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PubMed2006

Percutaneous needle aspiration of multiple pyogenic abscesses of the liver: 13-year single-center experience.

OBJECTIVE: The aim of this study was to report 13 years of experience in the management of multiple pyogenic liver abscesses with only percutaneous needle aspiration of the abscess cavities under sonographic guidance. MATERIALS AND METHODS: From December 1991 to October 2004, 39 consecutively registered patients (29 men and 10 women; age range, 37-82 years; mean age, 64 years) with 118 pyogenic liver abscesses were treated with sonographically guided percutaneous needle aspiration at our institution. The number of pyogenic liver abscesses per patient ranged from two to 15 (mean, 3.0). RESULTS: Eighty-seven percutaneous needle aspirations were performed on 39 patients with 118 pyogenic liver abscesses (range, 1-4 aspirations per patient; mean, 2.2 aspirations per patient). Because they were close to another aspirated abscess in the right lobe of the liver, 31 (26.3%) of 118 abscesses were aspirated without removal of the needle from the liver. Thirty-six (92.3%) of 39 patients were treated with a single aspiration of an abscess in a single session. The other three patients needed two aspiration sessions. No patient needed imaging-guided percutaneous catheter drainage or open surgical drainage. Complete reconstitution of liver parenchyma occurred within a maximum of 80 days. No abscesses recurred during the follow-up period, which ranged from 7 to 42 months (mean, 18 months). CONCLUSION: Percutaneous needle aspiration of multiple pyogenic abscesses under sonographic guidance is a safe, effective, and low-cost procedure. In our experience, percutaneous needle aspiration was acceptable to patients. Our data suggest that a trial of percutaneous needle aspiration should always be undertaken before catheter drainage or surgery.

Adult↗

PubMed1993

Therapeutic percutaneous aspiration of hepatic abscesses: effectiveness in 25 patients.

OBJECTIVE: The objective of this study was to evaluate the effectiveness of sonographically guided needle aspiration and systemic antibiotic therapy for the treatment of hepatic abscesses. SUBJECTS AND METHODS: From June 1989 to September 1991, sonographically guided needle aspiration and systemic antibiotics were used to treat 25 consecutive patients with 25 hepatic abscesses. Among 36 patients with hepatic abscesses who were admitted to the hospital during that time, six had antibiotic therapy only; of these, three had microabscesses, two had abscesses less than 3.0 cm in diameter, and one refused needle aspiration. Four patients had surgical external drainage (three had cholelithiasis in addition to hepatic abscesses, and one did not respond to needle aspiration). Two patients treated in 1989 had drainage via an indwelling catheter, which was the preferred method at that time. The remaining 24 patients and one patient who had needle aspiration followed by surgical drainage made up the study group. Seventeen of the hepatic abscesses were caused by pyogenic organisms, six by amoeba, and two by unknown organisms. Eighteen abscesses (72%) were aspirated once, four (16%) were aspirated twice in 8 days, two (8%) were aspirated three times in 14 days, and one (4%) was aspirated four times in 10 days. Persistent fever, pain and tenderness in the right upper quadrant, and leukocytosis were the indications for multiple aspirations. Follow-up sonography was performed to evaluate the outcome of treatment. RESULTS: In 16 cases (64%), the abscesses disappeared within a mean of 84 days. In eight cases (32%) with only partial follow-up, the patients were asymptomatic at the time of discharge and the abscesses were markedly smaller on the last follow-up sonograms (mean, 43 days). One patient (4%) did not respond to aspiration and had surgical drainage. The length of hospitalization varied from 5 to 42 days (mean, 22 days). In patients who became afebrile during the treatment, the fever had lasted from 0 to 10 days (mean, 3 days). Only one patient had a complication of the procedure, a pleural effusion that was treated conservatively. CONCLUSION: Our results show that sonographically guided needle aspiration combined with antibiotic therapy is effective as the initial treatment for hepatic abscesses.

Adult↗

PubMed1996

Percutaneous skeletal aspiration and core biopsy: complementary techniques.

