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PubMed2004

Saline-assisted endoscopic resection of rectal carcinoids: cap aspiration method versus simple snare resection.

BACKGROUND AND STUDY AIMS: Complete resection of small carcinoid tumors of the rectum is difficult during endoscopic polypectomy, because these tumors are often located in the submucosal layer of the rectal wall. To completely remove these tumors, we have used aspiration lumpectomy. In this study, we evaluated its clinical usefulness in comparison with strip biopsy. PATIENTS AND METHODS: We performed strip biopsy (December 1996 through March 2000) or aspiration lumpectomy (April 2000 through February 2003) in a consecutive series of patients with rectal carcinoid tumor. Eight carcinoid tumors in eight patients were resected by strip biopsy, and eight tumors in eight patients were resected by aspiration lumpectomy. RESULTS: The rate of complete removal of carcinoid tumors with aspiration lumpectomy (100 %) was significantly higher (P < 0.05) than that with strip biopsy (37.5 %). CONCLUSIONS: Endoscopic resection with aspiration lumpectomy is a useful and safe method for resection of small carcinoid tumors of the rectum.

Carcinoid Tumor↗
PubMed2005

[CT-Guided transthoracic aspiration of peripheral pulmonary nodules with a special bioptic needle].

Peripheral pulmonary nodules are difficult to reach bronchoscopically, so for a long time it has been tried, by the use of imaging techniques like X-ray, ultrasound and computed tomography, to aspirate these nodules for exact histological diagnosis. The computed tomography offers the best spatial orientation for methodical reasons, thus this technique is performed increasingly and with great accuracy in pulmonary lesions. Complications like bleeding into lung parenchyma or small pneumothorax after aspiration can be detected easier by computed tomography. In this study we evaluated the use of a special bioptic technique with the AUTOVAC(R) needle in 30 cases. Causing low parenchymal damage to the lung, this bioptic needle enables extraction of representative tissue samples for further pathological examination. In 21 of 30 (70 %) cases the histological specimen led to the diagnosis of malignancy, but 8 of those malignant specimen could have been verified as primary or secondary malignancy by using additional immunocytochemical techniques. In 2 of 30 cases (7 %) harmless hemorrhage into lung parenchyma occured after aspiration. In another 4 of 30 (13 %) cases pneumothorax occurred, requiring chest tube placement. The ct-guided lung biopsy with the AUTOVAC(R) needle represents a safe, low resilient diagnostic tool to obtain large tissue samples of specimen in good quality. Even in patients with compromised lung function because of severe chronic obstructive lung disease and/or emphysema, the described aspiration technique can be performed, if at the moment of aspiration procedure a pneumologist with corresponding equipment and trained medical staff is present, in order to place a chest tube in case of pneumothorax.

Biopsy, Needle↗
PubMed1995

[The fine-needle aspiration cytology of lymph nodes suspected of malignancy. Its diagnostic value and capacity to predict the histogenesis].

To examine the usefulness of fine needle aspiration cytology in the investigation of patients with enlarged lymph nodes, the authors made a retrospective evaluation of the results of 1158 aspirations in 838 patients (630 male, 208 female, mean age 44 [4-90] years). In these 1158 cases the diagnosis was verified histologically, serologically or by follow up extending over at least six months. In 94.6% (n = 1096) the aspirate gave an unequivocal diagnosis, in 4.2% (n = 48) the diagnosis was equivocal and in 1.2% (n = 14) no diagnosis was reached. There were 773 correct malignant results, 368 correct benign results and 16 false benign; in one case the assessment was false malignant. Sensitivity was 98% and specificity 99.7%. In benign lymphadenopathies the investigation achieved a specificity of 99.7%, and in metastases and malignant lymphomas the sensitivity was 97.8% and 98.2% respectively. In 211 out of 286 aspirations the cytological diagnosis correctly predicted the subsequent histological diagnosis; in 58 cases correct though imprecise expressions such as "highly malignant non-Hodgkin's lymphoma" were employed. No serious complications were encountered. Fine needle aspiration cytology enables the clinician to devise an exact diagnostic and therapeutic plan in nearly every patient with unexplained lymph node enlargement.

