Aspiration Site Research Articles

Use of an Oblique Obturator Radiograph in Aspiration at Anterior Iliac Crest

The purpose of this study was to evaluate the use of an oblique obturator radiograph in bone marrow aspiration. The authors retrospectively reviewed 22 patients who underwent bone marrow aspiration guided by the real-time oblique obturator radiograph while in a supine position at their institution between November 2009 and August 2010. The mean duration of bone marrow aspiration was 35±9 seconds. According to the visual analog scale, the postoperative pain score at the site of aspiration was an average 1.6 of 10. No complications were observed. The oblique obturator radiograph can improve the accuracy of the aspiration.

Tracheo-Bronchial Foreign Body Aspiration in Children: A One Year Descriptive Study

The aim of this work was to study the clinical presentation of tracheo-bronchial foreign body aspiration in children for its early diagnosis. This article attempts to address the potential hazards of foreign body inhalation in children and its subsequent management by rigid bronchoscopy. This study was conducted in Department of Otorhinolaryngology, K.L.E.S Dr. Prabhakar Kore Hospital, Belgaum, for a period of 1year. Children less than 16years of age with history suggestive or suspicious of foreign body aspiration were screened clinically and radiologically and those patients with high index of suspicion of foreign body were included in the study. All patients were subjected to rigid bronchoscopy under general anaesthesia and the results were analyzed. This study comprises of 29 patients with suspected foreign body aspiration. On rigid bronchoscopy, foreign body was found and successfully removed in 22 patients. Highest incidence was seen in boys between 1 and 2years age. History of foreign body aspiration was absent in most cases and children presented with combination of symptoms. Obstructive emphysema was commonest chest X-ray finding. There was no significant difference in the site of foreign body aspiration on the right and left bronchus and commonest foreign bodies were vegetative type. Complication rates in this study were low as compared to previous studies. Tracheo-bronchial foreign body aspiration is very common in children. Foreign body aspiration usually presents as an un-witnessed episode and a high index of suspicion by the surgeon, even in absence of a positive history is necessary to prevent morbidity and mortality due to delayed or misdiagnosis. Foreign body aspiration is an emergency and should be removed by rigid bronchoscopy at the earliest to prevent complications.

P30 What difference does bedside ultrasound guidance make to pleural fluid aspiration and drainage in a district general hospital setting?

BackgroundBritish Thoracic Society guidelines strongly recommend thoracic ultrasound prior to all pleural procedures for pleural fluid. Previous studies have shown lower rates of failure and pneumothorax following the use of...

Luteal Function and Follicular Growth Following Follicular Aspiration During the Peri‐Luteolysis Period in Bos indicus and Crossbred Cattle

Follicular estradiol triggers luteolysis in cattle. Therefore, the control of follicle growth and steroidogenesis is expected to modulate luteal function and might be used as an anti-luteolytic strategy to improve embryo survival. Objectives were to evaluate follicular dynamics, plasma concentrations of estradiol and luteal lifespan in Bos indicus and crossbred cows subjected to sequential follicular aspirations. From D13 to D25 of a synchronized cycle (ovulation = D1), Nelore or crossbred, non-pregnant and non-lactating cows were submitted to daily ultrasound-guided aspiration of follicles >6 mm (n = 10) or to sham aspirations (n = 8). Diameter of the largest follicle on the day of luteolysis (7.4 ± 1.0 vs 9.7 ± 1.0 mm; mean ± SEM), number of days in which follicles >6 mm were present (2.3 ± 0.4 vs 4.6 ± 0.5 days) and daily mean diameter of the largest follicle between D15 and D19 (6.4 ± 0.2 vs 8.5 ± 0.3 mm) were smaller (p < 0.01) in the aspirated group compared with the control group, respectively. Aspiration tended to reduce (p < 0.10) plasma estradiol concentrations between D18 and D20 (2.95 ± 0.54 vs 4.30 ± 0.55 pg/ml). The luteal lifespan was similar (p > 0.10) between the groups (19.6 ± 0.4 days), whereas the oestrous cycle was longer (p < 0.01) in the aspirated group (31.4 ± 1.2 vs 21.2 ± 1.3 days). Hyperechogenic structures were present at the sites of aspiration and were associated with increase in concentration of progesterone between luteolysis and oestrus. It is concluded that follicular aspiration extended the oestrous cycle and decreased the average follicular diameter on the peri-luteolysis period but failed to delay luteolysis.

