Percutaneous Needle Aspiration Research Articles

Study on Computed Tomography (CT) Guided Transthoracic Fine Needle Aspiration Cytology (FNAC) in the Diagnosis of Intrathoracic Mass Lesions - Not Approachable by USG

Background: Intrathoracic mass is a general issue encountered by the physicians in whole world including Bangladesh. Accurate diagnosis is important for proper management. Percutaneous fine needle aspiration cytology (FNAC) has been extensively utilized and widely accepted as an important means of diagnostic technique. This study was performed to know and justify the computed tomography (CT) guided FNAC as a diagnostic modality for the diagnosis of intrathoracic masses which are non-approachable by ultrasonography (USG). Methods: It was a descriptive type of cross sectional study and conducted among 30 patients having ultrasonologically non approachable intrathoracic masses during the period of Feb 2016 to July 2016 in Combined Military Hospital (CMH), Dhaka considering selection criteria and informed written consent using purposive sampling technique. FNAC was done in all the patients. After further investigation, a definitive diagnosis was made. The analysis of the surgical specimen, the biopsy, the therapeutic response, and the clinical follow-up all contributed to the ultimate diagnosis. A comparison was done between the cytological and final diagnosis for thirty cases. Ethical issues were properly addressed. Results: Initially CT guided FNAC was carried out on all patients. Conclusive cytological diagnosis was possible in 28 patients yielding 93.33% diagnostic accuracy. FNAC diagnosed 24 cases as malignant intrathoracic mass, 04 as benign lesion and 02 undiagnosed due to inadequate tissue material. In final diagnosis 25(75%) diagnosed as malignant and 05(25%) diagnosed as benign. Diagnosis of two patients was impossible by FNAC due to inadequate tissue material. Conclusion: CT guided FNAC of intrathoracic mass allow early diagnosis with lesser trauma and lower cost. This procedure avoided more invasive diagnostic surgery. Bangladesh Armed Forces Med J Vol 56 No (2) December 2023, pp 10-16

Evaluating the risk of malignancies of the diagnostic categories proposed by the World Health Organization System for Reporting Lung Cytopathology: a two-year single institutional experience.

Introduction The WHO System of Reporting Lung Cytopathology proposed a 5-tiered system in 2023. We report the risk of malignancies (ROMs) of bronchial washing/lavage and percutaneous fine needle aspiration (FNA) specimens. We also evaluated the change of ROMs when image correlation is required. Methods Lung cytology cases in 2021 and 2022 with histologic follow-up were included. CT reports were reviewed to identify cases with a solid nodule/tumor but benign cytological findings. These were reassigned from the "Benign" to "Non-diagnostic" category, and the ROMs were re-estimated. Results A total of 1031 bronchial washing/lavage and 206 FNAs were identified. The ROMs of bronchial washing/lavage were "Non-diagnostic" 56.5% (13/23), "Benign" 41.9% (320/764), "Atypical" 71.7% (71/99), "Suspicious for malignancy" 94.7% (72/76), and "Malignant" 100% (70/70). The ROMs of FNAs were "Non-diagnostic" 66% (33/50), "Benign" 58.2% (39/67), "Atypical" 70% (28/40), "Suspicious for malignancy" 96.2% (25/26), and "Malignant" 100% (70/70). When image finding was considered, cases initially assigned as "Benign" were re-classified to "Non-diagnostic" with decreases in ROMs for the "Benign " category. Conclusions Malignancy risks associated with the WHO System of Reporting Lung Cytopathology diagnostic groups were reported. Image correlation for the "Benign" category led to a decrease in case number and ROM.