Adult↗
PubMed2000

Endothelial selectin blockade attenuates lung permeability of experimental acid aspiration.

BACKGROUND: A central role for the polymorphonuclear leukocyte (PMN) in experimental acid aspiration has been demonstrated by the observation that PMN depletion reduced pulmonary vascular permeability. This study investigates the role of recombinant soluble P-selectin glycoprotein ligand-immunoglobulin fusion protein (rPSGL-Ig), a P- and E-selectin antagonist in moderating acid aspiration lung injury. METHODS: Tracheostomy tubes were placed in male C57BL/6 mice and 0.1 N HCl was instilled into the trachea at 2 mL/kg after intravenous injection of (125)I-albumin. After 4 hours the lung vascular permeability index (PI) and PMN accumulation in the bronchoalveolar lavage fluid were assessed. RESULTS: PI in neutropenic mice was 63% reduced compared with the untreated group and similar to the PI of mice treated with 1 mg/kg rPSGL-Ig before acid aspiration. PMN count of 19 +/- 5 in the bronchoalveolar lavage fluid in rPSGL-Ig treated mice was significantly less than the untreated group PMN count of 586 +/- 72. The respective PI in mice treated with rPSGL-Ig (1/2) hour and 1 hour after acid aspiration was 45% and 39% reduced compared with the untreated group. CONCLUSIONS: Endothelial selectin blockade is as effective as PMN depletion in moderating acid aspiration induced lung permeability. Delayed antiselectin therapy can decrease lung injury.

Animals↗
PubMed1995

Educational and occupational aspirations of "common man" boys: Kahl's study revisited.

The relationships between parents' getting-ahead-getting-by orientations, adolescents' perceptions of those parental orientations, and aspirations for adolescents with different levels of intellectual ability and from various social status backgrounds were examined. Data were collected from 516 Australian 16-year-olds (250 boys, 266 girls) and their parents. The adolescents were classified into four contexts defined by the median split of scores on intellectual ability and family social status. Within each ability-status context, relationships among the variables were examined by constructing regression surfaces that were formed from models that included terms to test for possible linear, interaction, and curvilinear associations. The findings suggest that (a) in each context, perceptions of parents' orientations had strong associations with adolescents' aspirations; (b) for adolescents from low ability-lower status contexts, perception of parents' orientations acted as a threshold variable such that they were related to aspirations only at medium to high perception levels; and (c) in each context, parents' aspirations were related to adolescents' educational aspirations at each level of adolescents' perceptions of parents' orientations.

Adolescent↗
PubMed1995

Fine needle sampling without aspiration.

Four hundred and ten thyroid nodules, 127 breast lumps and 43 lymph nodes were sampled and analyzed to compare the classical aspiration (ASP) technique with the non aspiration needle jab (NASP) technique. The adequacy of cellularity, significant blood staining and the discomfort felt by the patient were assessed and statistically analyzed. The non aspiration technique was found to be superior to the classical aspiration technique for fine needle sampling of thyroid in all aspects. However, for breast lesions, while the discomfort felt and the staining with blood was less with the non aspiration technique, the overall cellular yield was unsatisfactory. The adequacy of cellular yield was, however, comparable for malignant breast lesions with either technique. For lymph node sampling, both techniques showed equivalent results with regard to the cellularity but, the NASP technique was superior in other aspects. Although the overall patient discomfort and blood staining was significantly less, the adequacy of the cellularity was influenced by the site and the nature of the lesion. Thus it can be concluded that the technique needs to be selected depending on the anatomic site, the clinical situation, the personal experience and the preference of the operator.

Biopsy, Needle↗
PubMed1998

An evaluation of transvaginal ultrasound-guided aspiration of simple adnexal cysts.

