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PubMed2003

Multiple target aspiration technique for subacute stereotactic aspiration of hematomas within the basal ganglia.

BACKGROUND: Stereotactic surgery for deep-seated intracerebral hematomas as a minimally invasive procedure has gained wide acceptance, but debate continues to be controversial concerning the issue of how to aspirate a sufficient proportion of the hematoma with minimized risk for the patient. The objective of this paper is to present a modified stereotactic aspiration technique which complies saliently with both demands. METHODS: The multiple target aspiration technique was used in a series of 64 consecutive patients with spontaneous hematomas within the basal ganglia. The results obtained with this technique were evaluated with particular regard to degree of aspiration and rate of recurrent hemorrhage and were compared with results achieved with stereotactic techniques utilizing physical fragmentation or chemical lysis of the clots. RESULTS: Using this technique, it was feasible in one single surgical procedure to aspirate more than 80% of the hematoma volume in 73.4% of the patients. Mean degree of aspiration was 88.8%, and rebleeding occurred only once (1.6%). These results compare favorably with those achieved with application of intricate stereotactic techniques. CONCLUSION: The multiple target aspiration technique performed in the subacute stage is a rapid and simple method for stereotactic removal of deep-seated hematomas and combines a high success rate with very low risk of recurrent hemorrhage.

Adult↗
PubMed1980

Percutaneous transtracheal aspiration in the diagnosis and treatment of aspiration pneumonia in children.

Seventy-four transtracheal aspirations and expectorated sputum specimens were collected from a number of children with aspiration pneumonia. The aspirates were cultured for aerobic and anaerobic bacteria. Cultures obtained through TTA contained fewer pathogens than in cultures of expectorated sputum. Gram stains of TTA aspirates offered prompt presumptive bacteriologic diagnosis in 93% of patients, whereas Gram stains of expectorated sputum were not specific. The recovery of Gram-negative enteric rods in the TTA aspirate provided guidance in adding an aminoglycoside to the antimicrobial therapy in 35 children (47%). Side effects of TTA included mild hemoptysis and, in rare instances, subcutaneous emphysema. We found TTA to be a generally safe and useful procedure in the diagnosis and therapy of aspiration pneumonia in children.

Adolescent↗
PubMed1996

Importance of diffuse aspiration bronchiolitis caused by chronic occult aspiration in the elderly.

Diffuse aspiration bronchiolitis (DAB) is a new term that we proposed to define a clinical entity that is characterized by a chronic inflammation of bronchioles caused by recurrent aspiration of foreign particles. In the present study, a total of 4,880 consecutive autopsies were reviewed and we found 31 patients with DAB (0.64%). To investigate the clinicopathologic features of DAB, the 23 patients with DAB (age, 81.2 +/- 6.2 years [mean +/- SD]), from whom clinical information was available, had their features compared to those of 40 randomly selected patients with aspiration pneumonia (age, 81.9 +/- 8.3 years [mean +/- SD]). Oropharyngeal dysphagia was observed in half of the patients with DAB, and two thirds of patients with DAB were bedridden. The onset of DAB was more insidious than aspiration pneumonia, and in half of the patients with DAB episodes of aspiration were unrecognized. Neurologic disorders (52.2%) and dementia (47.8%) were common associated diseases. Most patients with DAB showed signs of bronchorrhea, bronchospasm, and dyspnea. The macroscopic appearance of the cut surface of DAB lung showed diffusely scattered miliary yellowish nodules that resembled those of diffuse panbronchiolitis (DPB). Histologic findings of DAB were characterized by localization of chronic mural inflammation with foreign body reaction in bronchioles. Recurrence of small amounts of aspiration might play a role in the pathogenesis of DAB. In view of possible therapeutic intervention, we emphasized the importance of recognizing this entity and differentiating DAB from pulmonary diseases associated with bronchospasm in the elderly, in particular, late-onset asthma and DPB.

Aged↗
PubMed2004

Intratracheal albumin reduces interleukin-8 in tracheobronchial aspirates in piglets after meconium aspiration.

