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PubMed1997

Comparison of endobronchial needle aspiration with forceps and brush biopsies in the diagnosis of endobronchial lung cancer.

Endobronchial forceps biopsy (FB) specimens of lung carcinoma are not uncommonly interpreted as nondiagnostic owing to extensive crush artefact, necrosis, or insufficient tissue. FB cannot be performed in some endobronchial lung cancers (EBLCs) with massive bleeding tendency due to fragility and friability. Cytological studies from the brushings and washings may also be unproductive, increasing the bronchoscopist's frustration. The aim of this study was to compare the diagnostic yield and complications of endobronchial needle aspiration (EBNA) with those of FB and brush biopsy (BB) in EBLCs examined by fibreoptic bronchoscopy. A prospective sequential study was carried out on 151 in-patients with EBLC. Bronchial aspiration (BA), EBNA and BB were performed in the patients with respiratory distress and with accompanying tumours of high bleeding tendency, completely obstructing main bronchi (Group 1: 68 patients). BA, EBNA and FB were performed in those with either central or peripheral EBLCs but without respiratory distress and/or significant bleeding tendency (Group 2: 83 patients). In Group 1, the diagnostic yield of EBNA was found to be 90%, whereas that of BB was 66% (p < 0.05). In the same group, EBNA provided cell types in 95%, compared with 88% by BB (p > 0.05). EBNA was diagnostic in 92% of Group 2 patients, while FB established diagnosis in 78% of patients (p > 0.05). In determining cell type, no significant difference was found between EBNA (95%) and FB (97%) (p > 0.05). Regarding complications (only bleeding), there was no significant difference (p > 0.05) between EBNA (7%) and BB (13%), or between EBNA (4%) and FB (17%). We conclude that in endobronchial lung cancers: 1) the diagnostic yield of endobronchial needle aspiration is higher than brush biopsy; 2) endobronchial needle aspiration increases the yield of brush biopsy when forceps biopsy cannot be performed owing to significant bleeding; 3) endobronchial needle aspiration increases the diagnostic yield when a forceps biopsy specimen is inadequate because of crush artefact, necrosis, or tissue resistance; and 4) endobronchial needle aspiration is as safe as brush biopsy and forceps biopsy.

Biopsy↗
PubMed1997

Sensitivity and cost-effectiveness of fine-needle aspiration with immunocytochemistry in the evaluation of patients with a pulmonary malignancy and a history of cancer.

OBJECTIVE: To determine the sensitivity and cost-effectiveness of transthoracic fine-needle aspiration in the separation of primary from metastatic malignancy. MATERIALS AND METHODS: Eighty-nine malignant pulmonary fine-needle aspirations in patients with a history of cancer were classified retrospectively by light microscopy, comparison with previous material, and immunocytochemistry. Decision analysis compared the cost-effectiveness of fine-needle aspiration, bronchoscopy, and thoracoscopy. RESULTS: Fine-needle aspiration classified 87% of the malignancies as primary (n = 7) or metastatic (n = 70) and 13% as indeterminate. By immunocytochemistry alone, 14 of 18 malignancies were subclassified. Decision analysis showed that pulmonary fine-needle aspiration with select use of thoracoscopy was more cost-effective than either bronchoscopy or thoracoscopy alone in many common clinical scenarios. CONCLUSIONS: Pulmonary fine-needle aspiration with immunocytochemistry is sensitive and cost-effective in subclassifying malignancies in patients with a history of cancer.

Adult↗
PubMed1997

Combined use of stereotactic aspiration and intracerebral streptokinase infusion in the surgical treatment of hypertensive intracerebral hemorrhage.