We carried out this clinical study to evaluate the benefits the risks of transvaginal ultrasound-guided aspiration in a group of patients. The study group consisted of 22 premenapausal women who were detected as having benign adnexal cysts, based on ultrasound appearances. Before the procedure, all patients were evaluated thoroughly by pelvic examination, transvaginal ultrasound and serum measurements of CA-125. Oestradiol CA-125, follicle stimulating hormone, luteinising hormone and progesterone were analysed in aspirated cystic fluids as well as cytological evaluation. It was concluded that measurements of follicle stimulating hormone, luteinising hormone, oestradiol and progesterone concentrations in cystic fluid had no prognostic significance. But CA-125 levels over 55 iu/ml were likely to predict the recurrence of the cysts. Cytological examination of the aspirated cystic fluids revealed that 21 cysts were benign functional cysts, but one was serous cystadenoma. We observed recurrence following aspiration in five patients (22.7%) who were followed for 6 months. Patients with simple ovarian cysts will benefit from transvaginal ultrasound-guided aspiration by being saved from surgery and its related complications. However, its use should be limited to those masses that appear to be completely cystic with well-defined borders, because of the risk of the intra-abdominal spillage of the contents of complicated cysts.

Journal Article↗
PubMed1997

Bacterial isolates from blood and lung aspirate cultures in Gambian children with lobar pneumonia.

As part of a study of the aetiology of pneumonia in malnourished and well nourished children, 100 children aged between 3 and 58 months with pneumonia were investigated using blood culture and culture of lung or pleural aspirates. In 44 children one species of bacterium was isolated from blood (6), lung culture (30), or both (8), while in eight children two species were isolated. In four of these eight children, one organism was isolated from blood culture, while a different organism was isolated from lung or pleural aspirate, indicating that blood culture does not always reflect the true aetiology of pneumonia. In this group of children with lobar pneumonia or empyema, blood culture alone yielded a bacterial pathogen in 18 (18%) cases, while the addition of percutaneous lung aspiration or pleural aspiration increased the yield to 52 (52%). In experienced hands the procedure of percutaneous lung aspiration is safe. It gave significant therapeutic advantages to the six children in this series from whom Staphylococcus aureus or Mycobacterium tuberculosis were isolated.

Bacteremia↗
PubMed2006

Value of repeat ultrasound-guided fine-needle aspiration in nodules with benign cytological diagnosis.

PURPOSE: To assess the value of repeat ultrasound-guided fine-needle aspiration (US-FNA) in nodules with benign cytological diagnosis. MATERIAL AND METHODS: One-hundred-and-eighty-seven patients undergoing repeat US-FNA were included after a benign cytological diagnosis had been made by the initial US-FNA. They were divided into a re-aspiration group, who underwent repeat US-FNA within 6 months for a discordant pathological and clinico-radiological result, and a follow-up aspiration group, who underwent repeat US-FNA after 6 months without any clinical or radiological suspicion. The cancer rate in each group and the US findings of the later-diagnosed malignant nodules were assessed. RESULTS: Nine malignancies were verified in the 187 cases (4.8%) by repeat US-FNA or surgery. In 44 patients in the re-aspiration group, 6 malignancies were identified (13.6%), compared with 3 malignancies in the 143 patients in the follow-up aspiration group (2.1%) (P<0.05). The later-diagnosed malignant nodules were an average of 1.0 cm in diameter; 66.7% were round; 66.7% were circumscribed; 100% were solid; 88.9% were hypoechoic; and 55.6% contained calcifications on US. CONCLUSION: The follow-up of nodules with benign cytological diagnosis without clinicoradiological suspicion of malignancy is warranted using imaging surveillance rather than repeated US-FNA.

Adult↗
PubMed2004

Can the aspiration detected by videofluoroscopic swallowing studies predict long-term survival in stroke patients with dysphagia?

