Single Aspiration Research Articles

Effects of equine bone marrow aspirate volume on isolation, proliferation, and differentiation potential of mesenchymal stem cells

To compare the mesenchymal stem cell (MSC) yield and chondrogenic and osteogenic differentiation from 5- and 50-mL bone marrow aspirates from horses. Six 2- to 5-year-old mixed-breed horses. Procedures-2 sequential 5-mL aspirates were drawn from 1 ilium or sternebra. A single 50-mL aspirate was drawn from the contralateral ilium, and 2 sequential 50-mL aspirates were drawn from a second sternebra. The MSC yield was determined through the culture expansion process. Chondrogenesis and osteogenesis were evaluated by means of conventional laboratory methods. The second of the 2 sequential 50-mL sternal aspirates yielded few to no MSCs. Independent of location, the highest density of MSCs was in the first of the 2 sequential 5-mL fractions, although with subsequent culture expansion, the overall yield was not significantly different between the first 5-mL and first 50-mL fractions. Independent of location, chondrogenesis and osteogenesis were not significantly different among fractions. Independent of fraction, the overall cell yield and chondrogenesis from the ilium were significantly higher than that from the sternum. This study failed to detect an additional benefit of 50-mL aspirates over 5-mL aspirates for culture-expanding MSCs for equine clinical applications. Chondrogenesis was highest for MSCs from ilial aspirates, although it is not known whether chondrogenesis is indicative of activation of other proposed pathways by which MSCs heal tissues.

The Value of Hip Aspiration in Pediatric Transient Synovitis

Hip transient synovitis (TS) is a common pediatric orthopaedic problem. Although a self-limiting illness, it often makes the patient temporarily disabled and poses a diagnostic difficulty because of its similarity to septic arthritis in clinical manifestations. The aim of this study was to evaluate the use of a single ultrasound-guided hip aspiration as a treatment modality for TS. Between the years 1984 and 1989, 112 children with TS were treated through bed rest and using nonsteroidal anti-inflammatory drugs (group 1). Between the years 1990 and 1999, 119 children diagnosed with TS were treated using hip aspiration, bed rest, and nonsteroidal anti-inflammatory drugs (group 2). Recovery parameters were compared between these patient groups. Twenty-four hours after admission, limping was noted in 92% and 10% of the patients in groups 1 and 2, respectively, (P < 0.001). Refusal to bear weight was observed in 14% and 1% in groups 1 and 2, respectively, (P < 0.001), and hip joint pain was reported in 81% and 6% in groups 1 and 2, respectively, (P < 0.001). Larger joint effusions were found to be the reason behind the inability to bear weight. Pain due to TS may be because of capsule stretching owing to the accumulation of joint effusion. Ultrasound-guided hip aspiration relieves pain and limitation in movement and provides rapid differential diagnosis from septic arthritis of the hip joint.

Intramural pseudocysts of the upper gastrointestinal tract.

Background:Intramural pseudocysts or pseudocysts occurring in the gastrointestinal tract (GIT) wall are rare and there is a paucity of data on their clinical features and management.Patients and Methods:We retrospectively evaluated patients with intramural pseudocysts seen at our institution over the past 6 years. Intramural location was confirmed either on surgery or endoscopic ultrasound (EUS). Depending upon the symptoms, their control with the conservative medical therapy and procedural consent, the patients underwent EUS guided single time aspiration of the pseudocyst or transmural drainage or transpapillary drainage or surgery.Results:A total of 9 patients with intra mural pseudocysts (male: n = 8; mean age ± SD: 39.3 ± 8.0 years; age range: 24-54 years; five patients having chronic and four patients having acute pancreatitis) were studied. The pseudocysts were located in the wall of the second part of the duodenum in five patients, in the gastric wall in three patients and in the lower esophageal wall in one patient. The size of the pseudocysts ranged from 8 mm to 8 cm and 3/9 (33%) patients had associated extra mural pancreatic pseudocysts. All patients had abdominal pain on presentation. Along with pain the patients with duodenal intramural pseduocysts also had symptoms suggestive of gastric outlet obstruction (3) or jaundice (1). The patient with esophageal intramural pseudocyst had dysphagia along with abdominal pain. Majority of these patients could be successfully treated endoscopically with no significant complications.Conclusions:Intramural pseudocysts of the upper GIT are very rare and EUS is a useful investigational modality for diagnosing and treating them.