Henna as a Durable Preoperative Skin Marker

For many surgical procedures skin marking is required well before surgery and induction of anesthesia. In some cases, the patient may need to be standing or sitting while the skin area is marked. Marking of perforators and varicosities in chronic venous diseases, marking of stoma sites for urinary or fecal diversions are some examples. The side of surgery should ideally be marked preoperatively to avoid wrong side surgery. Marks made with conventional marking pens fade or disappear with preoperative skin preparation, whereas marks made with henna paste, which is orange to dark brown in color, last for up to 3weeks in spite of regular showers and skin cleansing, even with ethanol. This property of henna encouraged us to use it as a preoperative skin marker. Henna paste was used as a preoperative skin marker in 250 patients. In 154 patients with chronic venous diseases, perforators and varicosities were marked during duplex scanning. Henna was used to mark the colostomy site in 28 patients with carcinoma of the rectum prior to abdominoperineal resection of the rectum (APR) (four of them laparoscopic APR) and the aspiration site in 11 patients with liver abscesses and 4 patients with pleural empyemas, under ultrasonographic (USG) guidance. In addition, henna was used to mark the correct side of surgery in 47 patients undergoing unilateral inguinal hernia surgery. Marking was done from 1 to 8days before surgery. The marking with henna was clearly visible in all the cases even after preoperative skin preparation with ethanol up to 8days after application. There were no complications associated with the marking. All marks disappeared 4weeks after application. In terms of successful execution of the desired procedure, the use of henna marking was successful in all the cases. Henna is an ideal substance for use as a preoperative skin marker. It can be safely and effectively used as a marker for varicose vein surgery, ultrasound-guided identification of lesions, establishing the ideal site for stomas on the abdominal wall, and to identify the correct side of surgery. Markings made with henna are durable and do not fade with routine bathing or preoperative skin preparation. In most cases there are no associated complications. Henna is cheap, safe, and convenient, and indications for its use can be ubiquitous.

Can a Bone Marrow-based Graft Replacement Result in Similar Fusion Rates as Rib Autograft in Anterior Interbody Fusion Procedures for Adolescent Thoracolumbar Scoliosis?

Nonrandomized consecutive case series comparing interbody spine fusion with autograft versus bone marrow-based graft replacement (BGR). Effectiveness of bone marrow-based graft versus rib autograft in achieving anterior interbody fusion of the thoracolumbar/lumbar spine. The use of bone marrow (BM) with graft materials was shown in a prior study to aid with bone regeneration. Limited clinical data are currently available to demonstrate the effectiveness of BM for spinal applications. Engineered matrices of collagen type I coated with hydroxyapatite and combined with BM have been safely used in both spinal and long bone applications. Nineteen consecutive patients from 2003 to 2006 underwent anterior interbody fusion through an anterior approach with dual-rod instrumentation and structural interbody support for thoracolumbar scoliosis. Within 19 patients, there were 42 disc levels treated with graft replacement material combined with BM (BGR+BM) and 25 disc levels with rib autograft. The mean follow-up time was 17 months with a minimum of 6 months. Clinical and radiographic data included Scoliosis Research Society (SRS)-22 questionnaires and pain and fusion assessments of posterior-anterior and lateral radiographs, collected preoperatively and at 6, 12, and 24 months, postoperatively. At 6 months, 72% of BGR+BM segments versus 44% of autograft segments were defined as fused. All BGR+BM segments were fused by 12 months, and all autograft segments were fused by 24 months. There was no pseudoarthrosis or instrumentation failure, and interbody fusion rate was 100%. The average correction was 73.5+/-13.5%. The overall loss of correction from the immediate alignment to postoperative follow-up was less than 4%. There was no loss of sagittal plane alignment or measured kyphosis. No morbidity was observed at the BM aspiration site. Anterior spinal fusion using bone marrow-based graft substitutes for thoracolumbar adolescent idiopathic scoliosis demonstrated equivalent results to rib autograft when used with dual-rod instrumentation and structural support. In this patient series, the rate of fusion was faster in the bone marrow-treated segments. These results suggest that for patients as described in this cohort, bone marrow-based graft replacements can thus be used as an alternative, or adjunct, to autograft to achieve interbody fusion in scoliosis surgery.

