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At least 19 recordsLinked to original sources

PubMed1999

Aspiration needle biopsy in preoperative selection of thyroid nodules defined at fine-needle aspiration as microfollicular lesions.

The palpable thyroid nodules that are diagnosed as microfollicular by fine-needle aspiration cytologic analysis are usually excised for the low probability that the nodule is a well-differentiated follicular cancer. The authors retrospectively assess the use of aspiration needle biopsy (either 16- or 18-gauge needles) in the preoperative selection of the nodules diagnosed as microfollicular at fine-needle aspiration (either 20- or 22-gauge needles). Aspiration needle biopsy is a type of large needle biopsy that is a relatively easy and innocuous method of obtaining tissue fragments for preoperative histologic examination of palpable thyroid nodules. From 1980 through 1996, 6,314 patients with palpable thyroid nodules were examined by fine-needle aspiration; 29.5% of these nodules were also examined preoperatively by aspiration needle biopsy. Of all the patients with nodules, 6% received a fine-needle aspiration diagnosis of microfollicular nodule. Two hundred sixty of the 380 nodules (68%) that were diagnosed as microfollicular at fine-needle aspiration were also examined by aspiration needle biopsy; inadequate specimens were obtained in 17% of cases; pure microfollicular structure was confirmed by aspiration needle biopsy in 35% of the nodules; and aspiration needle biopsy showed the remaining 48% to contain a macrofollicular component suggesting a benign hyperplastic lesion. Seventeen nodules that were found to be microfollicular at fine-needle aspiration cytologic analysis and micromacrofollicular at aspiration needle biopsy were excised and the postoperative result was benign in all cases. Twenty-five nodules diagnosed as microfollicular either on both fine-needle aspiration and aspiration needle biopsy were excised and the postoperative diagnoses were benign (20 nodules) or malignant (5 nodules). These data indicate that aspiration needle biopsy can be used for preoperative selection of the nodules that are microfollicular at fine-needle aspiration by identifying the nodules with high probability of being malignant and thus contributing to the reduction in the number of surgical operations for benign nodules.

Adenocarcinoma, Follicular↗

PubMed1988

Transtracheal aspiration and fine needle aspiration biopsy for the diagnosis of pulmonary infection in heart transplant patients.

A total of 129 transtracheal aspirations or fine needle aspirations, or both, were performed in 65 heart and heart-lung transplant patients to identify the causative pathogen in suspected pulmonary infection. Transtracheal aspiration was performed in 82 instances, fine needle aspiration in 47, and both procedures in 23. Both transtracheal and fine needle aspiration were highly specific, 96% and 100%, respectively. Sensitivity for transtracheal aspiration was lower than for fine needle aspiration, 70% and 89%, respectively. The lower sensitivity of transtracheal aspiration is attributed to its performance in all patients with suspected infection regardless of chest radiographic findings. Fine needle aspiration was performed when identifiable lesions could be used as a "target." Overall accuracy of transtracheal aspiration was 78% compared to 91% for fine needle aspiration both alone and combined with transtracheal aspiration. More invasive procedures such as bronchoalveolar lavage and open lung biopsy were required in only three patients (2%). Transtracheal aspiration resulted in one minor complication (1%). The commonest complication of fine needle aspiration was pneumothorax (21%). There were no deaths associated with either procedure. We conclude that in heart and heart-lung transplant patients with suspected pulmonary infection, transtracheal aspiration and fine needle aspiration are safe and accurate methods to identify the causative organism. More invasive techniques may be required in a small minority of patients.

Biopsy, Needle↗

PubMed1992

A prospective randomized study comparing aspiration only with aspiration and flushing for transvaginal ultrasound-directed oocyte recovery.

