Blind Aspiration Research Articles

No Difference in Reintervention at 1-Year Between Ultrasound-Guided versus Blind Dorsal Carpal Ganglion Aspiration

The purpose of this retrospective comparative study was to compare the efficacy of dorsal carpal ganglion aspiration in patients who underwent either "blind" (using surface anatomy alone) or ultrasound-guided (US-guided) aspiration. Outcome measures were conducted during the coronavirus disease 2019 pandemic via telephone for a minimum of 12 months after aspiration, with efficacy defined by reintervention with either repeat aspiration or surgical excision. Data are reported for 141 patients (46 blind; 95 US-guided) at an average of 28 months (range, 12-55 months) from aspiration. Reintervention was not significantly different based on the mode of aspiration-26% and 24% for blind aspiration and US-guided, respectively. Patient-perceived recurrence was higher at 65% for the entire cohort. Patients who received steroid injection at the time of aspiration perceived lower rates of recurrence-44% versus 77% for patients who received a steroid injection and patients who did not, respectively. This study found no significant difference between blind or US-guided aspiration in reintervention at a minimum of 1-year follow-up. Patients who received steroids at the time of aspiration perceived lower rates of recurrence. Therapeutic III.

The Additional Value of Lower Respiratory Tract Sampling in the Diagnosis of COVID-19: A Real-Life Observational Study.

Background: Since December 2019, SARS-CoV-2 has been causing cases of severe pneumonia in China and has spread all over the world, putting great pressure on health systems. Nasopharyngeal swab (NPS) sensitivity is suboptimal. When the SARS-CoV-2 infection is suspected despite negative NPSs, other tests may help to rule out the infection. Objectives: To evaluate the yield of the lower respiratory tract (LRT) isolation of SARS-CoV-2. To evaluate the correlations between SARS-CoV-2 detection and clinical symptoms, and laboratory values and RSNA CT review scores in suspect patients after two negative NPSs. To assess the safety of bronchoscopy in this scenario. Method: A retrospective analysis of data from LRT sampling (blind nasotracheal aspiration or bronchial washing) for suspected COVID-19 after two negative NPS. Chest CT scans were reviewed by two radiologists using the RSNA imaging classification. Results: SARS-CoV-2 was detected in 14/99 patients (14.1%). A correlation was found between SARS-CoV2 detection on the LRT and the presence of a cough as well as with typical CT features. Typical CT resulted in 57.1% sensitivity, 80.8% accuracy and 92.3% NPV. Neither severe complications nor infections in the personnel were reported. Conclusions: In suspect cases after two negative swabs, CT scan revision can help to rule out COVID-19. In selected cases, with consistent CT features above all, LRT sampling can be of help in confirming COVID-19.

Robotic Label-Free Precise Oocyte Enucleation for Improving Developmental Competence of Cloned Embryos.

The invisibility of domestic oocyte nucleus in bright field currently forces operators to blindly aspirate nucleus out in oocyte enucleation, usually causing large cytoplasm losses and poor developmental competences of cloned embryos. Although fluorescent labeling of nucleus allows for nucleus localization, the involved photobleaching problems and barriers to the execution of enucleation process limit its online-application in oocyte enucleation. This paper reports a novel label-free oocyte enucleation method for precise removal of the nucleus with less cytoplasm loss. The relative positions between the injection pipette and nucleus for complete removal of nucleus with less cytoplasm loss were determined through a finite element modeling of nucleus aspiration. To position injection pipette to the above positions relative to nucleus, the appropriate oocyte orientation and trajectory of injection pipette inside oocyte were derived according to the offline-calibrated 3-D distribution of nucleus and the simulated dynamic drift of nucleus that occurs as injection pipette is maneuvered inside oocyte. Finally, a robotic label-free precise enucleation procedure was established. The experimental results on more than 1000 porcine oocytes proved that this system is capable of reducing cytoplasm loss by 60% at the same level of enucleation success rate and almost doubling the cleavage rate of clone embryos in comparison to blind aspiration method. The results prove that our method significantly improves the developmental competence of cloned embryos in comparison to manual enucleation method. Our method is expected to improve the extremely low success rate of animal cloning in the future.