Clinical insights into liver abscess: a comprehensive analysis of presentation, etiology and management in Northeastern India, Silchar, Assam

Hepatic abscess is a prevalent disease in Northeastern India with a myriad clinical feature. The present study is aimed to understand the clinical profile, microbiological aetiologies, and management outcomes in patients with hepatic abscesses in Northeastern India, Silchar. In the surgery department of Silchar medical college and hospital, 20 cases of hepatic abscess were studied from January 2022 to October 2023. Records were kept for history, examination, and laboratory investigations. Ultrasound-guided aspiration of the abscess was done, and samples were subject to relevant investigation. The mean age of patients was 33 years, 2/3rd of the patients were from lower socioeconomic status. Alcoholic history was elicited from 45% of the patients. The abscesses were predominantly in the right lobe (70%) and solitary (65%). Etiology of the cases, 55% amoebic, 40% pyogenic, and 5% were tubercular in origin. Pigtail catheterization was done in 70% of the patients; percutaneous needle aspiration was done in 25% of the cases. No cases of mortality were noted. Amoebic and tubercular abscess were solitary in nature whereas pyogenic abscesses were multiple. The amoebic and pyogenic abscess had right lobe predominantly affected whereas in tubercular abscesses left lobe involvement was more common. The most common presentation was young male of low socioeconomic status having solitary amoebic abscess usually in the right lobe of liver

A novel use of endobronchial ultrasound bronchoscope to biopsy supraclavicular lymph node

Background: Accurate staging for patients with lung cancer is essential for management and prognostication. Percutaneous ultrasound-guided fine needle aspiration (US FNA) of supraclavicular lymph nodes is not always performed clinically for variety of reasons. Our study explores the utility of supraclavicular lymph node biopsy using the endobronchial ultrasound (EBUS) bronchoscope at the time of a mediastinal staging procedure as a possible alternative to US FNA. Methods: This study included 22 patients who underwent supraclavicular lymph node biopsy using the EBUS bronchoscope during lung cancer staging procedure from 2019 to 2021 at the University of Pennsylvania. Feasibility and safety of the procedure were reported. Descriptive statistics were performed for baseline demographics, imaging features, pathology results, tumor cellularity and adequacy for oncological testing. Results: The procedures were safely performed in all patients with no safety events reported. All patients were diagnosed with malignancy and EBUS-guided supraclavicular lymph node FNA showed definitive diagnosis in 19. Of the 16 patients with the final diagnosis of non-small cell lung cancer (NSCLC), 14 had tumor seen in supraclavicular lymph node sampling and 9 were upgraded to Stage IIIB disease from lower mediastinal lymph node staging. Eleven supraclavicular lymph node samples had tumor cellularity >10%. Eight samples were sent for next generation sequencing (NGS). Three of them were the only source for NGS. Conclusions: Supraclavicular lymph node biopsy using the EBUS bronchoscope is a feasible and safe procedure to perform during lung cancer staging. Sampling has significant clinical value for accurate staging and oncologic testing.

Demographics and prognosis of patients with pyogenic liver abscess due to Klebsiella pneumonia or other species

BackgroundPyogenic liver abscess (PLA) is a potentially life-threatening intra-abdominal infection. We compared the clinical features, treatments, and prognoses of patients who had Klebsiella pneumonia pyogenic liver abscess (KPPLA) and non-Klebsiella pneumonia pyogenic liver abscess (non-KPPLA). MethodsA retrospective analysis was used to compare the medical records of KPPLA and non-KPPLA patients with positive pus cultures at a single hospital in China from January 2017 to December 2019. ResultsWe examined 279 patients with definitively established PLA, 207 (74.2 %) with KPPLA, and 72 with non-KPPLA. The non-KPPLA group had a higher Charlson comorbidity index, longer hospital stay, longer duration of fever, and greater hospital costs. Multivariate analysis showed that alcohol intake (OR: 2.44, P = 0.048), cancer (OR: 4.80, P = 0.001), ICU admission (OR: 10.61, P = 0.026), resolution of fever OR: 1.04, P = 0.020), and a positive blood culture (OR: 2.87, P = 0.029) were independent predictors of primary treatment failure. Percutaneous needle aspiration (PNA) and pigtail catheter drainage (PCD) provided satisfactory outcomes, but PNA led to shorter hospital stays and reduced costs, especially in KPPLA patients whose abscesses were smaller than 10 cm. ConclusionKPPLA and non-KPPLA patients had some differences in comorbidities and treatment strategies, and non-KPPLA patients had a significantly worse prognosis.

