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PubMed1995

Laparoscopic cholecystectomy with an ultrasound surgical aspirator.

Laparoscopic cholecystectomy using an ultrasound surgical aspirator has been performed in our department since March 1991. The horn cover was altered in order to be inserted through a trocar 10 mm in diameter. The main purpose of this device is to explore Calot's triangle by fragmentation and aspiration of the fatty tissue without damaging the nerves, vessels, and cystic duct. First the serosa of the Calot's triangle is cut via electrocautery with the sharp-angle hook dissector we designed. Then the cystic duct and cystic artery are efficiently exposed by the ultrasound surgical aspirator. This procedure is perfectly adapted for laparoscopic cholecystectomy. We obtained favorable results with the ultrasound surgical aspirator in 135 cases including 40 cases with a negative gallbladder, as evaluated by endoscopic retrograde cholangiography. In conclusion, the ultrasound surgical aspirator is suitable for skeletonizing the cystic duct and cystic artery, and the procedure is perfectly safe.

Cholecystectomy, Laparoscopic↗
PubMed1996

Effect of occlusion of a tracheotomy tube on aspiration.

The purpose of the present study was to investigate the effect of occlusion of a tracheotomy tube on aspiration utilizing fluoroscopy. Twenty consecutive tracheotomized patients referred for a modified barium swallow were included. Selection criteria were ability to tolerate tracheotomy tube occlusion during the modified barium swallow procedure, no surgery of the upper aerodigestive tract except tracheotomy, and no history of oropharyngeal cancer or stroke. There was 100% agreement among 3 independent reviewers on ratings of the presence or absence of aspiration. It was found that the occlusion status of the tracheotomy tube did not influence the prevalence of aspiration. Nine of 10 (90%) subjects who exhibited aspiration were over 65 years of age (mean = 72 years 2 months). No trends were observed for bolus consistency, type of tracheotomy tube, or presence/absence of a nasogastric tube and ratings of aspiration.

Adolescent↗
PubMed1994

The use of scintigraphy in the management of patients with pulmonary aspiration.

Pulmonary aspiration was assessed using a scintigraphic swallowing procedure in 14 dysphagics in whom penetration of the larynx had been previously diagnosed. No patient had recent evidence of aspiration pneumonia. Imaging was performed during and following ingestion of a cupful of thin liquid admixed with between 1-2 mCi of Tc-99m sulfur colloid. Follow-up scans were obtained several hours later as needed to assess airway clearance. Five of the fourteen (36%) showed penetration distal to the trachea. Seven (50%) were indeterminate for aspiration, as isotope localized to the neck could not be clearly designated as being in either airway or foodway. Two subjects had negative studies. Of patients with subtracheal penetration, (1) fractions of the ingested material which were aspirated ranged from < 1%-25%, and (2) elimination from airways was complete or near-complete by 3 hours. The presence of an immediate or delayed cough was noted but did not correlate with subtracheal aspiration. Based on the results of scintigraphy, 8 of 9 patients on some form of liquid restriction at the time of testing were allowed to ease restrictions. Five patients without prior liquid restriction were allowed to continue to drink. We propose that scintigraphy provides important data on airway penetration and clearance that is useful in the dietary management of dysphagic patients.

Adult↗
PubMed1980

Cytodiagnosis of soft tissue tumors and tumor-like conditions by means of fine needle aspiration biopsy.

In the evaluation of soft tissue tumors primary sarcomas must be differentiated from other malignancies, such as cancer metastases, malignant lymphomas, as well as benign tumors and tumor-like conditions. As far as possible this should be done without open biopsy to avoid local spread. Fine needle aspiration biopsy as opposed to thick needle biopsy utilizes smaller needle diameters up to 0.8 mm with assumed negligible risks of local or distant tumor spread. Such a fine needle aspiration biopsy for cytodiagnosis was supposed to increase the reliability of the preoperative diagnosis. In a consecutive series of 187 patients referred to an orthopedic oncology group because of suspected malignancy fine needle aspiration biopsy was made. In 129 cases with histology and in 49 non-operated cases with at least 2 years of clinical follow-up the reliability of the method is analyzed. In 163 cases the aspirated material was sufficient for a diagnosis and 152 cytological reports were correct regarding the diagnosis of a malignancy contra a benign tumor or tumor-like condition. Thirty-five of 43 malignancies were primary soft tissue sarcomas, 28 of these with a correct cytologic diagnosis of sarcoma. Eight were malignant lymphomas or carcinomas. Fourty-nine patients with 48 benign and one malignant cytological diagnosis were not operated upon. At least 2 years of clinical follow-up confirmed a benign diagnosis in these cases. The total reliability is thus around 85%. Fine needle aspiration biopsy is considered to be a very valuable complement to other investigations in the diagnostic work-up of soft tissue tumors.