Stereotactic aspiration is well known for its simplicity and safety in the surgical treatment of hypertensive intracerebral hemorrhage. Postoperative fibrinolytic infusion with urokinase or recombinant tissue plasminogen activator and drainage of liquified hematoma are often used to improve the removal of hematoma. We evaluated the safety and effectiveness of streptokinase in this treatment modality in patients with hypertensive intracerebral hemorrhage or cerebellar hemorrhage. Twelve patients with hypertensive intracerebral hemorrhage underwent stereotactic aspiration using streptokinase as a fibrinolytic agent. There were six cases of putaminal hemorrhage, three of thalamic hemorrhage, and three of cerebellar hemorrhage. All but one patient had a large hematoma and presented with intracranial hypertension. Stereotactic aspiration was undertaken to remove the hematoma. Postoperatively, streptokinase was infused into the residual hematoma every 6 to 12 hours via a catheter implanted during the operation. Liquified hematoma was aspirated by syringe manually just before each infusion of streptokinase. The average duration of the entire treatment was 6 days (range 1-7). The residual hematoma at the end of treatment was less than 10 mL in all patients. Intracranial hypertension also subsided significantly in all patients. Only one patient had aspiration-induced bleeding during the operation. We conclude that stereotactic aspiration of hypertensive intracerebral hemorrhage is relatively safe and simple. Streptokinase can be infused intracerebrally to drain residual hematoma without severe side-effects.

Adult↗
PubMed1998

Low frequency epithelial cells in bone marrow aspirates from prostate carcinoma patients are cytogenetically aberrant.

BACKGROUND: Low frequency epithelial cells occur in bone marrow aspirates of 25-50% of patients with locally confined prostate carcinoma. It is assumed that bone marrow epithelial cells derive from the primary tumor; however, it has not been established unequivocally that they are tumor cells. Immunofluorescence approaches were used to quantify the frequency of epithelial cells in bone marrow aspirates from prostate carcinoma patients and genotypic analyses were used to determine whether they contained numeric aberrations of chromosomes 1, 7, and 8. METHODS: Epithelial cells in bone marrow aspirates collected after radical prostatectomy were visualized using fluorescence microscopy and fluorophore-linked antibodies against cytokeratin 8,18 (CK) and prostate specific antigen (PSA). Antibodies specific for proliferating nuclear cell antigen (PCNA) were used to evaluate the cycling status of discriminated cells. Copies of chromosomes 1, 7, and 8 in the discriminated epithelial cells were quantified using fluorescence in situ hybridization. RESULTS: CK+ cells were present in bone marrow aspirates from 30 of 66 patients (approximately 45%) at a median frequency of 1.4 CK+ cells/10(5) mononuclear cells. Few CK+ epithelial cells in the bone marrow aspirates coexpressed PSA and none of the CK+ cells expressed PCNA. Approximately 70-75% of the CK+ cells contained 7 and 8 aneusomies. Gains of chromosome 1 occurred in 42% of the CK+ cells. CONCLUSIONS: The majority of CK+ cells in bone marrow aspirates collected after surgery are cytogenetically aberrant, which is consistent with a primary tumor origin. The prevalence and frequency of CK+ cells is independent of tumor stage/grade and androgen treatment.

Aged↗
PubMed1999

Four-duct ligation: a simple and effective treatment for chronic aspiration from sialorrhea.

OBJECTIVES: To determine the effectiveness of bilateral submandibular and parotid duct ligation on children with severe neuromuscular impairment and chronic aspiration of salivary secretions and to identify any predictable anatomical connections between the submandibular duct and sublingual glands. DESIGN: Case series; retrospective anatomical study of adult cadaveric submandibular gland specimens. SETTING: Academic tertiary referral medical center. PATIENTS: Five children with severe neuromuscular impairment and recurrent aspiration pneumonitis. INTERVENTION: The children underwent bilateral submandibular and parotid duct ligation. The oral cavities of 8 cadavers were dissected to identify anatomical connections between the submandibular duct and sublingual glands. MAIN OUTCOME MEASURES: Incidence of postoperative aspiration pneumonitis; gross anatomical connections between the submandibular duct and sublingual gland in cadaveric specimens. RESULTS: No postoperative airway obstruction, infection, or xerostomia was noted, and technetium scanning confirmed control of salivary secretions from major salivary glands. Caregivers noted diminished salivary secretions and no aspiration pneumonia. CONCLUSIONS: This new, simple intraoral procedure controls aspiration pneumonitis with minimal surgical dissection and has less morbidity than procedures involving major salivary gland excision. Ranula formation, a common complication of submandibular duct transposition, is unlikely in this procedure because the sublingual ducts are not interrupted.

Adolescent↗
PubMed1991

Bilateral vocal cord teflon injection. An ineffective treatment for recurrent aspiration pneumonia.