OBJECTIVE: To compare aspiration only with aspiration and flushing of ovarian follicles during transvaginal ultrasound (US)-directed oocyte recovery. DESIGN: Prospective randomized study. PATIENTS: One hundred patients who were undergoing an in vitro fertilization (IVF) treatment cycle. INTERVENTIONS: All patients underwent pituitary desensitization before the administration of gonadotropins. Monitoring of ovarian stimulation and the criteria for the administration of human chorionic gonadotropin were similar in both groups. In patients in whom aspiration alone was used, each follicle was aspirated until it was empty. The US probe was then rotated until every drop of follicular fluid had been aspirated before the next follicle was aspirated and the procedure repeated. For patients who had aspiration and flushing, each follicle was aspirated and then flushed up to a maximum of six times before moving to the next follicle. In both groups, all follicles greater than 10 mm were aspirated. RESULTS: The indication for IVF and mean age of the patients were comparable in the two groups. There were no significant differences between the aspiration and the aspiration and flushing groups in terms of the number of oocytes retrieved (11 versus 9), the oocyte recovery rates (77.5% versus 77.0%), the fertilization rates (55.6% versus 60.0%), the number of embryos transferred (2 versus 2), or the number of clinical pregnancies (12 versus 13). The time taken for oocyte recovery was significantly shorter (15 versus 30 minutes, P less than 0.00001), and the dose of pethidine required significantly less (50 mg versus 100 mg, P less than 0.00001) in the aspiration only group. CONCLUSIONS: Aspiration alone produces comparable oocyte recovery rates as aspiration and flushing while significantly reducing the length of the procedure and the dose of analgesia required. Aspiration alone suffices for virtually all cases during transvaginal US-directed oocyte recovery.

Adult↗

PubMed1997

Aspiration to obtain osteoblast progenitor cells from human bone marrow: the influence of aspiration volume.

UNLABELLED: Bone marrow contains osteoblast progenitor cells that can be obtained with aspiration and appear to arise from a population of pluripotential connective-tissue stem cells. When cultured in vitro under conditions that promote an osteoblastic phenotype, osteoblast progenitor cells proliferate to form colonies of cells that express alkaline phosphatase and, subsequently, a mature osteoblastic phenotype. We evaluated the number of nucleated cells in bone-marrow samples obtained with aspiration from the anterior iliac crest of thirty-two patients without systemic disease. There were nineteen male patients and thirteen female patients; the mean age was forty-one years (range, fourteen to seventy-seven years). The prevalence and concentration of the osteoblast progenitor cells also were determined, by placing the bone-marrow-derived cells into tissue-culture medium and counting the number of alkaline phosphatase-positive colony-forming units. In order to assess the effect of aspiration volume, two sequential experiments were performed. In the first experiment, aspiration volumes of one and two milliliters were compared. In the second experiment, aspiration volumes of two and four milliliters were compared. The mean prevalence of alkaline phosphatase-positive colony-forming units in the bone-marrow samples was thirty-six per one million nucleated cells (95 per cent confidence interval, 28 to 47); a mean of 2400 alkaline phosphatase-positive colony-forming units was obtained from a two-milliliter aspirate. There was a significant difference among the patients with respect to the number of alkaline phosphatase-positive colony-forming units in these bone-marrow samples (p < 0.001). Seventy per cent of this variation in the prevalence was due to variation among patients, and 20 per cent was due to variation among aspirates. The number of alkaline phosphatase-positive colony-forming units in the aspirate increased as the aspiration volume increased. However, contamination by peripheral blood also increased as the aspiration volume increased. An increase in the aspiration volume from one to four milliliters caused a decrease of approximately 50 per cent in the final concentration of alkaline phosphatase-positive colony-forming units in an average sample. CLINICAL RELEVANCE: On the basis of these data, we recommend that, when bone marrow is obtained with aspiration for use as a bone graft, the volume of aspiration from any one site should not be greater than two milliliters. A larger volume decreases the concentration of osteoblast progenitor cells because of dilution of the bone-marrow sample with peripheral blood. We estimate that four one-milliliter aspirates will provide almost twice the number of alkaline phosphatase-positive colony-forming units as will one four-milliliter aspirate. In addition, these data confirm that humans differ significantly from one another with respect to the cellularity of bone marrow and the prevalence of osteoblast progenitor cells. Additional studies are necessary to determine if the number or prevalence of alkaline phosphatase-positive colony-forming units in bone marrow is a determining factor in the efficacy of an autogenous bone or bone-marrow graft and to ascertain how the number and function of alkaline phosphatase-positive colony-forming units may change as a function of factors such as age, menopausal status, and selected diseases.

Adolescent↗

PubMedDate not supplied

A comparison of intercostal and abdominal routes of splenic aspiration and bone marrow aspiration in the diagnosis of visceral leishmaniasis.

