Percutaneous fine needle biopsy.
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Biopsy, Needle↗
Biomedical subjects
S Torp-Pedersen
Publications and source records attributed to S Torp-Pedersen.
Ultrasonically guided fine needle aspiration biopsy of retroperitoneal mass lesions.
Ultrasonically-guided fine needle aspiration biopsy of retroperitoneal mass lesions was performed in 96 consecutive patients. The puncture was done transperitoneally, guided by a dynamic scanner. The procedure is rapid with a high diagnostic sensitivity and specificity. A correct cytological diagnosis was established in 88% of the punctured masses with no false positives. Guided fine needle aspiration biopsy is recommended as an integral part of the ultrasound study of retroperitoneal tumour diagnosis. There were no complications to any of the biopsies and the risk is regarded as minimal.
Biopsy, Needle↗
Histological sampling with a 23 gauge modified Menghini needle.
A 23 gauge modified Menghini (Surecut) needle biopsy technique for obtaining tissue core biopsies was compared with the conventional fine needle aspiration biopsy technique in the diagnosis of ultrasonically detected abdominal mass lesions. In 30 consecutive cases (19 malignant and 11 benign), adequate material for histological examination was obtained in 87% and for cytological examination in 97%. The diagnostic accuracy with respect to malignancy was 84% for histology and 89% for cytology. The predictive value of malignancy was 100% in both. The histological material provided additional information in four cases of malignancy, concerning the type and origin of the tumours, and in nine cases of benign lesions, indicating the type of lesion that appeared as a tumourlike mass in the ultrasound study. The Surecut needle biopsy has been found valuable in obtaining histological material from abdominal mass lesions and may supplement or even replace the fine needle aspiration biopsy in such lesions.
Abdominal Neoplasms↗
Ultrasonically guided fine-needle aspiration biopsy of gastrointestinal mass lesions.
Ultrasonically guided fine-needle aspiration biopsy was performed in 78 patients with ultrasonically demonstrable typical gastrointestinal mass lesions. Of these patients, 61 later proved to have malignant lesions (18 in the stomach, three in the small intestine, and 40 in the colon or rectum), and 17 had benign lesions. In 50 of 61 cases of malignant lesions, the cytologic diagnosis was positive for cancer. There were no false positives. It is concluded that when a structure with the ultrasonic characteristics of a gastrointestinal mass lesion is disclosed, fine-needle aspiration biopsy can safely and conveniently differentiate between malignant and benign lesions in most cases. The ultrasonically guided biopsy is suggested as an alternative to endoscopically guided biopsy.
Biopsy, Needle↗
Major complications and deaths due to interventional ultrasonography: a review of 8000 cases.
Complications related to approximately 8000 ultrasound-guided punctures performed in our institution during the last 19 years are reported. This study includes 3500 fine needle biopsies, 700 large bore needle biopsies, 2800 punctures of fluid collections using either a 1.2-mm spinal needle or a 7.5 F pigtail catheter, and 1000 percutaneous nephrostomies. The majority were abdominal punctures. The complication rate was 0.187% (0.100% to 0.313%) and the mortality rate 0.038% (0.013% to 0.113%). Using the fine needle data exclusively, these rates were 0.200% (0.086% to 0.400%) and 0.028% (0.000% to 0.171%), respectively. The 95% confidence limits are in brackets.
Adult↗
A randomized, controlled study of a single intra-articular injection of etanercept or glucocorticosteroids in patients with rheumatoid arthritis.
OBJECTIVE: Glucocorticosteroids are used successfully for both systemic and intra-articular treatment of arthritis. Inhibitors of tumour necrosis factor alpha (TNF-alpha) are effective when administered systemically and this study was performed to compare the effect of intra-articular injection of these two substances. DESIGN: A randomized, parallel-group, double-blind study with an independent observer. Thirty-eight patients with flare of arthritis in a single joint (wrist, elbow, or knee) were given intra-articular 25 mg etanercept or 40 mg methylprednisolone guided by ultrasound. The primary end-point was the 4-week change in pain in the target joint. The study complied with Good Clinical Practice (GCP) and the Consolidated Standards for Reporting of Trials (CONSORT) statement. RESULTS: At 4 weeks no difference in pain outcome between treatment groups was demonstrated by analysis of covariance (ANCOVA). Pain on the Visual Analogue Scale (VAS) for etanercept was baseline mean 40.9 (SD 19.6) mm, follow-up 32.7 (29.1) mm (p = 0.29), methylprednisolone baseline mean 47.1 (29.6) mm, follow-up 25.3 (24.7) mm (p<0.001). The investigator's evaluation was for etanercept baseline 30.6 (21.2) mm, follow-up 17.1 (15.5) mm (p = 0.054) and for methylprednisolone baseline 35.4 (26.4) mm, follow-up 11.9 (14.6) mm (p = 0.012). Joint swelling was for etanercept baseline 1.78 (0.73), follow-up 1.25 (0.77) (p = 0.015) and for methylprednisolone baseline 1.74 (0.73), follow-up 0.71 (0.77) (p<0.001). One serious adverse event was seen in a patient treated with methylprednisolone injection. CONCLUSION: Although no difference between groups was demonstrated, the within-group effect of methylprednisolone was more marked than that of etanercept. Injections with 25 mg etanercept were well tolerated. However, the cost of etanercept will presumably limit its use to patients with adverse reactions to steroid.
