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PubMed2004

A new follicle aspiration needle set is equally effective and as well tolerated as the standard needle when used in a prospective randomized trial in a large in vitro fertilization program.

OBJECTIVE: To compare the effectiveness and tolerability of two different 17-gauge follicle aspiration needles used in a large in vitro fertilization (IVF) program. DESIGN: Prospective, randomized single blinded study. SETTING: Private IVF center. PATIENT(S): Three hundred women undergoing IVF were randomly allocated at the time of oocyte retrieval to either the study needle (n = 151; follicle aspiration set [FAS] set) or the standard needle (n = 149; Echotip) used in the practice. Patients were blinded to the needle used. INTERVENTION(S): Transvaginal ultrasound-guided oocyte aspiration. MAIN OUTCOME MEASURE(S): Number of eggs retrieved/follicles visualized, retrieval time, mean amount of blood in the aspirate, egg damage, patient tolerance, physician acceptability, implantation, and pregnancy rate. RESULT(S): No differences were found in the number of eggs retrieved normalized to follicles visualized. Egg damage (4% vs. 4.2%), average blood in the aspirate (2.2 vs. 2.2), and retrieval time per egg (38 vs. 36 seconds) were similar with both needles. There were also no differences in pain or cramping scores (at 30 minutes and 24 hours after retrieval) or in the physicians' ratings of the two needles. The percentage of patients receiving an embryo transfer (ET), the implantation rate per embryo transfer, and the clinical pregnancy rate per embryo transfer were comparable for both needles. CONCLUSION(S): The FASs are equivalent.

Adult↗

PubMed2000

Randomized clinical trial of the effect of needle gauge and local anaesthetic on the pain of breast fine-needle aspiration cytology.

BACKGROUND: Breast fine-needle aspiration cytology (FNAC) is an invasive investigation which can be uncomfortable or distressing. This randomized study investigated the discomfort of breast FNAC and the effect of different techniques. METHODS: Some 116 FNAC samples were taken from 98 women with a palpable breast mass. Each patient was randomized to one of four study groups; aspiration was performed using a green-hub (21 G) or blue-hub (23 G) needle, either with or without local anaesthetic. Each patient scored the pain of the whole procedure using a visual analogue scale. RESULTS: A green-hub needle caused significantly more discomfort (mean(s.e.m.) pain score 5.1(0. 4) cm) than a blue-hub needle (2.9(0.4) cm), or either a blue- or green-hub needle with local anaesthetic (3.0(0.4) and 2.1(0.4) cm respectively) (F = 10.28, 3112 d.f., P < 0.01, analysis of variance). CONCLUSION: The discomfort of breast FNAC is dependent upon the gauge of the needle and the use of local anaesthetic. A blue-hub needle without local anaesthetic should be first choice for breast FNAC.

Anesthesia, Local↗

PubMed1995

Automated large-core needle biopsy of surgically removed breast lesions: comparison of samples obtained with 14-, 16-, and 18-gauge needles.

PURPOSE: To determine the needle size that would consistently enable the pathologist to correctly diagnose tissue core biopsy specimens. MATERIALS AND METHODS: Fifty-seven surgically removed mass lesions of the breast were sampled with a short-throw automated biopsy gun and an 18-gauge needle first, followed by a 16- and a 14-gauge needle. Samples were evaluated independently by three pathologists, and findings were compared with the final diagnosis made at surgical excision biopsy. RESULTS: The sensitivity for the diagnosis of all 26 malignant lesions was 100%, 92%, and 65% for biopsy samples obtained with 14-, 16-, and 18-gauge needles, respectively. Specificity for malignancy was 100% for all three needle sizes. All of the benign diseases were correctly diagnosed in samples obtained with all three size needles except for two samples that did not survive processing. CONCLUSION: Biopsy samples obtained with a 14-gauge needle provide the most accurate diagnosis, which correlates with the diagnosis made with the surgical excision biopsy technique.

Automation↗

PubMed2005

Cost-effectiveness of fine-needle-aspiration cytology of thyroid nodules with intranodular vascular pattern using two different needle types.