Two hundred and seventy patients with febrile splenomegaly and coming from areas where visceral leishmaniasis (VL; kala-azar) is endemic and in whom the diagnosis of kala-azar was strongly suspected were randomly divided into 3 groups, subjected to splenic aspiration by the intercostal route, splenic aspiration by the abdominal route, and bone marrow aspiration, respectively, for demonstration of amastigotes. Pain immediately after aspiration, requiring a few analgesic tablets, occurred in 8, 16 and 20 patients of the 3 groups, respectively. Pain on the day after aspiration was reported by 2, 4 and 6 patients, respectively. One patient, in the abdominal group, developed gastro-intestinal haemorrhage but this was managed with blood transfusion; he was not suffering from VL. No patient died. The abdominal route of splenic aspiration was not feasible in 12 patients (13%), as their spleen size was less than 3 cm, and they were subsequently aspirated by the intercostal route. On the first aspiration, amastigotes were seen in 68 patients (76%) in the intercostal group, 64 patients (71%) in the abdominal group and 42 patients (46%) in the bone marrow group. Two weeks later, 15 patients (17%) in the bone marrow group and in whom amastigotes had not been detected, but whose fever continued, were subjected to intercostal splenic aspiration and amastigotes were detected. After 2 months, 3 patients in the intercostal group and 4 patients in the abdominal group gave positive aspirates, and 2 patients in the intercostal group, one in the abdominal group, and one in the bone marrow group did so at the third aspiration. Thus only 200 (74%) of 270 patients were suffering from VL. It was concluded that, with some precautions, splenic aspiration is a safe and easy method for the diagnosis of VL, and the intercostal route is preferred because it is feasible in a larger proportion of cases and anatomically safer than the abdominal route, and it gives a positive result more often than bone marrow aspiration.

Adolescent↗

PubMed1997

Routine audit of breast fine needle aspiration (FNA) cytology specimens and aspirator inadequate rates.

In an attempt to improve the quality of the breast FNA specimens we instigated a continuing audit of this procedure in this hospital. All FNAs since 1990 have had the following recorded: mode of aspiration, e.g. freehand or image guided, patient presentation (screening or symptomatic), patient diagnostic category, cytological diagnosis and final histological diagnosis. Aspirator performance was assessed by means of the inadequate aspiration rate (IR) of FNAs performed on patients with a final diagnosis of cancer (FDC) and diagnostic category A patients (clinically or radiologically malignant lesions). An ongoing annual review of the performance of all the aspirators was undertaken, all of whom received individual feedback. Counselling and further training were offered where indicated by poor performance. Over the period 1990-1995 a total of 13537 FNAs were performed by 27 aspirators. The IR on category A and FDC cases over this period was 16.0% and 18.1%. The best performance achieved by an aspirator in a calendar year was an IR of 3.6% with no inadequate specimens in either FDC or category A lesions, and the best performance over the entire period was an average IR of 11.75% and 14.25% for FDC and category A groups, respectively. The overall IR on category A patients ranged from 15.9% to 23.8% and on FDC cases from 12.2% to 21.7%. There was a significant improvement in individual junior aspirator performance when their first year was compared with their last year on the unit. In some cases a deterioration in intra-aspirator performance was observed, from an IR of 6% to 33%. The overall IR rate of the unit remained stable for FDC patients, 15.5% in 1990 compared with 15.1% in 1995. This appeared to be largely due to a high proportion of the aspirations being performed by experienced personnel with consistent IRs. However, concealed within the overall rate there were some poor performers who benefited from counselling and/or further training. These results indicate an important role for audit in identifying poor aspirators who benefit from targeted training and advice, thereby improving the quality of FNA specimens, and ultimately patient care.

Biopsy, Needle↗

PubMed2002

Transbronchial needle aspiration in diagnosing and staging lung cancer: how many aspirates are needed?