Adult↗
Imaging of intratendinous distribution of glucocorticosteroid in the treatment of Achilles tendinopathy. Pilot study of low-field magnetic resonance imaging correlated with ultrasound.
OBJECTIVE: Recently, a positive treatment effect of intratendinous injections of steroid in Achilles tendonitis (AT) has been described. Our aim was to test the localization and distribution of the injected steroid in both healthy (animal) tendons and in diseased human Achilles tendons. MATERIAL AND METHODS: Four pig tendons were injected in vivo and harvested. The harvested tendons were placed in 0.2 Tesla MRI scanner, in order to select the optimal MRI sequences for tracking and localizing the bolus injection. Three patients with AT were treated with intratendinous steroid injection. Injections were placed in the pathologic areas of the tendon guided by ultrasound (US). MRI and US were performed at baseline and again immediately and 60 minutes after injection. A final follow-up MRI was performed 1 month after the injection. RESULTS: In the animal model, significant recoil of the injected substance was seen in all cases. In all three patients the injection was readily distributed within the tendon and no recoil through the injection channel was found. One-month follow-up showed a total regression of hyperaemia on US as well as regression of intratendinous oedema on MRI in all 3 patients. CONCLUSION: It is possible to demonstrate the distribution pattern of injected steroid in diseased Achilles tendons by MR-imaging. In contrast to the recoil experienced in the healthy tendon of the animal, the lack of recoil of the injected volume through the injection channel in the sick human tendon may be caused by a derangement of the fibre structure, which allows the extra volume to be distributed within the lesion. This indicates that the effect on AT of intra-tendinous injections of steroid is due to a local intra-tendinous action of the drug.
Achilles Tendon↗
Ultrasonically guided fine needle aspiration of suggested enlarged parathyroid glands.
Ultrasonically guided fine needle aspiration from 22 ultrasonically suspect enlarged parathyroid glands was performed in 21 consecutive patients with biochemically confirmed hyperparathyroidism. Histologic examination revealed parathyroid tissue in 20 and thyroid tissue in 2 of the 22 ultrasonically suspect parathyroid glands. The aspirated material (21 patients) was analysed for PTH content and compared with the PTH content in aspirates from corresponding thyroid tissue. In all but one, a higher PTH content was found in aspirates from parathyroid glands. Further, the aspirated material (16 patients) was cytologically examined for parathyroid cells. In 10 of 14 histologically confirmed parathyroid glands cells of parathyroid origin were found, but in 4 cases only cells of endocrine origin were seen. The results and the use of fine needle aspiration in relation to the ultrasonic findings are discussed.
Adult↗
Nine pheochromocytomas in the same patient. Final mapping with ultrasound and angiography.
A 37-year-old man presented with hypertension and elevated urine catecholamine. Ultrasound scanning revealed a solid tumour of the right adrenal gland and two solid tumours in the retroperitoneum. The findings were confirmed with computed tomography and abdominal angiography. At surgery only the tumour of the right adrenal gland was removed. The histopathologic diagnosis was pheochromocytoma. Postoperatively the symptoms and biochemistry were unchanged and the patient was referred for further treatment. At ultrasonography and abdominal aortography 6 remaining tumours were demonstrated. Surgery was performed and 8 pheochromocytomas were extirpated (3 were closely spaced small tumours in a conglomerate corresponding to one of the visualized tumour sites). On histopathologic examination no signs of invasive growth were found. The patient recovered completely. The blood pressure was still normal 2 1/2 years later. Angiography and non-invasive examination of the entire abdomen and pelvis should be routine when pheochromocytomas are searched for.
Adrenal Gland Neoplasms↗