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PubMed1995

Comparison of secretory component for immunoglobulin A with albumin as reference proteins in tracheal aspirate from preterm infants.

OBJECTIVES: To determine whether the concentration of secretory component (SC) in tracheal aspirate samples is less altered by changes in alveolar-capillary permeability and thus is a more reliable reference standard than albumin for the measurement of other components obtained by saline lavage in preterm infants. METHODS: A total of 1229 tracheal aspirate and 1530 blood samples were collected from 195 neonates to evaluate the effects of advancing postnatal and gestational age, resolution of acute respiratory distress syndrome (RDS), steroid therapy for chronic lung disease, and acute sepsis on tracheal aspirate SC and albumin levels. The tracheal aspirate and blood samples were analyzed by enzyme-linked immunosorbent assay techniques for SC and albumin concentrations. RESULTS: The mean values for the concentrations of aspirate and plasma SC did not vary significantly during an 8-week study period (n = 100) and did not vary with either gestational age (23 to 36 weeks) or postnatal age. Albumin concentration significantly decreased in aspirate samples from 1.67 +/- 0.77 mg/dl at week 1 to 0.41 +/- 0.21 mg/dl at week 8 (p < 0.001), whereas serum levels increased from 2.65 +/- 0.36 to 2.99 +/- 0.54 gm/dl (p < 0.001), suggesting a decrease in alveolar-capillary leakage with advancing postnatal age. The concentration of SC in aspirate samples from 51 infants who received dexamethasone remained constant during the first week of therapy, whereas the concentration of albumin decreased from 1.33 +/- 0.91 mg/dl at the initiation of therapy to 0.51 +/- 0.34 mg/dl on treatment day 7 (p < 0.001). The onset of sepsis (n = 40) was not accompanied by a significant change in either aspirate SC or albumin levels. However, in infants who had a deterioration in respiratory status concomitant with the onset of sepsis (n = 10), the levels of aspirate albumin increased whereas serum levels decreased (p < 0.001), suggesting an increase in alveolar-capillary leakage; the levels of aspirate SC remained unaltered. CONCLUSIONS: Secretory component may serve as a more valid reference protein for the standardization of tracheal aspirate collection in preterm infants during evaluation of changes in inflammatory mediators in disease states and therapeutic interventions that alter alveolar-capillary integrity.

Acute Disease↗

PubMed2003

Aspiration and sclerotherapy versus hydrocelectomy for treatment of hydroceles.

OBJECTIVES: To compare aspiration and sclerotherapy using sodium tetradecylsulfate (STDS) with open hydrocelectomy in the treatment of hydroceles with regard to safety, efficacy, and cost-effectiveness. METHODS: Patients with symptomatic hydroceles were prospectively enrolled in an aspiration and sclerotherapy protocol between October 1998 and June 2000. Patients in this group underwent percutaneous aspiration followed by sclerotherapy with an STDS-based solution. This group was compared with a group of patients chosen consecutively who underwent hydrocelectomy between December 1996 and August 1999. Primary outcome measures included patient satisfaction and procedural success. Secondary outcome measures included complications and comparative costs. RESULTS: A total of 27 patients with 28 hydroceles were enrolled in the aspiration and sclerotherapy protocol and compared with 24 patients with 25 hydroceles in the hydrocelectomy group. Mean follow-up for the aspiration and sclerotherapy group and hydrocelectomy group was 8.9 and 16.4 months, respectively. Patient satisfaction was 75% for aspiration and sclerotherapy and 88% for hydrocelectomy. The overall success rate for aspiration and sclerotherapy was 76% compared with 84% for hydrocelectomy. The complication rate was only 8% in the aspiration and sclerotherapy group, but 40% in the hydrocelectomy group. Comparative costs per procedure demonstrated that hydrocelectomy was almost ninefold more expensive than aspiration and sclerotherapy. CONCLUSIONS: In the treatment of hydroceles, aspiration and sclerotherapy with STDS represents a minimally invasive approach that is simple, inexpensive, and safe but less effective than hydrocelectomy. Aspiration and sclerotherapy is a viable first-line therapeutic option in the management of hydroceles.

