Simple Aspiration Research Articles

Efficacy of an opposite position aspiration on resolution of pneumothorax following CT-guided lung biopsy.

To evaluate the efficacy of aspiration in an opposite position to deal with pneumothorax after CT-guided lung biopsy. A retrospective study was developed involving 210 patients with pneumothorax who had undergone CT-guided percutaneous core biopsies from January 2012 to March 2014 for various pulmonary lesions. Asymptomatic patients with minimal pneumothorax were treated conservatively. Simple manual aspiration was performed for symptomatic patients with minimal pneumothorax and for all patients with moderate to large pneumothorax. An opposite position aspiration was performed when simple manual aspiration failed. The efficacy of simple manual aspiration and the opposite position aspiration was observed. Among 210 patients with pneumothorax, 128 (61.0%) asymptomatic patients with minimal pneumothorax were treated conservatively. The remaining 82 were treated with attempted simple manual aspiration. Out of these 82 patients, simple manual aspiration was successful in 58 (70.7%, 58/82) cases. The complete and partial regression rates were 17.2% (10/58) and 82.8% (48/58), respectively. In the other 24 patients (29.3%, 24/82), simple aspiration technique was ineffective. An opposite position (from prone to supine or vice versa) was applied, and a new biopsy puncture site was chosen for reaspiration. This procedure was successful in 22 patients but not in 2 patients who had to have a chest tube insertion. The complete and partial regression rates were 25.0% (6/24) and 66.7% (16/24), respectively. Applying the new method, the total effective rate of aspiration improved significantly from 70.7% (58/82) to 97.6% (80/82). The opposite position aspiration can be safe, effective and minimally invasive treatment for CT-guided lung biopsy-induced pneumothorax thus reducing the use of chest tube significantly. (1) Opposite position aspiration can elevate the success rate of aspiration significantly (from 70.7% to 97.6% in our study); (2) this procedure is a safe, effective and minimally invasive treatment for pneumothorax caused by biopsy; and (3) opposite position aspiration is a useful technique to reduce the use of chest tube, which has clinical significance.

Parathyroid ultrasonography: the evolving role of the radiologist.

Previously, radiologists played a limited role in the treatment of parathyroid disease, primary focusing on the preoperative localization of parathyroid lesions responsible for hyperparathyroidism. But, the widespread use of high-resolution ultrasound has lead to the increasing detection of parathyroid incidentalomas (PTIs). Consequently, radiologists may be required to differentiate PTIs from thyroid lesions, which is most reliably accomplished through the fine needle aspiration-parathyroid hormone analysis. Various nonsurgical treatment modalities for hyperfunctioning parathyroid lesions have been developed with some efficacy. Especially for symptomatic nonfunctioning parathyroid cysts, simple aspiration is a first-line procedure for diagnosis and treatment, while ethanol ablation is a subsequent treatment modality for recurrent cases.

Management of cystic or predominantly cystic thyroid nodules: role of simple aspiration of internal fluid

Purpose: The purpose of this study is to evaluate the efficacy of simple aspiration of cystic thyroid nodules by comparing with control groups to exclude the occurrence of spontaneous regression by the definition of current guidelines of American Thyroid Association. Materials and methods: 217 nodules from 210 patients with cystic thyroid nodules (cystic portion >50%) were included. Nodules were classified into three groups as follows: Group 1, observation only; Group 2, fine needle aspiration (FNA) without aspiration of internal fluid; and Group 3, FNA after aspiration of internal fluid. Significant nodule size change was defined as a difference in the largest diameter of 20%, as seen on the last follow-up ultrasound (US) compared to the initial US. Results: Demographic characteristics did not show significant differences among the three groups except for the patient age (p = 0.039). Mean nodule size significantly decreased only in group 3 (p = 0.005). Significant nodule size reductions were observed in 22.0% (13/59) in group 1, 25.7% (28/109) in group 2, and 40.8% (20/49) in group 3, respectively. Conclusions: Aspiration of internal fluid should be considered as the first-line procedure for both the diagnosis and treatment of cystic or predominantly cystic thyroid nodules.