150 IN VITRO AND IN VIVO DEVELOPMENT OF EMBRYO FOLLOWING BIOPSY WITH DIFFERENT TECHNIQUES IN MOUSE EMBRYOS

In vitro development ratios, quality evaluation, in vivo implantation, and fetal development ratios were investigated following aspiration biopsy in 8-cell mouse embryos and trophectoderm biopsy in blastocyst developed from 8-cell stage embryos in vitro. Superovulated CB6F1 hybrid female mice (5–6 weeks) were sacrificed 68 to 72 hours after hCG administration. Eight-cell embryos were flushed from oviducts of the sacrificed mouse with HTF medium supplemented with HEPES and 3 mg mL–1 BSA. Embryos were randomly divided into two groups. In the first group, embryos at 8-cell stage were used for a single cell blastomer aspiration; in the second group, embryos were cultured in vitro until blastocyst stage. Trophectoderm cells (15% of trophoblastic cells) were biopsied from developing blastocysts. There were also control groups for both groups. Biopsy procedures for both groups were applied in 50 µL drops of Ca2+/Mg2+ free HTF medium containing HEPES+3 mg mL–1 BSA+5 µg mL–1 cytochalasine B. After biopsy, embryos were cultured in Quinn’s blastocyst medium supplemented with 4 mg mL–1 BSA and incubated in 5% CO2 and 5% O2 incubator at 37°C for 48 and 24 hours for blastomer aspiration and trophectoderm biopsy groups, respectively. While some developing blastocysts were used for determining total cell number, some of them were transferred to the recipients. Results were evaluated by independent t-test and ANOVA of SPSS 17.0 statistic program (SPSS Inc., Chicago, IL, USA). In blastomere biopsy and control groups, development rates were determined as 81.02% (121/152) and 96.37% (62/63), while the total cell numbers were determined as 50 and 50, respectively. There was no significant difference between groups in terms of development ratios and total cells. In blastomer biopsy and control groups, the implantation sites and fetal development rates were found as 25% (9/36) and 26% (8/30), and 19.44% (7/36) and 20% (6/30), respectively. No significant difference was observed between groups in terms of implantation sites and fetal development rates. In trophectoderm biopsy and control groups, while the development rates were found as 86.96% (69/79) and 93.33% (23/28), the total cell numbers were 26.66 and 55.33, respectively. Although there was not any significant difference between groups in terms of development rates, there was a significant difference between groups in terms of total cell numbers (P &lt; 0.05). In trophectoderm biopsy and control groups, the implantation sites and fetal development rates were determined as 21.88% (7/32) and 59.09% (13/22), and 0% (0/32) and 18.18% (4/22), respectively. Although there was not any significant difference between groups in terms of implantation sites, there was a significant difference between groups in terms of fetal development rates (P &lt; 0.05). Therefore, it was concluded that biopsy applied at early stage of embryonic development does not affect embryo development negatively and biopsy procedures applied at early developmental stages have more advantages especially in embryos developing faster with low total cell numbers such as mouse species. Supported by TUBITAK KAMAG-107G027).

Aspiration and Sclerotherapy: a Nonsurgical Treatment Option for Hydroceles

We demonstrated that hydrocele aspiration and sclerotherapy with doxycycline is an effective and safe nonsurgical treatment option for hydrocele correction. The medical records of patients who underwent hydrocele aspiration and sclerotherapy were analyzed in a retrospective cohort study for success rates as well as improvement in scrotal size and discomfort after a single hydrocele aspiration and sclerotherapy treatment. Patients who reported decreased scrotal size, improved physical symptoms and satisfaction with the procedure were considered as having success with hydrocele aspiration and sclerotherapy. A total of 29 patients (mean age 52.8 years) presenting with 32 nonseptated hydroceles underwent hydrocele aspiration and sclerotherapy with doxycycline between 2005 and 2012. Of the hydroceles 27 (84%) were successfully treated with a single aspiration and sclerotherapy procedure. Overall mean followup was 20.8 months. Three patients reported moderate pain which resolved in 2 to 3 days. Of those patients in whom hydrocele aspiration and sclerotherapy failed, 1 had hydrocele successfully resolved with a second aspiration and sclerotherapy treatment, 3 did not have success with a second procedure and underwent hydrocelectomy, and 1 wanted immediate surgical correction. Hydrocele aspiration and sclerotherapy was successful in correcting 84% of simple nonseptated hydroceles with a single treatment. This result is an increase from previously reported success rates involving a single hydrocele aspiration and sclerotherapy procedure with tetracycline (75%). The success rate of a single hydrocele aspiration and sclerotherapy procedure is similar to the reported success rates involving hydrocelectomy while avoiding the hospital expense and many other complications. We conclude that the hydrocele aspiration and sclerotherapy procedure is a reasonable, nonsurgical and underused treatment option for nonseptated simple hydroceles.