Cost-Benefit Analysis↗

PubMed2001

Ovarian follicular development following administration of progesterone or aspiration of ovarian follicles in Holstein cows.

The objective of this study was to compare the effects of administration of a single injection of progesterone (P4) and follicle aspiration on Day 7 of the estrous cycle on the timing and synchrony of follicular wave emergence, time of ovulation, and concentrations of P4, estradiol and FSH in Holstein cows. Twenty cows were assigned to 4 groups (n=5 cows per group) in a 2 by 2 factorial arrangement. Cows were treated on Day 7 (Day 0 = estrus) of the estrous cycle with either sham follicular aspiration and an oil vehicle administered intramuscularly (control), aspiration of ovarian follicles (aspiration), 200 mg of P4 im, or aspiration and 200 mg of P4 im (aspiration + P4). On Day 11, PGF(2alpha)(25mg) was administered to all groups. Synchrony of ovulation was less variable in each of the treatment groups compared with the control group (P<0.05), whereas ovulation was delayed in cows in the P4 group (P<0.05). Day of follicular wave emergence was delayed in the cows of the P4 group compared with cows in the aspiration and aspiration + P4 groups (P<0.01), whereas variability in wave emergence was less among both groups of aspirated cows compared with the cows in the control group (P<0.01). More follicles 4 to 7 mm in diameter were detected in the 2 aspiration groups compared with the cows in the control and P4 group (P<0.05). No difference was detected among groups in the maximum concentration of FSH associated with follicular wave emergence. We conclude that both the administration of P4 and the aspiration of follicles on Day 7 of the estrous cycle improves the synchrony of ovulation when luteolysis is induced on Day 11 and results in similar concentrations of FSH at the time of follicular wave emergence, but the timing of wave emergence and the number of follicles post-emergence differ.

Animals↗

PubMedDate not supplied

An atraumatic aspirator for use in autologous transfusion and cardiac bypass.

Surgical aspiration has long been seen as the weak link in surgical blood recovery. Aspiration causes a high degree of hemolysis that leads to high plasma hemoglobin levels and reduces the number of erythrocytes available for reinfusion. Aspiration also damages platelets, generates emboli, and increases bleeding time. The major source of the high hemolysis and the other blood damage that occurs during suction is the aspiration of air with the blood. To address this problem, a jet driven aspirator that immediately separates and removes air during suction was designed and tested. The aspirator suctions blood at a range of rates from 100 to at least 700 ml/min, separates and removes 80-100% of the aspirated air, operates at any orientation, and generates subatmospheric pressures on the order of only an inch of water. During in vitro hemolysis testing, the removal of air by the jet driven aspirator showed a significant reduction in hemolysis: plasma hemoglobin levels increased 19.4 mg/dl without air removal and only 1.8 mg/dl with air removal (p < 0.001). In comparative testing with a conventional vacuum operated suction tube, the jet driven aspirator showed significantly less hemolysis (p < 0.001) than did the conventional aspirator at comparable blood and air aspiration rates.

Animals↗

PubMed2002

Laryngeal adductor reflex and pharyngeal squeeze as predictors of laryngeal penetration and aspiration.