PURPOSE: This study aimed to evaluate whether the aspiration detected by videofluoroscopic swallowing study (VSS) could predict the long-term survival in stroke patients with dysphagia in the post-acute phase of stroke. METHODS: A cohort of 182 consecutive patients with stroke-related dysphagia referred for VSS from July 1994 to April 1999 was retrospectively constructed. VSS findings and clinical features in the post-acute phase of stroke were recorded. The records thus obtained were then linked to the National Death Register to track the occurrence of patient deaths until December 31, 2000. RESULTS: Of the 182 patients, 91 (50%) showed aspiration during VSS performed for a median duration of 8.4 weeks after stroke, and 76 (42%) had silent aspiration. In the post-acute phase of stroke (14.7 +/- 8.7 weeks after stroke, mean + standard deviation), 56 (31%) were tube-fed, and 88 (48%) were wheelchair-confined. A total of 65 patients died in a median follow-up duration of 30.8 months after VSS. Patients were classified into three groups based on the findings of VSS-detected aspiration or penetration, but no difference was noted in their survival curves. In the Cox stepwise regression analysis, only advanced age, recurrent stroke (hazard ratio 1.74, 95% CI 1.06-2.85), the need of tube-feeding (hazard ratio 2.07, 95% CI 1.19-3.59), and being wheelchair-confined (hazard ratio 2.83, 95% CI 1.54-5.19) during follow-up were independent predictors of long-term survival. CONCLUSIONS: VSS-detected aspiration during the post-acute phase of stroke was not predictive for the long-term survival in stroke patients with dysphagia.

Adult↗
PubMed2001

Rigid nasal endoscopy versus sinus puncture and aspiration for microbiologic documentation of acute bacterial maxillary sinusitis.

Sinus puncture and aspiration is an invasive procedure that hinders patient enrollment in studies of acute bacterial maxillary sinusitis (ABMS). Pain and minor bleeding also limit its potential diagnostic utility in clinical practice. Cultures obtained by rigid nasal endoscopy were compared with those from sinus puncture and aspiration in 53 patients with ABMS; 46 patients were assessable. Considering recovery of Haemophilus influenzae, Moraxella catarrhalis, or Streptococcus pneumoniae from puncture and aspiration as the gold standard, endoscopy cultures demonstrated a sensitivity of 85.7% (95% confidence interval, 56.2-97.5), specificity of 90.6% (73.8-97.5), positive predictive value of 80% (51.4-94.7), negative predictive value of 93.5% (77.2-98.9), and accuracy of 89.1% (75.6-95.9). Ten adverse events related to puncture and aspiration occurred in 5 (9.6%) of 52 patients; there were no endoscopy-related adverse events. In our study, the largest to date, endoscopic sampling compared favorably with puncture and aspiration for identifying H. influenzae, M. catarrhalis, and S. pneumoniae in ABMS and produced less morbidity.

Acute Disease↗
PubMed1999

Hydraulic analysis of the functional properties of saline-jet aspiration thrombectomy catheters.

The purpose of this paper is to clarify the functional properties of a saline-jet aspiration thrombectomy catheter based on hydraulics. This catheter, developed by the authors, aspirates intravascular thrombi by means of the effect of a high-speed jet. We have derived the relationships between Qs, Qa, and p(n), where Qs is the water supply rate, Qa is the water aspiration rate and p(n) is the negative pressure created in the distal lumen of the catheter. The relationships are represented by simple equations using c1 and c2, where c1 and c2 are coefficients proper to the catheter. We have obtained c1 and c2 experimentally for three types of catheter with different distal shapes. Two practical conclusions are derived from this study. First, making a short taper at the distal end increases the negative pressure created and is advantageous for thrombus aspiration. Second, making the diameter of the inner tube and nozzle smaller is essential for improving the aspiration ability of the catheter.

Catheterization↗
PubMed1994

Breast fine-needle aspiration. A comparison of thin-layer and conventional preparation.

