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[Peritonsillar abscess treated with puncture and aspiration].

Out of 48 patients treated for peritonsillar abscess in our department in 1988, 45 were treated with needle aspiration. In 43 of these the aspiration was positive. More than one aspiration was only required in seven patients, no patient was needle aspirated more than twice. Five patients were treated with abscess tonsillectomy secondary to needle aspiration. In two cases the indication may have been failure of treatment. No complications were recorded in relation to aspiration. Followup time was seven months (median). There were two cases of recurrence of the abscess and five patients subsequently had one episode of tonsillitis after discharge. Needle aspiration is suggested as part of a selected strategy of treatment for peritonsillar abscess.

Adolescent↗

A new filter technique permitting traditional histopathological assessment of fine needle aspiration specimens.

We describe a new filtration method based on a transport medium technique which allows histopathological assessment of the tissue fragments present in many fine needle aspirates. Fine needle aspiration cytology and biopsy preparations obtained from equally divided transport medium specimens were compared in a study comprising 104 palpable breast lesions and 29 other miscellaneous lesions. In general, fine needle aspiration biopsy provided better information on tumour origin and differentiation than fine needle aspiration cytology, particularly with systemic aspirates and those which were heavily bloodstained. In most instances fine needle aspiration biopsy also provided sufficient material to perform specialised staining and immunohistological techniques, and it is suggested that it may have a role in supplementing direct smear fine needle aspiration cytology in these areas.

Biopsy, Needle↗

Kerosene aspiration: immediate and early pulmonary and cardiovascular effects.

Hydrocarbon aspiration is responsible for substantial morbidity and mortality in both children and domestic animals. To better understand the pathogenesis of hydrocarbon poisoning, we evaluated the effects of aspiration of 0.5 ml/kg of kerosene on various pulmonary and cardiovascular variables over a 4-hr period in a canine model. Heart rate and blood pressure decreased immediately after kerosene aspiration but returned to control values within 60 min. Respiratory rate and intrapulmonary shunting were increased and PaO2 was decreased for up to 4 hr after kerosene aspiration. PaCO2 increased and pH decreased immediately after aspiration but returned to baseline within 45 and 90 min, respectively. Intrapleural pressure became more negative after kerosene was aspirated, which suggests that total lung compliance was diminished. Kerosene aspiration resulted in severe and persistent intrapulmonary physiologic shunting, hypoxemia, bradycardia, and hypotension.

Administration, Inhalation↗

Luteal phase serum progesterone levels after follicle aspiration with and without clomiphene citrate treatment.

Peripheral serum progesterone (P) levels were studied on random days after the spontaneous luteinizing hormone (LH) surge in women who underwent follicle aspiration. Comparisons were made with ovulatory women treated with clomiphene citrate (CC) undergoing follicle aspiration and women undergoing midcycle general anesthesia and laparoscopy without follicle aspiration. There were no differences in mean P levels in the group of women who underwent follicle aspiration, compared with the group who did not. Women treated with CC showed higher P levels during the first week of the luteal phase. During the second week of the luteal phase P levels were similar, regardless of follicle aspiration alone or in combination with CC use. In the groups not using CC, more individual women had P levels less than 10 ng/ml. Follicle aspiration does not appear to reduce luteal phase P levels in groups of patients in the natural menstrual cycle or receiving CC. Some individual patients, however, appear to be at risk for lower P levels, particularly after follicle aspiration or general anesthesia, in the natural cycle.

Clomiphene↗

Aspiration of the breast and nipple discharge cytology.

Between 1 January 1974 and 30 June 1984, 1,003 specimens obtained from the breast were submitted for cytologic evaluation to the Department of Pathology at the Waterbury Hospital Health Center. Eighty-eight per cent were obtained by fine needle aspiration of a palpable mass; the remainder were smears of nipple discharges. Precytologic and postcytologic clinical data were available for 80 per cent of the specimens. In the fine needle aspiration group, there were 219 instances of proved carcinomas; 79 per cent of these had either positive or suspicious cytologic findings. Seventy-five per cent of the patients with positive cytologic results underwent mastectomy without prior histologic confirmation of the needle aspiration and all were confirmed as malignant growths. There were 41 false-negative aspirates which were reviewed in detail. The cytologic slides of 24 of the 41 false-negative aspirates were available for re-evaluation by a second, independent cytopathologist. Only one was thought to have been misread initially; the remainder appeared to have been falsely negative for technical reasons related to aspiration or fixation technique or tumor size less than 1 centimeter. There was one false-positive finding in a patient who was found to have fat necrosis at biopsy. Results of nipple discharge cytology were less accurate. Positive or suspicious cytology was found in only five of 11 proved instances of carcinomas. There was one false-positive and five false-negative results in this group. We conclude that needle aspiration of palpable masses of the breast is an accurate, cost effective procedure which is readily adaptable to a community hospital, provided that a pathologist with an interest in cytology is available.