Recurrent aspiration pneumonia is a potentially lethal problem, and its treatment is controversial. A variety of procedures have been advocated to prevent aspiration. These are reviewed briefly. We have been dissatisfied with established procedures because they usually require external approaches with considerable complexity and potential complications. Therefore, we attempted to obstruct the glottic airway by injecting both vocal cords with Teflon in a series of patients with recurrent aspiration pneumonia secondary to severe neurologic impairments. Since Teflon injection of the vocal cords bilaterally did not reliably prevent aspiration, we cannot recommend it for routine use in the treatment of chronic aspiration.

Humans↗
PubMed1991

The causes and complications of late diagnosis of foreign body aspiration in children. Report of 210 cases.

Late diagnoses of foreign body aspiration were defined as occurring beyond 3 days between the aspiration of the foreign body, or onset of symptoms, and correct diagnosis. We reviewed a total of 210 children with late diagnosis of foreign body aspiration. The causes creating late diagnosis of foreign body aspiration in children were as follows: (1) parental negligence (106/210, 50%); (2) misdiagnosis by the fellow professionals and pediatricians (39/210, 19%); (3) the normal chest roentgenographic findings (29/210, 14%); (4) lack of typical symptoms and signs (26/210, 12%); (5) mismanagement (8/210, 4%); and (6) a negative bronchoscopic finding (2/210, 1%). The most common complications encountered were obstructive emphysema (77/186, 41%), mediastinal shift (63/186, 34%), pneumonia (43/186, 24%), and atelectasis (33/186, 18%) in 186 patients who underwent a chest roentgenographic examination. The incidence of major complications was 64% (48/75) in the children who were diagnosed within 4 to 7 days; however, the complication rate was 70% (39/56) in those with a delay in diagnosis of 15 to 30 days, and 95% (20/21) in the cases with a delay in diagnosis of over 30 days after aspirating the foreign bodies.

Child, Preschool↗
PubMed1981

Physiological effects of corticosteroids in foodstuff aspiration.

Aspiration of gastric contents that contain small food particles has been shown to cause severe pneumonitis, even when the pH of the aspirate is greater than 2.5. The effects of corticosteroids on the hemodynamic and ventilatory consequences of this type of aspiration have not been investigated. Twenty healthy mongrel dogs were anesthetized and 2 mL/kg of gastric contents (pH 5.9) that contained small food particles were injected into their tracheas. Group 1 animals (controls, N = 10) received no therapy. Group 2 animals (steroid-treated, N = 10) were given methylprednisolone intravenously, 30 mg/kg, three times a day beginning one hour after aspiration. The animals were observed for 14 days, during which time there were no statistically significant differences between the groups in mortality, PaCO2, pH, systemic and pulmonary arterial blood pressures, fractional intrapulmonary shunt, or histological findings. Arterial PO2 was lower at 24 hours in group 2 dogs than in group 1 dogs. We conclude that steroids are of no benefit in the treatment of foodstuff-induced aspiration pneumonia.

Animals↗
PubMed1997

Effect of aspiration of milk on mechanisms of neural control in the airways of developing rabbits.

We studied the effects of recurrent aspiration of milk on neural control of airways in young developing rabbits. Beginning at 1 week of age, rabbits received 0.5 ml/kg of whole milk or sterile physiologic saline intranasally while under light methoxyflourane anesthesia 5 days a week for a period of 3 weeks. At 4 and 8 weeks of age, in vitro studies of contractile and relaxant responses of tracheal smooth muscle (TSM) segments were evaluated. To assess the neurally mediated contractile responses, frequency response curves to electrical field stimulation (EFS) were performed with results expressed in terms of frequency of EFS causing 50% of the maximal contractile response (ES50) values. In addition, the contractile responsiveness of TSM to methacholine (MCh) as reflected by the concentration causing 50% of the maximal contractile response (EC50) values was also determined to evaluate the underlying cholinergic reactivity of this segment of airway. To assess nonadrenergic noncholinergic inhibitory (NANCi) responses, experiments were performed on TSM contracted with neurokinin A in the presence of atropine, propranolol, and indomethacin. EFS was delivered to the contracted tissue at stimulation frequencies ranging from 5 to 30 Hz with results expressed as mean percent relaxation. Recurrent aspiration of milk but not saline increased EFS-induced contractile responses, as shown by significantly lower ES50 values compared with the control group: P = 0.02 and P = 0.001 at 4 and 8 weeks of age, respectively. TSM responsiveness to MCh was no different between the two groups, suggesting that alterations in prejunctional mechanisms of neural control were most likely responsible for the increased contractile response to EFS. The NANCi responses were significantly decreased by milk aspiration at both 4 and 8 weeks of age, with the abnormalities less pronounced at the later time point. These findings demonstrate that repeated aspiration of milk leads to abnormal mechanisms of neural control within airways of developing rabbits. While aspiration of milk altered both contractile and relaxant responses to EFS, the former abnormalities became more pronounced with time while the latter appeared to be resolving. These observations suggest that injury to an airway early in development does not necessarily resolve with time but may persist, with functional abnormalities becoming more pronounced even after the airway insult has ceased.