OBJECTIVES: The contribution of laryngopharyngeal (LP) sensory deficits to the outcome of swallowing and the relationship between sensory and motor deficits in the laryngopharynx is unclear. The study purpose is to determine if patients with LP sensory and motor deficits are at increased risk for laryngeal penetration and aspiration during swallowing, and to determine the relationship between pharyngeal motor weakness and LP sensory deficits. MATERIALS AND METHODS: Endoscopic evaluation of swallowing with sensory testing was performed on 122 dysphagic patients who were prospectively divided into two groups. The control group was 76 patients with normal sensitivity, determined by an intact laryngeal adductor reflex (LAR) on air pulse stimulation of the mucosa innervated by the superior laryngeal nerve. The study group was 46 patients with severe sensory deficits, determined by an absent LAR. Each group was given puree followed by thin liquid, noting presence or absence of laryngeal penetration and aspiration. Pharyngeal muscle strength was assessed by noting presence or absence of pharyngeal contraction during voluntary adduction of the vocal folds (pharyngeal squeeze). RESULTS: In control subjects, with purees, 6 of 76 (7.90%) penetrated and 3 of 76 (3.94%) aspirated; with thins, 26 of 76 (34.2%) penetrated and 13 of 76 (17.1%) aspirated. In the absent LAR group, with purees, 39 of 46 (84.8%) penetrated and 32 and 46 (69.6%) aspirated; with thins, 46 of 46 (100%) penetrated and 43 of 46 (93.5%) aspirated. For both consistencies, the differences in prevalence of penetration and aspiration between groups was significant (P <.0001, chi2). In control subjects, pharyngeal squeeze was impaired in 17 of 76 (22.4%), with penetration of puree in 6 of 17 (35.3%) and aspiration in 3 of 17 (17.6%). In the absent LAR group, squeeze was impaired in 41 of 46 (89.1%), with penetration of puree in 39 of 41 (95.1%) and aspiration in 32 of 41 (78.0%). The difference in the prevalence of pharyngeal weakness between groups was significant (P <.0001). The difference in the prevalence of penetration and aspiration was higher in the absent LAR/impaired contraction cohort than in the normal sensation/impaired contraction cohort (P <.0001). CONCLUSION: Absence of the LAR and impaired pharyngeal squeeze puts patients with dysphagia at high risk for laryngeal penetration and aspiration compared with patients with an intact LAR and intact pharyngeal squeeze. There is a strong association between motor and sensory deficits in the laryngopharynx.

Adult↗

PubMed2006

Ovum pick-up in sheep: a comparison between different aspiration devices for optimal oocyte retrieval.

In vivo ovum pick-up (OPU) in sheep may be improved with a proper choice of aspiration elements (needle and tubing) and aspiration vacuum pressure. In the present study, two experiments were carried out. In Expt 1, visible follicles in ovaries of slaughtered ewes (treated separately according to their diameters: small<3 mm, medium 3-5 mm and large>5 mm) were aspirated using different combinations of the three studied factors such as aspiration flow rate (10, 20, 30, 40 and 50 ml water/min), needle gauge (18 and 20 G) and tubing inner diameter (1, 2 or 3 mm internal diameter). In Expt 2, a study with two 18 G needles of different lengths (18 G: 82 mm; 18 GL: 600 mm) was carried out, using ovaries obtained post-mortem, and performing in vivo laparoscopic follicular aspiration on ewes. We considered good quality oocytes as those with both complete compact cumulus and a homogeneous cytoplasm. Recovery rate, proportion of good quality oocytes (good quality oocytes/100 oocytes recovered) and overall efficiency (good quality oocytes/100 follicles aspirated) were noted. In Expt 1, aspiration flow rate affect remarkable proportion of good quality oocytes (69.5%, 50.5%, 44.8%, 36.5% and 28.3% for flows from 10 to 50 ml/min respectively, p<0.05). Needle gauge did not affect aspiration device efficiency. Thin and intermediate tubings were more effective (overall efficiency rates: 34.9%, 32.3% and 28.1% for 1, 2 and 3 mm respectively, p<0.05). Follicle size did not affect recovery rate, but proportion of good quality oocytes was higher for large (77.9%) and medium (64.4%) follicles (p<0.05). Finally, some combinations of the aspiration device showed greater effectiveness. In Expt 2, needle length did not influence recovery rate, but good quality oocytes rate was significantly modified both post-mortem and in vivo (good quality rate for 18 G vs 18 GL needles: 69.5% vs 47.7% and 58.1% vs 25.4%, post-mortem and in vivo respectively, p<0.05). We conclude that low-aspiration flow rates (10 and 20 ml/min) with thin or intermediate tubings (1 and 2 mm), and any short needle (18 G or 20 G) are the most adequate aspiration factors for OPU in sheep.

Animals↗

PubMedDate not supplied

Ultrasound-guided fine-needle aspiration biopsy of bone lesions: a preliminary report.