Significance of incidental detection of filariasis on aspiration smears: A case series

Filariasis is a major public health problem in tropical and subtropical countries including India. Although there are reports of incidentally diagnosed cases of lymphatic filariasis in the existing literature, the significance of this finding needs to be summarised in one place. The association of filariasis with neoplasms is still debatable. For this series, cases diagnosed as filariasis on aspiration cytology (with or without coexistent pathology) over a period of 1 year were retrieved. The cases with a clinical suspicion of filariasis were excluded. Hence, five cases with incidental diagnosis of filariasis on aspiration cytology were included. The site of aspiration included one case each of thyroid, breast, bone marrow, cervical lymph node, and subcutaneous nodule. Of these, three cases showed microfilariae, one showed only adult female worm while one showed both microfilariae and adult worm. Two cases did not show any inflammatory response while three cases showed a variable inflammatory reaction. Only one case (thyroid aspirate) had a coexistent pathology (colloid goitre). Filariasis may be detected in a clinically unsuspected case, especially in an endemic zone. The spectrum of host response may vary from no reaction to a marked inflammatory response. The entire spectrum of changes should be kept in mind while practicing cytopathology in an endemic area. In such situations, a high index of suspicion and careful screening of cytology smears are keys to a correct diagnosis. At the same time, keen search for a coexisting pathology, benign or malignant, is also mandatory.

The cytologic features of NUT midline carcinoma

Nuclear protein in testis (NUT) midline carcinoma (NMC) represents an aggressive, high-grade carcinoma typically involving the upper aerodigestive tract or mediastinum. Although the tumor was originally noted in young persons, we have subsequently identified 5 adult cases. To our knowledge, the cytology of NMC has not been systematically described. We recently published a series of NMCs identified by fluorescent in situ hybridization for characteristic NUT rearrangement. Three of these patients had undergone fine-needle aspiration. Patient age, sex, primary tumor location, and aspiration site were noted. Cases were assessed for the following: cellularity, architecture, cytoplasm, cell size, nuclear contours, nucleoli, chromatin, anisonucleosis/cytosis, mitotic activity, background, and nuclear crush. The 3 cases occurred in 2 women and 1 man, ages 31-79 years. Primaries involved the sinonasal tract (2) and larynx. Aspirates were of right neck masses (2) and supraclavicular lymph node. Smears were highly cellular and generally noncohesive. Cytoplasm was scant/delicate, although occasional cells with denser cytoplasm were noted in 1 case. Cells were 2-3 times the diameter of a small lymphocyte with irregular nuclear contours, discrete nucleoli, and fine/granular to vesicular chromatin. Anisonucleosis/cytosis was slight to moderate. Mitotic figures were noted in each case. The background contained naked nuclei and karyorrhectic debris; nuclear crush was noted. NMCs exhibit cytologic features of a poorly differentiated or undifferentiated carcinoma. Although reports mention squamous differentiation as a histologic feature, it is typically focal, and overt squamous differentiation was not identified in our cases. Given morphologic overlap with other high-grade carcinomas, diagnosis requires a high index of suspicion.

Diagnosis of bone marrow necrosis

Two cases of bone marrow necrosis (BMN) were diagnosed during life. Both patients developed BMN as a terminal event in the evolution of untreated malignant lymphoma. No earlier cases of BMN in untreated malignant lymphoma are reported in the literature. In one patient necrotic and normal bone marrow were simultaneously obtained from two different aspiration sites, showing the focal nature of the process. BMN itself being reversible, the diagnosis in vivo is important. A better knowledge of the significance of a yellow brown viscous fluid obtained by bone marrow aspiration and the exact interpretation of necrotic bone marrow films are essential to recognition of BMN.