OBJECTIVE: To compare the cytological findings of hypoechoic thyroid nodules with intranodular vascular pattern (pattern II) obtained by two different needles (Neolus 25 gauge, Chemil, Wenzhou, China vs Yale Spinal 25 gauge, Becton Dickinson, Madrid, Spain) in euthyroid patients and to evaluate their cost-effectiveness. METHODS: From January 2001 to December 2003, 480 euthyroid patients with a hypoechoic thyroid nodule pattern II were referred for US-FNAC. The nodules were alternatively evaluated by Neolus or by Yale Spinal with the stylet (YS+) or without the stylet (YS-), in order to evaluate if the cytological results could be due to the presence of the stylet or to the different length of the two needles. For each nodule two passes were performed and the material was obtained by capillary action. Material was smeared on slides, fixed, and stained by Papanicolaou techniques. Cytological specimens were evaluated in blind by the same experienced cytopathologist. RESULTS: Inadequate cytological specimens because of blood contamination were present in 30 (18.7%) samples by Neolus needle and in 22 (13.8%) by YS- compared to only 5 (3.1%) by YS+. In 6 (20%) cases of the 30 repeated US-FNAC by Neolus and in 4 (18%) of the 22 US-FNAC by YS-, material remained inadequate for diagnosis because of blood contamination. All the five repeated samples obtained by YS+ became adequate for diagnosis and resulted benign nodules. Direct costs of US-FNAC procedure are currently 72.30 Euro including cytological examination. The cost of Neolus and Yale needles is 0.19 Euro and 3.0 Euro, respectively. The estimated total cost to obtain a cytological diagnosis by a Neolus needle (160 + 30 repeated US-FNAC) was 13809.2 Euro vs 12919.5 Euro by Yale Spinal needle (160 + 5 repeated US-FNAC). CONCLUSION: This study demonstrates that the use of Yale Spinal needles greatly reduces inadequate cytological specimens, and therefore limits both direct and indirect costs.

Biopsy, Fine-Needle↗

PubMedDate not supplied

[Comparison of the results of transthoracic needle biopsy of the lungs using the Nordenström and the Rotex needles].

In the diagnostics of nodular and infiltrative lung lesions in 28 patients the transthoracic needle biopsy of the lung was performed both by Nordenström and Rotex needle. In confirming the cancer, both needles were equally satisfactory. By Rotex needle the tissue sample was obtained also from hard lesions from which the tissue sample with Nordenström needle couldn't be obtained. By transthoracic needle biopsy of the lung the diagnosis of benign disease was confirmed in two patients with isolation of Mycobacterium tuberculosis from the sample obtained by Rotex needle.

Adolescent↗

PubMed1997

Core needle biopsy. A useful adjunct to fine-needle aspiration in select patients with palpable breast lesions.

BACKGROUND: Fine-needle aspiration (FNA) biopsy is an established, highly accurate method for diagnosing palpable breast lesions. However, in some cases a definitive diagnosis cannot be made by FNA alone, either due to the inherent limitations of cytology itself or the ability to obtain adequate material for diagnosis. This study evaluated the usefulness of a supplemental core needle biopsy performed by a cytopathologist in conjunction with an FNA biopsy in select patients. METHODS: Twelve patients with palpable breast lesions underwent the combined FNA/core needle biopsy procedure during the study period from March 1995 through March 1996. All 12 patients first had an FNA aspiration that was preliminarily evaluated by the FNA cytopathologist while the patient was at the clinic. If the cytopathologist was unable to render a definitive diagnosis of the lesion type or if a repeat FNA was requested by the clinician because of a previous non-definitive FNA result, a core needle biopsy was then performed. RESULTS: When the FNA and the core needle biopsies were reviewed together, a correct definitive diagnosis was made in 10 of the 12 cases. In contrast, review of the FNA material alone yielded a correct definitive diagnosis in only five cases. CONCLUSIONS: The supplemental core needle biopsy was found to be especially useful in: 1) providing a definitive diagnosis of infiltrating carcinoma in those cases in which the FNA diagnosis was reported as "suspicious;" 2) providing ample tissue for ancillary studies; and 3) differentiating a phyllodes tumor from a fibroadenoma. It is the authors' opinion that the FNA cytopathologist is the physician best qualified to perform the combined FNA/core needle biopsy procedure should he/she deem it necessary.