Transbronchial needle aspiration has emerged as a key technique for sampling mediastinal adenopathy but variable yields are reported. To determine the number of aspirates needed to optimize yield, we prospectively studied transbronchial needle aspiration and the sequential effect of each successive specimen on diagnostic yield in 79 patients with known or suspected lung carcinoma and mediastinal adenopathy. A total of 451 aspirates were performed in 79 patients (mean, 5.7 aspirates per patient; range, 2-13) with 45 cases (57%) positive for malignancy. A cytologically positive transbronchial needle aspiration occurred with the first aspirate in 42% of patients in whom this procedure established mediastinal nodal involvement. All positive results were achieved with seven or fewer aspirates. Similar yields were obtained for small cell and non-small cell lung cancer after seven aspirates. Rapid on-site specimen cytologic evaluation was used in 55 of 79 cases (70%), with a positive diagnosis obtained in 39 of 55 cases (71%) with on-site evaluation compared with six of 24 cases (25%) performed without on-site evaluation. The data suggest there is a plateau in yield after seven transbronchial needle aspirates, which may be sufficient to obtain an optimal yield in assessing patients with lung cancer and mediastinal adenopathy.

Adult↗

PubMed2002

Fat laden macrophages in tracheal aspirates as a marker of reflux aspiration: a negative report.

OBJECTIVES: Refluxed gastric material aspirated into the lungs is an important cause of acute and chronic pulmonary disease. Currently, the presence of fat-laden macrophages (FLM) in tracheobronchial secretions of children is a conventional marker for reflux aspiration. However, this assay is limited by its apparent lack of specificity. The aim of this study was to reevaluate the role of this assay in diagnosing reflux aspiration. METHODS: The tracheal aspirates of sixty-four consecutive children with clinically significant gastroesophageal reflux undergoing upper gastrointestinal endoscopy under general anesthesia, and 34 other children from the routine operative schedule were evaluated. Both groups were further subdivided on the basis of presence or absence of associated respiratory symptoms. After intubation, tracheal aspirates were collected, fixed, and stained for FLM. By grading the amount of intracellular fat present, a semiquantitative lipid index was computed. Tracheal aspirates with a lipid index of 100 or greater were considered positive. RESULTS: Twenty-four of the 64 children with reflux symptoms and 14 of 34 children without reflux symptoms were positive for FLM. Sixteen of 37 children with both gastroesophageal reflux and respiratory symptoms and 10 of 26 children negative for both tested positive for FLM. The mean lipid index of the subgroup of children with both reflux and respiratory symptoms was not significantly different from that of the subgroup that was negative for both conditions. Despite computing a semiquantitative lipid index, an index of 100 or greater only had a sensitivity of 38% and specificity of 59%. CONCLUSION: Assay of FLM in the tracheal aspirates of children considered at risk of reflux aspiration is not a sensitive or specific as a marker for reflux aspiration.

Biomarkers↗

PubMedDate not supplied

Detection of aspiration in enterally fed patients: a requiem for bedside monitors of aspiration.

BACKGROUND: Pulmonary aspiration of gastric and oropharyngeal contents is common in enterally fed patients. Detection of early aspiration in these patients has relied on clinical impression, the coloring of enteral feedings with dyes, and less commonly the detection of elevated glucose in tracheal aspirates. The potential benefits, risks, and clinical use of bedside monitors of aspiration are under increasing scrutiny. METHODS: Literature review. Although this review reflects the opinions of the authors, recommendations of an expert consensus panel (North American Summit on Aspiration, which included one author, J. P. Maloney) were also used to guide recommendations. The specific recommendations of that panel are presented elsewhere. RESULTS: No large prospective clinical trials have been done to evaluate the use and safety of bedside monitors for aspiration. Clinical impression remains a poor "gold standard" of aspiration diagnosis in enterally fed patients. The coloring of enteral feedings with blue dyes (chiefly FD&C Blue No.1) is ubiquitous in hospitals despite evidence that it is not sensitive and potentially harmful. Cases of absorption of blue dye from enteral feedings in patients with critical illness have raised concern about the safety of the blue dye method, particularly in light of apparent toxic effects of these dyes on mitochondria. The glucose detection method has not been embraced; it too has little use and is labor intensive. CONCLUSIONS: Use of colored dyes in enteral feedings and glucose detection methods should be abandoned. Nonrecumbent positioning is an evidenced-based method for aspiration prevention that needs to be re-emphasized. Novel bedside methods of detecting early aspiration are needed to supplement preventative strategies.

Enteral Nutrition↗

PubMed1998

[Outcome of repeated pulmonary aspiration in frail elderly. The Project Team for Aspiration Pneumonia].