Docetaxel, carboplatin, trastuzumab, and bevacizumab (TCH+B) for early-stage HER2/neu(+) breast cancer and bone marrow micrometastases.

TPS655 Background: Bone marrow (BM) micrometastases confer a poor prognosis to early-stage breast cancer (BC) and HER-2/neu(+) BC is a high-risk phenotype. We have shown that BM-associated stromal cells support the survival of metastatic BC in microenvironmental niches and this activity is dependent on VEGF and CXCL-12. Therefore, the growth of nascent tumor cell clusters in BM might be impeded by disrupting stromal cells or their activating ligands, such as VEGF. There is also a positive association between HER-2/neu and VEGF expression in BC, thereby implicating VEGF in the aggressive phenotype of HER-2/neu overexpression. These observations support the use of combination therapies directed against both HER-2/neu and VEGF for the treatment of HER-2/neu(+) BC. We therefore hypothesize that an anti-VEGF agent (bevacizumab) given with docetaxel, carboplatin and trastuzumab (TCH) will eradicate the BM of HER-2/neu(+) BC micrometastases by disrupting stromal cell support within the micrometastatic BM niche. Methods: Subjects with AJCC Stage I-III HER2/neu(+) BC will undergo a single iliac-crest BM aspirate and biopsy. If the BM is positive for CK+ micrometastases, up to 17 patients will receive TCH+B therapy (docetaxel at 75 mg/m2 IV and carboplatin at AUC 6 IV given every 3 weeks for 6 cycles; trastuzumab at 4 mg/kg IV loading dose, then 2mg/kg IV every week; bevacizumab at 15 mg/kg IV every 3 weeks). Four weeks after the 6th cycle of therapy, a repeat BM aspiration and biopsy will be performed to score for response of BC micrometastases to therapy. Patients with a complete clinical response in BM will continue with trastuzumab every 3 weeks at 6 mg/kg to a total of 1 year. Patients with persistent micrometastases will receive both trastuzumab and bevacizumab every 3 weeks to a total of 1 year of therapy. These patients will then have a repeat BM aspirate and biopsy at the end of the 1 year to score for final response. The primary objective of this clinical trial is to determine clinical response against BC micrometastases in BM. The second objective is to investigate the specific contribution of VEGF and CXCL-12 signaling to BM support of micrometastatic BC cells.

Observations on Hydroceles Following Adolescent Varicocelectomy

There is wide variation in the reported incidence of hydrocele after varicocelectomy (0% to 29%). We determined the incidence of hydroceles and hydrocelectomy following adolescent varicocelectomy, the time it took for them to manifest, and the results of aspiration and surgical correction. Our adolescent varicocele registry was reviewed to identify patients with a post-varicocelectomy hydrocele. We evaluated physical examination and ultrasound findings, postoperative interval to development and treatment results. A total of 400 patients with at least 6 months of postoperative followup underwent 521 varicocelectomies (16 redo, 1 right, 104 bilateral) from 1987 to 2010. Mean followup was 32 months (range 6 to 182). Hydrocele was detected in 80 of 521 (15.4%) at a mean of 2 years after surgery. The incidence of hydrocele was higher in open vs laparoscopic (p <0.001), bilateral vs unilateral (p = 0.013), nonlymphatic sparing vs lymphatic sparing (p = 0.043) and Palomo vs laparoscopic nonlymphatic sparing (p = 0.001) procedures. Eight patients underwent aspiration for a large postoperative hydrocele. In all 8 patients fluid returned to pre-aspiration status. There were 29 patients (5.6%) who underwent Jaboulay bottleneck hydrocelectomy and none had recurrence. Hydroceles are a common sequela of varicocelectomy, with the fewest hydroceles occurring after laparoscopic lymphatic sparing varicocelectomy. Patients should be followed for at least 2 years after varicocelectomy to examine for the presence of hydroceles. Although there have been reports on the use of aspiration for post-varicocelectomy hydrocele, we have not had success in those with a single aspiration. Jaboulay bottleneck hydrocelectomy had a 100% success rate in this select group.