Meconium aspiration induces pulmonary inflammation and reduces surfactant function. We hypothesized that albumin mixed with meconium attenuates pulmonary inflammation and improves surfactant function after meconium aspiration. We measured the concentration of free fatty acids (FFA) in the meconium (110 mg dry weight/mL) and added albumin to provide a molar FFA:albumin ratio of 1:1. Newborn piglets, 0-2 day of age, artificially ventilated and exposed to hypoxemia by ventilation with 8% O2, were randomized to group A receiving meconium (n = 12), or group B receiving meconium + albumin (n = 12), 3 ml/kg intratracheally. The animals were reoxygenated for 8 h. Reoxygenation was started when mean arterial blood pressure was < 20 mm Hg or base excess was < -20 mmol/L. During 8 h of reoxygenation the interleukin-8 concentrations in tracheobronchial aspirates increased 5-fold more in the meconium vs. the meconium + albumin groups (93 +/- 56 vs. 18 +/- 4 pg/mL, p < 0.005). There were no differences between the groups for tumor necrosis factor alpha in tracheobronchial aspirates, recruitment of inflammatory cells in the airspaces or surfactant function in bronchoalveolar lavage fluid. In conclusion, albumin significantly decreased interleukin-8 concentrations in tracheobronchial aspirates after meconium aspiration.

Animals↗
PubMed1994

Glucose content of tracheal aspirates: implications for the detection of tube feeding aspiration.

OBJECTIVE: To determine, using a sensitive glucose assay, whether monitoring of tracheal aspirate glucose concentration could serve as a marker of aspiration of enteral feedings. DESIGN: Prospective, controlled trial. SETTING: Intensive care units of a tertiary care hospital. PATIENTS: Fifteen enterally fed and 15 nonenterally fed, tracheally intubated patients who had normal lung fields on a routine chest radiograph. INTERVENTIONS: Patients with endotracheal tubes undergoing routine tracheal suctioning had tracheal secretions collected three times per day with a minimum of 4 hrs between samples for up to 5 days. Daily chest radiographs were reviewed for evidence of the development of pneumonitis using defined criteria. MEASUREMENTS AND MAIN RESULTS: Glucose concentrations in five commonly used commercial feeding formulas, as well as in the medications patients were receiving enterally or as an oral wash, were measured. Tracheal secretion glucose concentrations were 66 +/- 54 (SD) mg/dL (3.7 +/- 3.0 mmol/L) and 105 +/- 70 mg/dL (5.8 +/- 3.9 mmol/L) in the enterally fed and nonenterally fed patients, respectively (p = NS). Of the medications administered, the majority contained negligible glucose, but ten had > 3 mg/dose of glucose. However, there was no correlation between administration of these medications and the tracheal glucose concentrations. Tracheal glucose concentrations were similar in patients who received medications containing glucose and patients who received either no medications or medications with negligible glucose content. A small but significant correlation between blood glucose and tracheal secretion glucose concentrations (r2 = .15, p < .05) was observed. None of the patients developed aspiration pneumonitis. Glucose concentrations in widely used commercial formulas (44 to 202 mg/dL; 2.4 to 11.2 mmol/L) overlapped considerably with glucose concentrations in tracheal secretions in the absence of aspiration and were for the most part within 2 SD of mean values in tracheal secretions. CONCLUSIONS: Tracheal secretions contain high glucose concentrations, both in enterally fed patients without evidence of aspiration pneumonitis and in nonenterally fed patients. The concentration of glucose in tracheal secretions appears to be determined, in part, by ambient extracellular glucose concentrations. We conclude that measurement of glucose in tracheal secretions is unlikely to be useful in monitoring for tube feeding aspiration in tracheally intubated, enterally fed patients.

Aged↗
PubMed1983

Cytologic examination and CEA measurement in aspirated pancreatic material collected by percutaneous fine-needle aspiration biopsy under ultrasonic guidance for the diagnosis of pancreatic carcinoma.

Diagnostic accuracy of the cytologic examination or CEA measurement in pancreatic fluid obtained by percutaneous fine-needle aspiration biopsy under ultrasonic guidance, was investigated in 26 patients with histologically proven carcinoma of the pancreas, and the incidence of positive results of cytology and CEA assay were compared in pancreatic fluid obtained by percutaneous fine-needle aspiration biopsy and by endoscopic cannulation of the ampulla of Vater in the same 19 patients. Positive cytologic findings were observed in the fluid obtained by percutaneous aspiration biopsy of 88.5% of the patients with pancreatic carcinoma. The location of the cancer had no influence on the cytology, but positive results were more frequent in patients with distant metastases than in those with localized tumor or locally invasive carcinoma. Positive cytologic results were obtained in the pancreatic fluid obtained by endoscopic cannulation from the ampulla of Vater of only 15.8% of the patients examined by both methods, but percutaneous fine-needle aspiration biopsy significantly increased the diagnostic rate. In the specimens obtained by aspiration biopsy, tumor cells were much more abundant and easily recognizable. When cytologic examination does not provide any evidence of malignancy, measurement of CEA levels in pancreatic fluid is probably useful. Combination of the cytology and CEA assay of the specimens obtained by percutaneous fine-needle aspiration biopsy of the pancreas increased the diagnostic rate to 100%.