OBJECTIVE: Although core biopsy is the standard for percutaneous bone biopsy in most other organs aspiration biopsy is frequently performed. We prospectively evaluated 138 patients with skeletal lesions, performing both core and aspiration biopsies to determine if these techniques have a complementary role. SUBJECTS AND METHODS: Over a 2-year period, 138 consecutive patients underwent skeletal biopsy. In each patient, two or three histologic cores were obtained percutaneously using standard techniques followed by a single aspiration pass with a 22-gauge spinal needle and 20 cc of negative pressure. Histologic and cytologic evaluations of cores and aspirates were interpreted according to usual pathologic and cytologic criteria. Results were classified as matches (positive or negative), mismatches (aspiration or core only positive), mismatches (either aspiration or core more specific), insufficient samples, inaccurate diagnoses, and both false-negative. RESULTS: Twenty-eight patients had specific neoplasms diagnosed on both core and aspiration biopsy, and 40 patients were negative on both. The diagnosis was made only by core in 17 and only by aspiration in 11. Core was more specific in 11, and aspiration was more specific in seven. There were three insufficient cores and 18 insufficient aspiration specimens. One false-negative result was seen by both techniques, and the cytology of two aspiration biopsies was misinterpreted. CONCLUSION: A complementary role exists for aspiration and core skeletal biopsy, and we suggest both should be routinely performed.

Biopsy↗

PubMed1999

[Scintigraphic demonstration of aspiration in long-term ventilation patients with tracheotomy].

The main complication of enteral feeding in prolonged mechanical ventilation via tracheostomy is the subsequent aspiration pneumonia. We used a scintigraphic method for the detection of enteral feeding aspiration and compared the results with clinical evidence of aspiration. The study population consisted of 62 consecutive tracheotomised patients (16 females, age: 64.1 +/- 11.1 years). The swallowing test was done in an upright or semirecumbent body position with the patients spontaneously breathing. The standard feed consisted of a liquid, semiliquid and solid meal which was labelled by 100 MBQ 99 TC. Scintigraphic aspiration (SA) was defined as positive if radioactivity was detected in the bronchial system. Clinical aspiration (CA) was defined as positive if there was cough, choking and distress after swallowing; furthermore, when receiving enteral feeding during suctioning or bronchoscopy. Both clinically significant aspiration (CA) and scintigraphic aspiration (SA) were found to be identical in 10 of 62 (16%) patients. CA, but not SA: 4/62 (6.5%). SA, but not CA (Subclinical aspiration): 4/62 (6.5%). Nor CA neither SA: 44/62 (71%) patients. Radiolabelled feed can be used as a feasible marker to detect aspiration. The test is a useful screening test and strategy to minimize aspiration. The scintigraphic method failed to identify all tracheotomised patients with clinically significant aspiration. However, scintiscanning did suggest that some patients had subclinical aspiration.

Deglutition↗

PubMed2002

[Observation of aspiration of laryngectomees in TE shunt speech without prosthesis].

OBJECTIVE: To investigate the course of variation and influencing factors on aspiration in laryngectomees who underwent tracheoesophageal (TE) shunt speech without prosthesis. METHOD: Sixteen laryngeal cancer patients who were operated on for TE shunt voice rehabilitation without prosthesis after total laryngectomy. These laryngectomees experienced aspiration in different degrees after the operation. We designed a questionnaire to follow up alteration aspiration. RESULT: Of sixteen laryngectomees, the longest follow-up time was nine years and six months, the shortest time was one year and three months, no one got lost in the follow-up. In the follow-up period, three laryngectomees died, other thirteen still survived. There were three basic aspiration variational courese: Seven patients changed from no leakage to slight leakage. Four patients remained slight leakage. Five patients changed from obvious leakage to slight leakage. Aspiration affect TE shunt speech in four different ways: No leakage, good voice; slight leakage, still good voice. No leakage,hard voice. If speak, take more time and use great effort. However,in some patients, if the slight leakage gradually appeared, the voice seemed to be better. If the slight leakage remained in the same degree,the patient got good voice all the time. Obvious leakage, hard voice. When leakage gradually became slight, voice grew better. There were no laryngectomees had the following situations: obvious leakage all the time, bad voice all the time. It was considered that radiation therapy induced aspiration in six laryngectomees. Neck infection and pharyngeal leak were believed to cause aspiration in five laryngectomees. CONCLUSION: Any surgical procedures with good voice, but no postoperative aspiration is the best choice in voice rehabilitation in laryngectomees. However, if some laryngectomees only have slight liquid food aspiration without interference with their normal diet; at the same time, those laryngectomees have high speech level,we consider the operation is acceptable. Definitely, radiation therapy, neck infection and (or) pharyngeal leak have some influence on aspiration. The variational course of aspiration and phonation change affected by aspiration are complex problems which need further investigation.

