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PubMed2004

Safety of fine-needle aspiration in patients with small hepatocellular carcinoma.

OBJECTIVE.: This study was to clarify the safety of fine-needle aspiration of small hepatocellular carcinoma (HCC). METHODS.: Ninety consecutive patients with small hepatocellular carcinoma (46 with single nodule, 44 with multiple nodules, all </=3cm) who had a comparative angiography performed within 50 days (median 16 days) after aspiration were included. RESULTS.: The angiographic detection of hepatocellular carcinoma was not influenced by the procedure of aspiration except in one (1.1%) with small arterioportal shunt. The newly developed nodules of hepatocellular carcinoma were not localized in the segment of aspirated nodule located. None of the new nodules was located along the needle tract. Patients with single nodule caused by hepatitis C had a significantly higher incidence of appearance of new nodule than those caused by hepatitis B (38.46% versus 4.35%, p=0.0159). Patients with multiple nodules had a significantly higher incidence of appearance of new nodule than patients with single nodule (60% versus 18.18%, p<0.005). These results indicated that the newly developed nodules were related to the disease process rather than the procedure of aspiration. CONCLUSIONS.: Fine-needle aspiration is a safe procedure in the collection of specimens for the diagnosis of small hepatocellular carcinoma.

Journal Article↗
PubMed2006

Thrombus aspiration reduces microvascular obstruction after primary coronary intervention: a myocardial contrast echocardiography substudy of the REMEDIA Trial.

OBJECTIVES: The aim of this study was to clarify the role of microembolization in the genesis of microvascular obstruction (MO) after percutaneous coronary intervention (PCI). BACKGROUND: Fifty consecutive patients entered the myocardial contrast echocardiography (MCE) substudy of the REMEDIA (Randomized Evaluation of the Effect of Mechanical Reduction of Distal Embolization by Thrombus Aspiration in Primary and Rescue Angioplasty) trial, which defined the role of a new thrombus-aspirating device in preventing distal microembolization after PCI. METHODS: A total of 25 patients were randomized to be pretreated with thrombus aspiration before PCI of the culprit lesion and 25 received standard PCI. At 24 h, 1 week, and 6 months after PCI, MCE was performed by Sonovue, and real-time imaging was performed by contrast pulse sequencing technology. Regional wall motion score index (WMSI), contrast score index (CSI), endocardial length of wall motion abnormality (WML) and contrast defect (CDL), end-diastolic and end-systolic left ventricular (LV) volumes, and ejection fraction were calculated. RESULTS: At each time point, in patients treated with a thrombus-aspiration filter device, WMSI, CSI, WML, and CDL were significantly lower and ejection fraction higher (p < 0.05 vs. control patients), whereas LV volumes were slightly but not significantly smaller compared with control patients. In the overall study population, the extent of MO significantly correlated with temporal changes in LV volumes. CONCLUSIONS: Thrombus aspiration used at the time of PCI significantly reduces the extent of MO and myocardial dysfunction, although it does not have a significant favorable effect in preventing LV remodeling. Thus, the beneficial effect of thrombus aspiration occurs at the microvascular level, but additional mechanisms may play a role in influencing the final extent of MO, which strictly correlates with post-infarct LV remodeling.

Aged↗
PubMed2006

Can a fluoroscopic estimation of pharyngeal constriction predict aspiration?