Aspiration pneumonia is a major cause of death among frail elderly patients. Pulmonary aspiration is commonly reported in association with episodes of pneumonia, but the clinical significance and outcome in patients with recurrent pulmonary aspiration remain uncertain. We studied outcomes retrospectively in elderly patinents with recurrent aspiration. A total of 38 patients (M25, F13: mean age 81.4 yr) who were recognized to have undergone repeated aspiration were enrolled. Of them, 89.5% had suffered cerebrovascular disorder or other neurological disorders as the major underlying disease, and 63.2% showed moderate or severe cognitive impairment. Activities of daily living (ADL) were low and 97.4% were bedridden. At the time of enrollment, 79% had aspiration pneumonia or aspiration bronchitis. The mean number of admissions during the observation period was 2.3, and 60.9% of admissions were due to pneumonia. Of the patients obsered, 84.2% died during the observation period: the median survival time was 736 days. Major causes of death were pneumonia, respiratory failure, and asphyxia (65.6%). Percutaneous endoscopic gastrostomy (PEG) was carried out in 16 patients and these patients survived longer than patients who did not undergo PEG, although 75% of the PEG group died of pneumonia. We conclude that: 1) repeated pulmonary aspiration mostly occurrs with underlying diseases of cerebrovascular disorders, dementia, and deterioration of ADL, and 2) although the prognosis following repeated pulmonary aspiration was poor. PEG contributed to a longer survival, but did not prevent pneumonia.

Activities of Daily Living↗

PubMed1977

Aspiration in local anesthesis. Comparison between disposable self-aspirating and usual syringes.

The positive aspirations obtained with a self-aspirating syringe (Astra, Sweden) were compared with those obtained when aspiration was performed manually (Uniject syringe, Hoechst, West Germany). The subjects were 1186 army recruits, to whom 2348 injections of local anesthetic were given in connection with dental treatment. When aspiration was performed manually, the results were positive in 4.7% of the cases; with the self-aspirating syringe, they were positive in 1.1% of the cases. The total frequency of positive aspirations was significantly higher (P less than 0.001) with the manual aspiration technique than with the self-aspirating syringe was due to the fact that the value did not include aspiration occurring when the injection needle ruptured small blood vessels.

Adolescent↗

PubMedDate not supplied

Fine needle aspiration of the breast. Importance of the aspirator.

All 503 fine needle aspirations (FNAs) of the breast performed over a three-year period at the Medical Center Hospital of Vermont were analyzed. There were 93 aspirates diagnosed as "positive," all of which were from patients eventually shown to have cancer. However, there were 38 patients with primary carcinoma in which the FNA was not diagnosed as positive, for a diagnostic failure rate of 31.4%. In order to determine the possible effect of technique as practiced by an experienced aspirator in diminishing such diagnostic failures, we compared 190 aspirates obtained by a single individual with 193 aspirates obtained by 15 individuals in the same community. For the single experienced aspirator, the technical failure rate was 9.8% whereas in the group with many aspirators it was 45.9%. This finding confirms that, although fine needle aspiration of the breast is considered easy to perform, skill on the part of the aspirator is important for satisfactory results.

Biopsy, Needle↗

PubMed2003

The nasogastric feeding tube as a risk factor for aspiration and aspiration pneumonia.

PURPOSE OF REVIEW: Aspiration is one of the most common complications in enterally fed patients. The source of aspiration is due to the accumulation of secretions in the pharynx of reflux gastric contents from the stomach into the pharynx. The true prevalence of aspiration is difficult to determine because of vague definitions, poor assessment methods, and varying levels of clinical recognition. RECENT FINDINGS: There is evidence in the literature showing that the presence of a nasogastric feeding tube is associated with colonization and aspiration of pharyngeal secretions and gastric contents leading to a high incidence of Gram-negative pneumonia in patients on enteral nutrition. However, other aspects may be equally important and should also be considered when evaluating a patient suspected of having aspiration and aspiration pneumonia. The mechanisms responsible for aspiration in patients bearing a nasogastric feeding tube are (1). loss of anatomical integrity of the upper and lower esophageal sphincters, (2). increase in the frequency of transient lower esophageal sphincter relaxations, and (3). desensitization of the pharyngoglottal adduction reflex. SUMMARY: Sometimes it is possible to differentiate whether the aspirate is gastric or pharyngeal. The kind of bacterial contamination is, however, more difficult to establish. Oral or dental disease, antibiotic therapy, systemic illness or malnutrition and reduction of salivary flow are responsible for colonization of Gram-negative bacteria in oral and pharyngeal flora in nasogastric-tube-fed patients. The use of a nasogastric feeding tube and the administration of food increase gastric pH and lead to colonization of gastric secretions. It has also been suggested that gastric bacteria could migrate upward along the tube and colonize the pharynx.