Analysis of Fine-needle Aspiration Cytology of the Salivary Gland

Fine needle aspiration (FNA) cytology has been widely accepted as a safe method for diagnosis of salivary gland lesions. This study investigated the accuracy of FNA cytology of salivary gland lesions by correlation between histology and cytology. One hundred and thirty-one archived salivary gland FNA specimens collected between January 1994 and December 2002 from 131 patients were correlated with histopathology findings. The major reasons for false-negative and false-positive results in cytologic diagnosis were determined. Considering the results of histopathology as the diagnostic standard, the sensitivity of FNA cytology in diagnosing malignancy was 74% (17/23) after excluding two cases which had a cytodiagnosis of suspicion of malignancy. Excluding eight cases that had a cytodiagnosis of suspicion of malignancy, the diagnostic specificity was 99% (97/98). There were six false-negative and one false-positive cases. This study demonstrated that FNA cytology of the salivary gland is a useful technique for diagnosis of salivary gland lesions. Inadequate labeling of the aspiration sites and insufficient cellularity were the most important factors that resulted in incorrect cytologic interpretation.

Swallowing Outcomes After Radiotherapy for Laryngeal Carcinoma

To describe swallowing physiology and functional outcomes at select intervals after definitive radiotherapy for laryngeal carcinoma. We also examined associations among patient, tumor, and treatment characteristics and swallowing outcomes. Retrospective review. The University of Texas M. D. Anderson Cancer Center, Houston. This study cohort included 40 patients who underwent definitive radiotherapy for laryngeal carcinoma (from February 2001 to June 2004). Modified barium swallow (MBS) studies were performed for 32 patients at 3 test intervals following irradiation: less than 6 months, 6 to 11 months, and 12 or more months. We recorded the presence or absence of aspiration (sensate or silent), 5 pharyngeal phase disorders, and 2 structural abnormalities. We also recorded pretreatment dysphagia complaints, feeding tube dependency, T classification, disease site, mucositis grade, and radiotherapy schedule with or without chemotherapy. Eighty-four percent of patients (27 of 32) referred for MBS studies after undergoing radiotherapy aspirated; 44% (12 of 27) did so silently. Silent aspiration was more prevalent during MBS studies conducted 1 or more years after radiotherapy. Pharyngeal phase disorders were observed more frequently than structural abnormalities (P < .01). Most patients required a feeding tube (78% [31 of 40]); however, 52% of the tubes (16) were eventually removed. We found no significant association between the occurrence of aspiration and disease site, T classification, treatment regimen, or pretreatment variables (P > .05). Pretreatment and posttreatment levels of feeding tube dependency were significantly associated (P = .03). Patient-reported dysphagia before treatment did not predict posttreatment swallowing outcomes (P > .05). Dysphagia is a common outcome after laryngeal preservation with radiotherapy. Contrary to expectations, few parameters that we measured were significantly associated with swallowing outcomes in our study.

Retrospective Evaluation of Percutaneous Endoscopic Gastrostomy in Jamaica

The technique of percutaneous endoscopic gastrostomy (PEG) tube placement has now replaced surgical gastrostomy as the method of choice for long-term enteral feeding. The outcomes of PEG placement have not been evaluated since its introduction to Jamaica in 1999. We performed a retrospective audit of PEG procedures performed at a major referral centre in Jamaica between January 1999 and January 2007. There were 240 PEG tubes placed in 215 patients during the study period. There was PEG-related morbidity in 5.4% of patients. The commoner complications included aspiration (2.1%), bleeding (1.3%), tube dislodgement (1.3%) and surgical site infection (0.8%). There were no reports of stomach perforation, gastro-enteric fistulae or intra-abdominal sepsis in this series. There was 1.7% mortality within one week of PEG tube placement and 9.6% mortality at 30 days. PEG placement is being performed at this institution with acceptable overall morbidity and mortality. Aspiration rates are higher than accepted, but may be reduced by the avoidance of over-sedation, minimal gastric insufflation and complete aspiration of gastric contents before the procedure.

Fine‐needle aspiration in the diagnosis of head and neck lesions: A review and discussion of problems in differential diagnosis

Fine-needle aspiration (FNA) has become the predominant initial diagnostic technique for lesions at a number of sites within the head and neck. The technique has achieved this level of usage because it is relatively inexpensive, rapid to perform, well accepted by patients, associated with low morbidity, and has a relatively high diagnostic accuracy. Sites in the head and neck amenable to FNA include the thyroid, cervical masses and nodules, salivary glands, intraoral lesions and lesions in the paraspinal area and base of skull. Diagnostic accuracy is dependent on the site of aspiration as well as the skill of the individual performing and interpreting the FNA. Studies have shown that FNA is most accurate when the individual interpreting the FNA is the same individual who obtained the aspirate material. Each site undergoing FNA within the head and neck is associated with a set of differential diagnoses and diagnostic challenges which will be discussed.