BACKGROUND: The pharyngeal constriction ratio (PCR) is a ratio of pharyngeal area measured in lateral fluoroscopic view at the point of maximum pharyngeal constriction during the swallow to the pharyngeal area measured with the bolus held in the oral cavity. We hypothesize that the PCR may represent a surrogate measure of pharyngeal strength. OBJECTIVE: To investigate the relationship between the PCR and aspiration. STUDY DESIGN AND SETTING: Data from a computerized clinical database of individuals undergoing a videofluoroscopic swallow evaluation at a tertiary academic swallowing center was acquired. RESULTS: Two hundred sixty videofluoroscopic studies were abstracted. The mean PCR was 0.32 (+/- 0.02) for individuals who aspirated and 0.20 (+/- 0.02) for individuals who did not (P < 0.001). In a multiple logistic regression analysis, the PCR was significantly associated with the prevalence of aspiration (P < 0.01). Individuals with a PCR greater than 0.25 were 3 times more likely to aspirate (95% CI = 1.7, 5.1). CONCLUSIONS: The pharyngeal constriction ratio is associated with the presence of aspiration on fluoroscopy. Before the PCR can be used as a surrogate measure of pharyngeal constriction, correlation with pharyngeal manometry will be necessary. SIGNIFICANCE: The pharyngeal constriction ratio is associated with the presence of aspiration on fluoroscopy. EBM RATING: B-3b.

Aged↗
PubMed2004

Simple aspiration versus chest-tube insertion in the management of primary spontaneous pneumothorax: a systematic review.

BACKGROUND: The initial treatment of a primary spontaneous pneumothorax (PSP) is controversial. Guidelines of the British Thoracic Society recommend simple aspiration for all PSP requiring intervention. The placement of chest tubes is only advocated for patients who fail simple aspiration. However, the American College of Chest Physicians Delphi Consensus Statement found simple aspiration to be rarely appropriate in the management of PSP. AIMS: To compare simple aspiration with chest-tube drainage in the initial management of PSP. METHODS: Meta-analysis of randomized controlled trials (RCTs). OUTCOME MEASURES: Reductions in duration of hospital stay, recurrence rate and pain or dyspnoea score were classified as benefits, whereas reductions in successful events were classified as risks. DATA COLLECTION AND ANALYSIS: For dichotomous data, the relative risk (RR) and 95% confidence intervals were calculated. For continuous data, weighted mean differences (WMD) were used. RESULTS: Three RCTs were identified with a combined total of 194 patients. Simple aspiration was associated with shorter hospitalization (WMD -1.30 days [-2.20 to -0.39]). The results for success rate could not be combined because of differences in outcome definitions. However, a pooled result for "success at 1 week or more" showed no significant difference between either intervention (RR 0.86 [0.67, 1.11]). Results of recurrence at 1 year were also not significantly different (RR 0.73 [0.39-1.38]). Different reporting systems for pain scores meant that data could not be pooled. Only one trial reported dyspnoea scores. CONCLUSION: RCT evidence in this field is limited, and the total sample size is too small to make any firm conclusion. On the basis of current available evidence, simple aspiration is advantageous in the initial management of PSP because of shorter hospitalization. There is no significant difference in recurrence at 1 year using either modality, and the efficacy data are inconclusive.

Chest Tubes↗
PubMed2006

Endoscopic surgery for spontaneous basal ganglia hemorrhage: comparing endoscopic surgery, stereotactic aspiration, and craniotomy in noncomatose patients.