Chemical pleurodesis for first presentation of primary spontaneous pneumothorax

Primary spontaneous pneumothorax (PSP) most commonly occurs in young, tall, lean males. The PSP recurrence rate varies between 16 and 52 % after the first episode. This high recurrence rate has stimulated the development of different therapeutic approaches, ranging from simple aspiration to invasive therapies, including chemical pleurodesis or surgery. Chemical pleurodesis is a procedure which uses sclerosing agents to cause adhesion between the two layers of the pleura. Traditionally, chemical pleurodesis for PSP has been recommended only if the patient is unwilling or unable to undergo surgery. However, several prospective, randomized trials have shown that additional chemical pleurodesis following simple aspiration or chest tube drainage is a safe and more effective initial treatment for PSP than simple aspiration and drainage alone and significantly reduces pneumothorax recurrence and subsequent thoracic surgery. In this article, the role of chemical pleurodesis in the first presentation of PSP is reviewed.

Nonsurgical Root Canal Therapy of Large Cystic Periapical Lesions Using Simple Aspiration and LSTR (Lesion Sterilization and Tissue Repair) Technique: Case Reports and Review

Introduction: This review and case report presents the treatment of two large cystic periapical lesions using simple aspiration technique for decompression and triple antibiotic paste for disinfection of the root canal system. Methods: A non-surgical approach was followed for the two large cystic periapical lesions. Simple aspiration irrigation technique along with lesion sterilization therapy with triple antibiotic paste was used without any surgical intervention. Results: Complete periapical healing of both the cyst like periapical lesions occurred without any surgical intervention. A 1 year follow-up radiograph showed complete healing of the lesion. Conclusion: Pathogenesis, histology, and molecular cell biology of inflammatory apical true cysts are not different from pocket cysts. Therefore, inflammatory apical true cysts might regress after nonsurgical root canal therapy by the mechanism of apoptosis or programmed cell death, similar to inflammatory pocket cysts. Non-surgical approach using a combination of Simple Aspiration technique and LSTR (lesion sterilization and tissue repair) technique was successful in healing large cyst-like periradicular lesions.

Assessment of spontaneous pneumothorax in adults in a tertiary care hospital.

Context:Pneumothorax continues to be a major cause of morbidity and mortality among respiratory patients, but there is a paucity of data regarding etiology, clinical profile, management, and outcome of spontaneous pneumothorax (SP), from this part of the world.Aims:To assess the patients of spontaneous pneumothorax in adults with special reference to the etiology, clinical presentation, management, and outcome of SP.Settings and Design:Prospective, observational study conducted in a tertiary care institution over a period of one year.Materials and Methods:All adult patients of SP attending the department of pulmonary medicine in a tertiary hospital were studied and detailed clinical, radiological, and management data were recorded and analyzed.Results:Sixty consecutive patients, who satisfied the inclusion criteria were included in the study. Among them 10 had primary spontaneous pneumothorax (PSP) and 50 had secondary spontaneous pneumothorax (SSP). The overall male to female ratio was 4:1. The mean age of the PSP patients was 26.3 ± 2.19 years, whereas, that of the SSP patients was 53.42 ± 2.07 years (P < 0.0001). Seventy percent of the patients were smokers. The most common clinical manifestation of PSP was chest pain (80%) in contrast to dyspnea in SSP (96%). The most common cause of SSP (42%) was found to be chronic obstructive pulmonary disease (COPD) followed by pulmonary tuberculosis (30%). The cases were managed with intercostal tube drainage (85%), simple aspiration (8.33%), and observation (6.67%). Full expansion of the lung was noted in 91.67% of the cases.Conclusion:Spontaneous pneumothorax was more common in men. SSP was far more common in this study, and the predominant underlying cause of SSP was COPD, which surpassed tuberculosis as the leading cause of SSP. This is in contrast to the results from previous studies done in our country. Intercostal tube drainage was the mainstay of treatment and the response was good.