Adolescent↗

Aspiration in head and neck surgical patients.

Aspiration, the entry of material into the airway below the true vocal folds, has been reported in various types of postsurgical head and neck patients. This study was designed to examine radiographically a group of 30 head and neck surgical patients with postoperative swallowing difficulties and to identify the relationship between the physiologic causes of aspiration in each patient and the surgical procedure. The modified barium swallow technique is needed to identify the nature of aspiration in these patients. Aspiration before, during, and after the swallow was caused by a variety of problems including reduced tongue control, delayed triggering of the swallowing reflex, reduced glottic closure, reduced laryngeal elevation, and reduced pharyngeal peristalsis. Eight patients exhibited two causes of aspiration. No one food consistency caused greater aspiration in all patients. The best and worst food consistencies varied with the cause of aspiration.

Adult↗

Lymphography and percutaneous fine needle node aspiration biopsy in the staging of bladder carcinoma.

Forty-two patients with infiltrating bladder tumor were submitted to pedal lymphography with percutaneous fine needle node aspiration biopsy on an out patient basis. Of 41 evaluable patients, 59% had a positive lymphangiogram. Adequate material was obtained in 81% of the patients. Of 12 patients with a normal lymphography, none had a positive aspiration whereas 40% of the positive lymphangiograms correlated with a positive aspiration. The high rate of positive lymphangiogram negative aspirate is attributed to inflammatory changes due to previous TUR of the tumor. Twenty-one patients were submitted to radical cystectomy: 12 negative aspirations correlated with 11 negative lymphadenectomies, and 4 positive aspirations with 4 positive lymphadenectomies. There was no mortality and only mild morbidity in this series. Lymphography with fine needle percutaneous node aspiration biopsy has a role in the pre-operative staging of bladder carcinoma. Positive pelvic wall lymph nodes upgrade bladder carcinoma from a local to a systemic disease that is no longer amenable to any form of local treatment. Nodal assessment is therefore critical to treatment planning in order to spare the N+ patients unnecessary radical surgery. Pelvic lymph nodes have been evaluated, in the past, radiologically by bipedal lymphography or C.A.T. scanning. The high false positive and negative rates of these procedures (Benson et al., 1981; Boccon-Gibod et al., 1982) preclude their routine use (Correa 1982; Walsh et al., 1980).(ABSTRACT TRUNCATED AT 250 WORDS)

Biopsy, Needle↗

Clinical value of fine-needle aspiration cytology and biopsy in the evaluation of male infertility. A comparative study of 48 infertile patients.

OBJECTIVE: To evaluate whether fine-needle aspiration cytology of the testis can be considered as a diagnostic parameter in the evaluation of male infertility. PATIENTS AND METHODS: We studied 30 oligospermic and 18 azoospermic patients using 63 fine-needle aspiration samples and 57 biopsy samples obtained surgically (10 cases) or with a spring-loaded biopsy device (47 cases). Cytologic evaluation of spermatogenesis was performed by studying longitudinal segments of seminiferous tubules and cytocentrifuged dissociated cells. RESULTS: Comparison between fine-needle aspiration and the biopsy methods gave concordant results in 72.2% of cases. Discordant findings were recorded in 10 cases (27.8%). In eight cases, significant maturation into spermatozoa was recognized in samples obtained by fine-needle aspiration only, whereas moderate to severe hypospermatogenesis or germ cell aplasia were demonstrated in samples obtained by the spring-loaded biopsy device or by open surgical biopsy. Germ cell aplasia was recognized in samples obtained by both methods in 75.0% of cases. Insufficient specimens were obtained by fine-needle aspiration and the spring-loaded biopsy device in 15.9% and 12.3% of cases, respectively, whereas all surgical biopsy specimens were of good quality. Four bleeding episodes and one case of epididymitis were observed after use of the spring-loaded biopsy device, but no complication was related to either surgical biopsy or fine-needle aspiration. CONCLUSION: The findings show that fine-needle aspiration cytology could represent a more reliable means of identifying significant numbers of the most mature germ cells.