Biopsy, Needle↗
PubMed1995

Usefulness of aspiration cytology in prostate cancer detection.

Aspiration cytology and core needle biopsy were performed in 79 patients who were suspected of having prostate cancer. Aspiration cytology and TURP were done in 77 cases not suspected of the disease. In the former group, they were both positive in 13 cases, aspiration cytology was negative and core needle biopsy positive in 4, and the reverse in 3 cases in whom cancer was confirmed by repeat core biopsy. All of the latter group were judged by aspiration cytology as being benign. Three cancers were detected by TURP. Aspiration cytology is a recommendable method in subjects with suspected prostate cancer.

Adenocarcinoma↗
PubMed2001

Effect of tracheotomy tube occlusion on upper esophageal sphincter and pharyngeal pressures in aspirating and nonaspirating patients.

The biomechanics of the pharyngeal swallow in patients with a tracheotomy tube were investigated with manometry. Upper esophageal sphincter (UES) and pharyngeal pressure recordings were made with and without occlusion of the tracheotomy tube. Criteria for selection were ability to tolerate tracheotomy tube occlusion for both 5 minutes prior to and during the first manometric analysis, absence of surgery to the upper aerodigestive tract other than tracheotomy, and no history of oropharyngeal cancer or stroke. Aspiration was determined objectively by fiberoptic endoscopic evaluation of swallowing (FEES) immediately prior to manometric recording. Eleven adult individuals with tracheotomy participated; 7 swallowed successfully and 4 exhibited aspiration on FEES. The results indicated no significant effect of tracheotomy tube occlusion on UES or pharngeal pressures in either aspirating or nonaspirating patients. It was concluded that the biomechanics of the swallow as determined by UES and pharyngeal manometric pressure measurements were not changed significantly by tracheotomy tube occlusion in aspirating or nonaspirating patients. These results support previous observations that subjects either aspirated or swallowed successfully regardless of tracheotomy tube occlusion status.

Adult↗
PubMed1998

Aspiration lesions of the amygdala disrupt the rhinal corticothalamic projection system in rhesus monkeys.

In macaque monkeys, aspiration but not excitotoxic lesions of the medial temporal lobe limbic structures, the amygdala and hippocampus, produce a severe impairment in visual recognition memory. Furthermore, certain ventromedial cortical regions, namely the rhinal (i.e., entorhinal and perirhinal) cortex, are now known to be critical for visual recognition memory. Because the route taken by temporal cortical efferent fibers, especially perirhinal efferents, passes nearby the amygdala, it is possible that inadvertent damage to these fibers is produced by the aspirative but not the excitotoxic process, thereby accounting at least in part for the different behavioral outcomes of the two types of lesion. To test this idea, we assessed the integrity of the rhinal corticothalamic projection system after aspiration lesions of the amygdala. Three rhesus monkeys with unilateral amygdala removals received bilaterally symmetrical injections of a retrograde fluorescent tracer into the medial portion of the mediodorsal nucleus of the thalamus. Retrogradely labeled cells were identified using conventional fluorescence microscopy techniques. In all three cases, the rhinal cortex of the intact hemispheres contained moderate numbers of retrogradely labeled cells. By contrast, the rhinal cortex of the amygdalectomized hemispheres consistently contained few retrogradely labeled cells, and a direct comparison of the two hemispheres showed this difference to be statistically significant. A similar asymmetric pattern was observed for area TE but not for the cortex lining the dorsal bank of the superior temporal sulcus, nor for the rostral cingulate motor area, which was examined as a control. The results indicate that aspiration lesions of the amygdala not only remove the cell bodies of the amygdala, as intended, but also inadvertently disrupt projection fibers arising from cells in the rhinal cortex and area TE that pass nearby or through the amygdala en route to the thalamus. Behavioral studies examining the effects of aspiration lesions of the amygdala in nonhuman primates need to take these findings into consideration.