Adenocarcinoma↗
PubMed1999

Effect of a one-way tracheotomy speaking valve on the incidence of aspiration in previously aspirating patients with tracheotomy.

The purpose of the present study was to investigate the incidence of aspiration in previously aspirating patients with tracheotomy after use of a one-way tracheotomy tube speaking valve. Twenty consecutive inpatients from the acute care setting of a large urban tertiary care teaching hospital were included. All subjects had objective documentation of aspiration by a fiberoptic endoscopic evaluation of swallowing prior to placement of a one-way tracheotomy speaking valve, from 2 to 7 days of valve use with intelligible speech production, and no surgery to the upper aerodigestive tract except tracheotomy. Results indicated that incidence of aspiration was not affected by use of a one-way tracheotomy speaking valve. These results are in agreement with previous observations that subjects either aspirated or swallowed successfully regardless of tracheotomy tube occlusion status. Also, no significant differences were found between aspiration status and time since tracheotomy, time off ventilator, or duration of valve use. It was concluded that use of a one-way speaking valve provided mostly nondeglutitive benefits and should not be considered to promote successful swallowing for patients with tracheotomy in the acute care setting.

Aged↗
PubMed1993

A comparison of the Pipelle device and the Vabra aspirator as measured by endometrial denudation in hysterectomy specimens: the Pipelle device samples significantly less of the endometrial surface than the Vabra aspirator.

OBJECTIVE: The distribution and relative area of endometrial sampling of two endometrial biopsy techniques, Pipelle and Vabra aspiration biopsy, were compared. STUDY DESIGN: Twenty-five patients scheduled for hysterectomy were randomly assigned to undergo preoperative endometrial biopsy by Pipelle device (12 patients) or Vabra aspiration (13 patients). The endometrial cavities of the surgical specimens were photographed, and percent denudation was determined by a point-counting method. RESULTS: The percentage of endometrial surface area sampled by the Pipelle device was 4.2% +/- 0.92% (mean +/- SEM), and by Vabra aspirator 41.6% +/- 5.7% (p < 0.0001). The mean number of endometrial surfaces (one anterior and one posterior) sampled by the Pipelle device was 1.08 +/- 0.15, and by the Vabra aspirator 2 +/- 0 (p = 0.001). The mean number of endometrial quadrants (four anterior plus four posterior) sampled by the Pipelle device was 2.4 +/- 0.41, and by the Vabra aspirator 7.4 +/- 0.42 (p < 0.0001). CONCLUSION: We conclude that the Vabra aspirator is statistically superior to the Pipelle device for sampling the endometrial cavity when the total surface area sampled and the distribution of surfaces sampled are considered.

Adult↗
PubMed2005

A comparative study of fine needle aspiration cytology versus non-aspiration technique in thyroid lesions.

The present study was done to explore the diagnostic yield by the non-aspiration technique as compared with fine needle aspiration cytology (FNAC) of lesions in the thyroid gland. This method of non-aspiration fine needle cytology, which utilizes no active suction or aspiration, was performed on 150 patients presenting with enlargement of the thyroid gland. Smears were then cytologically assessed as unsuitable, diagnostically adequate or diagnostically superior, without knowledge of the sampling method employed. Diagnostically superior specimens were obtained significantly more frequently by the non-aspiration technique in 136 benign lesions and 14 neoplasms. Thus, the non-aspiration technique combined with FNAC can result in obtaining good quality cellular material in thyroid lesions.

Biopsy, Fine-Needle↗
PubMed1990

Do hourly averaged pH readings correlate with those from point readings of aspiration? Comparison of two different electrode positions with simultaneous aspiration.

Hourly averaged data from continuous intraluminal pH recording were compared with the point aspiration in five 24-hour studies performed on healthy volunteers. Two different electrode positions were compared simultaneously with aspiration. The correlation was performed using the median from the whole hour's recording of the electrode against the aspiration point. There was a significant correlation between both electrodes and aspiration (p less than 0.001), although both electrodes read consistently lower than aspiration: electrode A (gastric antrum), median pH = 1.4; electrode B (gastric body), pH = 1.9; aspiration, pH = 2.3. These findings show that data reported in clinical trials using different recording techniques are not directly comparable and must be interpreted appropriately. The position of the electrode may also be important.

Adult↗
PubMed1988

Stereotactic aspiration of putaminal hemorrhage using a double track aspiration technique.