A Comparative Study of Conservative vs. Percutaneous Needle Aspiration of Liver Abscess based on Liquefaction

A Comparative Study of Conservative vs. Percutaneous Needle Aspiration of Liver Abscess based on Liquefaction

Cystic adventitial disease van de arteria poplitea: casus en literatuuroverzicht

Cystic adventitial disease of the arteria poplitea: case report and literature review Cystic adventitial disease (CAD) is a relatively rare condition (responsible for 1 in 1,200 cases of calf claudication) with the formation of a mucinous cyst in the tunica adventitia. The arterial, rather than the venous, vascular structures are affected in a relatively young, predominantly male population. Several locations have been described, most of them in the popliteal artery (80-85%). Etiologically, several hypotheses have been put forward, without clear consensus, although the synovial and developmental theories are currently considered the most plausible. The patient’s history generally involves complaints of claudication without the presence of important cardiovascular risk factors. Typically, a spasmodic feeling in the calf with varying degrees of exertion is described, with spontaneous recovery after some period of rest. Of paramount importance is the consideration of CAD in a story of intermittent claudication. A Doppler ultrasound, as well as a CT scan and/or an MRI with associated angiography can all be used for the diagnosis. Surgery with complete excision and interposition of a venous graft is the treatment of choice. The cyst can also be drained by means of a percutaneous ultrasound-assisted needle aspiration, but this is associated with a high need of revision. Percutaneous endovascular treatment with a balloon angioplasty (and possibly stenting) does not show favorable results. Recurrence of CAD after surgical resection is minimal. Recently, several cases have been described with spontaneous resolution of claudication after conservative management without surgical resection need and/or aspiration.

Percutaneous catheter drainage versus percutaneous needle aspiration for liver abscess: a systematic review, meta-analysis and trial sequential analysis

ObjectiveTo compare the effectiveness and safety of percutaneous catheter drainage (PCD) against percutaneous needle aspiration (PNA) for liver abscess.DesignSystematic review, meta-analysis and trial sequential analysis.Data sourcesPubMed, Web of Science, Cochrane...

Splenic Lesions as a Soft Pointer Towards the Diagnosis of Enteric Fever: A Case Series.