Enteral Nutrition↗

PubMed1999

Utility of punch biopsy for lesions that are hard to aspirate by conventional fine-needle aspiration.

BACKGROUND: Fine-needle aspiration (FNA) is a fast, reliable, and cost-efficient technique for diagnosing palpable masses. However, when the lesion is small, dermal in location, shallow in depth, or fibrotic, the cellular yield by FNA may be limited and thus hinder an accurate diagnosis. The authors examined the value of punch biopsy (PB) in diagnosing such hard-to-aspirate lesions. METHODS: The authors reviewed 49 PB specimens from 47 patients who presented in their FNA clinic from June 1994 to July 1997. RESULTS: The lesions were typically described as ill-defined erythematous skin lesions or as papules or small, firm, subcutaneous nodules (average size, 0.7 cm). Patients' previous history included breast carcinoma (in 36 cases), nonmammary carcinoma (in 3 cases), melanoma (in 2 cases), squamous carcinoma of the skin (in 2 cases), cutaneous T-cell lymphoma (in 2 cases), small lymphocytic lymphoma (in 1 case), and no history of malignancy (in 1 case). PB sites included chest wall, breast, extremities, abdominal wall, neck, back, scalp, and forehead. Of the 37 cases in which FNA was performed before PB, 21 aspirates (57%) were nondiagnostic because of scant cellularity, 11 aspirates (31%) were positive (9) or suspicious/atypical (2) for malignancy, and 5 aspirates (14%) were negative for malignancy. Seventeen (81%) of the 21 nondiagnostic aspirates and 10 of the 11 suspicious/atypical aspirates were positive for malignancy on PB specimens. Twelve PBs were done without prior FNA, 8 (67%) were positive for malignancy, and 4 (33%) were negative. In 7 patients, the findings from the PB specimens (new diagnosis of malignancy in 5 cases and recurrence of disease in 2 cases) led to surgical excision of the lesion. CONCLUSIONS: PB is a valuable adjunct to FNA for diagnosing hard-to-aspirate lesions.

Adult↗

PubMed1995

Unsatisfactory aspirates from fine-needle aspiration biopsies: a review.

While there is much evidence that fine-needle aspiration biopsy (FNAB) is sensitive and specific, there is little information comparing the proportions of unsatisfactory aspirates obtained by clinicians or pathologists. We reviewed 2,199 FNAB reports of superficial lesions. Cases were grouped by organ/site and according to who performed the biopsy. The proportions of unsatisfactory aspirates were computed for clinicians and pathologists. Both groups performed approximately equal numbers of procedures. Overall, 9% of aspirates obtained were unsatisfactory (n = 191). Pathologists had lower proportions of unsatisfactory aspirates in all sites. Of aspirates obtained by clinicians, 14% were unsatisfactory, compared to 3% of those obtained by pathologists (P < .00001). The proportion of unsatisfactory aspirates appears to decrease as physician experience increases, and pathologists may have more experience with FNAB than do clinicians. Other advantages pathologists may have include technique and working with tissue regularly. Both clinicians and pathologists can expect to decrease their proportions of unsatisfactory aspirates by performing FNABs frequently.

Biopsy, Needle↗

PubMedDate not supplied

Diagnosis of small intestinal bacterial overgrowth in clinical praxis: a comparison of the culture of small bowel aspirate, duodenal biopsies and gastric aspirate.