The purpose of this preliminary study was to determine the feasibility of ultrasound-guided fine-needle aspiration biopsy of suspected neoplastic lesions of bone. Ultrasound-guided fine-needle aspiration biopsy samples were obtained in 23 patients (22 dogs and one cat) with radiographic evidence of a destructive or destructive/productive bone lesion. The lesions were located in the appendicular skeleton in 20 patients and in the axial skeleton in three. Histopathology from tissue core biopsies and/or necropsy was not deemed necessary in 11 patients where ultrasound-guided fine-needle aspiration biopsy results were conclusive for neoplasia. A cytologic diagnosis from ultrasound-guided fine-needle aspiration biopsy was confirmed by histologic samples obtained at surgery or necropsy in five patients. In one of these five, ultrasound-guided fine-needle aspiration biopsy samples were diagnostic for sarcoma when tissue-core biopsy was inconclusive. Both ultrasound-guided fine-needle aspiration biopsy and tissue core biopsy techniques were inconclusive in one patient. Ultrasound-guided fine-needle aspiration biopsy samples were nondiagnostic in five patients where a follow-up histopathologic diagnosis of neoplasia was made. It was concluded that ultrasound-guided fine-needle aspiration biopsy of bone, if diagnostic, may help avoid the need for a tissue-core biopsy in some instances. However, a negative ultrasound-guided fine-needle aspiration biopsy sample does not rule out neoplasia. A negative ultrasound-guided fine-needle aspiration biopsy should be followed by a tissue-core biopsy and histologic analysis in all patients. Ultrasound-guided fine-needle aspiration biopsy seems to be a promising technique for the diagnosis of bone lesions.

Animals↗

PubMed1988

Assessment of pulmonary macrophage and neutrophil function in sequential bronchoalveolar lavage aspirates in sarcoidosis.

Bronchoalveolar lavage was performed in eight patients with biopsy proved sarcoidosis and eight control subjects matched for age and smoking habit, three sequential 60 ml aliquots of sterile saline being used. Each aliquot was aspirated and analysed separately to determine total and differential cell counts. Cellular metabolic activity was stimulated with latex and measured by means of luminol enhanced chemiluminescence to assess neutrophil activity and lucigenin enhanced chemiluminescence to assess macrophage activity. In control subjects mean total cell counts were significantly greater in the second aspirate than in the first, but fell slightly in the third. Similarly, in the patients with sarcoidosis mean total cell counts increased from aspirate 1 to a maximum in aspirate 2, before falling again marginally in aspirate 3. The only significant difference in cell counts between patients with sarcoidosis and controls was an approximately threefold increase in total lymphocyte counts in the former in each of the three aspirates. Luminol chemiluminescence was similar in patients with sarcoidosis to that in controls in the first aspirate, but was significantly greater in the second and third aspirates. Lucigenin chemiluminescence was also significantly greater in the second and third aspirates only. Thus in patients with sarcoidosis lymphocyte numbers are increased in all three aspirates whereas cellular metabolic activity is increased to a greater extent in later aspirates, which may reflect events occurring in the periphery of the lung segment.

Acridines↗

PubMed1999

Multiple fluid collections: CT- or US-guided aspiration--evaluation of microbiologic results and implications for clinical practice.

PURPOSE: To determine if patients with multiple fluid collections need every collection aspirated and if cross-contamination is a risk if separate sterile procedures are not followed for each aspiration. MATERIALS AND METHODS: Records from 1,076 imaging-guided percutaneous aspirations and drainages over 39 months were retrospectively reviewed; 124 patients had multiple fluid collections drained, which yielded 287 aspirates. The patients were divided into two groups: those (n = 82) with multiple collections aspirated on any 1 day, and those (n = 61) with multiple collections aspirated over 10 days. Nineteen patients were included in both groups. Gram stain microscopy and culture results were compared between sequential aspirates in each patient, and their potential effects on antimicrobial therapy and theoretic risk for cross-contamination were evaluated. RESULTS: In 82 patients undergoing multiple aspirations on any 1 day, multiple microorganisms differed in 32 patients, which indicated a need for therapy change in 18 (22%) patients. In 61 patients undergoing aspiration on different days, microorganisms differed in 32 patients, which indicated a need for therapy change in 15 (25%) patients. Cross-contamination could have occurred in 28 of 93 (30%) aspirates from patients with a second or subsequent collection if separate sterile procedures had not been undertaken. CONCLUSION: When multiple fluid collections are identified, aspirates from all collections should be obtained through separate sterile procedures to ensure optimal antimicrobial coverage and avoid cross-contamination.