Presence of intratumoral anechoic foci predicts an increased number of endoscopic ultrasound‐guided fine‐needle aspiration passes required for the diagnosis of pancreatic adenocarcinoma

For reduction in cost, time and risk of complications, the number of endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) passes should be minimized. Previous studies have shown that tumor differentiation and site of aspiration will affect the number of passes in patients with pancreatic cancer. There have been no reports that EUS features of pancreatic malignancies per se will influence the number of passes. Our aim was to prospectively assess various factors that would affect the number of passes in patients with pancreatic cancer. Between May 2003 and December 2004, 41 patients with presumed pancreatic cancer were studied. EUS-guided FNA was performed with an Olympus GF-UC2000P echoendoscope and a 22-gauge needle. On-site assessment of the specimen by a cytopathologist was available during the procedure. Adenocarcinomas were confirmed in 25 patients. Pancreatic adenocarcinomas with intratumoral anechoic foci required a higher number of diagnostic passes than those without anechoic change (3.40 vs 2.27, P < 0.05). An average of 4.00 FNA passes for diagnosing a well-differentiated adenocarcinoma was also significantly higher than the 2.40 diagnostic passes for a moderately differentiated adenocarcinoma and the 2.00 passes for a poorly differentiated one (P < 0.05). The existence of intratumoral anechoic foci was not a rare finding under detailed EUS investigation of pancreatic cancer. Both the existence of intratumoral anechoic foci and the differentiation of the cancer are significant predictive factors for the number of diagnostic EUS-FNA passes.

Clinical Utility of Transbronchial Needle Aspiration of Mediastinal Lymph Nodes in the Diagnosis of Sarcoidosis in Stages I and II

To analyze the individual and combined diagnostic yield and clinical utility of transbronchial needle aspiration and transbronchial biopsy in the histologic diagnosis of sarcoidosis in stages I and II. We performed a prospective study enrolling all the patients admitted to our hospital between July 2001 and June 2006 with mediastinal lymph nodes of a diameter of over 10 mm and clinical and radiological indication of sarcoidosis. The patients underwent the following tests in the order specified: a transbronchial needle aspiration of 1 or more lymph nodes using a 19-gauge histology needle until 2 satisfactory specimens were obtained, a bronchoalveolar lavage, and 4 to 6 transbronchial biopsies. A total of 32 patients were enrolled during the study period. Of these, 26 were finally diagnosed with sarcoidosis. The mean (SD) age of the patients was 38.9 (10.6) years and there were 13 women (50%). The mean (SD) lymph node diameter was 23.5 (6.5) mm. The most common lymph node aspiration sites were the subcarinal station (9 patients, 34.6%) and a combination of the subcarinal and paratracheal stations (7 patients, 26.9%). Computed tomography scans of the chest revealed parenchymal involvement in 12 (46.2%) patients. Fifteen (57.7%) patients were diagnosed by transbronchial biopsy and 16 (61.5%) by transbronchial needle aspiration. These techniques were used in isolation in 7 (26.9%) and 8 (30.8%) patients, respectively (P>.05). Diagnosis was achieved with the combined results of transbronchial biopsy and needle aspiration in 23 (88.4%) patients. Overall, the diagnostic yield of the combined techniques was significantly higher than that of either one in isolation (P=.01 vs transbronchial biopsy and P=.02 vs needle aspiration). In patients with parenchymal involvement, yield was better for the combined techniques only in comparison with transbronchial biopsy (P=.01). Only 4 (15%) patients developed complications and 20 (76.9%) tolerated the procedures well. Diagnostic yield was significantly higher when transbronchial biopsy and transbronchial needle aspiration were used in combination than when used alone, particularly in patients without parenchymal involvement. There were few complications and tolerance was good.