Evidence-Based Medicine Improves the Emergent Management of Peritonsillar Abscesses Using Point-of-Care Ultrasound.

Physical examination for peritonsillar abscess (PTA) has limited sensitivity. Traditional management involves blind needle aspiration, which has a false negative rate of 10-24%. A randomized controlled trial by Costantino etal. demonstrated that point-of-care ultrasound (POCUS) improves PTA management. Compare the use and impact of POCUS between patient cohorts prior to and after the trial by Costantino etal. Retrospective cohort study of adult patients diagnosed with PTA. Cohort 1 presented to the emergency department (ED) January 2007-December 2008. Cohort 2 presented between January 2013 and December 2014. Data were separated into those with POCUS vs. without ultrasound (NUS). Primary endpoint was POCUS utilization. Secondary endpoints were successful aspiration, otolaryngology (ear, nose, and throat [ENT]) consultation, computed tomography (CT) imaging, unscheduled return visits, and length of stay (LOS). The Fisher's exact and t-tests analyzed data. Cohort 1 enrolled 48 patients, vs. 114 patients for cohort 2. Twelve patients in cohort 1 had a POCUS (25%) vs 89 in cohort 2 (78%) (p<0.0001; odds ratio [OR] 0.09 (95% confidence interval [CI] 0.04-0.20). Emergency physician (EP) successful aspiration: 89.1% POCUS vs. 24.5% NUS (p<0.0001; OR 25 [95% CI 10-59]). Combined EP/ENT successful aspiration: 99.0% POCUS vs. 80.3% NUS (p<0.0001; OR 24 [95% CI 3-193]). ENT consultation:12.9% POCUS vs. 65.6% NUS (p<0.0001; OR 0.07 [95% CI 0.03-0.17]). CT usage: 23.8% POCUS vs. 37.7% NUS (p=0.07; OR 0.51 [95% CI 0.25-1.02]). Return visits: 3.96% POCUS vs. 18.0% NUS (p=0.004; OR 0.18 [95% CI 0.05-0.61]). POCUS use has increased for PTA treatment, improves aspiration, and decreases consultations, CTs, return visits, and LOS.

Safety and efficacy of ultrasound guided percutaneous needle aspiration of liver abscess

Background: Liver abscesses, both amoebic and pyogenic, continue to be an important cause of morbidity and mortality in tropical country. Traditionally for many years they were treated with antimicrobial alone, blind percutaneous aspiration or surgical exploration. This conception gradually changes into guided percutaneous aspiration or drainage with development of advanced diagnostic imaging modality.&#x0D; Objectives: To evaluate the safety and efficacy of management of liver abscess by Ultrasound (US) guided percutaneous needle aspiration.&#x0D; Methods: From August 2009 to July 2018 a total 380 patients with liver abscess were referred to the department of radiology and imaging for US guided percutancous aspiration. All patients were evaluated clinically and by USG. Aspiration of the abscess was carried out under strict aseptic precaution.&#x0D; Results: A total of 380 patients with liver abscess were successfully treated, consisting of 338 males and 42 females, male female ratio 8:1. The age ranges from 11 to 80 years. Majority (78%) had single abscess and 22% had two or more. Most of the abscess are located in the right lobe of liver (79%). Single needle aspiration were needed in 30% of patient, second aspiration were needed in 38% of patients and third aspiration in 32% of patients. Average aspiration per patient was 2.02. The amount of aspirated pus ranged from 250 to 2450 ml.&#x0D; Conclusion: Ultrasound guided percutaneous needle aspiration of liver abscess is a safe and successful therapeutic approach in the treatment of liver abscess whether pyogenic or amoebic.&#x0D; Bang Med J (Khulna) 2018; 51 : 3-6

Difference in post mortem tryptase level between peripheral venous and arterial samples in non-anaphylactic deaths

Different sampling technique can impact on post mortem tryptase levels. A previous study demonstrated a significant difference in femoral post mortem total tryptase between blind transcutaneous aspiration and directly sampling during internal examination. The possible reason for this may be due to arterial contamination. This 6-month retrospective study compared 21 paired femoral venous and arterial total post mortem tryptase levels. All cases were non-anaphylactic deaths with a range of natural and unnatural causes of death and presence of resuscitation. Two outliers with higher tryptase were noted in arterial samples. Apart from the outliers, there was no significant difference between the two sample sites, showing a mean difference of 0.89 μg/L (95% CI 1.21–2.99, p=0.11). None of the venous post mortem tryptase levels were above 10 μg/L. This study suggests techniques in minimising arterial blood contamination should be used when sampling for post mortem tryptase.