Adult↗

PubMed2004

Bronchial auscultation: an effective adjunct to speech and language therapy bedside assessment when detecting dysphagia and aspiration?

Detection of aspiration by bedside examination has frequently been found to be clinically inadequate when compared with videofluoroscopy (VF) as the gold standard. In Doncaster, UK, a new multidisciplinary approach to bedside assessment was devised using physiotherapists (PT) performing bronchial auscultation (BA) in combination with the speech and language therapists' (SLT) clinical examination of dysphagia. In this study 105 patients referred for VF examination of dysphagia were first tested by the BA team. Comparison was made between the results of the VF team and the results of the BA team in classifying the patients as "aspirating" or at "risk of aspirating." A high degree of agreement was found for risk of aspiration (sensitivity 87%), although specificity was low (37%). BA was highly specific (88%) when confirming the absence of aspiration, but sensitivity to the presence of aspiration was 45%. From the 105 patients tested, the BA team would have failed to modify the diet in only one subject who was aspirating and would have unnecessarily modified the diet of 17 subjects. In conclusion, in the sample population of individuals with complex dysphagia, the BA team approach reliably detected patients identified by VF as at risk of aspiration. In the group of patients identified by VF as aspirating, the BA team proved unreliable in detecting the presence of aspiration, although it did reliably identify patients who were not aspirating. BA is a potentially useful clinical tool which requires further research.

Adolescent↗

PubMed2005

Silent aspiration: what do we know?

Although clinically evident aspiration is common in subjects with dysphagia, a significant proportion may aspirate silently, i.e., without any outward signs of swallowing difficulty. This article reviews the literature on the prevalence, etiology, and prognostic significance of silent aspiration. An electronic database search was performed using silent aspiration, aspiration, dysphagia, and stroke as search terms, together with hand-searching of articles. Silent aspiration has been described in many conditions and subgroups of patients (including normal individuals), using a number of detection methods, making comparisons a challenge. The best data are for acute stroke, in which 2%-25% of patients may aspirate silently. Mechanisms associated with silent aspiration may include central or local weakness/incoordination of the pharyngeal musculature, reduced laryngopharyngeal sensation, impaired ability to produce a reflexive cough, and low substance P or dopamine levels. In terms of prognosis, silent aspiration has been associated with increased morbidity and mortality in many but not all studies. However, some degree of silent aspiration at night may be normal in healthy individuals. The phenomenon of silent aspiration is poorly understood and further research is needed to improve methods of detection and thereby better define its prevalence and prognostic significance.

Age Factors↗

PubMed2002

Limited reliability of lipid-laden macrophage index restricts its use as a test for pulmonary aspiration: comparison with a simple semiquantitative assay.

The lipid-laden macrophage index (LLMI) is a semiquantitative evaluation of alveolar macrophage lipid content used in diagnosis of pulmonary aspiration. To date, there are no published reports regarding the reliability of LLMI. We sought to evaluate the interobserver and intraobserver variability and validity of LLMI and to compare it to a simpler macrophage lipid content index (LCI). To evaluate reliability we compared both the LLMI and LCI of 26 bronchoalveolar lavage (BAL) specimens from 14 aspirators and 12 non-aspirators on 10 separate occasions by two observers. The ranges of means and standard deviations (SD) of LLMI for observer 1 (Obs 1) were 19-160 (5-31) for aspirators, and 0-48 (0-15) for non-aspirators; and those of observer 2 (Obs 2) were 77-249 (13-33) for aspirators and 47-170 (8-37) for non-aspirators. The ranges of means and SD of LCI for Obs 1 were 2-8 (0-2) for aspirators and 0-4 (0-1) for non-aspirators, compared with 2-9 (0-2) for aspirators and 1-6 (0-2) for non-aspirators for Obs 2. No statistical significance was found between LLMI and LCI by comparing coefficients of variation (CV) in either groups or observers. Poor agreement between the two observers was found using a Bland Altman analysis, with the difference of the two observations mostly exceeding zero and becoming larger as the average of the two observations became bigger. The combined sensitivity, specificity, and positive and negative predictive value (PPV and NPV) for both observers of the LLMI were 57%, 75%, 84%, and 69% and those of LCI were 58%, 92%, 93%, and 69%. We conclude that there is poor reliability for both methods. The LCI is simpler and appears to be at least as good as the LLMI.