BACKGROUND: This prospective study aimed to evaluate the safety, neurological outcomes, and cost-effectiveness of 3 surgical procedures for spontaneous basal ganglia hemorrhage. METHODS: Ninety noncomatose patients with basal ganglia hemorrhages were randomized into 3 groups. Group A (n = 30) underwent endoscopic surgery, group B (n = 30) underwent stereotactic aspiration, and group C (n = 30) underwent craniotomy. Waiting time of surgery, length of operation time, and blood loss were compared between all groups. On the second operative day, we evaluated the amount of residual hematoma and the hematoma evacuation rate by computed tomography scan. Surgical mortality and complications were recorded 3 months after the procedure. Neurological outcomes were evaluated by functional independence measure (FIM) score, Barthel index score, and muscle power (MP) of affected limbs 6 months after surgery. We also evaluated the cost-effectiveness of each procedure. RESULTS: There was significant delay in waiting timing of the stereotactic aspiration (172.56 +/- 93.18 minutes; P < .001). Craniotomy had the longest operation time (229.96 +/- 50.57 minutes; P < .001). Blood loss was most significant in the craniotomy (236.13 +/- 137.45 mL; P < .001). The highest hematoma evacuation rate was seen in the endoscopic surgery (87% +/- 8%; P < .01). The mortality rate was 0% in group A, 6.7% in group B, and 13.3% in group C (P = .21). The complication rate was 3.3% in group A, 10% in group B, and 16.6% in group C (P = .62). The most major complications were rebleeding and infection. The FIM score was higher in the endoscopic surgery (79.90 +/- 36.64) than in the craniotomy (33.84 +/- 18.99; P = .001). The Barthel index score was also significantly better in the endoscopic surgery (50.45 +/- 28.59) than in the craniotomy (16.39 +/- 20.93; P = .006). There was more improvement in MP of affected limbs in endoscopic surgery than in craniotomy (P = .004). Endoscopic surgery was more cost-effective than craniotomy using FIM and Barthel index (P < .02 and P < .05, respectively). CONCLUSIONS: Both endoscopic surgery and stereotactic aspiration are minimally invasive and are effective procedures with low complication and mortality rates; however, the waiting timing of stereotactic aspiration is usually longer. Endoscopic surgery may be an appropriate substitute for stereotactic aspiration. It produces good neurological outcomes and aids in rapid hematoma evacuation. Craniotomy may be used for emergency decompression of enlarged hematoma if endoscopic surgery or stereotactic aspiration is not available.

Adult↗
PubMed1999

Is Streptococcus pneumoniae the leading cause of pneumonia of unknown etiology? A microbiologic study of lung aspirates in consecutive patients with community-acquired pneumonia.

PURPOSE: Although a wide variety of recognized pathogens can cause community-acquired pneumonia, in many patients the etiology remains unknown after routine diagnostic workup. The aim of this study was to identify the causal agent in these patients by obtaining lung aspirates with transthoracic needle aspiration. SUBJECTS AND METHODS: During a 15-month period, all consecutive patients with community-acquired pneumonia who were eligible for transthoracic needle aspiration were enrolled in the study. In addition to conventional microbial methods (culture of blood and sputum, serologic studies), we performed cultures and genetic and antigen tests for common respiratory pathogens in lung aspirates. RESULTS: The study group consisted of 109 patients. Conventional microbial studies identified an etiology in 54 patients (50%), including Mycoplasma pneumoniae in 19 patients, Chlamydia pneumoniae in 9 patients, and Streptococcus pneumoniae in 9 patients. Among the remaining 55 patients, study of the lung aspiration provided evidence of the causal agent in 36 (65%). In 4 additional patients with a single microbial diagnosis by conventional methods, the lung sample provided evidence of an additional microorganism. The new pathogens detected by lung aspiration were S. pneumoniae in 18 patients, Haemophilus influenzae in 6 patients, Pneumocystis carinii in 4 patients, and C. pneumoniae in 3 patients; other organisms were identified in 4 patients. CONCLUSIONS: In our study, S. pneumoniae was the leading cause of community-acquired pneumonia, accounting for 25% of all cases, including about one-third of the cases the cause of which could not be ascertained with routine diagnostic methods.

Adult↗
PubMed1993

Carcinoembryonic antigen assay of intra-abdominal fine-needle aspirates.

Differentiating abscesses from necrotic tumors has important therapeutic implications. Currently, cytologic examination is the "gold standard," but it has a low sensitivity for cystic/necrotic tumors. To address this problem, a prospective study was conducted comparing the results of cytologic examination with those of carcinoembryonic antigen (CEA) immunoassay of fine-needle aspirates in 24 patients undergoing radiologically or surgically guided fine-needle aspiration. Of 26 fine-needle aspirates, 20 were malignant and 6 benign. Final results were correlated with pathologic examination (when available), clinical review, and follow-up. Three patients had an abscess associated with perforated, recurrent carcinoma, of whom only one had cytologic assessment prior to drainage. The sensitivity of fine-needle aspiration was 85%, and for adenocarcinoma alone, 80%. CEA sensitivity (greater than 5 ng/mL) was 50%, and for adenocarcinoma, 90%; the specificity of the assay was 64%. A high CEA level alone was diagnostic of metastatic carcinoma of the colon in two fine-needle aspirates. Cytologic assessment and CEA assay of fine-needle aspirates and cyst/abscess drainage facilitate the diagnosis of unsuspected adenocarcinoma.