Amygdala↗
PubMed1996

Rotator cuff calcifications: treatment with ultrasound-guided percutaneous needle aspiration and lavage.

OBJECTIVE: To analyze the results of ultrasound (US)-guided needle puncture, aspiration and lavage in the treatment of symptomatic calcific tendinitis of the rotator cuff. DESIGN AND PATIENTS: Atraumatic pain in 61 shoulders of 58 patients was resistant to conservative therapy. The average age of the treated patients was 42 years (range 26-49 years), follow-up was 12 months, and the mean diameter of the calcifications was 1.6 cm (range 1.1-2.9 cm). With US guidance and local anesthesia, two needles were placed within each calcification. The calcification was punctured 10-15 times and saline solution injected and aspirated using the needles until the aspirate was free of calcific particles. RESULTS AND CONCLUSIONS: Based on radiographs at 1 year follow-up. 74% (45 of 61) of the calcifications decreased, including 28% (17 of 61) which disappeared totally, and 26% (16 of 61) were unchanged. Calcifications with a faint or absent shadow on US proved to be nearly liquid (slurry calcification in 93% (14 of 15) of cases and could be aspirated. Clinical results were excellent in 74% (45 of 61), moderate in 16% (10 of 61) and poor in 10% (6 of 61) of cases. US offers technical advantages over fluoroscopy, and the typical US image of a slurry calcification helps to select the most suitable patients for aspiration treatment. The results are comparable with those using fluoroscopic guidance.

Adult↗
PubMed2001

CT findings of the chest in adults with aspirated foreign bodies.

The aim of this study was to assess the imaging findings in adult patients with tracheobronchial foreign body aspiration. Nineteen patients (11 men and 8 women; age range 26-89 years) with foreign-body aspiration were retrospectively reviewed. Nine patients were outpatients with non-specific symptoms and ten were hospitalized with nonresolving pneumonia (n = 6), after detection of a dental fragment on a chest radiograph following intubation (n = 3), and there was one mentally retarded patient with empyema. An aspirated dental fragment was seen on a chest radiograph in 3 patients and an endobronchial foreign body on CT in 16, appearing as a dense structure within the bronchial lumen. The foreign body was right sided in 14 cases and left sided in 5. Three cases were missed at first interpretation. Associated findings on CT were volume loss, hyperlucency with air trapping and bronchiectasis in the affected lobe. Thirteen patients were managed with bronchoscopy, whereas 2 needed thoracotomy. In 1 patient bronchoscopy failed to detect a foreign body, indicating a false-positive CT diagnosis. One patient expelled an aspirated tablet and two refused invasive procedure. The foreign bodies found mainly were bones and dental fragments. A high clinical suspicion is necessary to diagnose a foreign body. Since CT is often used to evaluate various respiratory problems in adults, it may be the first imaging modality to discover an unsuspected aspirated foreign body in the bronchial tree.

Adult↗
PubMed2003

Simultaneous modified barium swallow and blue dye tests: a determination of the accuracy of blue dye test aspiration findings.

The overall objective of this pilot study was to determine blue dye test reliability and validity for the identification of aspiration of secretions, food, and/or drink in 50 simultaneously administered blue dye (BDT) and modified barium swallow (MBS) tests of tracheostomized individuals. With the MBS as an objective test of aspiration, BDT sensitivity and specificity identifying aspiration were less than 80% and 62%, respectively. Certain tracheostomy tube conditions and food consistencies were associated with more accurate BDT aspiration results than others. Characteristics of the aspiration episodes, interpretation of the results, and needs for further research are discussed.