Diagnostic utility of flexible bronchoscopy in mediastinal and hilar lymphadenopathies

Background Mediastinal and/or hilar lymphadenopathy with or without parenchymal lesions are difficult in the diagnosis via noninvasive techniques. Objective To assess the role of flexible fiberoptic bronchoscopy (FOB), in particular, blind transbronchial needle aspiration (TBNA) in the diagnosis of mediastinal and/or hilar lymphadenopathies. Patients and methods A cross-sectional study was carried out on 42 out of 83 patients presented by chest radiography of hilar and/or mediastinal lymphadenopathies with or without parenchymal lesions. Contrast-enhanced computed tomography chest and FOB, TBNA, and bronchoalveolar lavage were done for all patients. Forceps biopsy and bronchial brushing were done for some patients with bronchoscopic airway abnormalities. Results A total of 52 patients underwent FOB procedures; among them 10 (19.2%) patients were excluded due to nonconclusive diagnosis for further evaluations; final histopathological and/or microbiological diagnosis was confirmed in 42 (80.8%) patients, and they were included in data analysis. Among them, 25 (59.5%) patients had malignant lymphadenopathies (five patients had small cell lung cancer, 18 patients had nonsmall cell lung cancer, and two patients had lymphoma) and 17 (40.5%) had benign lymphadenopathies (eight patients had sarcoidosis, three patients had tuberculosis, six patients had reactive lymphadenitis). The overall sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of TBNA in the diagnosis of intrathoracic lymphadenopathies were 75.00, 54.50, 60.00, 70.60, and 64.29%, respectively. Conclusion Bronchoscopy with TBNA has good sensitivity and negative predictive value with fair specificity and positive predictive value in the diagnosis of intrathoracic lymphadenopathies. TBNA is a safe, effective procedure and can be performed easily during routine diagnostic bronchoscopy, and minimize the requirement for mediastinoscopy and thoracotomy.

Ultrasound-Guided Aspiration Does Not Reduce the Recurrence Rate of Ganglion Cysts of the Wrist

Background Ganglion cysts are the most frequent soft tissue tumor encountered in the upper extremity and are commonly treated by aspiration or by surgical excision. Ultrasound is a promising addition to traditional aspiration, as it allows for visualization of the needle within the ganglion before aspiration. Questions Are ganglion cysts of the wrist less likely to reoccur if they are aspirated under ultrasound guidance versus "blind" aspiration without the use of ultrasound guidance? Does patient functionality change based on whether or not the cyst recurred? Patients and Methods In total, 52 patients were successfully contacted and recurrence rates were compared between those whose cyst was treated with ultrasound-guided (13 patients) with those whose cyst was treated with blind aspiration (39 patients). Mean follow-up time was 2.9 years. Results Recurrence rates were 69% (9 patients) and 74% (29 patients) for the ultrasound-guided and blind aspiration groups, respectively ( p -value: 0.73), showing no significant difference in recurrences of wrist ganglion between the two groups. A metric of functionality (Quick-DASH [Disabilities of the Arm, Shoulder, and Hand]) revealed worse outcomes in patients who experienced return of ganglion cyst after aspiration versus those who did not. Conclusion Additional studies with improved sample sizes are needed to demonstrate the superiority of ultrasound-guided aspiration versus blind aspiration. Due to a high recurrence rate following aspiration (both ultrasound-guided and blinded), a lower threshold for surgical intervention is likely reasonable. Level of Evidence This is a Level IIIb study.

Comparison of Blind Endotracheal Aspiration and Bronchoscopic Brush Biopsy Sampling Methods for Bacteriological Diagnosis of Ventilator-Associated Pneumonia in Intensive Care Unit.

