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Fifty patients in a community hospital underwent evaluation of the biliary system by the new small-gauge needle technique of percutaneous transhepatic cholangiography. The high success rate, ease of performance, and low complication rate attest to the worth of this procedure in the diagnosis of hepatobiliary disease.
This systematic review and meta-analysis evaluated complication rates and diagnostic yield reported in studies of adult native kidney biopsy using 16-gauge (16 G) or 18-gauge (18 G) needles. We included randomized trials and cohort studies of real-time ultrasound-guided biopsies, including case series. MEDLINE, Embase, and CENTRAL were searched through October 2024. Two reviewers independently performed study selection, data extraction, and risk of bias assessment using Joanna Briggs Institute tools. Random-effects meta-analyses estimated pooled proportions with 95% confidence intervals (CI), and univariable random-effects meta-regression explored study-level associations with major complications, transfusion, or gross hematuria. We screened 4,499 titles and abstracts and reviewed 319 full-text articles; 62 studies comprising 68 biopsy series were included. The pooled major complication rate in studies using 16 G needles was 1.83% (95% CI: 1.20-2.79) and 1.29% (95% CI: 0.78-2.13) in studies using 18 G needles, with no statistically significant difference. Mean glomerular yield was 18.8 with 16 G and 17.5 with 18 G needles. In study-level meta-regression, studies with higher prevalence of acute kidney injury, lower mean estimated glomerular filtration rate, or lower mean hemoglobin reported higher pooled complication rates. Most studies were single-arm cohorts; between-needle differences therefore reflect indirect study-level contrasts. Interpretation is limited by retrospective design and heterogeneity across studies. Overall, studies using both needle sizes reported low complication rates and similar diagnostic yield, although definitions and reporting varied. Direct comparative studies are needed to determine whether meaningful differences exist.
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The results of these tests demonstrated that aspiration through 30-gauge needles is possible, but since the flow rate is so diminished its clinical application is questionable. The evaluation of the physical properties of these needles proved them to be tough, durable, and suprisingly resistant to breakage, even under the most extreme manipulations and stresses. The insertion of needles into the plastic material clearly showed that the needles are always deflected toward the side without the bevel (the side that contains the point). Finally, the deposition patterns of the injected fluid in tissue have no relationship to the bevel.
A prospective study was made in 255 patients following spinal anaesthesia to detect the incidence of post operative headache, reference also being made to the size of needle used for lumbar puncture. There was a difference in the frequency of headache related to the size of needle used (9.7% with 22 gauge needle as against 6.7% with 25 gauge needle). Also the value of prophylaxis of headache by means of an epidural blood patch was shown (1.3%). Age also played a role, the older the patient, the less the risk of headache. The social class of the patient played no role at all.
There are no significant differences in perception of pain produced by penetrations of 25-, 27-, and 30-gauge needles in the retromolar fossa. Six dentists received three series of six needle penetrations, three in each retromolar fossa, at one-week intervals. The penetrations were made to a depth of 2 to 3 mm with use of a rapid in-and-out motion by 25-, 27-, and 30-gauge needles in an alternating sequence. The perception of pain for each penetration was recorded, tabulated, and statistically analyzed. There were no significant differences in the perception of pain elicited from the use of the three needles.
A simple nonsurgical technique of obtaining fat samples by aspiration from the gluteal prominence was developed by Hirsh in 1960 and has been in use in our Nutrition Clinic at the Mount Sinai Hospital for several years. We have modified it for field use and the analysis of fat-soluble hydrocarbon residues. All the materials which will contain the fat sample to be analyzed are washed with acetone and pesticide residue-free hexane, and a 15 gauge needle and 33 cc syringe are sterilized. Aspiration of fat from the lateral gluteal prominence is accomplished under local xylocaine anesthetic. The anesthetic also serves as the vehicle into which the fat is broken by the shearing action of the 15 gauge needle. Fat particles are sucked into the syringe by a constant vacuum kept on the syringe during lateral movement of the needle under (and parallel to) the skin within the gluteal fat pad; 200--500 ml of fat can be obtained for hydrocarbon residue analysis. The only complications have been some mild hematomas at the site of the aspiration. The method avoids surgical biopsy and sutures and takes about 7--8 min.
Needle aspirations of benign and malignant epithelial lesions of the thyroid were investigated in 265 patients. An 18-gauge needle connected to a 20-cc glass syringe was used to puncture each tumoral mass. Smears were stained by the Wright-Giemsa method. The material obtained consisted of 180 nontoxic goiters, 18 toxic goiters, 15 cases of thyroiditis and 52 malignant lesions. Aspirations taken from 21 patients (8%) were either blank or contained only blood and insufficient material for diagnosis. Results were correlated with clinical findings and laboratory tests. Biopsies were obtained only in selected patients to establish the final diagnosis. One false positive and one false negative were recorded. Although well-preserved follicular patterns can be seen on the cytologic specimens, the differentiation of thyroid adenoma from early follicular carcinoma based on cytologic criteria only if fraught with many difficulties. Cell density, nuclear structure and presence of nucleoli are sometimes helpful in making the cytologic diagnosis of thyroid carcinoma.