Adolescent↗

PubMed2002

Objective assessment of swallowing dysfunction and aspiration after radiation concurrent with chemotherapy for head-and-neck cancer.

PURPOSE: To objectively assess swallowing function after an intensive chemoradiation regimen for locally advanced head-and-neck cancer and to assess the clinical implications of swallowing dysfunction. PATIENTS AND METHODS: Twenty-nine patients with nonresectable Stage IV head-and-neck cancer participated in a Phase I study of radiation, 70 Gy/7 weeks, concurrent with weekly gemcitabine. Because of a high rate of mucosal toxicity, reduced drug doses were delivered to subsequent patient groups: 300, 150, 50, and 10 mg/m(2)/week. Twenty-six of these patients underwent prospective evaluation of swallowing function with videofluoroscopy and esophagogram. Studies were performed pretherapy, early post-therapy (1-3 months), and late post-therapy (6-12 months). RESULTS: Complete tests were performed pretherapy in 22 patients, early post-therapy in 20, and late post-therapy in 13. Twenty-five patients had at least one post-therapy study. Post-therapy dysfunction was characterized by reduced inversion of the epiglottis, delayed swallow initiation and uncoordinated timing of the propulsion of the bolus, opening of the cricopharyngeal muscle, and closure of the larynx, all of which promoted aspiration during and after the swallow. In addition, reduced base-of-tongue retraction with reduced contact to the posterior pharyngeal wall and incomplete cricopharyngeal relaxation resulted in pooling in the pyriform sinuses and vallecula of residue, which was frequently aspirated after the swallow. Post-therapy aspirations were typically "silent," eliciting no cough reflex, or the cough was delayed and noneffective in expelling the residue. Aspiration was observed in 3 patients (14%) in the pretherapy studies, in 13 (65%) in the early post-therapy studies, and in 8 (62%) in the late post-therapy studies (aspiration rates post-therapy vs. pretherapy: p = 0.0002). Six patients had pneumonia requiring hospitalization 1-14 months after therapy (median: 2.5 months), being the likely cause of death in 2 patients. Five cases of pneumonia occurred among 17 patients who had demonstrated aspiration in the post-therapy studies, compared with no cases of pneumonia among 8 patients who had not demonstrated aspiration (p = 0.1). Of the 4 patients who had not undergone any post-therapy study, 1 developed pneumonia. Mucositis scores, prolonged tube feeding, presence of tracheostomy tube, and gemcitabine doses were not found to be related to aspiration or pneumonia risk. CONCLUSIONS: After intensive chemoradiotherapy, significant objective swallowing dysfunction is prevalent. It promotes aspiration, which may not elicit a cough reflex and may be associated with pneumonia. Aspiration pneumonia may be an underdocumented complication of chemoradiotherapy for head-and-neck cancer. Future studies should examine whether routine post-therapy videofluoroscopy and training aspirating patients in safe swallowing strategies can reduce this risk.

Combined Modality Therapy↗

PubMed2001

Screening of milk aspiration in 105 infant death cases by immunostaining with anti-human alpha-lactalbumin antibody.

To determine the frequency and degree of milk aspiration in infant death cases, immunohistochemical examinations were performed on lung sections from 41 sudden death cases and 64 in-hospital death cases using anti-human alpha-lactalbumin antibody. Milk aspiration to some degree was detected in more than half of the sudden death cases and in about one-third of the in-hospital death cases. A semi-quantitative examination of the amount of aspirated milk was subsequently performed in the positive cases. The amount of aspirated milk in the sudden death cases was significantly higher than that in the in-hospital death cases. The frequency distribution of the amount of aspirated milk was similar in shape in both groups. In most cases, a very small amount of aspirated milk was detected. The aspirated milk was assumed to be a result of occasional gastroesophageal reflux or cardiopulmonary resuscitation. However, in five cases, much larger amounts of aspirated milk were found. In these cases, milk aspiration may have been an important part of the cause of death. We concluded that slight milk aspiration is not rare in infant death cases, and that in a few cases, the aspiration is lethal. An immunohistochemical screening test is available to perform a postmortem diagnosis in these cases.