Abscess↗
PubMed2001

Pneumonia after cardiac surgery is predictable by tracheal aspirates but cannot be prevented by prolonged antibiotic prophylaxis.

BACKGROUND: The purpose of this study was to assess the value of tracheal aspirate as a predictor of pneumonia after coronary artery bypass grafting and to evaluate the efficacy of prolonged perioperative antibiotic prophylaxis. METHODS: Tracheal aspirates of 500 patients undergoing coronary artery bypass grafting were taken immediately after intubation and analyzed for microorganisms by Gram stain and semiquantitative microbiologic cultures. All patients received 2 g ceftriaxone as a single-dose perioperative antibiotic prophylaxis before operation. Results of Gram stains were available before the patients were transferred to the intensive care unit. After the results were known, both groups of patients (positive Gram stain, group 1; negative Gram stain, group 2) were randomly assigned to either conventional antibiotic prophylaxis (A), consisting of ceftriaxone 2 g on postoperative day 1, or prolonged antibiotic prophylaxis (B), with ticarcillin + clavulanic acid 3 x 5.2 g during 72 hours. RESULTS: From 500 patients, 91 had a positive Gram stain whereas 409 had a negative one. The incidence of pneumonia was significantly higher in patients with preoperative positive tracheal aspirates (15.3%) than in patients with a negative one (3.6%; p < 0.01). However, prolonged prophylaxis did not reduce the rate of postoperative pneumonia, which was as high as 13% in untreated positive patients versus 17% in treated positive patients, and 2% in untreated negative patients versus 4% in treated patients. In patients who had pneumonia, there was a high correlation between the microorganisms found in preoperative aspirates and those observed when aspirates were repeated (100% correlation in patients with conventional antibiotic prophylaxis and 87% in those with prolonged prophylaxis). CONCLUSIONS: Early postoperative pneumonia (<7 days) is most likely caused by microorganisms that colonize the respiratory tract before operation. The risk of pulmonary infection after coronary artery bypass grafting can be predicted from the preoperative tracheal aspirates. Prolonged perioperative antibiotic prophylaxis has no efficacy in reducing the incidence of pulmonary infections.

Aged↗
PubMed1990

Ultrasound guided fine needle aspiration of ovarian cysts: diagnosis and treatment in pregnant and non-pregnant women.

Ovarian cysts are conventionally managed by laparoscopy or laparotomy. Twenty-two patients underwent fine needle aspiration of ovarian cysts under ultrasound control. Four patients were pregnant, and in two of these, aspiration of the cyst was performed transvaginally. The aspirate was examined cytologically and correlated with histology where available. The technique and results are discussed. No complications occurred. It is concluded that fine needle aspiration under ultrasound guidance is simple, safe and useful in the management of ultrasonically benign unilocular ovarian cysts in pre-menopausal women. It is of particular use in pregnancy, and in patients unsuitable for laparoscopy or surgery. Surgery can be reserved for cysts which recur after aspiration, cysts with a haemorrhagic aspirate, cysts in post-menopausal women and those with ultrasonic criteria of malignancy.

Adult↗
PubMed1982

The role of aspiration cytology in a radiotherapy and oncology centre.

The role of aspiration cytology for a Department of Radiotherapy and Oncology was assessed in 158 patients with a wide range of tumours. Aspirates were taken from breast, lymph nodes, skin, bone, muscle and subcutaneous tissues. Malignant cells were identified in 91% of 107 malignant tumour aspirates. There was one possibly false positive report on a lymph node aspirate. Fifty other lesions were aspirated in which no malignant cells were seen, and were subsequently found to be benign. Aspiration cytology was found to be a simple, cheap and convenient investigation which was useful in the management of 83% of the whole group of patients, and detrimental to none.