To the Editors: Enteric fever is a major public health problem in developing countries.1 The highest incidence is in children between 5 and 9 years-of-age.2 Splenic abscess (SA) is a rare extra-intestinal complication of salmonellosis with a reported incidence of 0.29%–2%.3,4 Salmonella SA is rare but carries a high risk of morbidity and mortality if unrecognized and untreated.5 This case series presents 3 cases of enteric fever complicated with splenic lesions. Case 1: A 5-year-old female patient presented with fever, pain in the abdomen, vomiting and loose stools for 10 days. On examination, she had a tender abdomen with hepatomegaly. She was started on ceftriaxone due to suspicion of enteric fever. Ultrasonography (USG) of the whole abdomen on admission day was normal. Widal serology on day 11 of illness was positive (1:320 for Titre of H antibody and Titre of O antibody). Blood culture grew nalidixic acid-resistant Salmonella typhi (Table 1). Because she continued to remain febrile, azithromycin was added on day 7 of the hospital stay, and a repeat USG was performed on day 10 of the stay, showing SA (1.4 × 2.1 × 2.3 cm) at the lower pole. USG-guided needle aspiration was performed, and antibiotics continued. She became afebrile over the next few days, was started on oral cefixime and discharged. TABLE 1. - Baseline Characteristics, Clinical, Lab and Management Details of Cases Patient Characteristics Case 1 Case 2 Case 3 Age at presentation (years) 5 12 4 Symptoms (duration in days) Fever Yes (10) Yes (21) Yes (10) Pain abdomen Yes (8) Yes (18) Yes (3) Vomiting Yes (8) No Yes (3) Loose stools Yes (8) No No Per abdomen examination Tenderness Yes Yes Yes Hepatomegaly (liver span) Yes (11 cm) Yes (12 cm) Yes (12 cm) Splenomegaly No Palpable spleen tip No Investigations at admission Haemoglobin (gm/dL) 9.3 11 11.5 TLC (per mm3) 7,800 8,260 5800 DLC (N%/ L %/ M %) 74/20/3 76/14/4 56/33/10 Platelet count (per mm3) 39,000 3,69,000 1,54,00 CRP (mg/dL) 97 36 43 Widal test (titres) Positive (1:320) Negative Positive (1:320) Antibiotics (days) Ceftriaxone (14) f/b cefixime (7) Azithromycin (14) Ceftriaxone (14) f/b cefixime (7) Ceftriaxone (14) f/b cefixime (7) Follow up USG 1 × 1.06 × 1 cm abscess, 1-month postdischarge. Resolution of splenic abscess, 2-month postdischarge Resolution of splenic abscess Resolution of splenic granuloma Typhoid vaccine status Unvaccinated Unvaccinated Unvaccinated CRP, C-reactive protein; DLC, Differential leukocyte count; f/b indicates followed by; TLC, Total leukocyte count; USG, ultrasonography. Case 2: A 12-year-old male presented with 3 weeks of high-grade fever and left abdominal pain. Examination revealed tenderness and palpable spleen tip. Ceftriaxone was initiated empirically. Widal serology was negative, and the blood culture was sterile. Other investigations to evaluate for the etiology of fever, including tuberculosis, were negative. USG abdomen revealed 3 SA, the largest 2.5 × 2.2 cm in splenic parenchyma. Ultrasound-guided aspiration of the largest abscess was performed. Pus culture grew Salmonella paratyphi A. Ceftriaxone was continued as per the sensitivity report. Subsequently, he became afebrile and was started on cefixime and discharged. Case 3: A 4-year-old female presented with fever for 10 days, pain in the abdomen, and vomiting for 3 days. She was started on intravenous ceftriaxone empirically, keeping a possibility of enteric fever. Due to persistent abdominal pain, USG of the abdomen was performed, which revealed multiple hypo-echoic foci in the spleen suggestive of splenic granuloma. Blood investigations revealed a positive Widal test (1:320 dilution titers for Titre of H antibody and Titre of O antibody) and blood culture grew Salmonella typhi. She became afebrile by day 4 of the hospital stay. She was given 7 days of intravenous ceftriaxone, followed by 7 days of cefixime. USG whole abdomen repeated 1-week post-discharge, showed no splenic granuloma. Salmonella SA is rare but carries a high risk of morbidity and mortality if unrecognized and untreated.5 Diagnosis is often delayed in children due to its rarity and nonspecific symptoms. USG abdomen is usually the first investigation performed in suspected cases, and sensitivity can be as high as 90% in the hands of an experienced operator. Percutaneous needle aspiration and antibiotics for 2–3 weeks may be sufficient in many cases, though the actual duration of antibiotics required is not known. The splenic abscess could be a pointer toward the diagnosis of enteric fever in high-burden settings like India. Though radiologic clearing can require 2–3 months, patients usually become asymptomatic after 2–3 weeks of adequate antibiotics and drainage.

Hepatic Abscess in Adults: Integrated Approach and Surgical Considerations

Hepatic abscesses are suppurated cavities caused by the invasion and multiplication of microorganisms within the liver parenchyma. This condition is relatively uncommon, with an estimated incidence of 2.3 to 3.6 cases per 100,000 people yearly. However, the incidence is higher in specific populations, such as patients with underlying liver disease, diabetes, or other immune-compromising conditions. The most common cause of liver abscesses is the spread of infection from other parts of the body, such as the biliary tract or gastrointestinal tract. Other causes include trauma to the liver, such as from a penetrating injury or surgery or the presence of a foreign body in the liver. Liver abscesses are broadly divided into two types: amoebic and pyogenic. The clinical presentation might vary, including fever, abdominal pain, nausea and vomiting, jaundice, and weight loss. In some cases, there may be no symptoms. Diagnosis typically involves an ultrasound or CT scan, which can show the presence of a fluid-filled mass in the liver. CT is the standard modality for diagnosis. Blood tests may also evaluate liver function and identify any underlying infections. Treatment typically involves a combination of antibiotics to target the underlying infection and drainage of the abscess. Supportive measures like hydration and pain management may also be necessary. In addition, close monitoring and follow-up are essential to ensure that the abscess has resolved and there are no complications. In some cases, surgical intervention may be necessary to remove the abscess or repair any damage to the liver. Liver abscess drainage is typically indicated in patients with significant, symptomatic abscesses or those who do not respond to medical treatment with antibiotics. In addition, abscesses at risk of rupturing or located close to vital structures, such as major blood vessels, may require drainage to prevent serious complications. Two drainage methods are presently available: non-surgical options, such as percutaneous needle aspiration or percutaneous catheter drainage, and surgical options, such as open drainage or laparoscopic drainage. This review identifies when these alternatives should be used, taking adverse effects, symptoms, and comorbidities into account.