Animals↗
PubMed2003

Scintigraphic method to detect silent aspiration during sleep in postsurgical patients with oral cancer.

BACKGROUND: A simple method to detect silent aspiration during sleep has not been established in postsurgical oral cancer patients. METHODS: Radioactive paste consisting of (99m)TcO(4) (-) and carboxylmethylcellulose was prepared and placed in a maxillary prosthesis with a cavity in the palatal space. The patient was requested to wear this appliance during sleep, and the following morning the patient was subjected to scintigraphic scanning. Both the anterior and posterior aspects of the thorax were scanned using a Shimazu Medical gamma camera with window settings adjusted to a low energy collimator at 500 kilocounts per image. RESULTS: Silent aspiration that had not been detected by videofluoroscopic examination was clearly demonstrated by the scintigraphic method, showing aspiration of radioactive paste during sleep in the left thorax of the patient. CONCLUSIONS: The method reported for establishing aspiration is simple and reliable to assess silent aspiration during sleep in patients with oral cancer.

Aged↗
PubMed2006

Aspiration during swallowing in typically developing children of the First Nations and Inuit in Canada.

Children of the First Nations and Inuit in Canada have a high propensity for lower respiratory tract infections. Overcrowding, poor housing, passive smoke exposure, and lack of breast feeding (Martens P, Bond R, Jebamani L, Burchill C, et al. http://www.umanitoba.ca/centres/mchp/reports/pdfs/rfn_pdfs/rfn_report.pdf.; MacMillan H, Walsh C, Jamieson E, Crawford A, Boyle M. http://www.hcsc.gc.ca/fnihbdgspni/fnihb/aboriginalhealth/reports_summaries/regional_survey_ch1.pdf.; Wardman AE, Khan NA. Int J Circumpolar Health 2004;63:81-92) have been cited as important contributing factors in the occurrence of lower respiratory tract infections. However, aspiration during swallowing has thus far not been considered as a co-factor in the occurrence of lower respiratory tract infections in these children. We present a retrospective case series of seven typically developing children of the Canadian First Nations and Inuit, in whom aspiration during swallowing was detected in the course of investigating associations with recurrent lower respiratory tract infections. None of the children had any of the known risk factors for aspiration during swallowing such as developmental variation, prematurity, neuromotor problems, or anatomic abnormalities of the upper aerodigestive tract. We speculate that aspiration during swallowing in typically developing children may be an important, previously unrecognized co-factor in the occurrence of lower respiratory tract infections, particularly in the communities of the Canadian First Nations and Inuit. Further prospective studies will be needed to determine whether aspiration during swallowing represents an independent risk factor for the occurrence of lower respiratory tract infections in these children.

Canada↗
PubMed1994

Pilot study of 12-month outcomes of nursing home patients with aspiration on videofluoroscopy.