Biopsy, Needle↗

PubMed1996

[Incidence of postmyelography syndrome and postmyelography complaints after lumbar puncture with the Sprotte pencil-like needle in comparison with the Quincke needle].

PURPOSE: Myelography in combination with a postmyelography CT is an important presurgical examination because of its excellent visualisation of the disc, the bone and the contrast-filled dura. Side effects after myelography can be observed in up to 50% of patients. The pathophysiological mechanism is thought to be increased cerebrospinal fluid leakage at the puncture site. Since the introduction by Sprotte in 1979 of the pencil-point needle, a modification of Whitacre's needle, fewer complaints after lumbar puncture have been reported. The aim of the study was to examine the influence of two types of needle points and the temperature (37 degrees C vs 21 degrees C) of the contrast medium (CM; iotrolan, Isovist) on the incidence of side effects of lumbar puncture for myelography. MATERIAL AND METHODS: In a prospective randomized trial the incidence of complaints after lumbar puncture with intrathecal CM application was evaluated by the use of a 21-G pencil-point needle as modified by Sprotte compared to our usual 22-G needle with a Quincke bevel. Some 412 patients (201 female, 211 male; mean age 54.05 +/- 7.4 years) were investigated. Directly after examination and 1. 3 and 5 days later the patients were questioned about complaints (headache, neck stiffness nausea, vomiting, buzzing in the ear and dizziness). The results were tested by the chi square test. RESULTS: A significantly lower incidence of complaints was seen after lumbar puncture with the pencil-point needle/Quincke needle (headache: 6.3%/18.9%, P < 0.0001; headache lasting 3 days: 0.5%/7.8%, P < 0.0001; headache lasting 5 days: 0%/2.4%, P = 0.0305; nausea: 0%/4.9%, P = 0.0009; vomiting: 0%/3.4%, P = 0.0009; dizziness: 0%/3.4%, P = 0.0074; neck stiffness: 0%/3.4%, P = 0.0074). The temperature of the CM had no influence on the complaints. No influence was seen on the quality of the myelogram. No relation to sex and age was found. CONCLUSION: Complaints after lumbar puncture and myelography are caused by the cerebrospinal fluid leakage at the puncture site. The incidence of side effects related to this leakage can be reduced by using a pencil-point needle. The temperature of the CM has no influence on the complaints.

Adolescent↗

PubMed2007

Needle track dissemination of follicular thyroid carcinoma following fine-needle aspiration biopsy: report of a case.

Few reports have been concerned with the risk of needle track dissemination of tumor cells following fine-needle aspiration biopsy, especially for follicular thyroid nodules. A 61-year-old woman who underwent fine-needle aspiration biopsy and surgery 5 years previously for follicular thyroid adenoma presented with nodules that had developed in the sternocleidomastoid and omohyoid muscles of the anterior neck. These nodules were located along a line from the skin to the thyroid that coincided with the needle track of the previous biopsy. Following surgical resection, histological diagnosis determined the nodules to be follicular carcinoma. The clinical course and linear arrangement of the lesions were highly suggestive of needle track dissemination of tumor cells following fine-needle aspiration biopsy. Although fine-needle aspiration biopsy is a useful tool for the diagnosis of thyroid nodules, it is important to consider the risk of tumor cell dissemination.

Adenocarcinoma, Follicular↗

PubMedDate not supplied

Enhancing needle durability by silicone coating of surgical needles.

The purpose of this study was to assess the effect of coating surgical needles with silicone on their durability. Needle durability is a measure of needle sharpness after repeated passage through tissue. Needle sharpness was determined by quantitating the energy required to pass a designated needle repeatedly (20 times) through porcine skin, linea alba, colon, and aorta. The results demonstrate that the durability and sharpness of silicone-coated needles were significantly greater than those of comparable uncoated needles in linea alba, colon, and aorta, but not in skin.