Pediatric Liver Abscess: Outcomes of Protocol-based Management and Predictors of Poor Outcome.

Liver abscess (LA) is an important cause of morbidity in children, especially in tropical countries. There is a paucity of data in pediatric LA with no standard guidelines regarding the best modality of treatment and drainage. With a large influx of patients at our center and protocol-based management; we aimed to study clinic-radiologic profile, risk factors, complications and outcomes of children with liver abscess and assessed possible predictors for poor outcomes. This retrospective observational study was conducted from January 2019 to September 2019 at a tertiary care hospital in India. Records of all children (<12 years of age) with ultrasonographically diagnosed liver abscess were accessed for clinic-radiological and demographic profile, laboratory investigations, treatment, complications and outcomes. Patients were categorized into favorable or unfavorable groups based on predefined criteria and were compared for possible predictors of poor outcomes. Outcomes for the protocol-based management were analyzed. There were 120 cases of pediatric liver abscess with a median age of 5 years at presentation. The commonest clinical features were fever (100%) and pain in the abdomen (89.16%). The majority of liver abscesses were solitary (78.4%) and in the right lobe (73.3%). Malnutrition was present in 27.5%, overcrowding for 76.5% of patients and worm infestation in 2.5% of patients. Age-related leukocytosis ( P = 0.004), neutrophilia ( P = 0.013), elevated Aspartate transaminase ( P = 0.008), elevated alanine transaminase ( P = 0.007) and hypoalbuminemia ( P = 0.014) were significantly more in the unfavorable group. Overall, 29.2% of patients underwent conservative management with antibiotics alone, 25.0% underwent percutaneous needle aspiration (PNA), 49.1% underwent ultrasound-guided percutaneous drain (PCD) insertion and open surgical drainage (OSD) was needed in a single patient. The success rate was 100% for conservative management, 76.6% for PNA, 94.7% for PCD and 100% for OSD with an overall mortality of 2.5%. Age-related leukocytosis, neutrophilia, elevated aspartate transaminase or alanine transaminase and hypoalbuminemia at presentation are predictors of poor outcomes in pediatric liver abscess. Protocol-based management leads to the appropriate use of PNA and PCD while decreasing mortality and morbidity related to either.

Pneumothoraxes after CT-guided percutaneous transthoracic needle aspiration biopsy of the lung: A single-center experience with 3426 patients.

The purpose of this study is to determine how long patients who developed pneumothorax were followed up on in the emergency department, how many patients required chest tube placement, and what factors influenced the need for a chest tube in patients who underwent computed tomography (CT)-guided percutaneous transthoracic fine needle aspiration biopsy (PTFNAB). Patients who developed pneumothorax following CT-guided PTFNAB were analyzed retrospectively. In cases with pneumothorax, the relationship between chest tube placement and the size of the lesion, the lesion depth from the pleural surface, the presence of emphysema, and the needle entry angle were investigated. It was determined how long the patients were followed up in the emergency department, when a chest tube was placed, and when patients who did not require chest tube placement were discharged. CT-guided PTFNAB was performed in 3426 patients within two years. Pneumothorax developed in 314 (9%) cases and a chest tube was placed in 117 (37%). The risk factor for chest tube placement was found to be the lesion depth from the pleural surface. The lesion depth from the pleural surface of >24 mm increased the risk of chest tube placement by 4.8 times. Chest tubes were placed at an average of five hours (5.04 ± 5.57). This study has shown that in cases with pneumothorax that required chest tube placement, the lesion depth from the pleural surface is a risk factor. Patients who developed pneumothorax on CT during the procedure had chest tubes placed after an average of five hours.