Two hundred forty-two breast fine-needle aspirates prepared by the Cytyc ThinPrep Processor were compared with aspirates prepared by the conventional smear method. Palpable and nonpalpable mammographic breast lesions were aspirated and the first half of the aspirate was submitted for conventional smears and the second half was rinsed into a proprietary fixative and loaded on the ThinPrep Processor for monolayer slide preparation. The matched pairs were diagnosed and analyzed separately in a double-blinded manner and later paired for comparison. Diagnoses correlated exactly in 62% of cases. The diagnosis of fibroadenoma was made in only 4 of 21 cases on ThinPrep (19% correlation). Semiquantitative analysis of several cytologic features indicated potential pitfalls for accurate diagnosis using the ThinPrep Processor. These included loss of background constituents (such as stroma and adipose tissue), decreased cellularity and single ductal epithelial cells, and decreased cytologic detail including size, shape and nuclear texture. The ThinPrep Processor may play a role in breast fine-needle aspiration, but further investigation is warranted before it is used as a sole preparatory method.

Adult↗
PubMed1991

Fluorescent cytochemical detection of estrogen and progesterone receptors in breast fine-needle aspirates.

Estrogen and progesterone receptors were studied in fine-needle aspiration biopsy specimens of 56 patients with primary, recurrent, or metastatic breast carcinoma. The ligands, 17 B-estradiol-6-carboxymethyloxine-bovine serum albumin fluorescein isothiocyanate (FITC-BSA estradiol) and hydroxyprogesterone hemisuccinate bovine serum albumin tetramethyl rhodamine isothiocyanate (TMRITC-BSA progesterone), were used in the fluorescent cytochemical method. The findings obtained from the aspirated cells with the use of the fluorescent cytochemical technique were compared with results obtained from the cell population of the same tumor after removal with the use of both the fluorescent cytochemical technique and the biochemical dextran-coated charcoal (DCC) assay. For the needle aspirates, there was 89% concordance for estrogen receptor and 86% concordance for progesterone receptor between biochemical and cytochemical results. A high degree of correlation was also demonstrated between fine-needle aspirates and imprint preparations with the use of the cytochemical technique. This study suggests that the fluorescent cytochemical technique is an effective tool in assessment of estrogen and progesterone receptor content in fine-needle aspirates of primary and metastatic breast cancer. The fluorescent cytochemical technique can be performed easily at community hospitals and is well suited for specimens of insufficient size for biochemical assay.

Adult↗
PubMed2000

Short-term breast cancer prediction by random periareolar fine-needle aspiration cytology and the Gail risk model.

BACKGROUND: : Biomarkers are needed to refine short-term breast cancer risk estimates from epidemiologic models and to measure response to prevention interventions. The purpose of our study was to determine whether the cytologic appearance of epithelial cells obtained from breast random periareolar fine-needle aspirates or molecular marker expression in these cells was associated with later breast cancer development. METHODS: : Four hundred eighty women who were eligible on the basis of a family history of breast cancer, prior precancerous biopsy, and/or prior invasive cancer were enrolled in a single-institution, prospective trial. Their risk of breast cancer according to the Gail model was calculated, and random periareolar fine-needle aspiration was performed at study entry. Cells were characterized morphologically and analyzed for DNA aneuploidy by image analysis and for the expression of epidermal growth factor receptor, estrogen receptor, p53 protein, and HER2/NEU protein by immunocytochemistry. All statistical tests are two-sided. RESULTS: : At a median follow-up time of 45 months after initial aspiration, 20 women have developed breast cancer (invasive disease in 13 and ductal carcinoma in situ in seven). With the use of multiple logistic regression and Cox proportional hazards analysis, subsequent cancer was predicted by evidence of hyperplasia with atypia in the initial fine-needle aspirate and a 10-year Gail projected probability of developing breast cancer. Although expression of epidermal growth factor receptor, estrogen receptor, p53, and HER2/NEU was statistically significantly associated with hyperplasia with atypia, it did not predict the development of breast cancer in multivariable analysis. CONCLUSION: : Cytomorphology from breast random periareolar fine-needle aspirates can be used with the Gail risk model to identify a cohort of women at very high short-term risk for developing breast cancer. We recommend that cytomorphology be studied for use as a potential surrogate end point in prevention trials.

Adult↗
PubMed2005

Late presentation of tracheobronchial foreign body aspiration in children.