Prevalence, Characteristics of Ear Deformity and Treatment Tendency for Auricular Hematoma in Elite Wrestlers

Wrestlers has frequently injured on his ear by friction or hitting. If the ear injury like hematoma did not treat appropriately, it should be deform to disfigured outer shape. We analyzed the incidence and characteristics of ear deformity with elite wrestlers. We took the photo with elite 58 male wrestlers’ ears. We surveyed the carrier of elite player, duration of training time, ear injury history, treatment history and satisfactory scale of his ear shape. The characteristics of ear shape were classified by Yotuyanagi classification. 44 wrestlers has deformity of his ear in elite wrestlers (76%, 44/58). Right side ear deformity is 50 cases, bilaterally involvement is one case. Microtia was 11 (24%), ear protrusion was 15 (33%) cases. Yotuyanagi type IB was 13 (29%) cases that deformity extending from helix to antihelix. Type IIA was 12 (27%) cases that deformity with a substantial change with good structural integrity in outline of the ear. Acute ear injury was treated with simple icing (33 cases, 56%), aspiration and compression (6 cases, 10%). 34 wrestlers (77%) dissatisfied his own ear shape. 10% of acute ear injuries treat appropriately in domestic elite male wrestlers. 76% of the wrestlers has an ear deformity and dissatisfaction.

Intraocular juvenile xanthogranuloma masquerading as conjunctivitis in an adult

A 22-year-old female presented to us with redness, pain and intermittent blurring of vision in the left eye of one month duration. She had been diagnosed as a case of conjunctivitis elsewhere for which she was being treated with topical antibiotics. Examination of the anterior segment revealed diffuse conjunctival congestion, the presence of an inferonasal iris bulge and a streak of hyphema. Ultrasound biomicroscopy revealed an irregular echogenic mass lesion in the iris extending into the ciliary body. Fine needle aspiration cytology revealed the presence of large giant cells with multiple nuclei and pigments in the cytoplasm suggestive of Touton giant cells and multiple histiocytes confirming the diagnosis of juvenile xanthogranuloma. The patient was prescribed oral and topical steroids and the lesion resolved. Juvenile xanthogranuloma can masquerade as conjunctivitis and simple aspiration cytology can be helpful in establishing the diagnosis instead of a more invasive incision or excision biopsy.

A Case of Management of Benign Lymphoepithelial Cysts of the Parotid Gland in Patient Infected with Human Immunodeficiency Virus

Human immunodeficiency virus (HIV)-positive patients rarely develop benign lymphoepithelial cysts (BLEC) in the parotid gland. BLEC is characterized by painless and commonly bilateral enlargements of the parotid gland, CD8 lymphocytosis, and cervical lymphadenopathy. The management of these disorders includes repeated simple aspiration, antiretroviral medication, parotidectomy, radiotherapy, and sclerotherapy. Parotidectomy is known to have the best cosmetic result and the lowest recurrence rate. We present the first case of BLEC from a HIV-positive patient in Korea.

Management of pneumothorax and prolonged air leak.

Pneumothorax refers to the presence of air within the pleural cavity, which may arise from a spontaneous defect in the visceral pleural surface, or through iatrogenic or other thoracic trauma. The most common cause in the developed world is iatrogenic pneumothorax. Most frequently, it can be managed conservatively or through simple pleural aspiration or drainage. A persistent air leak, >2 days' duration, develops in one-third of patients. When patients are managed with chest drainage alone, the median time for resolution of air leak is longer in patients with a pneumothorax secondary to an underlying lung disease (11 vs. 7 days). Interventional pulmonology is not usually required for the resolution of simple pneumothorax, but offers important minimally invasive techniques for treating persistent air leak and bronchopleural fistula. Following assessment of the site of the air leak within the bronchial tree, techniques are described for the sealing of leak using tissue or fibrin glues, endobronchial devices of various kinds, and combination approaches. Bronchoscopic sealing of air leaks can often avoid the requirement for thoracic surgical intervention. They may prove life-saving in patients who are difficult to wean from mechanical ventilation or extracorporeal membrane oxygenation because of catastrophic air leaks.

P176 Iatrogenic Pneumothorax Post Ct-guided Lung Biopsy - How Do We Manage It?