Biopsy, Needle↗
PubMed1997

Pyogenic liver abscess: treatment with needle aspiration.

OBJECTIVE: Percutaneous needle aspiration as an alternative to continuous percutaneous catheter drainage in combination with systemic antibiotics for the treatment of pyogenic liver abscess has never been popular. The authors report their experience with needle aspiration and evaluate its safety, effectiveness and role in treating pyogenic liver abscess. MATERIALS AND METHODS: The results of needle aspiration performed in 101 liver abscesses of 64 unselected consecutive patients with male to female ratio of 2.5:1 and average age 56.3 +/- 16 years were reviewed. The abscesses were pyogenic in 63 patients (98.4%), and multiple in 18 patients (28.1%). Thirty-nine abscesses (38.6%) were > or = 5 cm in diameter. Complete pus removal from each abscess was attempted with 18 gauge thin-walled trocar needles and ultrasound guidance. RESULTS: The percentage of abscesses requiring one, two and three, or more sessions of aspiration was 49.5%, 23.7% and 26.7%, respectively. The overall success rate was 96.8%. The success rate was unrelated to the largest size or number of abscess in the patient. Two patients died from uncontrolled sepsis. One serious complication of liver laceration requiring laparotomy occurred. CONCLUSION: Percutaneous needle aspiration in combination with systemic antibiotics is safe and effective in treating pyogenic liver abscess, it should be considered as a first line alternative to catheter drainage, especially for multiple abscesses. The need for repeat aspirations follows a 'fifty per cent rule'.

Aged↗
PubMed1994

Microsurgical epididymal sperm aspiration and intracytoplasmic sperm injection: a new effective approach to infertility as a result of congenital bilateral absence of the vas deferens.

OBJECTIVE: To present and assess the efficacy of a new approach for the treatment of infertility due to congenital bilateral absence of the vas deferens. DESIGN: A retrospective study of consecutive trials. SETTING: Centre for Reproductive Medicine, which is a tertiary referral institution. PATIENTS: Twelve couples suffering from infertility because of congenital bilateral absence of the vas deferens. INTERVENTIONS: A microsurgical epididymal sperm aspiration procedure was performed in the husbands, followed by intracytoplasmic sperm injection of oocytes recovered from the wives. Cleaving embryos were transferred to the uterine cavity 48 hours after the intracytoplasmic sperm injection procedure. MAIN OUTCOME MEASURES: Sperm parameters after microsurgical epididymal sperm aspiration, fertilization, cleavage, and pregnancy rates. RESULTS: In all 14 microsurgical epididymal sperm aspiration procedures, sperm was retrieved. Notwithstanding the poor quality of this epididymal sperm, a fertilization rate of 58% was achieved after intracytoplasmic sperm injection. On 10 occasions, embryos were transferred and five patients became pregnant, i.e., an overall pregnancy rate of 35.7% per started trial and 50.0% per transfer. Another two patients became pregnant after replacement of frozen-thawed embryos, which increases the pregnancy rate to 50.0% per microsurgical epididymal sperm aspiration procedure. Early pregnancy wastage was 57%, limiting the ongoing pregnancy rate to 21.4% per microsurgical epididymal sperm aspiration procedure. CONCLUSION: This study shows the combined microsurgical epididymal sperm aspiration-intracytoplasmic sperm injection procedure to be highly efficient in achieving fertilization in vitro, even after recovery of grossly impaired epididymal sperm.

Adult↗
PubMed1998

Acute changes in endometrial thickness after aspiration of functional ovarian cysts.

