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PubMed1996

Deaths due to foreign body aspiration in children: the continuing hazard of toy balloons.

Asphyxia due to aspiration of a foreign body is a common cause of accidental death in children. Foreign body aspiration is the most likely cause of accidental fatalities in children under 1-year-of-age. Children may die due to airway obstruction by food objects such as hot dogs, nuts, candies, grapes, seeds, and egg shells. Non-food objects such as balloons, coins, pop tops of beverage cans, pills, safety pins, ball bearings, marbles, and baby powder also may be fatally aspirated. To better understand and help prevent this well recognized health risk to children, we reviewed 10 years of cases at the Cook County Medical Examiner's Office in which deaths in children 14-years-of-age and younger were due to aspiration of foreign objects. The most common item that caused fatal aspiration in our series was a toy balloon.

Adolescent↗
PubMedDate not supplied

Personal values related to primary care specialty aspirations.

BACKGROUND AND OBJECTIVES: Two recent studies showed that personal values influence specialty choice. However, both studies assessed the perceived influence of values instead of measuring values directly. The present study measured and compared the values of aspirants to primary care versus other specialties. METHODS: In 1993, first-year medical students, entering residents, and graduating residents at a private Midwestern medical school completed a questionnaire on their specialty aspirations and completed the Schwartz Values Survey, which measures the importance of 10 types of values: achievement, benevolence, conformity, hedonism, power, security, self-direction, stimulation, tradition, and universalism. A three-factor MANOVA (specialty aspiration, gender, level of training) was performed on the importance ratings. RESULTS: The three MANOVA main effects were significant. Primary care aspirants rated power and self-direction values lower and benevolence values higher than did aspirants to other specialties. Women gave higher ratings to universalism and benevolence and lower ratings to power, tradition, and conformity values than did men. Medical students rated security values lower than did the two resident groups. CONCLUSIONS: This study demonstrates the relationship of personal values and specialty choice and provides empirical support for admissions policies that incorporate personal values into the admissions process.

Career Choice↗
PubMed1996

Analysis of intra-operative aspirates taken during microsurgical refertilization in obstructive azoospermia--preliminary results. The BMFT Study Group for Microsurgery, Giessen.

The reasons for the discrepancy between 'patency' and 'pregnancy' in the outcome of microsurgical refertilization are partially unknown. The quality of the intra-operative aspirate and of the spermatozoa at the level of the anastomosis are discussed worldwide as important factors influencing the success of fertilization in the case of post-operative patency. In 152 men undergoing microsurgical refertilization (vasovasostomy, tubulovasostomy, microsurgical epididymal sperm aspiration, transurethral resection of the ejaculatory duct), 281 aspirates were classified intra-operatively according to Silber, and post-operatively using the Shorr staining technique. In 62 aspirates a computer-aided sperm analysis (CASA) was performed. The percentage of intact spermatozoa decreased from 94.9% at the caput to 9.4% at the cauda epididymidis. The post-operative classification demonstrated an acceptable correlation (0.71) to all grades of intraoperative classification. There was a good correspondence in Silber 4 and 5 but worse in Silber 1 and 2. In CASA, the percentage of motile spermatozoa was not different between epididymal and post-epididymal aspirates. Furthermore, velocity parameters did not differ significantly, but there was a significantly higher straightness of post-epididymal spermatozoa in comparison to epididymal spermatozoa.

Adult↗
PubMedDate not supplied

Aspiration cytopathology of lymphoblastic lymphoma and leukemia: the MCV experience.

