Tumor Puncture Research Articles

Osteoid osteoma: elevation of cardiac and respiratory rates at biopsy needle entry into tumor in 10 patients.

To evaluate changes in cardiac and respiratory rates in a consecutive series of patients who underwent percutaneous treatment for lesions presumed to be osteoid osteoma in whom general anesthesia was established. Changes in cardiac and respiratory rates were evaluated after establishment of stable general anesthesia in 14 patients who underwent needle biopsy and radio-frequency treatment. Cardiac and respiratory rates were recorded at penetration of skin, muscle, periosteum, cortex, and tumor. Treatment was performed before the biopsy report was available. Biopsy results revealed osteoid osteoma in 10 patients, chondroblastoma in one, and a herniation pit in one. Results in the two remaining patients were nondiagnostic and were excluded. Puncture of skin, muscle, and periosteum caused no detectable change. However, in the 10 patients with biopsy-proved osteoid osteoma, puncture of the tumor caused the mean cardiac rate to increase an average of 26 beats per minute (40%) to 91 (range, 62-114; P <.001) and the mean respiratory rate to increase an average of 12 breaths per minute (50%) to a mean of 37 (range, 25-52; P <.001). These changes occurred within seconds of tumor puncture and were often the first indication to the surgeon that the tumor had been entered. In the two patients with other diagnoses at biopsy, no such change was apparent. Mean cardiac and respiratory rates increase significantly at needle puncture of osteoid osteoma.

Image distortion in US-guided liver tumor puncture with curved linear array.

Our objective was to systematically examine the influence of probe geometry, puncture route, and composition of the abdominal wall on the deviation error with needle display. We made a simplified simulation model of the puncture needle passing to the liver tumor, using a microcomputer system, and visualized the degree of distortion of the puncture needle, changing the thickness and component of the abdominal wall as well as the radius of the probe, site, and angle of puncture. The puncture needle exhibited a displacement error of -10.9 to 3.8 mm (center hole) and -11.3 to 3.8 mm (side attachment). The shift was less accentuated when the radius of the probe was large. The displacement error was less accentuated in the center and accentuated in the left side of the field of view. It is recommended that liver puncture under US guidance be generally performed using a probe with a larger radius through the center hole with the most obtuse puncture angle possible, but when the tumor is localized in the hepatic dome, a more tightly curved probe should be used with an acute angle. We must consider a possible large error in display of the puncture needle during liver puncture and try to prevent hazardous complications.

Laparoscopic management of adnexal masses: a gold standard?

To review recent literature on the laparoscopic management of adnexal masses, when this approach may be considered as a gold standard. Cyst rupture was recently demonstrated to be a significant prognostic factor in stage I invasive epithelial carcinoma, and it was recommended to restrict the laparoscopic approach to patients with preoperative evidence that the cyst was benign. The laparoscopic approach is still highly controversial in masses suspicious at ultrasound. The limits of the laparoscopic approach are discussed reviewing recent literature and our experience. The laparoscopic management of adnexal masses appears to be safe in most hospitals even in developing countries. This approach is being used with increasing frequency in unusual indications such as newborns, children, adolescents and pregnant women. The learning curve for endoscopic surgery appears to be longer than expected. Many patients with benign adnexal masses, such as ovarian endometrioma, are still treated by laparotomy or with an inadequate endoscopic technique. Several studies have suggested that the stripping technique is a tissue-sparing procedure. The laparoscopic puncture of malignant ovarian tumours confined to the ovaries is uncommon, and should be avoided whenever possible. The teaching of endoscopy is essential to promote adequate procedures performed according to the principles of microsurgery and to preserve postoperative ovarian physiology.

Laparoscopic partial kidney ablation using high-intensity focused ultrasound

A laparoscopic ultrasound probe was developed for image-guided high-intensity focused ultrasound (HIFU) ablation of renal tissue. The probe expands the application of a commercially available HIFU system (SonablateTM) to laparascopic operations. It consists of a 4-MHz focused rectangular HIFU piezoceramic transducer (30×10 mm, FL=30 mm) confocally coupled with a circular central element (8 mm in diameter) used for real-time pulse-echo imaging during treatment. Precise mechanical movements of the transducer enable it to treat targeted tissue volumes. The probe was fully characterized by measuring its electrical impedance, acoustic field, and total acoustic power output. Moreover, the acoustic field was simulated using an analytical model. The laparoscopic probe was able to generate acoustic power levels up to 35 W that correspond to focal intensities over 2200 W/cm2 in tissue, sufficient for tissue ablation through rapid temperature rise (&amp;gt;90&amp;lt;th&amp;gt;°C) and cavitation mechanisms. The probe was tested in an in vivo animal study in which 15 pigs were treated through a sterile laparoscopic procedure. A lesion with dimensions of 23×17×11 mm ±1 mm was successfully generated in the left kidney of each pig during a treatment time of less than 30 min. Histology results demonstrated homogeneous well-delineated lesions generated in the target region.