A 45-cm Chiba needle with a 20-cm sheath at the hub end has been used successfully for percutaneous transhepatic cholangiography in 10 patients, including chronic decompression in one patient. This method permits localization of the biliary tree, vascular structures, cysts, cavities, pelvocalyceal system, and tumors with a 22 gauge needle and allows placement of a larger catheter for drainage or a larger needle for biopsy if required. No complications were observed.
An analysis was made of the effect of sodium heparin solution on the determination of arterial blood PCO2, pH, and bicarbonate. Dilution of blood by heparin solution did not affect the pH of blood samples significantly but reduced the measured PCO2 and th calculated bicarbonate and base excess in direct proportion to the amount of dilution. Used in the usual quantities as an anticoagulant, lubricant, and filler of needle and syringe dead space, heparin solution caused a 17 per cent or greater reduction in PCO2 and bicarbonate in approximately 17 per cent of the arterial blood samples currently received for analysis in a university hospital laboratory. Such unrecognized errors could cause misinterpretations of acid-base status. Completely filling the sampling syringe with blood and using a small-gauge needle will reduce the error.
For 38 consecutive patients presenting with breast masses we compared accuracy of diagnosis, before biopsy, of the techniques of clinical examination, bilateral xeromammography, and aspiration cytology with a 10-cc syringe and a 22-gauge needle. Of the 38 patients, nine had carcinoma and 29 had benign breast disease. The overall diagnostic accuracy showed a perfect correlation between aspiration cytology and subsequent biopsy for carcinoma in this group. Clinical impression made the correct diagnosis in 89.5% of the cases and bilateral xeromammography produced the correct diagnosis in 84.9%. Both clinical impression and mammography were incorrect in diagnosing 33.3% of the malignancies. The technique of cytologic aspiration is a simple, accurate, and effective adjunct to the early diagnosis and treatment of carcinoma of the breast, and this should become a part of the initial evaluation of the patient who presents with a breast mass.
To remove preretinal blood from the posterior pole, balanced salt solution is irrigated into the eye through a 21-gauge needle. The needle previously used for infusion is used as a port of exit. I have treated seven patients with this method without harmful effects.
Presented is a simple method for decompression of a cyst with the use of a modified stent. The patient is instructed in methods of removal, insertion, and irrigation by means of a blunt No. 16 gauge needle. Periodic follow-up radiographic examinations permit reduction in tube length as the defect "fills in".
Peritoneal lavage has proven to be a useful tool for evaluating abdominal trauma. However, morbidity levels associated with the technique have inhibited its wide acceptance. A technique has been developed that avoids the complications associated with use of a standard dialysis trocar or a mini-laparotomy. The technique uses an 18 gauge needle, a wire guide with soft tip and a number 9 French Teflon catheter. The test can be completed in 20 to 30 minutes and has been done in as little as seven minutes. This technique has been used by 51 different physicians in 132 cases with a single avoidable complication which occurred when one of the contraindications was violated.
In 104 patients undergoing anaesthesia of short duration, two different solvents, propylene glycol and cremophor, were compared in a double-blind trial. Diazepam 10 mg in a coded solution was injected into a superficial vein of the hand using a small-gauge needle. The vein was examined after 14 days. The frequency of thrombophlebitis with propylene glycol was 62.2% and with cremophor 3.4% (P less than 0.001). The frequency of pain on injection was also in favour of the new solvent (P less than 0.001). The possibility of anaphylactic reactions accredited to cremophor, however, restricts the use of the new injection.
Six bilateral loop arteriovenous fistulas from the femoral artery to the femoral vein were constructed in dogs using Dacron-mesh-coated human umbilical vein. Each graft was punctured twice weekly with a 16 gauge needle for up to 36 weeks, and biopsies were done every four to eight weeks. The long-term patency was 83% at 24 weeks. There was no thrombosis from the needle puncture. Serial histologic examination revealed progressive transmural fibrous cell ingrowth and progressive neointimal cell formation. Scanning electron microscopy demonstrated areas of disrupted basement membrane covered with laminar fibrin meshes, probably representing sites of needle puncture. With multiple attenuated internal reflection spectroscopy of the graft lumens, minimal to moderate lipid deposition was observed to a depth of 1 micrometer at 32-36 weeks. No abnormal amounts of minerals were found within the graft walls with energy-dispersive x-ray analysis. Critical surface tensions remained within the biocompatible range of 20-30 dynes/cm. Human umbilical vein possesses many of the surface chemistry qualities of an ideal vascular prosthesis, has excellent long term patency, and is suitable for use where angioaccess with repeated needle puncture is needed.
A procedure has been designed (the chamber-scarification test), which possesses greatly increased sensitivity for assessing the irritancy of topically applied materials. A forearm test site is criss-cross scarified by drawing a 30-gauge needle over the skin with just enough pressure to cleave the epidermis without drawing blood. The test agent is applied in an aluminum chamber once daily for 3 days. The advantages of the method over conventional patch testing are: enhanced capacity to measure mild irritants, reduced time (3 days versus 10 to 21 days), less effort, less cost, less discomfort for the volunteers and greater reproducibility.
Various methodologies were examined for the isolation of inflammatory cells from diseased human gingiva. The best recovery of viable gingival lymphocytes (gMNC) was achieved by a method which combined initial collagenase digestion followed by gentle teasing with an 18-gauge needle.