Adult↗

PubMed1986

Lymph node aspiration in the management of Hodgkin's disease.

Diagnosing recurrent Hodgkin's disease is an important oncologic problem. When relapse does not occur in peripheral nodal sites, then a major surgical exploration is often considered. Lymph node aspiration is proposed as a less invasive approach capable of establishing a diagnosis in some instances. In this retrospective study, 19 patients with Hodgkin's disease underwent 64 lymph node aspirations. Of these patients, 17 had suspected Hodgkin's disease with involvement at an inaccessible site. Two patients with a primary diagnosis of Hodgkin's disease underwent aspiration of a peripheral site. Of these 19 patients, five (26.3%) had a positive aspirate and only two (10.5%) had an unsatisfactory aspirate. No patient had a false-positive aspirate. Of 15 patients with a negative aspirate, five (33%) had a false-negative aspirate. In no case did a false-negative aspirate delay appropriate therapy. In those patients with a positive aspirate, surgical exploration was avoided. We conclude that lymph node aspiration cytology is useful as an initial step to document clinical relapse of Hodgkin's disease at a site that might require a major surgical procedure for diagnosis.

Adult↗

PubMed1994

Tracheal aspirate correlates with protected specimen brush in long-term ventilated patients who have clinical pneumonia.

STUDY OBJECTIVE: This study was undertaken to determine whether tracheal aspirate cultures correlate with protected specimen brush (PSB) cultures in the diagnosis of probable ventilator-associated pneumonia (VAP). DESIGN: Retrospective evaluation of 52 episodes of clinical pneumonia in 38 patients who underwent bronchoscopy and PSB as well as tracheal aspirate cultures. SETTING: The study took place in long-term, acute care hospital associated with a university medical school. This hospital specializes in ventilator-assisted patients. PATIENTS: The patient population consisted of long-term ventilated patients (average ventilation time was 22 weeks; range, 4 weeks to 3 years) who presented with the clinical diagnosis of VAP (fever, increased white blood cell count, new infiltrate on chest radiograph, and bronchorrhea). No patient had received antibiotics for the preceding 5 days at the time of bronchoscopy or tracheal aspirate culture. MEASUREMENTS: The tracheal aspirate and PSB culture and sensitivities results. RESULTS: Identical organisms were recovered in both the tracheal aspirate and PSB cultures in 36 of 52 episodes of VAP (69 percent). No organism was recovered in either the tracheal aspirate or the PSB in 4 of 52 suspected episodes (8 percent). Positive bacterial cultures in the tracheal aspirate but not the PSB were found in 8 of 52 (15 percent) episodes. In 3 of 52 episodes (6 percent), 1 isolate of pathogenic bacteria was found on PSB and 2 were found on tracheal aspirate cultures. However, all three isolates had the similar antibiotic sensitivities. In the final episode, the PSB culture grew an organism that was not present in the tracheal aspirate culture (2 percent). When comparing the tracheal aspirate with the PSB, the following were calculated: sensitivity = 97.7 percent; specificity = 50 percent; positive predictive value = 91.3 percent; and negative predictive value = 80 percent. CONCLUSION: Tracheal aspirate cultures correlate with PSB cultures in patients receiving long-term ventilation who have clinical pneumonia, and they can be used to direct initial antibiotic therapy in this group of patients.

Aged↗

PubMed1993

The value of aspiration of the hip joint before revision total hip arthroplasty.