Amoebic Liver Abscess: An Appraisal

Amoebic Liver Abscess: An Appraisal

The transvaginal probe as a uterine manipulator: a new technique to simplify transabdominal chorionic villus sampling in cases with difficult access to the trophoblast

To evaluate the efficacy of using the transvaginal probe to manipulate the uterus and change the position of the trophoblast, and to simplify access to the chorionic villus under difficult conditions. One thousand five hundred and thirty-nine procedures were performed in our centre in 1524 pregnant women from September 2006 to September 2009. In 90 of these, a difficult access to the trophoblast was observed and uterine manipulation under continuous ultrasound guidance with a double needle technique, was applied to obtain the sample. Of these, 86 samples were taken from singleton pregnancies and 4 from two bichorionic twin pregnancies One thousand five hundred and thirty-nine transabdominal chorionic villus sampling (TA-CVS) procedures were conducted on 1524 pregnant women. As many as 1449 were performed without manipulation with the transvaginal probe and in 90 cases the manipulation was carried out. In 89 cases, access to the trophoblast was difficult and the uterus was manipulated, which enabled an adequate TA-CVS to be performed with a single aspiration. In one case, TA-CVS was not performed due to significant pelvic pain in a patient with a fixed, retroflexed uterus and a previous history of endometriosis. Uterine manipulation with the transvaginal probe may be a useful solution in cases where TA-CVS is limited by difficult access to the trophoblast.

Significance of Repeatedly Nondiagnostic Thyroid Fine-Needle Aspirations: Table 1

Nondiagnostic thyroid fine-needle aspirations are associated with a risk of malignancy that can be reduced with repeated aspiration. However, the significance of repeated nondiagnostic aspirates is less well studied. This study assessed the risk of malignancy for repeated nondiagnostic aspirates from a large series of cases using the results of histologic follow-up. From a series of 7,089 aspirates, there were 1,671 nondiagnostic aspirates (23.6%), and 235 of these (14.1%) had histologic follow-up. The risk of malignancy for a single nondiagnostic aspirate was 20.0% (47/235). A total of 51 cases had repeated aspiration. The risk of malignancy for cases with a second nondiagnostic aspirate was 0% (0/23), which was significantly less than for patients with a single nondiagnostic aspirate (20.0%; P = .03). Patients with 2 sequential nondiagnostic thyroid aspirates have a very low risk of malignancy. Cytologists should strive to better convey this risk in their reports.

Effects of infant formula on cell homeostasis and cytokine levels in an in vivo and in vitro murine aspiration model

The role of infant formula aspiration in lung injury has not been studied extensively. We evaluated the effects of a single infant formula aspiration into the lungs of mice and the effect of infant formula exposure on cell lines representing murine alveolar macrophages and type II epithelial cells. To study the effects of exposure to infant formula on cell count histology and cytokine levels in an in vivo and in vitro model of aspiration. In vivo: Juvenile mice received 2.5 µl/g of 50% infant formula intranasally. Bronchoalveolar lavage samples were collected at 1, 2, and 7 days after aspiration and evaluated for cell count and differential. In vitro: RAW 264.7 and MLE-15 cells were exposed to 1% infant formula for 6 hr. Extracellular levels of IL-6, TNF-α, MIP-2, and KC were measured in lavage fluid and cell media using ELISA assays. In vivo: An increase in neutrophils, IL-6 and KC levels were noted 24 hr after infant formula exposure. In vitro: An increase in TNF-α levels from RAW 264.7 and MIP-2 and KC levels from MLE-15 cells was noted after infant formula exposure. A single aspiration of infant formula into the lungs leads to an acute inflammatory response involving both lung macrophages and epithelial cells.