EXPERIENCE OF ENDOSCOPIC ULTRASOUND IN AN AUSTRALIAN TERTIARY HOSPITAL

There is minimal prospective data on endoscopic ultrasound (EUS) experience in Australia. This study aimed to review the recent EUS experience of a single Australian tertiary hospital. Data of all EUS carried out at St Vincent's Hospital, Melbourne, Australia were prospectively collected from August 2002 to September 2005. Patient demographics, indications, anatomical sites of EUS and fine-needle aspiration (FNA) were extracted from the database. A subset of 231 patients were involved in a prospective study to assess the clinical effect of EUS: with accuracy and outcomes data derived from surgical histology and pre-EUS and post-EUS questionnaires. Five hundred and sixty-one procedures were carried out for 526 patients. Men comprised 57% (n = 300). Mean age was 60 years (range, 19-92 years). The indications were (i) oesophageal 30.7% (n = 172); (ii) pancreaticobiliary 29.6% (n = 166); (iii) mediastinal and lung 20.7% (n = 116); (iv) gastric 15.9% (n = 89); and (v) duodenal 3.2% (n = 18). Endoscopic ultrasound-guided FNA was carried out in 30.3% procedures (170/561). Overall EUS accuracy was 84% (55/67 patients) and EUS-guided FNA accuracy was 88% (28/32 patients). There were no major complications. This is the largest reported Australian experience of EUS to date. Overall EUS was accurate, safe with no major complications or mortality and had useful outcomes. The role, expertise and accessibility of EUS in the Australian clinical setting are anticipated to continue to increase.

Unusual Bone Marrow Findings in a Patient with Congenital Amegakaryocytic Thrombocytopenia.

BACKGROUND: Congenital Amegakaryocytic Thrombocytopenia (CAMT) is a rare bone marrow failure syndrome that presents with isolated thrombocytopenia within the first year of life. Classic diagnostic bone marrow findings reveal absent or significantly decreased megakaryocytes with otherwise normal marrow cellularity. We present a case of a newborn with CAMT whose initial bone marrow aspirate showed an appropriate number of megakaryocytes.CASE: A caucasian male presented on day-of-life (DOL) 1 with petechiae and a platelet count of 13,000/mcL. Physical exam, WBC count and hemoglobin were otherwise normal. Alloimmune thrombocytopenia evaluation and CMV serology were negative. Platelet transfusions were required almost daily to maintain platelet counts >100,000/mcL in the neonatal period. Tibial bone marrow aspirate performed on DOL 21 revealed normocellular marrow with a normal number of immature megakaryocytes. [Display omitted] Cytogenetics were normal and DNA breakage studies were negative. Beyond 1-month-of-age, platelet counts were maintained >25-30,000/mcL with 1–2 transfusions per week. Repeat bone marrow aspirate and biopsy on DOL 102, from the iliac crest, again was normocellular, but was now significant for marked megakaryocytic hypoplasia.Number of Megakaryocytes Found on Serial Bone Marrow AspiratesAgePatientAge-Matched Control21 days31.6102 days02.14 slides per aspiration site were examined at the feathered edge at 40× magnification. Data is expressed in average number of megakaryocytes/10 hpfMutation analysis of the gene responsible for the thrombopoietin receptor MPL was notable for a homozygous point mutation in exon 3, resulting in a substitution of proline for arginine at amino acid position 102. This missense mutation has been previously associated with CAMT.CONCLUSION: This is the third reported case of normal megakaryocyte numbers found on the initial bone marrow aspirate, in a patient who was later diagnosed with CAMT. CAMT should not be excluded from the differential diagnosis of persistent thrombocytopenia within the first year of life, solely based on normal numbers of megakaryocytes on the initial bone marrow. The presence of immature megakaryocytes may represent early morphological findings in CAMT.

Grasping forceps–assisted endoscopic mucosal resection of early gastric cancer with a novel 2-channel prelooped hood

Endoscopic mucosal resection with a cap-fitted panendoscope (EMRC) such as a soft prelooped hood is a useful, effective, and safe technique. One problem with this method is that the lesion cannot always be maintained in the center of the cap because the procedure is performed blindly after aspiration. We developed a 2-channel prelooped hood that facilitates EMRC while simultaneously allowing both grip of the center in the lesion and irrigation of the aspiration site and evaluated the usefulness of this end hood for early gastric cancer. Retrospective study. Between August 2003 and October 2004, patients underwent our novel EMR. Twelve cases of early gastric cancer. Two side holes were fabricated by drilling in the cap portion of a conventional soft prelooped hood, and then the irrigation tube and the accessory channel tube were glued to the exterior surface of the holes. We placed the fabricated transparent hood at the tip of the endoscope and performed grasping forceps-assisted endoscopic aspiration mucosectomy. Accurate aspiration and the rate of en bloc resection. We obtained a satisfactory field of view and accurate aspiration in the center of the tumor in all lesions. The rate of en bloc resection was 91.7% (11/12). Gastric intramucosal cancer. Grasping forceps-assisted endoscopic mucosal resection with a novel 2-channel prelooped hood is safe and useful for mucosal resection of intramucosal cancers less than 20 mm and may help center the lesion in the cap before resection.