Adult↗

[A study of aspiration in infants with recurrent pneumonia by Barium swallow examination using different concentrations of barium].

We conducted barium swallow examinations using different concentrations of barium sulfate suspension (10, 30, 60 w/v%) in infants with recurrent pneumonia. Aspiration of swallowed barium into the airway was demonstrated in 43 of 54 infants (44 of 56 examinations). Of these, 22 infants had no neurological or anatomical abnormality. In comparing the degree of aspiration and the barium concentration, it was found that the higher the concentration of barium, the less severe the degree of aspiration tended to be. There was no infant in whom thicker barium aggravated aspiration. The difference in the degree of aspiration was considered to be attributable to difference, in the viscosity of barium. The results of our study showed aspiration to the airway was more frequent than previously reported, and occurred even in infants without any other abnormality. The detectability of aspiration was dependent on the concentration of barium sulfate suspension. Because the viscosity of conventionally used milk is identical to that of 10-20 w/v% barium, 10-20 w/v% barium should be used in barium swallow examinations for infants with recurrent pneumonia.

Barium Sulfate↗

[Nuclear DNA content in breast carcinoma by fine needle aspiration biopsy].

The usefulness of the measurement of nuclear DNA content by fine needle aspiration biopsy was evaluated through a comparative study of fine needle aspirated and tissue samples. Nuclear DNA content was measured in patients with 28 primary and 2 metastatic lesions of breast carcinoma using fluorescent cytophotometry with Feulgen stain. The rate of correspondence on DNA ploidy pattern of aspirates and tissue samples was 86.7%. There was a significant correlation with DNA index (DI) (R = 0.85, p < 0.001) and S-phase fraction (%S) (R = 0.79, p < 0.001). The rate of correspondence of DI subgroups (3 aneuploid subgroups and diploid) was 80.8%. No tumor size affected values of DI and %S of aspirates. However, %S of papillotubular carcinoma showed small difference compared with values of tissue samples. Nuclear DNA content of fine needle aspirated samples had a significant correlation with that of tissue samples, providing the estimation of the original ploidy pattern and DI. Fine needle aspiration biopsy is an easy technique and able to be carried out repeatedly. Thus, the measurement of nuclear DNA content using aspirates is useful for broad practical purposes.

Adenocarcinoma↗

Fine needle aspiration of abdominal fat for the diagnosis of amyloidosis.

Amyloidosis is a dysproteinemia characterized by extracellular deposition of amyloid fibrils. Its diagnosis depends on the demonstration of the characteristic apple-green birefringence in tissue stained with Congo red. Aspiration of subcutaneous fat as a means of procuring tissue has received attention in the internal medicine literature. However, this application of fine needle aspiration biopsy has not been investigated extensively by cytopathologists. We therefore report our experience. Over the past two years we performed 18 aspirations of subcutaneous fat on 17 patients in whom amyloidosis was clinically suspected. Eight aspirates were positive for amyloid, and nine were negative. There were no known false-negative results. False positives were more problematic, occurred early in our experience and were due to overinterpretation of occasional long, slender, green strands representing collagen. The true positives were all characterized by large numbers of short, apple-green strands intimately associated with the fat, oriented in multiple directions and occurring in much, if not all, of the aspirated fat. Attention to details of the aspirated material other than the presence or absence of apple-green birefringence can lead to a correct distinction between amyloid and collagen. We conclude that abdominal fat pad aspiration is useful in the workup of suspected amyloidosis, especially since it is a safe, easily performed procedure.

Abdomen↗

A locally made mucus aspirator.

Examination of nasopharyngeal aspirate for the presence of viral antigens in children with acute lower respiratory tract infections is a standard procedure in establishing a viral aetiology. In the absence of other sophisticated methods such as lung puncture or trans-tracheal aspiration, mucopus aspirated from the nasopharynx can be used even to identify caustive organisms. Here, it is essential to perform a microscopic examination in addition to culture. The disposable mucus aspirators used in other countries are expensive and are not practical for routine use in our country. This paper describes how a mucus aspirator was turned out with low cost heat resistant materials that are locally available. The aspirator is steam sterilisable and can be used with a disposable F8 gauge feeding tube. The cost of one aspirator is about Rs. 100.

Humans↗

The use of epididymal fine-needle aspiration for the diagnosis of male genital tract obstruction.