Introduction Iatrogenic Pneumothoraces (IP) are a common complication of computerised tomography (CT)-guided lung biopsy. Management depends on size, underlying lung disease, and symptoms. The British Thoracic Society (BTS) Guidelines comment that the majority of IPs do not require intervention. If needed aspiration is successful in 89%(1). Size of pneumothorax is assessed differently by the BTS and The American College of Chest Physicians (ACCP),(1, 2). This study reports the management of IP over a 15-month period. Methods All IP over 15-months were analysed. Data extraction forms for each IP episode utilised electronic clinical, MDT notes and radiological images. Results 160 day-case CT-guided lung biopsies were performed. There were 32 IPs, 20% of all biopsies. Five IPs were >2 cm at hilar level, classified as large by BTS guidance. Fifteen were >3 cm apically, described as large by ACCP classification. There was poor agreement between BTS and ACCP sizing of pneumothoraces, (kappa 0.26). All BTS-classified large pneumothoraces, and 9(60%), of ACCP-classified large pneumothoraces required intervention. Fifteen (47%) patients with IP, all asymptomatic with pneumothoraces Nine (28%) IPs underwent inpatient observation. Three subsequently required intervention, all of which were small at hilar level but large apically, or symptomatic. Aspiration was performed in 4 patients, one being >2 cm at hilar level and all >3 cm apically. Two required subsequent tube drainage. Five (16%) IPs were treated initially with intercostal chest drainage. Four had pneumothoraces >2 cm at hilar level, and the other had a large apical pneumothorax. Only one was symptomatic. Five patients were initially observed or had simple aspiration but subsequently required tube drainage. Conclusions Two-thirds of the IPs were managed conservatively. Thirteen percent of patients had aspiration of which three-quarters needed subsequent intervention. Symptoms or FEV1 did not predict need for intervention. The BTS and ACCP criteria for size assessment had poor agreement and clinical judgement was used to decide on treatment.

Respiratory secretion analyses in the evaluation of ventilator-associated pneumonia: a survey of current practice in pediatric critical care.

Ventilator-associated pneumonia is among the most common nosocomial infections in the PICU. Respiratory secretion cultures and Gram stains are frequently obtained for diagnosis and to guide therapy, but their specificity is questionable. We conducted a scenario-based survey of pediatric intensivists to assess their antibiotic use in response to hypothetical tracheal aspirate culture and Gram stain results. Scenario-based survey. A hypothetical PICU. Three hypothetical scenarios of intubated children with fever and leukocytosis: a 4-month-old child with respiratory syncytial virus infection; a 7-year-old child with acute respiratory distress syndrome; and a 10-year-old child with aspiration pneumonia. Scenario-based survey of pediatric intensivists from the Pediatric Acute Lung Injury and Sepsis Network. Ninety-four percent of the pediatric intensivists surveyed would obtain a respiratory secretion culture and Gram stain in the evaluation of an intubated child with fever and leukocytosis, most by simple tracheal aspiration but a minority (32%) by bronchoalveolar lavage. "Bacterial pathogenicity" was considered the most important result of the analysis. Although there were some differences across the three scenarios, most would initiate antibiotics if culture results identified methicillin-sensitive or methicillin-resistant Staphylococcus aureus or Pseudomonas and, on average, continue antibiotics for 7-10 days. The majority of pediatric intensivists would obtain respiratory secretion cultures and Gram stains in the evaluation of an intubated child with fever and leukocytosis and initiate antibiotics guided by the results. The specificity of respiratory secretion cultures and Gram stains for the diagnosis of ventilator-associated pneumonia requires critical evaluation as this diagnosis is responsible for more than half of antibiotic use in the PICU.

Contemporary therapy of intracoronary thrombus: laser and bioresorbable scaffold

A 25-year-old diabetic, smoker presented with an acute anterior ST-segment elevation myocardial infarction. Immediate coronary angiography demonstrated an occluded left anterior descending artery (LAD) with large proximal thrombus burden. Simple aspiration catheter thrombectomy restored some antegrade flow but was unsuccessful in removing the thrombus (Fig. 1a). Photoablation using excimer laser coronary atherectomy (ELCA) was more effective in debulking the thrombus and restored TIMI 3 blood flow (Fig. 1c). Optical coherence tomography (OCT) clarified that the atherothrombotic material was localised without distal or proximal thin-cap fibroatheroma in the LAD (Fig. 1b). A bioresorbable vascular scaffold (BVS) was deployed and post dilated (Fig. 1d, e) with full expansion demonstrated with OCT (Fig. 1f, g) resulting in complete resolution of ST-segment elevation and symptoms. He made an excellent recovery and left hospital on day 3 post MI. He has subsequently returned to a full, active life. This case highlights both the effectiveness of ELCA in treating massive intracoronary thrombus and use of BVS to avoid long-term residual metallic stent in a young patient with coronary heart disease embarking on their revascularisation journey.