Malignant lymphoma, lymphoblastic type (LL), and acute lymphoblastic leukemia (ALL) are two well-known pediatric malignancies whose diagnoses are typically established by surgical tissue biopsy and/or bone marrow examination. The status of fine-needle aspiration (FNA) biopsy in the diagnosis and management of these lymphoblastic malignancies is controversial. We present our experience from the past 7 years using FNA in children from 10 months to 15 years (mean age 10.5 years) of age with lymphoblastic cancers; in addition, two adult patients with ALL are included. Superficial FNA was performed in 16 cases (one patient had two aspirations 16 months apart). Eight patients were diagnosed with LL, six with ALL, and the one patient with two separate aspirates had lymphoblastic transformation of chronic myelogenous leukemia (CML). Five patients presented with the superior mediastinal syndrome. Sites of FNA included lymph node (nine cases), parotid gland (one), and soft tissues of the neck (four), buttock (one), and forehead (one). There were no complications from FNA. Except for one case (case 8), the patients with ALL and CML were previously diagnosed and treated for their disease, and FNA was performed primarily for the detection of disease recurrence. Conversely, in all eight children with LL, FNA was performed as the initial procedure to establish a primary diagnosis in previously well individuals. All eight LL patients responded-some dramatically-to chemotherapy. Two patients with LL and one with lymphoid blast crisis arising in CML had subsequent surgical biopsies that confirmed the FNA diagnosis. Immunophenotyping performed from 15 of 16 aspirates confirmed the T cell derivation of all cases of LL and 4 of 6 of ALL. Two of the ALL cases had a pre-B cell phenotype. Sufficient cells were obtained by FNA for flow cytometric DNA analysis in 9 of 16 cases. All cases but one were diploid, and 6 of 9 showed a high (> 6%) S phase. Our experience suggests that, when combined with immunologic phenotyping, definitive initial pathologic diagnosis of LL and recurrent ALL is possible and preferable using only aspiration cytopathology. It should be considered as part of the initial evaluation and management whenever a mass lesion appears in a child with a suspected lymphoblastic neoplasm. It can preclude the need for a surgically procured piece of tissue in those with a mediastinal mass and the superior mediastinal syndrome.

Adolescent↗
PubMed1997

Fine-needle aspiration: technique and smear preparation.

Fine-needle aspiration is a rapid, accurate and inexpensive method to obtain a tissue specimen for diagnosis of suspicious lesions. The number of fine-needle aspirations performed can be expected to increase in this era of cost-conscious medicine. However, an accurate diagnosis is highly dependent on the quality of the smears, adequate clinical information and the experience of the pathologist. The clinician must be able to perform this procedure skillfully and provide good smears. Fine-needle aspiration skills can be learned by using the techniques described in this article and by continued training and experience. The most important factors are immobilization of the mass, the use of very small fine needles, sampling both with and without aspiration, use of multiple passes with the needle, reaspiration of any residual mass after fluid drainage if a cyst is encountered, aspiration of the margins of large masses, the two-slide smearing technique and rapid fixation of smears. Finally, extensive clinical information must be supplied to the pathologist interpreting the smears.

Biopsy, Needle↗
PubMed1995

Microsurgical autogenous sperm reservoir with simultaneous epididymal sperm aspiration: a novel approach for the man with surgically unreconstructable obstruction.

The purpose of this article is to present a technique for microsurgical marsupialization of an epididymal tubule to the tunica vaginalis to create an autogenous sperm reservoir (ASR) with simultaneous epididymal aspiration. This procedure is offered to men with bilateral congenital absence of the vas deferens (CAV) or otherwise surgically unreconstructable reproductive tracts. Sperm (mean +/- standard error of the mean, 33 +/- 13 x 10(6)) have been percutaneously recovered by fine needle aspiration of an ASR in 47% (7/15) of men. Motile sperm have been recovered as long as 2 years following surgery. Simultaneous epididymal aspiration at the time of marsupialization has yielded a mean of 20.2 +/- 6.9 x 10(6) total sperm per aspirate. Thawed sperm, recovered and cryopreserved at the time of ASR surgery, has been successfully employed for two couples in pregnancies achieved with in vitro fertilization. The microsurgical ASR is a viable alternative in the treatment of men with CAV or otherwise unreconstructable reproductive tracts. Simultaneous epididymal sperm aspiration maximizes a couples fertility options with a single surgical procedure.

Cryopreservation↗
PubMed1997

[Relationship between the presence of side-holes in bone marrow aspiration needle and the number of harvested bone marrow mononuclear cells].