The role of aspiration of the hip joint before revision of a total hip arthroplasty remains controversial. To address this issue, we reviewed the results of 270 consecutive hips in which aspiration had been attempted before revision procedures that were performed between 1980 and 1988. All hips had intraoperative findings and clinical follow-up of at least two years to confirm the presence or absence of infection. Only six (2 per cent) of the 270 hips were determined to be infected. Aspiration had been attempted in all six hips, but fluid could be obtained from only four. All six hips also had clinical or radiographic signs, or both, of infection, including increasing pain within three years after the arthroplasty (four hips), inability of the patient to attain pain-free status after the original procedure (four hips), radiographic findings compatible with infection (six hips), and a positive finding on culture of a specimen obtained from a previous aspiration (two hips). Because of these factors, aspiration was attempted a second time in four of the six hips and a third time in three of the four. The four hips from which fluid could be obtained had a total of ten successful aspirations; the cultures of specimens obtained from six of these procedures were positive and those from four were negative. The appearance of the capsular tissue at the time of the operation suggested infection in five of the six infected hips. Histological sections were positive for inflammation in all six: there was acute inflammation only in one, chronic inflammation only in two, and acute and chronic inflammation in three. No organisms were seen on gram stains of specimens from any of the six infected hips. Of the 254 hips that did not have an infection and had been aspirated successfully, thirty-two (13 per cent) had a false-positive result on culture of a specimen of the aspiration fluid. Only two (6 per cent) of the thirty-four hips that had a positive result on culture of fluid from the initial aspiration had a true-positive result. No hip had a true-positive result on culture of fluid that had been aspirated preoperatively without also having clinical and radiographic evidence of infection. On the basis of these findings, we recommend that aspiration be performed in selected patients rather than routinely. It also should be performed only if a detailed clinical history suggests infection or if radiographs demonstrate focal lysis, aggressive non-focal lysis, or periostitis.

Aged↗

PubMed2005

Aspiration of osteoprogenitor cells for augmenting spinal fusion: comparison of progenitor cell concentrations from the vertebral body and iliac crest.

BACKGROUND: Successful arthrodesis in challenging clinical scenarios is facilitated when the site is augmented with autograft bone. The iliac crest has long been the preferred source of autograft material, but graft harvest is associated with frequent complications and pain. Connective tissue progenitor cells aspirated from the iliac crest and concentrated with allograft matrix and demineralized bone matrix provide a promising alternative to traditional autograft harvest. The vertebral body, an even larger reservoir of myeloproliferative cells, should provide progenitor cell concentrations similar to those of the iliac crest. METHODS: Twenty-one adults (eleven men and ten women with a mean age of 59 +/- 14 years) undergoing posterior lumbar arthrodesis and pedicle screw instrumentation underwent transpedicular aspiration of connective tissue progenitor cells. Aspirates were obtained from two depths within the vertebral body and were quantified relative to matched, bilateral aspirates from the iliac crest that were obtained from the same patient at the same time. Histochemical analysis was used to determine the prevalence of vertebral progenitor cells relative to the depth of aspiration, the vertebral level, age, and gender, as compared with the iliac crest standard. The cell count, progenitor cell concentration (cells/cc marrow), and progenitor cell prevalence (cells/million cells) were calculated. RESULTS: Aspirates of vertebral marrow demonstrated comparable or greater concentrations of progenitor cells compared with matched controls from the iliac crest. Progenitor cell concentrations were consistently higher than matched controls from the iliac crest (p = 0.05). The concentration of osteogenic progenitor cells was, on the average, 71% higher in the vertebral aspirates than in the paired iliac crest samples (p = 0.05). With the numbers available, there were no significant differences relative to vertebral body level, the side aspirated, the depth of aspiration, or gender. An age-related decline in cellularity was suggested for the iliac crest aspirates. CONCLUSIONS: The vertebral body is a suitable site for aspiration of bone marrow for graft augmentation during spinal arthrodesis.

Aged↗

PubMed2005

Comparison of relative value of bone marrow aspirates and bone marrow trephine biopsies in the diagnosis of solid tumor metastasis and Hodgkin lymphoma: institutional experience and literature review.