The diagnosis of peripheral lung lesions: transbronchial biopsy using a radial probe endobronchial ultrasound

Background: Radial probe endobronchial ultrasound (RP-EBUS) has been used in the diagnosis of peripheral lung lesions (PLLs). We reviewed the traditional modality of transbronchial biopsy using RP-EBUS as well as recent developments in improving the diagnostic yield.Current Concepts: Until now, the forceps biopsy of PLLs has played a key role in acquiring tissue samples during the RP-EBUS procedures. Forceps biopsy is a safe and minimally invasive procedure; however, its diagnostic yield was reported to be around 70%, which is significantly lower than that of percutaneous needle aspiration or biopsy. So far, various studies have been conducted to improve the diagnostic yield of the RP-EBUS procedure. The combination of novel navigation systems, such as virtual or electromagnetic navigation bronchoscopies, for locating PLLs in the complex bronchial tree has increased the diagnostic yield of the RP-EBUS procedure. Moreover, newly developed ancillary devices, such as the PeriView FLEX needle or cryobiopsy, as well as traditional modalities such as the guide sheath and brushing cytology, can improve the outcomes of the RP-EBUS procedures. Concerning the bronchoscope size, it has been confirmed that a 3 mm-diameter ultrathin bronchoscope has a higher diagnostic yield than a 4 mm-diameter thin bronchoscope.Discussion and Conclusion: RP-EBUS is a safe and useful method to diagnose PLLs. When traditional and novel modalities are appropriately combined, the diagnostic yield can be increased.

Different modalities of management of liver abscess

Background: Liver abscess is an acute suppurative infectious disease of liver parenchyma which may be pyogenic, amoebic or tubercular. It can occur due to direct blood spread through enterohepatic circulation or due to ascending infection occurring through biliary tree. Aim was to evaluate effectiveness of various management strategies in the management of liver abscess. Methods: It is a prospective study carried out in 100 patients of age 12-80 years between 1st December 2021 to 31st May 2022 who presented to general surgery department and diagnosed with liver abscess. Results: 10% cases were treated conservatively with antibiotics only, 59% cases were treated with percutaneous needle aspiration, 21% patients were treated with percutaneous pigtail catheter drainage, 10% cases were treated with open surgical drainage. Conclusions: Liver abscess with size less than 5 cm or 50 cc can be managed conservatively but liver abscess with size &gt;5 cm need intervention.

Percutaneous catheter drainage versus needle aspiration for liver abscess management: an updated systematic review, meta-analysis, and meta-regression of randomized controlled trials.

Liver abscess is a life-threatening condition. Percutaneous catheter drainage (PCD) and percutaneous needle aspiration (PNA) are both minimally invasive techniques used to manage liver abscess. We aim to compare both techniques' efficacy and safety. We performed a systematic review and meta-analysis involving randomized controlled trials (RCTs) from PubMed, Embase, Scopus, WOS, Cochrane, and Google scholar until July 22nd, 2022. We pooled dichotomous outcomes using risk ratio (RR) presented with a 95% confidence interval (CI) and continuous outcomes using mean difference (MD) with 95% CI. We registered our protocol with ID: CRD42022348755. We included 15 RCTs with 1,626 patients. Pooled RR favored PCD (RR: 1.21 with 95% CI: 1.11, 1.31, P<0.00001) in success rate and recurrence after six months (RR: 0.41 with 95% CI: 0.22, 0.79, P=0.007). We found no difference in adverse events (RR: 2.2 with 95% CI: 0.51, 9.54, P=0.29). Pooled MD favored PCD in time to clinical improvement (MD: -1.78 with 95% CI: -2.50, -1.06, P<0.00001), time to achieve 50% reduction (MD: -2.83 with 95% CI: -3.36, -2.30], P<0.00001) and duration of antibiotic needed (MD: -2.13 with 95% CI: -3.84, -0.42, P=0.01). We found no difference in the duration of hospitalization (MD: -0.72 with 95% CI: -1.48, 0.03, P=0.06). The results were heterogeneous for all the continuous outcomes which were all measured in days. Our updated meta-analysis concluded that PCD is more effective than PNA in liver abscess drainage. However, evidence is still uncertain, and more high-quality trials are still required to confirm our results.

A RANDOMIZED COMPARATIVE STUDY OF CONSERVATIVE VS PERCUTANEOUS NEEDLE ASPIRATION OF LIVER ABSCESS BASED ON PERCENTAGE OF ITS LIQUEFACTION.