Administration, Oral↗
PubMed2001

Balloon catheter for cyst aspiration in a thoracoscopic resection of mediastinal cysts.

In a thoracoscopic resection of mediastinal cysts, aspiration of the cyst contents at the beginning of the procedure is often helpful because it allows the cyst to be more easily grasped and manipulated. Spillage of the cyst contents into the thoracic cavity may, however, occur during aspiration when an ordinary aspiration needle is used. If the cyst contents are infective, then a subsequent contamination of the thoracic cavity may develop. We therefore use a specially designed double-balloon catheter for aspiration to minimize spillage of the cyst contents into the thoracic cavity. We describe herein the usefulness of this aspiration technique.

Catheterization↗
PubMed2006

The effects of IVF aspiration on the temperature, dissolved oxygen levels, and pH of follicular fluid.

PURPOSE: To investigate the effects of IVF aspiration on the temperature, pH, and dissolved oxygen of bovine follicular fluid. METHODS: The temperature was monitored at various positions in an aspiration kit. Dissolved oxygen and pH were measured before and after aspiration. RESULTS: The temperature of follicular fluid dropped by 7.7 +/- 1.3 degrees C upon aspiration. Dissolved oxygen levels rose by 5 +/- 2 vol.%. The pH increased by 0.04 +/- 0.01. CONCLUSIONS: The temperature change was attributed mainly to evaporation of fluid in the collection tube. Changes in dissolved oxygen levels and pH were due to contact with air. Standard vacuum-based aspiration may induce changes in follicular fluid, which could be detrimental to oocyte health and affect attempts to correlate chemical characteristics with oocyte quality.

Animals↗
PubMed1995

Ultrasonographically guided transvaginal aspiration of tuboovarian abscesses and pyosalpinges: an optional treatment for acute pelvic inflammatory disease.

OBJECTIVE: Our purpose was to assess the value of ultrasonographically guided transvaginal aspiration of tuboovarian abscesses and pyosalpinges presenting with the clinical picture of acute pelvic inflammatory disease. STUDY DESIGN: Fifteen patients seen for acute pelvic inflammatory disease were treated by ultrasonographically guided transvaginal aspiration of pus from tuboovarian abscesses and pyosalpinges, followed by local and systemic administration of antimicrobal therapy. RESULTS: Improvement of symptoms followed aspiration in all patients. Temperature dropped to normal within 24 to 72 hours, and pain completely disappeared within 3 days. All patients were symptom free during a follow-up period of 6 months after aspiration. CONCLUSION: Ultrasonographically guided transvaginal aspiration of pyosalpinges and tuboovarian abscesses is an effective, simple, and safe treatment. It avoided the need for laparoscopy or laparotomy.

Abscess↗
PubMed1985

Fine-needle aspirates of uveal melanomas and prognosis.

The computer-assisted measurement of the standard deviation of the nucleolar area from pathologic slides of uveal melanomas correlates strongly with prognosis, but the eye must be removed and examined histologically. Because it is possible to perform fine-needle aspiration biopsies of intraocular tumors, we designed a study to determine if a fine-needle aspiration biopsy sample yields the same prognostic information as the enucleation specimen. In comparing the standard deviation of the nucleolar area measured from a fine-needle aspiration biopsy sample obtained from 53 freshly enucleated eyes with the standard deviation of the nucleolar area measured from the matched enucleation specimen, we found only a modest correlation (r = 0.57) between the two measurements. A t-test of matched pairs indicated a significant difference between the two measurements (P less than .01). The fine-needle aspiration biopsy technique does not yield the same prognostic information as the larger enucleation specimen because fine-needle aspiration biopsy material may not be representative of the tumor.

Biopsy, Needle↗
PubMed1983

Mammography after needle aspiration of palpable breast masses.