Background:The diagnosis of ventilator-associated pneumonia (VAP) is a challenge because the clinical signs and symptoms lack both sensitivity and specificity. Further confirmation of the diagnosis of VAP can be done by other diagnostic procedures such as bronchoscopic and blind endotracheal aspiration, but the selection of either diagnostic procedure is debatable.Aims:The aim is to study and compare the role of bronchoscopic protected specimen brush biopsy (PSBB) and blind endotracheal aspiration for diagnosis of VAP.Settings and Design:This prospective comparative study was conducted in multidisciplinary Intensive Care Unit of a tertiary care hospital.Materials and Methods:Thirty patients clinically diagnosed to have VAP were further evaluated by bronchoscopic and blind endotracheal aspiration. The P value of PSBB and blind aspiration techniques was calculated, taking clinical pulmonary infection score of ≥6 as reference standard.Statistical Analysis Used:Statistical analysis was done using Chi-square and t-test.Results and Conclusions:Our study shows that for the diagnosis of VAP, PSBB and blind aspiration had Chi-square value of 0.83 with degree of freedom 1 which showed P = 0.3623 which is not significant. t-test value is 0.402 with degree of freedom 1 and P = 0.7567 which is still not significant. There was a good microbiologic concordance among bronchoscopic and nonbronchoscopic distal airway sampling techniques. Blind endotracheal aspiration is a comparable technique for bacteriological diagnosis of VAP.

Availability of Hysteroscopy-Guided Resection of Endometrial Polyp

Endometrial polyp is a common disease that is often found in adult women. When malignancy is not pointed out pathologically in specimens of the blind endometrial aspiration biopsy or curettage biopsy and obvious lesion that needs to be treated is not observed by transvaginal ultrasonography, observation for periods depending on each case is usually indicated. To confirm the adequacy of such a management, we investigated past cases in which hysteroscopy-guided resection of endometrial polyp and pathological investigation in our hospital are underwent.

Ultrasound assessment of the gastric contents for the guidance of the anaesthetic strategy in infants with hypertrophic pyloric stenosis: a prospective cohort study

BackgroundEvacuation of gastric content through a nasogastric tube, followed by rapid sequence induction, is usually recommended in infants undergoing pyloromyotomy. However, rapid sequence induction may be challenging, and is therefore controversial. Some anaesthetists regularly perform classical non-rapid induction technique, after blind aspiration of the gastric contents, although this aspiration may have been incomplete. This prospective observational study aimed to assess whether the ultrasound monitoring of the aspiration of the stomach contents, may be useful to appropriately guide the choice of the anaesthetic induction technique, in infants undergoing pyloromyotomy. MethodsInfants undergoing pyloromyotomy were consecutively included. Ultrasound assessment of the antrum was performed before and after the aspiration of the gastric contents through a 10 French gastric tube. The stomach was defined as empty when no content was seen in both supine and right lateral positions. The correlation between antral area and the aspirated gastric volume was also tested. ResultsWe analysed 34 infants. Ultrasound examination of the antrum failed in three infants. The stomach was empty in 30/34 infants (nine before aspiration, 21 after aspiration), allowing to perform a non-rapid induction technique in 88.2% of the infants. There was a significant correlation between antral area measured in right lateral decubitus and the aspirated gastric volume. ConclusionsOur results suggest that the qualitative ultrasound assessment of the antral content may be a simple and useful point-of-care tool, for the choice of the most appropriate anaesthetic technique for pyloromyotomy according to the estimated risk of pulmonary aspiration of gastric contents.

Think ultrasound first for peritonsillar swelling

Peritonsillar abscess (PTA) is one of the most common deep neck space infections that can potentially have life-threatening complications if inadequately diagnosed and not treated promptly. The ability of clinicians to reliably differentiate PTA from peritonsillar cellulitis by physical examination alone is limited and blind needle aspiration, the typical method of diagnosis of PTA, is also unreliable. We review the available evidence supporting the use of ultrasound, either intraoral ultrasound or transcutaneous ultrasound to be the initial imaging modality of choice for evaluation of PTA and be used for real-time needle guidance.