Animals↗

PubMed2001

Clinical aspiration-related practice patterns in the intensive care unit: a physician survey.

OBJECTIVE: To characterize physician practice patterns regarding the clinical, microbiological, and antimicrobial-related events of suspected or documented aspiration and aspiration pneumonia within the intensive care unit. DESIGN: National mail survey. SETTING: University medical center. STUDY POPULATION: Critical care physician members of the Society of Critical Care Medicine. INTERVENTIONS: Survey questionnaire. MEASUREMENTS AND MAIN RESULTS: The response rate was 645 (32%) of 2,000 mailed surveys; analysis of data represents completed questionnaires from 605 respondents. Intensivists (42.3%), pulmonologists (22.6%), and surgeons (21.6%) represent the majority of respondents. Altered level of consciousness (67.9%) in the intensive care unit was identified as the predominant predisposing factor for aspiration pneumonia. Sixty-four percent of physicians used sputum specimens, rather than protected specimen brushes or bronchoalveolar lavage, as the diagnostic source of bacterial cultures in cases of suspected aspiration pneumonia. Microbiological assessment of aspiration pneumonia revealed the absence of any predominant pathogen, although Staphylococcus aureus and Pseudomonas aeruginosa were cited in 40.1% of combined responses, whereas anaerobes represented the fifth most prevalent cultured bacteria. In cases of suspected and confirmed aspiration, 51.9% and 77.7% of respondents, respectively, would prescribe an antimicrobial agent in the absence of a definitive infectious process, with administration of dual antimicrobial therapy increasing from 28.9% to 46.0% in suspected vs. confirmed cases of aspiration. In the treatment of aspiration pneumonia, 27.6% of physicians preferred pathogen-specific therapy, whereas the remainder (72.4%) selected an empirical antibiotic regimen based on prior clinical experience. Overall, a beta-lactam/beta-lactamase inhibitor, followed by a cephalosporin, aminoglycoside in combination, or clindamycin, was most often selected for empirical therapy of all defined aspiration-related clinical diagnoses. CONCLUSIONS: Our study revealed a divergent approach to antimicrobial treatment of cases of aspiration in the intensive care unit. Further investigation is warranted to determine why empirical antimicrobials are initiated frequently for noninfectious stages of aspiration.

Adult↗

PubMed1996

Pulmonary aspiration following Dettol poisoning: the scope for prevention.

1. After ingestion, Dettol liquid (4.8% chloroxylenol, pine oil, isopropyl, alcohol), a common household disinfectant, can cause central nervous system depression and corrosion of the oral mucosa, larynx and the gastrointestinal tract. The main risk from Dettol poisoning is pulmonary aspiration, leading to pneumonia, adult respiratory distress syndrome (ARDS) and/or sudden cardiorespiratory arrest. 2. To determine to what extent pulmonary aspiration in Dettol poisoning could be prevented, 13 patients treated in a general teaching hospital in Hong Kong were studied. Their clinical details were compared with those of control Dettol poisoning cases without pulmonary aspiration in order to identify possible risk factors for this complication. 3. At presentation, evidence of pulmonary aspiration was present in eight of the 13 patients prior to gastric emptying, but the use of gastric lavage without adequate protection of the airways could have aggravated the problem in three. In two other patients, evidence of aspiration was only present after gastric lavage was performed. The consequences of pulmonary aspiration were pneumonia (n = 10), ARDS (n = 2), acute exacerbation of asthma or chronic obstructive airway disease (n = 2) and sudden cardiorespiratory arrest (n = 1). Three patients with aspiration pneumonia (n = 2), ARDS (n = 1) and/or sudden cardiorespiratory arrest (n = 1) died. 4. Compared with the controls, the median amount of Dettol ingested was considerably larger (400 vs 150 ml), vomiting (100% vs 72.6%) and drowsiness/ confusion (60.2% vs 19.4%) occurred more often. 5. Amongst the 13 patients with Dettol poisoning and pulmonary aspiration, gastric lavage using the nasogastric tube technique without adequate production of the airways had been responsible for the occurrence or worsening of aspiration in two and three patients, respectively. Thus, gastric lavage particularly when using a nasogastric tube appeared to carry more harm than benefits in patients with Dettol poisoning. If the procedure is considered necessary, say because of the concomitant ingestion of the other poisons, the airways must first be well protected and the oropharyngeal aspiration and lavage technique using a wide bore Jacques tube is recommended. 6. Comparison with a control group has identified other risk factors for pulmonary aspiration: the amount of Dettol ingested, the occurrence of vomiting, drowsiness or confusion.