Su1381 EUS-Guided Gallbladder Drainage As an Alternative Treatment for Malignant Biliary Obstruction After Unsuccessful ERCP: Outcomes of Long Term Follow-Up

Su1381 EUS-Guided Gallbladder Drainage As an Alternative Treatment for Malignant Biliary Obstruction After Unsuccessful ERCP: Outcomes of Long Term Follow-Up Masayuki Kitano, Hajime Imai, Ken Kamata, Takamitsu Komaki, Hiroki Sakamoto, Masatoshi Kudo Department of Gastroenterology and Hepatology, Kinki University, Osaka-sayama, Japan Background and Aims: Transpapillary biliary drainage is sometimes difficult due to severe biliary stricture, duodenal stenosis and surgically altered anatomy. EUSguided drainage has been recognized as an alternative method enabling the internal drainage. Recently, EUS-guided gallbladder drainage (EUS-GBD) was reported as a treatment of decompression for acute cholecystitis. We employed the new technique as an alternative treatment for malignant obstructive jaundice and assessed its outcomes of long term follow-up. Patients and Methods: A total of 10 patients underwent EUS-GBD for treatment of acute cholecystitis due to obstruction of cystic duct by a covered metal stent (CMS) (n 5) and obstructive jaundice due to malignant biliary stricture (n 5). In 5 patients with obstructive jaundice, transpapillary drainage had been unsuccessful, and EUS revealed that the cystic duct was not involved by the tumor. A linear echoendoscope was introduced into the stomach or the duodenum. Following visualization of a swollen gallbladder adjacent to the gastric antrum or the duodenal bulb, the echoendoscope was manipulated in order to identify an appropriate puncture route that has no interposing vessels. The gallbladder was punctured with a 19G needle under the enodsonographic guidance. After the gallbladder is irrigated by a large amount of saline ( 500mL) to avoid the peritonitis by leakage of the bile, a 0.025-inch guide wire is introduced until it was coiled within the gallbladder, and then 5.5-9-Fr catheters were serially advanced over the guide wire to dilate the tract. Finally, a 7-Fr. pigtail-type stent was deployed in the gallbladder. The technical success, the functional success, the complications and the stent patency were assessed. Results: The gallbladder was successfully punctured by the needle and irrigated in all patients. The needle was punctured from the stomach and the duodenum in 7 and 3 patients, respectively. However, dilation of the punctured hole was difficult in 2 of 5 patients with acute cholecystitis caused by the CMS due to thickening of the gallbladder wall. Consequently, these 2 patients were followed up after a single aspiration and irrigation. The remaining 8 patients underwent deployment of a stent after successful dilation of the punctured hole. The symptoms were relieved in all patients. Two weeks after the procedure, the bilirubin level was decreased in the 5 patients with obstructive jaundice. No apparent complications such as peritonitis and bleeding occurred in all patients. The median survival time was 134 days (range51-236 days). No additional intervention was needed in 9 patients except a patient treated with a single aspiration of the gallbladder. Conclusion: EUS-guided gallbladder drainage is a possible alternative treatment of decompression in the biliary system when the transpapillary drainage is unsuccessful.

Su1420 EUS Guided Single Step Complete Aspiration of Peripancreatic Fluid Collections and Pseudocysts Following Acute Pancreatitis: A Pilot Study

Su1420 EUS Guided Single Step Complete Aspiration of Peripancreatic Fluid Collections and Pseudocysts Following Acute Pancreatitis: A Pilot Study

In situ methotrexate injection after transvaginal ultrasound-guided aspiration of ovarian endometriomas: A randomized controlled trial

To evaluate prospectively the efficacy and safety of in situ methotrexate injection after transvaginal ultrasound-guided aspiration of ovarian endometriomas in well selected patients. Randomized controlled trial. El-Menya infertility research and treatment center (MIRTC), Egypt. Two hundred and ten patients complaining of symptomatic ovarian endometriomas during reproductive age. Transvaginal ultrasound aspiration (group I) versus aspiration and in situ methotrexate injection (group II). Of 210 patients, 188 patients were available for follow-up; malignant cells were not found in any of them. The overall success rate after complete follow up was 54.73% in group I versus 86.02% in group II, among those patients 25 patients (26.3%) needed single aspiration, 14 patients (14.7%) needed two aspiration, and 13 patients (13.6%) needed three aspiration in study group I versus 62 patients (66.6%) needed single injection, 11 patients (11.8%) needed two injections and 7 patients (7.5%) needed three injections in group II which represented statistically significant difference (P < 0.05). The cyst size and volume of fluid aspirated were statistically significant factors in the resolution of the cyst (P < 0.05), while patients age was not. Transvaginal ultrasound-guided aspiration and in situ methotrexate injection is simple, safe, non-invasive and effective in the treatment of selected cases of ovarian endometriomas with much acceptability among patients.