Examination of Accuracy in the Assessment of Gastric Residual Volume

Increased gastric content from enteral nutrition intolerance is thought to place patients at risk for pulmonary aspiration. Although considered a questionable practice, blind gastric tube aspiration is the most common approach to measure gastric content. This simulated study evaluated the accuracy of residual volume (RV) assessment via tube aspirations made from known volumes by controlling the syringe pull technique, feeding tube properties, fluid viscosity, and placement of tubes in the fluid. This study was conducted in a metrology laboratory. Aspirates were obtained using a force measurement test system to control force of the syringe pull technique using 3 different procedures (slow 10 inches per minute [ipm], intermittent 10 ipm, and fast 40 ipm). Four different feeding tubes, 10 Fr and 18 Fr, each made of polyurethane and polyvinyl chloride, were placed in varying depths of 100 mL of either water or formula. The effect of fluid viscosity was also examined. Overall, 108 RVs were analyzed using a force measurement test system. Actual content of RV was underestimated 19% on average and varied across tube size and viscosity. Intermittent and slow syringe pull techniques yielded greater aspirate quantities, although neither technique aspirated the full amount of volume available. The 10 Fr feeding tubes yielded larger RVs in more viscous fluid, yet the 18 Fr tubes performed better with fluids of lower viscosity. Based on this simulation, RV assessment does not accurately reflect the total volume of the contents available and, therefore, the clinical utility of this assessment should be further investigated.

Combined Transbronchial Needle Aspiration and 99mTc-2-Methoxy-Isobutyl-Isonitrile Single Photon Emission Computed Tomography for Diagnosing Enlarged Mediastinal Lymph Nodes

BackgroundTo demonstrate the diagnostic accuracy of an integrated approach of blind trans-bronchial needle aspiration (TBNA) and 99mTc-2-methoxy-isobutyl-isonitrile single photon emission computed tomography (99mTc-MIBI-SPECT) in diagnosing mediastinal lymph adenopathy. MethodsSixty-one consecutive patients with mediastinal lymph adenopathy undergoing both TBNA and 99mTc-MIBI-SPECT were prospectively enrolled. Mediastinoscopy was attended in case of negative TBNA. ResultsEighty-three adenopathies were sampled (73 malignant and 10 benign). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of TBNA was 74%, 100%, 100%, and 34%, respectively; and of 99mTc-MIBI-SPECT were 96%, 80%, 97%, and 73%, respectively. Combining TBNA and 99mTc-MIBI-SPECT results sensitivity, specificity, PPV, NPV of 97%, 100%, 100%, and 83%, respectively, were obtained. TBNA alone avoided mediastinoscopy in 65% of cases, while an integrated approach could have potentially obviated mediastinoscopy in 76%. Conclusions99mTc-MIBI-SPECT improved the sensitivity and the NPV of TBNA, reducing the need of mediastinoscopy.

Uso combinado de aspiración por punción transbronquial y tomografía computarizada de emisión fotónica única con 99mTc-2-metoxi-isobutil-isonitrilo para el diagnóstico de ganglios linfáticos mediastínicos agrandados

BackgroundTo demonstrate the diagnostic accuracy of an integrated approach of blind trans-bronchial needle aspiration (TBNA) and 99mTc-2-methoxy-isobutyl-isonitrile single photon emission computed tomography (99mTc-MIBI-SPECT) in diagnosing mediastinal lymph adenopathy. MethodsSixty one consecutive patients with mediastinal lymph adenopathy undergoing both TBNA and 99mTc-MIBI-SPECT were prospectively enrolled. Mediastinoscopy was attended in case of negative TBNA. ResultsEighty three adenopathies were sampled (73 malignant and 10 benign). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of TBNA was 74%, 100%, 100%, and 34%, respectively; and of 99mTc-MIBI-SPECT was 96%, 80%, 97%, and 73%, respectively. Combining TBNA and 99mTc-MIBI-SPECT results sensitivity, specificity, PPV, NPV of 97%, 100%, 100%, and 83%, respectively, was obtained. TBNA alone avoided medistianoscopy in 65% of cases, while an integrated approach could have potentially obviated mediastinoscopy in 76%. Conclusions99mTc-MIBI-SPECT improved the sensitivity and the NPV of TBNA, reducing the need of mediastinoscopy.