Animals↗

PubMed2000

Comparison of a new screw-tipped intraosseous needle versus a standard bone marrow aspiration needle for infusion.

The purpose of this study is to compare the speed and ease of establishing intraosseous infusion using a standard bone marrow needle (SBMN; $8) and a new screw-tipped intraosseous needle (Sur-Fast; $42). The study is an experimental design. A total of 42 medical students, without prior IO experience, were recruited as study subjects. Subjects were randomized to perform the IO procedures in one of two models: (1) turkey femur or (2) pork ribs. Each subject performed an initial trial using both IO needles without practice (inexperienced) and a second trial using both IO needles after practice (experienced attempt), such that in total, each subject completed four attempts (two with each needle type). IO placement times were measured, and placement difficulty scores were measured using a 10 cm visual analog scale (VAS). The averaged elapsed time to successful IO completion was significantly shorter for the SBMN in the initial "inexperienced" attempt (33 versus 54 seconds, P = .019), but there was no significant difference in the postpractice "experienced" attempt. VAS difficulty scores were lower (easier) for the SBMN for both inexperienced and experienced trials. Success rates were significantly higher for the Sur-Fast needle during the experienced attempt (95% versus 79%, P < .05), but there was no significant difference in success rates during the inexperienced attempt. The Sur-Fast screw-tipped intraosseous needle does not show superiority over the SBMN in this intraosseous model, therefore its higher cost is difficult to justify based on this study.

Animals↗

PubMed1996

A cooled needle electrode for radiofrequency tissue ablation: thermodynamic aspects of improved performance compared with conventional needle design.

RATIONALE AND OBJECTIVES: I developed and tested a cooled needle electrode (CNE) for radiofrequency (RF) tissue ablation in vitro. METHODS: A 2-mm needle electrode with two lumina for internal water perfusion and irrigation of the needle tip and a conventional needle electrode were tested in ex vivo calf liver during different levels of output power (wattage). RF lesions produced by the two needle types were further evaluated with a thermal camera. RESULTS: When the CNE was used, a significant increase in the duration of ablation was observed, which caused a significant increase in delivered energy and lesion size when compared with the conventional needle electrode. The largest lesion produced with the CNE was almost spherical and measured 41 x 37 mm (longitudinal x transverse). The cooling effect was reflected in the image obtained with the thermal camera. CONCLUSION: This technique produced very large lesions compared with conventional methods and may have a role in many different kinds of RF needle ablation.

Animals↗

PubMedDate not supplied

The PENCAN 25-gauge needle: a new pencil-point needle for spinal anesthesia tested in 1,193 patients.

BACKGROUND AND OBJECTIVES: The PENCAN 25-gauge spinal needle is a new pencil-point needle with an inner diameter of 0.32 mm resulting in a relatively high cerebrospinal fluid (CSF) flow. The PENCAN 25-gauge needle was tested for ease of identification of a successful dural puncture, the failure rate of spinal anesthesia, and the incidence of postdural puncture headache (PDPH). METHODS: In a multicenter trial, the needle was tested in patients undergoing spinal anesthesia. A questionnaire evaluated the characteristics of the dural puncture. A second questionnaire was used to assess postspinal side effects (PDPH, atypical headache, audiovisual disturbances). RESULTS: In 1,193 patients, dural puncture was evaluated as easy in 85.2%, as moderate in 6.2%, as difficult in 6.7%, and as impossible in 1.9%. Needle performance was assessed as excellent or satisfactory in 96.9%. In 95.9% of patients, CSF appeared within 2 seconds. A perceptible "click" was noticed in 78.4% of patients. In 1.9%, CSF could not be obtained, because of spine deformities, obesity, or bending of the needle. In 1,166 patients, postpuncture complaints were evaluated, involving 635 women (54.5%), 773 patients (66.3%) under the age of 50 years old, and 170 (14.6%) cesarean deliveries. The overall incidence of PDPH was 1.3% (n = 15). A bloodpatch was needed in five patients. After cesarean delivery the incidence of PDPH was 3.4%, all responding to conservative treatment. Atypical headache and isolated audiovisual disturbances occurred in 7.5% and 1.5% of patients, respectively. CONCLUSIONS: A failure rate of 1.9% together with a 1.3% incidence of PDPH were comparable to other 25-gauge pencil-point needles. The rapid appearance of CSF and a perceptible "click" made prompt recognition of successful dural puncture possible.

