaining adequate material especially for small-sized nodules, as well as providing more accurate cytologic evaluation. Indeed, the difference between the costs of two procedures might be acceptable.

Adolescent↗

Needle-localization biopsy of the breast: impact of a selective core needle biopsy program on yield.

PURPOSE: To determine the effect of a selective core biopsy program on the yield at needle-localization biopsy (NLB) of nonpalpable lesions. MATERIALS AND METHODS: Two hundred consecutive core biopsy samples of the breast were evaluated in an ongoing consecutive series of 1,172 NLB samples. RESULTS: Before implementation of the core biopsy program, the yield at NLB improved from 21% at 100 cases to 35% just before the introduction of core biopsy. After implementation, the yield increased gradually to 55% at 200 cases. The yield in masses increased from 21% at 100 cases to 43% just before the initiation of the core biopsy program and then increased dramatically to 72% at 200 cases. The percentage of small lesions detected did not change with implementation: 88% of invasive cancers measured less than 1.5 cm and 60% measured less than 1 cm in the last 100 cases. CONCLUSION: Appropriate selection of cases for core biopsy can more than double the yield of cancer in NLB samples without a decrease in the percentage of small cancers detected.

Adolescent↗

Nucleic acid amplification of Mycobacterium tuberculosis complex DNA from archival fine needle aspiration smear scrapings vs. fresh fine needle aspirates of tuberculous lymphadenitis.

OBJECTIVE: To assess the efficacy of the nucleic acid amplification (NAA) technique for Mycobacterium tuberculosis (MTB) complex from archival fine needle aspirate (FNA) smear scrapings of confirmed cases of extrapulmonary tuberculosis (EPTB) for a retrospective diagnosis of EPTB as compared to NAA from fresh FNA material from the same cases. STUDY DESIGN: Smear scrapings from 51 cases; 33 cases of tuberculous lymphadenitis (from patients who had undergone NAA 1 year before for MTB from fresh FNA material); 13 negative controls from nontuberculous, archival FNA smears; and 5 known acid-fast bacilli (AFB)-positive sputum smears, were subjected to NAA using the IS6110 primer sequence of M tuberculosis. Ziehl-Neelsen staining was done in all the smears. RESULTS: Of the 33 cases of tuberculous lymphadenitis, 15 (45.4%) were AFB positive and 18 (64.5%) AFB negative. MTB NAA was positive in 73.3% (11 of 15 AFB-positive cases) in the freshly aspirated material and was observed in 60% (9 of 15 AFB-positive cases) when done on DNA extracted from the archival smear scrapings of the same cases. Similarly, in the 18 AFB-negative cases, MTB NAA positivity was 72.2% (13 of 18) on fresh material and 44.4% (8 of 18) on archival smear scrapings from the same AFB-negative cases. Overall NAA positivity was 51.5% for archival smear scrapings as compared to 71% for fresh FNA of the same cases. CONCLUSION: Low NAA sensitivity of MTB DNA in archival material of known tuberculous cases limits the routine use of NAA based retrospective molecular diagnosis of MTB complex.

Biopsy, Fine-Needle↗

[Which is more useful for central venous catheterization? A comparison between a 22 gauge metal needle (Argyle) and a 24 gauge plastic cannula with a metal needle (Insyte)].

BACKGROUND: Central venous catheterization is commonly performed by puncturing the internal jugular vein. However, placement of central venous catheters is not without risk. We compared the Argyle and the Insyte in terms of usefulness and incidence of complications during central venous catheterization. METHODS: Twenty adult patients for cardiac operation were randomly allocated into two groups; 10 patients in the Argyle group (Group A) and 10 patients in the Insyte group (Group B). RESULTS: In both groups, no kinking or stucking of the guide wire occurred during insertion. No accidental puncture of the carotid artery occurred in Group B, while it occurred in one case in Group A. The time required for insertion of the guide wire was not significantly different between the two groups, though it tended to be shorter in Group B than in Group A (19.3 +/- 14.6 sec vs 34.6 +/- 34.0 sec). On ultrasonography, the Argyle was observed to compress the internal jugular vein and to be prone to penetrate both anterior and posterior walls. CONCLUSIONS: Using the Argyle makes it a little more difficult to place the needle in the appropriate venous lumen. We conclude that central venous catheterization with the Insyte was quicker and safer than with the Argyle.

Adult↗

Diagnosis of thyroid nodules. Use of fine-needle aspiration and needle biopsy.

The accuracy of diagnosis of 455 thyroid nodules evaluated by cytological and histological specimens obtained by fine- and large-needle biopsy, respectively, was compared with that for 1,094 nodules previously evaluated by clinical methods. The use of cytohistological data halved the number of patients with suspected cancer and doubled the number of patients to be observed. Cancers identified at operation for high and intermediate cancer-risk patients increased 75%, and operation for diagnosis of benign disease decreased 70%. Forty-two of 47 excised cancers were included in the cytohistological probable cancer group. Only 29 of these cancers were so classified clinically. Two cancers not diagnosed cytologically were suspected histologically and vice versa for one cancer. All 51 excised cytohistologically benign nodules were benign. There were more false-positive findings with cytological than with histological specimens.

Adenoma↗