Adult↗

PubMed1997

Comparison of the cellularity and presence of residual leukemia in bone marrow aspirate and biopsy specimens in pediatric patients with acute lymphoblastic leukemia (ALL) at day 7-14 of chemotherapy.

BACKGROUND: Many pediatric chemotherapy protocols for treatment of ALL require a bone marrow examination at day 7 or day 14 after initiation of therapy. The usefulness of a bone marrow biopsy, in addition to an aspirate, has been a frequently asked question. PROCEDURE: This study addresses the evaluation of bone marrow cellularity and presence of residual leukemia in both aspirate and biopsy specimens in 45 consecutive pediatric patients (ages 1-19 years, 19 females, and 26 males) with ALL 7-14 days after initiation of therapy. DISCUSSION: 20/45 patients showed evidence of residual leukemia by bone marrow biopsy; 16/20 (80%) of these had evidence of residual leukemia in the aspirate specimen. Of the 4 aspirate specimens that did not demonstrate residual leukemia, 2 had <5% blasts and 2 had too few cells in the aspirate for evaluation. Of the 25/45 bone marrow biopsy specimens with no detectable residual leukemia, 14 of the aspirates had <5% blasts, and 11 had too few cells in the aspirate for evaluation. 13/45 (29%) of the aspirates had too few cells for a differential count. The bone marrow cellularity judged from the aspirate specimen was considered to be low (0-1+) in 34/45 patients. Of these 34 patients, the bone marrow biopsy showed hypocellularity (<20% cellularity) in 12/34, moderate cellularity (20-79% cellularity) in 14/34, and hypercellularity (>79% cellularity) in 8/34. CONCLUSIONS: We conclude that both the bone marrow aspirate and biopsy specimens provide important information in evaluating the response to chemotherapy in pediatric patients with ALL at day 7-14 of induction chemotherapy. The aspirate alone may be misleading in terms of cellularity in many patients and may not provide evidence of residual leukemia.

Adolescent↗

PubMedDate not supplied

Effect of the Passy-Muir Valve on aspiration in patients with tracheostomy.

OBJECTIVE: To assess potential benefit of a Passy-Muir Speaking Valve (PMV) in decreasing aspiration in patients with a tracheostomy. BACKGROUND: Many patients with tracheostomy exhibit clinically significant aspiration. It has been previously noted that aspiration can often be reduced or eliminated by plugging or removing the tracheostomy tube. Some patients, however, do not tolerate removal or plugging of their tracheostomy tube, which then leads to persistent aspiration. We postulated that a one-way speaking valve may restore more normal subglottic and glottic air flow and reduce aspiration. METHODS: Alert patients with a tracheostomy and clinical evidence of aspiration were eligible for study. Eleven patients with tracheostomy and known aspiration were studied with a modified barium swallow. Radiographic examination was used to evaluate the presence and amount of aspiration while patients swallowed both with and without a PMV in place on their tracheostomy tube. RESULTS: Aspiration was reduced (or eliminated) during swallowing in all 11 patients when they wore a PMV, when compared to swallowing with an open (unvalved) tube. This improvement was achieved with liquids, semisolids, and pureed consistencies. CONCLUSION: This study demonstrates that a Passy-Muir speaking valve facilitated swallow and reduced aspiration in patients with a tracheostomy and known aspiration.

Adult↗

PubMed2004

Clinical impact of endoscopic ultrasound and endoscopic ultrasound-guided fine-needle aspiration in the management of rectal carcinoma.