The aim of this study was to evaluate the yield of nucleated cells in bone marrow harvested by means of Downs' Islam aspiration needles with or without side-holes. Twenty marrow donors for HLA identical sibling transplants were studied. Bone marrow nucleated cells were harvested 50 ml in the right iliac bone with a Downs' Islam aspiration needle with or without side-holes and 50 ml in the left with another kind of needle by means of 5 ml aspirations in each donor. There were no significant difference between the number of nucleated cells by means of Downs' Islam aspiration needles with and without side-holes by cross-over analysis. All nucleated cell counts were 33.06 +/- 12.93 x 10(3)/microliter (mean +/- standard deviation) by means of the needle with side-holes and 32.90 +/- 15.25 x 10(3)/microliter by means of the needle without side-holes. The Downs' Islam aspiration needle without side-holes seems to be better in bone marrow harvest from normal volunteers than that with side-holes, because the former may be stronger than the latter.

Adolescent↗
PubMed1997

The use of fine needle aspiration biopsy in the management of thyroid disease.

Fine needle aspiration biopsy is now a first line investigation in thyroid disease. The purpose of this study was to evaluate the results of this technique in comparison with routine histopathology. A total of 593 aspirations over a four year period were included. There were 390 (65.7%) solitary nodules, 124 (20.9%) multinodular goiters, 66 (11.1%) diffuse goitres and 13 (2.2%) recurrent post thyroidectomy nodules. Radioisotope scanning in 386 cases showed 325 (84.2%) cold nodules, 54 (14.0%) warm nodules and 7 (1.8%) hot nodules. There were 458 (77.2%) colloid goitres and cysts, 14 cases of thyroiditis (2.2%) and 30 malignancies diagnosed on fine needle aspiration biopsy. In 19 cases (3.2%) a diagnosis of follicular neoplasm and in 29 cases (4.9%) a diagnosis of suspicious aspirate was made. Histological results were available in 176 cases. In 108 cases findings of histology and FNAB were compared with radioisotope scanning. A sensitivity of 92.8% and 42.8%, a specificity of 90.1% and 98.7% and accuracy index of 90.3% and 94.3% was found, when considering suspicious cases alternatively as positives and negatives. Surgery was recommended in all suspicious cases to prevent reduction in sensitivity of the technique. Fine needle aspiration biopsy was found to be a highly effective procedure which can obviate a lot of unnecessary surgery in thyroid lesions.

Adolescent↗
PubMedDate not supplied

Transvaginal ultrasonographically controlled aspiration of ovarian endometriomas.

Evaluation of the results of the fine needle ultrasonographically directed aspiration of ovarian endometriomas in relation to the efficacy of aspiration of the content, invasiveness, recurrences and complications. The investigation included 30 patients--28 with unilateral and 2 with bilateral ovarian endometriosis in whom 36 aspirations have been performed. Total evacuation of the content was achieved during the first effort in 26 patients versus 4 patients in whom a repeated procedure had to be done. All the patients were controlled during the 1 year post-aspiration period, on average. The recurrence rate was 56.66%. Complications have not been recorded. The transvaginal ultrasonographic fine needle aspiration of the ovarian endometriomas is associated with a high incidence of recurrences but it proved to be a simple, safe, cheap and minimally invasive technique which can be repeated for several times if necessary, in selected patients.

Adolescent↗
PubMed1998

Percutaneous needle aspiration in the treatment of hepatic abscess: factors influencing patients' outcome.

Sixty-four consecutive cases of hepatic abscess diagnosed over a 6-year period and all treated by ultrasound-guided percutaneous needle aspiration and systemic antibiotics were retrospectively reviewed to ascertain factors influencing the outcome in these patients. The 64 patients had in total 101 liver abscesses which averaged 4.7 cm in diameter. Two patients (3.1%) required surgery for associated biliary tract disease. Five patients (7.8%) died from septicaemia and/or serious condition or malignancy. The remaining 57 patients (89.1%) were successfully treated--45 cases (70.3%) showed fully-resolved abscess/es after a mean period of 69.9 days after initial aspiration; 12 patients (18.8%) showed markedly-shrunken abscess cavity size over an average of 30.7 days and all were asymptomatic on discharge from hospital. No correlation was demonstrated between number of abscesses and successful patient recovery--42 of 46 patients (91.3%) with solitary hepatic abscess recovered, 6 of 8 patients (75.0%) with 2 abscesses and 9 of 10 patients (90.0%) with more than 2 abscesses were successfully treated. No correlation was detected between abscess size and number of aspirations required, majority of abscesses (73.3%) requiring no more than two aspirations irrespective of their sizes. Of the 57 patients cured, no significant correlation between abscess size and degree of abscess healing was evident. Our results demonstrate the effectiveness of percutaneous needle aspiration and it should be considered a first-line treatment in the management of liver abscess, irrespective of their number and sizes.