Hematoma resulting from attempted aspiration of a palpable breast mass can cause incorrect mammographic interpretation by rendering irregular and indistinct the otherwise smooth and sharply defined margins characteristic of a benign lesion. In this study of recently aspirated breast masses, we found 17 benign lesions that demonstrated poorly defined, irregular margins on mammograms that suggested malignancy. All these false-positive interpretations occurred when aspiration preceded mammography by less than 2 weeks (17 of 47, 36 percent); no such diagnostic error occurred in the 31 cases when mammography was delayed for 2 weeks or more after aspiration. An appreciation of the frequency and natural history of postaspiration hematoma formation should either encourage physicians to request mammography before carrying out invasive procedures, or alternatively, to defer mammography until 2 weeks after aspiration, since mammography then should more clearly portray the benign characteristics of truly benign masses, thereby possibly obviating biopsy.

Biopsy, Needle↗
PubMed1986

Fine-needle aspiration in the diagnosis of cervical lymphadenopathy.

The extent of workup in patients with cervical adenopathy has always been controversial. Extensive workup in the absence of a histologic diagnosis indicative of a malignant process is unwarranted. Although open biopsy may be necessary for certain benign conditions, its routine application for metastatic nodes is not advised. We have used fine-needle aspiration as a routine procedure in the initial evaluation of cervical adenopathy. Over the past 3 years, 140 needle aspirations have been performed. Adequate specimens were obtained in 97 percent of the patients and the diagnostic accuracy was 96 percent. Overall, 45 percent of the patients had the diagnosis of a malignant tumor established whereas others had benign tumors. Metastatic squamous cell carcinoma was diagnosed accurately in all of the patients. Other malignant tumors reported accurately included lymphoma, adenocarcinoma, and metastatic thyroid carcinoma. Among the benign conditions, accurate diagnoses could be established in patients with tuberculosis, chronic lymphadenitis, and hyperplastic lymph nodes. The findings of fine-needle aspiration are helpful in directing subsequent workup. If the findings do not correlate with the clinical suspicion, greater weight is given to the clinical picture and diagnostic workup appropriate for the suspected disease is performed. Proper use of fine-needle aspiration requires close communication between an experienced cytologist and the head and neck surgeon. This series demonstrates that fine-needle aspiration is a safe, accurate, and valuable tool for the evaluation of cervical adenopathy.

Adenocarcinoma↗
PubMed1987

Final diagnosis by fine-needle aspiration biopsy for definitive operation in breast cancer.

This work has been based on 15 years experience with more than 10,000 needle aspiration biopsies of the breast. Fine-needle aspiration biopsy was used in place of open breast biopsy for definitive operation in breast cancer. Our experience with 2,623 aspiration biopsies over a 3 year period has been reviewed. There was a total of 323 cancers, of which 257 (80 percent) were unequivocally diagnosed by fine-needle aspiration biopsy. Definitive operation was performed in 244 of these patients (95 percent) without open biopsy. Thirteen had an excisional biopsy before definitive operation at the request of the referring physician. The sensitivity was 80 percent and the specificity was 98 percent. There were no false-positive diagnoses. The positive predictive value was 100 percent. False-negative diagnoses were made in 9 percent of the patients, half of whom had nonpalpable carcinomas. Our experience shows that fine-needle aspiration biopsy is accurate in the diagnosis of breast cancer, and when the finding is positive, it can be used for definitive breast operation, eliminating the need for open biopsy. A management algorithm has also been presented herein.

Algorithms↗
PubMed1987

Early diagnosis of pancreatic infection by computed tomography-guided aspiration.

We performed 92 computed tomography-guided percutaneous needle aspirations of pancreatic inflammatory masses in 60 patients suspected of harboring pancreatic infection. Thirty-six patients (60%) were found by Gram stain and culture to have a total of 41 separate episodes of pancreatic infection. Among 42 aspirates judged to be infected by computed tomography-guided aspiration, all but one were confirmed by surgery or indwelling catheter drainage. Among 50 aspirates judged to be sterile, no subsequent evidence of infection was found. All patients tolerated the procedure well and no complications were noted. As a result of this technique, we observed that pancreatic infection occurs earlier than has been previously appreciated (within 14 days of the onset of pancreatitis in 20 of the 36 patients) and that infection may recur during prolonged bouts of pancreatitis. We conclude that guided aspiration is a safe, accurate method for identifying infection of the pancreas at an early stage.

Acute Disease↗