Epididymal fine-needle aspirations (EFNA) were performed on 29 epididymides of 17 infertile, azoospermic men in whom testicular cytology revealed adequate spermatogenesis. Sonograms confirmed the presence of all the excretory male organs. EFNA was performed to diagnose and locate the site of genital tract occlusion. The presence of cuboidal epithelial cells in the aspirate was the sole indication that epididymal content was aspirated. In 10 (34%) of the 29 aspirates there were only cuboidal epithelial cells and no spermatozoa, indicating proximal occlusion in the rete testis, in the canaliculi efferentes or in the most proximal segment of the epididymis itself. Occlusion in the distal segment of the epididymis or in the vas deferens was diagnosed in 13 epididymal aspirates (45%) which contained both cuboidal cells and spermatozoa. From 6 epididymides (21%) no conclusion could be reached because of failed aspirations. There are a variety of treatment modalities available for male genital tract obstruction, such as reconstructive surgery or assisted reproductive technology using sperm aspiration technique. The success rate of treatment is mainly dependent on the site of obstruction. Since vasography has its own limitations and hazards, diagnostic EFNA should be performed before treatment in men in whom genital obstruction is suspected.

Biopsy, Needle↗

Diagnostic yield of duodenal biopsy and aspirate in AIDS-associated diarrhea.

OBJECTIVES: To evaluate the diagnostic yield of performing duodenal biopsies and aspirates in AIDS patients with chronic diarrhea. METHODS: Retrospective review of esophagogastroduodenoscopy (EGD) records from January 1993 to March 1995 to identify those patients who underwent EGD for evaluation of AIDS associated diarrhea and had a duodenal biopsy and/or aspirate. Biopsies were examined for pathogens using routine histology and special stains, viral culture, and electron microscopy. Duodenal aspirates were evaluated for ova and parasites. All patients had previous negative stool studies. Pathology laboratory charges (hospital and professional fees) for each test and charges per positive test were determined. RESULTS: Of the 57 patients included in this study, 56 had a duodenal biopsy and 42 had a duodenal aspirate. An established pathogen was identified in only 15 (26%) patients. One patient had both Mycobacterium avium complex and microsporidia. Pathogens were identified in seven patients by hematoxylin and eosin stain, in three patients by acid-fast bacillus stain, and in six patients by electron microscopy. No pathogens were identified with Gomori's methenamine silver stain (44 patients), duodenal aspirate for ova and parasites (46 patients), immunoperoxidase stains (4 patients), or viral culture (4 patients). Cryptosporidia were identified in six, microsporidia in five, Mycobacterium avium complex in three, and Giardia lamblia and adenovirus each in one patient. CONCLUSIONS: In this series, the diagnostic yield of EGD with duodenal biopsy and aspirate in AIDS associated diarrhea was low. Pathogens were identified in 26% of patients; predominantly Cryptosporidium organisms and microsporidia. The routine performance of aspiration of duodenal contents for parasite examination and staining of duodenal tissue with Gomori's methenamine silver stain for fungal identification are not recommended. One should consider obtaining tissue for electron microscopy whenever duodenal biopsies are performed. The utility of EGD in AIDS associated diarrhea may improve as more effective therapies become available.

AIDS-Related Opportunistic Infections↗

Fine-needle aspiration cytopathology of malignant fibrous histiocytoma.

BACKGROUND: Most pathologists generally accept malignant fibrous histiocytoma (MFH) as the most common soft tissue sarcoma in adults. This study examines the authors' aspiration cytopathology experience with this tumor, describes its cytomorphology, and determines the reliability of such a diagnosis by fine-needle aspiration biopsy (FNAB). METHODS: The authors' files were reviewed for cases diagnosed as MFH by FNAB, and for surgical pathology cases of MFH previously aspirated but not diagnosed as such by cytology. RESULTS: Fifty-two cases of MFH (by FNAB or histology) were recovered from the combined files; 42 aspirates had tissue confirmation. Patient age ranged from 15-88 years (mean, 63 years); the male:female ratio was 1.2. Thirty aspirates were from primary tumors, and 12 were from recurrences or metastases. From the 29 aspirates diagnosed as MFH, 24 (83%) were determined to be MFH on subsequent surgical excision. Four of the remaining cases were other sarcoma subtypes, and there was one organizing thrombus (false-positive). The remaining 13 aspirates were identified as unqualified sarcoma (11 cases) or a different sarcoma subtype (2 cases). Eleven of these were histologically diagnosed as MFH, and 2 as other sarcomas. No single cytologic feature or combination of features distinguished MFH. Patterns ranged from single cells to large storiform fragments. Spindled, plasmacytoid, and pleomorphic cell shapes were found; pleomorphic cells were often multinucleated. All cases of MFH had malignant nuclear morphology. Diagnostic pitfalls included low cellularity, obscuring blood and inflammation, and inadequate clinical and/or radiologic information. CONCLUSIONS: The diagnostic role of FNAB in soft tissue lesions remains controversial. FNAB is important in the initial triage of patients with soft tissue tumors, and is particularly accurate for confirming recurrent or metastatic disease. Although making an initial diagnosis of sarcoma by FNAB is reliable, specific subtyping of them as MFH is more problematic.