Giant Brain Abscess in a Neonate: Good Outcome with Single Transfontanelle Aspiration and Antibiotic Therapy

Giant Brain Abscess in a Neonate: Good Outcome with Single Transfontanelle Aspiration and Antibiotic Therapy

Allogeneic Hematopoietic Stem Cell Transplantation (HSCT) for the Treatment of Children with Very High Risk (VHR) Acute Lymphoblastic Leukemia (ALL) In First Remission (CR1)

AbstractAbstract 3546Between August 1988 and December 2009, 40 pediatric patients (pts) received an allogeneic HSCT for the treatment of very high risk ALL in CR1. They were 22 males and 18 females, aged 0.8 –19.2 years (median 10.0). Thirty eight patients had very high risk features: high white cell count greater than 200,000/mm3 (N=7), hypodiploidy (N=6), including double hypodiploidy (N=3), high risk cytogenetics with t(9;22) (N=14) or Mixed Lineage Leukemia (MLL) (N=3), and induction failure (N=23). Induction failure was defined morphologically by a single marrow aspirate revealing greater than 35% blasts by day +7 of induction, or greater than 5% blasts by day +14 or day +28 of induction. The remaining two patients included one infant ALL with a WBC >100,000/mm3 and one patient with ALL, Evans Syndrome and a prior CNS hemorrhage and fungal infection. Twenty two patients had one VHR feature while 16 patients had two VHR features. Patients received marrow or peripheral blood stem cell transplants from HLA-matched siblings (N=14) or volunteer unrelated donors (N=21) or unrelated double cord blood transplants (N=5). Unrelated donors were HLA-matched for 12 pts, but mismatched for nine pts at one (N=6) or two Class I antigens (N=3). All cord blood donors were matched at 4 or 5/6 HLA-antigens. Twenty three patients received T-cell depleted grafts following cytoreduction with hyperfractionated total body irradiation (HF-TBI) 1,375-1,500 cGy, Thiotepa (Thio) 5 mg/Kg/day × 2 and Cyclophosphamide (CY) 60 mg/Kg/day × 2. Grafts were marrow T-cell depleted with soy bean agglutinin and e-rosetting for 15 patients or peripheral blood stem cells T-cell depleted by CD34 selection and E-rosetting for 8 patients. Twelve pts received unmodified grafts following cytoreduction with a TBI-CY based regimen (N=8) or chemotherapy regimen (N=4). Five patients received double cord blood grafts following HF-TBI 1,375 cGY, Fludarabine 25 mg/m2/day × 3 and CY 60 mg/Kg/day × 2. Graft-versus-host disease (GvHD) prophylaxis for the BMT recipients included cyclosporine (CSA) + methotrexate or steroids, and for the cord blood recipients, CSA and mycophenolate mofetil.With a median follow-up of 11.1 years (range 0.6–21.9 yrs), the 10-year overall survival and disease-free survival of the entire cohort were 78% and 70% respectively, and 80% and 72% respectively when excluding the accidental death. Two recipients of T-cell depleted grafts suffered a graft failure (one early and one late), both of whom received a secondary T-cell depleted graft from a (different) mismatched related donor, engrafted and are alive and well. Two recipients of unmodified marrow grafts relapsed 4.9, and 18.9 months post BMT, one of whom is still alive disease free following treatment with chemotherapy. One recipient of a double cord blood graft relapsed three months post transplant. The overall risk of relapse for the entire cohort was 15%. Six pts died; cause of death was: relapse (N=2), secondary malignancy (N=2), acute GvHD (N=1), and accidental death (head trauma) (N=1). Grade 2–4 GvHD was diagnosed in recipients of unmodified grafts (N=3), double cord blood graft (N=2) and T-cell depleted grafts (N=1). The OS and DFS for recipients of T-cell depleted transplants following TBI THIO CY were both 83% with a 0% relapse rate.In summary, the outcome of allogeneic HSCT for children with very high risk ALL in CR1 in our series appears to be superior to that reported with chemotherapy for patients with these very high risk features. Moreover, the use of hyperfractionated TBI, Thio and CY followed by T-cell depleted grafts from related or unrelated donors was associated with a very good outcome with no relapse and minimal GvHD. Disclosures:No relevant conflicts of interest to declare.