OBJECTIVE: To evaluate the influence of aspiration of functional ovarian cysts on endometrial thickness. DESIGN: Prospective study. SETTING: An IVF Unit of an academic medical center. PATIENT(S): Twenty-two patients from our IVF program, in whom administration of a gonadotropin-releasing hormone agonist preparation in the "long protocol" failed to induce pituitary desensitization, as evidenced by a serum E2 concentration of >55 pg/mL and the presence of an ovarian cyst of >20 mm in diameter. INTERVENTION(S): Transvaginal ultrasonographic-guided cyst aspiration was performed, and 2 days later, serum E2 concentration and endometrial thickness were reassessed. MAIN OUTCOME MEASURE(S): The values of serum E2 concentration and endometrial thickness before and after cyst aspiration were compared. RESULT(S): Two days after ovarian cyst aspiration, the serum E2 concentration dropped from a mean (+/-SD) of 203 +/- 93 to 37 +/- 34 pg/mL. The mean (+/-SD) endometrial thickness was 9.6 +/- 2.0 mm before cyst aspiration and decreased to 5.9 +/- 2.4 mm after the procedure. CONCLUSION(S): Within 48 hours after ovarian cyst aspiration, a significant reduction in endometrial thickness occurs concomitant with a sharp decline in serum E2 levels. The phenomenon of acute reduction in endometrial thickness in response to acute estrogen withdrawal has not been described previously. The exact mechanism and endometrial component involved in the "shrinking" process should be further investigated.

Adult↗
PubMed1999

Ultrasound guided aspiration of endometrioma--a new therapeutic modality to improve reproductive outcome.

OBJECTIVE: To evaluate the therapeutic efficacy and reproductive outcome following ultrasound guided aspiration (UGA) of endometrioma in infertile patients. METHOD: This is a prospective non-randomized clinical report of UGA in 22 infertile patients with endometrioma. The aspiration of endometriotic cysts was carried out transvaginally in nine and transabdominally in 13 patients. Following aspiration intranasal buserilin was given to eight and danazol to 14 patients. In the case of recurrence a reaspiration was done. Patients were allowed to conceive following medical therapy. Recurrence of endometrioma and conception rate was recorded and correlated with endometrioma size and volume aspirated. RESULT: A total of 47 aspirations were done. There were no procedure related complications. Reaspiration was required in six patients and one was operated (total recurrence 7/22--31.8%). During a mean follow-up of 20+/-8.4 months nine patients (40.9%) conceived and eight have already delivered at term. The recurrence risk and the conception rate was not affected by the cyst size or volume aspirated. CONCLUSION: UGA of endometrioma can be an effective and safe alternative therapeutic procedure in infertile patients with endometrioma to improve their reproductive outcome.

Adult↗
PubMed1991

Flow cytometry of fine needle aspirations of the Sprague-Dawley rat testis: defining normal maturation and the effects of multiple biopsies.

Quantitative assessment of spermatogenesis by flow cytometry reproducibly correlates with histological examination. Flow cytometry of fine needle aspirates from the testis was used to analyze normal spermatogenesis of Sprague-Dawley rats. Aged matched male weanlings were divided into 3 groups: group 1-5 rats underwent bilateral percutaneous aspiration of the testes with a 22 gauge Chiba needle on postpartum days 19, 24, 30 and 40; group 2-5 rats aspirated on days 24, 30 and 40, and group 3-4 rats aspirated on days 30 and 40. This sequential approach allowed for evaluation of normal spermatogenesis and the effects of repeated fine needle aspiration on spermatogenesis. Deoxyribonucleic acid distribution analysis by flow cytometry correlates with haploid (1N), diploid (2N), tetraploid (4N) and S phase cell populations. These cell populations were evaluated and comparisons among each group were made at all biopsy times. No significant differences in mean 2N, 4N or S phase cell populations in single versus repeat biopsied testes were detected. However, there was a significant increase in the 1N population at 30 days post partum in the repeat biopsy group (p = 0.037), which normalized by day 40. This increase in 1N corresponds to the beginning of meiosis, which is maximal between postpartum days 30 and 40, and occurs earlier in the repeat biopsied testis. Repeat fine needle aspiration of the testis can be performed without significantly affecting spermatogenesis in the "weanling" rat. This provides a useful technique in the future investigations of the time related effects of varicocele, chemotherapy and toxicologic drugs on spermatogenesis.