Transthoracic puncture in the diagnosis of peripheral lung cancer: Methods and techniques

The paper discusses how to perform transthoracic puncture of peripheral lung tumors of various sizes by using different controlling techniques (X-ray television and computed tomography). It also analyzes whether an adapter can be used to reduce the incidence of a puncture-induced complication, such as traumatic pneumothorax.

A new procedure for frameless computer navigated stereotaxy.

Stereotactic procedures using frame-based systems have become well established in neurosurgery. Later, stereotactic computers have provided the neurosurgeon with a broader range of applications. A new, frameless stereotactic guide which utilizes the navigational abilities of a computer has been developed. This clinical study evaluates the accuracy and safety of the system when applied for puncture of tumours and abscesses in the cerebrum. Using a frameless setup 36 patients were operated on for a total of 39 intracranial processes over a period of two years. Three patients were operated on twice. Computer data, time of surgery, anesthesia, complications, tumour localization and tissue examinations were recorded. Biopsies were obtained from all lobes of the cerebrum and a diagnosis established in all cases except two. Mean age and total range was 52 years and 15-82 years, respectively. Median time of surgery was approximately 60 minutes including positioning of the patient and the registration process on the stereotactic computer. Local anesthesia was used for 25 operations and general anesthesia for 14 operations. There was one postoperative abscess formation in a previously immunosuppressed patient and a per-operative epileptic seizure caused by electrocoagulation of the dura in a second patient. Based on this clinical study a new procedure for obtaining stereotactic biopsies of intracranial processes is introduced. All tumours were successfully reached with two cases of complications.

Endosonographic imaging in pancreatic disease

Since its introduction in the early 1980s, endoscopic ultrasound (EUS) has revolutionized the imaging of the pancreas. The technique has proved reliable in the detection and assessment of small pancreatic lesions and accurate in the preoperative staging of pancreatic carcinoma when compared with other techniques such as abdominal ultrasound, endoscopic retrograde cholangiopancreatography, computed tomography, and nuclear magnetic resonance imaging. Other indications in which EUS has shown to be valuable include acute and chronic pancreatitis, tumors of the papilla of Vater, choledocholithiasis, as well as common bile duct tumors. Interventional EUS, including fine-needle aspiration puncture of pancreatic tumors and celiac plexus neurolysis for the palliation of pain in chronic pancreatitis or pancreatic carcinoma, is increasingly being performed. In this article, EUS imaging in pancreatic diseases is described, pointing out its uses and accuracy in various lesions.

Preoperative Tumor Embolization

We performed an embolization of tumors which we considered to need preoperative embolization, such as deep-seated tumors, or hypervascular tumors. We experienced 12 such cases in the two-year period from September 1996. Eight cases were meningiomas, one case was a hemangiopericytoma, one case was an angiofibroma and two cases were glomus tumors. As embolic material, we usually use estrogen-alcohol and polyvinyl acetate which soften the tumor. When a provacative test is either impossible or positive, the distal induction of a microcatheter is impossible or a dangerous anastomosis is present, we select polyvinyl alchol particles (120 approximately 250mum) and liquid coils. We performed an embolization of a very hypervascular tumor, juvenile angiofibroma, by a direct tumor puncture, using a mixure of N-butylcyanoacrylate, lipiodol and tantalum powder. Angiography in all cases showed a reduction of the tumor stain. The embolic method should be selected based on a combination of such factors as the purpose of embolization, the identification of the feeding artery and the histological findings.

筋肉内血管腫の治療経験

The margins of intramuscular hemangiomas are usually obscure making extensive resection, including normal muscle necessary. Such resections can at times result in impairment of function.To reduce the post-operative functional impairment, we performed preoperative embolization to intramuscular hemangioma by percutaneous tumor puncture with n-butyl cyanoacrylate (Histoacryl®) for clarifing the tumor margins. Consolidated tumor margins were easily identified at the time of surgery. After five months follow-up, there was no signs of recurrence and the patient has no impairment of function. Preoperative percutaneous embolization with n-butyl cyanoacrylate was useful to clearly delineate the range of tumor resection needed.