Anesthesia, Spinal↗

PubMed1988

Effect of bedside needle disposal units on needle recapping frequency and needlestick injury.

Needle recapping has been shown to be one of the leading causes of needlestick injuries. Frequency of recapping has not been reported. This study was designed to determine the frequency of needle recapping by nursing personnel and the effect of bedside needle disposal units on the frequency of recapping and needlesticks. Seventy-four nurses carrying out 312 activities involving use of needles were observed. The subjects were not aware of the nature of the study. The recapping frequency was 93.9%. The study was repeated after educational programs and following installation of a hospital-wide bedside needle disposal system. Fifty-three nurses performing 151 activities with needles were observed. Frequency of recapping was 94%. There was no significant difference in the rate of recapping or needlestick injuries after installation of the new needle disposal system. Educational programs regarding recapping, a very common practice, may be ineffective. Alternate methods for preventing needlesticks may be necessary.

Accidents, Occupational↗

PubMed2003

Dural tissue trauma and cerebrospinal fluid leak after epidural needle puncture: effect of needle design, angle, and bevel orientation.

BACKGROUND: The effects of epidural needle design, angle, and bevel orientation on cerebrospinal fluid leak after puncture have not been reported. The impact of these factors on leak rate was examined using a dural sac model. Dural trauma was examined using scanning electron microscopy. METHODS: Human cadaveric dura, mounted on a cylindrical model, was punctured with epidural needles using a micromanipulator. Tissue was punctured at 15 cm H2O (left lateral decubitus) system pressure, and leak was measured at 25 cm H2O (semisitting) pressure. Leak rates and trauma were compared for the following: (1) six different epidural needles at 90 degrees, bevel parallel to the dural long axis; (2) 18-gauge Tuohy and 18-gauge Special Sprotte epidural needles, 30 degrees versus 90 degrees; (3) 18-gauge Tuohy, bevel perpendicular versus parallel to the dural long axis. RESULTS: With the 90 degrees puncture, bevel parallel, the greatest leak occurred with a 17-gauge Hustead (516 +/- 319 ml/15 min), and the smallest leak occurred with a 20-gauge Tuohy (100 +/- 112 ml/15 min; P = 0.0018). A 20-gauge Tuohy puncture led to statistically significant reductions in leak (P value range, 0.0001-0.0024) compared with all needles except the Special Sprotte. With the 30 degrees versus 90 degrees angle, 30 degrees punctures with an 18-gauge Tuohy produced nonstatistically significant leak reductions compared with the 18-gauge Tuohy at 90 degrees. The puncture angle made no difference for the Special Sprotte. Nonsignificant reductions were found for the Special Sprotte compared with the Tuohy. With the 18-gauge Tuohy bevel orientation, perpendicular orientation produced nonstatistically significant reductions in leak compared with parallel orientation. CONCLUSIONS: Cerebrospinal fluid leak after puncture was influenced most by epidural needle gauge. Leak rate was significantly less for the 20-gauge Tuohy needle.

Anesthesia, Spinal↗

PubMed1987

The complementary role of fine needle aspiration cytology and Tru-cut needle biopsy in the management of breast masses.