BACKGROUND/AIMS: This study was undertaken to validate the usefulness of the culture of duodenal biopsy specimens and gastric aspirate compared to the culture of small bowel aspirate for diagnosing small intestinal bacterial overgrowth. We also investigated the occurrence of predisposing conditions in these patients. METHODOLOGY: Seventy five consecutive patients, admitted because of symptoms which caused us to suspect small intestinal bacterial overgrowth, were studied. For all patients, specimens for the culture of small bowel aspirate, duodenal biopsies and gastric aspirate were obtained during upper endoscopy. RESULTS: Eighteen patients showed growth of gram negative bacteria, 22 growth of gram positive bacteria and 35 showed no significant growth in cultures of small bowel aspirate. Cultures of duodenal biopsies revealed gram negative bacteria in 11 patients, gram positive bacteria in 9 and no growth in 55. Cultures of gastric aspirate revealed gram negative bacteria in 7 patients, gram positive bacteria in 12 and no growth in 51. Ten of the 18 patients with gram negative overgrowth and 13 of the 22 patients with gram positive overgrowth had a predisposing condition. In contrast, only 4 of the 35 without overgrowth had a predisposing condition. CONCLUSIONS: The culture of duodenal biopsy specimens or gastric aspirate is a less sensitive method than the culture of small bowel aspirate. Most patients with culture-proven small intestinal bacterial overgrowth had at least one predisposing condition.

Adult↗

PubMed1976

Aspiration pneumonia; incidence of aspiration with endotracheal tubes.

Aspiration has been suggested as a source of pulmonary complications seen in patients with tracheal intubation. A previous study demonstrated that the high incidence of aspiration in patients with tracheostomies can be decreased by modification of the tracheostomy tube cuff design. In the present protocol, 100 patients with endotracheal tubes in place were studied to document the incidence of aspiration and to attempt to decrease the incidence by modification of cuff design. Utilizing an Evans blue dye test to detect aspiration, 27 of the 48 patients (56%) with standard low volume, high pressure cuffed tubes had positive tests. In 17 patients with modified standard cuffed tubes, the incidence of aspiration was decreased to 29% (5 patients). Aspiration was further decreased to 20% (7 patients) in the 35 patients with high volume, low pressure cuffed tubes. These results demonstrate that the incidence of aspiration in patients with endotracheal tubes can be decreased by modification of endotracheal tube cuff design.

Adolescent↗

PubMed2005

Manual thrombus-aspiration improves myocardial reperfusion: the randomized evaluation of the effect of mechanical reduction of distal embolization by thrombus-aspiration in primary and rescue angioplasty (REMEDIA) trial.

OBJECTIVES: The aim of this study was to evaluate the use of a new manual thrombus-aspirating device in unselected patients with ST-segment elevation acute myocardial infarction (STEMI) undergoing urgent percutaneous coronary intervention (PCI). BACKGROUND: Failure to achieve myocardial reperfusion often occurs during PCI in patients with STEMI. The use of thrombus-aspirating devices might improve myocardial reperfusion by reducing distal embolization. METHODS: We prospectively randomized before coronary angiography 100 consecutive patients with STEMI to either standard PCI or PCI with manual thrombus-aspiration. Primary end points of the study were post-procedural rates of myocardial blush grade (MBG) > or =2 and ST-segment resolution (STR) > or =70%. Analyses were planned by intention to treat. RESULTS: Ninety-nine patients entered the analyses. The rates of post-procedural MBG > or =2 and STR > or =70% were, respectively, 68.0% and 44.9% in the thrombus-aspiration group compared with 58.0% and 36.7% in the standard PCI group: odds ratio (OR) 2.6 (95% confidence interval [CI] 1.2 to 5.9), p = 0.020, and 2.4 (95% CI 1.1 to 5.3), p = 0.034, respectively. Moreover, the rate of patients achieving both the angiographic and electrocardiographic (ECG) criteria of optimal reperfusion was significantly higher in the thrombus-aspiration group compared with standard PCI: 46.0% versus 24.5%, OR 2.6 (95% CI 1.1 to 6.2), p = 0.025. In multivariate analysis, randomization to thrombus-aspiration was a significant independent predictor of achievement of MBG > or =2 and STR > or =70% (p = 0.013). CONCLUSIONS: This prospective randomized study shows that manual thrombus-aspiration in unselected patients with STEMI undergoing primary or rescue PCI is clinically feasible and results in better angiographic and ECG myocardial reperfusion rates compared with those achieved by standard PCI.

Angioplasty, Balloon, Coronary↗