The role of venography in the evaluation of malfunctioning central venous access ports (CVAPs)

18535 Background: Malfunction of CVAPs is common in cancer patients receiving chemotherapy. We evaluated the role of venography as a means of assessing the cause of malfunction. Methods: We reviewed and analyzed data available from cancer patients who had a venogram for a malfunctioning CVAP between 1/03 to 3/05. All patients in our institution who have a malfunctioning CVAP receive a trial of intracatheter thrombolytics. If the malfunction persists, then a venogram is performed through the catheter. Results: Seventy-seven patients were studied. The indication for evaluation was inability to aspirate blood (54%), pain (18%), swelling at site of injection (10%), difficult aspiration and infusion (6.5%) and others (11.5%). Forty-four patients had chest ports (31% left and 26% right side), while 33 patients had the CVAP placed in the upper extremity (24% right and 18% left arm). Fibrin sheath or thrombus was the most common finding in 44% of patients, and 41% of venograms were normal. Only two patients had soft tissue extravasation of contrast. Sites of extravasation were in the chest at the catheter/port junction and in the supraclavicular area secondary to a catheter fracture. In patients with aspiration failure, 68% had either a fibrin sheath or thrombus at the catheter tip, 14% had CVAP malposition as the only abnormality, 14% were normal and one patient had extravasation. The CVAP tips were optimally positioned in 70% of patients (distal superior vena cava (SVC), venocava-atrial junction or atrium), while 30% were in a suboptimal position (proximal SVC, brachiocephalic, azygous, or internal jugular vein). Suboptimally positioned CVAPs had a higher incidence of an associated abnormality compared to optimally positioned CVAPs (58% vs. 4% P = 0.001). Only five CVAPs were removed, for extravasation (1), cellulitis (2), and malposition (2). Conclusion: Although the incidence of extravasation was low, venography evaluation could be considered in patients with malfunctioning catheters receiving a vesicant drug to help prevent a potentially significant complication. CVAPs with suboptimally positioned tips had a higher rate of associated abnormalities, emphasizing the importance of proper tip position. No significant financial relationships to disclose.

Open epididymal sperm aspiration (OESA): minimally invasive surgical technique for sperm retrieval

Male infertility caused by irreparable obstructive azoospermia is widely treated with MESA (Microsurgical Epididymal Sperm Aspiration) or TESE (Testicular Sperm Extraction) or PESA (Percutaneous Epididymal Sperm Aspiration) followed by an Intracytoplasmatic Spermatozoa Injection (ICSI). For each procedures are claimed advantages and disadvantages. Aim of this work is to describe our technique (OESA) for sperm retrieval reporting the results. From 1998 to 2003 153 sperm retrieval procedures in azoospermic patients were performed. The technique consists in a small (1 cm.) surgical incision of scrotal wall under local or spinal anaesthesia. After inspecting the intrascrotal component to record the status of the epididymis and of the testicle, epididymal sperm aspiration was performed in the most appropriate site with 18 gauge needle. The aspirated spermatozoa were used immediately after aspiration not being permitted in our Institute cryopreservation. When no sperms were found TESE was performed. In 78 cases aspiration from epididymis was successful (OESA). In the other patients (75) TESE was performed. Higher count of spermatozoa were retrieved in all cases of OESA. Pregnancy rate was 26.6% for OESA and 6.4% for TESE. No complications occurred. This technique is very simple and easy allowing to obtain the advantages of microsurgical techniques (mainly choice of the most appropriate site of aspiration and immediate haemostasis if needed) with minimal invasivity (avoiding epididymal surgical incision). Moreover if OESA does not allow sperm extraction is possible to perform immediately TESE.