Adolescent↗
PubMed1998

The feasibility of peripheral blood stem cell collection for autograft following failure in bone marrow aspiration.

High doses of cytotoxic drugs may impair stem cell collection. Failure in stem cell collection by bone marrow aspiration can be rescued by harvesting Peripheral Blood Stem Cell (PBSC) after a combination of chemotherapy and hematopoietic growth factor. We, therefore, retrospectively evaluated the possibility of collecting PBSC after chemotherapy and/or G-CSF administration in 12 patients with insufficient Granulocyte-macrophage colony-forming unit (CFU-GM) counts after bone marrow aspiration (all patients had previously received heavy chemotherapy for hematologic malignancies); median collection of CFU-GM/kg count was 2,9 x 10(4)/kg (range 0,4 to 8 x 10(4)/kg) whereas the minimal count required for autografting is 10 x 10(4)/kg. Median collections of CFU-GM from PBSC were 5,8 x 10(4)/kg. While the CFU-GM collected in PBSC was higher than after bone marrow aspiration, only 5 patients had enough PBSC for autografting. In another case, addition of cells collected from both PBSC and bone marrow aspiration yielded a sufficient number of CFU-GM to allow autografting. Therefore in this selected and small group of patients, failure in bone marrow aspiration does not seem to be predictive of a low PBSC collection but a long therapy free interval and use of G-CSF alone for PBSC mobilization could constitute a valuable alternative. Three patients had a successful short term hematologic reconstitution out of the four patients having had an autograft.

Adult↗
PubMed1998

Percutaneous testicular sperm aspiration: a convenient and effective office procedure to retrieve sperm for in vitro fertilization with intracytoplasmic sperm injection.

PURPOSE: After intracytoplasmic sperm injection was established to facilitate in vitro fertilization in men with the most severe semen abnormalities, the use of testicular sperm to achieve conception became feasible. We investigated the use of a method of percutaneous needle aspiration previously used for diagnostic purposes to obtain testicular sperm for intracytoplasmic sperm injection. MATERIALS AND METHODS: A method of percutaneous aspiration of sperm was developed to facilitate intracytoplasmic sperm injection. A total of 69 testicular aspirations were performed for diagnostic purposes and 179 to obtain sperm on the day of egg retrieval for couples undergoing in vitro fertilization with intracytoplasmic sperm injection. The procedures were performed in an outpatient facility. Most patients received intravenous sedation and a few received only local anesthesia. RESULTS: Sperm adequate for intracytoplasmic sperm injection were obtained in all men with obstructive azoospermia, including those with significant testicular atrophy and those with anejaculation or necrospermia. Adequate numbers of sperm for intracytoplasmic sperm injection were retrieved less reliably in men with nonobstructive azoospermia. The number of sperm correlated positively with testicular size. Morbidity and discomfort were nonexistent. Sperm were obtained from 43 of 69 men undergoing diagnostic and 170 of 179 men undergoing therapeutic aspiration. Sperm motility ranged from 0 to 20% and viability from 55 to 85%. CONCLUSIONS: Percutaneous testicular sperm aspiration is a cost-effective method to retrieve sperm for intracytoplasmic sperm injection in select men with obstructive azoospermia, anejaculation and necrospermia, and some with nonobstructive azoospermia.

Equipment Design↗
PubMed1998

Specimen adequacy and false-negative diagnosis rate in fine-needle aspirates of palpable breast masses.