Puncture of Submucosal and Extrinsic Tumors: Is there a Clinical Need? Puncture Techniques and Their Accuracy

Cytological or histological tissue diagnosis of submucosal and extrinsic tumors adjacent to the upper gastrointestinal tract is required in many patients for differentiation of benign and malignant lesions. In the case of a submucosal lesion, it can be most efficiently obtained by transendoscopic needle puncture using a conventional endoscope and a guillotine needle device sampling histological tissue specimen. In the case of an extrinsic paraesophageal mass lesion in the dorsal mediastinum, transmural EUS-guided fine needle aspiration puncture appears to be an efficient technique for the differentiation of benign and malignant lesions. However, for transgastral or transduodenal EUS-guided FNA puncture, especially of pancreatic tumors, new prototypes of aspiration catheters with an extending steel needle are mandatory to obtain diagnostic tissue specimens.

A CASE OF RETROPERITONEAL LYMPHANGIOMA IN AN ADULT MAN

An adult case of retroperitoneal lymphangioma, that is rare in an adult by a review of the literature, is reported. A 74-year-old man was admitted to the hospital because of an abdominal mass. We suspected it to be retoperitoneal lymphangioma extremely by abdominal ultrasound study, CT scan and magnetic resonance imaging (MRI). Laparotomy showed a unilocular chylous cyst in the retroperitoneal cavity, and it was extirpated completely. Generally, surgical treatment is choised for this disease at first, but we suggest that the local injection of Bleomycin or OK-432 should be useful if a complete extripation is impossible. So far 123 cases of retroperitoneal lymphangioma have been reported in Japan, and only 13 cases had a of chylous cyst. Furthermore only 10 cases were able to be diagnosed preoperatively by tumor puncture or lympangiography. Recent development of the image diagnosis, especially MRI, would contribute to increase the current diagnostic percentage of this disease.

Ultrasound‐guided puncture of cystic tumors in the lower pelvis of young women

During the period from 1984 through 1986, 72 ultrasound-guided cyst punctures were performed in 60 young women (less than or equal to 40 years). Thirty-one punctures were performed using the transabdominal route and 41 punctures under the guidance of endovaginal scanning. General or local anesthesia were used in 97% of the transabdominal punctures while the corresponding figure for the endovaginal technique was 49%. Seventy-seven percent (46/60) of the women developed no new cysts within one year of the last puncture. Thirteen percent (8/60) had to be punctured twice and 3% (2/60) three times. No complications occurred in any of the 72 punctures. Of those women with cyst relapses and/or persistent abdominal pain, 7 were subjected to laparotomy and 5 to laparoscopy. Ultrasound-guided puncture of cystic tumors in the lower pelvis of young women seems to be an alternative to laparoscopically guided puncture or laparotomy. As compared to surgery, the ultrasound-guided technique may mean less risk for pelvic adhesions in young women with unproven fertility.

Possibilities of ultrasonic examination of the mammae (author's transl)

1,344 women were examined in the course of 3 years by means of the ultrasonic system Multiplanar MS 3 which was coupled direct to the skin. This direct coupling to the skin of the breast and the freely mobile sound head enable immediate puncture of tumours of the breast in direct ultrasonic vision. In multiple cysts it will be possible to puncture all cysts--including the occult ones--in one session. In the first 229 examined tumours, the rate of accuracy of the diagnosis "cyst" was 98%. Successful punctures, including the non-palpable cysts, were effected down to a minimum volume of 0.1 ml. The problem of the nonpalpable cysts can be considered as solved from the sonographic angle. In our case, this entailed omission, and hence saving in cost, of every third biopsy of the mammae (approximately 200 out of 600 biopsies per annum).

Recent biopsy technics in respiratory pathology

SummaryThe pleural-biopsy puncture finds its indication in the positive and differential diagnosis 1° of tuberculous effusions where it regularly brings a decisive and immediate argument much superior to the inconstant and tardy nature of the bacteriological results; 20 of cancerous effusions where, combined with the eytological study of the pleural liquid, it assures a diagnosis of aetiology in the great majority of cases. These data are confirmed by our experience in 54 successive cases.Biopsy through te transtracheobronchial puncture of tumours and adenopathies localized at a distance of the large vessels is technically possible today. It is often the only technique permitting a diagnosis of aetiology and that without making use of the different surgical explorations. A positive diagnosis was reached in 12 of our 20 cases and 7 out of 12 were decisive.Tumours and especially adenopathies of the anterior part of the superior mediastinum, which cannot be reached by transtracheobronchial puncture, will be ...

Percutaneous Puncture of Renal Cysts and Tumors

Percutaneous Puncture of Renal Cysts and Tumors

Percutaneous Puncture of Renal Cysts and Tumors

Percutaneous Puncture of Renal Cysts and Tumors