Animals↗
PubMed1987

Use of fine needle aspiration for detection of stage A prostatic carcinoma before transurethral resection of the prostate: a clinical trial.

The incidence of stage A prostatic carcinoma is approximately 10 per cent. We performed a clinical trial to determine if pre-prostatectomy fine needle aspiration could detect reliably stage A prostatic carcinoma. In 102 men with clinically staged benign disease by digital examination we performed a 4-quadrant fine needle aspiration of the prostate before prostatectomy. The cytological diagnosis of the aspirate was compared to the pathological diagnosis obtained at prostatectomy in all patients. The incidence of stage A prostatic carcinoma in this group of patients was 18.6 per cent (19 of 102 men). Sufficient aspirate material for cytological diagnosis was obtained in 98 of 102 men (96 per cent), including 17 with a diagnosis of carcinoma. When adequate diagnostic material was obtained, fine needle aspiration detected all cases of clinical stage A2 prostatic carcinoma but it did not detect stage A1 prostatic carcinoma. There were no false positive diagnoses. We conclude that routine pre-prostatectomy fine needle aspiration of the prostate can be safe, cost-effective and clinically useful.

Aged↗
PubMed1989

Transbronchial needle aspiration in the practice of bronchoscopy.

We reviewed the records of all patients who underwent bronchoscopy with a flexible fiberoptic instrument and transbronchial needle aspiration (TBNA) at our institution between August 1983 and December 1985. During 85 bronchoscopy sessions, 89 TBNAs were performed in 84 patients. Seventy-three aspirates were obtained from 68 patients who were eventually proved to have a malignant lesion. Of these 68 patients, 25 had positive results of TBNA (37%). Of these 25 patients, 15 had non-small-cell cancers (11 bronchogenic and 4 metastatic from extrapulmonary sites), and 10 had small-cell carcinomas. In patients with a malignant lesion, 23% of the central aspirates (from paratracheal regions or within 2 cm of the carina) and 65% of the distal aspirates (beyond 2 cm from the carina) were positive (a total yield of 34%). Five of the distal aspirates were obtained from peripheral lesions under fluoroscopic guidance, and three were positive for a malignant process. In eight patients, the only malignant finding at bronchoscopy was the aspirate. Two of the eight patients had carcinoma metastatic to the lung, three had small-cell carcinoma, and the other three had bronchogenic carcinoma. In five patients, TBNA obviated more invasive diagnostic measures. We find TBNA to be useful in selected patients. It increases our diagnostic yield for small-cell carcinoma and carcinoma metastatic to the chest. TBNA should be considered when a submucosal process is present, extrinsic compression is evident, or an accessible extrabronchial mass is found radiographically.

Adult↗
PubMed2000

A syringe adapter to facilitate aspiration at amniocentesis.

BACKGROUND: Syringes were developed for injection, not aspiration. We describe an adapter that attaches to a standard syringe and aspirates by advancement rather than withdrawal. TECHNIQUE: The adapter consists of a syringe barrel extension and an attachable finger grip. The adapter attached to a standard syringe allows aspiration by advancement rather than withdrawal, with the same hand motion used as with injection. EXPERIENCE: In a comparison of timed in vitro fluid aspiration by 10 practitioners, mean times for aspiration of 15 mL were 32.4 seconds (range 24-45) with standard technique and 25.3 seconds (range 24-30) with the adapted syringe (P < .003, paired t test). Thirteen of 14 physicians who used the adapted syringe in vivo reported that much less effort was required, and one physician reported that a little less effort was required. Overall, eight practitioners reported that the adapted syringe made amniocentesis much easier and six found no difference between the two devices. CONCLUSION: This adapter converts a standard syringe to one permitting aspiration by advancement rather than withdrawal. Practitioner feedback was positive with regard to ease of use, degree of effort, and overall satisfaction.

Amniocentesis↗