BACKGROUND: As fine-needle aspiration (FNA) has become a critical component of the investigation of palpable breast masses, false-negative diagnoses have become a major concern, prompting reevaluation of the definition of specimen adequacy. Although cytopathologists agree that a number of parameters relate to the adequacy of an FNA specimen, there is no unanimity on the role of epithelial cell quantitation in the determination of an adequate FNA. To better understand the significance of epithelial cellularity, false-negative FNA samples from palpable breast lesions were reviewed. METHODS: False-negative FNA smears of palpable breast masses that had been performed and assessed immediately by cytopathologists were retrieved from the files of The University of Texas M. D. Anderson Cancer Center, and the number of epithelial cell clusters (ECCs) was determined. Aspirates were classified as adequate if a total of six or more ECCs (each comprised of at least five to ten well preserved cells) were present on all slides, or as inadequate if fewer than six ECCs were present. RESULTS: From 4455 aspirates of palpable breast masses, 51 false-negative aspirates were identified, 41 of which were available for review. No interpretative errors were identified. Twenty-one FNAs (51.2%) were classified as adequate and 20 FNAs (48.8%) as inadequate. The adequate false-negative aspirates contained between 8 to 100 ECCs. A comparison of adequate and inadequate false-negative specimens showed no significant differences in the mean age of patients (56.4 years vs. 57.8 years), the mean number of FNA passes (3.7 passes vs. 3.0 passes), the mean palpation size of the lesions (2.8 cm vs. 2.9 cm), or the mean pathologic size of the lesions (2.1 cm vs. 2.2 cm). Cases of invasive lobular carcinoma were more common in the false-negative smears with fewer than six ECCs. CONCLUSIONS: Including the number of ECCs as a parameter of adequacy could reduce the rate of false-negative FNA diagnoses of palpable breast masses by approximately 50%. However, the presence or even abundance of ECCs does not eliminate the potential for a false-negative cytologic diagnosis. Cytologic diagnoses must be correlated with clinical and imaging findings (the triple test) to reduce the rate of false-negative cases, but benign triple test results do not entirely exclude the possibility of carcinoma, and such cases require periodic follow-up.

Adult↗
PubMed2004

Ampicillin + sulbactam vs clindamycin +/- cephalosporin for the treatment of aspiration pneumonia and primary lung abscess.

Aspiration pneumonia, necrotising pneumonia and primary lung abscess are complications arising from the aspiration of infectious material from the oral cavity or stomach. There is limited information on optimal antibacterial therapeutic regimens. Patients with pulmonary infection following aspiration (n = 95) were included in a prospective, open, randomised, comparative multicentre trial to compare the safety, clinical and bacteriological efficacy of ampicillin + sulbactam vs. clindamycin +/- cephalosporin. Treated patients (n = 70) received sequential antibiotic therapy with either ampicillin + sulbactam (n = 37) or clindamycin (n = 33), with or without a second- or third-generation cephalosporin, administered until the complete resolution of clinical and radiological abnormalities. Definite or presumptive pathogens were isolated from 58 patients. Mean duration of therapy was 22.7 days for ampicillin + sulbactam and 24.1 days for clindamycin. In patients treated with ampicillin + sulbactam, the clinical response was 73.0% at the end of therapy and 67.5% 7-14 days after therapy. For clindamycin, the rates were 66.7% and 63.5%, respectively. Bacteriological response was similar in both treatment arms. Nine patients died (12.9%), with a Simplified Acute Physiology Score of > 30 points being the only significant predictive factor for therapeutic failure. Ampicillin + sulbactam and clindamycin +/- cephalosporin were both well-tolerated and proved equally effective in the treatment of aspiration pneumonia and lung abscess.

Adolescent↗
PubMed1958

Diagnostic abdominal aspiration.

Aspiration of the abdominal cavity to withdraw fluid that collects in almost all cases of intra-abdominal disease that necessitates operation is a relatively easy and safe procedure that can help in deciding for or against operation in borderline cases. Diagnostic aid is given by observing the color, odor and cell content of the fluid. Inability to obtain fluid, although in general reassuring, cannot be trusted absolutely, for there may be severe disease without aspirable exudate. Sometimes the intestine may be punctured by the aspirating needle, which contaminates the aspirate but apparently does not bring about leakage of bowel content.