PURPOSE: There is scant data about the clinical impact of endoscopic ultrasound-guided fine-needle aspiration in rectal carcinoma. This study was designed to determine the impact of endoscopic ultrasound-guided fine-needle aspiration on the staging and management of rectal carcinoma and to compare the staging accuracy of computed tomography scan, endoscopic ultrasound, and endoscopic ultrasound-guided fine-needle aspiration. METHODS: The records of 60 consecutive patients diagnosed with rectal carcinoma referred for endoscopic ultrasound staging were reviewed. Computed tomography scans, endoscopic ultrasound imaging, endoscopic ultrasound-guided fine-needle aspiration staging, surgical pathology, and subsequent treatment were compared. RESULTS: Of 48 patients who underwent computed tomography scan imaging, the additional information provided by endoscopic ultrasound changed management in 38 percent of patients. Sixteen patients identified as having nonjuxtatumoral lymph nodes underwent fine-needle aspiration and the additional information obtained changed therapy in three (19 percent) of these patients. All five cases of recurrent rectal carcinoma were correctly diagnosed by fine-needle aspiration. Tumor staging accuracy was 45 percent (computed tomography) and 89 percent (endoscopic ultrasound; P<0.0001); nodal staging accuracy was 68 percent (computed tomography), 85 percent (endoscopic ultrasound), and 92 percent (endoscopic ultrasound-guided fine-needle aspiration; P=not significant). CONCLUSIONS: Endoscopic ultrasound imaging was better than computed tomography scanning at overall tumor staging, whereas endoscopic ultrasound-guided fine-needle aspiration demonstrated a trend toward more accurate nodal staging. Preoperative staging with endoscopic ultrasound resulted in a change of management in 38 percent of patients. The addition of fine-needle aspiration changed the management in 19 percent of those who underwent nonjuxtatumoral lymph node sampling. Endoscopic ultrasound-guided fine-needle aspiration accurately diagnosed 100 percent of those with recurrent rectal carcinoma. Clearly, endoscopic ultrasound and endoscopic ultrasound-guided fine-needle aspiration are important for the staging and management of rectal carcinoma and for detecting disease recurrence.

Biopsy, Fine-Needle↗

PubMed1995

Collection of oocytes from cattle via follicular aspiration aided by ultrasound with or without gonadotropin pretreatment and in different reproductive stages.

Ultrasound-guided follicular aspiration was performed on 29 Holstein-Friesian cows/heifers twice weekly at 3- to 4-d intervals over a period of 2 consecutive estrous cycles (total 42 d). For visualization of the ovaries and guidance of the aspiration needle, a 6.5 MHz fingertip probe on a 62 cm probe carrier was inserted into the vagina. The disposable aspiration needle was connected to a permanent rinse tubing system, thus ensuring minimum death of oocytes in the aspiration processs. After penetration of the vaginal wall, the needle was inserted into a follicle of the rectally fixed ovary. Cumulus oocyte complexes (COC) were aspirated at a pressure of 100 mm Hg. In the first experiment, the effect of an additional gonadotropin treatment 4 d prior to aspiration was investigated in 8 lactating cows. Following FSH-treatment, the number of aspirated follicles was higher (P < 0.05) than in the nontreated animals (10.6 +/- 0.7 vs 8.9 +/- 0.5). The number of recovered COC (7.0 +/- 0.6 vs 5.8 +/- 0.5), the recovery rate (COC per aspirated follicle) (66.6% vs 65.4%), the percentage of viable COC (56.8% vs 52.1%), the cleavage rate upon in vitro maturation and in vitro fertilization (56.7% vs 59.8%) as well as the rate of morula/blastocyst formation (3.8% vs 2.9%) were similar in both groups. In the second experiment, follicles were aspirated in 4 lactating cows, 6 dry cows, 4 pregnant cows (first 35 d of pregnancy), and 4 heifers. The average number of aspirated follicles and recovered COC was higher (P < 0.05) in the first 2 groups (10.6 +/- 0.6 and 9.3 +/- 0.7 follicles; 7.2 +/- 0.5 and 6.9 +/- 0.7 oocytes) than in trie 2 other treatment groups (7.3 +/- 0.5 and 8.1 +/- 0.5 follicles; 5.0 +/- 0.4 and 5.7 +/- 0.5 oocytes). The percentage of viable COC was higher (P < 0.05; 68.3%) in lactating animals than in all the other groups (49.7, 52.5 and 57.4%, respectively). Similarly, upon in vitro fertilization, cleavage rate was higher (P < 0.05; 63.4%) in lactating cows than in the other groups (43.7, 50.5, 55.1%, respectively). A total of 21.5, 22.7, 11.9 and 13.5%, respectively, in the 4 groups of the in vitro fertilized oocytes reached the morula and blastocyst stages. After transfer of a total of 48 embryos 22 pregnancies (45.8%) were established as detected on Day 65. We conclude that 1) repeated aspiration of viable COC at short intervals is possible, 2) additional FSH-treatment does not increase oocyte yields, and 3) viable blastocysts can be produced from cattle at various reproductive phases irrespective of the reproductive phase.