The diagnosis of tracheobronchial foreign body (FB) aspiration in children is often delayed or overlooked. The aim of this study is to examine the causes of delay (>1 month) in the diagnosis and to study the complications of late presentation and their management. During the period between July 1993 and August 2002, 128 patients with suspected FB aspiration were admitted to KKUH, Riyadh, Saudi Arabia. Twenty-eight patients out of 128 patients presented late (>1 month). The medical records of those 28 patients were reviewed in respect to: history of FB aspiration, physical signs of symptoms, reason for delayed presentation, radiological investigation, complications and their management, and follow-up. There were 16 males and 12 females; the average age was 3.28 years (range 1--11 years). All of them experienced chronic cough at presentation. Thirteen (48 per cent) children had a history suggestive of FB aspiration. Seventeen (63 per cent) children presented with complications that included pneumonia (n=13), bronchiectasis (n=3), and bronchoesophageal fistula (n=1). The diagnostic delay was attributed to physician misdiagnosis (n=9), failure by parents to seek early medical advice (n=4), patients left against medical advice (n=1), and the cause of delay was unknown in the remaining 14 children. Rigid bronchoscopy was performed in all patients. FB was found in all cases except four. Complications were treated as follows: pneumonia with intravenous antibiotics, bronchiectasis conservatively and bronchoesophageal fistula repaired surgically. Follow-up ranged from 6 to 48 months. Diagnostic delay of tracheobronchial FB aspiration has significant morbidity in children. A high index of suspicion and early referral are essential in preventing such complications.

Adrenal Cortex Hormones↗
PubMed1986

Aspiration cytology of cutaneous metastatic melanoma and epidermoid carcinoma of the penis.

Aspiration biopsy cytology is an accurate, safe, innocuous alternative to excisional biopsy in diagnosing the nature of concomitant superficial nodules or lymphadenopathy in patients with known cutaneous malignancy. In patients with penile cancer, aspiration biopsy cytology may avoid the morbidity (30-50%) and mortality (3%) of groin dissection staging. A positive aspirate is conclusive of Stage III tumor and, in patients with occult nodal metastases, may lead to early curative lymphadenectomy. In the present study of 28 patients with known cutaneous malignant melanoma, the aspiration biopsy cytology of 31 superficial nodules resulted in a cytologic diagnosis of metastasis in 29 nodules from 26 patients. In the management of patients with known melanoma, the positive cytology of superficial nodules is conclusive of metastatic disease and requires an accurate radiologic study to establish or exclude disseminated disease. Surgical removal of a metastatic superficial nodule is indicated when the lesion is considered localized disease and the patient, having been accurately examined, is determined to be apparently free of disease in other sites and organs. When systemic diffuse melanoma is found, the excision of metastatic superficial nodules is unnecessary. Positive aspiration cytology may avoid risk from ill-judged surgical procedures and indicate appropriate palliative treatment of the disease.

Biopsy, Needle↗
PubMed1997

Diagnostic screening of systemic amyloidosis by abdominal fat aspiration: an analysis of 100 cases.

Congo red staining of abdominal fat aspirates was used as a screening procedure for systemic amyloidosis in 100 consecutive patients with symptoms suggestive of systemic amyloidosis. Nine samples were positive for amyloid. To assess the reliability of the method, we reviewed the patients' clinical records and their other biopsy data. All nine patients with positive fat specimens had a clinical course suggestive of amyloidosis. Fat aspirates were positive in nine of 11 patients with documented systemic amyloidosis. The sensitivity of the abdominal fat aspiration-amyloid technique was 82%, its specificity was 100%, and the predictive value of a positive result was 100%. Sixteen patients underwent both cutaneous biopsy and abdominal fat aspiration, and the results of Congo red staining were concordant in all cases. Although this method requires training to avoid sampling difficulties, abdominal fat aspiration is a highly reliable screening procedure for the diagnosis of AL amyloidosis, AA amyloidosis, and familial amyloidotic neuropathy (FAP).

Abdomen↗