Introduction:- Liver abscess is one of the common acute abdominal condition. Conservative management and percutaneous needle aspiration are the commonly used methods of management. But there is no common consensus between the physicians regarding best option out of these two. To Aim:- compare and to identify the better treatment modality among these two options for the treatment of liver abscess based on the percentage of liquefaction. A total of 140 patients with liver abscess were included in the study. T Patients and Methods:- hey were grouped in to Group A and B, based on percentage of liquefaction, they were further subdivided into conservative and aspiration subgroups and randomized. The outcomes of the two procedures were studied with respect to reduction in abscess cavity size, reduction in leukocyte count and patient's satisfaction. There was a signicant reduction in the ab Results:- scess size and leukocyte count in conservative subgroup of group-A, than conservative sub group of group B. Whereas there was signicant reduction abscess size and leucocyte count noted in aspiration sub group of Group B than aspiration sub group of Group A. Signicantly more number of the patients in conservative subgroup of group-A expressed their satisfaction, than conservative sub group of group B. Whereas signicantly more number of patients in aspiration sub group of the group B expressed their satisfaction than aspiration sub group of group A. present study concludes that conservative Conclusion:- treatment is also better option for liver abscess with 30-50% liquefaction, and aspiration is ideal for 50-70% liquefaction

Ultrasonographic and pathomorphological changes in Alimentary Lymphoma in cats

The study aimed to determine the characteristic changes in alimentary lymphoma in cats during ultrasonography, pathoanatomic and cytological examination of biopsy material. The survey objects are cats with gastroenterological disorders with suspected alimentary lymphoma of different ages and genders. The diagnosis was made based on a clinical examination according to generally accepted methods, laboratory blood examination, ultrasound examination, pathomorphological examination of the intestinal walls and lymph nodes, and cytological examination of the lymph node material obtained by the TIAB method. The authors carried out the material sampling for cytological examination using percutaneous fine needle aspiration (FNA) biopsy under ultrasound control on the Mindray Z6 Vet apparatus. In addition, the authors conducted pathological and cytological studies in the Vet Union laboratory. When analyzing ultrasound examination in cats diagnosed with alimentary lymphoma, hepatomegaly, 1% ascites, 3% hydrothorax, 3 % increase in mediastinal lymph nodes, 7% splenomegaly, 16% violation of differentiation of intestinal layers, 16% violation of differentiation of intestinal layers, 29% increase in mesenteric lymph nodes, 29 % thickening of intestinal walls were observed in 12% of cases. Cytological examination revealed rounded, large, separately located cells. The population is monomorphic. During a histological study in the intestinal wall, adjacent fatty tissue of the omentum, and lymph node tissue, there is a highly cellular invasive formation constructed from diffuse layers of rounded lymphoid neoplastic cells with a scanty fibrous stroma. The most characteristic ultrasound findings are the thickening of the intestinal walls and an increase in mesenteric lymph nodes.

Assessment of risk factors in pyogenic liver abscesses in children.

Pyogenic liver abscess (LA) is a significant contributor to morbidity and mortality in developing countries like India. The risk factors predisposing to the LA specifically in children are not known. Studies done in the past largely remain inconclusive and have identified only probable causes. The cause of LA in children with no coexisting illness remains unknown. This prospective observational study was conducted at a tertiary teaching hospital located in New Delhi, India. All children between 2 months and 12 years of age with sonographically confirmed LA presenting to the hospital were included and managed with appropriate intravenous antibiotics and relevant investigations. A total of 52 children were included. The mean age was 6 years and 4 months, and the male: female ratio was 1.4:1. Around 50% of the patients were malnourished. Fever, abdominal pain and loss of appetite were the most common symptoms. Nine patients (17%) were managed conservatively, 13 (25%) needed percutaneous needle aspiration and 30 (57.69%) required drainage using a pigtail catheter. Poor socioeconomic status and anaemia were found to be the most commonly associated risk factors. Selective immunoglobulin A (IgA) deficiency was the most common primary immunodeficiency disorder followed by T-cell defect. On multivariate analysis, it was seen that in those with clinical icterus, gamma-glutamyl transferases >350 IU/m, and those with impending rupture, the time to defervescence was significantly different (P = 0.05). Poor socioeconomic status causing malnutrition emerged as a significant risk factor for LA in children. Selective IgA deficiency was the most common immunodeficiency seen in a few children. Adopting a conservative approach like aspiration and percutaneous drainage led to lower mortality and good recovery rates.