Adolescent↗

Management of foreign body aspiration in infancy and childhood. A life-threatening problem.

It is well known that young children have tendency to place objects in their mouths, frequently leading to aspiration of foreign bodies (FBs) into the tracheobronchial tree (TBT). The patient group comprised 596 patients with a history of suspected aspiration of FBs into the TBT who were bronchoscoped for diagnosis and treatment. There were 306 male (51.3%) and 290 female (48.7%) patients, with a mean age of 2.4 years (range 3 months-13 years). Sunflower seeds and hazelnuts were the most common FBs that were extracted using an open-tube rigid bronchoscope (Storz, Germany) and suitable coaxial forceps (Storz, Germany). Patients admitted within 48 hours following the aspiration numbered 341 (57.2%). The distribution of FBs between the right and left lung and trachea was 53, 37 and five percent, respectively. The aspirated material was visible on the chest x-ray in only 10 percent cases, which facilitated in making the diagnosis. Despite a history of aspiration, bronchoscopy was negative in 21 (3.4%) of the cases. Thoracotomy and subsequent bronchotomy was the treatment of choice in seven (1.5%) and lobectomy in two (0.3%) cases. Cardiorespiratory arrest was observed in five (0.8%) cases, three of whom (0.5%) died during bronchoscopy (2 cases) or thoracotomy (1 case). In conclusion, patients with FB aspiration are rapidly recognized from their histories and easily treated by bronchoscopy and extraction of the aspirated foreign body. A high index of suspicion is crucial for early diagnosis. However, education is the best preventive measure for decreasing the incidence of this problem.

Airway Obstruction↗

Extracorporeal membrane oxygenation for hydrocarbon aspiration.

Extracorporeal membrane oxygenation is a pulmonary bypass procedure that has been employed in adults to provide temporary treatment for reversible acute pulmonary and cardiac insufficiency. The technology of membrane oxygenation has been used since 1977 in neonates with predictably fatal pulmonary failure due to respiratory distress syndrome, persistent fetal circulation or persistent pulmonary hypertension of the newborn, meconium aspiration syndrome, and congenital diaphragmatic hernia. The use of extracorporeal membrane oxygenation in older children with other pulmonary disorders has been limited. We report two cases of hydrocarbon aspiration involving petroleum-based products, both successfully treated with extracorporeal membrane oxygenation. A 15-month-old male infant who aspirated baby oil (light mineral oil) is particularly unusual owing to the generally expected low risk of aspiration with a hydrocarbon of such viscosity (greater than 60 Saybolt Universal Seconds). The second patient is a 16-month-old male infant who aspirated furniture polish (mineral seal oil). In both children severe intractable hypoxemia developed despite intensive ventilatory support, and they became candidates for alternative therapy. Extracorporeal membrane oxygenation provides a potentially life-saving option when a patient fails to respond to conventional therapy for hydrocarbon aspiration.

Extracorporeal Membrane Oxygenation↗

Effects of methylprednisolone on resolution of acid-aspiration pneumonitis.

We studied the effects of methylprednisolone sodium succinate on the pulmonary function of unanesthetized dogs for four days after aspiration of 1.5 to 2.0 mL/kg of 0.1N hydrochloric acid. Methylprednisolone sodium succinate (30 mg/kg) was administered to nine dogs at 2, 8, and 24 hours after acid aspiration. Nine animals were untreated after aspiration and served as controls. Acid aspiration caused significant increases in venous admixture and reductions in Pao2 in both groups of animals. These changes persisted for 96 hours after aspiration. There were no differences in cardiac output, venous admixture, and blood gas values between treated and untreated animals at any time. At death there were no differences between groups in amounts of lung water or histologic characteristics. We concluded that methylprednisolone administered after hydrochloric acid aspiration does not affect resolution of the injury.

Animals↗