Intrapleural minocycline pleurodesis for the treatment of primary spontaneous pneumothorax.

The role of chemical pleurodesis in the treatment of primary spontaneous pneumothorax remains unclear. According to current practice guidelines, chemical pleurodesis is reserved for patients who are unable or unwilling to have surgery. Some recent studies showed that intrapleural minocycline pleurodesis could decrease the rate of pneumothorax recurrence, when used either as the initial treatment for simple pneumothorax after successful aspiration and drainage or as an adjuvant treatment for complicated or recurrent pneumothorax following thoracoscopic surgery. The purpose of this review is to discuss the current available evidence on intrapleural minocycline pleurodesis for the treatment of primary spontaneous pneumothorax. In a recently published prospective, randomized controlled trial, additional minocycline pleurodesis following simple aspiration and drainage was a well tolerated and more effective initial treatment for a first episode of primary spontaneous pneumothorax than simple aspiration and drainage alone. Other prospective, randomized controlled trials showed that additional minocycline pleurodesis after thoracoscopic treatment was a well tolerated and convenient procedure which can reduce the rate of ipsilateral recurrence of primary spontaneous pneumothorax. Intrapleural minocycline pleurodesis can be considered an adjunct to standard treatment of primary spontaneous pneumothorax, after either simple aspiration and drainage or after thoracoscopic surgery.

Surgical management of post BCG vaccine lymphadenitis, comparative retrospective study

Introduction: Adverse reactions following BCG vaccination are uncommon, with an estimated prevalence of 0.4 per 1000 vaccines. The options for surgical management of post BCG vaccine suppurative lymphadenitis are incision and drainage, total excision, or simple needle aspiration. The aim of the study is to compare the outcome of surgical treatment of suppurative post BCG lymphadenitis using simple needle aspiration versus primary excision. Patients and methods: A retrospective file review was done for all children who presented, with a diagnosis of post BCG vaccine suppurative lymphadenitis (axillary and/ or supraclavicular), to the pediatric surgery clinic in two tertiary pediatric surgery centers during the period from January 2007 to January 2013. Results: The study population included 91 patients, 38 in Group 1 versus 53 in Group 2. There were 60 males and 31 females. Two groups were identified in the study, according to the type of management at the initial presentation, Group 1 who were managed with simple needle aspiration and Group 2 who were managed with primary surgical excision. Patients who received antituberculous treatment were excluded from the study. Conclusion: Primary surgical excision for post BCG suppurative lymphadenitis showed better outcomes than needle aspiration in the current study population.

Ambulatory management of primary spontaneous pneumothorax: the good is (not always) the enemy of the better (evidence)

Pneumothorax is defined as the presence of air in the pleural cavity. A pneumothorax might occur spontaneously in patients without underlying lung disease (primary spontaneous pneumothorax (PSP)) or in patients with an underlying lung disease (secondary spontaneous pneumothorax), most commonly chronic obstructive pulmonary disease. The underlying cause of spontaneous pneumothorax is likely to be the rupture of “emphysema-like changes” (small bullae or blebs) on the pleural surface, which allows air from the lung into the pleural space. Smoking, male sex and height are the major risk factors for the development of a PSP. There is evidence of a pleural inflammatory reaction in patients with PSP, involving an increase in eosinophils and neutrophils as well as elevated inflammatory cytokines compared with blood levels [1]. From an epidemiological point of view, PSP remains a significant health problem, with an annual incidence of 18–28 per 100 000 in males and 1.2–6.0 per 100 000 in females [2, 3]. Primary therapeutic goals for PSP include removal of air from the pleural space and prevention of recurrences. Air evacuation may be achieved by simple manual needle aspiration, by a small bore tube or a conventional chest tube, the tubes being attached to a one-way valve or to a water-seal device, with or without active suctioning [4]. The treatment of PSP would lend itself well to ambulatory management, since patients are usually young, without relevant comorbidities, and the condition itself caries a low morbidity and mortality [5]. Furthermore, outpatient-orientated treatment rather than hospitalisation might be favoured by many patients and would substantially reduce health-cost expenses. Unfortunately, however, the adherence to recommendations of outpatient management of patients with PSP in clinical practice is rather low [5, 6]. The lack …

Pneumothorax.