CONTEXT: Bone marrow aspirates as well as bone marrow trephine biopsies are frequently performed to assess whether there is marrow involvement by a malignancy. Numerous reports differ in the relative value of these 2 procedures and fail to provide concise guidelines that can help choose the appropriate technique in this clinical situation. OBJECTIVE: To compare the relative value of aspirates and trephine biopsies in the diagnosis of solid tumor metastasis and Hodgkin lymphoma. In addition, we correlate our findings with those of the literature to provide a concise practice guideline. DESIGN: Sixty-six cases showing bone marrow involvement by solid tumor and Hodgkin lymphoma in bone marrow aspirates, bone marrow trephine biopsies, or both were included in the study. The diagnosis and findings made on aspirates were compared with those made on trephine biopsies in each case. RESULTS: In those cases where both aspirate and trephine biopsy were available for evaluation, there was a 22% positive correlation in the findings on aspirates and trephine biopsies. The correlation between aspirates and trephine biopsies was highest in cases of small cell carcinoma of the lung (3/11, or 36.3%) followed by breast carcinoma (7/20, or 35%), prostate carcinoma (1/9, or 11.1%), and Hodgkin lymphoma (1/20, or 5%). Two of 5 cases from the miscellaneous category demonstrated simultaneous involvement of aspirate and trephine biopsy by a gastric carcinoma as well as an adrenal gland carcinoma. CONCLUSIONS: Bone marrow aspirate and bone marrow trephine biopsy should both be performed in patients with proven or suspected malignancies where staging may affect management. However, bone marrow aspirate has only a minimal role, if any, in detecting bone marrow involvement by Hodgkin lymphoma. In cases of breast carcinoma, small cell carcinoma of lung, and prostate carcinoma, aspirate evaluation may confirm trephine biopsy results or, more rarely, provide the sole confirmation of the malignancy.

Biopsy↗

PubMed1990

Fine needle aspiration of pancreatic fluid collections.

The complications of pancreatitis remain diagnostic and therapeutic challenges. Patients with simple pancreatitis, pancreatic necrosis, pseudocyst, noninfected fluid collection or abscess may all have similar clinical pictures. During the last decade computerized tomography (CT)-guided needle aspiration of peripancreatic fluid collections has been increasingly used as a diagnostic tool for pancreatic abscesses. This study reviewed the effectiveness of CT-guided needle aspiration of peripancreatic fluid collections at our institution in terms of diagnostic accuracy, correlation with eventual outcome, and safety. Charts of patients who underwent needle aspiration of de novo peripancreatic fluid collections over the past 2 years were reviewed. Thirty-five patients underwent 50 aspirations. Eleven patients (31%) had a positive aspirate culture; seven of these had a positive Gram's stain. There were no false positive Gram's stains but four false negatives. Twenty-four (69%) patients had negative aspirate Gram's stains and cultures. Patients with positive aspirate cultures were treated with antibiotics only (2), CT-guided drain placement (7), or surgical drainage (3). The mortality related to each of these therapeutic modalities was 50 per cent, 0 per cent, and 33 per cent, respectively. Of the 24 patients with negative aspirate cultures, five had no further treatment, 12 received antibiotics, and six underwent CT drain placement. All these patients survived. There was one false negative aspirate culture. This patient underwent delayed surgical drainage but expired. There were no major complications from CT-guided aspiration. CT-guided aspiration appears to be a safe and reliable method of diagnosing infection in peripancreatic fluid collections.(ABSTRACT TRUNCATED AT 250 WORDS)

Abscess↗

PubMed1997

Ovum pick up in swine: the influence of aspiration vacuum pressure on oocyte recovery from preovulatory follicles.

Endoscopical ovum pick up (OPU) in swine is a minimal invasive and reliable technique to aspirate oocytes from preovulatory follicles for studying intrafollicular development and oocyte maturation as well as for IVM/IVF-programs. The aim of the present study was to determine the effect of different aspiration vacuum pressures on oocyte recovery and on the morphology of cumulus oocyte complexes (COCs). Oestrus of crossbred Landrace gilts (n = 33) was synchronized by feeding altrenogest and follicular growth was stimulated with 1,000 IU PMSG 24 h after the last altrenogest application. On day 4 after PMSG application preovulatory healthy follicles of > 5 mm diameter were aspirated laparoscopically. Aspiration was carried out using a two-way cannula and an electronic aspiration pump. Five different vacuum pressures were used: 10, 17, 32, 47 and 66 ml water/min, corresponding to 30, 60, 125, 250 and 375 mm Hg, respectively. Fluids from different follicles were pooled per ovary and the morphology of cumulus oocyte complexes (COCs) was determined microscopically immediately after aspiration. COCs were classified into oocytes with intact cumulus (i.e. compact or slightly expanded COC), oocytes with corona radiata and denuded oocytes. A total of 695 follicles were aspirated and 501 COCs recovered. Increasing the aspiration pressure stepwise from 10 ml water/min up to 66 ml water/min resulted in a decrease in oocyte recovery rate. A significant higher (P < 0.05) rate of oocyte recovery (77.4% v.s. 59.8%) was achieved using a vacuum pressure of 17 ml water/min compared to 66 ml water/min, respectively. There was a tendency to reduce the portion of COCs with intact cumulus from 82 to 88% to 77% if the vacuum pressure increased to more than 47 ml water/min. A higher aspiration pressure provoked an increase (P < 0.05) in the number of denuded oocytes: 0 to 3% at 10 to 32 ml water/min, respectively, compared to 10% at 47 ml water/min to 17% at 66 ml water/min. These results demonstrate that variation in aspiration pressure affects oocyte recovery rate and COC quality. Aspiration vacuum pressure of 17 to 32 ml water/min was found to be optimal in swine both for oocyte recovery and COC quality.