Journal Article↗

PubMed2004

Usefulness and validity of diagnostic nasogastric aspiration in patients without hematemesis.

STUDY OBJECTIVE: We estimate the test characteristics of nasogastric aspiration to diagnose upper gastrointestinal tract hemorrhage in patients without hematemesis. METHODS: In this retrospective cohort study, medical records from patients admitted to 2 urban hospitals between 1997 and 2002 for gastrointestinal tract bleeding without hematemesis were reviewed. Positive nasogastric aspiration results were classified by the severity of hemorrhage, and negative results were classified by the presence or absence of bile. The reference standard for nasogastric aspiration was the source of bleeding-upper versus non--upper gastrointestinal tract--from the hospital discharge summary. Confidence intervals (CIs) for proportions and likelihood ratios (LRs) were calculated. RESULTS: Of 333 eligible patients, 235 were offered nasogastric aspiration, and 220 accepted the test. Results of 220 attempts were distributed as follows: negative, 158 (72%), including 9 (4%) with bile; nasogastric aspiration aborted, 13 (6%); and positive, 49 (23%), including 4 (2%) that were strongly positive (> or =450 mL red blood). Test characteristics of nasogastric aspiration to detect upper gastrointestinal tract bleeding in 213 patients with a reference standard diagnosis were as follows: sensitivity 42% (95% CI 32% to 51%), specificity 91% (95% CI 83% to 95%), negative predictive value 64% (95% CI 56% to 71%), and positive predictive value 92% (95% CI 79% to 97%). The nasogastric aspiration accurately predicted the source of bleeding in 66% of patients (95% CI 59% to 72%). The likelihood ratio of a positive nasogastric aspiration was 11 (95% CI 4 to 30), and the likelihood ratio of a negative nasogastric aspiration was 0.6 (95% CI 0.5 to 0.7). CONCLUSION: In patients without hematemesis, a positive nasogastric aspiration, seen in 23%, indicates probable upper gastrointestinal tract bleeding (LR+ 11), but a negative nasogastric aspiration, seen in 72%, provides little information (LR- 0.6).

Aged↗

PubMed1997

Factors associated with the quality before freezing and after thawing of sperm obtained by microsurgical epididymal aspiration.

OBJECTIVE: To identify whether the cause, site of ductal obstruction, and characteristics of fluid aspirates are associated with the cryosurvival and fertility after thawing of sperm obtained during reconstruction of the excurrent ducts with microsurgical epididymal sperm aspiration, vasal sperm aspiration, or both. DESIGN: Prospective study. SETTING: Andrology center at a tertiary care institution. PATIENT(S): Men undergoing reconstruction of the excurrent duct and sperm aspiration (n = 42) or microsurgical epididymal sperm aspiration (n = 11). INTERVENTION(S): Sperm were tested for an association with the cause and site of obstruction. Fertilization and pregnancy rates after sperm aspiration and intracytoplasmic sperm injection (ICSI) were evaluated for fresh and frozen aspirates. MAIN OUTCOME MEASURE(S): Motile sperm count and percentage motility after thawing. RESULT(S): The motile sperm count before freezing was significantly higher in the caput epididymis than in the corpus. The motile sperm count before freezing was related inversely to the distance from the caput where the sperm were aspirated. Sperm from clear and opaque fluid aspirates had better percent motility than those from cloudy and creamy fluid aspirates. High fertilization and pregnancy rates were achieved using both fresh and frozen epididymal sperm. CONCLUSION(S): None of the factors studied was associated with cryosurvival of aspirated epididymal or vasal spermatozoa. Because motility is low after thawing, these specimens are best used with ICSI.

Adult↗