Abdomen↗
PubMed1975

Bacteriologic flora of aspiration-induced pulmonary infections.

The role of anaerobic and aerobic microorganisms in the genesis of pneumonia or lung abscess in patients with historical, clinical, and radiologic findings suggestive of aspiration was compared to their role in similar patients without these findings. Bacterial specimens were obtained by transtracheal aspiration or thoracentesis. Anaerobes were isolated in 100% of the patients who were aspiration-prone as contrasted with only 20% of those who were not. Isolation of a single species or no growth was more common in the nonaspiration group, whereas multiple isolates were more common in the aspiration group. Patients with lung abscesses were treated with penicillin and all of them responded clinically, despite occasional recovery from the culture specimen of penicillin-resistant organisms. This suggests that lung abscess may be the result of a synergistic bacterial infection.

Haemophilus influenzae↗
PubMed1997

A randomized controlled trial of penicillin vs clindamycin for the treatment of aspiration pneumonia in children.

OBJECTIVE: To compare the effectiveness of intravenous penicillin vs clindamycin for the treatment of aspiration pneumonia. DESIGN: A double-blind, randomized controlled trial. SETTING: A tertiary care pediatric hospital. PATIENTS: We enrolled 42 children, aged 6 months to 18 years, who were admitted to the hospital for the treatment of aspiration pneumonia. All of the children had underlying conditions that predispose to aspiration. INTERVENTION: The patients were randomly assigned to receive intravenous penicillin G sodium, 250,000 U/kg every 24 hours, or intravenous clindamycin phosphate, 30 mg/kg every 24 hours. MAIN OUTCOME MEASURE: The primary outcome measure was "time to ready for discharge" from the hospital. RESULTS: In an effectiveness (intention to treat) analysis, the median time (interquartile range) to ready for discharge from the hospital was 4.9 days (range, 2.8-6.5 days) in the penicillin-treated group and 3.4 days (range, 2.3-6.8 days) in the clindamycin-treated group (P = .66). Results were not markedly altered when adjusted for the age difference of the groups or in the efficacy analysis (after the exclusion of 9 patients who withdrew from the trial). Rates for readmission to the hospital were similar in the 2 groups. CONCLUSION: Penicillin and clindamycin seem to be equally effective for the treatment of aspiration pneumonia in children hospitalized for this illness.

Adolescent↗
PubMed1997

Meconium aspiration induces ARDS-like pulmonary response in lungs of ten-week-old pigs.

To investigate whether aspiration of meconium induces a hemodynamic and histologic pulmonary response similar to that frequently seen in experimental acute respiratory distress syndrome, twelve 10-week-old pigs with postnatally adapted lungs were studied. Six 10-week-old pigs received 3 ml/kg 20% human meconium via the endotracheal tube. Six control pigs of the same age were given sterile saline. Ventilator settings were adjusted to keep PaO2 above 8 kPa and PaCO2 below 5 kPa. The pulmonary hemodynamic response to aspiration consisted of two separate hypertensive components. An initial peak in pulmonary artery pressure (PAP) and pulmonary vascular resistance (PVR) was followed by a progressive increase in PAP and PVR in the meconium group, whereas in the saline group these parameters returned to baseline levels. The distribution of PVR, determined by pulmonary artery occlusion, was characterized by an increase in the postarterial resistance immediately after meconium aspiration and a progressive increase in both arterial and postarterial resistance during the later phase. On histological examination, marked neutrophil sequestration was seen in the meconium lungs. In addition, lung edema formation was significantly enhanced in the meconium group, as shown by an increased lung wet/dry weight ratio. Thus, meconium aspiration resulted in a biphasic pulmonary pressor response and severe pulmonary inflammation. This response resembled that of models of experimental acute respiratory distress syndrome following diverse types of precipitating insults; this suggests that similar pathophysiologic mechanisms are elicited and cause similar pulmonary dysfunction following different forms of lung injury.

Animals↗