Animals↗

PubMed1998

Fiberoptic endoscopic documentation of the high incidence of aspiration following extubation in critically ill trauma patients.

The purpose of this study was to investigate the incidence of aspiration following extubation in critically ill trauma patients. This prospective pilot study included 20 consecutive trauma patients who required orotracheal intubation for at least 48 hours. All subjects underwent a bedside transnasal fiberoptic endoscopic evaluation of swallowing at 24 +/- 2 hr after extubation to determine objectively aspiration status. Aspiration was defined as the entry of a blue dyed material into the airway below the level of the true vocal folds, with silent aspiration occurring in the absence of any external behavioral signs such as coughing or choking. Aspiration was identified in 9 of 20 (45%) subjects and 4 of these 9 (44%) were silent aspirators. Therefore, silent aspiration occurred in 20% of the study population. Eight of the 9 (89%) aspirating subjects resumed an oral diet from 2-10 days (mean, 5 days) following extubation. All subjects had no evidence of pulmonary complications. It was concluded that trauma patients after orotracheal intubation and prolonged mechanical ventilation have an increased risk of aspiration. An objective assessment of dysphagia to identify aspiration may reduce the likelihood of pulmonary complications after extubation.

Adolescent↗

PubMedDate not supplied

Does the presence of esophagitis prior to PEG placement increase the risk for aspiration pneumonia?

The aim of this study is to determine if the endoscopic presence of esophagitis predicts aspiration pneumonia after the initiation of enteral feedings in a newly placed PEG tube. A retrospective analysis of 278 patients who received a PEG tube from November 1999 to June 2002 was performed. All PEG procedures performed by a single endoscopist were reviewed from the GI Trac database at the Medical University of South Carolina. Eleven of the procedures were aborted due to technical difficulties. Nine patients received the PEG for gastric decompression only. Seven patients died within 14 days of PEG placement from non-PEG-related complications and were excluded. The resulting 251 patients included for our analysis successfully had PEG tube placement and had at least 14 days of enteral feeding. Esophagitis was defined macroscopically by the endoscopic presence of mucosal edema, friability, or obscurity of the normal vascular pattern in the distal esophagus. Aspiration was defined as the witnessed regurgitation of or tracheal suctioning of PEG feedings. Pneumonia as a consequence of aspiration was defined by development of fever and new infiltrate on chest radiograph within 14 days of PEG placement. Two hundred fifty-one patients had PEG placement (M, 127; F, 124; average age, 62.4 year; age range, 18-95 years) performed by a single endoscopist over a 32-month period. Fourteen (5.6%) of these patients had clinically evident pulmonary aspiration, with seven of them developing pneumonia. Thirteen (93%) of these patients had normal esophageal mucosa. One of the 24 patients (4%) with esophagitis or esophageal ulceration present endoscopically had an aspiration event with subsequent pneumonia. None of the 20 patients found to have some other form of esophageal pathology had an aspiration event. The overall incidence of aspiration pneumonia after the initiation of PEG feedings was 2.7% (7/251). The odds ratio that the presence of esophagitis would predict the development of aspiration pneumonia was 1.60, with a 95% confidence interval of 0.18 to 13.89. This study argues that the presence of esophagitis alone does not increase the risk of aspiration pneumonia from PEG feedings. Other factors apart from esophagitis play an important role in the incidence of aspiration pneumonia with PEG feeding

Adolescent↗