Chronic encapsulated intracerebral hematoma: a rare complication after stereotactic radiosurgery for cerebral arteriovenous malformation

We read with great interest the article entitled “Operative intervention for delayed symptomatic radionecrotic masses developing following stereotactic radiosurgery for cerebral arteriovenous malformations-case analysis and literature review” by Foroughi et al. [1] in the May 2010 issue of this journal. The authors presented two cases of delayed masses that had developed following stereotactic radiosurgery (SRS) for the treatment of cerebral arteriovenous malformations (AVMs) and discussed the relevant literature. They pointed out that some cases had presented with hemorrhage in the cystic cavity. We would like to add a comment regarding this point. Chronic encapsulated intracerebral hematoma (CEIH) is a rare cerebrovascular disease that behaves as a slowly expanding lesion with a gradual onset [2]. We previously reported a case of delayed CEIH that developed after SRS for a cerebral AVM, which was treated by a single aspiration following the placement of a reservoir [3]. Furthermore, we experienced a similar case of a delayed mass that developed after SRS for an AVM. This patient underwent surgical excision and was diagnosed as CEIH by a pathological method. We suppose that SRS for an AVM can cause the formation of CEIH. Based on our experiences, it is suggested that some delayed masses with hemorrhage after SRS for an AVM may be CEIH.

Does a Repeated Benign Aspirate Change the Risk of Malignancy After an Initial Atypical Thyroid Fine-Needle Aspiration?

Repeated fine-needle aspiration of the thyroid is sometimes recommended after an atypical diagnosis. However, histologic follow-up for patients with a benign second aspirate is limited. I reviewed the results of all thyroid aspirations with repeated aspirations and surgical resection for the last 13 years at Baptist Hospital, Miami, FL, and Homestead Hospital, Homestead, FL, and combined these with the results of intraoperative cytology and the literature. During the period, a total of 7,089 cases were aspirated and 1,331 resections were performed. There were 6 (1.7%) of 361 false-negative cases. Relevant intraoperative cytology was available for 24 cases. The order of the diagnoses (benign then atypical, atypical then benign) did not significantly affect the risk of malignancy (15% and 9%; P = .30). Patients with an atypical and benign diagnosis had a risk of malignancy (15%) higher than a single negative aspirate (3%; P < .001) and lower than that of patients with a single atypical diagnosis (27%; P < .001). Repeated aspirates are not independent events. Patients with a benign diagnosis after an atypical diagnosis have a risk of malignancy between the risks of a single benign or atypical diagnosis. Cytologists should strive to better communicate this risk.

Role and accuracy of rapid on‐site evaluation of CT‐guided fine needle aspiration cytology of lung nodules

To prospectively investigate the role of trans-thoracic fine needle aspiration cytology (FNA) and the value of rapid on-site evaluation (ROSE) in the clinical management of patients with pulmonary nodules/masses. Computed tomography (CT)-guided FNA is commonly employed for the diagnosis of lung lesions although its position in the diagnostic work-up is still a matter of debate. We reviewed 311 patients (211 males and 100 females, mean age 69.5 years) admitted to the University of Padova from 2004 to 2008, correlating the results of cytology with the available histological findings obtained from biopsies, surgery or autopsy. Smears were adequate in 305 cases (98%) and inadequate in six (2%); a diagnosis of malignancy was achieved in 263 cases (86.2%); 39 cases (12.8%) were classified as non-malignant; and three cases (1%) were classified as suspect for malignancy. When correlated with histology, FNA with ROSE discriminated malignant versus non-malignant lesions (Cohen's kappa 0.78), with three false negatives (sensitivity 96.3%, specificity 100%). Moreover, a satisfactory overall agreement of 71.4% was achieved in differentiating the cancer histological types. Pneumothorax occurred in 13 cases, haemoptysis in four, and chest pain in three. A single aspiration was sufficient in 79.6% of patients; two aspirations were needed in 17.4% and three in 3%. The low complication rate was related to the limited number of aspirations needed due to ROSE. FNA with ROSE is a safe and useful tool in the diagnostic work-up of lung cancer patients, with no contraindications to its use as the first diagnostic procedure for all patients with peripheral lung lesions. FNA with ROSE should be reconsidered in the guidelines for diagnosing and managing lung cancer.

Suspected Needle Stick Transmission of Bartonella vinsonii subspecies berkhoffii to a Veterinarian

Suspected Needle Stick Transmission of Bartonella vinsonii subspecies berkhoffii to a Veterinarian