The 12-month clinical outcomes of nursing home patients who underwent videofluoroscopic swallowing evaluation was determined. A retrospective review of 40 patients in a teaching nursing home who had videofluoroscopic swallowing studies from 1987 through 1989 was performed. Clinical outcomes measured included feeding tube placement, rehospitalization within 1 year, prolonged nursing home stay (> 6 months), pneumonia, and pneumonia death. It was determined if outcomes were associated with the presence of aspiration on videofluoroscopy and subsequent feeding tube placement. In the 12-month follow-up period, 17 of 40 patients (43%) who underwent videofluoroscopic swallowing evaluation developed pneumonia and 18 of 40 (45%) died. Twenty-two patients demonstrated aspiration on videofluoroscopy. Increased rehospitalization was the only outcome measure that was associated with the presence of aspiration on videofluoroscopy (p < or = 0.05). Of 22 patients with aspiration, 15 had feeding tubes placed. This group had a higher rate of pneumonia (p < or = 0.05) and pneumonia death (p < or = 0.05) compared with the 7 patients with aspiration who did not receive feeding tubes. Patients with nasogastric tubes had a higher death rate (7/9) than patients with gastrostomy tubes (2/8; p < or = 0.05), but similar rates of rehospitalization and pneumonia. Nursing home patients who underwent video-fluoroscopic swallowing evaluation had poor clinical outcomes at 12 months, regardless of their test results.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

Prevention of aspiration pneumonia during long-term feeding by percutaneous endoscopic gastrostomy: might cisapride play any role? An open pilot study.

The risk of aspiration during tube feedings has been reduced but not abolished by percutaneous endoscopic gastrostomy (PEG). This open study was planned to evaluate whether cisapride may play some role in preventing aspiration in long-term enteral feeding via PEG. A group of 29 patients, unable to swallow because of head and neck cancer (14 cases) or neurological disorders (15 cases) entered the study; 7 neurological patients, fed via nasogastric tube before PEG placement, had suffered from aspiration pneumonia during nasogastric feeding. All patients underwent PEG, and 10 mg cisapride was routinely given via PEG before each administration of enteral feeding and 6 h after its initiation when the feeding was continued for 12 h or more. Only 1 minor complication was observed during the acute hospital setting (ileus, spontaneously resolving after 36 h). After hospital discharge, the patients were followed for a total of 4935 days of feeding (range 47-508 days, mean time per patient: 170 days) and assessed weekly for the development of complications. No episode of probable/possible aspiration pneumonia was observed during the follow-up. Two neurological patients with involuntary movements had rupture of the feeding tube, which was replaced without complications. These results support the hypothesis that cisapride might play some role in the prevention of aspiration in patients fed via PEG, and justify the planning of some controlled, double-blind trials to verify such a hypothesis.

Adolescent↗
PubMed1994

Videofluoroscopic predictors of aspiration in patients with oropharyngeal dysphagia.

The purpose of this investigation was to determine the relationship between aspiration and seven other variables indicative of pharyngeal stage dysphagia. Additionally, we looked at the relationship between aspiration and oral stage dysphagia. Multiple logistic regression analysis identified five independent predictors of aspiration that were significant at the p = 0.05 level: vallecular stasis, reduced hyoid elevation, deviant epiglottic function, diffuse hypopharyngeal stasis, and delayed initiation of the pharyngeal stage of the swallow. A linear trend was observed in that, as the severity of vallecular stasis, pyriform sinus stasis, diffuse hypopharyngeal stasis, or delayed initiation of the pharyngeal stage of the swallow increased, the proportion of patients who aspirated also increased. A stepwise logistic regression model furnished estimates of the odds ratio for each independent variable and can be used by clinicians to calculate the risk of aspiration in patients who demonstrate pharyngeal stage dysphagia.

Adult↗
PubMed1993

Is penicillin G an adequate initial treatment for aspiration pneumonia? A prospective evaluation using a protected specimen brush and quantitative cultures.