STUDY OF ETIOLOGY OF LIVER ABSCESS AND IT'S DIFFERENT WAYS OF MANAGEMENT

Background: Liver abscess are cystic, space occupying lesion within liver parenchyma. It has become one of the most common disease with more prevalence in underdeveloped and developing countries. Pyogenic liver abscess more common in western world while amoebic liver abscess are more common in underdeveloped countries and people living with lower socio-economic conditions. Liver abscess, undiagnosed and untreated, has a very high mortality rate. With early diagnosis and prompt institution of specic therapy, the prognosis is good and the mortality is very low. Surgical management was the mainstay for treating liver abscess earlier. However, USG guided percutaneous needle aspiration and percutaneous drainage procedure shown a favorable outcome with less average length of stay in hospital. In this study we aimed to study etiology of liver abscess and its different ways of management. To study the etiology of liver abscess Aim: Materials And Methods: and its different ways of management. This is a prospective, observational study was conducted in GSVM Medical College, LLR &amp; Associated Hospitals, Kanpur (UP).Study was done on 100 patients with different types of liver abscess. Patient with ruptured liver abscess were not included. Outcomes were assessed on the basis of recurrence (with regular follow ups at one month, three months, six months and one year); relieving of symptoms and length of stay in hospital. Results: Out of 100 patients majority of patients were in the age range of 31-45 (56.0%) followed by 46-60 (22.0%) with mean age of 40.74±10.53 years. Most of the cases were males (98%), and females (2.0%). Majority of patients were with lower socioeconomic status (96%). Most of the patient having amoebic liver abscess (66%) with positive ELISA for antibodies, while 34 % of patient having pyogenic liver abscess with 10% having bacterial growth on culture examination having E.coli . 84% of cases having liver abscess in right lobe and were single (66.0%). On the basis of their personal history, comorbidities and clinical features, 14.05 were diabetic, 44.0% were alcoholic, 98% were having fever with 60% cases have chills and rigor and 100% having pain in right upper quadrant. Majority of cases undergone pigt Conclusion: ail treatment were pyogenic (76.4%) and majority of amoebic abscess were treated with aspiration (72.7%) and difference was found statistically signicant with p value of 0.001. Reduction in size of abscess cavity was observed in all the cases but recurrence was higher in conservative treatment (p=0.007) and length of stay was higher in pigtail (p&lt;0.001).

Percutaneous needle aspiration versus catheter drainage in the management of liver abscess: an updated systematic review and meta-analysis.

Liver abscesses differ in their aetiology, location, and number. Image-guided percutaneous drainage techniques are the currently used management for liver abscesses. We conducted our study to compare the clinical safety and efficacy of percutaneous needle aspiration (PNA) to percutaneous catheter drainage (PCD). A systematic review of major reference databases was undertaken in February 2022 for randomized controlled trials (RCTs) that compare PNA to PCD in treating liver abscess patients. The quality of the included trials was assessed using the Cochrane tool. Statistical meta-analysis was conducted using RevMan and open meta-analyst software. Fifteen RCTs were included in this review, with 1676 patients enrolled. The overall quality of the included trials was moderate, with most domains of unclear risk. PCD was superior to PNA in the success rate (RR=1.23; 95% CI [1.12, 1.36], P< 0.00001), time for achieving 50% reduction of cavity size (MD=-2.32; 95% CI [-3.07, -1.57], P< 0.00001), and time for clinical improvement (MD=-1.92; 95% CI [-2.55, -1.28], P< 0.00001). The two modalities did not differ in the days of hospital stay, duration of IV antibiotics, and time needed for total or subtotal reduction of cavity size (P= 0.36, P= 0.06 and P= 0.40, respectively). High heterogeneity levels were detected. Regarding major complications, the two modalities were equally safe (P= 0.39). PCD has a higher success rate and results in a faster 50% reduction in the abscess cavity size and clinical improvement. The two modalities are equally safe.