Double track aspiration was used to remove the hematoma between 6 and 24 hours from onset in nine cases of putaminal hemorrhage. This technique was used in cases where an approach along the long axis of the hematoma was not feasible. With this method, aspiration is done at two target points lying anterior and posterior of the somewhat harder central region, at which aspiration is not attempted. This technique allows aspiration of most of the serum components, which are depicted as low density areas in computed tomographic (CT) scans, and some 53 to 85% of the main mass of the hematoma, which is seen on CT as high density areas. There was no rebleeding among these nine patients, and the remaining hematoma in all cases was located between two target points--a fact that is thought to indicate that the central portion of the hematoma is in fact somewhat harder than the peripheral portions. Although the double track aspiration technique has the disadvantage of producing two tracks, it is thought to be an effective method in such cases because it allows safe and thorough hematoma aspiration.

Adult↗
PubMed2002

[Aspiration versus aspiration plus ultrasonography-guided alcohol administration for simple renal cysts: recurrence and complications].

In this study the results of two percutaneous treatment of simple renal cysts are compared: aspiration alone versus aspiration and ethyl alcohol injection. Out of 40 patients, 17 have been treated with aspiration only and 23 with aspiration and ethanol injection. Recurrent disease has been observed in 88.2% of patients in the aspiration group and 30.4% in the aspiration and ethanol injection group. This difference is statistically significant as shown by the Kaplan-Mayer curve when evaluated by the Log-rank test, and this is sufficient to justify such treatment as a first quality choice.

Adult↗
PubMed2005

A comparison between endoscopically middle meatal aspiration culture using modified aspiration instrument and direct maxillary antral tap culture in chronic rhinosinusitis.

OBJECTIVES: To evaluate the accuracy of endoscopically guided middle meatal aspiration culture by comparing the culture results between middle meatal aspiration using the modified aspiration instrument and direct maxillary antral tap. MATERIAL AND METHOD: Sixteen patients with chronic rhinosinusitis underwent functional endoscopic sinus surgery (FESS) were enrolled. Both endoscopically middle meatal aspiration culture (EMAC) using modified aspiration instrument and direct antral tap culture (ATC) were performed before FESS. Microbiologic data were compared and analyzed for any statistical differences between EMAC and ATC. RESULTS: The positive culture rates were 93.75% in both EMAC and ATC groups. Aerobic and facultative anaerobic bacteria were found in 87.5% of EMAC group and 81.25% of ATC group. The two most common bacteria in both groups were coagulase-negative Staphylococcus and Staphylococcus aureus. The association between EMAC and ATC was strong to moderate (13/16) 81.25%. CONCLUSION: EMAC appears to be a valuable alternative to ATC for guiding bacterial-specific therapy in chronic rhinosinusitis. This modified aspiration instrument should be useful in clinical practice and serve as a cost effective procedure.

Adolescent↗
PubMed1992

[Type A personality and level of aspiration in preschool children: some basic characteristics of aspiration levels and their modifications by introducing risk-taking and competitive situations].

The purpose of this study was to investigate some characteristics of aspiration levels of Type A preschoolers. Twenty-two Type A and twenty-one Type B subjects selected from 245 preschoolers were given three tasks: ball-throwing task 1, ball-throwing task 2, and ringtoss task. After investigating some basic characteristics of aspiration levels in a standard situation (ball-throwing task 1), risk-taking (ball-throwing task 2) and competitive (ringtoss task) situations were introduced in order to study the modifications of aspiration levels. The results indicated that Type A children showed higher aspiration levels than Type B children, but that no differences of changes in aspiration levels by introducing risk-taking and competitive situations were found between the two types. These results were discussed from the view point of formation of Type A characteristics.

Aspirations, Psychological↗
PubMed1999

Pseudoglandular formations in clot sections from fine needle aspirates--an artefact caused by bubble formation during aspiration.

AIMS: To report the occurrence of an uncommon artefact producing pseudoglandular formations in clot sections from haemorrhagic fine needle aspirations. METHODS: All available histological material from 610 fine needle aspirations by pathologists (23 g needle) over a five year period was reviewed. The frequency and associations of the pseudoglandular artefact was assessed. RESULTS: Clot sections were prepared in 41 of the 610 cases (7%). Bubbles were present in the clots in 22 of these cases (54%), and in three cases (7%) these were lined by lymphocytes creating pseudoglandular formations. These were two lymph node aspirates and one thyroid aspirate. In four further cases lesser numbers of cells partly lined some of the bubbles; these were lymphocytes, macrophages, or in one case, thyroid epithelial cells. CONCLUSIONS: When clot sections are prepared in cases of haemorrhagic fine needle aspiration, bubbles are often produced during suction; these can on occasion become lined by lymphocytes or other cells, leading to pseudoglandular formations. Recognition of this artefact will prevent unnecessary further investigation of their nature.

Adult↗