Pneumothorax-either spontaneous or iatrogenic-is commonly encountered in pulmonary medicine. While secondary pneumothorax is caused by an underlying pulmonary disease, the spontaneous type occurs in healthy individuals without obvious cause. The British Thoracic Society (BTS, 2010) and the American College of Chest Physicians (ACCP, 2001) published the guidelines for pneumothorax management. This review compares the diagnostic and management recommendations between the two societies. Patients diagnosed with primary spontaneous pneumothorax (PSP) may be observed without intervention if the pneumothorax is small and there are no symptoms. Oxygen therapy is only discussed in the BTS guidelines. If intervention is needed, BTS recommends a simple aspiration in all spontaneous and some secondary pneumothorax cases, whereas ACCP suggests a chest tube insertion rather than a simple aspiration. BTS and ACCP both recommend surgery for patients with a recurrent pneumothorax and persistent air leak. For patients who decline surgery or are poor surgical candidates, pleurodesis is an alternative recommended by both BTS and ACCP guidelines. Treatment strategies of iatrogenic pneumothorax are very similar to PSP. However, recurrence is not a consideration in iatrogenic pneumothorax.

Primary tubercular mastitis masquerading as malignancy

The significance of primary tubercular mastitis is due to rare occurrence and often overlooked and misdiagnosed as pyogenic breast abscess or malignancy. Despite the high incidence of tuberculosis in India, reports of breast tuberculosis among the total number of mammary conditions varies between 0.64% and 3.59%. We report a case of a 35-year-old lady with breast lump of 3 months duration, which simulated malignancy on clinical examination but fine needle aspiration cytology revealed granulomatous mastitis secondary to tuberculosis. High level of suspicion and simple fine needle aspiration procedure with micro-biological tests will clinch the final diagnosis.

Make it spin: individual trapping of sperm for analysis and recovery using micro-contact printing

In this article, we describe the development of a high throughput platform to spatially manipulate viable sperm for motility measurements and recovery of the best single sperm for fertilization purposes. Micro-contact printing was used to pattern islands of adhesive proteins (fibronectin) separated by sperm repellent species (Pluronic acid F-127) on commercially available polystyrene substrates. Following washing, arrays of viable single sperm were captured onto the islands demonstrating for the first time that sperm can be trapped by micro-contact printing with patterning efficiency of 90% while retaining 100% viability. These were then subjected to motility analysis whilst remaining spatially confined to the islands. Single sperm motility was assessed (n = 37) by software analysis measuring the number of rotations per second (degrees s⁻¹). The assignment of array coordinates allows the more active single sperm to be easily identified and recovered by a simple micromanipulator pipette aspiration step with automated possibility for assisted reproductive technologies or further quality correlation analysis. Taken together, we show for the first time a technique to simultaneously screen thousands of viable single sperm for motility assessment while retaining the ability for single species recovery for enhanced fertilization purposes.

Utility of hCG dosage in the management of gestational trophoblastic diseases

Measurement of hCG remains today central for diagnosis, treatment and follow-up of gestational trophoblastic diseases (GTD). In order to evaluate this contribution, we conducted a prospective cohort study in the Service of high-risk pregnancy of Rabat Maternity Les Orangers and the Laboratory of Rabat Military Teaching Hospital Mohammed V over a period of eighteen months. 35 patients were included. The hCG assay was determined by electrochemiluminescence. The general frequency of the GTD is of 0.33/100 childbirth. The average age of our patients was 30.5 years. 26 patients had hCG level abnormal and higher than 200 000 UI/mL when diagnosed with GTD; 34 patients had simple endo-uterine aspiration and 1 a chemotherapy. Among 34 patients, 25 (73.5%) had a favourable evolution characterized by normal hCG level within 3 to 13 weeks and complete remission. Serum hCG remained stable and negative in all these patients with a follow-up of 18 months. 9 patients had unfavourable evolution characterized by reaxent after negativation or stagnation of hCG levels. A rigorous monitoring of hCG levels during treatment and follow-up is essential to improve forecast of these diseases.