Fine needle aspiration cytology (FNA) and Tru-cut needle biopsy (TNB) have been used for the pre-operative diagnosis of cancer in breast masses as alternatives to open breast biopsy. The accuracy of clinical examination, fine needle aspiration biopsy and Tru-cut needle biopsy was assessed in 230 patients with palpable breast masses and the value of using both biopsy methods in the management was prospectively evaluated. Clinical diagnosis had a sensitivity of 89.2% and specificity of 78.4% (32.7% false positive, 6.5% false negative). Aspiration cytology was diagnostic in 78.4% of cancers and 71.6% of benign lesions [excluding non-diagnostic samples (27.4%), sensitivity was 96.6% and specificity was 100%]. Tru-cut needle biopsy identified 82.9% of cancers and 61.7% of benign lesions [excluding non-diagnostic samples (33.3%), sensitivity was 96.7% and specificity was 100%]. There were no false positive errors with either aspiration cytology or needle biopsy. Statistical comparison showed that there was no significant difference between aspiration cytology and needle biopsy. The combined result of both biopsies was superior to clinical examination when non-diagnostic samples were excluded. With the routine use of both biopsy techniques, frozen section was avoided in 73% of all cancers and unnecessary operations were avoided in 33.5% of patients which included breast cysts, benign mammary dysplasia and inflammatory lesions.

Adult↗

PubMed1993

Comparative study of the skin pathergy test with blunt and sharp needles in Behçet's disease: confirmed specificity but decreased sensitivity with sharp needles.

OBJECTIVE: To compare the specificity and sensitivity of the skin pathergy test performed with blunt and sharp needles in patients with Behçet's disease. METHODS: The skin pathergy test was performed using the simultaneous four needle prick method with blunt and sharp, thick and thin needles in 92 patients with Behçet's disease, 64 healthy controls, and 128 patients without Behçet's disease. The test was evaluated at 48 hours. RESULTS: No positive skin pathergy test was found in healthy controls and patients without Behçet's disease. The frequency and intensity of the positive skin pathergy test with blunt needles were significantly higher than those with sharp needles. CONCLUSION: This study reconfirmed the specificity of a positive skin pathergy test for Behçet's disease using blunt and sharp needles and showed a decreased sensitivity and intensity of the reaction with sharp needles.

Adolescent↗

PubMed1992

A simultaneous comparison of acupuncture needle and insulated needle sphenoidal electrodes for detection of anterior temporal spikes.

Uninsulated acupuncture needles have been used as sphenoidal electrodes, but the issue of insulation has not been adequately addressed. In this report, acupuncture needles and insulated needle sphenoidal electrodes were simultaneously used to compare the rate of spike detection, spike amplitude and distribution of maximal spikes from eight spike foci in seven patients with temporal lobe epilepsy. When compared to the insulated needle electrode, the acupuncture needle electrode was equally effective in spike detection, but spike amplitudes tended to be smaller and maximal spikes were less frequently encountered. Thus, insulation has an influence on the spikes recorded by the acupuncture needle sphenoidal electrode. However, the overall effect appears to be not sufficiently different from the insulated needle electrode for the purpose of detecting anterior temporal spikes in outpatient EEG recordings for the diagnosis of temporal lobe epilepsy.

Acupuncture Therapy↗

PubMed2000

[Clinical evaluation of combined spinal-epidural anesthesia by needle-through-needle approach in 485 surgical cases].

We analyzed retrospectively the technical and clinical consequences of combined spinal-epidural anesthesia by needle-through-needle approach over the last two years. A Tuohy-type 18-gauge epidural needle (Perican; B. Braun Co.) and long pencil-pointed 27-gauge spinal needle (Whitacre; Becton-Dikinson Co.) were selected. Spinal anesthesia was administered with 0.5% tetracaine. A total of 485 anesthesia cases included 144 cases for lower abdominal, 193 cases for gynecological and 148 cases for orthopedic surgeries. The successful subarachnoid puncture with only one attempt was recorded in 89% of abdominal, 71% of gynecological and 72% of orthopedic cases. On the other hand, in three (0.6%) cases even with several attempts, the puncture was not possible. Inadvertent dural puncture and subarachnoid catheterization occurred in six (1.2%) and four (0.6%) cases, respectively. Inadequate spinal anesthesia was supplemented with epidural anesthesia in 13% of abdominal, 21% of gynecological and 7% of orthopedic cases. No serious complication occurred. We conclude that this needle-through-needle approach facilitates subarachnoid puncture with an ultra-fine spinal needle and subsequent epidural catheterization serves for supplemental and post-operative analgesia unless inappropriate subarachnoid indwelling occurs.

Adolescent↗