OBJECTIVE: To evaluate the bacteriology of early aspiration pneumonia using a protected specimen brush and quantitative culture techniques, and whether penicillin G is adequate as initial treatment pending culture results. PATIENTS AND METHODS: 52 patients (of which 45 required mechanical ventilation) meeting usual clinical criteria for aspiration pneumonia were prospectively included. On admission, patients were given intravenous penicillin G and a protected specimen brush was performed < or = 48 h after. RESULTS: Cultures of the brush were negative (< 10(3) CFU/ml) in 33 patients (1 had blood cultures positive with S. pneumoniae) and positive (> or = 10(3) CFU/ml) for S. pneumoniae in 2 patients. Seventeen patients had a positive culture (> or = 10(3) CFU/ml) for at least one penicillin G resistant microorganism, with a total of 20 organisms (S. aureus: 6; H. influenzae: 2; Enterobacteriaceae: 8; P. aeruginosa: 3; C. albicans: 1). In 4 of these patients, a penicillin-sensitive pathogen was also recovered in significant concentrations (S. pneumoniae: 2; Streptococcus sp.: 2). These 17 patients with a resistant pathogen did not differ from the 35 other patients with respect to need for ventilatory support and mortality rate. By contrast, they were older (61.1 +/- 21.9 vs. 42.9 +/- 18.8 years; p < 0.005) and required longer mechanical ventilation (6.1 +/- 4.6 vs. 3.5 +/- 2.7 days; p < 0.03) and hospitalization (11.2 +/- 8.8 vs. 6.7 +/- 4.7 days; p < 0.02). Of 17 patients 12 with penicillin G resistant organisms versus 0/35 without, were in-hospital patients and/or had a digestive disorder (p < 0.001). CONCLUSION: The broad range of offending organisms seen in early aspiration pneumonia precludes use of any single empiric regimen, making protected specimen brush mandatory in many patients. Nevertheless, the involvement of S.pneumoniae in a notable proportion of our patients suggests that routine penicillin prophylaxis after early aspiration (at least in most patients with community-acquired aspiration) is warranted given the potential severity of pneumococcal sepsis in such patients.

Adult↗
PubMed1988

How useful is gastroesophageal reflux scintigraphy in suspected childhood aspiration?

It has been suggested that gastroesophageal reflux scintigraphy (GRS) might be useful in assisting one in determining therapy for patients suspected of aspirating or becoming apneic secondary to gastroesophageal reflux. This, however, has not been our experience and in reviewing 23 patients with recurrent pneumonia and/or apnea who had GRS, we were able to detect aspiration in only one. This was especially significant since 13 (59%) of these patients had demonstrable reflux, and of these, eight were treated successfully for suspected aspiration even though none was demonstrated isotopically. To be sure, the demonstration of pulmonary aspiration with GRS had little influence on patient selection and response to therapy. For this reason we feel there is little justification in depending on the GRS for the specific purpose of trying to document pulmonary aspiration in infants and children who are refluxing.

Apnea↗
PubMed1991

Surgical treatment for aspiration following esophageal reconstruction--a report of two cases and the techniques involved.

Severe aspiration following esophageal reconstruction is often very difficult to treat while preserving the larynx. However, we have successfully adopted a modified surgical procedure previously employed for aspiration caused by neurological diseases or head and neck cancer surgery. We report herein the use of this modified procedure against aspiration in 2 cases following esophagectomy. In the first case, a combination of cricopharyngeal myotomy, infrahyoid myotomy and laryngeal pull-up, with approximation of the thyroid cartilage against the hyoid bone and that of the hyoid bone against the mandible, were performed simultaneously with the primary esophagectomy. In the second case, cricopharyngeal myotomy, infrahyoid myotomy, laryngeal pull-up and infrafold silicone injection were performed three months after the primary operation. Good results were achieved in both cases. Thus, for any case at risk of aspiration after esophagectomy or for any case with severe aspiration following esophagectomy that does not respond to swallow therapy, these operative rehabilitation procedures should be performed before laryngectomy is considered.

Esophagectomy↗
PubMed1992

Scintigraphic detection of salivary aspiration: description of a new diagnostic technique and case reports.

Pneumonia is the feared consequence of persistent aspiration of saliva. Although some persons with impaired protection of the laryngeal airway are thought to be at risk, it is not known with certainty which factors are important. Some patients receive tracheostomies to enhance airway safety, often without clear evidence of aspiration of oropharyngeal secretions. A simple, readily available technique is described by which oral secretions are scintigraphically labeled with technetium-99m sulfur colloid via slow intraoral infusion. Subsequent sequential chest imaging with a gamma camera allows detection and tracking of the aspirated material. Three persons are described in whom this technique was used. In one, the scintigraphic analysis was instrumental in implicating infected saliva as the likely source of recurrent pulmonary infections. Although the method is useful in detecting aspiration of saliva in high risk persons, more study is needed to equate the degree of aspiration visualized with the risk of pulmonary disease.

Aged↗