Value of Ultrasound Before Joint Aspiration

The purpose of this article is to illustrate and discuss the value of ultra-sound screening before joint aspiration. Before joint aspiration, ultrasound assessment of the overlying and surrounding soft tissues requires little time and is relatively inexpensive. Bursal fluid collections, soft-tissue abscesses, and other fluid collections that would be undetected with fluoroscopy or blind aspiration can thus be identified. Ultrasound screening before joint aspiration can aid diagnosis and decrease the risk of iatrogenic complications.

Diagnostic yield of fine-needle aspiration puncture for cytology of multifocal liver lesions: A comparison between image-guided and blind aspirations

BackgroundIn patients with palpable hepatomegaly and space occupying lesions demonstrated by imaging techniques, blind fine needle aspiration puncture (FNAP) at the patient's bedside is feasible. ObjectiveTo compare the diagnostic yield of the fine needle aspiration puncture (FNAP) performed blindly or under radiological control in patients with hepatomegaly and multiple solid space occupying lesions in the liver, demonstrated by ultrasonography. MethodsA retrospective study was made of 169 consecutive FNAPs of liver tumors performed either blindly at the bedside by an internist (55 patients) or imaged-guided by a radiologist (114 patients). ResultsThe diagnostic yield of the technique performed blindly to demonstrate malignancy was 78% (95% confidence interval [CI]: 66–87%) vs. 83% (95% CI: 75–89%, p=.42) obtained in the image-guided FNAPs. The diagnostic yield did not vary based on type of tumor invading the liver. ConclusionBlind FNAP procedures in patients with palpable enlarged liver due to solid space occupying lesions is as effective as those performed under radiological control.

Rentabilidad diagnóstica de la punción-aspiración con aguja fina para citología en lesiones hepáticas multifocales: comparación entre la punción a ciegas vs. la dirigida por imagen

BackgroundIn patients with palpable hepatomegaly and space occupying lesions demonstrated by imaging techniques, blind fine needle aspiration puncture (FNAP) at the patient's bedside is feasible. ObjectiveTo compare the diagnostic yield of the fine needle aspiration puncture (FNAP) performed blindly or under radiological control in patients with hepatomegaly and multiple solid space occupying lesions in the liver, demonstrated by ultrasonography. MethodsA retrospective study was made of 169 consecutive FNAPs of liver tumors performed either blindly at the bedside by an internist (55 patients) or imaged-guided by a radiologist (114 patients). ResultsThe diagnostic yield of the technique performed blindly to demonstrate malignancy was 78% (95% confidence interval [CI]: 66-87%) versus 83% (95% CI: 75-89%, P=.42) obtained in the image-guided FNAPs. The diagnostic yield did not vary based on type of tumor invading the liver. ConclusionBlind FNAP procedures in patients with palpable enlarged liver due to solid space occupying lesions is as effective as those performed under radiological control.

PROXIMAL SARTORIUS TENDON RUPTURE AS A CAUSE OF TRAUMATIC ANTERIOR HIP PAIN-A CASE REPORT OF A PROFESSIONAL FOOTBALLER

BackgroundSartorius injuries are seldom mentioned in medical literature. Thus developing an evidence-based management plan for sartorius muscle and tendon injuries can be challenging. In this case a grade 3 tear...

US-Guided Joint Approach for Diagnostic or Therapeutic Purposes

Benefits of US Guided Joint Aspiration 1. To patient-determine if joint fluid is really present to avoid traumatic, unnecessary aspiration attempt-detect other fluid collections such as bursitis, and soft tissue abscess to avoid septic inoculation-without radiation hazard 2. To radiologist - Expand hands-on skills and radiologists’ role Step approach with US 1. Position - Relaxed as possible 2. US examination of affected body area - Localize joint under ultrasound 3. Identify effusion - Confirm the expected findings - Identify the most adequate path 4. Aspirate using sterile technique Skin prep, draping, anesthesia, visualization, puncture and aspiration In daily practice, diagnostic or therapeutic joint approaches are carried out under ultrasonographic guidance because of several advantages. Accurate knowledge of variable joint anatomies and entry sites makes patients comfortable. We will describe the appropriate positioning and various sonographic approaches for variable joints with some technical tips. 1. US guided joint aspiration offers several advantages over the blind aspiration. 2. Knowing appropriate positioning, and entry sites, the beginners and non-experts can easily approach variable joints.